bluuebunny/crossref_metadata_2025 huggingface dataset:
A core outcome set for studies evaluating interventions to prevent and/or treat delirium for adults requiring an acute care hospital admission: an international key stakeholder informed consensus study
Authors: Rose Louise , Burry Lisa , Agar Meera , Blackwood Bronagh , Campbell Noll L. , Clarke Mike , Devlin John W. , Lee Jacques , Marshall John C. , Needham Dale M. , Siddiqi Najma , Page Valerie
Published: June 2021

Background

Trials of interventions to prevent or treat delirium in adults in an acute hospital setting report heterogeneous outcomes. Our objective was to develop international consensus among key stakeholders for a core outcome set (COS) for future trials of interventions to prevent and/or treat delirium in adults with an acute care hospital admission and not admitted to an intensive care unit.

Methods

A rigorous COS development process was used including a systematic review, qualitative interviews, modified Delphi consensus process, and in-person consensus using nominal group technique (registration http://www.comet- initiative.org/studies/details/796).

Participants in qualitative interviews were delirium survivors or family members. Participants in consensus methods comprised international representatives from three stakeholder groups: researchers, clinicians, and delirium survivors and family members.

Results

Item generation identified 8 delirium-specific outcomes and 71 other outcomes from 183 studies, and 30 outcomes from 18 qualitative interviews, including 2 that were not extracted from the systematic review. De-duplication of outcomes and formal consensus processes involving 110 experts including researchers (N = 32), clinicians (N = 63), and delirium survivors and family members (N = 15) resulted in a COS comprising 6 outcomes: delirium occurrence and reoccurrence, delirium severity, delirium duration, cognition, emotional distress, and health-related quality of life. Study limitations included exclusion of non-English studies and stakeholders and small representation of delirium survivors/family at the in-person consensus meeting.

Conclusions

This COS, endorsed by the American and Australian Delirium Societies and European Delirium Association, is recommended for future clinical trials evaluating delirium prevention or treatment interventions in adults presenting to an acute care hospital and not admitted to an intensive care unit.
A systematic review of prediction models to diagnose COVID-19 in adults admitted to healthcare centers
Authors: Locquet Médéa , Diep Anh Nguyet , Beaudart Charlotte , Dardenne Nadia , Brabant Christian , Bruyère Olivier , Donneau Anne-Françoise
Published: June 2021

Background

The COVID-19 pandemic is putting significant pressure on the hospital system. To help clinicians in the rapid triage of patients at high risk of COVID-19 while waiting for RT-PCR results, different diagnostic prediction models have been developed. Our objective is to identify, compare, and evaluate performances of prediction models for the diagnosis of COVID-19 in adult patients in a health care setting.

Methods

A search for relevant references has been conducted on the MEDLINE and Scopus databases. Rigorous eligibility criteria have been established (e.g., adult participants, suspicion of COVID-19, medical setting) and applied by two independent investigators to identify suitable studies at 2 different stages: (1) titles and abstracts screening and (2) full-texts screening. Risk of bias (RoB) has been assessed using the Prediction model study Risk of Bias Assessment Tool (PROBAST). Data synthesis has been presented according to a narrative report of findings.

Results

Out of the 2334 references identified by the literature search, 13 articles have been included in our systematic review. The studies, carried out all over the world, were performed in 2020. The included articles proposed a model developed using different methods, namely, logistic regression, score, machine learning, XGBoost. All the included models performed well to discriminate adults at high risks of presenting COVID-19 (all area under the ROC curve (AUROC) > 0.500). The best AUROC was observed for the model of Kurstjens et al (AUROC = 0.940 (0.910–0.960), which was also the model that achieved the highest sensitivity (98%). RoB was evaluated as low in general.

Conclusion

Thirteen models have been developed since the start of the pandemic in order to diagnose COVID-19 in suspected patients from health care centers. All these models are effective, to varying degrees, in identifying whether patients were at high risk of having COVID-19.
Which species discovers novel food sources first? A camera trap study in a natural environment
Authors: Randler Christoph
Published: June 2021

Birds underlie a predation-starvation risk, and foraging should show a diurnal/circadian pattern. Camera traps were used to study visitation patterns and discovery of a novel food source in woodland birds in SW Germany. A total of 18 species occurred at feeders with nine of them being exploratory species. Great Tits (Parus major) discovered novel food sources first in most instances, and first discoveries occurred on average at 10:38, while it took 97 h for the first detection of the food source. Population size was correlated with discovery. The study supports the predation-starvation risk hypothesis with discovery of food sources in the morning.
How text sentiment moderates the impact of motivational cues on crowdfunding campaigns
Authors: Yuan Xiang , Wang Luyao , Yin Xicheng , Wang Hongwei
Published: June 2021

Arousing funders’ motives for crowdfunding participation is a challenge for every entrepreneur. According to self-determination theory, crowdfunding involvement is driven by two kinds of motivations: extrinsic and intrinsic motives. Campaign narratives with different sentimental orientations could act as cues triggering funders’ motives of capital-giving differently. Thus, we focus on the moderating effect of text sentiment on the motivational cues in crowdfunding campaigns. We hypothesize that the sentiment of campaign narratives moderates the relationship between motivational cues and fundraising success. Data are selected from 270,000 campaigns of the crowdfunding website Indiegogo. Empirical analysis demonstrates that the sentiment strength positively moderates the effect of intrinsic motives on fundraising success but negatively moderates the impact of extrinsic motives on fundraising success. The findings provide managerial insights for practitioners to stimulate specified motives by using the narratives with proper sentiment strength.
Do the RMB exchange rate and global commodity prices have asymmetric or symmetric effects on China’s stock prices?
Authors: Long Shaobo , Zhang Mengxue , Li Keaobo , Wu Shuyu
Published: June 2021

With the rapid expansion of the RMB exchange rate’s floating range, the effects of the RMB exchange rate and global commodity price changes on China’s stock prices are likely to increase. This study uses both auto regressive distributed lag (ARDL) and nonlinear ARDL (NARDL) approaches to explore the symmetric and asymmetric effects of the RMB exchange rate and global commodity prices on China’s stock prices.
Our findings show that without considering the critical variable of global commodity prices, there is no cointegration relationship between the RMB exchange rate and China’s stock prices, and the coefficient of the RMB exchange rate is not statistically significant. However, when we introduce global commodity prices into the NARDL model, the result shows that the RMB exchange rate has a negative effect on China’s stock prices, that there indeed exists a long-run cointegration relationship among the RMB exchange rate, global commodity prices, and stock prices in the NARDL model, and that global commodity price changes have an asymmetric effect on China’s stock prices in the long run. Specifically, China’s stock prices are more sensitive to increases than decreases in global commodity prices. Thus, increases in global commodity prices cause China’s stock prices to decline sharply. In contrast, the same magnitude of decline in global commodity prices induces a smaller increase in China’s stock prices.
Role of CT scan thorax in nCovid19—a case-based review
Authors: Moleyar Vishnu sharma , Noojibail Anupama , I Nagaraj shetty , D S Harsha , M Nithish Bhandary
Published: June 2021

Background

Most of the morbidity and mortality in nCovid19 is due to pneumonia which can be reduced by early diagnosis and treatment. Chest CT scan plays an important role in the early diagnosis and management of respiratory complications due to nCovid19. Clinicians should be aware about the indications for the CT scan of the thorax, timing of investigation, and limitations of CT.

Main body of abstract

Chest CT scan is indicated in patients with moderate to severe respiratory symptoms and pretest probability of nCovid19 infection, when RT-PCR test results are negative, and in patients for whom an RT-PCR test is not performed or not readily available. When a rapid antigen test is negative and an RT-PCR test report takes time, CT can be used in seriously ill patients to decide whether it is COVID or not. For patients who are dependent on oxygen even after 2 weeks, CT may help to show the extent of lung involvement and predict long-term prognosis. CT may be done to exclude nCovid19 pneumonia. For patients with high risk for nCovid19 who require an immediate diagnosis to rule out lung involvement, CT can be done. A normal CT excludes nCovid19 pneumonia. CT scan is required in confirmed cases of nCovid19 pneumonia when complications are suspected clinically. These include pulmonary thromboembolism, pneumothorax, mediastinal/surgical emphysema, bacterial pneumonia, and unexplained deterioration with new shadows in chest X-ray. CT pulmonary angiogram is indicated when pulmonary embolism is suspected, and in other cases, plain CT should be done. In pre-operative cases where emergency surgery is required, nCovid19 disease is suspected clinically, and RT-PCR report awaited or not available, CT thorax can be done.

Conclusion

CT scan is useful for early diagnosis of lung involvement, detection complications, triaging of cases, risk stratification, and preoperative evaluation in select cases. CT scan should be done only when there is a definite indication so to reduce radiation hazards and to reduce health care expenditure. Normal CT excludes nCovid19 lung involvement, but the patient may have upper respiratory involvement which may progress later to involve lungs.
Vitamin D deficiency in a high secure forensic psychiatry hospital: A clinical audit and service evaluation
Authors: Gillett George , Chudleigh-Warren Samantha , Hardy Benedict , Gordon Charles Robert
Published: June 2021

Aims

To assess concordance with guidelines on monitoring vitamin D levels and prescribing prophylaxis or replacement. To assess the association between the implementation of local guidelines and prevalence of vitamin D deficiency.

Background

Vitamin D deficiency is associated with various adverse health outcomes including osteoporosis, fractures and myalgia. Most recently, vitamin D deficiency has been hypothesised as a risk factor for severe COVID-19 infection. Risk factors for vitamin D deficiency include incarceration, ethnicity, diet and a diagnosis of psychiatric disorder. Vitamin D deficiency is known to be prevalent among individuals within forensic mental health institutions.

Local Trust guidelines advise that vitamin D levels should be checked within one-month of hospital admission, followed by checks at three-monthly intervals. Recommendations for prescribing depend on patients’ vitamin D levels; deficient (<25nmol/L), insufficient (25 < 50nmol/L) or adequate (50-150nmol/L). We assessed concordance with these guidelines at Broadmoor Hospital, UK.

Method

Medical records, laboratory results and drug charts were assessed for a total of 75 patients across 15 wards. Data were collected using a standardised audit tool, including; date of admission, admission vitamin D level, most recent vitamin D level and the dose and frequency of vitamin D prescribed.

Result

76.4% of patients had their vitamin D levels checked within one month of admission. 66.7% of patients had their vitamin D checked within the last 3 months. For patients with an admission vitamin D level recorded, 43.6% had deficient vitamin D levels, 43.6% had insufficient levels and 12.7% had adequate levels. For patients with a more recent serum vitamin D level, 14.5% had deficient levels, 38.7% had insufficient levels and 46.8% had adequate levels. For patients with a documented serum vitamin D level, 21.4% were prescribed the correct dose, 22.9% were under-dosed, 14.3% were over-dosed and 41.4% received no dose where guidelines suggested they should.

Conclusion

Comparison of admission and most recent vitamin D levels suggests a general improvement in prevalence of vitamin D deficiency associated with the implementation of local guidelines. However, we identify significant areas for improvement. A substantial proportion of patients lacked admission or regular monitoring of vitamin D levels and a substantial proportion of patients were under-dosed or received no dose where guidelines suggested they should have. We propose that better concordance with guidelines may improve clinical outcomes further. This may prove especially important during the COVID-19 pandemic, given a potential association between vitamin D deficiency and severity of respiratory infection.
Validation of the internet addiction test (IAT) to Sinhalese and assessment of internet addiction among school children in Sri Lanka
Authors: Gunathillaka Kavinda , Wijesinghe Chamara , Gunasekera Trivon , Premathilake Bhagye , Rodrigo Asiri , Pathmeswaran Arunasalam , Kuruppuarachchi Lalith
Published: June 2021

Aims

To translate Young's Internet Addiction Test (IAT) to Sinhalese and validate for use in a Sri Lankan population. Following validation of the questionnaire, to use the validated questionnaire to assess the prevalence of internet addiction in a school going population in the Western province of Sri Lanka and identify characteristics of those addicted to the internet.

Background

The internet is widely used across the world and in Sri Lanka. Though essential for everyday life there are many negative aspects of internet use. Addiction to the internet is one such problem and identified to exist among the general population and students in other countries. The most common tool used to measure internet addiction is Young's internet addiction test. The phenomena of internet addiction has not been scientifically studied in Sri Lanka according to our knowledge.

Method

A school-based cross-sectional analytical study conducted in two stages among students aged 15 to 19 years. In stage 1 of the study, 200 students were administered the Sinhalese translation of the IAT and internal consistency and test retest validity assessed. Once validation of the scale was established the translated scale was used on a sample of 2800 students to assess presence of internet addiction.

Result

The Sinhala translation of the Internet addiction test showed good reliability and validity The Chrohnbach's alpha value was 0.78 and Pearson correlation coefficient of 0.85 and therefore suitable to use in a Sinhalese speaking population in Sri Lanka.

Internet addiction was identified among the study population. 8% of the entire study sample and 12.6% among those using the internet showed features of internet addiction. The majority of cases of internet addiction identified were mild 8.2% followed by moderate internet addiction in 3.6% and only 0.9 % having severe internet addiction. There were no significant demographic or internet use related features identified among those with internet users and those not addicted to the internet.

Conclusion

This study demonstrated that the Sinhala translation of Young's IAT is suitable to assess internet addiction in Sri Lanka. It also identified that there are students in Sri Lanka who are addicted to the internet. This will possibly impact negatively on their lives at a crucial stage of development and have immediate as well as long term detrimental effects. More studies are required to identify characteristics of those who are addicted to the internet and to plan interventions.
Differential attainment in undergraduate medical education: a systematic review
Authors: Gupta Abhishek , Varma Shreya , Gulati Radhika , Rishi Natasha , Khan Nagina , Shankar Rohit , Dave Subodh
Published: June 2021

Aims

Differential attainment (DA) amongst Black and Minority Ethnic (BAME) medical students and postgraduate trainees including Psychiatry trainees has been extensively documented in medical education, with non-white medical students being 2.5 times more likely to fail high-stake examinations compared to their White counterparts. The Equality Act 2010 places a responsibility on public bodies such as Royal Colleges to address discrimination in training and assessment. Understanding DA in undergraduate medical education can help understand DA in the postgraduate setting. Consequently, this systematic review aims to detect the processes that enable and impede DA in UK undergraduate medical education.

Method

Seven online databases including PubMed, Scopus, PyschInfo, and ERIC were searched. A formal grey literature search was also conducted. Inclusion criteria comprised studies dated from January 1995 to present and included UK undergraduate medical students. We present the preliminary findings from 13 papers, analysed to create a conceptual framework for a further mixed methods analysis. The studies were critically appraised for methodological quality.

Result

Five key themes emerged from the preliminary analysis of 13 papers. BAME students experienced:

Being ‘divergent’: Not feeling part of the current organisational learning milieu

Lack of social capital: Difficulty in being absorbed into existing ‘networks’ of relationships in a manner that is ‘approachable’ and not ‘intimidating’

Continuum of discrimination: ‘Indirect’ impact of subtle communication processes in the learning environment undermining individual ‘belief’ in own performance

Institutional discriminatory factors: Culture, rules, norms, and behavioural routines of educators that lead to differential outcomes for learners

Lack of external support: Relative lack of interventions tackling DA.

Conclusion

The key finding of this review is that British BAME undergraduate medical students experience discriminatory behaviours early in medical schools that impact on personal, educational, and professional outcomes. These factors may need to be borne in mind by postgraduate training organisations such as the Royal College of Psychiatrists as they commence the challenging task of addressing DA.
TMS-EEG indexes abnormal GABAergic signalling in patients with schizophrenia
Authors: Shergill Sukhwinder S , Santoro Viviana , Rocchi Lorenzo , Hou Meng Di , Premoli Isabella
Published: June 2021

Aims

Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation tool designed to probe the strength of inhibitory and excitatory neurotransmission in the cortex. Combined with electromyography, paired-pulse TMS paradigms have revealed a deficit in inhibition mediated by GABA-A receptors in patients with schizophrenia. Combined TMS-electroencephalography (TMS-EEG) provides a more detailed examination of cortical excitability and may shed more light into the pathophysiology of schizophrenia. Of the various peaks of the TMS-evoked EEG signal, responses at 45 (N45) and 100 ms (N100) likely reflect GABA-A and GABA-B receptor-mediated inhibition, respectively. Responses at 25 ms (P25) are affected by voltage-gated channel ligands, whereas glutamatergic processes may be related to the P70 component. We here aim to systematically investigate the role of these neural processes in patients with schizophrenia by using TMS-EEG.

Method

TMS-evoked EEG potentials (TEPs) were recorded in patients with schizophrenia (n = 19) and in age-matched healthy controls (n = 17). 150 TMS pulses at 90% of resting motor threshold were applied over the left primary motor cortex during EEG recording. Differences in TEPs between the two groups were analysed for all electrodes and for time windows corresponding to each TEP (P25: 0.015-0.035 ms; N45: 0.035-0.06 ms; P70: 0.035-0.06 ms; N100: 0.09-0.14ms) by applying multiple independent sample t-tests. Further, a cluster-based permutation analysis approach was implemented to correct for multiple comparisons.

Result

Compared to controls, patients showed amplitude reduction for the P25 (negative and positive cluster; p < 0.001 and p = 0.04, respectively), N45 (negative and positive cluster; p < 0.001 and p = 0.001, respectively) and P70 component (negative and positive cluster; p = 0.04 and p = 0.004, respectively).

Conclusion

There results extend on previous literature about impairment of GABA-A receptor mediated inhibition in schizophrenia, as demonstrated by the N45 amplitude reduction, whereas no significant differences in GABA-B index (i.e., N100) were revealed. Our results also showed that, although specific mechanisms underlying P25 and P70 have not been fully elucidated yet, excitatory neurotransmission is altered in this clinical population. To conclude, TMS-EEG may provide a more comprehensive view of the inhibitory and excitatory mechanisms involved in the pathophysiology of schizophrenia.
Prevalence of psychosocial distress in school going adolescents in rural Pakistan: findings from a cross-sectional epidemiological survey
Authors: Hamdani Syed Usman , Huma Zill-e- , Javed Hashim , Warraitch Azza , Rahman Atif , Nizami Asad Tameezuddin , Minhas Fareed Aslam
Published: June 2021

Aims

Early interventions are recommended in adolescents to prevent long-term psychiatric morbidity. However, in Low and Middle Income Countries (LMICs), where there are no child and adolescent mental health services, early identification of adolescents at-risk of mental health problems remains a challenge. Pediatric Symptoms Checklist (PSC) is used in preventive child healthcare services in a number of high income countries for early identification of children and adolescents in need of mental health services. The aim of this study was to assess the reliability and validity of self-rated, Urdu version of PSC to identify at-risk adolescents studying in the public schools of rural Rawalpindi in Pakistan.

Method

We did a cross-sectional epidemiological survey with all adolescents aged 13–15 years, studying in 41 public schools of Kallar Syedan sub-district in Rawalpindi, Pakistan. An adapted Urdu version of self-reported PSC was used to assess the psychosocial distress in adolescents in-terms of externalizing, internalizing and attention problems. Strengths and Difficulties Questionnaire (SDQ) was used as a gold standard measure. Youth version of PSC and SDQ were administered in classroom settings by trained research teams.

Result

The data were collected from 5856 adolescents (response rate 97%) between April-May, 2019. The mean age of the participants was 14.37 years (±1.06); 51% participants were female. The internal consistency reliability of Urdu version of PSC was good (Cronbach alpha 0.85). At the standard cut-off score of PSC ≥28, the prevalence rate of psychosocial distress in adolescents was 25.5% (27.4% in boys & 23.6% in girls). Using the SDQ total difficulties score ≥16 as a standard criterion; the area under the ROC curve was 0.85 (95% CI 0.82–0.88), with a sensitivity of 57.64% and specificity of 89.10% of PSC. If the sensitivity and specificity of PSC is optimized to 76% at the cut-off score of PSC ≥ 24, the prevalence rates of psychosocial distress in adolescents is increased to 41%.

Conclusion

In our study, 1 in 4 adolescents in public schools of rural Rawalpindi in Pakistan have been identified at-risk of poor socio-emotional development. Urdu version of PSC is a reliable and valid tool to identify adolescents in need of psychosocial interventions in public schools of rural Pakistan. While the standard cut-off score yields a better specificity; PSC with relatively lower cutoff score can be used a screening tool to identify at-risk adolescents in public schools of rural Pakistan.
Transition from Methylphenidate to Atomoxetine: reasons for switching and clinical outcome
Authors: Cassar Fabrizia , Grech Giovanni , Grech Bertha , Cassar Joseph
Published: June 2021

Aims

Attention Deficit Hyperactivity Disorder (ADHD) is a behavior disorder originating in childhood comprising of a constellation of features including inattention, impulsivity, and hyperactivity. The National Institute of Clinical Excellence (NICE) Guidelines 2018 recommends methylphenidate as a first line pharmacological agent for treatment of children aged 5 years and over with ADHD. Lisdexamfetamine, dexamfetamine and atomoxetine are recommended in this order if methylphenidate is not tolerated or if symptoms did not respond to separate 6-week trials. Our aim was to, assess the transition of methylphenidate to atomoxetine, the reasons for switching and its clinical outcome in order to make recommendations to current practice regarding treatment of ADHD.

Method

The study examined a total of 53 children between 0-16 years of age who were being treated for ADHD with atomoxetine at CYPS till September 2018. Data was collected from patients’ files retrospectively by using a proforma based on the NICE guidelines 2018 ADHD: diagnosis and management.

Result

Out of 53 patients’ on atomoxetine in September 2018, 49 were included in the study. Results recorded side-effects as the main reason for switching from methylphenidate to atomoxetine. Unwanted side-effects were documented in 71.7% of patients of which 57.9% exhibited more than 1 side-effect with the two commonest side-effects documented being weight loss and decreased appetite. The audit highlighted the fact that the correct dose of atomoxetine was only administered in 17.2% of children with 56.9% of patient's being given a higher dose than recommended. Initial weight was not documented in 19% and hence, ideal dose could not be calculated. Overall, atomoxetine was shown to be an effective treatment. Out of the 40 patients documented to have hyperactivity this symptom was decreased in 82.5% whilst 82.9% were shown to have increased concentration. 35 patients had documented impulsivity and this was decreased in 62.9% of cases. 11 patients had documented anxiety with 72.7% being treated effectively with atomoxetine. 31% of patients’ had documented side-effects with 16% of these being tics. 20% of patient's required augmentation.

Conclusion

The results indicate that the majority of doctors at CYPS in Malta adhered to the NICE guidelines 2018 and atomoxetine was proven to be efficacious as a second line drug in the treatment of ADHD. However, better adherence to NICE guidelines is required when it comes to the calculation of appropriate dosage. Our prediction is had dose recommendations according to weight been adhered to there may have been less side-effects documented.
Reasonable adjustments for autistic adults
Authors: Hashmi Nazish , Davidson Conor
Published: June 2021

Aims

To embed the use of reasonable adjustments for adults with autism within in mental health services.

Objectives

The objectives of the project are as follows:

To identify how many service users with a diagnosis of autism are under care of local mental health services

Is there evidence that reasonable adjustments were considered for these service users

If identified as needing reasonable adjusments is there evidence of such adjustments being made

Method

We looked at service users with an established diagnosis of autism under care of Leeds and York NHS foundation trust to ascertain if reasonable adjustments have been considered. The audit is based on guidelines provided by Think Autism-department of health statutory guidance 2014. This is based on autism act 2009.

Data were collected for 30 cases in mainstream mental health services undr care of various teams including inpatient and community.

Result

It was identified that in only 2/30 cases reasonable adjustments were considered and agreed upon. Only 1/30 service users had a disability status updated on electronic patient records. None of the service users had a hospital passport or reasonable adjustment care plan completed.None of the records had “good evidence” of reasonable adjustments.

These findings point to a wider issue for the trust as well as natioanlly as it indicates that autism is not being adequately taken into account for patients accessing our services. Due to the lack of reasonable adjustments adults with autism are potentially at increased risk to disengage leading to deterioration in their mental state and increase in risks.

Conclusion

These findings point to a wider issue for the trust as it indicates that autism is not being adequately taken into account for patients accessing our services. Due to the lack of reasonable adjustments adults with autism are potentially at increased risk to disengage leading to deterioration in their mental state and increase in risks.

We recommend training in autism for all healthcare professionals in the trust to improve their understanding of autism, including making reasonable adjustments.

We also recommend review trust procedure about recording diagnoses and disability status on electronic patient records. We recommend that the reasonable adjustments section on care director is more prominent and easily accessible.

We recommend that an ‘autism flag’ is prominent on patient records to alert staff to the presence of autism
Audit on clozapine dose and plasma level correlation for patients with chronic treatment-resistant psychosis
Authors: Macnamara Olivia , Lawton John , Lankappa Sudheer
Published: June 2021

Aims

Clozapine is associated with a risk of severe adverse events for which there are current monitoring systems are in place; however, there are no established regimens for monitoring of clozapine plasma levels. Recent Medicines and Healthcare products Regulatory Agency (MHRA) guidance advises clozapine levels should be monitored in certain clinical situations where toxicity may be suspected. This audit aimed to evaluate current practice of clozapine level monitoring within one Local Mental Health Team (LMHT).

Method

Electronic (RiO) records of 41 patients (33 male, 8 female; aged from 27 to 76 years; mean age 45 years) registered to the ZTAS system within the Nottingham City Central LMHT were reviewed. 46% had been on clozapine for over 16 years. 73.3% of patients were within clusters 12 and 13; 25.4% of patients were in cluster 11, with one patient in cluster 8. Dates of clozapine plasma level tests for each patient between 2006 and 2020 were found on the electronic NoTIS system, along with clozapine, norclozapine and total clozapine levels. Concurrent clozapine dose and regimens were obtained from pharmacy records from 2018 onwards.

Result

273 clozapine plasma levels were conducted between 2006 and 2020. The average interval between levels taken was 10 months, 2 weeks but had a wide range, the shortest interval being 2 days, the longest being 13 years. 88 levels taken were >600 ug/L, suggesting increased toxicity risk. 108 levels were <350 ug/L, suggesting possible sub-optimal dosing or non-compliance. Statistical tests on correlation coefficient, although statistically non-significant (R = 0.37), showed a positive trend between total clozapine dose and the plasma level between all 3 parameters (i.e. clozapine, norclozapine and total clozapine).

Conclusion

There does not appear to be any routine plasma clozapine level monitoring throughout the LMHT with an average interval between tests of 10 months. There was a non-significant but positive trend between total daily dose of clozapine and clozapine level. 32% of clozapine levels returned were higher than the recommended level. We would recommend as suggested in the guidelines from MHRA, clozapine plasma levels should be monitored in certain clinical situations with increased toxicity risk. Trough levels should be taken with records of time of previous dose taken. Limitations of this study included a small sample size (41 patients) with data collection reliant on electronic systems. It was unclear if these results represent trough levels, making values difficult to interpret. Multifactorial impact on clozapine metabolism causes wide patient variability in plasma levels.
Developing resilience and promoting positive mental health strategies in university students
Authors: Kacic Viktor , Zimmerman Frank , Milbourn Ben , Girdler Sonya , Black Melissa , Bölte Sven , Hayden-Evans Maya
Published: June 2021

Aims

Suicide is one of the leading causes of death in young people living in Australia, accounting for 7.3% of all deaths among individuals aged 15–19 years. Historically, high levels of suicide have been recorded in Australian university students. This project aims to develop and test a massive online course-program (MOOC) for university students, underpinned by literature and strength-based suicide prevention principles, building resilience and awareness of mental health promoting activities.

Method

A scoping review of the literature was undertaken to explore the effectiveness of current suicide prevention programs for undergraduate university students, and the effective elements contributing to the success of these programs. Six electronic databases were searched to identify relevant literature. Further, mental health consumers and university students were involved in co-producing the content of the six modules of the ‘Talk-to-me' MOOC.

Result

Nine articles were included in the review, discussing four types of programs including; gatekeeping, education, promotional messaging and online consultation. It was apparent from this review that there is a significant dearth of interventions and programs currently available to reduce the risk of suicide among undergraduate students, with many of the programs having limited efficacy. Despite this, a number of program elements were identified as beneficial to preventing suicide among post-secondary students including upskilling of students, and improving resilience, and self-management. These findings and further consultation with mental health consumers and undergraduate university students underpinned the development of the content of the ‘Talk-to-me' MOOC which is tailored to meet the needs of university students. The MOOC contains six modules: Mental fitness; strategies to increase mental fitness; self-harm; suicidal behaviour in young adults; interventions for suicidal behaviour; and, gatekeeper interventions. Two case study senarios depicting mental health challenges commonly experienced by yound adults portraying appropriate crisis communication skills were developed and filmed complementing the six ‘Talk-to-me' modules.

Conclusion

Overall, studies included in the review provide evidence to suggest that preventative programs, incorporating an educational component may be effective to be used in the MOOC to improving help-seeking behaviours among post-secondary education students. Findings from this review have underpinned the development of the ‘Talk-to-Me' MOOC which was launched in March 2020. To date this MOOC has enrolled over 45,000 participants from over 150 countries, with the average age of users being 24 years. Collectively, this line of work highlights that MOOCs are an effective means of mental health promotion to young adults.
Increasing staff confidence about domestic abuse identification, disclosure and safeguarding in a community mental health team
Authors: McCausland Beth , Minicozzi Nicola , O'Halloran Siobhan , Ward Avril , Elliott Kerry
Published: June 2021

Aims

To increase staff confidence about identifying Domestic Abuse (DA), particularly regarding ‘how to ask’ to encourage disclosure and the pathways available for appropriately safeguarding survivors; in a Community Mental Health Team (CMHT) setting.

Background

DA is bi-directionally associated with mental health (MH) disorders; 1:4 women in contact with MH services are currently experiencing DA. MH professionals (MHPs) are in a privileged position to identify DA and support survivors. However, this is dependent on MHPs receiving adequate training about DA. For this, we collaborated with Pathfinder, a national pilot project run by a consortium of five expert partners that aims to establish comprehensive health practice in relation to DA and Violence Against Women & Girls in Acute Hospital Trusts, MH Trusts and Primary Care. In Southampton, Pathfinder has funded two domestic and sexual abuse (DSA) advocates to both train MH staff and take a small caseload of MH service users who are experiencing abuse.

Method

We conducted a baseline survey of staff confidence across the following domains:

Knowing the legal definition of DA,

The process used to escalate a DA concern,

How to make a referral,

How to complete DASH forms,

How and when to refer to Pathfinder,

What the following acronyms mean: PIPPA, MAPPA, MARAC, IDVA, DASH,

What HRDA and MASH mean,

How to ask about DA,

Who to signpost service users to if they make a disclosure, and when to involve the police.

We presented the survey results at the regional Pathfinder strategic group, with Trust management representatives present. This project fits within the strategic group's sustainability aims to increase DA awareness and safeguarding processes across the Trust.

The Pathfinder funded DSA Advisors delivered a four-hour training package targeting the surveyed questions and wider information on DA. We then re-surveyed to see if staff confidence had increased. We are currently analyzing the number of referrals to the Pathfinder service pre- and post-training.

Result

Staff confidence increased across all domains following the training (% mean increase): Qs1 (35%), Qs2 (9%), Qs3 (45%), Qs4 (81%), Qs5 (25%), Qs6 (49%), Qs7 (89%), Qs8 (62%) and Qs9 (48%).

We have now arranged a bi-monthly drop-in at the CMHT by the DSA advisor who provided the training, to embed the link between the services and maintain staff confidence. We will circulate these results to advocate that this training is provided across the Trust.
Audit on High Dose Antipsychotic Treatment (HDAT) Monitoring at Rampton Hospital
Authors: Das Astha , Yanson Ian
Published: June 2021

Aims

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High Dose Antipsychotic Treatment defined as 100% of the maximum recommended dose in British National Formulary, either as single agent or in combination.

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HDAT and poly-pharmacy may be linked to heightened mortality for psychiatric patients. The Committee on Safety of Medicines, Medicines and Healthcare Products Regulatory Agency recommended ECGs, electrolyte monitoring after each dose escalation, and 6 monthly intervals.

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The Royal College of Psychiatrists in 2006 suggested some justifiable cases of temporary poly-pharmacy with careful monitoring.

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This audit has been done in past to improve standards, especially in High Secure Setting where prescribing HDAT is a common practice

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To audit adherence to “HDAT monitoring guidelines” including regular monitoring of bloods, physical observations and ECG , done after every dose escalation plus at every 6 months.

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To monitor compliance with consent to treatment documentation including reasons of being on HDAT, documentation of physical health monitoring results

Method

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All patients prescribed high dose antipsychotic (regular and as required) were identified by treating Consultants and also going through drug cards.

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One year retrospective review of haematological, ECG and physical observations were identified through Electronic notes

Result

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6 % of patients received HDAT within Rampton Hospital in 2018(12 males’ vs 6 females).

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All patients on Regular HDAT had yearly TFT done whereas only 71% had prolactin monitoring done.

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Approximately 50-60% of patients had quarterly blood monitoring including glucose, electrolytes, lipids, liver function test and full blood count.

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About 40% of patients had quarterly ECG monitoring recorded.

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100% patients on regular HDAT had quarterly physical observation monitoring compared to 81% patients on HDAT (including PRN).

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Consent forms were completed for all patients on HDAT. 85% patients on regular HDAT has the reasons for treatment documented in the notes compared to 100% patients on HDAT (including PRN).

Conclusion

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Improvement in monitoring of blood parameters and cardiac function (ECG) 40-60% as compared to 2014 audit (8% to 23%).

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Yearly monitoring of TFTs and Prolactin also appeared better (100% and 71%) which was (88% and 72% in 2014).

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Quarterly physical observations were recorded in 77% patients on regular HDAT in 2014 which improved to 100% in 2018.

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There was slight difference for those who were on PRN (77% to 81%). All prescribers informed about results and reminded of recommended guidelines

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Reaudit in 2021-22 to measure change in clinical practice in prescribing HDAT.
What is mental wellbeing?
Authors: Baldwin David , Sinclair Julia , Simons Gemma
Published: June 2021

Aims

To explore the theory of wellbeing and to propose an operational definition for wellbeing in doctors.

Hypothesis: An operational definition for wellbeing in doctors is needed in order for it to be measured and interventions to improve it developed.

Background

There is no internationally recognised definition for wellbeing and yet wellbeing is an increasingly fashionable topic of research and development, including in doctors. This is because wellbeing can be described using either hedonist, or eudonist philosophy and there is a lack of conceptual clarity about what wellbeing is, and how it works. Research into the measurement of mental wellbeing has been dominated by individualist societies, with the inherent bias towards measuring self-centred components and not the other-orientated components that might be valued more in collectivist societies and by doctors.

Method

The Centre for Workforce Wellbeing (C4WW), a collaboration between the University of Southampton and Health Education England, was created to support research into the nature, assessment and enhancement of wellbeing in physicians. A literature review of the philosophy, definition and measurement of wellbeing was undertaken with a focus on mental wellbeing at work and specifically in doctors.

Result

A concept map of the relationship between wellbeing terms has been created and was used to understand and classify where mental wellbeing itself was being defined and measured in studies, as opposed to a component of wellbeing, or determinant of wellbeing. Thematic analysis was used to develop an operational definition of wellbeing for doctors.

Conclusion

Measurement of wellbeing and interventions for wellbeing cannot be developed if you cannot clearly define what wellbeing is. An operational definition of mental wellbeing in doctors is ethically required to prevent research waste and to allow us to identify and recreate when doctors thrive, not just survive.

Health Education England funded PhD.
Representation of #CAMHS on social media platform TikTok
Authors: Chadee Preetisha , Evans Sacha
Published: June 2021

Aims

The video-based free social media app, TikTok, has grown in popularity during the COVID-19 pandemic, with half of British children using Tik Tok regularly. With more than 2 billion downloads, it was the most downloaded app of 2020. Child and Adolescent Mental Health Services (CAMHS) is currently found on TikTok via the hashtag #CAMHS. The aim of this study was to explore how CAMHS is represented on TikTok through reviewing the hashtags associated with CAMHS and exploring the themes of videos with the #CAMHS hashtag.

Method

The Tik Tok app was downloaded and a search for the hashtags which featured the word #CAMHS was undertaken. A thematic analysis of the top 100 most popular uploaded videos featuring the #CAMHS was conducted. The number of likes, views and shares of the videos featuring each theme was recorded.

Result

Videos with the hashtag #CAMHS had 203.9 million views, followed by: #camhsmeme(s) totalling 43.1 million views, #camhsjokes with 21.4 million views and #camhskids, 12.5 million views. The top 100 most popular videos represented 24% of total viewed videos with the hashtag #CAMHS.

The most popular recurrent themes associated with the hashtag #CAMHS in our sample were: raising awareness of mental health symptoms and management (40% of videos), reference to self-harm (27% of videos) and negative perception of CAMHS (27% of videos).

Raising awareness of mental health symptoms and management had the most likes (3,694,700) and views (17,435,900). This was followed by videos with themes of reference to self-harm (3,006,300 likes and 14,382,700 views). The most shared themes were: reference to suicide (shared 56,763 times) and videos which portrayed a theme of negative perception of CAMHS (40,628 shares). Videos with themes of a negative perception of CAMHS also garnered 1,762,500 likes and 8,666,900 views.

Conclusion

CAMHS is actively represented on TikTok through freely accessible unregulated videos. Videos with themes of raising awareness of mental health symptoms and management can potentially allow young people to share their experiences. Nonetheless, popular hashtags such as #CAMHSmemes and #CAMHSjokes, as well as videos featuring themes of negative perception of CAMHS, could potentially undermine the reputation of CAMHS to existing and future service users. The content of these videos should be taken seriously by CAMHS clinicians as it can potentially provide an insight into service users’ experiences of CAMHS on a scale that has not been observed before. Presently these videos are not screened or modulated by the NHS CAMHS service.