bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular risk quantification using QRISK-3 score in people with intellectual disability
Authors: Ho Jamie Sin Ying , Rohra Vikram , Korb Laura , Perera Bhathika 
Published: June 2021

AimsThe prevalence of cardiovascular diseases (CVD) in people with intellectual disability (ID) is around 14%, higher than the general population. However, CVD risk assessments are not consistently performed. Given the high risk of premature deaths in people with ID, it is important to identify preventable risk factors and follow evidence-based interventions. QRISK-3 is a validated risk-stratification tool, which calculates the 10-year risk of developing a heart attack or stroke (https://qrisk.org/three/index.php). There are no published studies on the use of QRISK-3 in people with ID. This project aimed to understand the use of QRISK-3 in an ID clinic and to quantify individual CVD risks to recommend appropriate management options.MethodA cross sectional study was performed on 143 patients open to an ID psychiatry clinic. Patients and carers were sent an accessible information leaflet on this study. Basic demographic data and information on psychiatric diagnoses were collected. Patients were grouped according to the presence of severe mental illness (SMI) defined as schizophrenia, bipolar disorder and other psychotic illnesses. QRISK-3 ≥ 10% was defined as elevated risk in accordance with NICE guidelines. Patients who had a high QRISK-3 score were advised to contact their GP.ResultOf 143 patients, 73 (51.0%) had a mild ID and the remaining had a moderate to severe ID. The mean age was 43.3 years, 53.1% were male. Overall, 28 (19.6%) participants had an elevated CVD risk, of whom 16 (57.1%) were not on statins, which is the recommended treatment. The mean QRISK-3 score was 6.31 (standard deviation [SD] 8.95), and the relative risk is 3.50 (SD 7.13). The proportion of QRISK-3 ≥ 10% and mean score were not significantly different in those with SMI, but those with SMI were more likely to be prescribed statins than those without (14 [31.1%] vs 10 [10.2%], p = 0.002). Statins were given to 24 (16.8%) participants, of whom 12 (50%) had elevated CVD risk. 89% had a blood pressure recording within the past 5 years, 87% had height and 88% had weight recorded. 73% had lipid serology results recorded.ConclusionElevated CVD risk was common in this ID study population, and more than half with elevated QRISK-3 were not on the medical treatment recommended by national guidelines. QRISK-3 could feasibly be implemented in the outpatient setting. Increased routine CVD risk assessment and management should be considered as another measure to reduce morbidity and mortality.
Improving remote prescribing in a CAMHS community team during the COVID-19 pandemic
Authors: Tai Sarah , Huang Hannah Chu-Han , Batham Oliver , Anandakumar Brindha , Abbott Christopher 
Published: June 2021

AimsPrior to the COVID-19 pandemic, prescriptions were usually collected by patients/families in person from the CAMHS community team base. Due to social distancing measures introduced during the pandemic, face-to-face contact between staff and patients had to be minimised. This led to an increase in remote prescribing, including from home. Feedback from team doctors was that the process of following the Remote Prescribing Protocol (RPP) was taking up a significant portion of their day, preventing them from doing other clinical work.Our aim was to reduce the time taken to complete a remote prescription to pre-pandemic levels (under 15 minutes).MethodWe used PDSA methodology in this QI project:
1)Plan: Survey sent out to team duty doctors to identify the most time-consuming steps in RPP which could be safely delegated to administrative staff2)Do: Email sent requesting administrative staff clarify several details with patients/families when they request a prescription. This included the names and doses of medication, how many days they had left, where they wanted the prescription sent to (home/pharmacy) and the relevant address. If the patient usually received their repeat prescription from their GP, they were re-directed to their GP3)Study: Following the intervention above, team doctors recorded how long it took to complete a remote prescriptionResultThe average time taken to complete a prescription fell from 31 minutes (pre-intervention) to 22 minutes (post-intervention). The range of time taken also dropped from 10-241 minutes (pre-intervention) to 0-46 minutes (post-intervention). The medications taking above the average time to complete were more likely to be non-controlled drugs rather than controlled drugs (which one may typically think would be more time-consuming to write out).ConclusionWhilst we have successfully reduced the time for remote prescribing, we have not reached the target of reducing it down to less than 15 minutes (pre-pandemic timings). As part of the next PDSA cycle, we have carried out a survey to ask what barriers remain. Checking patient's notes and recent prescriptions can still be inefficient. We propose introducing an intervention whereby this can also be safety delegated to administrative staff e.g. including a copy of the most recent prescription in the request.In the future, we will continue to improve the RPP with further PDSA cycles and carry out an audit on the system on a regular basis to ensure standards are met.
Four-six year clinical follow-up of deep brain stimulation for obsessive compulsive disorder
Authors: Tyagi Himanshu 
Published: June 2021

BackgroundOver the past 20 years a number of robust studies have established the clinical effectiveness and safety of Deep brain stimulation (DBS) in adults with profound multi-treatment-refractory obsessive-compulsive disorder (OCD). However long term (>12 months) outcomes with this novel neurosurgical intervention are still inadequately reported. Our group conducted the first UK study of DBS in OCD between 2013-2017. All participants in our trial achieved a responder status at 15 month endpoint and the main results were reported in 2019. A specialist multidisciplinary clinic was established after the trial to provide life-long aftercare in the form of scheduled clinical and hardware reviews. Here we are reporting a preliminary analysis of the long-term clinical, functional and social outcomes from this cohort.MethodLong term follow-up clinical data (15–75 months, 2015 onwards) were prospectively collected from the participants who were enrolled in the original MRC-UCL pilot study of DBS for OCD. DBS parameters, battery health and status, social circumstances, mental state and medication adjustments were noted alongside the outcome measures of YBOCS at clinical follow-up encounters. Additional ratings of GAF, SDS and certain qualitative measures were recorded at least once every year since initial study completion.ResultFive out of six participants continued with DBS treatment and kept responder status. One participant had his DBS switched off and hardware removed. One participant had multiple hospital admissions to manage comorbidity progression to primary condition. One participant had OCD severity scores revised upwards despite continuing gains in QoL. Secondary outcomes generally matched the 15 month end point of initial trial. All participants experienced minor to major changes in their relationships with partners or family. Qualitative feedback indicated that DBS was well tolerated by 5/6 subjects but the burden of specialist follow-up remained significant.ConclusionOur long term follow-up data indicate that DBS is safe and conferred a sustained long-term benefit in reduction of obsessive-compulsive symptoms. A non-trivial burden of checking and maintenance of implanted hardware, comorbidity-unmasking following successful OCD treatment, perceived ‘burden of normality’ by the participant, need for life-long follow-ups with specialist multidisciplinary team including DBS nurses, highly specialist psychiatrists from National OCD service, neuropsychiatrists, neurologists and neurosurgeons partially counterbalances the gains offered by this treatment. Overall DBS offers a safe, effective and enduring alternative to participants who do not respond to any other form of OCD treatment and do not wish to undergo ablation surgery.
A UK-wide survey of Balint, support groups and psychotherapy training opportunities for SAS (Specialty Doctors and Associate Specialists) Psychiatrists
Authors: Vaida Alina , Awal Masud 
Published: June 2021

AimsTo investigate SAS Psychiatrists’ opportunities for Balint-type, support groups and psychotherapy training opportunities nationwide, for which there is a lack of existing literature or established framework.MethodAn online questionnaire was sent to UK-wide SAS psychiatry doctors with the support of the RCPsych Speciality Doctors and Associate Specialist Psychiatrists Committee (SASC). The survey enquired about location, work experience, future plans, Balint-type groups, psychotherapy opportunities and support.Result122 doctors completed the questionnaire, estimated to constitute approximately 8% of SAS psychiatry posts (or more if considering all vacancies), based on the RCPsych Census (2015), from across all UK nations.Time spent in an SAS role varied widely between months (10%) to over 20 years (5%), with the median and mode being 8–12 years (25%). Regarding future career plans 61% responded that they would be considering either the Certificate of Eligibility for Specialist Registration (CESR) route, or applying for future training or both.24% reported being part of a Balint-type group whilst almost double this number (47%) said they would be interested to join but none were available. 31% were part of a reflective practice or support group whilst 44% reported that they were interested in joining but none were available. Only 7% said that they were not participating or not interested in either a Balint group or a reflective group. Free-response comments suggested these opportunities were usually reserved for trainees and service commitments prevented attendance.76% of respondents reported access to an SAS Tutor, but only 21% confirmed access to a psychotherapy tutor.Half of respondents indicated they did not have access to information and guidance they needed regarding accessing psychotherapy opportunities, with only 27% thinking they did.24% reported managing to gain experience in at least one psychotherapeutic modality, 44% of whom received medical psychotherapist supervision; whilst 13% said they did not intend to pursue this.ConclusionThe results highlight that interest in joining Balint and reflective support groups significantly exceeds local provision. As these groups are not mandatory requirements for CESR application, the interest expressed (including amongst those reporting to be SAS by choice) suggests that SAS Psychiatrists value these opportunities for their recognised professional developmental and clinical benefits; these include peer support, understanding doctor-patient interactions and having a space to reflect on the emotional impact of clinical work. Trusts should consider supporting SAS doctors wishing to join new or existing Balint-type or other supportive reflective clinician groups.
Prevalence, associated factors and prevention of burnout in psychiatry trainees in Central and North West London NHS Foundation Trust
Authors: Xia Grace , Jayakumar Ahrane 
Published: June 2021

AimsTo assess burnout, resilience, professional quality of life and coping mechanisms in Central and North West London psychiatry traineesObjectivesTo determine Key factors associated with stress and burnout in workplace Effects of burnout on patient care and doctors Coping mechanisms used by traineesBackgroundBurnout is a well established condition that has been recently reported to affect a third of doctors. Psychiatrists in particular represents a high risk group among doctors for experiencing burnout, alcohol and drug use, posing suicide risk and other forms of work related stress.MethodThe study comprised of a cross sectional questionnaire survey which included measure of stress (General Health Questionnaire), burnout (Maslach Burnout Inventory), and satisfaction with medicine as a career and personality (Big Five). During October to December 2019, core trainee and specialty trainee doctors in CNWL were asked to complete an online survey via emails.ResultWe collected data from 50 CNWL psychiatry trainees. The sample consisted of 20 females (40%) and 30 males (60%). Ages varied from 26–58 years old, with a median age of 28. Core trainees (CT1–3) were recorded as 72% and specialty trainees at 28%.Of those who responded, around half of the trainees (52%) experienced high levels of stress outside of work in their personal life. The most common causes that trainees felt makes psychiatry a stressful profession were violence and fear of violence, limited resources, dealing with confrontational patients, inability to affect systemic change and increasing culture of blame. Around half of respondents (54%) felt that they have experienced burnout but only 26% of respondents knew where to go to find resources to help cope with burnout. Physical exercise and speaking to colleagues were the most common coping mechanisms used by trainees to deal with stress.Free text responses on what can be improved in workplace to enhance a positive experience of work included improving multidisciplinary interactions, easily accessible resources and increasing staffing levels. 74% of respondents felt they continued to care about what happens to patients regardless of working conditions.ConclusionHalf of CNWL trainee doctors who responded have experienced burnout. Some factors associated with stress and burnout in doctors are unique to psychiatry profession. Free text responses were useful in identifying areas for improvement in work places and useful coping mechanisms, which can be used to inform prevention and implement interventions to tackle burnout.
Driving digitisation of the workforce. Junior doctor's digital devices rollout at South London and Maudsley NHS Foundation Trust: an early review of uptake, usage and effects
Authors: Zacharia Tharun 
Published: June 2021

AimsA Quality Improvement Project (QIP) was completed at South London and Maudsley NHS Foundation Trust (SLaM) to provide access of Trust laptops and smartphones (digital devices) to training doctors.The aim of the study was to assess the views of trainees before and after the rollout of digital devices. Also, to assess barriers of device uptake/usage.MethodTrainee doctors were surveyed before mass release of digital devices. Trainees were surveyed again 2 months later, providing ample opportunity to request a device.Correlated survey questions asked about training grade, expectation to request a digital device (and subsequent completed request), expected usage cases (and actual usage cases), expected benefits (and actual benefits), perceived importance of access to each device (before and after access) and barriers for device uptake. Also inquired were general comments about the project and actual lead time on device access.Result110, mixed training grade, doctors participated in both surveys combined. There was a high demand for digital devices. Laptop requests were highest, with greater clarity of potential usage cases noted for a laptop. Laptops were perceived to be the more important device to a trainee.Common usage cases for laptops were clinical work (in and out of working hours). There was also high usage around educational and audit/QIP activities. Smartphones were used only for clinical work (in and out of working hours).Having access to each device was most beneficial in saving clinician time. Other sizable benefits included improvements in communication with patients and other professionals, as well as benefits toward patient safety. The laptop specifically also improved educational access.A larger proportion of trainees requested a mobile phone than were previously expecting to. New ways of working due to the pandemic were noted to be motivating factors toward usage of devices.The biggest barrier to device uptake was the delay from request to acquisition (often over 4 weeks).Numerous respondents used personal devices for Trust related activities. This was more prevalent with smartphones, than with laptops.ConclusionDigital device rollout was a valued endeavour, with enhanced demand secondary to the pandemic. Primary usage and benefits supported clinical effectiveness. The primary access barrier was the delay from point of request to point of delivery. As SLaM, and the NHS as a whole, becomes increasingly digitised, this program is vital to allow the Trust to ensure the trainee workforce are digitally equipped to continue to deliver safe, effective and quality care.
Clozapine & constipation: an audit of bowel habit monitoring and laxative prescribing in inpatients on clozapine
Authors: Boyd Holly , de Zuniga Anna Manso 
Published: June 2021

AimsTo establish how often bowel habits are monitored in inpatients on clozapineTo determine how many of these patients are prescribed laxatives and whether these are utilisedBackgroundIt's estimated that 30-60% of patients will suffer from constipation whilst on clozapine; this can lead to ileus, intestinal obstruction and bowel ischaemia, all of which can be fatal. Constipation is much more common than clozapine-induced blood dyscrasias, and has a higher mortality rate. Despite this, there is no strict universal framework for bowel habit monitoring equivalent to the compulsory FBC monitoring. Local trust guidance indicates that bowel habits should be monitored regularly, at least at any point of blood sampling. However, monitoring processes across the trust were noted to be variable, as were laxative prescribing practices.MethodThe data sample of current inpatients on clozapine across the trust was identified from pharmacy records. The patient's Rio notes from the preceding 3 months were searched for predetermined terms relating to bowel habits and constipation, and the notes were then analysed for assessment of bowel habit. The number of FBCs collected during this 3 month period was then used to produce comparison with the audit standard. The data on laxative prescribing were collected from current medication lists on EPMA.ResultA data sample of 31 current inpatients was identified. The audit found that only 54.8% (17) of patients had their bowel habits monitored at least with every FBC taken. There was significant variability between different wards, with the best performing ward having 100% adherence to the audit standard, and the worst performing having 0%. In terms of laxative prescribing, it was found that 87.1% (27) of patients had at least 1 regular or 1 PRN laxative prescribed. Regular laxatives were prescribed for 61.2% (19) of patients, whereas only PRN laxatives were prescribed in 25.8% (8) of patients. Of those prescribed only PRN laxatives, only 50% (4) ever utilised this medication.ConclusionBowel habits are not consistently monitored across the trust in inpatients on clozapine, leaving room for potentially life-threatening side effects to be missed. Additionally, regular laxative prescribing is not standard throughout the trust, which could further add to the potential for significant constipation-related morbidity to occur. A standard method of monitoring bowel habits throughout the trust, as well as a trust laxative prescribing policy, could be a way of remedying this issue and preventing harmful outcomes for our patients on clozapine.
An audit into the management of COVID-19 in a high security psychiatric hospital
Authors: Carthy Elliott , Sengupta Samrat 
Published: June 2021

AimsComprehensive and timely data collection during a pandemic is crucial in developing guidelines and policy as well as evaluating their effectiveness. In turn, this will improve planning for future incidents. While this is being undertaken at a national level by Public Health England, more specific information as it relates to psychiatric care is important in understanding the neuropsychiatric, psychological and social effects of the pandemic. The management of patients with COVID-19 presents a unique challenge in inpatient psychiatry settings both in terms of diagnosis and treatment. This is perhaps greater still in forensic settings due to the increased risk of violence and aggression. This audit aimed to firstly assess the consistency of local practice to national guidance from Public Health England. Secondly, it aimed to describe the clinical management of suspected and confirmed cases of COVID-19 in this high security forensic hospital and how readily broad, national guidance can be implemented in this unique setting. We present an audit with three cycles, one from each wave of COVID-19 in England during 2020.MethodThis was a retrospective audit in a high secure forensic psychiatry hospital in the United Kingdom, into the investigation and management of suspected and confirmed cases of COVID-19 compared to national guidelines from Public Health England. It includes three cycles, one undertaken in each national wave of COVID-19 in England in 2020.ResultTen patients have been included in cycle 1, 12 in cycle 2 and 21 in cycle 3 as those where COVID-19 was a considered diagnosis. SARS-CoV-2 was detected in one patient in cycle 1 and 12 patients in cycle 3. All patients recovered, most of whom remained on-site with supportive care in self-isolation on a dedicated ward for positive cases. Three patients required additional treated with oral antibiotics and dexamethasone, one of whom required admission to the local general medical hospital for continuous supplemental oxygen.ConclusionThis is the first study to describe the management of the novel COVID-19 pandemic in a high security forensic psychiatry hospital and how readily national guidance can be implemented in this unique setting. Hospital practice at identifying suspected cases and the management of confirmed cases of COVID-19 was shown to be consistent with national guidance. It also allowed for clinicians to exercise their judgement about testing for atypical cases and for repeat testing where appropriate.