bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associate Hospital Managers’ Discharge Powers Under Section 23: Should the Days of the Hospital Managers’ Hearings Be Numbered?
Authors: Nicholls Rebecca 
Published: July 2023

AimsUnder section 23 of the Mental Health Act, the managers of the hospital have the power to order discharge of a patient detained under certain sections. In the past, the need for this power has been questioned, but the debate reared its head following the ‘Modernising the Mental Health Act’ government review in 2018, which initially proposed that the managers’ hearing should be abolished. The aim of this research was to critically analyse the law to determine whether or not managers’ hearings should be removed in legal reform.MethodsA literature review was performed using the legal databases Lexis Library and Westlaw to identify relevant primary legislation, secondary legislation, case law, articles and other secondary sources. These were critically analysed to discuss the managers’ hearing's strengths, weaknesses and potential proposals for reform.ResultsIn favour of retaining the managers’ hearing in its existing format, it provides an independent power of discharge that is accessible, subject to scrutiny and an important safeguard, particularly for those lacking capacity. In favour of abolishing the managers’ hearing, the tribunal system satisfies the Government's requirement under Article 5(4) of the European Convention for Human Rights; the managers’ panel could be viewed as a duplication of effort without legal representation and a necessary medical member, with limited powers in comparison to a tribunal and arguably low discharge rates. Its usual procedure was challenged during the COVID-19 pandemic, and the Convention on the Rights of Persons with Disabilities moves away from the traditional medical model, suggesting reforms to the Act may be needed.ConclusionCase law has ruled that the managers’ panel has equivalent standing to the tribunal and criticism has been largely anecdotal. The absence of evidence surrounding the process is a major weakness in this debate with no nationally held records of outcomes. Whilst the duplication of effort and overlap with the tribunals’ powers has been a consistent argument for abolishment, the managers’ hearing stands as a robust and accessible safeguard in providing an opportunity for detention under the Act to be reviewed. Any reform must continue to empower and involve patients, supporting them in exercising their rights. On balance, this review concludes that the days of the managers’ hearing should not be numbered without further research.This research was completed as a Masters in Mental Health Law (LLM) dissertation through the University of Northumbria.
Psychometric Properties of the 7-Item Generalized Anxiety Disorder (Gad-7) in Nigerian Pregnant Women Attending Primary Health Care
Authors: Olaluwoye Oluwaseun , Onofa Lucky , Sowunmi Oladipo 
Published: July 2023

AimsMaternal mental health is an integral component of services that should be rendered to pregnant women in addition to their physical health during their antenatal care. Mental health conditions are screened for during these visits. There is a high prevalence of anxiety disorders among this group of women. A common questionnaire used to screen for anxiety is the 7-item generalized anxiety disorder (GAD-7). However, this instrument has not been validated among pregnant women in Nigeria. We conducted research among pregnant women in Southwest Nigeria to demonstrate the psychometric properties of GAD-7 using the anxiety modules of the Mini International Neuropsychiatric Interview (MINI) as a gold standard.MethodsWe administered both GAD-7 and the anxiety module of MINI among 203 pregnant women who attended 4 randomly selected primary health centres in Southwest Nigeria. The data collected from these questionnaires were analysed using the Statistical Package for Social Sciences (SPSS).The reliability of GAD-7 was assessed with Cronbach's alpha to estimate its internal consistency. The validity of GAD-7 was examined with an assessment of its concurrent validity, sensitivity, and specificity analysis and a receiver operator characteristic curve.Using Pearson correlations, we evaluated the concurrent validity of GAD-7 and the anxiety modules of the M.I.N.I. The sensitivity, specificity, positive predictive, and negative predictive values of GAD-7 were determined with the MINI as a gold standard. The predictive accuracy was further determined from receiver operating curve analysis using the area under the curve as a standard measure.ResultsThe internal consistency value measured by Cronbach's alpha for GAD-7 was 0.709. GAD-7 correlated minimally with the anxiety modules of MINI with a coefficient score (r) of 0.393 at a p-value of 0.01. GAD-7 has a low sensitivity & negative predictive value of 14.1% and 57.8% respectively and a high specificity & positive predictive value of 97.3% and 81.2% respectively. The area under the curve using receiver operating curve analysis was above the chance line of 0.5 with a value of 0.0557 at p < 0.05.ConclusionGAD-7 is a reliable and moderately valid instrument to screen anxiety among pregnant women in Southwest Nigeria.
Prevalence and Risk Factors of Postpartum Depression in a Tertiary Care Centre, Puducherry
Authors: Punnoose Zarine Maria , Thilakan Pradeep 
Published: July 2023

AimsPostpartum depression (PPD) is the experience of depressed mood that begins anytime within the first four weeks after delivery. When left untreated, it can affect the infant's emotional and cognitive development and mother's health and family. South Indian studies on this topic are sparse. This study aimed at identifying the prevalence and risk factors of PPD in a tertiary care centre in Puducherry.MethodsThis was a prospective cohort study which included 140 antenatal women between 34 and 36 weeks’ period of gestation, and followed up at 6 weeks postpartum. Tools used in the study were semi-structured questionnaire to collect the sociodemographic details, Postpartum Depression Predictive Inventory – Revised version and Edinburgh Postnatal Depression Scale.Results10% were found to have antepartum depression and at the postpartum visit, 18.6% were found to have depression. The risk factors identified were inadequate spousal support, unsatisfactory marital relationship, poor relationship with in-laws, prenatal anxiety and depression, low self esteem, maternity blues, child care stress, infant temperament, health problems and frequent hospital visits. Among these, presence of maternity blues (OR = 30.370) and infant health problems (OR = 14.742) had the highest risk.ConclusionMajority of the women with PPD reported depressive symptoms in the third trimester itself, hence antenatal and postnatal women should be routinely screened for depression and managed promptly. Failing to attach significance to prolonged maternity blues and frequent infant health problems has been found to increase the risk for developing PPD significantly.
Evaluating the Potential Benefit of Implementing the STAR (Socio-Technical Allocation of Resources) Methodology in Mental Health Commissioning Decisions
Authors: Sidhu Manu , Okhiria Renée 
Published: July 2023

AimsA rise in mental illness has inspired the UK government to increase mental health service funding by £2.3 billion/year, deepening the need for robust evidence on how to best allocate mental health resources. The STAR methodology was co-developed by the London School of Economics and the Health Economics Unit to help commissioners allocate resources by combining a value-for-money analysis with stakeholder engagement. The aim of this research was to evaluate the potential benefit of implementing the STAR methodology in the allocation of mental health resources.MethodsThe barriers and facilitators to commissioning cost-effective mental health services were systematically reviewed. The potential for STAR to overcome these barriers and promote these facilitators was then evaluated by analysing its socio-technical components and assessing its real-world implementation in the COPD pathways of five ICSs.ResultsFragmentation and cross-sectoral responsibility for the funding and delivery of services can hinder multi-sector buy-in. STAR has overcome this barrier in the COPD pathways of five ICSs by pooling their budgets and building partnerships across sectors through decision conferencing that has facilitated shared priority setting.Lacking community involvement impedes local stakeholders from embracing change. By championing local stakeholders, STAR's ‘socio’ component involves front-line workers in funding decisions and fosters a sense of ownership over service adjustments.The value placed on each outcome varies between sectors, often resulting in conflicting incentives. By considering each sector's interests, STAR enables a consensus on which outcomes to optimise for. Furthermore, STAR's ‘technical’ components strengthen the objective value-for-money evaluations of the interventions that contribute to each outcome. When modelling the health gain and cost of COPD interventions, STAR discovered that CBT offers a relatively high return on investment, despite often being overlooked as a core intervention for COPD. STAR's economic evaluations are communicated in easily interpretable ways to facilitate a shared understanding on which resources are most worth funding.ConclusionResource allocation decisions are fuelled by the quality of evidence supporting them. Compared with physical health services, mental health services lack evidence that reflects the qualitative and quantitative nature of their outcomes. In particular, services that rely mostly on subjective reports, such as psychotherapy, lack objective value-for-money evaluations, resulting in a hesitancy for funding. By measuring the health gain and cost of each mental health intervention in a systematic, transparent and objective way, STAR enables commissioners to improve the allocative efficiency of mental health resources, thus improving population mental health without increasing cost.
A Systematic Review of Aerobic Exercise to Improve Cognitive Function in Older People Without Known Cognitive Impairment
Authors: Balaskanda Swarupa Sri , Egemonye Azuka , Faruqui Rafey 
Published: July 2023

AimsThere is an increasing amount of evidence to suggest that regular physical exercise supports healthy ageing. Regular physical activity provides health benefits for the cardiovascular, respiratory and musculoskeletal systems as well as many other benefits. As well as improving cardiovascular fitness, aerobic activity in particular may also have beneficial effects on cognition among older people. In this paper, we aimed to systematically review the effect of aerobic physical activity, aimed at improving cardiorespiratory fitness, on cognitive function in older people without known cognitive impairment.MethodsWe searched the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, the Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE, PsycINFO, LILACS, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch), ClinicalTrials.gov with no language restrictions.We included all published randomised controlled trials (RCTs) comparing the effect of aerobic physical activity programmes with any other active intervention or no intervention on cognitive function. Participants were ages over 55 with no known cognitive impairment. We looked at trials, which measured effects on both fitness and cognition.We reviewed the data from trials published since August 2013 to further the research completed by Young J, Angevaren M, Rusted J, Tabet N (published in 2015). This systematic review looked at all the studies completed before August 2013.ResultsThere were a few trials that met our inclusion criteria. The aerobic activity programme that participants were subjected to varied in length.The comparison between aerobic exercise to any active intervention showed no evidence of benefit from aerobic exercise in cognition.None of our analyses showed a cognitive benefit from aerobic exercise despite the interventions demonstrating benefits to cardiorespiratory fitnessConclusionThe findings from the available data from the RCTs did not show any evidence that aerobic physical activities, including those which successfully improve cardiorespiratory fitness, have any cognitive benefit in cognitively healthy older adults. Larger studies with longer term interventions and longer follow up would be recommended.
Telemedicine for Memory Service Assessments, a Literature Review
Authors: Treloar Dominic 
Published: July 2023

AimsMemory clinic waiting times are at a record high, increasing from 13 weeks in 2019 to 17.7 weeks in 2022. This backlog is partially due to COVID-19 disruption. Staff are concerned that waiting times are resulting in missed diagnoses, particularly with early-onset memory loss, and that relatives of patients with challenging behaviours are not receiving adequate support. At the start of the pandemic, many Memory Service Assessments (MSAs) were done via teleconsultation to ensure patients could access services despite lockdowns. Telemedicine has continued to be used for MSAs and is a strategy proposed to tackle waiting times. This literature review explores whether using telemedicine for MSAs is evidence-based.MethodsA search using the MEDLINE database was conducted, using the terms ‘dementia’, plus ‘telemedicine’, ‘video calls’, and ‘telephone calls’. This identified one relevant systematic review and one clinical trial. The identified evidence was insufficient for a systematic review. A google search carried out with the same terms, identified a variety of non-academic papers: NHS Audits, Quality Improvement Projects, Clinical Network publications, and one governmental publication.ResultsTelemedicine was reported to reduce waiting lists. Appointments could be organised quickly, without infection risk, and without requiring transportation. At-home telemedicine consultations were relaxing for some patients and reduced demand for home visits. However, clinicians reported that some environments were cluttered and noisy, impacting the MSA.Patients struggled with the complex telemedicine technology; carers were required to facilitate the calls, which increased the risk of an inaccurate assessment. Patients with sensory impairments disliked telemedicine, and clinicians struggled to distinguish between cognitive impairment and poor hearing. Financial inequalities at times prevented telemedicine. Some relatives felt that patients would mask their memory symptoms in teleconsultations, and not speak openly about their concerns. Clinicians felt adequate safeguarding assessments were not possible over teleconsultation. There was no inclusion of the long-term impact of these assessments. No distinction was made between dementia subtypes.ConclusionThe National Audit of Dementia, RCPsych 2021, encourages the future use of telemedicine for MSAs. However, there is limited evidence to support its use. Telemedicine was essential during COVID-19 and may help reduce waiting times, but may also produce worse outcomes than face-to-face consultations. Only pilot studies without randomisation exist on the topic and none of these are UK based. Further research is required to produce NHS-specific data on the impact telemedicine has on: the quality of MSAs, the patients’, carers’, and clinicians’ experiences, and memory service waiting times.
Systematic Review of the Safety and Tolerability of Injectable Prolonged-Release Buprenorphine (Buvidal) in Adults With Opioid Dependence
Authors: Williams Laura , Saima Saima 
Published: July 2023

AimsWidely available opioid substitute treatments have numerous limitations including the potential for non-compliance, misuse, diversion and accidental overdose. The advent of a prolonged-release, injectable form of buprenorphine may be the solution to overcoming these issues, as well as reducing the intrusion on the patient's daily life. Initial trials have shown success in achieving a significantly higher percentage abstinence compared to placebo. This systematic review and meta-analysis will examine efficacy, safety and tolerability data.MethodsA systematic review and meta-analysis, including all randomised controlled trials reporting raw data on efficacy, safety and side effects of injectable buprenorphine. Included articles were identified using PubMed, Ovid (EMBASE and MEDLINE), Google Scholar and Cochrane Library.Participants were either community outpatients or hospital inpatients, aged over 18 years, with opioid use disorder. Interventions were prolonged-release injectablebuprenorphine of any preparation or dosing schedule, compared to a control such as sublingual buprenorphine or placebo.The primary outcome measure was treatment efficacy, specifically treatment retention and negative urine drug screen results. The secondary outcomes measures were drug related adverse events, severe adverse events, nonfatal serious adverse events, mortality, discontinuation, and drug overdose.Six articles were selected for inclusion following assessment using our exclusion criteria. Study quality was assessed using the CASP tool and Cochrane Risk of Bias 2. Review Manager 5.4.1 was used for data synthesis.ResultsOur primary endpoint was efficacy, using treatment retention and negative urine samples as surrogate markers. Regarding treatment retention there was a statistically significant increase in the ‘Buvidal’ group compared to the control group (OR = 1.46, 95% CI = 1.12 to 1.89, P = 0.005). There was also a statistically significant increase in negative urine samples in the ‘Buvidal’ group compared to the control group (OR = 1.38, 95% CI = 1.26 to 1.52, P < 0.00001).We examined a number of secondary outcomes which focussed on safety and tolerability data. These showed no statistically significant differences between the two groups (drug overdose (OR = 0.09), drug related adverse events (OR = 1.75), severe adverse events (OR = 0.93), nonfatal serious effects (OR = 0.65), mortality (OR = 1.63) and discontinuation (OR = 1.52)).ConclusionThe studies have shown the efficacy of ‘Buvidal’ was statistically significant in comparison to the control groups, with no difference in their side effect profiles.To our knowledge, this is the first systematic review and meta-analysis of its kind, and our results support the hypothesis that ‘Buvidal’ is an effective and safe treatment for opioid use disorder.
Unspoken: Verbal Sexual Harassment by Patients in Psychiatry
Authors: Butler-Laurence Jo , Huang Xiaofei Fiona 
Published: July 2023

AimsPatient-initiated verbal sexual harassment (PIVSH) is common in the healthcare workplace, however institutes often neglect to address it. Objectives: (1) Define extent of PIVSH among staff at South London and the Maudsley Trust (sLaM), (2) Characterise the impact of PIVSH on staff, (3) Understand barriers to reporting PIVSH, (4) Inform policy and training to support staff.MethodsA questionnaire from Scruggs et al. (2020) was adapted with types of PIVSH on a standardised scale of severity from ‘most’ to ‘least’ harassing. The anonymous, retrospective, online survey was disseminated to sLaM staff via Trust-wide communications, staff networks and Whatsapp groups. Descriptive statistics were used to analyse quantitative data (PIVSH frequency, confidence to respond to PIVSH, reporting practices). Respondents used free text to describe the impact of PIVSH, reasons for not reporting harassment, and views on the role of the Trust and supervisors in addressing PIVSH. Qualitative data were analysed using thematic analysis and externally validated.Results42 responses were received across staff groups. 95.2% respondents had experienced PIVSH in the last year. 26.2% had formally reported an incident of PIVSH, with only 30.8% stating the report had been actioned by a senior. ‘Less severe’ harassment types were the most common, and the type staff were least confident to address. Five themes were identified in thematic analysis:
1.Nature of PIVSH: Unwanted, covert, influenced by victim demographics, the situation, and motivation of the perpetrator2.Response to PIVSH: Victim's emotional and practical response, and of the wider MDT3.Impact on trainee: Personal (desensitisation, feeling unsupported) and professional (time off, moved teams, avoidance of wards)4.Barriers to action: Practical barriers to reporting (lack of time, complexity) and organisational culture (‘patient unwell’ justification, trivialisation, lack of trust in management)5.Areas of improvement identified: Written policy on PIVSH clearly communicated to staff and patients; wider cultural changes of zero tolerance to PIVSH; open discussion and reporting, backed up by education and training; formalised support post-PIVSH eventConclusionThere is a negative impact of PIVSH on staff at sLaM and it is not properly recognised. The NHS is its staff and we cannot afford to neglect their well-being. Action as a result of this survey will include:
1.Creation of a training package with Maudsley Simulation2.Development of informational posters for clinical spaces3.Write up-to-date trust policy on PIVSH
Our Care Improvement System
Authors: Cuhraja Alina , Sullivan Jill , Boellinghaus Inga , Wray Josephine , Charles Michael , Oluwole-Moore Olukunle , Williams Hugh , Jones Emma 
Published: July 2023

AimsOur Care Improvement System is an integrated quality and performance system designed to develop co-ordinated approach to managing performance at all levels of the organisation, ensuring everything we do is aligned to achieving our goals set out in our Trust strategy. The aim of this programme is to help the team move away from typical firefighting routines, towards a more structured routine of problem solving, applying quality improvement tools and methodology.MethodsFive members of multidisciplinary team (MDT) in a Lewisham Community Mental Health Team were chosen as the core working team. They underwent four-month training programme which was one day per month plus weekly team coaching sessions from the Trust's Quality Improvement lead. One targeted measure was identified. This was to focus on improving patient discharges for more manageable caseloads, and ultimately provide a better staff and patient experience. A3 methodology was adopted to provide a structured framework for thinking through the problem. This included: problem statement, current situation, aims statement, root cause analysis, change ideas, actions, progress and benefits, and insights. In parallel, daily improvement huddles (15-minute long team meetings) were adopted to enable the team to problem solve other identified improvement work. The huddles follow a set structure of reviewing work in progress, new improvement opportunities, work that needs to be escalated and celebrated. This work was gradually widened to include the entire team.ResultsThe team's caseload was observed to be continuously going up from 200 in September 2021 to 264 in October 2022. We aimed to increase the number of safe discharges and to sustain a steady team caseload. Root cause analysis utilising a fishbone diagram identified barriers to discharge, such as lack of MDT approach and structure to discharge planning. Change ideas included creation of standard work, describing how an MDT discharge meeting would work. Actions were agreed to implement structured weekly MDT discharge meetings where four cases are discussed and safe discharge plans agreed, sharing responsibility for discharge decision. This has allowed us to reduce and maintain a steady caseload with 258 patients in January 2023.ConclusionImplementing Our Care Improvement System has not only provided a structure to our improvement work and improved our caseload but has also consolidated our team in working together for a common goal. We have naturally implemented structure to all other team meetings, which have now become more focused and productive, making our team a more rewarding place to work.