bluuebunny/crossref_metadata_2025_split huggingface dataset:
A survey on psychiatry trainees’ experiences of racism
Authors: Rais Aicha , Burton Richard , Rauf Adeel 
Published: June 2021

AimsTo measure rates of racism experienced and witnessed by trainees training in Derbyshire.BackgroundDerbyshire Healthcare Psychiatry trainee workforce comprises 39.1% white, 52.2% ‘Black, Asian and Minority Ethnic’ (BAME) and 8.7% undisclosed ethnicity. Racism can affect trainees by increasing risk of poor mental health and psychological distress leading to worse health outcomes. Discrimination, marginalisation and segregation is related to poorer quality education and employment opportunities.MethodElectronic surveys were sent out via e-mail to trainees in the North and South Derbyshire Hospital sites, accessible online from 11th to 31st December 2020.Questions asked about personal experiences of racism, witnessing racism from patients and/or staff whilst training in Derbyshire. Trainees were asked if they know how to report incidents and if routinely reported. Trainee ethnicity was recorded.ResultA total of 56 trainees received a survey request. Response uptake rate 25% (14 out of 56). Respondents comprised of 36% white and 64% BAME doctors. Over one third (36%) of trainees reported experiencing racism from staff. 64% of trainees reported experience of racism from patients. There was no report of racism witnessed by staff towards patients. 29% of trainees reported witnessing both staff on staff racism and patient on staff racism. 93% of trainees reported witnessing racism from patients to staff. 29% BAME trainees reported experiencing racism from both staff and patients. 7% BAME trainees said they experienced racism from staff alone. 36% of trainees reported experiencing racism from patients only (4 BAME and 1 white trainee). 57% of trainees do not know how to report racism. 50% of trainees said they would report racism if they knew how.ConclusionRacism remains a barrier affecting the lives of trainees requiring attention. BAME trainees are disproportionately affected by racism, and report witnessing more incidents, from staff and patients in the workplace. There remains an apprehension by doctors to report racism. A departmental presentation has been delivered on racism, unconscious bias, incident reporting process and sources of support. A workshop with the ‘Equality Diversity Inclusion’ team has been delivered to all trainees with the presence of the Freedom to Speak Up Guardian. Our British Medical Association Local Negotiating Committee Representative has also been informed.
Enhanced faculty development: using the GMC survey to run a trainer development workshop
Authors: Schmidt Martin , Leung Timothy 
Published: June 2021

AimsTo investigate whether the General Medical Council (GMC) National Training Surveys (NTS) can be analysed to create a trainer development workshop that improves postgraduate training.BackgroundAs part of its role in quality assurance of medical training, the GMC conducts an annual survey of trainers and trainees. The Trainer survey, part of the NTS, consists of 47 questions which are grouped into 11 indicators of quality. At Surrey and Borders Partnership NHS Foundation Trust, we were keen to use the comprehensive data in the NTS to improve training. We analysed each question to create a workshop to engage trainers in discussion about improving the experiences of trainers and trainees.MethodOur analysis of the NTS used data from the online reporting tool to calculate the scores that were obtained for each question in the 2018 NTS. A question was discussed at the workshop if it performed poorly relative to other questions in the indicator; to provide useful information; or to clarify ambiguity. Indicators where interesting comparisons can be drawn between the views of trainers and trainees were also discussed. The 90-minute workshop was led by the Leadership and Education Fellow and Director of Medical Education. Attendees were subsequently sent an online survey.ResultThe workshop consisted of an introduction to the NTS; group discussion on which indicators were felt to be important, good- or poor-performing; discussion of specific questions; and a review of feedback from trainees.12 questions and 3 indicators (Handover, Supportive environment, Rota design) were discussed. 11 questions were chosen for poor performance, which sought to contextualise the results within the experience of attendees. 8 questions were chosen to provide information, such as resources and current initiatives. 3 were chosen to clarify ambiguity. Many questions met several criteria.17 attendees responded to the online survey. 64.7% agreed or strongly agreed that the NTS asks questions that are important for them. 76.5% agreed or strongly agreed that the NTS can be used to improve the trainer experience.In the subsequent NTS, there was an improvement in 9/11 indicators in the Trainer Survey, with four green flags denoting performance in the top quartile of trusts nationally.ConclusionThe NTS can be used to structure a workshop that trainers feel can improve their experience. Our strategy demonstrates the value of analysing the NTS dataset intelligently to engage trainers in improving training.
Developing a differential attainment e-learning course for consultants who supervise trainees within Oxleas NHS Foundation Trust
Authors: Tomlinson Naomi , Kahai Bani , Balogun Femi 
Published: June 2021

AimsTo create an e-learning course to promote awareness of differential attainment and encourage supervisors to reflect on their own experiences and practice.MethodFunding was gained from Health Education England to create the e-learning course. A questionnaire was constructed to gauge baseline knowledge and attitudes towards differential attainment amongst the consultant body. All consultants attending a local Faculty Day were asked to respond, and following this an explorative discussion on the topic was chaired by the authors. The results of the survey were collated and free-text answers were coded thematically. In parallel, information from academic publications and professional resources was gathered and summarised. A script was created with support from web developers Kineo and was refined over several drafts. The e-learning module was published on the Oxleas learning environment on the 10th February 2021.Result34 supervisors responded to our questionnaire. 75% had heard of DA, with 45% identifying personal experience of it. However only 35% identified it as a problem in their work place and 39% did not consider it in their clinical practice. Thematic analysis of free text comments revealed three main themes – emotions and experiences associated with differential attainment, a desire for increased training and a desire for more open discussions with struggling trainees. Some answers also revealed poor or incomplete understanding of the topic.From the questionnaire and the literature, four key areas were identified – defining differential attainment, describing the scope of the problem, challenging misconceptions about differential attainment and the role of the social network in attainment. These four areas became section titles for the e-learning course.ConclusionThere is an appetite for information pertaining to differential attainment amongst our consultant body. A trainer facing e-learning course was created to promote awareness and reflection on current practice. Evaluation of the impact of the module is ongoing. The course is being shared with the confederation of South London local education providers.
Potential drug targets in the kynurenine pathway to treat acute schizophrenia
Authors: Malhotra Ayush , Manowitz Paul 
Published: June 2021

AimsSchizophrenia is a serious developmental psychiatric disorder with a neurodegenerative component that causes marked deterioration in social relationships and ability to work. Present treatments are not satisfactory. Meta-analysis of placebo-controlled studies in acute schizophrenia shows that only a minority of patients have a good response to current antipsychotic medications. Therefore, there is a need for more effective psychopharmacologic treatments for this disorder.MethodThe purpose of this paper is to provide new interpretations of existing data to provide a scaffolding for the development of novel drug targets for the treatment of schizophrenia. The causes of schizophrenia are most likely heterogeneous and involve both genetic and environmental factors. The authors examined a wide range of purported causes of schizophrenia to identify a common biochemical pathway that would contribute to this disorder. This review specifically did not consider pathways that supported the dopamine hypothesis of schizophrenia since historically drugs focused on dopaminergic mechanism, as noted in the aims, have not been successful for many patients with schizophrenia.ResultTwo prominent schizophrenia-associated factors that have been widely studied with significant supporting evidence are stress and inflammation. Stress and inflammation share a common biochemical pathway that converges on the kynurenine pathway of the metabolism of tryptophan, an essential amino acid. At one end of the pathway, recently hospitalized patients with schizophrenia have been found to have low plasma tryptophan levels, whereas chronic schizophrenics have not, suggesting stress- and/or inflammation-induced increased metabolism of tryptophan. At the other end of the pathway, there is increased level of cerebrospinal fluid kynurenic acid in patients with schizophrenia as compared with healthy controls. Salivary kynurenic acid is associated with stress intolerance in schizophrenia. Importantly, natural occurring compounds in this pathway have significant CNS effects that include neurotoxicity and altered neural transmitter behavior.ConclusionStress and inflammation, both associated as causes of schizophrenia, are linked by a common biochemical pathway involving kynurenine. Examination of specific elements of the kynurenine pathway may aid in the identification of drug targets for schizophrenia.
Transition from child and adolescent mental health services to adult mental health services: children in care and adopted children
Authors: Adamopoulos Paula , Samuel Rani 
Published: June 2021

AimsMental health transition-related disengagement is a major public health problem. This study aims to review children in care (CIC) and adopted children's transitions from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). This study aims to illustrate the often overlooked complexities that are associated with this population's transitions.It is hypothesised that this population is at an increased risk for disengagement post-transition. Such is hypothesised as a result of the population's increased prevalence of complex mental health problems, neuro-developmental needs and developmental trauma. This population would benefit from a transition (optimal), as opposed to a transfer of care (suboptimal).MethodThis retrospective case study included young people from Lewisham CAMHS's team for looked after and adopted children. Optimal transition was evaluated using four criteria: continuity of care, parallel care, a transition planning meeting and information transfer.ResultA total of 34 cases (male = 14, female = 20) were included, 88% of which were CIC (12% were adopted children). 85% of the cases included reports of at least one form of abuse and/or neglect. 59% of the cases were categorised as having more than one diagnostic group of mental health problems.30% (n = 11) of the cases were discharged and were not recorded to have re-engaged with Lewisham AMHS. 12% of the cases had an outcome as 'unknown' due to miscellaneous reasons.Only 18% (n = 6) of the cases had an ‘optimal’ transition. 18% (n = 6) had a suboptimal transfer and of those cases, 66% (n = 4) did not engage with AMHS beyond three months post-transfer. 21% (n = 7) were re-referred to Lewisham AMHS after being discharged from CAMHS. None of the re-referred cases engaged with AMHS post-referral.ConclusionIn conclusion, these findings demonstrate that this population is highly complex and can often experience suboptimal transitions from CAMHS to AMHS. Anything less than an 'optimal' transition yields a low ratel of therapeutic engagement. Recommendations for clinical practice includes an extended period of ‘overlap time’ between CAMHS to AMHS for CIC and adopted children. This overlap period will enable mental health practitioners to provide more informed and consistent support that incorporates the needs of CIC and adopted children. Such a provision will enhance therapeutic engagement and subsequently, promote better outcomes for CIC and adopted children. These findings have important resource implications for both CAMHS and AMHS teams.
A quality improvement project (QIP) to address communication and safety concerns from the on-call team at the Bethlem Royal psychiatric hospital out-of-hours through the introduction of weekend safety huddles
Authors: Allis Helen , Zahedi Mariam , Stephenson Thomas , Newson Michael , Kumar Anil 
Published: June 2021

AimsThere have been long-standing concerns about communication and safety on the Bethlem site out-of-hours due to its size, acuity and the number of specialist services; these issues were exacerbated by the COVID-19 pandemic. A Quality Improvement Project was designed to address communication and safety concerns from the on-call team at the Bethlem Royal psychiatric hospital out-of-hours through the introduction of weekend safety huddles.MethodDaily weekend safety huddles were introduced to improve communication regarding workload, acuity, new admissions, seclusion reviews, deteriorating patients; and to improve team cohesiveness and trainee support out-of-hours.The QIP team involved the deputy medical director, the associate director for speciality units, consultants, the college tutor, specialty registrars and core psychiatry trainees. Prior to initiating the huddles, the QIP team met to decide which specialties to involve, to agree on an agenda and liaise with other sites regarding existing huddles. Once the huddles began in April 2020, the team met periodically to agree next courses of action and to troubleshoot. The huddles initially involved acute services and eventually included CAMHS, Forensic, Older Adults, Specialist Units, all on-call consultants, the on-call registrar, two core trainees, the psychiatric liaison manager and the duty senior nurse.ResultData were gathered throughout the QIP using Likert scale surveys which were sent to all junior doctors on the out-of-hours rota. Paper surveys were used initially but were later replaced with Microsoft Forms to ensure anonymity.The percentage of respondents who answered “most of the time” or “all of the time” increased across all parameters when comparing data from before and after implementation of the safety huddles.These results included improvement in: understanding of workload and acuity (9% before vs 69% after), discussion of new admissions on site (4% before vs 90% after), discussion of patients with deteriorating mental health (35% before vs 90% after) and physical health (22% before vs 83% after), understanding of number of patients in seclusion (61% before vs 93% after) and feeling part of a cohesive “on-call” team (17% before vs 86% after). In addition, the results suggested a reduction in frequency of safety concerns on site (83% answered at least “sometimes” before vs 62% after).ConclusionThe results of the final survey demonstrated a measurable and positive impact on communications between the out-of-hours team, improved team cohesiveness and a reduction in safety concerns. The lessons learnt also influenced decisions made in formatting safety huddles at other trust sites.
Prescribing and monitoring high dose and combined antipsychotics in community mental health team
Authors: Banerjee Dipanjan , Green Tracey , Khan Umama 
Published: June 2021

AimsThe aim was to establish the prevalence of prescription of combined and high dose antipsychotics in the community mental health team and to see if such patients were being offered regular monitoring as advised by NICE guidelines.BackgroundThe use of high dose antipsychotic treatment (HDAT) should be in line with the recommendations of the Royal College of Psychiatrists Consensus statement on high dose antipsychotic Treatment. Such treatment should be initiated only when standard treatments have failed. As high dose prescribing of antipsychotic medications can potentially harm than benefit causing serious side effects and sudden death. Close monitoring and documentation are required. Also, reviewing these patients at regular intervals is recommended.MethodA retrospective audit of 50 case notes of patients currently on antipsychotics was done. Case notes were selected randomly from a pool of 300 plus patients under the care of Isle of Wight NHS Trust in the HoNos Cluster 11 and 12 care pathways. Data were gathered on patients` demographics, diagnosis, medication monitoring. Data were analysed and discussed with consultant psychiatrist and senior mental health pharmacist. Patients who were not on any antipsychotic medications were not included in the audit.Result90% of the patients were on single antipsychotic (45 out of 50), 4.45% (2 out of 45)were above BNF recommended dose. 10% (5) patients were prescribed combined antipsychotics. 40% (2)of them were above BNF recommended maximum dose. A total of 8% (4 out of 50) patients were on above BNF recommended maximum dose. All the patients on high dose antipsychotics had a clear plan documented in the system. Documented monitoring of Full blood count was found in 75%, blood glucose in 50%, lipid in 75%, cardiac monitoring (Electrocardiogram or ECG) in 0%, physical health monitoring in 0%ConclusionAs far as we know, this is the first time an audit has been done on the patients under the Community Mental Health Team on high dose antipsychotic treatment. The data showed areas of good practice as the majority of the patients were on monotherapy, and all the patients on a high dose or combined antipsychotics had clear management plans outlined in their notes. However, the audit also highlighted areas that currently need improvements such as regular monitoring of the patients on high dose and combined antipsychotics. It should also be clearly documented, recorded, and reviewed at six-monthly intervals.
Improving patient waiting times and quality of care by arranging access to notes from a neighbouring trust
Authors: Basdanis Georgios , Fenton Cormac 
Published: June 2021

AimsWe aim to improve waiting times in the Emergency Department and improve the overall quality of care of out-of-area patients by arranging for the liaison team to have access to the electronic notes system of a neighbouring trust.MethodSt Thomas’ Hospital is located in south London, right opposite the City of Westminster. As a result, approximately 20% of patients we see in mental health liaison are from that locality. Given that they belong to a different trust, we do not have access to their notes, which leads to a delay in trying to establish whether they are known to local mental health services. Often, staff are reluctant to divulge information. When information is shared, it is often late and/or incomplete. We approached the Chief Clinical Information Officer and Head of Information Governance from Central and North West London (CNWL) NHS Foundation Trust. We held weekly meetings which included both IT departments. Our IT had to install the electronic notes application (SystmOne) on our computers and open relevant firewall ports. The information is access through an NHS Smartcard, therefore CNWL had to authorise read-only Smartcard profiles for every member of the liaison team. A quick reference guide was created for all staff that would be using the new application. The system went live on 21 January 2021.ResultWe audited patient outcomes in December 2020 and February 2021 for initial comparison. In December 2020, the median time from referral to discharge was 6 hours 35 minutes. 25% of patients were admitted and 17% discharged with HTT. In February 2021, the median time from referral to discharge was 3 hours 19 minutes. 16% of patients were admitted and 5% discharged with HTT.ConclusionIt is likely that by reducing the time required for collateral information, overall waiting times in the emergency department will be reduced. Clinicians are likely to feel more confident in their discharge planning if they have access to all clinical notes and previous risk assessments, which might in turn reduce referrals to HTT or admission. There should be further attempts by neighbouring NHS trusts, especially in London, to ensure access to their electronic notes system in order to reduce waiting times and improve the quality of patient care. We have already been approached for more information by a trust in North London who are interested in establishing access to a neighbouring trust's notes.
Clozapine initiation in the Belfast Health and Social Care Trust (BHSCT)
Authors: Cairns Rebecca , Guy Stephen 
Published: June 2021

AimsThe aim of this project is to improve the quality of documentation and recording of the assessment and monitoring of patients commencing clozapine in BHSCT.BackgroundClozapine is an effective treatment for patients with schizophrenia who have not responded to at least two other antipsychotics. Due to clozapine's significant side effect profile patients must be carefully assessed prior to treatment initiation with close monitoring of their physical observations and reported side effects during initiation.The BHSCT Clozapine Pathway currently uses a Clozapine Assessment Integrated Care Pathway (ICP) common to inpatient and outpatient clozapine titrations and a Clozapine Titration ICP which varies slightly between inpatient and outpatient titrations.MethodThe Clozapine ICPs of patients commenced on clozapine in BHSCT in a 9 month period commencing January 2019 were reviewed. Handwritten clinical records were used to collect data on rates of completion of all aspects of the pathway.These results were used to identify areas of the pathway that were being poorly completed and the “Method for Improvement Model” used to trial changes to the pathway using Plan-Do-Study-Act (PDSA) cycles.Result20 patients in BHSCT were commenced on clozapine in the 9 month period. 1 Clozapine Initiation Pathway could not be located; therefore data were collected on 19 patients. 2 patients were initiated in the community and 17 patients initiated as inpatients.The results showed that sections of the Clozapine Assessment ICP were poorly completed; for example only 27% of the “Patient Baseline Preparation Checklist” were complete, with 60% partially complete and 13% completely blank.In the inpatient clozapine titration ICP the physical observations record was complete in only 20% of patients and the side effects monitoring record complete in only 13% of patients. Conversely the physical observations and side effects monitoring records were complete in 100% (n = 2) of patients.ConclusionBHSCT Clozapine Pathways were being poorly completed, with outpatient pathways being completed better than inpatient pathways. Analysis of the data shows that repetition of information in various parts of the pathway leads to gaps in documentation.Parts of the pathway that were poorly completed have been redesigned and the impact of these changes assessed using the PDSA cycle method. It is hoped that this along with education of staff will lead to an improvement in the assessment and monitoring of patients being commenced on clozapine.