Care planning is a key requirement for recovery-focused mental health care. Audit tools are available so that services can assess their alignment with accepted care planning standards but few benchmarks are available, especially for health services outside the United Kingdom.To assess implementation of recommended care planning in an Australian mental health setting for people recently hospitalised, a sample of service user records was audited against care plan requirements. Of 164 eligible records, 113 (69%) showed a care plan. Of the 113 care plans, 40 (35%) contained a risk assessment and 1 (1%) a crisis management plan.Thirty five (31%) contained some social needs assessment, 1 (1%) contained a physical health assessment, and 53 (47%) identified a primary healthcare physician. This audit indicated a large gap between recommendations and actual practice. Similar audits in other health services are required. Action is needed to integrate care planning into behavioural health practice.
BACKGROUND
Neuroprotective agents have the potential to improve the outcomes of revascularisation therapies in acute ischemic stroke patients (AIS) and in those unable to receive revascularisation. Afamelanotide, a synthetic α-melanocyte stimulating hormone analogue, is a potential novel neuroprotective agent. We set out to assess the feasibility and safety of afamelanotide for the first time in AIS patients.
METHODS
AIS patients within 24 hours of onset, with perfusion abnormality on imaging (Tmax) and otherwise ineligible for revascularisation therapies were enrolled. Afamelanotide 16 mg implants were administered subcutaneously on Day 0 (D0, day of recruitment), D1 and repeated on D7 and D8, if not well recovered. Treatment emergent adverse events (TEAEs) and neurological assessments were recorded regularly up to D42. Magnetic resonance imaging (MRI) with FLAIR sequences were also performed on D3 and D9.
RESULTS
Six patients (5 women, median age 81, median NIHSS 6) were recruited. Two patients received 4 doses and four patients received 2. One patient (who received 2 doses), suffered a fatal recurrent stroke on D9 due to a known complete acute internal carotid artery occlusion, assessed as unrelated to the study drug. There were no other local or major systemic TEAEs recorded. In all surviving patients, the median NIHSS improved from 6 to 2 on D7. The median Tmax volume on D0 was 23 mL which was reduced to a FLAIR volume of 10 mL on D3 and 4 mL on D9.
CONCLUSIONS
Afamelanotide was well tolerated and safe in our small sample of AIS patients. It also appears to be associated with good recovery and radiological improvement of salvageable tissue which needs to be tested in randomized studies.
ClinicalTrials.gov Identifier: NCT04962503
A method was tested to extract reliable estimates o f stretch reflex gain during a simple upper limb task involving dynamic muscle contractions. The gain estimates obtained from a 10hz sinusoidal stretch perturbation were comparable in dynamic tasks and constant contractions of similar average magnitude. It was concluded that the method may permit studies of functionally related changes in reflex gain during upper limb tasks.
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