bluuebunny/crossref_metadata_2025 huggingface dataset:
Audit of section 2 and section 3 mental health act paperwork in Derby inpatient psychiatric units using an audit tool by Mason et al. (2012)
Authors: Pearson Abigail , Horton Andrew , Akroyd Mike
Published: June 2021

Aims

Complete an audit of Section 2 and Section 3 Mental Health Act Paperwork in Derby Inpatient psychiatric units using an audit tool developed in a study by Mason et al. (2012).

Background

The 1983 Mental Health Act enables doctors approved on behalf of the Secretary of State under Section 12 to be able to make recommendations for the detention of individuals with a mental health problem where the degree and/or nature, and associated risk to that person's health or safety, or that of others, makes inpatient care necessary. For the detention and the associated deprivation of their liberty to be lawful, it is necessary that the clinical situation meets certain criteria as outlined in the Mental Health Act.

Method

Ward status was reviewed for each inpatient ward in Derby and the first five patients alphabetically, who were detained under sections 2 or 3 were selected. The Mental Health Act medical recommendation documents were reviewed according to the necessary criteria, using an assessment tool generated from a study by Mason et al. in 2012 ‘Compulsion under the Mental Health Act 1983: audit of the quality of medical recommendations’. A junior colleague was trained to analyse Mental Health Act paperwork using the audit tool. Medical recommendations were reviewed and rated as ‘clear’, ‘implied’ or ‘none’ for each criterion.

Result

Evidence of a mental health problem and the nature or degree of illness was well documented. Evidence regarding why informal admission was not appropriate was also reasonable but with room for improvement. Poor compliance was evident mostly in relation to the justification related to risk to health, safety or others, the lowest clearly documented percentage of these appear to be regarding health.

Conclusion

From analysing the documentation, often written justification incorporated general safety as a whole; however health and safety are identified by the mental health act as separate criterion requiring clear justification of each. In a number of occasions people failed to identify which of the three risk categories were relevant for the patient. Potential criticisms of this audit include the subjective nature of the interpretation of clearly explained and implied and that data analysis was completed by a non-section 12 approved doctor. Data were presented at the local weekly academic teaching to raise awareness of the results and a recommendation was made for the subject to be included in the junior doctor induction.
An audit of liaison service provision in Aneurin Bevan University Health Board
Authors: Rankin Jennifer , Espley Heledd
Published: June 2021

Aims

Aneurin Bevan University Health Board (ABUHB) isundertaking a review of the Mental Health Liaison Service provision within it's acute general hospitals. The current liaison service is a small nurse led team which is available between 8am and midnight. ABUHB has recently opened a new Specialist Critical Care Hospital with the liaison service moving into a new base. A new model of care has been developed across the healthboard which has stretched the Liaison Service across several sites. Therefore, the liaison service may need to expanded to be able to provide high quality and timely care across a wide geographical area. The audit aims to idenitfy areas in which the liaison service is performing well in while identiying areas that need improvement. This audit may provide a focus for recommendations to enhance the current liaison provision.

Method

The liaison service was audited against RCPsych Psychiatric Liaison Accreditation Network (PLAN) quality standards. PLAN identified eighteen functions of a liaison team and provided details of quality standards within each function. These standards are either considered essential, expected or desirable. An accredited service is expected to meet 100% of essential standards, 80% of expected standards and 60% of desirable standards. Data were taken from a combination of sources including ABUHB policies, service managers and senior clinicians within both mental health and acute services.

Result

When comparing the current liaison service provision in ABUHB, 30% of essential standards were not met and 21% were only somewhat met. Particular domains that were identifed as needing improvement included policies and procedures and urgent and emergency mental health care. 36% of expected standards were met with 41% not met. Notable domains that the service was performing poorly in included governance; induction, and providing teaching and support to acute colleagues. 89% of desirable standards were not met.

Conclusion

The audit idenitifed that the current liaison service fails to meet core standards set out by RCPsych. This audit provides quantitative data to demonstrate that the liaison service is in need of improvement and investment. As a result, enhaving the current liaison service is now a priortity for the health board. A business case is being developed to consider enhancing the liaison service with a view to developing a Consultant led multidisciplinary team. The business case can use PLAN quality standards to make recommendations for improvements to the service.
A closed loop audit of clerking psychiatric histories in an acute psychiatric inpatient unit
Authors: Smith Samuel Richard , Ark Rajiv , Aravinth Thirunavukkarasu
Published: June 2021

Aims

An accurate and complete history is a key component of a medical consultation. Evidence suggests that up to 80% of diagnosis may be made entirely off the patient history. The aim of this closed loop audit was to examine the effects of a clerking pro forma on the quality of doctors clerking histories of new patients admitted to an acute psychiatric inpatient unit, against standards suggested in the New Oxford Textbook of Psychiatry.

Method

Data for this audit were gathered by finding the initial clerking history for inpatients at The Orchard on ECR and RIO. The clerking histories of the 18 inpatients present on 12.10.20 were initially audited. These standards recommend in the in the New Oxford Textbook of Psychiatry include; Patient Identification (ID), Presenting Complaint (PC), History of Presenting Complaint (HPC), Psychiatric history, Medical history, Family history, Forensic history, Social history, Personal history, Premorbid personality, Mental state exam (MSE). After analysis of the results of the first loop, a clerking pro forma was created and distributed to junior doctors to implement. The clerking histories for the subsequent 18 patients to be admitted were then audited and compared.

Result

The results of the first audit cycle were poor. Only patient identification and presenting complaint were present in 100% of clerked histories. Concerningly, only 72% of the histories included the patients’ medical histories, forensic histories were included 44% of the time, and social history just 39% of the time.

The implementation of a clerking history proforma showed improvements in all areas of clerking. Patient ID, PC, HPC, psychiatric history and MSE were now present in 100% of clerked histories. Forensic history showed a statistically significant improvement from 44% to 73% [X2(1) = 5.9; p = 0.015]. Social history showed a statistically significant improvement from 39% to 78% [X2(1) = 5.6; p = 0.018]. Premorbid personality showed a statistically significant improvement from 44% to 89% [X2(1) = 8.0; p = 0.005]. Personal history showed a non-statistically significant improvement from 39% to 56%, as did medical history from 72% to 94%, and family history from 39% to 61%.

Conclusion

In conclusion, the implementation of a clerking history pro-forma has significantly improved the quality and completeness of clerking histories gathered by doctors at The Orchard. This is hopefully increase diagnostic accuracy and improve the quality of care of patients in the hospital.
Auditing improvements to physical health in the acute psychiatric inpatient setting
Authors: Silverblatt Joshua A. , Ruparelia Risha , Shodunke Ayotunde
Published: June 2021

Aims

Whilst patient psychiatric health is the primary focus in the acute psychiatric inpatient setting, there has been a recent focus on ensuring a greater integration with physical health to address the physical health outcome inequalities between patients with psychiatric conditions and those without. Despite the ward having a robust physical health clerking proforma, there were issues with its completion; at initial clerking patients often aren't able, or refuse, to consent to physical examination or investigations. This lead to the trust's electronic physical health form, designed to collate these results, not always being completed. Our aim was to increase the rates of completion.

Method

Changes to ward handover sheets were made in an effort to increase rates of physical health form completion and improve 24 and 72 hour completion rates. Columns were added delineating which parts of the physical clerking were outstanding, ensuring the MDT were aware of which jobs needed actioning. Data for two months prior and post intervention were analysed.

Result

266 admissions were analysed for the two months prior and post the intervention. Form completion rose from July (88%) to October (100%), with 24 and 72 hour completion rate increasing from 47% & 55% respectively, to 84% & 96%, during the same time period. Greater completion rates of physical health forms led to increased knowledge of patients’ physical health issues. Having 96% of patients physical health issues within three days of admission (cf. 55%, July), led to a 'physical health huddle' being held during the MDT. This provided a platform to discuss relevant physical health treatment plans with the whole team. These findings were summarised under a new column on the handover sheet and updated biweekly during the MDT meeting. Placement on the handover sheet ensured daily visibility to all staff.

Conclusion

Simple structural changes can bring physical health to the fore in psychiatric care. Timely and more complete physical health data enabled biweekly reviews of physical health issues and allowed input across the MDT. Increased knowledge and awareness of physical health issues led to an increase in medical review requests. These are currently performed on an ad hoc basis, which can be quite disorganised and inefficient. The results above, of improved physical health outcomes based on a structured approach, have led to a recommendation of a biweekly physical health clinic, with specific staffing allocation, to ensure a more thorough and efficient way to address physical health.
An audit cycle of physical health monitoring and record keeping of long term in-patients at male and female psychiatric rehabilitation wards using QI approach
Authors: Tahseen Hina , Bramall Peter
Published: June 2021

Aims

To complete an audit cycle to evaluate and improve physical health monitoring practice for in-patients by incorporating small QI based projects between baseline audit and re-audit.

Background

People with mental health illness are at increased risk of physical illness, morbidity and mortality compared with general population, mainly due to adverse effects of psychotropic medications, polypharmacy, poor lifestyle choices and socio-economic difficulties. It is important to recognise the need for active health promotion, including formal health checks for psychiatric in-patients.

Method

Standards were obtained from NICE Guidelines, RCPsych Report on Physical Health in Mental Health and Cygnet Health Care's Physical health policy.

An Audit tool with simple checklist was generated from key areas of Cygnet's physical health policy. Physical Health Files of 24 patients from Female Rehabilitation Ward and 28 patients from Male Rehabilitation Ward were audited in the initial audit cycle.

Checklist included physical health examination within 24 hours of admission, Annual Health Improvement Profile (HIP), Monthly physical health reviews (including observations and weights), High Dose Antipsychotics Monitoring, Bloods and ECG records. After the initial baseline audit in Apr., 2019, some of the Quality Improvement (QI) approaches (4 PDSA cycles, driver diagrams, model for improvement) were used before conducting the re-audit in Oct., 2019.

Result

The baseline audit in Apr., 2019 showed 98% compliance with physical assessment within 24 hours of admission, however, there was a significant gap in the monthly physical health reviews (62%), Annual HIP (30%), High-dose antipsychotic monitoring (10%) and ECG/Bloods for antipsychotic monitoring (64%) as per guidelines. 10 Female and 12 male patients had regularly refused obs, weight checks and physical health monitoring.

The re-audit showed an overall improvement of 92% in compliance, with increased High-dose antipsychotic monitoring (100%), Monthly physical health clinics (88%), Annual HIP (75%), Annual antipsychotic monitoring/bloods/ECG(95%).

Conclusion

Interventions, using QI approaches, between baseline and re-audit, included MDT discussion around strategies to improve patients’ engagement with monthly physical health clinics with Specialty doctor, adding to care plan points, timescales and reminders in doctors’ diaries for next bloods and ECGs due, MDT and patients’ health education and a designated support staff for physical obs and maintaining physical health files. This helped in providing a framework to test recommended changes and evolve design based on repeated date collection between cycles.

The QI Interventions helped in implementation of a more holistic approach towards assessments due to which, the re-audit demonstrated a sustained improvement in compliance with all aspects of physical health monitoring.
Improving the patient involvement in research and development on acute psychiatric wards – an audit and quality improvement project
Authors: Varvari Ioana , El – Sayeh Hany , McIlrae Shona , Bonner Susan
Published: June 2021

Aims

The local audit aimed at measuring awareness of research and development policies and implementation of local and national standards. Our findings generated a quality improvement project with two main objectives: first, improving patient approach and recruitment in research and second, improving trainee satisfaction within our trust.

Method

A cohort of new inpatient admissions was identified over a period of 4 weeks, between October 2019 and November 2019, on the two psychiatric wards at the Briary Wing, Harrogate District Hospital. Based on local and national standards, we designed and developed a qualitative (questionnaire) and quantitative (audit tool) approach that was aimed at both staff and patients. Our steps included: assessing awareness and implementation of standards, a retrospective collection of data on the wards, and analysis of the data in Microsoft Excel.

Result

Only one ward implemented the local guidance from which we identified a sample of 14 consecutive new admissions that were currently present on the ward and were able to answer our questions. 13 of those patients were noted as ‘approached’ on our visual board from which only 3 patients remembered reading a leaflet about research options in the admission pack, however, they have not been verbally informed. There was no process in place to assure the re-approaching of initially unwell patients or to follow up on discharge for those interested. Documentation was available in only 9 of the cases and was nonspecific: ‘admission pack done’.

Conclusion

The awareness and understanding of Research and Development policies are poor and they are difficult to apply in practice in a busy inpatient environment without a clear process in place. This results in patients missing the opportunity to learn and understand more about research or to participate in ongoing studies. Quality improvement work needs to be done to improve patient recruitment in research in inpatient settings. Simple flow charts and stepwise processes as exemplified by our action plan have the potential to improve service quality, as well as patient and trainee satisfaction.
Delirium – are we doing enough prevention and basic management in acute settings?
Authors: Watkins Anna , Flechais Remy , Tarfarosh Shah
Published: June 2021

Aims

To identify the prevalence of delirium and/or dementia on complex medicine wards.

To assess the use non-pharmacological prevention and management options in these patients.

Background

Delirium, a common hospital syndrome, is often multi-factorial. So, the management needs not only treating a reversible cause but also minimising the factors that could increase the risk of developing delirium, or worsen its course.

The Scottish-Intercollegiate-Guidelines-Network (SIGN) and National-Institute-for-Health-and-Care-Excellence (NICE) guidelines outline non-pharmacological factors to reduce the risk of developing delirium, and for its management once established.

These factors include orientation, ensuring patients have their glasses and hearing aids, promoting sleep hygiene, maintaining optimal hydration and nutrition, early mobilisation, appropriate lighting and providing cognitively stimulating activities.

Method

SIGN, NICE and local guidelines were used to develop a checklist of core non-pharmacological factors that minimise the risk of developing delirium and help in its management. Adherence to recommendations from these guidelines was thus evaluated in 4 Complex Medical Units of The John-Radcliffe Hospital (Oxford University Hospitals NHS Foundation Trust), cross sectionally. The data were collected by interviewing nursing staff on the wards, assessing the ward environment, reviewing nursing charts and electronic patient records.

Result

There were 57 patients aged >65 years across all four wards, with average percentages of delirium and dementia patients being 46% and 34%, respectively. Nurses were unsure about their patients having hearing or visual aids in 41% and 29%, respectively. On all four wards there was no clear signage, no digital clock, no calendar, and earplugs were not offered. Overall, the use of non-pharmacological recommendations was sub-optimal across a number of items. After a month, when the notes were reviewed, it was found that 18 out of those 57 patients had passed away (32%) and the average length of stay for delirium/dementia patients was way more than the other patients during that admission.

Conclusion

We found high rates of delirium and dementia and a lack of consistent use of recommended non-pharmacological strategies for their management. Better adherence to these could help shorten length of stay and improve patient outcomes.

Recommendations for patients with/at risk of delirium:

–

Bedside board for each patient with the name of the ward/hospital, picture of the named nurse.

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Ensuring visible clock/calendar.

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Non-pharmacological delirium management checklist to be added to the daily nursing notes.

Emphasis on visual/hearing aids and daily reorientation.

–

Appropriate lighting in the bays.

–

Offer earplugs if not sleeping at night.
COVID and early intervention: the impact of COVID-19 on referrals to an early intervention service
Authors: Whyte Adam , Reid Alastair
Published: June 2021

Aims

COVID-19 has a demonstratable impact on the population's mental health and is associated with an increased incidence of psychiatric disorders, including patients experiencing psychotic presentations. The aim of this study was to explore whether referral rates within a county-wide Early Intervention (EI) service changed in response to the COVID-19 pandemic. The EI service provides NICE approved treatments and support for patients experiencing a First Episode Psychosis (FEP).

Method

Data were collected from all referrals to the EI service between March–December 2019 and March–December 2020. Clinical notes were reviewed to ascertain whether the referred patient was assessed and if they were subsequently accepted on to the team's caseload.

Result

During the March–December 2019 period 147 referrals were made to the EI service, with 66 patients being accepted for treatment by the service (44.9% of referrals). In March–December 2020, 127 referrals were made, a 13.6% reduction compared to the same period in 2019, however 70 referrals were accepted (55.1% of referrals).

Whilst the overall referrals declined during the COVID-19 period, there were notable increases in both April and August 2020, by 25.0% and 70.0% respectively.

Conclusion

Although overall referrals to the EI service reduced during the COVID-19 pandemic compared similarly to the previous year, there was a noteworthy increase in the proportion of patients accepted onto the team's caseload.

Potential explanations for this finding include the possibility of an increased incidence of first episode psychosis during this period, or that restrictions in accessing primary care and secondary mental health services during the COVID-19 pandemic reduced the number of patients being referred whose symptoms were not representative of First Episode Psychosis (FEP).

This study highlights that mental health services, such as EI teams, have experienced a persistent level of need over the past year and that ongoing investment in psychiatric services is warranted to meet this sustained requirement for support and interventions.
Trials and tribulations of diagnosing and managing psychosis secondary to non-convulsive epilepsy
Authors: Awara Mahmoud , Smalley Joshua , Havenga Matt , Elnenaei Manal
Published: June 2021

Objective

To highlight the importance of reviewing diagnosis and management of refractory psychosis and to share that with the scientific community; and to also shed some light on the dilemma and challenges that professionals may face to diagnose and treat organic psychosis. In addition, to look at the possible similarity/dissimilarity in psychopathology between organic and primary psychosis and differences in opinions through presenting the history and course of illness of this patient.

Case report

We present the case of a 51-year-old female who had a 28-year history of treatment-resistant schizophrenia. She did not report or display any seizure activity, and an extensive investigation was unremarkable. The unusual nature of her psychopathology, which was predominantly visual hallucinations and somatic delusions, and the difficult to treat nature of her symptoms, prompted investigation with Electroencephalograph which demonstrated bilateral temporal lobe epileptic activity.

Discussion

Treatment with divalproex sodium and discontinuation of antipsychotic medication achieved an excellent response, where her visual hallucinations and somatic delusions were both remarkably ameliorated.

Conclusion

The differentiation between organic/secondary and functional/primary psychosis is an area of contention between psychiatrists and neurologists and also within each of these specialties.

The myriad of psychopathology and associated treatment resistant psychotic symptoms that patients with non-convulsive epilepsy may experience should result in building a long desired bridge between neurology and psychiatry to collaborate in managing such cases.
Characterization of a novel CSF1R mutation causing hereditary diffuse leukoencephalopathy with spheroids in a case presenting with young-onset dementia
Authors: Nasr Walid , Gad Mahmoud , Qassem Tareq
Published: June 2021

Objective

This poster aims to report an unregistered mutation CSF1R gene in a patient presenting young-onset dementia.

Hypothesis: Novel heterozygous deletion–insertion mutation in the Colony-Stimulating Factor 1 Receptor (CSF1R) gene is linked to a case of hereditary diffuse leukoencephalopathy with spheroids (HDLS), presenting with young-onset dementia.

Background

CSF1R mediates proliferation, differentiation, and survival of monocytes/ macrophages and microglia. Pathogenic variants in the CSF1R gene cause autosomal dominant diffuse hereditary leukoencephalopathy with spheroids characterized by variable behavioural, cognitive, and motor changes, usually presenting with young-onset dementia. The average lifespan after the start of the symptoms is often 6 years.

Case report

Molecular genetic analysis of whole-exome sequencing (WES) was carried out for a 49-year-old male patient presenting with rapid cognitive decline, behavioural symptoms and impaired sphincteric control.

Discussion

WES identified the heterozygous deletion–insertion variant c.2356_2357delinsAC p.(Leu786Thr) (chr5:149435867-49435868; hg19) in the CSF1R gene. To the best of our knowledge the variant has not been described in the literature so far (HGMD 2019.3). No allele frequencies in the general population have been documented.

Conclusion

We believe that we have identified a novel mutation in the CSF1R gene. This mutation is likely to be linked to this patient presenting with young-onset dementia.
Access to firearms: essential factor for risk management in psychiatry
Authors: Walsh Donnchadh , Fallon Una , Patel Sonn , Walsh Elizabeth
Published: June 2021

Objective

Increase awareness of the risk associated with access to firearms in clinical practice.

Case report

A 57-year-old man, with a 30 year history of schizophrenia, was reviewed routinely at home. His illness is predominantly characterised by chronic delusions of a grandiose nature. He believes he has been offered various senior employment positions and has acted on these beliefs by presenting at workplaces in business attire. He has no insight into his condition. At review, he described awakening a week earlier in a panic and seizing hold of his legally held shotgun. He planned to shoot out the window as he believed people were breaking in. His wife prevented him from doing so by taking the gun and hiding it. A few days later he found the gun and intended to frighten off potential pursuers by pretending to shoot birds. He was persuaded to surrender the gun and it was taken to the local Garda (Police). A short time later, he presented to Garda Headquarters, over an hour away, seeking the return of his gun. At review, he had limited insight into the potential seriousness of the situation. The team immediately liaised with Gardaí, a HCR- 20 risk assessment was completed and clozapine levels checked.

Discussion

We had not know that our patient owned a shotgun despite very regular contact with him. During a comprehensive psychiatric history we routinely ask about risk of harm to self and others, but rarely ask specifically about access to or ownership of guns. Working on a farm, rural living or having an interest in shooting sports may raise the issue. Suicide, security breaches and homicide are the main risks conferred by firearms in mental illness. Mental illness is not necessarily prohibitive to gun ownership. Applicants for gun certificates in the UK must disclose specific medical conditions, including a psychotic illness, and an automatic medical report is sought. In the Irish Republic it is the responsibility of the applicant to declare any specific physical or mental health condition. Although a medical report may be sought, it is not automatic in all cases. Lack of insight into psychotic illness may potentially influence self-declaration upon application for a certificate.

Conclusion

Awareness of a persons access to firearms should be part of our routine risk assessment.
Michael Kohlhaas Syndrome – Taking the court to court
Authors: Ward Louisa
Published: June 2021

Objective

To explore Michael Kohlhaas syndrome and development of litigious paranoia.

Case report

A 50-year-old Swiss woman spent a number of weeks travelling around the UK, reporting to police that her family in Switzerland were working with their police, doctors and the mafia to kill her. She was therefore running away for her own safety, and trying to seek legal help to investigate. She had been in close contact with a woman in London who claimed to be able to give her legal aid in exchange for payment. On admission to the ward, it was felt that the legal aid was actually feeding her persecutory delusions.

Discussion

We discovered that she had in fact been detained in Switzerland prior to coming to the UK, and the discharge report was obtained which diagnosed her with Michael Kohlhaas syndrome and Folie a deux.

Conclusion

This poster will further explore Michael Kohlhaas syndrome and litigious paranoia, with connection to this case.
Factor structure of medical students’ attitudes towards psychiatry: findings from a nationally representative sample from Sri Lanka
Authors: Baminiwatta Anuradha , Chandradasa Miyuru , Ediriweera Dileepa , Dias Shavindra
Published: June 2021

Aims

The aim of this study was to examine the factor structure of attitudes towards psychiatry among medical students by using the ‘Attitude towards psychiatry-30’ (ATP-30) scale, which is one of the most widely used psychometric tools in assessing medical students’ attitudes regarding psychiatry. We also aimed to explore the possible existence of meaningful subscales in the ATP-30 scale.

Method

Secondary data from a survey of 743 final-year medical students from nine medical schools in Sri Lanka were subjected to factor analysis. Models based on empirical evidence were tested with Confirmatory Factor Analysis (CFA) for model fit using Comparative Fit Index (CFI), Tucker Lewis Index (TLI), root mean square error of approximation (RMSEA) and Chi square. To explore the underlying latent structure of the scale, Exploratory Factor Analysis (EFA) with oblique (i.e. Promax) rotation was employed. Horn's parallel analysis and goodness-of-fit statistics for a series of EFA models tested with different numbers of factors were used in determining the number of factors to retain. Items conceptually external to the emerging factors or with factor loadings less than 0.4 were discarded. Gender invariance of the final model was tested by configural, metric and scalar invariance. Internal consistency of subscales was assessed using McDonald's omega (ω).

Result

Three models based on literature (one-, five-, and eight- factor) were disproved by CFA. EFA revealed a six-factor solution, encompassing 18 out of the 30 items, to be the most theoretically meaningful factor structure. This six-factor model was affirmed by a CFA (CFI = 0.94, TLI = 0.92, RMSEA = 0.036). These factors were, namely, ‘the image of psychiatrists’, ‘psychiatric patients and mental illness’, ‘efficacy of treatment’, ‘psychiatric teaching’, ‘career choice’, and ‘psychiatry as an evidence-based discipline’. This six-factor solution was invariant across gender. ‘The image of psychiatrists’ appeared to be the most salient factor, and formed the most consistent subscale (ω = 0.71). The internal consistencies of the other subscales were modest (ω = 0.55–0.67). The overall 18-item scale showed good internal consistency (ω = 0.78).

Conclusion

Our findings provide evidence of a multi-dimensional structure in medical students’ attitudes towards psychiatry, endorsing six meaningful subscales of the ATP-30. Future researchers and educators can utilize these subscales in identifying specific attitudinal domains which are more closely associated with students’ future choice of a career in psychiatry, and also in identifying specific areas where attitudes are more stigmatized, so that appropriate interventions can be incorporated into the undergraduate psychiatric curriculum.
Trainees4trainees: an innovative peer support project for junior doctors across specialties
Authors: Behrman Sophie , Higham Aisling , Vlachos Haido , Stegen Gerti
Published: June 2021

Aims

The BMA's survey results (Caring for the Mental Health of the Medical Workforce, 2019) and HEE's NHS Staff and Learners’ Mental Wellbeing Commission report (2019) highlighted declining staff wellbeing. The COVID-19 pandemic has sharpened focus on this and the effects of moral injury on healthcare professionals. Shielding, social distancing and redeployment led to many medical trainees being increasingly isolated at a time of heightened anxiety and adversity. Psychiatry trainees tend to have good access to reflective groups, but this is not customary in other training programmes.

Method

Intervention

“Trainees4trainees” was set up by trainees across specialties as a HEE-TV well-being project, led by the Deanery Trainee Improvement Fellow. Peer support groups are run on Zoom, facilitated by 2 trainees with special training in peer support. Psychiatry trainees have been involved in designing and facilitating groups and training facilitators from other specialties; facilitators have regular supervision from a consultant psychiatrist in medical psychotherapy. Trainees are supported to discuss challenging experiences and think about their emotional responses in a supportive and validating group.

Result

Feedback

We are in the process of formal data collection to assess the impact of the intervention. Informal feedback suggests the groups are a powerful support to individuals who otherwise have no avenue to think about the psychological impact of their experiences. The groups have supported trainees to feel less isolated and bolstered their resilience.

Conclusion

Future plans

We have faced challenges in the practicalities of establishing and maintaining groups. We are working with Training Programme Directors to move towards running the groups in protected time within working hours and advocate that reflective groups, such as our peer support groups, are a key part of future medical and surgical Training Programmes.
The long and short of it!
Authors: Chaudhry Sidra , Ghosh Adwaita
Published: June 2021

Aims

The aim of this study was to conduct a literature search on long and short QTc and its implications on prescribing medications.

We also intended to assess the knowledge of psychiatry core trainees in the South Yorkshire region regarding QTc and its implications on prescribing for patients.

Background

The majority of emphasis lies in ensuring the QTc interval is within range for our patients before initiation of psychotropic medication and as part of monitoring during the maintenance phase. The main dread for most psychiatrists is a prolonged QTc interval, however, a short QTc is equally important to identify and manage.

Method

A literature search was performed using the key words “QTc, psychotropics, and ECG”. Results revealed extensive data on long QTc, but very few articles on prescribing psychotropics and short QTc. Most psychotropics are known to prolong QTc interval, which is what clinicians are worried about most when deciding to prescribe medications in mental health services. However, short QTc is also an equally important ECG finding which should not be ignored. We conducted a survey amongst core trainees in the South Yorkshire training scheme to gauge trainees’ knowledge of QTc and its implications when prescribing psychotropic medications. The survey was designed with SurveyMonkey and had seven questions to keep it user friendly.

Result

The survey was distributed to 47 core trainees working in the South Yorkshire region with a response rate of 42.5%. CT1s comprised 30%, CT2s comprised 40% and CT3s comprised 30% of the total number of responders. 60% trainees reported performing and reviewing ECGs as an integral part of their jobs. 50% trainees believed both a short and long QTc interval were life threatening with 50% considering only long QTc as being fatal. 95% of the responders reported not knowing any medications causing QTc shortening; however 100% reported knowing medications causing QTc prolongation.

Conclusion

The results clearly show that we need to increase awareness regarding short QTc interval and its implications on patient health. Review of literature also highlights the challenges in treating patients with QTc abnormalities. In such situations, it's advised to seek advice from Cardiology colleagues to ensure safe and effective patient care. It would also be beneficial to arrange refresher workshops to help psychiatrists brush on their ECG skills.
An enquiry into my use of supervised clinical assessments in the supervision of junior trainees
Authors: Choo Yuan
Published: June 2021

Aims

As a particular example of action research, to enquire into my use of Assessments of Clinical Expertise in my supervision of junior trainees, with the intention of further developing my own practice as an educator.

Background

Work-Place Based Assessments (WPBAs) play an established role currently in the assessment of trainee doctors(tenCate, 2017). In psychiatry, supervised clinical assessments(ACE/mini-ACE) assess a trainee's proficiency in various areas. As part of my PGCert in Medical Education, I was inspired to examine how I conduct and utilise this form of assessment, and indeed the underpinning values and beliefs, about learning, and developing professional wisdom.

Method

This enquiry was situated within the interpretivist tradition. I interrogated my views about the epistemology of knowledge, and how they had changed from pre-university. I made clear my influences from Coles (Fish & Coles, 1998) on professional practice. I investigated my values in performing an assessment, comparing them to those of the wider community. I examined the literature on the validity of this as a tool. I then performed an assessment of a junior, with a consultant observing, before interviewing them separately.

Result

There has been a paradigm shift in how I view assessments, from pre-university in Singapore, to medical training in the UK. The history of WPBAs and the values espoused is intriguing. Consultants and experts may view assessments differently from trainees, but a core value of developing professional judgement is common.

In my interview with the consultant, there were themes around having a clear focus for an assessment, and provision of feedback; the rating scales and how they used them to stimulate feedback; and our shared values in performing an assessment. With the junior, the themes were around the delivery of feedback (including non-verbal), an appreciation of my encouraging self-reflection and understanding, and the observable values in my carrying out of the assessment, which could be compared to those of other assessors.

Conclusion

WPBAs have their merits, and shortfalls. I am aware of my values and beliefs when utilising them, and have identified a plan to further develop my own practice. This case study is particular, but possibly not unique, in how WPBAs are used in medical education.
Tackling constipation in patients on high dose antipsychotics
Authors: Eappen Sandhya
Published: June 2021

Aims

The aim of this audit was to look into patients on high dose antipsychotics who had developed complications of constipation in the PICU setting .

Background

Antipsychotics are usually used in the treatment of Schizophrenia and other psychotic illnesses. Drug such as Clozapine mainly has a higher risk profile due to gastrointestinal hypo motility. It could present as constipation, fecal impaction or a bowel obstruction and could even lead to death.

Method

During ward rounds enquired on bowel habits and diet.

Physical examination of patients complaining of abdominal pain.

Screened notes in past to see how many patients complained of constipation and interventions suggested and used.I65.

Result

3 of the 10 patients on PICU were on high dose antipsychotics and 2 of them had reported constipation. Of which one required daily review and vigorous treatment with laxatives and dietary changes.

Recommendation

Bristol stool chart introduced as part of care plan for all patients.

Teaching presentation of constipation and its treatment management was given to the PICU team.

Involving medical team early on for assessment and prophylactic laxatives prescription.

Liaison with the pantry team to include more options of fruits and vegetables into daily meal plan for patients.

Data and material handed over to next trainee to Re-audit and complete audit cycle.

Conclusion

Appropriate prevention and early management of side effects can enhance the benefits of antipsychotics. Bowel function monitoring and the use of prophylactic laxatives for patient on high dose antipsychotics such as clozapine is advisable to prevent complications related to it.
The challenges of delivering addictions psychiatry teaching in the COVID era
Authors: Hammersley Rebecca , Martin Amy
Published: June 2021

Aims

During the pandemic, addiction psychiatry moved from face-to-face lectures (delivered by Addictions Psychiatrists) to bitesize pre-recorded lectures (delivered by clinical teaching fellows) alongside interactive tutorials (delivered by Addictions Psychiatrists). The Addictions Team developed an online tutorial (delivered via Blackboard Collaborate) containing a combination of information slides, case studies, interactive quizzes, and short videos. These were delivered ‘live’ to small groups of students in up to four simultaneous virtual classrooms on a 6-weekly rolling basis. We aimed to assess student and tutor feedback regarding the move to interactive online tutorials in addiction psychiatry.

Method

Two questionnaires sought feedback from students and tutors, focussing on the change from face-to-face to virtual teaching during a 20-week period.

Result

21 (of 161) students completed the questionnaire.

•

100% ‘strongly agreed’ or ‘agreed’ that the content of the tutorial was relevant to learning outcomes.

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52% felt ‘somewhat comfortable’ unmuting their microphones to contribute verbally, contrasting to 24% feeling ‘not very’ or ‘extremely uncomfortable’. In practice, only 30% of students contributed verbally.

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57% felt most comfortable contributing via the written ‘chat’ function (rather than audio or camera).

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65% felt either ‘somewhat’ or ‘very comfortable’ turning their cameras on, but only 1 student turned their camera on across all tutorials.

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48% felt the tutorial was more accessible virtually than face-to-face; 5% considered it less so.

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When COVID restrictions are lifted, 14% would prefer the tutorial to remain virtual, 53% would rather it returned face-to-face, and 33% had no preference.

7 (of 7) tutors completed the questionnaire.

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100% felt that students having their camera on would make their experience of delivering teaching ‘much better’ or ‘better’.

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71% of tutors felt that students contributed ‘slightly’ or ‘significantly’ less in the virtual classroom.

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Only 29% of tutors found the experience of virtual teaching ‘very’ or ‘somewhat’ enjoyable, contrasting 43% finding it ‘somewhat’ or ‘very’ unenjoyable.

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Several white space tutor comments suggested the lack of audio-visual engagement made teaching less rewarding, whilst also preventing them from adapting content, pace, and teaching style to suit the group's needs. Tutors felt that the ease of delivering teaching from any location was beneficial.

Conclusion

Virtual teaching has become embedded in medical education and will likely remain so post-pandemic. For it to be an effective and enjoyable experience, for both students and teachers, there needs to be adaptation of content, technology, etiquette and culture.
More than just the mental health act – foundation-specific teaching to inspire psychiatrists
Authors: Heminway Robert , Fitzmaurice Lauren , Alhaj Hamid , Fearnley Edward
Published: June 2021

Aims

This project aimed to further develop a teaching programme for Foundation Doctors attached to a psychiatry rotation. The purpose was threefold – to educate foundation doctors about important psychiatric topics; to encourage them to think about wider impacts of psychiatry; and to inspire them to consider psychiatric training in the longer term.

Background

The Royal College of Psychiatrists’ mission statement includes actively promoting psychiatry as a career and improving knowledge of mental health, including its interactions with people's physical and social backgrounds. Targeting foundation doctors rotating into psychiatry posts is a good opportunity to achieve these objectives, as they will be the cross-speciality doctors of the future, and have specific learning needs given their unique rotations and new medical careers.

Method

On one Wednesday morning per month Foundation Doctors had a specific teaching session for them. The sessions consisted of four 30-minute teaching blocks which, crucially, were given by foundation doctors. They were facilitated by a core psychiatry trainee, and the topics were decided by the doctor teaching each 30-minute block. The foundation doctors were able teach on any topic related to psychiatry that interested them. Feedback forms were developed and provided at the end of each session for the foundation doctors, as well as at the end of each recent foundation rotation, to get feedback on the overall quality of the course delivered.

Result

The programme has now had 6 complete cohorts of foundation doctors. We have built a varied topic bank from past sessions, including the Mental Health Act, dementia, the Mind-Body Problem, psychiatry in video games and sociology of psychiatric illness, amongst other topics. All foundation doctors questioned have agreed or strongly agreed that the sessions were helpful for their psychiatric rotation and general medical training. Particularly praised aspects were the ability to discuss psychiatric topics that weren't normally discussed in an academic environment, being able to take ownership over learning and practicing giving teaching. Vitally, core trainee facilitators also found the sessions inspiring for their training.

Conclusion

The Foundation Teaching Programme has increased doctors’ knowledge of a range of psychiatric topics, the breadth of which and agency in choosing topics has increased engagement with psychiatry, regardless of planned medical training speciality. Areas to explore in the future include potentially opening attendance to medical students and physician associate students, and to other regions of the deanery. Evaluating the long-term impact of this training is also warranted.