bluuebunny/crossref_metadata_2025 huggingface dataset:
Cangfu Daotan Wan alleviates polycystic ovary syndrome with phlegm-dampness syndrome via disruption of the PKP3/ERCC1/MAPK axis
Authors: Li Yuan , Wu Haicui , Guo Ying , Wei Chaofeng , Guan Lu , Ju Wenhan , Lian Fang
Published: July 2023

Background/Aim

Cangfu Daotan Wan (CFDTW) has been widely used for polycystic ovary syndrome (PCOS) patients in the type of stagnation of phlegm and dampness. In this study, we aimed to evaluate the mechanism underlying the therapeutic effect of CFDTW on PCOS with phlegm-dampness syndrome (PDS).

Methods

In silicoanalysis was adopted to identify CFDTW potential targets and the downstream pathways in the treatment of PCOS. Expression of PKP3 was examined in the ovarian granulosa cells from PCOS patients with PDS and rat PCOS models induced by dehydroepiandrosterone (DHEA). PKP3/ERCC1 was overexpressed or underexpressed or combined with CFDTW treatment in ovarian granulosa cells to assay the effect of CFDTW on ovarian granulosa cell functionsviathe PKP3/MAPK/ERCC1 axis.

Results

Clinical samples and ovarian granulosa cells of rat models were characterized by hypomethylated PKP3 promoter and upregulated PKP3 expression. CFDTW reduced PKP3 expression by enhancing the methylation of PKP3 promoter, leading to proliferation of ovarian granulosa cells, increasing S and G2/M phase-arrested cells, and arresting their apoptosis. PKP3 augmented ERCC1 expression by activating the MAPK pathway. In addition, CFDTW facilitated the proliferation of ovarian granulosa cells and repressed their apoptosis by regulating PKP3/MAPK/ERCC1 axis.

Conclusion

Taken together, this study illuminates how CFDTW confers therapeutic effects on PCOS patients with PDS, which may offer a novel theranostic marker in PCOS.
A novel method for assessment of airway opening pressure without the need for low-flow insufflation
Authors: Haudebourg Anne-Fleur , Moncomble Elsa , Lesimple Arnaud , Delamaire Flora , Louis Bruno , Mekontso Dessap Armand , Mercat Alain , Richard Jean-Christophe , Beloncle François , Carteaux Guillaume
Published: July 2023

Background

Airway opening pressure (AOP) detection and measurement are essential for assessing respiratory mechanics and adapting ventilation. We propose a novel approach for AOP assessment during volume assist control ventilation at a usual constant-flow rate of 60 L/min.

Objectives

To validate the conductive pressure (Pcond) method, which compare the Pcond—defined on the airway pressure waveform as the difference between the airway pressure level at which an abrupt change in slope occurs at the beginning of insufflation and PEEP—to resistive pressure for AOP detection and measurement, and to compare its respiratory and hemodynamic tolerance to the standard low-flow insufflation method.

Methods

The proof-of-concept of the Pcond method was assessed on mechanical (lung simulator) and physiological (cadavers) bench models. Its diagnostic performance was evaluated in 213 patients, using the standard low-flow insufflation method as a reference. In 45 patients, the respiratory and hemodynamic tolerance of the Pcond method was compared with the standard low-flow method.

Measurements and main results

Bench assessments validated the Pcond method proof-of-concept. Sensitivity and specificity of the Pcond method for AOP detection were 93% and 91%, respectively. AOP obtained by Pcond and standard low-flow methods strongly correlated (r = 0.84, p < 0.001). Changes in SpO2 were significantly lower during Pcond than during standard method (p < 0.001).

Conclusion

Determination of Pcond during constant-flow assist control ventilation may permit to easily and safely detect and measure AOP.
Giant cell arteritis-related cerebrovascular ischemic events: a French retrospective study of 271 patients, systematic review of the literature and meta-analysis
Authors: Penet Thomas , Lambert Marc , Baillet Clio , Outteryck Olivier , Hénon Hilde , Morell-Dubois Sandrine , Hachulla Eric , Launay David , Pokeerbux Mohammad Ryadh
Published: July 2023

Background

Cerebrovascular ischemic events (CIE) are among the most severe complications of giant cell arteritis (GCA). Heterogeneity between different studies in the definition of GCA-related CIE leads to uncertainty regarding their real prevalence. The aim of our study was to evaluate the prevalence and describe the characteristics of GCA-related CIE in a well-phenotyped cohort completed by a meta-analysis of the existing literature.

Methods

In this retrospective study performed in the Lille University Hospital, all consecutive patients with GCA according to American College of Rheumatology (ACR) diagnostic criteria were included from January 1, 2010, to December 31, 2020. A systematic review of the literature using MEDLINE and EMBASE was performed. Cohort studies of unselected GCA patients reporting CIE were included in the meta-analysis. We calculated the pooled summary estimate of GCA-related CIE prevalence.

Results

A total of 271 GCA patients (89 males, mean age 72 ± 9 years) were included in the study. Among them, 14 (5.2%) presented with GCA-related CIE including 8 in the vertebrobasilar territory, 5 in the carotid territory, and 1 patient having multifocal ischemic and hemorrhagic strokes related to intra-cranial vasculitis. Fourteen studies were included in the meta-analysis, representing a total population of 3553 patients. The pooled prevalence of GCA-related CIE was 4% (95% CI 3–6, I2 = 68%).

Lower body mass index (BMI), vertebral artery thrombosis on Doppler US (17% vs 0.8%, p = 0.012), vertebral arteries involvement (50% vs 3.4%, p < 0.001) and intracranial arteries involvement (50% vs 1.8%, p < 0.001) on computed tomography angiography (CTA) and/or magnetic resonance angiography (MRA), and axillary arteries involvement on positron emission computed tomography (PET/CT) (55% vs 20%, p = 0.016) were more frequent in GCA patients with CIE in our population.

Conclusions

The pooled prevalence of GCA-related CIE was 4%. Our cohort identified an association between GCA-related CIE, lower BMI, and vertebral, intracranial, and axillary arteries involvement on various imaging modalities.
Fixed point theorems in graphical cone metric spaces and application to a system of initial value problems
Authors: Shukla Satish , Dubey Nikita , Shukla Rahul
Published: July 2023

In this paper, we introduce the notion of graphical cone metric spaces over Banach algebra and prove some fixed point results for a particular type of contractive mappings defined on such spaces. These results extend and generalize several results from metric, graphical metric, and cone metric spaces. Some examples that demonstrate the results proved herein are provided. An application of our results to the existence of solution of a pair of initial value problems is provided.
Normalized solutions for the discrete Schrödinger equations
Authors: Xie Qilin , Xiao Huafeng
Published: July 2023

In the present paper, we consider the existence of solutions with a prescribed $l^{2}$

l
2

-norm for the following discrete Schrödinger equations, $$ \textstyle\begin{cases} -\Delta ^{2} u_{k-1}-f(u_{k})= \lambda u_{k} \quad k\in \mathbb{Z}, \\ \sum_{k\in \mathbb{Z}} \vert u_{k} \vert ^{2}=\alpha ^{2}, \end{cases} $$

{

−

Δ
2

u

k
−
1

−
f
(

u
k

)
=
λ

u
k

k
∈
Z
,

∑

k
∈
Z

|

u
k

|
2

=

α
2

,

where $\Delta ^{2} u_{k-1}=u_{k+1}+u_{k-1}-2u_{k}$

Δ
2

u

k
−
1

=

u

k
+
1

+

u

k
−
1

−
2

u
k

, $f\in C(\mathbb{R}) $
f
∈
C
(
R
)
, α is a fixed constant, and $\lambda \in \mathbb{R}$
λ
∈
R
arises as a Lagrange multiplier. To get the solutions, we investigate the corresponding minimizing problem with the $l^{2}$

l
2

-norm constraint: $$ E_{\alpha}=\inf \biggl\{ \frac{1}{2}\sum \vert \Delta u_{k-1} \vert ^{2}-\sum F(u_{k}): \sum \vert u_{k} \vert ^{2}=\alpha ^{2} \biggr\} . $$

E
α

=
inf

{

1

2

∑
|
Δ

u

k
−
1

|
2

−
∑
F
(

u
k

)
:
∑
|

u
k

|
2

=

α
2

}

.
An elaborative analysis on a minimizing sequence with respect to $E_{\alpha}$

E
α

is obtained. We prove that there is a constant $\alpha _{0}\geq 0$

α
0

≥
0
such that there exists a global minimizer if $\alpha >\alpha _{0}$
α
>

α
0

, and there exists no global minimizer if $\alpha <\alpha _{0}$
α
<

α
0

. It seems that it is the first time to consider the solution with a prescribed $l^{2}$

l
2

-norm of the discrete Schrödinger equations.
Scattering threshold for a focusing inhomogeneous non-linear Schrödinger equation with inverse square potential
Authors: Boulaaras Salah , Ghanmi Radhia , Saanouni Tarek
Published: July 2023

This work studies the three space dimensional focusing inhomogeneous Schrödinger equation with inverse square potential $$ i\partial _{t} u-\biggl(-\Delta +\frac{\lambda}{ \vert x \vert ^{2}}\biggr)u + \vert x \vert ^{-2\tau} \vert u \vert ^{2(q-1)}u=0 , \qquad u(t,x):\mathbb{R}\times \mathbb{R}^{3}\to \mathbb{C}. $$
i

∂
t

u
−

(
−
Δ
+

λ

|
x

|
2

)

u
+
|
x

|

−
2
τ

|
u

|

2
(
q
−
1
)

u
=
0
,

u
(
t
,
x
)
:
R
×

R
3

→
C
.
The purpose is to investigate the energy scattering of global inter-critical solutions below the ground state threshold. The scattering is obtained by using the new approach of Dodson-Murphy, based on Tao’s scattering criteria and Morawetz estimates. This work naturally extends the recent paper by J. An et al. (Discrete Contin. Dyn. Syst., Ser. B 28(2): 1046–1067 2023). The threshold is expressed in terms the non-conserved potential energy. As a consequence, it can be given with a classical way with the conserved mass and energy. The inhomogeneous term $|x|^{-2\tau}$

|
x
|

−
2
τ

for $\tau >0$
τ
>
0
guarantees the existence of ground states for $\lambda \geq 0$
λ
≥
0
, contrarily to the homogeneous case $\tau =0$
τ
=
0
. Moreover, the decay of the inhomogeneous term enables to avoid any radial assumption on the datum. Since there is no dispersive estimate of $L^{1}\to L^{\infty}$

L
1

→

L
∞

for the free Schrödinger equation with inverse square potential for $\lambda <0$
λ
<
0
, one restricts this work to the case $\lambda \geq 0$
λ
≥
0
.
A comparative study of the anthropometric status of adults and children in urban and rural communities of the North West Region of Cameroon
Authors: Akob Faith Asangha , Pillay Kirthee , Wiles Nicola , Siwela Muthulisi
Published: July 2023

Background

Cameroon, like many other developing countries, is experiencing a double burden of malnutrition. With increasing urbanization, communities are exposed to high calorie diets and sedentary lifestyles, which contribute to overnutrition. However, the nutritional status of the communities may vary with geographic location. The aim of the current study was to investigate the prevalence of underweight, overweight and abdominal obesity among adults as well as overweight, underweight, stunting and wasting among children in selected urban and rural communities of the North West Region (NWR) of Cameroon. The study also compared these parameters between selected urban and rural areas.

Methods

Cross-sectional study design was used to investigate the anthropometric status of adults (18–65 years) and children (1–5 years) from two rural (Mankon and Mendakwe) and two urban (Mankon and Nkwen) communities in the NWR of Cameroon. The study included 156 adults and 156 children per study site from different households. A multistage sampling technique was used to select the participants and study sites Anthropometric measurements were taken using standardised methods for selected indices: weight, height, waist circumference and mid-upper arm circumference (MUAC). Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 25 and a p-value of < 0.05 was considered statistically significant.

Results

Adults from Nkwen (urban) were either overweight (n = 74; 47.4%) or obese (n = 44; 28.2%) with 43.6% (n = 68) from urban Mankon obese, whilst adults from rural Mankon were normal weight (49.4%; n = 77), 2.6% (n = 4) from Mendakwe (rural) were underweight and 64.1% (n = 100) were normal weight. Children in the rural areas were severely underweight (n = 45; 14.4%), while children in the urban areas were either normal (n = 158; 50.6) or overweight (n = 43; 13.8%). More females in the urban sites (n = 39; 53.4% in Nkwen and n = 43; 69.4% in urban Mankon) had a large waist circumference (WC) compared to those in the rural sites (n = 17; 22.1% in Mendakwe and n = 24; 38.1% in rural Mankon). Males in the urban areas had large WC compared to those in the rural sites (n = 19; 24.4% in Nkwen; n = 23; 24.7% in urban Mankon; n = 15; 16.1% in rural Mankon and n = 2; 2.6% in Mendakwe). Mid-upper arm circumference (MUAC) values indicated that most children in both urban (n = 147; 94.2% in Nkwen; n = 152; 97.4% in urban Mankon) and rural areas (n = 142; 91.0% in rural Mankon; n = 154; 98.7% in Mendakwe) were not acutely malnourished.

Conclusions

This study found a higher prevalence of overweight and obesity among adults and children in the urban areas of Nkwen and Mankon, compared to rural Mankon and Mendakwe. Thus, there is a need to investigate and address the causes of the high prevalence of overweight and obesity in these urban areas.
Exploring the factors influencing the use of health services by people with diabetes in Northwest China: an example from Gansu Province
Authors: Dang Ying , Yang Yinan , Cao Shuting , Zhang Jia , Wang Xiao , Lu Jie , Liang Qijun , Hu Xiaobin
Published: July 2023

Background

Diabetes is associated with high morbidity, mortality and quality-of-life impairment in patients. In China, the number of people suffering from diabetes ranks first in the world. Gansu Province is located in northwest China and is an economically underdeveloped region of China. By analyzing the level of health service utilization of people with diabetes in Gansu Province, the degree of equity in health service utilization and its influencing factors were studied to provide scientific data to support the promotion of health equity for people with diabetes and the introduction of relevant policies by relevant authorities.

Methods

A sample of 282 people with diabetes who were 15 years old and above was chosen by multi-stage stratified sampling method. A structured questionnaire survey was conducted via face-to-face interviews. Random forest and logistic regression analysis were used to demonstrate the effects of the explanatory variables on health seeking behaviors from predisposing, enabling and need variables. The concentration index was used to indicate the equity of health service utilization across households of different economic levels.

Results

The outpatient rate for the diabetic population surveyed was 92.91%, with 99.87% of urban patients, higher than the 90.39% of rural patients. The average number of hospital days per person was 3.18 days, with 5.03 days per person in urban areas, which was higher than the 2.51 days per person in rural areas. The study showed that the factors most likely to influence patients to seek outpatient services were frequency of taking diabetic medication, whether or not they were contracted to a household doctor, and living environment; the top three factors most likely to influence patients with diabetes to seek inpatient services were number of non-communicable chronic disease, self-assessment of health status, medical insurance. The concentration index for outpatient service utilization and inpatient service utilization were − 0.241 and 0.107, respectively, indicating that outpatient services were concentrated on patients at lower income levels and patients at higher income levels tended to favor inpatient services.

Conclusion

This study found that the low level of health care resources available to people with diabetes, whose health status is suboptimal, makes it difficult to meet their health needs. Patients' health conditions, comorbidities of people with diabetes, and the level of protection were still important factors that hindered the use of health services. It is necessary to promote the rational use of health services by diabetic patients and further improve the corresponding policies to achieve the goal of chronic disease prevention and control in “Health China 2030”.
‘Cynefin, a Sense of Place', a National, Cultural, Public Education Programme to Ensure Young Peoples Voices Are at the Heart of Decision Making
Authors: John Ollie , Ahuja Alka , Johns Gemma , Jewell Delyth
Published: July 2023

Aims

‘Cynefin’ has many layers of meaning – it's a Welsh noun with no direct equivalent in English. The word conjures a very personal 'sense of place', belonging, familiarity, and relationship to the place of your birth or upbringing.The new school curriculum in Wales encourages young people to gain a fuller understanding of their identities, communities and histories that come together to form their 'cynefin'.Our aim was to develop a national and cultural programme of public education, co-produced with young people, that enabled them to explore issues that matter to them; whilst ensuring that these issues were at the heart of decision making in the national parliament of Wales ‘Senedd’.

Methods

Through a series of design workshops and evaluation, a diverse programme of public education was created by the Royal College of Psychiatrists Wales, Technology Enabled Care (TEC) Cymru, and co-produced with young people.

The programme engaged 230 participants and was delivered across different mediums, including topical school debates; YouTube videos of facilitated discussion on areas of relationships, loneliness, finance, and body image. Further formal opportunities were created for secondary school pupils in giving consideration for careers in mental health e.g inception of a youth advisory group in TEC Cymru, establishing of a mental health research award for sixth form students and a summer school programme.

The debates were complimented through further creative opportunities. The National Children's Laureate undertook a series of creative workshops with Schools, capturing themes that were then animated and shared through social media campaigns.

The whole programme was delivered bilingually, in English and Welsh, and showcased at the URDD National Eisteddfod.

Results

The programme captured a series of issues that are important to young people, whilst it has informed and influenced the development of the National educational curriculum in Wales, and gave opportunity to directly inform Senedd members.

The programme informed the creation of the Senedd Cross-Party Group on Climate, Nature & Wellbeing that is co-chaired by a Senedd member and the Youth Climate Ambassadors.

The young people who attended the Senedd Summer School have been successful in applications to their first-choice university studies, whilst the recipient of the research award is now attending medical school.

Conclusion

A co-produced programme of public education can be both enriching for young people and serves to inform key government policy. It is a great way of engaging young people and destigmatising mental illness and related myths.
An Analysis of Factors Associated With Readmission Within Ninety Days From a Community Mental Health Rehabilitation Team
Authors: White Ursula , Baginski Anna , Bashir K
Published: July 2023

Aims

Frequent readmissions present a challenge to both community and inpatient mental health services and are frequently used as a quality indicator. Service users who are readmitted also tend to have a poorer prognosis and can be characterised as ‘revolving door’ patients. Determining modifiable factors that affect rates of readmission may allow mental health services to target interventions such as to improve outcomes and service users’ experiences

Methods

The caseload of an inner-city NHS community rehabilitation team was examined for psychiatric admissions over the period from January 2022 to January 2023. This was divided into an admission group and a readmission group. Readmission was defined as service users who were admitted within ninety days of the index admission. A variety of factors related to the index admission and subsequent discharge were examined and compared between the two groups to identify factors associated with readmission.

Results

The community rehabilitation team caseload comprised of 122 care-coordinated service users. The readmission rate to an inpatient psychiatric ward between 1st January 2022 and 1st January 2023 was 37.5%. Factors that appeared to be protective against readmission were positive engagement with therapies during the index admission, such as dual diagnosis team, psychology, and occupational therapy. Additionally, service users who were discharged on a Community Treatment Order had significantly reduced rates of readmission. A shorter index admission was also associated with reduced rates of readmission. Involvement of the Home Treatment Team and medication changes in the week prior to discharge were not associated with reduced rates of readmission

Conclusion

The results of this study suggest that the provision of therapies by allied healthcare professionals should be prioritised in inpatient settings. Service users should be strongly encouraged to engage, and poor engagement may be considered an indication that the service user is not yet ready for discharge. Community Treatment Orders, where appropriate, should be considered to be protective against readmission. Longer inpatient stays may be associated with readmission since these service users are more likely to be severely unwell. Nevertheless, service users who require longer admissions are at high risk for readmission and interventions should be considered to mitigate this risk.
Well-Track’ Project: Fitbit Based Intervention for Early Intervention in Psychosis (EIP) Patients to Improve Sleep, Physical Activity, and Well-being and Prevent Weight Gain
Authors: Griffiths Chris , da Silva Ksenija , Jiang Harmony , Jugon Sue , Walker Kate , Kelbrick Marlene
Published: July 2023

Aims

Physical activity, sleep, mental health, physical health, well-being, quality of life, cognition, and functioning are interconnected factors. Compared to general population average, people experiencing psychosis have lower levels of physical activity, high levels of sedation, and more sleep problems (Soundy et al. 2013; Vancampfort et al. 2015). This is linked to symptoms of depression, lower well-being, hopelessness, lower quality of life and physical health conditions, such as: cardiovascular disease (CVD), stroke, hypertension, osteoarthritis, diabetes, and chronic obstructive pulmonary disease (COPD) (Rhodes et al. 2017; Schuch et al. 2017). Engaging in physical activity is associated with improved quality of life, psychotic symptomatology, cognition, functioning and physical health for people with psychosis experience (Mittal et al. 2017). To be effective, interventions need to be individualised (Griffiths et al. 2021). An early intervention in psychosis (EIP) service intervention was delivered: the provision of a Fitbit and its software apps, sleep hygiene and physical activity guidance, motivational interviewing, workbook goal setting through three sessions with a clinician. EIP service staff used Fitbits themselves, sharing experiences with patients. Aim was to improve sleep, physical activity, well-being, and prevent weight gain.

Methods

Outcome measure data collection from baseline to 6 week follow-up. Change in physical activity, sleep, mental health, well-being and physical weight were assessed in 50 participants, and fifteen participants were interviewed. People with lived experience of psychosis were part of the research team and contributed to design, analysis and reporting.

Results

Improvements were found in physical activity, sleep, mental health, and well-being, and there was no weight gain. Most patients actively used the Fitbit and its software apps, guidance and workbook to set goals and to make positive changes to their lifestyle and daily routines to improve motivation, quality of sleep, and level of physical activity.

Conclusion

Healthy effective sleep and physical activity/exercise is important to EIP service patients’ well-being and mental and physical health. EIP staff successfully and fully integrated the Well-Track intervention into routine service provision. The project has better allowed staff to effectively engage with and discuss issues around sleep, physical activity, well-being and mental health and reducing weight gain. The intervention was beneficial, relatively easy and low cost to implement, and well-liked by patients and staff; and therefore could be offered by all EIP services. EIP services should consider and assess sleep and physical activity/exercise issues and promote healthy effective sleep and physical activity/exercise within recovery focused practice.
TRAILBLAZER-ALZ 4: Topline Study Results Directly Comparing Donanemab to Aducanumab on Amyloid Lowering in Early, Symptomatic Alzheimer's Disease
Authors: Salloway Stephen , Lee Elly , Papka Michelle , Pain Andrew , Oru Ena , Ferguson Margaret B. , Wang Hong , Case Michael , Lu Ming , Collins Emily C , Brooks Dawn A. , Sims John
Published: July 2023

Aims

To evaluate the potential superiority of donanemab vs. aducanumab on the percentage of participants with amyloid plaque clearance (≤24.1 Centiloids [CL]) at 6 months in patients with early symptomatic Alzheimer's disease (AD) in phase 3 TRAILBLAZER-ALZ-4 study. The amyloid cascade in AD involves the production and deposition of amyloid beta (Aβ) as an early and necessary event in the pathogenesis of AD.

Methods

Participants (n = 148) were randomized 1:1 to receive donanemab (700 mg IV Q4W [first 3 doses], then 1400 mg IV Q4W [subsequent doses]) or aducanumab (per USPI: 1 mg/kg IV Q4W [first 2 doses], 3 mg/kg IV Q4W [next 2 doses], 6 mg/kg IV Q4W [next 2 doses] and 10 mg/kg IV Q4W [subsequent doses]).

Results

Baseline demographics and characteristics were well-balanced across treatment arms (donanemab [N = 71], aducanumab [N = 69]). Twenty-seven donanemab-treated and 28 aducanumab-treated participants defined as having intermediate tau.

Upon assessment of florbetapir F18 PET scans (6 months), 37.9% donanemab-treated vs. 1.6% aducanumab-treated participants achieved amyloid clearance (p < 0.001). In the intermediate tau subpopulation, 38.5% donanemab-treated vs. 3.8% aducanumab-treated participants achieved amyloid clearance (p = 0.008).

Percent change in brain amyloid levels were −65.2%±3.9% (baseline: 98.29 ± 27.83 CL) and −17.0%±4.0% (baseline: 102.40 ± 35.49 CL) in donanemab and aducanumab arms, respectively (p < 0.001). In the intermediate tau subpopulation, percent change in brain amyloid levels were −63.9%±7.4% (baseline: 104.97 ± 25.68 CL) and −25.4%±7.8% (baseline: 102.23 ± 28.13 CL) in donanemab and aducanumab arms, respectively (p ≤ 0.001).

62.0% of donanemab-treated and 66.7% of aducanumab-treated participants reported an adverse event (AE), there were no serious AEs due to ARIA in donanemab arm and 1.4% serious AEs (one event) due to ARIA were reported in aducanumab arm.

Conclusion

This study provides the first active comparator data on amyloid plaque clearance in patients with early symptomatic AD. Significantly higher number of participants reached amyloid clearance and amyloid plaque reductions with donanemab vs. aducanumab at 6 months.

Previously presented at the Clinical Trials on Alzheimer's Disease - 15th Conference, 2022.
A Quality Improvement Project to Improve Audio Quality for Remote Attendees of a Ward Round at a London Older Adult Psychiatric Ward
Authors: Hamour Omer , Morrin Hamilton
Published: July 2023

Aims

Our aim was to investigate the extent and impact of poor audio quality during remote ward rounds using Microsoft Teams. We intended to compare attendees' audio quality experience with our expectation that a cardioid polar microphone would make it difficult for attendees to hear all members of the multidisciplinary team. We also hypothesized that switching to an omnidirectional recording system would improve perceived audio quality, communication, and patient care.

Methods

This study is a continuation of a previous quality improvement project carried out on a general adult ward within the same Trust. This iteration involved individuals who participated remotely in ward rounds at a dementia specialist ward over a four-month period in 2022/2023. Participants of the study included staff from the ward team, community care coordinators and patient family members, who completed a digital feedback questionnaire about the audio quality. Due to the nature of their illness, no patients completed the questionnaire.

There were no exclusion criteria. Data from Likert scale questions were analysed. Little demographic data were collected, and qualitative data were analysed by identifying themes and grouping responses based on thematic frequency.

Results

In the pre-implementation survey, 12 responses were received from patient family members, 9 ward team members and 2 community mental health workers. Before the intervention, 3/12 participants rated the sound quality as "bad" and the same number were "dissatisfied" with the sound quality during ward rounds (modal response "neutral" for both, 6/10). Only 3/12 attendees reported being able to hear and understand everyone present in the ward round all the time, and one person reported only rarely hearing and understanding a single person in the room when they spoke.

All respondents agreed that the sound quality impacted their experience of the ward round. The three most common issues reported were people speaking too far from the microphone, voices sounding muffled, and poor internet connection causing gaps in speech.

Common themes identified in the qualitative data included: frustration, disengagement, and damage to patient care.

Conclusion

In summary, our findings indicate that when using a built-in laptop microphone with unidirectional pick-up, remote ward round attendees were not satisfied with the audio quality. However, this may be improved through the use of an omnidirectional system. Potential benefits from this technology may be optimised through the use of automatic transcription for individuals who may be hearing impaired, and ensuring optimal positioning for adequate sound detection.
Improving Care for Service Users With Learning Disability by Increasing Early MDT Coordination for Those Referred With Behaviours That Challenge
Authors: Knox Benjamin , Jones Anthony , Mufti Shaista , Gimbuta Chloe , Eady Nicole , Boddington Ellen , Ash Katie
Published: July 2023

Aims

Our aim was for 80% of new referrals for behaviours that challenge within Tower Hamlets Community Learning Disability service to have an MDT coordinated approach by July 2022. This followed concerns about disjointed care and long waits for therapeutic support when being referred between different MDT branches within the service having a negative impact on patient care.

Methods

An MDT project team was formed and weekly meetings were arranged. A driver diagram was created. Our primary outcome measure was determined: percentage of referred patients per week that had MDT coordinated assessments, with data being collected manually from electronic progress notes and MDT meeting minutes. Number of referrals per week was recorded as a process measure. Baseline data were added to the Life QI web platform upon collection, allowing generation of run charts for outcome and process measures. The time-frame over which referrals were recorded was changed from weekly to fortnightly, to help differentiate graphically between zero values resulting from the absence of MDT coordination and those resulting from no referrals being received on a given week. Attempts were made to obtain service user input via easy-read questionnaires and subsequent discussion in a service user participation group. A weekly Positive Behavioural Support meeting was set up and a Positive Behavioural Support database was established, and the combination of these changes simplified data collection and gave a focus to MDT working and collaboration for these service users. Data were recorded from 28/06/2021 to 03/07/2022 initially and subsequently extended to 06/11/2022 as part of a further PDSA cycle.

Results

A shift in proportion of service users referred with behaviour that challenges who had MDT involvement at the point of allocation was observed, to above the mean value of 0.5, commencing 07/02/2022, this shift was sustained until the project's endpoint. In terms of our process measure, the median number of new behaviour that challenges referrals per fortnightly period to psychiatry and psychology was one. This ranged from 0-4 referrals per fortnightly period, but no sustained change in this value was observed over the course of the project.

Conclusion

Implementing a new behaviour that challenges database and weekly meeting to focus on MDT coordinated working in those newly referred with behaviour that challenges has been successful in leading to a measurable and sustained improvement in the proportion of those service users receiving timely MDT coordinated care.
Audit of Seclusion Practice in an Inpatient Adult Intellectual Disability (ID) Psychiatry Unit
Authors: Kumar Praveen , Graves Catriona , Jones Sheena
Published: July 2023

Aims

To investigate if current practice regarding the use of seclusion in an adult ID assessment and treatment unit was in keeping with the newly developed NHS Highland Seclusion Policy.

Methods

Case notes were reviewed for all patients who had had a period of seclusion between 20 September and October 2022.

Data were collected regarding the following:

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Administration of seclusion (date; time started; medication used prior; reason for administration & duration);

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15 min interval monitoring (record of patient's mental & physical state including presentation, behaviour, conscious levels, respirations & appearance)

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Review at 2 and 4 hours (including plans on how to end seclusion)

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Documented Datix submitted and Monitoring of improvements.

Results

Thematic analysis showed that the most common reason for the use of seclusion was due to increasing agitation and aggression.

Data collection showed that the following information was missing from case records:

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Use of anxiolytic before seclusion;

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Under the 15 minute interval recording - respiration rate & appearance was missed most of the times;

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Review at 2 hours: Plans to end seclusion was often missed; Review at 4 hours: on most occasions the duty consultant was not informed. They could give valuable insight and plans on stopping seclusion if it has prolonged more than 4 hours.

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Datix was not sent every time seclusion commenced and this is needed as it would further provide to better identify and manage patients needing it.

Conclusion

Seclusion places people at risk. It is vital to ensure that there is robust monitoring of the patient's mental and physical state to reduce the risks associated with seclusion and, in particular, when medication which may lead to respiratory depression has been used. Seclusion should be used for the shortest time possible - explicit consideration of when and how to end seclusion provides an opportunity to limit the length of this highly restrictive intervention and minimise the impact on the person.

The results of the audit were shared with the staff team via the Seclusion Policy Short Life Working Group and will allow subsequent drafts of the service protocol to reflect good clinical practice. Results were also shared via the internal teaching programme and at the Clinical Governance forum. An additional session will also be provided during the induction plan for new trainees. Finally, a reaudit will be done to assess changes in seclusion practice.
Quality Improvement Project: Improving the Handover Process Between Junior Doctors at the Hammersmith and Fulham Mental Health Unit
Authors: Ramanathan Rathy , Khan Fariah , Arakkal Darshana
Published: July 2023

Aims

Handover is an integral aspect of clinical work for all doctors. During on calls it involves the transfer of responsibility and accountability for some or all aspects of patient care, to another person on a temporary basis. It is potentially a highly perilous step, and when carried out improperly can cause errors compromising patient safety. In recent times, handover is more important than ever due to the increase in shift patterns of working. Further the General Medical Council (GMC) has clear exceptions that all doctors should ‘keep colleagues well informed when sharing the care of patients.’

Methods

At Hammersmith and Fulham Mental Health Unit there was no formal junior doctor handover in place between changes of shift. Handover of clinical information between regular teams and the long day on call doctor was adhoc, informal and disorganised.

In 2021, we identified this significant patient safety concern, and introduced a handover sheet with a populated table contained pertinent information: date of the request, the location of the patient, the demographic details of the patient, the clinical information regarding the patient, the requested job and whether the task was completed. Junior doctors were instructed to complete the table which was kept in a folder in the junior doctor room when handing over information to the on call doctor. If the request was urgent and a face to face handover was not possible, doctors were encouraged to telephone the on call doctor to provide an additional verbal handover.

Results

The GMC trainee survey identified that handover was a strong negative outlier with a trainee satisfaction rate of 44.79% in 2018. This was evident again in the GMC trainee survey 2019, where handover was again identified as negative outcome in comparison to the average with a trainee satisfaction score of 48.26%.

Having formalised the handover, the GMC trainee survey in 2021 identified a significant improvement in the trainee satisfaction rate of 59.03%; together with the results now being within the national average. Local trainee feedback survey also supported this finding with increased confidence being reported in the handover process.

Conclusion

Good handover does not happen by chance; this was clearly demonstrated following the implementation of a formal and structured proforma within the junior doctor handover at the Hammersmith and Fulham Mental Health Unit. This intervention not only improved the trainee confidence in the handover process but ultimately reduced the potential risk to patient safety.
Improving Physical Health Monitoring on an Inpatient Dementia Assessment Unit – a Quality Improvement Project
Authors: Shanley Ivan , Ghoneim Fatma , Attanayake Nadeera , Ford Jennifer , Kutraite Alina , Nkungu Thembisa , Maccabe Elle
Published: July 2023

Aims

Meadowview Ward is a dementia assessment unit based at Thurrock Community Hospital as part of Essex Partnership University NHS Foundation Trust. Patients with advanced dementia are routinely admitted with significant physical comorbidities and, as such, robust physical health monitoring is required. Members of the nursing team felt that it would be helpful to formalise the approach to physical health monitoring in order to allow all members of the multidisciplinary team to be aware of the necessary requirements. It was decided to formulate a physical health monitoring prompt sheet to facilitate discussion regarding physical health during ward rounds.

Methods

A multidisciplinary discussion took place to identify the areas of monitoring which should be routinely highlighted in ward rounds. Items labelled as routine monitoring requirements were also listed. A prompt sheet was then devised which divided ward round discussion into nursing and medical feedback, with each section having specific areas for discussion (for example oral intake, recent blood results, any pending investigations). This included prompts for other staff groups including physiotherapists and occupational therapists. A section was also added regarding ongoing monitoring requirements, such as routine outpatient appointments and whether transport had been booked.

In order to assess the impact of the introduction of the prompt sheet a questionnaire was provided to members of the multidisciplinary team who regularly attend ward round. This assessed their perception of the quality of physical health monitoring both before and after the introduction of the prompt sheet, the impact of the sheet on ward rounds and whether they wished the intervention to continue.

Results

There was a significant increase in staff satisfaction with physical health monitoring on the ward (n=7, P = 0.0065). 100% of staff surveyed rated the introduction of the prompt sheet as “strongly helpful” and that they “strongly agree” the use of the prompt sheet should continue. An initial concern from the team had been the potential for the use of the sheet to delay ward rounds, however 57% of respondents reported no impact on ward round duration and 43% felt it strongly expedites assessments.

Conclusion

The introduction of the physical health monitoring prompt sheet has been widely perceived as a success within our multidisciplinary team. It has also demonstrated the effectiveness of a multidisciplinary approach to quality improvement projects, ensuring the wide variety of expertise within teams is utilised.
Fluoxetine Induced Menorrhagia
Authors: Shaheen Manar
Published: July 2023

Aims

Selective serotonin reuptake inhibitors play important role in treatment of various psychiatric disorders. Commonly prescribed SSRIs include Sertraline and Fluoxetine. Fluoxetine has a high level of serotonin reuptake inhibition and a prolonged half-life. SSRIs can increase the risk of gastro-intestinal bleeding. A recent systematic review suggested an increased risk of intracranial bleeding in patients taking SSRIs. Psychiatric patients on SSRIs may present with menstrual disorders. Currently, there is limited information on its effect on menstrual cycle. The aim of this study is to explore the possible association between Fluoxetine and menorrhagia.

Methods

Case Study ,29 years old, female patient, diagnosed with mixed anxiety and depression ICD-10 F41.2. No previous medical history of menstrual disorders. She started sertraline medications, initial dose of 50 mg, which was gradually titrated to 150 mg. After 12 weeks, Sertraline was discontinued due to limited effectiveness and was started on fluoxetine 20 mg. Dose was gradually titrated to 40 mg, Menorrhagia for 14 days was reported. Physical examination was unremarkable. A period of discontinuation of fluoxetine attempted leading to partial resolution of symptoms. However, 2 weeks later after careful examination of the risks and benefits, Fluoxetine was re-introduced. A trial of Tranexamic Acid 1 gm t.ds. for five days at the expected date of menstruation was initiated.

Results

Patient had no changes in her scheduled menstrual bleeding when she was using Sertraline. However, after 2 weeks of initiating 20 mg of fluoxetine the patient reported heavy prolonged bleeding with estimated 100% increase in volume and duration of the scheduled bleeding. Dose titration to 40 mg, led to further increase in the severity and duration of the bleeding. Changes in platelet function tests was reported 3 months after initiation of treatment; however, the results remained within the normal range. Tranexamic Acid 1 gm t.ds. for five days led to significant reduction in the severity and duration of bleeding.

Conclusion

Using the WHO-UMC Causality Categories to explore association of the study findings, it is likely/ probable that Fluoxetine is associated with menorrhagia. A likely dose effect association was observed. Possible explanation of the increased risk of bleeding relates to its inhibitory action on platelet aggregation. However, Fluoxetine can be used safely for long term when Tranexamic acid was add. Tranexamic Acid has primary effect on thrombin generation; Its secondary effects is on improving platelet function and coagulation factors, leading to successful reduction in duration and severity of the bleeding.
Physical Health Monitoring in Patients on Antipsychotics: A Clinical Audit
Authors: O'Donnell Alice , Chatterjee Jayanta
Published: July 2023

Aims

Patients with serious mental illness are more likely to suffer from serious physical health conditions, including: obesity, diabetes, heart failure and stroke. This, combined with the side effects of antipsychotic medication including weight gain and cardiac changes, means that patients with psychosis under the Early Intervention Services (EIS) taking antipsychotics require regular physical health monitoring, as per NICE guidelines. This includes: yearly BMI, blood pressure, ECG, blood tests (FBC, U+E, lipids, HbA1c, prolactin, LFT), alcohol status and smoking status. Our audit aims to assess the compliance of physical health checks for patients on antipsychotic medication under the EIS first episode psychosis team.

Methods

Patients on our caseload (for >6 months) between 01/2022 and 01/2023 (n=36) were included in this audit, and relevant data were collected using electronic records (i.e. carenotes and affinity). Data were recorded and stored electronically, and analysed using Excel and GraphPad. Patient information was discussed with their lead practitioner to ensure data collected was accurate. Our audit standard was set at 100%.

Results

In terms of BMI, 91.67% (n=33) of patients had a recorded BMI, with 19.44% (n=7) of our patients being overweight and 19.44% (n=7) being classified as obese. Of the patients classified as overweight or obese (n=14), 85.71% (n=12) had received advice about their diet or exercise. Blood pressure measurements were available for 86.11% (n=31), and 13.89% (n=5) of these patients were found to have hypertension. Information relating to patients' alcohol, smoking and recreational drug use was recorded in 97.22% (n=35) of our patients.

Qrisk data were not collected in 22.73% (n=5) of patients who were eligible for measurement (n=22). Furthermore, ECG tests were not recorded in 72.22% of patients (n=26). Compliance with blood tests was less than the desired standard, with 75% (n=27) of patients having an up to date FBC, U+E, lipids and HbA1c measurement.

Conclusion

Specific areas of physical health monitoring are carried out to a high standard in the EIS service, but there are areas which warrant improvement, particularly Qrisk and ECG monitoring. The EIS team is to re-audit these outcomes in 3 months' time, after presentation of results to the team and physical health check clinics are employed.