bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental Health Literacy in Foundation Doctors - a Survey in the York and Humber Area
Authors: Varvari Ioana , Foster Harry , Nirodi Pratibha
Published: June 2022

Aims

We aimed to measure the baseline mental health literacy in Foundation Doctors in the Yorkshire and Humber area, identify any gaps in knowledge with the purpose of addressing these within the new foundation psychiatry teaching program, developed by North Yorkshire Health Education England.

Methods

In January 2021, a questionnaire comprising of O'Connor's Mental Health Literacy Scale was sent electronically to all Foundation Doctors in the York and Humber area, that were in a placement at that time. The O'Connor's Mental Health Literacy Scale (MHLS) has been used since its publication in 2015 and is a 35 item, univariate scale that demonstrated good internal and test-retest reliability. It covers the following attributes: a) ability to identify disorders, b) knowledge about seeking information, risk factors and etiology, self-treatment, resources and support available, c) attitudes about mental disorders and seeking professional help. The anonymized data were collected and analysed in Microsoft Excel.

Results

In total, we received 49 responses to the questionnaire. Overall, 85% of respondents demonstrated good mental health literacy. Breaking this down further, 91% demonstrated knowledge of core psychiatric diagnostic criteria, 68.4% were literate in etiology and risk factors, 92% and respectively 95.9% understand what resources for treatment and professional help are available. Importantly when looking at attitudes about mental disorders overall 17% of respondents showed a degree of stigma and barriers in seeking professional help. For example, 2% strongly agreed that mental health conditions are not real illnesses, 34.7% were unsure whether people with mental illness are dangerous, 40.9% neither agreed nor disagreed they would move next door with someone with a mental illness and 14.3% would not be willing to have someone with a mental illness marrying into the family. When looking at barriers to seeking help, 12% answered they would not tell someone if they had a mental health problem, with 16.3% unsure whether they would tell someone if they had a mental health problem.

Conclusion

Overall, our survey demonstrated good mental health literacy in our cohort, however, there are areas of improvement, the main ones being etiology, risk factors, and attitudes towards mental health. It is important to recognize these deficits, as they have been linked with poor health outcomes and barriers in seeking and providing care. Moving forward, standardization of teaching programs and anti-stigma training could be an evidence-based approach to tackling these issues.
Gender Identity and Questioning in Klinefelter's Syndrome
Authors: Cai Valerie , Yap Tet
Published: June 2022

Aims

KS is a congenital condition with 47, XXY chromosome karyotype. Due to a lack of understanding of the condition amongst healthcare providers, KS is grossly underdiagnosed, with most patients never receiving a diagnosis. Within this population, gender dysphoria is suggested to be of higher incidence than in the general population. To establish the validity of this claim and to improve care for patients with KS, particularly in the area of gender service provision, we need to identify whether there is a significant proportion of XXY individuals that experience gender dysphoria. The aim of our study is to determine whether UK patients with a diagnosis of KS are more predisposed to gender dissatisfaction.

Methods

A PRISMA literature review was conducted on the epidemiology, management, and treatment outcomes of KS patients with gender dysphoria. Based on the results of the literature review, we then conducted a cross-sectional survey of patients serviced by the Klinefelter Syndrome Association on gender satisfaction. The survey recorded 81 responses.

Results

Of the entire study population, gender distribution was 65% male, 6% female, 4% non-binary, 2% gender fluid, 3% neither, 1% equally male and female, and 1% intersex. This contrasted with most patients’ assigned birth on their birth certificate, which was 92.5% male and 3.75% female. Most patients surveyed enjoyed living as the sex written on their birth certificate (61.64%), which seemed to correlate closely with the proportion of patients that identified as male (65%).

Conclusion

Literature Review: As a whole, KS patients documented in research presented to psychiatric and sexual health services during adulthood, requesting either sex reassignment surgery or changes to hormonal replacement therapy. The sparse amount of research over a long period of time has created a reliance on outdated research techniques. Patient Survey: Survey results show that there are a significant proportion of survey respondents that do not identify as male despite it being written on their birth certificate; however, the majority prefer to be identified as male. This suggests that certain individuals with KS are at higher risk of gender dissatisfaction and dysphoria. Importantly, these observations are not substantiated with clinical judgement of a psychiatrist/mental health worker, which should aim to be incorporated in future research. Additionally, longitudinal studies should aim to establish whether certain age groups would be more at risk of gender dissatisfaction and gender dysphoria or if trends change with age.
Impaired Grid-Like Representations at Theta Frequency in Schizophrenia
Authors: Convertino Laura , Bush Daniel , Zheng Fanfan , Adams Rick , Burgess Neil
Published: June 2022

Aims

Schizophrenia is a chronic brain disorder characterised by distortion of thoughts and perception. Several studies have shown a key role of the hippocampal formation in the pathophysiology of schizophrenia. Patients show impaired theta coherence between medial temporal lobe and medial prefrontal cortex (mPFC), and impairment of knowledge structuring and inferential processes. Both the hippocampal formation and mPFC contain hexadirectional modulation of activity, indicative of grid cell populations. Grid cells play an important role in mapping the environment and are believed to represent the transition structure between task states. With other cell populations in the hippocampal formation, they play a fundamental role in inference, episodic memory, and spatial navigation. Here, we investigate whether schizophrenia is associated with disrupted grid firing patterns.

Methods

To test this hypothesis, we asked 18 participants with diagnoses of schizophrenia and 26 controls (matched for age, sex and IQ) to perform a spatial memory task in magnetoencephalography (MEG), while navigating a virtual reality environment. We first analysed theta (4–10 Hz) power during movement onset compared to stationary periods. We then source-localised the signal and looked for the hexadirectional modulation of theta band oscillatory activity by heading direction during movement onset. We also controlled for other symmetries in theta frequencies (four, five, and eight fold) and hexadirectional modulation in other frequencies. The same participants performed an inference task outside MEG, which we used for correlation analysis.

Results

The peak of theta power during movement onset was stronger in controls compared to patients (p < 0.05). In the control group, we found hexadirectional modulation of theta power by movement direction in the right entorhinal cortex (p < 0.005). This effect was absent in patients with a significant difference between groups (p < 0.05), suggesting that their entorhinal grid firing patterns may be disrupted. No other symmetry modulated theta power significantly in controls or patients, and hexadirectional modulation during movement onset was found only in theta frequencies in controls. Performance in the inference task was significantly impaired in schizophrenic patients, and spatial memory performance in both controls and patients was positively correlated with their performance in the inference task.

Conclusion

These results are consistent with the hypothesis that impairments in knowledge structuring and inference associated with schizophrenia may arise from disrupted grid firing patterns in entorhinal cortex. Although further work is needed to better understand the role of grid cells in health and disease, this work provides new insights into dysfunction of the hippocampal formation in schizophrenia.
Autonomic Dysregulation in Individuals With Psychiatric Disorders and Healthy Controls: Results From the CAP-MEM Observational Cohort
Authors: Costa Tiago , Hill Sean , Taylor Abigail , Green Anna , Black Francesca , Watson Stuart
Published: June 2022

Aims

Psychiatric disorders are associated with fatigue and with impairment to a range of cognitive domains, including executive functioning, learning, memory and complex attention. Similar impairments are seen in autonomic nervous system (ANS) dysfunction. The aetipathogenic significance of this for psychiatric disorders is unknown. The main aim of the cap-mem study was to characterize the relationships between ANS and cognitive function in a sample of none-clinical controls and people with mental health, neurodevelopmental and neurodegenerative disorders. The potentially confounding role of medication was included within this analysis.

Methods

The sample was recruited via secondary care mental health trusts. ANS function was assessed using self-report measures of ANS dysfunction symptoms (COMPASS-31) and fatigue (VAFS). Cognitive ability in various domains was measured using a validated, computerised assessment tool (THINC-IT). Psychiatric status and medication status were self-reported, and where possible, disorder severity measured using a rating scale (CGI-S).

Results

Participants with depression had a significantly higher COMPASS-31 and VAFS scores (higher being more severe), with effect sizes being medium to large. Medication did not fully explain the associations observed. Overall, participants with mental health disorders, when compared to healthy controls, had significantly higher levels of cognitive impairment. Levels of ANS dysfunction significantly and positively correlated with cognitive impairment. The severity of the psychiatric disorder significantly correlated with both ANS dysfunction (p < 0.001) and cognitive impairment. These results were found across all cognitive tests (p < 0.05), other than reaction times in the N-back test, a measure of working memory.

Conclusion

Our results show significant association between ANS dysfunction, psychiatric disorders and cognitive impairments. This is consistent with previously published data. There is now a need to understand the underlying mechanisms and the directionality of the associations. If these mechanisms are shared and relate to autonomic dysfunction, targeted treatments addressing this directly could be helpful with mental health disorders and associated burdensome symptoms, such as cognitive impairments and fatigue. This study is part of a wider project assessing cognitive ability and autonomic functioning in psychiatric populations, and investigating treatments that directly address autonomic dysfunction in psychiatric samples, such as non-invasive transauricular vagus nerve stimulation (taVNS).
Exploring School Students’ Knowledge and Expectations of Careers in Psychology, Psychiatry and Mental Health Nursing: A Thematic Analysis
Authors: Fosker Hannah , Andrews Hayley , Addison Sarah , Winter Rachel
Published: June 2022

Aims

Attracting more doctors and nurses to mental health careers is vital to support the growing demand for mental health services. Despite low numbers of doctors choosing psychiatry, and a shortage of mental health nurses, psychology degrees remain a popular choice. This study explores the understanding and knowledge students studying psychology A Level have about mental health careers, and the careers guidance they have received. We ask ‘are students who are interested in studying psychology at university an untapped resource for recruitment to psychiatry and mental health nursing?’.

Methods

Focus groups were held with A-Level psychology students considering applying to university to study psychology. Focus group discussions were recorded, transcribed and anonymised and were analysed using thematic analysis.

Results

Three key themes were identified. Firstly, student interest in psychology as a degree subject (with mental illness, neurobiology and human behaviour cited as key interests). Secondly, student motivation for a future career in which they would have a therapeutic role working with people with mental illnesses. Thirdly, student knowledge, or lack of it, around what a career in psychology or other mental health careers would entail, and the pathways to these.

Conclusion

There remains uncertainty in young people regarding what the different types of mental health practitioner roles are, and the career pathways to these. More detailed, accurate information made available to students interested in working with people with a mental illness may lead to more students considering a career in mental health nursing or medicine (and then psychiatry) as an alternative to a psychology. It is important that those aspiring to become clinical psychologists understand the qualifications required and competitive nature of this profession. Inaccurate information runs the risk of students acquiring significant university debt, only to find they are not qualified for the type of role they envisaged. A lack of accurate, high quality and timely careers information may also be depriving psychiatry and mental health nursing of enthusiastic, able and motivated students. This study adds support to the need for better careers guidance and awareness around mental health careers for school and sixth form students.
Prevalence of Workplace Bullying in the Syrian Graduate Medical Education System During COVID-19 Pandemic and Civil War: A National Cross-Sectional Study
Authors: Alchallah Mhd Obai , Alolabi Homam , Mohsen Fatema , AlHalabi Nawras , Abbas Ghadir , Latifeh Youssef , Sawaf Bisher
Published: June 2022

Aims

Workplace Bullying (WPB) is a severe stressor that can negatively impact an individual's physical and psychological health. WPB, a type of occupational violence, is the third leading cause of death in the workplace worldwide. This study delivers an estimated prevalence of bullying among healthcare practitioners in the Syrian graduate medical education system and to explore its prevalence within socio-demographic subgroups.

Methods

A cross-sectional study was conducted in Damascus, during the Syrian war crisis. A total of 478 residents and fellows fully completed the survey. Respondents completed questions regarding socio-demographic information and workplace bullying.

Results

Of 478 respondents, 267 (55.9%) were males. The majority (89%) reported being subjected to workplace bullying, and (92%) of them witnessed their colleagues being bullied. Supervisor/attendings (45%), and peer/resident (40%) were the most frequent source of perceived bullying followed by supervisor/consultant (34.5%), and Patients (33.5%). Attempts to belittle and undermine work 434 (90.7%) was the most frequently reported bullying behavior. Specific bullying behaviors were more reported by males, ＜170 cm height, ≥ 25 BMI kg/m2, and postgraduate year 1 (PGY) participants. Credible published national data regarding the number of Syrian medical residents are not available to evaluate the representativeness of our sample.

Conclusion

Many participants reported experiencing bullying in the Syrian graduate medical education programs. Enforcing anti-bullying policies, closely monitoring work environments, and encouraging anonymous reporting of workplace bullying, is crucial to eliminate these behaviors in the healthcare system. A longitudinal study should be conducted to gain more knowledge and insight into workplace bullying among healthcare practitioners.
Derivation and Validation of the Management and Supervision Tool (MaST) Risk of Crisis (RoC) Algorithm Using Electronic Health Record (EHR) Data
Authors: Patel Rashmi , Oram Jamie , Hebden Nick , Payne Zo , Morse Martin , Gadd Caroline
Published: June 2022

Aims

The Management and Supervision Tool (MaST) helps NHS mental health care professionals identify patients who are most likely to need psychiatric hospital admission or home treatment, due to severe mental illness, through a Risk of Crisis (RoC) algorithm driven by electronic health record (EHR) data analytics. We describe the derivation and validation of the MaST RoC algorithm, and its implementation to support preventative mental healthcare in the NHS.

Methods

The RoC algorithm was developed and evaluated with EHR data from six UK NHS trusts using Ordered Predictor List propensity scores informed by a priori weightings from pre-existing literature, as well as real-world evidence evaluating the associations of clinical risk factors with mental health crisis using NHS EHR data. Mental health crisis was defined as admission to a psychiatric hospital or acceptance to a community crisis service within a 28-day period. Predictor variables included age, gender, accommodation status, employment status, Mental Health Act (MHA) status (under section or Community Treatment Order), and previous mental health service contacts (including hospital admissions and crisis services). Data were analysed using Ordered Predictor List propensity scores. The algorithm was derived using structured EHR data from 2,620 patients in a single NHS trust and externally validated using data from 107,879 patients in five other NHS trusts. Qualitative and quantitative data on feasibility, acceptability and system efficiency impacts of MaST implementation were obtained through staff surveys and local audits.

Results

The factors associated with greatest propensity for mental health crisis included recent previous crisis, multiple previous crises, higher number of mental health service contacts in recent weeks, MHA section, accommodation status and employment status. The RoC algorithm identified 64% and 80% crises in its top quintile. Sentiment analysis of staff surveys suggested that the use of MaST improved productivity by reducing time taken to access patient information to support caseload management that was previously difficult to obtain through manual review of EHRs. The systems efficiency audit revealed a reduction in duration of crisis and inpatient admissions following MaST implementation.

Conclusion

The MaST RoC algorithm supports the identification of people more likely to use crisis services in NHS mental health trusts, is feasible to implement, and improves systems efficiency. EHR-derived algorithms can support real-world clinical practice to improve outcomes in people receiving NHS mental healthcare.
Decoloniality in the Psychedelic Research Space
Authors: Raphael Juliet
Published: June 2022

Aims

Since the 1950's, there has been increasing interest in the potential of the psychedelic experience to generate an enhanced state of emotional well-being in those suffering from a range of mental disorders. Following the so-called ‘War on Drugs’, much of this research was curtailed until a new surge of interest resulting in a ‘psychedelic renaissance’. This has come at a time where powerful institutions, including the medical sphere, are being asked to address their oppressive and damaging pasts; these narratives bear particular relevance to psychedelic research given the widespread use of entheogenic plants as medicines and tools for spiritual healing amongst indigenous groups worldwide, and the political history of the War on Drugs. The aim of this study was to explore how those in the psychedelic community have come to understand what it means to ‘decolonise’ this space and to situate these conversations within existing literature.

Methods

Semi-structured interviews were conducted with 10 participants who were recruited using theoretical and snowball sampling. Data collection and analysis were carried out from a critical theoretical standpoint, further borrowing from aspects of constructivist grounded theory methodologies. This involved open coding of existing literature to devise an interview guide, followed by coding of interview transcripts to generate several key themes as they emerged from the primary data.

Results

Analysis of the data generated 8 sub-themes, which were then combined to create the 4 main themes;

•

The Making of a ‘New’ Medicine

•

Scientism and Spirituality

•

Appreciation vs Appropriation

•

Beyond Decriminalisation

A theoretical framework which sought to bridge decolonial and social justice approaches was used to understand how participants made links between these two related but distinct concepts. Foucauldian theories of biopower were also explored and integrated into the discussion. Participants assigned wide-ranging meaning to the concept of decoloniality in reference to psychedelic research, though there were calls not to appropriate the term itself and senselessly apply it to any issues of injustice.

Conclusion

The study demonstrated the participants’ willingness to engage in a discussion which explored some uncomfortable truths regarding psychedelic research. There was a suggestion amongst some participants that the space can never be truly decolonised given the capitalist and neo-colonial manifestations within the current space. Future research should seek to facilitate more critical discussion of the epistemic, material, and geopolitical injustices which exist, and critical indigenous methodologies offer a meaningful way of understanding and undoing the hierarchical power structures currently at play.
Web Pages on Mindfulness-Based Interventions: A Review on the Different Training of Third-Wave Psychotherapies Available in the United Kingdom
Authors: Loo Jiann Lin , Selvakumar Jashan , Ohn May Honey , Dhandapani Asha , Soundararajan Sathyan , Ali Sahar , Gaurishankar Nikhil
Published: June 2022

Aims

With extensive evidence and track record on efficiency, third-wave psychotherapies, i.e. mindfulness-based interventions (MBIs), have gained popularity in the United Kingdom (UK) as the mainstream tool for mental health and well-being. During the COVID-19 pandemic, a lot of MBI training has shifted from physical meetings to online to improve access nationally. To date, there is limited data on the differences of online MBIs available in the UK. This web pages review is aimed to elucidate the available resources for online training on MBIs in the UK.

Methods

Google Search engine was used to identify web pages providing MBI training in the UK from February 2021 to March 2021. The search words used were “mindfulness”, “acceptance commitment therapy”, “dialectical behaviour therapy”, “DBT”, “Compassion focused therapy”, “CFT”, “England”, “Northern Ireland”, “Scotland”, “Wales”, and “United Kingdom”. The search word “ACT” was omitted due to a high number of irrelevant search results. Inclusion criteria were any web page providing mindfulness training in the English language, based in the UK. Exclusion criteria were web pages that were not from the UK with limited information and the web page was not about the provision of mindfulness training. Given the high number of web pages appearing in the Google Search for each of the localities, further search was stopped when all ten web pages that appeared on a Google search page were all excluded.

Results

The total number of web pages returned from searches was 23,030,000 of which were 13.1 million for England, 2.89 million for Scotland, 3.09 million for Wales, 2.18 million for Northern Ireland, and 1,770,000 were unspecified. Only 165 web pages offering MBI training were included. Among those, 57% were for the general public while 30% had information for both professionals and the public. The majority of them, i.e. 65% offered online training courses when only 25% of them offered both online and face-to-face training. There were 25% of web pages offering free basic courses for the public. There was a similar split between the group, individual and mixed training.

Conclusion

There is a significant amount of MBI training resources available online for both public and professionals. One interesting finding is that a significant portion of them provide free basic training which is very encouraging and certainly has a positive impact on the accessibility of mindfulness education during the pandemic disruption.
Incidence of Smoking Rates and Relapse During the COVID-19 Pandemic
Authors: Sinha Pratyaksha , Hammoud Mais
Published: June 2022

Aims

Along with the numerous structural and cultural changes in healthcare brought about by the COVID-19 pandemic has had an overwhelming psychosocial impact on marginalized communities. Those with substance use disorders (SUD) are a particularly vulnerable group as they are more susceptible to infections and now have less access to healthcare. Smoking cigarettes is known to increase risk of respiratory tract infections due to suppression of respiratory function and impairment of the immune system. It is important to study the smoking rates and relapses over the course of the pandemic to observe whether the increased risk of COVID inflection in smokers and the psychosocial stress of the lockdown have affected the behavior.

Methods

We searched databases including PubMed, PsycArticles, and Cochrane Library using applicable keywords for Substance-Related Disorders, Smoking, and the COVID-19 pandemic lockdown. 69 articles from the results were reviewed, out of which 1 was a meta-analysis and 1 was a systematic review. Other reviews and papers were also consulted to consider case studies and smaller group analyses.

Results

The results of the analysis showed that COVID-19 lockdowns have been negatively affecting those who struggle with substance use disorders, especially that of tobacco use. Evidence suggests a surge of addictive behaviors (both new and relapse) including behavioral addiction over the two years. Recent studies have noted an increase of tobacco use during the pandemic. In some studies, smoking frequency numbers remained stable, and quit attempts decreased.

Conclusion

The psychosocial changes brought on by the pandemic have increased the incidence of smoking frequency and relapse in ex-smokers. This might be due to the increased financial, social, and physical stress, and due to the increased difficulty in accessing healthcare services due to the lockdown. Other stressors contributing to increased smoking could be the stress of contracting a fatal disease, possibility of loss of employment, prolonged confinement, and feeling of boredom. Smoking-related behaviors also increase the risk for contracting the infection due to frequent physical interactions to purchase cigarettes, hand-to-mouth contact when smoking, and increased use of communal smoking places. COVID-19 and addiction are the two pandemics which concurrently can cause a major public health threat. It is important to make the public aware of the increased COVID-19 infection risk attributed to smoking. Hospitals should also resume de-addiction services and provide easy access to advice, support, and pharmacotherapy to those in need.
Self-Rating Recovery in Forensic Settings: Associations Between Patients Views of Their Own Recovery, and Measures of Violence Risk and Symptoms
Authors: Synnott Caroline , Rock Catherine , Amin Hania , Mhuricheartaigh Eimear Ni , Kennedy Harry G , Davoren Mary
Published: June 2022

Aims

The aim of this study was to ascertain the correlations between patients’ views of their recovery and clinicians’ views of patients recovery, symptoms and risk, in a cohort of patients in the National Forensic Service Dundrum (NFMHS).

Methods

A cross sectional study was performed of all inpatients in the NFMHS Dundrum. The self-rated Dundrum tool was offered to all 96 in-patients and completed by 64. Clinican rated measures of violence risk (HCR-20), programme completion (Dundrum-3), recovery (Dundrum-4), symptoms (PANSS) and functioning (GAF MIRECC) were rated. ANOVA and concordance ratings were calculated using SPSS

Results

A total of 64 patients agreed to participate, of whom 10 were female. The self-rated Dundrum-3 correlated with the staff rated Dundrum-3 (0.471, p < 0.001). The self-rated Dundrum-4 correlated with the staff rated Dundrum-4 (0.373, p = 0.003). The self-rated Dundrum-3 correlated with the HCR-20 total (0.0352, p = 0.005), HCR-C (0.3677, p = 0.004), and HCR-R (0.301, p = 0.018). The self-rated Dundrum-3 correlated significantly with GAF occupational (-0.273, p = 0.48), symptomatic (-0.299, p = 0.03). The self-rated Dundrum-4 correlated only with the GAF symptomatic (-0.333, p = 0.05). The self-rated Dundrum-3 correlated with PANSS positive (0.457, p = 0.001), PANSS negative (0.514, p < 0.001), PANSS general (0.395, p = 0.004) and PANSS total (0.352, p = 0.005). The self-rated Dundrum-4 correlated with PANSS positive (0.356, p = 0.01) and PANSS negative (0.413, p = 0.002).

Conclusion

There was good correlation between patient and clinician ratings of programme completion and recovery. Patient self-ratings of programme completion and recovery correlated with staff ratings of functioning and symptoms. The directions of agreement were correct
MDT Clinics on a General Adult Acute Psychiatric Ward: Staff's Views and Person-Centred Care
Authors: Alalade Ademola , Siddiqui Zaha Kamran , Jong-Nam Yiu , Lekka Nikoletta
Published: June 2022

Aims

Person-Centred Care (PCC) focuses on knowing the person behind the patient, engaging them as an active partner in their treatment, encouraging self-management and shared decisions. Inpatient multidisciplinary (MDT) clinics offer an opportunity for PCC by working collaboratively with service users (SU) in developing care plans. The aims of this project were to explore staff views and levels of satisfaction regarding the running of MDT clinics, to assess the quality and efficacy of changes made to MDT clinics, and to identify areas of practice which need improvement.

Methods

In April 2021, MDT meetings of an acute inpatient clinical team were repurposed to 30-minute clinics with SU and relevant key professionals present, focusing on SU needs. Two staff surveys were completed in June and October 2021. Following the first survey, changes were made to the days clinics were run, attendance schedule, and staff allocation of responsibilities for efficient clinic running. In the second survey, a 14-question questionnaire was sent to all 48 staff members. The questions explored staff experience of MDT clinics. The measures were both qualitative and quantitative.

Results

The overall response rate was 31.25%, of which 40% by medical and 40% by nursing staff. Staff reported there was a positive impact in the collaborative development of care plans, including improved SU involvement, increased involvement of families, improved contribution from different professionals, and formulations providing greater insight. They reported improved task orientation, directed responsibility for task completion within the team, and enhanced role and responsibility of the named nurse. They thought there was less time for 1:1 work, but that the “overall benefits are worth it”. Improved relationship with SU was reported by 85%, increased engagement with SU care by 93%, and identifying clear goals for care plans by 93%. Nevertheless, problems with planning and logistics were reported by 77%. Main challenges included time management especially with external visitors or combination of remote and face-to-face attendees, relatively poor attendance of CMHT and family members, difficulties with informing and preparing SU ahead of their clinic times, number of attendees, and dissemination of MDT care plans.

Conclusion

Repurposing MDT meetings to MDT clinics focusing on SU needs has a positive impact in inpatient clinical practice. MDT clinic planning and improving the involvement of community teams and family members can contribute to an optimal purposeful inpatient admission. Conducting inpatient MDT clinics can be a crucial part of working collaboratively with SU and PCC.
Urine Testing in a Local Drug and Alcohol Service: How Has the COVID-19 Pandemic Affected the Frequency of Urine Testing in Patients With Opiate Addiction?
Authors: Barker John , Lagundoye Olawale , Nield Thomas
Published: June 2022

Aims

When a dependant opiate user seeks help from a substance misuse service, it is vital that some form of drug testing is conducted. This is commonly a urine test and will show the patient's drug use over recent days and is used as a basis to guide treatment. All patients should have a urine sample collected and tested on the same day as their initial appointment, however, we hypothesised that the switch to remote consultations would have reduced the number of urine tests conducted post-pandemic.

Methods

All the patients initially assessed by the substance misuse services for treatment of opiate addiction within the Sheffield Health and Social Care NHS Foundation Trust between 01/03/19 (1 year prior to the pandemic) and 01/03/21 (one year after the pandemic).

The resultant sample contained 1403 patients: 739 patients were referred to Sheffield substance misuse services prior to the start of the COVID-19 pandemic; 664 patients were referred to Sheffield substance misuse services during or after the start of the COVID-19 pandemic.

An algorithm was developed to allow interrogation of the electronic notes to record whether or not urine samples were taken and recorded in the relevant section of the patient's electronic record. This information was then transferred to an Excel spreadsheet.

Results

The proportion of patients who had a urine test on the same day as their initial appointment was significantly higher in the year prior to the pandemic (79.0%) than the subsequent year (35.8%).

Conclusion

36% of the sample in the year subsequent to the pandemic had a urine test the day after their initial assessment, rather than on the same day. This delay in urine analysis can be attributed to the large number of initial appointments being conducted via telephone during the COVID-19 pandemic. This led to a delay in getting patients into clinic to give a urine sample. However, the remaining 64% of patients had no sample recorded in their notes in the appropriate proforma. Suggestions for improvement are to include a session on urinalysis as part of the weekly CPD to drive an improvement in this score back to pre-pandemic levels.
Admission Clerking- Inpatient Adult Psychiatric Unit - a Quality Improvement Project
Authors: Dhandapani Asha , Rajan Sathyan Soundara , Salmoiraghi Alberto , Sambhi Rajvinder , Baker Catherine , Kendrick Joanne , Stewart Sherrie
Published: June 2022

Aims

To improve the clerking proforma and physical healthcare for General Adult Psychiatric inpatients in Heddfan Psychiatric Unit, Wrexham by 100% within 18 months period with a long term goal of continuous improvement.

Methods

We started the project with a baseline audit which showed the incompleteness of vital data when clerking a patient in adult psychiatric inpatient unit. This was compared with various standards from Core competencies for a trainee in Psychiatry, NICE guidelines and Local trust policy from our own trust BCUHB for physical health monitoring and Department of Health Guideline for VTE.

With the findings obtained, we went ahead to create a proforma encompassing all the details.

The use of various Quality improvement tools such as Fishbone diagram, Drivers diagram and PDSA cycles gave as overwhelming results

Results

The baseline audit, repeat audits and PDSA cycles have shown tremendous and overwhelming results in terms of completion of the proforma. This has resulted in mandatory details being inputted sufficiently in the patient's notes.

Many of the important details such as medication details, allergy status, legal and forensic status, mental state examination, risk assessment, VTE assessment, investigation details and documentation have shown to have improved during this 1 year

Conclusion

This QIP has been patient centred as this is the main goal. Following the PDSA cycle, we have identified that it has been efficient and effective. It has been safe and also reduced the chances of patient neglect. The structure of the proforma used does not discriminate or show any inequalities and is timesaving too.

The SWOT analysis has been completed, which has shown that the teamwork and support from the Consultants and other stakeholders have been a major strength. There are a few weaknesses such as unavailability of ECG machine, missing documentation of investigations despite completing them but however with timely education to the junior doctors, we are hoping for improvement further. This QIP has opened up doors for various opportunities, such as including nursing and pharmacy admission forms into this proforma. Though there are few threats in achieving 100% success, we are hoping for the best
Introduction of the Buddy Scheme to First Year Core Trainees (CT1s) in the West Midlands Deanery
Authors: Burlingham Amy , Eltagy Louay , Shanmugaratnam Hari
Published: June 2022

Aims

Following a reflective session in the Birmingham MRCPSYCH course organized by West Midlands Deanery, CT1s identified the need for an informal peer support mechanism that bridged the gap between what is expected of them and the challenges of adjusting to the training scheme. This need became even more apparent during the COVID-19 era. This led to the creation of the buddy scheme. The main aims of the scheme are to design and develop a sustainable mechanism by which core trainees in higher years can support their year 1 counterparts informally, ease the transition of CT1 trainees into training and eliminate obstacles to success and reduce the differential attainment that hinders international medical graduates’ (IMGs) outcomes.

Methods

The pilot phase started on August 2020. During this phase 3 trusts in the West Midlands were approached to share in the scheme. A fourth trust already had their own local buddy scheme. Only 1 trust shared in the process at the beginning and a second one joined later. The scheme was coordinated by the local Post Graduate Medical Education Departments in the respective trusts. All CT1s newly joining the training program were paired with a more experienced core trainee (CT2) who had their respective job the previous year. Next phase started in August 2021. During this phase all 3 trusts shared in the scheme from the beginning. A training session on the expectation from CT2s was conducted for them. A higher trainee was allocated to coordinate the process for each trust. CT2s were advised to meet their buddies at least once a month in the first 3 months.

Results

A total of 24 CT1s shared in the pilot phase. All of them found the training either good or very good. 57% of CT1s found the scheme helpful in easing the transition into training and made them more confident in fulfilling their role. Most of them communicated with their buddies 1–2 times in the pilot phase. In the second phase around 40 CT1s shared in the scheme. Around 80% of CT1s found the scheme helpful and recommended that it continues. There was more contact between buddies at this stage.

Conclusion

All trainees found it easy to approach their buddy and would consider becoming a buddy next year. The most discussed topics were portfolio, work-place based assessments, expectations of the day job and on-call duties, followed by exams and end of year assessments (ARCP).
Reducing the Pressure on Mental Health Team by Improving Post-Discharge Follow-Up of Self-Harm or Suicidal Patients in Primary Care
Authors: Imtiaz Nafiz , McLaughlin John
Published: June 2022

Aims

Northern Ireland has had the highest suicide and self-harm rate in the UK since 2012 according to National Statistics Office with 12.5 deaths per 100,000 population compared to 10.5 in the rest of the country. Evidence shows that the risk of suicide hugely increases following self-harm, and the greatest risk is immediately after the self-harm episode. Better access to health care, especially to primary care, in this period, can actively reduce the risk to this vulnerable patient group. Patients assessed for self-harm in the emergency department are often followed up by the mental health/crisis team. Due to lack of resources and staff shortages this is often not possible in a timely fashion. NICE suggests that patients should be offered a follow-up appointment in primary care within 48 hours of discharge. We aimed to ensure 70% of patients discharged from secondary care following an episode of suicidal ideation or self-harm are contacted proactively by mental health practitioner (MHP) or GP within 48 hours of communication from secondary care.

Methods

The project underwent two PDSA cycles. An electronic workflow was created to provide easy patient identification, assessment and follow-up. A process mapping was done after discussion with the GPs, administrative team, practice nurses and MHP. Outcome was measured by finding out percentage of patients: 1) Contacted within 48 hours of communication following an episode of self-harm 2) Appropriately coded 3) Comprehensively assessed 4) Risk stratified and minimized following each cycle.

Results

Over a period of three months, following two PDSA cycles, the frequency of these contacts increased from 0 to 80% (median) with an average 3.8 (83%) patients reviewed per week. The patient experience and satisfaction also improved significantly.

Conclusion

General practice (GP) has long been known as the next of kin for patients in the health care system. As GP is mostly the first point of contact for the patients, it can contribute significantly to ease the rising pressure on the mental health team. Also, a small number of weekly contacts from each GP can make a huge difference in nationwide patient safety and experience. We hope this intervention will significantly improve patient safety and reduce further self-harm presentation to ED in the long run.
The HDAT Helper - Developing an Online Tool to Improve the Safety and Accuracy of Antipsychotic Prescribing
Authors: Lawrence Christopher
Published: June 2022

Aims

High Dose Antipsychotic Therapy (HDAT) prescriptions and combinations of antipsychotic agents are not currently recommended as standard practice by the RCPsych. College guidance (RCPsych, CR 190) advises that there is “little convincing evidence that off-label prescription of doses of antipsychotic medication above the licensed dosage range has any therapeutic advantage in any clinical setting” and that “any prescription of high-dose antipsychotic medication should be seen as an explicit, time-limited individual trial with a distinct treatment target”. Despite this, both national and local data demonstrate that HDAT has continued to be used regularly across psychiatric inpatient settings, often out of hours and often secondary to the use of PRN Antipsychotics, without a clear treatment plan or rationale. My aim was to create a simple, accessible, online tool that would allow prescribers to quickly and efficiently calculate the BNF percentage of any antipsychotic prescription and that this will enable safer prescribing.

Methods

With the support of a web-developer, I developed an online tool quickly and easily calculate antipsychotic BNF percentages. The tool can be found here: www.hdat.co.uk

Results

The HDAT Helper has been well received at local presentations and I have recently gained the support of senior management at Southern Health NHS Foundation Trust to develop an education programme on HDAT and the HDAT Helper to expand use of the tool across Southern Health.

Conclusion

The current expert guidance, clinical research and my own audit work demonstrates that there are ongoing issues with the prescription of high dose antipsychotics and that at times this occurs inadvertently when different agents are combined.

I believe that the HDAT Helper can make prescribing of antipsychotic agents clearer and more efficient and as a result significantly improve patient safety.
Introducing an MDT Morning Huddle on an Adult Inpatient Unit During the COVID-19 Pandemic
Authors: Parmar Sita , Pierscionek Tomasz , Souchon Helen , Thompson Naomi , Shahzad Amina , Koshy Rithika , Marks Nokuthula , Doku Victor , Veeramah Saraspadee
Published: June 2022

Aims

This quality improvement project aimed to introduce a staff communication tool, ‘the morning huddle’, to Goddington ward (Green Parks House, Oxleas NHS Foundation Trust). The huddle's purpose was to share key information between members of the ward's multidisciplinary team (MDT) regarding patient risk, diagnosis, mental state and treatment progress.

Methods

The project team worked with the Oxleas Quality Improvement (QI) team to create a structured huddle with agreed goals that commenced at 9am each morning. The team sought views from ward staff on the existing communication process before implementing the huddle via a series of weekly questionnaires. The morning huddle was introduced on 26th May 2020 and all members of the team were invited (including the ward consultant, junior doctors, ward manager, nursing staff, healthcare assistants, psychologists, occupational therapist, and ward administrator).

Following multiple PDSA (Plan, Do, Study, Act) cycles, the team further refined the morning huddle into a meeting with a set template that included COVID-19 test results, psychiatric risk concerns, medication adherence, and barriers to discharge. The project team also timed the huddle, aiming for it to last a maximum of 30 minutes. A questionnaire was distributed to ward staff weekly after the huddle was implemented to ascertain their views on the process. Data collection for the project ended on 2nd August 2020.

Results

The project's main outcomes were based on two questions from the weekly staff questionnaire:

1. “How effective did staff members find the morning huddle in addressing their concerns about patients and promoting safety of patients and staff?”

This improved over the course of the project, starting with 20% of staff finding the huddle “good” or “very good” in its effectiveness to 77% finding it “good” or “very good” in the final questionnaire.

2. “How effectively do staff feel that their concerns about patients are addressed by the rest of the team?”

This also improved, starting with 40% of staff selecting “well” or “very well” to 100% in the final questionnaire.

Conclusion

Goddington ward introduced a huddle that was valued by the entire MDT. The huddle improved how well staff felt their concerns about patients were addressed and a noticeable improvement in team morale was observed. While the project succeeded in implementing a huddle that staff appreciated, patient outcomes also need to be considered in future