bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of rRNA depletion methods for capturing the RNA virome from environmental surfaces
Authors: Shiwa Yuh , Baba Tomoya , Sierra Maria A. , Kim JangKeun , Mason Christopher E. , Suzuki Haruo
Published: July 2023

Objective

Metatranscriptomic analysis of RNA viromes on built-environment surfaces is hampered by low RNA yields and high abundance of rRNA. Therefore, we evaluated the quality of libraries, efficiency of rRNA depletion, and viral detection sensitivity using a mock community and a melamine-coated table surface RNA with levels below those required (< 5 ng) with a library preparation kit (NEBNext Ultra II Directional RNA Library Prep Kit).

Results

Good-quality RNA libraries were obtained from 0.1 ng of mock community and table surface RNA by changing the adapter concentration and number of PCR cycles. Differences in the target species of the rRNA depletion method affected the community composition and sensitivity of virus detection. The percentage of viral occupancy in two replicates was 0.259 and 0.290% in both human and bacterial rRNA-depleted samples, a 3.4 and 3.8-fold increase compared with that for only bacterial rRNA-depleted samples. Comparison of SARS-CoV-2 spiked-in human rRNA and bacterial rRNA-depleted samples suggested that more SARS-CoV-2 reads were detected in bacterial rRNA-depleted samples. We demonstrated that metatranscriptome analysis of RNA viromes is possible from RNA isolated from an indoor surface (representing a built-environment surface) using a standard library preparation kit.
Extracorporeal hemoadsorption therapy as a potential therapeutic option for rapid removal of Apixaban in high risk-surgical patients: a case report
Authors: Dalmastri Vittorio , Angelini Andrea , Minerva Vera , Ballarini Melissa , Grammatico Francesco , Todeschini Paola , Pizzini Attilia Maria , Silingardi Mauro , La Manna Gaetano
Published: July 2023

Background

Apixaban is a non-vitamin K antagonist oral anticoagulant (NOACs) recently emerged as an effective alternative to conventional vitamin K antagonists (VKAs) in the treatment of several thromboembolic disorders. However, in case of overdose or in patients requiring emergency surgery there is a high bleeding rate and severe adverse side effects due to the absence of an antidote. There is promising data from in vitro and clinical studies, that certain antithrombotic agents (that is Rivaroxaban and Ticagrelor) have been successfully removed by the extracorporeal hemoadsorption therapy CytoSorb. Here, we present the case of a patient successfully treated with CytoSorb as a kind of antidote to enable emergency surgery for bilateral nephrostomy.

Case presentation

A 82-year-old Caucasian man was admitted to the Emergency Room with acute kidney injury (AKI) in the context of severe bilateral hydroureteronephrosis. The patient’s medical history included chronic obstructive pulmonary disease, arterial hypertension, atrial fibrillation (anticoagulated with Apixaban) and a locally advanced prostate adenocarcinoma treated with trans-ureteral resection of the bladder and radiotherapy in the previous months. The indication for a bilateral nephrostomy could not be considered immediately given the major bleeding risk due to Apixaban, which was discontinued and replaced with calciparin. After 36 hours of continuous renal replacement therapy (CRRT), the Apixaban blood level was still elevated and it was decided to install CytoSorb into the running CRRT to accelerate the drug clearance. After 2 hours 30 minutes, there was good reduction of Apixaban from 139 to 72 ng/ml (reduction rate of 48.2%) registered, and this allowed for an easy placement of bilateral nephrostomies without complications. Four days after surgery renal function parameters further normalized, the patient did not require additional dialysis treatments and Apixaban therapy was prescribed again once the patient returned home.

Conclusions

In this case we report the findings of a patient with post-renal AKI requiring emergency nephrostomy placement while on chronic anticoagulation with Apixaban therapy. Combined treatment with CRRT and CytoSorb was associated with the rapid and effective removal of Apixaban allowing for prompt and urgent surgery while simultaneously ensuring the low risk of bleeding as well as an uneventful post-operative course.
Antioxidant and chemoprotective potential of Streptomyces levis strain isolated from human gut
Authors: Verma Jaya , Attri Shivani , Arora Saroj , Manhas Rajesh Kumari
Published: July 2023

In the current study,Streptomyceslevisstrain HFM-2 has been isolated from healthy human gut.Streptomycessp. HFM-2 was identified based on the polyphasic approach that included cultural, morphological, chemotaxonomical, phylogenetic, physiological, and biochemical characteristics. 16S rRNA gene sequence of strain HFM-2 exhibited 100% similarity withStreptomyceslevisstrain 15423 (T). The EtOAc extract ofStreptomyceslevisstrain HFM-2 showed potential antioxidant activity, along with 69.53 ± 0.19%, 64.76 ± 0.13%, and 84.82 ± 0.21% of scavenging activity for ABTS, DPPH, and superoxide radicals, respectively at 600 µg/mL. The IC50values i.e. 50% scavenging activity for DPPH, ABTS, and superoxide radicals were achieved at 497.19, 388.13, and 268.79 (µg/mL), respectively. The extract's reducing power and total antioxidant capacity were determined to be 856.83 ± 0.76 and 860.06 ± 0.01 µg AAE/mg of dry extract, respectively. In addition, the EtOAc extract showed protection against DNA damage from oxidative stress caused by Fenton’s reagent, and cytotoxic activity against HeLa cervical cancer, Skin (431) cancer, Ehrlich-Lettre Ascites-E (EAC) carcinoma, and L929 normal cell lines. The IC50values against HeLa, 431 skin, and EAC carcinoma cell lines were found to be 50.69, 84.07, and 164.91 µg/mL, respectively. The EtOAc extract showed no toxicity  towards L929 normal cells. In addition, flow cytometric analysis exhibited reduced mitochondrial membrane potential (MMP), and enhanced levels of reactive oxygen species (ROS). The EtOAc extract was chemically analyzed using GCMS to determine the components executing its bioactivities.
Methods of postoperative void trial management after urogynecologic surgery: a systematic review and meta-analysis
Authors: Dong Xue , Huang Wu , Niu Jinyang , Lei Tingting , Tan Xin , Guo Tao
Published: July 2023

Background

Voiding trials are used to identify women at risk for postoperative urinary retention while performing optimal voiding trial management with minimal burden to the patient and medical service team. We performed a systematic review and meta-analysis of postoperative void trials following urogynecologic surgery to investigate (1) the optimal postoperative void trial methodology and (2) the optimal criteria for assessing void trial.

Method

We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and relevant reference lists of eligible articles from inception to April 2022. We identified any randomized controlled trials (RCTs) in English that studied void trials in patients undergoing urogynecologic surgery. Study selection (title/abstract and full text), data extraction, and risk of bias assessment were conducted by two independent reviewers. Extracted study outcomes included the following: the correct passing rate, time to discharge, discharge rate without a catheter after the initial void trial, postoperative urinary tract infection, and patient satisfaction.

Results

Void trial methodology included backfill-assisted and autofill studies (2 RCTs, n = 95). Backfill assistance was more likely to be successful than autofill (RR 2.12, 95% CI 1.29, 3.47, P = 0.00); however, no significant difference was found in the time to discharge (WMDs =  − 29.11 min, 95% CI − 57.45, 1.23, P = 0.06). The criteria for passing void trial included subjective assessment of the urinary force of stream and objective assessment of the standard voiding trial (3 RCTs, n = 377). No significant differences were found in the correct passing rate (RR 0.97, 95% CI 0.93, 1.01, P = 0.14) or void trial failure rate (RR 0.78, 95% CI 0.52, 1.18, P = 0.24). Moreover, no significant differences were found in the complication rates or patient satisfaction between the two criteria.

Conclusion

Bladder backfilling was associated with a lower rate of catheter discharge after urogynecologic surgery. The subjective assessment of FOS is a reliable and safe method for assessing postoperative voiding because it is less invasive.

Systematic review registration

PROSPERO CRD42022313397
On shrinking projection method for cutter type mappings with nonsummable errors
Authors: Ibaraki Takanori , Saejung Satit
Published: July 2023

We prove two key inequalities for metric and generalized projections in a certain Banach space. We then obtain some asymptotic behavior of a sequence generated by the shrinking projection method introduced by Takahashi et al. (J. Math. Anal. Appl. 341:276–286, 2008) where the computation allows some nonsummable errors. We follow the idea proposed by Kimura (Banach and Function Spaces IV (ISBFS 2012), pp. 303–311, 2014). The mappings studied in this paper are more general than the ones in (Ibaraki and Kimura in Linear Nonlinear Anal. 2:301–310, 2016; Ibaraki and Kajiba in Josai Math. Monogr. 11:105–120, 2018). In particular, the results in (Ibaraki and Kimura in Linear Nonlinear Anal. 2:301–310, 2016; Ibaraki and Kajiba in Josai Math. Monogr. 11:105–120, 2018) are both extended and supplemented. Finally, we discuss our results for finding a zero of maximal monotone operator and a minimizer of convex functions on a Banach space.
Decay rate of the solutions to the Cauchy problem of the Bresse system in thermoelasticity of type III with distributed delay
Authors: Choucha Abdelbaki , Boulaaras Salah , Jan Rashid , Guefaifia Rafik
Published: July 2023

The decay rate of solutions to a Bresse system in thermoelasticity of type III with respect to the distributed delay term is the subject of this study. We demonstrate our major finding utilising the energy approach in the Fourier space.
Social inequalities in self-perceived health in Chile, does the urban environment matter?: a cross-sectional study
Authors: López-Contreras Natalia , Puig-Barrachina Vanessa , Vives Alejandra , Olave-Müller Paola , Gotsens Mercè
Published: July 2023

Background

The health of a population is determined by urban factors such as the physical, social and safety environment, which can be modified by urban regeneration policies. The aim of this study was to analyze the associations of elements of the social, physical and safety environment of the neighborhood in the urban context with self-perceived health (SPH), according to axes of inequality, such as gender and educational level in Chile in 2016.

Methods

Cross-sectional study using a nationally representative population-based survey of Chile. We used data from the 2016 National Survey of Quality of Life and Health. Poor SPH in the urban population older than 25 years was analyzed in relation to social, physical and safety environment variables. Poisson multilevel regression models were estimated to obtain prevalence ratios (PR) and their respective 95% confidence intervals (95%CI). All analyses were stratified by sex and educational level.

Results

SPH was worse in women than in men, especially in those with a lower education level. Poor SPH was associated with lack of support networks (PR = 1.4; 95%CI = 1.1–1.7), non-participation in social organizations (PR = 1.3; 95%CI = 1.1–1.6) and perceived problems with the quality of public space (PR = 1.3; 95%CI = 1.2–1.5) in women with a medium-high educational level and with a feeling of not belonging to the neighborhood (PR = 1.5; 95%CI = 1.2–1.8) and the perception of pollution problems (PR = 1.2; 95%CI = 1.0-1.4) in women with a low educational level. A feeling of unsafety was associated with both educational levels (PR = 1.3; 95%CI = 1.0-1.5). Poor SPH was associated with the feeling of not belonging (PR = 1.7; 95%CI = 1.2–2.5), and unsafety (PR = 2.1; 95%CI = 1.8–2.4) in men with a medium-high educational level, while there were fewer associations in men with a lower education level.

Conclusions

Urban interventions are recommended to improve the health of the resident population and should take into account axes of inequality.
Do founders attribute their success to skill or luck?
Authors: Lough Benjamin J. , McFadden Alyssa
Published: July 2023

This study analyzes transcripts derived from 183 podcast interviews that ask successful entrepreneurs whether luck or skill and hard work account for their success. It quantitatively disaggregates founders’ answers to this standard question based on differences in their gender, race, and geography of their birth. Qualitative analysis further considers the degree to which founders’ perspectives might be associated with an internalized locus of control and their social positioning, alongside their identities and belief systems. Results indicate differences across gender, but no strong evidence of difference was evident by race and geography. Thematic analysis of transcripts revealed several additional determinants that founders attributed to their success. By investigating the lived experiences of successful founders disaggregated by gender, race, and geography, this study sheds light on how diverse founders attribute their success to various internal and external forces.
Engaging diverse patients in a diverse world: the development and preliminary evaluation of educational modules to support diversity in patient engagement research
Authors: Michalak Erin E. , Cheung Iva W. , Willis Elsy , Hole Rachelle , Pomeroy Beverley , Morton Emma , Kanani Sahil S. , Barnes Steven J.
Published: July 2023

Background

Current practices for engaging patients in patient-oriented research (POR) result in a narrow pool of patient perspectives being reflected in POR. This project aims to address gaps in methodological knowledge to foster diversity in POR, through the co-design and evaluation of a series of educational modules for health researchers in British Columbia, Canada.

Methods

Modules were co-created by a team of academic researchers and patient partners from hardly-reached communities. The modules are presented using the Tapestry Tool, an interactive, online educational platform. Our evaluation framework focused on engagement, content quality, and predicted behavior change. The User Engagement Scale short form (UES-SF) measured participants’ level of engagement with the modules. Survey evaluation items assessed the content within the modules and participants' perceptions of how the modules will impact their behavior. Evaluation items modeled on the theory of planned behavior, administered before and after viewing the modules, assessed the impact of the modules on participants’ perceptions of diversity in POR.

Results

Seventy-four health researchers evaluated the modules. Researchers’ engagement and ratings of module content were high. Subjective behavioral control over fostering diversity in POR increased significantly after viewing the modules.

Conclusions

Our results suggest the modules may be an engaging way to provide health researchers with tools and knowledge to increase diversity in health research. Future studies are needed to investigate best practices for engaging with communities not represented in this pilot project, such as children and youth, Indigenous Peoples, and Black communities. While educational interventions represent one route to increasing diversity in POR, individual efforts must occur in tandem with high-level changes that address systemic barriers to engagement.
Shifts in the rhizosphere microbiome and exudation profile of avocado (Persea americana Mill.) during infection by Phytophthora cinnamomi and in presence of a biocontrol bacterial strain
Authors: Reverchon Frédérique , García-Meléndez Mariel , Guevara-Avendaño Edgar , Mora-Chávez Oscar , Solís-García Itzel A. , Dáttilo Wesley , Guererro-Analco José A. , Méndez-Bravo Alfonso , Monribot-Villanueva Juan L. , Patiño-Conde Violeta , Pineda-García Fernando , Rebollar Eria A.
Published: July 2023

Background

Rhizosphere microbiomes are fundamental for plant health, development, and productivity, but can be altered by the incidence of soil-borne pathogens. The dysbiosis (disturbance of the microbiome structure of healthy plants) caused by these pathogens, combined with the recruitment of beneficial microorganisms by the diseased plant, may cause shifts in the rhizosphere microbiome during the infection process. These shifts are likely to be associated with changes in the rhizosphere metabolic profile, as the biochemical dialog, or crosstalk, between host plants and their microbiome is mostly mediated by root exudates. Our objective was to elucidate the shifts in the avocado rhizosphere microbiome and associated changes in the rhizosphere metabolome induced by the infection of the oomycete Phytophthora cinnamomi. We also evaluated the effect of inoculating a bacterial biological control agent (BCA) of P. cinnamomi on the avocado rhizosphere microbiome, in the presence and absence of the pathogen, and on morphological and physiological plant variables, to confirm the potential of the BCA to alleviate the stress induced by the disease.

Dataset presentation

Here, we present a novel dataset collected from a time-course experiment with four treatments: (1) control trees; (2) trees infected with P. cinnamomi; (3) trees inoculated with the BCA; (4) trees infected with P. cinnamomi and inoculated with the BCA. During the infection process, we measured plant morphological and physiological variables and collected rhizosphere soil samples for bacterial and fungal amplicon sequencing, bacterial RNA-seq and metabolomic analyses.

Conclusions

Collectively, our data elucidate the shifts in the avocado rhizosphere microbiome after infection by P. cinnamomi and when inoculated with a BCA, and help understand how a pathogen or a beneficial bacterium can alter plant-microbiome crosstalk. Understanding the effect of P. cinnamomi or a BCA on the avocado tree physiology and on the avocado rhizosphere microbiome and metabolome will direct our search for disease biomarkers or potential pathogen antagonists, help identify metabolites related to the recruitment of microorganisms, and assist us in developing integrated disease management strategies.
A robust and consistent stack generalized ensemble-learning framework for image segmentation
Authors: Faska Zahra , Khrissi Lahbib , Haddouch Khalid , El Akkad Nabil
Published: July 2023

In the present study, we aim to propose an effective and robust ensemble-learning approach with stacked generalization for image segmentation. Initially, the input images are processed for feature extraction and edge detection using the Gabor filter and the Canny algorithms, respectively; our main goal is to determine the most feature descriptions. Subsequently, we applied the stacking generalization technique, which is generally built with two main learning levels. The first level is composed of two algorithms that give good results in the literature, namely: LightGBM (Light Gradient Boosting Machine) and SVM (support vector machine). The second level is the meta-model in which we use a predictor model that takes the base-level predictions to improve the accuracy of the final prediction. In the stacked generalization process, we use the Extreme Gradient Boosting (XGBoost); it takes as input the sub-models’ outputs to better classify each pixel of the image to give the final prediction. Today, several research works exist in the literature using different machine learning algorithms; in fact, instead of trying to find a single efficient and optimal learner, ensemble-based techniques take the advantage of each basic model; they integrate their outputs to obtain a more consistent and reliable learner. The result obtained from the models of individuals and our proposed approach is compared using a set of evaluation measures for image quality such as IoU, DSC, CC, SSIM, SAM, and UQI. The evaluation and a comparison of the results obtained showed more consistent predictions for the proposed model. Thus, we have made a comparison with some recent deep learning-based unsupervised segmentation methods. The evaluation and a comparison of the results obtained showed more coherent predictions for our stacked generalization in terms of precision, robustness, and consistency.
Identifying components existing in Agile software development for achieving “light but sufficient” documentation
Authors: Habib Basit , Romli Rohaida , Zulkifli Malina
Published: July 2023

The Agile nature allows changes within the development procedure which can sometimes be non-predictable and affect the cost and time of the software. Face-to-face communication appears to be a faster process in Agile Software Development (ASD) in practice, but issues such as understandability and communicativeness cause ambiguity between the customer and the developer. Among the existing works, achieving light but sufficient documentation in ASD remains a challenge. Most previous studies have simply highlighted the issues associated with less documentation, its limitations, and challenges, but no proper solution has yet been proposed. As an initial step in our theoretical study, we conducted a systematic literature review (SLR) to identify the related components and subcomponents that are applicable in supporting Agile documentation. As such, the fundamental concepts related to software documentation have been studied in order to align with documentation in ASD. The identification of these components can be useful in achieving the concept of “light but sufficient” documentation in Agile, which will aid in achieving customer satisfaction.
Weight Monitoring and Antipsychotics: Are We Compliant With NICE Guidelines?
Authors: Mitchell Byrone , Chivers Gary , Drife Jenny
Published: July 2023

Aims

To improve Antipsychotic weight monitoring for patients within the Homeless Outreach (START) team.

Methods

All adult patients accepted by the START team (Lambeth, Southwark, and Croydon locations) between June and October 2022 that had been initiated on Antipsychotic medication were identified retrospectively (n = 11).

Electronic notes (ePJS) of these patients were subsequently reviewed to assess the following:

1.

Was there compliance with NICE weekly weight monitoring (for the first 6 weeks) following Antipsychotic initiation?

2.

Was weight measured at least once following Antipsychotic initiation?

3.

Was a Physical Health Screen documented following Antipsychotic initiation?

Results

During the audit period a total of 56 patients were accepted by the START team. Of these 11 (20%) were initiated on Antipsychotic medication. 0 patients had weekly weight monitoring compliant with NICE guidelines. 0 patients had their weight measured at least once following Antipsychotic initiation. A Physical Health screen was documented for 4 (36%) patients following Antipsychotic initiation.

Conclusion

This audit highlighted the poor compliance of weight monitoring in this cohort of patients, which can be attributed to several reasons. The homeless population are known to have poor engagement with health services. This coupled with reduced staff awareness of NICE antipsychotic monitoring guidelines can act as a barrier to carrying out appropriate physical health checks.

1.

The following interventions were implemented:

2.

To address staff awareness, START team members were given a presentation on the importance of Antipsychotic monitoring and current NICE guidelines.

3.

An alert will be added to patient notes (ePJS) on initiation of Antipsychotic medication to remind staff to carry out required weight monitoring.

4.

Portable weighing scales were purchased for the team to ensure patients’ weight can be measured on outreach reviews.
Can You Teach Clinical Communication Virtually?
Authors: Montgomery Adam , Ramjan Faeez , Cannon Alistair , Kohara Sae , Saunders Chloe , Umasankar Deekshitha , Zac-Williams Lois , Butler Sophie
Published: July 2023

Aims

An extracurricular clinical communication course called PsychED Up, with a focus on Psychiatry, met with challenges during the COVID-19 pandemic and the associated social distancing requirements. The course is usually delivered face-to-face by a small team of doctors, medical students, actors and lived-experience practitioners, and consists of large-group teaching on a weekly topic, followed by small group simulations. A small-scale study was performed to evaluate whether conducting clinical communication teaching and simulation online was acceptable, effective and feasible.

Methods

Twelve students and ten faculty members participated in the online session, performing live clinical scenarios with simulated patients, over a two-hour period. Pre-and post-course questionnaires were designed with quantitative measures of confidence and qualitative questions about participants’ experience. Eight students completed both questionnaires. Questionnaire answers were analysed using a mixed-methods approach, with themes identified from the qualitative long answers, and statistical analysis of quantitative answers was also performed.

Results

Students found the session beneficial, with all indicating that they would sign up for a full online course. Based on answers to the quantitative questions, 50% of students felt more prepared for their clinical examinations. (p = 0.046). However, all participants noted a reduction in their ability to read non-verbal cues and body language. Returning students found they were less attentive during the session compared with the original face-to-face teaching (p = 0.05). Actors and faculty members found that the online course was feasible, acceptable and effective. However, most agreed that it was not preferable to teaching clinical communication skills face to face. Technological issues were minimal.

Conclusion

The majority of students and faculty found the session both beneficial and enjoyable, but felt face to face sessions would be more helpful in teaching clinical communication. Student attentiveness and awareness of non-verbal cues were highlighted as concerns. However, students generally responded positively to the online course, particularly the quality and diversity of peer feedback. Teaching clinical communication virtually has the potential to be successful, and has implications for future undergraduate medical teaching.
An Audit on Venous Thromboembolism Risk Assessment in Older Persons Mental Health Inpatient Unit in North Wales With the Aim of a Quality Improvement Project
Authors: Soundararajan Sathyan , Dhandapani Asha , Wallis Finlay , Bhalerao Manjiri
Published: July 2023

Aims

The aim is to undertake a baseline audit of VTE risk assessment in older persons mental health unit in all 3 sites in North Wales. Following the implementation of recommendations, we aim to repeat the audit with an aim to complete a Quality improvement project.

Methods

A retrospective audit was conducted in older persons mental health unit in all 3 sites of North Wales in Betsi Cadwaladr University Health Board.

A prospective opportunistic sample of all the inpatients in the old age psychiatric unit was audited. Standards were based on the NICE and Department of Health guidelines.

We collected the data by reviewing the patients notes. The data collection happened in December 2022 to January 2023. We made a simple protocol to collect the data from all 3 sites.

The target was for 100 % compliance in all standards.

Results

From the audit data collection, the results are as follows:

Overall, we gathered details of 29 patients in East, 21 patients in Central and 11 patients in the West (A total of 61 patients)

In the East, out of 29 patients, there was a form for VTE risk assessment in clerking proforma. However only 6/9 forms were filled by the junior doctors. In Central, out of 21 patients, only 2 patients had a form in their file but they were not filled. In Bryn Hesketh unit, there were no VTE risk assessment forms at all. In West, out of 11 patients, 3 of them had a VTE risk assessment form that were filled. Overall, we noticed that in some of the patient's medication chart, there was a mention about they receive prophylaxis for VTE or not. However, that was not consistent.

There is no standard proforma noted in any of the wards in Central and West. In East, there is a clerking proforma noted and in some patients hence as part of the proforma as the VTE risk assessment is already included the junior doctors do fill the VTE risk assessment form.

Conclusion

I hope this audit will help in improving the patient care by identifying the risks factors of VTE earlier and preventing it. This would be in accordance with the guidelines.

It was evident that VTE risk assessment and prophylaxis was not something that was being considered for patients admitted to the old age psychiatric inpatient unit. However due to the risk factors this group of patients possess it is something vitally important. As a consequence of presenting the audit across the trust, a service change was recommended with a VTE risk assessment proforma planned to be introduced across the trust will be adapted to support use in psychiatric inpatients which can be used by mental health trusts.
Is Borderline Personality Disorder Madness? a Qualitative Study of the Perceptions of Medical Students in Somaliland
Authors: Arisna Hanny , Handuleh Jibril , Bhui Kamaldeep , Pereira-Sanchez Victor , Lee Tennyson
Published: July 2023

Aims

As the next generation of doctors, medical students' perception of patients with personality disorder (PD) is critical. Yet a systematic review of the literature shows this has not been studied. The study aims to identify 1) the understanding and perception of medical students about PD and 2) factors that may relate to this knowledge and perception.

Methods

A focus group discussion (FGD) was conducted with eight medical students in their sixth year at Amoud University, Somaliland. We presented a case vignette of a patient with typical Borderline PD symptoms (which would meet DSM5 criteria for Borderline PD) and used Barts Explanatory Model Inventory (BEMI) to explore the issue. The FGD was recorded, transcribed, translated and thematically analysed.

Results

The Medical students showed accurate knowledge regarding Borderline PD, recognising features of unstable mood, impulsiveness, and emptiness. Medical students showed binary perception, whether this patient was ‘crazy’ (waali) or not crazy. They perceived their community as a strong African Muslim population. Half the participants believed religious intervention would be helpful “I believe in Islam. So, to some degree it could be managed in certain religious centrs”. Importantly, medical students, when asked to divest of their professional identity, and to describe their personal views as members of the local population, then associated PD with craziness or madness.

Conclusion

The views of PD as craziness or ‘madness’ and the role of religious intervention have important implications for training and service development. The importance of a culturally sensitive training to medical students regarding PD in order to match cultural and religious views, and consideration of development of health services which are sensitive to religious practice is highlighted. We recommend including social and cultural implications in the training of medical students to better prepare them for the complexity of managing PD.
Introducing the Emotional Logic Method as a Self-Care Approach for Staff Well-being
Authors: England Rosie , Langsford Marian , Nainar Feroz
Published: July 2023

Aims

The Emotional Logic method teaches that although unpleasant, all emotions have an inbuilt useful purpose. Through recognising our emotional responses to situations, this solution-focused approach helps us discover the hidden losses behind our emotions, empowering us to move forwards. Activating our inner Emotional Logic can help to build emotional resilience, improve self-awareness, strengthen relationships and reduce burn out.

Methods

The Emotional Logic method was introduced to staff across the Learning Disability Psychiatry Division during a two hour webinar. The session was advertised via email circular to all staff with an emphasis on using the method for self-care. It was attended by thirty-two, clinical and non-clinical staff from across the multi-disciplinary team. Interactive polls were used during the session as well as feedback forms at the end.

Results

In Emotional Logic, a safe place is a physical place, relationship or mindset that we can visit when we are doubting our resources to cope, here we can let our emotions settle and make a plan. An interactive poll during the session showed that 98% of staff could identify a safe place. This was reduced to only 52% when asked if they could identify an accessible safe place at work.

The session overall was rated as 4.57 (on a scale of 1(poor)-5(excellent) 90% said they felt Emotional Logic was relevant to them personally, with the remaining 10% answering “maybe.” Qualitative feedback included: “I thoroughly enjoyed all aspects of the session which would benefit me personally and on a professional level” “Helped me to manage my thoughts/control my thoughts” “Its always hard to take a look at yourself and your behaviors or reactions to things that impact you on a daily basis and I think that a lot of people would find it a real benefit.” 86% said they would be interested in further learning.

Conclusion

In order to care for other people, we need to first look after ourselves. The striking statistic that 48% of staff do not have an accessible safe place at work highlighted the importance of providing staff with the tools to help improve their own well-being. The session was an introductory session, which will be built on through offering follow up workshops and formal courses. The aim of these will be to improve self-care whilst also providing a language to use with colleagues and patients to help everybody move forwards.
How Can We Better Understand and Address the Issue of Alcoholism in the British Sikh Punjabi Community? Based on the Above, How Can the Medical School Curriculum Be Improved So Clinicians Can Better Meet the Needs of the British Sikh Punjabi Community and Diverse Communities in General? a Narrative Literature Review
Authors: Kochhar Ankita , Clinch Megan
Published: July 2023

Aims

Alcoholism within the British Sikh Punjabi (BSP) community is a severe issue caused by a complex array of psychosocial, political, and cultural factors. The current biomedical model taught at UK medical schools fails to address psychosocial aspects of disease, restricting the ability for doctors to treat patients holistically. As a result, doctors under-diagnose and under-treat patients with alcohol use disorders (AUD). There is a need to understand how medical education can address the needs of communities like the BSP to ensure better treatment and management in the future.

Aims and Objectives

To explore the factors affecting alcohol consumption amongst the BSP community, as well as the barriers and facilitators they experience towards help-seeking. The results will help to make recommendations on how current alcohol-related teaching in medical school curriculums may be improved, and specifically, how to produce more culturally competent future doctors.

Methods

Two narrative literature reviews were conducted. 37 studies were included. The first search underwent thematic analysis with reference to a Public Health England framework, and the second underwent inductive thematic analysis. Key themes were discussed, analysed, and consequently the results from both literature searches were compared to produce appropriate recommendations.

Results

The first review found that alcoholism is increasing in prevalence in the BSP population. The eleven themes identified corresponded to drivers, determinants, and consequences of consumption. A prominent theme identified included ‘economic and social structures influencing alcoholism within the BSP community’, which addressed the impact of gender roles, acculturation, and racial discrimination on alcohol consumption. The second review identified two themes and three subthemes. The ‘current level of alcohol-related teaching in the curriculum’ theme highlighted that approximately 14 hours is dedicated to this crucial topic. Overall, these findings indicated the need for multifaceted interventions to change the current provision of education.

Conclusion

Currently, the BSP population fail to access treatment services due to fear of shame and stigma. Thus, doctors must be empathetic and sensitive to this, and be aware of how to explore psychosocial aspects of patient's lives and how this influences their AUD. Providing culturally competent services will ensure that holistic interventions are implemented, leading to earlier detection, prevention, and management of alcohol-related harms. This will ensure that individuals from the BSP community feel comfortable in help-seeking. Recommendations were targeted at medical schools and their students, with a predominant focus on the provision of culturally competent services.
Rewilding Medical Education
Authors: Kumar Praveen , Thonning Johanna , Santosh Ananya , Barnes Nicholas
Published: July 2023

Aims

Access to a healthy environment offers broad health benefits and has been declared a human right (UNHCR, 2021). However, despite the release of position statements by royal colleges on the climate and ecological emergency, there appears to have been limited opportunities for dissemination and sharing of knowledge, understanding and opportunities for action for many doctors and medical students in the North of Scotland. Hence, this project was aimed to create awareness on the importance of nature connectedness and explore its association with good physical and mental health and well-being. It was also so the medical students can understand the relationship between nature connectedness and the experiences in nature through active observation and hands-on engagement activities alongside acknowledging already active allies providing practical environmental volunteering activities.

Methods

9 Medical students, 3 Core Psychiatry Trainees, 1 Psychologist and 1 Child and Adolescent Psychiatrist met at Trees for Life, Dundreggan. We were introduced to 2.5 hours of mindful grounding techniques, mindful eating, connecting with nature through art along with sensory exercises such as tree hugging and trust building activities by Nature for Health. We interacted in group work to design nature-based activities that can be used in clinical practice to improve mental well-being in people living with OCD, depression, ADHD, trauma and eco-anxiety.

Results

Learning experience amidst nature was well received by participants who also gained positive effects on their own personal well-being. The project successfully brought the participants together to access, care for and enjoy green spaces whilst learning about allied programs available in the community. The participants also learnt how nature can aid mental health recovery and well-being, whilst giving people a chance to do their bit towards the fight against climate change.

Conclusion

We suggest to incorporate teachings on climate change in medical education with consideration on using green spaces as delivery sites to enhance nature connectedness (local green social prescribing opportunities such as Green Walking, Green Gym, conservation volunteering, city farms, forest schools by The Conservation Volunteers, The Wildlife Trusts and the ‘Rewild and Recover’ programme from Trees of Life). We also suggest to promote our future healthcare professionals to collaborate with other groups linking nature restoration to human health and well-being. Awareness on benefits of nature connectedness should become one of the most important aspects of medical education in this century to foster a generation of healthcare professionals with pro-nature attitudes and active engagements with the natural world.
Depictions of Mental Health in “ Top Boy ”
Authors: Quadros Wesley , Sule Akeem
Published: July 2023

Aims

Social psychiatry faces a challenging relationship with pop culture. Understanding pop culture portrayals of mental health culture could be valuable to public mental health. ‘ Top Boy ‘ is a fictional show touching upon the experience of individuals living in the grip of a mental health syndemic in inner-city London.

Methods

AS & WQ had structured discussions to analysing themes, social determinants and psychiatric correlations in Top Boy.

Results

Top Boy touches on aspects of mental health including immigration, the impact of violence, the impacts of urbanicity and deprivation syndemics, domestic abuse and PTSD.

Violence as a trigger for PTSD is illustrated in the story of Jason, a young child who is exposed to domestic violence, resulting in avoidance of this environment and association with gangster Sully. Jason becomes desensitised to violence. Greater PTSD is linked with violence in a dose-dependent fashion (Abram et al., 2004).

Sully watches Jason die after a racially motivated attack, illustrating the nested nature of such trauma as Sully develops PTSD; he is seen re-experiencing the fire. Sully can later be seen to be hyperaroused to perceived threat. Exposure to violence, particularly in the context of gang membership, is strongly associated with anxiety disorders. (Coid et al 2011)

Impacts on relationships and childhood neglect are explored through Ra'Nell and Lisa. Lisa is a single mother who's survived an abusive relationship. She becomes severely depressed resulting in her being sectioned and an extended psychiatric admission. Ra'nell, her son, falls into the narcotic trade, leading to truancy and violence. His friend Gem is seen to try drugs when forced to act as a mule. Involvement in the drug economy leads to drug dependence among gang members (Coid et al 2011).

These come together in the estate syndemic; psychiatric morbidity is exacerbated synergistically with health inequalities caused by poverty, stress, structural violence and racial discrimination. This leads to educational disadvantage through truancy in the cases of Ra'nell and Ats, who's mother suffers from the mental health effects of unemployment and deportation threat. Individuals are then more likely to interact with gangs in this syndemic environment and so the cycle of illegal activity, violence and ill health perpetuate.

Conclusion

Gang members currently will make a large contribution to mental health disability and service burden in syndemic areas. Top Boy illustrates the challenge and opportunity for public mental health in the context of such syndemics.
Study on Concordance of ICD-11, ICD-10, and DSM-5 Diagnostic Guidelines for Alcohol and Opioid Use Disorders
Authors: Afroz Omar , Agrawal Alok , Ambekar Atul
Published: July 2023

Aims

To study the implications of proposed changes in guidelines in ICD-11 in Alcohol and Opioid Use Disorder patients. To evaluate the concordance of ICD-11 with ICD-10 and DSM-5. To compare endorsement of various criteria for dependence between ICD 11 and other systems. To examine the agreement between ICD-11 and other systems with regard to the severity of dependence. To compare the application of WHO ASSIST in screening across systems.

Methods

A cross-sectional study among newly registered, adult male patients attending NDDTC OPD, or community clinics and using the substance in the last week. N = 200 (100 each of Alcohol and opioids). Instruments: Semi-structured proforma, CIDI 3, ASI-lite, WHO-ASSIST, AUDIT. Items of CIDI were used to make the diagnosis according to various systems. The diagnostic agreement was assessed by Kappa. Endorsement frequencies of the criteria were compared across diagnostic systems. Scores of scales across systems were compared using Two Independent sample t-test.

Results

The highest prevalence of Dependence was found using ICD-11. Almost perfect agreement between ICD-11 and ICD-10 for both Use Disorder and Dependence for all substances (kappa >0.8) except Inhalants. Agreement for AUD, CUD, and IUD between ICD-11 and DSM-5 was substantial but less than almost perfect. Similar findings for ICD-11 Dependence and DSM-5 Moderate-Severe Use Disorder in Benzodiazepines and Inhalants (kappa ranging from 0.693–0.790). High endorsement frequencies of Salience for Alcohol and Opioids, and Craving and Tolerance for all substances (ICD Dependence); Inability to cut down or control, Craving, and Tolerance (DSM-5 UD). Mean scores of AUDIT and ASSIST were generally lower in participants who received the diagnosis according to ICD-11 (sig. difference for CUD and Cannabis Dependence).

Conclusion

There are significant implications of the changes in ICD-11, and further testing of the impact of these changes needs to be done.
Perception of Trainees and Trainers Working in Birmingham and Solihull Mental Health NHS Foundation Trust About Exception Reporting and Its Implication on Medical Education - a Qualitative and Quantitative Research
Authors: Jehanzeb Saima , Javed Asma , Williams Katie , Tadros George , Muzaffar Sajid
Published: July 2023

Aims

The aim of this research was to explore if exception reporting (ER) has improved the work life balance of junior doctors, and if safeguards proposed during junior doctors’ contract have helped doctors in raising concerns about unsafe work patterns or any missed training opportunities.

Methods

This study was reviewed and approved by the Health Research Authority (HRA). We reviewed the number and nature of exception reports completed by trainees between January 2017 and February 2020 by analysing the available ER data (obtained from Guardian of Safe Working) and explored perception of trainees and trainers about exception reporting (ER) by using semi structured and structured surveys. The target population included Core Psychiatry Trainees, GPVTS, Speciality Trainees, Foundation year Trainees and Consultant Psychiatrists.

Results

About 383 exceptions were reported between February 2017 and February 2020 by trainees in BSMHFT. Two separate surveys emailed to trainees and trainers (between December 2020 and July 2021) collected 35 responses from trainees and 22 from trainers.

80% of the trainees had not reported any exceptions in the last one year and 57.14% of the trainers never got involved in exception reporting. Main issues reported were working unsafe hours by trainees (15%), working beyond rostered hours (52.38%) trainers and (52.38%) trainees, failing to achieve educational goals (4.76%) trainers and (10%) trainees, impact on clinical supervision (4.76%) trainers. Reasons for failing ER “Too busy (58.06%), reporting makes no difference (29.03%), a culture to discourage exceptions (29.03%), didn't have logins (16.13%), did not know how to report (35.48%), other reasons. Time off in lieu (TOIL) was commonly reported outcome by trainees (69%) and trainers (62%). 62.07% trainees and 57.14% of trainers neither agreed nor disagreed that ER had improved the quality of training.

Trainees (43.67%) and trainers (58.82%) both did not think that TOIL had resulted in reduction in training time (never 44%). 51.74 % trainees neither agreed nor disagreed that ER made any improvement to their work life balance.

Conclusion

This is the first, mixed method, research looking at both exception reporting data and perception of trainees and trainers. Emerging themes for failure to exception report are guilt, self-blame, culture to discourage, too time consuming, busy workplace, not to offend, reflects being weak.

This research can have wider implications if applied across other trusts nationally, exploring emerging themes. Reasons for declining number of ER needs further exploring of trainees’ anxiety, regarding implications and repercussions of ER, impact of TOIL on continuity of care.