bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Audit on the Measurement of Antipsychotic Side Effects Using Rating Scales (GASS, LUNSERS, and SESCAM) in Community Settings
Authors: Sodiya Olusegun , Adegoke Adewole , Ilinoiu Geanina , Morgans Clare 
Published: July 2023

AimsThis clinical audit aimed to assess if monitoring of side effect of antipsychotics is adhered to using the Trust and National institute of clinical excellence (NICE) guidelines.One of the determinants of prognosis in schizophrenia is compliance to medications. Hence, the importance to monitor patient's tolerability of side effects when they are on antipsychotic medications. Several patients during episodes of relapse have reported that experience of side effects were their main reasons for defaulting on their medications. This underpins the importance to monitor patients’ tolerability of side effects when prescribed antipsychotics. Recommended monitoring scales are Glasgow antipsychotic scale, Liverpool University neuroleptic side effect rating scale, and Side effects scale for antipsychotic medication.MethodsThe 1st cycle of the audit was conducted from March 30th to April 30th, 2021, and the 2nd cycle was done between 4th October and 28th October 2022. In both cycles random sampling was used to select 50 patients on the caseloads of two community mental health teams. The data were collected with a tool designed using NICE guidelines and the Trust policy on monitoring of psychotropic medications.ResultsFor all selected patients in the 1st cycle, no rating scales were used to assess side effects at three months or after one year of commencement of antipsychotics. However, there were random documentation of side effects written as case notes in 96% of patients. Extrapyramidal side effects (EPSE) were the most documented of side effects in the 1st cycle. The re-audit saw an improvement of 24% in the use of an objective rating scale to monitor side effects. Similarly, as in the 1st cycle, EPSE were the most reported side effects in the 2nd cycle.ConclusionThis audit showed a significant gap in the objective monitoring of side effects of patients on antipsychotics as none of the recommended rating scales were used on the selected patients in the 1st cycle. Although, there was an improvement in the use of rating scales of up to 24% in the re-audit as compared to 0% in the 1st cycle, the uptake was still far from the ideal. There is a need for the Trust and NICE guidelines to be adhered to in the monitoring of side effects of antipsychotics as this is likely to have a positive impact on compliance to medications by patients.
Naloxone Audit
Authors: Venan Paster 
Published: July 2023

AimsThe aim of this audit was to look into the services’ fidelity of Naloxone provision and training across the Essex wide area compared with local guidelines as well as national guidelines (UK guidelines on clinical management of drug misuse and dependence, 2017)MethodsThe electronic records database for substance misuse services (THESEUS) was used for extracting the data. A total of 1991 patient records were analysed out of these 885 patient records were excluded, as these patients had never injected heroin. The remaining 1106 patient records were treated as the QUALIFYING POPULATION. A time frame period of 3 years (2019 to 2021) was further applied to the qualifying population, which resulted in 700 patient records being analysed for Naloxone data.ResultsNaloxone provision was recorded under two different headings in the electronic database. The first heading, Naloxone episode – indicated the discussion held by the professional with the patient regarding the use of Naloxone. The second heading, Naloxone event – indicated the actual event of Naloxone being provided to the patient by a professional. There was a lack of clarity on both episode and events data capture regarding previously injected status.Another important finding was that in the NON-QUALIFYING POPULATION i.e., patients who have never injected heroin in the past were provided with Naloxone for 367 patients, although this is a good practice it comes at the expense of missing out on providing Naloxone to patients who would definitely need it (OUALIFYING POPULATION)Conclusion1.The robustness of the data collection done by the professionals was commendable, but this was let down by the ambiguity and obscurity of the data recorded on two different headings (episode and events)2.There was evidence of Naloxone being provided to the patients who have not injected heroin3.There was accurate documentation on the type of Naloxone being issued (Injectable vs Nasal)4.There was sparse documentation on the Naloxone training provision within the electronic system.
Side-Effect Monitoring for Patients on Depot Antipsychotic Medication Within a Community Treatment Team
Authors: Waterman Harry , Zaborowska Hanna , Taylor Julie 
Published: July 2023

AimsTo determine whether the community treatment team (CTT) were meeting the following three trust standards for patients receiving antipsychotic depot medication: 1. 100% of patients should have side effects monitored using a validated scoring system in the form of the Glasgow Antipsychotic Side-effect Scale (GASS) once yearly. 2. 100% of patients should have had a GASS completed ever. 3. 100% of patients with a completed GASS should have this document available in full. Additionally adherence to these measures was compared to the previous year's audit to assess for change following interventions and change in documentation.MethodsA list of 146 patients receiving antipsychotic depot medication within the CTT was produced and subsequently set up in a Microsoft excel spreadsheet. Exclusion criteria were then applied as follows: any patient no longer under the CTT, any patient no longer on depot antipsychotics and any patient admitted in hospital at the time of audit (to allow for comparison to previous year where this was applied.) Following this 127 patients remained for whom I accessed their online notes and searched for evidence of completed GASS, when this was completed and if the full completed form was available. Once these data were gathered percentage of completion was calculated for each of the three standards outlined above both overall and subsequently broken down by depot administration group. These results were then compared to the results of the previous year's audit.ResultsNone of the three standards outlined above were met, however notable improvement was noted when compared to the previous year and are listed below:
1.In this audit 66% of patients had received a GASS in the previous year compared to 53% previously.2.In this audit 97% of patients had a completed GASS ever compared to 95% previously.3.In this audit 99% of patients with a completed GASS had the full document available compared to 98% previously.4.Additionally significant variation between depot administration groups was identified ranging from 17% completion to 100% completion.ConclusionIt is clear the standards of 100% completion of GASS yearly are not being met however there was notable improvement following previous intervention suggesting this was beneficial and further interventions have been put in place including, but not limited to, supply of a spreadsheet with up to date list of when patients are due a repeat GASS for future tracking to further improve adherence to standards.
Developing a New Lithium Policy
Authors: Wong Brandon , Baird Kitty , MacLaren Tom 
Published: July 2023

AimsThe psychiatry liaison team at Chelsea and Westminster Hospital (C&W) specialises in working together with different healthcare teams to improve patient outcomes. Following feedback received from ward teams who manage the patients that we support on a daily basis, we identified a need for an accessible and user-friendly document that could give some guidance towards safely managing patients on lithium, including lithium toxicity. We do not anticipate medical teams at C&W to initiate lithium therapy without liaison psychiatry input. The most likely scenario where staff will encounter lithium is in patients admitted whilst on established lithium therapy. The aim of the guidance document is to support our medical and surgical colleagues across the hospital site to safely continue to prescribe lithium.MethodsTo create this document, we reviewed joint Lithium Policies across several NHS Trusts in England. This policy has been adapted from Central and North West London's own policy to be more specific in supporting best practice for clinicians in initiating, monitoring and adjusting lithium therapy in a safe and timely way.Junior doctors in liaison psychiatry wrote policy which was re-drafted with consultant support and input. Additionally, specialist advice was provided by mental health pharmacists for subsequent revisions. At present, the policy is awaiting discussion at a prescribing group meeting prior to starting the implementation process across the trust.ResultsMultidisciplinary feedback from pharmacy has advised that this guidance is particularly useful because lithium patients are so infrequent (approximately 55 patients on lithium at C&W in a 12 month period). Ward teams are therefore unfamiliar with prescribing and managing lithium, and crucially, at recognising signs and symptoms of toxicity. The guidance is not only functional, but is incredibly accessible. It is well laid out and makes use of colour to make it user-friendly. It is an appropriate length and includes a one page overview that is ideal for printing or for quick-reference.ConclusionDeveloping this lithium policy has been a key patient safety project. We hope this document will be a useful and safe tool for ward teams to refer to. Liaison psychiatry continue to have an excellent relationship with our ward colleagues and we hope this policy represents our ongoing dedication towards service development.During this process, we have been grateful for the expert help from our pharmacy colleagues and have learnt about how liaison psychiatry can support ward teams by creating a robust and easy to follow guideline.
The Impact of Prophylactic Medication Use on the Recurrence of Bipolar Episodes in the BDRN Pregnancy Study
Authors: Dias Marisa Casanova , Perry Amy , Kelson Mark , Gordon-Smith Katherine , Craddock Nick , Jones Lisa , Florio Arianna Di , Jones Ian 
Published: July 2023

AimsWomen with bipolar disorder have a high recurrence rate in the perinatal period. However, the use of prophylactic medication can be a concern during pregnancy and breastfeeding. There are few studies looking at the impact of prophylactic medication on the risk of recurrence.The aims of this study are to describe the use of medication in women with bipolar disorder in the perinatal period and the impact of that prophylactic medication on the rate of postnatal recurrence.MethodsThe BDRN (Bipolar Disorder Research Network Study) is the largest individual network of individuals with bipolar disorder and related mood disorders in the world. The BDRN pregnancy study is a prospective observational study which took place in the UK. We collected sociodemographic, clinical and medication data from pregnant women with a diagnosis of bipolar disorder and who were euthymic entering the postpartum period. The clinical data were collected via interviews during pregnancy and the postpartum and access to clinical records where those were available.Data were analysed for association using χ2 tests and logistic regression.ResultsOur total sample for this analysis comprised of 103 women who met the criteria.We found that 71 (70%) were taking medication at delivery: 43 (43%) antipsychotics, 9 (9%) antidepressants, 10 (10%) mood stabilisers, (6 lithium, 4 anticonvulsants and 9 multiple medication classes).Of the total sample, 44 (43%) experienced a postpartum recurrence: 21 (20%) had an episode of postpartum psychosis, 15 (15%) of non-psychotic depression and 8 (8%) of hypomania. Of the postpartum psychotic episodes 11 were of mania with psychosis, 8 of mania without psychosis and 2 of psychotic depression.There was no significant association between taking medication at delivery and postpartum recurrence χ2 (1)=0.116, p=0.73.In a multivariable analysis there continued to be no association when adjusted for age, ethnicity, parity, severity (previous admissions, age at impairment, bipolar subtype) and previous psychotic symptoms aOR 1.35 95%CI [0.45; 4.00], p=0.59.ConclusionA high number of bipolar women are taking medication at delivery and in the majority, antipsychotics are prescribed. The postnatal recurrence rate in both medicated and unmedicated women is high.Our findings align with recent electronic health records and observational studies, but differ from older clinical cohort and higher Lithium-prescribing sample studies. Limitations include the study design and confounding by indication. Further research in larger populations is necessary to inform clinical decision-making for women and their healthcare providers.
A Peer-Supported, Recovery-Focused Illness Management Programme for People With Early Psychosis
Authors: Chien Wai Tong 
Published: July 2023

AimsTo examine the effects of a peer-supported recovery-focused self-management of Psychosis (PRSP) modified from the Crisis-resolution-team Optimisation and RElapse Prevention (CORE) programme (Johnson et al. 2018) for psychotic patients’ recovery, mental state, problem solving ability and other patient outcomes over 18 months follow-up, compared with either a psychoeducation/treatment-as-usual group.MethodsA assessor-blinded, three-arm multicentre RCT was conducted. A list of 198 Chinese patients with recent-onset psychosis randomly selected from four Community Centers for Mental Wellness in Hong Kong (2021–2022) and randomly assigned into one of the three study groups (PRSP, psychoeducation or treatment-as-usual group) by matching with computerized random numbers. After four-month interventions, the patient outcomes were measured at immediately, 9 months and 18 months post-intervention, and analysed on intention-to-treat basis using Generalised Estimating Equation test.ResultsSignificant interaction (Group × Time) treatment effects of the PRSP were found on six outcomes (recovery, psychotic symptoms, functioning, problem-solving, and service satisfaction) between three groups at post-test, Wald χ2 = 7.05–21.87, p = 0.02-0.001, with moderate to large effect sizes (η2) of 0.12–0.24, compared to treatment-as-usual. Level of recovery, problem-solving and service satisfaction of the PRSP were also significantly greater improved than psychoeducation group at 9 and 18 months follow-ups with moderate effect sizes (0.07–0.10).ConclusionThe findings can provide evidence about the long-term effectiveness of the peer-facilitated, recovery-based self-management programme in early psychosis on improving patients’ recovery and mental condition, functioning, and service satisfaction. Self-learning of illness management through effective problem-solving strategies, together with peer-support, are increasingly useful in recovery-focused intervention for early psychosis in views of inadequate healthcare resources/staffs.
Racial Microaggressions in Healthcare Settings: A Scoping Review
Authors: Khan Nagina , Hafeez Danish , Goolamallee Tayyib , Arora Ananya , Smith Will , Shankar Rohit , Dave Subodh 
Published: July 2023

AimsRacial microaggressions occur when subtle or often automatic exchanges of aversive and covert racism are directed towards people identifying as racialized groups. Consequently, affecting individuals' mental and physical health. Healthcare professionals are a vulnerable group to the effects of racial microaggressions, given the high prevalence of burnout. The aim of the review was to explore healthcare professionals and students' experience of racial microaggressions in healthcare settingsMethodsA PROSPERO registered scoping review was conducted using the PRISMA extension for scoping review guidelines. The literature search was undertaken in August 2020, of five databases, MEDLINE, EMBASE, CINAHL, PsycINFO, EMCARE and we also searched the ‘grey literature.’ Studies featuring primary data on racialized or migrant microaggressions towards professionals or students in healthcare settings were included. We excluded studies that were not in English. QDA Miner was used to analyse the data, using a non-essentialist perspective, which suggests that ‘culture’ is a movable concept used by different people at different times to suit purposes of identity, politics and science.ResultsOur search identified 8 papers (5 qualitative, 2 mixed and 1 quantitative) on the experience of microaggressions towards healthcare professionals and students (n = 602). Almost all (87.5%) were conducted in North America and only one (12.5%) in the UK. The primary themes were as follows:Intersectionality: Individual and group social categorizations of race, class, and gender were described as interconnected, leading to interdependent systems of discrimination or disadvantage. Healthcare professionals indicated that increasing diversity and racial representation can reduce bias and thus microaggressions among stakeholders in the culture of work.Workplace culture and lack of senior support: The healthcare curriculum, and the manner of its delivery were found to propagate ideas encouraging racial microaggressions. Seniors behaving as role-models by challenging microaggressions could encourage an open and accountable environment. Supervision was a tool for allyship that reduced the threat of negative race-related incidents.Intervention: Acknowledging racial microaggressions within healthcare, as well as quantifying their presence with tools, encouraged a stronger and more effective response from institutions. Teaching curriculum also served as a useful platform to teach and address microaggressions.ConclusionRacial microaggressions were experienced as having a detrimental impact on healthcare professionals’ well-being and mental health. Consequently, this affected the efficiency, the workplace culture, patient outcomes and job satisfaction. Given the multifaceted nature of racial microaggressions, tackling them requires a complex and wide-ranging response from institutions.
Core conserved transcriptional regulatory networks define the invasive trophoblast cell lineage
Authors: Vu Ha T. H. , Scott Regan L. , Iqbal Khursheed , Soares Michael J. , Tuteja Geetu 
Published: July 2023

ABSTRACT
The invasive trophoblast cell lineages in rat and human share crucial responsibilities in establishing the uterine-placental interface of the hemochorial placenta. These observations have led to the rat becoming an especially useful animal model for studying hemochorial placentation. However, our understanding of similarities or differences between regulatory mechanisms governing rat and human invasive trophoblast cell populations is limited. In this study, we generated single-nucleus ATAC-seq data from gestation day 15.5 and 19.5 rat uterine-placental interface tissues, and integrated the data with single-cell RNA-seq data generated at the same stages. We determined the chromatin accessibility profiles of invasive trophoblast, natural killer, macrophage, endothelial and smooth muscle cells, and compared invasive trophoblast chromatin accessibility with extravillous trophoblast cell accessibility. In comparing chromatin accessibility profiles between species, we found similarities in patterns of gene regulation and groups of motifs enriched in accessible regions. Finally, we identified a conserved gene regulatory network in invasive trophoblast cells. Our data, findings and analysis will facilitate future studies investigating regulatory mechanisms essential for the invasive trophoblast cell lineage.
Oxidative stress effects are not correlated with differences in heat tolerance among congeners of Mytilus
Authors: Dowd W. Wesley , Somero George N. 
Published: July 2023

ABSTRACT
The physiological mechanisms that limit thermal tolerance are broadly relevant to comparative biology and global change. Species differences in macromolecular stability play important roles in evolved patterns of heat tolerance, but other mechanisms such as oxidative stress have also been hypothesized to contribute. For example, mussels in the genus Mytilus exhibit evolved physiological differences at several levels of organization that have been linked with interspecific differences in whole-organism heat tolerance. Both omics and behavioral studies suggested that variation in resistance to oxidative stress plays a role in these differences. Functional data are needed to test this hypothesis. Here, we compared three Mytilus congeners to examine whether susceptibility to oxidative stress contributes to acute heat tolerance. We assayed the activity of two antioxidant enzymes (catalase, superoxide dismutase), as well as levels of oxidative damage to lipids, DNA and individual proteins (using gel-based proteomics methods). In addition, we assessed these oxidative stress responses after repeated episodes of heat stress experienced in air or while immersed in seawater, given that survival and competitive outcomes between Mytilus congeners differ in these two contexts. The results are generally inconsistent with patterns that would be expected if oxidative stress contributes to thermal sensitivity. Rather, the more heat-tolerant congeners suffer comparable or even elevated levels of oxidative damage. As predicted, different treatment contexts led to distinct changes in proteome-wide abundance patterns and, to a lesser extent, protein carbonylation profiles. Overall, the results question the relevance of oxidative damage as a mediator of heat tolerance in this genus.
Παραγοντική ανάλυση της συμμετοχής ενηλίκων στην εκπαίδευση: η περίπτωση των Εσπερινών Γενικών Λυκείων της νησιωτικής Ελλάδας
Authors: Παπαδημητρίου Αχιλλέας 
Published: July 2023

Το φαινόμενο της συμμετοχής των ενηλίκων στην εκπαίδευση και η διερεύνηση των παραγόντων που επηρεάζουν την τελική τους απόφαση, είναι από τα σημαντικότερα θέματα που απασχολούν ερευνητικά το πεδίο της συνεχιζόμενης εκπαίδευσης. Στην Ελλάδα, πριν από περίπου 60 χρόνια, ιδρύονται για πρώτη φορά τα Εσπερινά Λύκεια τα οποία ανήκουν στη δευτεροβάθμια εκπαίδευση και απευθύνονται κυρίως σε άτομα που εργάζονται την ημέρα (ενήλικα και ανήλικα). Από την ίδρυσή τους έως σήμερα, ποτέ δεν είχαμε ερευνητικά στοιχεία για τα ενήλικα άτομα που κατοικούν στη νησιωτική χώρα και συμμετέχουν σε αυτά. Σκοπός της παρούσας έρευνας είναι η διερεύνηση των παραγόντων συμμετοχής των ενηλίκων στα Εσπερινά Γενικά Λύκεια της νησιωτικής Ελλάδας. Η έρευνα, η οποία είναι ποσοτική, διεξήχθη το 2022 και έλαβαν μέρος 268 ενήλικοι μαθητές και ενήλικες μαθήτριες Εσπερινών Λυκείων, από όλες τις διοικητικές περιφέρειες της νησιωτικής χώρας. Για τη συλλογή των δεδομένων χρησιμοποιήθηκε ερωτηματολόγιο και η ανάλυσή τους έγινε στο SPSS. Στα δεδομένα εφαρμόστηκε ανάλυση παραγόντων με τη μέθοδο της ανάλυσης κύριων συνιστωσών και προέκυψαν οι παράγοντες που επηρεάζουν την απόφαση για συμμετοχή. Από το πλέγμα των παραγόντων που εντοπίστηκαν, τέσσερις είναι πολύ σημαντικοί (αυτοαξιολόγηση, στάση απέναντι στην εκπαίδευση, εκπαιδευτική προοπτική και προσδοκίες), ενώ υπάρχουν και άλλοι που φαίνεται ότι επιδρούν αρκετά και διαδραματίζουν κάποιο ρόλο.