bluuebunny/crossref_metadata_2025 huggingface dataset:
Audit of Risk Assessment Tool in Adolescent Eating Disorders
Authors: Punukollu Mallika , Mulligan Camilla
Published: August 2024

Aims

Aim:

To develop better prioritisation and assessment of high-risk patients.

Standard:

RCPsych Junior MARSIPAN guidelines advise that reasonable aims for a first presentation to primary care involve physical examination and referral to the appropriate CAMHS or paediatric service depending on the level of risk. The framework set out within the guidelines can be used to highlight areas useful to assess and grade concern.

NICE guidelines also state that in primary care, when assessing for an eating disorder or deciding whether to refer people for assessment, the following should be considered: BMI or body weight for their age, rapid weight loss, restrictive eating practices, mental health problems, physical signs of malnutrition, poor circulation and behaviours such as excessive exercise, unexplained electrolyte imbalance or hypoglycaemia.

Indicator and target: Proportion of GP referrals which contain information to allow risk assessment and prioritisation of referrals within CAMHS.

Methods

Eating disorder referrals were reviewed over a three month period. Using EMIS, SCI store referrals were reviewed to check the source of referral and information included.

Referrals were checked against the following criteria: weight, degree of weight loss, fluid intake, calorie intake, heart rate, blood pressure, mental health screening, compensatory behaviours and blood analysis.

Results

First cycle Results: from period from May–July 2021, comprising 8 referrals. The percentage of referrals which included information on the following were: weight 25%; weight loss 50%; calorie intake 37.5%; fluid intake 12.5%; heart rate 0%, blood pressure 12%, mental health 62%, compensatory behaviours 12.5%, bloods analysis 25%.

Action plan: Pro forma was developed to increase awareness of the information that is useful to CAMHS to prioritise and assess risk as per standards expected from NICE and Junior MARSIPAN guidelines.

This was circulated to East Renfrewshire GP practices in August 2021.

Second cycle Results: Referrals were reviewed in the period after the pro forma was circulated from Sept–Dec 2021. This comprised of 4 referrals. Upon review results showed that the percentage of referrals which included information on the following were: weight 100%; weight loss 50%; calorie intake 25%; fluid intake 25%; heart rate 25%, blood pressure 50%, mental health 100%, compensatory behaviours 75%, bloods analysis 50%.

Conclusion

The audit showed, that following the pro forma being circulated, there was an improvement in proportion of referrals which contained appropriate information (26% compared with 55% cumulative percentage of information included).
Anticholinergic Burden in People With Learning Disability and Mental Health Difficulties: A Baseline Audit
Authors: Sahadevan Sreeja , Hicks Melissa , Tharian Reena , Patteril Elizabeth , Alexander Regi
Published: August 2024

Aims

Background:

The cumulative effect of having one or more prescription drugs with anticholinergic properties is known as the Anticholinergic Burden (ACB). ACB can increase mortality and morbidity. Adults with learning disability are a high-risk group for this.

Aims:

To evaluate Anticholinergic Burden (ACB) for adults with learning disability and co-existing mental health conditions and make practice recommendations.

Methods

A baseline audit was carried out over a period of 1 month on those treated within two specialist in-patient units in England. Routinely collected information including diagnosis, prescribed medication, clinical outcomes (Clinical Global Impression – CGI) and side-effect scales (ACB calculator, Anticholinergic Effect on Cognition – AEC, Liverpool University Neuroleptic Side-effect Rating Scale – LUNSERS, Glasgow Antipsychotic Side-effect Scale – GASS) were collated and analyzed using quantitative methods.

Results

19 patients were included. Mean age was 37 years, 89% (n = 17) were male and 95% (n = 18) of white British ethnicity. The clinical diagnoses included 74% (n = 14) with mild learning disability, 68% (n = 13) with a major mental illness (psychosis or affective disorder), 53% (n = 10) with autism and 32 (n = 6) with a personality disorder. 89% (n = 17) were on antipsychotics, 63% (n = 12) on mood stabilizers, 58% (n = 11) on antimuscarinic drugs for antipsychotic side effects, 58% (n = 11) on anxiolytics, 32% (n = 6) on antidepressants and 89% (n = 17) on medication for physical conditions. Including pro re nata (prn) medication, the mean ACB calculator score was 6.68 and 4.21 on the AEC scale. On LUNSERS, the mean score was 23.13 (medium side effects), on GASS 8.87 (mild or absent side effects), on CGI efficacy index 6 (decided clinical improvement with side-effects not significantly interfering with functioning) and on CGI global improvement 2.37 (much improved).

Conclusion

The ACB in people with learning disability and mental health problems is high. While an ACB calculator score of 3+ is described as associated with increased mortality and morbidity in the general population, the mean score in this sample was double that if prescribed prn medication was included. Medication prescribed for both mental and physical health reasons. Despite the high ACB, they show good clinical improvement and functioning regarding their mental health. The scores on other side effect scales are not exceedingly high either. There is a need for more research to set the specific practice standards regarding ACB measurement and monitoring in this group. Adequate health education for patients and staff should be a priority to maintain vigilance regarding ACB effects.
Adherence of Baseline Physical Health Monitoring for Patients Receiving Antipsychotic Medications in a Psychiatry Ward, Lahore
Authors: Suleman Asma , Madeeh Hashmi Ali
Published: August 2024

Aims

•

To identify current practices regarding baseline tests monitoring for antipsychotic medications.

•

To identify potential causes for not adhering to the standard guidelines.

•

To ensure all the baseline tests have been documented and reviewed properly.

Methods

In a retrospective analysis, a cohort of 28 patient case notes was examined in June 2023 to assess the baseline physical health parameters within the Psychiatry department at Punjab Institute of Mental Health, Lahore, in accordance with the guidelines outlined in “The Maudsley Prescribing Guidelines in Psychiatry 13th edition.” The data was analyzed to fulfill the audit objectives, and significant trends were subsequently identified.

Results

The baseline assessments encompassed a comprehensive blood count, urea and electrolyte analysis, liver function testing, blood glucose measurement, and blood pressure monitoring, all of which were conducted in 100% of the cases. Nevertheless, electrocardiography (ECG) was only carried out in 71% of the cases prior to the initiation of antipsychotic treatment. Regrettably, there was a lack of documentation regarding baseline weight/BMI monitoring, serum prolactin level assessment, and creatinine phosphokinase level measurement.

Conclusion

The audit revealed several areas of concern that warrant immediate attention and improvement. These include:

•

Protocols and Guidelines: The absence of defined protocols poses a significant challenge to maintaining consistent and standardized practices within the department.

•

Awareness and Training: There is a noticeable lack of awareness among medical staff, including doctors and nurses, regarding the importance and proper procedures for baseline assessments.

•

Sampling Errors: The occurrence of sampling errors during the data collection process has impacted the reliability and accuracy of the obtained results.

•

Administrative Challenges: Administrative issues have been identified as a barrier to the seamless implementation of baseline assessment protocols.

•

Resource Allocation: Insufficient funding for laboratory resources has hindered the comprehensive and timely conduct of essential tests.

•

Test Availability: The limitations in the availability of certain required tests have impeded the thoroughness of baseline assessments for patients.

Addressing these areas of improvement is critical to enhancing the quality of care and ensuring the holistic well-being of our patients. It is imperative to implement robust protocols, enhance staff awareness and training, rectify administrative challenges, secure adequate funding for resources, and ensure the availability of essential tests. These measures will contribute to the delivery of comprehensive and effective healthcare services within the Psychiatry department at Punjab Institute of Mental Health, Lahore.
Assessment of Compliance With NICE Guidelines on Safety Planning Following Self-Harm in Elderly Patients in a Mental Health Trust
Authors: Tariq Safyan , Prasanna Aparna , Lau Ryan
Published: August 2024

Aims

Our aim was to evaluate the extent to which the risk assessment protocol post self-harm incidents for patients aged over 65 at the Black Country Healthcare Trust is aligned with the recommendations set forth in the NICE Guideline (NG225). We specifically sought to determine whether safety plans are incorporated as recommended by the NICE Guideline (NG225), and in the absence of a distinct safety plan, whether essential components of such a plan are integrated within the risk assessment framework utilised following episodes of self-harm.

Methods

A retrospective audit was conducted utilizing data from the trust on self-harm incidents over a six-month duration. Of the 1,408 recorded incidents, 68 involved individuals aged 65 years or older. A sample of 30 incidents was randomly selected from this cohort to constitute the target sample for this study. Each case was anonymized with a unique identifier and subjected to a comprehensive review employing a bespoke data collection instrument, expressly developed for this audit. The review process was facilitated by the trust's digital record system (RIO). Data collated for analysis encompassed a range of variables, including demographic details, diagnostic classifications, geographical location, care setting, self-harm methodologies, the severity of the self-harm events, the origin of data, and compliance with the stipulated criteria of the NICE Guidance (NG225).

Results

Comprehensive safety plans were present in a minority of cases, specifically 6.7% (2 out of 30 patients). The documentation of individual components of the safety plan, analysed separately, yielded the following results:

1.

Documentation of self-harm mechanisms was achieved in 70% of cases (21/30).

2. Identification of precipitants or triggers was noted in 56.7% of cases (17/30).

3. The formulation of coping strategies was documented in 20% of the sample (6/30).

4. The enumeration of essential contacts was completed in 33.3% of cases (10/30).

5. The identification of family members pertinent to the patient’s support network was noted in 33.3% of cases (10/30).

6. The inclusion of contact details for these identified individuals was present in 30% of cases (9/30).

7. Guidelines to ensure a safe environment were applicable and recorded in 38.9% of the relevant cases (7/18).

Conclusion

The majority of patients did not have a safety plan post self-harm incidents. Notwithstanding the absence of a comprehensive safety plan, critical elements prescribed by NICE Guidance (NG225) were insufficiently addressed within the risk assessment and subsequent management planning post self-harm.
Audit of Sub-Therapeutic Dosing of Methadone as Opioid Substitution Therapy
Authors: Wilson Paul
Published: August 2024

Aims

Clinical guidance indicates that methadone doses of 60–120mg are therapeutic as opioid substitution therapy (OST). Audit was completed to understand why patients open to Newcastle Treatment and Recovery (Addictions) are being prescribed doses below 60mg and to identify areas for improvement.

Methods

285 patients were identified via prescription software as currently prescribed <60mg methadone. A random sample of 50 cases was obtained for audit during signing of routine prescriptions. Case sample was adjusted to ensure even distribution between keyworkers. Review then completed of prescribing card and clinical entries in the last 6 months. Standards included reason for subtherapeutic dosing and evidence of instability with use of illicit opioids, or other substances (excluding alcohol or cannabis), alongside secondary outcomes.

Results

54% of cases were found to currently be undergoing a change in their dose – mostly reducing though 2 increasing and 2 preparing to switch to buprenorphine. The remaining 46% were maintained on a consistent dose of methadone below 60mg. Of these 8 were advised to change their dose but this was declined. The remaining 15 had no additional advice recorded and remained on sub-therapeutic dose. Of 50 cases 8 were unstable with regards illicit opioid use, 21 were using other substances (1 gabapentin with the remaining using cocaine). For those using illicit opioids 63% were advised of an increase but declined whilst 25% were not advised of any change in their OST. Of those using other substances 48% had no change in OST considered whilst a further 10% continued with a reduction.

Conclusion

The audit found that a proportion of cases prescribed a sub-therapeutic dose were being maintained on this dose. Most concerning was the proportion of patients who were not advised to increase despite use of illicit opioids but also the proportion who were not following advice from their keyworker. Additional concerns highlighted uncertainty in practice around the role of OST in those who remain using other substances, in particular cocaine. Department of Health guidance recommends that doses in these cases should be optimised which would mean at least targeting therapeutic range. Recommendations made included to develop further training to ensure consistency of practice as well as requiring that all patients on sub-therapeutic doses of methadone should be booked for strategic care plan reviews at a minimum of 6 monthly.
Imaginator
Authors: Gardner-Bougaard Emily , Sevri Athina , Do Simplicio Martina
Published: August 2024

Aims

Self-harm affects around 20% of all young people in the UK. Treatment options for self-harm remain limited and those available are either non-specific or long and costly and may not suit all young people. There is an urgent need to develop new scalable interventions to address this gap.

Imaginator is a novel imagery-based intervention targeting self-harm initially developed for 16–25-year-olds. It is a blended digital intervention delivering Functional Imagery Training (FIT) via therapist sessions and a smartphone app. In this study we piloted a new version of Imaginator extended to adolescents from age 12 after co-producing a new app with a diverse group of young people experts-by-experience.

We aimed to assess feasibility of delivering Imaginator in Children and Adolescent Mental Health Services (CAMHS) and adult secondary mental health services and gather young people's feedback on the intervention

Methods

Participants were recruited from West London NHS Trust Tier 2 CAMHS and adult Mental health Integrated Network Teams (MINT) teams. They underwent a baseline screening and were allocated to a therapist for three face-to-face FIT sessions in which the app was introduced followed by five phone support sessions. Outcome assessments were conducted after completing therapy, approximately 3-months post-baseline, including questionnaire measures and a qualitative feedback interview.

Qualitative data were analysed using a co-produced thematic analysis method with lived experience co-researchers.

Results

Thirty-four participants were referred (31 female, 2 male, 1 transgender; mean age = 18.4), of which 30 met inclusion criteria and completed screening. Out of 25 who started therapy 16 completed the intervention. Only 15 completed the quantitative outcome assessment, and 10 the interviews. There was an overall reduction in number of self-harm episodes over 3-months from pre- to post-intervention

Five main themes were identified: Imaginator therapy impact, mental imagery acceptability and efficacy, usefulness and usability of the app, integration of the app in therapy and need for improvements. Young people found Imaginator helpful at improving their mental health, in particular the use of mental imagery techniques. The app was overall well received but improvements were suggested.

Conclusion

Our study suggests that Imaginator can be extended to adolescents, is acceptable and has potential as a brief intervention reducing self-harm in young people under mental health services. A future RCT is needed to robustly test the intervention efficacy, after considering issues around high attrition in outcome measures.
A Case Study of Cognitive Impairment Associated With Levetiracetam
Authors: McKenzie Stefan , Seelam Kalyan
Published: August 2024

Aims

In patients with cognitive impairment, it is important to assess the possible impact of medications on cognition. Levetiracetam is an antiepileptic medication used in the management of epilepsy. Its effect on cognition is unclear.

Methods

We present a case study of a 57-year-old female who developed cognitive impairment associated with levetiracetam.

She was referred to Memory Services from her GP due to cognitive impairment. Her past medical history included an optic nerve glioma which was surgically removed followed by radiotherapy, and meningiomas which were managed with stereotactic radiosurgery. She had no previous psychiatric history.

Following a first seizure, she was started on levetiracetam 250 mg BD. Over the following months, she developed worsening symptoms of poor memory, fatigue and lethargy, sleeping excessively, headaches, and subsequently, low mood and occasional suicidal thoughts. Levetiracetam dose was halved. When seen in Memory Services 3 months later, it was reported that there had been a gradual but partial improvement in her symptoms since the dose reduction. Addenbrooke's Cognitive Examination (ACE-III) score was 67/100. Short form mood scale was 3/15, below the threshold for depression. Blood tests were normal. MRI Head showed meningiomas and diffuse white matter hyperintensities, both unchanged from previous imaging.

The patient then started lamotrigine and stopped levetiracetam. On follow up (2 months after initial memory assessment), ACE-III score improved to 80/100 and it was reported that her symptoms had completely resolved.

Results

In this case, there is evidence to support a causal link between levetiracetam and the patient's cognitive impairment – there was a temporal relationship, dose response relationship, and reversibility, which are all in the Bradford Hill criteria for causation. Other causes were considered and deemed less likely, including depression; the mood symptoms were not the predominant symptoms and developed after the other symptoms, and the patient scored below the threshold score for depression on short form mood scale.

Regarding the aetiology in this case, one hypothesis is that there may have been risk factors that made this patient more susceptible to cognitive side effects from the biological effects of levetiracetam, such as previous neurosurgery and radiosurgery. Another hypothesis is that the levetiracetam may have triggered an atypical depressive episode which manifested predominantly with memory symptoms and tiredness.

Conclusion

This case study highlights the importance of reviewing medications when assessing cognitive impairment, and of obtaining a clear timeline of symptoms. There is a need for further research looking at the effect of levetiracetam on cognition.
Catatonia Following Oral Ingestion of Cannabis
Authors: Tewari Abhinav , Pathak Ashish , Pathak Andrea
Published: August 2024

Aims

Catatonia is a neuropsychiatric syndrome that affects motor, speech, and behavioural functions. The link between catatonia and cannabis use is complex and poorly understood, with limited evidence from case reports about the neuropsychiatric manifestations. This paper aims to describe an unusual presentation of catatonia precipitated by a drink made from cannabis leaves (a.k.a. ‘Bhang’).

Methods

Mr JP, a 22-year-old college student, was admitted to an acute medical ward in North India. The medical team sought psychiatry opinion following the unusual presentation: sudden onset of mutism, staring, and rigidity. Physical examination revealed tachycardia and redness of the eyes. Routine blood investigations, EEG and MRI-Brain were unremarkable. Urine drug screen was positive for cannabis. Initially reluctant due to fear of legal troubles, the accompanying friends later revealed a history of ingestion of cannabis leaves (Bhang) for recreational purposes twelve hours ago. Following the clinical diagnosis of catatonia, the lorazepam challenge test led to improvement in rigidity and verbal responsiveness. No overt psychotic symptoms, such as delusions or hallucinations, were noted at the time or during follow-up. JP had previously experimented with smoked cannabis without any diagnosed psychiatric or medical complications requiring inpatient management. He was abstinent from all forms of cannabis use over the past three months due to college exams and denied any illicit substance use. Over the next two days, as the effects of the ingested cannabis wore off and oral lorazepam (6 mg/day) was continued, JP was back to his previous self with stable vital signs. He was discharged from the hospital with a plan to taper and stop lorazepam on an outpatient basis.

Results

‘Bhang' has been a culturally acceptable cannabis form in the Indian subcontinent for centuries, providing an interesting cultural aspect to the case. This case highlights an unusual clinical instance of cannabis use; Oral ingestion led to a drastic presentation requiring hospitalisation, while the smoked form did not result in any similar sequelae. The study's limitations include the inability to test for synthetic cannabinoids and the lack of objective catatonia scoring scale(s).

Conclusion

With the surging popularity of cannabis use in recent years, it is essential to be aware of its various forms and exercise a high degree of suspicion towards unusual presentations. Further research is needed to understand the link between cannabis use and catatonia at the neurotransmitter level, mediated by individual risk factors.
Prescription Patterns in Adolescent Patients With Depressive Disorder at a Tertiary Care Centre in Singapore
Authors: Chee Tji Tjian , Han Ngoh Mark Ye , Hoe Yew Ron , Qi Chong Crystal Xue , Vanessa Tan Pei Sheuan
Published: August 2024

Aims

We aim to examine the prescription patterns of local psychiatrists for adolescent patients with depressive disorder, treated on an outpatient basis, as part of an integrated programme for management of mood disorders in adolescent patients (IPMDA) in Singapore.

Methods

An longitudinal cohort observational study was carried out at a psychiatry out-patient department in the National University Hospital of Singapore, as part of a specialised programme for the treatment of adolescents, aged 13 to 18, with depressive disorder. The data which were collected included information about age, gender, education, therapy provision and drug prescription included generic name and dosing.

Results

A total of 129 patients were included in the study. 81.7% (n = 105) were females and 18.3% (n = 24) were males. 72 (76.4% female, 23.6% male) patients were started on medications. All patients were initiated on a monotherapy regime of antidepressants.

The most commonly prescribed antidepressant was Fluoxetine (58.3%), followed by Sertraline (18.1%), Fluvoxamine (12.5%), Escitalopram (6.9%), Mirtazapine (2.8%) and Amitriptyline (1.4%).

Conclusion

Our findings revealed that current psychopharmacology practice for depressive disorder in Singapore generally follows the published Singaporean treatment guidelines, which is generally kept up to date with wider international recommendations.

The factor of pricing may affect the lower prescription of certain medications, such as Escitalopram, as it is more expensive than the other prescribed medications in the list.
Prevalence and factors associated with suicidal ideation and attempts among war-affected internally displaced people in northwest Ethiopia, 2022
Authors: Tadesse Gebresilassie , Gashaw Fanuel , Amare Zeleke Tadele , Fentahun Setegn , Yitayih Sewbesew
Published: August 2024

Background

People who are forced to leave home often experience emotional suffering and may be disproportionately subjected to risk factors for suicide. Although it is a grave concern for the global public health community, it has not been understood in Ethiopia.

Aims

This study aims to assess the prevalence and factors associated with suicidal ideation and attempts among war-affected internally displaced people in northwest Ethiopia, 2022.

Method

From 23 May to 22 June 2022, a cross-sectional study design was conducted, and a sample of 765 participants was selected through simple random sampling. A structured interview was employed to collect data. Suicidal ideation and attempts were assessed using the Composite International Diagnostic Interview.

Results

Out of 751 interviewed participants with a response rate of 98.2%, the magnitude of suicidal ideation and attempt was 22.4% (95% CI: 19.5%, 25.4%) and 6.7% (95% CI: 5.1%, 8.7%), respectively. People of female gender, having depression, family with a history of mental illness, and poor social support were significantly associated with both suicidal ideation and attempts. Furthermore, post-traumatic stress symptoms and the death of a family member were significantly associated with suicide ideation and attempt, respectively.

Conclusion

At least one in five of the displaced people in this population had experienced suicide ideation, and one in fifteen had attempted suicide. Therefore, strengthening early detection and intervention for individuals is recommended, especially for females with depression, post-traumatic stress symptoms, family with a history of mental illness, poor social support and the death of family members.
Quantifying the Core Deficit in Classical Schizophrenia From Three Independent Samples of Psychosis Spectrum Patients
Authors: Rathnaiah Mohanbabu , Liddle Elizabeth , Liddle Peter
Published: August 2024

Aims

In schizophrenia, disorganisation and impoverished mental activity (as described in the classical descriptions by Kraepelin and Bleuler) together with impaired cognitive function, predict persisting functional impairment (Liddle, 2019). We propose that in schizophrenia, four ‘classical’ features (disorganisation, impoverished mental activity, cognitive dysfunction, and impaired role-functioning) arise from a shared pathophysiological process that increases risk of persisting functional impairment. We also propose that this shared process creates a risk of subsequent episodic reality distortion (delusions and hallucinations). In the current work, we investigate whether a single latent variable accounts for the shared variance in the four ‘classical’ features. We also investigate whether the severity of this latent variable based on assessment of long-standing classical symptoms predicts severity of current reality distortion.

Methods

We performed maximum likelihood factor analysis of disorganisation, impoverishment, cognition and role-function in three separate samples of patients (n = 54, n = 128, n = 64) with DSM diagnosed schizophrenia, schizo-affective disorder or bipolar disorder. In the first two samples, we quantified current disorganisation and impoverished mental activity using the Positive and Negative Syndrome Scale (PANSS). In the third, we scored persistent disorganisation and impoverished mental activity according to Symptoms & Signs of Psychosis Illness (SSPI) based on systematic examination of case records. We assessed cognition using the Digit Symbol Substitution Test (DSST) and role-function using the Social & Occupational functioning scale (in two studies) and the Personal & Social Performance scale (in one study). We quantified current reality distortion by summing SSPI scores for current delusions and hallucinations.

Results

In each of the three studies, a single latent variable accounted for more than 50% of variance. Loadings were similar whether current or persistent symptoms were used. The latent variable derived from persistent symptom scores correlated significantly with current reality distortion.

Conclusion

This series of studies provide further evidence that disorganisation, impoverished mental activity, cognitive impairment and impaired role function share substantial variance, consistent with the proposal that they reflect a core pathophysiological process underlying ‘classical’ schizophrenia. Furthermore, our findings are consistent with the hypothesis that over time, this pathophysiological process increases the risk of episodic reality distortion. However, these were all cross-sectional studies, and need to be confirmed using longitudinal data. Our findings have potential clinical and research implications including development of a custom-made clinical tool to quantify the core deficit as well as investigating targeted interventions employing medication or neuromodulation.
The Social and Clinical Factors Associated With Mental Health Act (MHA) Use Among Children and Adolescent Inpatients: A Cohort Study Using Electronic Health Records
Authors: Walker Susan , Freitas Daniela Fonseca , Downs Johnny , Nyikavaranda Patrick , Johnson Sonia
Published: August 2024

Aims

Little is known about the use of the Mental Health Act (MHA) in children and young people (CYP). There is some evidence that having a diagnosis of psychosis or substance misuse disorder, having an intellectual disability, being older and being of black ethnicity are associated with involuntary admission. However, the existing literature is limited and relies on retrospective case note review or surveys based on a small number of sites over short periods of time. We investigated the social and clinical factors associated with MHA use in CYP using electronic health records. We hypothesised that older adolescence, psychosis, more severe illness, the presence of risk to others and Black ethnicity would be associated with involuntary admission under the MHA.

Methods

Using data from the Clinical Record Interactive Search (CRIS) system for South London and the Maudsley (SLaM) services we identified 2165 CYP under 18 years, with a first admission to inpatient units between 2007 and 2021 with complete data on variables of interest; 1638 (75.7%) were voluntary patients for the duration of the admission and 527 (25.3%) had been detained under a section 2 or 3 of the MHA during the admission. We conducted univariable logistic regression to investigate the association between clinical factors (diagnosis, severity of illness, risk) and social factors (gender, age, ethnicity, deprivation) with the outcome i.e. MHA admission. We then conducted multivariable logistic regression to investigate the association between the clinical and social factors and involuntary admission.

Results

In multivariable analyses we found evidence that a diagnosis of psychosis (OR 2.63, 95% CI 1.83–3.76, p < 0.001), being older (age 13–15 years: OR 5.88, 95% CI 3.46–10.03, p < 0.001; age 16–17 years: OR 6.72, 95% CI 3.97–11.41, p < 0.001), having a developmental disorder (OR 1.60, 95% CI 1.04–2.47, p = 0.033) and being of Black ethnicity (OR 2.14, 95% CI 1.60–2.89, p < 0.001) were associated with involuntary admission after accounting for other factors. Being less impaired (i.e. a higher CGAS score) was associated with a lower odds of involuntary admission (moderate impairment: OR 0.56, 95% CI 0.42–0.74, p < 0.001; lowest impairment: OR 0.41, 95% CI 0.30–0.54, p < 0.001).

Conclusion

In this large cohort of child and adolescent inpatients from South East London, we found that CYP of Black ethnicity are more likely than those from White groups to have an involuntary than voluntary psychiatric hospitalisation, after adjusting for social and clinical factors relating to admission. The finding that Black CYP are more than twice as likely to experience involuntary admission is in keeping with prior literature in CYP and the adult literature. This racial inequity requires further investigation to address disparities in access to mental health care and application of the MHA.
Classification and Regression Trees to Predict for Survival for Patients With Hepatocellular Carcinoma Treated With Atezolizumab and Bevacizumab
Authors: Brown Timothy J. , Gimotty Phyllis A. , Mamtani Ronac , Karasic Thomas B. , Yang Yu-Xiao
Published: August 2024

PURPOSE

Systemic therapy with atezolizumab and bevacizumab can extend life for patients with advanced hepatocellular carcinoma (HCC). However, there is substantial variability in response to therapy and overall survival. Although current prognostic models have been validated in HCC, they primarily consider covariates that may be reflective of the severity of the underlying liver disease of patients with HCC. We developed and internally validated a classification and regression tree (CART) to identify patient characteristics associated with risks of early mortality, at or before 6 months from treatment initiation.

METHODS

This retrospective cohort study used the nationwide Flatiron Health electronic health record–derived deidentified database and included patients with a diagnosis of HCC after January 1, 2020, who received initial systemic therapy with atezolizumab and bevacizumab. CART was developed from available baseline clinical and demographic information to predict mortality within 6 months from treatment initiation. Model characteristics were compared to the albumin-bilirubin (ALBI) model and was further validated against a contemporary validation cohort of patients after a data update.

RESULTS

A total of 293 patients were analyzed. The CART identified seven cohorts of patients from baseline demographic and laboratory characteristics. The model had an area under the receiver operating curve (AUROC) of 0.739 (95% CI, 0.683 to 0.794) for predicting 6-month mortality. This model was internally valid and performed more favorably than the ALBI model, which had an AUROC of 0.608 (95% CI, 0.557 to 0.660). The model applied to the contemporary validation cohort (n = 111) had an AUROC of 0.666 (95% CI, 0.506 to 0.826).

CONCLUSION

Using CART, we identified unique cohorts of patients with HCC treated with atezolizumab and bevacizumab with distinct risks of early mortality. This approach outperformed the ALBI model and used clinical and laboratory characteristics that are readily available to oncologists caring for these patients.
Experiences and Satisfaction With Telehealth During the COVID-19 Pandemic: The Perspectives of Patients With Cancer in Australia
Authors: Nanda Arnav , Lam Lyn Ley , Lynch Jodi , Soudy Hussein
Published: August 2024

PURPOSE

There has been a significant rise in telehealth consultations across Australia since COVID-19 was declared a worldwide pandemic. We aimed to obtain patient feedback on telehealth, identify key strengths and weaknesses, and assess the feasibility of telehealth beyond the pandemic.

METHODS

A survey was developed to obtain patient feedback on telehealth. Patients attending medical oncology clinics at St George Hospital and Sutherland Hospital from April 1, 2020, to May 31, 2020, were identified. Patients who were reviewed via phone or videoconference were included in this study. Eligible patients were texted or emailed a survey link within a week of their telehealth consultation. Surveys were anonymous and completion of the survey implied informed consent. Patients who did not have a mobile number or e-mail were excluded from this study.

RESULTS

One thousand fifty-nine patients were reviewed during the study period, of whom 644 (60%) were reviewed via telehealth. The survey response rate was 36.3% (230 patients responded of 634 surveys sent). Ten telehealth patients did not have a mobile number or email and were excluded. Sixty-seven percent of telehealth consults were for active surveillance, 31% for prechemotherapy/treatment reviews, 1.6% for best supportive care, and 0.5% for new consults. Seventy percent of patients were satisfied that their medical needs were met via telehealth. Ninety percent wanted another telehealth consult, and 73% wanted telehealth to continue post resolution of the pandemic. Minimizing risk of exposure to COVID-19 and patient convenience were identified as key strengths of telehealth while absence of physical examination was the main disadvantage.

CONCLUSION

Majority of the patients surveyed were satisfied that telehealth safely met their medical needs. There is a considerable demand for telehealth to continue beyond the pandemic.
Devimistat (CPI-613) With Modified Fluorouarcil, Oxaliplatin, Irinotecan, and Leucovorin (FFX) Versus FFX for Patients With Metastatic Adenocarcinoma of the Pancreas: The Phase III AVENGER 500 Study
Authors: Philip Philip A. , Sahai Vaibhav , Bahary Nathan , Mahipal Amit , Kasi Anup , Rocha Lima Caio Max S. , Alistar Angela T. , Oberstein Paul E. , Golan Talia , Metges Jean-Philippe , Lacy Jill , Fountzilas Christos , Lopez Charles D. , Ducreux Michel , Hammel Pascal , Salem Mohamed , Bajor David , Benson Al B. , Luther Sanjeev , Pardee Timothy , Van Cutsem Eric
Published: August 2024

PURPOSE

Metastatic pancreatic adenocarcinoma (mPC) remains a difficult-to-treat disease. Fluorouarcil, oxaliplatin, irinotecan, and leucovorin (FFX) is a standard first-line therapy for mPC for patients with a favorable performance status and good organ function. In a phase I study, devimistat (CPI-613) in combination with modified FFX (mFFX) was deemed safe and exhibited promising efficacy in mPC.

METHODS

The AVENGER 500 trial (ClinicalTrials.gov identifier:
NCT03504423
) is a global, randomized phase III trial conducted at 74 sites across six countries to investigate the efficacy and safety of devimistat in combination with mFFX (experimental arm) compared with standard-dose FFX (control arm) in treatment-naïve patients with mPC. Treatment, administered in once-every-2-weeks cycles until disease progression or intolerable toxicity, included intravenous devimistat at 500 mg/m
2
total per day on days 1 and 3 in the experimental arm. The primary end point of the study was overall survival (OS).

RESULTS

Five hundred and twenty-eight patients were randomly assigned (266 in the experimental arm and 262 in the control arm). The median OS was 11.10 months for devimistat plus mFFX versus 11.73 months for FFX (hazard ratio [HR], 0.95 [95% CI, 0.77 to 1.18];
P
= .655) and median progression-free survival was 7.8 months versus 8.0 months, respectively (HR, 0.99 [95% CI, 0.76 to 1.29];
P
= .94). Grade ≥3 treatment-emergent adverse events with >10% frequency in the devimistat plus mFFX arm versus the FFX arm were neutropenia (29.0%
v
34.5%), diarrhea (11.2%
v
19.6%), hypokalemia (13.1%
v
14.9%), anemia (13.9%
v
13.6%), thrombocytopenia (11.6%
v
13.6%), and fatigue (10.8%
v
11.5%), respectively.

CONCLUSION

Devimistat in combination with mFFX did not improve long- and short-term mPC patient outcomes compared with standard FFX. There were no new toxicity signals with the addition of devimistat.
An Advanced Twin-Screw Granulation Technology: The use of Non-Volatile Solvents with High Solubilizing Capacity
Authors: Kolipaka Siva Satyanarayana , Junqueira Laura Andrade , Ross Steven , Garg Vivek , Mithu Md Sadeque Hossein , Bhatt Saumil , Douroumis Dennis
Published: August 2024

Purpose

Twin-screw wet granulation (TSWG) is a manufacturing process that offers several advantages for the processing of water-insoluble active pharmaceutical ingredients (APIs) and has been used for increasing the solubility and dissolution rates. Here we introduce a novel TSWG approach with reduced downstream processing steps by using non-volatile solvents as granulating binders.

Methods

Herein, TSWG was carried out using Transcutol a non-volatile protic solvent as a granulating binder and dissolution enhancer of ibuprofen (IBU) blends with cellulose polymer grades (Pharmacoat® 603, Affinisol™, and AQOAT®).

Results

The physicochemical characterisation of the produced granules showed excellent powder flow and the complete transformation of IBU into the amorphous state. Dissolution studies presented immediate release rates for all IBU formulations due to the high drug-polymer miscibility and the Transcutol solubilising capacity.

Conclusions

Overall, the study demonstrated an innovative approach for the development of extruded granules by processing water-insoluble APIs with non-volatile solvents for enhanced dissolution rates at high drug loadings.

Graphical Abstract
Changes in the Bile Acid Pool and Timing of Female Puberty: Potential Novel Role of Hypothalamic TGR5
Authors: Vanden Brink Heidi , Vandeputte Doris , Brito Ilana L , Ronnekleiv Oline K , Roberson Mark S , Lomniczi Alejandro
Published: August 2024

Context

The regulation of pubertal timing and reproductive axis maturation is influenced by a myriad of physiologic and environmental inputs yet remains incompletely understood.

Objective

To contrast differences in bile acid isoform profiles across defined stages of reproductive maturity in humans and a rat model of puberty and to characterize the role of bile acid signaling via hypothalamic expression of bile acid receptor populations in the rodent model.

Methods

Secondary analysis and pilot studies of clinical cohorts, rodent models, ex vivo analyses of rodent hypothalamic tissues. Bile acid concentrations is the main outcome measure.

Results

Lower circulatory conjugated:deconjugated bile acid concentrations and higher total secondary bile acids were observed in postmenarcheal vs pre–/early pubertal adolescents, with similar shifts observed in infantile (postnatal day [PN]14) vs early juvenile (PN21) rats alongside increased tgr5 receptor mRNA expression within the mediobasal hypothalamus of female rats. 16S rRNA gene sequencing of the rodent gut microbiome across postnatal life revealed changes in the gut microbial composition predicted to have bile salt hydrolase activity, which was observed in parallel with the increased deconjugated and increased concentrations of secondary bile acids. We show that TGR5-stimulated GnRH release from hypothalamic explants is mediated through kisspeptin receptors and that early overexpression of human-TGR5 within the arcuate nucleus accelerates pubertal onset in female rats.

Conclusion

Bile acid isoform shifts along stages of reproductive maturation are conserved across rodents and humans, with preclinical models providing mechanistic insight for the neuroendocrine-hepatic-gut microbiome axis as a potential moderator of pubertal timing in females.
A Study on the Establishment of Monitoring Indicators through a Survey on the Status of Preserved Relics in Seoul
Authors: Wi Koang Chul , Kim Jae Kyu , Oh Seung Jun
Published: August 2024

Prior research, expert opinions, and field surveys were conducted to discuss the direction of improvement in response to problems such as negligence in management of preserved remains under the "Act on the Protection and Investigation of Buried Cultural Properties." As a result of the study, it was also suggested that it is necessary to secure the budget as a legal and institutional supplement, and that the terminology needs to be reorganized. In addition, an on-site survey of 79 preserved relics in Jongno-gu and Jung-gu, Seoul, suggested the need for continuous management of the ruins, and the evaluation results of 21 ruins that can be evaluated by monitoring indicators confirmed that they were insufficient. Based on these results, measures to secure budget and manpower, utilize measures, and increase efficiency should be established so that the monitoring results can be categorized and managed into grades A, B, and C.
A Study on the Improvement of Glass Protector Function in Artworks
Authors: Moon Hee Kyoung , Song Song Yi , Beom Dae Geon , Han Kyeong Soon
Published: August 2024

Most of the frame glass protectors used to protect artworks from natural and artificial damage are made of pure glass without any special function. However, currently, art museums need various functions to protect works and increase exhibition viewing, such as preventing glass protectors from scattering, blocking ultraviolet rays, suppressing mold growth on the surface of artworks, and reducing light reflection on glass. Accordingly, this study conducted durability, antibacterial, and visibility evaluations using glass with the most transparent film among commercially available anti-bacterial and low-reflection films. First, the transparency of the film was checked to ensure smooth viewing of the artwork, and it was confirmed that the glass with the low-reflection film attached to the outermost part had the highest light transmittance. In addition, as a result of observing the adhesion of the film to confirm the anti-scattering function, it was observed that the anti-bacterial film had better adhesion than the low-reflection film, and the scattering of glass fragments attached to the anti-bacterial film was relatively small. In addition, glass with an anti-bacterial film showed a higher UV protection rate than glass without an anti-bacterial film. As a result of measuring microbial activity (ATP) at one-week intervals to confirm the effect of inhibiting mold growth, it was found that the microbial activity of glass with only anti-bacterial film attached and glass with anti-bacterial film attached to the outermost layer was the lowest. Finally, each glass specimen was applied to the color chart to compare colors, check surface roughness, and evaluate visibility. Accordingly, it was confirmed that the color difference was the smallest in white and black, and the difference in height of the irregularities on the glass surface with the low-reflection film attached to the outermost part was found to be the smallest. The results of this study are expected to serve as basic data for research that will not only improve the function of glass protectors used in artworks and protect works more effectively, but also improve existing exhibition and viewing environments.
Study of Corrsion System on Iron Artefacts through Neutronic Analysis
Authors: Kim Lee Yun , Kim TaeJoo , Kim Jong Yul , Cho Nam Chul
Published: August 2024

This study was conducted to confirm the possibility of using the corrosion products of iron artifacts and corrosion systems for non-destructive analysis using neutrons by applying the non-destructive analysis method and the destructive analysis method together to the analysis of the corrosion system of iron artifacts. As a result of transmission analysis, the shape of the artifact, the boundary between the metal layer and the corrosion layer, etc. could be confirmed, and through tomography, the shape, surface shape, and internal cross section of the artifact could be confirmed. It was confirmed that the corrosion thickness using the residual stress measurement method has a high reliability of less than 10% of an error compared to other analysis results, so it is highly likely to be used to measure the corrosion thickness. It was confirmed that the corrosion layer of the iron artifact analyzed this time was mainly Goethite among the types of DPL and was embedded with Magnetite/Maghemite. Since the neutron analysis can estimate the corrosion thickness non-destructive, it is highly likely to be used to study the corrosion rate of iron artifacts by burial environment through additional studies.