bluuebunny/crossref_metadata_2025 huggingface dataset:
ESO Guideline on covert cerebral small vessel disease
Authors: Wardlaw Joanna M , Debette Stephanie , Jokinen Hanna , De Leeuw Frank-Erik , Pantoni Leonardo , Chabriat Hugues , Staals Julie , Doubal Fergus , Rudilosso Salvatore , Eppinger Sebastian , Schilling Sabrina , Ornello Raffaele , Enzinger Christian , Cordonnier Charlotte , Taylor-Rowan Martin , Lindgren Arne G
Published: June 2021

‘Covert’ cerebral small vessel disease (ccSVD) is common on neuroimaging in persons without overt neurological manifestations, and increases the risk of future stroke, cognitive impairment, dependency, and death. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist with clinical decisions about management of ccSVD, specifically white matter hyperintensities and lacunes, to prevent adverse clinical outcomes. The guidelines were developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We prioritised the clinical outcomes of stroke, cognitive decline or dementia, dependency, death, mobility and mood disorders, and interventions of blood pressure lowering, antiplatelet drugs, lipid lowering, lifestyle modifications, glucose lowering and conventional treatments for dementia. We systematically reviewed the literature, assessed the evidence, formulated evidence-based recommendations where feasible, and expert consensus statements. We found little direct evidence, mostly of low quality. We recommend patients with ccSVD and hypertension to have their blood pressure well controlled; lower blood pressure targets may reduce ccSVD progression. We do not recommend antiplatelet drugs such as aspirin in ccSVD. We found little evidence on lipid lowering in ccSVD. Smoking cessation is a health priority. We recommend regular exercise which may benefit cognition, and a healthy diet, good sleep habits, avoiding obesity and stress for general health reasons. In ccSVD, we found no evidence for glucose control in the absence of diabetes or for conventional Alzheimer dementia treatments. Randomised controlled trials with clinical endpoints are a priority for ccSVD.
Insights into shopping travel behavior: latent classes in relation to attitudes towards shopping
Authors: Bönisch Lisa , von Behren Sascha , Chlond Bastian , Vortisch Peter
Published: June 2021

Background

The car has so far played an important role for transporting goods. However, new services emerging from e-commerce may increasingly reduce its relevance as the transporting of goods might no longer be a reason for car use. As a result, e-commerce or the delivery of goods by third-parties can function as potential supplement for car-free households and support a car-free lifestyle. To assess this potential, appropriate segmentation to subgroups is needed to better understand differences in shopping behavior and the linked role of the car.

Methods

The presented study from Munich (Germany) provides a comprehensive approach by applying a latent class analysis. The classification revealed six distinct classes with differences in shopping behavior as well as sociodemographic and spatial characteristics. To asses underlying motivations, this approach is complemented through relating the latent classes to attitudes towards shopping and mode choice.

Findings

Results show that those people who frequently use their cars also have an affinity for frequent online shopping. This relationship should be considered when discussing whether e-commerce can promote a car-free lifestyle.
Gall-forming aphids are protected (and benefit) from defoliating caterpillars: the role of plant-mediated mechanisms
Authors: Kurzfeld-Zexer Lilach , Inbar Moshe
Published: June 2021

Background

Interspecific interactions among insect herbivores are common and important. Because they are surrounded by plant tissue (endophagy), the interactions between gall-formers and other herbivores are primarily plant-mediated. Gall-forming insects manipulate their host to gain a better nutrient supply, as well as physical and chemical protection form natural enemies and abiotic factors. Although often recognized, the protective role of the galls has rarely been tested.

Results

Using an experimental approach, we found that the aphid, Smynthurodes betae, that forms galls on Pistacia atlantica leaves, is fully protected from destruction by the folivorous processionary moth, Thaumetopoea solitaria. The moth can skeletonize entire leaves on the tree except for a narrow margin around the galls that remains intact (“trimmed galls”). The fitness of the aphids in trimmed galls is unharmed. Feeding trials revealed that the galls are unpalatable to the moth and reduce its growth. Surprisingly, S. betae benefits from the moth. The compensatory secondary leaf flush following moth defoliation provides new, young leaves suitable for further gall induction that increase overall gall density and reproduction of the aphid.

Conclusions

We provide experimental support for the gall defense hypothesis. The aphids in the galls are protracted by plant-mediated mechanisms that shape the interactions between insect herbivores which feed simultaneously on the same host. The moth increase gall demsity on re-growing defoliated shoots.
Patients’ experiences of the use of point-of-care ultrasound in general practice – a cross-sectional study
Authors: Andersen Camilla Aakjær , Brodersen John , Rudbæk Torsten Rahbek , Jensen Martin Bach
Published: June 2021

Background

The use of point-of-care ultrasonography (POCUS) performed by general practitioners (GPs) in primary care settings is increasing. Previous studies have focused on GP-reported outcomes and little is known about patients’ perspectives on the use of POCUS technology within the general practice consultation. The purpose of this study was to examine patients’ experiences with POCUS in general practice within the areas where GPs have indicated that POCUS affected aspects of the consultation.

Methods

A questionnaire was developed using a mixed methods sequential design. Analytical themes from interviews with GPs were converted into items in a questionnaire by the research team. The questionnaire was then further developed in several rounds of pilot tests involving both patients and GPs. The final questionnaire was used in a cohort study conducted in 18 Danish office-based general practice clinics from January 2018 to August 2018. All patients examined with POCUS were asked to complete the questionnaire on tablets immediately after their consultation.

Results

Out of 691 patients examined, 564 (81.6%) questionnaires were available for analysis. The patients reported that they were well informed about the purpose (98%) and the results (97%) of the POCUS examination; however, 29% reported that they were not informed about the difference between POCUS and an imaging-specialist’s ultrasound examination. Almost all patients (99%) reported that POCUS was integrated naturally into the consultation, and 45% reported that POCUS improved the doctor-patient relationship.

The majority of patients felt that they had been more thoroughly examined (92%) and taken more seriously (58%) when POCUS was part of the consultation. They felt POCUS gave them a better understanding of their health problem (82%), made them feel more secure (86%) and increased their trust in the physician’s assessment (65%). Moreover, the patients reported that POCUS use improved the level of service (95%) they experienced and the quality of care (94%) in general practice.

Conclusion

We found that an examination including POCUS in general practice was a positive experience overall for the majority of patients. Future research should further explore reasons for patient confidence in POCUS and whether or not the reassuring value of POCUS is valid.

Trial registration

ClinicalTrials.gov Identifier:NCT03416608
Association between physical activity and mortality in end-stage kidney disease: a systematic review of observational studies
Authors: Martins Pedro , Marques Elisa A. , Leal Diogo V. , Ferreira Aníbal , Wilund Kenneth R , Viana João L.
Published: June 2021

Background

End-stage Kidney Disease patients have a high mortality and hospitalization risk. The association of these outcomes with physical activity is described in the general population and in other chronic diseases. However, few studies examining this association have been completed in end-stage Kidney Disease patients, raising the need to systematically review the evidence on the association of physical activity with mortality and hospitalization in this population.

Methods

Electronic databases (EBSCO, Scopus and Web of Science) and hand search were performed until March 2020 for observational studies reporting the association of physical activity with mortality or hospitalization in adult end-stage Kidney Disease patients on renal replacement therapy (hemodialysis, peritoneal dialysis and kidney transplant). Methodological quality of the included studies was assessed using the Quality in Prognosis Studies tool. The review protocol was registered in PROSPERO (CRD42020155591).

Results

Eleven studies were included: six in hemodialysis, three in kidney transplant, and two in hemodialysis and peritoneal dialysis patients. Physical activity was self-reported, except in one study that used accelerometers. All-cause mortality was addressed in all studies and cardiovascular mortality in three studies. Nine studies reported a significant reduction in all-cause mortality with increased levels of physical activity. Evidence of a dose-response relationship was found. For cardiovascular mortality, a significant reduction was observed in two of the three studies. Only one study investigated the association of physical activity with hospitalization.

Conclusions

Higher physical activity was associated with reduced mortality in end-stage Kidney Disease patients. Future studies using objective physical activity measures could strengthen these findings. The association of physical activity with hospitalization should be explored in future investigations.
Incidence, pattern and mechanisms of injuries and fractures in children under two years of age
Authors: Rosendahl Karen , Myklebust Ramona , Ulriksen Kjersti Foros , Nøttveit A. , Eide Pernille , Djuve Åsmund , Brudvik Christina
Published: June 2021

Background

Fractures in children under 2 years of age are rare, and little has been published on their mechanisms. We aimed at examining the incidence, mechanisms, pattern and fracture characteristics in a large, population-based cohort of otherwise healthy children.

Methods

This retrospective, cross-sectional study includes all children aged 0–2 years, attending the Accident and Emergency department in Bergen between 2010 and 2015, due to an injury warranting radiography. Clinical data was categorized from the medical notes, and all radiographs were reviewed by an experienced paediatric radiologist.

Results

In total 408 children (212 male), 3–23 months of age (mean 17.7 months), were included. 149 (77 male) children had a total of 162 fractures, yielding an annual incidence of 5.4 per 1000, varying from 0.7 per 1000 for those under 12 months of age, increasing tenfold to 7.3 per 1000 for children aged 12–24 months of age. More than half of the fractures (53.1%) were seen in children aged 18–23 months, while none was found in those under 7 months of age. The youngest age group had mostly femur and tibia fractures, the oldest mostly forearm fractures (n = 55, 33.9%), followed by tibia fractures (21.6%) and fractures to the clavicle (14.8%). The reported mechanisms for the 162 fractures were fall from a chair/bed/table (41.4%), fall from own height (18.5%) or crush injury (15.4%). In 8 of 162 (4.9%) fractures, the history was clearly inconsistent and suspicious of non-accidental injury (NAI).

Conclusion

Injuries and fractures in young children in general, and non-ambulant children in particular, are rare and should be thoroughly assessed for NAI. Level of evidence: Retrospective, population based cross-sectional study. Level 3.
Evaluation of biofilm colonization on multi-part dental implants in a rat model
Authors: Blank Eva , Grischke Jasmin , Winkel Andreas , Eberhard Joerg , Kommerein Nadine , Doll Katharina , Yang Ines , Stiesch Meike
Published: June 2021

Background

Peri-implant mucositis and peri-implantitis are highly prevalent biofilm-associated diseases affecting the tissues surrounding dental implants. As antibiotic treatment is ineffective to fully cure biofilm mediated infections, antimicrobial modifications of implants to reduce or prevent bacterial colonization are called for. Preclinical in vivo evaluation of the functionality of new or modified implant materials concerning bacterial colonization and peri-implant health is needed to allow progress in this research field. For this purpose reliable animal models are needed.

Methods

Custom made endosseous dental implants were installed in female Sprague Dawley rats following a newly established three-step implantation procedure. After healing of the bone and soft tissue, the animals were assigned to two groups. Group A received a continuous antibiotic treatment for 7 weeks, while group B was repeatedly orally inoculated with human-derived strains of Streptococcus oralis, Fusobacterium nucleatum and Porphyromonas gingivalis for six weeks, followed by 1 week without inoculation. At the end of the experiment, implantation sites were clinically assessed and biofilm colonization was quantified via confocal laser scanning microscopy. Biofilm samples were tested for presence of the administered bacteria via PCR analysis.

Results

The inner part of the custom made implant screw could be identified as a site of reliable biofilm formation in vivo. S. oralis and F. nucleatum were detectable only in the biofilm samples from group B animals. P. gingivalis was not detectable in samples from either group. Quantification of the biofilm volume on the implant material revealed no statistically significant differences between the treatment groups. Clinical inspection of implants in group B animals showed signs of mild to moderate peri-implant mucositis (4 out of 6) whereas the mucosa of group A animals appeared healthy (8/8). The difference in the mucosa health status between the treatment groups was statistically significant (p = 0.015).

Conclusions

We developed a new rodent model for the preclinical evaluation of dental implant materials with a special focus on the early biofilm colonization including human-derived oral bacteria. Reliable biofilm quantification on the implant surface and the symptoms of peri-implant mucositis of the bacterially inoculated animals will serve as a readout for experimental evaluation of biofilm-reducing modifications of implant materials.
Mental health service preferences of patients and providers: a scoping review of conjoint analysis and discrete choice experiments from global public health literature over the last 20 years (1999–2019)
Authors: Larsen Anna , Tele Albert , Kumar Manasi
Published: June 2021

Background

In designing, adapting, and integrating mental health interventions, it is pertinent to understand patients’ needs and their own perceptions and values in receiving care. Conjoint analysis (CA) and discrete choice experiments (DCEs) are survey-based preference-elicitation approaches that, when applied to healthcare settings, offer opportunities to quantify and rank the healthcare-related choices of patients, providers, and other stakeholders. However, a knowledge gap exists in characterizing the extent to which DCEs/CA have been used in designing mental health services for patients and providers.

Methods

We performed a scoping review from the past 20 years (2009–2019) to identify and describe applications of conjoint analysis and discrete choice experiments. We searched the following electronic databases: Pubmed, CINAHL, PsychInfo, Embase, Cochrane, and Web of Science to identify stakehold,er preferences for mental health services using Mesh terms. Studies were categorized according to pertaining to patients, providers and parents or caregivers.

Results

Among the 30 studies we reviewed, most were published after 2010 (24/30, 80%), the majority were conducted in the United States (11/30, 37%) or Canada (10/30, 33%), and all were conducted in high-income settings. Studies more frequently elicited preferences from patients or potential patients (21/30, 70%) as opposed to providers. About half of the studies used CA while the others utilized DCEs. Nearly half of the studies sought preferences for mental health services in general (14/30, 47%) while a quarter specifically evaluated preferences for unipolar depression services (8/30, 27%). Most of the studies sought stakeholder preferences for attributes of mental health care and treatment services (17/30, 57%).

Conclusions

Overall, preference elicitation approaches have been increasingly applied to mental health services globally in the past 20 years. To date, these methods have been exclusively applied to populations within the field of mental health in high-income countries. Prioritizing patients’ needs and preferences is a vital component of patient-centered care – one of the six domains of health care quality. Identifying patient preferences for mental health services may improve quality of care and, ultimately, increase acceptability and uptake of services among patients. Rigorous preference-elicitation approaches should be considered, especially in settings where mental health resources are scarce, to illuminate resource allocation toward preferred service characteristics especially within low-income settings.
How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis
Authors: Hibbert Peter D. , Basedow Martin , Braithwaite Jeffrey , Wiles Louise K. , Clay-Williams Robyn , Padbury Robert
Published: June 2021

Background

A key characteristic of healthcare systems that deliver high quality and cost performance in a sustainable way is a systematic approach to capacity and capability building for quality improvement. The aim of this research was to explore the factors that lead to successful implementation of a program of quality improvement projects and a capacity and capability building program that facilitates or support these.

Methods

Between July 2018 and February 2020, the Southern Adelaide Local Health Network (SALHN), a network of health services in Adelaide, South Australia, conducted three capability-oriented capacity building programs that incorporated 82 longstanding individual quality improvement projects. Qualitative analysis of data collected from interviews of 19 project participants and four SALHN Improvement Faculty members and ethnographic observations of seven project team meetings were conducted.

Results

We found four interacting components that lead to successful implementation of quality improvement projects and the overall program that facilitates or support these: an agreed and robust quality improvement methodology, a skilled faculty to assist improvement teams, active involvement of leadership and management, and a deep understanding that teams matter. A strong safety culture is not necessarily a pre-requisite for quality improvement gains to be made; indeed, undertaking quality improvement activities can contribute to an improved safety culture. For most project participants in the program, the time commitment for projects was significant and, at times, maintaining momentum was a challenge.

Conclusions

Healthcare systems that wish to deliver high quality and cost performance in a sustainable way should consider embedding the four identified components into their quality improvement capacity and capability building strategy.
Using syndromic measures of mortality to capture the dynamics of COVID-19 in Java, Indonesia, in the context of vaccination rollout
Authors: Djaafara Bimandra A. , Whittaker Charles , Watson Oliver J. , Verity Robert , Brazeau Nicholas F. , Widyastuti  , Oktavia Dwi , Adrian Verry , Salama Ngabila , Bhatia Sangeeta , Nouvellet Pierre , Sherrard-Smith Ellie , Churcher Thomas S. , Surendra Henry , Lina Rosa N. , Ekawati Lenny L. , Lestari Karina D. , Andrianto Adhi , Thwaites Guy , Baird J. Kevin , Ghani Azra C. , Elyazar Iqbal R. F. , Walker Patrick G. T.
Published: June 2021

Background

As in many countries, quantifying COVID-19 spread in Indonesia remains challenging due to testing limitations. In Java, non-pharmaceutical interventions (NPIs) were implemented throughout 2020. However, as a vaccination campaign launches, cases and deaths are rising across the island.

Methods

We used modelling to explore the extent to which data on burials in Jakarta using strict COVID-19 protocols (C19P) provide additional insight into the transmissibility of the disease, epidemic trajectory, and the impact of NPIs. We assess how implementation of NPIs in early 2021 will shape the epidemic during the period of likely vaccine rollout.

Results

C19P burial data in Jakarta suggest a death toll approximately 3.3 times higher than reported. Transmission estimates using these data suggest earlier, larger, and more sustained impact of NPIs. Measures to reduce sub-national spread, particularly during Ramadan, substantially mitigated spread to more vulnerable rural areas. Given current trajectory, daily cases and deaths are likely to increase in most regions as the vaccine is rolled out. Transmission may peak in early 2021 in Jakarta if current levels of control are maintained. However, relaxation of control measures is likely to lead to a subsequent resurgence in the absence of an effective vaccination campaign.

Conclusions

Syndromic measures of mortality provide a more complete picture of COVID-19 severity upon which to base decision-making. The high potential impact of the vaccine in Java is attributable to reductions in transmission to date and dependent on these being maintained. Increases in control in the relatively short-term will likely yield large, synergistic increases in vaccine impact.
Is functional fitness performance a useful predictor of risk of falls among community-dwelling older adults?
Authors: Ho Hsin-Hung , Fang I-Yao , Yu Yi-Chien , Huang Yi-Ping , Kuo I-Ling , Wang Li-Ting , Tsai Ming-Chueh , Chang Shao-Hsi , Hsueh Ming-Chun
Published: June 2021

Background

Falls among older adults are a serious public health problem. Many studies indicate that positive functional fitness performance decreases the risk of falls. A limited amount of previous study has investigated the association between broad functional fitness and the fall risk. This study examines the associations between functional fitness and the risk of falling among community-dwelling older adults.

Methods

Three waves of cross-sectional data were collected from 2017 to 2019 in Taipei City, Taiwan. Six hundred sixty-five participants aged ≥65 years were randomly recruited from 12 districts of Taipei. Eight functional fitness tests (i.e., back scratch, chair-sit and-reach, 8-ft up-and-go, 30-s sit-to-stand, 30-s arm curl, 30-s single-leg stance, 2-min step, and hand grip strength tests) were performed to record the physical performance of older subjects. A Chinese version of the fall-risk questionnaire (FRQ) was used to calculate the fall risk scores. Linear regression and logistic regression were utilized to estimate the relationships of each functional fitness and fall risk.

Result

The results showed that 37.45% of older adults had a high risk of falling. It was found for each functional fitness that performance was linearly associated with the risk of falling. Moreover, older adults with low-performance levels in all functional fitness except back-scratching were more likely to have a higher risk of falling.

Conclusions

Our study indicated that functional fitness performance appears to provide valid predictive guidance for reducing the risk of falling among the older population.
The reasons why patients abscond from public hospitals in southeastern Iran: a qualitative study
Authors: Moradpour Mahnaz , Amiresmaili Mohammadreza , Nekoei-Moghadam Mahmood , Dehesh Tania
Published: June 2021

Background

Patient absconding from hospital is one of the permanent issues the hospitals face, which poses many risks and challenges to the patient, hospital, and society. The present study aimed to identify the reasons for patient absconding behavior for public hospitals in southeastern Iran.

Methods

The present study is a qualitative study which was conducted at three public hospitals in southeastern Iran using purposive sampling through semi-structured interviews with 63 informants involved in patient treatment process. Data were analyzed using Colaizzi content analysis (CCA) method.

Results

Three main themes of economic, social factors, and factors related to the hospital covering 15 subthemes were identified to explain the reasons for patients absconding behavior.

Conclusion

There are many reasons for reducing patients absconding from hospitals, and one of the main reasons is the patients’ economic and social problems. The absconding behavior can lead to harm and problems for patients, and some emotional and occupational consequences for the employees and nurses. Paying attention to this issue and considering some courses of action to prevent patient absconding might lead to a considerable promotion of public trust and eliminate many problems for hospitals.
Financial technology and the future of banking
Authors: Broby Daniel
Published: June 2021

This paper presents an analytical framework that describes the business model of banks. It draws on the classical theory of banking and the literature on digital transformation. It provides an explanation for existing trends and, by extending the theory of the banking firm, it illustrates how financial intermediation will be impacted by innovative financial technology applications. It further reviews the options that established banks will have to consider in order to mitigate the threat to their profitability. Deposit taking and lending are considered in the context of the challenge made from shadow banking and the all-digital banks. The paper contributes to an understanding of the future of banking, providing a framework for scholarly empirical investigation. In the discussion, four possible strategies are proposed for market participants, (1) customer retention, (2) customer acquisition, (3) banking as a service and (4) social media payment platforms. It is concluded that, in an increasingly digital world, trust will remain at the core of banking. That said, liquidity transformation will still have an important role to play. The nature of banking and financial services, however, will change dramatically.
Assessment of interobserver reliability and predictive values of CT semiquantitative and severity scores in COVID lung disease
Authors: Andrew Dhilip , Shyam Karthik , Cicilet Soumya , Johny Jovis
Published: June 2021

Background

The coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and first reported in December 2019 at Wuhan, China, has since then progressed into an ongoing global pandemic. The primary organ targeted by the virus is the pulmonary system, leading to interstitial pneumonia and subsequent oxygen dependency and morbidity. Computed tomography (CT) has been used by various centers as an imaging modality for the assessment of severity of lung involvement in individuals. Two popular systems of scoring lung involvement on CT are CT semiquantitative score (SQ) and CT severity score (CT-SS), both of which assess extent of pulmonary involvement by interstitial pneumonia and are partly based upon subjective evaluation. Our cross-sectional observational study aims to assess the interobserver reliability of these scores, as well as to assess the statistical correlation between the respective CT scores to severity of clinical outcome.

Results

Both the SQ and CT-SS scores showed an excellent interobserver reliability (ICC 0.91 and 0.93, respectively, p < 0.05). The CT-SS was marginally more sensitive (99.2%) in detecting severe COVID pneumonia than SQ (86.5%). The positive predictive value of SQ (98.3%) is more than CT-SS (78%) for detecting severe disease. The similarity of interobserver reliability obtained for both scores reiterates the respective cutoff CT scores proposed by the above systems, as 18 for SQ and 19.5 for CT-SS.

Conclusion

Both the SQ and CT-SS scores display excellent interobserver reliability. The CT-SS was more sensitive in detecting severe COVID pneumonia and may thus be preferred over the SQ as an initial radiological tool in predicting severity of infection.
A simple chest CT score for assessing the severity of pulmonary involvement in COVID-19
Authors: Abdel-Tawab Mohamed , Basha Mohammad Abd Alkhalik , Mohamed Ibrahim A. I. , Ibrahim Hamdy M.
Published: June 2021

Background

A major role of CT in COVID-19 pneumonia is to assess disease severity and progress. In this study, we aimed to assess the validity, reliability, and survival outcomes of simple chest computed tomography (CT) score in the evaluation of the severity of lung involvement in coronavirus disease 2019 (COVID-19) compared with the current chest CT score.

Results

This retrospective analysis included 213 patients (121 men and 92 women; mean age, 46 ± 15.6 years; range, 1–85 years). The ROC curve was used to compare the validity of both scores. Interreader agreement (IRA) for both scores was calculated using Cohen’s kappa statistic. The survival analysis of both scores was investigated using the Kaplan–Meier survival analysis. The simple score showed a comparable validity with the current score (AUC = 0.89 and 0.90, respectively; p = 0.61). The ROC analysis demonstrated that a simple score of > 3 and a current score of > 12 were potential predictors of death with sensitivity values of 81.8% and 86.4% and specificity values of 96.3% and 93.7%, respectively. The simple score showed a higher IRA compared with the current score (κ = 0.645 and 0.458, respectively). Both scores were comparable for predicting survival outcomes.

Conclusion

The simple score was non-inferior for predicting survival outcome, compared with the current chest CT score. Furthermore, we suggest that the simple score should be used as it is simpler and more consistent.
International overview of phallometric testing for sexual offending behaviour and sexual risk
Authors: Bickle Andrew , Cameron Colin , Hassan Tariq , Safdar Hira , Khalifa Najat
Published: June 2021

Phallometry is an objective method of assessing male sexual arousal. The main applications in forensic psychiatry concern the evaluation of men charged with or convicted of sexual offences, the evaluation of those with suspected paraphilias not subject to the criminal justice system, risk assessment and measurement of response to sex offender treatment. In some jurisdictions, phallometry is incorporated into legal decisions about release from custody or discharge from secure hospitals. This paper provides a brief overview of the international development of phallometry, considers challenges to its broader adoption and discusses future directions for research and clinical practice.
Preparing students for psychiatry OSCE's in the COVID-19 pandemic. How can PsychSocs help?
Authors: Conti Isabella , Gilkinson Chloe
Published: June 2021

Aims

The need for social distancing during the COVID-19 pandemic has led medical schools to make use of video conferencing platforms in their Objective Structed Clinical Exams (OSCE) for the first time. Additionally the suspension of OSCE's in 2020 due to the pandemic ,has meant this cohort of final year students have never been examined on psychiatry skills. Our aims were to assess if our student psychiatry society (PsychSoc) run OSCE could help to prepare medical students for novel virtual stations ahead of their final examinations, and how this format of mock examination could be improved in the future.

Method

Our PsychSoc (QUB Mind Matters) hosted a virtual mock psychiatry OSCE for 24 final year medical students using the video conference platform Zoom, approximately 1 month before their finals. The OSCE comprised 4 stations each lasting 8 minutes, and covered psychiatric history taking, risk assessment and drug counselling. Stations were marked by psychiatry trainees in individual breakout rooms to closely simulate real examination conditions. A post-event online questionnaire was distributed to all participants. 5-point Likert scales and free text responses were used to gather feedback regarding the content and delivery of the mock. A response rate of 100% was achieved (n = 24).

Result

The feedback from students was overwhelmingly positive, with 100% (n = 24) agreeing/strongly agreeing that the mock OSCE left them feeling more prepared for their final exam. 95.8% (n = 23) agreed that the opportunity to practice virtual OSCE stations improved their confidence, and all 24 students agreed/strongly agreed that they would like more practice of virtual OSCE stations. A common theme that emerged when asked how our mock could have been improved was the need for a group feedback session covering common pitfalls in addition to individual feedback.

Conclusion

The lack of clinical experience and shift towards online learning has led to increased stress around clinical exams in the student population. PsychSocs can supplement formal teaching by providing students the opportunity to practice virtual communication and history taking skills that are not always covered in their undergraduate curriculum. However, as a psychiatry society our mock only assessed psychiatry skills, many of which may be relatively well suited to an online format. We would welcome further evaluation of the applicability of student run virtual mock OSCE's to other specialties. We have demonstrated that PsychSocs can offer much needed practice for students through mock OSCE's and have highlighted ways to enhance their delivery.
To identify errors in prescribing practice in an inpatient psychiatric unit and improve compliance with Mental Health Commission of Ireland regulations relating to prescribing
Authors: Corrigan Kate , Conlan-Trant Rebecca , Cleary Shannon
Published: June 2021

Aims

Prescribing errors can lead to patient harm and are a patient safety issue. In 2019 the Acute Psychiatric Unit in Tallaght Hospital was identified by the Mental Health Commission of Ireland as non-compliant with regulation 23 of the Mental Health Act pertaining to the Ordering, Prescribing, Storing and Administration of Medication. Compliance with regulation 23 is a mandatory condition for the registration of the Unit as an Approved Centre to provide treatment for mental illness in Ireland. Regular auditing was performed to identify areas of non-compliance in prescribing practices and where identified to improve upon these practices per Mental Health Commission standards.

Method

A cross sectional review of 14–18 medication Kardexes was completed monthly from August – December 2020. Kardexes were audited against 20 standards set by the Mental Health Commission. An electronic audit tool was used to collect data. Medical teams were informed of any incidences of non-compliance. Education sessions delivered by both medical staff and the ward pharmacist were provided to junior doctors and consultants regarding the Mental Health Commission regulations for prescribing. We developed information leaflets that were placed at the front of Kardex folders highlighting key areas where errors were regularly made. Monthly staff emails were sent reminding prescribers of the importance of adhering to guidelines and updating them on the most recent audit results.

Result

Improvements were noted in all aspects of prescribing over the five-month period. Prescriptions of non-proprietary medication improved from 40% of Kardexes to 87% over the five-month period. Recording of prescriber medical registration number improved from 80% to 87% of Kardexes. Documentation of the dates of initiation and discontinuation of a medication improved from 40% to 67%. The use of appropriate patient identifiers on Kardexes improved from 93% to 100%.

Conclusion

Targeting staff across multiple domains including emails, information leaflets and education sessions resulted in consistent improvements in medication prescribing. The Mental Health Commission has since inspected the Acute Psychiatric Unit in Tallaght Hospital in 2020 and deemed it fully complaint with regulation 23 pertaining to medication prescribing.
Insomnia management; don't sleep on it
Authors: Donnelly Maria , Mercadillo Nieves , Davidson Stuart
Published: June 2021

Aims

In this project our aim was to improve patient safety and care by reducing hypnotic prescription medication administration. We also wanted to reduce over-prescribing/unnecessary prescribing which has a negative pharmaceutical impact on the environment and is a huge expenditure issue for the NHS. NICE guidance for Insomnia management states “After consideration of the use of non-pharmacological measures, hypnotic drug therapy is considered appropriate for the management of severe insomnia interfering with normal daily life; it is recommended that hypnotics should be prescribed for short periods of time only, in strict accordance with their licensed indications” Side effects are common with hypnotic usage including, most importantly, the development of tolerance and rebound insomnia.

Method

The interventions we implemented included the development of an educational presentation about insomnia, the development of an “Insomnia Management Flow chart” to be used at admission point, training sessions for ward staff, shared teaching programmes with patients at their sleep management sessions, face to face and email correspondence to inform medical trainees about this project and gathering feedback from patients and staff before and after this project.

Result

The results of this project demonstrated a total reduction in hypnotic tablet administration was very significant with a 44.5% reduction post intervention.

Conclusion

This demonstrates the positive change in our clinical practice that has resulted from our interventions. This will improve patient safety and reduce cost of hypnotic medications for the NHS. Following on from this initial intervention, we feel that we can continue to make further changes and expand the changes we made on this ward, to other similar wards in our hospital, trust and to other inpatient psychiatric wards further afield.
Heart rate variability and emotion regulation in adults with eating disorders or obesity: a systematic review
Authors: Gilkinson Chloe , Schmidt Ulrike , Gallop Lucy , Flynn Michaela
Published: June 2021

Aims

Emotion regulation (ER) impairments are central trans-diagnostic phenomena across the spectrum of eating disorders (EDs) and obesity, where maladaptive eating behaviors act to suppress negative emotions. Self-report assessments are the most commonly used tools for assessing an individual's ER capacity, however, subjective self-reporting is limited by a tendency toward response bias and issues with common method variance. Prior empirical and theoretical research supports the use of heart rate variability (HRV) to objectively assess individual differences in ER capacity. Several studies have examined the association between HRV and ER in EDs and obesity. However, to date, no review synthesising the overall findings exists. This review aimed to summarise the empirical evidence that has examined the relationship between ER and HRV in adults with EDs/obesity, in addition to assessing the validity of HRV as a physiological biomarker of ER in these populations.

Method

A comprehensive search was performed on PubMed, MEDLINE and PsycINFO, with identified studies screened against a priori inclusion/exclusion criteria. Eligible studies underwent quality-assessment using the Joanna Briggs Institute Critical Appraisal Tools, and data were synthesised qualitatively.

Result

17 publications were included, consisting of data on participants with obesity, binge eating disorder (BED), bulimia nervosa (BN), anorexia nervosa (AN), and/or subclinical presentations. Studies were small (average sample size n = 46.4), predominantly female (87.9%), and were highly variable in methodology, with different diagnostic tools, self-report measures, and emotional tasks/paradigms used.

Conclusion

The evidence suggests that HRV is a valid, objective biomarker of ER impairments in AN, BN, BED, emotional eating, and obesity. Despite some inconsistencies, likely attributable to methodological heterogeneity, EDs/obesity appear to be characterised by irregular resting state vagal activity and abnormal stress reactivity. Furthermore, the autonomic dysfunction observed across EDs/obesity may be reversible by novel effective interventions such as HRV-biofeedback or PlayMancer videogame therapy.
HappyMaps: a single hub of resources on children and young people's mental health for parents and professionals
Authors: Griffiths Georgina , Krischer Jasmin , Roberts-Collins Cara , Lunts Elaine
Published: June 2021

Aims

Mental health issues in children and young people are a growing concern and the benefits of intervening early are well established for many mental health problems, but existing Child and Adolescent Mental Health Services (CAMHS) are often over-stretched with variable waiting times for assessment. Many children also have problems which do not reach the referral thresholds and parents are left to find advice elsewhere. Existing resources for parents are scattered across many different websites and therefore difficult to access both for parents and professionals working with young people. With this in mind, and in consultation with CAMHS Bristol and many other stake-holders (including parents themselves) we designed an easily navigable website intended as a single comprehensive portal of resources for parents of children with mental illness and difficulties.

Method

Qualitative research methods were used to gather information about how the website should be designed and also to gather feedback once the website was live. Focus groups were performed with parents/carers and stakeholder discussions took place to inform the design of the website. Once the website was live, surveys via a Survey Monkey link on the website and Google Analytics were used to evaluate the website.

Result

60,000 users have utilised the website since the launch in March 2019. Two thirds of users are women and one third are men. Most popular webpages that are visited are primary, secondary, help-in -a-crisis and self-help for young people. Positive feedback has been collected from both parents/carers and service providers. The website has continued to develop and is now a registered charity and has received community lottery funding, which will allow for further evaluation and developments.

Conclusion

HappyMaps has been successful in providing a single hub of information for parents/carers, GPs, CAMHS workers and teachers. Future work involves evaluating the website and attracting interest from other CAMHS teams and professionals in other areas of the UK so that they can create HappyMaps sections for their populations.
Improving the safety of rapid tranquilisation in older people
Authors: Harris Richard , Sheldon Rollo , McNulty Jane , Cherry Scott
Published: June 2021

Aims

To identify intramuscular rapid tranquilisation (IMRT) events in all >65 years inpatients in Sussex Partnership NHS Foundation Trust (SPFT) and to establish whether accompanying documentation meets SPFT guidelines. This is a re-audit, initial data were collected in 2016. Multimodal intervention has been implemented since initial data collection. In psychiatric inpatients IMRT should be administered as a last resort to calm acutely disturbed patients after verbal de-escalation and an offer of oral medication has failed. IMRT can cause physical health complications and impact therapeutic relationships. Quality improvements made since initial data collection were: an IMRT treatment algorithm for >65s, a teaching package for staff, IMRT prescription area on medicine cards and post IMRT physical monitoring forms – in line with updates to trust IMRT policy.

Method

Retrospective case note audit cycle of 119 patients. Electronic and paper records were reviewed for inpatients >65 years on 1/9/2019. Records were examined for instances of IMRT– the following features were noted: diagnosis; verbal de-escalation; oral medication offered prior to IMRT; IMRT prescription location; and post-IMRT monitoring. Descriptive statistics were performed. This audit was approved by the trust audit committee.

Result

There were 34 RT events in 17 patients, reduced from 83 RT events in 20 patients in 2016. De-escalation was attempted in 62% versus 34% in 2016, oral medication offered first in 71% versus 59% in 2016. Physical monitoring was fully completed in 50% of instances in 2019, an improvement from 23% in 2016.

Conclusion

Education, a new treatment algorithm, medicine card changes, and IMRT physical monitoring forms have improved adherence to trust standards. There was a 49% reduction in IMRT events in 2019 versus 2016. De-escalation is being performed more frequently, and oral sedation offered in more cases. The physical monitoring of patients has improved.
A quality improvement project focused on improving the completion of ‘notification of diagnosis’ forms for the dementia register, in an outpatient setting
Authors: Johnston Katherine , Megahey Lauren
Published: June 2021

Aims

The dementia register is designed to keep a record of all patients diagnosed with mild cognitive impairment (MCI) or dementia. Following diagnosis, a ‘notification of diagnosis’ form should be completed and the patient added to the register. The register is used to collate figures and to assess capacity and demand on services.

Our baseline audit revealed suboptimal completion of these forms, therefore we initiated a quality improvement project. Our aim was to achieve completion of the ‘notification of diagnosis’ forms in 50% of new memory patients seen in clinic and diagnosed with MCI or dementia, within 3 months.

Method

A baseline audit of a random sample of 52 patients, from the 380 patients on the memory clinic list was analysed. 40 of these 52 patients had a diagnosis of MCI or dementia and when cross-matched with the dementia register, only 12 (30%) of the 40 were on the register.

We designed an improvement project which focused on improving awareness of the process and facilitating ease of completion of the form, for example, by placing the form in all new patients’ notes. Our results were then monitored and reviewed on a monthly basis for 3 months, to assess the impact of these changes.

Result

Each month, the percentage completion of the 'notification of diagnosis' forms was calculated for new memory patients diagnosed with MCI or dementia in clinic. In the first month of the project (November 2020), 75% completion of forms was achieved. This was a significant improvement from baseline. In December, 66.7% completion was achieved (plus one patient was already on the register) and in January 2021, there was 50% completion (plus one patient was already on the register).

Conclusion

The results showed an improvement in the completion of forms from baseline, and we did reach the initial aim set at 50% by 3 months. However, the trend of the results showed a steady decline in percentage completion of forms over the 3 month period. We noted that over time the forms were no longer consistently placed in the new patients’ notes, reducing accessibility to the forms. Other potential factors include a reduction in enthusiasm/ a decline in prioritisation of this project over time. Suggestions have been made to facilitate ongoing improvement and the results will continue to be reviewed.