bluuebunny/crossref_metadata_2025_split huggingface dataset:
Weight Monitoring and Antipsychotics: Are We Compliant With NICE Guidelines?
Authors: Mitchell Byrone , Chivers Gary , Drife Jenny 
Published: July 2023

AimsTo improve Antipsychotic weight monitoring for patients within the Homeless Outreach (START) team.MethodsAll adult patients accepted by the START team (Lambeth, Southwark, and Croydon locations) between June and October 2022 that had been initiated on Antipsychotic medication were identified retrospectively (n = 11).Electronic notes (ePJS) of these patients were subsequently reviewed to assess the following:
1.Was there compliance with NICE weekly weight monitoring (for the first 6 weeks) following Antipsychotic initiation?2.Was weight measured at least once following Antipsychotic initiation?3.Was a Physical Health Screen documented following Antipsychotic initiation?ResultsDuring the audit period a total of 56 patients were accepted by the START team. Of these 11 (20%) were initiated on Antipsychotic medication. 0 patients had weekly weight monitoring compliant with NICE guidelines. 0 patients had their weight measured at least once following Antipsychotic initiation. A Physical Health screen was documented for 4 (36%) patients following Antipsychotic initiation.ConclusionThis audit highlighted the poor compliance of weight monitoring in this cohort of patients, which can be attributed to several reasons. The homeless population are known to have poor engagement with health services. This coupled with reduced staff awareness of NICE antipsychotic monitoring guidelines can act as a barrier to carrying out appropriate physical health checks.
1.The following interventions were implemented:2.To address staff awareness, START team members were given a presentation on the importance of Antipsychotic monitoring and current NICE guidelines.3.An alert will be added to patient notes (ePJS) on initiation of Antipsychotic medication to remind staff to carry out required weight monitoring.4.Portable weighing scales were purchased for the team to ensure patients’ weight can be measured on outreach reviews.
Can You Teach Clinical Communication Virtually?
Authors: Montgomery Adam , Ramjan Faeez , Cannon Alistair , Kohara Sae , Saunders Chloe , Umasankar Deekshitha , Zac-Williams Lois , Butler Sophie 
Published: July 2023

AimsAn extracurricular clinical communication course called PsychED Up, with a focus on Psychiatry, met with challenges during the COVID-19 pandemic and the associated social distancing requirements. The course is usually delivered face-to-face by a small team of doctors, medical students, actors and lived-experience practitioners, and consists of large-group teaching on a weekly topic, followed by small group simulations. A small-scale study was performed to evaluate whether conducting clinical communication teaching and simulation online was acceptable, effective and feasible.MethodsTwelve students and ten faculty members participated in the online session, performing live clinical scenarios with simulated patients, over a two-hour period. Pre-and post-course questionnaires were designed with quantitative measures of confidence and qualitative questions about participants’ experience. Eight students completed both questionnaires. Questionnaire answers were analysed using a mixed-methods approach, with themes identified from the qualitative long answers, and statistical analysis of quantitative answers was also performed.ResultsStudents found the session beneficial, with all indicating that they would sign up for a full online course. Based on answers to the quantitative questions, 50% of students felt more prepared for their clinical examinations. (p = 0.046). However, all participants noted a reduction in their ability to read non-verbal cues and body language. Returning students found they were less attentive during the session compared with the original face-to-face teaching (p = 0.05). Actors and faculty members found that the online course was feasible, acceptable and effective. However, most agreed that it was not preferable to teaching clinical communication skills face to face. Technological issues were minimal.ConclusionThe majority of students and faculty found the session both beneficial and enjoyable, but felt face to face sessions would be more helpful in teaching clinical communication. Student attentiveness and awareness of non-verbal cues were highlighted as concerns. However, students generally responded positively to the online course, particularly the quality and diversity of peer feedback. Teaching clinical communication virtually has the potential to be successful, and has implications for future undergraduate medical teaching.
An Audit on Venous Thromboembolism Risk Assessment in Older Persons Mental Health Inpatient Unit in North Wales With the Aim of a Quality Improvement Project
Authors: Soundararajan Sathyan , Dhandapani Asha , Wallis Finlay , Bhalerao Manjiri 
Published: July 2023

AimsThe aim is to undertake a baseline audit of VTE risk assessment in older persons mental health unit in all 3 sites in North Wales. Following the implementation of recommendations, we aim to repeat the audit with an aim to complete a Quality improvement project.MethodsA retrospective audit was conducted in older persons mental health unit in all 3 sites of North Wales in Betsi Cadwaladr University Health Board.A prospective opportunistic sample of all the inpatients in the old age psychiatric unit was audited. Standards were based on the NICE and Department of Health guidelines.We collected the data by reviewing the patients notes. The data collection happened in December 2022 to January 2023. We made a simple protocol to collect the data from all 3 sites.The target was for 100 % compliance in all standards.ResultsFrom the audit data collection, the results are as follows:Overall, we gathered details of 29 patients in East, 21 patients in Central and 11 patients in the West (A total of 61 patients)In the East, out of 29 patients, there was a form for VTE risk assessment in clerking proforma. However only 6/9 forms were filled by the junior doctors. In Central, out of 21 patients, only 2 patients had a form in their file but they were not filled. In Bryn Hesketh unit, there were no VTE risk assessment forms at all. In West, out of 11 patients, 3 of them had a VTE risk assessment form that were filled. Overall, we noticed that in some of the patient's medication chart, there was a mention about they receive prophylaxis for VTE or not. However, that was not consistent.There is no standard proforma noted in any of the wards in Central and West. In East, there is a clerking proforma noted and in some patients hence as part of the proforma as the VTE risk assessment is already included the junior doctors do fill the VTE risk assessment form.ConclusionI hope this audit will help in improving the patient care by identifying the risks factors of VTE earlier and preventing it. This would be in accordance with the guidelines.It was evident that VTE risk assessment and prophylaxis was not something that was being considered for patients admitted to the old age psychiatric inpatient unit. However due to the risk factors this group of patients possess it is something vitally important. As a consequence of presenting the audit across the trust, a service change was recommended with a VTE risk assessment proforma planned to be introduced across the trust will be adapted to support use in psychiatric inpatients which can be used by mental health trusts.
Is Borderline Personality Disorder Madness? a Qualitative Study of the Perceptions of Medical Students in Somaliland
Authors: Arisna Hanny , Handuleh Jibril , Bhui Kamaldeep , Pereira-Sanchez Victor , Lee Tennyson 
Published: July 2023

AimsAs the next generation of doctors, medical students' perception of patients with personality disorder (PD) is critical. Yet a systematic review of the literature shows this has not been studied. The study aims to identify 1) the understanding and perception of medical students about PD and 2) factors that may relate to this knowledge and perception.MethodsA focus group discussion (FGD) was conducted with eight medical students in their sixth year at Amoud University, Somaliland. We presented a case vignette of a patient with typical Borderline PD symptoms (which would meet DSM5 criteria for Borderline PD) and used Barts Explanatory Model Inventory (BEMI) to explore the issue. The FGD was recorded, transcribed, translated and thematically analysed.ResultsThe Medical students showed accurate knowledge regarding Borderline PD, recognising features of unstable mood, impulsiveness, and emptiness. Medical students showed binary perception, whether this patient was ‘crazy’ (waali) or not crazy. They perceived their community as a strong African Muslim population. Half the participants believed religious intervention would be helpful “I believe in Islam. So, to some degree it could be managed in certain religious centrs”. Importantly, medical students, when asked to divest of their professional identity, and to describe their personal views as members of the local population, then associated PD with craziness or madness.ConclusionThe views of PD as craziness or ‘madness’ and the role of religious intervention have important implications for training and service development. The importance of a culturally sensitive training to medical students regarding PD in order to match cultural and religious views, and consideration of development of health services which are sensitive to religious practice is highlighted. We recommend including social and cultural implications in the training of medical students to better prepare them for the complexity of managing PD.
Introducing the Emotional Logic Method as a Self-Care Approach for Staff Well-being
Authors: England Rosie , Langsford Marian , Nainar Feroz 
Published: July 2023

AimsThe Emotional Logic method teaches that although unpleasant, all emotions have an inbuilt useful purpose. Through recognising our emotional responses to situations, this solution-focused approach helps us discover the hidden losses behind our emotions, empowering us to move forwards. Activating our inner Emotional Logic can help to build emotional resilience, improve self-awareness, strengthen relationships and reduce burn out.MethodsThe Emotional Logic method was introduced to staff across the Learning Disability Psychiatry Division during a two hour webinar. The session was advertised via email circular to all staff with an emphasis on using the method for self-care. It was attended by thirty-two, clinical and non-clinical staff from across the multi-disciplinary team. Interactive polls were used during the session as well as feedback forms at the end.ResultsIn Emotional Logic, a safe place is a physical place, relationship or mindset that we can visit when we are doubting our resources to cope, here we can let our emotions settle and make a plan. An interactive poll during the session showed that 98% of staff could identify a safe place. This was reduced to only 52% when asked if they could identify an accessible safe place at work.The session overall was rated as 4.57 (on a scale of 1(poor)-5(excellent) 90% said they felt Emotional Logic was relevant to them personally, with the remaining 10% answering “maybe.” Qualitative feedback included: “I thoroughly enjoyed all aspects of the session which would benefit me personally and on a professional level” “Helped me to manage my thoughts/control my thoughts” “Its always hard to take a look at yourself and your behaviors or reactions to things that impact you on a daily basis and I think that a lot of people would find it a real benefit.” 86% said they would be interested in further learning.ConclusionIn order to care for other people, we need to first look after ourselves. The striking statistic that 48% of staff do not have an accessible safe place at work highlighted the importance of providing staff with the tools to help improve their own well-being. The session was an introductory session, which will be built on through offering follow up workshops and formal courses. The aim of these will be to improve self-care whilst also providing a language to use with colleagues and patients to help everybody move forwards.
How Can We Better Understand and Address the Issue of Alcoholism in the British Sikh Punjabi Community? Based on the Above, How Can the Medical School Curriculum Be Improved So Clinicians Can Better Meet the Needs of the British Sikh Punjabi Community and Diverse Communities in General? a Narrative Literature Review
Authors: Kochhar Ankita , Clinch Megan 
Published: July 2023

AimsAlcoholism within the British Sikh Punjabi (BSP) community is a severe issue caused by a complex array of psychosocial, political, and cultural factors. The current biomedical model taught at UK medical schools fails to address psychosocial aspects of disease, restricting the ability for doctors to treat patients holistically. As a result, doctors under-diagnose and under-treat patients with alcohol use disorders (AUD). There is a need to understand how medical education can address the needs of communities like the BSP to ensure better treatment and management in the future.Aims and ObjectivesTo explore the factors affecting alcohol consumption amongst the BSP community, as well as the barriers and facilitators they experience towards help-seeking. The results will help to make recommendations on how current alcohol-related teaching in medical school curriculums may be improved, and specifically, how to produce more culturally competent future doctors.MethodsTwo narrative literature reviews were conducted. 37 studies were included. The first search underwent thematic analysis with reference to a Public Health England framework, and the second underwent inductive thematic analysis. Key themes were discussed, analysed, and consequently the results from both literature searches were compared to produce appropriate recommendations.ResultsThe first review found that alcoholism is increasing in prevalence in the BSP population. The eleven themes identified corresponded to drivers, determinants, and consequences of consumption. A prominent theme identified included ‘economic and social structures influencing alcoholism within the BSP community’, which addressed the impact of gender roles, acculturation, and racial discrimination on alcohol consumption. The second review identified two themes and three subthemes. The ‘current level of alcohol-related teaching in the curriculum’ theme highlighted that approximately 14 hours is dedicated to this crucial topic. Overall, these findings indicated the need for multifaceted interventions to change the current provision of education.ConclusionCurrently, the BSP population fail to access treatment services due to fear of shame and stigma. Thus, doctors must be empathetic and sensitive to this, and be aware of how to explore psychosocial aspects of patient's lives and how this influences their AUD. Providing culturally competent services will ensure that holistic interventions are implemented, leading to earlier detection, prevention, and management of alcohol-related harms. This will ensure that individuals from the BSP community feel comfortable in help-seeking. Recommendations were targeted at medical schools and their students, with a predominant focus on the provision of culturally competent services.
Rewilding Medical Education
Authors: Kumar Praveen , Thonning Johanna , Santosh Ananya , Barnes Nicholas 
Published: July 2023

AimsAccess to a healthy environment offers broad health benefits and has been declared a human right (UNHCR, 2021). However, despite the release of position statements by royal colleges on the climate and ecological emergency, there appears to have been limited opportunities for dissemination and sharing of knowledge, understanding and opportunities for action for many doctors and medical students in the North of Scotland. Hence, this project was aimed to create awareness on the importance of nature connectedness and explore its association with good physical and mental health and well-being. It was also so the medical students can understand the relationship between nature connectedness and the experiences in nature through active observation and hands-on engagement activities alongside acknowledging already active allies providing practical environmental volunteering activities.Methods9 Medical students, 3 Core Psychiatry Trainees, 1 Psychologist and 1 Child and Adolescent Psychiatrist met at Trees for Life, Dundreggan. We were introduced to 2.5 hours of mindful grounding techniques, mindful eating, connecting with nature through art along with sensory exercises such as tree hugging and trust building activities by Nature for Health. We interacted in group work to design nature-based activities that can be used in clinical practice to improve mental well-being in people living with OCD, depression, ADHD, trauma and eco-anxiety.ResultsLearning experience amidst nature was well received by participants who also gained positive effects on their own personal well-being. The project successfully brought the participants together to access, care for and enjoy green spaces whilst learning about allied programs available in the community. The participants also learnt how nature can aid mental health recovery and well-being, whilst giving people a chance to do their bit towards the fight against climate change.ConclusionWe suggest to incorporate teachings on climate change in medical education with consideration on using green spaces as delivery sites to enhance nature connectedness (local green social prescribing opportunities such as Green Walking, Green Gym, conservation volunteering, city farms, forest schools by The Conservation Volunteers, The Wildlife Trusts and the ‘Rewild and Recover’ programme from Trees of Life). We also suggest to promote our future healthcare professionals to collaborate with other groups linking nature restoration to human health and well-being. Awareness on benefits of nature connectedness should become one of the most important aspects of medical education in this century to foster a generation of healthcare professionals with pro-nature attitudes and active engagements with the natural world.
Depictions of Mental Health in “ Top Boy ”
Authors: Quadros Wesley , Sule Akeem 
Published: July 2023

AimsSocial psychiatry faces a challenging relationship with pop culture. Understanding pop culture portrayals of mental health culture could be valuable to public mental health. ‘ Top Boy ‘ is a fictional show touching upon the experience of individuals living in the grip of a mental health syndemic in inner-city London.MethodsAS & WQ had structured discussions to analysing themes, social determinants and psychiatric correlations in Top Boy.ResultsTop Boy touches on aspects of mental health including immigration, the impact of violence, the impacts of urbanicity and deprivation syndemics, domestic abuse and PTSD.Violence as a trigger for PTSD is illustrated in the story of Jason, a young child who is exposed to domestic violence, resulting in avoidance of this environment and association with gangster Sully. Jason becomes desensitised to violence. Greater PTSD is linked with violence in a dose-dependent fashion (Abram et al., 2004).Sully watches Jason die after a racially motivated attack, illustrating the nested nature of such trauma as Sully develops PTSD; he is seen re-experiencing the fire. Sully can later be seen to be hyperaroused to perceived threat. Exposure to violence, particularly in the context of gang membership, is strongly associated with anxiety disorders. (Coid et al 2011)Impacts on relationships and childhood neglect are explored through Ra'Nell and Lisa. Lisa is a single mother who's survived an abusive relationship. She becomes severely depressed resulting in her being sectioned and an extended psychiatric admission. Ra'nell, her son, falls into the narcotic trade, leading to truancy and violence. His friend Gem is seen to try drugs when forced to act as a mule. Involvement in the drug economy leads to drug dependence among gang members (Coid et al 2011).These come together in the estate syndemic; psychiatric morbidity is exacerbated synergistically with health inequalities caused by poverty, stress, structural violence and racial discrimination. This leads to educational disadvantage through truancy in the cases of Ra'nell and Ats, who's mother suffers from the mental health effects of unemployment and deportation threat. Individuals are then more likely to interact with gangs in this syndemic environment and so the cycle of illegal activity, violence and ill health perpetuate.ConclusionGang members currently will make a large contribution to mental health disability and service burden in syndemic areas. Top Boy illustrates the challenge and opportunity for public mental health in the context of such syndemics.
Study on Concordance of ICD-11, ICD-10, and DSM-5 Diagnostic Guidelines for Alcohol and Opioid Use Disorders
Authors: Afroz Omar , Agrawal Alok , Ambekar Atul 
Published: July 2023

AimsTo study the implications of proposed changes in guidelines in ICD-11 in Alcohol and Opioid Use Disorder patients. To evaluate the concordance of ICD-11 with ICD-10 and DSM-5. To compare endorsement of various criteria for dependence between ICD 11 and other systems. To examine the agreement between ICD-11 and other systems with regard to the severity of dependence. To compare the application of WHO ASSIST in screening across systems.MethodsA cross-sectional study among newly registered, adult male patients attending NDDTC OPD, or community clinics and using the substance in the last week. N = 200 (100 each of Alcohol and opioids). Instruments: Semi-structured proforma, CIDI 3, ASI-lite, WHO-ASSIST, AUDIT. Items of CIDI were used to make the diagnosis according to various systems. The diagnostic agreement was assessed by Kappa. Endorsement frequencies of the criteria were compared across diagnostic systems. Scores of scales across systems were compared using Two Independent sample t-test.ResultsThe highest prevalence of Dependence was found using ICD-11. Almost perfect agreement between ICD-11 and ICD-10 for both Use Disorder and Dependence for all substances (kappa >0.8) except Inhalants. Agreement for AUD, CUD, and IUD between ICD-11 and DSM-5 was substantial but less than almost perfect. Similar findings for ICD-11 Dependence and DSM-5 Moderate-Severe Use Disorder in Benzodiazepines and Inhalants (kappa ranging from 0.693–0.790). High endorsement frequencies of Salience for Alcohol and Opioids, and Craving and Tolerance for all substances (ICD Dependence); Inability to cut down or control, Craving, and Tolerance (DSM-5 UD). Mean scores of AUDIT and ASSIST were generally lower in participants who received the diagnosis according to ICD-11 (sig. difference for CUD and Cannabis Dependence).ConclusionThere are significant implications of the changes in ICD-11, and further testing of the impact of these changes needs to be done.