Posttraumatic stress disorder (PTSD) has been associated with advanced epigenetic age cross-sectionally, but the association between these variables over time is unclear. This study conducted meta-analyses to test whether new-onset PTSD diagnosis and changes in PTSD symptom severity over time were associated with changes in two metrics of epigenetic aging over two time points.

We conducted meta-analyses of the association between change in PTSD diagnosis and symptom severity and change in epigenetic age acceleration/deceleration (age-adjusted DNA methylation age residuals as per the Horvath and GrimAge metrics) using data from 7 military and civilian cohorts participating in the Psychiatric Genomics Consortium PTSD Epigenetics Workgroup (total N = 1,367).

Meta-analysis revealed that the interaction between Time 1 (T1) Horvath age residuals and new-onset PTSD over time was significantly associated with Horvath age residuals at T2 (meta β = 0.16, meta p = 0.02, p-adj = 0.03). The interaction between T1 Horvath age residuals and changes in PTSD symptom severity over time was significantly related to Horvath age residuals at T2 (meta β = 0.24, meta p = 0.05). No associations were observed for GrimAge residuals.

Results indicated that individuals who developed new-onset PTSD or showed increased PTSD symptom severity over time evidenced greater epigenetic age acceleration at follow-up than would be expected based on baseline age acceleration. This suggests that PTSD may accelerate biological aging over time and highlights the need for intervention studies to determine if PTSD treatment has a beneficial effect on the aging methylome.

Autistic women are at high risk of developing restrictive eating disorders (REDs), such as anorexia nervosa.

This study provides an overview of the clinical characteristics of autistic women with REDs to (i) enhance understanding of increased risk, and (ii) support the identification of autistic women in eating disorder services.

We compared self-reported autistic and disordered eating characteristics of: autistic participants with REDs (Autism + REDs; n = 57); autistic participants without REDs (Autism; n = 69); and women with REDs who are not autistic (REDs; n = 80). We also included a group of women with high autistic traits (HATs) and REDs, but no formal autism diagnosis (HATs + REDs; n = 38).

Autism + REDs participants scored similarly to Autism participants in terms of autistic characteristics and to REDs participants in terms of experiencing traditional disordered eating symptoms. Autism + REDs participants were distinguished from both groups by having more restricted and repetitive behaviours and autism-specific eating behaviours related to sensory processing, flexibility and social differences. HATs + REDs participants showed a similar pattern of scores to Autism + REDs participants, and both also presented with high levels of co-occurring mental health difficulties, particularly social anxiety.

The presentation of autistic women with REDs is complex, including both traditional disordered eating symptoms and autism-related needs, as well as high levels of co-occurring mental health difficulties. In eating disorder services, the REDs presentation of autistic women and those with HATs should be formulated with reference to autism-specific eating behaviours and co-occurring difficulties. Treatment adaptations should be offered to accommodate autistic characteristics and related needs.

The purpose of induction is to welcome our new employees and also ensure that they have the information and support to carry out their roles effectively. A robust induction not only benefits the doctor but also helps employers to ensure the delivery of high-quality patient care, increases retention, reduces absenteeism, and will promote the organization as a good employer. Doctors need to be supported in the workplace to provide safe, high-quality patient care. Induction as a minimum should introduce doctors to employer procedures and rules, arrangements for clinical governance (patient safety, clinical errors, clinical risk management, complaints, and litigation), orientation, and support. We have developed a new Induction folder containing all the necessary information for a beginner in Psychiatry in North Wales

We initially arranged for a preintervention questionnaire for the Junior doctors in Psychiatry in North Wales. That included Core trainees, Foundation year doctors, Senior house officers (LAS CT- SHO, JCF- non-training post), and GP trainees.

The QIP started in 2019 August with Audits followed by PDSA cycles. Over a period of 2 years, various doctors both from the present and from the last 3 years were contacted via email and google forms. We completed 3 PDSA cycles.

During these 2 years, we included certain topics that were missed, such as medication during an emergency, contact details from the deanery, etc. We have been following up on the Induction folder with the new doctors as and when there is new recruitment.

The first PDSA showed promising results. Following the first PDSA, we amended a few changes in order to improve the response which resulted in an overwhelmingly positive response from the new doctors/ old doctors in Psychiatry. Following the third PDSA, we included details from the deanery contact and updated the contact details from our own trust.

2 years of work on this project has yielded good results. However, the sustainability of changes is questionable. This indicates continuity in changes. We are hoping that the new trainee doctors, either junior or senior trainees can consider working on this project and continue to amend changes on yearly basis.

The amended version of the folder can be completed at least 4 weeks prior to the major induction that happens every August.

We will consider sharing the Induction folder as handbooks/ pdf versions to all the trainees and non-trainees in our trust. Apart from this, we will continue to keep the information at a high quality and standards. We will achieve this by ensuring feedback from the new doctors.

Problematic drinking of alcohol is a common problem in the United Kingdom. As alcohol is a central nervous system (CNS) suppressant, when a chronic user abruptly stops drinking alcohol, the alcohol-mediated CNS inhibition is withdrawn and the glutamate-mediated CNS excitation is left unchecked leading to a total excitation of the CNS. This results in alcohol withdrawal syndrome (AWS). The aim of this audit was to assess the compliance to the health board's policy for management of AWS available in the intranet as NU16 which was developed based on the NICE guidelines, across the wards in the General hospital. We aimed to assess compliance concerning four aspects:

1. 1. Initial clinical and laboratory assessment

2. 2. Prescribing for alcohol detoxification (benzodiazepines and vitamins)

3. 3. Scoring of and adherence to CIWA-Ar

4. 4. Specialist advice during the admission

We requested for the case records of patients admitted to the Wrexham Maelor Hospital during May 2022 with problematic alcohol consumption. We have received 56 case notes from the medical records department among which, 50 fulfilled the inclusion criteria. A case report form was prepared based on the NU16 and anonymized data were collected.

Average age of the participants was 56 years ranging from 21 to 95.There were 29 males and 21 females. Mean days in the hospital was 3.25(+0.88). Only 4% of the records had complete documentation of drinking history, 84% had documentation of physical examination, and 20% had the documentation of signs of Wernicke's encephalopathy. CIWA-Ar was applied in 44% with correct scoring only in 24%. Compliance to laboratory investigations varied from 16% for gamma glutamyl transferase (GGT) to 84% for full blood count. Benzodiazepines were prescribed for 38%, oral thiamine was prescribed for 58%, 42% had two pairs of intravenous pabrinex three times a day and 6% had received 1 pair once a day. Benzodiazepine regimen was completed in 75% and alcohol liaison opinion was obtained only in 16%

We could find that there were omissions in multiple areas of adherence to the guidelines in all the four domains. Alcohol liaison team is conducting special training programs for the management of AWS for all the clinical staff in the general hospital with the aim that compliance should improve in the near future.

We aimed to arrange the local Postgraduate teaching in psychiatry as per the Deanery requirement/ HEIW requirement. We aim to achieve a better target with regard to local teaching as noted from the previous year's GMC trainee survey

The project started in 2019. 3 sets of audits and PDSA's were done- one each year, before the final PDSA. During these 3 audits, only non-consultants were participants.

During the 4th PDSA, in 2022-2023, a purposive sample was selected to provide the best information possible for the audit. It included Consultant Psychiatrists from all three sites in North Wales, Trainees( Junior/ Senior), SHO, speciality doctors, FY2, GP trainees and Clinical fellows. The criteria for participation were that the doctors should be working in Psychiatry and should have attended the local postgraduate programme. Access to the internet and appropriate device was mandatory as an add-on availability.

An online questionnaire was emailed to the participants. There were only 3 questions for the Consultants and 5 for the non Consultants’ group. 2 weeks window was offered to fill out the forms.

The 3 audits done initially revealed that consistent formal teaching was not provided. The candidates also found the current programme not fulfilling the criteria laid by the deanery and that their educational needs were neglected. The summary of the old audits suggested that the teaching had worsened eventually.

The final PDSA was done in 2022-2023. The overall time to fill out the form was 1.43 minutes. An equal number of Consultants and Non-consultants filled out the form. 31 Consultants rated the new programme as 4.23 for 5. The 31 non-consultants rated the programme 3.68 out of 4 and 95% identified that the new postgraduate programme covered the core trainees' requirements as per the MRCPsych Handbook from the Deanery.

Prioritisation of the most important facilitators and identification of ‘easy wins’ are important steps in this process.

The purpose of this study was to develop a national expert group consensus amongst a range of relevant stakeholders; senior doctors, residents, patients, allied healthcare professionals and healthcare managers allowing us to;

1. 1. identify important barriers and facilitators of learning in clinical environments and

2. 2. indicate priority areas for improvement. Our overarching objective was to provide information to guide policymakers and those tasked with the delivery of graduate medical education in tackling the provision of high-quality clinical learning environments in challenging time

To improve the clerking proforma and physical healthcare for General Adult Psychiatric inpatients in Heddfan Psychiatric Unit, Wrexham by 100% within 18 months period with a long term goal of continuous improvement.

We started the project with a baseline audit which showed the incompleteness of vital data when clerking a patient in adult psychiatric inpatient unit. This was compared with various standards from Core competencies for a trainee in Psychiatry, NICE guidelines and Local trust policy from our own trust BCUHB for physical health monitoring and Department of Health Guideline for VTE.

With the findings obtained, we went ahead to create a proforma encompassing all the details.

The use of various Quality improvement tools such as Fishbone diagram, Drivers diagram and PDSA cycles gave as overwhelming results

The baseline audit, repeat audits and PDSA cycles have shown tremendous and overwhelming results in terms of completion of the proforma. This has resulted in mandatory details being inputted sufficiently in the patient's notes.

Many of the important details such as medication details, allergy status, legal and forensic status, mental state examination, risk assessment, VTE assessment, investigation details and documentation have shown to have improved during this 1 year

This QIP has been patient centred as this is the main goal. Following the PDSA cycle, we have identified that it has been efficient and effective. It has been safe and also reduced the chances of patient neglect. The structure of the proforma used does not discriminate or show any inequalities and is timesaving too.

The SWOT analysis has been completed, which has shown that the teamwork and support from the Consultants and other stakeholders have been a major strength. There are a few weaknesses such as unavailability of ECG machine, missing documentation of investigations despite completing them but however with timely education to the junior doctors, we are hoping for improvement further. This QIP has opened up doors for various opportunities, such as including nursing and pharmacy admission forms into this proforma. Though there are few threats in achieving 100% success, we are hoping for the best

This audit aimed to assess the adherence to the anti-psychotic policy for delirium in the medical wards. It aimed to assess compliance with each of the guidelines mentioned in the health board's policy which is based on the National Institute for Health and Cares Excellence (NICE) guidelines.

After registering the audit, the Acute medical ward was approached for the hospital numbers of all the patients admitted in the months between January and March 2021, and 70 case records were screened. Case notes of patients above 18 years who were diagnosed with delirium including those after managing alcohol withdrawal were included. Those who were admitted only with alcohol withdrawal delirium were excluded. 47 case records were selected for data collection. A proforma was prepared based on the policy available in the intranet and data were entered.

Retrospective data of 47 patients who had delirium were analysed which included 18 males and 29 females. The mean age of the participants was 80.7 years (range 40–101; SD + 30). The mean days of referral after admission were 28(+7.07). 34%were diagnosed to have delirium by the treating team,8.5% were diagnosed by the Emergency Department (ED) team and 57.4% were diagnosed by the liaison psychiatric team. 57% had another psychiatric diagnosis. The cause for delirium was mentioned in 55% of the records and the most common cause was urinary tract infection (31%) followed by multifactorial delirium (27%). Antipsychotics were prescribed for 57% and among those who received 74% received risperidone, 15% received olanzapine, and 11% haloperidol. Compliance was 100% in prescribing appropriate antipsychotics, maximum dose, investigations (expect x-ray chest and CT scan), only 54% compliance was observed with regards to stopping the antipsychotic before discharge and in 23% it was mentioned to be monitored by the GP and another 23% by the treating team.

This audit has displayed the lacuna in the prescription of antipsychotics for patients diagnosed with delirium. Periodic programs will be planned and executed for training the liaison practitioners and the staff in the medical wards regarding the diagnosis and management of delirium especially the prescription of antipsychotics. A re-audit will be conducted after 6 months.

The aim of this audit is to assess whether healthcare staff are correctly donning and doffing PPE when entering and leaving the wards (changed to donning and doffing PPE when within 2 metres vicinity of a patient).

Consultants/ Junior doctors/ Ward managers/ Staff nurses/ student nurses/ Health care support workers/ Occupational therapist/ Psychologists/ Student nurses/ Housekeeping staff, were all included in this Audit. None of the staff was aware of this Audit and this was an entirely random observation. We used a standard proforma in order to audit. Followed by the Audit, we trained the staff in the unit and then re-audited.

98% of them wore mask whilst in the ward and 94% of them washed their hands after doffing. 36% did not wear them appropriately and about 10-14% did not wear PPE at all. A mere 7 out of 50 alone used hand gel. Overall the donning and doffing of PPE was not being followed and adhered to according to the standards from PHE as per the first Audit. In particular, during donning only 1/3rd of them donned the PPE as per guidance. Likewise, the doffing technique was also poor, with only half of them removing the apron and mask correctly. Unfortunately, only 7 of the 50 people were observed to have used hand gel in between the doffing. This could be potentially increasing the risk of the spread of the coronavirus.

We had trained almost 150 staff members in the Heddfan unit with regard to PPE/ donning and doffing.

Handwashing prior to donning was achieved by all the staff. All the staff, that is 100 % of them adhered to the donning technique in line with the guidance in comparison to just 64% during the first Audit. Whilst hardly just 1/2 to 2/3rd of the staff followed the doffing technique adequately, the second audit showed that only 2 of the 50 staff did not follow the guidance. A meagre/ handful of them followed the utilisation of hand gel in between the tasks of doffing during the first Audit. Almost 90% of them followed the technique properly during the second Audit. Thus showing that the PPE training was successful.

Following the PPE training that was provided to them there was a good response from the staff and this went on to show how effectively we have managed the prevention/ contamination of virus in our unit.