bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are We Monitoring Our Lithium Patients as Well as We Should be? A Two-Cycle Audit Evaluating Lithium Clinic Documentation in a District General Hospital in Wales
Authors: Mohammed Huda , Islam Rahatul , Sparrow Cressida , Chan Timothy 
Published: August 2024

AimsLithium is a mood-stabiliser with a narrow therapeutic index. Patients are known to be at risk of lithium toxicity if they are unaware of how to recognise its signs. NICE guidelines outline the information that must be relayed to these patients. Furthermore, GMC Good Medical Practice highlights the importance of clear and contemporaneous patient records that contain relevant clinical information.The aim of this two-cycle audit was to assess the quality of documentation for patients reviewed in lithium clinic and to analyse the consistency of the notes recorded to ensure high quality care provision and communication within the department, in line with the NICE guidelines.MethodsThe inclusion criteria were patients over the age of 65, prescribed lithium and were actively reviewed in the monthly lithium clinic at the Older Person's Mental Health Service (OPMHS) at Princess of Wales Hospital in Wales.A data collection form was created to ensure all the relevant data in line with NICE guidelines was captured including serum lithium level, lithium dose, other psychotropics, side effects, renal function, patient mood, safety netting advice provided including signs of toxicity and awareness of lithium card. A standard of 100% was set for this data to be captured for each patient.ResultsCycle 1 was completed in November 2023 where a total of 18 patient records were selected (N = 18). Lithium dose, lithium level and renal function were recorded in over 83.3% (n = 15) of the files audited. Details on psychotropics were recorded in 61.1% (n = 11), side effects in 50% (n = 9) and patient mood in 77.8% (n = 14). Safety netting advice was recorded in 11.1% (n = 2). Furthermore, it was noted data recorded varied between clinicians.The results of this audit were disseminated to OPMHS team. A proforma was introduced to encourage capture of all relevant information and to ensure consistency. Feedback was collected from clinicians using the proformas and relevant changes were made.A second cycle of this audit was carried out after the proforma was introduced to the subsequent clinic (N = 12). This showed an improvement in record-keeping including lithium dose, lithium levels, psychotropics and side effects of 100% (n = 12). Renal function and mood were recorded in 91.7% (n = 11) of files and safety netting advice provision in 75% (n = 9) of files audited.ConclusionIntroduction of a proforma is a simple and effective way to ensure relevant and important details are documented. This is not only for good clinical practice, but for medico-legal reasons also.
An Interdisciplinary Approach to the Management of Ketamine Induced Uropathy
Authors: McKnight Rebecca , Horgan Patrick 
Published: August 2024

AimsThis report describes the treatment of a patient with ketamine induced uropathy. This condition can be significantly debilitating due to its severe effect on the urinary system. This report outlines an interdisciplinary approach to the care of the patient involving addictions services, urology and primary care.MethodsThe patient presented with a history of inhalation of ketamine intermittently for four years and daily for three years. His highest daily use was 14 grams per day.He developed multiple urinary symptoms including dysuria, urgency, incontinence, haematuria and abdominal and urethral pain. He had significant weight loss and suicidal thoughts. After six years of use, he was reviewed by urology, however was discharged within a year, after missing appointments. Investigations included ultrasound which showed kidneys of normal appearance; flexible cystoscopy which showed a small bladder with acute bleeding and posterior wall ulcer; urodynamic studies showed overactive bladder.He attended a private, inpatient detoxification programme, however relapsed after this admission and self-referred to local addictions services. When assessed there, a detailed history and physical examination were completed. Baseline electrocardiogram and blood investigations were completed and were broadly normal.It was felt that a collaborative approach between addictions services, primary care, urology, and a regional addictions detoxification centre could help him manage his symptoms and achieve more sustained abstinence. Following interdisciplinary discussions, he was commenced on solifenacine to treat his urinary frequency, mirtazapine for his mood and buscopan for pain. Motivation interviewing approaches were used to help him reduce his ketamine use.ResultsKetamine is a synthetic drug with marked dissociative, stimulant and hallucinogenic properties. There has been a rising trend in adults entering treatment with harmful ketamine use in recent years. In 2023, 2,211 people entered treatment for harmful ketamine use in England, a fivefold increase from 2014. Ketamine induced uropathy would be expected to occur in a high proportion of these people. A survey of adolescents demonstrated that 60% of ketamine users had lower urinary tract symptoms. There are a range of medical and surgical options to treat ketamine induced uropathy but no clear agreed approach for its holistic management in the UK.ConclusionThis case report highlights the consequences of prolonged ketamine use on the urinary tract system. It highlights an example of effective interdisciplinary working between addictions services, primary care and urology. The authors recommend the development of nationally agreed guidelines on ketamine induced uropathy with emphasis on collaborative, inter-service working.
Transcending Erotomania: A Case of Long-Term Multi-Comorbid Management in an Adolescent Medium Secure Unit
Authors: Shahid Manzar , Shah Parag , Siddique Muhammad Saqib 
Published: August 2024

Aims20 year old patient open to mental health services since the age of 8. Through the years, they have had work-up and diagnoses of ADHD, ASD, Schizoaffective Disorder (with prominent erotomanic delusions) and sexual identity concerns.They spent a number of years in psychiatric in-patient units following an index offence. Initially in an adolescent LSU and subsequently in an adolescent MSU.After 5 years of their stay at the MSU, their transition to an adult rehabilitation ward was planned and completed.Methods20 year old, oldest of 5 siblings, born with no complications during or after pregnancy and at full-term. First referred to mental health services aged 6 regarding difficulties at school leading to a diagnosis of ADHD.At age 13, re-engaged with mental health services following concerns around self-harm, disappearing from home, alcohol use. Also with difficulties around gender identity and sexual orientation. Shortly after, elements of ASD were identified, including social and communication difficulties and special interests which included single females.Around age 16, patient developed erotomanic delusions. First towards a female friend in dance class – patient wanted to run away with them and have their babies, and carried a knife to hurt anyone who tried to get in their way, eventually leading to the index offence. In addition, there were similar erotomanic delusions with regards to at least 2 famous female music personalities.With a significant mood component accompanying the psychosis, she was diagnosed and managed as having Schizoaffective Disorder.ResultsThe patient presented with a complex, multimodal presentation which took time and a comprehensive holistic approach. They were trialled on 3 different antipsychotics and eventually clozapine which needed stopping due to side effects. Best response was eventually observed with a return to olanzapine.Patient also had 19 treatments of ECT (13 being high dose) with marked transient improvement.Psychology, OT and the MDT largely focussed on building therapeutic relationships with the patient which gradually helped the patient develop insight around their erotomanic delusions and the impact on their life.ConclusionDespite the complexities of this case, it highlighted that a robust, consistent, holistic approach can change lives even though this may take some time. The patient was utilizing leaves off the ward, taking part in the education sessions and activities on the ward and has recently been transferred to an adult rehabilitation ward after years in an adolescent specialist in-patient service.
The impact of transformational leadership on workers’ personal resources: latent profile analysis and links with physical and psychological health
Authors: Cortés-Denia Daniel , Pulido-Martos Manuel , Bosak Janine , Lopez-Zafra Esther 
Published: August 2024

Background
Several studies have examined the impact of leadership on employee well-being and health. However, this research has focused on a variable-centred approach. By contrast, the present study adopts a person-centred approach.

Aims
To (a) identify latent ‘resources’ profiles among two samples combining vigour at work, work engagement and physical activity levels; (b) examine the link between the identified profiles and indicators of psychological/physical health; and (c) test whether different levels of transformational leadership determine the probability of belonging to a particular profile.

Method
Two samples of workers, S1 and S2 (NS1 = 354; NS2 = 158), completed a cross-sectional survey before their annual medical examination.

Results
For S1, the results of latent profile analysis yielded three profiles: spiritless, spirited and high-spirited. Both high-spirited and spirited profiles showed a positive relationship with mental health, whereas spiritless showed a negative relationship. For S2, two profiles (spirited and spiritless) were replicated, with similar effects on mental health, but none of them was related to total cholesterol. In both samples, transformational leadership determined the probability of belonging to a particular profile.

Conclusions
Transformational leadership increased the probability of belonging to a more positive profile and, therefore, to better workers’ health.
Systematic Review of Referral and Care Pathways for Children and Young People of Black Ethnicity Through Child and Adolescent Mental Health Services Compared With Other Ethnic Groups: An International Comparison
Authors: Odebiyi Babatunde , Ani Cornelius , Sultana Rezina , Ayodeji Eunice , Dubicka Bernadka 
Published: August 2024

AimsThe review explored differences in sources of referrals and utilisation of child and adolescent mental health services (CAMHS) among children and young people (CYP) of black ethnicity compared with other ethnicities. We also explored international differences.MethodsWe searched MEDLINE (through Ovid), PsycINFO, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Web of Science using a priori defined search terms to identify relevant records. We used the “Population, Exposure, and Outcome” (PEO) framework to define search terms. Pairs of authors assessed papers for inclusion, extracted the data and conducted quality assessment. The systematic review was pre-registered with PROSPERO (CRD42021249619).ResultsWe identified 110 studies which all had quantitative design. The results indicate that compared with other ethnic groups, CYP of black ethnicity were less likely to be screened for mental disorders, and more likely to be referred by non-voluntary sources such as social/child welfare services and juvenile justice systems. CYP of black ethnicity were also less likely to utilise all types and levels of mental health services with the exception of school-based services. CYP of black ethnicity were less likely to access psychological intervention or to be prescribed psychotropic medications. Also, CYP of black ethnicity were more likely to experience coercive treatments, and to receive poorer quality of care. These findings were similar across different countries.ConclusionCYP of black ethnicity experience significant disadvantages across their care journeys through CAMHS. Addressing the drivers for these disadvantages is crucial for improving access to care for this group.
Emergency Department (ED) Walkouts in a Mental Health Crisis: West London NHS Trust Liaison Psychiatry Response to the London Metropolitan Police's Right Care Right Person Approach
Authors: Bielli Margherita , Rosen David , Patel Sachin , Cho Yena 
Published: August 2024

AimsPatients walking out of ED during mental health crises are commonly encountered in Liaison Psychiatry. Responsibility for high-risk or vulnerable walkouts had predominantly fallen on the police due to resource pressures in health and social care services. In 2023, London's Metropolitan Police announced a new partnership model, the “Right Care Right Person” (RCRP) approach. This supported the withdrawal of police involvement in mental health crises and allowed health and social care agencies who have the expertise and authority to act, to fulfil their role. This QI project aimed to understand the extent of police involvement in ED walkouts prior to the implementation of RCRP, introduce a new protocol for managing these situations, and evaluate its impact in terms of resource use and patient outcomes.MethodsThe Trust's incident reporting system was used to identify mental health-related ED walkouts between May–August 2023, prior to the introduction of RCRP. Patients’ notes were reviewed to identify immediate actions taken following the walkout, including whether the police were involved, what action they took and patient outcomes. This was used to create a new Trust-wide ED walkout protocol, incorporating the Metropolitan Police's risk assessment tools. This was disseminated to frontline staff. A repeat analysis took place in November–December 2023, post-RCRP, to analyse how ED walkouts were being managed, and by which service. Furthermore, the analysis explored the nature of any patient harm which occurred following the incidents.ResultsWe found 29 walkouts from A&E between May–August 2023 (pre-RCRP), compared with 35 between November–December 2023 (post-RCRP). Police were called in 79% of cases pre-RCRP and 74% post-RCRP. Pre-RCRP police was not involved in 41% of cases, and in 81% of cases post-RCRP. Mental health services made first contact following walkout in 41% of cases pre-RCRP, and in 46% post-RCRP. LAS made contact in 29% of cases post-RCRP. Post-RCRP 26% of patients who walked out were admitted to a Mental Health Trust within 7 days. 20 patients had their treatment delayed, 5 suffered from neglect. 3 patient walkouts resulted in harm to others, and 2 resulted in self-harm.ConclusionAs expected, police responded to fewer walkout reports, and our data shows this gap has been filled by other services. The Trust's risk assessment-based approach to managing walkouts has shown promising results. The next stage of the project will focus on developing local protocols for the identification and management of patients at high risk of walkout.
Relationship Between 1,5-Anhydroglucitol and Renal Function Assessed by Dynamic Renal Scintigraphy in Type 2 Diabetes
Authors: Ni Jiaying , Su Hang , Wang Yaxin , Lu Wei , Wang Yufei , Bao Yuqian , Lu Jingyi , Zhou Jian 
Published: August 2024

Abstract

Context
The reliability of serum 1,5-anhydroglucitol (1,5-AG) in patients with type 2 diabetes and renal insufficiency remains controversial.

Objective
To evaluate the relationship between renal function and serum 1,5-AG and to assess the extent to which renal function influences 1,5-AG.

Methods
A total of 5337 participants with type 2 diabetes were enrolled. The measured glomerular filtration rate (mGFR) was assayed using 99mTc-DTPA dynamic renal scintigraphy. All subjects were stratified into 5 groups based on mGFR (≥120 [n = 507], 90-120 [n = 2015], 60-90 [n = 2178], 30-60 [n = 604], and &lt;30 mL/min/1.73 m2 [n = 33]).

Results
Overall, the serum 1,5-AG and mGFR levels were 3.3 (1.7-7.0) μg/mL and 88.6 ± 24.1 mL/min/1.73 m2, respectively. mGFR was found to be negatively correlated with 1,5-AG levels (r = −0.189, P &lt; .001). Multiple linear regression revealed that mGFR was independently and negatively related to serum 1,5-AG after adjusting for covariates including hemoglobin A1c (HbA1c; P &lt; .001). In subgroups with mGFR ≥ 30 mL/min/1.73 m2, the correlation coefficients between 1,5-AG and HbA1c, fasting plasma glucose, postprandial plasma glucose, and the differences between postprandial and fasting plasma glucose remained significant (range, −0.126 to −0.743, all P &lt; .01). However, the link between 1,5-AG and traditional glycemic markers was attenuated in individuals with mGFR &lt; 30 mL/min/1.73 m2. Sensitivity analysis after excluding anemic patients showed similar results regarding the relationship between serum 1,5-AG and HbA1c across the mGFR subgroups.

Conclusion
Although we observed a weak inverse correlation (r = −0.189) between mGFR and serum 1,5-AG in type 2 diabetes, 1,5-AG remains a valid marker for assessing glucose control in subjects with mild or moderate renal dysfunction.
The Association Between Thyroid Differentiation Score and Survival Outcomes in Papillary Thyroid Carcinoma
Authors: Wang Jennifer R , Zafereo Mark E , Cabanillas Maria E , Wu Chia Chin , Xu Li , Dai Yaoyi , Wang Wenyi , Lai Stephen Y , Henderson Ying , Erasmus Lauren , Williams Michelle D , Joshu Corinne , Ray Debashree 
Published: August 2024

Abstract

Context
Thyroid differentiation score (TDS), calculated based on mRNA expression levels of 16 genes controlling thyroid metabolism and function, has been proposed as a measure to quantify differentiation in papillary thyroid carcinoma (PTC).

Objective
The objective of this study is to determine whether TDS is associated with survival outcomes across patient cohorts.

Methods
Two independent cohorts of patients with PTC were used: (1) The Cancer Genome Atlas (TCGA) thyroid cancer study (N = 372), (2) MD Anderson Cancer Center (MDACC) cohort (N = 111). The primary survival outcome of interest was progression-free interval (PFI). Association with overall survival (OS) was also explored. The Kaplan–Meier method and Cox proportional hazards models were used for survival analyses.

Results
In both cohorts, TDS was associated with tumor and nodal stage at diagnosis as well as tumor driver mutation status. High TDS was associated with longer PFI on univariable analyses across cohorts. After adjusting for overall stage, TDS remained significantly associated with PFI in the MDACC cohort only (adjusted hazard ratio [aHR] 0.67, 95% CI 0.52-0.85). In subgroup analyses stratified by tumor driver mutation status, higher TDS was most consistently associated with longer PFI in BRAFV600E-mutated tumors in the MDACC cohort after adjusting for overall stage (TCGA: aHR 0.60, 95% CI 0.33-1.07; MDACC: aHR 0.59, 95% CI 0.42-0.82). For OS, increasing TDS was associated with longer OS in the overall MDACC cohort (aHR = 0.78, 95% CI 0.63-0.96), where the median duration of follow-up was 12.9 years.

Conclusion
TDS quantifies the spectrum of differentiation status in PTC and may serve as a potential prognostic biomarker in PTC, mostly promisingly in BRAFV600E-mutated tumors.
Autoimmune Encephalitis
Authors: Irani Sarosh R. 
Published: August 2024

ABSTRACT

OBJECTIVE
This article focuses on the clinical features and diagnostic evaluations that accurately identify patients with ever-expanding forms of antibody-defined encephalitis. Forms of autoimmune encephalitis are more prevalent than infectious encephalitis and represent treatable neurologic syndromes for which early immunotherapies lead to the best outcomes.

LATEST DEVELOPMENTS
A clinically driven approach to identifying many autoimmune encephalitis syndromes is feasible, given the typically distinctive features associated with each antibody. Patient demographics alongside the presence and nature of seizures, cognitive impairment, psychiatric disturbances, movement disorders, and peripheral features provide a valuable set of clinical tools to guide the detection and interpretation of highly specific antibodies. In turn, these clinical features in combination with serologic findings and selective paraclinical testing, direct the rationale for the administration of immunotherapies. Observational studies provide the mainstay of evidence guiding first- and second-line immunotherapy administration in autoimmune encephalitis and, whereas these typically result in some clinical improvements, almost all patients have residual neuropsychiatric deficits, and many experience clinical relapses. An improved pathophysiologic understanding and ongoing clinical trials can help to address these unmet medical needs.

ESSENTIAL POINTS
Antibodies against central nervous system proteins characterize various autoimmune encephalitis syndromes. The most common targets include leucine-rich glioma inactivated protein 1 (LGI1), N-methyl-d-aspartate (NMDA) receptors, contactin-associated proteinlike 2 (CASPR2), and glutamic acid decarboxylase 65 (GAD65). Each antibody-associated autoimmune encephalitis typically presents with a recognizable blend of clinical and investigation features, which help differentiate each from alternative diagnoses. The rapid expansion of recognized antibodies and some clinical overlaps support panel-based antibody testing. The clinical-serologic picture guides the immunotherapy regime and offers valuable prognostic information. Patient care should be delivered in conjunction with autoimmune encephalitis experts.
NMOSD and MOGAD
Authors: Sechi Elia 
Published: August 2024

ABSTRACT

OBJECTIVE
This article reviews the clinical features, MRI characteristics, diagnosis, and treatment of aquaporin-4 antibody–positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD). The main differences between these disorders and multiple sclerosis (MS), the most common demyelinating disease of the central nervous system (CNS), are also highlighted.

LATEST DEVELOPMENTS
The past 20 years have seen important advances in understanding rare demyelinating CNS disorders associated with AQP4 IgG and myelin oligodendrocyte glycoprotein (MOG) IgG. The rapidly expanding repertoire of immunosuppressive agents approved for the treatment of AQP4-NMOSD and emerging as potentially beneficial in MOGAD mandates prompt recognition of these diseases. Most of the recent literature has focused on the identification of clinical and MRI features that help distinguish these diseases from each other and MS, simultaneously highlighting major diagnostic pitfalls that may lead to misdiagnosis. An awareness of the limitations of currently available assays for AQP4 IgG and MOG IgG detection is fundamental for identifying rare false antibody positivity and avoiding inappropriate treatments. For this purpose, diagnostic criteria have been created to help the clinician interpret antibody testing results and recognize the clinical and MRI phenotypes associated with AQP4-NMOSD and MOGAD.

ESSENTIAL POINTS
An awareness of the specific clinical and MRI features associated with AQP4-NMOSD and MOGAD and the limitations of currently available antibody testing assays is crucial for a correct diagnosis and differentiation from MS. The growing availability of effective treatment options will lead to personalized therapies and improved outcomes.