Adjustment disorder is characterized by an emotional or behavioral response to a stressful event or change in life. This condition can impact a student’s academic performance, social life, and overall well-being. Adjustment disorder with the stressor is a psychological response to identifiable stressors that result in the development of emotional or behavioral symptoms. These symptoms cause significant impairment in various areas of functioning, such as social, occupational, or academic performance.

Students with adjustment disorder may experience a range of symptoms, including feelings of sadness, anxiety, hopelessness, and a lack of concentration. They may also have trouble sleeping, feel overwhelmed, and struggle to cope with daily responsibilities. These symptoms can be triggered by various factors such as academic pressure, relationships, family issues, or cultural adjustments.

This study aims to determine the prevalence of adjustment disorder among undergraduate students and investigate the potential risk factors of stress that can lead to adjustment difficulties.

Recognize the signs of adjustment disorder, how to access support, and how to create a supportive environment, therefore, students can effectively manage this condition and thrive in their academic and personal lives.

To prioritize mental health and provide the necessary resources for students to navigate the challenges of adjustment disorder effectively.

Adjustment Disorder‑New Model 20 (ADNM‑20) was used to assess prevalence of adjustment disorder among undergraduate students. It is a diagnostic tool used to assess adjustment disorder in individuals experiencing significant life stressors. The ADNM 20 is specifically designed to capture the nuanced manifestations of adjustment disorder with the stressor, enabling clinicians to make accurate assessments and develop targeted treatment plans.

Adjustment disorder is a real and impactful challenge and a common mental health condition among undergraduate students at Prince Mohammad Bin Fahd University, Al Khobar, Saudi Arabia.

Adjustment disorder can significantly affect a student’s academic performance. The inability to focus, persistent feelings of distress, and a lack of motivation can lead to a decline in grades and overall achievement. By recognizing the signs, accessing support, and creating a supportive environment, students can effectively manage this condition and thrive in their academic and personal lives. It’s crucial to prioritize mental health and provide the necessary resources for students to navigate the challenges of adjustment disorder effectively.

None Declared

Individuals with severe mental illnesses are at an increased risk of morbidity and mortality from cardiovascular diseases compared with the general population. Dyslipidaemia is a well-established contributor to CVD risk, alongside factors such as obesity, hypertension, smoking, diabetes, and a sedentary lifestyle. Many patients with severe mental illnesses often exhibit a combination of these risk factors. Notably, second-generation antipsychotics, particularly clozapine, are associated with a significant risk to elevate lipid levels. However, dyslipidaemia is a treatable condition, and various interventions are available to decrease the risk, ultimately reducing the associated morbidity and mortality. Therefore, NICE guidelines recommend monitoring of lipid profile initially at baseline, 3 months and then annually and cardiovascular risk assessment by validated tools like QRISK3 or Assign Score (validated tool used in Scotland).

The first aim of this audit was to see if a lipid profile had been done within the past 12 months in patients on clozapine treatments and second aim was to see if cardiovascular risk had been assessed using a validated tool i.e. Assign Score and lastly to check if lipid results and Assign Score had been communicated to the General Practitioner.

The audit included 40 patients receiving clozapine treatment under the care of this local CMHT. We excluded 13 patients who were already on statin medication, those newly initiated on clozapine within the last three months or those who were aged below 30 years or above 74 years. The data collection spans from October 2022 to October 2023. Our analysis focused on bloods results in the last 12 months. After that, we searched for the cardiovascular risk assessment in last 12 months of patients’ electronic notes. Additionally, a comprehensive review of all communication records with General Practitioners was undertaken.

Lipid profile testing was done in 22 of 27 (81.1%) of the audited patients, revealing that a significant proportion, 59.9% (13 of 22), exhibited elevated total cholesterol levels exceeding 5mmol/L. However, the assessment of cardiovascular risk within the specified timeframe was notably low, with only 1 of 27 (3.70%) of the audited patients undergoing this evaluation. Furthermore, communication with General Practitioners (GPs) regarding lipid profiles was observed in a mere 4 of 22 (18.18%) of cases where such testing was conducted.

The clinical audit showed a good level of compliance with lipid profile monitoring; however, notable deficiencies were noted in the assessment of cardiovascular risk and communication with GPs. These findings emphasized the need to enhance our compliance with protocols for a more comprehensive approach to safeguard the cardiovascular health of patients receiving clozapine. As a result, we have proposed improvement strategy at our local CMHT meeting involving the implementation of a structured process, wherein the clozapine clinic nurse initiates an electronic task for the relevant medic to review the results. The medic is then tasked with calculating the cardiovascular risk and communicating both lipid results and the risk assessment to the GP, ensuring their inclusion in the annual review correspondence and subsequent management. A repeat audit will be done after 12 months.

1. 1. To measure the extent to which medication orders in inpatient prescription charts conform to the section in BNF (British National Formulary) on prescription writing.

2. 2. To implement changes with the intention of improving prescriptions and administration records.

Prescription charts of patients admitted in adult male and female psychiatry ward were analysed in three cycles, (1 September to 20 October 2022, then 1st December to 31st 2022 and then: 1st January 2023 to 28th February 2023) which added up to a total of 431, 170 and 490 prescriptions in respective cycles.

Each drug prescription was examined to see if it met the standards outlined in BNF.

Percentage of prescriptions meeting each standard was calculated in each cycle.

First Cycle was followed by presentation of BNF guidelines of prescription writing on 7th December 2022 and copies of those BNF guidelines were placed at both male and female nursing counters. After 1 month, a short re-audit was done to assess the improvement which was satisfactory but this audit's results were not presented. Lastly, after one year of presentation of BNF guidelines in the department, two months of prescription charts were re-audited in cycle 3.

• • Cycle 1: Initial evaluation revealed significant discrepancies in prescription accuracy and adherence to administration protocols. Key areas for improvement were identified and discussed with the postgraduate residents.

• • Cycle 2: Following the implementation of targeted interventions, a re-evaluation showed measurable improvements in prescription accuracy and compliance with administration protocols. However, areas for further improvement were still identified, particularly in the documentation of prescription changes.

• • Cycle 3: The final cycle demonstrated further improvements in prescription practices, with a significant reduction in discrepancies and errors.

• • Legibility remained high across all cycles, with a slight improvement in Cycle 3.

• • The use of generic drug names saw a remarkable increase from 40.6% in Cycle 1 to 84.69% in Cycle 3, indicating a strong adherence to best practices.

• • Block letters usage improved significantly from 17% in Cycle 1 to 71.42% in Cycle 3, enhancing the clarity of prescriptions.

• • The practice of providing a start date saw near-perfect compliance by Cycle 3, increasing from 82.8% in Cycle 1 to 99.18%.

Other findings were similar as well.

The audit successfully demonstrated the effectiveness of clinical audits in improving prescription quality in male and female adult wards. It highlighted the effectiveness of the interventions and the importance of continuous monitoring and feedback.

Working memory is a vital construct in efficient verbal memory encoding (Cotton & Ricker, 2021). Working memory is impacted by attentional capacities (Riccio, Cohen, Garrison, & Smith, 2005). Mood symptoms impact efficient information processing and consolidation of memory (Hubbard, 2016; Lukasik, 2019). This study examines self-reported symptoms of depression, anxiety, and stress as possible moderators of the relationship between working memory and a verbal list-learning task.

Archival data from 415 adults (Mage= 56.10, SD=18.05; Medu= 15.5 SD=2.2; 53% female; 73% white) were collected at an outpatient clinic. Sex and race were not available in a small percentage of cases included in analyses. The Wechsler Adult Intelligence Scale 4th Edition Digit Span subtest was given to assess attention and working memory. Although Digit Span Forward is a measure of simple attention, not working memory, it was included in initial analyses because the subtest was given as a whole. The three components of Digit Span total, Forward, Backward, and Sequencing were also investigated separately, with the two latter scores being better representations of working memory. Learning was assessed via the California Verbal Learning Test (CVLT-II) total T-Score (Trials 1-5). Mood was assessed via the Depression Anxiety and Stress Scales (DASS-42).

Results of a hierarchical linear regression showed a significant effect between total Digit Span performance and total learning on the CVLT-II in the Block 1 (F(3, 411)=14.383, p =<.001 , AR2=.095). Standardized beta weights and p-values for Digit Span Forward, Backward, and Sequencing were (ß=-.50, p=.374), (ß= .159, p=.009), and (ß=.210, p<.001) respectively. In Block 2, when the DASS variables were introduced, the model remained significant F(3,408)=2.602, p=.05 , AR2=.017). The DASS anxiety and stress subscales had significant beta weights in the model (ß=-.172, p=.015) and (ß=.144, p=.039) respectively, with depression being insignificant (ß=--.023, p=.724).

Mood symptoms have been shown to be an important consideration when assessing working memory and verbal learning performance (Massey, Meares, Batchelor, & Bryant, 2015). Present results demonstrate that when accounting for working memory, anxiety and stress were significant predictors of performance on a measure of verbal learning. Additionally, as the components best representing working memory, Digit Span Sequencing and Backward were significantly correlated with verbal learning, whereas a measure best representing simple attention, Digit Span Forward, was not significantly correlated with verbal learning.

Attention plays a key role in auditory processing of information by shifting cognitive resources to focus on incoming stimuli (Riccio, Cohen, Garrison, & Smith, 2005). Mood symptoms are known to affect the efficiency with which this processing occurs, especially when consolidation of memory is required (Massey, Meares, Batchelor, & Bryant, 2015). Without proper focus on relevant task information, improper encoding occurs, resulting in negatively affected performances. This study examines how depression, anxiety, and stress moderate the relationship between auditory attention and verbal list-learning.

Archival data from 373 adults (Mage= 56.46, SD=17.75; Medu = 15.45, SD=2.2; 54% female; 74% white*) were collected at an outpatient clinic. Race was not available in a small percentage of cases included in analyses. Auditory attention was assessed via the Brief Test of Attention (BTA). Learning was assessed via the California Verbal Learning Test (CVLT-II) total T-Score (Trials 15). Mood was assessed via the Depression Anxiety and Stress Scales (DASS-42). A moderation analysis was conducted utilizing the DASS-42 as the moderator between the relationship of BTA and CVLT-II.

Block 1 of the hierarchical regression was significant in that BTA contributed significantly toward verbal learning on the CVLT-II (F(1, 378)=30.141, p =<.001 , AR2=.074). The standardized beta weight and p-value for BTA were (ß=.272, p<.001). When DASS variables were introduced into Block 2, the model remained significant F(3, 375)=4.227, p =.006 , AR2=.030). The DASS Anxiety subscale had significant beta weights in the model (ß=-.210 p=.004), whereas Depression and Stress were not significant (ß=.039, p=.563) and (ß=.021, p=.765), respectively.

The current study examined whether mood symptoms affect the relationship between auditory attention and verbal learning. Present results confirm previous research that auditory attention has a significant impact on verbal learning (Massey, Meares, Batchelor, & Bryant, 2015; Weiser, 2004). Building upon prior research, these results indicate that when accounting for auditory attention, clinicians should be aware of possible confounds of anxiety, which may artificially suppress auditory attention. In some circumstances, a differential diagnosis may require consideration that absent anxiety auditory attention may be within normal range. Continued assessment and evaluation regarding the impact of anxiety is crucial for neuropsychologists when examining performances on verbal learning.

Following feedback from paramedics and staff, escorting patients to the A&E, concerns were raised when some information was missed during the verbal handover from patient/escorting staff to the ambulance/A&E staff. At times the purpose of the transfer was not clear. Essex Partnership University NHS Foundation Trust (EPUT) “Discharge and Transfer Clinical Guidelines” ( CG24) provides clear guidelines to staff when a person is transferred while in the care of the Trust to another service such as another acute trust or, discharged from EPUT services completely. However, there are no current guidelines available for transferring patients for clinical reasons: in case of emergency or acute medical condition, for specialist treatment or investigation. The standard was used: the “Ambulance handover to emergency care standard V1.0” created by Professional Record Standards Body (PRSB). 100% of patients should have a support letter from doctors with relevant information shared with paramedics or the A&E department on transfer to a general hospital. The scope of the audit was Peter Bruff Mental Health Assessment Unit and Ardleigh Acute Inpatient Ward.

The data were collected retrospectively from notes available on the electronic health record database (Paris). The audit tool focused on quantitative and qualitative data collection on patient transfer.

Inclusion criteria: all patients admitted to the Peter Bruff MH Assessment Unit (male and female) and the Ardleigh Ward (female) over the period from 1 September to 15 September 2022. All data were anonymised. Results were tabulated and presented in statistical form back to the clinical teams.

There were identified 18 male and 33 female patients on the Peter Bruff MH Assessment Unit. 2 patients were sent to the A&E via ambulance and 4 patients attended the A&E with staff escort. A support letter was available on one occasion. Compliance 17%.

Within the analysed period there were 15 female patients identified on the Ardleigh ward. 5 patients attended the A&E. A support letter was available on two occasions. Compliance 40%.

All transfers should be managed in a sensitive way ensuring all communication is clear, to promote robust information sharing between inpatient wards and A&E.

A template of the care summary and handover letter was created, which provided a standard structure of headings that is meaningful to clinicians and patients.

The burden of healthcare-associated infections (HAIs) is higher in low- and middle-income countries, but HAIs are often missed because surveillance is not conducted. Here, we describe the identification of and response to a cluster of Burkholderia cepacia complex (BCC) bloodstream infections (BSIs) associated with high mortality in a surgical ICU (SICU) that joined an HAI surveillance network.

A 780-bed, tertiary-level, public teaching hospital in northern India.

After detecting a cluster of BCC in the SICU, cases were identified by reviewing laboratory registers and automated identification and susceptibility testing outputs. Sociodemographic details, clinical records, and potential exposure histories were collected, and a self-appraisal of infection prevention and control (IPC) practices using assessment tools from the World Health Organization and the US Centers for Disease Control and Prevention was conducted. Training and feedback were provided to hospital staff. Environmental samples were collected from high-touch surfaces, intravenous medications, saline, and mouthwash.

Between October 2017 and October 2018, 183 BCC BSI cases were identified. Case records were available for 121 case patients. Of these 121 cases, 91 (75%) were male, the median age was 35 years, and 57 (47%) died. IPC scores were low in the areas of technical guidelines, human resources, and monitoring and evaluation. Of the 30 environmental samples, 4 grew BCC. A single source of the outbreak was not identified.

Implementing standardized HAI surveillance in a low-resource setting detected an ongoing Burkholderia cepacia outbreak. The outbreak investigation and use of a multimodal approach reduced incident cases and informed changes in IPC practices.