bluuebunny/crossref_metadata_2025_split huggingface dataset:
“The Only Way Is Up; Lets Do It!”- a Quality Improvement Project for Physical Health Improvement for Patients Diagnosed With Schizophrenia at a CMHT in Glasgow Using Smart Interventions
Authors: Marron Brooke , Anderson Lindsay , Cheema Fahd , Dow Eleanor , Hutchison Stuart , Kazmierczyk Marcel , Bindra Jasmeet , Dourish Jonathan , Richardson Julie 
Published: July 2023

AimsCardiovascular death is the leading cause of early mortality in patients with schizophrenia. We audited physical health monitoring (via Lester tool) of all patients diagnosed with schizophrenia over the past year. There were 163 patients, 60% were up-to-date on blood tests, but only 28% had an up-to-date ECG. We found poor documentation of lifestyle risk factors (smoking/alcohol/weight) and recording of interventions that were offered to modify these. We felt it was important to try a pro-active model of engagement and intervention in order to improve outcomes and empower patients in collaboration with GPs.MethodsA subset of the cohort (35 patients) were invited along for an all-inclusive check up with a doctor at the psychiatry clinic (blood tests, discussion and advice regarding lifestyle risk factors and on-site ECG utilising the new Kardia 6L) lasting 30 minutes. Information was collated and then distributed via a letter to the GP, the consultant psychiatrist and the patient.ResultsOf the 35 patients invited to attend the physical health check-up, 18 (51%) attended. All patients then underwent physical health monitoring and discussion of how to improve their risk factors. The Kardia6L allowed for QTc monitoring to occur quickly and easily in the outpatient setting and was liked and accepted by patients. We found that most patients were overweight (88%) and were undertaking less than 30 minutes of exercise a day (50%). Half of the patients required active medical intervention (statin, blood pressure or diabetes medication). The Kardia6L allowed us to attain 88% compliance with achieving up-to-date ECGs and provided instant results to the clinicians/patients.ConclusionIn this first phase of the quality improvement project we were able to show that half of the patients were willing to attend for in person monitoring. Patient engagement was better as intervention was being delivered at their usual CMHT by their Psychiatrists. The model of a shared letter between patient, GP and psychiatry encouraged shared responsibility for carrying these issues forward. From participating in the project the psychiatry team plan to review patient's medication and develop a robust intervention plan regarding weight loss/exercise/diet from the CMHT in collaboration with GPs as there are clear issues affecting our patient's health long term. The Kardia6L proved to be a quick/easy way to monitor QTc safely in an outpatient setting and allowed us to provide this as one step process at CMHT without requiring referral to Cardiology while improving compliance with annual ECGs.
The African and Caribbean Doctors Buddy Group (ACDBG) at HPFT- Hertfordshire Partnership University NHS Foundation Trust
Authors: Robinson Lianne , Fapohunda Mosunmola , Giwa-Osagie Abiemwense , Ogunleye Bolanle , Okhiria Oritseweyinmi , Aina Olalekan 
Published: July 2023

AimsThere are increasing amounts of documented evidence that Black and Ethnic Minority (BME) NHS staff are more likely to face exclusion and discrimination. The MWRES- Medical Workforce Race Equality Standards Report details the disadvantages faced by BME doctors in the NHS. This piece of work shows a strategy to support doctors of African and Caribbean origin working in HPFT. Launched in 2021, the HPFT African and Caribbean Doctors Buddy Group (ACDBG) is a group for all doctors of any grade working in HPFT from African and Caribbean backgrounds. The group aims to bring together doctors of these backgrounds to build a group of clinicians who advocate for equity for African and Caribbean patients and medical professionals. Another key focus of the group is to support and motivate each other, focusing on individual health and well-being and sharing mutually beneficial experiences.MethodsDoctors of the groups' ethnic backgrounds across all grades identified 34 (20.1%) African-Caribbean doctors out of the 169 BAME doctors in Hertfordshire Partnership University NHS Foundation Trust (HPFT). Of this, there are 30 doctors of African and 4 of Caribbean backgrounds, with 14 in Consultant, 7 in Staff Grade, Associate Specialist and Specialty (SAS) and 13 in Training posts.The identified doctors received an invitation to attend the group meeting. Attendance was optional; membership was free with no long-term commitment. The group has an active social media presence to communicate and attract interested colleagues.ResultsThe group has met at least three times a year to provide opportunities for meaningful engagement and networking. These have included formal meetings as well as informal dinner events. Feedback from attendees has been very positive, with members mainly commenting on having found support from fellow members in navigating new experiences or learning from how others have sorted culturally unique challenges encountered in their working lives. Our international doctors have expressed joy in finding a resource to obtain guidance in settling into work and support with career development.ConclusionFeedback received from members of the group indicate that the doctors have found the group extremely useful. It gives an opportunity for expressive communication to promptly address concerns of any form or nature, on a personal or collective level, thereby improving positive well-being and career progression. Their positive experiences in pastoral care improved inclusion, productivity, retention and ultimately quality of care provided to service users.
Co-Production of a Digital Symptom Self-Management Resource for Patients With Functional Neurological Disorder
Authors: Sudra Miten , Lee In Woo , Mohanarajah Giruchaandan , Suthanthirakumaran Methushaa , Williams Verity , Dunlop Alan , Alschamaa Ranya , Collison Wendy , Faruqui Rafey 
Published: July 2023

AimsPatients with Functional Neurological Disorder (FND) experience neurological symptoms which may impair motor control, sensory function, or awareness. Long waiting lists before treatment mean the risk of relapse during this period is high. A lack of knowledge around FND also results in a lower quality of life. Therefore, it is important patients with FND receive appropriate psychoeducation to empower them to understand and manage their symptoms. We aimed to strengthen our symptom self-management booklet for patients in a community neuropsychiatry setting, using a co-production model and taking forward improvements into a digital audiovisual format.MethodsWe used co-production as part of a quality improvement project (QIP) at East Kent Neuropsychiatry Service to identify improvements to our existing symptom self-management booklet and apply these in the production of a digital resource. Initially, the symptom self-management booklet was distributed to 10 patients, awaiting further assessment and treatment, chosen by the multidisciplinary team following triage appointments. Two weeks later, 7 patients reviewed the booklet with 4 medical students by phone and qualitative and quantitative feedback was obtained from patients and carers. Quantitative feedback was collected using an adapted 20-point Ensuring Quality Information for Patients (EQIP) tool. Informed by this feedback, scripts were developed for the audiovisual resource. The scripts were further reviewed by a medical student, 2 multidisciplinary team members and 3 Trust Communications Department members.ResultsThe first QIP cycle highlighted the importance of the symptom self-management booklet. Most patients had used the booklet. Patients found it a helpful source of information. Two patients noticed a considerable improvement in their quality of life, others did not due to the short length of booklet use. . EQIP tool demonstrated an improved score of 80.51% compared to previous round of feedback (53.33%). Carers identified the booklet as reassuring. Additional links to external information was identified as an area for development.Patient feedback informed the development of scripts for the audiovisual resource. Consultation with the Trust Communications Department identified three themes of improvement: accessibility to patients, increased clarity and concise language, and an appropriate visual format, therefore scripts were further refined.ConclusionOur QIP shows the value of a psychoeducation and symptom self-management tool for FND patients which was positively received by patients and carers. Collaborating with patients in the digitalisation of this information allows for a more accessible resource which effectively addresses patient concerns and empowers symptom self-management.
Prevalence and Outcomes of First-Episode Psychosis With Substance Misuse Within an Outpatient Setting
Authors: Wee Ryan , Ozer Mikail , Anwar Lubna 
Published: July 2023

AimsMisuse of certain drugs is a common precipitant of first-episode psychosis (FEP). Substance misuse is known to exacerbate psychotic symptoms, and it is unclear if substance misuse at the time of initial presentation impacts outcomes of care in FEP. Here, in this quality improvement project (QIP), we aimed to quantify the prevalence of drug misuse within an outpatient early intervention service (EIS) and determine the outcomes (in terms of time-to-discharge and discharge destination) of service users based on their substance misuse history.MethodsIn this QIP, we randomly sampled 100 patients referred to and discharged from an outpatient service for psychosis (Barnet EIS). We excluded patients who were referred to the service but were discharged due to referral rejection, non-attendance at psychiatry review and/or other reasons. Data regarding demographic and clinical information, the nature of substance misuse, and discharge destinations were obtained through a review of electronic health records, including GP letters and hospital notes. The time-to-discharge was defined as the time between referral acceptance and discharge from EIS. As this work is part of a QIP, written consent was not obtained to conduct this project.ResultsOf 100 patients obtained from the discharged caseload, 38 patients were accepted and reviewed in Barnet EIS. 24 patients (63.2%) had no substance misuse history at the time of initial FEP, while 14 patients (36.8%) had some substance misuse history. Of the 14 patients with substance misuse, cannabis was most frequently used. The average age of patients was 27.2 ± 1.4 years old. The age of onset of psychosis was similar between patients with and without substance misuse (two-sample t-test, p = 0.74).In terms of discharge destination, patients with and without substance misuse were discharged back to their GPs at similar proportions (chi-square test, p = 0.81). Finally, the number of days patients spent under the care of Barnet EIS was similar between patients with and without substance misuse (two-sample t-test, p = 0.54).ConclusionIn this QIP, over 30% of patients presenting with FEP reported substance misuse. The most common recreational drug used was cannabis. Discharge destinations and the time spent in EIS were broadly similar between patients with and without substance misuse. The relatively high rates of substance misuse in FEP found in this study have important implications for commissioning additional services – such as urine drug testing or drug liaison services – within EIS teams.
An Audit of Information Provided to Paramedics / A&E Staff on Transfer to the Colchester General Hospital
Authors: Zinchenko Oksana , Shoka Ahmed , Hamza Yaser , Mujtaba Aamir , Mtika Vincent , Riding Stephanie 
Published: July 2023

AimsFollowing feedback from paramedics and staff, escorting patients to the A&E, concerns were raised when some information was missed during the verbal handover from patient/escorting staff to the ambulance/A&E staff. At times the purpose of the transfer was not clear. Essex Partnership University NHS Foundation Trust (EPUT) “Discharge and Transfer Clinical Guidelines” ( CG24) provides clear guidelines to staff when a person is transferred while in the care of the Trust to another service such as another acute trust or, discharged from EPUT services completely. However, there are no current guidelines available for transferring patients for clinical reasons: in case of emergency or acute medical condition, for specialist treatment or investigation. The standard was used: the “Ambulance handover to emergency care standard V1.0” created by Professional Record Standards Body (PRSB). 100% of patients should have a support letter from doctors with relevant information shared with paramedics or the A&E department on transfer to a general hospital. The scope of the audit was Peter Bruff Mental Health Assessment Unit and Ardleigh Acute Inpatient Ward.MethodsThe data were collected retrospectively from notes available on the electronic health record database (Paris). The audit tool focused on quantitative and qualitative data collection on patient transfer.Inclusion criteria: all patients admitted to the Peter Bruff MH Assessment Unit (male and female) and the Ardleigh Ward (female) over the period from 1 September to 15 September 2022. All data were anonymised. Results were tabulated and presented in statistical form back to the clinical teams.ResultsThere were identified 18 male and 33 female patients on the Peter Bruff MH Assessment Unit. 2 patients were sent to the A&E via ambulance and 4 patients attended the A&E with staff escort. A support letter was available on one occasion. Compliance 17%.Within the analysed period there were 15 female patients identified on the Ardleigh ward. 5 patients attended the A&E. A support letter was available on two occasions. Compliance 40%.ConclusionAll transfers should be managed in a sensitive way ensuring all communication is clear, to promote robust information sharing between inpatient wards and A&E.A template of the care summary and handover letter was created, which provided a standard structure of headings that is meaningful to clinicians and patients.
Complex Conflicts for the Asylum Seeker – External, Internal and Therapeutic
Authors: Dinneen Brid , Ahrens Jennifer 
Published: July 2023

AimsIn 2020, 82 million people worldwide were forcibly displaced. In the same year, the UK received asylum applications for over 37,500 people. 76% of initial decisions made in the year to June 2022 have been grants of protection, meaning they have been awarded refugee status or humanitarian protection. However, many people wait years for a final decision on their claim. COVID-19 has exacerbated this issue and extended the backlog further. Most refugees are survivors – of transit, war, torture, trauma, loss. Recognition of the mental health needs of these survivors in countries of settlement is growing and with it an acknowledgment of the complexities faced. Despite finding relative security in their country of asylum, settlers are often faced with new psychosocial stressors as they simultaneously contend with the impact of their trauma in a foreign settings with cultural and language differences. Providing access to good quality mental health care, one that caters to these complexities, is essential.MethodsWe report the case of a 25-year-old, single, Tigrinya speaking, male Eritrean asylum seeker. In August 2022 he arrived into the UK in the back of a lorry having left Eritrea on foot three years previously having fled conscription. Whilst migrating, he was tortured, witnessed killings, was human trafficked and enslaved. Shortly after arrival in the UK he developed a psychotic illness and was admitted to an acute psychiatric ward. Treatment resistant schizophrenia emerged, clozapine was commenced and his condition improved.ResultsThe journey to clozapine was not smooth. His clinical presentation was complex, in the beginning we struggled to establish the source of his distress unsure of what was psychosis and what were symptoms of post-traumatic stress. We struggled to distinguish medication side effects from somatising. We struggled communicating, building trust, breaking down language and cultural barriers.In order to treat the illness we had to understand it and our patient. We adopted a multidisciplinary approach to deliver, in the first instance, principals of psychological first aid: addressing the refugee agenda as part of meeting his basic needs. With time and thanks to a wonderful interpreter we were able to build trust, strong and safe lines of communication. Slowly we became better interpreters ourselves, more able to decipher his distress. The interpreter helped us to be more culturally competent, thus, building our connection stronger. As the young man's acute condition settled, he began to trust us and his psychosis abated.ConclusionOur case highlights the importance of holistic care when managing displaced individuals in psychiatric settings. Interpreters are invaluable to trauma informed practice, beyond facilitating verbal communication they can help us to understand the culture of the people we are supporting, helping us to provide connection beyond the words. Trust in the context of psychosis and trauma in a displaced individual is hard earned but should be prioritised.
Atypical Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report
Authors: Grant Heidi 
Published: July 2023

AimsNeuroleptic malignant syndrome (NMS) is a rare condition experienced by patients taking typical and/or atypical antipsychotic medications. There are well-established diagnostic criteria for NMS. However, differentiating it from serotonin syndrome and malignant hyperthermia—particularly in the intensive care setting--is problematic and thus remains a diagnosis of exclusion. A case report of a patient with atypical NMS in intensive care is described and the subsequent learning points gleaned from the patient are presented.MethodsA 28 year-old female was admitted to the intensive care unit (ITU) following a self-inflicted traumatic injury. The patient was known to local mental health services and her medical history includes personality disorder, anxiety and depression. Regular psychiatric medications prior to hospitalization included flupentixol and quetiapine. Remifentanil was administered in a continuous infusion for sedation as the patient was intubated and ventilated. Valproic acid and levetiracetam were given for seizures.Repeated spikes in temperature, rigidity and slightly elevated creatine kinase (CPK) were observed in the patient. Autonomic dysfunction was also noted; the patient experienced bradycardic episodes that increased in frequency and duration. On two occasions, this resulted in asystole and cardiopulmonary resuscitation (CPR) had to be commenced with return of spontaneous circulation following CPR. Mental status changes were unable to be assessed due to ongoing sedation of the patient. On the advice of the clinical pharmacist, remifentanil was switched to fentanyl. Quetiapine and flupentixol were also discontinued after consulting with the psychiatric team. In addition, the patient responded quickly to dantrolene administration and to active cooling.ResultsMain diagnostic criteria for NMS include hyperthermia, rigidity, mental status changes and autonomic dysfunction. The definition of atypical NMS includes three of these four criteria. Serotonin syndrome was ruled out as the patient was not taking any selective serotonin reuptake inhibitors (SSRI) nor selective serotonin-norepinephrine reuptake inhibitors (SNRI). Malignant hyperthermia was also considered as the patient had received a volatile anaesthetic gas, isoflurane, for sedation purposes; however, symptoms persisted long after it was stopped.ConclusionAtypical NMS is a diagnosis of exclusion that must be considered in patients in an intensive care setting who experience refractory hyperthermia. A multidisciplinary team is essential in caring for critical care patients who exhibit symptoms of NMS, including psychiatry, neurology, and clinical pharmacy.
“It's All in the Head” Well! Not Always: Mental Health Patients Are Not Immune to Physical Pain
Authors: Javed Asma , Sharma Rajasee 
Published: July 2023

AimsEmotionally unstable personality disorder (EUPD) patients are known to frequently present to acute hospitals with pain symptoms. Multiple pain syndromes like fibromyalgia, chronic fatigue syndrome etc. are also commonly diagnosed in this group of population. It can be difficult to differentiate psychosomatic pain from physical pain during these hospital presentations. Failure to exclude physical causes of pain can lead to inadequate pain relief and missed serious diagnosis.MethodsWe describe a 29-year-old lady known to have Type 1 Diabetes, chronic pancreatitis and past history of several overdoses. She was being supported by Home Treatment Team (HTT) before coming to the hospital. She presented to the Emergency Department (ED) after ingesting 40 tablets of Pregabalin. She was referred to mental health liaison service for ongoing suicidal thoughts. On assessment, she admitted taking multiple overdoses to relieve her of severe abdominal pain. Her pain symptoms had been attributed as attention seeking behaviour. She disclosed feelings of rejection and abandonment by hospital staff. Liaison team negotiated with emergency department staff to complete a physical health examination that revealed tenderness and guarding in the abdomen. She was booked for elective cholecystectomy after surgical review. However, she had to be admitted from ED for laparoscopic cholecystectomy because of worsening of pain and vomiting. She was referred to Pain Management Team after surgery. The team was cautious in providing her with pain medications considering past history of overdoses. She was unable to tolerate pain and voiced thoughts of overdose. We liaised with Pain Management Team to optimise her analgesics and arranged daily supervision of pain medications with HTTResultsOur patient's physical symptoms of acute cholecystitis and frequent overdoses with pain medications were attributed to her personality disorder that resulted in dismissal of her real pain that “Its is all in the head”. This led to persistent pain affecting her mental health.ConclusionPatients diagnosed with EUPD should be carefully assessed to exclude organic causes of pain before attributing their symptoms to mental health disorders. A thorough assessment and treatment of physical symptoms can improve their mental health as well as reduce attendance in health facilities.