bluuebunny/crossref_metadata_2025_split huggingface dataset:
Revisiting Dental Care and Mental Health: A Quality Improvement Project of Dental Care for Patients With Severe Mental Illness Living in a Community Rehabilitation Centre
Authors: Wang Yuepeng , Singh Sukhdev , Duah Lucy , Salih Serge , Allin Matthew 
Published: August 2024

AimsThe Care Quality Commission report (Smiling matters: oral health care in care homes) showed that too many people living in care homes were not being supported to maintain and improve their oral health. Lime Tree Garden is a purpose-built care home for up to 24 adults with mental health needs supporting people with enduring mental health illness to develop basic life skills so they can live supported in the community.This is a quality improvement project aiming to improve oral health and to reduce the burden of oral diseases in people with mental disorders and ensure timely access to dental treatment in Lime Tree Gardens through meeting the NICE quality standards of care.MethodsAuditing current implementing status of oral health procedures in place and comparing with NICE guidelines and quality standards: 1) Adults who move into a care home have their mouth care needs assessed on admission; 2) Adults living in care homes have their mouth care needs recorded in their personal care plan; 3) Adults living in care homes are supported to clean their teeth twice a day and to carry out daily care for their dentures. For each patient, their dental care plan is recorded and compared with NICE guideline.ResultsThere are challenges and space for improvement while implementing Oral health toolkit for adults in care homes at Lime Tree Gardens. A significant amount of patients (>90%) have unmet needs in terms having oral health.ConclusionThere is a need to address the dental health challenges in this vulnerable population with recurrent and enduring mental illness. It is important to integrate and highlight dental health, as an important part of physical heath into the overall medical management of patients with severe mental illness in residential rehabilitation psychiatry.
Compliance With 72 Hour Follow-Up and 6 Week Medical Review in a Brixton Community Mental Health Team
Authors: Wong Dominic , Badawy Katie , Bahl Shivaan , Dudha Shivani , Keynejad Roxanne 
Published: August 2024

AimsWe sought to determine to what extent guidelines regarding 72 hour follow-up and 6 week medical review were being followed in a Community Mental Health Team in Brixton. Further, we aimed to find out what was happening in situations where these guidelines were not met, then implement interventions to ameliorate some of the identified barriers.MethodsFirst, we conducted a retrospective review of all patients discharged from any hospital or home treatment team, over a time period from 01/07/2023 to 01/11/2023. Patients with discharge dates not in this timeframe, or those still admitted to hospital, were deemed ineligible and excluded. We extracted the dates of discharge, 72 hour follow-up, and medical review, and calculated percentages of patients who received follow-up in the required time who should have received it. Supplementary data on care-coordinator contact within a month, and primary support contact were gathered as well.Our primary intervention was direct engagement with the involved community mental health team, delivering the findings of our retrospective review in an oral presentation on 01/11/2023. We also designed an informational poster to be disseminated among the team as well as a discharge template proforma for care coordinators to bring to patient discharges to help them acquire vital contact information details. Following the intervention, we gathered the second round of data in the same way as described earlier, from 01/11/2023 to 19/01/2024.ResultsA considerable improvement was noted in the rate of 6 week medical review, with 69% of patients successfully achieving this target in the post-intervention population (n = 18), as compared with 56% in the pre-intervention population (n = 18). However, no significant change was observed in rates of successful 72 hour follow-up between the populations (63% to 58%). This was attributed to deep-rooted barriers such as lack of robust communication services between the wards and community mental health teams, which potentially shows a need for development of underlying system integration. Qualitatively, positive feedback was given by members of the team who described dedicating more time than previously on checking if patients have been followed up on time.ConclusionOverall, we demonstrate moderate success for a low-intensity quality improvement intervention bringing about significant improvements in 6 week medical review compliance. Interestingly, our results indicate that the longer-term 6 week medical review may be more amenable to our awareness-based intervention than 72 hour follow-up, suggesting a different array of logistical barriers between the targets.
Developing the New Kent Complex Psychosis Service (KCPS): Reducing the Limitations Imposed by Treatment-Resistant Psychosis
Authors: Adelola Aderopo , Whiskey Eromona , Morgan Patricia , Secchi Agostina , Stentzel Hayley 
Published: August 2024

AimsA third to a half of patients with psychosis fail to recover to premorbid levels of functioning. Within these are a group of patients with treatment-resistant psychotic disorders, whose presentations are complex, with significant comorbidities, prolonged hospital admissions, and poor social and occupational functioning. Reports suggest an underutilization of clozapine, which is the licensed treatment for resistant schizophrenia for reasons ranging from prescribers’ expertise or reluctance to intolerable side effects and comorbid psychiatric or medical conditions. In Kent, Surrey, and Sussex, clozapine prescription is only 4.93%, which is the third lowest among NHS England Regions.Complex psychosis in Kent and Medway NHS Partnership and Social Care Trust (KMPT) was handled through a referral through the Out-of-Area Treatment panels to the South London and Maudsley (SLAM) Psychosis unit. This had lengthy wait time for admission and required approval for out-of-area costs which can be significant for longer admissions, placed a considerable travel burden on the family/carers, and made it difficult for reintegration into the local community.MethodsThe KCPS was set up as a consultation service to ensure that patients receive the right care to facilitate recovery and that our healthcare professionals and teams are supported in meeting the needs of patients with complex psychosis. This multidisciplinary service, comprising psychiatrists, pharmacists, occupational therapists, and administrators, commenced functioning in January 2023 and we examined the first year of operation. KCPS reviewed the detailed psychiatric/medication history, highlighting prior treatment and effectiveness, with a focus on doses, tolerability, duration, and adherence; we explored the social, occupational, and psychological functioning of each patient; liaised with referrers/carers, reviewed the relevant research literature and provided holistic recommendations to the referrers.ResultsFrom January to December 2023, there were 36 referrals from a mixture of services, 26.3% of these were from acute wards. The patient's mean age was 42.8 years; 75% were male; the most common diagnosis was schizophrenia (50%), and the commonest comorbidities were Autism spectrum disorder and diabetes (13.9% and 27.8% respectively). Feedback from referrers and carers reported a high level of satisfaction with the service.ConclusionReasons for referral included diagnostic uncertainty, comorbidity, intolerable side effects of clozapine leading to its early discontinuation, and poor psychosocial functioning. The KCPS recommendations were deemed useful in changing the trajectory of illness in some individuals, leading to early discharge and avoiding an out-of-area placement for treatment. Professionals appreciated the opportunity to discuss complex cases in a supportive, friendly, and in-house environment.
Time From Diagnosis of Lewy Body Dementia to Death: Retrospective Study Exploring Patients Within Humber Older People's Mental Health Services
Authors: Adeoye Sunday , Bhattarai Manorama 
Published: August 2024

AimsLewy Body Dementia (LBD) is the second commonest dementia. It accounts for around 7% of dementia cases in secondary care. Studies have shown that LBD patients have an accelerated trajectory towards death when compared with other forms of dementia. Studies have suggested that LBD cases, as compared with Alzheimer dementia, have accelerated cognitive decline, more comorbid conditions, a higher mortality rate, greater service use and poorer quality of life. Most previous studies of LBD have been based on select research cohorts, so less is known about the naturalistic patterns, characteristics, and outcomes of the disease in routine clinical settings.The aim of the study is to determine the average duration from the time of diagnosis to death among patients with Lewy body dementia in OPMH to understand the prognostic pattern of LBD in our locality.Objectives
1.To determine the commonest age of diagnosis and death of patients diagnosed with LBD in OPMH.2.To explore sociodemographic distribution of patients within the study population.3.To determine the time from diagnosis to death of patients diagnosed with LBD in OPHM.4.To determine the common psychotropics combinations used in management of LBD in our psychogeriatric unit.MethodsThis is a retrospective cross-sectional study of all the patients with diagnosis of LBD that presented to Humber Older People Mental Health Services in Hull. The sample consisted of electronic records of all 39 patients under the team but only 38 met the inclusion criteria. Patients’ records were reviewed and information such as gender, ethnicity, age at diagnosis, age at death or age at recruitment if alive, and psychotropic medication they are/were on was retrieved from the records. The time from diagnosis to death was obtained by subtracting age at diagnosis from age at death and this is recorded in years.ResultsThe result showed that majority of our patients were male and about 68.4% of our patients received their diagnosis between the age of 70 and 84 years and that 59.3% of them died within 5 years of receiving their diagnosis. The result also showed that the commonest psychotropic prescribed for LBD patients were single anticholinesterase inhibitor (donepezil or rivastigmine).ConclusionThis study showed that majority of patients died within 5 years of receiving their diagnosis of Lewy body dementia. This underscores the fatality and mortality associated with Lewy body dementia. More needs to be done in developing strategies to ensure improved awareness of Lewy body dementia in our community.
An Evaluation of Referrals and Attendance at a Perinatal Specialist Mental Health Service
Authors: Best Francesca , Dakroury Mennatullah 
Published: August 2024

AimsThis service evaluation had four aims:
1.Breakdown the sources of referrals to one Perinatal Specialist Mental Health Service.2.Calculate the average waiting time from referral to an initial assessment.3.Analyse the Did Not Attend (DNA) rate for initial assessments.4.Suggest possible service improvements to reduce waiting times and DNA rates.MethodsReferrals made in the period May−July 2023 to the Cumbria, Northumberland, Tyne and Wear (CNTW) Perinatal Specialist Mental Health Service were collated. Data regarding the source of referral, demographic details of the patient, whether they were accepted for assessment and whether they did or did not attend their assessment and the outcome of the case was analysed.ResultsMidwives and GPs made the greatest number of referrals (37% and 26% respectively). Out of 263 referrals, 47 did not meet the criteria for an initial assessment – the largest single contributor to this number being referrals from GPs. Just under 16% of referrals made by GPs were found more suited to primary care services after initial assessment compared with 11% amongst referrals from midwives.The average waiting time from an accepted referral to assessment was 29.85 days. This is higher than the CNTW two-week wait target.Of the 203 patients offered assessments, there were 20 occasions on which patients DNA. Those who DNA were more likely to have history of domestic abuse (55% compared with 48% amongst those who attended their assessment first-time). Of the patients who DNA their first appointment, 1/3 attended future appointments.Text reminders about appointments proved extremely popular; where there was information available, 98% of patients were agreeable to text reminders about their appointments.ConclusionWaiting times could be reduced by implementing tighter guidelines for referrals and further educating referrers on the specific role of the perinatal service in contrast to primary psychological services, thus reducing unnecessary assessments.Text reminders should continue to be used in addition to offering assessments at home where suitable. In several cases, patients who had forgotten about their appointment were still agreeable to assessment when met at home.Future research could be carried out in collaboration with patients who DNA to better understand the barriers they face to attendance.
Pilot Study of Community Group Mindfulness Training
Authors: Cornwall Alexandra , Sergison Naz , Cornwall Peter L 
Published: August 2024

AimsCommunity mental health transformation relies on the integration of NHS, local authority, and voluntary agencies to deliver mental health care and support where and when people need it. There is a concern that resources may be diverted to services focused on those with less severe problems and without robust outcome data. We plan to develop a network of self-sustaining mindfulness support groups in a disadvantaged locality with very limited community resources. We provided a pilot mindfulness programme to a group of mothers of primary school age children in East Cleveland.MethodsParticipants were recruited through poster adverts at a primary school. The programme was delivered through 12 weekly hour-long sessions at the school. The group facilitators had basic training in mindfulness. The aim was to teach basic mindfulness practices that could be used in everyday life, including breath work, meditation, and journalling. Mental health status at baseline, mid-point (week 6) and end point (week 12) was measured using the GHQ-12 (score 0–36 and a threshold for likely psychiatric disorder). Data was analysed using t test for continuous scores and χ2 test for caseness.Results14 women responded to the invitation and 9 completed the programme attending a mean of 11.2 sessions. The mean age of participants was 37.4 years and 8 reported previous mental health treatment with medication or psychological therapy, with 4 currently taking medication, but none were known to secondary mental health care services. GHQ-12 scores at baseline indicated significant levels of mental health distress (mean score = 24.1, caseness = 100%). At the midpoint there was a 56.2% reduction in GHQ-12 scores, and this increased to 62.0% at the endpoint. 2 participants remained GHQ cases at both follow-up assessments. The improvement was highly significant (baseline mean score (SD) = 24.1 (2.71); final mean score (SD) = 9.11 (6.15); paired t test: t = 7.23, df = 8, P = 0.0001).ConclusionThis was a novel programme where participants gained access through being parents of primary school aged children. Despite being an unselected community sample, the participants reported significant levels of psychological distress. This highlights both that most people with mental health problems have no contact with psychiatric services and that there remains a high level of unmet need in the community. In this sample, a remarkable level of improvement was demonstrated from a relatively simple and straightforward intervention. Clearly, this will benefit from replication in greater numbers in more diverse samples and settings and with follow-up to see if the benefits persist beyond the intervention phase.
Service Evaluation of a Boxercise Programme in an Inpatient Rehabilitation Setting
Authors: Graham Alexander , Canning Leah , Lachman Meenakshi 
Published: August 2024

AimsWe undertook a service evaluation obtaining feedback from service users in an inpatient rehabilitation setting about a weekly Boxercise class. The aim was to assess the experiences of service users, and the role it has in their recovery.We hypothesised that the class would be well received by service users in aspects of enjoyment, impact on biopsychosocial wellbeing and recovery based on positive comments made by service users.There is an increasing trend to utilise physical activity as an adjunct to improve mental health within healthcare settings; to increase motivation, educate on healthier lifestyles and to enhance well-being outcomes. This Boxercise programme has been developed by the Healthy Living Advisor within the rehabilitation inpatient facility at Leeds and York Partnership Trust. The programme has run for one year, and there has been a large uptake of service users who participate in the group. The Boxercise classes aim to encourage discipline, communication, spatial awareness, and cognitive skills in a modality that is interesting to service users.MethodsService users who are regular participants in a Boxercise programme at an inpatient rehabilitation centre completed a questionnaire. A five-point Likert scale assessed participant views across seven domains. Participants were then asked to write three words that describe their feelings about the Boxercise programme, complete a drawing showing their thoughts after a Boxercise class and provide suggestions for improvement.ResultsEleven participants completed the questionnaire. Average scores for the domains were as follows: enjoyability 4.45/5 (89%), physical health 4.55/5 (91%), mental health 4.27/5 (85%), recovery 4.09/5 (82%), socialising 3.91/5 (82%), safety 4.64/5 (93%), continue after discharge 3.36/5 (67%).The ‘three words' were put in a word cloud generator with highest weighted words: ‘Fun', ‘Good', ‘Energetic', ‘Confident'.Common themes from the pictures shown were smiling faces and ‘strongman' images.Six participants gave feedback that more equipment (pads and gloves) would help to improve their experience in the classes.ConclusionThe Boxercise programme received positive feedback from participants that aligns with the hypothesis; particularly in safety, enjoyability, benefit to physical health and benefit to mental health.The participants had positive views on the class as an adjunct to the management of their physical and mental wellbeing. The feedback from all the participants is that they felt safe during the classes.This service evaluation indicates that the participants value the Boxercise classes as an enjoyable activity and as an adjunct to their treatment.
Relationship Between Use of Dementia-Specific Nursing Institutions and Psychotropic Drugs, Mortality, and Morbidity
Authors: Lee Jung Suk , Lee Byung Ook 
Published: August 2024

AimsIn South Korea, to care for patients with dementia, a new dementia-specific nursing institution has been established that, unlike general nursing institutions, uses shared living rooms and provides customized programs for dementia. This study aims to investigate the effectiveness of dementia-specific nursing institutions. For this purpose, whether psychotropic drugs (antipsychotics, antidepressants, sedatives, mood stabilizers) used to treat behavioral and psychological symptoms of dementia (BPSD) are prescribed, and the mortality and morbidity rates mentioned as side effects of psychotropic drugs (cerebrovascular disease, fall-related fractures, pneumonia, pressure ulcers) varied depending on the use of a dementia-specific nursing institution.MethodsUsing the National Health Insurance Service's customized and Long-Term Care Insurance databases for older people, we collected data over the four years since the introduction of dementia-specific nursing institutions. Among patients with dementia aged 65 years or older, those who used dementia-specific nursing institutions and those who used general nursing institutions were matched for gender, age, history of cerebrovascular disease, disability, comorbidities, and history of taking psychotropic drugs. Thus, 835 users of dementia-specific nursing institutions and 2,505 users of general nursing institutions were analyzed. During the study period, the subjects' use of psychotropic drugs, mortality, and morbidity (cerebrovascular disease, fall-related fractures, pneumonia, and pressure ulcers) were determined. After controlling for variables such as Activities of Daily Living (ADL) scores, the effect of using a dementia-specific nursing institution on mortality and morbidity was analyzed using a logistic regression model.ResultsUsers of dementia-specific nursing institutions were more likely to be prescribed antipsychotics, antidepressants, and sedatives during the study period compared with users of general nursing institutions. Also, users of dementia-specific nursing institutions had a lower mortality rate and lower morbidity rates of pneumonia and pressure ulcers than users of general nursing institutions.ConclusionUsers of dementia-specific nursing institutions had significantly lower mortality rates and morbidity rates of pneumonia and pressure ulcers. This is attributed to dementia-specific nursing institutions encouraging social interaction and physical activity by providing shared living rooms and specialized programs catered towards patients with dementia. However, since the influence of other confounding variables cannot be ruled out, more precisely designed research is needed in the future.