bluuebunny/crossref_metadata_2025 huggingface dataset:
Mariposa House service evaluation project & co-production: new women's NHS forensic community step-down hostel
Authors: Jheeta Mandip , Dodge Liam , Zachariah Elizabeth , Connolly Theresa
Published: June 2021

Aims

To understand and learn from patients’ views and experiences. Ultimately, to improve quality, safety, and patients’ experiences and outcomes.

Service evaluation project of Mariposa House, London, the new women's forensic high support community step-down hostel after hospital admission. Run in partnership with Langley House (charitable) Trust. It is a co-produced, rare and innovative service- to our knowledge the only NHS women's service of its kind in England. In female and forensic community populations: transitions are the highest risk periods; the same treatment as men is unlikely to produce the same outcomes; and performance indicators and outcome measures are poorly understood.

Method

Confidential patient questionnaire and self-reported Recovering Quality of Life (ReQoL) measure. Given to all patients in Mariposa House, before (in hospital) and 2-3 months after transfer to hostel. Themes included “my: care; voice (co-production); transition; & gender”. 12 questionnaires were received from 9 patients: 5 completed both pre- & post-; 3 (20%) were given but not received. Analysed by thematic content analysis. Additional focus group feedback session with patients and staff.

Result

Overall, patients had very positive and similar views about both hostel and hospital(s), and similar views about both. Generally, patients feel treated with compassion, dignity and respect, and listened to and understood by staff members. They feel involved in and positive about their care.

There was a huge amount of involvement in co-producing the service and feeding back experiences, which has been very helpful. Co-production activities included: interviewing for staff and tenders; choosing hostel building; stakeholder meetings; and participating in meetings about training, policies and expectations. “I've been in hospital for so long moving was scary! But helping set up the project has given me confidence to move.”

There was strong agreement that transitions are difficult. Views on gender-specific needs being met were very positive, for both hostel and hospital. The main area for improvement was having better awareness of local neighbourhood and facilities- booklet now produced. Quality of life measures were at least maintained from hospital to hostel: 80% (n = 4) showed no reliable improvement/ deterioration, and 20% (n = 1) showed reliable improvement.

Conclusion

There are very positive and similar views about the hostel and hospital(s). Co-production and service user involvement has been very helpful. The new hostel has maintained patient satisfaction and quality of life measures compared to established inpatient services. These are positive findings, and crucially: in a less- secure, contained, established, and cheaper new community setting, involving complex and challenging transitions.
Medication charts and consent to treatment documentation audit in an acute mixed in-patient psychiatry unit in south Manchester
Authors: Mitra Madhumanti , Hussain Shahid , Raynor Emma , Wong Joanna , Thom Jennifer
Published: June 2021

Aims

The main aim of this audit was to look at documentation in medication charts in an acute mixed inpatient unit in South Manchester. In addition, we also looked at completion of capacity assessment and consent to treatment forms as appropriate.

Background

Safe prescription, administration and monitoring of medication is key to effective patient care. Due to the busy nature of inpatient hospital wards, errors do unfortunately occur both with the medications, and with the recording of their administration.

We will use a data collection tool to collect data as per standards described in our local GMMH policy. The medication chart will be used as the standard, as this is the current chart that is in use in the Trust.

Method

Data were collected from 31 medication charts for inpatients admitted in the ward between the 5/12/19 to 18/12/19. We captured data from each page of the medication chart that required a record to be made by any staff, including details of prescribing, administration and pharmacist checks. Data were recorded as either Yes/No or NA (Not Applicable). Data were then summarised and analysed using MS excel.

Result

Of the 31 patients, 22 (71%) had a capacity assessment form completed and 16 (52%) had a consent to treatment form completed. From the data analysis, it was clear that there are high rates of completion for the ‘essential’ parts of all prescriptions, including medicine name, dose, route and data. ‘Route’ was only recorded for 40% of prescriptions for depot medicines. Details of the administration of a medicine by a nurse was generally well-completed. For as required medications, all information relating to administration (date, time, dose and given by) were fully completed for 100% of prescriptions. For regular prescriptions however, the administration details were not as well-completed, where date of administration was recorded in 84% of prescriptions and signature in 29% of prescriptions. Unique patient identifiers are well-recorded on Page 1 of the prescription chart, though not maintained throughout the prescription chart. Nature of reaction to an allergy or sensitivity was only recorded in 6 of the 21 patients (29%).

Conclusion

Overall, there were good completion rates for the mandatory parts of the prescriptions. However improvements could be made for prescriptions as well as administration and pharmacy checks. The capacity assessment and consent to treatment forms could be improved upon too. We plan to put the recommendations and re-audit in 3-6 months’ time.
Service evaluation and research project: pros and cons of centralisation of ECT services in Pennine Care NHS Foundation Trust
Authors: Mitra Madhumanti , Hayden Katherine
Published: June 2021

Aims

The aim of this project would be to understand about the pros and cons/ benefits and risks of using a centralised model of ECT (currently being followed due to COVID restrictions) rather than a decentralised model of ECT (which has been the norm for a long time). A comparative account of both types of systems would help identify whether it could be implemented in Pennine Care and the results could be potentially transferable to other similar settings.

Method

An online survey was undertaken from staff members working in Pennine Care who have been involved in ECT delivery and management. The survey was undertaken between 07/12/2020 and 11/01/2021 and included questions relating to pre-COVID ECT (June 2019 to February 2020) and during-COVID ECT (March 2020 to November 2020). Questions were around travel of staff/patients for ECT, whether they had a preference for a model and their reasons around it. Data were summarised in MS Excel and free text comments analysed to gain an understanding of staff's preferences and reasoning behind their choices.

Result

Although some boroughs had patients attending from other boroughs in pre-COVID times, considerably more staff (53.85%) and patients (61.54%) had to travel for ECT during COVID times. Around 50% staff expressed a clear view for decentralised services; the common reasons being safer for patients, better continuity of care, less travelling issues, patients more likely to consent, easier to manage correct paperwork, easier to send staff who knows patients well, less driving for staff and likely less cancellations. Around 40% staff expressed a clear view for centralised services; the common reasons being less staff needed, better infection control, easier to maintain staff skills, efficiency, developing clinical expertise with larger number of cases, education opportunities, better set-up of clinics, transportation and accessibility. Some concerns raised for the centralised model were managing patients with complex anaesthesia, travelling for unwell/ disturbed patients, too high patient numbers, poor communication and impact on training.

Conclusion

In summary, there was a mixed view of which services are preferable. Further discussion in trust wide ECT forum will be helpful to move things forward. Although it is likely that services may shift from a decentralised to a centralised system, we need to ensure this is done safely and in particular, address the main concerns around centralisation.
Vitamin D monitoring and management within men's secure services
Authors: Niblett Jason , Pantall Shay-Anne , Ahmed Anis
Published: June 2021

Aims

To audit the investigation, identification and treatment of Vitamin D deficiency within Men's Secure Services.

Background

Vitamin D and/or vitamin D deficiency has been suggested to play a role in the pathogenesis of mental illness. There is evidence that Vitamin D inadequacy is pandemic among rehabilitation patients in inpatient settings. Patients within secure hospitals are similarly considered to be at high risk, due to their limited solar exposure during often lengthy admissions. It has been suggested that these patients should be considered an ‘at-risk’ cohort, for whom Vitamin D supplementation should be routine. Men's secure services in Birmingham comprise of two medium secure units and a low secure rehabilitation unit. Here we present an audit of Vitamin D monitoring and treatment completed in 2019.

Method

A three year retrospective review of electronic patient records, for all inpatients admitted within men's secure services as of 1 September 2019 (n = 188). Standards were based on the Trust accepted guidelines for management of Vitamin D deficiency.

Result

Key findings included:-

The majority of inpatients were Caucasian (43%) and African-Caribbean (24%). Ages ranged from 18 to 70, with a mean age of 39.

Approximately two-thirds (65%) had been in hospital for over a year, of which 44% had been admitted for more than 3 years. The average length of admission was 885 days.

Only 47% of patients had their Vitamin D level checked within the study period.

Of those checked, 24% were tested within 1 month of admission. The mean duration between admission and Vitamin D testing was 464 days.

Results ranged from 10.3 to 118.5nmol/L. A high rate of Vitamin D deficiency was identified (54%), whilst a further 16% had ‘inadequate’ levels.

23% of those identified as requiring treatment did not receive any supplementation, whilst 59% of those with sufficient Vitamin D were prescribed treatment.

Only 48% had their levels rechecked following treatment; of these, only 59% now had an adequate Vitamin D status.

Conclusion

This audit demonstrates limited Vitamin D monitoring within male forensic inpatients. There was a high prevalence of Vitamin D insufficiency in this population, yet a substantial proportion of patients with identified deficiency were not prescribed any treatment. Ongoing monitoring and review of treatment effectiveness was poor. We argue that more consideration should be given to this population, with robust guidelines introduced for the treatment of this specific ‘at-risk group’.
A description of the use of zuclopenthixol decanoate long-acting injection in a large mental health trust
Authors: Pantall Shay-Anne , Whitehouse Emily , Brownell Lisa
Published: June 2021

Aims

Adherence with antipsychotic medication is an important factor in the prevention of relapse in psychotic disorders such as schizophrenia. Long acting antipsychotic injections promote improved adherence. In recent years, second generation antipsychotic long-acting injections have become increasingly popular, and little has been written about the use of the older depot medications. Here, we explore the current use of one of the first-generation antipsychotic long acting injections in Birmingham and Solihull Mental Health NHS Foundation Trust.

Method

An 18-month retrospective case-note review of all patients who started zuclopenthixol decanoate during the first 6 months of 2018 (n = 45)

Result

Key findings included: -

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71% were male

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The mean age was 37 (range 19-65)

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The most common diagnoses were: schizophrenia (51%), bipolar affective disorder (18%) and schizoaffective disorder (13%). We noted that 2 individuals (4%) had a primary diagnosis of recurrent depressive disorder, 2 (4%) had a primary diagnosis of emotionally unstable personality disorder.

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60% of those who were prescribed zuclopenthixol decanoate discontinued it within the 18-month follow-up period.

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The vast majority of discontinuation occurred within the first 6 months, and after this, few individuals stopped treatment.

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The most common reason for discontinuation was side effects (57%), with other reasons including patient choice (7%), non-compliance (7%), pregnancy (4%), or needle phobia (4%).

Conclusion

Zuclopenthixol decanoate has been used for individuals with both schizophrenia and paranoid psychosis (where it is licenced) and also occasionally for other indications. A high proportion discontinued the zuclopenthixol within 6 months, this generally being attributed to adverse effects. Those who were still receiving this medication at 6 months were very likely to continue to take it throughout the 18 months. We would therefore recommend robust monitoring for and management of adverse effects in the early phases of treatment.
Reducing the use of high dose antipsychotic medication in acute adult inpatient psychiatric units
Authors: Pantall Shay-Anne , Warwicker Sarah , Brownell Lisa
Published: June 2021

Aims

To evaluate the use of antipsychotics, and high dose antipsychotic treatment (HDAT) in psychiatric inpatient units

Background

The Royal College of Psychiatrists published a consensus statement on high dose antipsychotic medication in October 1993. Such treatment carries an increased risk of adverse effects including towards ventricular tachycardia and sudden death.

Method

A retrospective case note review of all male patients on acute adult inpatient units in a psychiatric hospital in South Birmingham on a date in June 2018 (n = 45) including review of electronic patient records and prescriptions. This was compared with the results of an earlier study, with identical methods, undertaken in June 2015.

Result

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In both 2015 and 2018, only a minority of patients (20% and 11% respectively) were informal.

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In both 2015 and 2018, the majority of inpatients had a diagnosis of schizophrenia (54% and 67%)

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In both 2015 and 2018, 93% inpatients were prescribed antipsychotic medication.

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In 2015, 56% patients were prescribed HDAT. This reduced in 2018 to 16%.

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This reduction in use of HDAT was almost entirely due to a reduction in the prescription of PRN antipsychotic medication.

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In terms of regularly prescribed antipsychotic medication, in both years, the most commonly prescribed drug was flupentixol, with a range of other second generation oral and long acting medications being prescribed, usually at doses within BNF limits.

Between the two years, there was a substantial change in the prescribing of PRN antipsychotics. In 2015, 59% individuals were prescribed at least one PRN antipsychotic (27% were prescribed two). In 2018, this reduced to 40% prescribed at least one, and only 2% being prescribed 2 PRN antipsychotics. In both years, oral quetiapine was a common choice (39% patients in 2015 prescribed oral quetiapine, and 34% in 2018). In 2015, 39% patients were prescribed oral or intramuscular aripiprazole, while this reduced to 7% in 2018.

Conclusion

The vast majority of psychiatric inpatients were being prescribed antipsychotic medication. Prescription of high dose antipsychotic medication was common in 2015, and this was largely attributable to high levels of prescribing of PRN antipsychotics. Following an educational programme for junior doctors and ward nurses, and the introduction of electronic prescribing, we achieved a significant change in practice, particularly in the prescribing of PRN antipsychotics, which has reduced our patients’ risk of receiving high dose antipsychotic medication.
Physical health of patients under EIP - a service evaluation
Authors: Priya Anu , Dhanasekar Keerthan , Hill-Cousins James , Aziz Mudasar , Suleiman Osama , Mills Katherine , Lloyd Megan
Published: June 2021

Aims

The aim of the project was to get a baseline of the number of patients who have had blood tests, ECG and physical health observations completed in the past 12 months.

Method

There are 30 patients under Early Intervention in Psychosis team at Bassetlaw Hospital , Nottinghamshire. The elctronic notes and blood reporting system were checked for each of the patients, to get the data on blood test results , ECG reports and Physical health (Blood pressure, heart rate and weight) .

Result

It was noted that 19/30 patients had Blood tests completed, 14/30 had ECG completed and 19/30 had physical health checks completed. All these patients except one were on antipsychotic medications.

Conclusion

Further work is still required in getting 100% results for all these different variables. This may include the need to review the process of how we engage the patients for physical healthcare checks. With the inclusion of a physical healthcare worker now, we might be able to improve results. Hence this evaluation would be redone in a years' time.
Balint style case-based discussion group for medical students in Bassetlaw Hospital
Authors: Priya Anu , Bhogal Hardev
Published: June 2021

Aims

To evaluate feedback from Balint style case based discussion groups and to reflect on learning points.

We have three medical students from Sheffield University on six week psychiatry placements at Bassetlaw Hospital and we get eighteen students in a year. In order to further develop their approach towards reflection and their understanding towards the doctor patient relationship we developed the Balint style case based discussion group, and each group of students attend three sessions during their placement.

Method

The groups are held on a weekly basis and consist of the three medical students and 1-2 facilitators. As the group is small one of the facilitators may participate with the students for the Balint process and to help encourage the students. Following completion of the third session of the discussion group we gain written feedback from the students. A total of 17 feedbacks have been reviewed over the period of November 2018 -November 2019.

Result

16 students stated that this was their first experience at Balint Group and all except one student felt that they were given a good introduction about Balint groups before starting. When asked about the most significant thing that they have learnt in the group, the majority of students marked reflecting feelings to improve relationships with patients, exploring why they feel a certain way with patients and that the doctor patient relationship can affect the consultation.

One student stated that they would not recommend it to colleagues as they felt it was relevant more to doctors rather than medical students. Another student recommended having more people in a group.

Conclusion

Overall, it has been a positive experience with the medical students during the groups and with feedbacks. We have reflected on difficult topics like bereavement, fantasized about the purpose of a patient's delusion and shared the joy of a patient who was discharged after a long stay. While we think we have been able to teach the students some tips on reflection, we ourselves have been able to reflect on certain topics we would not have if not raised by the students. Some medical students have contacted the larger Balint Group in Sheffield for further sessions. Considering our experience, we will continue with the sessions at Bassetlaw Hospital.
Distinguishing vulnerable clients from psychotic patients with follow-up mortality data
Authors: Burke Aggrey
Published: June 2021

Aims

The aim of the present study is to determine whether vulnerable non-psychotic clients presenting in court proceedings do not share the same mortality profile as psychotic patients in similar environments. It is hypothesised that the two display quite separate mortality profiles.

Background

The increased mortality of psychiatric patients and prisoners has been documented but less is known of the outcomes among other vulnerable populations .

The population for study is a consecutive series of assessments in court proceedings of carers of children at risk and violent offenders.

Method

Assistants not involved in the initial assessments transferred data from case notes and this material was transferred to computer files. Statistical analysis SPSS19

Formal psychiatric diagnoses were those agreed in court proceedings. National mortality records were searched and copies of death certificates obtained. A small number of cases known to have returned overseas were excluded. 772 cases were studied. One in five were assessed in prison, twice as many gave a history of violent criminal behaviour. Over a half suffered abuse or neglect or admitted to being unhappy in childhood. Three subgroups have been identified: Vulnerable with no psychotic illness(60%), psychosis with no evidence of personality disorder or of mixed psychosis(18%), linked psychosis(22%). It was found that demographic variables , deprivation factors, adverse childhood experiences and outcomes and clinical variables are in excess among linked psychotics compared with other groups. Linear regression of unnatural death among psychotic patients identifies five risk factors. The distribution of high-risk factors among linked psychosis is more than twice that found in other groups.

Result

Natural mortality is most evident among clients suffering from psychosis without personality disorder or mixed disorder.Unnatural mortality is more than 10 times greater among patients with linked psychosis, compared with those with no psychosis and four times greater than other psychoses. Risk factors for unnatural mortality are: physical illness, stressful relationship, violence to self or others, detained and history of behaviour disorder.

Conclusion

The findings of the present study demonstrate that vulnerable clients without psychosis are less likely to die by unnatural causes than clients who suffer psychosis coexisting with personality disorder or mixed psychosis. The null hypothesis is upheld. The findings suggest that risk assessment of vulnerable populations should take account of risk factors of unnatural death which have been identified in this study.
Is pregnancy status being assessed within women's secure services?
Authors: Rampling Jeremy , Pantall Shay-Anne , Woodman Hannah
Published: June 2021

Aims

To establish rates of pregnancy testing on admission of women within a blended secure service.

Background

Women with psychiatric illness are known to be at increased risk of pregnancy, often due to engagement in risky sexual behaviours such as having a higher numbers of sexual partners and engaging in sexual activity whilst under the influence of drugs or alcohol. Awareness of pregnancy at the point of admission to psychiatric hospital would inform ongoing care plans to manage the pregnancy in the safest, least restrictive environment and inform future prescribing decisions, to minimise the risk of teratogenicity associated with some psychotropic medications. Ardenleigh in Birmingham is a blended female secure unit. No pregnancy screening guidelines for this population currently exist. This audit sought to establish current rates of pregnancy testing at the point of admission with a view to developing future guidelines.

Method

A retrospective case note audit of electronic records of all patients admitted to Ardenleigh blended women's service as of 1st September 2019 (n = 26). The expected standard for pregnancy testing within one month of admission was set as 100%.

Result

Key results include:

The majority of patients (67%) were aged under 35 years (range 20–56). The most common ethnicities were Caucasian (42%) and African-Caribbean (38%). Almost half (46%) had a primary diagnosis of paranoid schizophrenia.

Two women were known to be pregnant at the point of admission. Only 54% of women with an unknown pregnancy status were screened for pregnancy within one month of admission.

Rates of screening were particularly poor in women aged under 25 years (43%) and between 36 and 45 (0%).

Women not screened for pregnancy were typically admitted from other hospital settings, including AWA services (27%) or other medium secure units (55%). 2 women admitted from prison were not tested (29%)

Of those tested, the majority were checked using urine hCG (92%).

None of the women tested were found to be pregnant.

Conclusion

Overall pregnancy testing on admission to the unit was poor, with only 54% of service users screened. Less than 100% compliance could result in serious consequences for both the woman and unborn baby if a pregnancy is not discovered. Updating the admission checklist for Ardenleigh to include pregnancy testing may prove beneficial. It is recommended that a re-audit is completed 6 months following checklist introduction.
Psychiatric liaison team memory pathway: does it achieve the standards set out in NICE clinical guideline 97?
Authors: Senaratne Manouri , Jabeen Afshan , Hyams Alisha , Deary Carol , Stathers Sarah
Published: June 2021

Aims

Early assessment, diagnosis and management for people living with dementia is essential, both for the patient and their carers. We recognised delays in established local pathways when patients had unplanned acute hospital admissions preventing them from attending memory diagnostic appointments. The Psychiatric Liaison Team (PLT) Memory Pathway was introduced as we had the skills and expertise to resume the process and to find new undetected patients.

Our aim was to determine how well the newly implemented PLT Memory Pathway follows the standards outlined in the National Institute of Health & Care Excellence (NICE) Clinical Guideline 97 (CG97): Assessment, management and support for people living with dementia and their carers.

Method

A retrospective analysis of all PLT referrals from July 2018 to February 2020 (20 months) was performed to identify patients on the community memory pathway and those with possible undetected cognitive impairment. Data were collected from electronic patient records which included demographics, primary and collateral history, cognitive testing and imaging, dementia type among others. Results were analysed using Microsoft Excel.

Result

41 patients were included (59% female). 80% of patients were referred for memory problems or confusion. 63% had previous referrals to a memory service and was on the community memory pathway at the time of the referral. 34% were on anticholinergic medication but in only 14% were this documented as reviewed. 100 % were offered and had head imaging. A finding worthy of note was the absence of any from the ethnic minority background. 63% of patients were given a memory diagnosis and 34% had anti-dementia medication started. Patients’ families were made aware of the diagnosis in 83% of cases, due to the absence of next of kin details in the patient record. Primary Care was made aware in 100% of cases; post-diagnostic support was 100%.

Conclusion

The PLT is well placed to bridge the service gap between the acute care trust and established community memory services when dealing with patients with dementia. A dedicated Memory Pathway has helped to close this gap and adherence to NICE CG97 standards was good, but there is room for improvement. A particular focus will be on improving documentation of anticholinergic medication review and exploration for the absence of ethnic minority patients. Aiming to achieve 100% family involvement is also recommended.

This study has been submitted to the Royal College of Psychiatrists' Faculty of Old Age Annual Conference 2021.
Audit of physical health monitoring on admission to Mill Lodge (CAMHS Inpatient Unit, York)
Authors: Steiu Andreea , Diggins Emma , Thevarajan Nagulan
Published: June 2021

Aims

This audit aimed to evaluate the standard of initial physical health assessment that young people receive on admission to Mill Lodge.

Adherence to recommendation 2.6.3 of the service specification for Tier 4 CAMHS was assessed. Standard 2.6.3 of the service specification for Tier 4 child and adolescent mental health services states that “on admission all young people must have an initial assessment (including a risk assessment) and care-plan completed within 24 hours. Where admission is for day/in-patient care this will include a physical examination.” In line with this standard this audit will evaluate the use of physical examination, baseline blood tests and ECG carried out on young people.

Background

Mental health problems in children and young people are associated with both short- and long-term physical health problems. It is therefore important that they undergo full physical health assessment on admission to a Tier 4 inpatient unit.

Method

Electronic records were reviewed for all patients admitted within a 6 months period, between 1st August 2018 and 1st February 2019. Data were collected in March 2019 and entered directly into an excel spread sheet designed for data collection. A total of 23 patients were identified for inclusion in this audit.

Simple statistical analysis was carried out using excel.

Result

Over 80% of patients who did not refuse had a completed physical examination (85%), blood results recorded (82%) and ECG (84%) within the first 24 hours of their admission. 100% of patients who did not refuse had bloods and ECG checked at some time during their admission, with 90% having a physical examination.

For several patients (3 physical examination, 2 bloods, 3 ECG), no reason was documented as to why the procedure or examination did not take place. For 1 patient, blood tests were delayed due to having no blood tubes available.

Conclusion

Taken into account the result of this audit and bearing in mind the importance of physical examination as part of the admission process, it is important to try and support both regular Mill Lodge staff and on-call junior doctors to follow Standard 2.6.3's guidance around physical examination on admission to hospital. While good results were seen in many areas, the ward is not yet achieving the standard of 100%. A re-audit will take place in twelve months’ time to review recommendation and compliance.
Assessment and management of patients detained under Section 136 in Northwick Park Hospital emergency department
Authors: Telesia Laurence , Fraser Lauren
Published: June 2021

Aims

To evaluate the role of the Emergency Medicine team (EM) within a London Emergency Department (ED) in assessing and managing patients detained under Section 136 of the Mental Health Act, 1983 (S136).

Background

S136 allows detention and transfer of people to ED and psychiatric hospitals for further assessment. EDs are optimised for the investigation and management of the medically unwell, but attending ED may also delay access to psychiatric services if required. Minimal research has been performed to investigate the relative benefits of transferring people under S136 to ED versus psychiatric hospitals.

Method

Electronic notes were searched to identify those attending under S136 between 01/04/2017 and 31/03/2018. Scanned medical notes were reviewed and data extracted regarding patient demographics, length of ED stay, reason for S136 use, investigations and interventions undertaken by EM.

Result

This identified 95 attendances by 87 patients. The mean age was 35 years (range 15-75) and 59% of attenders were male. The mean duration of stay was 7 hours 34 minutes (range 6 minutes - 25 hours 50 minutes).

Reasons for S136 use were abnormal behaviour (32), expressed suicidal ideation (29), overdose (15), self-harm (13), overdose plus self-harm (4), being found wandering (1) and was unclear for 1 presentation.

In 39 attendances no investigations beyond history and examination were performed by EM. Only 6 patients had investigations that were not bloods, electrocardiogram or urinalysis. These included X-radiograph trunk (4), computed tomography (CT) head (3), X-radiograph limb (3), CT cervical spine (1), Focused Assessment with Sonography for Trauma (1).

No interventions were given by EM in 55 attendances. Twenty-nine different medications were prescribed and 18 patients were prescribed intravenous fluids. Three had wounds dressed, 3 glued, 3 sutured and 1 stapled.

Conclusion

There were difficulties categorising the reason for S136 use, as clear documentation was often unavailable, but the vast majority of patients were detained due to abnormal behaviour, expressed suicidal ideation and self-harm.

Few attending ED under S136 received investigations or interventions that could not be offered within a psychiatric hospital. There was a wide range in duration of stay within ED, however 65% of attendances were longer than the standard 4 hour target.

Future research may assess the relative benefits of ED versus psychiatric hospitals in assessing those detained. This could aid services in meeting both the physical and psychiatric needs of patients whilst making efficient use of available resources.
Audit of high dose antipsychotic prescribing in the havering community recovery team
Authors: Umeh Chinedu , Ionita Simona
Published: June 2021

Aims

The main aim of this audit was to determine the prevalence of HDAP in Havering Community Recovery Team (CRT). The secondary aim was to determine how well HDAP has been monitored and documented - specifically, whether discussions around the reasons for continuing and the risks and benefits have been discussed.

Background

There is a focus to reduce high dose antipsychotic prescribing (HDAP) due to the lack of evidence that it is efficacious and that smaller doses have an equivalent effect and are better tolerated. Similarly, the consensus by the Royal College of Psychiatrists is that any prescribing of high dose antipsychotics should be an 'explicit, time-limited individual trial’ with a distinct treatment target. There should be a clear plan for regular clinical review including safety monitoring. The high-dose regimen should only be continued if the trial shows evidence of benefit that is not outweighed by tolerability or safety problems.' Following a CQC inspection in 2014 of NELFT which found that the trust was failing to comply with the relevant requirements of the Health and Social Care Act 2008 with regards to safe use of medicines, yearly audits of inpatient HDAP have been undertaken. Although improvements have been made in the inpatient setting, no such audits have been performed in the community setting and consequently there is no data in NELFT regarding community services compliance with the above regulations.

Method

All 349 patients in Havering CRT clinical records were screen by either using RIO or GP letters from recent CPA reviews. A data collection and analysis tool was created using Microsoft Excel. Data collection and analysis was carried out by the project lead and checked by a fellow project member.

Result

Of the 349 patients included for analysis:

16 (4.58%) of patients were prescribed a high-dose antipsychotic

Of the 16 prescribed high dose antipsychotics:

0 out of 16 had the high dose antipsychotic monitoring form available

12 (75%) had well documented evidence of review of HDAP.

4 (25%) had no documented evidence of review of HDAP.

Conclusion

There is a small group of patients receiving high dose antipsychotic therapy for which better monitoring is needed. This should include education of staff regarding HDAP, better documentation in their care plans and working with pharmacy to make HDAP monitoring forms available widely in the community.
Prognostic Implications of Preablation Stimulated Tg: A Retrospective Analysis of 2500 Thyroid Cancer Patients
Authors: Tian Tian , Xu Yangmengyuan , Zhang Xinyue , Liu Bin
Published: June 2021

Context

The risk of persistent and recurrent disease in patients with differentiated thyroid cancer (DTC) is a continuum that ranges from very low to very high, even within the 3 primary risk categories. It is important to identify independent clinicopathological parameters to accurately predict clinical outcomes.

Objective

To examine the association between pre-ablation stimulated thyroglobulin (ps-Tg) and persistent and recurrent disease in DTC patients and investigate whether incorporation of ps-Tg could provide a more individualized estimate of clinical outcomes.

Design, Setting, and Participants

Medical records of 2524 DTC patients who underwent total thyroidectomy and radioiodine ablation between 2006 and 2018 were retrospectively reviewed.

Main Outcome Measure

Ps-Tg was measured under thyroid hormone withdrawal before remnant ablation. Association of ps-Tg and clinical outcomes.

Results

In multivariate analysis, age, American Thyroid Association (ATA) risk stratification, distant metastasis, ps-Tg, and cumulative administered activities were the independent predictive factors for persistent/recurrent disease. Receiver operating characteristic analysis identified ps-Tg cutoff (≤10.1 ng/mL) to predict disease-free status with a negative predictive value of 95%, and validated for all ATA categories. Integration of ps-Tg into ATA risk categories indicated that the presence of ps-Tg ≤ 10.1 ng/mL was associated with a significantly decreased chance of having persistent/recurrent disease in intermediate- and high-risk patients (9.9% to 4.1% in intermediate-risk patients, and 33.1% to 8.5% in high-risk patients).

Conclusion

The ps-Tg (≤10.1 ng/mL) was a key predictor of clinical outcomes in DTC patients. Its incorporation as a variable in the ATA risk stratification system could more accurately predict clinical outcomes.
Brown Adipose Tissue, Adiposity, and Metabolic Profile in Preschool Children
Authors: Tint Mya Thway , Michael Navin , Sadananthan Suresh Anand , Huang Jonathan Yinhao , Khoo Chin Meng , Godfrey Keith M , Shek Lynette Pei-Chi , Lek Ngee , Tan Kok Hian , Yap Fabian , Velan S Sendhil , Gluckman Peter D , Chong Yap-Seng , Karnani Neerja , Chan Shiao-Yng , Leow Melvin Khee-Shing , Lee Kuan Jin , Lee Yung-Seng , Hu Houchun Harry , Zhang Cuilin , Fortier Marielle V , Eriksson Johan G
Published: June 2021

Context

An inverse relationship between brown adipose tissue (BAT) and obesity has previously been reported in older children and adults but is unknown in young children.

Objective

We investigated the influence of BAT in thermoneutral condition on adiposity and metabolic profile in Asian preschool children.

Design, Setting, and Participants

A total of 198 children aged 4.5 years from a prospective birth cohort study, Growing Up in Singapore Towards Healthy Outcomes (GUSTO) were successfully studied with water-fat magnetic resonance imaging of the supraclavicular and axillary fat depot (FDSA). Regions within FDSA with fat-signal-fraction between 20% and 80% were considered BAT, and percentage BAT (%BAT; 100*BAT volume/ FDSA volume) was calculated.

Main Outcome Measures

Abdominal adipose tissue compartment volumes, ectopic fat in the soleus muscle and liver, fatty liver index, metabolic syndrome scores, and markers of insulin sensitivity.

Results

A 1% unit increase in %BAT was associated with lower body mass index, difference (95% CI), −0.08 (−0.10, −0.06) kg/m2 and smaller abdominal adipose tissue compartment volumes. Ethnicity and sex modified these associations. In addition, each unit increase in %BAT was associated with lower ectopic fat at 4.5 years in the liver, −0.008% (−0.013%, −0.003%); soleus muscle, −0.003% (−0.006%, −0.001%) of water content and lower fatty liver index at 6 years.

Conclusions

Higher %BAT is associated with a more favorable metabolic profile. BAT may thus play a role in the pathophysiology of obesity and related metabolic disorders. The observed ethnic and sex differences imply that the protective effect of BAT may vary among different groups.
An Open-label Phase I/IIa Clinical Trial of 11β-HSD1 Inhibitor for Cushing’s Syndrome and Autonomous Cortisol Secretion
Authors: Oda Satoko , Ashida Kenji , Uchiyama Makiko , Sakamoto Shohei , Hasuzawa Nao , Nagayama Ayako , Wang Lixiang , Nagata Hiromi , Sakamoto Ryuichi , Kishimoto Junji , Todaka Koji , Ogawa Yoshihiro , Nakanishi Yoichi , Nomura Masatoshi
Published: June 2021

Context

11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) inhibitors demonstrate antimetabolic and antisarcopenic effects in Cushing’s syndrome (CS) and autonomous cortisol secretion (ACS) patients.

Objective

To confirm the efficacy and safety of S-707106 (11β-HSD1 inhibitor) administered to CS and ACS patients.

Design

A 24-week single-center, open-label, single-arm, dose-escalation, investigator-initiated clinical trial on a database.

Setting

Kyushu University Hospital, Kurume University Hospital, and related facilities.

Patients

Sixteen patients with inoperable or recurrent CS and ACS, with mildly impaired glucose tolerance.

Intervention

Oral administration of 200 mg S-707106 after dinner, daily, for 24 weeks. In patients with insufficient improvement in oral glucose tolerance test results at 12 weeks, an escalated dose of S-707106 (200 mg twice daily) was administered for the residual 12 weeks.

Main Outcome Measures

The rate of participants responding to glucose tolerance impairment, defined as those showing a 25% reduction in the area under the curve (AUC) of plasma glucose during the 75-g oral glucose tolerance test at 24 weeks.

Results

S-707106 administration could not achieve the primary endpoint of this clinical trial (>20% of responsive participants). AUC glucose decreased by −7.1% [SD, 14.8 (90% CI −14.8 to −1.0), P = 0.033] and −2.7% [14.5 (−10.2 to 3.4), P = 0.18] at 12 and 24 weeks, respectively. S-707106 administration decreased AUC glucose significantly in participants with a high body mass index. Body fat percentage decreased by −2.5% [1.7 (−3.3 to −1.8), P < 0.001] and body muscle percentage increased by 2.4% [1.6 (1.7 to 3.1), P < 0.001].

Conclusions

S-707106 is an effective insulin sensitizer and antisarcopenic and antiobesity medication for these patients.
IGF-I, Growth, and Body Composition in Preterm Infants up to Term Equivalent Age
Authors: Yumani Dana F J , Lafeber Harrie N , van Weissenbruch Mirjam M
Published: June 2021

Context

There are concerns that a higher fat mass in the early life of preterm infants is associated with adverse cardiometabolic outcomes in young adulthood.

Objective

To investigate the role of IGF-I and growth in determining body composition of preterm infants at term equivalent age.

Methods

An observational study was conducted from August 2015 to August 2018. From birth to term equivalent age, IGF-I levels were measured bi-weekly and growth was assessed weekly. At term equivalent age, body composition was assessed through air displacement plethysmography; 65 infants with a gestational age of 24 to 32 weeks were assessed at term equivalent age, of whom 58 completed body composition measurement. The main outcome measures were fat (free) mass (g) and fat (free) mass percentage at term equivalent age.

Results

In the first month of life, each 0.1 nmol/L per week increase in IGF-I was associated with a 465 g (SE 125 g) increase in fat free mass. A greater increase in weight SDS in the first month of life was associated with a higher fat free mass percentage (B 200.9; 95% CI, 12.1-389.6). A higher head circumference SDS was associated with more fat free mass (r = 0.46; 95% CI, 0.21-0.65). However, a greater increase in weight SDS up to term equivalent age was associated with a lower fat free mass percentage (B −55.7, SE 9.4).

Conclusion

These findings suggest that impaired growth in the first month of life is associated with a less favorable body composition at term equivalent age.
Asymmetric Synthesis of (−)-Atorvastatin Calcium by Tandem Catalysis
Authors: Murata Keisuke , Minami Riko , Fuwa Haruhiko
Published: June 2021

A seven-step synthesis of (−)-atorvastatin calcium, an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, has been developed. The key transformations of the present synthesis are a tandem olefin cross-metathesis/hemiacetalization/intramolecular oxa-Michael addition and a subsequent regioselective Baeyer–Villiger oxidation for the stereocontrolled construction of the syn-3,5-dihydroxy carboxylic acid substructure.
Ultra-high Capacity Li[Ni1/3Co1/3Mn1/3]O2 Cathode Synthesized Using a Novel MnO2 Template
Authors: Jang Hyun-Ju , Lee Seong-Hee , Park Eui-Jeong , Kim Hae-In , Son Jong-Tae
Published: June 2021

An ultra-high capacity Li[Ni1/3Co1/3Mn1/3]O2 (T-LNCM) cathode material was synthesized using a novel MnO2 template comprising nanorods of 114 nm diameter, which increased the surface area of the material to 3.19 m2 g−1. Owing to its large surface area and high lithium diffusion coefficient (4.72 × 10−14 cm2 s−1), T-LNCM exhibits an ultra-high capacity of 220.2 mAh g−1 at 0.1 C. The capacity of T-LNCM is significantly higher than that of the conventional LNCM cathode material.
Superior objective and subjective image quality of deep learning reconstruction for low-dose abdominal CT imaging in comparison with model-based iterative reconstruction and filtered back projection
Authors: Tamura Akio , Mukaida Eisuke , Ota Yoshitaka , Kamata Masayoshi , Abe Shun , Yoshioka Kunihiro
Published: June 2021

Objective:

This study aimed to conduct objective and subjective comparisons of image quality among abdominal computed tomography (CT) reconstructions with deep learning reconstruction (DLR) algorithms, model-based iterative reconstruction (MBIR), and filtered back projection (FBP).

Methods:

Datasets from consecutive patients who underwent low-dose liver CT were retrospectively identified. Images were reconstructed using DLR, MBIR, and FBP. Mean image noise and contrast-to-noise ratio (CNR) were calculated, and noise, artifacts, sharpness, and overall image quality were subjectively assessed. Dunnett’s test was used for statistical comparisons.

Results:

Ninety patients (67 ± 12.7 years; 63 males; mean body mass index [BMI], 25.5 kg/m2) were included. The mean noise in the abdominal aorta and hepatic parenchyma of DLR was lower than that in FBP and MBIR (p < .001). For FBP and MBIR, image noise was significantly higher for obese patients than for those with normal BMI. The CNR for the abdominal aorta and hepatic parenchyma was higher for DLR than for FBP and MBIR (p < .001). MBIR images were subjectively rated as superior to FBP images in terms of noise, artifacts, sharpness, and overall quality (p < .001). DLR images were rated as superior to MBIR images in terms of noise (p < .001) and overall quality (p = .03).

Conclusions:

Based on objective and subjective comparisons, the image quality of DLR was found to be superior to that of MBIR and FBP on low-dose abdominal CT. DLR was the only method for which image noise was not higher for obese patients than for those with a normal BMI.

Advances in knowledge:

This study provides previously unavailable information on the properties of DLR systems and their clinical utility.