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There is growing concern about the influence of the pharmaceutical industry on psychiatric teaching and psychiatric professionalism as a whole. As a consequence, several national and international medical and psychiatric associations have issued guidelines to regulate the interactions between physicians and industry.
The EFPT-PRIRS study aims to provide the lacking data on the extent and nature of these interactions among psychiatric trainees across Europe.
Study objectives were determined by the EFPT research group (EFPT-RG), after discussion with national and international experts. A survey was then devised compiling previously published questionnaires extending them by questions with specific relevance to psychiatric trainees. The resulting questionnaire was piloted amongst members of the EFPT-RG, modified accordingly and subsequently distributed to the national study coordinators. All 24 EFPT member countries were invited to participate in the study and data collection is currently ongoing.
Preliminary analysis reveals the vast differences in industry - trainee relationships across European countries as well as major differences in personal attitudes towards these interactions.
EFPT-PRIRS will potentially have an impact on the regulation of the interactions between the pharmaceutical industry and psychiatric trainees.
There are high rates of psychiatric morbidity associated with refractory epilepsy. It is unclear whether seizure frequency or comorbid psychiatric illness impacts more upon patients’ quality of life in epilepsy. The objective of this study was to establish which of these two factors impacted more upon patients.
Patients with medically refractory epilepsy who were admitted to the National Neurological Centre in Beaumont Hospital were recruited to the study. Structural Clinical Interview for DSM IV (Axis I) (SCID I) and SCID II (Axis II) were the objective measures and HADS, and QOLIE-89 were the subjective measures utilized.
A total of 138 patients had SCIDs conducted over the four year study. 75 patients (54.4%) had an Axis I disorder. Of these 30 patients (21.7%) had a mood disorder, 18 patients (13%) had an anxiety disorder and 49 patients (35.5%) were diagnosed with a psychotic disorder. There was no relationship between patient seizure frequency and HADS (p=0.94) or QOLIE-89 (p=0.93) scores. Patients having a high number of seizures were not more likely to have a SCID Axis I diagnosis than patients with a low number of seizures (p=0.246). Patients with a mood disorder were more likely to have a lower QOLIE-89 score than patients without a mood disorder (p=0.0001).
Patients with medically refractory epilepsy have high rates of psychopathology. Seizure frequency is not correlated with the presence, severity of psychiatric symptoms or quality of life. The presence of a psychiatric disorder and its severity is strongly correlated with quality of life.
According to the cognitive model of addiction by Beck taking substance represents the final common voice of the activation of beliefs through the involvement of craving.
To assess whether beliefs related to craving is a prognostic factor for relapse 6 months after a residential alcohol withdrawal and analyze the evolution of these beliefs.
107 participants were solicited for this non-interventional prospective study in a department of Psychiatry and Addictive Medicine. All patients showed a dependence on alcohol, and were hospitalized for alcohol withdrawal and had to master the French language and be reachable by telephone to help ensure follow-up. The presence of severe cognitive disorders or schizophrenia constitute a basis for non-inclusion. In the end, 68 patients were included. Beliefs related to craving on alcohol were assessed by Craving Beliefs Questionnaire (CBQ), psychiatric and addictive comorbidities by the MINI and consumption of alcohol by the AUDIT.
Among the 68 patients, 27 were abstinent and 25 had relapsed at 6 months. The CBQ score at baseline was positively correlated with relapse at 6 months (p <.05). Relapsers were characterized by more frequent presence of major depressive disorder, suicidal risk, antisocial personality and an AUDIT and alcohol dependence largest scores. Three months after hospitalization CBQ score drops significantly among non-relapsers (p <.001) but not among relapsers.
This study supports the role of beliefs related to alcohol craving in the relapse after residential withdrawal. These beliefs could be assessed in routine practice and treated with cognitive therapies.
Depression is one of the main causes of disability in the Western countries. This evidence presents new challenges for somatic medicine, such as surgery.
To determine the influence of patients’ depression on (i) length of hospital stay (LOS, which is a proxy of recovery) after major surgery, and (ii) LOS anticipated by surgeon preoperatively.
To explore the influence of depression on recovery after major surgery, and whether and how surgeons take into account patients’ emotional and psychological status in the care of their patients.
Prospective multicentre observational study. Depression was assessed with HADS (HADS > 8 showing the presence of significant depression). Two cox PH models were fitted to evaluate the influence of depression on patients’ LOS (first model) and anticipated LOS (second model). Adjustment variables were (i) preoperative (age, sex, anxiety, diagnosis, BMI, biology), (ii) intraoperative (blood transfusion, length of intervention), (iii) postoperative (morbidity).
Of 372 recruited patients (which had undergone major liver surgery), 69 (18,5%) had HADS>8. After adjustment, depression was a risk factor for a prolonged LOS (HR 1.96, 95%CI 1.44–2.63). However, depression was unrelated to the anticipated LOS (HR 1.26, 95%CI 0.90–1.66).
1 in 5 patients presented a significant level of depression. Depression was independently associated to longer LOS (ie. longer recovery time after surgery). However this data was not taken into account by surgeons, which failed to integrate that in their previsions. A psychiatric culture and education need to be developed in surgery, as well as more collaboration.
Previous studies have revealed developmental problems in children of homeless families. The number of homeless families has increased by 5 in 10 years.
To estimate the adaptative behavior of homeless children aged 0-5 years old in Paris region and to analyze the impact of homelessness on children's development.
In 2013, a random survey was conducted among homeless families housed in emergency centres for asylum-seekers, emergency housing centres, social reinsertion centres and social hotels in the Paris region. A bilingual interviewer and a psychologist conducted the survey in 17 languages. A nurse took the anthropometric measures and collected health data from child health and immunization cards. For children aged 0-5 years old, mothers (or fathers when mothers were absent) were asked about the children's adaptative behavior using the Vineland Adaptative Behavior Scales, Second Edition (Vineland-II).
The built random sample consisted in 801 families including 557 in which the selected child was 0-5 years old, which represents 11448 children (95% CI = 10354 – 12541). The estimated mean of the composite score of Vineland-II is 76.98 (95% CI = 74.07 – 76.70) (SD = 12.03) which mean that 9259 children aged 0-5 years old (95% CI = 7684 – 10833) have a developmental delay. The most associated factor with the decrease of the Vineland-II score is the age (p<10-16) in the linear multivariate model.
ENFAMS survey reveals large developmental problems among homeless children in Paris region.More children are exposed to homelessness more the disorders are important.
The aim of the present study was to explore any heterogeneity in the 6-month clinical response in antipsychotic drug-naive schizophrenia patients, and to determine predictors of that outcome.
467 antipsychotic drug-naive schizophrenia patients were included in France nationwide and followed up over 6 months. In order to identify trajectories of clinical response, a latent class growth analysis was performed using the Clinical Global Impression-Severity (CGI-S) scores at baseline, 1, 3 and 6 months. Regression models were used to identify predictors of trajectory membership.
Five trajectory groups were identified: a rapid response group (n=45), a gradual response group (n=204), patients remaining mildly ill (n=133), patients remaining very ill (n=23) and a group with unsustained clinical response (n=62). Predictors of the 6-month clinical response were baseline CGI-S score (odds ratio 3.1; 95% confidence interval, 2.1-4.4) and negative symptoms (OR 1.5; 95%CI, 1.2-1.9). The sole predictor of rapid response as compared to gradual response was employment (OR 2.5; 95%CI, 1.2-4.9).
Clinical response in schizophrenia patients 6 months after a first-ever antipsychotic drug initiation is heterogeneous. Therapeutic strategies in first episode should take account of symptoms severity and of early clinical response, in order to maximize the chances of recovery.
In France alcohol is the second cause of death after smoking, and it is a main cause of absenteeism and disability at work. Over 50% of people who have not returned to work (RTW) after 6 months off never resume their professional activity.
The aim of this study is to identify factors affecting the RTW after a residential alcohol withdrawal.
This is a prospective, non-interventional nested study (within a prognostic study of relapse after inpatient alcohol withdrawal) conducted from September 2013 to February 2014 in the Psychiatry and Addictology department of Bichat University Hospital in Paris. All alcohol-dependent sick-listed workers, admitted for a residential alcohol withdrawal have been included. Baseline assessment included sociodemographic, occupational, somatic, psychiatric and addictologic characteristics. The influence of these variables on RTW after 6 months follow-up have been studied using survival analysis.
Among 107 eligible patients, 30 met the inclusion criteria and were followed up, and 22 (73.3%) had RTW before the end of the follow-up period. The median duration of sick-leave is 58.5 days, and the interquartile range is 15.5-246 days. The independent workers, employees on fixed-term contract, part-time employees and outdoor had shorter sick-leave. Severity of alcoholism, agoraphobia, residential withdrawal history, being sick-listed before hospitalization, longer duration of hospitalization and being transferred to aftercare service increased the duration of sick-leave.
This exploratory study identifies factors that impede and facilitate the RTW process after a residential alcohol withdrawal. Studies on a larger scale are needed to generalize the findings.
Empathy is critical to the development of professionalism in medical students, but evidence suggests that empathy actually declines over the course of undergraduate medical education.
Improving medical student empathy by encouraging students to think about the person behind the illness.
Two interventions were studied. From December 2015 until November 2016, a fourth year psychiatry medical student book club was conducted. Students were asked to read an autobiography of a lived experience of psychosis. The old age simulation suit aims to simulate the sensory and physical impairments faced by older adults with age related illnesses. A training session provided a transient experience of old age for the students.
Forty-four students completed the feedback on the book club. Twenty-eight (64%) stated that they strongly agreed with the statement ‘the book club encouraged me to consider the person behind the illness’. Thirty-nine (89%) stated that after attending the book club their empathy towards people with mental health problems had increased. Eleven students completed full feedback following the old age simulation session. Empathy statements relating to living in an ageing body improved from the pre-test median score of 4 (range 1–7) to a median score of 6 (range 2–8) post-teaching session. Empathy statements focusing on sensory and physical impairments had pre-test score median of 3 (range 1–7) and post-test median 8 (range 3–9).
Feedback from these sessions has demonstrated that with a little creativity, empathy training can be delivered to medical students with a positive impact.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
North East London NHS Foundation Trust (NELFT) provides an extensive range of integrated community and mental health services for people living in London serving a population of 1.5 million people. With an annual budget of £325 million NELFT is one of the largest community service providers in the United Kingdom (UK). NELFT is responsible for the education and training of the entire workforce and in August 2016, it employed a nurse fellow to work with the medical education fellows so it could focus on multidisciplinary team (MDT) teaching.
(1) Providing MDT teaching by delivered by a MDT medical education team.
(2) Improving the training experience of all trainees, nurses and allied health professionals in NELFT.
(3) Improving physical health knowledge for mental health staff.
(4) Improving mental health knowledge of physical health staff.
Two psychiatrists and one nurse manager worked together on joint projects to deliver the MDT teaching. Teaching sessions where at least one psychiatrist and nurse manager delivered teaching on serious incidents affecting patient care, identification and management of sepsis in community settings and empathy training using an old age simulation suit.
Multiple teaching sessions were delivered to MDTs within the Trust. Staffs were receptive to learning in MDTs rather than traditional splits according to professions. Due to the success of this teaching and the reputation of the medical education team, neighboring Trusts have expressed an interest in working in partnership with the team to further enhance teaching and learning in acute and community settings.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Role-playing scenarios are widely used in psychiatry education, both as a means of assessment and for teaching various clinical skills. But can you get as much from them by learning vicariously as an observer? Fourth-year medical students from Queen Mary University of London were invited to a psychiatry practice OSCE (objective structured clinical examination), shortly before end of year exams. We created 96 places, approximately 40% of the year, but to maximize numbers students also rotated through the six-station OSCE circuit in pairs. For each scenario students alternated either undertaking the OSCE task or observing.
Objectives and methods
We sought to identify if there was a significant difference in student experience depending on whether they were the ‘candidate’ or ‘observer’. Students were asked to rate their learning experience in each station on a five-point Likert scale and this was analyzed using an ordinal logistic regression model.
While students rated their experiences as ‘observers’ marginally lower than that of ‘candidates’, we found no statistically significant difference (OR = 0.629, P = 0.093). Practice OSCEs took place over six half-days with different facilitators and role-players, but we identified no interaction from these factors. For one station on depression, we found a statistically significant interaction in which ‘candidates’ rather than ‘observers’ rated better experiences (P = 0.032).
Observation by learners is frequently used within simulated clinical scenarios and may have a number of potential advantages. However, while unable to examine the direct impact on knowledge or skills, we found no significant difference in student-reported experiences between ‘candidate’ and ‘observer’ positions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Populations of native North American parasitoids attacking Agrilus Curtis (Coleoptera: Buprestidae) species have recently been considered as part of an augmentative biological control programme in an attempt to manage emerald ash borer, Agrilus planipennis Fairmaire, a destructive wood-boring beetle discovered in North America in 2002. We evaluate trapping methods to detect and monitor populations of two important native larval parasitoids, Phasgonophora sulcata Westwood (Hymenoptera: Chalcididae) and Atanycolus Förster (Hymenoptera: Braconidae) species, attacking emerald ash borer in its introduced range. We found that purple prism traps captured more P. sulcata than green prism traps, yellow pan traps, and log samples and thus were considered better for detecting and monitoring P. sulcata populations. Trap type did not affect the number of captures of Atanycolus species. Surprisingly, baiting prism traps with a green leaf volatile or manuka oil did not significantly increase captures of P. sulcata or Atanycolus species. Based on these results, unbaited purple prism traps would be optimal for sampling these native emerald ash borer parasitoids in long-term management programmes.
From an evolutionary perspective, psychological factors that bear on reproductive success are of particular importance as such factors directly pertain to Darwin’s bottom line. The psychology surrounding human mating, then, is particularly important from a Darwinian perspective. Mating intelligence is a construct that integrates work on mating psychology with work on intelligence. This broad construct is divided into two general sets of abilities: cognitive mating mechanisms (such as the ability to detect romantic interest on the part of a potential mate) and mental fitness indicators (which are outward behavioral displays of intelligence that facilitate successful courtship).
Technological advances have led to better patient outcomes and the expansion of clinical services in paediatric cardiology. This expansion creates an ever-growing workload for clinicians, which has led to workflow and staffing issues that need to be addressed. The objective of this study was the development of a novel tool to measure the clinical workload of a paediatric cardiology service in Cape Town, South Africa: The patient encounter index is a tool designed to quantify clinical workload. It is defined as a ratio of the measured duration of clinical work to the total time available for such work. This index was implemented as part of a prospective cross-sectional study design. Clinical workload data were collected over a 10-day period using time-and-motion sampling. Clinicians were contractually expected to spend 50% of their daily workload on patient care. The median patient encounter index for the Western Cape Paediatric Cardiac Service was 0.81 (range 0.19–1.09), reflecting that 81% of total contractual working time was spent on clinical activities. This study describes the development and implementation of a novel tool for clinical workload quantification and describes its application to a busy paediatric cardiology service in Cape Town, South Africa. This tool prospectively quantifies clinical workload which may directly influence patient outcomes. Implementation of this novel tool in the described setting clearly demonstrated the excessive workload of the clinical service and facilitated effective motivation for improved allocation of resources.
Electron microscopy is uniquely suited for atomic-resolution imaging of heterogeneous and complex materials, where composition, physical, and electronic structure need to be analyzed simultaneously. Historically, the technique has demonstrated optimal performance at room temperature, since practical aspects such as vibration, drift, and contamination limit exploration at extreme temperature regimes. Conversely, quantum materials that exhibit exotic physical properties directly tied to the quantum mechanical nature of electrons are best studied (and often only exist) at extremely low temperatures. As a result, emergent phenomena, such as superconductivity, are typically studied using scanning probe-based techniques that can provide exquisite structural and electronic characterization, but are necessarily limited to surfaces. In this article, we focus not on the various methods that have been used to examine quantum materials at extremely low temperatures, but on what could be accomplished in the field of quantum materials if the power of electron microscopy to provide structural analysis at the atomic scale was extended to extremely low temperatures.
Project management expertise is employed across many professional sectors, including clinical research organizations, to ensure that efforts undertaken by the organization are completed on time and according to specifications and are capable of achieving the needed impact. Increasingly, project leaders (PLs) who possess this expertise are being employed in academic settings to support clinical and preclinical translational research team science. Duke University’s clinical and translational science enterprise has been an early adopter of project management to support clinical and preclinical programs. We review the history and evolution of project management and the PL role at Duke, examine case studies that illustrate their growing value to our academic research environment, and address challenges and solutions to employing project management in academia. Furthermore, we describe the critical role project leadership plays in accelerating and increasing the success of translational team science and team approaches frequently required for systems biology and “big data” scientific studies. Finally, we discuss perspectives from Duke project leadership professionals regarding the training needs and requirements for PLs working in academic clinical and translational science research settings.
Epoch of Reionisation (EoR) data analysis requires unprecedented levels of accuracy in radio interferometer pipelines. We have developed an imaging power spectrum analysis to meet these requirements and generate robust 21 cm EoR measurements. In this work, we build a signal path framework to mathematically describe each step in the analysis, from data reduction in the Fast Holographic Deconvolution (FHD) package to power spectrum generation in the εppsilon package. In particular, we focus on the distinguishing characteristics of FHD/εppsilon: highly accurate spectral calibration, extensive data verification products, and end-to-end error propagation. We present our key data analysis products in detail to facilitate understanding of the prominent systematics in image-based power spectrum analyses. As a verification to our analysis, we also highlight a full-pipeline analysis simulation to demonstrate signal preservation and lack of signal loss. This careful treatment ensures that the FHD/εppsilon power spectrum pipeline can reduce radio interferometric data to produce credible 21 cm EoR measurements.
We apply two methods to estimate the 21-cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly spaced triangles of antenna tiles, as well as an estimate based on data gridded to the uv-plane. The direct and gridded bispectrum estimators are applied to 21 h of high-band (167–197 MHz; z = 6.2–7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point-source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 h, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21-cm bispectrum may be accessible in less time than the 21-cm power spectrum for some wave modes, with detections in hundreds of hours.