Care plans in community mental health: an audit focusing on people with recent hospital admissions

The final publication is available at Springer via: http://dx.doi.org/10.1007/s11414-016-9504-0Care planning is a key requirement for recovery-focused mental health care. Audit tools are available so that services can assess their alignment with accepted care planning standards but few benchmarks are available, especially for health services outside the United Kingdom. To assess implementation of recommended care planning in an Australian mental health setting for people recently hospitalised, a sample of service user records was audited against care plan requirements. Of 164 eligible records, 113 (69%) showed a care plan. Of the 113 care plans, 40 (35%) contained a risk assessment and 1 (1%) a crisis management plan. Thirty five (31%) contained some social needs assessment, 1 (1%) contained a physical health assessment, and 53 (47%) identified a primary healthcare physician. This audit indicated a large gap between recommendations and actual practice. Similar audits in other health services are required. Action is needed to integrate care planning into behavioural health practice

A feasibility and safety study of afamelanotide in acute stroke patients – an open label, proof of concept, phase iia clinical trial

Abstract Background Neuroprotective agents have the potential to improve the outcomes of revascularisation therapies in acute ischemic stroke patients (AIS) and in those unable to receive revascularisation. Afamelanotide, a synthetic α-melanocyte stimulating hormone analogue, is a potential novel neuroprotective agent. We set out to assess the feasibility and safety of afamelanotide for the first time in AIS patients. Methods AIS patients within 24 h of onset, with perfusion abnormality on imaging (Tmax) and otherwise ineligible for revascularisation therapies were enrolled. Afamelanotide 16 mg implants were administered subcutaneously on Day 0 (D0, day of recruitment), D1 and repeated on D7 and D8, if not well recovered. Treatment emergent adverse events (TEAEs) and neurological assessments were recorded regularly up to D42. Magnetic resonance imaging (MRI) with FLAIR sequences were also performed on D3 and D9. Results Six patients (5 women, median age 81, median NIHSS 6) were recruited. Two patients received 4 doses and four patients received 2. One patient (who received 2 doses), suffered a fatal recurrent stroke on D9 due to a known complete acute internal carotid artery occlusion, assessed as unrelated to the study drug. There were no other local or major systemic TEAEs recorded. In all surviving patients, the median NIHSS improved from 6 to 2 on D7. The median Tmax volume on D0 was 23 mL which was reduced to a FLAIR volume of 10 mL on D3 and 4 mL on D9. Conclusions Afamelanotide was well tolerated and safe in our small sample of AIS patients. It also appears to be associated with good recovery and radiological improvement of salvageable tissue which needs to be tested in randomized studies. ClinicalTrials.gov Identifier NCT04962503, First posted 15/07/2021