bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding the Length of Stay (LOS) in Mental Health Acute Wards for Patients of the Joint Homelessness Team vs Other Westminster Patients
Authors: Gesell Sutapa , Hall Hugh 
Published: July 2023

AimsThe Joint Homelessness Team (JHT) is a specialist mental health service for rough sleepers in Westminster. Patients have many years of declining mental health, leading to a downward social decline, resulting in homelessness.There is a concern that mental health patients are discharged prematurely due to bed pressures. This means treatment may not be optimised, with social issues and risks remaining. Serious mental illness (SMI) is associated with reduced life expectancy and high morbidity. Thus, homelessness and SMI are a double-hit of risks for people. For JHT patients, there are many barriers to admission, including coordinating complex street or S135(1) assessments and police availability; some cases have taken months or years to plan. If patients remain sub-optimally treated at discharge, there's a high risk they abandon accommodation and return to rough-sleeping; leading to further lost years of illness and homelessness.MethodsThis was a retrospective analysis. Via SystmOne, we identified all JHT admissions in 2021 and their LOS. Data were collected, including demographics, mode of admission, discharge destination and whereabouts at three months (as a secondary endpoint). LOS figures were gathered for other Westminster patients from general adult wards for 2021.ResultsThere were 57 JHT admissions in 2021. 1 patient was excluded as still admitted. 22 patients were already care-coordinated by JHT and admitted for relapses; for the remainder it was a first admission.For Westminster patients, there was a low variation throughout the year in number of monthly admissions and LOS; monthly average LOS range was 30-38 days. For JHT, there was higher variability for number of admissions and LOS with no seasonal pattern; monthly average LOS ranged from 4-95 days.At three months, 22 (39%) patients were not housed in the community. Of these: 3 were discharged to the streets; 9 became street homeless; 3 were discharged to ‘Stepdown’ and went AWOL soon after; 5 patients were readmitted; 2 patients their location was unknown. 28 (50%) were housed in homeless hostels.The data were presented at a borough-wide academic meeting.ConclusionWhile the dataset is small, the LOS for JHT was inconsistent, reflecting the variability of the cohort. This may need further exploration.With 39% of admissions having unsatisfactory endpoints, this suggests that many patients were not well enough to work collaboratively out in the community. There was a consistent pattern of shorter admissions leading to poorer endpoints at three months.
Ethnic Differences in Dose and Levels of Clozapine: Exploring Need for Any Specific Monitoring Needs
Authors: Jiwanmall Stephen , Kar Nilamadhab , Obuobie Akua , Maiti Tanay , Lester Deborah , Mclaughlin Kerry , Hanson Thomas 
Published: July 2023

AimsClinical research shows that compared to Caucasian patients, Asian patients appear to have a lower clozapine dose requirement for clinical efficacy. Hence, appropriate dose adjustment should be considered in Asian patients receiving maintenance clozapine therapy. Secondly, studies in the UK report that Asian patients with treatment-resistant schizophrenia were less likely to receive clozapine than Caucasian patients. The objectives of this study were to find out the ethnic difference in dose and levels of clozapine in ethnic minority patient (BME (Black and minority ethnic) populations and to explore if there is a need for any specific monitoring.MethodsDemographic (age, gender, and ethnicity) and clinical variables (diagnosis, clozapine dose, plasma level of clozapine and nor-clozapine, smoking status, side effect profile, and physical comorbidities) were collected from the electronic patient records and analysed.ResultsThe sample consisted of 66 (56.4%) Caucasians, 22 (18.8%) Asians, 21 (17.9%) African-Caribbean, and 8 (6.8%) mixed ethnicity patients. Their age range was 19-80, with an average of 46.9 ±11.9 years.Among the ethnic groups, age, clozapine, nor-clozapine level and QTc were comparable, except for the dose of clozapine; Caucasian had the highest dose (414.8±140.0 mg), followed by African-Caribbean (373.8±163.7 mg), Asian (333.8±121.2 mg) and mixed (260.7±110.7 mg) (F3.68, p<0.05). The difference remained significant when all the BME groups were combined as well.Side effects such as hypersalivation, drowsiness, blurred vision, polyuria, sore throat, headache, vomiting (none), dizziness, difficulty passing urine, urine incontinence, flu-like symptoms, nausea, were comparable among ethnic groups.There was no difference in smoking among the groups. Considering comorbidities compared to BME, Caucasians had significantly lower rate of hypertension (27.1% vs 9.1%, p<0.01); diabetes (18.6% vs 4.5%, p<0.05), however dyslipidemia (5.1% vs 3.0%) was comparable.In addition to the above, the dose of clozapine was positively correlated with clozapine and norclozapine levels (p<0.05). Clozapine and norclozapine levels correlated significantly (p<0.001). Age was negatively correlated with norclozapine assay (p<0.05) and positively with the number of cigarettes. It appears as the age increases, the number of cigarettes goes up, and norclozapine levels come down.ConclusionThere are a few variations of clozapine prescribing in different ethnic groups. Although the Caucasians had higher doses, they had comparable blood levels. A higher proportion of BME patients on clozapine had hypertension and diabetes, emphasizing metabolic risk. Our study findings suggest clozapine monitoring should look into ethnicity related risk factors.
Demographic Characteristics of Adolescents Referred for Psychoanalytic Psychotherapy – Who Is Being Left Out?
Authors: Pietrogrande Erica , Strzelczak Agnieszka 
Published: July 2023

AimsIn response to the growing awareness of health inequalities in the UK, institutions are called to take responsibility in tackling obstacles to equality, diversity and inclusion to mental health services access. This study aims to evaluate the demographic profile of referrals from London borough of Camden residents (aged 18 to 25 years) to the Tavistock Adolescents and Young Adults Service (AYAS) for psychodynamic psychotherapy. We aim to evaluate whether the demographic characteristics of referrals were a good representation of the local population.MethodsAge, gender, and ethnicity of Camden AYAS referrals received between 12th April and 14th December 2021 (n=38, age range 17 to 24 years) were collected retrospectively using the electronic patient record system and compared with the following age groups of the latest Camden Census data (2011): 16-17, 18-19 and 20-24 years.The two sets of data were analysed using Chi-Square goodness of fit test.ResultsFemales were significantly overrepresented among AYAS referrals compared to Camden population (86.5% vs 52.8%, X2=16.83, p=.001).No conclusion could be reached regarding transgender individuals due to lack of data about transgender population in 2011 Census data.Ethnicity was recorded in n=33 referrals and evaluated at group and subgroup level, utilising standardised categorisation.We found that the proportions of five main ethnic categories differed significantly between the AYAS and Census groups, (X2=13.07, p=.05). In the AYAS referrals Mixed ethnicity group was over 3 times higher than expected based on Census data, while the Asian group was markedly underrepresented.Significant disproportions were also identified at ethnic subcategory level (X2=39.98, p=.01).No one of Asian-Bangladeshi or Asian-Chinese ethnicity was referred to AYAS in the timeframe considered.People of Black ethnicity were represented as expected overall with all referrals (n=3) identifying as Black-African.Although overall White ethnicity was represented as expected, White-British were underrepresented (18.2% vs 39.2%) with majority of referrals identifying as other White ethnic subcategories (36.4% vs 15.5%).ConclusionLimitations of this study include sample size, outdated Census data and limitations of statistical tests used. Our findings indicate males are under-referred to the AYAS psychotherapy service together with some ethnic minorities (Asian overall, and in particular Asian-Chinese and Asian-Bangladeshi).This may be due to unconscious bias in the referral process. Further exploration is needed to understand underlying causes so that effective strategies to promote equality in access to services can be implemented.
Are We Executing Our Vision?
Authors: Raju Sri , Chouhan Priyanka , Balan Nisha 
Published: July 2023

Aims/BackgroundSafety plan and Goal setting are standard interventions offered by CAMHS Crisis Resolution and Home Treatment team. The Department of Health Best Practice Principles and NICE guidelines recommend collaborative production of risk management plans and recovery orientated input. We wanted to ensure compliance and understand patient's views on usefulness of these.Aims:- Did all patients complete safety plan and goal setting? Was this done collaboratively?Did these strategies help?Were documents easy to access?MethodsThere were two arms to the project.
1.Review of 40 electronic case notes out of 715 patients seen from Jan to April 2021. We looked at completion of safety plan, goal setting, goals achieved, HONOSCA scores, risk ratings and mood scores.2.Between April and July 2022, willing patients were requested to complete anonymised electronic questionnaire through a QR code. The questionnaire asked if patients felt included when completing the safety plan and goal setting, whether these interventions helped recovery and if the documents were easy to access. A free text option for feedback was also given.This proposal was approved by the Improvement and Knowledge Hub within the LPT NHS trust who confirmed that ethical approval was not required.Results are reported in percentages.ResultsCase notes review (n=40):
•99% had safety plans completed, done collaboratively.•90% had goal setting completed, done collaboratively•Rationales documented within the notes for not completing.•85% reported Improved mood scores•90% reported improved risk ratings•65% achieved 2 or more of 3 goals set.•67.5% had HONOSCA at admission (average score 13.6) and discharge (average score10.5) – improvement documented.Questionnaires: 18 questionnaires returned.
•100% completed safety plan and goal setting•83% reported they felt included when doing safety plan and goal setting.•83% said goal setting was helpful in recovery.•94% said safety plan helped.•82% reported easy access to documents.ConclusionResults suggest compliance with guidelines and strategies are useful. There is consistency in relevant information from the case note review and questionnaire feedback. Case note review included objective and subjective perspectives. Questionnaires gathered patient perspective; in confidence/anonymously.Recommendations:
1.Repeat survey ensuring case review and patient feedback for same period.2.Use children and young people friendly version, offer paper version, advertise widely - to improve questionnaire response rate.3.Complete HONOSCA on admission and discharge.4.Research to explore usefulness of interventions in CYP
Satisfaction Survey of Patients and Carers for Telephone vs Face-to-Face Reviews - a Service Evaluation Project
Authors: Sevim Busra Acar , Randhawa Tani , Haworth Katherine , Khan Kehkashan 
Published: July 2023

AimsThe COVID-19 pandemic necessitated major changes in clinical care, including remote patient contact. Havering Older Adults Mental Health Team and Memory Service (HOAMHT&MS) patients often fell within the vulnerable category for poorer outcomes with the SARS-CoV-2 virus, so remote contact was preferable during the pandemic. Telephone assessments were offered to replace face-to-face reviews for some patients. Feedback from patients and carers was collected to compare these modes of patient contact. Remote assessment has positive impacts including; improving access to care in remote areas/when local services cannot meet demand and for disabled patients. Understanding the patient experience about remote assessments helps navigate decisions about future modes of consultation.MethodsThis evaluation was organised in HOAMHT&MS. A Rio* diary search was conducted for practitioners from 15/07/2020 to 15/10/2020. 75 questionnaires were sent from each clinic (OAMHT and Memory Service). We sent an equal number of questionnaires for telephone appointments and face-to-face reviews. Questionnaires were posted to patients with pre-paid envelopes to return responses.*Rio is our Electronic Patient Record SystemResultsWe had a total return of 23 questionnaires from the Memory Service and 24 from the OAMHT clinic. Most questions were a likert scale from Poor (1) to Excellent (5). The overall satisfaction score out of 5 (average of all the responses):OAMHT:Patient/telephone: 3.7 (n=13)Patient/face-to-face: 4.1 (n=7)Memory Service:Carer/telephone: 4.4 (n=8)Carer/face-to-face: 4.2 (n=9)Some of the open ended feedback:OAMHT:•Carer/telephone:“The telephone was rushed and at the end of the meeting the person wanted to sign my husband off.”
•Patient/face-to-face:“Help was always there for me.”“The clinic deserves a medal.”Memory Service:•Carer/telephone:“Very helpful - I am now contacting them for further advice. They understand my stress and give me full support.“
•Patient/face-to-face:“Very happy with the care and attention from the consultant, doctor and nurses at the memory service.”ConclusionOAMHT Responses:•Face-to-face feedback more positive•Patients experienced more distress - nature of illness (distress/crisis) compared to memory (usually gradual decline)•Telephone appointments seem less satisfactory - less likely to meet the emotional need of patient/carerMemory Service:•Generally positive feedback from carers and patients in all areas - able to take a meaningful history over telephone
Optimising and Future-Proofing Dementia Care With Amnestic Mild Cognitive Impairment (aMCI) Clinics
Authors: Raninga Smit Kishorbhai , Wasunna-Smith Brenda , Millward Alice , Rees Kerry , Kuruvilla Tarun 
Published: July 2023

AimsAmnestic Mild Cognitive Impairment (aMCI) is considered a pre-dementia (prodromal) phase of Alzheimer's disease (AD), with a higher probability in patients with positive biomarkers (temporo-parietal region, atrophy on CT/MRI imaging and hypometabolism on FDG-PET scan).We developed a pilot service development project in the North Sector of Gloucestershire Health and Care (GHC) Trust. Its’ main aim was to ease some of the pressures on the Memory Assessment Service (MAS) nurses and the medical memory clinics. The main objectives were: 1. To develop and run an aMCI Clinic service for eight months between March and November 2022 at GHC with North Sector patients to reduce waiting times compared to the preceding years. 2. In patients with aMCI and a positive biomarker, continue annual cognitive testing with early identification of conversion to dementia, thereby starting anti-dementia medication, and continue through the post-diagnosis pathway. Future plans include creating a business case for the Care Commission Group to consider commissioning a countywide aMCI service.MethodsPatients (n=23) with the diagnosis of aMCI and a positive biomarker were selected. Data included the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) to assess patients’ daily functioning, clinical history and service satisfaction questionnaires. Different initial objective tests, including Addenbrookes Cognitive Examination (ACE-III), Repeatable Battery for the Assessment of Neuropsychological Status (R-BANS), Telephone Interview for Cognitive Status (TICS), and Rowland Universal Dementia Assessment Scale (RUDAS) were used. Data for waiting times from referral to first assessment were collected and statistically analysed using a repeated measures design across years 2020,2021,2022(March-November) and a one-way repeated measure ANOVA was performed.ResultsAnalysis of waiting time indicated a non-significant decrease in waiting times from referral to first assessment. A decrease in the waiting times from September 2022-November 2022 was noted, pointing towards a possible time lag effect. Within six to twelve months of repeat testing, 62% of patients remained with an aMCI diagnosis whereas 32% of patients progressed to dementia (Alzheimer's or Vascular). From the post-appointment patient feedback received (65%), all patients reported to be very satisfied (57%) or satisfied (9%).ConclusionIt is prudent to assess the time lag effect on the results produced in subsequent months. A repeat review with a larger sample size to increase the sensitivity and specificity of the results obtained is recommended.
Exploring the Trend in the Use of Electroconvulsive Therapy (ECT), Modified ECT and Transcranial Magnetic Stimulation (TMS) in Northamptonshire Healthcare Trust
Authors: Tariq Safyan , Alwetayan Salem , O'Neill-Kerr Alex 
Published: July 2023

AimsOur aim was to analyse the trend in the use of new courses of ECT in Northamptonshire Healthcare Trust from 2007 to 2022 and to compare the use of ECT, Modified ECT (MECT), TMS, Ketamine and combined TMS + Ketamine in the Treatment Centre and The Centre for Neuromodulation in Northamptonshire Healthcare Trust from 2013 to 2022.MethodsData for new ECT courses were collected from the Treatment Centre in Northamptonshire Healthcare Trust from 2007 to 2022. These data were then compared with new courses for TMS, MECT, ketamine and combined TMS + Ketamine from various sites across the trust from 2013 to 2022. These data have been represented as two separate graphs the first showing trend of ECT and the second comparison of the trend of ECT, MECT, TMS, Ketamine & combined TMS + Ketamine.ResultsThe data show that there has been a significant decrease in the number of ECT and MECT procedures performed in recent years, with a decrease of over 50% to 70% in new courses of ECT & MECT among various units in the trust. Regarding the data for TMS treatment vs ECT there is a gradual decrease in ECT and increase in TMS over the years, of particular note is the recent period of 2019 to 2022 during which there were 10 times more referrals for TMS compared to ECT at Northamptonshire Healthcare Trust. During this period TMS accounted for 87% of the total new treatments, while ECT accounted for 9% and Ketamine 4%.ConclusionOur findings suggest that TMS is becoming an increasingly popular treatment option for depression and may eventually replace ECT and Modified ECT as the primary treatment in the Northamptonshire Healthcare Trust. This poster provides an overview of the current state of ECT, Modified ECT, TMS, and ketamine as treatments for depression, and highlights the need for further research to better understand the relative effectiveness and safety of these treatments, especially in treatment-resistant depression cases.
Enhancing Medical Governance of Care Within an EIP Service
Authors: Veldmeijer Claire , Perera Samantha , Fuller Martin , Kavanagh Gail , Whale Richard 
Published: July 2023

AimsWe aimed to enhance the clinical governance of medical input to patients within Brighton Early Intervention in Psychosis (EIP) service. The Service Standard Operational Policy indicates that patients should be medically reviewed every 6 months as part of the Care Programme Approach (CPA) and include review of: diagnosis, service eligibility, medication positive and negative effect, clinical improvement, risk assessment and physical health.MethodsThe EIP caseload on a specific date was reviewed to explore if a medical CPA review had taken place. A detailed medical letter evidenced this. A meeting was convened between team doctors to identify from electronic records when the last medical CPA had taken place. General characteristics of the delayed review group were identified. An excel spreadsheet was used to create a system to autogenerate when a next review is required.Results142 patients were identified on the EIP caseload. 21 patients had been discharged so were excluded. 121 patients were eligible for this audit, including 8 inpatients. 46 (38%) patients were identified as having an overdue CPA review.Those with overdue CPA reviews were found to be overall clinically stable, on the caseload for over a year and those who had had a recent change in Lead Practitioner (LP) who were not aware of service operational policy due to high staff turnover linked with the COVID-19 pandemic. Some duplications of routine medical reviews were identified between team doctors within the 6 months.ConclusionThis service was not achieving CPA standards of the operational policy. A spreadsheet was set up to proactively alert the LP when patients required a 6 month review. Policy information sessions were set up for the team and will be specifically included in new worker induction training. A full audit cycle will be completed by implementing the change made and re-auditing to see if there is an improvement. Duplications of routine medical reviews will be explored in more detail.
The Patient's Guide to Buvidal: A Service Improvement of a Digital Repository of Patient Information for Patients Taking Buvidal in Wales
Authors: Ward Devon 
Published: July 2023

AimsBuvidal is being used with patients with opioid dependence. Only 35% of patients read the paper patient information leaflet, which could be improved by condensing the information, making it accessible and relevant. Therefore, the aim was to create a series of informative videos answering important questions for patients taking Buvidal and then evaluate their perceived efficacy.MethodsData were collected from a questionnaire taken by patients taking Buvidal and healthcare professionals (HCPs) working in Substance Misuse Psychiatry in Wales. The results and preferences were analysed and the information was used to create 5 videos addressing the questions the participants thought were the most important. A second questionnaire was sent out alongside the videos to the original participants to gauge their utility. The Patient's Guide to Buvidal can be accessed on YouTube: shorturl.at/afjl3.ResultsAll participants reported that the videos would be useful in answering their questions about Buvidal. Participants ranked the use of Buvidal, the effect of comorbidities and other substances on taking Buvidal and side effects as the most important topics to be covered in the videos. Understanding and confidence increased in a mean of 80% of the topic areas discussed. HCPs reported an increase in 9 out of the 12 topic areas, whereas patients reported an increase in 7. There was no statistically significant difference between prescriber and patient confidence (t(22) = 0.197, p=0.05). 100% of the participants stated they enjoyed the videos and preferred them to the patient information leaflet.ConclusionThe digital repository could be a valuable addition to the holistic care of patients taking Buvidal to improve their understanding of important questions and topic areas. The use of one long video using YouTube's bookmark feature may be preferred by patients to easily navigate the videos. In the future, new medications and routes may benefit from videos like this targeted at HCPs as well.