Aims: The Mental Welfare Commission (MWC) has provided information outlining good practice for consent to treatment in relation to The Mental Health (Care and Treatment) (Scotland) Act 2003. Patients prescribed psychotropic medications beyond two months of initial detention under the Mental Health Act require a statutory T2 or T3 form, depending on the patient’s ability and willingness to consent to treatment. Without a valid form being in place, there is no legal authority to continue to administer medication.

A MWC report in February 2024 highlighted a number of concerns around the use of community Compulsory Treatment Orders (cCTOs). One of the recommendations from this report was the need to ensure audit processes are in place with regards medical treatment given under cCTOs. This initial audit cycle was commissioned in response to the report and aimed to determine whether T2/T3 forms were (i) in place, (ii) valid and (iii) concordant with what the patient was being prescribed in the community.

Methods: Administrative staff from psychiatric subspecialties within NHS Lanarkshire were contacted to gain access to spreadsheets detailing patients detained under a cCTO, as well as online files containing electronic copies of their T2/T3 certificates for review. Patients who were detained under a cCTO at the time of data collection were included (July 2024–October 2024). Review of the patients T2/T3 forms and electronic medical records took place to record whether they were (i) in place, (ii) valid and (iii) reflective of what was currently being prescribed.

Results: 89 patients were identified as being on cCTOs. 3 of those did not have T2 or T3 forms in place yet, all for valid reasons.

For the forms that were in place, 96.5% were considered valid though only 65.9% were concordant with what the patient was being prescribed in the community.

Conclusion: Almost all patients had appropriate T2/T3 forms in place, suggesting the administrative system in place to manage this is working well.

There were significant discrepancies between what medication had been authorised under T2/3 forms and what the patient was prescribed which will require further review by individual teams.

Recommendations include sharing of the findings, as well as the MWC Good Clinical Practice guidelines, with Responsible Medical Officers and General Practitioners to increase awareness of the need for medication regimes to be compliant with the relevant T2/T3 forms. Additionally, ongoing audit within psychiatry units on an annual basis to improve practice in this area is required to maintain and improve standards.

Aims: The Mental Welfare Commission (MWC) released a report in February 2024 recommending the use of audit to ensure good clinical practice in the use of community Compulsory Treatment Orders (cCTO) as part of the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA). One particular area of concern was the use of care plans under section 76 of the Act.

An audit was performed across NHS Lanarkshire Mental Health services to determine if all patients on cCTOs had Section 76 care plans in place that were valid and compliant with the minimum standards set out by the MWC.

Methods: Medical records administration staff were contacted across all of the psychiatry specialities within the health board, to supply a list of patients on cCTOs. Their electronic medical records were reviewed and relevant data collated by the authors to determine if the appropriate paperwork was in place, was valid, and met the minimum standards, as set out by the MWC.

Results: Within NHS Lanarkshire, there were 89 patients on cCTOs. 87 of these had a Section 76 care plan in place, though one of these was considered invalid.

Only 24% of the care plans were found to meet all of the minimum standards. There was noted to be a high degree of variability in which of the minimum standards were met, how the care plans were documented and the quality of the information contained within them, across the specialties and between individual psychiatrists.

Conclusion: This was the first audit looking at cCTO Section 76 care plans carried out in NHS Lanarkshire. It demonstrated there is a need for standardisation of these care plans across mental health services, to ensure that as a minimum, all statutory information is documented.

Recommendations from the audit included the use of a proforma to capture the information required to meet the minimum standards, as well as provide prompts for additional information to improve the quality of the care plans. It has also been recommended that each psychiatry specialty sets up their own annual audit of care plans, and an audit tool for this has been provided.

To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.

An experiment was conducted at one location in 1999 and two locations in 2000 to determine the critical weed-free period for peach in North Carolina. The cultivars for the three locations were ‘Contender’, ‘Norman’, and ‘Summerprince’. Weed-free intervals of 0, 3, 6, 9, 12, and 15 wk after peach tree bloom were established. Paraquat at 1.1 kg ai/ha plus nonionic surfactant at 0.25% v/v was applied every 10 d, after treatments were initiated at peach bloom, to maintain weed-free plots. Large crabgrass, hairy vetch, and smooth crabgrass were the primary weeds in Contender. Horseweed, smooth crabgrass, and large crabgrass were the primary weeds in Norman. Bermudagrass, smooth pigweed, and common lambsquarters were the primary weeds in Summerprince. No differences in trunk cross-sectional area were observed between the weed-free periods. Maintaining the orchard floor weed-free for 12 wk after peach tree bloom resulted in the greatest fruit size (individual fruit weight and diameter), total yield, and fruit number.