To translate the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-ELD14 (EORTC QLQ-ELD14) into Chinese and validate its effectiveness in China.

The Chinese version was developed through a rigorous translation and back-translation process based on the Brislin model, followed by cross-cultural adaptation through expert consultation. A total of 260 elderly cancer patients from a tertiary hospital in Tianjin were recruited between June 2024 and February 2025 to evaluate the instrument’s reliability and validity.

Among the 248 completed responses, the Chinese version of the EORTC QLQ-ELD14 demonstrated robust psychometric properties. The questionnaire comprises 7 dimensions (14 items), with item-level content validity indices ranging from 0.800 to 1.000 and a scale-level content validity index of 0.980. Exploratory factor analysis identified 7 underlying factors, accounting for 82.913% of the cumulative variance. Internal consistency was excellent, with a Cronbach’s α of 0.958 for the total scale and dimension alphas exceeding 0.800. Test–retest reliability was 0.849 for the total scale and ranged from 0.813 to 0.856 across dimension.

The Chinese version of the EORTC QLQ-ELD14 has good reliability and validity, which is suitable for evaluating the quality of life of elderly cancer patients within Chinese cultural contexts.

Background/Rationale

The military coup in Myanmar in February 2021 caused widespread disruption to medical education. Many psychiatry trainees and trainers joined the Civil Disobedience Movement (CDM), resulting in the suspension of formal postgraduate psychiatry training nationwide and posing a serious threat to the future psychiatric workforce. In response, Myanmar CDM psychiatrists, supported by the psychiatrist diaspora, developed an alternative pathway to sustain postgraduate psychiatry training in a conflict setting.

Aims/Objectives

To restore postgraduate psychiatry training while maintaining academic standards, clinical competency, and professional integrity through an innovative, digitally enabled, and internationally supported training model.

Biweekly online Continuing Medical Education (CME) sessions commenced in March 2021. By September 2023, CDM psychiatrists collaborated with retired academics and diaspora psychiatrists from the United Kingdom, United States, and Australia to develop a formal curriculum. The programme was finalised in December 2023 and approved by the Federal Health Professional Council and Interim University Councils. An online Master of Medical Science (Psychiatry) programme was launched on 15 January 2024. The programme focused on clinical knowledge development through weekly Zoom lectures and Moodle-based learning, and clinical skills development through supervised practice, CME case discussions, and workplace-based assessments. Research training was deferred due to safety concerns.

Trainee engagement was monitored through assignment completion, participation in synchronous teaching, and completion of supervised clinical attachments. Ten trainees enrolled. Assignment completion reached 100%, participation in teaching was at least 75%, and clinical attachment completion exceeded 90%. Between April and May 2025, seven trainees completed final assessments, including multiple-choice examinations and virtual clinical examinations with live assessors and simulated patients. All seven trainees passed and were certified as qualified psychiatrists. A 360-degree evaluation demonstrated high satisfaction among trainees, supervisors, and assessors.

Despite severe disruption, Myanmar’s CDM psychiatrists successfully revitalised postgraduate psychiatry training using a decentralised, digitally enabled, and internationally supported model. This experience demonstrates that high-quality postgraduate psychiatry education can be sustained in fragile and conflict-affected settings and offers a scalable framework for global mental health workforce development.

Acknowledgements: We acknowledge all Civil Disobedience Movement (CDM) mental health professionals in Myanmar and the Myanmar psychiatrist diaspora worldwide for their collective leadership, academic contribution, and unwavering commitment to sustaining postgraduate psychiatry training under conflict conditions.

Dissociative Identity Disorder (DID), previously known as Multiple Personality Disorder, is characterised by the presence of two or more distinct personality states, often arising as a coping mechanism for severe and prolonged trauma. Based on the structural dissociation theory, Phase-Oriented Therapy is currently the treatment model recommended by the International Society for the Study of Trauma and Dissociation. It comprises three phases: Phase 1 (Stabilisation), Phase 2 (Trauma Processing) and Phase 3 (Integration and Rehabilitation). Despite its clinical significance, the evidence base remains limited, with phase-specific strategies underexplored. This review examines how dissociative parts are managed throughout the three phases of Phase-Oriented Therapy in individuals with DID, emphasising therapeutic goals, key techniques used, clinical challenges and treatment outcomes.

A narrative review was conducted using the SPIDER framework. Literature was sourced from databases such as PubMed, Wiley, EBSCO and Google Scholar using terms related to DID and Phase-Oriented Therapy. Included studies consisted of case reports, observational studies, systematic reviews and clinical guidelines.

Phase 1, the stabilisation phase, was consistently identified as foundational, with therapeutic aims including safety, emotion regulation and psychoeducation. Reported outcomes included improved affect regulation and self-control. However, many patients struggled to progress beyond this phase due to a significant level of symptoms or early dropout.

Phase 2 focused on trauma processing through exposure-based and cognitive restructuring techniques, including inner communication and grief processing. Outcomes included greater affect tolerance, reduced self-blame and improved internal communication between parts. However, several studies noted delayed symptom improvement, with treatment effects often emerging only during follow-up.

Phase 3 emphasised self-integration, functional adaptation and acceptance of functional multiplicity, defined as cooperative coexistence of parts without complete fusion. Patients showed improvements in daily functioning and a renewed sense of purpose, though some residual dissociative symptoms remained at the end of treatment.

Across studies, common challenges included high attrition rates, underdiagnosis and limited access to therapists trained in dissociation-specific approaches. Variations in treatment length,intensity and manualisation also contributed to inconsistent outcomes.

Phase-Oriented Therapy offers a structured, trauma-informed and clinically meaningful approach to managing DID. While current evidence highlights its clinical value, significant gaps remain, particularly around phase transition criteria, long-term outcomes and treatment standardisation. Future studies should prioritise controlled trials, longitudinal follow-up and more precise definitions of phase progression to strengthen the empirical foundation for this treatment model.

We set out to finish the audit loop started in 2024 at The Cove CAMHS unit. Our goal was straightforward: to prove that the fixes we put in place were actually working. Specifically, we wanted to see if tribunal reports were finally being submitted on time and if clinicians were properly documenting their conversations with the young people they treat. We also needed to ensure that our clinical standards didn’t slip during a period of systemic change, particularly with the introduction of a new digital reporting template late in the year.

We compared two years of tribunal reports side-by-side: the 2024 baseline and the 2025 re-audit. In total, we reviewed every single report produced across both years (N=28) against 27 mandatory standards from the MHA Code of Practice. The interventions we tested between the two years included a new administrative tracking system for legal deadlines and a clearer clinical pathway designed to make sure patient discussions weren’t just happening, but were being recorded accurately in the notes.

Overall compliance climbed from 94.4% to 97.1%. Our biggest success was in timeliness: we moved from a failing 64.3% to a perfect 100% submission rate. We also saw documented patient discussions more than double, jumping from 28.6% to 64.3%. However, the data revealed a new problem: a compliance dip (85.2%) directly linked to the new digital template. Because certain prompts were missing in the new software, clinicians started omitting patient strengths and detention justifications–a critical finding that highlights the hidden risks of digital transitions.

Completing this audit cycle confirms that administrative delays in tribunal reporting are solvable through better process mapping. While reaching 100% timeliness is a significant win for the ward, the 64.3% compliance in documenting patient discussions shows that clinical culture takes longer to change than administrative rules. Our discovery of a “transition gap” with the new template warns that digital updates can inadvertently sideline statutory details. We must now move beyond administrative fixes to focus on meaningful engagement, ensuring the “voice of the child” remains central to the tribunal process, regardless of the reporting format used.

This audit aimed to review patterns of psychotropic prescribing within a community LD psychiatry service in Caerphilly, focusing on medication type, dosage, documented clinical indication, and trends in medication change over time.

Psychotropic medications play a central role in the management of mental health conditions among individuals with Learning Disability. However, their use in this population requires careful consideration due to increased vulnerability to adverse effects, polypharmacy, and challenges in monitoring efficacy and safety. National guidelines, including those from NICE and the Royal College of Psychiatrists, emphasize the importance of regular review, clear documentation of indications, and adherence to best practice standards to minimize inappropriate prescribing.

A retrospective review of clinic and home visit letters for all patients seen by the community LD psychiatry service during the audit period was undertaken. Data were collected by 3 doctors on level of LD, presence of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD), psychiatric diagnoses, psychotropic medications prescribed, antipsychotic dose expressed as a percentage of the British National Formulary (BNF) maximum, and medication changes over the audit period.

A total of 117 patients were included. 114 (97.4%) were prescribed at least one psychotropic medication. 77 patients (65.8%) were prescribed antipsychotics, mostcommonly risperidone (n=37). Antipsychotic doses ranged from 1.5% to 100% of the BNF maximum, with 47 patients (61.0%) prescribed doses at or below 25% of the maximum.

A clear mental health diagnosis supporting antipsychotic use was documented in 23 of 77 patients (29.9%), while behaviours that challenge were documented in a further 15 patients (19.5%). No clear indication for antipsychotic prescribing was recorded in the remaining 39 patients (50.6%). Antidepressants were prescribed to 44 patients; anxiety or depressive disorders were documented in 16 patients (36.4%), while 8 patients (18.2%) had no documented indication.

Over the audit period, psychotropic medication remained unchanged in 57 patients (48.7%), increased in 27 patients (23.1%), reduced in 23 patients (19.7%), and switched or cross-titrated in 6 patients (5.1%).

This audit demonstrates high rates of psychotropic prescribing within a community LD caseload, with substantial gaps in documentation of clinical indication, particularly for antipsychotic and antidepressant use. Although some medication reduction occurred, increases were more common than reductions. Improved documentation, structured medication review processes, and multidisciplinary approaches are required to support safe prescribing and align practice with national guidance.

Background

Armed conflict and political instability are major determinants of population mental health, disrupting service delivery, workforce sustainability, and prevention systems. Following the 2021 military coup in Myanmar, formal psychiatric training pathways and national mental health services were severely fragmented or collapsed. In response, the Myanmar Board of Psychiatry (M.B.Psych) was reconstituted in 2025 to support a population-oriented, task-shared mental health system operating under complex humanitarian conditions.

Aims

To describe a national public mental health model integrating workforce development, service delivery, prevention, and community-based interventions in a protracted conflict setting.

A descriptive programme analysis was conducted using routine training, service delivery, and supervision data from M.B.Psych activities between January and December 2025. Interventions were mapped across core public mental health domains, including promotion, prevention, treatment, capacity building, and system governance.

M.B.Psych implemented a multi-layered mental health system spanning community, primary, and specialist care. Workforce capacity was strengthened through postgraduate psychiatric training, undergraduate teaching, medical education programmes, and international global mental health certification, with seven psychiatrists qualifying during the study period, supporting continuity of specialist care despite widespread displacement.

Population-level preventive and promotive interventions included nationwide Psychological First Aid, Mental Health and Psychosocial Support (MHPSS), mhGAP training, suicide prevention services, and school-based mental health programmes. Task-sharing enabled trained volunteers, lay counsellors, and primary care clinicians to deliver frontline care with structured psychiatric supervision.

Clinical services were delivered through an integrated hybrid model combining tele-mental health, primary mental health clinics, suicide prevention hotlines, and targeted on-ground psychiatric deployment in conflict-affected regions. Diaspora psychiatrists provided sustained supervision, psychotherapy training, and clinical governance support. Contextually adapted resources, including a Myanmar-language WHO Group PM+ manual and military-focused MHPSS materials, supported scalable and culturally appropriate interventions.

This public mental health model demonstrates that equitable, population-based mental health systems can be sustained during armed conflict through task-sharing, digital delivery, diaspora engagement, and integrated education–service frameworks. The Myanmar experience offers transferable lessons for global mental health system strengthening in fragile and conflict-affected settings.

Acknowledgements

The authors acknowledge the commitment and resilience of all Civil Disobedience Movement (CDM) mental health professionals, psychiatrists, psychologists, trainees, volunteers, and the Myanmar psychiatrist diaspora who contributed to service delivery, training, supervision, and community mental health support under extremely challenging conditions.

Cardiac arrest on ward–post incident review and reflections identified recognition and escalation of the physically deteriorating patient as a key improvement target to improve staff morale and confidence moving forward in context of incident.

SMART goals:

Specific – Improve nursing staff and allied health professionals’ ability in recognising, managing, and escalating physically unwell patients.

Measurable – with results measured via standardized questionnaire scores.

Achievable – through a specialized teaching programme developed by ward doctors.

Relevant – in context of recent significant incident on the ward.

Time specific – in a 6-month timeframe.

Teaching sessions targeting initial assessment and escalation of the physically deteriorating patient were delivered on a two-weekly basis over a time of 4 months, each session was 30 minutes in duration. Subdivision of broad topics was introduced to address nuanced scenarios. Domains were chosen based on common clinical queries and situations that were identified on the ward from a survey of both doctors, nursing staff and allied health care professionals. Session content was pitched at a role-specific level. Session topics included–Airways, NEWS2, SBAR, hypoglycaemia, fluid monitoring, pain, seizures, stroke, UTI.

Data was collected via pre-/post-course questionnaires. The questionnaire consisted of 9 questions in SBA format, following a short clinical scenario stem – 1 question for each clinical domain. Confidence scores (Likert scale) were assessed for each of the 9 domains.

Confidence improved across all wards following the teaching sessions. Small but notable decline in clinical performance post-training in some areas. Persistent performance gap between RMNs and HCAs.

Teaching sessions were delivered in modality of one live session per topic – making it difficult to ensure that all surveyed staff had attended all sessions. There were limited opportunities for staff to review the teaching material after a session, or especially if a session was missed due to rota or clinical commitments.

Therefore an opportunity was identified to develop e-learning modules focusing on weakest domains (Airways, NEWS, SBAR, UTI, hypoglycaemia).

Mode of delivery would be changed to e-learning modules on a digital learningplatform. This allows for easy access for staff in their various schedules, the ability to revisit the material, as well as increased ease in collecting data, adjusting the teaching materials and maintaining consistency in quality of teaching across time.

The COVID-19 pandemic has affected mental health, with a particular impact on depressive symptoms. Metabolic syndrome is also linked to depression, but their combined effects remain unclear.

To examine the independent and combined effects of COVID-19 seropositivity and metabolic syndrome on depressive symptoms, considering demographic and health-related factors.

A cross-sectional analysis was conducted using 2021–2022 Encuesta Nacional de Salud y Nutrición data. Depressive symptoms were assessed with the Center for Epidemiological Studies Depression Scale (CESD-7), including subscales for positive affect, negative affect and somatic symptoms. COVID-19 seropositivity was determined through seroprevalence data, and metabolic syndrome was defined using Adult Treatment Panel III criteria. Logistic and linear regression models evaluated associations between COVID-19 seropositivity, metabolic syndrome and depressive symptoms, adjusting for demographic and health factors.

Among 10 890 adults, 3312 (30.4%) had depressive symptoms. COVID-19 seropositivity (n = 7790, 71.7%) was associated with higher odds of depressive symptoms (odds ratio 1.22, 95% CI 1.08–1.38) and increased CESD-7 scores (coefficient 0.39, 95% CI 0.19–0.58), particularly negative affect (coefficient 0.16, 95% CI 0.05–0.27) and somatic symptoms (coefficient 0.23, 95% CI 0.12–0.34). Metabolic syndrome was associated with depressive symptoms (odds ratio 1.17, 95% CI 1.02–1.33), mainly through negative affect (coefficient 0.27, 95% CI 0.12–0.41). No significant interaction was found between COVID-19 seropositivity and metabolic syndrome.

COVID-19 seropositivity and metabolic syndrome independently increase depression risk, highlighting the need for integrated mental and metabolic health screening.