Genetic factors are thought to play an important role in antipsychotic-induced weight gain (AIWG). Polygenic risk scores (PRS) could provide a measure of genetic predisposition to antipsychotic drug induced weight gain (AIWG). We conducted a study to examine how a PRS, generated using SNPs, identified from a recent meta-analysis, related to weight-change over time in people with first episode-psychosis (FEP).

The PRS included SNPs in six different genes, identified as having significant associations (p<0.05) with AIWG. These were HTR2C rs3813929; MTHFR rs1801133; ADRA2A rs1800544; MC4R rs489693; LEPR rs1137101 and CNR1 rs1049353. An additive PRS and a risk allele based weighted PRS were created based on risk allele counts and presence or absence of risk alleles respectively. The additive PRS was also used to create low/high genetic risk groups for analysis. The association between PRS and weight gain per day (WGPD) in grams/day as well as BMI percentage change (=>7%) was investigated using regression models.

In multiple regression analysis, the additive PRS significantly predicted AIWG in females (adjusted r²=0.59, B: unstandardised regression coefficient=24.4 grams/day p <0.05), but not in males. ANCOVA showed that high genetic risk groups had greater WGPD (p=0.018), with significant PRS gender interactions driven by markedly higher WGPD in high-risk females (p=0.039).

Follow-up comparisons indicated that in females, those with ≥7 risk alleles had substantially higher WGPD scores (adjusted Mean=138.8 grams/day, 95% CI [99.6, 178.1]) compared with those with ≤6 alleles (adjusted Mean=40.4 grams/day, 95% CI [−5.5, 86.2]). In males, WGPD scores were not significantly different across genetic risk categories.

We report a PRS that is predictive of weight gain in women treated for first episode psychosis, accounting for 59% of the variance daily weight-gain over time. Validation of the PRS in an independent cohort is required, as is determining whether it is feasible to apply the PRS prospectively in real world clinical settings to inform lifestyle measures and pharmacotherapeutic decisions in the treatment of FEP

‘et al’

Dr Adrian Phillipson, Sheffield Hallam University

Prof. Gavin P. Reynolds, Sheffield Hallam University

Prof. Caroline Dalton, Sheffield Hallam University

Compare the incidence of antibiotic prescribing for bronchitis and sinusitis before and after implementation of a multifaceted outpatient stewardship intervention.

Retrospective, quasi-experimental study.

Three primary care clinics within a Michigan health system.

Age 3 months and older who were diagnosed with acute bronchitis or rhinosinusitis.

Provider education paired with electronic health record order sentences for supportive care were implemented in September 2024. Patients diagnosed with bronchitis or sinusitis between October 2023 and January 2024 were included in the pre-intervention group (pre-ASP) while patients diagnosed between October 2024 and January 2025 were in the post-implementation group (post-ASP).

Total antibiotic prescribing for acute bronchitis and rhinosinusitis decreased significantly following the intervention (pre-ASP 65.6% vs post-ASP 53.9%, P = .024) and was driven by a significant reduction in prescribing for bronchitis post-ASP (36.7% vs 21.1%, P = .021). Antibiotic prescribing for rhinosinusitis decreased but did not reach statistical significance (94.4% vs 86.7%, P = .074). The relative reduction in antibiotic prescribing in the presence of a supportive care prescription for acute bronchitis was 51.2% (37.1% vs 18.1%, P = .018).

Supportive care order sentence implementation paired with provider education may be an effective outpatient stewardship practice to reduce antibiotic prescribing for URI.

This scoping review examines the literature on psychiatric in-patient ward rounds, a crucial and ubiquitous but understudied component of psychiatric care. We sought to examine the methods and perspectives used in research on ward rounds and identify recommendations for practice.

The review identified 26 studies from diverse in-patient settings but predominantly UK-based, which made 21 recommendations for practice. The commonest methods used were staff surveys and patient interviews. Patient experience, structure, efficiency and power dynamics were the commonest research foci.

Key recommendations for improving psychiatric ward rounds include reducing participant numbers, increasing patient involvement, structured documentation and regular scheduling. Despite weak empirical evidence supporting these suggestions, they are seen as feasible starting points for quality improvement. The review calls for future research to triangulate patient and staff reports with direct observation to better assess ward round effectiveness and outcomes.

Evaluate prescribing practices and risk factors for treatment failure in obese patients treated for purulent cellulitis with oral antibiotics in the outpatient setting.

Retrospective, multicenter, observational cohort.

Emergency departments, primary care, and urgent care sites throughout Michigan.

Adult patients with a body mass index of ≥ 30 kg/m2 who received ≥ 5 days of oral antibiotics for purulent cellulitis were included. Key exclusion criteria were chronic infections, antibiotic treatment within the past 30 days, and suspected polymicrobial infections.

Obese patients receiving oral antibiotics for purulent cellulitis between February 1, 2020, and August 31, 2023, were assessed. The primary objective was to describe outpatient prescribing trends. Secondary objectives included comparing patient risk factors for treatment failure and safety outcomes between patients experiencing treatment success and those experiencing treatment failure.

Two hundred patients were included (Treatment success, n = 100; Treatment failure, n = 100). Patients received 11 antibiotic regimens with 26 dosing variations; 45.5% were inappropriately dosed. Sixty-seven percent of patients received MRSA-active therapy. Treatment failure was similar between those appropriately dosed (46.4%) versus under-dosed (54.4%) (P = 0.256), those receiving 5–7 days of therapy (47.1%) versus 10–14 days (54.4%) (P = 0.311), and those receiving MRSA-active therapy (52.2%) versus no MRSA therapy (45.5%) (P = 0.367). Patients treated with clindamycin were more likely to experience treatment failure (73.7% vs 47.5%, P = 0.030).

Nearly half of antimicrobial regimens prescribed for outpatient treatment of cellulitis in patients with obesity were suboptimally prescribed. Opportunities exist to optimize agent selection, dosing, and duration of therapy in this population.

The SDMPH 10-year anniversary conference created an opportunity for a researcher to present at a professional association conference to advance their research by seeking consensus of statements using Delphi methodology.

Conference attendees and SDMPH members who did not attend the conference were identified as Delphi experts. Experts rated their agreement of each statement on a 7- point linear numeric scale. Consensus amongst experts was defined as a standard deviation < = 1. Presenters submitted statements relevant to advancing their research to the authors to edit to fit Delphi statement formatting.

Statements attaining consensus were included in the final report after the first round. Those not attaining consensus moved to the second round in which experts were shown the mean response of the expert panel and their own response for opportunity to reconsider their rating for that round. If reconsideration attained consensus, these statements were included in the final report. This process repeated in a third and final round.

37 Experts agreed to participate in the first round; 35 completed the second round, and 34 completed the third round; 35 statements attained consensus; 3 statements did not attain consensus.

A Delphi technique was used to establish expert consensus of statements submitted by the SDMPH conference presenters to guide their future education, research, and training.

An evaluation of the service and care provided to eating disordered patients referred to Tier 3 CAMHS within NHS Lanarkshire. Eating disorders are recognised as a relatively common disease with preventable mortality. The primary aim was to determine if patients with eating disorders adhere to the assessment and management as outlined in MEED and SIGN 164. The secondary aim was to scope the number of eating disordered cases to plan recruitment and training of specialist staff.

The pilot study was carried out in November 2022 and repeated in January 2024. The Electronic Patient Record and paper notes of eating disordered cases assessed in 2023 were used to audit against MEED and SIGN 164. Additional patient demographics including patient's age, sex, median BMI at initial appointment, working diagnosis and suspected co-morbidity were also collected. The service was further evaluated on its processes from source of referral, time taken to be seen, therapies offered and duration within service.

A total of 46 cases were identified in the audit compared to 57 in the pilot study. Most of the cases seen in 2023 were girls in their early teens (89% between the ages 13–16). 10% have a median % BMI <80%. 15 were given a diagnosis of AN (33%), 4 with BN (9%), 4 with ARFID (9%), 2 with OSFED (4%) and 19 with no formal diagnosis (42%). There was a high level of suspected comorbidity (80%).

Referrals were mostly made by GPs (87%), followed by school (11%) and other professionals (2%). The average time taken for the initial assessment was 63 days (40% were seen within 4 weeks). 14 (30%) of cases were offered FBT only whereas 3 (7%) had CBT-E. 7 (15%) did not receive any intervention and 19 (41%) were given other therapies.

With respect to the MEED risk markers, there had been improved recording of weight changes (40% to 80%), hydration status (40% to 70%), temperature (5% to 30%), bloods, over exercising (85% to 90%), purging (75% to 85%) and self-harm behaviours (85% to 90%). However there had been reduction in the recording of BP/HR (80% to 50%), ECG (75% to 40%) and engagement with services (75% to 60%).

Overall, there's some improvement in assessment and management of ED cases but the standard remains inadequate. This project has helped understand the gaps in services and provisions available. Ongoing evaluation is required to help steer service development and optimise patient care.

Ward rounds are complex clinical interactions crucial in delivering high-quality, safe, and timely patient care. They serve as a platform for the multidisciplinary team to collaboratively assess a patient's condition and actively involve the patient and their caregivers in shared decision-making to formulate a care plan. Ward rounds involve an intersection of factors worthy of consideration separate from the wider literature on inpatient experience and multidisciplinary team meetings. With this review our primary aim is to systematically identify what methods and perspectives researchers are using to understand ward rounds.

The databases searched were Medline, CINAHL, British Nursing Index, PsychInfo, and ASSIA as well as reference and citation checking. The search terms used were psychiatr* AND (ward round OR “multi disciplinary team meeting” OR “clinical team meeting”). Studies were included if they were peer reviewed, included primary research on psychiatric inpatient ward rounds in which patients are participants with no restriction on the type of ward or hospital, patient group, country or methodology.

224 records were retrieved and screened from the database search and 10 from other sources. 35 full texts were reviewed for eligibility and 26 included in the review. 16 studies had no particular theoretical perspective, 2 were constructivist, 2 critical realist, 2 lean methodology, 1 systems research, 1 phenomenological, 1 trauma informed and 1 critical theory. 9 focussed on patient experience, 5 ward round structure, 3 on power relationships, 3 on efficiency, 2 on shared decision making and 4 had a unique focus. Though often not explicit, critical theory influenced discussion of power is common in papers focused on patient experience and ward round structure. Cross-sectional surveys, interviews, focus groups and audit cycles were the most common methods. Key themes which emerge are anxiety provoked by ward rounds, preparation and communication, and the negotiation of power structures. Key tensions identified include being multidisciplinary versus overcrowding, efficiency versus personalisation and reliability versus responsiveness.

For a central part of inpatient psychiatric practice there is a limited range of research on psychiatric ward rounds. The influence of critical theories’ focus on power was widespread with limited representation of other theoretical perspectives and concerns. There was no research using experimental methods, but there was some implementation research. Key tensions are highlighted which services may wish to consider when revisiting ways of working on inpatient psychiatric wards.