bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seclusion on Psychiatric Intensive Care Unit – Is the Trust Medical Review Policy Being Followed?
Authors: Scanlon Hannah 
Published: July 2023

AimsSeclusion is a restrictive intervention used in inpatient settings for the safe management of patients who present with severe behavioural disturbance which is likely to cause harm to others. Clinical notes were used to establish if the trust policy of medical reviews for patients in seclusion was being followed on the Psychiatric Intensive Care Unit (PICU).MethodsPatients admitted to male PICU at Springfield Hospital, Southwest London, over a 4 month period (February 2022 to May 2022) were included in this audit. Patients who were secluded outside this time period or prior to admission to PICU were excluded from this audit.The clinical notes computer system (Rio) was searched using the term “seclusion”. The timing of initiation and termination of seclusion were noted as well as the timing and grade of medical professionals present for documented reviews.ResultsOver this period, 12 discrete episodes of seclusion were identified. The length of seclusion varied from 8 hours 45 minutes to over 5 days, with a mean length of almost 3 days (2 days, 20 hours, 25 minutes).As the length of seclusion differed so did the required medical reviews in line with trust policy. This involves Senior House Officer (SHO) review at 30 minutes, Registrar review at 8 hours, Consultant review at 24 hours followed by 2 senior reviews (one Registrar and one Consultant) over each subsequent 24 hour period of continuous seclusion.10 episodes of seclusion lasted over 24 hours in this audit. Of these 40% had the required medical reviews documented in the clinical notes appropriately for the full period of seclusion. 50% of cases had at least 1 missed or not documented Registrar review. There were 2 incidents of missed Consultant medical reviews for a 24 hour period of continuous seclusion.ConclusionFrom these results medical reviews were not being correctly carried out, or were not documented correctly, in the majority (60%) of cases of seclusion over 24 hours. This suggests missed opportunities for patient review to terminate seclusion at the earliest safe opportunity in line with national and trust guidance. These results have informed the update of trust guidelines on seclusion to bring it in line with national guidance with a view to improve patient care and will be re-audited.
Antipsychotic Prescribing for Behavioural and Psychological Symptoms of Dementia: An Audit of Prescribing Practices in the Harrogate Community Mental Health Team for Older Adults
Authors: Wilson Joanna , White Natasha , Croft Matthew , Ahmed Suman , Illsley Lynne , Hughes Paul 
Published: July 2023

AimsBehavioural and Psychological Symptoms of Dementia (BPSD) include a range of neuropsychiatric disturbances such as agitation, aggression, depression, and psychotic symptoms. These common symptoms can impact patients’ functioning and quality of life. Antipsychotic medication can be prescribed to alleviate some symptoms, but this comes with significant risks including cerebrovascular events and increased mortality. We aimed to review antipsychotic prescribing of the Harrogate Older Adult Community Mental Health Team (CMHT); to measure compliance with NICE guidance and local policy and thus improve the prescribing and monitoring process.MethodsUsing electronic patient records, we identified all patients under the care of the CMHT with a diagnosis of dementia currently receiving antipsychotic treatment; a total of 55 patients. A random sample of 24 patients were reviewed; their records were hand searched for relevant information.The standards measured were derived from the NICE Guideline (NG97) June 2018: ‘Dementia: assessment, management and support for people living with dementia and their carers’ as well as local trust guidance.ResultsAll 24 patients were receiving antipsychotics for severe distress or aggression. 88% of patients had an assessment of sources of distress before treatment was started, but only 42% had a non-pharmacological intervention before antipsychotic treatment was started. Once antipsychotic treatment had started this increased to 58%. For some patients, the reason for not receiving a non-pharmacological intervention was due to urgency of treatment or being on a waiting list for occupational therapy, but for most the reason was not explicitly documented.For 63%, there was evidence of a discussion of the risks of treatment with the patient, carer or family member. 63% had initial baseline blood tests and 54% had a baseline ECG. Of the patients who did not have initial monitoring, a suitable reason was given for just over 60%. Only 33% of patients who had antipsychotic treatment for over 12 weeks had a trial of discontinuation or dose reduction. Less than 22% of patients had physical health monitoring at one year of treatment.ConclusionThere were shortfalls in several areas including the offer of non-pharmacological interventions, regular review of the ongoing need for antipsychotics, and physical health monitoring.Introduction of a checklist before antipsychotics are prescribed is recommended, to include discussion of risks and benefits, non-pharmacological interventions, and initial monitoring. Also recommended is a system to identify when monitoring and review of antipsychotics are due.
The Utilisation Rate of Clozapine for Treatment Resistant Schizophrenia Within Trustwide Adult Inpatient Services Over One Year
Authors: Zhang Peter , Li Zhen Dong , Sami Musa 
Published: July 2023

AimsThe audit was undertaken to explore if inpatients with treatment resistant schizophrenia (TRS), or whose condition has not adequately responded to two antipsychotics of an optimal duration and dose, were offered clozapine as per NICE guidelines (CG178 1.5.7.2).MethodsData were collected retrospectively and anonymously from all electronic notes via the UK-CRIS analysis platform.The inclusion criteria required patients, aged 18–64 years, to have a schizophrenia (ICD10 F20) diagnosis and to have been admitted to one of ten Trust inpatient wards between 01/01/2020 and 01/01/2021.Patients were required to fulfil the criteria of treatment resistance, as having an inadequate response to two or more antipsychotic drugs, one of which was an atypical agent.Patients who had previously tried or were currently on clozapine were excluded. Those with non-schizophrenia psychotic disorders were also excluded. 347,645 records were electronically screened according to the criteria, and 209 records were reviewed.Results43 patients from the 209 patients reviewed were found to be eligible for clozapine. 28 (65%) were offered clozapine during their admission and 9 of these patients had started the titration process (21% of those eligible).Of the 19 patients who declined clozapine when offered, 14 had refused the drug with the most common reason of not accepting the required blood monitoring (n=10).Of the 15 eligible patients who were not offered clozapine, the clinical team had documented a consideration to offer clozapine in 6 patients (14%) but had rejected its, predominantly due to concerns of non-compliance.For 3 patients (7%) the clinical team considered for but did not offer clozapine. There was no documentation regarding clozapine for 6 patients (14%).ConclusionThis audit identified that most patients with TRS were offered clozapine during their admission. However, a proportion of patients were not offered the gold standard treatment for TRS and this may lead to poorer outcomes.It demonstrated that a minority of eligible patients ultimately start the drug. There are barriers for eligible patients to accept clozapine, for instance around the regular blood monitoring required.
Providing the Right Support at the Right Time for People With Learning Disabilities: A Mixed-Methods Study to Identify Change Goals for a Demand, Capacity and Flow Quality Improvement Project
Authors: Cai James , Barnett Joshua , Haberland Kirsty , Clarke Melanie , Fysh Grace , Chaplin Catriona , Lim Ivy , Martiello Michele , Hall Ian , Checkley Laura 
Published: July 2023

Aims1. To evaluate demand, capacity and flow of an integrated community learning disability service in a peri- and post-COVID-19 pandemic setting. 2. To improve flow of a community learning disability service. 3. To improve staff and service user satisfaction by engaging them and identifying common priorities.MethodsWe collected demand and capacity data of all disciplines in a community learning disability service for 2021–2022.We carried out focus groups with service users and their carers (N = 5) and surveyed them with a questionnaire consisting of 6 quantitative and 2 qualitative questions (N = 63), investigating the impact of waiting times on service user experience.We surveyed staff from all disciplines (N = 20) with a questionnaire consisting of 3 qualitative questions, to identify their views on waiting times and areas to optimise.We performed thematic analysis on all qualitative responses. We analysed quantitative data with descriptive statistics.ResultsFrom 2021–22, the number of accepted referrals to individual disciplines increased: for example referrals to psychiatry increased by 51.6% and referrals to OT increased by 32%.With regard to flow, the ratio of discharges to accepted referrals in the psychiatry discipline decreased from 1.5:1 to 0.6:1.A significant proportion of service users reported waiting months (31%) or years (16%) to be seen by the learning disability team. 28% of service users reported additional problems while waiting to be seen. 31% were unaware whether they were on a waiting list or not. Quantitative data showed average waiting times for psychiatry services did not change from 2021–2022 (23.1 and 23.3 days respectively).Thematic analysis from service users’ responses revealed an anxiety about needs not being met; a feeling of problems deteriorating while waiting; and communication issues.Staff responses revealed desires to intervene sooner to prevent unnecessary deteriorations; and to increase team working between disciplines.ConclusionQuantitative data analysis suggests a greatly increased demand for our service following the COVID-19 pandemic.Our thematic analysis identifies concern of deterioration secondary to prolonged waiting times. It also highlights that communication could be improved.As a result of this mixed-methods approach, the following change ideas were generated and are now being tested:
1.Improve communication with patients on waiting lists by testing an accessible customisable letter.2.Organise more joint assessments and reviews of service users with multiple disciplines.3.Short-term allocation of more urgent casework via a new integrated health and social care duty system.
What Factors Influence the Outcome of Psychiatry Postgraduate Written Exams, MRCPsych Paper a and B? a Qualitative Analysis From Trainees’ Perspective in West Midlands School of Psychiatry in UK
Authors: Javed Asma , Alkhadragy Rania 
Published: July 2023

AimsAnalysis of the Annual Report of Examination Results published by General Medical Council (GMC, 2020) revealed that trainees of West Midlands School of Psychiatry didn't perform well in written components of MRCPsych exams and showed pass rate between 2014 and 2019 as 54.6%. Therefore, this qualitative study was conducted to assess West Midlands School of Psychiatry core psychiatry trainees’ perception of factors that influence the outcome of MRCPsych Paper A and Paper B.MethodsQualitative research methodology with a grounded theory approach was used to systematically analyse the data and to evolve the theory rather than appraising the existing theory. The purposive and theoretical sampling strategies were used. Study population included all core psychiatry trainees in the West Midlands School of Psychiatry in 2021 who were invited via email for a semi-structured focus group interview. The participants’ information sheet and consent forms were sent with the interview invite. A total of 38 participants contributed. The data were collected through 3 focus groups and 2 one-to-one interviews. The interviews were recorded using the recording and transcription feature of Microsoft Teams. The transcription was checked manually for accuracy. The data were collected and analysed simultaneously till the point of theoretical saturation, thereafter a thematic analysis was conducted.ResultsThemes emerged were grouped under challenges faced by the participants such as work and time pressures, financial constraints, and lack of family support. Other challenges were related to virtual learning, a mismatch between local teaching course and exam schedule and lack of contextualisation in local course content. Most of the trainees had to rely on private courses which were adding financial burden. The majority felt that social isolation due to COVID-19 had a negative impact on their well-being. Participants suggested various recommendations for their local course content and delivery.ConclusionThe study highlighted the need for the local course content to be contextualised and tailored to the examination course. This could be achieved by including a variety of multiple-choice questions, case-based discussion, and small group teaching for the purpose of preparing and practising examination questions/scenarios. It also highlighted trainees’ need to utilise the study leave budget for private courses to ease financial burden. The International Medical Graduates (IMG) cohort identified that they need extra support and feedback about the examination preparation from the early beginning of the training to overcome differential attainment.
Upper-Body versus Lower-Body Cooling in Individuals with Paraplegia during Arm-Crank Exercise in the Heat
Authors: ALKEMADE PUCK , EIJSVOGELS THIJS M. H. , JANSSEN THOMAS W. J. , JANSEN KASPAR M. B. , KINGMA BORIS R. M. , DAANEN HEIN A. M. 
Published: July 2023

ABSTRACT

Purpose
For wheelchair users with a spinal cord injury, the lower body may be a more convenient cooling site than the upper body. However, it remains unknown if leg cooling reduces thermal strain in these individuals. We compared the impact of upper-body versus lower-body cooling on physiological and perceptual outcomes during submaximal arm-crank exercise under heat stress in individuals with paraplegia.

Methods
Twelve male participants with paraplegia (T4–L2, 50% complete lesion) performed a maximal exercise test in temperate conditions, and three heat stress tests (32°C, 40% relative humidity) in which they received upper-body cooling (COOL-UB), lower-body cooling (COOL-LB), or no cooling (CON) in a randomized counterbalanced order. Each heat stress test consisted of four exercise blocks of 15 min at 50% of peak power output, with 3 min of rest in between. Cooling was applied using water-perfused pads, with 14.8-m tubing in both COOL-UB and COOL-LB.

Results
Gastrointestinal temperature was 0.2°C (95% confidence interval (CI), 0.1°C to 0.3°C) lower during exercise in COOL-UB versus CON (37.5°C ± 0.4°C vs 37.7°C ± 0.3°C, P = 0.009), with no difference between COOL-LB and CON (P = 1.0). Heart rate was lower in both COOL-UB (−7 bpm; 95% CI, −11 to −3 bpm; P = 0.01) and COOL-LB (−5 bpm; 95% CI, −9 to −1 bpm; P = 0.049) compared with CON. The skin temperature reduction at the cooled skin sites was larger in COOL-LB (−10.8°C ± 1.1°C) than in COOL-UB (−6.7°C ± 1.4°C, P < 0.001), which limited the cooling capacity in COOL-LB. Thermal sensation of the cooled skin sites was improved and overall thermal discomfort was lower in COOL-UB (P = 0.01 and P = 0.04) but not in COOL-LB (P = 0.17 and P = 0.59) compared with CON.

Conclusions
Upper-body cooling more effectively reduced thermal strain than lower-body cooling in individuals with paraplegia, as it induced greater thermophysiological and perceptual benefits.
Assessment of heavy metals in food and drug packaging materials
Authors: Mukhi Senna , Rukmini M. S. , Ajay Manjrekar Poornima , Iyyaswami Reghupathi , H. Sindhu 
Published: July 2023

Background: Food and drug packaging materials are an integral part of our everyday life. Noxious elements can inadvertently be included in packaging materials in various stages of their production. Adulterants, adhesives, colorants and heavy metal interference are the common sources of contamination in food packaging materials. Heavy metal toxicity has far-reaching ill effects on living organisms. The present study aimed at qualitatively and quantitatively analysing heavy metal contamination of various materials that are used for food and drug packaging in India. Methods: The qualitative detection was done by rapid assay and heavy metals were quantified with the help of inductively coupled plasma-optical emission spectrometry (ICP-OES). A total of 13 types of food and drug packaging materials were procured from local market and analysed for four heavy metals viz. arsenic (As), vanadium (V), mercury (Hg) and cadmium (Cd). The concentration of each heavy metal in the samples was compared with permitted values published by the European Council. Results: Of the 13 samples, heavy metals were qualitatively detected in 10 samples. ICP­-OES values for quantitative estimation showed presence of heavy metal above permissible range in 10 of the studied samples for vanadium, all samples for arsenic, two samples for mercury and one sample for cadmium. Arsenic was found to be the commonest heavy metal contaminant, present in 13 samples above permissible limit. Conclusions: The significantly higher concentration of heavy metal poses a potential health risk to the consumer and affects the quality of the food.
NOÇÃO DE COMPETÊNCIA NA FORMAÇÃO DE PROFESSORES
Authors: C. B. Cerqueira Maria de Lourdes , Moreira Santos Solange Mary 
Published: July 2023

O objetivo deste artigo é contribuir para que os professores conheçam a noção de competência no olhar de autores nacionais e in- ternacionais e, especialmente no de Perrenoud, retirando dela as idéias centrais e procurando redimensioná-las de modo a oferecer subsídios para a formação inicial e continuada.
CARACTERIZAÇÃO DE ESCÓRIA DE FERRO-CROMO COMO AGREGADO GRAÚDO PARA A PRODUÇÃO DE CONCRETO
Authors: F. da Silva Filho Antônio , A. Moura Washington , Silva Leite Rôneison 
Published: July 2023

A questão ambiental tem sido motivo de ampla discussão em nível nacional e internacional, face à exploração desenfreada dos recursos naturais e à enorme geração de resíduos por parte da indústria. A reciclagem de resíduos sólidos é uma das formas de atenuar o proble- ma, reduzindo, por conseguinte, o impacto ambiental. Esta pesquisa objetivou caracterizar a escória de ferro-cromo como agregado graúdo para a produção de concreto. Os estudos desenvolvidos consistiram na caracte- rização química, mineralógica, ambiental, física e quanto à reatividade da escória de ferro-romo. Vale ressaltar que foi efetuada uma criteriosa avaliação do risco ambiental do uso da escória de ferro-cromo, face à presença, em sua constituição química, do cromo e da possibilidade de ocorrência de outros metais pesados. Os resultados dos ensaios demons- tram que a escória de ferro-cromo apresenta características compatíveis com as de agregado graúdo convencional para concreto.
INFLUÊNCIA DA FONTE DE NITROGÊNIO NO CRESCIMENTO DE LACTOBACILLUS ACIDOPHILUS UFV H2B20
Authors: Mendes de Figueiredo Hamilton , Vieira Passos Frederico José 
Published: July 2023

Com o objetivo de caracterizar um sistema de produção de células viáveis de L. acidophilus UFV H2b20, para adição em probióticos, estudos da cinética de crescimento do microrganismo foram conduzidos. Na produção de massa celular viável foi utilizado o soro de queijo ultrafiltrado (SQUF) como meio basal. A produção máxima de células de 3,1 x 109 UFC/ml foi alcançada quando o SQUF foi suplementado com proteose peptona no 3, à temperatura de crescimento de 37oC. Essa produção celular em proteose peptona nº 3 foi estatisticamente superior às demais fontes de nitrogênio utilizadas (Triptona, peptona, nitrogênio básico para levedura e aminoácido de caseína), com exceção do caldo Man, Rogosa & Sharpe (MRS) que também apresentou bom crescimento celular.
A REVOLUÇÃO DOS SONS: UMA PROPOSTA METODOLÓGICA PARA O ENSINO DE FONÉTICA/ FONOLOGIA DO PORTUGUÊS
Authors: Oliveira Josane Moreira de , Pedreira dos Santos Pepe Vera 
Published: July 2023

Este artigo nasceu de nossas experiências profissionais no ensino de fonética e fonologia da língua portuguesa nos cursos de Letras. Trata-se de uma nova maneira de abordar os assuntos de fonética e fonologia usando o humor e a criatividade em sala de aula.
IMPORTÂNCIA DO EQUILÍBRIO, DA DIVERSIFICAÇÃO E PLANEJAMENTO DE ATIVIDADES FÍSICAS EM ACADEMIAS EM PROL DE UMA MELHOR QUALIDADE DE VIDA
Authors: Amorim Amoedo Celestino 
Published: July 2023

Este trabalho tem como objetivo evidenciar a importânciado equilíbrio, da diversificação e planejamento das diversas atividadesfísicas oferecidas pelas academias de ginástica. As diversas práticaspedagógicas desenvolvidas deverão de forma planejada contribuir para
um estilo de vida saudável, somadas aos trabalhos sedentários do dia-a-dia, ajudarão a construir aptidões relacionadas às necessidades bio-psico-sociais dos alunos.
Infection prevention and control in neonatal units: An ethnographic study of social and clinical interactions among healthcare providers and mothers in Ghana
Authors: Sunkwa-Mills Gifty , Senah Kodjo , Tersbøl Britt Pinkowski 
Published: July 2023

Introduction
Healthcare-associated infections (HAIs) are a global health challenge, particularly in low- and middle-income countries (LMICs). Infection prevention and control (IPC) remains an important strategy for preventing HAIs and improving the quality of care in hospital wards. The social environment and interactions in hospital wards are important in the quest to improve IPC. This study explored care practices and the interactions between healthcare providers and mothers in the neonatal intensive care units (NICU) in two Ghanaian hospitals and discusses the relevance for IPC.

Methodology
This study draws on data from an ethnographic study using in-depth interviews, focus group discussions involving 43 healthcare providers and 72 mothers, and participant observations in the wards between September 2017 and June 2019. The qualitative data were analysed thematically using NVivo 12 to facilitate coding.

Findings
Mothers of hospitalized babies faced various challenges in coping with the hospital environment. Mothers received sparse information about their babies’ medical conditions and felt intimidated in the contact with providers. Mothers strategically positioned themselves as learners, guardians, and peers to enable them to navigate the clinical and social environment of the wards. Mothers feared that persistent requests for information might result in their being labelled “difficult mothers” or might impact the care provided to their babies. Healthcare providers also shifted between various positionings as professionals, caregivers, and gatekeepers, with the tendency to exercise power and maintain control over activities on the ward.

Conclusion
The socio-cultural environment of the wards, with the patterns of interaction and power, reduces priority to IPC as a form of care. Effective promotion and maintenance of hygiene practices require cooperation, and that healthcare providers and mothers find common grounds from which to leverage mutual support and respect, and through this enhance care for mothers and babies, and develop stronger motivation for promoting IPC.