bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing the Co-Variates of Suicide-Related Ideation and Self-Harm in an Older Adult Population Attending Emergency Departments in Ireland
Authors: Hoare Fiona , O'Donoghue Ann , Sweeney Colm , McCarthy Geraldine , Doherty Anne
Published: August 2024

Aims

Older people (people aged 65 and older) have high rates of suicide, and self-harm is a major risk factor for suicide. While rates of self-harm decrease with age, rates of suicide increase amongst this age group. The aim of this project is to analyse data collected by the National Clinical Programme for Self-Harm and Suicide-related Ideation (NCPSHI) to identify real-life evidence of the characteristics associated with older people who present with self-harm and suicidal ideation to emergency departments (ED) in Ireland. In examining the variables associated with self-harm we may be better able to identify the characteristics of older adults who are at highest risk, including those presenting with high lethality attempts.

Methods

The NCPSHI collects data on all patients who present with self-harm or suicide-related ideation to EDs in Ireland. We utilised a six-year cohort of anonymised data from the NCPSHI from 2018–2023, representing 5,041 presentations of older people (aged 60 and over); 6.9% of all presentations with self-harm and suicide-related ideation. We examined sociodemographic variables including sex, ethnic background, type of self-harm, lethality of self-harm and substance use contributing to the presentation, in addition to service use variables.

Results

Older people were less likely to present with self-harm – 45% of older people vs 52% of adults under 60 (p < 0.001). However, those episodes of self-harm were more likely to be categorised as “high lethality” – 20% vs 12% of people under 60 (p < 0.001). Older people were also more likely to have a mental health admission – 25% vs 16% (p < 0.001). Older people were much less likely to present with substance misuse: 30% vs 45% (p < 0.001). There were also significant differences in methods of self-harm. Older people were more likely to attempt drowning (1.5% vs 1.1%) or overdose (21% vs 20%). This was the common method of self-harm across all age groups.

Conclusion

Our results demonstrate the significant differences in characteristics of older people presenting to Irish emergency departments with self-harm versus younger people, where previously a paucity of data existed. The high lethality of self-harm amongst older people makes it imperative to identify the characteristics of self-harm in this population to understand the factors associated with increased risk and help us to develop treatments and services to meet their needs It also highlights the importance of providing education to staff working with this cohort to appropriately stratify and manage risk.
Preventing Self-Harm Among Adolescents Through Culturally Adapted Psychological Intervention in Pakistan: A Multicenter RCT
Authors: Tofique Sehrish , Chaudhry Nasim , Kiran Tayyeba , Gire Nadeem , Husain Nusrat
Published: August 2024

Aims

Self-harm is the preventable cause of premature death by suicide. In adolescents suicide is the fourth leading cause of death and Pakistan is one of the youngest nations in the world. Culturally relevant solutions for the prevention of self-harm among adolescent are almost non-existent in LMICs. The aim of this trial is to assess the clinical and cost-effectiveness of a culturally adapted manual assisted problem-solving intervention for youth (YCMAP) with history of self-harm (within 3 months) to reduce self-harm repetition over the period of 12 months.

Methods

This was a rater-blind, multicenter randomised controlled trial, with a nested qualitative component to explore perceived usefulness of the intervention from the perspective of different stakeholders. Primary care centers, emergency departments, medical units from participating healthcare facilities in Karachi, Hyderabad, Lahore, Rawalpindi and Multan, Pakistan served as recruitment sites in addition to self-referrals. Patients with a recent history of self-harm (n = 684) were assessed and randomised (1:1) into either of the two trial arms; YCMAP with enhanced treatment as usual (E-TAU) or E-TAU. The YCMAP is a manualized, psychological intervention based on problem-solving therapy, principles of cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), psychoeducation, and a comprehensive assessment of the self-harm attempt using stories of four young people, comprising 8–10 one-to-one sessions delivered over three months by trained therapists. Primary outcome was the reduction in the self-harm repetition at 12-month post-randomisation and secondary outcomes were distress, suicidal ideation, hopelessness, health-related quality of life (QoL), and level of satisfaction with service received, assessed at baseline, 3-, 6-, 9-, and 12-month post-randomisation.

Results

We screened 1099 young people for eligibility and 684 eligible, consented patients were randomly assigned to the YCMAP plus E-TAU arm (n = 342) and E-TAU arm (N = 342). Improvement in repetition rates of self-harm, hopelessness, suicidal ideation and psychological distress were clinically significant in YCMAP arm as compared with E-TAU. Thematic analysis of interviews with adolescents who participated in the intervention arm (N = 20) highlighted the intervention as useful in improving their mental health and well-being, and easy to understand.

Conclusion

Adolescents are an important target population for the prevention of suicide and other mental health problems. Implementation strategies are needed such as digitalization of culturally adapted manual assisted psychological interventions or task shifting approach for scalable suicide prevention interventions in low resource settings like Pakistan to meet mental health needs.
Prevalence and Associated Factors of Depressive Disorder After Exposed Prolonged Traumatic Event
Authors: Kim Moon-Doo
Published: August 2024

Aims

Depressive disorder is one of the most typical psychiatric disorders that occurs after a traumatic event. However, there has been minimal research regarding the prevalence and associated factors of depression after a traumatic event. Therefore, this study aims to investigate the prevalence of depressive symptoms and associated factors in the residents of the Gangjeong village, who have been exposed to a traumatic event recently for a prolonged period.

Methods

The subjects of this study were the residents of the Gangjeong village, who have been exposed to a traumatic event related to the construction of the Jeju Civilian-Military Complex Port. The questionnaires were used to assess the participants' general characteristics (sex, age, marital status, occupation, self-perceived health, etc.); in addition, for the clinical evaluation, overall stress was assessed through the Global Assessment of Recent Stress Scale (GARS), social support through Functional Social Support Questionnaire (FSSQ) and suicide risk through Mini-International Neuropsychiatric Interview-Plus (M.I.N.I-Plus). In order to evaluate the depressive symptoms, CES-D (Center for Epidemiologic Studies Depression Scale) was used.

Results

In 713 subjects, the prevalence of depressive symptoms was 18.5% (95% CI=15.66–21.36) (Table 1). Multivariate logistic regression analysis identified the length of residence and marital status as factors associated with depressive symptoms (Table 2). Furthermore, the depression group has a significantly higher score of overall stress (GARS), suicide risk and the lack of social support (FSSQ), in comparison with the non-depression group (depression gr. vs non-depression gr. : 28.8 ± 15.0 vs 12.8 ± 10.1, 4.9 ± 8.0 vs 1.1 ± 3.6, 44.8 ± 13.2 vs 34.0 ± 13.9, respectively).

Conclusion

The prevalence of depressive symptoms was higher among the study population compared with the general population. People exposed to the traumatic event, especially after prolonged exposure, should be assessed for environment factors, the status of overall stress, social support and the suicidal risk.
Examining Social Touch in Early-Life Stress
Authors: Lim Lena
Published: August 2024

Aims

Social contact is crucial for both immediate and later development of adaptive social and emotional behaviour. Tactile experiences during childhood influence the development of the social brain and frequent affectionate touch is associated with secure attachment style. Social touch is an important form of social interaction and plays a significant role in the formation and maintenance of relationships in humans across development, where the hedonic properties of touch are involved in improving the quality of life. However, relatively less research attention has focused on social touch experiences in individuals with a history of early-life interpersonal stress, particularly childhood maltreatment.

Methods

Social touch pleasantness ratings using a newly developed Social Touch task and attitudes about a variety of social touch behaviours using the Social Touch Questionnaire (STQ) were examined in 40 age- and gender-matched young adults (23 childhood maltreatment, 17 controls).

Results

The childhood maltreatment group had significantly lower STQ score than the control group, where lower STQ score was furthermore correlated with higher severity of maltreatment, particularly physical neglect. For the social touch task, females who experienced childhood maltreatment had significantly lower mean pleasantness ratings for positive social touch than their male counterparts, and these differences were mainly in response to touch given by stranger and friend of opposite gender.

Conclusion

These preliminary results show that early-life interpersonal stress from caregivers may potentially influence touch processing and pleasantness, particularly for females, and there is a need to further explore the effects of different touch giver role (e.g. friend, stranger, partner).
Ethical Concerns of Research Ethics Committees in Suicide Research: A Qualitative Study From Pakistan
Authors: Asif Muqaddas , Memon Rakhshi , Khoso Ameer B. , un Nisa Zaib , Husain Nusrat
Published: August 2024

Aims

Suicide is a global public health issue that requires sensitive research to inform effective prevention and treatment strategies. Despite the benefits of such research, it is accompanied by significant ethical challenges such as the potential for harm to participants' wellbeing. Various studies have explored the views of researchers in suicide research. This qualitative study aimed to explore the research ethics committee (REC) members’ experiences with suicide-related study applications to ascertain whether there are differences in approaches to dealing with suicide-related study applications.

Methods

We conducted semi-structured interviews with members of RECs (n = 9) from research-intensive universities and ethics committees in Pakistan. We also conducted a discussion group (n = 13) with members of REC from Pakistan, Nigeria and Sri Lanka. The topic guide delved into the opinions of REC members regarding ethical issues that they have come across while reviewing self-harm/suicide-related research proposals, the relevance of these issues with specific study designs, recommendations to resolve these issues, their approach to balancing risk and benefit, and guidance for researchers.

Results

The preliminary findings from thematic analysis revealed five major themes; 1) Ethical challenges, 2) Reasons for application rejection, 3) Areas of improvement, 4) Suggestions for addressing ethical issues, and 5) Researchers' attitudes towards amendments. Challenges in self-harm and suicide research included the sensitivity and stigma surrounding the topic, lack of interest and support, and difficulties in participant recruitment. The application faced rejection from the ethics committees primarily due to methodological errors, lack of procedural clarity, and insufficient understanding of the research procedure. Identified areas for improvement were the need for enhanced methodology and research patterns, as well as a better understanding of the methodological procedure. Recommendations for developing a robust research proposal included training and supervision for intervention studies, the inclusion of comprehensive ethical elements and practical plans in the proposal, and a focus on data protection, confidentiality, risk management, and harm identification. While a significant number positively acknowledged reviewer comments, some researchers opted for in-depth discussions rather than directly addressing the issues.

Conclusion

The study highlights the importance of ethical considerations and emphasises the need to address the lack of robust methodological procedures in self-harm and suicide research. Addressing these challenges and adopting suggested improvements is paramount for advancing ethical and impactful research in this context.
Therapeutic Patient Education for Severe Mental Disorders: A Systematic Review
Authors: Meraj Hafsa , Waqas Ahmed
Published: August 2024

Aims

Therapeutic Patient Education (TPE) aims to help patients self-manage their chronic condition over their lifetime, adapting to their evolving circumstances, as well as changes in their condition and treatment. The National Institute for Clinical and Healthcare Excellence underscores the importance of patient education as a crucial part of early interventions for mental disorders. This systematic review aimed to review TPE programmes in managing psychiatric disorders, considering the diversity in delivering agents, intervention formats, targeted skills, and therapeutic outcomes.

Methods

Comprehensive database searches, including Web of Science, PubMed, and COCHRANE, were conducted from September 2019 to January 2023, yielding 514 unique records, with 33 making it through rigorous evaluation for full-text review. Eleven studies met the inclusion criteria, focusing on various psychiatric disorders such as depression, bipolar disorder, psychosis, and multiple serious mental illnesses. A total of 38 studies were included from our previous review to supplement the current database search.

Results

Among 49 included interventions, 13 were aimed at bipolar disorder, depression (n = 12), multiple serious mental illnesses and comorbidities (n = 11), schizophrenia and psychoses (n = 13). A total of 21 interventions were delivered in groups followed by individual (n = 12), mixed format (n = 14) and electronically (n = 2).

TPE programmes exhibited diversity in delivering agents and intervention formats, with a notable presence of multidisciplinary teams and various professionals. The interventions prioritized coping strategies and disease management techniques, though the extent varied based on the disorder. Examining the different skills imparted during the interventions, the focus predominantly leaned towards the teaching of coping strategies. These encompassed both cognitive and behavioural coping skills, including areas such as self-confidence (n = 37), stress management (n = 39), critical thinking (n = 26), problem-solving (n = 18), goal setting (n = 31), situational awareness (n = 36), and self-care (n = 36), with unspecified coping skills also noted (n = 32).

Effectiveness was heterogeneous across studies; some interventions showed significant benefits in areas such as symptom management, coping, and functional improvement, while others reported no significant outcomes.

Conclusion

The findings underscore the potential of TPE in psychiatric care, revealing its multifaceted nature and varied impact. TPE not only addresses deficits but also leverages patients' existing strengths and capabilities. Despite the reported benefits, a portion of the interventions lacked statistical significance, indicating the necessity for continuous refinement and evaluation.
A Systematic Review of Studies of Attitudes and Beliefs of Healthcare Professionals Towards Non-Epileptic Attack Disorder (NEAD)
Authors: Townsend Amelia , Dobrzanski James , Shergill Sukhi , Rodda Joanne
Published: August 2024

Aims

Non epileptic attacks (also referred to as psychogenic non-epileptic seizures, functional seizures or dissociative seizures) are similar in appearance to epileptic seizures but are not accompanied by ictal electroencephalographic (EEG) discharges. NEAD is classified as either a conversion or dissociative disorder in DSM-V and ICD11 respectively, and is often associated with significant long-term disability. People with NEAD often access care across many different specialties and healthcare settings. Their experiences of doing so are frequently negative, based both on interactions with clinicians and integration of care.

The aims of this study were to review the existing literature on the attitudes of clinicians towards non-epileptic attack disorder (NEAD), and any differences that exist between professional groups.

Methods

The study followed PRISMA 2020 guidelines and was registered on the international prospective register of systematic reviews (PROSPERO). Three electronic databases (MEDLINE, EMBASE and PsycInfo) were searched for studies of clinician attitudes towards NEAD using pre-developed terms. These terms were optimised following familiarisation with the literature. Specific inclusion and exclusion criteria were applied, and studies were selected if they included data regarding the attitudes of healthcare professionals from any group towards NEAD. A data extraction template was used to synthesise study characteristics and outcomes. The Mixed Methods Appraisal Tool was used to appraise methodological quality of the included studies. Two reviewers independently completed the selection process and data extraction.

Results

The search strategy yielded 2885 citations, of which 76 were selected for review of the full publication based on the title and abstract. Inclusion/exclusion criteria were applied to full texts. The literature mainly included clinicians from general practice, neurology, emergency department and psychiatry. There was general negative stereotyping of people with NEAD and a lack of confidence in management. Attitudes differed between professions, particularly with respect to aetiology.

Conclusion

The literature highlighted that many clinicians held a negative attitude towards people with NEAD, and there was evidence of a general lack in confidence towards NEAD across all healthcare professional groups. There was a difference between healthcare professional groups, mostly related to views on aetiology. The review highlights the need for greater education related to NEAD with a focus on understanding aetiology and greater transparency in interdisciplinary working.
Are Opioid Receptor Antagonists Effective at Treating Antipsychotic-Induced Weight Gain? A Systematic Review and Meta-Analysis
Authors: Keat Lee Kenn Cheng , Twohig Matthew , Idoko Nguemo Pauline , Williams Benjamin David
Published: August 2024

Aims

Introduction: Second-generation antipsychotics are widely used in psychiatry but are associated with weight gain. Obesity is more prevalent in mental illness and may contribute to the mortality gap. Non-pharmacological management of antipsychotic-induced weight gain (AIWG) has limited success whilst pharmacological treatment typically involves antidiabetic medications that psychiatrists have less experience with. Recent developments in the field have shown promise with using centrally-acting opioid receptor antagonists (CORAs) at treating AIWG.

Objective: Review and synthesise the available RCT evidence on the efficacy of CORAs at treating AIWG.

Methods

Methodology: Four databases (Medline, Embase, PsycINFO, Cochrane) were searched, from database inception to present, for RCTs using CORAs (naloxone, naltrexone, samidorphan) to reduce AIWG. Our primary outcome sought was weight change in kilograms, with secondary outcomes of change in percentage of body weight, waist circumference and 7% or 10% weight change thresholds. We used random-effects meta-analysis due to study heterogeneity.

Results

A total of 450 articles were found (319 post-deduplication), of which seven met criteria (samidorphan = 4, naltrexone = 3, naloxone = 0) including n = 1,416 patients. On meta-analysis, change in body weight (kg) for CORAs as a class was statistically significant (RE = 1.37 kg; 95% CI: 0.51, 2.24). However, change in BMI was not statistically significant (RE = 0.61kg/m2; 95% CI: −0.56, 1.78). Remaining analysis was only available for samidorphan, which showed statistically significant improvement in change in body weight (%) (RE = 1.81%; 95% CI: 1.07, 2.55), absolute risk of weight gain ≥7% (RE = 12.41%; 95% CI: 6.55, 18.27), absolute risk of weight gain ≥10% (RE = 10.83%; 95% CI: 5.46, 16.21), and change in waist circumference (RE = 1.50 cm; 95% CI: 0.32, 2.67).

Conclusion

Evidence is strongest for samidorphan, though CORAs as a class remains poorly researched and the benefits are modest. Additionally, samidorphan is currently only available in the combination medication olanzapine-samidorphan and the literature reflects this. Further research is needed to examine its efficacy in AIWG from other antipsychotics.
‘An Emotional Earthquake’ – the Psychological Impact of the Earthquake in Syria on Mental Health Workers and the Value of Reflective Spaces: Who Cares for Carers?
Authors: Alachkar Mustafa
Published: August 2024

Aims

The war-ridden northern part of Syria was struck by a powerful earthquake in February 2023 leaving thousands of people dead or injured. The consequences of the earthquake on people's mental health are harder to evaluate but are likely to be severe and long-lasting, especially as people have lived through years of war and devastation.

This poster reports on facilitating reflective practice groups, online, where Syrian mental health professionals in northern Syria explored the psychological impact of the earthquake on them as individual and as professionals.

Methods

The author facilitated a series of online reflective practice group meetings. Three distinct groups of mental health workers were formed, each group consisting of 6–12 participants. Each group met twice, each session lasting an hour and a half, resulting in 6 meetings that took place between the 25th of February and the 18th of March 2023. In the first session the group discussed the psychological impact of the earthquake on them as individuals, and in the second the psychological impact on them as professionals.

Results

Thematic analysis was conducted on the discussions in the 6 reflective group meetings, resulting in three main themes: emotional responses, cognitive responses and helpful strategies. These themes are grouped detailed in terms of the impact of the earthquake on the personal and the professional lives of the participants.

Conclusion

Notwithstanding the limitations of this experience, it highlights the importance and value of group reflective spaces, as a way of helping mental health professionals process their emotional experiences in the aftermath of natural disasters.
Better Together – Organizing a PAN-London IMG and Educators Conference
Authors: Birgi Harleen Kaur , Carter Peter
Published: August 2024

Aims

International medical graduates (IMG) are an important and integral part of the NHS workforce. The 2022 General medical council (GMC) Workforce Report showed that of the doctors who joined the workforce in 2021, half (50%) were IMGs and 39% UK graduates. This report also emphasized the need for better inclusion and support for IMGs in order to enhance future retention.

With this conference we aimed to empower IMGs and their educators with tools and knowledge to better recognize and help mitigate the challenges that IMGs endure whilst working in NHS. We discussed about the factors affecting IMG career progression, wellbeing, and ways to overcome them.

Methods

It was a one-day conference targeted to the PAN-London cohort of IMGs and their educators of medical and surgical specialties. The programme included distinguished speakers from all branches of medical fraternity, the GMC and medical indemnity organisations. Five poster submissions were also selected to be presented on the day. The programme started with IMG consultants describing personal challenges and success stories with a focus on long-term NHS equality diversity inclusion plan. This was followed by an invigorating ‘Schwartz round’ wherein attendees were able to engage in open and reflective discussions of shared experiences in transition to the United Kingdom. The latter half of the day included workshops on mitigating differential attainment and medico-legal aspects of clinical practice. The conference was concluded by an informative discussion led by the head of GMC London.

Results

The conference was well-attended with 94 attendees present on the day. The audience encompassed a varied set of professionals including medical education managers, directors of medical education, educational supervisors and IMG doctors of all grades and specialties across different London trusts. The feedback was overwhelmingly positive with all the respondents in agreement that the learnings from the conference were relevant to their professional needs. The qualitative response from the attendees in summary was that conferences of a similar agenda and focus should be organized in the future as well.

Conclusion

Historically, there is clear evidence in literature that IMGs have lower success rates in both job and training progression, in comparison to British medical graduates. By organizing such conferences, the endeavor is to kick start a productive dialogue between IMGs and their educators, to target more favorable and successful overall outcomes, on a long-term basis. We hope that this initiative sets the building blocks for the way of the future.
Multiple Mini Journal Clubs to Improve Malaysian Trainee Psychiatrists' Critical Appraisal Skills
Authors: Loo Jiann Lin , Muhamad Rasat Muhammad Arif , Nor Hadi Noor Melissa , Pang Nicholas Tze Ping
Published: August 2024

Aims

The skill of critical appraisal is mandatory for evidence-based psychiatric practice although the process of learning can be tough for busy psychiatrist trainees. Ironically, reading alone does not translate into skill acquisition. The accessibility to conventional journal clubs may also be limited for doctors working in busy non-academic training centres. Therefore, attending an intensive workshop on critical appraisal skills can be a viable solution. This study elucidated the experience of using an innovative approach, i.e. Multiple Mini Journal Clubs (MMJC), to improve Malaysian trainee psychiatrists’ critical appraisal skills.

Methods

A one-day workshop was conducted for 19 participants who were preparing for MRCPsych Paper B, using the combination of 1) a pre-recorded video lecture with a two-hour question and answer session; 2) three 45-minute stations in a group of three persons to practice critical appraisal of a cross-sectional, a validation, and a randomised controlled study. A standardised approach, i.e. Critical Appraisal in Five Expressed Steps (CAFES), was used by facilitators. CAFES involved asking and answering the following big heading questions while incorporating other standard critical appraisal techniques under each of the headings: 1) What is the research question; 2) Can the research methodology answer the question; 3) Does the result make sense; 4) Are the findings translatable to my setting; 5) How to improve the study if I were to conduct a similar study. Three formative assessments were carried out using Single Best Answer and Extended Matching Items. Qualitative feedback and informed consent were collected.

Results

Hundred per cent of participants agreed that their objective of attending the workshop had been achieved through the MMJC, i.e. learned both the theory and skill of critical appraisal which allowed immediate translation into practice during the MMJC. Nevertheless, there was no statistical difference in participants’ achievement for pre-, mid- and post-workshop formative assessments, i.e. median of 7/25, 7/28, and 8/27 respectively. Positive responses toward MMJC included less performance anxiety in a small group, active interaction, individualised feedback, and fun. The challenges faced included the need for strict time management and a big group of facilitators. Suggestions for improvement included the extension of the workshop duration and breaking up the lecture into several sessions.

Conclusion

Further improvement and re-evaluation of the effectiveness of MMJC is required to optimise learning outcomes.
Enhancing Educational and Clinical Trainer's Support and Experience: A Quality Improvement Initiative
Authors: Mohamed Ashma , Majid Zafrina , Ige Abiola , Kopala Katie , Cotton Mary-Anne
Published: August 2024

Aims

The GMC Trainer's survey 2022 identified nearly two in ten (18%) trainers do not agree that their employer provides a supportive environment for everyone regardless of background, beliefs, or identity. A striking 52% of doctors working as trainers are identified as being at moderate to high risk of burnout. Surrey and Borders Partnership NHS Foundation Trust(SABP) has 63 active educational and clinical trainers.

We aim to enhance the overall experience of Educational and Clinical Trainers in SABP by gaining insights into their views and experiences and identifying key areas for improvement to support trainers in their roles, thereby contributing to a more resilient healthcare workforce.

Methods

We devised a 16 item questionnaire to gather anonymous data on trainers' experiences and views in their roles. Our study utilised an observational quantitative and qualitative cross-sectional design. Data capture was done on Microsoft Forms and analysed using Excel.

Results

We had 70% response rate, 90% agreed or strongly agreed they had adequate support and training, 95% feel able to fulfil educational CPD for appraisal however only 83% were able to complete reflections on trainee feedback. 93% agreed or strongly agreed that they enjoy being a trainer but only 67% agreed or strongly agreed that they knew how to access support if they felt burnt out. Only 43% felt that they had adequate time in their schedule to provide supervision. Analysis of responses stratifying International medical graduates and years of experience being a trainer did not identify additional needs.

Conclusion

Effective trainers are fundamental in shaping future doctors. Our survey results highlighted that a high percentage of trainers enjoy their role. Based on the results, strategies were identified to improve support that can be implemented through trainers’ drop-in sessions, advertising trainers' training sessions with more notice and developing the resources on the intranet including improving content and adding videos of training sessions. We also identified that appraisal and revalidation requirements for trainers, trainee surveys needed to be better advertised to improve feedback rates. We recommended that a document on the online appraisal platform (SARD) be added to clarify the requirements for appraisal and revalidation, and how these can be met. We suggested that Associate Medical Directors consider the need to ringfence time for educational and clinical trainers in their job plans.
Incorporating Trauma-Informed and Culturally Competent Care Within Domestic Violence Screening Training for Medical Students
Authors: Popoola Iyinoluwa
Published: August 2024

Aims

The link between domestic violence and poor mental health outcomes is well-established, with victims often experiencing anxiety, depression, and post-traumatic stress disorder (PTSD). This study aims to evaluate the current state of Domestic Violence (DV) screening training within the medical curriculum at King's College London, focusing on trauma-informed and culturally competent approaches. The objective is to identify gaps and propose recommendations for a comprehensive and inclusive training program.

Methods

Approved by the King's College London Research Ethics Office, this qualitative study was conducted using an online questionnaire that adopted a 5-point Likert-type scale. The study was conducted among KCL Medical Students (n = 25) to gather opinions on DV screening training, and the responses underwent thematic analysis.

Results

The survey indicated that 92% of participants had not received formal training on DV screening. In addition, 88% lacked guidance on responding to disclosures in a trauma-informed manner and only 8% believed they had training on responding to DV within diverse cultural contexts. The key themes were ‘Addressing Training Gaps and Challenges’, ‘Practical Skills Enhancement’, ‘Cultural Competency and Diversity' and ‘Comprehensive Understanding of Domestic Violence and Abuse’. Students expressed concerns about the lack of clear, direct education on escalating domestic violence cases. Furthermore, some medical students expressed apprehension about inadvertently re-traumatising or offending patients with a different cultural background.

Conclusion

The study highlights deficiencies in the current domestic violence screening training, emphasizing the urgent need for a more comprehensive, trauma-informed, and culturally sensitive curriculum. Recommendations include the incorporation of domestic violence education within the core curriculum and interprofessional education, survivor engagement, and challenging biases through adopting a critical pedagogy approach. These changes aim to enhance the understanding, attitudes, and practical skills of medical students in addressing domestic violence, ultimately contributing to a more inclusive and responsive medical education system.
Communication in Education – Improving Student Engagement With Mental Health Online Learning
Authors: Takao Yuki , Butler Sophie
Published: August 2024

Aims

Our mental health placement has a longitudinal design and students spend one day per week in psychiatry throughout their academic year, attending clinical placement and academic days on alternate weeks. Academic days include a small group tutorial, Balint group and self-directed learning, during which students are expected to complete a ‘virtual patient’ (VP) e-learning module. VPs align with the topic of their small group tutorial and are intended to facilitate their learning. Despite this, only a minority of students complete them. Our aim is to investigate and iteratively design interventions to improve uptake of learning.

Methods

Using an iterative process, we explored potential reasons for low student uptake by reviewing routine feedback from faculty and students; most tutors and students were unaware of the e-learning. We hypothesised that increased faculty awareness and promotion of VP could lead to an increase in student access numbers. The intervention was therefore of improved communication amongst faculty by fortnightly newsletter emails which include the topic of the academic day, explanation around what is expected of students with the website link to the VP, and other useful resources tutors may wish to use. Emails are sent by medical education administrators in the week before the academic day to all tutors. Access logs for the previous (2022–2023) and current (2023–2024) academic year were obtained so comparison could be made pre- and post-intervention.

Results

Results are available for 4 modules; thus far we are yet to see significant differences in engagement. There was a technical glitch for one module and for the other modules the difference in student access has been minimal (<5%). We also have qualitative feedback from 5/28 tutors. One was confused and thought they were being asked to do additional work, one requested for information about the VP without realising it was included in the newsletter email, and three said they found it helpful.

Conclusion

Fortnightly email newsletters is a simple and cost-effective way to possibly improve communication within faculty. It is likely difficult to promote student engagement with activities that their tutor is unaware of or perceives as invaluable. However there remain real challenges of using email as a communication tool for busy clinicians and is unlikely to make a difference as a stand-alone intervention. For future development we plan to include medical students and clinical supervisors as recipients in the mailing-list and spend time on a faculty development day to further explore this issue.
Simulated Learning for Psychotherapy: A Focus Group Study of Psychiatry Core Trainees in the North West of England
Authors: Winfield Sarah , Sharma Anju
Published: August 2024

Aims

Competence in delivering psychotherapy is a mandatory part of the core trainee (CT) curriculum, as mandated by the Royal College of Psychiatrists. CTs who are confident in delivering psychotherapy may provide more meaningful benefit for patients receiving therapy. Simulation is a well-established educational modality but is not widely utilised to teach psychotherapeutic competencies. We aimed to ascertain the views of current CT doctors regarding the use of simulation in psychotherapy training. A greater insight into learning needs would guide development of novel simulated psychotherapy educational resources. This was deemed a priority area for Simulation Based Education in the North West School of Psychiatry.

Methods

Primary data were collected from a virtual focus group of CTs (n = 3) from the North West School of Psychiatry, UK. All CTs in the region were invited to take part, participation was voluntary and informed consent was obtained prior to participation. The focus group was transcribed, analysed and data anonymised to ensure confidentiality.

Results

Participants expressed concerns about embarking on their first psychotherapy case with subthemes relating to: insufficient experience and training in psychotherapy prior to starting a case, the ability to provide an effective intervention for patients and progression through core training. Ideas for how simulated learning may help trainees develop skill in psychotherapy centred around: introductory teaching (with opportunities to watch recordings of simulated patient encounters, examples of psychotherapeutic techniques used as well as using simulation to experience psychotherapeutic supervision) and having opportunities to actively participate in, and observe, individual or group role plays. Engagement with professional actors and psychotherapy faculty during role plays was identified as a priority. Finally, the notion of an introductory Psychotherapy Simulation “one day workshop” was proposed.

Conclusion

There are many ways in which psychiatry CTs' anxieties regarding psychotherapy may be addressed. They may feel better prepared to embark on undertaking therapy clients by engaging in simulated learning opportunities: whether this be actively taking part in role plays and simulations or accessing pre-recorded content of pedagogical simulations outlining underpinning psychotherapeutic theory. The findings from the focus group will be used to inform development of a novel Psychotherapy simulation resource. This will aim to improve the quality of Psychotherapy training in the North West and foster trainees’ confidence in conducting therapy sessions. Psychotherapy faculty will also be interviewed in a subsequent Focus group. Co-production of resources with stakeholders could maximize acceptability and help to maintain ongoing engagement with the project.
Junior Doctor's Ideas, Concerns and Expectations About Electroconvulsive Therapy: An Educational Quality Improvement Project
Authors: Selwyn Victoria , Navanathan Julian , Howard Rebecca , Barcelos Yzobelle
Published: August 2024

Aims

There remains stigma surrounding electroconvulsive therapy (ECT) amongst junior doctors, as well as gaps in knowledge, recent studies have shown. The aim of this study is to reduce stigma and negative biases towards ECT among junior doctors in Hertfordshire.

This research strives to improve clinical knowledge regarding ECT amongst the same population of junior doctors.

After highlighting stigma and gaps in clinical knowledge amongst junior doctors, we aimed to implement an educational intervention to reduce these and assess the impact it made.

Methods

Over 80 doctors ranging from foundation year 1 doctors to consultants attended a weekly academic teaching for doctors working in Psychiatry. A 50-minute slot was set aside for a teaching session on ECT.

This included a pre- and post-teaching anonymous questionnaire, with open and closed questions, asking junior doctors about their previous exposure to ECT, and asking them to list three words they associated with ECT.

The teaching session included: what ECT is, indications, side effects, a short video explaining the procedure, an open discussion about stigma and ECT, a brief overview about the future of neuromodulation, and a consultant psychiatrist who is part of the ECT team talking through the before, during, after, and answering questions from the participants.

Results

31 participants answered the pre-intervention questionnaire. Of the 31 respondents, 70% reported learning about ECT during medical school. However, 40% reported little teaching and only 13% had observed ECT. From thematic analysis of free text responses, 54% of respondents expressed detailed understanding of ECT, with 71% agreeing that ECT is a humane treatment. 80% expressed that ECT should be part of NICE guidelines. 50% of respondents conveyed that stigmatised portrayals of ECT in popular culture have influenced their negative opinion of ECT.

Of the 10 responses to the post-teaching questionnaire, 100% agreed that ECT is a humane treatment and that ECT should be part of NICE guidelines for treatment of severe/treatment-resistant depression. From thematic analysis, when asked to name 3 words they associated with ECT, 60% of participants described ECT as effective or successful and 40% described ECT as safe. 72% of the words used were positive descriptors.

Conclusion

ECT is not covered thoroughly during medical school. Before this teaching, about half of the trainees expressed a negative opinion of ECT due to popular culture. Post-teaching, positive opinions had increased, and more trainees (100%) agreed that ECT is a humane treatment and should be part of NICE guidelines.
Implementing a Primary Care Referral Pathway for Further Investigations and Management of Fatty Liver Disease (FLD) in the Absence of Fibrosis Identified in Patients Who Have Undergone a Fibroscan Within the Belfast Addictions Service
Authors: Booley Zuhayr
Published: August 2024

Aims

Alcohol misuse presents a major health concern in Northern Ireland with a 50% rise in alcohol-specific deaths in the past 10 years1. Excessive alcohol use may lead to fat deposition within the liver and risks progressive liver disease secondary to fibrosis and/or inflammation. The aim is to extend upon an existent Hepatology referral pathway for patients with alcohol misuse and liver fibrosis on Fibroscan; to include onward referral to primary care for investigations of patients shown to have FLD in absence of fibrosis and facilitate early identification and intervention of associated metabolic syndromes. There was previously no referral mechanism for screening for metabolic syndromes such as diabetes, hypertension and hypercholesterolemia for these patients.

Methods

Case records were reviewed for all patients offered a Fibroscan through the Belfast Addictions service. Patients identified with evidence of steatosis on Fibroscan without fibrosis/cirrhosis i.e. liver stiffness score < 8Kpa and controlled attenuation score (CAP) > 248, would trigger an onward referral to primary care for further investigation and management. A letter was sent notifying the patients’ registered GP of the Fibroscan result and NICE recommendations for follow up liver function testing, HbA1c, lipid profile and Q-risk scoring for consideration of lipid lowering medication. A review of patients’ electronic care record (ECR) 2 months following the dispatch of letters was conducted to identify those patients who received further investigations.

Results

286 Fibroscans were conducted in the Belfast Addictions Service in 2023. Alcohol misuse was the indication for 92% of these scans with 32% identified as having evidence of fatty liver disease without fibrosis. This prompted onward referral for primary care follow up and letters were sent out to GPs from November 2023. Review of ECR 2 months post-intervention revealed of the 7 letters sent out in November, 57% (4) had follow up bloods and 75% (3) of those were shown to be deranged. Data collection is ongoing and will be complete by date of congress.

Conclusion

32% of the patients who had a Fibroscan in the Belfast Addictions service in 2023 had evidence of fatty liver disease without cirrhosis. Initial data shows a positive change in clinical practice and patient care, and builds upon the existing hepatology referral pathway.
Improving the Assessment of Memory and Cognitive Side Effects Post Electroconvulsive Therapy
Authors: Garvey Amy-May , Brady John
Published: August 2024

Aims

An April 2022 Electroconvulsive Therapy Accreditation Services (ECTAS) review of electroconvulsive therapy (ECT) services in the Southern Sector of the Western Health and Social Care Trust highlighted that the follow up of service users' memory and cognitive side effects post-ECT needed to be improved to deliver safer and more effective care. The aim of this MDT quality improvement project was to transform the follow-up process from a baseline of 13% of service users receiving memory assessment 1–2 months post ECT to 100% of service users receiving memory assessment 1–2 months post ECT over a 16 month period.

Methods

In June 2022, an MDT working group was established with key stakeholders from inpatient and community mental health services. Using driver diagrams, opportunities for improvement were collectively identified and innovative ideas proposed to overcome these barriers. The primary drivers for change were communication, resources, and education. Systems were established and PDSA cycles used to review our data and decide whether we needed to make a further change. 17 service users received ECT and were followed up within the 16 month period. Our third change brought about the most significant and sustained improvement to the process; establish ECT champions within community teams. The ECT champion's role was to improve communication between inpatient and community teams in regards to service users needing memory follow up post ECT.

Results

The introduction of three ECT champions within the community teams significantly improved communication between the inpatient and outpatient teams resulting in an improvement in the standard of care to our service users. Initial figures show 100% of service users having memory assessment follow up at 1–2 months post ECT in July 2023, October 2023 & December 2023. No service users required follow-up within the service in August/September/November 2023. Performance monitoring is ongoing as part of the service's governance meeting.

Conclusion

In conclusion, by improving communication, utilising resources more effectively and educating through ECT champions, the percentage service users receiving memory assessments at 1–2 months follow up post ECT achieved ECTAS standard of 100%. This will benefit our service users by enabling us to identify those who need further input. Looking into the future, we need to undertake a clinical audit to assess for a sustained improvement and ensure that no unintended consequences have been introduced from this QIP. We have shared our learning within the wider trust and plan to spread and scale our changes across a wider area.