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The drug-nutrient interaction between phenytoin and enteral feedings that results in decreased phenytoin bioavailability was first reported in 1982 by Bauer.~ The nature of the interaction has undergone considerable research; however, the exact mechanism of the interaction has not been found.Several factors may be involved in this complex phenomenon, including gastrointestinal transit time, the nitrogen source of the feeding, calcium content of the feeding, pH of the feeding, dosage form of phenytoin, and dilution of phenytoin suspension

BackgroundLong-standing ethnic inequalities in access and mental healthcare were worsened by the COVID-19 pandemic.ObjectivesStakeholders coproduced local and national implementation plans to improve mental healthcare for people from minority ethnic groups.MethodsExperience-based codesign conducted in four areas covered by National Health Service (NHS) mental health trusts: Coventry and Warwickshire, Greater Manchester, East London and Sheffield. Data were analysed using an interpretivist–constructivist approach, seeking validation from participants on their priority actions and implementation plans. Service users (n=29), carers (n=9) and health professionals (n=33) took part in interviews; focus groups (service users, n=15; carers, n=8; health professionals, n=24); and codesign workshops (service users, n=15; carers, n=5; health professionals, n=21) from July 2021 to July 2022.FindingsEach study site identified 2–3 local priority actions. Three were consistent across areas: (1) reaching out to communities and collaborating with third sector organisations; (2) diversifying the mental healthcare offer to provide culturally appropriate therapeutic approaches and (3) enabling open discussions about ethnicity, culture and racism. National priority actions included: (1) co-ordination of a national hub to bring about system level change and (2) recognition of the centrality of service users and communities in the design and provision of services.ConclusionsStakeholder-led implementation plans highlight that substantial change is needed to increase equity in mental healthcare in England.Clinical implicationsWorking with people with lived experience in leadership roles, and collaborations between NHS and community organisations will be essential. Future research avenues include comparison of the benefits of culturally specific versus generic therapeutic interventions.

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