bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seclusion Reviews: Audit of Medical Documentation in a Psychiatric Intensive Care Unit
Authors: Middleton Laura 
Published: July 2023

AimsSeclusion is a restrictive intervention used when a patient presents with risks that cannot be safely managed in their current environment. The Mental Health Act 1983 Code of Practice (MHA CoP) provides clear recommendations for both frequency and content of medical seclusion reviews, with compliance previously audited within Cheshire and Wirral Partnership NHS Foundation Trust (CWP). Following the initial findings however, change was not implemented. A new audit has therefore been commenced to reassess baseline practice and identify areas requiring improvement.MethodsThe MHA CoP audit tool outlines the following timeframes for assessment: initial medical review within 1 hour, 4-hourly medical reviews until first internal multidisciplinary review, twice daily medical seclusion reviews with at least 1 by the Responsible Clinician. Documentation should evaluate: physical and mental health, medication adverse effects, observation level, prescribed medication, risk to others and self, need for ongoing seclusion. Data were collected retrospectively for all episodes of seclusion occurring in a CWP Psychiatric Intensive Care Unit during August 2022.Results5 seclusion episodes related to 4 patients, ranging from 1 night to 15 days in duration. Regarding medical review frequency, 20% were seen face-to-face within 1 hour of seclusion commencing and 75% were seen 4-hourly until their internal multidisciplinary review. Mental health was more consistently commented on than physical health (97% vs 61% respectively), whilst medication was reviewed in 69% of assessments. Rationale for continuing seclusion was provided in 72%, referring to risk to others in 54%. Adverse medication effects and observation level were the least documented parameters (2%), followed by risk to self (7%).ConclusionAssessment time was often not explicitly stated and was substituted with time of documentation, meaning reviews may have occurred earlier than accounted for. The on-call doctor does cover multiple sites overnight, potentially contributing to delays in attending unforeseen time-sensitive tasks. Trust policy dictates constant visual observation must be maintained throughout seclusion and this is therefore not routinely subject to review or adjustment. Overall interpretation of the qualitative information was fairly subjective in a low number of seclusion episodes, however there was a notable lack of recording adverse medication effects and risk to self. Findings will be presented at junior doctor induction whilst a quick reference sheet is designed prior to reaudit. CWP's seclusion policy specifies medical review frequency, but does not outline expected content of documentation. There is scope to extend local policy and align with the MHA CoP.
An Audit Exploring Ethnic Inequalities in Accessing Perinatal Mental Health Services in Southwark
Authors: Morgan Wendy , Butler Joanne 
Published: July 2023

AimsWomen from Black and minority ethnic backgrounds have been shown to experience an increased burden of common postnatal mental health conditions and higher rates of involuntary admissions. However, evidence demonstrates disparities in these women accessing perinatal mental health support. Reasons behind barriers to access must be defined and addressed. Our aim was to explore ethnic inequalities in accessing Perinatal Mental Health Services in Southwark (SWK PMHS). We hypothesised that SWK PMHS would meet Royal college of Psychiatrists (RCPsych) gold standards in providing equitable access to care.MethodsThe Trust's local clinical database was used to extract our cohort of women aged 15–44 years with a birth episode in contact with SWK PMHS between September and December 2021. Individual data were collected via local clinical notes system to establish basic measures (demographics and ethnicity) and detailed information (referral outcome, interventions, safeguarding etc). Ethnicity data were compared to King's College Hospital birth records for 2021 and local census data via Office of National Statistics.Results105 patients were analysed in total. Overall, there was poor recording of ethnicity and 6.6% of referrals had no ethnicity documented at all. At the point of referral, there was no clear inequity based on ethnicity, with data appearing reflective of local census and maternity records. However, there were concerning inequities in treatment received by women in minority ethnic groups. Out of four hospital admissions in total, three (75%) of the women were from a Black ethnic group and all were detained. There were fewer referrals for psychology intervention for women in minority ethnic groups compared to women in the White ethnic group, with particularly low numbers of referrals for women in Asian and Mixed ethnic groups (2/35 women). 83% of all antipsychotics prescribed (5 out of 6) were to women from the Black ethnic group with the remainder being women in the White ethnic group. There were 31 safeguarding alerts, with almost half (48%) from women in the Black ethnic group.ConclusionThere were concerning variations in interventions and type of care received by women from minority ethnic groups. Women from Black and minority ethnic groups were underrepresented in accessing psychology intervention though conversely overrepresented for antipsychotic treatment, safeguarding alerts and involuntary admissions.This suggests that contrary to our hypothesis, SWK PMHS is not meeting RCPsych Gold Standards. Our audit findings reflect literature that there are apparent barriers to women from ethnic minority groups accessing certain specialist mental health services.
Review of Activity Within Unscheduled Care at Royal Cornhill Post-Pandemic
Authors: Mweemba Mutswairo , Lim Ying Tian 
Published: July 2023

AimsWe sought to review the changes in assessments within the Unscheduled Care Team (UCT) at Royal Cornhill in Aberdeen since the pandemic. Previous UCT data highlighted an increase in monthly assessments from October 2018 to October 2020 by 18% 240(204). We hoped to identify areas for intervention and reform within the UCT and the wider service.MethodsAn excel spreadsheet was distributed to clinicians on-call from 1st–31st October 2021 and 1st-31st October 2022. Data analysed included time of referral, the role of the clinician, source of referral (Enhanced Access, Acute medical admissions/A&E, Other Hospital Wards, Community Mental Health Teams (CMHT), Police, GP, GMEDS (out-of-hours GPs), and Other Sources), method of assessment, time taken to complete assessments, time taken to discuss assessments and assessment outcomes. The spreadsheet also had space for clinicians to provide additional qualitative data. Following the 2021 data collection, a PowerPoint presentation was given to members of staff with the initial findings from 2021. The UCT added additional practitioners to the twilight period 1700-2100 due to the noted increased demand during this period. They also spoke to CMHTs about Enhanced Access and to the Police directly, as they were the two most frequent referrers. Following the 2022 data collection, the 2021 and 2022 datasets were compared.ResultsThe overall number of assessments increased by 10% from 2021 to 2022 - 405(367). Additionally, total assessment time increased by 15% - 299(261) hours. In terms of assessment outcomes, the largest changes were seen in outpatient follow-up with CMHTs, with a 65% increase 238(144); UCT discharge, with a 43% decrease 64(112) and non-specified outcomes, with a 52% decrease 14(24). The largest changes in referral rates were from GMEDs 48(30) 60% increase, CMHTs 4(16) 75% decrease, GP 50(34) 47% increase. Enhanced access 96(95) and police referrals 78(77) remained the most stable, increasing by 1%.ConclusionThere has been an evident increase in workload for the UCT since the pandemic, which could be managed with additional staffing for the team. The targeted interventions, both for Enhanced access and Police, have limited the increase of their referral rate. Similar targeted interventions and review of referral criteria may mitigate increased demand from other sources. Increasing outpatient CMHT follow-up after assessment may suggest that routine outpatient work may not be back to pre-pandemic levels; further study would be required to confirm this.
Inpatient Ward Review Documentation Audit
Authors: Nurlu Derya , Raoof Abdul 
Published: July 2023

AimsGood medical records are essential to the continuity of patient care. The aims of this audit were to evaluate the quality of ward review documentation in 7 Psychiatry wards in Essex Partnership University NHS Foundation Trust, to identify areas of improvement, to recommend strategies to improve record keeping, and to measure their effectiveness by comparing records in the 1st and 2nd cycles of audit.MethodsA sample of 10 patients from each of the 7 wards was selected, for a total of 70 patients, in each of the 1st and 2nd cycles of the audit (Data were collected in the 1st cycle between 06-07-2021 and 22-07-2021, and 2nd cycle between 16-10-2022 and 07-11-2022). Samples were selected randomly among patients who were inpatient or discharged recently. The data were collected from the first, middle, and last ward reviews. If the patient was inpatient at the time of the data collection, data were collected from their first review, the last/most recent ward review, and one of the reviews in between. Patients who did not meet this criterion were excluded. Based on 1st cycle results, strategies were recommended to improve record keeping. After 15 months, 2nd cycle results were used to evaluate their effectiveness.ResultsThe results demonstrate significant areas of improvements in record keeping: a majority of questions did not meet the standard of 80% completion considered “satisfactory” in previous audits. In the 2nd cycle, 9 questions had a “satisfactory” completion rates. These were mandatory or automated questions and ones essential to immediate patient care. 7 questions had “average” completion rates above 45%. All (17) other questions and subquestions had “low” completion rates. Analysis of variations between cycles shows that question on “Responsible clinician” increased from 23.3% to 99.5% because it was automated. 4 other questions or sub-questions have seen a substantial increase in completion rate between the 1st and 2nd cycle. But our strategies’ effectiveness during the period of the audit has proven limited and difficult to trace.ConclusionIt can be concluded that more efforts should be dedicated to improving medical record in the psychiatry wards of Essex Partnership University NHS Foundation Trust. The most effective strategy to secure high ward review docummentation rates remains to make questions mandatory or auto-complete when possible. More research is necessary to demonstrate the effectiveness of other strategies such as the education of junior doctors in induction and awareness posters in wards.
Clinical Audit Reviewing Compliance With Respective Trust-Based Physical Health Monitoring Guidelines, Amongst Inpatients Prescribed Anti-Psychotic Medication in Two Distinct Secure Care Facilities: A Low Secure Unit and a Prison Personality Disorder Unit
Authors: Selvaraj Ashvini , Adebowale Falade 
Published: July 2023

Aims1.To review the current level of compliance with CPFT (Cambridge & Peterborough Foundation Trust) guidelines by inpatients prescribed anti-psychotics at George Mackenzie House (GMH) low-secure unit and likewise, with NHFT (Northamptonshire Foundation Trust) guidelines by inmates prescribed anti-psychotics at HMP Whitemoor's Fens Unit.2.To identify any differences or similarities in compliance rates between both sites.3.To identify any possible areas of difficulty in ensuring full compliance with said guidelines and suggest possible solutions.MethodsA retrospective design was used, in which the electronic and hardcopy patient records of service users at both sites, covering a specified time-frame (2nd Dec 2021- 2nd Dec 2022) were screened. Data collected from eligible users included demographic information, names of anti-psychotics used and results of each individual's screening profile measured against the respective Trust's guidelines.ResultsThe demographic profiles of eligible service users at both sites were largely similar.17 out of 18 services users from GMH and 23 out of 50 service users from the Fens Unit were found eligible for the audit.The majority of eligible service users at both sites (88-100%) were compliant with measurement of relevant laboratory markers, as per Trust guidelines.However, at both sites, there were notable omissions in monitoring of certain physical parameters, especially waist circumference (100% omission in both sites) and ECG monitoring ( 60% omission in prison,14% in GMH), which is important given the significant comorbidity of cardiovascular risk factors amongst service users at both sites.ConclusionWe noted disproportionate compliance in the monitoring of different physical health parameters. While laboratory tests were on the whole, satisfactorily monitored, there were gaps in other clinical measurements like waist circumference and ECG recordings. We postulate several reasons for this discrepancy, including:
•A possible lack of awareness about the importance of measuring parameters like waist circumference, which also indicates a lack of familiarity with Trust guidelines.•A lack of time/inconvenience in ensuring adequate recording of clinical parameters•Inadequate reminders to conduct relevant physical health checks.We suggest possible solutions to ensure 100% compliance: for example, creating a teaching session for staff and service users on pertinent topics, like metabolic syndrome or creating electronic aids to remind staff when physical measurements are due.This audit also engendered further questions on appropriateness of anti-psychotic prescription and importance of educating service users about physical complications of anti-psychotic use. These could be the focus of future audits.
Physical Health Monitoring in Patients Established on Clozapine
Authors: Yousefpour Camelia , Alex Rajesh 
Published: July 2023

AimsWe set out to compare the physical health monitoring of patients established on Clozapine within our local mental health team (LMHT) to national and trust guidance. We also compared data collected in this audit with results from a similar audit conducted in 2018 to identify if improvements had been made to services. We then sought to present the findings to our LMHT to shape the formation of a newly set up pharmacy technician led Clozapine clinic.MethodsNational Institute for Health and Clinical Excellence (NICE) and Nottinghamshire Healthcare Trust (NHT) guidelines were reviewed to set criteria for the audit. Where NICE and NHT guidance stipulated similar recommendations, NICE guidance was used to set criteria. Criteria was found to be met if it had been collected within the last 12 months. Data were collected by a single clinician over the period of one month on review of electronic medical records.Results30 patients were identified as established on Clozapine within our LMHT. 27 (90%) patients had a licensed diagnosis for Clozapine prescription. Smoking status was recorded in 26 (83.3%) patients and caffeine intake in 21 (70%) patients. Full blood count, liver function tests, urea and electrolytes all met the criteria at the 100% target however one patient was found to have Hba1c and lipid measurement outstanding. Weight was documented for 29 patients (96.7%) however waist circumference was documented in five (16.6%). This was the lowest scoring criteria. Pulse and blood pressure was recorded in 27 (90%) patients. Electrocardiograms were less consistently recorded as completed, with 22 (73.3%) recorded. Physical health monitoring was recorded for 27 (90%) patients, whilst 10 (33.3%) had a GASS-clozapine form completed. Percentages for all criteria that were measured in 2018 were found to be higher in the 2022 cycle.ConclusionFindings show that physical health monitoring for the patients prescribed Clozapine in our LMHT does not consistently meet guidance. Development of a ‘Clozapine clinic’ was already planned. Results from this audit were shared within the LMHT and recommendations were made as follows; i) a measuring tape to be placed in each room ii) data such as weight, blood pressure and heart rate to be entered in a way that it can be plotted over time iii)pharmacy technician to work with a healthcare assistant to ensure all criteria can be met in the designated yearly Clozapine clinic
The Effects of Rivastigmine on Neuropsychiatric Symptoms in the Early Stages of Parkinson's Disease: A Systematic Review
Authors: Reilly Siobhan , Dhaliwal Simran , Arshad Usman , Husain Nusrat , Macerollo Antonella , Da Costa Antonio 
Published: July 2023

AimsNeuropsychiatric symptoms including depression, apathy and psychosis are experienced by the majority of patients with Parkinson's disease. A subgroup of patients develop cognitive impairment, which may increase the risk of falls due to reduced attention. Acetylcholine deficit is thought to contribute to neuropsychiatric symptoms in Parkinson's disease. The acetylcholinesterase inhibitor rivastigmine is beneficial in Parkinson's disease dementia (PDD), but the consensus for the use of rivastigmine earlier in the disease course is unclear. This systematic review aims to assess the evidence for rivastigmine in the treatment of neuropsychiatric symptoms in Parkinson's disease without dementia.MethodsEMBASE, MEDLINE, PsychINFO, Cochrane CENTRAL, NGLC, NICE Evidence and medRxiv.org were searched for studies with terms relating to Population (Parkinson's disease) and intervention (rivastigmine).1922 references were identified, of which 358 were duplications.Inclusion criteria were: diagnosis of Parkinson's disease, rivastigmine intervention and the presence of neuropsychiatric symptoms or falls. Articles were excluded if they only related to patients with dementia.Following title and abstract review, 1331 articles were excluded.After full text review, 9 articles remained, which underwent a risk of bias analysis.ResultsOutcomes were heterogenous, so were not suitable for meta-analysis. Therefore, the results are presented in narrative form. The articles included 6 Randomised Controlled Trials (RCTs), 2 open-label trials and 1 case-series.Three of the studies focused on psychosis. Two of these studies indicated a benefit of rivastigmine on psychotic symptoms in Parkinson's disease. However, these studies were an open label trial and a case series, and the results were not reproduced during RCT.One RCT indicated benefit of rivastigmine in rapid eye movement behaviour disorder (RBD).One RCT showed improvements in apathy after treatment with rivastigmine.Two RCTs demonstrated a reduction in falls with rivastigmine treatment compared to placebo.One RCT showed a significant improvement on a performance-based measure of cognitive ability.One study identified brain areas that were hypoactive in hallucinating Parkinson's patients, and the reduced activity could be restored with rivastigmine. This restoration of activity was associated with improved attention compared to baseline.ConclusionThere is evidence that rivastigmine is beneficial for RBD and apathy in Parkinson's disease, independently from the presence of dementia. There is high level evidence that rivastigmine reduces falls, which may be due to improved attention. The impact of rivastigmine on psychotic symptoms is less clear, but is supported by current theoretical models which involve acetylcholine dysfunction in the generation of visual hallucinations in Parkinson's disease.
Multimorbidity and Polypharmacy in Psychosis: Identifying Potentially Significant Drug Interactions in an Old Age Inpatient Psychiatry Setting
Authors: Tewari Abhinav , Pathak Ashish 
Published: July 2023

AimsTo determine potentially significant drug interactions in an old age setting among inpatients with psychosis and medical comorbidities over the past 12 monthsMethodsStudy setting: old age inpatient functional wardSample size: 11Inclusion criteria:
•Inpatients on psychotropic medications with diagnosis ranging from F20 to F29 (ICD-10)•Comorbid chronic medical condition(s) requiring long term drug treatmentExclusion criteria:
•Patients with other/co-existing mental health diagnosis excluded•Antibiotics , OTC medications, herbal treatments, emergency treatments and other medications requiring short-term administration excluded from analysisStudy tools:
•Lexicomp® interaction checker
◦Category X: Avoid combination◦Category D: Consider therapy modification◦Further categories (In order of decreasing risk ratings: C, B, A) excluded from the analysisResultsOut of the total 67 inpatients admitted between January 2022 and December 2022, 17 patients had diagnosis ranging between F20 and F29. 4 patients were excluded due to no medical comorbidities and 2 were excluded due to lack of data. Among the 11 patients included in the analysis, the most common medical comorbidities were, in decreasing order, hypertension, hypercholesterolemia and chronic pain. A total of 114 interactions were noted between psychotropic medications and other physical health medications, as follows:No significant interactions: (category A, B, C): 103Category D (consider therapy modification): 10
•7 of these interactions were associated with administering Buprenorphine with other medications (Flupentixol, Gabapentin, Nortriptyline, Olanzapine, Amisulpride, Aripiprazole and Pregabalin) leading to additive CNS depressant effects.•Interaction of codeine with Valproate and Flupentixol carried risk of CNS depression.•Carbamazepine interacted with Risperidone via CYP enzyme induction.Category X (avoid combination): 1
•The interaction between Flupentixol and Glycopyrronium was associated with risk of severe anticholinergic effectsConclusionThis study is a preliminary investigation towards understanding the drug interactions in a population with long term mental health and physical health ailments. Awareness regarding the potential interactions can help avoid combinations with possible detrimental effects. The limitations of this study, in terms of sample size and quality of available data, can be overcome by conducting a planned study on a larger population.Financial Sponsorship: noneConflict of interests: none