St Cadoc's Hospital

Aims: Negative symptoms of schizophrenia are disabling and often show inadequate response to antipsychotic treatment. Dysfunction in cortical regions such as the anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) has been implicated in these symptoms. While repetitive transcranial magnetic stimulation (rTMS) has shown efficacy, deep transcranial magnetic stimulation (dTMS) offers the advantage of targeting deeper brain structures.To assess the efficacy of high-frequency dTMS in improving negative symptoms of schizophrenia and to examine its effects as measured by proton magnetic resonance spectroscopy (h-MRS).Methods: This sham-controlled, double-blind study randomized 46 patients with schizophrenia into active and sham dTMS groups. Participants received 10 sessions of high-frequency (10 Hz) dTMS at 100% of the resting motor threshold using an H7 coil over 2 weeks. Symptom severity was assessed using the Positive and Negative Syndrome for the Assessment of Negative Symptoms (SANS), and Clinical Global Impression (CGI) at baseline, 2 weeks, and 4 weeks post-treatment. h-MRS of the ACC and mPFC was performed at baseline and after 2 weeks of treatment.Results: A total of 43 patients completed the study. While both groups showed improvement over time, the active dTMS group demonstrated significantly greater improvement in negative symptoms, as reflected by a reduction in SANS scores compared with the sham group (p=0.003) and improvement in the negative subscale of PANSS (p=0.044). h-MRS analysis revealed a positive correlation between ACC total N-acetylaspartate (tNAA) levels after 2 weeks of treatment and baseline SANS anhedonia subdomain scores.Conclusion: High-frequency dTMS significantly improves negative symptoms and overall illness severity in schizophrenia. These findings highlight the potential role of dTMS as an adjunctive treatment and suggest that h-MRS may serve as a valuable biomarker for treatment response. Future studies with larger sample sizes are needed to further explore the therapeutic and neurobiological effects of dTMS.

Abstract ObjectiveTo assess patient and clinician satisfaction and identify any differences between the two with the use of video consulting (VC) in the fields of obstetrics and gynaecology (O&G) and fertility in Wales.DesignA retrospective electronic survey study.SettingAll public hospitals in Wales that used virtual methods for delivery of fertility and/or O&G appointments during and after the COVID‐19 pandemic between August 2020 and March 2022.PopulationPatients awaiting an appointment on the National Health Service, who have attended virtual fertility or O&G appointments in Wales, and fertility and O&G clinicians who have conducted appointments virtually.MethodsAnalysis of patient and clinician responses to a VC satisfaction survey delivered after their consultation taking place between August 2020 and March 2022.Main Outcome MeasuresPatient and clinician satisfaction rates with the use of virtual consultation in fertility and O&G appointments.ResultsIn satisfaction data collected from 420 patients and 161 clinicians, 83% of patients and 63% of clinicians reported their VC quality to be ‘very good’ or ‘excellent’. Difficulties when using VC were experienced by a minority of patients (1%–9%) and clinicians (1%–8%) and most patients (52v82%) and clinicians (34%–67%) found several aspects of VC to be ‘very beneficial’. Fertility patients rated their VC experience more positively than O&G patients.ConclusionsMost patients and clinicians were satisfied with their VC experience. Patients were more satisfied with the use of VC than clinicians. Fertility patients were more satisfied with the use of VC than O&G patients.

Self-disclosure of experiences of mental health difficulties is a complex process, particularly within the workplace. Research shows that a significant number of trainee clinical psychologists have lived experience of mental health difficulties and thus face the dilemma of whether to disclose and how to manage self-disclosure during doctoral training. Grounded theory methodology was used to explore trainee experiences of self-disclosure of mental health difficulties during training. Twelve trainee clinical psychologists from accredited doctoral programmes in the United Kingdom participated in semi-structured interviews about their experiences of disclosure. Six core categories emerged relating to 'motivations', 'enablers', 'barriers', 'features of disclosure', 'responses' and 'impact', each of which were comprised of several further sub-categories. The model that emerged is largely consistent with research on disclosure in healthcare professions and has implications for training programmes, supervisors and trainees when engaging in conversations about lived experience.

ObjectivesTo evaluate the usefulness and effectiveness of a new structured education module for children with type 1 diabetes: Structured Education Reassuring Empowering Nurturing (SEREN) ‘Diabetes at Diagnosis’.DesignRetrospective questionnaire-based service evaluation.Setting12/14 paediatric diabetes centres across Wales took part.ParticipantsChildren diagnosed with type 1 diabetes 1 year before (pre-SEREN group) and 1 year after the introduction of SEREN (post-SEREN group) were selected using a national diabetes register.Resource‘Diabetes at Diagnosis’ delivers structured education to empower children and families with self-management of type 1 diabetes.EvaluationPrimary outcomes were patient-reported effectiveness and user-friendliness of the educational resources and quality of life (PedsQL). Age-appropriate child and parent questionnaires were provided. Clinical outcomes included glycated haemoglobin (HbA1c) at 6 and 12 months, service engagement and diabetes-related hospital admissions in the first year.Results89/106 responded pre-SEREN and 108/115 post-SEREN, with no demographic differences at diagnosis. Parent scores for educational package evaluation significantly improved post-SEREN, with a non-significant trend towards improved results in children. PedsQL scores were similar. There was no change in HbA1c overall. Subgroup analyses at 12 months showed a trend towards a lower HbA1c in key stage 1–2 (62 vs 58 mmol/mol, p=0.06) and increased HbA1c in key stage 3–4 (56 vs 66 mmol/mol, p=0.009). There were no differences in hospital admissions or missed clinic appointments.ConclusionsThis is an evaluation of the only standardised type 1 diabetes structured education programme in use for children throughout Wales. This module improved parent-reported outcomes and showed a non-significant trend towards improved usefulness in children, without a difference in a PedsQL scores overall. Ongoing evaluation of the cohort who received subsequent SEREN modules may show the long-term benefit of the programme.

The original version of this article unfortunately contained two labelling errors in Fig. 3 and Figure S4.

Objective: The objective of this study was to design and create a ”Sound walk Guide” for children with autism spectrum disorder (ASD) transitioning between primary and secondary education. Methods: A literature review was conducted on transition tools used for children with ASD. This informed the development of a sound walk guide based on a sound walk audio tool. Results and Discussion: The literature review highlighted the sensory difficulties faced by children with autism during transition. It described some of the transition tools used in ASD from online training programs to virtual reality tools. However, there was little literature on specific tools for primary to secondary school transition. This informed the development of a user-friendly sound walk guide which was developed along with children and professionals in education and health.

Rationale and key points This is the fifth in a series of eight articles providing information about the Nursing and Midwifery Council (NMC) revalidation process. This article focuses on preparing five written reflective accounts for revalidation. » Reflective practice encourages nurses and midwives to use their learning to identify areas for improvement. » Reflective practice encourages nurses and midwives to relate their learning to the NMC code of professional standards of practice and behaviour. Reflective activity 'How to' revalidate articles can help to update your practice and provide information about the revalidation process, including how you can record and evidence CPD for revalidation. Reflect on and write a short account of: 1. How recording and evidencing CPD will demonstrate the skills, knowledge and experience you have gained in practice. 2. How you could use this article to educate your colleagues. Subscribers can update their reflective accounts at: rcni.com/portfolio.

The importance of ensuring robust arrangements for young people's transitions from specialist child and adolescent mental health services to specialist mental health services for adults is well documented in the international literature. Nonetheless, according to young people, there remains great variation in the quality of services in respect of their transitions. Furthermore, the problems that we report are by no means confined to single continents. This review examines recent literature and explores the themes that emerge from it with a view to finding solutions. Our findings from the literature suggest a clear strategic direction to improve the quality of the care of young people who need to move from specialist child and adolescent mental health services to specialist mental health services for adults. Our examination of the literature identifies a number of themes that have been recognized by practitioners and we have used them to define a model of care and aspects of good practice. We think they should be included within all evidence-based policies, protocols and care pathways for young people. There is little literature available that documents the personal experiences of young people in transition and their families, but consistent themes emerge from what is available. There are a number of topics that require active consideration when preparing young people for transition between services. Despite the limited volume of research, and particularly that which has directly involved young people and families, we know from anecdote, experience and local audit and research that improvements in service design and practice are required. These matters inform the solutions that we suggest. We see as pivotal involving young people directly in planning their own care and setting quality standards for healthcare and other services.

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