bluuebunny/crossref_metadata_2025 huggingface dataset:
Progression and Retention of Psychiatric Trainees in Wessex
Authors: Clough Zoe , Phiri Peter , Graves Lizi , Deshpande Mayura , Hazelgrove Jane
Published: July 2023

Aims

To explore factors influencing the progression and retention of Psychiatric trainees in training posts within the Health Education England Wessex region. Specifically: To understand what trainees value most in their training; to determine the degree to which trainees feel supported and valued in their training; to determine self-reported burnout measures in trainees; to understand factors that have a negative impact on training experience; to understand factors that are important to trainees when considering future job roles.

Methods

Online questionnaire survey, capturing both qualitative and quantitative data, open to all Wessex Psychiatric trainees and doctors who had left or completed a Wessex Psychiatry training scheme since 1.1.2018. Responses were collected between 7.6.2021 and 31.7.2021. The survey included a burnout scale, questions about how supported and valued trainees felt during training, and questions regarding career intentions. This project received approval from the Health Research Authority (IRAS 296985).

Results

•

50 participants completed the survey and were included in analysis.

•

38% were at risk or high risk of burnout.

•

Trainees felt more supported and valued by individuals such as clinical supervisors (70% felt well or very well supported and valued) than by organisations (41% felt well supported and 34% felt well valued by their Trust and Deanery).

•

Trainees rated ‘work-life balance’ as the thing they valued most in training (64%).

•

Poorly resourced services, trainee workload, lack of role models, experiences of aggression, and defensive practice of seniors were cited as reasons trainees considered leaving Psychiatric training.

•

The three most important factors cited by participants when considering a consultant post were ‘Position available with flexible working’(62%), ‘Position available within a supportive team of colleagues’ (54%) and ‘Positive experience working in the Trust as a Trainee’ (46%).

•

81% of higher trainees wished to work less than full time in a consultant position once they had completed training.

Conclusion

Flexible working arrangements and work life balance need to be considered in workforce planning. Measures to reduce burnout in psychiatric trainees need to be pro-actively explored by employing Trusts and Deaneries. Mentoring schemes, facilitation of peer support, and clear processes for how to raise concerns regarding supervision are recommended to enhance support for trainees. Junior doctor awards, improved feedback between Trusts and junior doctors and engagement of the Trust board with junior doctors are proposed to improve the sense of value trainees feel. Positive experiences as a trainee are likely to improve retention of local trainees into the local consultant workforce.
Psychodynamic Psychiatry Education and Training for Trainee Psychiatrists
Authors: FitzGerald James , Bo Lorna , Arends Fraser , Peters Pamela
Published: July 2023

Aims

Psychodynamic psychiatry training seminars are a blended supervision and experiential style approach to training health care professionals in reflective practice and formulation. They apply psychodynamic theory through case formulations, seminars, and Balint groups so that health care staff can improve their communication style, formulation skills and enhance their appreciation for patients with complex mental health problems. Our aim is to evaluate the provision of our psychodynamic psychiatry training sessions for psychiatry trainees in the Cambridgeshire and Peterborough NHS Foundation Trust, and to evaluate the perceived benefits of attending in terms of personal and professional development.

Methods

The evaluation used a standardized mixed-methods approach, with the sample consisting of psychiatry core trainees as part of the regional MRCPsych course. Sessions were delivered via an online format. The evaluation period was between November 2021 and January 2023. Data were gathered via a survey tool, adapted from the literature using Likert scales and free text questions to identify barriers and facilitators to the sessions.

Results

The survey collated data from thirty-seven core trainees ranging between CT1 to CT3. The majority of participants (> 90%) scored the sessions positively across the board in terms of the content of session material, length of training, and quality of delivery. The majority of attendees felt the sessions focused on the relevant clinical issues (97%), were relevant to their training (95%), and felt the group was a safe place to express and process anxieties and frustrations about their work (89%). Notably, the majority either agreed or strongly agreed the group had changed the way they think and practice (91%), including an appreciation of the emotional and symbolic aspects of patients' presentations (89%).

Conclusion

This evaluation reports early findings on psychodynamic psychiatry teaching for psychiatry trainees. Overall, the participants felt the sessions were relevant to their training and improved their personal and professional development. Key benefits of the sessions included increased insight into the emotional and symbolic aspects of the patient's symptoms and clinical issues, team working through cohesion, and the humanity of the doctor in the clinical relationship with the patient. This suggests that the sessions provide a much-needed space to process and reflect on the often-intense demands of clinical work and training. The main theme within barriers to the group processes was external in terms of other clinical demands requiring prioritization.
The Postcard Project: Improving Healthcare Staff's Knowledge of Good Quality Medical Care for Older Adults in Mental Health services
Authors: Franklin Lauren , Chubb Rebecca , Mulroy Rachel , Mander Louisa , Katandawa Nigel , Howe Camilla
Published: July 2023

Aims

Older adults in mental health services often have complex physical health needs, due to multimorbidity and frailty. Staff working in these services may not feel well-equipped to manage these needs, leading to symptoms being missed or unnecessary investigations. The authors designed written educational resources for healthcare professionals working across older adult services, both in hospital and the community. The Postcard Project aimed to improve staff knowledge of the physical health needs of older adults and encourage good quality, evidence-based care.

Methods

Twelve postcards were created focusing on twelve concepts of caring for the physical health needs of older adults within psychiatry services. These topics were highlighted as potential areas of staff weakness, the staff themselves, and a survey conducted prior to the project. The postcards contained key evidence-based information about the chosen topic, summarised in less than 7 bullet points, and provided links to relevant, digestible resources, such as up-to-date guideline summaries and podcasts. The postcards were released monthly and distributed via email and physical copies. A survey was carried out before the project via a Microsoft Form, where respondents ranked their confidence in their knowledge on different topics relating to the care of physical health in older patients, with 1 being not confident at all and 5 being very confident.

Results

57 people responded to this survey, including nurses, doctors, and other members of the multidisciplinary team. This survey showed a large discrepancy between different topics and staff's confidence. Staff were confident in identifying the symptoms of a UTI (83% confident) and fall prevention (79%). However, they were less confident with their understanding of CRP blood results (46%) and their ability to identify an Acute Kidney Injury (23%). Data are still being collected as to whether this project improved staff knowledge of these key concepts.

Conclusion

Staff in older adult mental health and community services were not confident with certain key aspects of good quality medical care of elderly patients before this project. The level of confidence varied between topic and profession. This project aimed to improve staff knowledge on the weaker topics, however, without the post-project survey data, it is not yet clear as to whether this project improved the knowledge of staff.
Equality, Diversity & Inclusion in the Workplace: Exploring the Experiences of Psychiatry Trainees Across the North West of England
Authors: Ozidu Victoria , Hosein Claire-Marie , Sparasci Oli , dos Santos Catarina Rodrigues , Inkster Clare
Published: July 2023

Aims

Everyone in the NHS deserves to work in an environment that is safe, welcoming, and free from discrimination, however recent surveys have highlighted that this is often not the case. Alarmingly, it has been recognised that few psychiatrists report any forms of discrimination and of those who have, there is often dissatisfaction with the response received from their employer. Due to a paucity of data relating to the experiences of psychiatry trainees in the North West, we sought to understand their lived experience and to co-design proposals for future work that may improve the status quo.

Methods

All psychiatry trainees across the North West of England in 2022 and early 2023 have been invited to complete an electronic, core training or sub-specialty specific higher training survey. Basic demographic details were collected. Respondents were asked a range of questions around their experience of discrimination in the workplace and good practice observed in managing this. Subsequently, each group of higher sub-specialty trainees were invited to a two-hour reflective session held face-to-face or via an online platform. Two further reflective sessions were arranged in Liverpool and Manchester for core trainees. During reflective sessions, attendees were presented with vignettes of workplace discrimination, developed from the results of the initial survey. Session facilitators guided a discussion on the feelings evoked by each vignette, whether attendees wanted to discuss their lived experience of similar incidents and to consider ideas for what may be done to support a trainee in these situations. A post session questionnaire was circulated.

Results

Over 100 individuals have completed the pre-session survey and attended a reflective session. Survey respondents were predominantly trainees who identified as Asian, Asian British, Black, Black British, Caribbean or African ethnicity, with a roughly 50:50 split between Male and Female.

Themes highlighted include:

That the vignettes used in the reflective sessions are representative of everyday workplace discrimination.

That training in microaggressions should be given to trainers, trainees and other clinical staff on a regular basis.

That the burden of managing discriminatory behaviour should be on the institution and not the trainee experiencing discrimination.

Conclusion

Many psychiatry trainees across the North West have lived experience of workplace discrimination and systems need to be implemented to improve trainees’ experience. Proposals for future improvements; such as the formation of a deanery wide reporting and management system for trainees who have faced workplace discrimination; are being co-developed to address current challenges.
INSIGHT: Evaluation of the Psychological Medicine Student Placements at HMP Berwyn, North Wales: Year One Findings
Authors: Nafees Sadia , Matusiak Jakub , Taylor-Clutton Andrea , Newman Simon , Poole Rob
Published: July 2023

Aims/Background

Social determinants of health (SDOH) are social factors that have a causal role in ill health and have an adverse effect on health outcomes. SDOH are part of the UK medical student curriculum but mainly discusses epidemiologically. There are few educational approaches that aim to incorporate an understanding of SDOH into the experiential and competency-based elements of undergraduate medical education. Prisoners are a population who experience high levels of stigma, social adversity and health disadvantage. Clinical attachments in prison may teach students about the impact of SDOH in a vivid and memorable way. Aims: We aim to explore changes in medical students' knowledge/attitude towards SDOH during and after psychiatry placements at HMP-Berwyn prison.

Methods

All year four medical students on psychiatry placement in North East Wales during 2021–2022 participated. In each of the six placement cohorts, one student did their psychiatry placement in prison. All the other students visited for one day. All students participated in two seminars focused on their prison experience and SDOH in psychiatry. Baseline and mid-placement bespoke questionnaires were completed, and all students participated in end-of-placement individual interviews.

Results

29 students participated. Student assessment of the importance of SDOH did not show a significant change between baseline and mid-placement. However, student attitudes to experience in prison became more positive at end-of-placement. Comparing baseline to mid-placement questionnaires showed a 14% increase in students' rating of prison placements as educationally beneficial. 14% of students mentioned improved confidence in dealing with challenging patients, and 28% commented on the benefits of exposure to incarcerated patients. Interestingly, only 3% of students considered hospital placement more beneficial than prison placement. Prison placement was considered an exceptional experience than other settings by 17%.

Conclusion

There are no previous UK empirical studies on medical student placements in prison. Overseas studies identify reduced anxiety over dealing with demanding patients. Our findings so far lack statistical power but show positive satisfaction and knowledge trends amongst participants. Prison placement appears to be acceptable and educationally valuable. It offers opportunities for experiential teaching about SDOH. In addition, it may improve student understanding of a marginalised and stigmatised population.

Implication for practice, policy and research

On completion, this study may provide evidence on one method of improving attitudes toward marginalised people and understanding SDOH in the medical profession.

This research was funded by Betsi Cadwaladr University Health Board and sponsored by Bangor University.
Improving the Interface Between Substance Misuse and Mental Health Services by Equipping Junior Doctors Working Within Mental Health Services, With Tools to Help Improve Competence in Assessment and Management of Dual Diagnosis(co-Occurrence of Substance Misuse and Mental Health problems)
Authors: Samad Samreen , Dugmore Lois , Hurton Nicola
Published: July 2023

Aims

Dual diagnosis (i.e. co-occurrence of substance misuse and mental health problems) is a norm rather a rarity making it vital for service users to receive high quality, patient focused and integrated care. That being said, patients with dual diagnosis often feel excluded from services with neither of the services taking overall responsibility. Lack of broad spectrum of expertise required to treat both conditions, has been identified as reason for gaps in service provision where NICE guidance emphasizes the need for staff training and supervision. This was highlighted during survey with doctors in LPT as baseline assessment to assess training needs. This project aims to upskill junior doctors in the assessment and management of patients with Dual Diagnosis by delivery of a training package to each round of junior doctors during the induction period. The training package includes an ebook as pre-requisite for attending induction followed by teaching and short video clip. The training module aims to:1)afford junior doctors the opportunity to assess and manage patients with dual diagnosis effectively. 2) minimise prescription errors, missed diagnosis and missed referrals to substance misuse services 3) improve compassion and reduce stigma

Methods

Training package was delivered to new cohort of junior doctors Jan 2023during their induction period.

We used pre teaching and post teaching questionnaires a means to measure the change in level of confidence that the junior doctors experienced across three domains:

1.

Assessment of service users for substance misuse

2.

Using validated tools for screening of service users for substance misuse

3.

Making referrals to appropriate services using substance misuse pathway.

Results

14 responses have been collected from junior doctors to date.

There was an improvement in level of confidence from across the three main domains.

In carrying out assessment for substance misuse, 86% reported “somewhat confident” (after teaching) compared to 7.1% (before teaching).

In using validated tools, 78% reported “somewhat confident” (after teaching) compared to 7.1% (before teaching).

In making referral to substance misuse services, 64% “somewhat confident” (after teaching) compared to 14% (before teaching).

Conclusion

The training package helped in improving the confidence level of junior doctors in carrying out assessment , using validated tools and making referral to substance misuse services. However, whether this translates to making them adept at assessment and management of substance misuse will need to be corroborated by measuring prescription errors and number of referrals to substance misuse services.
Experience and Well-being of Trainees in a Rural Mental Health Trust
Authors: Huntington Kate , Rajkumar Beena , Titova-Chaudhry Elena
Published: July 2023

Aims

Trainee doctors may find it difficult to express their thoughts and feelings concerning their workplace experience. It is important to gain feedback on their experiences allowing potential issues to be addressed and rectified. Identifying and managing concerns at an early stage with the provision of support may have a positive impact on trainee well-being and workforce retention in the future. This project aims to survey trainee doctors working in a rural mental health trust (Lincolnshire Partnership Foundation Trust - LPFT) on aspects relating to their experience, well-being and effect of rurality. This may allow greater insight into issues affecting trainees and allow improvements to be made.

Methods

An electronic survey, created on the website SurveyMonkey, was distributed to 43 trainee doctors within the LPFT. This sample represented all the trainees on placements in Lincolnshire.

Results

Twenty-three out of forty-three trainee doctors (53.49%) submitted responses. Analysis of responses showed some common themes of trainees reporting on supportive workplace supervisors and good relationships with staff in general. Other key findings highlighted those living a greater distance from their workplace found longer commutes difficult, especially if there was reliance on public transport. This had a significant impact on stress levels and well-being. Some trainees reported feelings of loneliness, conversely, other trainees felt fulfilled and settled in their current training programme.

Conclusion

This survey identified both positive and negative factors affecting the experience and well-being of trainees. Despite some long commutes, isolation from family and friends and other stressors (exams, fuel costs), positive factors were recognised. This included good supervisor support and relationships. Overall, 78.26% of trainees reported they felt the benefits of their training in the LPFT outweighed the drawbacks. However, it is important to recognise these conclusions are drawn from trainees responding to the survey and are not necessarily fully representative of all trainees’ perspectives.
Service Evaluation of Medical Undergraduate Psychiatry Placement
Authors: Zahreddine Nada , Beezhold Julian , Axford Jenny , Adebayo Ayomide , Theruvath-Chalil Rahna , Jenkins Oliver , McCormack Kristian , Abrar Sohail
Published: July 2023

Aims

There are no clear guidelines for the optimal organisation of psychiatry placements for medical undergraduates. Moreover, the UK needs to enrol more psychiatry trainees. This service evaluation aimed to show that an efficient psychiatry placement can improve attitudes of students towards psychiatry and increase their likelihood to choose psychiatry.

Methods

We evaluated the efficacy of a new strategy for the psychiatry placement of 24 fourth-year medical students from the University of East Anglia during the academic year 2021/2022. The strategy consisted of having a 4-week placement in one of 3 wards at the Norfolk and Suffolk Foundation Trust Woodlands Unit (PICU, acute male and female wards) with brief (one- to two-day) rotations across the wards, as well as the community team and individual areas of interest. This afforded students exposure to different settings, pathologies and levels of severity, with enough time in one service to allow integration into the team, participation in clinical and therapeutic activities and most important, observation of patient longitudinal improvement. Multidisciplinary teams were included by presenting the training as a win-win, and we relied on a good teaching culture at our Trust. We also offered a programmed induction day, a mid-placement meeting and an end-of-placement debrief. We evaluated the efficacy of the strategy using the Attitude Towards Psychiatry Questionnaire before and after the placement, as well as measuring overall satisfaction.

Results

The overall satisfaction score on a 5 point Likert scale was very good (M = 4.58; SD = 0.58). Mean ATP total score significantly improved from 116.50 (SD 9.49) to 133.00 (SD 8.68) over a maximum attainable score of 150 (F(1;23) = 69.70, p < .001, ηp2= .75), with 23 out of the 30 items having significantly improved individually as well. The reliability of the scale was high with a Cronbach's alpha of .81 before and .84 after the psychiatry placement. The question “I would like to be a psychiatrist” improved significantly from 2.54 to 3.25 on the 5 point Likert scale (F(1, 23) = 16.33, p < .001, ηp2= .42) with an increase in students answering “agree” or “strongly agree” from 16.7% to 45.8%. This improvement was significantly positively correlated with the overall satisfaction score (R = .528, p < .01).

Conclusion

Psychiatry placement for medical undergraduates is a valuable opportunity to improve their attitudes towards psychiatry and their likelihood of choosing psychiatry as a specialty. We present our strategy as a model toward these goals.
Thematic Analysis of Inquiries Into Concerns About Institutional Health Care
Authors: Elliott Rachael , White Erin , Nathan Rajan
Published: July 2023

Aims

Recent reports and inquiries indicate that the potential, identified from the early days of the asylum era, for residents of psychiatric institutions to be subject to abuse has not been eradicated. The findings and recommendations of individual inquiries are often so specific to their unique context that it can be difficult to draw general principles that have wider operationalizability. The aims of this study are to thematically analyse available inquiry reports into health care institutions from the mid-20th century to the present using a ‘generalisable’ framework in order (i) to identify the key themes underpinning the concerns raised, and (ii) to analyse how themes change (or persist) over time.

Methods

Inquiries relating to concerns about the institutional care of patients over the past 70 years were identified. In this pilot study, a selection of available reports were subject to thematic analysis to address the first phase of the study (identifying themes underpinning concerns).

Results

Four overarching themes were identified. The first three themes reflect the different levels of system analysis. Thus, the first theme, ‘the proximal dynamic,’ describes the nature of the interaction between staff and patients which is influenced by staff experience, attitude, and actions. The second theme, ‘the organisational dynamic’, comprises processes, policy and culture particularly, but exclusively, within the provider organisation. The third level of analysis, ‘the system dynamic’ theme, includes the influence on the concerns raised of the way the health system is configured (e.g. commissioning arrangements, and use of 'out-of-area' placements). The fourth theme, which cuts across the first three, is ‘the response to concerns’ which ranges from identifying early warning signs to responding to overt expressions of concerns (including whistleblowing).

Conclusion

Using thematic analysis to examine past inquiries into poor institutional care of patients, this study has identified a thematic structure which (i) emphasises that problems arise in a ‘dynamic’ that can be located at three levels of analysis (proximal, organisational and system) and (ii) includes a cross-cutting theme of the way concerns are responded to. This structure can be used as a learning framework for the current provision of inpatient services that has the potential to improve care in institutions, but this will require empirical testing.
Generalized Anxiety Disorder as a Precipitant to Perceived Stress and the Outcomes Associated With Academic Performance and Lifestyle: A Cross Sectional Study Among Medical Students in Sudan 2022
Authors: Ibrahim Danya , Ahmed Reem Mohamed , Bashir Moez Mohammed Ibrahim , Mohammad Ayman Zuhair , Ibrahim Basil , Mohammed Tibyan , Mohamed Mona Elfadl , Abdelgadir Tibyan , Mohammed Baraah , Ibrahim Moneib , Mirghani Kamil Shaaban
Published: July 2023

Aims

To examine the prevalence of Generalized anxiety disorder (GAD), levels of anxiety and perceived stress in Sudanese medical students. Also measuring students’ academic performance, the satisfaction with the former, and lifestyle characteristics. Then investigating the different correlations between all these factors.

Methods

We conducted a cross-sectional study at University of Khartoum, among Sudanese medical students. A self-administered anonymous online questionnaire was filled by 340 medical students,which includes Generalized anxiety disorder-2 (GAD-2), and Perceived Stress Scale (PSS-10), beside academic performance and lifestyle characteristics questions.

Results

The data obtained from 340 medical students revealed 3.8% (n = 13) had a previous GAD diagnosis and 29.1% scored ≥ 3 in GAD-2, indicating the possibility of having GAD, 7 of them have a previous GAD diagnosis. Among participants 9.7% use addictive substance, with 42% of them having a high GAD-2 score. Higher anxiety levels were associated with high stress scores (p = 0.000). High GAD-2 scores were significantly associated with those spending less than 10,000 SDG (18$)/week, increased hours of smart devices usage for entertainment (p-value = 0.004), and unhealthy diet (p-value = 0.004). Low anxiety scores were associated with improved quality of sleep (p-value = 0.00), satisfaction with religious practices (p-value = 0.00) and increased leisure /hobbies time (p-value = 0.018). Elevated stress levels were higher in females (p-value 0.035), students with lower academic performance satisfaction levels, and increased hours of smart devices usage for entertainment (p-value = 0.001). Reduced stress levels were associated with age > 23, increased time spent on leisure/hobbies (p-value = 0.002) and eating a healthier diet (p-value = 0.006). Mean academic score was positively associated with academic performance satisfaction (p-value = 0.00), making the mean academic score an indirect modulator for anxiety and perceived stress.

Conclusion

The study elaborates that GAD diagnosis is quite low; with almost third of participants having the probability of developing GAD, asserting the significance of implementing periodic mental health screening programs for medical students, early diagnosis of high-risk individuals, and early interventions through confidential access to mental health services to prevent further harm to the students' health. The impact of financial burden on medical students’ elevated the GAD-2 score; as well as poor lifestyle, i.e. habits such as unhealthy diet, increased hours of using smart devices, low sleep quality and low satisfaction with religious practices, which are all modifiable risk factors of GAD.
The Effect of Perinatal Depression on Child Development
Authors: Isidore Sadie , Ramdass Prakash
Published: July 2023

Aims

Perinatal Depression is a global issue, with several studies showing that it has detrimental effects on the development of children. The aim of this paper was to review these effects according to five domains of development: Cognitive, Motor, Behavioural and Social, Emotional, and Physical. These domains were then explored at four sub-categories of age: Neonate (0–30 days), Infant (1 month – 2 years), Young Child (2–6 years), and Child (6–12 years). This paper also aimed to examine how public health programs have been used to mitigate perinatal depression as a means of reducing child developmental issues.

Methods

We conducted a narrative review and searched PubMed and ScienceDirect for peer-reviewed articles, which explored perinatal depression and child development, as well as public health programs that attempted to challenge this problem. Articles were not limited by language or date.

Results

A total of 352 titles and abstracts were screened for eligibility, with a resultant 25 articles meeting the criteria to be included in this review. The studies examined were conducted in 14 countries across different continents, with sample sizes ranging from 13 dyads (mother-child pairs) to 6550 children. At the neonatal and infant levels, there were distinct effects in most domains, including low motor scores, increased risk of neuromuscular developmental delays, and issues with emotional regulation. However, at the older stages, there was a decrease in physical deficits, as social and emotional developmental issues became more prominent. These were displayed as anxiety, depression, attention deficit hyperactivity disorder, and increased likelihood of aggression and rule-breaking behaviour.

Conclusion

Perinatal depression has damaging effects on child development in all five domains and during all four stages of development. Public health programs that use alternative forms of treatment as opposed to interpersonal therapy should be emphasized. There is a need to conduct more research on children in the later stages of development in order to identify the potentially long-lasting effects of perinatal depression. There are also significant challenges in investigating perinatal depression, as the effects of antenatal depression and postnatal depression on child development are often explored separately.
Associate Hospital Managers’ Discharge Powers Under Section 23: Should the Days of the Hospital Managers’ Hearings Be Numbered?
Authors: Nicholls Rebecca
Published: July 2023

Aims

Under section 23 of the Mental Health Act, the managers of the hospital have the power to order discharge of a patient detained under certain sections. In the past, the need for this power has been questioned, but the debate reared its head following the ‘Modernising the Mental Health Act’ government review in 2018, which initially proposed that the managers’ hearing should be abolished. The aim of this research was to critically analyse the law to determine whether or not managers’ hearings should be removed in legal reform.

Methods

A literature review was performed using the legal databases Lexis Library and Westlaw to identify relevant primary legislation, secondary legislation, case law, articles and other secondary sources. These were critically analysed to discuss the managers’ hearing's strengths, weaknesses and potential proposals for reform.

Results

In favour of retaining the managers’ hearing in its existing format, it provides an independent power of discharge that is accessible, subject to scrutiny and an important safeguard, particularly for those lacking capacity. In favour of abolishing the managers’ hearing, the tribunal system satisfies the Government's requirement under Article 5(4) of the European Convention for Human Rights; the managers’ panel could be viewed as a duplication of effort without legal representation and a necessary medical member, with limited powers in comparison to a tribunal and arguably low discharge rates. Its usual procedure was challenged during the COVID-19 pandemic, and the Convention on the Rights of Persons with Disabilities moves away from the traditional medical model, suggesting reforms to the Act may be needed.

Conclusion

Case law has ruled that the managers’ panel has equivalent standing to the tribunal and criticism has been largely anecdotal. The absence of evidence surrounding the process is a major weakness in this debate with no nationally held records of outcomes. Whilst the duplication of effort and overlap with the tribunals’ powers has been a consistent argument for abolishment, the managers’ hearing stands as a robust and accessible safeguard in providing an opportunity for detention under the Act to be reviewed. Any reform must continue to empower and involve patients, supporting them in exercising their rights. On balance, this review concludes that the days of the managers’ hearing should not be numbered without further research.

This research was completed as a Masters in Mental Health Law (LLM) dissertation through the University of Northumbria.
Psychometric Properties of the 7-Item Generalized Anxiety Disorder (Gad-7) in Nigerian Pregnant Women Attending Primary Health Care
Authors: Olaluwoye Oluwaseun , Onofa Lucky , Sowunmi Oladipo
Published: July 2023

Aims

Maternal mental health is an integral component of services that should be rendered to pregnant women in addition to their physical health during their antenatal care. Mental health conditions are screened for during these visits. There is a high prevalence of anxiety disorders among this group of women. A common questionnaire used to screen for anxiety is the 7-item generalized anxiety disorder (GAD-7). However, this instrument has not been validated among pregnant women in Nigeria. We conducted research among pregnant women in Southwest Nigeria to demonstrate the psychometric properties of GAD-7 using the anxiety modules of the Mini International Neuropsychiatric Interview (MINI) as a gold standard.

Methods

We administered both GAD-7 and the anxiety module of MINI among 203 pregnant women who attended 4 randomly selected primary health centres in Southwest Nigeria. The data collected from these questionnaires were analysed using the Statistical Package for Social Sciences (SPSS).

The reliability of GAD-7 was assessed with Cronbach's alpha to estimate its internal consistency. The validity of GAD-7 was examined with an assessment of its concurrent validity, sensitivity, and specificity analysis and a receiver operator characteristic curve.

Using Pearson correlations, we evaluated the concurrent validity of GAD-7 and the anxiety modules of the M.I.N.I. The sensitivity, specificity, positive predictive, and negative predictive values of GAD-7 were determined with the MINI as a gold standard. The predictive accuracy was further determined from receiver operating curve analysis using the area under the curve as a standard measure.

Results

The internal consistency value measured by Cronbach's alpha for GAD-7 was 0.709. GAD-7 correlated minimally with the anxiety modules of MINI with a coefficient score (r) of 0.393 at a p-value of 0.01. GAD-7 has a low sensitivity & negative predictive value of 14.1% and 57.8% respectively and a high specificity & positive predictive value of 97.3% and 81.2% respectively. The area under the curve using receiver operating curve analysis was above the chance line of 0.5 with a value of 0.0557 at p < 0.05.

Conclusion

GAD-7 is a reliable and moderately valid instrument to screen anxiety among pregnant women in Southwest Nigeria.
Prevalence and Risk Factors of Postpartum Depression in a Tertiary Care Centre, Puducherry
Authors: Punnoose Zarine Maria , Thilakan Pradeep
Published: July 2023

Aims

Postpartum depression (PPD) is the experience of depressed mood that begins anytime within the first four weeks after delivery. When left untreated, it can affect the infant's emotional and cognitive development and mother's health and family. South Indian studies on this topic are sparse. This study aimed at identifying the prevalence and risk factors of PPD in a tertiary care centre in Puducherry.

Methods

This was a prospective cohort study which included 140 antenatal women between 34 and 36 weeks’ period of gestation, and followed up at 6 weeks postpartum. Tools used in the study were semi-structured questionnaire to collect the sociodemographic details, Postpartum Depression Predictive Inventory – Revised version and Edinburgh Postnatal Depression Scale.

Results

10% were found to have antepartum depression and at the postpartum visit, 18.6% were found to have depression. The risk factors identified were inadequate spousal support, unsatisfactory marital relationship, poor relationship with in-laws, prenatal anxiety and depression, low self esteem, maternity blues, child care stress, infant temperament, health problems and frequent hospital visits. Among these, presence of maternity blues (OR = 30.370) and infant health problems (OR = 14.742) had the highest risk.

Conclusion

Majority of the women with PPD reported depressive symptoms in the third trimester itself, hence antenatal and postnatal women should be routinely screened for depression and managed promptly. Failing to attach significance to prolonged maternity blues and frequent infant health problems has been found to increase the risk for developing PPD significantly.
Evaluating the Potential Benefit of Implementing the STAR (Socio-Technical Allocation of Resources) Methodology in Mental Health Commissioning Decisions
Authors: Sidhu Manu , Okhiria Renée
Published: July 2023

Aims

A rise in mental illness has inspired the UK government to increase mental health service funding by £2.3 billion/year, deepening the need for robust evidence on how to best allocate mental health resources. The STAR methodology was co-developed by the London School of Economics and the Health Economics Unit to help commissioners allocate resources by combining a value-for-money analysis with stakeholder engagement. The aim of this research was to evaluate the potential benefit of implementing the STAR methodology in the allocation of mental health resources.

Methods

The barriers and facilitators to commissioning cost-effective mental health services were systematically reviewed. The potential for STAR to overcome these barriers and promote these facilitators was then evaluated by analysing its socio-technical components and assessing its real-world implementation in the COPD pathways of five ICSs.

Results

Fragmentation and cross-sectoral responsibility for the funding and delivery of services can hinder multi-sector buy-in. STAR has overcome this barrier in the COPD pathways of five ICSs by pooling their budgets and building partnerships across sectors through decision conferencing that has facilitated shared priority setting.

Lacking community involvement impedes local stakeholders from embracing change. By championing local stakeholders, STAR's ‘socio’ component involves front-line workers in funding decisions and fosters a sense of ownership over service adjustments.

The value placed on each outcome varies between sectors, often resulting in conflicting incentives. By considering each sector's interests, STAR enables a consensus on which outcomes to optimise for. Furthermore, STAR's ‘technical’ components strengthen the objective value-for-money evaluations of the interventions that contribute to each outcome. When modelling the health gain and cost of COPD interventions, STAR discovered that CBT offers a relatively high return on investment, despite often being overlooked as a core intervention for COPD. STAR's economic evaluations are communicated in easily interpretable ways to facilitate a shared understanding on which resources are most worth funding.

Conclusion

Resource allocation decisions are fuelled by the quality of evidence supporting them. Compared with physical health services, mental health services lack evidence that reflects the qualitative and quantitative nature of their outcomes. In particular, services that rely mostly on subjective reports, such as psychotherapy, lack objective value-for-money evaluations, resulting in a hesitancy for funding. By measuring the health gain and cost of each mental health intervention in a systematic, transparent and objective way, STAR enables commissioners to improve the allocative efficiency of mental health resources, thus improving population mental health without increasing cost.
A Systematic Review of Aerobic Exercise to Improve Cognitive Function in Older People Without Known Cognitive Impairment
Authors: Balaskanda Swarupa Sri , Egemonye Azuka , Faruqui Rafey
Published: July 2023

Aims

There is an increasing amount of evidence to suggest that regular physical exercise supports healthy ageing. Regular physical activity provides health benefits for the cardiovascular, respiratory and musculoskeletal systems as well as many other benefits. As well as improving cardiovascular fitness, aerobic activity in particular may also have beneficial effects on cognition among older people. In this paper, we aimed to systematically review the effect of aerobic physical activity, aimed at improving cardiorespiratory fitness, on cognitive function in older people without known cognitive impairment.

Methods

We searched the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, the Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE, PsycINFO, LILACS, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch), ClinicalTrials.gov with no language restrictions.

We included all published randomised controlled trials (RCTs) comparing the effect of aerobic physical activity programmes with any other active intervention or no intervention on cognitive function. Participants were ages over 55 with no known cognitive impairment. We looked at trials, which measured effects on both fitness and cognition.

We reviewed the data from trials published since August 2013 to further the research completed by Young J, Angevaren M, Rusted J, Tabet N (published in 2015). This systematic review looked at all the studies completed before August 2013.

Results

There were a few trials that met our inclusion criteria. The aerobic activity programme that participants were subjected to varied in length.

The comparison between aerobic exercise to any active intervention showed no evidence of benefit from aerobic exercise in cognition.

None of our analyses showed a cognitive benefit from aerobic exercise despite the interventions demonstrating benefits to cardiorespiratory fitness

Conclusion

The findings from the available data from the RCTs did not show any evidence that aerobic physical activities, including those which successfully improve cardiorespiratory fitness, have any cognitive benefit in cognitively healthy older adults. Larger studies with longer term interventions and longer follow up would be recommended.
Telemedicine for Memory Service Assessments, a Literature Review
Authors: Treloar Dominic
Published: July 2023

Aims

Memory clinic waiting times are at a record high, increasing from 13 weeks in 2019 to 17.7 weeks in 2022. This backlog is partially due to COVID-19 disruption. Staff are concerned that waiting times are resulting in missed diagnoses, particularly with early-onset memory loss, and that relatives of patients with challenging behaviours are not receiving adequate support. At the start of the pandemic, many Memory Service Assessments (MSAs) were done via teleconsultation to ensure patients could access services despite lockdowns. Telemedicine has continued to be used for MSAs and is a strategy proposed to tackle waiting times. This literature review explores whether using telemedicine for MSAs is evidence-based.

Methods

A search using the MEDLINE database was conducted, using the terms ‘dementia’, plus ‘telemedicine’, ‘video calls’, and ‘telephone calls’. This identified one relevant systematic review and one clinical trial. The identified evidence was insufficient for a systematic review. A google search carried out with the same terms, identified a variety of non-academic papers: NHS Audits, Quality Improvement Projects, Clinical Network publications, and one governmental publication.

Results

Telemedicine was reported to reduce waiting lists. Appointments could be organised quickly, without infection risk, and without requiring transportation. At-home telemedicine consultations were relaxing for some patients and reduced demand for home visits. However, clinicians reported that some environments were cluttered and noisy, impacting the MSA.

Patients struggled with the complex telemedicine technology; carers were required to facilitate the calls, which increased the risk of an inaccurate assessment. Patients with sensory impairments disliked telemedicine, and clinicians struggled to distinguish between cognitive impairment and poor hearing. Financial inequalities at times prevented telemedicine. Some relatives felt that patients would mask their memory symptoms in teleconsultations, and not speak openly about their concerns. Clinicians felt adequate safeguarding assessments were not possible over teleconsultation. There was no inclusion of the long-term impact of these assessments. No distinction was made between dementia subtypes.

Conclusion

The National Audit of Dementia, RCPsych 2021, encourages the future use of telemedicine for MSAs. However, there is limited evidence to support its use. Telemedicine was essential during COVID-19 and may help reduce waiting times, but may also produce worse outcomes than face-to-face consultations. Only pilot studies without randomisation exist on the topic and none of these are UK based. Further research is required to produce NHS-specific data on the impact telemedicine has on: the quality of MSAs, the patients’, carers’, and clinicians’ experiences, and memory service waiting times.