Assessment and documentation of substance abuse by crisis resolution home treatment team: A quality improvement project

© 2024 Odisha Journal of Psychiatry. Published under a Creative Commons licence: https://journals.lww.com/odjp/fulltext/2023/19020/assessment_and_documentation_of_substance_abuse_by.5.aspxAIM: Substance abuse is associated with mental health crises, leading to increased attendance in A and E and hospital admissions. This quality improvement project (QIP) evaluated the assessment and documentation of substance abuse of patients admitted under the crisis resolution home treatment team (CRHT) as well as any change following a teaching session as an intervention. METHODS: Data from 40 consecutive patients admitted under the CRHT from the 1st of September 2023 were collected. The CRHT uses the “Core Crisis Resolution Team Fidelity Scale” as the standard of practice and this was utilized as the benchmark for the QIP. A teaching session for nursing staff was conducted as an intervention. Following the teaching session, the second cycle of data was collected from 40 consecutive patients. RESULTS: Substance abuse was documented by CRHT in 30% of patients (12/40). However, the proportion was 70% (28/40) when documentation by other secondary services, such as mental health liaison, community mental teams, and the sources of referral were considered. Following the educational session, CRHT documented substance abuse for 37.5% (15/40). When documentation by secondary services was checked, the percentage of patients with documented substance abuse was 67.5% (27/40). CONCLUSION: The QIP suggested a minor improvement in the documentation of substance use after the educational session of the nurses. Multiple sessions of sessions, a longer period before reassessment to allow change of practice, and a prompt in the evaluation document might improve the assessment and documentation of substance use by the patients in CRHT

Randomized study to compare efficacy of short stretch bandage systems from KOB with locally used Cotton Crepe Bandages in the treatment of lower limb lymphoedema

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The Capacity of Multi-Hop Wireless Networks with TCP Regulated Traffic

We study the capacity of multi-hop wireless networks with TCP regulated traffic. We study the dependence of the capacity on the transmission range of nodes in the network. Specifically, we examine the sensitivity of the capacity to the speed of the nodes and the number of TCP connections in an ad hoc network. By incorporating the notion of a minimal acceptable QoS metric (loss) for an individual session, we argue that the QoS-aware capacity is a more accurate model of the TCP-centric capacity of an ad-hoc network. We study the dependence of capacity on the source application (Telnet or FTP) and on the choice of the ad-hoc routing protocol (AODV, DSR or DSDV). We conclude that persistent and non-persistent traffic behave quite differently in an ad-hoc network

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Neurobiological effect of 7-nitroindazole, a neuronal nitric oxide synthase inhibitor, in experimental paradigm of Alzheimer’s disease

1086-1093Nitric oxide plays a role in a series of neurobiological functions, underlying behaviour and memory. The functional role of nNOS derived nitric oxide in cognitive functions is elusive. The present study was designed to investigate the effect of specific neuronal nitric oxide synthase inhibitor, 7-nitroindazole, against intracerebroventricular streptozotocin-induced cognitive impairment in rats. Learning and memory behaviour was assessed using Morris water maze and elevated plus maze. 7-nitroindazole (25 mg/kg, ip) was administered as prophylactically (30 min before intracerebroventricular streptozotocin injection on day 1) and therapeutically (30 min before the assessment of memory by Morris water maze on day 15). Intracerebroventricular streptozotocin produced significant cognitive deficits coupled with alterations in biochemical indices.These behavioural and biochemical changes were significantly prevented by prophylactic treatment of 7-nitroindazole. However, therapeutic intervention of 7-nitroindazole did not show any significant reversal. The results suggests that 7-nitroindazole can be effective in the protection of dementiainduced by intracerebroventricular streptozotocin only when given prophylactically but not therapeutically

Patient Outcomes in Crisis Resolution and Home Treatment Service: A Retrospective, Observational Study in Wolverhampton

Aims Crisis Resolution Home Treatment Team (CRHT) provides short-term treatment for psychiatric patients in the place of residence, dealing with mental health crises, risks, deterioration, and preventing hospital admissions. This team works round the clock, seven days a week. This study aimed to analyze the clinical outcomes of the service provided by the CRHT in Wolverhampton. Methods In a retrospective, observational, explorative study design, data was collected from the electronic medical records of 100 (54 female and 46 male) consecutive patients who were treated under the general adult (age range 18–65 years) CRHT from 1st December 2022. We collected outcome variables such as symptomatic improvement, change in risk status, days of treatment under CRHT, and discharge destination. Results In the sample, 76% had one psychiatric diagnosis, and co-morbidities were present in 20%, with 4% of patients having no syndromal diagnoses. The most common primary diagnosis was personality disorder (24%), followed by psychotic disorders (22%), anxiety disorders 21%, and depression (20%). Overall risk status of red changed from 87% at admission to 17%, at discharge; risk to self from 43% to 17% (p < 0.01), risk to others from 11% to 1% (p < 0.01), respectively. The mean length under care of CRHT was highest with anxiety disorder (27.7 ± 18.2 days), followed by personality disorders 23.7 ± 17.9 days. Age and number of days under CRHT were negatively correlated, suggesting younger age was linked to higher number of days (p < 0.05). Most (71%) patients showed an improvement in their mental health, 15% deteriorated and got admitted to the psychiatric hospital, 9% did not engage and 5% were considered not suitable for care under CRHT for various reasons such as having no fixed abode. Most (80%) patients were discharged back to the community following the CRHT period. Conclusion Despite the limitation of subjective clinical assessments, the results suggested that the CRHT was effective in considerable proportions of patients with symptomatic improvement and a decrease in risk level, with a small proportion being admitted to a psychiatric ward. There is a need for objective evaluation of risk and symptomatic change using validated instruments and assessing patient experiences about the services

Methotrexate in juvenile rheumatoid arthritis: randomized placebo controlled trial

Objectives: To evaluate, whether short-term treatment with Methotrexate (MTX) at the dose of 10 mg/m2 is superior to placebo in patients with Juvenile Rheumatoid arthritis (JRA) Patients and methods: In this double blind placebo controlled study, 31 patients who fulfilled the ACR criteria for the diagnosis of JRA were randomized to receive either weekly MTX 10mg/m2 (n=16) or placebo (n=15) for 6 months. The patients were evaluated at baseline, 3 and 6 months. Measures of disease activity included, visual analog scale for pain, duration of early morning stiffness, number of swollen and tender joints, improvement in systemic features, global improvement by physician and parents, Hb and ESR. Thirty and 50% response were defined using the guideline set aside by WHO/ILAR for drug trial in patients with RA. Results: The two groups were well matched with respect to patients and disease variables at baseline. Six patients dropped out of the study. In the MTX group, 11(78%) out of 14 achieved 30% or more response as compared to 6/11 (54%) in the placebo group at 6 months. The corresponding figures at 3 months were 10/15 (66%) and 3/11 (27%) respectively in both the groups. The differences were statistically not significant. Furthermore, there was no statistical difference between the individual disease variable values at 3 or 6 months between the two groups. Conclusion: At the end of 6 months treatment, methotrexate at the dose of 10mg/m2 is not significantly superior to placebo in JRA

Finite Element (FE) Shear Modeling of Woven Fabric Textile Composite

AbstractThis paper demonstrates the modeling of woven fabric textile composite under in-plain shear loading. The geometric modeling of fabric unit cell is modeled using TexGen textile modeling schema developed at the University of Nottingham. The yarns in the present scheme are treated as solid volume whose modeling depends upon various parameters such as yarn path, yarn cross- section, yarn surface. Periodic boundary conditions were identified to simulate the realistic nature of repetitive fabric unit cell.Transversely isotropic material law with non-linear transverse mechanical properties is incorporated using finite element (FE) simulation software ABAQUS®. This approach is initially validated for pure in-plain shear and compression loading; later on it is used to simulate the behavior of fabric under the combination of these loads which practically occurs during forming process. A successful prediction of shear force versus shear angle are made and was found that the majority of the energy being dissipated at higher shear angles due to yarn compaction. The scope of altering weave pattern and yarn characteristics is facilitated in this developed model

Unit Cell Model of Woven Fabric Textile Composite for Multiscale Analysis

AbstractThis paper presents a micromechanical unit cell model of 5-Harness satin weave fabric textile composite for the estimation of in- plane elastic properties. Finite element modeling of unit cell at mesoscopic level has been recommended over employing costly experimental setup for such sophisticated materials. The unit cell is identified based upon its ability to enclose the characteristic periodic repeat pattern in the fabric weave. Modeling of unit cell and its analysis for this new model are developed using an open source software, TexGen and a commercially available finite element software ABAQUS®. The scope of altering weave pattern and yarn characteristics is facilitated in this developed model. Several parametric studies were carried out in order to ascertain the effectiveness of the model and to investigate the effects of various geometric parameters such as yarn spacing, yarn width, fabric thickness and fibre volume fraction on the mechanical behavior of woven composites. Present analysis reveals that the values of Young's and shear modulus increased with increasing in the fabric parameters such as yarn width and fabric thickness. On the other hand it is decreased when the spacing between the yarns increased. A good comparision was obtained between the predicted results and available experimental and theoretical data in open literature for the developed unit-cell model and its suitability is tested for multi-scale analysis. The potential advantage of the present scheme lies in its ability which permits the textile modeling from building of textile fabric model to its solution including mesh generation undertaken using an integrated scripting approach thus requiring far less human time than traditional finite element models

Methotrexate in juvenile rheumatoid arthritis: randomized, placebo controlled study

Objectives: To evaluate, whether short-term treatment with Methotrexate (MTX) at the dose of 10 mg/ m2 is superior to placebo in patients with Juvenile Rheumatoid arthritis (JRA) Patients and methods: In this double blind placebo controlled study, 31 patients who fulfilled the ACR criteria for the diagnosis of JRA were randomized to receive either weekly MTX 10mg/m2 (n=16) or placebo (n=15) for 6 months. The patients were evaluated at baseline, 3 and 6 months. Measures of disease activity included, visual analog scale for pain, duration of early morning stiffness, number of swollen and tender joints, improvement in systemic features, global improvement by physician and parents, Hb and ESR. Thirty and 50% response were defined using the guideline set aside by WHO/ILAR for drug trial in patients with RA. Results: The two groups were well matched with respect to patients and disease variables at baseline. Six patients dropped out of the study. In the MTX group, 11(78%) out of 14 achieved 30% or more response as compared to 6/11 (54%) in the placebo group at 6 months. The corresponding figures at 3 months were 10/15 (66%) and 3/11 (27%) respectively in both the groups. The differences were statistically not significant. Furthermore, there was no statistical difference between the individual disease variable values at 3 or 6 months between the two groups. Conclusion: At the end of 6 months treatment, methotrexate at the dose of 10mg/m2 is not significantly superior to placebo in JRA