bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical health of patients under EIP - a service evaluation
Authors: Priya Anu , Dhanasekar Keerthan , Hill-Cousins James , Aziz Mudasar , Suleiman Osama , Mills Katherine , Lloyd Megan 
Published: June 2021

AimsThe aim of the project was to get a baseline of the number of patients who have had blood tests, ECG and physical health observations completed in the past 12 months.MethodThere are 30 patients under Early Intervention in Psychosis team at Bassetlaw Hospital , Nottinghamshire. The elctronic notes and blood reporting system were checked for each of the patients, to get the data on blood test results , ECG reports and Physical health (Blood pressure, heart rate and weight) .ResultIt was noted that 19/30 patients had Blood tests completed, 14/30 had ECG completed and 19/30 had physical health checks completed. All these patients except one were on antipsychotic medications.ConclusionFurther work is still required in getting 100% results for all these different variables. This may include the need to review the process of how we engage the patients for physical healthcare checks. With the inclusion of a physical healthcare worker now, we might be able to improve results. Hence this evaluation would be redone in a years' time.
Balint style case-based discussion group for medical students in Bassetlaw Hospital
Authors: Priya Anu , Bhogal Hardev 
Published: June 2021

AimsTo evaluate feedback from Balint style case based discussion groups and to reflect on learning points.We have three medical students from Sheffield University on six week psychiatry placements at Bassetlaw Hospital and we get eighteen students in a year. In order to further develop their approach towards reflection and their understanding towards the doctor patient relationship we developed the Balint style case based discussion group, and each group of students attend three sessions during their placement.MethodThe groups are held on a weekly basis and consist of the three medical students and 1-2 facilitators. As the group is small one of the facilitators may participate with the students for the Balint process and to help encourage the students. Following completion of the third session of the discussion group we gain written feedback from the students. A total of 17 feedbacks have been reviewed over the period of November 2018 -November 2019.Result16 students stated that this was their first experience at Balint Group and all except one student felt that they were given a good introduction about Balint groups before starting. When asked about the most significant thing that they have learnt in the group, the majority of students marked reflecting feelings to improve relationships with patients, exploring why they feel a certain way with patients and that the doctor patient relationship can affect the consultation.One student stated that they would not recommend it to colleagues as they felt it was relevant more to doctors rather than medical students. Another student recommended having more people in a group.ConclusionOverall, it has been a positive experience with the medical students during the groups and with feedbacks. We have reflected on difficult topics like bereavement, fantasized about the purpose of a patient's delusion and shared the joy of a patient who was discharged after a long stay. While we think we have been able to teach the students some tips on reflection, we ourselves have been able to reflect on certain topics we would not have if not raised by the students. Some medical students have contacted the larger Balint Group in Sheffield for further sessions. Considering our experience, we will continue with the sessions at Bassetlaw Hospital.
Distinguishing vulnerable clients from psychotic patients with follow-up mortality data
Authors: Burke Aggrey 
Published: June 2021

AimsThe aim of the present study is to determine whether vulnerable non-psychotic clients presenting in court proceedings do not share the same mortality profile as psychotic patients in similar environments. It is hypothesised that the two display quite separate mortality profiles.BackgroundThe increased mortality of psychiatric patients and prisoners has been documented but less is known of the outcomes among other vulnerable populations .The population for study is a consecutive series of assessments in court proceedings of carers of children at risk and violent offenders.MethodAssistants not involved in the initial assessments transferred data from case notes and this material was transferred to computer files. Statistical analysis SPSS19Formal psychiatric diagnoses were those agreed in court proceedings. National mortality records were searched and copies of death certificates obtained. A small number of cases known to have returned overseas were excluded. 772 cases were studied. One in five were assessed in prison, twice as many gave a history of violent criminal behaviour. Over a half suffered abuse or neglect or admitted to being unhappy in childhood. Three subgroups have been identified: Vulnerable with no psychotic illness(60%), psychosis with no evidence of personality disorder or of mixed psychosis(18%), linked psychosis(22%). It was found that demographic variables , deprivation factors, adverse childhood experiences and outcomes and clinical variables are in excess among linked psychotics compared with other groups. Linear regression of unnatural death among psychotic patients identifies five risk factors. The distribution of high-risk factors among linked psychosis is more than twice that found in other groups.ResultNatural mortality is most evident among clients suffering from psychosis without personality disorder or mixed disorder.Unnatural mortality is more than 10 times greater among patients with linked psychosis, compared with those with no psychosis and four times greater than other psychoses. Risk factors for unnatural mortality are: physical illness, stressful relationship, violence to self or others, detained and history of behaviour disorder.ConclusionThe findings of the present study demonstrate that vulnerable clients without psychosis are less likely to die by unnatural causes than clients who suffer psychosis coexisting with personality disorder or mixed psychosis. The null hypothesis is upheld. The findings suggest that risk assessment of vulnerable populations should take account of risk factors of unnatural death which have been identified in this study.
Is pregnancy status being assessed within women's secure services?
Authors: Rampling Jeremy , Pantall Shay-Anne , Woodman Hannah 
Published: June 2021

AimsTo establish rates of pregnancy testing on admission of women within a blended secure service.BackgroundWomen with psychiatric illness are known to be at increased risk of pregnancy, often due to engagement in risky sexual behaviours such as having a higher numbers of sexual partners and engaging in sexual activity whilst under the influence of drugs or alcohol. Awareness of pregnancy at the point of admission to psychiatric hospital would inform ongoing care plans to manage the pregnancy in the safest, least restrictive environment and inform future prescribing decisions, to minimise the risk of teratogenicity associated with some psychotropic medications. Ardenleigh in Birmingham is a blended female secure unit. No pregnancy screening guidelines for this population currently exist. This audit sought to establish current rates of pregnancy testing at the point of admission with a view to developing future guidelines.MethodA retrospective case note audit of electronic records of all patients admitted to Ardenleigh blended women's service as of 1st September 2019 (n = 26). The expected standard for pregnancy testing within one month of admission was set as 100%.ResultKey results include:
The majority of patients (67%) were aged under 35 years (range 20–56). The most common ethnicities were Caucasian (42%) and African-Caribbean (38%). Almost half (46%) had a primary diagnosis of paranoid schizophrenia.Two women were known to be pregnant at the point of admission. Only 54% of women with an unknown pregnancy status were screened for pregnancy within one month of admission.Rates of screening were particularly poor in women aged under 25 years (43%) and between 36 and 45 (0%).Women not screened for pregnancy were typically admitted from other hospital settings, including AWA services (27%) or other medium secure units (55%). 2 women admitted from prison were not tested (29%)Of those tested, the majority were checked using urine hCG (92%).None of the women tested were found to be pregnant.ConclusionOverall pregnancy testing on admission to the unit was poor, with only 54% of service users screened. Less than 100% compliance could result in serious consequences for both the woman and unborn baby if a pregnancy is not discovered. Updating the admission checklist for Ardenleigh to include pregnancy testing may prove beneficial. It is recommended that a re-audit is completed 6 months following checklist introduction.
Psychiatric liaison team memory pathway: does it achieve the standards set out in NICE clinical guideline 97?
Authors: Senaratne Manouri , Jabeen Afshan , Hyams Alisha , Deary Carol , Stathers Sarah 
Published: June 2021

AimsEarly assessment, diagnosis and management for people living with dementia is essential, both for the patient and their carers. We recognised delays in established local pathways when patients had unplanned acute hospital admissions preventing them from attending memory diagnostic appointments. The Psychiatric Liaison Team (PLT) Memory Pathway was introduced as we had the skills and expertise to resume the process and to find new undetected patients.Our aim was to determine how well the newly implemented PLT Memory Pathway follows the standards outlined in the National Institute of Health & Care Excellence (NICE) Clinical Guideline 97 (CG97): Assessment, management and support for people living with dementia and their carers.MethodA retrospective analysis of all PLT referrals from July 2018 to February 2020 (20 months) was performed to identify patients on the community memory pathway and those with possible undetected cognitive impairment. Data were collected from electronic patient records which included demographics, primary and collateral history, cognitive testing and imaging, dementia type among others. Results were analysed using Microsoft Excel.Result41 patients were included (59% female). 80% of patients were referred for memory problems or confusion. 63% had previous referrals to a memory service and was on the community memory pathway at the time of the referral. 34% were on anticholinergic medication but in only 14% were this documented as reviewed. 100 % were offered and had head imaging. A finding worthy of note was the absence of any from the ethnic minority background. 63% of patients were given a memory diagnosis and 34% had anti-dementia medication started. Patients’ families were made aware of the diagnosis in 83% of cases, due to the absence of next of kin details in the patient record. Primary Care was made aware in 100% of cases; post-diagnostic support was 100%.ConclusionThe PLT is well placed to bridge the service gap between the acute care trust and established community memory services when dealing with patients with dementia. A dedicated Memory Pathway has helped to close this gap and adherence to NICE CG97 standards was good, but there is room for improvement. A particular focus will be on improving documentation of anticholinergic medication review and exploration for the absence of ethnic minority patients. Aiming to achieve 100% family involvement is also recommended.This study has been submitted to the Royal College of Psychiatrists' Faculty of Old Age Annual Conference 2021.
Audit of physical health monitoring on admission to Mill Lodge (CAMHS Inpatient Unit, York)
Authors: Steiu Andreea , Diggins Emma , Thevarajan Nagulan 
Published: June 2021

AimsThis audit aimed to evaluate the standard of initial physical health assessment that young people receive on admission to Mill Lodge.Adherence to recommendation 2.6.3 of the service specification for Tier 4 CAMHS was assessed. Standard 2.6.3 of the service specification for Tier 4 child and adolescent mental health services states that “on admission all young people must have an initial assessment (including a risk assessment) and care-plan completed within 24 hours. Where admission is for day/in-patient care this will include a physical examination.” In line with this standard this audit will evaluate the use of physical examination, baseline blood tests and ECG carried out on young people.BackgroundMental health problems in children and young people are associated with both short- and long-term physical health problems. It is therefore important that they undergo full physical health assessment on admission to a Tier 4 inpatient unit.MethodElectronic records were reviewed for all patients admitted within a 6 months period, between 1st August 2018 and 1st February 2019. Data were collected in March 2019 and entered directly into an excel spread sheet designed for data collection. A total of 23 patients were identified for inclusion in this audit.Simple statistical analysis was carried out using excel.ResultOver 80% of patients who did not refuse had a completed physical examination (85%), blood results recorded (82%) and ECG (84%) within the first 24 hours of their admission. 100% of patients who did not refuse had bloods and ECG checked at some time during their admission, with 90% having a physical examination.For several patients (3 physical examination, 2 bloods, 3 ECG), no reason was documented as to why the procedure or examination did not take place. For 1 patient, blood tests were delayed due to having no blood tubes available.ConclusionTaken into account the result of this audit and bearing in mind the importance of physical examination as part of the admission process, it is important to try and support both regular Mill Lodge staff and on-call junior doctors to follow Standard 2.6.3's guidance around physical examination on admission to hospital. While good results were seen in many areas, the ward is not yet achieving the standard of 100%. A re-audit will take place in twelve months’ time to review recommendation and compliance.
Assessment and management of patients detained under Section 136 in Northwick Park Hospital emergency department
Authors: Telesia Laurence , Fraser Lauren 
Published: June 2021

AimsTo evaluate the role of the Emergency Medicine team (EM) within a London Emergency Department (ED) in assessing and managing patients detained under Section 136 of the Mental Health Act, 1983 (S136).BackgroundS136 allows detention and transfer of people to ED and psychiatric hospitals for further assessment. EDs are optimised for the investigation and management of the medically unwell, but attending ED may also delay access to psychiatric services if required. Minimal research has been performed to investigate the relative benefits of transferring people under S136 to ED versus psychiatric hospitals.MethodElectronic notes were searched to identify those attending under S136 between 01/04/2017 and 31/03/2018. Scanned medical notes were reviewed and data extracted regarding patient demographics, length of ED stay, reason for S136 use, investigations and interventions undertaken by EM.ResultThis identified 95 attendances by 87 patients. The mean age was 35 years (range 15-75) and 59% of attenders were male. The mean duration of stay was 7 hours 34 minutes (range 6 minutes - 25 hours 50 minutes).Reasons for S136 use were abnormal behaviour (32), expressed suicidal ideation (29), overdose (15), self-harm (13), overdose plus self-harm (4), being found wandering (1) and was unclear for 1 presentation.In 39 attendances no investigations beyond history and examination were performed by EM. Only 6 patients had investigations that were not bloods, electrocardiogram or urinalysis. These included X-radiograph trunk (4), computed tomography (CT) head (3), X-radiograph limb (3), CT cervical spine (1), Focused Assessment with Sonography for Trauma (1).No interventions were given by EM in 55 attendances. Twenty-nine different medications were prescribed and 18 patients were prescribed intravenous fluids. Three had wounds dressed, 3 glued, 3 sutured and 1 stapled.ConclusionThere were difficulties categorising the reason for S136 use, as clear documentation was often unavailable, but the vast majority of patients were detained due to abnormal behaviour, expressed suicidal ideation and self-harm.Few attending ED under S136 received investigations or interventions that could not be offered within a psychiatric hospital. There was a wide range in duration of stay within ED, however 65% of attendances were longer than the standard 4 hour target.Future research may assess the relative benefits of ED versus psychiatric hospitals in assessing those detained. This could aid services in meeting both the physical and psychiatric needs of patients whilst making efficient use of available resources.
Audit of high dose antipsychotic prescribing in the havering community recovery team
Authors: Umeh Chinedu , Ionita Simona 
Published: June 2021

AimsThe main aim of this audit was to determine the prevalence of HDAP in Havering Community Recovery Team (CRT). The secondary aim was to determine how well HDAP has been monitored and documented - specifically, whether discussions around the reasons for continuing and the risks and benefits have been discussed.BackgroundThere is a focus to reduce high dose antipsychotic prescribing (HDAP) due to the lack of evidence that it is efficacious and that smaller doses have an equivalent effect and are better tolerated. Similarly, the consensus by the Royal College of Psychiatrists is that any prescribing of high dose antipsychotics should be an 'explicit, time-limited individual trial’ with a distinct treatment target. There should be a clear plan for regular clinical review including safety monitoring. The high-dose regimen should only be continued if the trial shows evidence of benefit that is not outweighed by tolerability or safety problems.' Following a CQC inspection in 2014 of NELFT which found that the trust was failing to comply with the relevant requirements of the Health and Social Care Act 2008 with regards to safe use of medicines, yearly audits of inpatient HDAP have been undertaken. Although improvements have been made in the inpatient setting, no such audits have been performed in the community setting and consequently there is no data in NELFT regarding community services compliance with the above regulations.MethodAll 349 patients in Havering CRT clinical records were screen by either using RIO or GP letters from recent CPA reviews. A data collection and analysis tool was created using Microsoft Excel. Data collection and analysis was carried out by the project lead and checked by a fellow project member.ResultOf the 349 patients included for analysis:
16 (4.58%) of patients were prescribed a high-dose antipsychoticOf the 16 prescribed high dose antipsychotics:
0 out of 16 had the high dose antipsychotic monitoring form available12 (75%) had well documented evidence of review of HDAP.4 (25%) had no documented evidence of review of HDAP.ConclusionThere is a small group of patients receiving high dose antipsychotic therapy for which better monitoring is needed. This should include education of staff regarding HDAP, better documentation in their care plans and working with pharmacy to make HDAP monitoring forms available widely in the community.
Prognostic Implications of Preablation Stimulated Tg: A Retrospective Analysis of 2500 Thyroid Cancer Patients
Authors: Tian Tian , Xu Yangmengyuan , Zhang Xinyue , Liu Bin 
Published: June 2021

AbstractContextThe risk of persistent and recurrent disease in patients with differentiated thyroid cancer (DTC) is a continuum that ranges from very low to very high, even within the 3 primary risk categories. It is important to identify independent clinicopathological parameters to accurately predict clinical outcomes.ObjectiveTo examine the association between pre-ablation stimulated thyroglobulin (ps-Tg) and persistent and recurrent disease in DTC patients and investigate whether incorporation of ps-Tg could provide a more individualized estimate of clinical outcomes.Design, Setting, and ParticipantsMedical records of 2524 DTC patients who underwent total thyroidectomy and radioiodine ablation between 2006 and 2018 were retrospectively reviewed.Main Outcome MeasurePs-Tg was measured under thyroid hormone withdrawal before remnant ablation. Association of ps-Tg and clinical outcomes.ResultsIn multivariate analysis, age, American Thyroid Association (ATA) risk stratification, distant metastasis, ps-Tg, and cumulative administered activities were the independent predictive factors for persistent/recurrent disease. Receiver operating characteristic analysis identified ps-Tg cutoff (≤10.1 ng/mL) to predict disease-free status with a negative predictive value of 95%, and validated for all ATA categories. Integration of ps-Tg into ATA risk categories indicated that the presence of ps-Tg ≤ 10.1 ng/mL was associated with a significantly decreased chance of having persistent/recurrent disease in intermediate- and high-risk patients (9.9% to 4.1% in intermediate-risk patients, and 33.1% to 8.5% in high-risk patients).ConclusionThe ps-Tg (≤10.1 ng/mL) was a key predictor of clinical outcomes in DTC patients. Its incorporation as a variable in the ATA risk stratification system could more accurately predict clinical outcomes.
Brown Adipose Tissue, Adiposity, and Metabolic Profile in Preschool Children
Authors: Tint Mya Thway , Michael Navin , Sadananthan Suresh Anand , Huang Jonathan Yinhao , Khoo Chin Meng , Godfrey Keith M , Shek Lynette Pei-Chi , Lek Ngee , Tan Kok Hian , Yap Fabian , Velan S Sendhil , Gluckman Peter D , Chong Yap-Seng , Karnani Neerja , Chan Shiao-Yng , Leow Melvin Khee-Shing , Lee Kuan Jin , Lee Yung-Seng , Hu Houchun Harry , Zhang Cuilin , Fortier Marielle V , Eriksson Johan G 
Published: June 2021

AbstractContextAn inverse relationship between brown adipose tissue (BAT) and obesity has previously been reported in older children and adults but is unknown in young children.ObjectiveWe investigated the influence of BAT in thermoneutral condition on adiposity and metabolic profile in Asian preschool children.Design, Setting, and ParticipantsA total of 198 children aged 4.5 years from a prospective birth cohort study, Growing Up in Singapore Towards Healthy Outcomes (GUSTO) were successfully studied with water-fat magnetic resonance imaging of the supraclavicular and axillary fat depot (FDSA). Regions within FDSA with fat-signal-fraction between 20% and 80% were considered BAT, and percentage BAT (%BAT; 100*BAT volume/ FDSA volume) was calculated.Main Outcome MeasuresAbdominal adipose tissue compartment volumes, ectopic fat in the soleus muscle and liver, fatty liver index, metabolic syndrome scores, and markers of insulin sensitivity.ResultsA 1% unit increase in %BAT was associated with lower body mass index, difference (95% CI), −0.08 (−0.10, −0.06) kg/m2 and smaller abdominal adipose tissue compartment volumes. Ethnicity and sex modified these associations. In addition, each unit increase in %BAT was associated with lower ectopic fat at 4.5 years in the liver, −0.008% (−0.013%, −0.003%); soleus muscle, −0.003% (−0.006%, −0.001%) of water content and lower fatty liver index at 6 years.ConclusionsHigher %BAT is associated with a more favorable metabolic profile. BAT may thus play a role in the pathophysiology of obesity and related metabolic disorders. The observed ethnic and sex differences imply that the protective effect of BAT may vary among different groups.