bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit: children & young peoples's services depression pathway Tees, Esk & Wear Valley Trust wide compliance
Authors: Parker Mary , Gupta Veenu 
Published: June 2021

BackgroundThis complete cycle consists of an audit assessing compliance with the evidence based person-centred pathway of care for Depression in Children and Young People across the Trust, completion of an action plan and re-audit of progress, aiming to improve patient care. The pathway was derived from NICE Quality Standard 48/Clinical Guideline 28, updated for NICE Guideline 134 (2019) and includes comprehensive assessment considering comorbidities, social, educational and family context, parent/carer Mental Health assessment and plan for treatment including psychological therapies as first line treatment in mild depression.MethodThe Audit tool was compiled from the above evidence based pathway and NICE guidance. Each of the 26 community teams were requested to select 5 cases on the pathway who had completed a minimum of 6 treatment sessions (final sample size n = 61). The results were analysed for compliance against the pathway and compared with previous results by the clinical audit team.ResultThe results showed areas of good practice, maintained and improved on re-audit, with over 90% compliance in key evidence based areas regarding consideration of comorbidity, social and educational context and 100% compliance in offering psychological interventions.Improvement was obtained in some areas highlighted in the previous audit e.g. poor recording of ICD 10 diagnosis in medical records, 19%, improved to 30%, and less than 40% recording of symptom tracking via the RCADS (Revised Children's Anxiety and Depression Scale) monitoring improved to over 50%. There had been a failure to record identification or referral to other pathways/services for mild depression in the 16-18 age group with 0% compliance; this improved to 82% and 100% respectively.Areas still needing improvement were highlighted including recording of weekly monitoring of medication side-effects for first 4 weeks (43%) and a referral of parent/carers to mental health services after identifying issues (40%).Response to the audit also improved significantly from 29% of teams not responding in the initial audit to a limitation of only 1 of 26 (4%) at re-audit.ConclusionThis audit cycle has demonstrated that use of an evidence based approach has been instrumental in improving patient care. The Audit evidenced areas of good practice in holistic assessment and use of psychological therapies and importantly highlighted areas of significant improvement needed including initial monitoring of medication response and referral onwards of parents/carers with mental health issues. Continuous improvement in patient care is planned via a targeted action plan, and further re-audit.
Adult ADHD clinics in north Wales - case load prevalance & compliance with nice guidelines (quality evaluation project)
Authors: Raja Jawad , Azhar Zeenish , Salmoiraghi Alberto 
Published: June 2021

AimsMeasure compliance with National Institute for Health and Care Excellence (NICE) recommendations in four Adult CMHT'sGuide further service development.We audited the case notes of 20 patients each currently under care of 9 General Adult Consultants across 6 CMHT's in East side of North Wales against NICE standards using an adapted version of the ADHD audit support tool.My role in the Project & How does this represent my practice?I was the audit and overall lead for this projectI formulated the audit tool and registered my project with Audit Registration Team.I lead data collection and compilation of results.MethodOverall, this is the first audit of Adult ADHD Services in East side of North Wales.It established good compliance with NICE guidance for assessment and treatment.NICE has expressed the need for full mental health and social assessment including full history and physical examination prior to the drug treatment.Good compliance was observed in using & documenting Diagnostic Criteria (DSM-IV and/or ICD-10).There were deficiencies in conducting or arranging recommended physical examination & side effect monitoring.Drug treatment was the first line of treatment in the majority of cases.Antipsychotics were used in some patients referred for ADHD assessment, despite the fact that NICE has ruled out the use of antipsychotic drugs in treatment of core symptoms of ADHD.ResultPrevalence of Adult ADHD clinician case load in Wrexham and Fintshire Counties.Diagnosis of Adult ADHD according to ICD 10 & DSM IV Guidelines.Pre treatment screening of physical health for ADHD patients.Side effects monitoring of patients on stimulant medications.ConclusionThe finding highlights the need for more effort in educating clinicians about safety and effectiveness of antipsychotics in ADHD.Comprehensive treatment programmes that address psychological, behavioural, educational and occupational needs should be established.Development of local ADHD Clinics, support groups and in partnership with the voluntary sector should be encouraged.It is important that mental health professionals receive appropriate training in assessment, management & monitoring of ADHD patients with co morbid substance use disorder and other mental illnesses.BETSI Health Board to participate in national Prescribing Observatory for Mental Health (POMH-UK) Quality Improvement Programme (QIP) focusing on prescribing for ADHD in children, adolescents & adults.
Experiences of people seen in an acute hospital setting by liaison mental health services: responses from an online survey
Authors: Romeu Daniel , Guthrie Elspeth , Czoski-Murray Carolyn , Relton Samuel , Walker Andrew , Trigwell Peter , Hewison Jenny , West Robert , Crawford Mike , Fossey Matt , Hulme Claire , House Allan 
Published: June 2021

AimsRecently the NHS has expanded the provision of liaison mental health services (LMHS) to ensure that every acute hospital with an emergency department in England has a liaison psychiatry service. Little work has been undertaken to explore first-hand experiences of these services. The aim of this study was to capture service users’ experiences of LMHS in both emergency departments and acute inpatient wards in the UK, with a view to adapt services to better meet the needs of its users.MethodThis cross-sectional internet survey was initially advertised from May-July 2017 using the social media platform Facebook. Due to a paucity of male respondents, it was re-run from November 2017-February 2018, specifically targeting this demographic group. 184 people responded to the survey, of which 147 were service users and 37 were service users’ accompanying partners, friends or family members. The survey featured a structured questionnaire divided into three categories: the profile of the respondent, perceived professionalism of LMHS, and overall opinion of the service. Space was available for free-text comments in each section. Descriptive analysis of quantitative data was undertaken with R statistical software V.3.2.2. Qualitative data from free-text comments were transcribed and interpreted independently by three researchers using framework analysis; familiarisation with the data was followed by identification of a thematic framework, indexing, charting, mapping and interpretation.ResultOpinions of the service were mixed but predominantly negative. 31% of service users and 27% of their loved ones found their overall contact with LMHS useful. Features most frequently identified as important were the provision of a 24/7 service, assessment by a variety of healthcare professionals and national standardisation of services. Respondents indicated that the least important feature was the provision of a separate service for older people. They also expressed that a desirable LMHS would include faster assessments following referral from the parent team, clearer communication about next steps and greater knowledge of local services and third sector organisations.ConclusionOur survey identified mixed responses, however service users and their loved ones perceived LMHS more frequently as negative than positive. This may be attributed to the recent governmental drive to assess, treat and discharge 95% of all patients seen in emergency departments within four hours of initial attendance. Additionally, dissatisfied service users are more likely to volunteer their opinions. The evaluation and adaptation of LMHS should be prioritised to enhance their inherent therapeutic value and improve engagement with treatment and future psychiatric care.
Transition from child and adolescent mental health services to adult mental health services
Authors: Saour Tania 
Published: June 2021

BackgroundThe prevalence and recognition of mental health conditions in young people is growing. Around 50% of lifetime mental illness (except dementia) begins by the age of 14. Around 75% of adults requiring secondary mental health services developed problems prior to 18.The TRACK study of young people's transitions from CAMHS to AMHS has found that up to a third of teenagers are lost from care during transition and a further third experience an interruption in their care.A CQUIN for Transition has concluded that young children should have a transition plan 6 months before they turn 18.MethodAll young people aged 17 and a half years old were included in the data collection for this audit. Clinical information was reviewed using the West London RIO computer system. While reviewing the clinical documentation I was recording whether:Transitional plans had been discussed with the young person.If yes, what were they?Had a referral been made to the appropriate service?ResultThere were 180 open cases to the Hounslow Adolescent Team. 35 cases were over 18:At least 16 of these cases needed to be closed as no intervention was being provided.14 cases had an unclear plan.Of the 25 cases aged between 17.5 and 18 years of age transitional plans were:Transition was discussed in 11 cases (44%). This meant that transitional plans were not discussed in 56% of young people.Of these 11 cases 7 referrals were completed. (28%)ConclusionThe lack of consistent protocols for transition remains a significant barrier to health care provided to young people.Transitional planning needs to take place in an effective and timely manner to ensure continued patient centred care.Transitional discussions to be made a regular agenda item at team meetings.Care co-ordinator to be informed and reminded that transitional plans need to be explored with young people.Following a re-audit of this data 6 months on 100% of cases over the age of 18 were closed and transition was discussed in the remaining 56%.
Melatonin prescribing practices and the provision of sleep hygiene/parent-led sleep behavioural Interventions in S-CAMHS, Aneurin Bevan University Health Board (ABUHB)- Service evaluation as part of quality improvement project
Authors: Jalal Umer , Nukalapati Lokesh , Speedy Kathryn , Davies-Kabir Megan 
Published: June 2021

AimsTo identify the number of patients currently on melatoninTo determine the average duration of use of melatonin in patients under the care of S-CAMHS in ABUHBTo investigate whether behaviour interventions were tried and reinforced from time to timeTo identify any areas of improvementMethodData were collected at St. Cadoc's hospital, in January, 2021. S-CAMHS database was used. Out of total 346 patient currently being managed with pharmacological therapies, 115 (33.2%) are currently on melatonin. 57/115 were randomly selected as a sample for this this project. Patient notes and EPEX software were also used to collect information regarding the sleep management practices.ResultDuring analysis, it was noticed that within the sample, only 46 patients were actively on melatonin. Melatonin is prescribed for sleep related issues in ASD (8/46), ADHD (15/46), ASD and ADHD (10/46), ADHD and mood disorder (0/46), ASD and mood disorder (6/46), ADHD and behaviour difficulties (2/46), ASD with behaviour difficulties (1/46), mood disorder (4/46).39/46 patients are currently on melatonin for more than a year (85%). These patients also include 10 patients who have been using melatonin for 5 years or more.35 patients (76%) reported improved sleep or some benefit from melatonin.Evidence for implementation of parent-led sleep behavioural interventions:Prior to commencing melatonin- Clear evidence available for 35 patients only (76%). These interventions were however not deemed helpful by most of the service users.While prescribing melatonin- Clear evidence available for 39(85%) patients. Evidence base for melatonin was also discussed during this visit.During last follow-up visit- Evidence available for 31 patients only (67%).ConclusionMajority of patients under S-CAMHS ABUHB remain on melatonin therapy for longer than one year. Most of these patients have reported benefit from this therapy and preferred to remain on it despite being informed about evidence base for melatonin. Also, there is evidence for implementation of sleep behavioural interventions prior to prescribing melatonin, however their benefit remains unclear.Recommendations:The quality of education on sleep hygiene offered should be assessed and improved if neededFormal group sessions/workshops on sleep hygiene/parent-led sleep behavioural interventions at regular intervals might be useful in reducing the chances of long term polypharmacy or unlicensed drugsUse of outcome measures such as Child Sleep Habits Questionnaire at intervals can be helpful in identifying any improvement from educational/pharmacological interventionsS-CAMHS database (for patients actively on medications) needs a review and update
Experience of tele-psychiatry during COVID-19 amongst doctors working in a mental health trust: A survey
Authors: Chandra Pallavi , Kar Nilamadhab , Yahia Abdalla 
Published: June 2021

AimsThere is paucity of information about perspectives of psychiatrists about telemedicine practice during COVID-19 pandemic. It was intended to explore the experience of doctors using tele-psychiatry for provision of clinical care during the COVID-19 pandemic in a Mental Health Trust covering four cities in West Midlands, UK.MethodThe study was conducted as an anonymized questionnaire survey. A 10-item questionnaire was designed with items related to the clinical outcomes, challenges and provider satisfaction when using tele-psychiatry. It had mostly yes/no dichotomous responses along with the scope for making additional comments for each question. An online link of the questionnaire was sent via email to doctors of all grades working across the Black Country Healthcare NHS foundation Trust, in the West Midlands. The survey was open between July and October 2020; and monthly reminders were sent.ResultThe questionnaire was sent out to 159 doctors and 34 responded (response rate of 21.3%). Just over 50% had used both telephone and video consultations, whereas 47.1% responders had used telephone only. More than half (55.8%) reported that the tele-psychiatry affected clinical outcomes; and it was considered positive in around half (52.9%). Most (73.5%) of the responders found that limitations or challenges of using technology impacted on delivery of care remotely. However 64.7% psychiatrists were satisfied with the process overall; and 79.4% reported that they would like to use tele-psychiatry in the future as well.Survey captured many observations from the psychiatrists. Positive comments from the psychiatrists included expedited delivery of care, reduced non-attendance rates, as well as successful multidisciplinary meetings. Challenges in specific sub-specialties such as Child and Adolescent Psychiatry or Older Adult psychiatry were reported where complete assessments were not achieved successfully. The process was felt to be appropriate in general for stable or follow-up patients in comparison to new or acutely unwell patients. There was some worry expressed about missing out non-verbal cues which assist with mental state examination.ConclusionInspite of a low response rate, the survey provided some understanding about the experience of doctors practicing tele-psychiatry during pandemic. While technological challenges were acknowledged, tele-psychiatry seemed to have been accepted by a majority of doctors who are also willing to continue it in their future clinical practice. There is a need to explore in a larger sample involving both patients and clinicians about the beneficial effects of tele-psychiatry that can be incorporated in the usual psychiatric practice.
Improving “reasonable adjustments” for people with autism in the York Early Intervention in Psychosis Service
Authors: Whitney Daniel , Faravelli Emma , Wright Stephen 
Published: June 2021

AimsStudies show the prevalence of Autism Spectrum Conditions in EIP populations is 3.6-3.7% compared to approximately 1-1.5% in the general population. The Equality Act 2010 and the Autism Act 2009 make it a requirement for services to make ‘Reasonable Adjustments’ for people with Autism. The aim of this study was to improve how our service makes Reasonable Adjustments for people with autism.MethodThere were 15 patients in our service with a confirmed diagnosis of Autism. Pre and Post a discussion about reasonable adjustments, we invited them to rate, on a 5 point Likert scale, how well they felt the service was making Reasonable Adjustments for their Autism and whether discussing it had been helpful. We offered face to face or telephone discussions with someone with autism expertise to discuss reasonable adjustments. We allowed at least a month after the discussion before repeating the Likert scale.ResultThe pre-discussion rating, of whether the team was making reasonable adjustments for Autism, showed agreement (mean 4.2/5). This improved to 4.6/5 after a month post discussion about reasonable adjustments. Patients agreed to strongly agreed (4.6/5) that the discussion had been helpful. Reasonable adjustments identified were quite individual but responses followed the following main themes; (1) No adjustments were needed or wanted as some patients saw special arrangements for them as stigmatising and wanted to be treated like everyone else; (2) Adjustments around personal space in appointments eg sitting face to face, not sitting too close, explaining reason before moving closer; (3) Simplification/clarification of written information – eg some identified simpler language use and use of pictures; (4) Environment e.g. quieter, dimmed lights, clarity of signage in reception.ConclusionAutistic patients in our service already rated the team highly at making reasonable adjustments pre and post intervention and found it helpful to have a specific discussion. Reasonable adjustments were highly individualised but some themes emerged around personal space, written communication and clinic environment which staff could consider exploring routinely. Some patients did not want reasonable adjustments as they felt it could be stigmatising. Discussing reasonable adjustments is likely to benefit all patients, not just those with confirmed autism, we would suggest this should be built into routine practice.
Effect of Ester Side Chains on Photovoltaic Performance in Thiophene-Thiazolothiazole Copolymers
Authors: Yamanaka Kodai , Saito Masahiko , Mikie Tsubasa , Osaka Itaru 
Published: June 2021

Abstract
Thiazolothiazole-based π-conjugated polymers are promising semiconducting materials in organic photovoltaics (OPVs). In this study, we report on a series of thiophene-thiazolothiazole based polymers having ester side chains, PTzBTE and PTzBTEE. We first show a new synthetic methodology for their common monomer having ester group, in which the total yield was significantly improved by a factor of ten compared to the previous methodology. This resulted in polymer samples with high molecular weights. We then show that OPV cells using PTzBTE, in combination with PC61BM, gave quite high efficiencies of as high as 8.9% despite its limited absorption range. This value is significantly higher than that for PTzBT having only alkyl groups as the side chain and that obtained for a low-molecular weight PTzBTEE sample reported previously. On the other hand, although PTzBTEE had a well-ordered structure similar to PTzBTE, it showed lower OPV performances. Through investigations of electronic properties and structural order and morphology in thin films, structure-property-device performance relationships are carefully discussed. In addition, the OPV cells fabricated with a non-halogenated solvent showed efficiencies comparable to the cells fabricated by a conventional halogenated solvent.
Prognostic value of breast MRI characteristics before and during neoadjuvant endocrine therapy in patients with ER+/HER2- breast cancer
Authors: Ragusi Max AA , Winter-Warnars Gonneke AO , Wesseling Jelle , Linn Sabine C , Beets-Tan Regina G , van der Velden Bas HM , Elias Sjoerd G , Gilhuijs Kenneth GA , Loo Claudette E 
Published: June 2021

Objective:
To investigate whether BIRADS MRI characteristics before or during neoadjuvant endocrine therapy (NET) are associated with the preoperative endocrine prognostic index (PEPI) in ER+/HER2- breast cancer patients.

Methods:
This retrospective observational cohort study included 35 ER+/HER2- patients with 38 tumors (3 bilateral cases) treated with NET. The pre- and midtreatment (after 3 months) MRIs were evaluated by two breast radiologists for BIRADS imaging characteristics, shrinkage pattern, and radiologic response. PEPI was used as end point. PEPI is based on the post-treatment surgical specimen’s pT- and pN-stage, Ki67, and ER-status. Tumors were assigned PEPI-1 (good prognosis) or PEPI-2/3 (poor prognosis). We investigated whether pre- and midtreatment BIRADS characteristics were associated with PEPI.

Results:
Median patient age was 65 years (interquartile interval [IQI]: 53, 70). 17 tumors (44.7%) were associated with good prognosis (PEPI-1), and 21 tumors (55.3%) with poor prognosis (PEPI-2/3). A larger reduction in tumor size after 3 months of NET was significantly associated with PEPI; 10 mm (IQI: 5, 13.5) in PEPI-1 tumors vs 4.5 mm (IQI: 3, 7; p = .045) in PEPI-2/3 tumors. Other BIRADS characteristics, shrinkage pattern or radiologic response were not associated with PEPI.

Conclusion:
Only a larger reduction in tumor size on MRI after 3 months of NET was associated with PEPI-1 (good prognosis) in ER+/HER2- breast cancer patients.

Advances in knowledge:
MRI characteristics previously reported to be associated with prognosis during neoadjuvant chemotherapy are not necessarily associated with prognosis during NET in ER+/HER2- breast cancer patients.