bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perception of Trainees and Trainers Working in Birmingham and Solihull Mental Health NHS Foundation Trust About Exception Reporting and Its Implication on Medical Education - a Qualitative and Quantitative Research
Authors: Jehanzeb Saima , Javed Asma , Williams Katie , Tadros George , Muzaffar Sajid 
Published: July 2023

AimsThe aim of this research was to explore if exception reporting (ER) has improved the work life balance of junior doctors, and if safeguards proposed during junior doctors’ contract have helped doctors in raising concerns about unsafe work patterns or any missed training opportunities.MethodsThis study was reviewed and approved by the Health Research Authority (HRA). We reviewed the number and nature of exception reports completed by trainees between January 2017 and February 2020 by analysing the available ER data (obtained from Guardian of Safe Working) and explored perception of trainees and trainers about exception reporting (ER) by using semi structured and structured surveys. The target population included Core Psychiatry Trainees, GPVTS, Speciality Trainees, Foundation year Trainees and Consultant Psychiatrists.ResultsAbout 383 exceptions were reported between February 2017 and February 2020 by trainees in BSMHFT. Two separate surveys emailed to trainees and trainers (between December 2020 and July 2021) collected 35 responses from trainees and 22 from trainers.80% of the trainees had not reported any exceptions in the last one year and 57.14% of the trainers never got involved in exception reporting. Main issues reported were working unsafe hours by trainees (15%), working beyond rostered hours (52.38%) trainers and (52.38%) trainees, failing to achieve educational goals (4.76%) trainers and (10%) trainees, impact on clinical supervision (4.76%) trainers. Reasons for failing ER “Too busy (58.06%), reporting makes no difference (29.03%), a culture to discourage exceptions (29.03%), didn't have logins (16.13%), did not know how to report (35.48%), other reasons. Time off in lieu (TOIL) was commonly reported outcome by trainees (69%) and trainers (62%). 62.07% trainees and 57.14% of trainers neither agreed nor disagreed that ER had improved the quality of training.Trainees (43.67%) and trainers (58.82%) both did not think that TOIL had resulted in reduction in training time (never 44%). 51.74 % trainees neither agreed nor disagreed that ER made any improvement to their work life balance.ConclusionThis is the first, mixed method, research looking at both exception reporting data and perception of trainees and trainers. Emerging themes for failure to exception report are guilt, self-blame, culture to discourage, too time consuming, busy workplace, not to offend, reflects being weak.This research can have wider implications if applied across other trusts nationally, exploring emerging themes. Reasons for declining number of ER needs further exploring of trainees’ anxiety, regarding implications and repercussions of ER, impact of TOIL on continuity of care.
The Role of Depression and Anxiety in Explaining the Association Between Cognitive Function and Disability in the General Population
Authors: Lynham Amy , Kendall Kimberley , Walters James , Jones Ian 
Published: July 2023

AimsIn the United Kingdom, 14.6 million people reported having a disability in the year 2020–2021. Cognition may be one factor that contributes to disability, as previous studies have shown that cognitive abilities predict later health outcomes and prevalence of disability increases with decreasing cognitive function. Furthermore, studies have demonstrated a link between cognition and common psychiatric disorders, such as depression and anxiety. To our knowledge, no studies have examined the role of current mental health in the association between cognition and disability in a general population sample. The aim of this study was to examine the relationship between cognition, mental health and measures of disability/daily functioning in an online population sample. Our hypotheses were: 1) that lower cognitive performance would be associated with increased reported disability, and 2) that this association would be partly explained by current depression and anxiety symptoms.MethodsThe sample consisted of 3679 participants recruited from HealthWise Wales. Participants completed the Cardiff ONline Cognitive Assessment, a web-based battery of five tasks assessing processing speed, working memory, vocabulary, reasoning, and emotion identification. Disability was assessed using the World Health Organisation Disability Assessment Schedule (WHODAS). Real world measures of functioning were also included (currently employed, living with a partner, children and ever married). Current depression and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Linear and logistic regressions were conducted to assess the associations between cognitive performance and measures of disability/functioning. Structural equation modelling was performed to assess whether these associations could be partially explained by HADS scores, as well as measures of education and health/lifestyle factors.ResultsHigher cognitive performance was associated with lower overall WHODAS scores (B=−0.1, SE = 0.01, P = 1 × 10–13), living with a partner (OR = 1.13, 95% CIs = 1.06–1.21, P = 4.3 × 10–4) and being in employment or education (OR = 1.22, 95% CIs = 1.13–1.33, P = 2.1 × 10-6). HADS scores partially explained the relationship between cognition and: 1) WHODAS (80%), 2) employment (63%) and 3) living with a partner (37%). In addition, smoking status explained 3% of the relationship between cognition and WHODAS.ConclusionCurrent symptoms of depression and anxiety partially explained the relationship between cognition and three measures of disability/functioning. Alleviating these symptoms may improve patients’ daily difficulties. Future research should establish the direction of causality of these associations.
Recruitment and Retention Survey – What Did Speciality Trainees (STs) Say?
Authors: Mahmood Sajid , Kunigiri Girish 
Published: July 2023

AimsRecruitment and retention of medical staff is a national issue. Leicestershire Partnership NHS Trust (LPT) has significant challenge like many other neighbouring Trusts in this regard. Low level of staff means challenges in provision of adequate and efficient patientcare. There is a lack of flexibility for clinicians to get time for Supported Programmed Activity (SPA). Burn out of existing clinicians and loosing good will is common which increases patients’ complaint and potential risk of near misses and serious incidents. Despite the East Midland being one of the popular deaneries among STs, retention of locally trained STs post CCT remained a challenge. Thus, the aim of this study was to find out proportion of speciality trainees (STs) doctors satisfied with current job and to explore their views on current difficulties and ways to retain and support them post CCT in career progression within the training Trust.MethodsIt was a cross-sectional survey. The target population was STs working in the East Midland deanery. An online questionnaire was developed for data collection. Data were gathered through open (free text) and close (options provided) questions. Information was collected regarding job satisfaction, positive and negative of job, difficulties and challenges in current role, willingness to continue post CCT within Trust and if they would recommend friends or colleagues to join LPT. Results are reported in percentages for descriptive statistics.ResultsAbout 59% of the STs were satisfied with their current training. Key positive of jobs include helpful colleagues, good trainers and supervision, autonomy, flexibility, good on-call rota pattern, work life balance, and protected time for teaching. Interest is shown for various SPA activities (teaching, audit, QI project, research, leadership and management). However, wide variety of challenges being also reported at individual, team and organisational level.Over 70% of the participants shown interest to work for LPT post CCT but requested for additional support in term of flexibility of job description and role whereas remaining 30% reported to move into private sector due to better pay and work life balance. Surprisingly only 23.5% clearly stated, they would recommend a friend or a colleague to join LPT.ConclusionMajority of STs doctors were satisfied and willing to continue working post CCT in LPT. However, reported challenges need prompt response and early discussion and planning with STs in term of what local Trust can offer and support would ensure their retention and enhance recruitment while they are being advocate for the LPT.
A Systematic Review of Clinical Practice Guidelines on the Use of Deep Brain Stimulation for Obsessive-Compulsive Disorder
Authors: Mazzoleni Adele , Bhatia Shreya , Bantounou Maria Anna , Kumar Niraj S. , Dzalto Monika , Soiza Roy L. 
Published: July 2023

AimsDeep brain stimulation (DBS), an invasive neurosurgical treatment where electrical stimuli are delivered in target brain areas, is an intervention that has traditionally been used for neurological movement disorders, but that has recently been considered for the management of psychiatric conditions, one of these being obsessive compulsive disorder (OCD). This review aimed to identify and assess clinical practice guidelines on the use of DBS for OCD, and, secondly, whether or not recommendations are tailored to individual patient characteristics, such as age, gender and comorbidities.MethodsA systematic search of MEDLINE, EMBASE, APA Psych Info and Scopus was conducted, along with guideline development organisation websites, using all relevant synonyms of: “Guideline and DBS and OCD”. Studies were assessed by two independent reviewers, and discrepancies managed by a third reviewer. The protocol was registered with PROSPERO, following the PRISMA checklist. Included guidelines were appraised using the AGREE-II instrument.ResultsNine guidelines were identified in total. Eight recommended DBS as a last-line option in the management of OCD, whilst the National Institute for Health and Care Excellence (NICE) recommended DBS should be used for research purposes only in OCD. Variability in the recommendations was also noted; indeed, only NICE undertook a cost-effectiveness analysis, and only the Congress of Neurological Surgeons (CNS) recommended target areas for electrode placement (i.e. subthalamic nucleus and nucleus accumbens). No guidelines clarified DBS settings, nor peri-operative optimisation measures. Patients’ preferences, age groups differences, ethnicity or comorbidities were not considered by any guideline. The guidelines’ quality ranged from moderate to high (50–92%), as per AGREE-II, with domains ‘scope and purpose’ and ‘editorial independence’ scoring the highest and ‘applicability’ and ‘stakeholder involvement’ the lowest across all guidelines.ConclusionWhilst eight guidelines supported the use of DBS for OCD as last-line therapy, a lack of cost-analysis, specific DBS settings, peri-operative procedures, and patients’ circumstances were analysed. Given the lack of randomised controlled trials in this field, more rigorous research is needed prior to wider DBS implementation.
Service Users Experience in the Use of Tele-Psychiatry in Child and Adolescent Mental Health Services in NHS Orkney
Authors: Alli Oluwabukunmi , Patil Chetana 
Published: July 2023

Aims/BackgroundNear Me is a tele-psychiatry platform for conducting video consultation appointment in Child and Adolescent Mental Health Services (CAMHS) in NHS Orkney (NHSO). This model of consultation was introduced in NHSO CAMHS during the COVID-19 pandemic. The performance in offering effective clinical intervention in the domains of quality of care will determined through the experiences of both users and providers of care in this respect.To assess the perception and experiences of service users (clinicians, patients and their families) on the use of Near Me in NHS Orkney Child and Adolescent Mental Health Services by applying the domains of quality of care as a measure. To enable all stakeholders (policy planners, users and providers) to identify gaps and barriers in the use of Near Me and to inform change in practice.MethodsA survey was developed using the Telehealth Usability Questionnaire which is a validated tool to generate responses on the key domains of quality of care measures of appropriateness, reliability, access, timeliness, usefulness, effectiveness, interaction, quality, efficiency, safety, satisfaction and possibility of future use for both users and providers of care.The survey was made available on social media platforms including websites and online adverts for clinicians, patients and their families in Orkney to complete for a period for 10 weeks.Results28 responses were received with 14 completed responses (6 staffs & 8 patients and families) and 14 uncompleted responses (4 staffs and 10 patients & families).A mean rank test was applied to appropriately evaluate the responses received.Over 50% of respondents show high level of satisfaction in the use of tele-psychiatry services in all domains of quality of care in Orkney NHS CAMHS.Access, timeliness and safety are highly positively rated by both clinicians and service users.Improvement in network connections, improved coordination and understanding of technology will enhance the service.Better understanding of the handling of technical problems in tele-psychiatry services should be addressedReduction of in-person interactions was identified by some respondents as concern.Conclusion/recommendationTele-psychiatry is highly useful and accepted as revealed by the survey but network connections for the Near me platform needs to be improved. Face to face consultations should not be discounted and should be available where possible for better engagement.As the first survey of the use of tele-psychiatry in NHS Orkney, this study will serve to establish a baseline for future evaluation of tele psychiatry services in NHS Orkney CAMHS.
Multiprofessional Caseload Review in the Community Mental Health Team: Improving Patient Safety and Supporting Safe Discharges to Primary Care
Authors: Anwar Zarina , McClure Olivia 
Published: July 2023

AimsTo create greater capacity within the general adult psychiatry outpatient clinic to facilitate urgent medical review for patients when needed, and to reduce delays for those receiving ongoing routine care within existing resources by improving joint working processes within the multidisciplinary team. To support safe discharges to primary care and promote ongoing recovery by improving access to community resources and the voluntary sector.MethodsCaseload review for all patients under the outpatient clinics within South Leicestershire community mental health team began in August 2022. A template was developed in consultation with clinical colleagues and approved by the Trust clinical governance process. This includes salient clinical variables such stability, risk and medication. A consultant psychiatrist and senior nurse spend 2-4 hours weekly reviewing each patient's electronic record chronologically from those waiting the longest for an appointment. Using the template, one of the following for the patient's next appointment is determined, based on patient need:
•Nurse discharge clinic•Outpatient discharge clinic•Outpatient clinic for ongoing treatment•Transfer to another service (eg ADHD)A pilot nurse discharge clinic was carried out offering face to face reviews for patients identified as clinically stable for discharge over 4 weeks, with regular senior nursing supervision and medical input as required.ResultsBetween August 2022 to January 2023, 700 out of a total of 1717 caseload reviews have been completed. 39% of these are identified as suitable to be reviewed for discharge.In the pilot nurse discharge clinic, 137 patients were offered appointments: 82 were discharged, 16 did not attend, and 39 subsequently needed an outpatient appointment. There have been no serious incidents, complaints or re-referrals.The waiting time for an urgent outpatient appointment has reduced from six weeks to one week and for routine outpatient care from six months to four weeks.No work related absence for staff, and qualitative feedback from the multidisciplinary team has been positive.ConclusionReduction in high outpatient caseloads is achievable through robust multiprofessional caseload review, and patients can be safely discharged from the care of consultant psychiatrists by multidisciplinary team working. This creates greater capacity, flexibility and flow for those who need ongoing outpatient care to receive this is a timely manner, improving the safety and quality of patient care. This has also fostered a greater sense of cohesion for staff within the team.
Monitoring of Physical Health in Patients Prescribed Antipsychotic Medication Within a Medium-Secure Forensic Inpatient Setting: Assessing Compliance With Guidelines and Improving Procedures
Authors: Baker Morven , Canham Robyn 
Published: July 2023

AimsAntipsychotic use is associated with haematological, metabolic and cardiovascular abnormalities. If not monitored and acted upon, these contribute to the increased burden of physical health problems in those with severe mental illness. Appropriate monitoring (including blood tests and ECGs) is required in accordance with NICE guidelines. The aim of our project was to assess our adherence (within a medium-secure forensic inpatient setting) to guidelines, and to improve procedures and processes within the unit. The majority of our patients are taking antipsychotic medication, but prior to our project there was no system in place to determine who was due which monitoring tests and when. Our suspicion was that patients’ physical health was not being adequately monitored especially given the unit's lack of input from general practitioners.MethodsOur initial audit of patient notes took place in October 2022, assessing whether each of our 35 patients had had appropriate ECG and blood monitoring. After gathering these initial data we then systematically offered patients their monitoring. We set up processes to ensure this would be completed in a timely and organised fashion in the future, via creating a spreadsheet available on the shared drive and a chart within the doctor's office, adding instructions to the departmental junior doctor handbook, and liaising with colleagues.ResultsOf 35 patients, 34 (97%) were prescribed antipsychotics, 18 (51%) of these at ‘high dose’. Of those 34, blood tests for 22 (65%) patients were out of date or not completed as per NICE guidelines. ECGs for 21 (62%) patients were either missing or out of date. Following our gathering of the initial data and systematic completion of patient monitoring, at the time of re-audit in January 2023 monitoring was either completed or offered (with patient refusal) for 34 (100%) of patients.ConclusionWe identified that monitoring of physical health in those prescribed antipsychotics within our unit was sub-par, with the majority of patients not up to date with bloods or ECGs as per NICE guidelines when initial data were collected in October 2022. Following our project, at the time of re-audit in January 2023 monitoring was either completed or offered to 100% of patients. We have implemented systems to ensure this continues in the future, beyond junior doctor changeovers. This has potential application to other longer-stay psychiatric wards such as general adult rehabilitation wards and other forensic units.
Improving Outcome Measurement and Experience in an Adolescent Inpatient Unit Through Patient-Reported Measures
Authors: Davies-Kabir Megan , Price Ceri 
Published: July 2023

AimsA Quality Improvement project was conducted in Ty Llidiard, a 15-bed adolescent unit in South Wales, over a three-month period to introduce and embed outcome measurement from the perspective of young people (YP) admitted to the unit. This was done to meet two standards set by Quality Network for Inpatient CAMHS: 1. “Outcome measurement tools are completed from the perspective of young people”, 2. “The ward team use quality improvement methods to work on service improvements.” Through use of these measures we hoped to give the YP a stronger voice in the multidisciplinary ward round (MDT-WR) and to improve their experience of attending it.MethodsA validated patient-rated outcome measure (PROM) and experience measure (PREM) were chosen and adapted in co-production with the YP on the ward. The measures were selected on the basis of being quickly and easily understood and completed. The PROM provided useful ratings in key areas (“school”, “home”, “family”, “me”) and the PREM measured how patients experienced attending the MDT-WR. Outcomes and completion rate of these measures were audited weekly for three months, and several Plan-Do-Study-Act (PDSA) cycles were completed to increase their usage and to improve the YP's experience of attending their MDT-WR.ResultsFrom an initial baseline of 0% we achieved a maximum of 50% of YP on the ward completing a PROM each week, and a maximum of 100% of YP who attended MDT-WR completing a PREM. Three PDSA cycles improved our completion rate. PROM ratings were used as part of the clinical discussion in MDT-WR each week. Not all YP were well enough to complete it, but for those who were its clinical usefulness (and especially comparing scores in consecutive weeks) was reported in clinician feedback. PREM scores were presented and discussed a number of times in ward improvement meetings and management meetings and four PDSA cycles completed which incrementally increased the PREM average weekly scores.ConclusionWe were successful in introducing and then increasing the completion rate of patient rated measures. Through use of the PREM we were able to make changes to the ward round and demonstrate the subsequent improvements to the experience of the patients attending. We have demonstrated that outcome measurement from the perspective of YP can contribute usefully to the MDT-WR and can improve YP's experience of the service. Use of these measures will continue as standard practice on our unit and could contribute usefully in future service evaluation projects.