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Aims Addiction services in Essex are provided as a collaborative by NHS run Essex STaRS, Open Roads, SHARP and ARC provide psychosocial care. YPDAS supports the young people. Observed gap: Pregnant women with addiction problems were running from pillar to post to receive care and support needed during this challenging phase of their life. The one stop clinic provided an all-encompassing care pathway to fill the above need and improving outcomes for mothers and babies. Methods Description: The new pathway was setup in 2019 on a hub & spoke model. The one stop clinic was at centre, comprising Substance Misuse, Midwifery and Obstetrics. The spokes included Perinatal-mental health, Neonatal, Adult, Child Social services, CMHTS, Police, Criminal Justice and primary care. Simple entry criteria: 1. Substance Dependence 2. Positive pregnancy test with referral taken from any service. Patients receive comprehensive initial assessment covering addictions, mental health, social circumstances, obstetric history and physical health evaluation including foetal US scanning. Led by a team of psychiatrist, midwife, obstetrician and substance worker. Evaluation identifies risks from mental, physical health, safeguarding, support needs and formulates an initial engagement and management plan. Referral into all necessary organisations. A staggered follow up plan per every trimester agreed. Commencement or planned reduction of Opiate Substitution Therapy (OST), medication rationalisation, nutritional advice, enhanced antenatal monitoring. The regular follow-up via fortnightly midwife, drugs worker review. Monthly medial review in the clinic. The support from perinatal psychiatry teams, CMHTS, Social services, Criminal Justice safeguarding teams is roped in when needed. Child protection, safeguarding issues are addressed. Clear multi-directional communication is maintained at all times. A safe delivery plan along good neonatal management ensured with appropriate outcomes for mother & baby are achieved. Results Since 2019, this initiated 16 patients with various complexities. 12 women left hospital with their baby in their care. 1 left the area during the pregnancy. 2 babies were removed into care. 1 had a miscarriage, 1 had a false positive test. All women received contraceptive advice, one got tubectomy and many on long-term contraception. No significant mental health relapses or admissions. All managed to stabilize or reduce their opiates issues. Conclusion This One Stop Clinic has effectively addressed the complex needs of perinatal addiction patients. Centralised provision of care, duplication avoided, clear communication was a welcome relief for patients. Clinic has won a quality award.

Background: Body mapping is a creative therapeutic tool that brings together bodily experience and visual artistic expression. Initially, it was used by health and safety for detecting unspoken injuries in workforce, musicians to improve posture and coordination while decreasing injury. Its effectiveness in improving communication was exploited by allied health bodies for talking about sensitive sexual health issues and improve health awareness in Uganda, Kenya, India and Thailand. The technique involves patients to represent psychosomatic symptoms, body images, aches and pains, onto a chart (body map) using colours, pictures, symbols and words to represent various experiences. This is akin to a psychological enquiry where the clinician exploits the exercise to develop an understanding of the patient's psychopathology as well as foster a relationship. Case description: The author reports a case of middle aged man of Afro Caribbean origin with psychotic illness who was successfully treated by utilizing the concepts of body-mind mapping. This paper highlights the benefits of using body mapping in psychiatric practice by way of improved communication between patient and therapist to explore psychosomatic as well as builds therapeutic relationship. Discussion: Body mapping has been used by therapists in diverse areas like eating disorder, trauma etc. It helps to externalise somatic-emotional experience, to make meaning through the creative process of symbolization. This technique may be useful in cases of the chronic illnesses to aid engagement, compliance and insight. The wide prevalence of psychosomatic complaints across the world indicates the necessity for alternative models of interactive communication other than a language based psychiatric interview in all situations. Conclusion: Body mapping can be a useful clinical communication tool. When used appropriately, it has the potential to improve insight and compliance in psychiatric patients.

Objective: To compare the efficacy and safety of sustained release (SR) formulation of pregabalin with immediate release (IR) formulation in patient with diabetic peripheral neuropathic pain. Materials and Methods: In this open label, randomized, comparative, multicentric study, the primary efficacy measure was reduction in visual analogue scale (VAS) of short form McGill pain questionnaire (SF-MPQ) score from baseline to last visit. The secondary evaluation measures included reduction in SF-MPQ descriptive score and present pain intensity score and change in clinical global impression - improvement of illness (CGI-I) and clinical global impression - severity of illness (CGI-S) from baseline to last visit. Total duration of the study was 12 weeks. Safety evaluation was done by recording treatment emergent adverse events and laboratory investigations at baseline and end of treatment. Results: Of 265 randomized patients, 133 received pregabalin SR tablets and 132 pregabalin IR. Patients randomized to both treatments responded to respective treatments. The least square means of VAS score in both the groups were reduced significantly (P

Objective: The objective of this study was to evaluate the effect of outpatient celiac plexus block on acute pain reduction in patients with suspected median arcuate ligament syndrome., Methods: This is an Institutional Review Board approved, retrospective chart review. Data were collected and analyzed from patients who received celiac plexus blocks from November 1, 2021 through April 6, 2023. The primary outcome was pain reduction, determined by the change in numerical pain rating scale (NPRS) from pre-procedure to post-procedure. Additional data collected include patient demographics, comorbidities, preoperative symptoms and duration of symptoms., Results: There were 33 patients identified in this study. Thirty-one patients were included in the data analysis. The median age of the cohort was 29 years, and the median BMI was 20.4. 94% of the cohort was female. These patients were referred as part of an evaluation for symptomatic vascular compression disorders. For many patients, positive response to celiac plexus block was used as an indication to proceed with surgical MALS resection. We provide a diagnostic algorithm for MALs. All patients endorsed preoperative symptoms. Patients experienced a median pain reduction of -4 from baseline to immediately post-procedure., Conclusions: Celiac plexus blocks continue to be a tool for ruling out neurogenic median arcuate ligament syndrome in patients who have undergone extensive previous imaging and assessments for vascular compression disorders. Our data suggest that patients with suspected MALS may experience substantial immediate pain relief from temporary blocks of the celiac ganglion as guided by fluoroscopy in an outpatient setting., (© 2024 World Institute of Pain.)

Background: Surgeons in training must be able to accurately gauge their own ability and performance to better understand where additional practice is needed and can help inform self-directed learning endeavors. This study had the following 3 goals: (1) to examine the accuracy of residents' assessments of their endoscopic skills, (2) to investigate if accuracy improves over time and practice, and (3) to compare the efficacy of 3 interventions-practice only (PO), self-observation (SO), or expert observation (EO)-on self-assessment accuracy., Methods: Overall, 30 first-year general surgery residents completed a pretest on a colonoscopy simulator, which measured time to completion, time to reach the cecum, efficiency of screening, percentage of mucosal surface area examined, time the patient was in pain, and time with a clear view. Residents assigned to the SO and EO conditions reviewed a video of their own performances (SO) or an expert's performance (EO). Residents in all conditions engaged in practice trials using an abstract endoscopy training exercise. Residents then completed a posttest. Self-assessment was examined by calculating discrepancy scores by subtracting actual measurements from participant judgments., Results: Results indicated that performance for participants in the PO group significantly improved from pretest to posttest for 2 of the 6 metrics and participants in the SO and EO groups improved for 4 metrics. In terms of self-assessment discrepancy scores, only the EO group significantly improved for 2 of the 6 metrics (overall time and screening efficiency)., Discussion: Novice trainees are inaccurate self-assessors of their endoscopic skills before training. Allowing trainees to watch videos of themselves or an expert performing an endoscopic task enhances performance. Participants assigned to PO exhibited decreased ability to accurately judge their own performance. Those in the EO group became significantly better at assessing their overall time and overall efficiency., Summary: Novice trainees are inaccurate self-assessors of their endoscopic skills before training. Allowing trainees to watch videos of themselves or an expert performing an endoscopic task enhances performance., (Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)