bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex differences in the diagnostic algorithm of screening for heart failure by symptoms and NT-proBNP in patients with type 2 diabetes
Authors: Hofer-Zeni Sarah , Leutner Michael , Klimek Peter , Bellach Luise , Pavo Noemi , Prausmüller Suriya , Hülsmann Martin , Kautzky-Willer Alexandra
Published: August 2024

Objectives

This study aimed to assess the guideline recommended diagnostic tools NT-proBNP and NYHA classification, with a focus on sex-specific differences.

Background

Patients with Type 2 Diabetes (T2D) face a heart failure (HF) risk up to four times higher than those without T2D, particularly affecting women more than twice as much as men. Despite distinct pathophysiological differences between men and women, there are currently no sex-specific recommendations for the diagnostic algorithm of HF in diabetic patients.

Methods

A total of 2083 patients with T2D were enrolled, and the primary endpoint was heart failure during hospitalization within a 5-year timeframe. The secondary endpoint was all-cause death.

Results

In female patients, frequency of HF diagnosis prior to or during hospitalization and mortality did not differ significantly between NYHA II and III, in contrast to male patients. Additionally, there was no notable difference in mean NT-proBNP levels between NYHA stage II and III only in female patients. The multivariable regression analysis highlighted NYHA classification not to be a predictor of NT-proBNP levels in female but solely in male patients. On multivariable Cox regression NYHA score was also no significant risk factor for occurence of HF in female patients. Furthermore, there was no significant disparity in mortality between men with NT-proBNP levels between 125 and 400 pg/ml and those below 125 pg/ml, whereas in women mortality was significantly higher in the group with NT-proBNP levels between 125 and 400 pg/ml than below 125 pg/ml.

Conclusion

These findings suggest that NYHA classification may not be the most suitable tool for assessing the diagnosis of HF in female patients with T2D. Moreover, the need for consideration of a more symptom-independent screening for HF in female patients with T2D and re-evaluation of current guidelines especially regarding sex-specific aspects is highlighted.
Malaria community case management usage and quality of malaria care in a moderate Plasmodium falciparum burden region of Chadiza District, Zambia
Authors: Wallender Erika , Kabamba Bupe , Rutagwera Marie-Reine I. , Kangale Chabu , Miller John M. , Porter Travis , Musunse Maximillian , Gallalee Sarah , Bennett Adam , Psychas Paul , Gutman Julie R. , Hamainza Busiku , Thwing Julie
Published: August 2024

Background

Malaria community case management (CCM) can improve timely access to healthcare, and CCM programmes in sub-Saharan Africa are expanding from serving children under 5 years (CU5) only to all ages. This report characterizes malaria case management in the setting of an age-expanded CCM programme in Chadiza District, Zambia.

Methods

Thirty-three households in each of 73 eligible communities were randomly selected to participate in a household survey preceding a trial of proactive CCM (NCT04839900). All household members were asked about fever in the prior two weeks and received a malaria rapid diagnostic test (RDT); those reporting fever were asked about healthcare received. Weighted population estimates were calculated and mixed effects regression was used to assess factors associated with malaria care seeking.

Results

Among 11,030 (98.6%) participants with RDT results (2,357 households), parasite prevalence was 19.1% by RDT; school-aged children (SAC, 5–14 years) had the highest prevalence (28.8%). Prior fever was reported by 12.4% of CU5, 7.5% of SAC, and 7.2% of individuals ≥ 15 years. Among those with prior fever, 34.0% of CU5, 56.0% of SAC, and 22.6% of individuals ≥ 15 years had a positive survey RDT and 73.7% of CU5, 66.5% of SAC, and 56.3% of individuals ≥ 15 years reported seeking treatment; 76.7% across all ages visited a CHW as part of care. Nearly 90% (87.8%) of people who visited a CHW reported a blood test compared with 73.5% seen only at a health facility and/or pharmacy (p < 0.001). Reported malaria treatment was similar by provider, and 85.9% of those with a reported positive malaria test reported getting malaria treatment; 66.9% of the subset with prior fever and a positive survey RDT reported malaria treatment. Age under 5 years, monthly or more frequent CHW home visits, and greater wealth were associated with increased odds of receiving healthcare.

Conclusions

Chadiza District had high CHW coverage among individuals who sought care for fever. Further interventions are needed to increase the proportion of febrile individuals who receive healthcare. Strategies to decrease barriers to healthcare, such as CHW home visits, particularly targeting those of all ages in lower wealth strata, could maximize the benefits of CHW programmes.
Periareolar minimally invasive approach for cardiac surgery: a case series and description of technique with a review of literature
Authors: Mortada Hatan , Alsuhaim Abdulaziz , Alkhamees Nasser , Neel Omar Fouda
Published: August 2024

Background

Minimally invasive cardiac surgery (MICS) has garnered significant attention for its potential benefits, including decreased surgical trauma, accelerated recovery, and improved aesthetic outcomes. This case series aims to elucidate the technical aspects and assess the aesthetic, functional, and quality of life outcomes associated with the utilization of a periareolar incision approach in female patients undergoing cardiac surgery.

Methods

The periareolar MICS technique, performed with or without high-definition (HD) 3D endoscopic visualization, limited rib-spreading, and a periareolar incision spanning the 3 to 9 o’clock positions, was employed. We present a case series encompassing five female patients who underwent various cardiac procedures for different pathologies using this approach.

Results

No intraoperative complications occurred, and all patients experienced uneventful postoperative recoveries. The periareolar approach resulted in well-healed incisions with minimal scaring, preserving breast contour and yielding satisfactory cosmetic outcomes. Patients reported negligible pain levels and expressed contentment with the scar appearance.

Conclusion

The periareolar incision technique in MICS represents an efficacious approach characterized by favorable aesthetic outcomes and enhanced patient experience. Further investigations are warranted to compare different MICS approaches with respect to pain management and their impact on quality-of-life domains.
Association of postoperative delirium with hypotension in critically ill patients after cardiac surgery: a prospective observational study
Authors: Othman Saleh Mohammed Alhaj , Aziz Mohammed Ali Ali , Al-Mushiki Gaber Musaed Ali , Sriwayyapram Chanyanud , okubai Tecleab , Al-Muwaffaq Gamil , Xu Qin , Alqudaimi Mohammed
Published: August 2024

Background

Postoperative delirium (POD), an acute and variable disturbance in cognitive function, is an intricate and elusive phenomenon that occurs after cardiac surgery. Despite progress in surgical techniques and perioperative management, POD remains a formidable challenge, imposing a significant burden on patients, caregivers, and healthcare systems.

Methods

This prospective observational study involved 307 patients who underwent cardiac surgery. Data on the occurrence of delirium, clinical parameters, and postoperative characteristics were collected. A multivariate analysis was performed to assess the relationship between POH and POD.

Results

Sixty-one patients (21%) developed delirium, with an average onset of approximately 5 days postoperatively and a duration of approximately 6 days. On multivariate analysis, POH was significantly associated with POD, and the adjusted odds ratios indicated that patients with POH were more likely to develop delirium (OR, 5.61; p = 0.006). Advanced age (OR, 1.11; p = 0.002), emergency surgery (OR, 8.31; p = 0.001), and on-pump coronary artery bypass grafting were identified as risk factors of POD. Patients who developed delirium were typically older, more likely to be male, and had higher morbidity rates than those who did not.

Conclusion

POH is significantly associated with delirium in critically ill patients after cardiac surgery. Surgical complexity and advanced age contribute to the risk of developing POD and poor postoperative outcomes.
Antidepressant treatment initiation among children and adolescents with acute versus long COVID: a large retrospective cohort study
Authors: Tran Phuong TM , Amill-Rosario Alejandro , dosReis Susan
Published: August 2024

Background

Child and adolescent antidepressant use increased post-pandemic, but it is unknown if this disproportionally affected those who develop post-acute sequelae of coronavirus disease 2019 (COVID) or long COVID. This study compared the risk of antidepressant initiation among children and adolescents with long COVID with those who had COVID but did not have evidence of long COVID.

Methods

Our retrospective cohort study of children and adolescents aged 3–17 years at the first evidence of COVID or long COVID from October 1, 2021 through April 4, 2022 was conducted within Komodo’s Healthcare Map™ database. The index date was the earliest date of a medical claim associated with a COVID (COVID comparators) or long COVID diagnosis (long COVID cases). The baseline period was six months before the index date. The outcome was antidepressant initiation within twelve months after the index date. Due to the large number of COVID relative to long COVID cases, COVID comparators were randomly selected with a ratio of 2 COVID to 1 long COVID. We used propensity score matching to control for confounding due to imbalances in the baseline covariates. Log-binomial models estimated the relative risk (RR) of antidepressant initiation in the propensity score matched sample. We conducted several sensitivity analyses to test the robustness of our findings to several assumptions.

Results

Our child and adolescent sample included 18 274 with COVID and 9137 with long COVID. Compared with those with COVID, a larger proportion of long COVID children and adolescents had psychiatric disorders, psychotropic use, medical comorbidities, were previously hospitalized, or visited the emergency department. In the propensity score-adjusted analysis, the long COVID group had a statistically significant higher risk of antidepressant initiation relative to the COVID comparator (adjusted-RR: 1.40, 95% CI = 1.20, 1.62). Our findings were robust across sensitivity analyses.

Conclusions

The increased risk of antidepressant initiation following long COVID warrants further study to better understand the underlying reasons for this higher risk. Emerging evidence of long COVID’s impact on child mental health has important implications for prevention and early interventions.
Association between treatment with sacubitril/valsartan and the risk of Alzheimer’s disease: a clinical update
Authors: Garnier-Crussard Antoine
Published: August 2024

Since 2014, sacubitril/valsartan (Entresto®) is widely prescribed for heart failure. Despite neprilysin inhibition’s benefits in heart failure, concerns about potential amyloid-beta (Aβ) accumulation and Alzheimer’s disease (AD) risk have persisted. This narrative review, a decade post-approval, evaluates the risk of amyloid pathology and neurocognitive disorders in long-term sacubitril/valsartan use. Clinical trials, real-world studies, and pharmacovigilance data do not indicate an increased risk of cognitive decline. In patients treated with sacubitril/valsartan blood-based amyloid biomarkers show perturbations, while neuroimaging biomarkers reveal no significant increase in amyloid load. Despite a theoretical risk of amyloid accumulation and AD under treatment with sacubitril/valsartan, current clinical data appears reassuring, and there is no signal indicating an increased risk of cognitive decline, but a perturbation of amyloid blood-based biomarkers, which implies great caution when interpreting biomarkers in this context.
Scalable isolation of surface-engineered extracellular vesicles and separation of free proteins via tangential flow filtration and size exclusion chromatography (TFF-SEC)
Authors: Kawai-Harada Yuki , Nimmagadda Vasudha , Harada Masako
Published: August 2024

Background

Extracellular vesicles (EVs) represent small lipid bilayer structures pivotal in mediating intercellular communication via biomolecular transfer. Their inherent characteristics, including packaging, non-immunogenicity, and biofluid stability, position EVs as promising drug delivery vectors. However, developing clinical quality EVs requires multifaceted technological advancement.

Methods

In this study, a method is introduced for engineering extracellular vesicles (eEVs) from cultured cells and their subsequent isolation using lab-scale tangential flow filtration (TFF). This is the first study to evaluate DNA loading efficacy into EVs isolated by TFF, marking a significant milestone in the field of targeted drug delivery. Initially, cells are transfected with EV-display constructs to facilitate the secretion of eEVs bearing the desired coding molecules. Following brief centrifugation, the cell culture media undergoes filtration using hollow fiber filters. TFF, by applying a constant flow, effectively segregates molecules based on designated molecular weight cut-off (MWCO), enriching particles between 50 and 650 nm.

Results

Compared to conventional methods like ultracentrifugation, TFF demonstrates higher efficiency in removing undesired molecules/aggregates while exerting less stress on EVs. Characterization of eEVs through various assays confirms TFF’s superiority in isolating pure EV populations. Additionally, the necessity of size-exclusion chromatography (SEC) after tangential flow filtration (TFF) becomes evident for effectively removing unbound protein contaminants.

Conclusion

In conclusion, TFF-SEC emerges as a scalable and superior approach for eEV isolation, promising significant advancements in clinical applications.
Reviews
Authors: Aitken Julie
Published: August 2024

Geospatial Analysis Applied to Mineral Exploration, edited by Amin Beiranvand Pour, Mohammad Parsa, and Ahmed M. Eldosouky, 2023
Memorial
Authors: Gryshchuk Pavlo , Burianyk Michael
Published: August 2024

Serhii Serhiiovych Shavrin, 1989–2024
Seismic Soundoff: Key trends that will shape the oil and gas industry
Authors: Geary Andrew
Published: August 2024

In mid-May, CGG announced a name change to Viridien to better reflect its evolving business strategy, which includes expanding into new markets such as carbon storage and high-performance computing, while maintaining its core geoscience expertise. In episode 228, CEO Sophie Zurquiyah spoke about how artificial intelligence and machine learning will play a crucial role in Viridien's growth and discussed the key trends that will impact the oil and gas industry.
Association Between Prior Antipsychotic Adherence and Adherence Three Years After Clozapine Initiation: A Real-World Observational Study
Authors: Brodeur Sébastien , Courteau Josiane , Vanasse Alain , Roy Marc-André , Courteau Mireille
Published: August 2024

Aims

Our previous findings challenged the widely held view among a large proportion of psychiatrists (41% to 82%) that previous non-adherence to antipsychotics is a major barrier to the introduction of clozapine (Brodeur et al. 2022 BJPsych). Indeed, our previous work showed that most patients, even those with the poorest adherence profiles, remained on their treatment after clozapine initiation (>68% for clozapine and >84% for all antipsychotics combined) after one year of follow-up. Because of this, the study extended the follow-up period to three years to assess whether patterns of adherence were sustained over time. Therefore, this study aimed to determine whether poor adherence prior to initiating clozapine predicted poor adherence to clozapine or any other antipsychotic (including clozapine) three years after initiation.

Methods

This cohort study included 2,258 patients living in Quebec (Canada) with a diagnosis of SCZ who initiated oral clozapine between 2009 and 2016 (index date). Adherence to AP was measured by the medication possession ratio (MPR) over a 1-year period before and a 3-year period after the index date. Five groups of patients were formed based on their prior MPR level (independent variable), and two dependent variables were defined after clozapine initiation (good adherence (MPR ≥ 0.8) to any APs and to clozapine only). In addition to multiple logistic regression, state sequence analysis was used to visualise the trajectories of AP use over time, before and after clozapine initiation, for each group.

Results

The graphical representation of the SSA immediately showed that AP adherence was significantly improved in all groups, regardless of the level of previous adherence to AP treatment. On the other hand, logistic regression showed that poorer adherence to APs before the index date was significantly associated with an increased risk of poor adherence to any AP treatment 3 years after the index date (adjusted ORs ranging from 2.2 to 3.0). However, the majority of patients (ranging from 80.8% to 92.4%) had good adherence to any APs and to oral clozapine (ranging from 57.7% to 73.8%), regardless of previous adherence level.

Conclusion

These results add to previous findings and demonstrate that initiation of clozapine leads to improved adherence over a 3-year period. Although widely recognised by clinicians as a barrier to clozapine use, previous poor adherence does not appear to justify avoiding clozapine treatment in patients who would otherwise be considered eligible.
Pilot Study Examining the Potential Efficacy of Music-Based Activities for People Living With Dementia in a Hospital Setting
Authors: Abeywickrama Neha , Ellul Miraval Mel N. , Subramaniam Hari , Arshad Qadeer , Mukaetova-Ladinska Elizabeta B.
Published: August 2024

Aims

Pharmacological treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) is of limited benefit. The addition of non-pharmacological interventions is often essential for optimal symptom control. Music is a viable way to help patients communicate and improve quality of life. This study aims to find the most effective way to use music on a busy dementia ward.

Methods

17 inpatients (aged 63–93 years) took part over a five-week period. Music with projected lyrics was individualised and based on their preferences. Instruments (e.g., maracas) were used in some group sessions. We used the Neuropsychiatric Inventory Questionnaire (NPI-Q) and Music in Dementia Assessment Scales (MiDAS) to evaluate patients’ behaviour before and after musical intervention.

Results

Of NPI-Q scores, a significant difference between mean scores before and after the music intervention was found. Specifically, Delusion, Motor Disturbances, and Agitation scores were significantly reduced after music intervention. Of MiDAS, significant differences were found in Interest, Response, and Enjoyment during specific intervals.

Conclusion

A multisensory inpatient environment was effective in delivering music-based activities and managed behavioural symptoms in the short term to people with advanced dementia. Its use for inpatient wards must be further investigated as an economical and personalised non-pharmacological therapeutic tool for patients with dementia.
Perceived Stress and Food Consumption Among Pakistani Medical Students – a Survey Study
Authors: Azam Saad , Shahbaz Haania , Azam Fiza
Published: August 2024

Aims

The aims of this study included investigating the relationship between perceived stress levels and food consumption patterns amongst Pakistani medical students. Additionally, the study meant to determine whether there is a significant difference in food choice between high-stress and low-stress groups of students. Lastly, the study aimed to identify the specific food types most commonly consumed by medical students under high stress conditions.

The investigators of this study hypothesised that there is a significant difference in food choices between high-stress and low-stress groups of medical students.

Among the common health problems reported by medical students, stress stands out as one. Factors related to educational and psychological domains result in the development of stress. Changing dietary patterns is a commonly employed strategy used to deal with stress.

Methods

This study utilised an online survey administered among medical students across Pakistan. The data collection period was 4 weeks from 5th July to 5th August 2023. The survey was distributed conveniently using social media platforms. Sampling was done via the snow-ball method. Data analysis was done via SPSS.

Results

Our results from the population of 138 females (68.6%) and 63 males (31.3%) concluded that there were no significant differences in the perceived stress score between genders (p-value = 0.377) and between hostelites and non-hostelites (p-value = 0.816) using the Mann–Whitney test. We found statistically significant differences in the perceived stress score among the different frequencies for the consumption of snacks (p = 0.02) and fast foods (p = 0.008), but the stress score remained non-significant for fruits and vegetables (p-value = 0.089), ready-to-eat foods (p-value = 0.134), and sweets (p-value = 0.051) with the Kruskal–Wallis test.

Conclusion

While previous studies have shown a difference in perceived stress across genders and living arrangements, ours found none. In addition, we found snacks and fast foods to be the go-to for students in times of stress, but the consumption of healthier foods was not associated with a lower level of stress.
Review of Published ECTAS Data Set From 2012/2013 to 2021
Authors: Badrakalimuthu Vellingiri Raja
Published: August 2024

Aims

Electroconvulsive Therapy Accreditation Service (ECTAS) publishes minimal data set collected from ECT services subscribing to ECTAS accreditation. The aim of this study is to review minimal data set published by ECTAS towards understanding trends and statistically significant changes between 2013 and 2021.

Methods

ECTAS minimal data set has been published for years 2012/13, 2014/15, 2016/17 and 2021. Number of courses, age, gender, diagnoses, legal status, number of treatments, and score on Clinical Global Impression Scale (CGI) for acute treatments has been analysed for trends and statistical differences.

Results

ECTAS data set was not published for the years 2018, 2019 and 2020. In terms of number of courses of treatment per year, 2014/15 was highest with 2148 courses and lowest was in 2016/2017 with 1821 courses. Average number of treatments was 1995 and there was no statistical difference between the years. There was no statistical difference with mean age (61), gender (female 66%), and diagnosis (depression 87.5%). In terms of diagnosis though, there is better documentation of diagnosis in 2021, rather than broad categories such as catatonia used previously, and this has led to schizophrenia as diagnosis in 4% and mixed affective disorder in 5%.

There has been a gradual but not statistically significant trend to increase in treatments per course from 9.3 in 2012/13 to 10.1 in 2021. There is significant increase in number of patients detained at the start of treatment from 42% in 2012/13 to 57% in 2021. Percentage of people in moderate to amongst severely ill categories on CGI at the start has remained the same through the years (mean 96%). CGI at the end of treatment minimal improved to much improved has similarly remained through the year (mean 91%).

The 2021 data set includes subjective memory score with categories showing increases after ECT were 2 (“occasional increased lapses of memory”) and the yet milder category of 1.

Conclusion

Between the published data sets, there is no statistical difference apart from number of patients commencing ECT under the Mental Health Act. This may reflect increasingly better practice in assessing mental capacity, with a greater tendency to appropriate application of Mental Health Act legal framework ensuring legal safeguards for the patient such as right to appeal and statutory access to second opinion.
Integrated Moving on After Breast Cancer and Culturally Adapted Cognitive Behaviour Therapy Intervention for Depression and Anxiety Among Pakistani Women With Breast Cancer: Randomised Controlled Trial
Authors: Sherzad Silsila , Kiran Tayyeba , Chaudhry Imran Bashir , Hussain Nusrat , Chaudhry Nasim
Published: August 2024

Aims

Breast cancer is major cause of mortality in females, affecting 2.1m women annually. Annual mortality rates are double within south Asian women compared with high-income countries. Pakistan has very high rates of breast cancer. Co-morbid depression and anxiety is reported in more than one third of breast cancer survivors and predict higher recurrence and poorer survival.

Objective:

To evaluate the clinical effectiveness of Moving on After Breast Cancer Plus Cognitive Behaviour Therapy (Moving on ABC Plus) to reduce depression and anxiety in breast cancer survivors in Pakistan.

Methods

A mixed method randomized controlled trial with 354 survivors of breast cancer recruited from the in- and out-patient services of oncology departments both from public and private hospitals of 5 major cities in Pakistan.

Individuals scoring 10 or higher on either the Patient Health Questionnaire-9 (PHQ-9) or the Generalized Anxiety Disorder scale (GAD-7) were enrolled. All participants underwent assessments using the PHQ-9, GAD-7, Functional Assessment of Cancer Therapy—Breast; EuroQol-5D; Multidimensional Scale for Perceived Social Support; Intrusive Thoughts Scale; and Rosenberg Self-Esteem Scale at the baseline and were randomly assigned to one of two trial groups: Moving on ABC plus or routine care. Those in the intervention group received 12 individual sessions of Moving on ABC plus, facilitated by trained master-level psychologists over 4 months. Follow-up assessments were conducted at 3- and 6-months after randomization. Individuals in routine care group continued their standard care. Qualitative interviews were conducted with 15 participants from the intervention group upon completion of the intervention.

Results

The trial established the effectiveness of the integrated intervention, at 6-month follow up preserving 96% of retention. Intervention group reported a significantly higher reduction in depression, anxiety and intrusive thoughts, and improvement in health-related quality of life and self-esteem compared with routine care arm at end of the intervention. They endorsed the usefulness of intervention during qualitative interviews with improvement in psychological well-being, social support network, and interpersonal relationships. Fatigue was reported as a potential barrier to participating in the intervention.

Conclusion

Results of this trial are in favour of psychological intervention; therefore, such programs should be implemented as part of routine care to reduce psychological distress and improve quality of life of this vulnerable population.
Culturally Adapted School-Based Suicide Prevention Program for Pakistani Adolescents: Feasibility, Acceptability, and Preliminary Outcomes
Authors: Irshad Sehrish , Kiran Tayyeba , Chaudhry Nasim , Husain Nusrat , Panagioti Maria
Published: August 2024

Aims

Suicide is one of the leading causes of death among young people. For adolescents, schools are considered as the best place to identify and respond to youth suicide risk but evidence on culturally sensitive, school-based suicide prevention programs is limited in low-resource settings such as Pakistan. This study aims to explore the perspectives of students, parents, teachers, and general practitioners regarding cultural adaptation, participation experiences, identified areas for improvement, and recommendations for scaling up the school-based suicide prevention program in Pakistan.

Methods

This qualitative study was nested in a pilot randomized controlled trial that aimed at exploring the feasibility, acceptability and preliminary effectiveness of three suicide prevention interventions: (1) Linking Education and Awareness of Depression and Suicide-LEADS training for students (12–17 years), (2) Question-Persuade-Refer (QPR) training for teachers and parents and (3) Professional screening of at-risk students (ProfScreen) for health practitioners. A total of 8 focus group discussion (FGDs) were conducted at pre- and post-intervention stage with each type of stakeholder (students, teachers, parents and health professionals) by trained qualitative researchers using the semi-structured topic guides. Each FGDs involved a detailed presentation on intervention, sharing videos and educational posters.

Results

As a result of pre-intervention FGDs, adaptations were made in the content of the interventions and were further refined through consultations with Patient and Public Involvement and Engagement group. All stakeholders who participated in post-intervention FGDs marked this suicide prevention program as feasible, acceptable and helpful in both identifying the risk of and preventing self-harm and suicide among young individuals, while also enhancing treatment pathways. Stakeholders perceived the interventions as valuable in augmenting knowledge about mental health, understanding the impact of mental health challenges on functioning, reducing stigma, and providing stakeholders with the necessary skills to identify and guide at-risk individuals. Teachers and parents endorsed the importance of discussing issues with children. Improvement in clinical practice of clinicians and teaching practice of teachers as well as understanding others’ behaviors were also reported.

Conclusion

This study highlights potential role of culturally adapted school-based youth suicide prevention program for settings where rates of suicide are high and there are limited mental healthcare resources in addition to limited access to healthcare. School-based suicide prevention program is perceived as helpful in improving knowledge, attitudes, and help-seeking behaviours in adolescents.
Culturally Adapted Manual Assisted Problem-Solving Intervention for Older Adults With Suicidal Ideation (E-CMAP): A Study Protocol From Pakistan
Authors: Tofique Sehrish , Chaudhry Nasim , Chaudhry Imran Bashir , Miah Jahanara , Husain Nusrat
Published: August 2024

Aims

Suicide poses a significant public health issue, and the presence of suicidal thoughts stands out as a prominent risk factor, highlighting the importance of addressing this aspect for early intervention and prevention efforts. While older adults face an elevated risk of attempted suicide, research in this domain is currently constrained. This study aims to enhance and evaluate the efficacy of an E-CMAP (Culturally Manual Assisted psychological intervention for Elderly) in mitigating suicidal ideation among individuals aged 55 years and older in Pakistan.

Methods

The study will be carried out in 2 phases. Phase 1 is cultural adaptation and refinement of the intervention and phase 2 is exploratory randomised control trial. In Phase 1, focus groups were conducted (N = 2) with Health professionals and service users and carers for adaptation of CMAP manual for suicidal ideation. In Phase 2 randomized exploratory trial will be conducted with 192 older adults with suicidal ideation randomized either to 1) E-CMAP added to Treatment As Usual (TAU) or TAU arm. ECMAP is a problem solving intervention comprising 6 sessions delivered one to one over 3 months by trained therapists. All participants will be assessed at baseline and after intervention (i.e. 3 months) for suicidal ideation, hopelessness, depression, health-related quality of life, coping resources, satisfaction with intervention, and episodes of self-harm.

Results

Thematic Analysis of focus group discussions indicates that participants expressed a preference for incorporating a religious element into distraction techniques, delivering information about the significance of medical treatment, showcasing recorded sessions illustrating problem-solving techniques, and involving family throughout the intervention period.

Conclusion

A culturally tailored psychosocial intervention that incorporates problem-solving and cognitive components has the potential to decrease the risk of suicide among older adults.
Identifying Effective Psychotherapies for Older Adults in an Inpatient Setting: A Narrative Review and Synthesis
Authors: Sequeira Inês , De Souza Stephen
Published: August 2024

Aims

We sought to review the evidence available to answer the question: Which psychological therapies are effective in the treatment of depression in older adults in an inpatient setting?

Methods

An advanced literature search and systematic review was conducted using Web of Science and PubMed. A set of keywords were identified around depression, older age and the inpatient setting. These were combined with a wide range of keywords around psychological therapies.

Non-English language articles were translated using Google translate.

Articles were reviewed for the relevance to the study question by reviewing the title and abstract. Full text articles were retrieved for those felt to be relevant to the study question.

Results

Of 709 articles identified from both databases, 20 articles were retrieved for full text review. Five studies were identified that appeared to offer insight into the study question. These papers focused on interpersonal therapy, cognitive behavioural therapy, or behavioural group therapy.

Brand and Clingempeel (1992) investigated the incremental implementation of group behavioural therapy in a randomized control trial. The study did not show statistically significant differences between treatment groups, but clinical significance differences supported this intervention's efficacy.

A case study by Soller (1997) followed the journey of a 69-year-old man through inpatient CBT sessions over three and a half months. This was followed with outpatient follow up. There was improvement but this was primarily subjective reporting.

A randomized controlled trial by Snarski et al. (2011) looked at the efficacy of behavioural therapy. The authors' overall conclusion was that patients benefit from this intervention and that further investigations should be done to strengthen their findings further.

A pilot study by Cabanel et al. (2017) focused on determining the feasibility of a multi-professional adaptation of group behavioural therapy sessions. This paper provides a signal towards the effectiveness of multi-professional approach to treatment.

Bollmann et al. (2020) focused on the implementation of interpersonal skills groups. It showed good feasibility as well as good patient adherence. Self-reported and observer-reported depression ratings saw improvement throughout the study.

Conclusion

Although the studies showed a signal towards improvement for a range of therapies, the evidence from these studies is not convincing.

There is a lack of high quality research in this area. More studies are needed to determine the most appropriate psychological therapy to use and how this might be adapted to the transient nature of the inpatient setting.
Unlocking Optimal Strategies: A Systematic Review Exploring the Efficacy of Physical Exercise vs Cognitive Training for Enhancing Executive Functions in Mild Cognitive Impairment and Dementia
Authors: Grover Geetanjali , Edney S.M. , Tayyaba Saadia
Published: August 2024

Aims

While there is research on physical exercise and cognitive training on cognitive improvement in older adults, there is none comparing these two interventions for their efficacy on executive functioning specifically in the population with a diagnosis of Mild Cognitive Impairment (MCI) or dementia. This study aims to bridge this gap and determine the superiority between the two interventions to enhance executive functions among individuals with MCI or dementia. Besides establishing evidence for the benefits of these socially prescribed interventions, it also aims to highlight their differential effects on executive functions. Additionally, it seeks to evaluate the feasibility of implementing these interventions to provide evidence-based insights that inform clinical practice.

Methods

Sixteen randomised control trials were meticulously selected using the Cochrane selection manual and PRISMA guidelines from an extensive search across prominent academic databases. Stringent quality assessment was conducted for each study using the modified Centre for Reviews and Dissemination checklist, Jadad and PEDro scales and the Cochrane Risk of Bias tool ensuring methodological rigour. The studies provided a total of 1593 participants with a mean age of 74.36 (SD = 5.54), randomly allocated in various intervention groups. Each study was critically appraised, analysed and the findings presented as a narrative synthesis and a meta-analysis performed with the available data.

Results

Physical exercise showed statistically insignificant improvement on the Stroop Test (p = 0.19) while no significant correlation was seen in Verbal Fluency (p = 0.032). Cognitive Training intervention had a significant improvement in both Stroop test (P = 0.0009) and Verbal Fluency (p = 0.00). The study also found that diverse contextual and personal factors like socioeconomic levels, education, personal preferences, general health conditions, mood, dependence on others, and genetics, are some factors that influence an individual's response to intervention and hence determine its efficacy.

Conclusion

There is limited statistical evidence to conclude the superiority of one intervention over the other. However, this systematic review highlights that the effectiveness of an intervention cannot be assessed solely on its statistical effect size. Rather, one must go beyond numerical assessments for a comprehensive understanding of individual circumstances that may pose barriers to engagement with the interventions, thus influencing their acceptability and effectiveness. A holistic and multidimensional perspective of the disease with a personalised intervention plan may be the new solution.
An Investigation Into the Acceptability of the SAFER-YMH Care Bundle for Transitions Out of CAMHS Crisis and Liaison Services
Authors: Holland Josephine , Majumder Pallab , Roe James , Jones Neve , Sayal Kapil
Published: August 2024

Aims

The NHS long-term plan focuses on the improvement of Child and Adolescent Mental Health (CAMHS) community services including the roll out of 24/7 Crisis teams universally across the country. Crisis and Liaison teams form an important alternative to inpatient admission, offering intense, short-term support to young people in mental health crisis and often high levels of risk. The number of referrals to Crisis and Liaison services are rising. In order to maintain patient flow and meet demand, these teams also need safe, evidence-based protocols for efficient discharge, transition and handover of young people to community teams and services. The SAFER care bundle was designed to facilitate discharges from hospital, and this has been adapted to the SAFER-YMH bundle for discharges from adolescent mental health wards. A similar care bundle for discharge from teams offering alternatives to inpatient care has not yet been developed.

This study aimed to investigate the acceptability and necessary adaptations required for the use of the SAFER-YMH care bundle to facilitate transitions out of CAMHS Crisis and Liaison teams.

Methods

This study used stakeholder feedback from multiple sources through focus groups to adapt the SAFER-YMH care bundle for use in young people in transitions out of CAMHS Crisis and Liaison teams. Normalisation process theory was utilised as the theoretical foundation upon which the development of the adapted care bundle, and its potential implementation in the complex multifaceted healthcare landscape was based.

Results

Initial focus groups were held with young people, parents/carers, healthcare professionals from CAMHS crisis and liaison teams, CAMHS NHS management, NHS IT services, community CAMHS teams and NHS commissioners in two trusts in England. Following each focus group adaptations were made to the care bundle in an iterative manner. In the second round of focus groups, the adapted care bundle was presented to a mixed group of participants and agreed to be acceptable.

Conclusion

Through stakeholder feedback this study has adapted the SAFER-YMH to create the SAFER-YCL care bundle; an acceptable version for use in discharges from CAMHS crisis and liaison services. End-user design and involvement is vital in the development of clinical applications and pathways which are user-friendly and time-saving for healthcare professionals and also helpful for young people and their families.
Cognitive Behavioral Therapy Optimizing Post-Operative Outcomes Among Coronary Artery Bypass Graft Surgery Patients: A Systematic Review
Authors: Ibrahim Danya , Elkhidir Ibrahim H. , Mohammed Zainab , Abdalla Da'ad , Mohammed Omer A.
Published: August 2024

Aims

This review aims to evaluate the lasting advantages of cognitive behavioral therapy (CBT) in alleviating anxiety and depression and improving overall health outcomes post-CABG.

Methods

A comprehensive search across databases including Science Direct, PsycINFO, PubMed, Google Scholar, VHL, Cochrane, and Scopus was conducted up to October 2023. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Cochrane guidelines. Inclusion criteria involved randomized controlled trials reporting on CBT or CBT-based interventions tailored for CABG patients and control groups had usual care, with anxiety and depression symptoms, as well as quality of life, as primary outcomes. Outcome variations were analyzed through standard deviation, while efficacy was measured via confidence intervals. Evaluation of the intervention process included examining feasibility, adherence, acceptability, inclusion rates, safety, and tolerability.

Results

Three randomized controlled trials including a pilot study in America and Denmark, encompassing a total of 286 patients, were reported in this review. The participants' pooled mean age was 63.19 years (intervention) and 63.9 years (control), the male-to-female ratio was approximately 2:1 [males n = 174 (intervention n = 101; control = 73) while females n = 91 (intervention n = 60; control n = 31)], and cardiac as well as non-cardiac comorbidities including psychiatric diagnosis have been reported. The array of therapies ranged from education on anxiety and depression management skills to a combination of CBT and supportive stress management (SSM), and psychoeducational interventions paired with physical therapy. Results indicated that both CBT and SSM led to improvements in anxiety and depression symptoms, accompanied by reduced hospital stays, decreased hopelessness, lower scores in dysmorphic mood and irritability, lowered perceived cognitive impairment and stress, and increased satisfaction with therapy. The cognitive behavioral therapy demonstrated commendable feasibility, acceptability, safety, and efficacy, with some concerns raised about potential issues of low adherence.

Conclusion

This systematic review emphasizes the positive impact of CBT on depression, anxiety, and quality of life in individuals post-CABG surgery. Future studies should adopt standardized CBT protocols, comprehensively evaluating CBT's influence on overall patient prognosis, considering cardiovascular outcomes across diverse ethnic groups, exploring cost-effectiveness, and specific patient cohorts that could benefit the most from CBT interventions.
Familial Clustering of Adolescent Emotional Problems in a Nationally Representative Sample in Britain: A Multilevel Investigation
Authors: Jordan Kate , Patel Kishan , Srinivasan Ramya , Lewis Glyn
Published: August 2024

Aims

The prevalence of emotional problems, such as depressive and anxiety disorders, increases sharply during adolescence. There is evidence for familial clustering of mental health problems during early childhood and adulthood, however no studies have investigated whether adolescent mental health problems cluster within families. This study tests the hypotheses that i) emotional problems during adolescence cluster within families, and that ii) conduct, peer and hyperactivity problems, prosocial behaviour and overall emotional and behavioural difficulties during adolescence also cluster within families.

Methods

We used cross-sectional data from a nationally representative survey of UK households, collected between 2019 and 2021, with 4,088 participants aged 10–16 years. Analyses included 1,241 participants who had complete outcome data and complete data on all covariates of interest. The Strengths and Difficulties Questionnaire (SDQ) was used to examine emotional problems, as well as conduct, peer and hyperactivity problems, prosocial behaviour and total difficulties. Multilevel modelling was used to: estimate clustering of i) emotional problems and ii) conduct, peer and hyperactivity problems, prosocial behaviour and total difficulties, within families, after adjusting for several individual- and family-level covariates associated with adolescent mental health problems (including individual and family demographics, school and sibling bullying, quality of parent-child relationship, parent mental health and parent romantic relationship satisfaction).

Results

After adjusting for known covariates of adolescent mental health problems, there was substantial clustering of adolescent emotional problems (ICC: 0.439; CI95%: 0.36–0.52; SE: 0.042) and overall adolescent emotional and behavioural difficulties (ICC: 0.417; CI95%: 0.34–0.50; SE: 0.043) within families. There was also evidence of clustering of adolescent peer problems (ICC: 0.374; CI95%: 0.28–0.48; SE: 0.051), hyperactivity (ICC: 0.332; CI95%: 0.25–0.42; SE: 0.044), prosocial behaviour (ICC: 0.263; CI95%: 0.18–0.37; SE: 0.048) and conduct problems (ICC: 0.232; CI95%: 0.14–0.35; SE: 0.053) within families after adjustment.

Conclusion

We found strong evidence that adolescent emotional problems cluster within families even after accounting for individual- and family-level covariates which are associated with adolescent mental health problems. Over 40% of the variation was accounted for at the family level. This indicates how the contextual characteristics of the family environment may influence the mental health of young people. As such, social policy aiming to prevent or improve the mental health of young people should focus on family context.