bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Study to Determine How Frequently Patients Are Admitted to Acute General Hospitals With Psychiatric Presentations and Whether Acute Medics Feel Confident in Managing Such Cases
Authors: Viney Ruby , Umla-Runge Katja , Vrigkou Eleni 
Published: August 2024

AimsMental Health Trusts have seen significant funding cuts in recent years resulting in higher admissions to acute medical hospitals due to psychiatric disorders. Little information is available on the quantity of such presentations and no studies have explored how confident acute medical doctors feel in managing patients with mental health disorders.Primary objective: To evaluate whether acute medical doctors feel confident in the common psychiatry topics required to manage patients presenting to medical hospitals with mental health disturbances.Secondary objective: To determine how frequently patients with mental health disorders are admitted to medical beds, either primarily due to their psychiatric disorder or due to another medical problem.MethodsAcute medical doctors working in Merseyside, UK completed a self-report survey in which they rated their confidence level in relation to common psychiatric topics. Admission data for 4 large hospitals in Merseyside were analysed to determine the proportion of all patients admitted to medicine in a 1-year period who had a mental health disorder. Results were further broken down into primary diagnosis by ICD–11 code to determine which mental health conditions presented most frequently to general medical hospitals.Results10 acute medical registrars and 33 acute medical consultants completed the survey. Most acute medical doctors felt at least partly confident in their psychiatry knowledge. However, around a quarter of doctors lacked confidence in managing psychotropic medications and performing risk assessments, with a third of acute doctors unsure how to access specialist psychiatric advice.43.8% of all medical admissions had a mental health disorder. This was comprised of 3.1% who presented primarily due to a mental health illness, and 40.7% who had a mental health disorder but attended for a different reason. Substance misuse accounted for a significant proportion of these admissions.ConclusionDespite almost half of patients admitted to medical beds experiencing mental illness, many acute medical doctors lack confidence managing psychiatric ailments and half of the respondents felt their medical training has not prepared them sufficiently.In addition, many doctors are unsure how to access specialist advice when needed. This leaves both doctors and patients at risk of harm and suggests a need for additional psychiatric training for acute medical doctors and improved access to support.
Developing and Testing a Patient Feedback Survey for Patients Referred to the Bromsgrove Memory Clinic for Memory Assessment
Authors: Yousef Mohammed , Wooster Richard , Weerasena Lathika 
Published: August 2024

AimsA patient feedback survey was designed based on Memory Service National Accreditation standards. The aim was to measure if the Bromsgrove Memory Clinic was meeting these standards and to show if a patient survey could be obtained in a group with cognitive issues.MethodsThe 18-question survey was offered to patients referred by General Practitioners for memory assessment. The survey was designed with cognitive difficulties in mind and could be filled out jointly by patients and their accompanying person. Answers were collected using Likert scale format. 23 completed surveys were collected. Large font and facial expression diagrams were used to aid the participants. Surveys were collected during outpatient/home visits by clinicians (doctors/nurses) trained in memory assessment.ResultsFrom the first question, 12/23 strongly agreed they received enough information prior to the appointment to feel well prepared about what to expect, 9 chose agreed and 2 gave neutral answers. The second question asked how long they waited to receive an appointment, 13 were seen within 6 weeks or less from point of referral, 7 waited between 6-weeks and 3-months. 16 participants strongly agreed to feeling happy with appointment date/time. 17 strongly agreed the clinic was easy to locate.Next, 13/23 strongly agreed, 8 agreed, 1 was neutral that they felt confident the clinic would be able to meet their needs and 1 disagreed. Question seven asked “did staff explain the assessment process to you?” and 20/23 strongly agreed. Question eight asked if participants were given opportunity to ask questions, 22/23 strongly agreed. 21/23 strongly agreed enough time was given to discussing important information. 17/23 strongly agreed they knew they could stop the assessment at any point. 22/23 strongly agreed their privacy was respected.Questions 12–14 looked at information given, and they could class it as “Not enough, Right amount, Too much or Not applicable”. 19/23 indicated “right amount” for information given about diagnosis. 21/23 felt information about investigations or tests was the right amount. Regarding information about medications, 20 selected “the right amount”.18 strongly agreed the information, advice and support was helpful and sufficient. 19 strongly agreed they were treated with respect and dignity. 20 strongly agreed they wouldn't hesitate to recommend the service to others.ConclusionThe results showed an overwhelmingly positive memory service experience in Bromsgrove and it is possible to meaningfully survey this patient group with some adjustments. The survey could be repeated to monitor standards over time.
Venous Thromboembolism (VTE) Risk Assessment in an Older Adult Mental Health Inpatient Ward
Authors: Ajewole Oluwatobi , Ogbeide-Ihama Margaret 
Published: August 2024

AimsThis audit aimed to investigate how VTE risk assessments on one of our older adult inpatient units meet to the recommended standard by:
1.Assessing the compliance of admissions to the trust VTE policy, which is based on the corresponding National Institute for Health and Care Excellence (NICE) guideline.2.Determining if VTE assessments were performed using appropriate clinical tools, as recommended in the policy, and correctly recorded in patient notes.MethodsAll admissions to the ward (n = 77) within the one year from 01.06.2021 to 31.05.2022 were retrospectively reviewed for VTE assessments based on the abovementioned standards. Data was extracted from progress notes and ward round entries for completion of the VTE assessment during admission, documentation of the assessment tool, documentation of the VTE prophylaxis prescription if indicated, and reassessment of risks during admission.ResultsThis audit showed that only 3% of patients had a VTE assessment documented within the first 24 hours of admission. Overall, over a 10th of all patients never had an assessment, and of those who did, no one had the assessment tool used documented or uploaded on their clinical records. Also, of those who had a VTE assessment done, 5% were assessed to be at risk, and of these, only half had VTE prophylaxis prescribed.ConclusionThis audit showed the ward is essentially not meeting the standard for VTE risk assessment, with recommendations to incorporate VTE assessment as part of the clerking proforma and the medication charts, similar to the usual practice on physical health wards.
Audit of Documentation of Lifestyle Medicine Factors in the Leicestershire Early Intervention Psychosis Team Clinic Letters
Authors: Chithiramohan Tamara , Ahmed Shiraz , Gavotsi Dafni , Das Debasis 
Published: August 2024

AimsLifestyle medicine promotes the use of therapeutic lifestyle interventions to modify disturbed lifestyle factors which are thought to underlie chronic illnesses, including mental health conditions. It is important to identify and manage any disruptions in factors that lifestyle medicine has identified as being contributory towards sustaining good health. Aims were to identify the extent to which the early intervention in psychosis (EIP) medical team in Leicestershire are enquiring about the pillars of lifestyle medicine.MethodsThere are 6 pillars of lifestyle medicine, namely exercise, sleep, diet, refraining from toxins, positive social interactions and quality personal time. Motivation has been added as the 7th pillar for this audit. Gold standard would be to adequately explore all pillars at each medical review. Retrospective analysis was done of electronic patient records (SystmOne) for all patients on the EIP team case load, available on 19th May 2023. Information was gathered from the most recent medical review, using a predefined audit extraction tool. Information on each pillar was assessed based on whether it was fully explored, mentioned with some detail, mentioned with no further detail, or not mentioned at all. Data collection was carried out by three members of the team (TC, SA and DG).Results495 patients were identified and 459 had information from a latest medical review found on SystmOne. For all domains, “not mentioned” was the leader, ranging from 48.6–70.8%). For all domains, except for refraining from toxins, the second most common finding was “mentioned with no further details”.ConclusionOur results suggest EIP medical staff are either not discussing many of the seven pillars of lifestyle medicine with patients, or not documenting them in sufficient detail. Limitations of the study include that it was the most recent medical review being audited and there could have been more detail documentation in previous reviews. Distribution of the findings and recommendations from the audit were shared with the team and an educational poster detailing lifestyle factors was created. The online system is being adapted to include an option to input lifestyle factors. Re-audit should be done in 12 months.
An Audit of the Prescribing and Monitoring of Antipsychotic Medication in an Older Adult Inpatient Psychiatric Ward Using NICE Guidance [CG178] Psychosis and Schizophrenia in Adults: Prevention and Management
Authors: Shabaka Alaa , Parry Thomas , Ugah Mary , De Souza Stephen 
Published: August 2024

AimsThe National Institute for Health and Care Excellence (NICE) offers guidance for prescribing and monitoring of antipsychotic medications. In this audit we sought to investigate if our unit was compliant with this guidance.MethodsThe audit was carried out on a 28 bedded older adult inpatient psychiatric unit. The notes of all patients admitted to this ward on 27/11/2023 were reviewed. Any patient on an antipsychotic was included in the audit. Four standards reflecting the prescribing and monitoring of antipsychotics were identified. These were:
1.3.5.1 The choice of antipsychotic medication should be made by the service user and healthcare professional together, taking into account the views of the carer if the service user agrees.1.3.6.1 Before starting antipsychotic medication, undertake and record the baseline investigations.1.3.6.2 Before starting antipsychotic medication, offer the person with psychosis or schizophrenia an electrocardiogram (ECG).1.3.6.3 Treatment with antipsychotic medication should be considered an explicit individual therapeutic trial.1.3.6.4 Monitor and record the following (response to treatment – side effects – adherence – physical health) regularly and systematically throughout treatment.These five areas of guidance were broken down into 22 domains which are outlined in results below.ResultsOf 28 patients admitted to the ward, 22 were on antipsychotic medication.1.3.5.1: Medication benefits were discussed and documented in 9/19 cases (47%), with 3 patients refusing to engage in this discussion. Side effects were discussed and documented in 5/21 cases (23%).1.3.6.1: Patients underwent a range of investigations. In some cases, the patient hadn't been on the medication for long enough to require additional tests. Some patients were excluded as they refused testing. Glycosylated Haemoglobin (100%), Weight (100%), Pulse and Blood Pressure (100%), Blood Lipid Profile (86%), Prolactin Levels (77%), Assessment of nutritional status, diet (77%), baseline fasting blood glucose (38%), Level of Physical Activity (31%), Assessment of any movement disorder (22%), Waist Circumference (0%).1.3.6.2: An ECG was offered in 94% of cases.1.3.6.3: The rationale of continuing, changing or stopping the medication was recorded in 86% cases and no patients had antipsychotic doses above BNF maximum.1.3.6.4: Overall physical health monitoring, weekly weights and, pulse and BP at 12 weeks (100%). Adherence and response to treatment were both 95%. Measurement of glycaemic control (57%), movement disorders (14%) and side effects (13%).ConclusionWhile there are areas of good practice, there are a number of significant omissions. Remedies to these deficits will be proposed.
An Audit of the Consistency and Quality of Letters From Choice Appointments in CAMHS South Edinburgh
Authors: Dempsey Eileen 
Published: August 2024

AimsHypothesis: Choice letters generated by Child & Adolescent Mental Health Services (CAMHS) South Edinburgh are not consistent in quality and content.Aims:
1.To assess the consistency and quality of letters generated by clinicians following Choice appointments in CAMHS South.2.To observe the range of resources shared in Choice letters.MethodsPatients were identified retrospectively from the team Choice diary.Choice or Complex Choice appointments attended between 13th October–27th November 2023 at CAMHS South were included. See Soon appointments and appointments that were not attended or cancelled were excluded.Standards to which all letters should adhere were devised from the CAPA (Choice & Partnership Approach) Book and the CAMHS South Choice Handbook.Standards: current concerns, background information, patient goals, clinician impression, choices discussed, choices made, self-help agreed, services required, maximum two sides of A4, copy to patient, copy to referrer, sent within two weeks.Letters were accessed via electronic records and analysed with a proforma.A maximum of three letters per clinician was included.A log of resources and frequency shared was kept.Results57 appointments were attended, with 50 letters generated by 22 clinicians.Adherence to standards in 50 available letters:Current concerns 92%Background information 96%Patient goals 40%Clinician impression 62%Choices discussed 22%Choices made 100%Self-help agreed 52%Services required 100%Maximum two sides of A4 50%Copy to patient 88%Copy to referrer 100%Sent within two weeks 72%94 different resources were shared in the letters, with minimum 0 resources and maximum 19 resources per letter.ConclusionThere were areas of good quality and consistency in Choice letters, including documentation of current concerns, background information, and highlighting of required services. These are areas likely to feature in most assessments regardless of clinician background.There were areas that require improvement, including documentation of goals, clinician impression, self-help agreed, and keeping to a maximum of two sides of A4. These areas are perhaps more obscure for different types of clinician.A wide range of resources were shared in Choice letters with a considerable amount of variability in number of resources. This suggests differing levels of individualisation of resources to the patient.Since this audit, CAMHS South have implemented additional Choice training, electronic canned text for letters, and collation of Choice guidance. There is a plan to re-audit following these interventions.
Audit on Antidepressant Prescribing; Documentation of Indication; and Compliance With EIPN Standards in Medication Review, at Hailsham Early Intervention in Psychosis Service
Authors: Di Francesco Daniel , Todd James , Brooke Alice 
Published: August 2024

Aims•To improve documentation of antidepressant prescribing in our service, aiming to improve frequency of review, and guide measurement of outcomes.•Identify patients requiring medical review.The standards that we audited against are that, for patients under The Early Intervention in Psychosis Service (EIPS), a diagnosis should be recorded alongside each antidepressant prescription and, according to EIPN guidelines, psychotropic medications should be reviewed every 6 months.Population data from the UK indicates that lack of recording of a diagnosis is associated with increased duration of treatment, and reduced frequency of mental health reviews.MethodsIt was recorded for each patient whether they had an antidepressant prescribed, which medication, the documented indication, and their most recent medical review. Data was collected in a ‘snapshot' cross section of all 89 patients on the caseload in December 2023.Data was obtained from carenotes by reviewing clinic letters and clinical notes; and cross-referencing with GP records.Results33 patients (37%) were prescribed an antidepressant. Of these, 25 (76%) had a recorded indication. The commonest indication was mixed anxiety and depression followed by depression. Sertraline was by far the commonest prescribed antidepressant (52%) followed by mirtazapine. 3 patients were prescribed combination antidepressants. 67 patients (84%) had had a medical review within 6 months.ConclusionAmong patients with a first episode of psychosis, there is a significant comorbidity of depression and anxiety spectrum disorders.Our standard was met for most patients but there were several exceptions, and we considered why 8 patients did not have a listed diagnosis. There can be a degree of diagnostic uncertainty in distinguishing anxiety and depressive disorders from negative symptoms, and the affective changes that are an established part of recovery from an acute psychotic episode. In these circumstances it may be appropriate to consider a trial of antidepressants in consultation with the patient. Some of these patients also have been on long-term therapy which preceded their referral to EIPS, leading to uncertainty of the indication and pre-morbid status.We conclude the following recommendations:
1.Prompt a review of antidepressant use in those identified without a clear indication, discussing risks and benefits with the patient at next review.2.Arrange medical reviews for those exceeding the 6-monthly window.3.Record last review for patients under shared care.4.Re-audit in 6 months to monitor improvement.
Keeping Up Standards: An Audit of Adherence to Admission Standards on Acute Mental Health Wards in NHS Lanarkshire
Authors: Adam Louisa , Dillon Shaina , Docherty Emma , Guarino Francesca , Lindsay Leanne 
Published: August 2024

AimsWe audited the adherence to part of the minimum admission standards for Mental Health, Learning Disabilities and Addictions Services (MHLDA) for 6 acute wards, across two sites (UHH and UHW) in NHS Lanarkshire. We focussed on the section of the standards that the admitting junior doctor/ANP is responsible for. This comprised:
•An admission assessment (including presenting complaint, history of current episode of illness, medication, mental state examination and risk assessment).•Physical health assessment (examination, bloods, ECG, VTE assessment), medicine reconciliation and prescribing on HEPMA - within 12 hours.MethodsFive individuals collected data across both sites and both cycles. For our first cycle, all admissions in March 2023 were retrospectively reviewed, a total of 94 admissions (UHH 47, UHW 47). Electronic notes/systems were reviewed (Morse, Clinical Portal, Hepma, Trakcare).This first cycle demonstrated poor adherence to the minimum admissions standards. A proforma for admission statement was created, including prompts for the admission assessment and for the components of the physical health assessment, medicines reconciliation and prescribing. Presentations were made at postgraduate teaching and at ANP teaching. The majority of people were unaware of the existence of the admission standards or did not know where to find them. The admission standards document and the proforma were circulated via email and added to the shared R drive. A second cycle was completed, reviewing all admissions in July 2023, a total of 74 admissions (UHH 41, UHW 33). The proforma has now been included in the induction material for new doctors.ResultsFollowing interventions, there was improvement in completion of admission statement (90% vs 81%). There was improvement in the inclusion of all components, most notably MSE (91% vs 71%) and risk assessment (59% vs 18%). Where the proforma was used (57%), all aspects of admission statement were present (97–100%). When not used, there was variable inclusion of the different components (7–90%). There was improvement in the completion of all components of physical health assessment (except small decrease in medicine reconciliation). In every case of missing components with no documentation as to why, the proforma had not been used.ConclusionDevelopment of a proforma for admission assessment has led to improved completion of admission assessment, physical health assessment, medicines reconciliation and prescribing within 12 hours. Qualitative feedback is being sought on the proforma from junior doctors, ANPs and senior medics to guide next steps and further improvements. Review of the admissions standards guidance is now due.
Clinical Audit of Dementia Diagnosis and Management – According to Disease Severity
Authors: Fatunla Sylvia 
Published: August 2024

AimsThe NICE guidelines NG97 (1.5) currently recommend to consider memantine in addition to acetylcholinesterase inhibitors in the management of moderate to severe Alzheimer's dementia, if tolerated, as opposed to the mono-therapeutic management with either class of drug. This management practice was adopted by the trust and updated on Trust guidelines.I noted that most of the patients on follow up in memory clinic, had a generic diagnosis of dementia subtypes, without a mention of the degree of severity of the illness and as such, on monotherapy.AimThis audit serves to establish the practice in recent years, if patients diagnosed with dementia, were diagnosed, and managed according to the severity of their condition.If not, for necessary changes to be implemented in practice and a re-audit carried out.MethodsThe audit was conducted in February 2023 as a retrospective study. We analysed records of 60 patients seen for a diagnostic appointment in Middlesbrough Memory Service between January 2020 and December 2020.All referrals made to the memory clinic within 2020 were retrieved from trust electronic records and 5 patients were selected at random from each month using the google random number generator, and analysed on Excel.ResultsThe most common dementia diagnosis was mixed dementia (Alzheimer's + vascular disease) with 40% of diagnoses, followed by Alzheimer's disease at 39%, while Lewy body dementia was least diagnosed at 8%.Assessment: Only 46 records completed the dementia diagnostic pathway (initial assessment, ACE III, CT scan alongside pre-referral blood screen), the other 14 patients were unable to complete this pathway due to functional decline.Severity of illness: Of the patients evaluated, only 7% had the severity of disease in their diagnosis, which were all Moderate severity. 93% had generic diagnosis.Pharmacological Treatment: 46 out of 60 patients evaluated, were on medication.And all were on monotherapy, irrespective of disease severity, with majority being on anticholinesterase inhibitors (Donepezil) being the first and most popular choice.ConclusionSeverity of disease condition were not identified or documented.The use of combination therapy is yet to be considered at the diagnostic stage. This should be implemented before discharging a patient with moderate to severe disease. Although, local best practice is to offer this as early as moderate disease is identified.Combination therapy is yet to be adopted in the organic pathway.