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This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. [ABSTRACT FROM AUTHOR]

Background: Patients with anti- N -methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) show a wide range of behavioral abnormalities and are often mistaken for primary psychiatric presentations. We aimed to determine the behavioral hallmarks of ANMDARE with the use of systematic neuropsychiatric and cognitive assessments. Methods: A prospective study was conducted, with 160 patients admitted to the National Institute of Neurology and Neurosurgery of Mexico, who fulfilled criteria for possible autoimmune encephalitis and/or red flags along a time window of seven years. Cerebrospinal fluid (CSF) antibodies against the NR1 subunit of the NMDAR were processed with rat brain immunohistochemistry and cell-based assays with NMDA expressing cells. Systematic cognitive, neuropsychiatric, and functional assessments were conducted before knowing NMDAR antibodies results. A multivariate analysis was used to compare patients with and without definite ANMDARE according to antibodies in CSF. Results: After obtaining the CSF antibodies results in 160 consecutive cases, 100 patients were positive and classified as having definite ANMDARE. The most frequent neuropsychiatric patterns were psychosis (81%), delirium (75%), catatonia (69%), anxiety-depression (65%), and mania (27%). Cognition was significantly impaired. A total of 34% of the patients had a predominantly neuropsychiatric presentation without seizures. After multivariate analysis, the clinical hallmarks of ANMDARE consisted of a catatonia–delirium comorbidity, tonic-clonic seizures, and orolingual dyskinesia. Conclusions: Our study supports the notion of a neurobehavioral phenotype of ANMDARE characterized by a fluctuating course with psychotic and affective symptoms, catatonic signs, and global cognitive dysfunction, often accompanied by seizures and dyskinesia. The catatonia–delirium comorbidity could be a distinctive neurobehavioral phenotype of ANMDARE. [ABSTRACT FROM AUTHOR]

Diagnosis of BI-RADS category 4A, 4B, 4C, or 5 mammary lesions, by mammogram or echography, suggests the possibility of malignancy in different percentages, for which a biopsy is indicated by the BI-RADS system of the American College of Radiology. It is an invasive procedure which generates additional costs for the patient and the institution. However, the number of breast cancer diagnoses confirmed by histopathology, by means of biopsies of mammary lesions categorized based on image studies as BI-RADS 4A, 4B, 4C, or 5 performed at Hospital Civil in Culiacan, Sinaloa, Mexico, is unknown. OBJECTIVE: determine what percentage of mammary lesions categorized by image studies as BI-RADS 4A, 4B, 4C, o 5 were confirmed as malignant lesions based on histopathological results. METHODOLOGY: a transverse, observational study, with retrospective data collection. RESULTS: in the period from May 2013 to December 2015, 251 biopsies of mammary lesions categorized by image studies as BI-RADS 4A, 4B, 4C, and 5 were performed. Histopathological results were compared with prior image diagnoses, finding a percentage of malignancy of 4.2% for BI-RADS category 4A lesions, 20.4% for category 4B lesions, 30.7% for category 4C, and 100% malignancy for category 5 lesions. CONCLUSIONS: these percentages coincide with those established by the American College of Radiology, except only a smaller percentage of malignant lesions in category 4C, which was not statistically significant because it presented a confidence interval within the range established for that category. This suggests an adequate image-histopathological correlation at our center, placing it within international parameters for quality and other reference image centers. [ABSTRACT FROM AUTHOR]