bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit of Seclusion Practice in an Inpatient Adult Intellectual Disability (ID) Psychiatry Unit
Authors: Kumar Praveen , Graves Catriona , Jones Sheena 
Published: July 2023

AimsTo investigate if current practice regarding the use of seclusion in an adult ID assessment and treatment unit was in keeping with the newly developed NHS Highland Seclusion Policy.MethodsCase notes were reviewed for all patients who had had a period of seclusion between 20 September and October 2022.Data were collected regarding the following:
•Administration of seclusion (date; time started; medication used prior; reason for administration & duration);•15 min interval monitoring (record of patient's mental & physical state including presentation, behaviour, conscious levels, respirations & appearance)•Review at 2 and 4 hours (including plans on how to end seclusion)•Documented Datix submitted and Monitoring of improvements.ResultsThematic analysis showed that the most common reason for the use of seclusion was due to increasing agitation and aggression.Data collection showed that the following information was missing from case records:
•Use of anxiolytic before seclusion;•Under the 15 minute interval recording - respiration rate & appearance was missed most of the times;•Review at 2 hours: Plans to end seclusion was often missed; Review at 4 hours: on most occasions the duty consultant was not informed. They could give valuable insight and plans on stopping seclusion if it has prolonged more than 4 hours.•Datix was not sent every time seclusion commenced and this is needed as it would further provide to better identify and manage patients needing it.ConclusionSeclusion places people at risk. It is vital to ensure that there is robust monitoring of the patient's mental and physical state to reduce the risks associated with seclusion and, in particular, when medication which may lead to respiratory depression has been used. Seclusion should be used for the shortest time possible - explicit consideration of when and how to end seclusion provides an opportunity to limit the length of this highly restrictive intervention and minimise the impact on the person.The results of the audit were shared with the staff team via the Seclusion Policy Short Life Working Group and will allow subsequent drafts of the service protocol to reflect good clinical practice. Results were also shared via the internal teaching programme and at the Clinical Governance forum. An additional session will also be provided during the induction plan for new trainees. Finally, a reaudit will be done to assess changes in seclusion practice.
Quality Improvement Project: Improving the Handover Process Between Junior Doctors at the Hammersmith and Fulham Mental Health Unit
Authors: Ramanathan Rathy , Khan Fariah , Arakkal Darshana 
Published: July 2023

AimsHandover is an integral aspect of clinical work for all doctors. During on calls it involves the transfer of responsibility and accountability for some or all aspects of patient care, to another person on a temporary basis. It is potentially a highly perilous step, and when carried out improperly can cause errors compromising patient safety. In recent times, handover is more important than ever due to the increase in shift patterns of working. Further the General Medical Council (GMC) has clear exceptions that all doctors should ‘keep colleagues well informed when sharing the care of patients.’MethodsAt Hammersmith and Fulham Mental Health Unit there was no formal junior doctor handover in place between changes of shift. Handover of clinical information between regular teams and the long day on call doctor was adhoc, informal and disorganised.In 2021, we identified this significant patient safety concern, and introduced a handover sheet with a populated table contained pertinent information: date of the request, the location of the patient, the demographic details of the patient, the clinical information regarding the patient, the requested job and whether the task was completed. Junior doctors were instructed to complete the table which was kept in a folder in the junior doctor room when handing over information to the on call doctor. If the request was urgent and a face to face handover was not possible, doctors were encouraged to telephone the on call doctor to provide an additional verbal handover.ResultsThe GMC trainee survey identified that handover was a strong negative outlier with a trainee satisfaction rate of 44.79% in 2018. This was evident again in the GMC trainee survey 2019, where handover was again identified as negative outcome in comparison to the average with a trainee satisfaction score of 48.26%.Having formalised the handover, the GMC trainee survey in 2021 identified a significant improvement in the trainee satisfaction rate of 59.03%; together with the results now being within the national average. Local trainee feedback survey also supported this finding with increased confidence being reported in the handover process.ConclusionGood handover does not happen by chance; this was clearly demonstrated following the implementation of a formal and structured proforma within the junior doctor handover at the Hammersmith and Fulham Mental Health Unit. This intervention not only improved the trainee confidence in the handover process but ultimately reduced the potential risk to patient safety.
Improving Physical Health Monitoring on an Inpatient Dementia Assessment Unit – a Quality Improvement Project
Authors: Shanley Ivan , Ghoneim Fatma , Attanayake Nadeera , Ford Jennifer , Kutraite Alina , Nkungu Thembisa , Maccabe Elle 
Published: July 2023

AimsMeadowview Ward is a dementia assessment unit based at Thurrock Community Hospital as part of Essex Partnership University NHS Foundation Trust. Patients with advanced dementia are routinely admitted with significant physical comorbidities and, as such, robust physical health monitoring is required. Members of the nursing team felt that it would be helpful to formalise the approach to physical health monitoring in order to allow all members of the multidisciplinary team to be aware of the necessary requirements. It was decided to formulate a physical health monitoring prompt sheet to facilitate discussion regarding physical health during ward rounds.MethodsA multidisciplinary discussion took place to identify the areas of monitoring which should be routinely highlighted in ward rounds. Items labelled as routine monitoring requirements were also listed. A prompt sheet was then devised which divided ward round discussion into nursing and medical feedback, with each section having specific areas for discussion (for example oral intake, recent blood results, any pending investigations). This included prompts for other staff groups including physiotherapists and occupational therapists. A section was also added regarding ongoing monitoring requirements, such as routine outpatient appointments and whether transport had been booked.In order to assess the impact of the introduction of the prompt sheet a questionnaire was provided to members of the multidisciplinary team who regularly attend ward round. This assessed their perception of the quality of physical health monitoring both before and after the introduction of the prompt sheet, the impact of the sheet on ward rounds and whether they wished the intervention to continue.ResultsThere was a significant increase in staff satisfaction with physical health monitoring on the ward (n=7, P = 0.0065). 100% of staff surveyed rated the introduction of the prompt sheet as “strongly helpful” and that they “strongly agree” the use of the prompt sheet should continue. An initial concern from the team had been the potential for the use of the sheet to delay ward rounds, however 57% of respondents reported no impact on ward round duration and 43% felt it strongly expedites assessments.ConclusionThe introduction of the physical health monitoring prompt sheet has been widely perceived as a success within our multidisciplinary team. It has also demonstrated the effectiveness of a multidisciplinary approach to quality improvement projects, ensuring the wide variety of expertise within teams is utilised.
Fluoxetine Induced Menorrhagia
Authors: Shaheen Manar 
Published: July 2023

AimsSelective serotonin reuptake inhibitors play important role in treatment of various psychiatric disorders. Commonly prescribed SSRIs include Sertraline and Fluoxetine. Fluoxetine has a high level of serotonin reuptake inhibition and a prolonged half-life. SSRIs can increase the risk of gastro-intestinal bleeding. A recent systematic review suggested an increased risk of intracranial bleeding in patients taking SSRIs. Psychiatric patients on SSRIs may present with menstrual disorders. Currently, there is limited information on its effect on menstrual cycle. The aim of this study is to explore the possible association between Fluoxetine and menorrhagia.MethodsCase Study ,29 years old, female patient, diagnosed with mixed anxiety and depression ICD-10 F41.2. No previous medical history of menstrual disorders. She started sertraline medications, initial dose of 50 mg, which was gradually titrated to 150 mg. After 12 weeks, Sertraline was discontinued due to limited effectiveness and was started on fluoxetine 20 mg. Dose was gradually titrated to 40 mg, Menorrhagia for 14 days was reported. Physical examination was unremarkable. A period of discontinuation of fluoxetine attempted leading to partial resolution of symptoms. However, 2 weeks later after careful examination of the risks and benefits, Fluoxetine was re-introduced. A trial of Tranexamic Acid 1 gm t.ds. for five days at the expected date of menstruation was initiated.ResultsPatient had no changes in her scheduled menstrual bleeding when she was using Sertraline. However, after 2 weeks of initiating 20 mg of fluoxetine the patient reported heavy prolonged bleeding with estimated 100% increase in volume and duration of the scheduled bleeding. Dose titration to 40 mg, led to further increase in the severity and duration of the bleeding. Changes in platelet function tests was reported 3 months after initiation of treatment; however, the results remained within the normal range. Tranexamic Acid 1 gm t.ds. for five days led to significant reduction in the severity and duration of bleeding.ConclusionUsing the WHO-UMC Causality Categories to explore association of the study findings, it is likely/ probable that Fluoxetine is associated with menorrhagia. A likely dose effect association was observed. Possible explanation of the increased risk of bleeding relates to its inhibitory action on platelet aggregation. However, Fluoxetine can be used safely for long term when Tranexamic acid was add. Tranexamic Acid has primary effect on thrombin generation; Its secondary effects is on improving platelet function and coagulation factors, leading to successful reduction in duration and severity of the bleeding.
Physical Health Monitoring in Patients on Antipsychotics: A Clinical Audit
Authors: O'Donnell Alice , Chatterjee Jayanta 
Published: July 2023

AimsPatients with serious mental illness are more likely to suffer from serious physical health conditions, including: obesity, diabetes, heart failure and stroke. This, combined with the side effects of antipsychotic medication including weight gain and cardiac changes, means that patients with psychosis under the Early Intervention Services (EIS) taking antipsychotics require regular physical health monitoring, as per NICE guidelines. This includes: yearly BMI, blood pressure, ECG, blood tests (FBC, U+E, lipids, HbA1c, prolactin, LFT), alcohol status and smoking status. Our audit aims to assess the compliance of physical health checks for patients on antipsychotic medication under the EIS first episode psychosis team.MethodsPatients on our caseload (for >6 months) between 01/2022 and 01/2023 (n=36) were included in this audit, and relevant data were collected using electronic records (i.e. carenotes and affinity). Data were recorded and stored electronically, and analysed using Excel and GraphPad. Patient information was discussed with their lead practitioner to ensure data collected was accurate. Our audit standard was set at 100%.ResultsIn terms of BMI, 91.67% (n=33) of patients had a recorded BMI, with 19.44% (n=7) of our patients being overweight and 19.44% (n=7) being classified as obese. Of the patients classified as overweight or obese (n=14), 85.71% (n=12) had received advice about their diet or exercise. Blood pressure measurements were available for 86.11% (n=31), and 13.89% (n=5) of these patients were found to have hypertension. Information relating to patients' alcohol, smoking and recreational drug use was recorded in 97.22% (n=35) of our patients.Qrisk data were not collected in 22.73% (n=5) of patients who were eligible for measurement (n=22). Furthermore, ECG tests were not recorded in 72.22% of patients (n=26). Compliance with blood tests was less than the desired standard, with 75% (n=27) of patients having an up to date FBC, U+E, lipids and HbA1c measurement.ConclusionSpecific areas of physical health monitoring are carried out to a high standard in the EIS service, but there are areas which warrant improvement, particularly Qrisk and ECG monitoring. The EIS team is to re-audit these outcomes in 3 months' time, after presentation of results to the team and physical health check clinics are employed.
Service Provider Views on Mental Healthcare Access for UK Asylum Seekers Residing in Home Office Contingency Accommodation: A Qualitative Research Study
Authors: Brookes Rachael , Longley Nicky , Eisen Sarah , Roberts Bayard 
Published: July 2023

AimsSince 2020, the number of asylum-seekers residing in hotels sourced by the UK Home Office, termed Contingency Accommodation, has increased by over 20,000. Reports suggest that the risk of poor mental health in this population is high. The aim of this study was to help inform improvements to mental healthcare provision for UK asylum-seekers living in contingency accommodation by gaining a greater understanding of perceived barriers and facilitators to accessing care.MethodsSeventeen semi-structured interviews were conducted remotely with Healthcare Service Providers between June and August 2022. Study Participants were recruited using purposive and snowball sampling to include stakeholders from primary care, secondary care, and third sector organisations. Data were analysed initially using deductive analysis based on the Levesque et al Conceptual Framework. Further emergent themes were identified using inductive analysis conducted sequentially on the data.ResultsTwelve themes relating to barriers and three to facilitators to mental healthcare access were identified. The most dominant themes were language barriers and long referral wait times, particularly to access specialist services for torture survivors. Other emergent themes included differing explanatory models of mental distress between Service Users and Providers and fear of authorities and data sharing. Within hotels, there was a lack of standardisation to facilitate mental healthcare access and a reliance on outreach organisations to explain the structure of the health system. Digital exclusion was described in the form of poor reception in hotel rooms and lack of privacy for remote consultations. Perceived mental health complexity was found to act as a barrier to referrals for low intensity psychological therapies such as IAPT being made and accepted. There was a lack of consensus amongst stakeholders about the appropriate time in the asylum journey to refer for trauma-focused therapy. Voluntary and community services (VCS) were described as plugging gaps in mental healthcare, but their role was ill-defined and concerns were expressed about sustainability.ConclusionThis study identified complex and intersecting barriers at individual, community, health-system, and structural levels which, if addressed, could improve access to mental healthcare. Further work is required to quantify the burden of mental ill health amongst this group and to triangulate findings from this study with views of the asylum-seeking population. Specifically, this study highlights the need to establish exactly how VCS are meeting mental healthcare needs and how they can be better integrated into the healthcare system. Further research exploring the timing of trauma-focused therapy is also warranted.
B cell receptor-induced protein dynamics and the emerging role of SUMOylation revealed by proximity proteomics
Authors: Awoniyi Luqman O. , Cunha Diogo M. , Sarapulov Alexey V. , Hernández-Pérez Sara , Runsala Marika , Tejeda-González Blanca , Šuštar Vid , Balci M. Özge , Petrov Petar , Mattila Pieta K. 
Published: July 2023

ABSTRACT
Successful B cell activation, which is critical for high-affinity antibody production, is controlled by the B cell antigen receptor (BCR). However, we still lack a comprehensive protein-level view of the very dynamic multi-branched cellular events triggered by antigen binding. Here, we employed APEX2 proximity biotinylation to study antigen-induced changes, 5–15 min after receptor activation, at the vicinity of the plasma membrane lipid rafts, wherein BCR enriches upon activation. The data reveals dynamics of signaling proteins, as well as various players linked to the subsequent processes, such as actin cytoskeleton remodeling and endocytosis. Interestingly, our differential expression analysis identified dynamic responses in various proteins previously not linked to early B cell activation. We demonstrate active SUMOylation at the sites of BCR activation in various conditions and report its functional role in BCR signaling through the AKT and ERK1/2 axes.
A Research and Clinical Framework for Understanding Achilles Injury in Female Collegiate Gymnasts
Authors: Fryar Caroline , Tilley Dave , Casey Ellen , Vincent Heather 
Published: July 2023

AbstractGymnastics is a popular sport with a high injury rate, particularly at the collegiate level. Achilles tendon rupture is a catastrophic injury with career-changing impact. Over the last decade, there has been a growing incidence of Achilles tendon ruptures, especially in female gymnasts. Currently, neither the effects of contributing risk factors on Achilles tendon rupture nor the research frameworks to guide future intervention strategies have been well described. This article reviews the functional anatomy and mechanical properties of the Achilles tendon, provides precollegiate and collegiate intrinsic and extrinsic risk factors for Achilles tendon rupture, and proposes a research framework to address this injury from a systemic perspective. Potential clinical interventions to mitigate Achilles tendon injury are proposed based on currently available peer-reviewed evidence.
Nutritional Strategies for Endurance Cyclists — Periodized Nutrition, Ketogenic Diets, and Other Considerations
Authors: Wei Ryan J. , Orbeta Lindsay , Hatamiya Nicholas S. , Chang Cindy J. 
Published: July 2023

Abstract
Cycling is a growing sport worldwide since the COVID-19 pandemic. With the growing availability and interest in long distance events, professional and amateur cyclists are pushing themselves further and harder than ever before. Training and nutrition should be understood by the sports medicine professional in order to guide counseling toward proper fueling to avoid health consequences. This article reviews macronutrients and micronutrients, periodized training and nutrition, and the relevance of the ketogenic diet for endurance cyclists riding greater than 90 min.
Using the Method of Mutual Preferences to Build Sustainable Relationships Between Suppliers and Consumers in Supply Chains
Authors: Mironov V. , Abramova E. 
Published: July 2023

The purpose of the proposed article was to apply the method of mutual preferences to build sustainable relationships between suppliers and consumers in the CP under the conditions of both competitive and partner interaction strategies.
The use of the proposed method is based on the application of the Gale-Shapley algorithm. The article presents an algorithm that allows you to build a stable relationship in the case when suppliers and consumers interact according to the «many-to-many» principle, which assumes that both suppliers and consumers are allowed to cooperate with several counterparties at once and consumer quotas are set and suppliers. The considered case is especially relevant in the context of the diversity of economic relations between the participants of the CP.
According to the authors, the implementation of the proposed approach will allow companies to objectively determine the economic feasibility of forming supplier-consumer pairs, subject to the choice of reasonable priorities, taking into account mutual preferences, as well as using a set of incentive measures to consolidate sustainable partnerships in the DP.
Impact of volunteers in the emergency department
Authors: Mehta Freya , Griffiths Peter 
Published: July 2023

Background: Fundamental aspects of patient experience have been reported as substandard in emergency departments. Hospital volunteers can improve the patient experience in inpatient settings. However, evidence is limited on their impact in emergency departments. Aims: To determine whether emergency department volunteers could enhance patient experience through assisting with the psychological aspect of patient care and patients' nutritional needs. Methods: Patients attending an emergency department responded to a questionnaire as part of a cross-sectional study. Comparisons were made between when the volunteer scheme was running and when there were no volunteers. Outcomes included patient experience of emotional support from staff and access to food and drink. Results: Patients present when the volunteer scheme was running reported obtaining food and drink more often (96/124 vs 20/39, % rate difference 26, 95% CI 10–42, P=0.002) and that a member of staff offered them something to eat and drink more frequently (96/146 vs 19/52, % rate difference 29, 95% CI 14–45, P<0.001). There was no difference between patient responses when the volunteer scheme was running and not for emotional support from staff (49/68 vs 14/21, % rate difference 5, 95% CI-17-28, P=0.63). Conclusions: Hospital volunteers made a substantial contribution to providing food and drink to patients in the emergency department. Emotional support from volunteers was limited.
COMPOSIÇÃO QUÍMICA DAS FOLHAS DA RHIZOPHORA MANGLE L. E DO SEDIMENTO DE MANGUEZAIS NÃO IMPACTADOS E IMPACTADOS POR RESÍDUOS INDUSTRIAIS
Authors: Sales de Oliveira Sônia , Carvalhal Britto Ivomar , Bastos Freitas Hermínia Maria 
Published: July 2023

O estudo foi realizado nos manguezais dos estuários dos Rios Jacuípe e Capivara Pequeno, município de Camaçari, Litoral Norte do Estado da Bahia - Brasil, sob influência de resíduos industriais, emanados da Empresa de Proteção Ambiental do Pólo Petroquímico (CETREL). O manguezal do Canal de Itaparica, Baía de Todos os Santos, supostamente sem efeitos de poluentes, foi tomado como área controle. Foram coletadas folhas de Rhizophora mangle e sedimentos, em intervalos bimensais, no período de abril a outubro de 1988, objetivando avaliar a distribuição de macro e micronutrientes, sob a ação de resíduos industriais. Dosaram- se nas folhas e sedimentos os elementos químicos, Ca, Mg, K, P, C, N, Fe, Zn, Cu e Mn. O Ca, Mg, K e micronutrientes, foram analisados por espectrofotometria de absorção atômica. O P, em colorímetro a 725 mm e o N, pelo método Kjeldahl. Os resultados revelaram diferenças estatisticamente significantes (P<0,01), nos teores de P, Ca, Mg, K, C, N e micronutrientes entre os sedimentos dos manguezais estudados. O manguezal do estuário do Rio Capivara Pequeno apresentou teores bastante elevados de Ca, Mg, P, N e, sobretudo, de Fe e Zn, que atingiram valores em torno de 6.772,7 ppm e 109,3 ppm, respectivamente. Entretanto, o sedimento do estuário do Rio Jacuípe, mostrou teores menores para esses mesmos elementos. Quanto aos teores de elementos químicos nos tecidos foliares, observaram- se relevantes diferenças para o Ca, N, Fe, Zn e Cu, entre os manguezais estudados.