Objective Cardiometabolic risk prediction algorithms are common in clinical practice. Young people with psychosis are at high risk for developing cardiometabolic disorders. We aimed to examine whether existing cardiometabolic risk prediction algorithms are suitable for young people with psychosis. Methods We conducted a systematic review and narrative synthesis of studies reporting the development and validation of cardiometabolic risk prediction algorithms for general or psychiatric populations. Furthermore, we used data from 505 participants with or at risk of psychosis at age 18 years in the ALSPAC birth cohort, to explore the performance of three algorithms (QDiabetes, QRISK3 and PRIMROSE) highlighted as potentially suitable. We repeated analyses after artificially increasing participant age to the mean age of the original algorithm studies to examine the impact of age on predictive performance. Results We screened 7820 results, including 110 studies. All algorithms were developed in relatively older participants, and most were at high risk of bias. Three studies (QDiabetes, QRISK3 and PRIMROSE) featured psychiatric predictors. Age was more strongly weighted than other risk factors in each algorithm. In our exploratory analysis, calibration plots for all three algorithms implied a consistent systematic underprediction of cardiometabolic risk in the younger sample. After increasing participant age, calibration plots were markedly improved. Conclusion Existing cardiometabolic risk prediction algorithms cannot be recommended for young people with or at risk of psychosis. Existing algorithms may underpredict risk in young people, even in the face of other high‐risk features. Recalibration of existing algorithms or a new tailored algorithm for the population is required.

Background The present study was undertaken in a borderline personality disorder unit in Cambridge, UK. Our aim was to evaluate patient and staff perspectives on the current risk assessment procedure and to assemble opinions on a proposed change to this procedure. Methodology Structured interviews were conducted with patients and risk-assessing staff. Likert-scale and open questions were asked to gather both quantitative and qualitative data on both the preexisting risk assessment procedure and the proposed change to the procedure. The qualitative data was assembled into key themes. Results Patients and staff were moderately satisfied with the current risk assessment process, with patients scoring it an average of 2.75 out of 5 and staff scoring it 2.5 out of 5. Six key themes emerged as relevant to the process for both staff and patients: holistic approach, autonomy and freedom, responsibility, staff-patient relationship, time taken, and chance for reflection. One theme, "triggering negativity," emerged among patients only, while a theme exploring ideas about risk emerged only among staff. Conclusion Our study highlights the need to introduce a new risk assessment procedure that grants patients more freedom and responsibility and encourages staff to individualize the process for each patient by taking a holistic approach. This would cultivate a ward environment that is less risk-averse and more recoveryoriented.

This work addresses children's (under 6 years of age) fear and apprehension to visit dental clinics. We present a bespoke interactive Virtual Reality reproduction of the physical dental clinic, augmented with virtual characters and enriched with gamification style information for a richer user experience. The experience allows the user to navigate and familiarise themselves with the location and the procedures they will undertake before visiting the clinic. The experience is now being piloted at the Dental Public Health at the University Hospital of Wales.

This study was conducted in Springbank Ward, a specialist ward for patients with emotionally unstable personality disorder, based in Cambridge, United Kingdom. We aimed to assess any change in incident frequency following the introduction of a new protocol for leaving the ward, in which patients are offered an optional conversation with staff in place of a formal risk assessment checklist. We also aimed to assess patient and staff perceptions of the change. MethodsWe used data routinely collected by Springbank Ward to compare incident frequency in the year before and after the change in protocol. We conducted structured interviews with patients and staff to obtain qualitative data on the new protocol and used thematic analysis to interpret the interview data. ResultsThere were 466 incidents during the period before the change in protocol and 408 incidents in the period after. Adjusted for occupancy rate, there was no statistically significant difference in the frequency of incidents. Patients and staff were generally satisfied with the new protocol, with an average satisfaction rating of 4.1 out of 5. Thematic analysis generated five main themes: 'taking ownership', 'autonomy versus restriction', 'staff-patient interaction', 'staff expertise' and 'protocol efficiency'. ConclusionsOur study reveals high satisfaction with the new way risk is assessed and managed for patients leaving Springbank Ward, with an appreciation for its holistic and minimally restrictive approach. This was achieved without significantly increasing incident frequency.

AimsSpringbank Ward is a specialist unit for patients with a diagnosis of emotionally unstable personality disorder (EUPD). Psychiatric wards often use restrictive practices to try and minimise suicide risk. Using risk assessment checklists to decide whether to grant leave is one example. Research shows that it is not possible to predict suicide at an individual level, regardless of the assessment method used, so we questioned the utility of such an approach. A previous evaluation of our leave protocol showed that patients and staff would favour a less restrictive and more personalised approach. We introduced a new protocol that eliminated use of checklists, replacing them with an optional 1:1 conversation with staff before leaving the ward. Our aim was to gauge patient and staff satisfaction with the new protocol and investigate their views on the change.MethodsData were obtained through structured interviews with staff who assessed risk (nurses and psychiatrists) and patients. 9 patients and 8 members of staff were interviewed between 9–19 March 2021. Interviewees were presented with diagrams of both the new protocol and old risk assessment checklist and asked a series of questions, including: rating their satisfaction; any potential improvements; and whether they would prefer the previous or current protocol. Thematic analysis of interview answers was used to explore patient and staff perspectives. Two authors independently analysed the interview transcripts, before discussing any discrepancies to reach a unified set of themes, subthemes and codes.ResultsBoth patients and staff gave the new protocol an average satisfaction rating of 4.1/5. Thematic analysis generated five themes: “taking ownership”, “autonomy Vs restriction”, “staff-patient interaction”, “staff expertise” and “protocol efficiency”. Most interviewees agreed that the new protocol supported patients in taking responsibility for their safety, helping to prepare for life in the community. The protocol was considered minimally restrictive and more efficient than the previous system. The importance of communication and trust between patients and staff, as well as the use of staff intuition in holistically assessing risk, was emphasised. Potential disadvantages included the perceived riskiness of reducing restrictions and difficulty seeking support early in the admission.ConclusionIn general, the new protocol is rated highly by patients and staff and is considered to be minimally restrictive and more holistic, in line with the aims established by our previous evaluation. Our findings have implications regarding risk management for inpatients with EUPD.