bluuebunny/crossref_metadata_2025_split huggingface dataset:
Technology Enabled Remote Monitoring in Schools(TERMS): A Case Study Series Using Parallel Testing in Clinical Settings and School Workshops
Authors: Sameem Hafeesa , Ahuja Alka , Johns Gemma , Simmons Mrs Vicky , John Oliver 
Published: August 2024

AimsThe TERMS (Technology Enabled Remote Monitoring in Schools) project aimed to elucidate the operational dynamics of remote monitoring with bluetooth-enabled physical health monitoring devices. The focus was on measuring key parameters such as usage, perceived value, accuracy, and satisfaction among patients, their families, and healthcare staff. Additionally, we sought to explore the potential future integration of remote monitoring in educational settings through school site workshops.BackgroundDigital healthcare has become an indispensable part of effective healthcare provision on a global level. Remote monitoring is the use of technology, to monitor patients outside of a clinical setting with the help of medical devices, questionnaires, and clinical dashboards, allowing clinicians to review the data to assist in clinical assessment and decision-making. While this method is already established for conditions like Diabetes and Asthma it is not for other conditions like ADHD. This is especially a challenge for the younger demographic.Schools are pivotal for promoting student well-being and early interventions, leading to reduced negative outcomes like exclusion and school absence and enhanced academic attainment. The TERMS project strives to bridge the gap between education and healthcare by collaborating with schools and clinicians. This is in alignment with the digital and data strategy for health and social care in Wales as outlined by the Welsh Government(2023).MethodsThis study had 2 parts:Clinical Site Testing:Blue tooth-enabled clinical monitoring device readings were obtained after they were monitored first with traditional clinical monitoring devices. Additional qualitative feedback was also obtained.Educational Workshops:Workshops were carried out with students and teaching staff to collect qualitative and quantitative feedback on the remote monitoring equipment and patient-facing dashboard. This also set out to determine if remote monitoring in schools is feasible and how it could be implemented.ResultsA total of 47 clinical patient cases were included. The accuracy of the bluetooth-enabled device readings and those of traditional equipment were compared. Analysis of the qualitative data revealed useful domains and subdomains of opinions along with the user-friendliness of the software interface.ConclusionOverall, we have identified that patient and family perception of remote monitoring is positive, suggesting an improved/comparable level of care for their condition. Additionally, school workshops highlight that this service could be implemented within a school setting. As long as considerations were made for who would conduct the remote monitoring and what the role of the school would be.
Improving Communication Between the Community Learning Disability Team, Patients, Their Carers and Primary Care Services Within Aneurin Bevan University Health Board
Authors: Scanlon Kathleen , Richings Ceri , Howe Gareth 
Published: August 2024

AimsRecommendations from the NHS and the Royal College of Psychiatrists advise that patients receive a copy of all correspondence that is sent on to the GP. Often, within psychiatric services, letters are not routinely sent to patients.To improve communication with patients and their carers, the Aneurin Bevan Learning Disability team have been writing letters directly to patients and sending a copy to the GP.There is limited use of jargon, and the complexity of the language aims to reflect the individual's reading level.This study aimed to gain feedback from local GPs on the new letter format to ensure effective communication between teams.MethodsWe contacted Primary Care Services in the local area to gain feedback on how our clinic letters were being processed, we were informed that letters are reviewed by an admin team and only sent on to GPs if there are specific tasks to action, meaning that many of our letters remain unread.We identified 16 GP practices in the Torfaen and Monmouthshire area and sent a survey by email to gain feedback on the new correspondence style. The survey was sent out three times within a 12-month period.ResultsOf 16 GP practices just 6 responded, with just 1 GP stating that they had noticed a change in the letter style. 50% of GPs felt they received relevant information in the letters from the CLDT. The comments were largely positive with suggestions reflecting changes that have already been made. There is no feedback that suggests GPs feel they are not receiving adequate clinical information.ConclusionThe lack of response may highlight how infrequently GPs are reviewing the letters from the CLDT confirming the importance of prioritising doctor–patient correspondence. The limited communication from GP to CLDT emphasises the need for improvement in liaison between secondary and primary care services.The lack of negative feedback about the letters is encouraging. There is no feedback that suggests GPs feel they are not receiving adequate clinical information and clear feedback that GPs want clear and accessible information, particularly regarding specific actions for GPs.A clear limitation of this work is the lack of response to our survey. Reviewing these letters from our team is a very small proportion of a GPs workload, more time may be needed to ensure GPs have had contact with our team and are able to provide more detailed feedback.
Personality Disorder and Crisis in the COVID-19 Pandemic
Authors: Sethi Amar , Howe Andrew 
Published: August 2024

AimsTo identify if COVID-19 has changed the experience for patients under the care of Crisis Resolution Home Treatment teams (HTT).To identify if COVID-19 altered the response for HTT patients in the context of Personality Disorder (PD).To provide useful demographic and experiential information about patients using HTT with PD during crisis.MethodsData regarding the demographics of patients with personality disorders under the care of the Croydon crisis home treatment team were collected retrospectively for two, predetermined time windows. The first window was pre-COVID-19 (26/03/2019–25/03/2020) and the second window was during COVID-19 (26/03/2020–25/03/2021). The demographics of patients with personality disorder referred to the team during these two time periods included were compared.ResultsMore patients with personality disorder were referred to the Croydon HTT during COVID-19 (n = 82) when compared with the window before (n = 58). The proportion of referred patients with Emotionally Unstable Personality Disorder (EUPD) was constant before and during COVID-19. The average length of stay reduced from 22.6 days before COVID-19 to 18.7 days during COVID-19. The proportion of rejected referrals to the HTT of patients with personality disorder increased during COVID-19. Finally, the proportion of BAME (Black, Asian, Minority Ethnicity) referrals of patients with personality disorder increased during COVID when compared with before, with this finding not being replicated in any other ethnic group.ConclusionIncreased numbers of referrals may indicate worsening mental health in the community. This may have been compounded by an inability of community mental health teams and inpatient services to meet such an increase in demand for services. An overall reduction in inpatient admissions during COVID-19 supports this idea. There was a relatively larger drop in duration of admission for patient with personality disorder during COVID-19, when compared with all patients. This may be due to staff feeling unable to offer quick management for patients with personality disorder. Subsequently, staff may have selectively discharged such patients earlier. The rate of rejected referrals to the Croydon HTT was consistently higher than the acceptances both pre- and post- COVID-19. Therefore, HTT clinicians may feel unable to adequately treat PD.In conclusion, the number of referrals to the HTT increased during COVID-19, however, with a reduced average duration of stay with HTT for patients. The rejection rates for personality disorder patients were consistently higher than for other patient groups, both before and during COVID-19. Additionally, the proportion of patients with personality disorder from BAME backgrounds increased during COVID-19.
Correlation of Heart Rate Variability and Subjective Withdrawal Symptoms in Patients With Opioid Dependence, and Its Comparison in Patients Undergoing Detoxification With Patients Maintained on Opioid Agonist Treatment
Authors: Verma Adit , Sarkar Siddharth , Kochhar Kanwal Preet , Sood Esha , Chandran Dinu 
Published: August 2024

AimsPatients with opioid dependence seek treatment for the discomforting withdrawal symptoms. Accurate clinical assessment is essential as medications are optimized based on these withdrawal symptoms. However, subjective reporting can present challenges. Heart rate variability (HRV) can enhance clinical assessment and has taxonomic and therapeutic implications. This study aimed to explore the correlation between HRV and subjective withdrawal in patients with opioid dependence and to compare the HRV parameters in patients undergoing detoxification to those maintained on opioid agonist treatment and healthy controls.Methods3 groups of adult male participants were included. Group 1 included 40 patients with opioid dependence undergoing inpatient detoxification. Group 2 included 40 patients with opioid dependence receiving stable doses of buprenorphine on outpatient basis. Group 3 included 49 healthy controls. The Subjective Opiate Withdrawal Scale (SOWS) was used for withdrawal symptoms. For Group 1 and Group 2, HRV was assessed twice – before administration of morning dose of buprenorphine, and then 2 hours post administration. For Group 3 HRV was assessed once.ResultsAt baseline, resting heart rate differed significantly between the 3 groups (p < 0.001), it was highest for Group 2 (92.4) and lowest for Group 3 (79.4). In time domain parameters of HRV, the beat-to-beat variability was highest for Group 1 with standard deviation of all normal RR intervals (SDNN) = 134.8, root mean square of successive differences between normal heartbeats (RMSSD) = 181.7 and RR tri index = 8.9 (p < 0.005). In frequency domain parameters of HRV, total power was highest for Group 1 (98334.1, p < 0.001) while relative power did not differ significantly among the groups. The SOWS had a weak negative correlation with RMSSD in Group 2 (r = -0.312, p < 0.05) but did not have any correlation with HRV parameters in Group 1. Post administration of morning buprenorphine, the HRV parameters did not show a significant change in either of the groups (except reduction in very low frequency percentage in Group 1 from 12.013 to 7.196, p < 0.05).ConclusionA higher degree of subjective withdrawal is associated with lower beat-to-beat variability in patients on stable doses of buprenorphine. However, this exploratory study did not find a robust relationship between HRV and subjective withdrawal symptoms. Higher RMSSD (representative of higher vagal tone) in patients undergoing detoxification may suggest greater physiological adaptation to withdrawal symptoms. This study provides additional insights into HRV in patients with opioid dependence.
Associations Between Pathways Into Care and Service Use and Involuntary Hospitalisation Among Children and Young People
Authors: Walker Susan , Freitas Daniela Fonseca , Downs Johnny , Nyikavaranda Patrick , Johnson Sonia 
Published: August 2024

AimsThere is evidence that children and young people (CYP) of Black ethnicity are more likely to experience involuntary hospital admission. This is not explained by clinical and sociodemographic factors. One possible explanation are differences in pathways into, and/or use of mental health services (MHS). This study investigates the associations between ethnicity, pathways into MHS, MHS use and involuntary hospitalisation in CYP.MethodsUsing data from the Clinical Record Interactive Search (CRIS) system for (South London and the Maudsley) SLaM services we identified 652 CYP under 18 years admitted to inpatient units between 2008 and 2021 living within the SLaM catchment; 458 (70.2%) were admitted informally and 194 (29.7%) were detained. We conducted univariable logistic regression to investigate the association between pathways into MHS (referral source, S.136 presentation), MHS use (time known to services, recent appointment prior to admission, and presence of a care plan), clinical factors (diagnosis, severity, risk) and social factors (gender, age, ethnicity, deprivation) with the outcome i.e. involuntary admission. We then conducted multivariable logistic regression to investigate the association between the clinical and social factors and involuntary admission.ResultsIn multivariable analyses we found evidence that adverse pathways into MHS such as S.136 presentation (OR 6.25, 95%CI 2.06-19.01, p = 0.001), and referrals from social services (OR 4.92, 95%CI 1.49-16.19, p = 0.009) and police/legal services (OR 4.22, 95%CI 1.03-17.31, p = 0.045) were associated with involuntary hospitalisation. There was no evidence that the duration of contact with MHS, having had an appointment in the 28 days prior to admission or a care plan in the 12 months prior to admission were associated with involuntary hospitalisation after adjusting for other factors. There was evidence that being of Black ethnicity (OR 2.04, 95%CI 1.19-3.50, p = 0.010), older age (13–15 years: OR 4.46, 95%CI 1.57-12.72, p = 0.005; age 16–17 years: OR 8.67, 95%CI 3.08-24.41, p < 0.001) and having a diagnosis of a psychotic disorder (OR 4.21, 95%CI 2.21-8.02, p < 0.001) were associated with involuntary admission after accounting for pathways into and use of MHS.ConclusionIn this cohort of child and adolescent inpatients living in South East London, we found that CYP who experience adverse pathways into MHS are more likely to experience involuntary hospitalisation. Prior contact with MHS did not appear to influence involuntary admission. We found that Black CYP remained more than twice as likely to be admitted involuntarily after accounting for MHS use and pathways into MHS as well as social and clinical factors.
Psychiatry Residents' Views on Quality of Psychotherapy Training in Pakistan: A Cross-Sectional Survey
Authors: Khan Aazeen , Ahmed Raja Adnan 
Published: August 2024

AimsSeveral modalities of psychotherapies have an established therapeutic evidence base for many psychiatric disorders. Stakeholders around the world including the Royal College of Psychiatrists, recommend training of psychiatry trainees in psychotherapy as part of Psychiatry training. However, the quality and quantity of training in psychotherapy differ across different regions. Psychiatry training programmes in high-income countries are regularly audited to ensure minimum standards of training in psychotherapies among psychiatry trainees. There is a lack of reporting regarding psychotherapy training in low- and middle-income countries such as Pakistan. This study explores the experiences of Pakistan-based psychiatry residents regarding their psychotherapy training within the fellowship programme of the College of Physicians and Surgeons (FCPS) Pakistan.MethodsThis study employs a mixed-method survey approach, targeting psychiatry trainees registered with College of Physicians and Surgeons (CPSP) four-year training programme (FCPS) across different cities of Pakistan. Utilising a convenience sampling strategy supplemented by the snowball sampling method, an electronic survey was disseminated using social media platform over a 4-week period. The survey was anonymous and structured into three sections; essential demographic data of the participants, experiences with psychotherapy training, and open-ended questions allowing participants to freely express their thoughts and insights on improving psychotherapy training in Pakistan.ResultsOut of the 41 responses received, the majority were female respondents, totalling 27 (65%). All participants were FCPS trainees at various stages of their training, hailing from ten different cities across Pakistan. Findings indicated that 61% of respondents reported insufficient time to learn, understand, and apply psychotherapy techniques, while 53% identified a deficiency in supervision.In terms of therapeutic exposure, a predominant 34 participants (82%) encountered Cognitive Behavioural Therapy during their training. Mindfulness, Dialectical Behaviour Therapy, and Family Therapy each were reported by 12 respondents (30%). Interestingly, 34 of the respondents (82%) noted an increased interest in psychotherapy since starting their psychiatric training. However, only 20 respondents (48%), felt confident in delivering psychotherapy independently.A recurring theme emerged from the feedback: participants advocated for a more structured psychotherapy training program, emphasising the need for dedicated time specifically allocated for supervision and practical learning opportunities.ConclusionThis survey highlights that FCPS Psychiatry Residents in Pakistan are keen to learn more about psychotherapy. However, identified shortcomings in delivery, structure, and supervision suggest a need for comprehensive reforms. The findings emphasise on refining the psychotherapy training in low- and middle-income countries.
Implementation and Evaluation of a Local CBT Teaching Programme for Core Psychiatry Trainees
Authors: Bloomfield James , Leyden Eimear , Vaida Alina 
Published: August 2024

AimsCore Psychiatry Trainees (CTs) are required to complete two psychotherapy cases, utilising different therapeutic modalities as part of their training. During supervision sessions, CTs in Coventry and Warwickshire reported feeling underprepared to start their psychotherapy cases. Locally, the most frequently used modality for short cases is Cognitive Behavioural Therapy (CBT). Here we evaluate a local CBT teaching program implemented to prepare CTs, delivered by the trust Psychotherapy Tutor in conjunction with a CT, Dr Bloomfield, who has experience delivering CBT in a talking therapies service.MethodsWe implemented a teaching programme which consisted of 30-minute teaching sessions occurring immediately after Balint groups, which are usually well attended. Dr Bloomfield designed a teaching plan, with separate CBT teaching topics divided into 12 sessions. Each session focused on a CBT concept with practical examples. The effectiveness of psychotherapy teaching was evaluated with pre- and post-teaching online surveys assessing preparedness, confidence in formulation, and knowledge of specific techniques. The survey consisted of Likert scales ranging from 1–10 with lower numbers indicating a negative response. Trainees were also surveyed about Psychodynamic Psychotherapy in the absence of specific teaching, as a comparator.Results13 CTs responded to the pre-teaching survey and 16 CTs to the post teaching survey, with near-equal weighting across the training grades. Responses indicated a median increase across all areas for CBT, with trainees reporting higher confidence in formulation (7 to 8.5), improved knowledge of CBT techniques (5 to 8) and increased preparedness to start seeing patients (5 to 7). By comparison, there was a modest increase in preparedness (5 to 6) and confidence in psychodynamic formulation (3 to 3.5), with knowledge of specific aspects of Psychodynamic Psychotherapy unchanged (6 and 6).ConclusionRegional teaching alone may not be sufficient in preparing trainees to start seeing psychotherapy patients. The CBT learning needs of CTs in Coventry and Warwickshire were effectively met by providing a series of short, tailored sessions covering the different aspects of CBT, resulting in improved confidence, preparedness, and knowledge of CBT techniques. The same increases were not seen in trainees’ responses regarding Psychodynamic Psychotherapy, though small increases were seen in preparedness and confidence in formulation. Our next phase of the teaching will focus on Psychodynamic Psychotherapy teaching, with further repetition of the survey.
Dealing With Discrimination, Harassment and Bullying in Mental Health Settings: A Qualitative Evaluation of Training
Authors: Fotheringham Lachlan , Munro Katie 
Published: August 2024

AimsThis is a qualitative evaluation of a simulation/debrief based training session to address discrimination in an NHS workplace, delivered to psychiatry trainees. Videos portraying discrimination acted as the simulation, followed by a diamond model informed debrief.This evaluation aimed to:
•assess the effectiveness of this training session in terms raising awareness of discrimination, problematising discrimination, empowerment to act and skills building•explore the extent to which these stated aims are relevant to participants’ experience of discrimination, harassment and bullying at work•establish if this is a meaningful and acceptable training model for this topic•establish if there are more relevant themes that this training session should be focusing on and if so, what these are?MethodsA total of 8 trainees were interviewed between December 2022 and May 2023, having recently completed the training. A thematic analysis was undertaken by two researchers following established recommendations, seeking to bring out latent themes with an inductive, interpretative approach within a constructionist paradigm.ResultsTrainees attended with existing knowledge, skills and attitudes about discrimination, harassment and bullying, and about the training session itself.Both the simulation and debrief were valued by trainees. The debrief was more than just a discussion. Portrayals of discrimination in the videos/simulation could have been more subtle, and tackled a more diverse range of examples such as LGBTQ+.The learning objectives were largely met, and related to real challenges that trainees face. Trainees took away more than this, citing learning related to team cohesion and developing their sense in which discrimination in the context of mental illness requires special consideration.ConclusionThis model of training is providing good value in addressing a topic of strategic importance in a novel way. The impact on empowerment and skills development is likely to be particularly valuable in impacting real world responses to workplace experiences of discrimination. Promoting team cohesion and a space to thoughtfully consider the special case of discrimination in the context of mental illness are important additional benefits. The simulation/debrief model is likely to be crucial, providing learning which would be inaccessible to didactic or e-learning based modes of delivery. The simulation materials may be improved by depicting LGBTQ+ issues, and a more subtle portrayal of discrimination. While this evaluation was situated in a psychiatric context, it could have wide applicability to tackling similar challenges throughout NHS workplaces.