To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The aims of anaesthesia for cardiac surgery are: prevention of perioperative cardiac ischaemia and arrhythmias, tight haemodynamic control, avoidance of non-cardiac complications and early tracheal extubation. This chapter deals with the management of low-risk patients undergoing elective CABG surgery.
A recent metanalysis has demonstrated that there are differences in efficacy and acceptability of commonly prescribed anti-depressants (Cipriani et al. 2009). Escitalopram, sertraline, venlafaxine and mirtazapine were the most effective.
We wished to find out whether the data from our own practice corresponded with the data from the metanalysis.
To compare the efficacy of anti-depressant monotherapies in patients with unipolar depression at Bedford Hospital, using discharge rates as the outcome measure.
We included all patients with unipolar depression on an antidepressant monotherapy in Bedford hospital in our analysis (145 in total). We examined the clinical notes for each patient to assess whether they had been discharged from the out-patient clinic after being prescribed the antidepressant. This allowed us to calculate discharge rates for each antidepressant monotherapy.
A higher percentage of patients prescribed Escitalopram were discharged from clinic compared to theother anti-depressant monotherapies.
Our results support the findings of the meta-analysis. The discharge rates from Bedford hospital suggest that Escitalopram in particular is the most efficacious.
This audit in a small group of patients suggests that Escitalopram leads to the highest discharge rate compared to the other monotherapies prescribed.
There are differences in efficacy of commonly prescribed anti-depressants. Escitalopram, sertraline, venlafaxine and mirtazapine (‘the four’) were the most effective.
To compare the efficacy of ‘the four’ with other anti-depressant monotherapies prescribed either for the treatment of unipolar depression or other indications, using discharge rates as the outcome measure.
We studied all patients on an antidepressant monotherapy in Bedford hospital (206 in total). We examined the clinical notes for each patient prescribed antidepressants to assess whether they were discharged from the out-patient clinic. Hence we calculated rates of discharge for ‘the four’ and other antidepressant monotherapies for patients with unipolar depression or another psychiatric condition.
For patients with unipolar depression, discharge rates were higher for ‘The four’. For patients with other indications, discharge rates were higher for other antidepressant monotherapies. A greater percentage of patients with unipolar depression were discharged from clinic compared with people treated for other indications
This suggests that indication for which the antidepressant monotherapy is prescribed will affect the efficacy of treatment, as measured by discharge rates. The fact that a greater percentage of patients with unipolar depression were discharged from clinic compared with people treated for other indications may suggest that people with ‘treatment resistant depression’ may really have another disorder, for example borderline personality disorder, bipolar disorder or PTSD.
This audit suggests that ‘the four’ are more effective for the treatment of unipolar depression compared with other indications, using discharge rates as the outcome measure.
It has been demonstrated that there are differences in efficacy and acceptability of commonly prescribed anti-depressants (Cipriani et al. 2009). Escitalopram, sertraline, venlafaxine and mirtazapine were the most effective.
We wished to see whether our own data showed similar outcomes to the data from the metanalysis using decrease in suicidality as an outcome measure.
To compare the efficacy of anti-depressant monotherapies in patients with unipolar depression at Bedford Hospital, using suicidality (suicidal ideation and behaviour) as the outcome measure.
We included all patients with unipolar depression on an antidepressant monotherapy in Bedford hospital in our analysis (145 in total). We examined the clinical notes for each patient to assess whether they demonstrated suicidality after being prescribed the antidepressant. This allowed us to calculate rates of suicidality for each antidepressant monotherapy.
The prescription of sertraline was associated with the greatest reduction in suicidality, closely followed by citalopram.
Our results support the findings of the meta-analysis. None of the patients on Escitalopram expressed suicidality, so a reduction in suicidality rates could not be demonstrated for this monotherapy.
This audit in a small group of patients suggests that sertraline is associated with the greatest reduction in suicidality compared to the other monotherapies prescribed.
In the case of a first episode of psychosis among members of different associations of families of mentally ill people, little is known about their priorities and how satisfied they are with the help provided to them. A survey was conducted in five European family associations. Respondents emphasized the need for early (ambulant) intervention through outreach with very practical goals directed at creating stability and social functioning. About one-third of the respondents are unsatisfied or very unsatisfied. The highest percentage of unsatisfied respondents was in the following five areas of care: advice on how to handle specific problems; help with preserving or regaining social functioning; help with regaining structure and routine; information; prompt assistance preferably in patientˈs own environment. The agreement of these findings with findings from earlier studies underlines the importance of suggesting specific changes in the delivery of care.
Liaison Psychiatry is primarily concerned with the detection and treatment of psychiatric disorders within the general hospitals. 1A study2 also highlighted the presence of only 45.5 core trainee posts in this speciality nationally.
Aims & objective
To survey the liaison psychiatry service recently set up as a service provision at a psychiatry unit in North Derbyshire.
We retrospectively reviewed all case notes of patients who had been assessed from January 2007 to June 2009 by the consultation-liaison service.
A total of 136 patients had been assessed since this service began in September 2007. Majority of the patients (72%) were between the ages of 31 to 65 years, while the gender was equally distributed. 51% were referred from the medical ward and most of them had been referred by core trainee. 95% of the referral was during working hours and 74% of the patients were assessed within 24 hours. Their diagnosis was variable, for e.g. 29% had depression, 19% had substance misuse problems, 8% had psychosis etc. 66% of patients were managed by medication advice, psycho-education and referral to CMHT/GP.
Liaison psychiatry was established for service provision, but it is apparent that it fulfilled both clinical and educational needs, despite the challenges. Adequate experience can be gained with a well supervised service. The overall educational value of designing and implementing a new service as a trainee cannot be overstated; it is something which is difficult to learn in classrooms.
Addictive and psychiatric disorders are a significant barrier to retention in medical care leading to worse outcomes. As part of an HIV care expansion project, the H-STAR intervention was designed to treat substance use and psychiatric disorders for minority patients receiving co-located HIV medical care.
The intervention aim was to increase access to treatment for substance abuse and psychiatric disorders in minority HIV+ patients and reduce substance use.
The H-STAR primary objective was to offer substance and psychiatric evaluation and treatment with an integrated treatment model.
All participants in H-STAR underwent substance abuse screening and evaluation, using DSM-IV-TR criteria. Substance use was measured on the Government Performance Reports Act (GPRA) form at baseline and 6 months. Intensive outpatient treatment (IOP) using the Matrix Model as the behavioral intervention was available to all patients. All patients were offered and scheduled psychiatric evaluation and treatment with an onsite psychiatrist.
Of 123 enrolled persons with both baseline and 6 month GPRAs, the prevalence of substance abuse/dependence disorders were as follows: Alcohol: 32 (24.2%); Opiate: 54 (43.9%); Cocaine: 47(38.2%); and Marijuana: 26(21.1%). Thirty (22.1%) completed IOP. At 6 month follow-up there was statistically significant reduced use of alcohol, heroin and cocaine. Of 136 enrolled participants, seventy-five (55.1%) had psychiatric evaluations; 53 (70.7%) received medication management.
There was a significant reduction in all substance use; cocaine use remained the most prevalent. Despite open access to psychiatric evaluation, not all patients completed evaluation in spite of multiple attempts to reschedule.
In recent years the association between sexual dysfunction (SD) and obesity in the general population has drawn major attention. Although sexual dysfunction is common in psychosis, its relationship with weight gain and obesity remains unclear.
To investigate the association between sexual dysfunction and obesity in a cohort of patients with first episode psychosis.
Sexual function was assessed in a cohort of patients with first episode psychosis using the Sexual Function Questionnaire (SFQ). Anthropometric measures, including weight, BMI, waist, waist–hip ratio were investigated. Additionally, leptin and testosterone were investigated in male patients.
A total of 116 patients (61 males and 55 females) were included. Of these 59% of males and 67.3% of females showed sexual dysfunction (SD) according to the SFQ. In males, higher SFQ scores were significantly correlated with higher BMI (Std. β = 0.36, P = 0.01), higher leptin levels (Std. β = 0.34, P = 0.02), higher waist–hip ratio (Std. β = 0.32, P = 0.04) and lower testosterone levels (Std. β = −0.44, P = 0.002). In contrast, in females, SFQ scores were not associated with any of these factors.
While sexual dysfunction is present in both female and male patients with their first episode of psychosis, only in males is sexual dysfunction associated with increased BMI and waist–hip ratio. The association between SD, BMI, low levels of testosterone and high levels of leptin suggest that policies that lead to healthier diets and more active lifestyles can be beneficial at least, to male patients.
A zirconolite glass-ceramic material is a candidate wasteform for immobilisation of chlorine contaminated plutonium residues, in which plutonium and chlorine are partitioned to the zirconolite and aluminosilicate glass phase, respectively. A preliminary investigation of chlorine speciation was undertaken by analysis of Cl K-edge X-ray Absorption Near Edge Spectroscopy (XANES), to understand the incorporation mechanism. Cl was found to be speciated as the Cl- anion within the glass phase, according to the characteristic chemical shift of the X-ray absorption edge. By comparison with Cl K-edge XANES data acquired from reference compounds, the local environment of the Cl- anion is most closely approximated by the mineral marialite, in which Cl is co-ordinate to 4 x Na and/or Ca atoms.
The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.
We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.
This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.
Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).
Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.
Habitat prioritization and corridor restoration are important steps for reconnecting fragmented habitats and species populations, and spatial modelling approaches are useful in identifying suitable habitat for elusive tropical rainforest mammals. The Endangered Bornean banteng Bos javanicus lowi, a wild bovid endemic to Borneo, occurs in habitat that is highly fragmented as a result of extensive agricultural expansion. Based on the species’ historical distribution in Sabah (Malaysia), we conducted camera-trap surveys in 14 forest reserves during 2011–2016. To assess suitable habitat for the banteng we used a presence-only maximum entropy (MaxEnt) approach with 11 spatial predictors, including climate, infrastructure, land cover and land use, and topography variables. We performed a least-cost path analysis using Linkage Mapper, to understand the resistance to movement through the landscape. The surveys comprised a total of 44,251 nights of camera trapping. We recorded banteng presence in 11 forest reserves. Key spatial predictors deemed to be important in predicting suitable habitat included soil associations (52.6%), distance to intact and logged forests (11.8%), precipitation in the driest quarter (10.8%), distance to agro-forest and regenerating forest (5.7%), and distance to oil palm plantations (5.1%). Circa 11% of Sabah had suitable habitat (7,719 km2), of which 12.2% was in protected forests, 60.4% was in production forests and 27.4% was in other areas. The least-cost path model predicted 21 linkages and a relatively high movement resistance between core habitats. Our models provide information about key habitat and movement resistance for bantengs through the landscape, which is crucial for constructive conservation strategies and land-use planning.