Care pathways and healthcare management in a COVID-19 triage psychiatric inpatient ward at south london and maudsley nhs foundation trust

Introduction

The COVID-19 pandemic has enforced the restructuring of inpatient psychiatric services. In the UK, the South London and Maudsley NHS Foundation Trust has introduced a triage ward system to ensure all patients have a COVID test prior to admission to the general ward with the aim to reduce COVID transmission amongst psychiatric inpatients.

Objectives

To characterise the flow of patients through a COVID-19 psychiatric triage ward and the protocol of assessment and management used.

Methods

Descriptive analysis of patients admitted to a COVID-19 triage ward since its creation.

Results

The caseload of patients admitted to the COVID-19 triage ward since its inception will be presented. This will include the profile of patients admitted, their status (formal/informal) and their acceptance of COVID-19 tests. The protocol followed at this COVID-19 triage ward will be presented, and the challenges faced and suggestions to overcome them will be discussed.

Conclusions

This presentation aims to share the workflow and protocols adopted at a COVID-19 triage ward in the UK, discussing challenges experienced as well as good practices.

Conflict of interest

No significant relationships.

Validation of the HZETRN code for laboratory exposures with 1A GeV iron ions in several targets

A new version of the HZETRN code capable of validation with HZE ions in either the laboratory or the space environment is under development. The computational model consists of the lowest order asymptotic approximation followed by a Neumann series expansion with non-perturbative corrections. The physical description includes energy loss with straggling, nuclear attenuation, nuclear fragmentation with energy dispersion and downshift. Measurements to test the model were performed at the Alternating Gradient Synchrotron and the NASA Space Radiation Laboratory at Brookhaven National Laboratory with iron ions. Surviving beam particles and produced fragments were measured with solid-state detectors. Beam analysis software has been written to relate the computational results to the measured energy loss spectra of the incident ions for rapid validation of modeled target transmission functions.

Computational methods for the HZETRN code

Asymptotic expansion has been used to simplify the transport of high charge and energy ions for broad beam applications in the laboratory and space. The solution of the lowest order asymptotic term is then related to a Green's function for energy loss and straggling coupled to nuclear attenuation providing the lowest order term in a rapidly converging Neumann series for which higher order collisions terms are related to the fragmentation events including energy dispersion and downshift. The first and second Neumann corrections were evaluated numerically as a standard for further analytic approximation. The first Neumann correction is accurately evaluated over the saddle point whose width is determined by the energy dispersion and located at the downshifted ion collision energy. Introduction of the first Neumann correction leads to significant simplification of the second correction term allowing application of the mean value theorem and a second saddle point approximation. The regular dependence of the second correction spectral dependence lends hope to simple approximation to higher corrections. At sufficiently high energy nuclear cross-section variations are small allowing non-perturbative methods to all orders and renormalization of the second corrections allow accurate evaluation of the full Neumann series.

A space radiation transport method development

Improved spacecraft shield design requires early entry of radiation constraints into the design process to maximize performance and minimize costs. As a result, we have been investigating high-speed computational procedures to allow shield analysis from the preliminary design concepts to the final design. In particular, we will discuss the progress towards a full three-dimensional and computationally efficient deterministic code for which the current HZETRN evaluates the lowest-order asymptotic term. HZETRN is the first deterministic solution to the Boltzmann equation allowing field mapping within the International Space Station (ISS) in tens of minutes using standard finite element method (FEM) geometry common to engineering design practice enabling development of integrated multidisciplinary design optimization methods. A single ray trace in ISS FEM geometry requires 14 ms and severely limits application of Monte Carlo methods to such engineering models. A potential means of improving the Monte Carlo efficiency in coupling to spacecraft geometry is given in terms of re-configurable computing and could be utilized in the final design as verification of the deterministic method optimized design.

An improved Green's function for ion beam transport

Ion beam transport theory allows testing of material transmission properties in the laboratory environment generated by particle accelerators. This is a necessary step in materials development and evaluation for space use. The approximations used in solving the Boltzmann transport equation for the space setting are often not sufficient for laboratory work and those issues are the main emphasis of the present work. In consequence, an analytic solution of the linear Boltzmann equation is pursued in the form of a Green's function allowing flexibility in application to a broad range of boundary value problems. It has been established that simple solutions can be found for high charge and energy (HZE) ions by ignoring nuclear energy downshifts and dispersion. Such solutions were found to be supported by experimental evidence with HZE ion beams when multiple scattering was added. Lacking from the prior solutions were range and energy straggling and energy downshift with dispersion associated with nuclear events. Recently, we have found global solutions including these effects providing a broader class of HZE ion solutions.

A simple model for straggling evaluation

Some straggling models had largely been abandoned in favor of Monte Carlo simulations of straggling which are accurate but time consuming, limiting their application in practice. The difficulty of simple analytic models is the failure to give accurate values past 85% of the particle range. A simple model is derived herein based on a second order approximation upon which rapid analysis tools are developed for improved understanding of material charged particle transmission properties.

Zotepine in the prevention of recurrence: a randomised, double-blind, placebo-controlled study for chronic schizophrenia

RATIONALE

Zotepine is an antipsychotic drug with proven efficacy for treatment of acute episodes of schizophrenia. Antipsychotic drugs also require to be effective in prevention of recurrence.

OBJECTIVE

This trial was designed to compare the effects of zotepine and placebo in the prevention of recurrence of acute episodes in a population of patients with chronic schizophrenia.

METHODS

The study was a double-blind, parallel group, 26-week comparison of zotepine (300 mg daily, with fall back to 150 mg if necessary) versus placebo in 121 patients with chronic schizophrenia and a history of recurrence in the previous 18 months. The primary outcome measure was the time to recurrence. Other evaluations included the brief psychiatric rating scale (BPRS), the scale for the assessment of negative symptoms (SANS), the clinical global impression (CGI) severity and improvement scales, and the Simpson and Angus scale for extrapyramidal symptoms (EPS).

RESULTS

Fewer zotepine patients experienced recurrence over 26 weeks than placebo patients (4 versus 21, respectively). The estimated 26-week risk of recurrence was six times lower for zotepine than placebo (8.7% versus 52.8%; hazard ratio 0.16, 95% CI 0.053, 0.484; P<0.001). Scores on the BPRS and CGI supported the efficacy of zotepine. There was no difference between the treatments with respect to EPS.

CONCLUSIONS

Zotepine is effective in preventing recurrence in patients with chronic schizophrenia. The level of EPS was not different between zotepine and placebo.

A placebo-controlled comparison of zotepine versus chlorpromazine in patients with acute exacerbation of schizophrenia

OBJECTIVE

The aim of this study was to evaluate the efficacy of zotepine in the treatment of acute episodes of schizophrenia.

METHOD

Patients with acute exacerbation of schizophrenia (DSM-III-R criteria; n = 158) were allocated on a random, double-blind basis to receive zotepine (150 or 300 mg/day), chlorpromazine (300 or 600 mg/day) or placebo for 8 weeks. Symptoms were assessed on the BPRS, SANS and CGI scales at baseline and weeks 1, 2, 4, 6 and 8 and patients were assessed at these times for adverse effects. Analysis was by analysis of variance on the intent-to-treat population, with last observation carried forward.

RESULTS

Mean BPRS scores improved statistically significantly more with zotepine than chlorpromazine (point estimate of difference -12.4, 95% CI -18.3 to -6.5) or placebo (point estimate of difference -12.7, 95% CI -18.6 to -6.8). Zotepine produced significantly fewer extrapyramidal symptoms (EPS) than chlorpromazine.

CONCLUSION

Zotepine is an effective antipsychotic with low propensity for EPS.

An investigation into sound attenuation by earmould tubing

A major problem in high-gain post-aural hearing aids is acoustic feedback. One of the sources of feedback is the plastic tubing that guides the sound from the hearing aid hook to the ear canal. The objectives of this study were to determine the effects of increases in tubing wall thickness on the amount of acoustic feedback in the hearing aid system and to characterize earmould tubing. Five different samples of Tygon tubing were tested, of which four had different wall thicknesses; the study also compared Tygon tubing with medical grade PVC tubing. Measurement of the wall thickness, taken from scanning electron micrographs, showed that the wall thickness differed from the National Association of Earmould Laboratories standard by less than 6% and was well within the manufacturer's tolerances. Measurement of sound attenuation showed that an increase in the tubing wall thickness of 0.330 mm (Tygon 13 Standard to Tygon 13 Double Wall) caused an increase in sound attenuation of 2 dB, across the frequency range measured (0.5-4 kHz). It was also found that the medical grade PVC had a 5 dB greater sound attenuation than the equivalent Tygon tubing. While these differences are quite small, they could contribute to a reduction in acoustic feedback when used in conjunction with other hearing aid or earmould improvements.

A new exercise test for the assessment of heart failure: use of a self powered treadmill

Time limited exercise on a self powered treadmill was evaluated as a method of assessing functional capacity in patients with mild heart failure. The characteristics of the treadmill were established by exercising 11 controls at three speeds and two inclinations and comparing oxygen consumption with that on a motorised treadmill under the same conditions. Oxygen consumption on the self powered treadmill at an equivalent speed and inclination was significantly higher because of the work needed to overcome the friction of the belt. Unlike a conventional treadmill, increasing the gradient on the self powered treadmill did not increase oxygen consumption. The distance walked in 12 minutes on the self powered treadmill was measured in eight patients with mild heart failure and ten controls. Maximal oxygen consumption was measured in the same group on a conventional treadmill by a mass spectrometer. There was a significant correlation between the distance walked and maximum oxygen consumption. In patients with mild heart failure the distance travelled in 12 minutes on a self powered treadmill provides a practical, inexpensive, and sensitive method of assessing functional capacity.