Background: Treatment-resistant schizophrenia (TRS) is a major cause of disability. Clozapine is currently the only antipsychotic medication licensed for its treatment. However, the rate of treatment resistance among outpatients with schizophrenia or other psychoses, and the rate of use of clozapine among them, is not known. Aims: The aims of this study are (a) to determine the point prevalence of treatment-resistant psychosis in a community sample, and (b) to determine the number of patients with TRS who have never had a clozapine trial. Method: Clinico-demographic data were extracted from the case notes for 202 patients from two community mental-health teams. Results: We found that 56% (99/176) had a diagnosis of TRS, and 52% (51/99) of these patients had never been treated with clozapine. Patients of non-white ethnicity were less likely to have had a clozapine trial ( p=0.009). The point prevalence of treatment resistance within the bipolar affective disorder sample was 19% (5/26). Conclusion: These findings suggest that TRS is common in the community mental-health team, and a large proportion of these patients have not received clozapine. These findings indicate that identifying and treating treatment resistance should be a focus of community services for schizophrenia.

Healthcare, BMJ Simulation and Technology Enhanced Learning, and BMC Advances in Simulation) were examined from the first published issue of each journal until the final issue of 2018. Data extracted related to authorship of papers published in each of the three journals (i.e., type of article; gender of first and last authors; country and affiliation of first and last authors) and editorialship at each journal (i.e., the gender of each member of the journal's editorial board). Summary of results A total of 873 studies (49.5% original research, 50.5% non-research) met the inclusion criteria. Table 1 presents the gender comparison of first and last authors, and editorial board members for each journal. First and last authors were predominantly male across all journals. Further, with the exception of a female Editor-in-Chief of one journal, and a greater proportion of female than male associate editors in another, gender disparities across the remaining categories of editorial boards existed. Discussion and conclusions Male overrepresentation in authorship and editorialship was evident across the included journals, with female representation rates similar to those of previously conducted studies across a range of medical fields such as psychiatry, surgery and paediatrics. Recommendations Considering publication in peer-reviewed journals, and serving on editorial boards, is considered an important indicator of academic productivity and success, and serves as a means of influencing discourse and practice in a field, future efforts should focus on actionable strategies to improve rates of female authorship and editorialship.

2. Cramped text boxes enlarged 3. Introduced boxes to describe post-event observations and management A second in-situ simulation of pulseless electrical activity cardiac arrest was undertaken on PCCU during a normal working day. Further improvements were: 1. Text boxes rearranged for ease of usefree space to record interventions during resuscitation moved to the first page and nearer to the column recording the time. 2. Space to record adrenaline doses increased A third ward-based simulation tested the efficacy of these changes for clinical use, documentation of events, and NCAA data collection. Discussion, conclusions and recommendations Trialling a CA documentation proforma through simulated clinical events in a range of settings made it fit for purpose: enabling contemporaneous and comprehensive documentation of events, ensuring accurate data collection for NCAA and providing prompts for resuscitation as per APLS guidance. The use of simulation streamlined the process of new proforma development, allowing previously unforeseen glitches and inadequacies to be addressed before use with patients, adding to safety and improving quality.

AimsThe transition between Core Psychiatry Training (CPT) and Psychiatry HTs is often anxiously anticipated by trainee psychiatrists, in view of the heightened responsibility and increased demand faced by trainees. The author wrote and delivered a one-day simulation induction course for newly appointed CAMHS HTs across London. The aim of this course was to improve participant's confidence, skills and knowledge in managing a range of conditions and challenging scenarios in children and young people (CYP) presenting to CAMHS. The course was also designed to improve HT's confidence in supporting junior colleagues and in managing conflict resolution. There was also an overarching aim of increasing human factor skills by focusing on these within the scenarios and debriefs.MethodsThe simulation training was delivered online and consisted of five scenarios commonly faced by CAMHS SPRs based in a variety of settings. Themes within the scenarios included eating disorders and deliberate self-harm, as well as managing risk, multiple demands, and the psychosocial factors contributing to mental illness. Professional actors, plants and virtual backgrounds were used to enhance fidelity of the scenarios. Platform orientation and an introduction to simulation were initially provided followed by “ice breaker” activities, which were used to promote psychological safety amongst participants. Each scenario lasted approximately 10 minutes. Following each scenario, participants were supported to engage in a debrief using the Maudsley Debrief model. Pre- and post-course evaluation questionnaires were given to participants to complete and comparative analysis was conducted.ResultsSeven participants completed both the pre- and post- course evaluation questionnaires. The mean sum score for course specific questions was 51.86 (SD = 9.56) pre course, and 68.00 (SD = 10.08) post course, showing a 31.12% increase in knowledge, skills, and confidence across the course specific domains.The mean sum score for the Human Factors Skills for Healthcare Instrument (HFSHI) was 76.67 (SD = 17.26) pre course, and 86.50 (SD = 16.54) post course, showing a 12.82% increase in human factors skills.ConclusionThis simulation course demonstrated it is an effective and innovative way to help with induction for HT, resulting in an increase in knowledge, skills and confidence in trainees transitioning from CPT to HT, both in terms of factors specific to managing CYP's care and in relation to broader human factor skills.

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