bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Audit of Venous Thromboembolism (VTE) Risk Assessment in an NHS Trust Mental Health Inpatient Setting
Authors: Atmakur Manjula , Ibrahim Sururat , Adedipe Oluwakemisola 
Published: August 2024

AimsTo assess compliance with National Institute of Clinical Excellence (NICE) guidance (NG 89) recommendations on VTE risk assessment for mental health inpatients in Black Country Healthcare NHS Foundation Trust (BCHFT).MethodsNICE guidance (NG89) set out recommendations on VTE risk assessment for adult psychiatric inpatients. It recommends that:
•All adult psychiatric inpatients have their VTE risk assessed as soon as possible after admission or at the first consultant's review.•All patients have their VTE risk re-assessed at the point of consultant's review or if their clinical condition changes.•Any patient found to be at VTE risk should be considered for prophylaxis with Low Molecular Weight Heparin III (LMWH III), if the thrombotic risk outweighs the bleeding risk. Fondaparinux sodium should be considered in those with contraindications to LMWH III.•VTE pharmaco-prophylaxis should be continued until the patient is no longer at increased VTE risk.Using these recommendations as standards, we retrospectively evaluated inpatient clerking charts and progress notes of 49 inpatients across all the 23 wards in the Trust. Data were collected using a standardised audit tool on concordance with these standards to check how many patients had VTE risk assessment within 24 hours of their admission, whether patients had VTE risk re-assessment at any point during admission, whether the patients found to have increased VTE risk at admission were commenced on pharmaco-prophylaxis. Data was also collected to see if the patients commenced on VTE pharmaco-prophylaxis were re-assessed for continued need of the prophylaxis.Results30 patients (59.2%) were risk assessed for VTE within 24 hours of admission. Only 2% of patients had VTE re-assessment while on admission, but there was no record of the indication for this. All the 3 patients (6.1%), found to be at VTE risk on admission, were prescribed pharmaco-prophylaxis, but none of them had a VTE re-assessment to determine the prophylaxis’ continued need.ConclusionThe trust’s compliance with NICE recommendation for VTE risk assessment is below standard. We felt the trust's compliance is a reflection of the medical staff's awareness on the importance of VTE risk assessment in mental health settings, and also lack of Trust's policy on VTE risk assessment. Recommendations were suggested to include VTE risk assessment in the junior doctors’ induction programme and for the trust to have a VTE policy that factors in mental health risk factors.
Audit on Decisions Relating to Cardiopulmonary Resuscitation (CPR) in 2 Older Adult Inpatient Wards
Authors: Philip Joel , Cherian Vinu , Ford Jennifer 
Published: August 2024

AimsThis audit aimed to understand the practice of advance care planning with regard to cardiopulmonary resuscitation (CPR) in an older adult inpatient setting and to ultimately improve practices to conform to nationally set standards.The aims of the audit were:
(1) To determine the prevalence of advance care planning decisions relating to CPR in patients admitted to two older adult psychiatric wards at Thurrock Community Hospital.(2) To confirm that the practice of discussion and documentation of ‘Do Not Attempt Cardiopulmonary Resuscitation' (DNA-CPR) decisions is consistent with current national standards.MethodsFirst, we scrutinized whether the patient's preferences for CPR as a life-sustaining treatment were documented or known to the primary care physician at the time of admission, and whether there was a DNA-CPR order in place at the time of admission.Next, we looked at whether a discussion about CPR was facilitated with the patient (or those close to the patient) during the admission, whether the patient was involved in the discussion surrounding CPR and the reasons for their exclusion (if excluded), and at what point in time during the admission this discussion was carried out and whether it was properly documented.Finally, we assessed the level of completion of the DNA-CPR form itself.Total sample: 38 patients.Results13 out of 38 patients (34.21%) had a DNA-CPR form in place.10 out of 13 DNA-CPR forms (76.92%) were complete in all aspects.Discussion relating to DNA-CPR was not carried out in 29 out of 38 patients (76.32%) during their current admission.Mental Capacity Assessments and Best Interest meetings were not documented as having been carried out as was necessary in the 4 patients (0%) who did not have a designated Lasting Power of Attorney.ConclusionDiscussions about advance care planning and DNA-CPR were not being carried out in a timely manner as per the national guidelines.
Delirium Audit Project of the Greenwich Older Adult Mental Health Liaison Service
Authors: Ustun Anil 
Published: August 2024

AimsDelirium poses a significant risk in hospitals, with a prevalence of 20–30%. Queen Elizabeth Hospital conducted an audit focusing on delirium cases referred to the Greenwich Mental Health Liaison Team for Older Adults (GMHLT OA) between January and April 2023.The audit aimed to assess immediate and medium-term outcomes, identify improvement areas, and propose strategies for optimizing delirium treatment within GMHLT OA.MethodsPatient referrals received by OAMHLT are meticulously recorded in a logbook. Among the referrals, 39 patients from the target population were identified through a manual review of the documentation. To augment the data collection process, electronic databases were also reviewed to ensure comprehensive data retrieval.ResultsKey Findings:39 cases audited, predominantly females (62%).Most affected age group: 71–80 years.Infective causes (49%) and low mood (30%) were common.Antipsychotic treatment administered in 56% of cases.36% required institutionalization post-discharge.ConclusionThe audit underscores the complexity of delirium care, aligning with epidemiological data. It provides a foundation for targeted improvements to enhance patient outcomes within GMHLT OA. Based on the results the following recommendations and action plan were made:Implement multifaceted interventions and non-pharmacological approaches.Strengthen collaboration between departments for diverse referral sources.Explore regional resource allocation and establishment of care pathways based on local implications.
PANDAS Among the Lake District
Authors: Khokar Rehaan 
Published: August 2024

AimsPaediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) is an inflammatory brain disorder characterised by a new onset of obsessive-compulsive disorder, triggered by streptococcal infection likely inducing molecular mimicry of antistreptococcal antibody action within brain tissue. PANDAS is perhaps considered controversial in the field of psychiatry due to debates over the validity of the diagnosis, controversy surrounding aggressive antibiotic and immunomodulatory treatment and limited well-controlled case studies.MethodsA 13-year-old boy, X, presented with new onset worsening confusion, on a background of autism, to a child psychiatric clinic in the Lake District. During the summer, he developed a fixation with Harry Potter and began to act on confabulating beliefs that his mother is (and always has been) Lord Voldemort. X's behaviour became increasingly violent and aggressive and he now only spoke in ‘parseltongue’, refusing to communicate with anyone in any other way. A new personality change was identified as his usual routine behaviours and fixations had dissipated, such as a decrease in his ritualistic behaviours, a loss of his usual inquisitive nature, and an increased fascination with wearing sunglasses due to beliefs that the sun was poisoned by his mother, ‘Lord Voldemort’. Additionally, X's eating habits had markedly changed and now refused all forms of food. Clinically, X also developed a new and sustained tic and was tremulous in clinics, despite no evidence of focal neurological signs. Due to the relatively acute onset of symptoms, an organic cause was queried, which eventually led to the presumed diagnosis of PANDAS.ResultsExtensive investigations, such as an MRI of the brain, autoantibody testing for anti-AQP4, MOG-Ab, and other serological testing, showed no specific cause could be identified other than evident inflammatory changes in the brain. A ‘three-pronged’ treatment approach was adopted: increased psychotherapeutic intervention, antibiotic treatment and IV immunoglobulin therapy.ConclusionThis case illustrates the importance of recognition of PANDAS and, more pertinently, an appreciation of the biological aspect of the biopsychosocial approach to psychiatry. From the minimal evidence available, there is a suggestion of a relatively good prognosis for patients with suspected PANDAS when intervened timely; however, repeated infections or a chronic course of illness is more difficult to treat. PANDAS remains a diagnostic challenge and perhaps a mystery, with complicated impacts on not only the patient and their families but also the psychiatrist and wider teams involved in the management of care.
Navigating Complexity: A Case Report on Interplay of Intellectual Disability (ID), Schizophrenia, Clozapine Treatment and Chemotherapy
Authors: Marconi Alexandra , Martin Alaa 
Published: August 2024

AimsThe use of Clozapine treatment requires rigorous and mandatory monitoring due to the side effects profile of Clozapine. Certain clinical situations may pose a dilemma for clinicians such as concomitant use of clozapine during myelosuppressive chemotherapy. There is limited evidence-based data regarding Clozapine and chemotherapy. We report on a case of a clozapine-stabilized, Schizophrenia patient with Mild ID who was diagnosed with High Grade B-cell Non-Hodgkin's Lymphoma (NHL) requiring chemotherapy. The challenges of this complex case are detailed in this paper.MethodsA 56-year old man with a diagnosis of Mild ID, Schizophrenia and OCD. The patient has been taking Clozapine since 2001 daily dose of 600-400 mg for the past 20 years. Unfortunately, he was diagnosed with High Grade NHL in 2023. The decision was reached to continue Clozapine while undergoing chemotherapy sessions with frequent blood monitoring. Towards the end of his chemotherapy his bloods showed dangerously low (Clozapine red alert) requiring stopping Clozapine. The patient started showing signs of relapse in his mental state and subsequently commenced on Olanzapine. He continued to show signs of relapse and didn't recover to his previous baseline; the treatment plan is adding another antipsychotic or considering re challenging Clozapine.ResultsThis report contributes to a very limited literature on the concurrent use of clozapine with chemotherapy and the use of Clozapine “outside license”. The main treatment options facing clinician is stopping or continuing clozapine during chemotherapy. The dilemma of taking the path of withdrawing a medication on which a patient is stabilized may compromise psychiatric stability, yet there is a valid argument that such inconvenience would present more favourable outcome than facing the serious haematological risks of neutropenia. There is a need for robust and close liaison between psychiatrists, oncologist, and haematologist on the various clinical considerations.ConclusionIn summary, both clozapine and chemotherapy are known to cause neutropenia and agranulocytosis. The clinical decision to continue clozapine during chemotherapy could be challenging. Clinicians should be aware that psychotic decompensation in such patients would inevitably increase morbidity and perhaps mortality due to nonadherence to all proposed treatment, including chemotherapy. In the absence of guidelines and given the nature of treatment-resistant symptoms, clinicians should work in a multidisciplinary approach and carefully weigh the risks and benefits of continuing clozapine during chemotherapy.
A Case of Overlapping Extrapyramidal Side Effects and Neuroleptic Malignant Syndrome
Authors: Phan Jun Hua , Ugwu Kainechukwu , Er Fong Sally Li 
Published: August 2024

AimsNeuroleptic malignant syndrome (NMS) is a rare, life-threatening idiosyncratic reaction to medications, specifically dopamine receptor antagonists. We report a case of a patient who initially developed extrapyramidal side effects (EPSE) and subsequently developed NMS after being treated with flupentixol depot.MethodsA 64-year-old woman with an underlying recurrent depressive disorder with psychotic symptoms presented to a psychiatric hospital in June 2023. She exhibited self-neglect, low mood, paranoid delusions, and non-concordance to oral psychiatric medications.In the first week, she declined all oral medications and was subsequently started on flupentixol decanoate (Depixol) depot injection at 40 mg once every 2 weeks. While showing good improvements in her mental state, she began complaining of akathisia and dystonia since July 2023, consistent with extrapyramidal side effects secondary to flupentixol.The symptoms improved by lowering flupentixol to 30 mg every 2 weeks and adding procyclidine 5 mg twice daily and propranolol 20 mg three times daily.In early September 2023, she experienced severe restlessness, stiffness, muscle weakness and felt hot and clammy over 36 hours. Physical observations showed fever, tachycardia, and hypertension. Examination revealed diaphoresis, rigidity in both upper and lower limbs, lower limb weakness, and normal reflexes. Blood tests indicated acute kidney injury (AKI) stage 1, deranged liver function tests, and a creatinine kinase (CK) level of 9405.She was promptly admitted to the medical hospital for NMS and received extensive intravenous fluid rehydration along with oral Dantrolene. She made a complete recovery, and Depixol was discontinued. Two weeks later, she was started on quetiapine and gradually titrated to 50 mg once daily.ResultsEPSE and NMS are associated with dopamine receptor blockade and commonly occur during the initiation or dosage increment of neuroleptic medications.NMS is rare but life-threatening, presenting with manifestations of muscle rigidity, pyrexia, altered mental status, sympathetic nervous system lability and elevated CK.In our case, our patient, who recently started taking neuroleptic medication, experienced EPSE and later deteriorated acutely, raising a high suspicion of NMS. It is essential to consider other possible diagnoses, including serotonin syndrome, malignant hyperthermia, malignant catatonia and electrolyte disturbances.The commonly used diagnostic criteria include Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and Levenson's criteria but diagnosis of NMS remains clinical.The crucial step after identifying NMS is to immediately stop the neuroleptic agent, followed by supportive medical treatment.ConclusionEarly recognition and prompt treatment of NMS in our patient led to a full recovery.
Identifying digital biomarkers of illness activity and treatment response in bipolar disorder with a novel wearable device (TIMEBASE): protocol for a pragmatic observational clinical study
Authors: Anmella Gerard , Corponi Filippo , Li Bryan M. , Mas Ariadna , Garriga Marina , Sanabra Miriam , Pacchiarotti Isabella , Valentí Marc , Grande Iria , Benabarre Antoni , Giménez-Palomo Anna , Agasi Isabel , Bastidas Anna , Cavero Myriam , Bioque Miquel , García-Rizo Clemente , Madero Santiago , Arbelo Néstor , Murru Andrea , Amoretti Silvia , Martínez-Aran Anabel , Ruiz Victoria , Rivas Yudit , Fico Giovanna , De Prisco Michele , Oliva Vincenzo , Solanes Aleix , Radua Joaquim , Samalin Ludovic , Young Allan H. , Vergari Antonio , Vieta Eduard , Hidalgo-Mazzei Diego 
Published: August 2024

Background
Bipolar disorder is highly prevalent and consists of biphasic recurrent mood episodes of mania and depression, which translate into altered mood, sleep and activity alongside their physiological expressions.

Aims
The IdenTifying dIgital bioMarkers of illnEss activity and treatment response in BipolAr diSordEr with a novel wearable device (TIMEBASE) project aims to identify digital biomarkers of illness activity and treatment response in bipolar disorder.

Method
We designed a longitudinal observational study including 84 individuals. Group A comprises people with acute episode of mania (n = 12), depression (n = 12 with bipolar disorder and n = 12 with major depressive disorder (MDD)) and bipolar disorder with mixed features (n = 12). Physiological data will be recorded during 48 h with a research-grade wearable (Empatica E4) across four consecutive time points (acute, response, remission and episode recovery). Group B comprises 12 people with euthymic bipolar disorder and 12 with MDD, and group C comprises 12 healthy controls who will be recorded cross-sectionally. Psychopathological symptoms, disease severity, functioning and physical activity will be assessed with standardised psychometric scales. Physiological data will include acceleration, temperature, blood volume pulse, heart rate and electrodermal activity. Machine learning models will be developed to link physiological data to illness activity and treatment response. Generalisation performance will be tested in data from unseen patients.

Results
Recruitment is ongoing.

Conclusions
This project should contribute to understanding the pathophysiology of affective disorders. The potential digital biomarkers of illness activity and treatment response in bipolar disorder could be implemented in a real-world clinical setting for clinical monitoring and identification of prodromal symptoms. This would allow early intervention and prevention of affective relapses, as well as personalisation of treatment.
Trends in Presentation, Management, and Survival of Women With Breast Cancer in a Multiethnic, Middle-Income Asian Setting
Authors: Jaya-Prakason Sharminii , Kong Yek-Ching , Yip Cheng-Har , See Mee-Hoong , Taib Nur Aishah , Abdul Satar Nur Fadhlina , Jamaris Suniza , Teoh Li Ying , Ibrahim Rose Irnawaty , Bhoo-Pathy Nirmala 
Published: August 2024

PURPOSE Granular data on breast cancer (BC) are pertinent for surveillance, planning, and monitoring of cancer care delivery. We determined the trends in clinical presentation, management, and survival of women with BC in a multiethnic middle-income Asian setting over 15 years. METHODS Data of 7,478 Malaysian women newly diagnosed with invasive BC between 2005 and 2019 from three hospital-based cancer registries were included. Trends in demographic, tumor, and treatment characteristics were compared across period 1 (P1): 2005-2009, period 2 (P2): 2010-2014, and period 3 (P3): 2015-2019. Overall survival and net survival were determined. RESULTS More women in P3 than P1 were older than 60 years at diagnosis. Only a marginal increase in proportion of women with stage I disease was observed (23.7% v 27.2% in P1 and P3, respectively, P = .004). Nonetheless, patients were increasingly presenting with smaller tumors, fewer axillary node involvement, well-differentiated tumors, and hormone receptor expression in recent times. Proportion of women with human epidermal growth factor receptor 2 (HER2)–overexpressed tumors significantly decreased. Among indicated patients, receipt of anticancer therapies was somewhat similar over the calendar periods, except for neoadjuvant chemotherapy and anti-HER2 therapy, where increases in administration were noted. Significant improvements in survival were observed over the 15 years, particularly for HER2-overexpressed BCs. CONCLUSION Although the improvements in BC survival that we have observed validate ongoing cancer control efforts and treatment advances, study findings suggest that more could be done for earlier detection and improved access to effective therapies in our settings.
The Association Between Telomere Length and Diabetes Mellitus: Accumulated Evidence From Observational Studies
Authors: He Xinxin , Cao Lu , Fu Xueru , Wu Yuying , Wen Hongwei , Gao Yajuan , Huo Weifeng , Wang Mengdi , Liu Mengna , Su Yijia , Liu Ge , Zhang Ming , Hu Fulan , Hu Dongsheng , Zhao Yang 
Published: August 2024

Abstract

Objective
In order to assess the associations between telomere length (TL) and diabetes mellitus (DM), especially type 2 diabetes (T2DM), we performed this systematic review and meta-analysis.

Methods
PubMed, Embase, and Web of Science were thoroughly searched up to July 11, 2023. The pooled standardized mean difference (SMD) and the 95% confidence interval (CI) were evaluated using the random-effects model. Age, sex, study design, duration of diabetes, region, sample size, and body mass index (BMI) were used to stratify subgroup analyses.

Results
A total of 37 observational studies involving 18 181 participants from 14 countries were included in the quantitative meta-analysis. In this study, patients with diabetes had shorter TL than the non-diabetic, whether those patients had T1DM (−2.70; 95% CI: −4.47, −0.93; P &lt; .001), T2DM (−3.70; 95% CI: −4.20, −3.20; P &lt; .001), or other types of diabetes (−0.71; 95% CI: −1.10, −0.31; P &lt; .001). Additionally, subgroup analysis of T2DM showed that TL was significantly correlated with age, sex, study design, diabetes duration, sample size, detection method, region, and BMI.

Conclusion
A negative correlation was observed between TL and DM. To validate this association in the interim, more extensive, superior prospective investigations and clinical trials are required.
Developmental analysis of Spalt function in the Drosophila prothoracic gland
Authors: Ostalé Cristina M. , Pulido Diego , Vega-Cuesta Patricia , López-Varea Ana , de Celis Jose F. 
Published: August 2024

ABSTRACT
The Spalt transcriptional regulators participate in a variety of cell fate specification processes during development, regulating transcription through interactions with DNA AT-rich regions. Spalt proteins also bind to heterochromatic regions, and some of their effects require interactions with the NuRD chromatin remodeling and deacetylase complex. Most of the biological roles of Spalt proteins have been characterized in diploid cells engaged in cell proliferation. Here, we address the function of Drosophila Spalt genes in the development of a larval tissue formed by polyploid cells, the prothoracic gland, the cells of which undergo several rounds of DNA replication without mitosis during larval development. We show that prothoracic glands depleted of Spalt expression display severe changes in the size of the nucleolus, the morphology of the nuclear envelope and the disposition of the chromatin within the nucleus, leading to a failure in the synthesis of ecdysone. We propose that loss of ecdysone production in the prothoracic gland of Spalt mutants is primarily caused by defects in nuclear pore complex function that occur as a consequence of faulty interactions between heterochromatic regions and the nuclear envelope.