bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the Use of the Mental Health Risk Assessment (MHRA)
Authors: Sampey Libby , Walzl Dennis , Wee Colette , Clafferty Robert 
Published: June 2022

AimsThe MHRA is a comprehensive form on our electronic patient records system. It includes 11 sections assessing different risk categories, with tick boxes to evidence input from various members of the MDT. Anecdotal experience suggested that these forms were sometimes incomplete and often lacked input from MDT members other than nursing staff. We aimed to increase the completion rate and multidisciplinary team (MDT) involvement, particularly doctor involvement, in the electronic MHRA documentation on an acute inpatient psychiatric assessment ward at the Royal Edinburgh Hospital.Methods•Baseline survey (November cohort of 12 patients): data collection on number of sections completed (total number = 11) and whether the ‘psychiatrist’ box was ticked, indicating medical input.•Intervention: doctors on the ward reviewed all inpatient MHRAs, added additional assessments if appropriate, and ticked ‘psychiatrist’ involvement in the MHRA.•Repeat survey (February cohort of 11 patients): data collection as before and review of findings.ResultsIn our baseline survey (November 2021), 75% (9/12) of patients had all sections of the MHRA completed. 33% (4/12) had the ‘psychiatrist’ box ticked. In our repeat survey (February 2022), 91% (10/11) of patients had all sections of the MHRA completed. 100% (11/11) had the ‘psychiatrist’ box ticked.ConclusionAccurate assessment and management of risk is an important factor in the safety of patients and staff on acute psychiatric wards. Our baseline data showed that risk assessments had limited medical input and at times had sections which were not filled in at all. Review of the MHRA by medical staff improved this, and in some cases found and added relevant information which had been missed. As a person dependent intervention, this may not be a sustainable change. As a first step to introduce a sustainable system change, a visual prompt has been introduced, in the form of a blue triangle icon in the duty room whiteboard to highlight whether each patient has a complete and up to date MHRA. Further interventions could include integrating a review of the MHRA in weekly ward rounds. This audit also raised the issue of some relevant information having been missed from risk assessments and showed that further audit of the quality of risk assessments is indicated.
A Re-Audit Assessing the Standardisation of Admission Blood Tests for Patients on Norbury House (PICU)
Authors: Kaur Raminderjit , Sargent Sarah , Shanmugaratnam Hari , Winchester Mark 
Published: June 2022

AimsAssess if variation exists for routine blood tests performed on admission, evaluate compliance with MPFT guidelines when performing routine admission blood tests, compare results with the previous audit completed in October/November 2020 and identify strategies to improve and standardise admission blood tests.MethodsRetrospective blood result data were collected for all admissions to Norbury House (PICU) at St George's Hospital in Stafford over a two month period. For the original audit, this was between October and November 2020, following which a staff education programme raised awareness of trust guidelines regarding admission blood tests. This was then re-audited in May and June 2021 to assess its impact. Patients transferred from acute wards were included but repeat admissions were omitted. Data analysis was completed through Microsoft Excel.Results17 patients were included in the audit in October and November 2020 while 13 patients were included for the May and June 2021 audit. As per trust guidelines, the number of patients having the appropriate admission blood tests increased to 69% in 2021. Certain mandatory blood tests were requested far more regularly such as TFTs increasing from 71% in 2020 to 100% in 2021. Other vital blood tests on admission also increased substantially, such as Glucose increasing from 6% of admissions in 2020 to 69% in 2021 and Prolactin increasing from 77% in 2020 to 100% in 2021. All mandatory blood tests either increased in frequency or maintained a 100% completion rate, with the exception of Calcium which decreased slightly from 94% in 2020 to 92% in 2021.In the 2020 audit, unnecessary blood tests were requested for 88% of patients which was reduced substantially to just 21% of admissions in the 2021 audit. The total number of unnecessary tests also greatly reduced from 23 tests in total in 2020 to 3 in 2021.ConclusionIt is vital that patients being admitted to the PICU have the appropriate blood tests completed on admission, as they may be prescribed psychotropic medication that impacts their physical health and may have been self-neglecting prior to admission. Although the audit shows that the interventions completed following the last review have been hugely successful in improving compliance with trust guidelines and reducing waste of NHS resources, there is still significant room for improvement through the continual education of staff. This should then be re-audited again in Spring 2022 to ensure that the improvement continues.
Assessment of Legibility and Completeness of Prescriptions at Tertiary Care Hospitals: A Cross-Sectional Study
Authors: Saeed Sajeel , Tousif Kashif , Haider Tehseen , Dhillon Rubaid Azhar , Ebad ur Rehman Mohammad , Munir Attiya , Asif Omaima , Asif Nabeel , Arish Muhammad 
Published: June 2022

AimsThe aim of this study was to assess the legibility as well as components of a prescription prescribed by doctors in tertiary care hospitals of Rawalpindi, Pakistan.MethodsAn analytical cross-sectional study was conducted in pharmacies of two allied hospitals of Rawalpindi Medical University. Data were collected using stratified randomized sampling. A total of 661 prescriptions were selected and analysed for legibility by three experts. SPSS version 26.00 and Graph Pad Prism were used to enter and analyze the data. Descriptive statistics, correlational model and multinomial logistic regression were applied.ResultsA total of 1982 drugs were prescribed in 661 prescriptions. A total of 46.0% prescriptions were classified in grade 2 and 32.1% in grade 3. On average, 55.74% prescriptions were found to be complete. On average, prescriber's information, patient's information and medication details were present in 72.64%, 57.25%, and 36.73% prescriptions, respectively. Grade 1 (AOR = 0.62), grade 2 (AOR = 0.83), and grade 3 (AOR = 0.85) prescriptions had less odds of being complete compared to grade 4 prescriptions.ConclusionMajority of the prescriptions prescribed at tertiary care hospitals were barely legible and also quite a number of prescriptions were incomplete.
'Just Say No' (Or at Least Ask Why) STOMP Medication Reviews in Tower Hamlets Community Learning Disability Service
Authors: Jones Anthony , Fouladi-Nashta Shiva , Eady Nicole , Bedeau Simon , Hafezi Hannah 
Published: June 2022

Aims'STOMP stands for stopping over medication of people with a learning disability, autism or both with psychotropic medicines. It is a national project involving many different organizations which are helping to stop the over use of these medicines. STOMP is about helping people to stay well and have a good quality of life'. Our aim was to reduce the percentage of psychotropic burden on the LD and/or autism caseload in Tower Hamlets.MethodsWe reviewed the internal LD caseload that fit STOMP eligibility criteria (prescribed antipsychotics without an indicated mental health diagnosis).We calculated the% of BNF maximum dose for individual service users, aimed to reduced this, and reviewing the cumulative dose reduction achieved across the service, before and after an intervention.The primary intervention was the introduction of a pharmacy led clinic for service users meeting the criteria. This allowed closer f/u from LD pharmacist, thorough medication histories independent of their routine psychiatric reviews, and using GASS and BAI scales to quantify change achieved to their quality of life.We used early and rigourous people participation to consider the role medications (and their overprescription) in service users quality of life, and asked what service users want out of these medication reviews. Several focus groups were ran without People Participation Lead.ResultsPrior to starting of clinic - Of 29 STOMP eligible patients within TH CLDS, we have reduced antipsychotics in 8 of them through general raising awareness of STOMP (presentations to staff, reviews of GP letters to identify service users within the caseload who are likely to benefit and/or be receptive to dose reductions etc). So far total reduction of 45.4%, (and a total of three patients have been stopped all together).ConclusionThe majority of the results and intervention are yet to be collated, and we are collecting these over the next 2 months, but provisionally we hope to conclude that by reducing the quantity of psychotropic medication we prescribe will improve the quality of life for our service users
“Drilling Down”: psychiatry and dentistry in collaborative action
Authors: Cattra Chiara , Malaga Elizabeth Gonzalez 
Published: June 2022

AimsPeople with severe mental health illnesses experience multiple adverse physical health outcomes, in part caused by difficulties accessing, engaging with health promoting behaviour, treatment and recovery strategies. As oral health is a major contributor to physical and mental wellbeing, obstacles to care, prevention, and therapy play an important role in the oral health of individuals with mental illnesses. Psychiatric medications are known to predispose to oral health pathologies, including sialorrhea and dental caries, electroconvulsive therapy (ECT) may rarely result in dental fractures, and substance misuse may contribute to poor dental health. Unsurprisingly, COVID-19 has been more acutely noticed by those already at risk of worse oral health outcomes, including people with mental health conditions.MethodsWe address the interplay between mental health and dental care, outline evidence behind the vital importance of collaborative working, and advocate for a joint approach between mental health and dental teams utilising harm reviews adapted to assessing the impact of delay dental care upon patients and families’ quality of life. As COVID-19 persists and winter pressures are experienced every year, these raise the question of what needs to be done to demonstrate the effects of poor oral health on patients with learning difficulties and mental illness.ResultsWith annual winter pressures in healthcare, many elective operations are postponed to allow capacity for increased demand. Dental general anaesthetics are amongst the first lists to be suspended, particularly since the arrival of COVID-19. During the first peak of the pandemic, limited access to personal protective equipment and concerns over viral transmission risked by aerosol generating procedures restricted the provision of community dental care to urgent cases, and dental general anaesthetics to life-threatening infections alone.These impacts were particularly acute for those with learning difficulties and mental illness, further exacerbated by social, geographical and financial inequalities. Waiting for patients to deteriorate to access dental care treatment seems in direct opposition to the mental health movement towards community and early management of mental illnesses.ConclusionAdapted harm reviews are a powerful tool for mental health and dental teams to demonstrate to hospital managers the multidimensional impact that poor oral health has and causing physical, behavioural and emotional deterioration on patients, families and supporting staff. Wider understanding of the dental needs of those with mental health conditions may foster research on the interplay between oral and psychological health, and remains vital to multidisciplinary, compassionate and holistic care.
The Prevalence of OCD Like Symptoms Among UAE Residents During COVID-19 Pandemic
Authors: Alhaj Hamid , Ali Amena , Askari Hamid , Ibrahim Hend , Ali Leena Mohamed , Kassasand Leen , Nasere Noura Al 
Published: June 2022

AimsObsessive-compulsive disorder (OCD) is a psychiatric disorder characterised by repetitive, undesirable thoughts or acts. With the pandemic being on the rise, public health authorities have urged people to take proper health measures, specifically around hand washing and social distancing. It is hypothesised that such sudden change would cause excessive hygiene habits in people predisposed to OCD. Our study aimed to measure how COVID-19 pandemic affected the prevalence of OCD-like symptoms among the UAE population. Furthermore, we explored the correlation between these symptoms and demographic factors.MethodsThis was a quantitative cross-sectional study that used an online survey platform to collect responses from male and female adult UAE residents (aged between 18 and 60 years). The self-administered questionnaire included Yale-Brown Obsessive compulsive scale (YBCOS) to test the severity of obsessions and compulsions, in addition to demographic questions. People with a previous diagnosis of obsessive-compulsive disorder were excluded. Data were analysed using SPSS 23. A bivariate analysis to examine the correlation between the severity of the reported symptoms and sociodemographic characteristics, age, and ethnicity was conducted. A p-value <0.05 was considered statistically significant.ResultsA total of 343 questionnaires were completed and used for analysis; 244 of which were females and 99 were males. 63.5% of females had no symptoms of OCD, 24.6% had mild symptoms, 9% had moderate symptoms, 2.5% had severe symptoms, and 0.4% had extreme OCD symptoms. In males, 75.8% had no OCD symptoms, 18.2% had mild OCD, 6.1% had moderate OCD, and 0% had severe or extreme OCD. A significant correlation was found between the Emirate of residence and the severity of OCD-like-symptoms (P = 0.042). The most significant scores of OCD symptoms were in Sharjah, with 10 people out of 108 displaying moderate to extreme symptoms, Abu Dhabi with 9 out of 115 and Fujairah with 7 out of 56. Level of education, occupation and age had no significant role in the exhibition of the symptoms.ConclusionTo our knowledge this is the first study to investigate the prevalence of OCD-like symptoms within the UAE residents during COVID-19 pandemic. The symptoms of potential clinical significance of OCD are high, especially in females compared to the global prevalence studies prior to COVID-19, although a within-subject comparison is not possible. Further research is warranted to investigate the long-term effect of COVID-19 on OCD-like and other neuropsychiatric symptoms and elucidate possible mechanisms.
Evaluation of Fife Forensic CMHT Liaison Services Over 10 Years
Authors: Duthie Leanne , Pike Elspeth 
Published: June 2022

AimsFife FCMHT offer two forms of liaison; a court liaison service and a consultation service open to any professional requiring guidance on managing a person with mental disorder and offending behaviour. Our aims are to evaluate these services by analysing the number of referrals, reason for referral and outcomes in order to assess how our services are being used and help identify any areas for improvement.MethodsDetails about each referral made to the court liaison and consultation services and outcomes were recorded from January 2011 to December 2021. Data were analysed in excel.ResultsCourt Liaison Service1044 referrals were made; 778 of these were assessed. 98.7% were seen on day of referral. 76 required inpatient admission, 9 of whom had to be remanded in custody to await appropriate bed. Age ranged 15–78 years. Of those deemed fit to continue through court, 33% were felt to require further mental health input.Consultation Service280 referrals were made. Age ranged 15–83 years. The majority of referrals to this service came from criminal justice social work and NHS fife services. The majority of referrals were for specific advice or help with risk assessment and management. The average time between referral and consultation was 9.4 days.ConclusionReassuringly, our team responds promptly to referrals.25.5% of referrals made to the court service did not require assessment after triage. Only 7.3% of referrals required diversion away from the court system. Whilst 33% of those deemed fit to continue were identified as requiring further mental health input, this was often in the form of signposting to local services. As referrals are usually seen by health care in custody, this suggests mental health training for these teams would be of benefit to prevent delays in court proceedings and prevent unnecessary referrals.Of concern are those patients remanded in custody to await a psychiatric bed. Whilst numbers are small, it is an unacceptable outcome for these patients. This occurs due to no bed being available or a requirement for assessment by the admitting unit. This mirrors findings from the Barron Report.Our consultation service sees requests from a vast array of professionals. We believe this to be an efficient way for services to access the expertise within our team, avoiding unnecessary referrals causing delays to patient care. The majority of these referrals were for advice over a specific matter which can be dealt with succinctly by the team.
Implementing 360-Degree Simulation Training During Psychiatry Placement Inductions: A Mixed Methods Training Evaluation
Authors: Abraham Seri , Hewson Thomas , Kaye Emily , Soltani Niksa , Preston Gareth , Khanna Ankur , Higgins Sara , Ramkisson Roshelle 
Published: June 2022

AimsThe authors designed a simulation training programme for foundation doctors beginning psychiatry placements across a large mental health trust. The simulation training aimed to improve the confidence, competence, and well-being of foundation doctors through exposing them to realistic psychiatry scenarios and teaching clinical skills in a safe environment.MethodsFour clinical scenarios were filmed with a 360-degree camera, professional actress, and doctors working in psychiatry. The scenarios depicted the journey of a patient being admitted onto a psychiatry ward from the community. Various clinical skills were embedded into the videos including psychiatric history taking, risk assessment, managing acute distress, managing comorbid physical and mental health problems, using the Mental Health Act, and teamwork with colleagues. All videos were delivered to learners using simulation with head-mounted-displays (HMDs). Each video lasted 6–8 minutes and was accompanied by pre-briefing and de-briefing with experienced psychiatrists for a further 15–20 minutes. Participants rated their confidence regarding several skills in psychiatry on Likert scales from 1 to 5 immediately before and after the session. Wilcoxon signed rank tests were conducted to detect statistically significant differences in learner's median confidence ratings before and after the training. Free-text questions explored trainee's most and least favourite aspects of the simulation. A survey also was distributed to learners 2-months after the training to assess how it had influenced their clinical practice.Results20 foundation doctors completed the training and provided feedback. Following the simulation training, there were statistically significant improvements in foundation doctor's confidence in: completing psychiatric assessments (p < 0.01), managing physical health problems in psychiatry (p < 0.05), managing acute distress (p < 0.01), reporting information to senior colleagues (p < 0.05), and containing anxiety when communicating with patients (p < 0.05). Trainees highlighted the debriefing, group discussions, and “interactive” simulation videos as the most useful aspects of the training. Some trainees enjoyed viewing the 360-degree videos, whilst others found the HMDs difficult to use. Of the 8 trainees who completed feedback 2 months after the training, 7 (87.5%) felt that it had helped them in their current roles. All trainees agreed (37.5%) or strongly agreed (62.5%) that the simulation scenarios were closely aligned to real-life clinical encounters.ConclusionSimulation training in psychiatry using 360-degree videos and HMDs is generally well-received amongst foundation doctors. Embedding simulation training into placement induction can improve the confidence and skills of junior doctors starting psychiatry placements.
Safety of Delivering Eating Disorders Day Treatment Programme on the Virtual Platform in (COVID-19) Pandemic
Authors: Obiekezie Adaora , Friel Claudia , Pathan Mohammad Tayeem 
Published: June 2022

AimsIntensive treatment for eating disorders include day treatment programme and specialist inpatient. COVID-19 pandemic led to lockdown in the UK on the 23rd March 2020. Adult Eating Disorders Day Treatment Programme in Surrey started delivering their care on the virtual platform from that date. It offered a combination of ‘virtual’ only and ‘blended’ care (virtual and in person) for more than a year. This service evaluation examined the safety of delivering intensive eating disorders treatment on the virtual platform.MethodsData from March 2020 to March 2021 were retrospectively collected from Electronic patient record. Two clinicians collected the data on age, referral origin, accommodation, employment status, diagnosis (subtype), length of illness, comorbid mental and physical health diagnosis, duration of day care treatment, medication, admission weight and BMI, discharge weight and BMI, changes in bloods and ECG, acute hospital admission, risk-to-self events, admissions to Specialist Eating Disorders Unit and reasons for discharge.ResultsData indicated that 21 patients were admitted in day treatment programme over 1 year period. 10 patients had solely virtual treatment and 11 patients had blended day treatment programme. 11 patients had anorexia nervosa restrictive subtype, 5 patients had Anorexia Binge purge subtype and 5 patients had Anorexia Nervosa, Unspecified.Average length of illness was 4.49 years. Mean age for the group was 24.7 years and most patients lived with family (n 18) and were unemployed (n 11). More than 2/3rd (76%) patients had comorbid mental health diagnosis and 48% (n 10) had comorbid physical health diagnosis.Average length of admission was 5.26 months. Mean BMI on admission was 15.3 (Range 12–19) and mean BMI on discharge was 16.9 (Range 13.65–22).Safety and outcome data indicated that there were no serious incidents recorded in that time period. 1 (5%) patients required admission to acute hospital as their physical health deteriorated. 8 (38%) patients required specialist inpatient admission as the day care did not affect any changes to their eating behaviours, and 4 (19%) patients had events indicating self harm episodes(19%).ConclusionOur service evaluation data indicated that it is relatively safe to deliver day treatment programme on the virtual platform. Weekly face to face physical health monitoring (weight, BP, Pulse, temperature) and regular physical health investigations (Blood tests and ECG) were integral part of managing risks to health. On the other hand, delivering day treatment programme on the virtual platform has enabled the day treatment programme to prevent any significant outbreak of COVID-19 in a vulnerable group of patients and allowed them to receive uninterrupted support during pandemic.