The diagnosis of CHD not only affects the patient but also their entire environment, including parents, causing significant alterations in their mental health. This study was to assess the levels of anxiety and depression in parents of children with CHD at different stages of the disease.

The PMNCC and PMNCR questionnaires were administered to parents of children with CHD to measure levels of state anxiety (STAI-E) and trait anxiety (STAI-R).

A total of 459 questionnaires were administered. For the state anxiety questionnaire (STAI-E), the mean score was 36, with high anxiety levels observed in 81.3% of participants and above-average levels in 18.7%. Regarding the severity of state anxiety, 82.6% presented severe anxiety, followed by moderate anxiety in 17.2%. For the trait anxiety questionnaire (STAI-R), the mean score was 43, with high levels observed in 91.5% of participants and above-average levels in 7.2%. Severe anxiety predominated in 96.7% of cases.

The mental health of parents of children with CHD is often neither diagnosed nor adequately addressed in a timely manner by paediatric cardiology teams. Assessment and support from a multidisciplinary team are required for the early identification of these conditions.

Point-of-care technology (POCT) has expanded rapidly, particularly since the COVID-19 pandemic. However, less is known about which POCT applications and features patients and caregivers prioritize for lung disease management.

We refined a patient-facing survey based on feedback from an online focus group recruited through community and advocacy volunteer networks. The survey was then administered via ResearchMatch to uncompensated U.S. volunteers, who indicated interest in lung disease research (April 1 to May 14, 2025; 6,333 invitations). POCT perceptions were measured via a 10-point Likert scale.

We received 214 responses (3.4% response rate). Respondents were predominantly patients (79%), female (71%), and older than 60 years (59%). Mean ratings suggested strong perceived benefits across nine POCT benefits and low concern across most drawbacks. The greatest concern was insurance coverage for POCT-associated costs (mean score: 6.7/10). Obstructive lung conditions were most frequently prioritized for future POCT applications.

Among a national sample of ResearchMatch volunteers affected by lung disease, interest in POCT was high, and insurance coverage remained the most salient concern. By describing preferences and concerns of patients, this study informs future design, regulatory approval, and clinical integration. These findings provide evidence for POCT developers, clinicians, and policymakers focused on improving patient-centered care.

In a community mental health setting, we studied real-world relapse rates in patients with a history of psychosis, before and after switching from oral antipsychotics to a long-acting injectable antipsychotic (LAIA). We also aimed to evaluate the relevance of metabolic/demographic factors in relapse rate.

Twenty-five individuals with a past history of psychosis and variable medication concordance who were switched from oral antipsychotics to LAIAs were included in the study. Oral agents were converted to olanzapine equivalents whilst LAIA generics were converted to flupenthixol depot equivalents. The depot equivalent oral dose of olanzapine was calculated, assuming an oral bioavailability of 40%. Relapse-rates occurring over the time periods on oral therapy were compared with rates occurring following initiation of LAIAs. Relapse was defined as any psychiatric hospital admission.

A multivariable Poisson regression model including drug formulation/age/sex/smoking status/BMI were fitted with follow-up time as an offset to estimate adjusted incidence rate ratios and associations with relapse outcomes.

The mean±SD age of the 25 individuals was 50.6±13.9 years whilst 12 (60%) were male. Mean BMI of males/females was 28.1±9.3 kg/m2/ 32±6.4 kg/m2(higher in women) respectively. 65% of patients received either flupenthixol or zuclopenthixol depot with next most common depot being Risperidal Consta. The median (IQR) of daily oral olanzapine equivalent was 10mg (6.9 – 20.0mg)/day and after switching to depot was 16.0mg (5.4 – 40.7mg)/day. The 4-week depot equivalent dose for services users switched to depot was flupenthixol 480mg (200 – 1220mg) / 4-weeks.

Following adjustment for age/sex/smoking status/BMI, relapse rates were significantly lower during LAIA treatment compared with oral treatment (incidence rate ratio [IRR] 0.13, 95% CI 0.08–0.22, p<0.001). Thus depot antipsychotics were associated with an 87% reduction in relapse rates compared to oral therapy. Male sex/younger age/lower BMI were independently associated with higher relapse rates (Exp (beta) 1.9/0.98/0.94 respectively (p<0.05)).

In this real-world community mental health setting, this study highlights that depot antipsychotics provide a dramatic and sustained reduction of 87% in relapse rate for individuals with a history of psychosis. These findings support early prescription of LAIAs in prevention of psychosis relapse. Further evaluation is warranted to elucidate the potential of LAIAs as a treatment option after first presentation of psychosis.

Et al:

Ruth Parkman-Eason, Salford Royal Hospital, UK

Sophie Manttan, Salford Royal Hospital, UK

Yasitha llangasekera, University of Peradeniya, Sri Lanka

Olanzapine long-acting injection (OLAI) is prescribed as maintenance antipsychotic treatment within small established clinics in Southwark and Lambeth. Despite the association between long-acting antipsychotics use and reductions in the number of relapses and hospital admissions, and oral olanzapine being the most commonly prescribed antipsychotic, OLAI is the least commonly prescribed LAI. This is due to staff, space and funding resources needed for post-injection monitoring, a requirement unique to OLAI. In order to provide equitable access to evidence-based treatments like OLAI within the Trust, provision of OLAI must be expanded. This observational, non-interventional, retrospective study aims to measure a range of relevant outcomes in order to demonstrate the achievement of good treatment value.

25 patients were initiated on OLAI between January 2020 and January 2022 and were followed up for 2 years. Our main outcome measures are: continuation rates of OLAI over the 2 year follow-up period, and reasons for stopping, relapse rates (number of bed days and hospital admissions) 2 years before and after starting OLAI, adherence to physical health and side-effect monitoring, and physical health outcomes. A retrospective review of general clinical patient notes and OLAI clinic notes was conducted.

Out of the 21 patients included in analysis, the 2 year continuation rate was 42.9% (n=9). Within these 9 patients, there was a notable reduction in the mean number of bed days, and zero admissions during the 2 year follow-up period. The most common reasons for discontinuation were adverse effects, main one being weight gain, followed by post-injection monitoring. Physical health monitoring during the 2 year follow-up period was inconsistent, this may partly be due to the Covid-19 pandemic. Weight was most consistently measured, however blood test measures were done less frequently, and declined over time. For the 9 patients who were followed up for 2 years, weight increased by a mean of 7.42kg.

Whilst OLAI appears to have a very positive effect on the rate of relapse, especially with the reduction of admissions to zero, adverse effects and post-injection monitoring requirements may discourage patients from continuing. Next steps include embedding processes to ensure all physical health parameters are monitored, consider preventative measures against common adverse effects, and activities to improve acceptability of post-injection monitoring. By doing so, we can continue to promote patient safety as OLAI provision expands within the Trust. Co-authored with Dr Juliet Hurn, Consultant Psychiatrist at South London and Maudsley NHS Foundation Trust.

Antimicrobial stewardship programs (ASPs) are designed to optimize antimicrobial use for healthcare facilities and are required at all acute care and critical access hospitals (CAHs). However, rural CAHs often lack the resources to implement robust ASPs. The purpose of this study was to evaluate the impact of adding regional remote antimicrobial stewardship services across a 14-hospital system consisting of one acute care and thirteen CAHs.

Remote ASP expansion consisted of adding an infectious disease (ID) pharmacist and two ID physicians (0.3 FTE) to provide daily stewardship activities including prospective feedback on antibiotic optimization and use education through remote chart review and communication. Antimicrobial utilization, cost savings, and Clostridioides difficile infection (CDI) rates were tracked. Intervention data and acceptance rates were also collected.

In the first twelve months following regional remote stewardship expansion, the ASP demonstrated a $619,053.97 reduction (56% decrease in Antibiotic Cost/CMI adjusted patient days) in antimicrobial expenses. While only aztreonam use was significantly reduced at the acute care facility (P < .01), the use of vancomycin, meropenem, linezolid, and aztreonam decreased by 33%, 31%, 18%, and 35%, respectively, among the CAHs (P < .001). A 53% reduction in CDI rates was observed across the health system (P < .01). The program averaged 92 interventions per month, with an overall intervention acceptance rate of 86%.

Remote ASPs represent a viable strategy for extending antibiotic stewardship expertise to resource-limited settings to achieve financial and clinical benefits.

Patients undergoing craniotomy experience a higher risk of seizures in the ensuing months. Consensus is lacking regarding the appropriate timeframe for safe return to driving following craniotomy in patients not otherwise limited by neurological deficits or a history of epilepsy.

The Canadian Neurosurgery Research Collaborative (CNRC) distributed an anonymous, voluntary, electronic cross-sectional survey via SurveyMonkey to Canadian neurosurgeons. The survey comprised 16 questions designed to assess practice variations regarding recommendations for return to driving following craniotomy, stratified according to pathological diagnosis.

Forty-eight Canadian neurosurgeons responded to the survey. Driving recommendations varied greatly, with most surgeons recommending return to driving within one month of the craniotomy. The rationale behind these restrictions varied widely, consistent with the lack of evidence-based data to guide decision-making.

This study emphasizes the lack of standardized practices regarding return to driving recommendations for patients undergoing craniotomy without prior seizures. Development of national return to driving guidelines would assist Canadian clinicians in making informed decisions regarding the optimal timeframe for the safe return to driving.

To develop an approach for creating facility-specific urinary antibiograms accounting for the low number of isolates recovered in nursing homes (NHs).

Retrospective analysis of urine culture data collected in NHs in five states.

Data on 5097 urine culture isolates collected across 59 study NHs from January 1, 2020 to December 31, 2021. Four consulting microbiology laboratories served the study homes.

We compared a Clinical and Laboratory Standards Institute (CLSI) standard antibiogram model to four weighted-incidence syndromic antibiogram (WISCA) models utilizing alternate formatting rules. Ability to produce a facility-specific antibiogram with at least 30 isolates and the impact on susceptibility predictions were compared.

Only one facility could generate a CLSI standard antibiogram for the three most commonly recovered Gram-negative isolates over a one-year period. Ability to generate an antibiogram increased with each of the four WISCA models trialed (36%, 54%, 85%, 85%) with the most successful models combining all Gram-negative isolates over a two-year period. Shortening the definition of duplicate isolates from 12 to 3 months did not improve performance. Using all Gram-negative isolates, rather than the three most recovered pathogens, resulted in meaningful changes in the predicted activity of ampicillin-sulbactam, cefazolin, ceftriaxone, and trimethoprim-sulfamethoxazole in several study NHs.

These results suggest that WISCAs using 2-years of urinary culture data including all gram-negative isolates and excluding duplicate isolates within twelve months maximizes the number of NHs able to create a valid antibiogram.

Clozapine is licensed for treatment-resistant schizophrenia (TRS). Because of the risk of clozapine-induced agranulocytosis, its use requires regular haematological monitoring. Substantive evidence supports revisions of absolute neutrophil counts (ANCs) for clozapine discontinuation and ceasing of indefinite haematological monitoring.

To examine the cost-effectiveness and budget impact of different haematological monitoring schemes compared with the current UK monitoring practice for patients using clozapine.

We performed a cost-effectiveness and budget impact analysis from the healthcare system perspective over a 3-year period, comparing the current UK clozapine monitoring practice with extended haematological monitoring and a revision of ANC criteria. Costs and quality-adjusted life years (QALYs) were estimated using a semi-Markov model that followed a simulated cohort of 100 000 adults with TRS. Sensitivity analyses were conducted.

Extended haematological monitoring would lead to lower mean total costs per patient (6388.34 v. 5569.77 GBP) and not compromise quality of life (in QALYs 795.83 v. 795.79 days). A revision of ANC criteria for clozapine discontinuation would not substantially lower costs (6388.34 v. 6390 GBP), but lead to a slight increase in QALYs (795.83 v. 797.08 days), through patients benefitting from longer clozapine treatment. A combination of extended haematological monitoring and revision of ANC criteria would be the dominant strategy, which means that costs are lower (6388.34 v. 5548.50 GBP) and QALYs slightly increase (795.83 v. 797.03 days) compared with the current UK monitoring practice.

A revision of current UK clozapine monitoring practice would be beneficial from both a clinical and an economic perspective. Adjusting ANC criteria for clozapine cessation avoids unnecessary early discontinuation of clozapine treatment and has a positive impact on quality of life. An extension of monitoring intervals reduces costs borne by the healthcare system. Safety is not compromised by these changes.

Clozapine remains underused despite its unparalleled efficacy in treatment-refractory schizophrenia. One of the reasons for its underuse is the fear of severe neutropenia and its consequences.

To scrutinise the association between severe neutropenia and clozapine in a cohort of patients clinically diagnosed with clozapine-induced severe neutropenia.

We used data from the South London and Maudsley National Health Service Foundation Trust’s anonymised case register, known as the Clinical Record Interactive Search. We extracted details of cases where clozapine use was associated with two consecutive neutrophil counts below 1.5 × 109/L. A panel of clinicians independently assessed each case. Agreement was reached on which cases clozapine was the likely or definite cause of the severe neutropenia, the risk to life and whether or not rechallenge with clozapine could be attempted.

There were 96 cases where two consecutive neutrophil counts below 1.5 × 109/L were registered. The panel judged that 9 (9.4%) were definitely caused by clozapine and a further 11 (11.5%) were probably caused by clozapine. Overall, 18 (18.8%) patients should be precluded from ever receiving clozapine again according to the panel (all from the 20 cases where clozapine was the definite or probable cause). Of the remaining 76 cases of severe neutropenia the cause could not be determined in 60 cases, but in 11 cases the cause was benign ethnic neutropenia, in 2 others the cause was cancer chemotherapy, in 2 it was infections and in 1 it was laboratory error. In almost 80% of cases, clozapine was not the clear cause of the neutropenia observed.

The large majority of severe neutropenia episodes mandating cessation of clozapine may not be caused by clozapine. Threshold-based monitoring systems cause unnecessary stopping of clozapine because they lack the necessary specificity for clozapine-related blood disorders.

Point-of-care technologies (POCTs) have grown increasingly prevalent in clinical and at-home settings, offering various rapid diagnostic capabilities. This study presents findings from a nationwide survey conducted between November 2023 and January 2024, capturing clinician perceptions of POCTs.

The survey was distributed via email to healthcare professionals through academic and industry listservs and through LinkedIn posts. A total of 159 responses were analyzed.

Core priorities, including accuracy, ease of use, and availability, remain consistently valued over the years. However, several perceived benefits, including continuous patient monitoring, diagnostic certainty, and patient management exhibited significant declines in agreement compared to previous years. Despite this, clinician perceptions of POCTs’ abilities to enhance patient–provider communication remained stable. Evolving concerns may reflect heightened expectations and greater scrutiny as these technologies become commonplace. Agreement that POCTs may undermine clinical expertise increases, while concerns related to reimbursement and usability decline. Pilot questions related to artificial intelligence (AI) and machine learning (ML) indicated moderate openness to adopting AI-enhanced POCTs, particularly with tools offering novel clinical insights.

While POCTs continue to be an asset in clinical settings, the findings of this study suggest a shift in provider attitudes toward a more neutral standpoint. Limitations include a low response rate, self-selection, and missing demographic data from a subset of participants. Future surveys will further integrate AI/ML-related questions while prioritizing broader demographic and geographic reach.