Mount Carmel Hospital

IntroductionSeveral mental disorders are more common within the LGBTQ+ population, including depression, anxiety, eating disorders, and substance use disorders. Despite this, LGBTQ+ individuals face more barriers when accessing mental health services than the general population.ObjectivesThe primary aim of this study was to assess the perceptions of Cardiff University medical students on the barriers faced by LGBTQ+ individuals when accessing mental health help. The study also aimed to assess recommendations Cardiff University medical students have for improvement of services and to make them more accessible to LGBTQ+ individuals.MethodsA qualitative approach was used. An online questionnaire was created and distributed among Cardiff University medical students. It included 10 open-ended questions about their knowledge of LGBTQ+ mental health, the barriers to accessing it, and recommendations to decrease these barriers. Thematic analysis was performed on the answers.ResultsThe questionnaire had 12 participants. The thematic analysis produced 22 subthemes, which were grouped into the following five themes: i) perceptions of LGBTQ+ mental health, ii) factors affecting LGBTQ+ mental health, iii) general barriers to accessing mental health help, iv) LGBTQ+-specific barriers to accessing mental health help, and v) recommendations to improve access to mental health services. A scoping review was conducted on this subject to further analyse the current research. The scoping review produced nine studies, and the main themes that emerged were mental health stigma, LGBTQ+ discrimination, lack of LGBTQ+-affirmative services, the pathologisation of LGBTQ+ status, and financial barriers.ConclusionsIt was evident that more formal training on LGBTQ+ mental health at an undergraduate level for health professionals is needed, and that a lack of this is causing barriers to adequate provision of mental health services to this population. Furthermore, existing mental health services need to be more LGBTQ+-affirmative. Further research with a higher response rate could provide more generalisable results.Disclosure of InterestNone Declared

Abstract Aim Medical students and foundation year (junior) doctors often use maladaptive coping strategies, such as excessive energy drink (ED) and coffee consumption. This study analyzed these consumption patterns, considering the impact of exam periods, medical school progression, graduation status, and anxiety levels. Subject and methods Online questionnaires were administered to medical students at the University of Malta and junior doctors at the Malta national hospital in 2015 (phase 1, P1) and 2024 (phase 2, P2). The data were statistically analyzed; the supplementary qualitative data were juxtaposed with the core quantitative component to generate meta-inferences (QUAN + qual). Results Five hundred thirty-four participants were included, comprising 361 medical students and 173 junior doctors. P2 participants consumed more EDs than P1 during exam periods and initiated consuming EDs at older ages than P1. Commonest reasons for consumption were mixing with alcohol, staying awake, and studying/working. In P1, men consumed more EDs than women; this gender disparity was not significant in P2. No difference in ED/coffee consumption was observed between medical students and junior doctors. P2 participants consumed more EDs and coffee during exam periods; notably those consuming no EDs/coffee outside exam periods were less likely to consume during exam periods. Coffee was perceived to improve exam performance more than EDs. Smokers demonstrated a higher likelihood of consuming both EDs and coffee. No significant correlation was found between ED/coffee consumption and anxiety levels. Conclusion The authors recommend university campaigns and policies targeted toward health alternatives to EDs, revised exam timetables, and better education on ED contents.

IntroductionTobacco smoking is one of the leading causes of preventable morbidity and mortality worldwide (WHO, 2020). Smoking cessation campaigns have been effective at reducing smoking in the general population, but not in individuals with mental illness (Lê Cook et al., 2014). A downward trend in smoking has been noted in EU countries but smoking rates have remained stable in Malta (Country Health Profile, 2019).ObjectivesThis audit aims to assess smoking status, provision of smoking cessation advice and psychotropic dose adjustment depending on smoking status by the Bormla Mental Health Team.MethodsPatient health records were reviewed for patient demographics, psychiatric diagnosis, medical co-morbidities, smoking status and cessation advice and changes in psychiatric medication according to smoking status.ResultsOf the 171 patients studied, 35% (n=61) were smokers, 33% (n=58) were non-smokers while in 30% (n=52) the smoking status was undocumented. Smokers had a mean age of 50 years with an almost equal gender distribution (49% (n=30) male and 51% (n=31) female). The most common documented psychiatric diagnoses were depression (52.5% (n=32)) and anxiety (34.5% (n=21)), while 59% (n=36) had documented medical co-morbidities. Only 14% (n=9) where given smoking cessation advice and one patient was referred to the smoking cessation clinic. One third of smokers (n=20) were prescribed psychotropic medications which are affected by smoking status but only two patients had their doses adjusted.ConclusionsImproved smoking cessation advice, referral to services, consideration of smoking cessation while prescribing and documentation are need to better patient care.DisclosureNo significant relationships.

Abstract Background Persistence of biologic therapy in psoriatic arthritis (PsA) patients is an important factor in individualized patient treatment planning and healthcare policy and guideline development. . Objective To estimate the persistence of biologic agents prescribed to PsA patients in a real-life setting as well as factors associated with improved biologic drug survival in these patients. Methods Patients with PsA from a large health care provider database with at least two consecutive dispensed prescriptions of a biologic agent indicated for PsA from January 1st, 2002 until December 31st, 2018 were identified and followed until medication stop date or the end of observation period. Patients were considered non-persistent whenever a permissible lag time of 6 months from the time of prescription issuance until medication filling date was exceeded. Treatment changes were based on physician decisions and patient preferences. Demographic data including age, sex, body mass index (BMI), ethnicity, smoking history and socioeconomic status as well as Charlson comorbidity index were retrieved. Data regarding use of steroids and conventional disease-modifying anti-rheumatic drugs (cDMARDs) were also extracted. Descriptive statistics, including means (standard deviations) for continuous variables and frequencies (%) for categorical variables, were used. Persistence estimates were derived using non-parametric survival analysis using Kaplan-Meier functions, with treatment discontinuations as failure events. Cox regression hazard ratio models were conducted to investigate factors associated with drug persistence.Results 2301 PsA patients with 2958 treatment periods were identified and included in the analyses. Mean age of the study population was 50.9±14 years, 54% females, 70.4% with BMI>25, 40% current smokers, and 76% with a Charlson comorbidity index>1. The most commonly prescribed drug was etanercept (33%), followed by adalimumab (29%), golimumab (12%), secukinumab (10%), ustekinumab (8%) and infliximab (8%). While approximately 40% of patients persisted on therapy following 20 months of treatment, only about 20% of patients remained on any particular biologic agent after 5 years. Analyzing the data for all treatment periods while taking into account all lines of therapy, revealed that secukinumab had a higher persistency than adalimumab, infliximab and ustekinumab, with a Log Rank of 0.022, 0.047 and 0.001, respectively. Female sex and smoking were associated with lower drug persistence (HR=1.25, 95%CI=1.13-1.38 and HR=1.109, 95%CI=1.01-1.21, respectively). On analyzing the data using only the first indicated biologic line, no superiority of any single anti-Tumor Necrosis Factor-alpha (anti-TNFα) agent was observed. While, secukinumab was found to be superior as second line therapy to adalimumab, etanercept, infliximab and ustekinumab but not to golimumab with a Log-Rank P-value of 0.001, 0.004, 0.025 and 0.002, respectively. Conclusions In this large observational cohort studied in the era of biologic therapy, a relatively low drug persistence was observed, with female sex and smoking having a negative impact on persistency. None of the anti-TNFα agents was found to be more persistent than others as first line therapy, while secukinumab was found to be superior to other biologics when indicated as second line of therapy.

Reduced working hours and increased caesarean delivery rates have resulted in less exposure to intricate deliveries by obstetrics trainees. Though trainees may not be exposed to these deliveries as part of their training, conversely they may be expected to be proficient in them once starting independent clinical practice.This study aims to identify the verbal and non-verbal components of three intricate deliveries – Kiellands, non-rotational and assisted breech.Labour and delivery nursing staff were asked to identify those clinicians who they considered to be particularly skilled in intricate deliveries. Those identified consistently were invited to participate in the study. With written consent participants were then videoed performing each type of delivery on a model in order to identify the verbal and non-verbal components of the delivery. Two clinicians reviewed videos. The initial summary was then circulated to all participants for their approval.Themes identified included the need for careful assessment of suitability, the role of the multidisciplinary team, need for careful and appropriate communication with the parents, the technique of delivery itself and postpartum care and documentation. Overall the clinicians balanced respect for the “elegant technique” of intricate deliveries with careful assessment and when to stop should safety criteria not be met.There is still a role for intricate deliveries in modern obstetric practice, and a need for good quality holistic training programs on how best to perform such deliveries. By identifying verbal and non-verbal components of skilled deliveries these can then be translated into an useful educational tool.

Epidemiological studies show that substance abuse and bipolar disorder are strongly associated. The reasons include of self-treatment and poor self-control during hypomanic/manic periods. Substance abuse influences the outcome of bipolar disorder and makes diagnosis more difficult. Patients with bipolar disorder who abuse substances tend to have a worse outcome and greater suicidal risk. If good outcomes are to be achieved, substance abuse in these patients cannot be ignored. An integrated treatment approach of both conditions together probably gives the best results.

ObjectiveTo summarise the available evidence for the efficacy of neuromuscular training in enhancing sensorimotor and functional deficits in subjects with chronic ankle instability (CAI).DesignSystematic review with best evidence synthesis.Data SourcesAn electronic search was conducted through December 2009, limited to studies published in the English language, using the Pubmed, CINAHL, Embase, and SPORTDiscus databases. Reference screening of all included articles was also undertaken.MethodsStudies were selected if the design was a RCT, quasi RCT, or a CCT; the patients were adolescents or adults with confirmed CAI; and one of the treatment options consisted of a neuromuscular training programme. The primary investigator independently assessed the risk of study bias and extracted relevant data. Due to clinical heterogeneity, data was analysed using a best-evidence synthesis.ResultsFourteen studies were included in the review. Meta-analysis with statistical pooling of data was not possible, as the studies were considered too heterogeneous. Instead a best evidence synthesis was undertaken. There is limited to moderate evidence to support improvements in dynamic postural stability, and patient perceived functional stability through neuromuscular training in subjects with CAI. There is limited evidence of effectiveness for neuromuscular training for improving static postural stability, active and passive joint position sense (JPS), isometric strength, muscle onset latencies, shank/rearfoot coupling, and a reduction in injury recurrence rates. There is limited evidence of no effectiveness for improvements in muscle fatigue following neuromuscular intervention.ConclusionThere is limited to moderate evidence of effectiveness in favour of neuromuscular training for various measures of static and dynamic postural stability, active and passive JPS, isometric strength, muscle onset latencies, shank/rearfoot coupling and injury recurrence rates. Strong evidence of effectiveness was lacking for all outcome measures. All but one of the studies included in the review were deemed to have a high risk of bias, and most studies were lacking sufficient power. Therefore, in future we recommend conducting higher quality RCTs using appropriate outcomes to assess for the effectiveness of neuromuscular training in overcoming sensorimotor deficits in subjects with CAI.

SummaryAbnormal fetal growth increases the complications of pregnancy not only for the baby but also for the mother. Growth abnormalities also have lifelong consequences. These babies are at increased risk of insulin resistance, diabetes and hypertension later in life. It is important to identify these babies antenatally to optimise their clinical care. Although used extensively antenatally to monitor fetal growth, ultrasound has its limitations. Despite the use of more than 50 different formulae to estimate fetal weight, their performance has been poor at the extremes of fetal weight. Over the past 20 years there has been emerging interest in studying fetal soft tissue measurements to improve detection of growth abnormalities. This review paper outlines the value of soft tissue measurements in identifying fetal growth abnormalities, in estimating fetal weight and in managing diabetes mellitus in pregnancy.

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