bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing a virtual mock casc for trainees
Authors: Somerville Laura , McMurray Peter , Sing Vivian , Campbell Stephanie , McGee Meta 
Published: June 2021

AimsThe restrictions experienced due to the COVID-19 pandemic had impacts on how clinical teaching and assessment is conducted. The Royal College of Psychiatrists decided to run the final part of the membership exam, the Clinical Assessment of Skills and Competencies (CASC) online for the first time in September 2020. We aimed to prepare candidates in the Northern Ireland deanery for this by developing a virtual mock examination using the Zoom platform.MethodIn previous years, higher psychiatry trainees in the Northern Ireland deanery have run successful face to face mock examinations to help pre-membership trainees prepare for the CASC. We adapted some of this material to our virtual examination. 16 stations were run in total, in two circuits of eight. These stations were mapped to the Royal College CASC blueprint. Higher trainees were recruited to act as examiners, with core trainees acting as simulated patients. The mock examination was advertised through the local deanery and all candidates sitting in September availed of the opportunity (a total of 8 trainees).Zoom was used as the platform due to ease of use, familiarity and breakout room function. Each station formed one breakout room, and a facilitator moved candidates between rooms and provided timing prompts. Instructions were emailed to candidates in advance.A comfort break was provided between circuits. At the end of the mock examination, everyone was returned to the main room and examiners gave general feedback and tips. Individual feedback was provided by collating mark schemes for each candidate, which included free text feedback, and sending these via email.ResultDespite the evident challenges involved, the mock CASC ran smoothly. There was one minor delay of approximately 3 minutes due to technical difficulties, which was easily recouped. We obtained qualitative feedback from candidates which was positive, with trainees commenting that they felt “more at ease … less worried” about a digital exam, and that it was “efficient and effective”.All candidates who sat the mock examination were successful in the face to face CASC sitting which followed in September.ConclusionWe were able to successfully adapt what was previously an in-person mock CASC exam to the new digital format in a way that reflected how the actual CASC exam will run, and it was considered beneficial preparation by the candidates who sat this mock. This has improved trainee experience at a time when many teaching opportunities have been suspended.
The use of drama and theatre in enhancing communication skills of psychiatry trainees: a pilot study
Authors: Stevenson Laura , Khan Farooq , Bharmal Qusai , Odejimi Opeyemi , Samnani Sheliza , Wright Polly 
Published: June 2021

AimsVarious methods have been employed in the development of communication skills. This pilot study was designed to assess the acceptability, feasibility and cost-effectiveness of a specially designed workshop exploring the use of drama and theatre in enhancing the self-reported communication skills of psychiatry trainees. As a secondary aim, it assessed if the value of the improvements translated both into clinical practice and to training situations, including success in the Royal College of Psychiatrists (RCPsych) Clinical Assessment of Skills and Competencies (CASC) examination.MethodA three-day drama and theatre workshop was organised in the West Midlands Deanery in conjunction with specialist instructors from performing arts at the Hearth Centre, Birmingham. The Tension State technique developed by Jacques Lecoq and Forum Theatre approach, were some of the methods employed to enable participants to develop the softer, but essential communication skills required for effective practice. Work was also undertaken focussing on self-regulation. Fourteen trainees completed the first day of the workshop. This pilot study utilised a mixed methodology to evaluate participants’ views of the perceived impact of using drama and theatre to enhance their communication skills. Feedback was obtained from organisers and facilitators specifically relating to feasibility and cost effectiveness. Data were collected from participants using pre and post-workshop questionnaires and focus groups.ResultAll participants reported a positive and enjoyable experience, indicating that the approach was acceptable to those involved. The facilitators deemed this more novel approach to enhancing communication skills feasible, and cost effective and concluded that there was scope to incorporate it into routine psychiatry training in the area. It was however identified that the content of the workshop could be condensed, reducing the length therefore to two days. There was a notable increase in participants’ self-reported confidence in their communication skills post compared to pre-workshop. Trainees reported utilising the techniques in day-to-day practice. All of those participants who undertook the CASC examination during the workshop were successful, although it would be too presumptive to assume a causative effect. The workshop was completed without any adverse events and there were no concerns from a safety perspective.ConclusionDrama and theatre, as a novel approach, appears to have noticeable benefits in enhancing the communication skills of psychiatry trainees. The success of this pilot study in demonstrating acceptability, feasibility and cost effectiveness, suggests that drama and theatre techniques could be easily incorporated into psychiatry training and potentially other medical education programmes.
Mind and body: physical health monitoring in clozapine treatment
Authors: Abdelreheem Moataz , Connell Olivia , McNally Daniel , Ayeni Itunuayo Veronica , Smith Clare 
Published: June 2021

AimsTo evaluate physical health monitoring standards in patients on Clozapine in the community.StandardsNICE and BNF guidelines for patients on established clozapine treatment advise annual monitoring of weight, waist circumference, pulse, blood pressure, fasting blood glucose, HbA1c, blood lipids and overall physical health assessment. Full blood count is monitored 1-4 weekly.BackgroundIn the management of schizophrenia, antipsychotic medication remains the cornerstone of treatment. Patients affected carry a significant physical health burden with a reduced life expectancy of 10-25 years. Factors that contribute include sedentary lifestyles, consequent obesity and cardiovascular disease, disengagement from health services, a higher incidence of suicide and the physical side effects of antipsychotic medication. For these reasons, comprehensive routine physical assessment of patients on antipsychotic treatment is of central importance.MethodThis audit is a retrospective study of patients known to South Kensington & Chelsea Community Mental Health Team (CMHT). Patients (n = 48) were audited from the Clozapine clinic SystemOne database over a one year period (October 2018-2019) to assess annual monitoring of full blood count (FBC), urea and electrolytes (U&Es), lipid profile, liver function tests (LFTs), HbA1C, thyroid function tests (TFTs), clozapine levels, ECG, and general physical and mental health review.ResultOf the 48 patients, one was transferred to a different service so was excluded (n = 47 total).All (100.0%) of the patients had annual FBC tests. All but one (97.9%) of the patients had a physical health review including blood pressure, pulse, weight and BMI measurement. Three quarters (74.5%) received annual U&Es and LFTs. Almost two thirds of patients had annual lipid and HBA1c screening (63.8%) and over half the cohort had annual TFTs (61.7%). Regarding annual multidisciplinary mental health review, this was performed for the majority of the patients (70.2%).Contrastingly, only a quarter of the patients received annual screening of glucose and Clozapine levels (27.7% for both). Only 12 patients had annual ECG (25.5%).ConclusionFollowing review it is clear that most parameters were monitored annually in a majority of patients. However, shortcomings were detected, specifically annual ECG and waist circumference monitoring.In order to ensure comprehensive monitoring of mental and physical health of patients on Clozapine, flow charts of tests and reviews needed for each patient were written up clearly and will be included in the management pathway for every patient on Clozapine. This was agreed to minimise missing any step, particularly annual ECGs.
Using an electronic discharge notification system reduces the time delay between discharge and a summary being sent to the GP
Authors: Adams Alex , Ymisson Bodvar , Davies Virginia 
Published: June 2021

AimsAll patients discharged from our Paediatric Liaison Team will have an electronic discharge summary sent to their GP within 24 hours by January 2020.BackgroundWriting a GP discharge summary is an essential part of patient care and is a patient safety issue if not completed on time. The NHS England Standard Contract states discharge summaries should be completed and sent to a GP within 24 hours of discharge. Baseline data showed our median time between discharge and a GP summary being sent off as 3 days and a baseline survey of staff in our team rated our discharge summary process as inefficient and time consuming. At baseline our discharge summary was typed on a word document which was then emailed to admin staff who would print and post to the GP. Our electronic patient record had an inbuilt discharge notification function that generates and sends summaries via email to the GP that other teams in the trust were already using.MethodWe utilised the Model for Improvement Quality Improvement methodology. Initially we created a driver diagram breaking the process of discharge summary writing into its constituent components to generate change ideas. We then tested out these out in plan, do, study, act (PDSA) cycles whilst continually collecting data using a shared team spreadsheet to monitor for change.ResultWe found that switching to electronically sent discharge notifications improved our time from discharge to a summary being sent to the GP from a median of 3 days to 1 day. We noticed that alongside a shared team spreadsheet monitoring when summaries were written we also reduced variation of time between discharge and a summary from a range of 0-27 days (with an outlier of 161) to 0-9 days.ConclusionOn average the time from discharge to a summary being written met the standard and we reduced the variability of time delay by using an electronic notification. However only 56% of summaries were sent within the 24 hour limit. Key factors for continued variability identified during regular team meetings included overall caseload of patients, amount of staff on shift and technical issues with the form. Our plan for sustainability is to discuss monthly in the team meeting any discharges that took longer than 1 day and target further PDSA cycles to these issues.
An analysis of outcome measures in a specialist inpatient eating disorders unit in Aberdeen: changes since 2015 and response to the COVID-19 lockdown
Authors: Cross Emma , Morris Jane 
Published: June 2021

AimsIdentify differences in outcome measures between inpatient cohorts during the first year of the pandemic compared with preceding years.Identify key elements in the treatment provided by identifying any trends in the outcome measures between 2015 and 2021.BackgroundThe Eden Unit at the Royal Cornhill Hospital (RCH) in Aberdeen is a ten-bed specialist centre for the inpatient treatment of eating disorders (ED). Strict measures to control the spread of COVID-19 have meant that important aspects of therapy in the Eden Unit are no longer permissible. It is not known whether handicaps to providing the previous service are reflected in recent outcomes.MethodValues for age, length of stay (LOS), BMI, HbA1c (diabetic patients) and responses to three questionnaires: Eating Disorder Evaluation Questionnaire (EDE-Q); Depression Anxiety Stress Scale (DASS)-21; and Clinical Outcomes in Routine Evaluation (CORE). This data were collected for April 2020 to February 2021 (Pandemic) and compared with five preceding years, April 2015 to March 2020 (Pre-COVID). The project was registered with NHS Grampian Quality Assurance Team and approved by the MCN Quality Assurance subgroup. Ethical approval was not required. A data collection sheet allowed anonymised data to be entered into a Microsoft Excel TM Spreadsheet for analysis of baseline demographics.ResultAverage age of patients remained similar across the six years. Length of stay in the first year of the pandemic was significantly shortened. BMI on discharge in 2020/21 remained similar to preceding years. If relevant, HbA1c was measured throughout admission and comparison with BMI change reflected a focus on treating both diabetes and ED concurrently. Comparison of admission and discharge questionnaires to determine outcome measures proved difficult due to the small number of responses to both.ConclusionShorter LOS during the pandemic was a significant finding. Despite this, BMI on discharge remained similar, suggesting a shift to weight restoration due to lack of opportunities for an holistic approach due to restrictions. Key elements of treatment include careful monitoring of HbA1c and concurrent management of Type I Diabetes for those patients. The low response rate to questionnaires raises concern regarding their use, in their current format, as effective tools to measure outcomes. Though low numbers of questionnaire responses prevent firm conclusion, it appears that the reduced opportunities for elements of treatment to be undertaken in the community may have contributed to increased anxiety levels on discharge.
Improving the management of menopause in women with serious mental illness
Authors: Lorenzo Maria-Elena Di , Reilly Thomas , Walker-Tilley Tom , Mace Shubhra 
Published: June 2021

AimsTo improve the diagnosis and management of menopause in women with a serious mental illness in psychiatric services. This will be achieved by developing a questionnaire to systematically assess symptoms related to the menopause, based on NICE guidelines. Women will be offered information and advice, according to these guidelines. Barriers to the assessment or management of the menopause will be identified by piloting the questionnaire on an inpatient female ward.MethodWomen aged 40 years and over, admitted to an acute female in-patient ward in South London and Maudsley NHS Foundation Trust, were interviewed using a structured questionnaire.ResultIn total, 23 eligible women were approached of whom 17 (74%) agreed to take part with mean age 53 years (range 40–67 years). Nine women reported that they had undergone the menopause and four women reported experiencing perimenopausal symptoms. Fifteen women had not previously received information about the menopause. Of the 13 women who had undergone the menopause or were experiencing irregular periods, 7 reported experiencing hot flushes, night sweats and a general change in physical and mental health and four reported a change in mood. Seven women reported that the changes noted may have been related to the menopause over the previous 12 months. Eight women requested further information either in written format or in the form of an information group about the menopause.ConclusionWe identified women who were admitted to a psychiatric ward who had experienced symptoms related to the menopause that had impacted on their mental and physical health. It was evident that the majority of these women with severe mental illness had not had the opportunity to discuss their symptoms with a healthcare professional in the past and a significant proportion welcomed further information to help make sense of their symptoms. We intend to implement the questionnaire trust-wide with the eventual aim of developing a local guideline to inform the assessment and management of the menopause within our services.
“The path is smooth that leadeth on to danger”: caffeine and psychosis
Authors: Ganhao Isabel , Marinho Goncalo , Paixa Afonso , Trigo Miguel 
Published: June 2021

AimsTo review literature on the importance of caffeine intake with regard to psychosis. The need for intervention with regard to caffeine intake hinges on effectively recognizing potential risks.BackgroundCaffeine is the most widely consumed psychoactive substance worldwide and as such is generally considered acceptable but as a competitive adenosine antagonist, it affects dopamine transmission. Patients with serious mental illness are known to have higher caffeine intakes than the general population. The hierarchy of needs for this patient population is complex, frequently leaving the intake of caffeine under the radar of clinical priorities.MethodPubMed and Google Scholar search for caffeine/coffee and psychosis/schizophreniaResultOf the 43 articles that were considered relevant for clinical practice, caffeine consumption was associated with 1) appearance of psychotic symptoms and episodes (caffeine-induced psychosis) and chronic psychosis in high intake 2) exacerbation of psychosis in schizophrenic patients even in lower intakes, 3) treatment resistance possibly due to interference with antipsychotics (ex. clozapine), 4) abuse and addiction, 5) comorbidity with tobacco smoking and other addictions. Caffeine in low doses was associated with ameliorating cognitive and extrapyramidal side-effects of medication and as a potential treatment strategy for treatment-resistant schizophrenia.ConclusionCaffeine consumption may have a greater impact on psychotic symptoms and episodes than is recognized with negative effects outweighing any potential benefits. Greater awareness of the necessity to quantify caffeine intake and implementation of interventions to curb intake may contribute to better quality of care of serious mental illness. Further research is warranted.
Audit on nursing notes in a psychiatry in-patient setting
Authors: Gunathillaka Kavinda , Timbo Mariam , Ginn Stephen 
Published: June 2021

AimsWe aimed to assess the accessibility and informativeness of the content of daily nursing notes through an audit, and improve deficiencies identified.BackgroundNursing notes are an important source of observation findings, of in-ward psychiatry patients.There can be variations in the quality of the notes as well as information contained within.A basic level of clarity and information within all notes will be helpful in using these to inform the management of patients.MethodAn audit was carried-out in a ward treating working-age patients for psychiatric illnesses.Setting standards - standard required of a daily progress note was decided after discussion in multi-disciplinary team meeting (MDT). Clear language and information on; mental-state, medication, meals, physical health, personal care, activities, risks and use of leave, were identified as requirements.Retrospective audit - First audit cycle was carried-out by assessing the notes two weeks retrospectively. The assessment instrument used a qualitative measurement of the readability of the notes as well as quantitative assessment of the contents.Intervention - The standards set during the MDT, as well as a suggested format for recording notes, were communicated to the staff through email. Follow-up meetings with individual staff members and MDT, to evaluate staff satisfaction and new suggestions to improve the format were held. Difficulties staff encountered when implementing the format were discussed and resolved.Second audit cycle - Following implementation of the intervention, the notes were again assessed using the same instrument.ConclusionDifficulty in accessing information from the notes was noted in the first audit cycle. The average score for accessibility of information when scored on Likert scale + 3 to -3, was 1. Use of language scored 2 on average. On the second audit cycle, accessibility had increased to 3 on average while language score remained 2.Quantitative measurement was done for presence of information on; mental state, medication, meals, physical health, personal care, activities, risks and use of time away from ward. All of these parameters showed an increase in the post-intervention second audit cycle. Information on taking meals, medication, and physical health was present 100% of the time in the second cycle. Most improvement was in information on personal care which showed a five-fold increase, from 17% to 89%In conclusion, standard for nursing notes arrived via discussion and consensus in MDT, has been successful in improving the accessibility and information within nursing notes.
Investigating sleep quality on an inpatient psychiatry ward
Authors: Hughes Joshua , Thomas Rhianne , Macklin Jonathan , Owen Jonathan 
Published: June 2021

AimsSleep is essential for optimal physiological functioning, but often interrupted in hospital settings. Disturbed sleep is associated with relapse of mood disorders and multiple comorbidities including impaired immunological function and increased cardiovascular risk. There are unique environmental challenges on psychiatry wards, such as overnight monitoring. Recent studies highlight the importance of evaluating and managing inpatient sleep disturbance. Aims include exploring the extent to which patients’ sleep is impacted by inpatient admission, elucidating causes of sleep disturbance and determining ways to improve sleep during admission.MethodPatients aged 18–65 years, who consented and were expected to be inpatients for a week, were approached after 72 hours of admission (n = 35). Quantitative and qualitative data, including on pre-hospital and hospital sleep quantity and quality, were gathered, as part of a cohort characterisation. Questionnaires using Pittsburgh Sleep Quality Index elements were used to gather data. Offering earplugs as a sleep-aid intervention was implemented, with sleep quantity and quality reassessed 72 hours post-intervention. In response to feedback, sound monitoring at regular intervals overnight was undertaken using a decibel-metre to determine noise baseline and variation.ResultAll patients approached agreed to participate. Pre-hospital average sleep quantity was 5.2 hours, with restedness score of 4.3, and 71% patients rating their sleep as ‘bad’. After 72 hours post-admission, average sleep length was 6.5 hours and restedness 5.3. Of patients who accepted earplugs (59%), there were improvements to mean sleep quality and quantity (7.6 hours), with 86% patients rating earplugs helpful. All patients surveyed thought that earplugs should be offered routinely on admission. 70% of patients were prescribed benzodiazepines or z-drugs as required. Self-reported factors affecting sleep included noise, psychiatric symptoms and medication side effects, with 13 patients mentioning the former. Sound monitoring recorded an average decibel level with a range of 35–75 dB, with peaks reaching 95 dB.ConclusionPoor sleep in hospital is widespread. There is a need to understand and address modifiable environmental and ward factors implicated in sleep disturbance within inpatient settings. Pharmacological options for sedation are common, but it is important to focus on alternative options of low-cost, non-pharmacological interventions which promote sleep optimisation and enhance inpatient care.