Although uncommon, it is important to recognize persistent carotid-basilar connections, since they have a considerable hemodynamic impact on the posterior cerebral circulation via the carotid system. A critical reduction in the carotid blood flow will, therefore, have ischemic consequences in the posterior cerebral territories. In addition, such connections might be associated with anomalies of the vessel wall and be predisposed to aneurysm formation. The endovascular neurointerventionalist, as well as the vascular and skull base neurosurgeon, need to be aware of their anatomy and variations.
Background The membrane of Liliequist is one of the best-known inner arachnoid membranes and an essential intraoperative landmark when approaching the interpeduncular cistern but also an obstacle in the growth of lesions in the sellar and parasellar regions. The limits and exact anatomical description of this membrane are still unclear, as it blends into surrounding structures and joins other arachnoid membranes. Methods We performed a systematic narrative review by searching for articles describing the anatomy and the relationship of the membrane of Liliequist with surrounding structures in MEDLINE, Embase and Google Scholar. Included articles were crosschecked for missing references. Both preclinical and clinical studies were included, if they detailed the clinical relevance of the membrane of Liliequist.Results Despite a common definition of the localisation of the membrane of Liliequist, important differences exist with respect to its anatomical borders. The membrane appears to be continuous with the pontomesencephalic and pontomedullary membranes, leading to an arachnoid membrane complex around the brainstem. Furthermore, Liliequist's membrane most likely continues along the oculomotor nerve sheath in the cavernous sinus, blending into and giving rise to the carotid-oculomotor membrane. Conclusion Further standardized anatomical studies are needed to clarify the relation of the membrane of Liliequist with surrounding structures but also the anatomy of the arachnoid membranes in general. Our study supports this endeavour by identifying the knowledge hiatuses and reviewing the current knowledge base.
AimsPeople with Severe Mental Illness (SMI) are at increased risk of developing diabetes. There is currently a lack of monitoring and standardisation of diabetes care in the NHS psychiatric inpatient setting. This presents as a missed opportunity, as inpatient admission could be used to improve diabetes care for this population. We surveyed the multi-disciplinary teams in psychiatric inpatient units across England to develop understanding of current diabetes care in this setting.MethodsA 13-item questionnaire was designed to assess the knowledge, attitudes and skills relating to diabetes care. This was piloted via think out loud interviews with 5 staff at a Forensic unit. Amendments were then made to the questionnaire to improve the validity prior to national roll-out.Site coordinators working within General Adult, Old Age, Rehabilitation and Forensic inpatient services were recruited via medical education and academic links. This included 19 inpatient sites within 11 NHS Mental Health Trusts across England. Site coordinators circulated the questionnaire, primarily via electronic survey. A small number of paper responses were also collected.Results156 responses were collected via the national survey (electronic = 136, paper = 20). 6 responses were excluded due to missing professional role information or roles not involving physical healthcare. Respondents included within the analysis comprised 43 Doctors, 55 Nurses and 52 Allied Healthcare Professionals.93% of respondents agreed that addressing physical health needs was an important part of the mental health team's role, although only 28% had received physical healthcare training within the last 12 months.68% agreed that they had adequate skills and knowledge to manage diabetes safely on the ward. 69% agreed that the diabetic care on the ward was of an acceptable standard according to National Institute for Health and Care Excellent (NICE) guidelines. This reflects a need for appropriate training and guidance to help improve this aspect of care.Additionally, only 51% agreed that they felt able to refer a patient with diabetes to the most appropriate diabetes service based on type of diabetes and medication prescribed. This highlights an important issue, as cohesive shared-care and clear referral pathways are key when considering effective diabetes management.ConclusionPsychiatric inpatient admission could be used opportunistically to improve the healthcare disparities for people with comorbid diabetes and SMI. This national survey highlights key areas that would need to be addressed to standardise and optimise diabetes care in this setting. This includes appropriate training, clear guidelines and cohesive shared-care pathways.
AimsWe aimed to measure the baseline mental health literacy in Foundation Doctors in the Yorkshire and Humber area, identify any gaps in knowledge with the purpose of addressing these within the new foundation psychiatry teaching program, developed by North Yorkshire Health Education England.MethodsIn January 2021, a questionnaire comprising of O'Connor's Mental Health Literacy Scale was sent electronically to all Foundation Doctors in the York and Humber area, that were in a placement at that time. The O'Connor's Mental Health Literacy Scale (MHLS) has been used since its publication in 2015 and is a 35 item, univariate scale that demonstrated good internal and test-retest reliability. It covers the following attributes: a) ability to identify disorders, b) knowledge about seeking information, risk factors and etiology, self-treatment, resources and support available, c) attitudes about mental disorders and seeking professional help. The anonymized data were collected and analysed in Microsoft Excel.ResultsIn total, we received 49 responses to the questionnaire. Overall, 85% of respondents demonstrated good mental health literacy. Breaking this down further, 91% demonstrated knowledge of core psychiatric diagnostic criteria, 68.4% were literate in etiology and risk factors, 92% and respectively 95.9% understand what resources for treatment and professional help are available. Importantly when looking at attitudes about mental disorders overall 17% of respondents showed a degree of stigma and barriers in seeking professional help. For example, 2% strongly agreed that mental health conditions are not real illnesses, 34.7% were unsure whether people with mental illness are dangerous, 40.9% neither agreed nor disagreed they would move next door with someone with a mental illness and 14.3% would not be willing to have someone with a mental illness marrying into the family. When looking at barriers to seeking help, 12% answered they would not tell someone if they had a mental health problem, with 16.3% unsure whether they would tell someone if they had a mental health problem.ConclusionOverall, our survey demonstrated good mental health literacy in our cohort, however, there are areas of improvement, the main ones being etiology, risk factors, and attitudes towards mental health. It is important to recognize these deficits, as they have been linked with poor health outcomes and barriers in seeking and providing care. Moving forward, standardization of teaching programs and anti-stigma training could be an evidence-based approach to tackling these issues.
AimsThe primary aims of our study is to gather ideas from young people about developing an intervention for children who first started using social media. Our study also aims to investigate whether different types of social media use are associated with impact of social media on emotions and self-esteem.MethodsAn anonymous questionnaire was distributed to young people (16–25 years old), who were UK residents, through word of mouth, social media and university newsletters. We assessed participants’ baseline characteristics, including types of social media use (active, active-passive and passive), impact of social media. We also explored young people's idea on developing a social media intervention, including how it should be delivered, topics that needs to be covered. Quantitative data were analysed using descriptive statistics and ordinal regression analysis.Results90 young people completed the questionnaire. 37.8% of the participants started using social media before 13 years old. Analysis has shown that interacting with other users and creating social media content is associated with higher self-rated negative impact on self-esteem from social media, but there is no association between impact on self-esteem and reacting to other's social media content or browsing other's social media content. Types of social media use were not associated with a self-rated impact of social media on emotions. Regarding the co-development of an intervention for social media, young people believe the best ways to distribute information about social media is through an interactive session by professionals (36.7%) or teaching it in class (28.9%) while the least popular ways are poster/booklet (1.11%) and mobile phone app (1.11%). The majority of young people felt the following topics on social media to be useful to cover during interventions, including risks on social media (85.6%), emotional safety on social media (81.1%), social media hygiene (70.0%), coping strategies and finding help on social media (66.7%), communication on social media (58.9%).ConclusionAlthough types of social media use are not associated with impact on emotions from social media, those who create social media content are at higher risk of having more impact on self-esteem. Interventions should be developed to help protect or improve self-esteem while using social media. This could be done by focusing on different topics. Future interventions for young social media users should be interactive and led by experts. They should also start before children reaches the common legal age of social media use to make them more resilient to the digital world.
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