bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving COVID-19 Vaccination Uptake in Service Users Admitted to an Acute Inpatient Psychiatric Ward
Authors: Holliday Miranda , Stock Lisanne , Patel Bhina , Natour Fidaa , Cohn Victor , Chavarri Mercedes
Published: June 2022

Aims

It is well known that individuals suffering from mental illness have more comorbidities and lower life expectancies compared to the general population. It is unsurprising therefore, that these individuals are more vulnerable to both contracting COVID-19, and developing severe illness if infected. When patients are admitted to a psychiatric inpatient unit this offers an invaluable opportunity to ensure that unvaccinated patients are identified, and if consenting, are supported to receive whichever dose of the vaccine they require. We undertook an audit to examine the proportion of patients admitted who had not received their first, second or third dose of the COVID-19 vaccination. Reviewed in the context of gender, age, ethnicity, legal status, mental health diagnoses and additional comorbidities, in order to determine any trends that might assist in improving uptake. We then repeated the audit aiming to offer the appropriate COVID-19 vaccination to every newly admitted unvaccinated patient. If refused, to then council reluctant patients, providing simple, understandable vaccine information, and to re-offer vaccination.

Methods

The audit took place on a mixed adult psychiatric inpatient ward in London.

The first cycle of the audit was completed retrospectively. Data were collected from the electronic notes of new admissions from November and December 2021 (total 41). This included information on COVID-19 vaccination status, and documentation of vaccines offered and administered during admission. Additional information was also compiled to calculate risk stratification scores.

Subsequently, we repeated the audit cycle for admissions in January and February 2022 (on-going). However, this time with the aim that all patients have their COVID-19 vaccination status documented promptly, and that their next vaccination is offered/administered during admission if required.

Results

Results from the initial audit cycle showed 33/41 patients had not received a full set of COVID-19 vaccinations (or no vaccination record found). Only 6/33 unvaccinated patients were offered the next vaccination during admission, and 3/33 actually received one. 21/33 patients without a full set of vaccinations were BAME (Black, Asian and minority ethnic).

Initial results from the second cycle showed an improvement in the number of patients offered the vaccine. 5/10 unvaccinated patients were offered vaccines in January, however data collection is ongoing.

Conclusion

Although our data set is not yet complete, initial results show that a simple intervention such as early identification of unvaccinated patients on admission, can act as a prompt to clinicians to ensure vaccines are offered. Thereby, increasing vaccine compliance in this vulnerable patient group.
Re-Audit of Compliance With Standard Operating Procedure for Prescription of Depot Medication Within the Wolverhampton Older Adult Services
Authors: Ling Clare Siew Boon , Prasanna Aparna
Published: June 2022

Aims

1) To re-audit the current practice of depot prescribing within the Wolverhampton Older Adult Enhanced Community Mental Health Teams (ECMHT). 2) To assess whether the implementation of a memory aid for prescribers has improved compliance of current practice to the Black Country Healthcare Foundation Trust (BCHFT) standard operating procedures (SOP) protocol.

Methods

All depot cards were identified from the Wolverhampton Older Adult ECMHT in January 2022. The cards were assessed for their compliance with the 15 standards for depot prescription writing as set out by the BCHFT SOP protocol. If a standard was not met, reasons for non-compliance were documented. The compliance rate for each standard was then compared to the results from a previous audit performed in January 2021.

Results

A total of 13 depot cards were identified. Out of the 15 standards, 6 of them had a 100% compliance rate. The two standards with the lowest compliance rate were ‘Standard 3’ and ‘Standard 7’. Standard 3 states that “Prescriptions should be signed and dated appropriately, including full signature and name printed”. This standard only achieved 15% compliance. This was a 60% reduction from the previous 75% compliance. Standard 7 states that “The interval expressed should be using the word ‘every’”. This standard achieved a compliance rate of 31%. This was a 12% improvement from the previous 19%.

Conclusion

This re-audit has shown there is still significant room for improvement regarding depot prescribing. The reason for non-compliance to Standard 3 was largely due to prescribers not printing their names alongside their signatures. This is likely due to the lack of an assigned space for “Prescriber's name” to be printed on the form. Also, like the previous audit in 2021, prescribers are still not using the word ‘every’ when filling in the frequency of depots (Standard 7). Despite this, there is a 12% improvement in compliance rate which shows that the memory aid did help some prescribers to comply to Standard 7.

These results will be discussed at the trust's Clinical Audit and Effectiveness Committee meeting. We will then revise the community depot cards to include columns for both prescriber's signature and name. Finally, we will harmonise depot cards from all localities in BCHFT. We will continue to include the memory aid at the front of all depot card folders as it has proven effective. We aim to complete these by March 2022.
Audit of Prolactin Levels Monitoring for Inpatients on Antipsychotics in SABP
Authors: Majid Zafrina , Fulmali Amit , Tamilson Bruce , Bloxam Ruth , Varma Deeksha , Abdallah Lubna , Mirza Khalid
Published: June 2022

Aims

To establish whether our practice is meeting NICE and Maudsley guidelines in establishing baseline prolactin levels in an inpatient set-up before starting treatment with antipsychotic medications with a medium or high-risk of causing hyperprolactinaemia.

Methods

Data were collected retrospectively from case notes of 127 patients from 9 wards at Surrey and Borders Partnership NHS Foundation Trust (SABP).

We reviewed if the baseline prolactin was measured for inpatients before commencing on antipsychotics with medium or high risk of hyperprolactinemia.

We reviewed if patients with elevated prolactin levels were assessed and managed appropriately.

Results

SABP is currently achieving 43% in recording serum prolactin levels for inpatients who are on antipsychotics with medium or high-risk of hyperprolactinemia respectively.

Inpatient ward 76 patients out of total 127 were on antipsychotics with medium to high-risk of developing hyperprolactinemia.33 patients had their serum prolactin checked bringing the compliance to 43%,2 patients were excluded due to incomplete data bringing the sample size to 31.

3 had elevated prolactin. Out of 3 patients,1 patient was managed appropriately with MRI brain, followed by change of antipsychotic medication and repeat prolactin levels. For 1 patient, prolactin

level was rechecked. Unfortunately, no documentation of assessment of symptoms of hyperprolactinemia was found in all three patients case notes.

Conclusion

The trust is falling short of meeting NICE and Maudsley guidelines of monitoring prolactin level. It is possible to introduce a robust system within the Trust so that we are complaint with a NICE and Maudsley prolactin monitoring guidelines.

We need to local Trust guidelines for management of hyperprolactinaemia in line with NICE and Maudsley guideline of monitoring prolactin levels.

Safety netting advice and leaflets explaining symptoms of hyperprolactinaemia should be provided to all the patients on antipsychotics with medium to high risk of developing hyperprolactinemia.
Clinical Audit and Reaudit of Driving Risk Assessment During Leave Risk Discussions Within an Adult Mental Health Inpatient Hospital
Authors: Muzenda Muredzwa Adelina , Loh Zhiyu , Mahmoud Nasr , Khan Aqif , Kour Jatinder , Nzekwe Amechi
Published: June 2022

Aims

All detained patients should have a leave risk discussion carried out prior to commencement of home leave. Driving risk must be clearly discussed and captured during the assessment. Driving advice as per DVLA guidance must be documented in case notes and discharge summaries. The aim was to audit and reaudit the use and quality of the driving risk assessment during leave risk discussions within adult mental health inpatient wards at one site under the Tees, Esk and Wear Valleys NHS Foundation Trust. The authors hypothesise that compliance to local policies could be improved upon.

Methods

Standards were set based on local policies. The audit was conducted across all adult acute inpatient wards within the identified mental health hospital. All inpatients who went on a period of home leave during their admission and ultimately discharged during the period from 1 April 2021 to 30 April 2021 (initial audit) and 1 October 2021 to 31 October 2021 (reaudit) were assessed. The data were collected using an audit tool. An Excel spreadsheet was used to collate data: specifically driving status of the patient, whether a leave risk discussion which captured driving risk was carried out, and whether DVLA advice was captured on discharge letters.

Results

48 patients (19 were drivers) during the initial audit and 27 patients (9 were drivers) during the reaudit met the inclusion criteria. For the initial audit, overall compliance for leave risk discussion (73%), specifically for driving risk assessment, did not meet target compliance. Only 5% of drivers were given written DVLA guidance on discharge letters. The reaudit showed a 100% compliance in the use and quality of leave risk discussion. 56% of patients had written confirmation of discussion on DVLA driving advice recorded on discharge summary.

Conclusion

There has been significant improvement in the use and quality of leave risk discussion, and documentation of DVLA driving advice on discharge summary during the reaudit.

The results were discussed at the Regional Audit meeting and the Inpatient Leadership Meeting. The following improvement plan was agreed and implemented:

1.

Regular communication amongst Multi-Disciplinary Team (MDT) during Leave Risk Discussion. One healthcare professional assigned to inform patient of the advice and capture conversation on case notes.

2.

Junior doctor induction to reiterate importance of capturing DVLA advice on discharge letters.

3.

MDT to discuss driving risk and advice during discharge meetings. “Driving advice discussion” to be added to discharge meeting checklist.
Psychiatric Induction Programme in Fife
Authors: Philp Cassie , Geller Barbara , Alexander Fiona
Published: June 2022

Aims

To improve the Psychiatry induction for DiTs in Fife.

Methods

The purpose of induction is to provide Doctors in Training (DiT) with a smooth, supported transition between roles. Delivered well, it will promote confidence and also provide a thorough grounding in the key requirements of the role and clarity regarding sources of help.

A recent report, commissioned by the GMC, identified the key areas which should be covered in induction. The findings demonstrated a clear link between inadequate inductions to the impact on doctors’ well-being and patient safety issues.

A questionnaire was issued to DiTs completing Psychiatry inductions in August and December 2021. Questions focused on the following key areas highlighted in the GMC report:

•

Gaining access to workplace settings and systems

•

Physical orientation of workplace

•

Team inductions

•

Daytime role and out of hours working and rotas.

•

Familiarisation with common cases/procedures that doctors may deal with in this speciality: risk management, use of the MHA

Results

Questionnaire Results: Key Issues highlighted

August 2021

•

FY2 to ST6 inducted together: differing experience levels

•

Differences in site inductions (psychiatry is spread across 3 hospitals in Fife)

•

Issues obtaining swipe cards/keys

•

IT access for emails and various computer systems delayed

•

Computer systems training not done

December 2021

•

Lack of psychiatry experience of FY2s

•

Continued IT access issues initially

Conclusion

In September 2021, a working group was established comprising DiT representatives and those responsible for induction. The August 2021 results were disseminated and key improvements were identified in areas covered by the clinical induction:

•

An improved induction check list universal for all sites.

•

Induction documents for each role detailing responsibilities and useful information.

•

Integration of IT training.

The December results highlighted improvements in many areas but continued a theme of concerns for FY2s starting in Psychiatry. The transition to this speciality is a significant adjustment as it operates differently to most specialities, requiring different skills and knowledge.

Plans have been made to provide simulation events which would give DiTs practical experience in a safe environment of various topics e.g., risk management in psychiatry. Additionally, there are plans to revise induction for speciality trainees.
Audit of Timely Assessment, Diagnosis and Post-Diagnostic Support Provided by the West Leeds Memory Assessment Service
Authors: Romeu Daniel , Jawaid Zumer , Turner Helen
Published: June 2022

Aims

In Leeds, Key Performance Indicators (KPIs) specify that patients should be offered an initial assessment within eight weeks of referral to the Memory Assessment Service (MAS) and diagnosed within 12 weeks. Additionally, post-diagnostic support (PDS) should be offered within two weeks of diagnosis. There are concerns that these targets are not being met due to the COVID-19 pandemic's impact on referrals and staff absence. This audit aims to establish whether the West Leeds MAS meets KPIs relating to the assessment and diagnosis of dementia and the provision of PDS in 80% cases.

Methods

The 67 patients who were referred to the West Leeds MAS between 1 June and 31 July 2021 were included in this audit. Data were collected retrospectively from electronic patient records using an online proforma designed a priori. All data were quantitative and analysed descriptively using Microsoft Excel.

Results

59 patients received an initial assessment; 19 (32%) received their initial assessment within 8 weeks, 14 (24%) had a delayed assessment with a documented reason, and the remaining 26 (44%) had a delayed assessment with no clear reason. 41 patients received a diagnosis; 23 (56%) received the diagnosis within 12 weeks, 12 (29%) had a delayed diagnosis with a documented reason, and 6 (15%) had a delayed diagnosis with no clear reason. Of those diagnosed, 25 (61%) were allocated a PDS appointment. No patients were offered PDS within 2 weeks of diagnosis, with no documented reasons for these delays.

Conclusion

The MAS failed to meet the KPIs of interest, which may be partly explained by staffing issues and a backlog of referrals following the service's suspension in 2020. We aim to raise awareness of the KPIs, and the importance of documentation when KPIs cannot be met, by presenting at local meetings. We plan to liaise with clinical managers to identify systemic strategies to improve flow through the service while ensuring patient-centred care, and we will assess impact by repeating the audit in 12 months.
Outcome of Did Not Attend Outpatient Appointment
Authors: Saleh Kalsum , Ige Annolusola
Published: June 2022

Aims

Failure to attend outpatient clinic appointments by service users without prior notification is a major contributor to waste resources. Failure to attend earlier in treatment predicts attrition later in treatment (Goode, 1997; Aubrey et al, 2003) leading to further waste of resources. The department of health figures for England show that failure to attend outpatient clinic is more in mental health clinics (19.1%) compared with overall figures for other specialties 11.7% (Department of Health, 2003). Lack of appropriate follow-up when a service user does not attend as appointment has been identified as a contributory factor in Serious Incident investigations, Domestic Homicide Reviews and Safeguarding Adults Reviews. Our aim of this study is to see if we are adherent to trust policy or not.

Methods

A questionnaire tool was designed by using trust guidelines regarding DNA appointment

a.

Was The DNA Recorded in patient's records? YES/NO

b.

Was the information (DNA) shared with GP? YES/NO

c.

Was The DNA discussed in MDT meeting? YES/NO

d.

For new referrals was the referrer involved in review and decision of next step? YES/NO

e.

Were alternative venues considered for carrying out the assessment to support the person to engage, e.g. GP Surgery? YES/NO

Data were collected by team and analysed by Dr Saleh using electronic records.

Results

88 outpatient appointments were flagged as DNA appointments between 1 April 2021 to 31st May 2021

1.

In 87.5% cases DNA was recorded in patient's records?

2.

In 45.45% cases the information (DNA) was shared with GP

3.

In 45.45% cases DNA was discussed in MDT meeting

4.

In 0% case the referrer was involved in review and decision of next step

5.

In 11.36% cases alternative venues was considered for carrying out the assessment to support the person to engage, e.g. GP Surgery.

6.

25 patients DNA appointment twice

Conclusion

We are not adherent to trust policy.
Audit Of Psychotropic Prescribing in the Crisis Team at Fieldhead Hospital According to NICE Guidelines
Authors: Shahbaz Shumaila , Garside Maya , Rajanna Tim
Published: June 2022

Aims

To ensure that psychotropic prescribing and monitoring in the Crisis Team is compliant with NICE guidelines and to provide excellent patient care and to practice medicine safely.

Methods

Medication prescribing should be a collaborative decision by the service user and the prescriber. This allows patients to have autonomy to decide their treatment plan. NICE provides guidelines for prescribing medication which includes baseline investigations, reviews of treatment including side effects, and physical health monitoring.

We selected 50 admitted patients for the audit from April 2021 until September 2021, who were prescribed psychotropic medications. We used medication cards and electronic patients’ records (System One). Our exclusion criteria were the 72-hour post-discharge follow-up from the inpatient ward.

The audit standards included as follows: age, gender, the indication, the start of medications, dose, within BNF limits, discussion, consent from the patient, comorbidities, physical health monitoring, response to treatment, monitoring of side effects, and other important information.

Results

100% results for indication, dosage, discussion with the patient, and side effects monitoring.

We had promising results for benefits from the treatment (46 out of 50 patients responded to treatment) and 4/50 did not respond to treatment. Unfortunately, one patient died from an overdose of illicit drugs, not with prescribed medication and one was admitted, and one felt worse, and one did not have any response.

However, 22 out of 50 patients were prescribed antipsychotic medication.11 out of 22 patients had ECG and blood done by the Crisis Team and 4 done by other parties (hospital and primary care).3 had recent blood tests but no ECG.2 patients did not have physical health monitoring and the reason was not documented.2 patients were started on antipsychotic by the Crisis Team, but the dose was not changed.

In terms of side effects, 8 out of 50 reported some side effects.

6 of them were prescribed antidepressants. They reported difficulty in sleeping and palpitations with Venlafaxine, nausea with Fluoxetine, nonspecific side effects with Citalopram, and sedation with Trazadone. 2 patients felt dizziness, diarrhoea, and muscle spasms with Mirtazapine. One patient had a metallic taste with Zopiclone. For side effects with antipsychotics, only one patient reported side effects with Olanzapine.

Conclusion

•

The Crisis Team is working at excellent standards on most areas of psychotropic prescribing and monitoring

•

The Crisis Team needs to improve physical health monitoring of their patients.
A Snapshot of Prescribing in Intellectual Disability CAMHS
Authors: Simpson Struan
Published: June 2022

Aims

There is increasing recognition of the use of psychotropic medication in young people with intellectual disability (ID) at a population level but little is known about day-to-day prescribing practice. This project aimed to characterise medication use in this group and assess standards of prescribing practice with reference to RCPsych guidelines.

Methods

Data werecollected by case note review of young people prescribed psychotropic medication within a community ID CAMHS Service. An index prescription was assessed against standards of prescribing - this was the longest standing script for each young person in the study.

Results

73 young people were recruited, aged 7–20 years, predominantly with moderate or severe ID. There was a high degree of comorbidity predominantly with autistic spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and anxiety presentations. Diagnoses did not differ by sex (p > 0.05) however behaviours that challenge were proportionately higher in females (p = 0.014). A high proportion of youngsters displayed behaviours that challenge (68.5%, n = 50) and almost all of these young people (96%, n = 48) had an additional diagnosis. ADHD presentations were negatively associated with behaviours that challenge (p = 0.047).

The hypnotic melatonin was most frequently used medication (56.2%, n = 41) followed by SSRI's (49.3%, n = 36) and antipsychotics (20.5%, n = 15). It was common for use of multiple medications (67.1%, n = 49), typically combining melatonin with a stimulant, SSRI or antipsychotic medication (61%, n = 31). Medications were generally used at modest doses.

The index prescription was in place for a median of 25 months (IQR 28.5, Range 1–108). The indication for prescribing was well documented (98.6%, n = 72) however severity (67.1%, n = 49) and frequency (56.2%, n = 41) recording was poorer. 6-monthly review rate was relatively low (62.5%, n = 40) but the likelihood of review did not reduce with increasing prescription length (p > 0.05). Review of medication response (94.2%, n = 65) and side-effects (73.9%, n = 51) was good. Overall there was poor documentation around consent-to-treatment procedures for young people over 16 years of age with only 17.2% (n = 5) having valid authorisation for medication in their case notes.

Conclusion

This study provides rich clinical data about current clinical practice around prescribing in youngsters with ID. Comorbidity is common and results suggest there may be a bias in labelling behaviours that challenge in males as ADHD-related. A range of (multiple) psychotropic medications are used, often for long-periods despite a lack of evidence base. Clinicians are encouraged to ensure rigorous review and consent-to-treatment processes to minimise harms and over-prescribing in this vulnerable population.
Inpatient Ward Review Safety Documentation Re-audit
Authors: Zinchenko Oksana , Meakin Yasmin , Davies Lloyd , Bhan - Kotwal Shafalica
Published: June 2022

Aims

In 2018 the Psychiatry Ward Review Safety Checklist was created for ward reviews on the Trust electronic clinical recording system with the aim to improve the documentation of legal and safety information. In 2019 an audit was conducted to ensure compliance with the safety checklist and in 2022 a re-audit was conducted to evaluate the effectiveness of the ward review checklist. Both audits examined 6 questions: Have you discussed the legal status of the patient? Is the patient for resuscitation? Does the patient currently have capacity for admission? Does the patient demonstrate deteriorating health? Does the patient have any physical health concerns? Review indication, current dosage and side effects of medications.

Methods

A retrospective case note review of three ward round assessments of a sample of 25 patients. First male and first female admission of the month to Tower Ward (Landermere Centre, Clacton On Sea) were selected over the period from 1st December 2020 to 1st December 2021. Inclusion criteria: all patients. Exclusion criteria: None.

We maintained the same standards as the previous audit in 2018 and 2019: 80% completion.

Results

12 male and 13 female patients were identified.

Q1. This was documented in 88% patients during the 1st week, and in 100% patients in mid-point stay and pre-discharge. In 2019 it was documented in 93% of the cohort.

Q2. This was documented in 42% in the 1st week, in 53% patients in midpoint and 45% in pre-discharge review. In 2019 this was recorded as 39% compliancy.

Q3. This was documented in 92% in the 1st week and midpoint, and in 67% during the pre-discharge review. In 2019 capacity was only documented in 14% of the cohort.

Q4. It was directly mentioned in 100% patients in all three reviews. In 2019 this was recorded in 64% of cases.

Q5. It was documented in 92% in the 1st week and mid-point review, and in 88% of the cohort in the pre-discharge review. In 2019 it was recorded for 69% of the cohort.

Q6. The information was included in 88% of the cohort during the 1st week, in 83% in mid-point and 75% in the pre-discharge review. In 2019 it was recorded for 81% of the cohort.

Conclusion

Compared to the 2019 audit the overall compliance with the documentation was satisfactory (over 80%) in all audited points with the exception of question 2 regarding resuscitation status for all audited weeks (40–50%).
Psychosis as a Possible Prodrome of Multiple Sclerosis: A Case Report
Authors: Al-Melh Mishal Abu , Farghal Mohammed , Abdelall Nasser
Published: June 2022

Aims

Multiple sclerosis (MS) is an autoimmune disease characterized by focal demyelinating lesions that can affect any part of the central nervous system. The highlight of the disease is the wide range of neurological deficits; however, psychiatric manifestations are not uncommon. MS is associated with psychiatric comorbidities, such as depression and anxiety disorders. This is due to either its disease process or its therapies that have been well documented in the literature. However, the link between psychosis as a prodrome and MS remains understudied and relatively uncommon.

Methods

We present a 40-year-old gentleman who developed isolated psychiatric manifestations for about 10 years in the form of progressive behavioral changes, social and occupational dysfunction, coupled with persecutory delusions. No personal or family history of mental illnesses. He was diagnosed and treated as a case of schizophrenia by a psychiatrist with multiple antipsychotics with a minimal improvement of his symptoms. Three months before our assessment the patient had a history of difficulty walking associated with urine and fecal incontinence. On examination, he had restricted affect and was easily agitated. Neurological examination revealed hypertonia and hyperreflexia in his left upper and lower limbs with normal power bilaterally. T2-weighted magnetic resonance imaging (MRI) brain showed multiple non-enhancing characteristic demyelinating lesions with typical shape and distribution. Further work-up was done to confirm the diagnosis of MS and exclude differentials, including a negative autoimmune screen, anti-aquaporin-4 (AQP4), and Myelin oligodendrocyte glycoprotein (MOG) antibodies. Visual evoked potentials documented bilateral severe disturbance in the visual pathway in both eyes, suggesting axonal loss. The patient is a candidate for a disease-modifying therapy for MS. Natalizumab or Ocrelizumab was selected based on his clinical criteria and will be started after proper preparation.

Results

Psychiatric comorbidities in MS are associated with reduced compliance to disease-modifying therapies and lower quality of life. Studies reported that lesions in the periventricular area in the temporal region may be associated with psychosis, but not as an isolated presentation in patients with MS.

Conclusion

MS is one of the differentials of psychotic disorder due to a medical condition, and rarely may present with pure psychiatric manifestations preceding any obvious neurological deficits, leading to delay in the diagnosis. Despite being uncommon, a high index of suspicion should be kept in patients with atypical presentations associated with limited response to multiple antipsychotics. This highlights the importance of conducting a thorough physical examination and work-up to exclude an organic pathology, necessitating proper management.
Brain Development in Children With Early Onset Liver Disease
Authors: Earl Megan , Blackmore Charlotte , Day Jemma , Samyn Marianne , Dhawan Anil , McAlonan Grainne
Published: June 2022

Aims

Biliary Atresia (BA) is a progressive inflammatory liver disease and the most frequent indication for pediatric liver transplant. There is a strong association between BA in adulthood and reduced cognitive abilities, however, data on neurodevelopmental outcomes at an early age are scarce, with small participant numbers. Hence, the neurodevelopmental difficulties in BA are poorly understood in childhood even though the brain development and maturation occur in parallel with the time-course of BA. This study aimed to characterize the cognitive and behavioral phenotype within BA infants from the age of 14 months to 4 years and investigate the extent to which this group deviates from children of typical development.

Methods

42 infants with BA that were diagnosed and treated at Kings College Hospital were recruited into this study. These infants ranged from 14 months to 4 years (mean age = 3 Years, 1 month). Out of the 42 infants, 19 had received a liver transplant, 22 were stable on their native liver, and 1 was on the transplant waiting list. 36 Mullens Scale of Early Learning assessments and 42 Vineland Adaptive Behavior Scale Interviews were collected. 42 typically developing infants (TD) were also recruited into the study, matched for age and gender to the BA population. First, we compared the whole group with BA to TD; then we compared children with BA on their native liver to those with a transplant.

Results

Across the cohort with BA, infants scored significantly lower on the Vineland Summary T-Score compared to age-matched TD control children (t(82) = −5.05, p < .001) and across all domains of the Vineland. They also scored significantly lower than TD children on the Mullens Development Assessment (t(66) = −6.52, p < .001), and this was also across all domains. BA children on their native liver scored lower on both instruments than children who had received a liver transplant, however, this difference did not reach significance.

Conclusion

Individuals with Biliary Atresia, regardless of their transplant status, show lower levels of development across all aspects, suggesting a global delay. These findings suggest that all of these young children remain at significant risk for neurodevelopmental difficulties. These findings emphasize that special attention to neurodevelopment needs to be given as part of a holistic approach to care in a serious life-long illness. Work is ongoing to understand the trajectory of brain maturation in these children to ensure neurodevelopmental needs are addressed alongside physical health.
PREVENT: Assessing and Improving Knowledge of the Sodium Valproate Pregnancy Prevention Programme in Psychiatric Prescribing
Authors: Havens Laura
Published: June 2022

Aims

The sodium valproate PREVENT programme was introduced by the Medicines and Healthcare products Regulatory Agency (MHRA) in March 2018, and is now a legal requirement due to valproate's risks in pregnancy. This project had two main aims: 1) To assess clinician knowledge of PREVENT, and identify deficiencies in current education. 2) To assess the barriers psychiatrists face in achieving compliance with PREVENT.

Methods

Knowledge and awareness of PREVENT was assessed through an online survey sent to local consultants and specialty doctors in February 2021. The survey included ten questions, four were Likert style to assess attitudes, two assessed local arrangements and four were knowledge based. A free-text section allowed respondents to describe challenges faced implementing PREVENT. Results were analysed, an educational presentation given at local teaching and a poster was created and distributed - both targeting areas of weakest knowledge. A repeat survey was sent out in June 2021, and results collected to reassess.

Results

The pre-teaching survey received twelve responses, the post teaching survey received eleven. In both, 75% of respondents represented general adult services, and 25% represented intellectual disability services.

There was an improvement in confidence of knowledge with all respondents being either “somewhat” (55%) or “very confident” (45%) post-teaching compared to 75% being “somewhat” confident, 10% “unsure” and 17% “very confident” prior to intervention. Pre-teaching, 10% of respondents were unaware that a risk acknowledgement form must be signed annually, while post-teaching 100% correctly identified this should be annual.

Respondents correctly identifying “highly effective” forms of contraception rose from 83% to 100% following teaching. Post-teaching there was an increase of 31% in the number of respondents correctly identifying the necessary documentation where a patient declines the PREVENT programme.

Pre-teaching, half of respondents were unsure if their team had a reminder system for risk acknowledgement forms, and 42% reported having no system. Post-teaching, 27% of respondents reported now having a reminder system in place, and 27% had plans to implement one.

Conclusion

Initial results showed variable knowledge of the PREVENT programme, and a lack of awareness of the administrative requirements including risk acknowledgement forms. Results demonstrated an improvement in knowledge and organisation to help support compliance with the PREVENT programme. Respondents highlighted that knowledge of the PREVENT programme quickly deteriorates given how rarely it is used. Further work includes a full audit of compliance with PREVENT across the health board, as well as considering “refresher” sessions to prevent atrophy of knowledge.
The Contribution of Transference Focused Psychotherapy in Improving Psychiatry Trainees’ Attitude and Technical Confidence Towards Patients With Personality Disorders
Authors: Sinisi Arianna , Marchi Mattia , Prior David , Lee Tennyson
Published: June 2022

Aims

Transference-focused psychotherapy (TFP) is a manualized evidence-based treatment for severe personality disorders (PDs) based on a psychodynamic approach that focuses on object relations theory. It has been used as a teaching tool in different psychiatric settings. Psychiatry trainees are often the “first-responders” in multiple services, and they have to deal with patients with PDs in various settings. Yet there is a documented gap in psychiatry trainees’ education regarding the assessment and management of patients with PD pathology. The aim of our study was to evaluate whether a series of teaching sessions on TFP theory and techniques as applied to PD could improve the attitude and technical confidence of psychiatric trainees in the clinical encounter of a patient with a PD.

Methods

Two cohorts of psychiatry trainees in Tower Hamlet's East London Foundation Trust received four teaching sessions, each of one hour duration, on TFP theory and techniques. All the sessions were delivered online, using video teleconferencing software. 14 Trainees completed 2 questionnaires, pre- and post-teaching: the Attitude to Personality Disorder Questionnaire (APDQ) and the Clinical Confidence with Personality Disorder Questionnaire (CCPDQ). The APDQ asks the responder to score from 1–6 the frequency they experience certain feelings towards patients with PD. In the absence of a suitable instrument, we developed the CCPDQ consisting of a set of 13 questions rated on a 6-point Likert scale addressing key issues identified in TFP including establishing and maintaining the treatment frame and in implementing the 4 main techniques. We also conducted a 1-hour focus group post teaching which was videorecorded, transcribed, and analysed thematically.

Results

On quantitative analysis, the Wilcoxon signed-rank test indicated statistically significant improvements in the total APDQ score (P = 0.003, r = 0.81) and in the CCPDQ questionnaires (P = 0.001, r = 0.88).

The thematic analysis showed an overall positive effect of the TFP teaching on trainees’ attitude and confidence: they felt it improved their understanding of the nature of personality disorder, their awareness and management of countertransference, awareness of object relations and relation dyads at play in the encounter.

Conclusion

Training junior doctors about TFP theory and techniques as applied to PD can significantly improve their attitude towards these patients and their technical confidence in the clinical encounter. Of note, our workshop is resource light and can easily be delivered by remote teaching. Based on these findings, teaching of TFP in the core psychiatric training curriculum should be considered.
ERG activity is regulated by endothelial FAK coupling with TRIM25/USP9x in vascular patterning
Authors: D'Amico Gabriela , Fernandez Isabelle , Gómez-Escudero Jesús , Kim Hyojin , Maniati Eleni , Azman Muhammad Syahmi , Mardakheh Faraz K. , Serrels Bryan , Serrels Alan , Parsons Maddy , Squire Anthony , Birdsey Graeme M. , Randi Anna M. , Bolado-Carrancio Alfonso , Gangeswaran Rathi , Reynolds Louise E. , Bodrug Natalia , Wang Yaohe , Wang Jun , Meier Pascal , Hodivala-Dilke Kairbaan M.
Published: June 2022

Precise vascular patterning is crucial for normal growth and development. The ERG transcription factor drives Delta-like ligand 4 (DLL4)/Notch signalling and is thought to act as a pivotal regulator of endothelial cell (EC) dynamics and developmental angiogenesis. However, molecular regulation of ERG activity remains obscure. Using a series of EC-specific focal adhesion kinase (FAK)-knockout (KO) and point-mutant FAK-knock-in mice, we show that loss of ECFAK, its kinase activity or phosphorylation at FAK-Y397, but not FAK-Y861, reduces ERG and DLL4 expression levels together with concomitant aberrations in vascular patterning. Rapid immunoprecipitation mass spectrometry of endogenous proteins identified that endothelial nuclear-FAK interacts with the deubiquitinase USP9x and the ubiquitin ligase TRIM25. Further in silico analysis confirms that ERG interacts with USP9x and TRIM25. Moreover, ERG levels are reduced in FAKKO ECs via a ubiquitin-mediated post-translational modification programme involving USP9x and TRIM25. Re-expression of ERG in vivo and in vitro rescues the aberrant vessel-sprouting defects observed in the absence of ECFAK. Our findings identify ECFAK as a regulator of retinal vascular patterning by controlling ERG protein degradation via TRIM25/USP9x.
Metformin inactivates the cGAS-STING pathway through autophagy and suppresses senescence in nucleus pulposus cells
Authors: Ren Chenghao , Jin Jie , Li Chenchao , Xiang Jianwei , Wu Yaosen , Zhou Yifei , Sun Liaojun , Zhang Xiaolei , Tian Naifeng
Published: June 2022

Intervertebral disc degeneration (IVDD) is a complex process involving many factors, among which excessive senescence of nucleus pulposus cells is considered to be the main factor. Our previous study found that metformin can inhibit senescence in nucleus pulposus cells; however, the mechanism of such an action was still largely unknown. In the current study, we found that metformin inactivates the cGAS-STING pathway during oxidative stress. Furthermore, knockdown of STING (also known as STING1) suppresses senescence, indicating that metformin might exert its effect through the cGAS-STING pathway. Damaged DNA is a major inducer of the activation of the cGAS-STING pathway. Mechanistically, our study showed that DNA damage was reduced during metformin treatment; however, suppression of autophagy by 3-methyladenine (3-MA) treatment compromised the effect of metformin on DNA damage. In vivo studies also showed that 3-MA might diminish the therapeutic effect of metformin on IVDD. Taken together, our results reveal that metformin may suppress senescence via inactivating the cGAS-STING pathway through autophagy, implying a new application for metformin in cGAS-STING pathway-related diseases.
Independently paced Ca2+ oscillations in progenitor and differentiated cells in an ex vivo epithelial organ
Authors: Kim Anna A. , Nguyen Amanda , Marchetti Marco , Du XinXin , Montell Denise J. , Pruitt Beth L. , O'Brien Lucy Erin
Published: June 2022

Cytosolic Ca2+ is a highly dynamic, tightly regulated and broadly conserved cellular signal. Ca2+ dynamics have been studied widely in cellular monocultures, yet organs in vivo comprise heterogeneous populations of stem and differentiated cells. Here, we examine Ca2+ dynamics in the adult Drosophila intestine, a self-renewing epithelial organ in which stem cells continuously produce daughters that differentiate into either enteroendocrine cells or enterocytes. Live imaging of whole organs ex vivo reveals that stem-cell daughters adopt strikingly distinct patterns of Ca2+ oscillations after differentiation: enteroendocrine cells exhibit single-cell Ca2+ oscillations, whereas enterocytes exhibit rhythmic, long-range Ca2+ waves. These multicellular waves do not propagate through immature progenitors (stem cells and enteroblasts), of which the oscillation frequency is approximately half that of enteroendocrine cells. Organ-scale inhibition of gap junctions eliminates Ca2+ oscillations in all cell types – even, intriguingly, in progenitor and enteroendocrine cells that are surrounded only by enterocytes. Our findings establish that cells adopt fate-specific modes of Ca2+ dynamics as they terminally differentiate and reveal that the oscillatory dynamics of different cell types in a single, coherent epithelium are paced independently.
Three Flaws in One Justification A Critical Examination of Nussbaum’s Reasoning Behind Her List of Capabilities
Authors: Arun M. Onur
Published: June 2022

Who should decide what makes one’s life good? This is a long-standing question that has recently led to an unresolved discussion between two leading figures of the contemporary political and social theory, namely Amartya Sen and Martha Nussbaum. In this discussion, addressing the adverse effects of unjust social conditions on people’s choices such as the problem of adaptive preferences, Nussbaum proposes a philosophically-informed list of aspects of the good life developed from a particular normative account. However, the reasoning behind her proposal, I argue, involves three flaws that appear due to absence of a sociologically-informed account of people’s choices. First, considering that unjust social conditions can adversely affect not only people’s choice on aspects of good life, but also their choices in achieving these aspects, developing a list from a philosophical account of the good life cannot be a solution against these adverse effects. Second, Nussbaum excessively generalises her findings based on data involving a quite limited number of disadvantaged women in a way that her findings are applicable to all disadvantaged people living in varied social settings. Third, both existing empirical evidences and the qualitative data I collected in three distinct settings of Turkey demonstrate that disadvantaged people are not necessarily those who, as Nussbaum implicitly addresses, are unable to develop sophisticated/reasoned judgements on their material conditions, but might be those who must have developed the ability of deliberately adapting their preferences to make a living within given structural inequalities.
Η χρήση της μουσικής στη λατρεία του Ασκληπιού
Authors: Δερβένη Παρασκευή
Published: June 2022

Η λειτουργία των ασκληπιείων καθιερώθηκε σε πολλές περιοχές εντός και εκτός του αρχαιοελλαδικού χώρου και πολλοί άνθρωποι τα επισκέπτονταν για να θεραπευτούν σωματικά και ψυχικά. Η παρούσα έρευνα επιχειρεί να αναδείξει μέσω της, κατά το δυνατόν, ενδελεχούς προσέγγισης των επιγραφικών και λογοτεχνικών μαρτυριών τη θεραπευτική ιδιότητα της χρήσης μουσικής στη λατρεία του Ασκληπιού. Η έρευνά μας επικεντρώνεται κυρίως, στη συγκέντρωση, καταγραφή και ανάλυση των σωζόμενων λατρευτικών ασμάτων, προερχόμενων από ασκληπιεία διαφορετικών τοποθεσιών και χρονικών περιόδων. Η συμπερασματική μας πρόταση συμπυκνώνεται στη διαπίστωση ότι η λατρευτική μουσική υπήρξε ένα από τα μέσα που χρησιμοποιούσαν οι ιερείς-θεραπευτές για να επιτύχουν ολιστική προσέγγιση στην αντιμετώπιση των προβλημάτων υγείας των επισκεπτών, η οποία δρούσε ευεργετικά παράλληλα με τις υπόλοιπες θεραπευτικές διαδικασίες. Στο πλαίσιο της λατρείας του Ασκληπιού, οι θεραπευτές φαίνεται πως ενέταξαν συνειδητά τη χρήση μουσικής για θεραπευτικούς σκοπούς, δίχως να έχουν βασιστεί σε τεκμηριωμένες αναλύσεις και δεδομένα αλλά στη βαθιά τους πίστη και στην εμπειρική τους γνώση για τη δύναμη της μουσικής.
Prevalence of pulmonary tuberculosis in Al-Najaf governorate, Iraq
Authors: Al-Hadraawy Saleem Khteer , Alhadrawi Kais Khudhair , Aljanaby Israa Abduljabbar Jaloob , Aljanaby Ahmed Abduljabbar Jaloob , Zabibah Rahman S
Published: June 2022

Background: pulmonary tuberculosis (PTB) is one of the most global dangerous infectious diseases worldwide, particularly in developing countries. Mycobacterium tuberculosis (Mtb) is the most infectious agent that caused PTB transferred by air droplets from one person to other. In the present epidemiological study, we aimed to record the total numbers and percentages of patients infected with PTB caused by Mtb during 12 months in AL-Najaf Governorate, Iraq.   

Methods: This study has been done in 2019 from January to the end of December in the north and south region of AL-Najaf Governorate, Iraq. Sputum of PTB-patients has been stained by Ziehl–Neelsen to Mtb diagnosis according to World Health Organization (WHO) recommendation.

Results: We recorded 174 PTB-patients in AL-Najaf Governorate 2019; 89 male and 85 female; 101 and 73 in the north and south sections respectively. The age group 16-24 was the highest infected. Quarter two recorded the highest numbers of PTB-patients; 33 (60%) in the north section and 22 (40%) in the south section.

Conclusion: There was low PTB incidence in AL-Najaf Governorate 2019 but the Youngers were the most susceptible to infection. Infection in the north section was higher than in the south section and there were no high differences between genders. Seasons have no high effect on the number of infections.
Prevalence of diabetes mellitus among newly detected sputum positive pulmonary tuberculosis patients and associated risk factors: A cross-sectional study
Authors: Hullalli Rashmi , Gudadinni M R , Motappa Rohith
Published: June 2022

Background:Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is one of the rising public health problems. There is growing evidence that DM is an important risk factor for TB. This study was carried out to know the prevalence of DM among newly detected sputum positive pulmonary TB patients registered in District Tuberculosis Centre and to assess the risk factors of DM among TB patients.

Methods:In a cross-sectional study, newly detected sputum positive pulmonary TB patients were screened for DM (those having symptoms of DM). Furthermore, they were diagnosed by detecting blood glucose levels (≥200 mg/dL). Mean, standard deviation (SD), Chi-squared and Fisher-Freeman-Halton exact tests were used to determine the significant associations. P-values less than 0.05 were considered to be statistically significant.

Results:A total of 215 TB patients were included in this study. The prevalence of DM among TB patients was found to be 23.7% (2.8% known and 97.8% new cases). Significant associations were found between age (>46 years old), educational status, smoking habits, alcohol consumption, physical activity, presence of DM symptoms and family history of DM.

Conclusions:Routine screening for DM is mandatory due to its increasing prevalence, which may help in early diagnosis and to reduce complications by proper management that in turn helps in the successful outcome of TB treatment.