bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Service Evaluation of the National High Secure Deaf In-Reach Service
Authors: Kaler Gurpreet 
Published: June 2022

AimsThe National High Secure Deaf Service at Rampton Hospital provides inpatient assessment, treatment and rehabilitation for D/deaf* males living with a range of difficulties including complex responses to trauma, mental health difficulties and/or learning disabilities. In 2011, the Deaf Prison In-Reach Service was established in conjunction with Yorkshire Specialist Commissioning Group and Nottinghamshire NHS Trust aiming to provide specialist support to D/deaf prisoners. * ‘D’ = Deafness as a culture, ‘d’ = deafness as a medical disability.MethodsThe team evaluated the service to raise awareness of the specific needs of D/deaf prisoners by identifying and describing characteristics, demographics, trends and patterns within existing data as well as highlighting the nature of offences, prevalence of trauma and length of time over tariff. A secondary aim was to identify areas for development to adequately meet the needs of D/deaf prisoners.ResultsAfter reviewing data for 29 prisoners (female = 3, male = 26), the most common source of support offered by the DPRIS was signposting (over 50%), followed by direct individual work (with nursing or psychology), assessment and consultancy.Since 2011, the DPRIS has assessed 30 individuals and completed over 717 prison visits for assessments and interventions. Whilst this has been acknowledged as a small number, it has been attributed to the difficulties locating D/deaf prisoners and lack of awareness regarding the DPRIS. Currently, referrals to the DPRIS come from prison healthcare staff, but this fails to address the wider specialist needs of this population: basic communication needs, occupational needs and risk reduction work. It also excludes individuals unknown to healthcare.Direct engagement with the DPRIS included: focused risk reduction work, anger management, mental health monitoring, and 1:1 psychology work. Prior to involvement from the DPRIS, five individuals declined to engage in prison therapy. With support from the DPRIS, two were transferred to more appropriate placements, one was recommended for transfer (not transferred) and one received mental health monitoring (nursing). One continued to decline which could be attributed to potential (lack of) motivation/readiness.This evaluation supports the need for specialist interventions to ensure equitable access to recovery and rehabilitation.ConclusionWhat Next?It is hoped that the unique needs of this population will be communicated amongst professionals and steps will be made to address these as previously recommended in reports from the BDA (2016) and the Howard League.
The Effects of Remote Consultation (RC) on Outpatient Clinic Attendance Rates in City Community Mental Health Team (CMHT) and Patient Feedback on RC
Authors: Miller Ting , Thomas Joshua , Mukundan Anitha 
Published: June 2022

AimsThe outbreak of COVID-19 in 2020 forced a sudden change in service delivery in CMHT. Remote consultations (RC) via telephone or video were introduced to facilitate safe contact between staff and patients. Traditional face to face (F2F) appointments have high rates of non-attendance (DNA). This project aimed to examine whether the DNA rate for CMHT appointments has been affected by the introduction of RC. In addition to this, patients were asked to give feedback about how they felt about the use of RC.MethodsWe retrospectively studied the outcome of outpatient medical appointments within City CMHT over two periods, namely pre COVID-19 which was between April to June 2019 and during COVID-19 which corresponded to the same period in 2020. A list of patients over these two periods were extracted from trust electrical medical record: System One (S1). Further review patients’ notes on S1 was conducted to identify DNA group, among which detailed information including gender, age groups, types of outpatient clinics (urgent or routine, first review or follow-up review), types of consultations (remote or F2F).In addition, an anonymous patient feedback form on RC was given out to 30 patients attending F2F appointments at the clinic between May and August 2021.Results94% appointments were conducted remotely in 2020 while 100% were F2F in 2019 during the periods studied. 2020 saw a 16% increase in attendance rate and a nearly half reduction in cancelled appointments from 30% to 16%. There was a slight drop in DNA rate by 2%.19 patient feedbacks indicated at least one RC experience. Among them, 47% rated it as very good and 58% felt RC offered the same level of care and treatment as F2F. On the other hand, 74% would like to be seen F2F for future appointments when given a choice.Free comments about RC were captured including ‘Not everything gets covered’, ‘it makes me anxious to talk to a medical team over the phone’ and ‘things like bruises could be missed in a RC’. However, one patient said they found RC is less stressful.ConclusionA massive shift from F2F to RC was seen due to COVID-19 restriction. Attendance rated was improved with RC, however, it was mainly achieved by a significant reduction in cancelled appointments. Its impact on overall DNA rate appeared minuscule.Despite nearly half of the patients indicated RC is as good as F2F. Most patients prefer f2f for future consultation.
7 Day Follow-Up Arrangements Following Discharge From Psychiatric Hospital; How Do We Perform?
Authors: Alston Jemima , Balliou Rozet , Erlebach Naomi , Evans Zach , Grieve Anna , Hand Silas , Jindal Shreya , Lim Phei Yi , Shaw Matt , Wama Chukyi , Meadowcroft Ben , Murdie Douglas 
Published: June 2022

AimsThe first 7 days following discharge from inpatient to community psychiatric services is a period that is associated with an increased risk of suicide. NICE Guideline 53 recommends that patients discharged from inpatient psychiatric services should be reviewed by relevant community services within 7 days. We aim to determine how different teams in NHS Lothian performed in meeting this recommendation, and to ascertain the outcome of a specific intervention in North-West Edinburgh (NW).MethodsWe collected data of NW, North-East (NE), South-West (SW), South-East (SE) Edinburgh, East Lothian and Midlothian patients discharged from General Adult Psychiatry wards in the Royal Edinburgh Hospital for the calendar year of 2021. East and Midlothian were used as a comparison to Edinburgh services as the former have an integrated inpatient and community team.The data focused on the percentage of patients followed-up within 7 days of discharge. We also collected data for all NW CMHT patients discharged between January 2018 and November 2021 to analyse the intervention of using ‘Estimated Discharge Dates’ in ward rounds implemented in June 2020. Data were collected from NHS Lothian Analytical Services and anonymised in line with NHS Information Governance Policy.Furthermore, qualitative data were collected anonymously from staff within NHS Lothian in the form of an online questionnaire to ascertain strengths and weaknesses of the current systems.ResultsOver the calendar year of 2021, 1,398 patients were discharged. The average age was 41 years old.Regarding percentage of patients receiving 7 day follow-up, East Lothian (n = 191/249; 76.7%) and Midlothian (n = 95/122; 77.9%) performed better than Edinburgh services; NW (n = 173/268; 64.6%), NE (n = 172/301, 57.1%), SW (n = 155/247, 62.8%), SE (n = 123/211; 58.3%).The intervention in NW in June 2020 did not have a significant impact on 7 day follow-up.The questionnaire identified difficulties in transitions from inpatient to community care, particularly communication between teams.ConclusionThe performance of East and Midlothian versus Edinburgh services is interesting given their integrated model. This appears to support the findings of the questionnaire.The lack of impact of the intervention in NW will need explored further with the team to identify difficulties.Rather than complete service remodelling, perhaps moving towards a more integrated approach such as allocated discharge-coordinating community and inpatient nurses would be worthwhile. We will involve the NHS Lothian Quality Improvement team in exploring this to improve patient outcomes.
The Use of Skype Video Telecommunication (VTC) for Social Visits in a Medium Secure Hospital: A Service Evaluation
Authors: Okonkwo Obinna , Gibbon Simon , McCarthy Lucy , Taylor Nicholas 
Published: June 2022

AimsThe COVID-19 pandemic brought unprecedented disruptions in the ways we lived and interacted with one another. Research studies done in the immediate aftermath suggested that the COVID-19 pandemic and associated lockdown restrictions may have increased feelings of isolation and loneliness, which together with disruptions in services may have precipitated psychological distress and mental health deterioration, particularly among persons with pre-existing mental health conditions. Following the introduction of first national lockdown in late March 2020, all visits to the hospital by family and friends were ceased. VTC became one of the rapid interventions implemented across several NHS Hospitals to promote continued patient contact with carers. In October 2021, we set out to undertake an evaluation project to determine the level of patient satisfaction with the use of Skype for social visits, to understand patient and staff perspectives on its pros and cons, and to understand patient preference post-COVID-19 pandemic.MethodsAll ward-based staff who had ever facilitated Skype social visits and all patients who had had at least one social visit facilitated by Skype were approached to participate in the project. Data were collected using anonymous questionnaires with both quantitative and qualitative items.ResultsA total of twenty-nine patients and thirty-nine nursing staff participated in the study.Sixty-two per cent of patient-participants reported being satisfied with the Skype social visits and over half (52%) rated the Skype social visits as ‘the same’ as face-to-face visits. All participants reported patient-satisfaction with the process and speed of setting up a Skype visit, the benefits of visual contact and the reduction of travel costs. A few patient-participants noted that they relished the opportunity of seeing their home environment. Issues regarding increased demands on staffing resources, privacy, IT skills, and hardware and software glitches were identified.Overall, Skype social visits have been a positive experience for the patients and have not resulted in any significant risk concerns. Most patients (90%) indicated that they would like Skype social visits to continue post-COVID-19 pandemic.ConclusionThe average length of stay (LOS) of patients is often longer in forensic compared to general adult mental health units and about 4.5 years at the study site. This evaluation found that the introduction of Skype for the purposes of social visits was considered a useful development by both patients and staff. The study findings were fed back to all stakeholders and certain changes have been implemented as a result.
Service Evaluation Exploring the Use of Standardised Assessment Tools to Assess Non-Cognitive Symptoms of Dementia
Authors: Romeu Daniel , Taylor Amelia , Graham Alexander , Chatterjee Jane , Saraiva Sonia , Underwood Ben , Wolverson Emma , Russell Gregor , Crowther George 
Published: June 2022

AimsPain, depression, anxiety, and psychosis are common non-cognitive symptoms of dementia. They are often underdiagnosed and can cause significant distress and carer strain. Numerous standardised assessment tools (SATs) exist and are recommended for the assessment of non-cognitive symptoms of dementia. Anecdotal evidence suggests that SATs are used rarely and inconsistently. This study aims to explore which SATs to detect non-cognitive symptoms of dementia are recommended in local guidelines and used in practice across different organisations. Secondary aims were to identify barriers and facilitators to using these tools.MethodsThis service evaluation is cross-sectional in design. A questionnaire was developed and distributed to clinicians working with patients with advanced dementia in any setting, across four geographical locations (Leeds, Bradford, Hull, and Cambridge). Quantitative data were analysed descriptively, and qualitative data from free-text comments were interpreted using thematic analysis.Results135 professionals from a range of backgrounds and clinical settings completed the survey. Respondents indicated that SATs for non-cognitive symptoms in dementia were rarely used or recommended. Respondents were unaware of the existence of most SATs listed. 80% respondents felt that SATs were a useful adjunct to a structured clinical assessment. The most recommended tool was the Abbey Pain Scale, with 41 respondents indicating its recommendation by their Trust. Perceived facilitators to using SATs include education and training, reliable IT systems and accessibility. Barriers include lack of time and training.ConclusionNumerous SATs are available for use in dementia, but they are rarely recommended in local policy or used in practice. There appears to be a lack of consensus on which, if any, are superior diagnostic tools, and on how or when they should be applied.
Review of Remote Consultations in Learning Disability During COVID Pandemic
Authors: Saraswat Charvi , Bright Catherine 
Published: June 2022

AimsThe aim of this project was to assess the efficacy of remote consultations in patients with Learning Disability (LD). In Aneurin Bevan University Health Board, teleconsultation or “Attend Anywhere” (Video) platforms are the two types of remote consultation that is being offered.MethodsA 9- point Questionnaire was used to assess the efficiency of the consultation. During consultation (Either telephone or attend anywhere), data were collected by the consultants by answering the questionnaire. 23 clinics organised between 04/06/2020 to 23/06/2020 for Service Users' (SU) follow-up.The following key points were covered in the questionnaire:
1.Mode of consultation- telephone or attend anywhere2.Presence of the SU3.Introduction4.Availability of information (patient notes/shared drives) prior to consultation5.Time constraints6.Information not covered due to lack of face-to-face consult7.Technical difficulties8.Expectations from SU9.Feedback from SUResults1.The most common mode of consultation was via telephone (70%), followed by Attend Anywhere (30%)2.The majority of conversations were with SU's family or carers (70%); consultations with SU were only 30%. SU were unable to attend the consultation due to: Communication difficulty (26%), follow-ups provided by carer's/family's feedback (21.7%), SU away due to physical health reasons, or in day care (17.3%).3.Introductions were done and sufficient information regarding the service users were available in all consultations.4.Expectation of SU/carers/family was with regards to medication review (43%).5.52% of remote consultation were disrupted due to technical problems, for instance call drops and line disruptions, microphone issues and SU not being able to use attend anywhere because of its complexity.ConclusionIt was demonstrated that remote consultation could possibly be most effective for medication reviews or regular follow-up appointments.Some of the aspects that were not covered due to the shortcomings of remote consultations were:
a.Difficulty in assessing body language and facial expressionsb.Difficulty in assessing the level of function of SUc.Unable to monitor physical health parametersd.Difficulty in picking up non-verbal cues, and assess eye contact to ascertain mood component of presentation.In summary it seems in the early stages of the pandemic, telephone consultation was the predominant form of remote consultation. Further work would be useful to obtain the views of people with LD, their carers and families as to which form of consultation would be their preference and whether remote consultation is acceptable for this patient group.
Optimising Treatment Delivery and Reducing Length of Stay in an Adult In-Patient Unit
Authors: Singh Urvashnee , Salter Fiona , Cartwright Fiona 
Published: June 2022

AimsLifetime prevalence of eating disorders worldwide is 8.4% (3.3–18.6%) for women and 2.2% (0.8–6.5%) for men and this prevalence has been increasing over time. Anorexia nervosa has become a greater burden on secondary care: Not only have admission rates increased, but so too have multiple admissions per person with Anorexia Nervosa. Conservative treatment approaches and long lengths of stay have both direct and indirect costs for patients, hinder access to the service for potential patients and reduce service cost effectiveness. Ramsay Clinic Hollywood is a voluntary, private ten bed adult eating disorder inpatient service in Perth, Western Australia (WA). It is the only inpatient eating disorder specialist service for people over the age of 16, in both the private and public sector in WA. Over the past eight years, our focus has been on optimizing treatment delivery to minimise time spent in hospital for individuals with anorexia. The aim of this study was to evaluate whether instituting a rapid refeeding protocol was effective in optimising treatment outcomes, such as rate of refeeding and reducing length of stay (LOS).MethodsA retrospective review of data collected for all inpatients from 2013–2019 was conducted. The outcomes evaluated were length of stay and number of readmissions.ResultsUtilising a rapid refeeding protocol successfully increased the rate of refeeding from 0.6kg/week to 1.5kg/week. This led to a reduction in average length of stay from 52 days in 2013 to 24 days in 2017. Concomitantly we have been able to double the number of patients admitted to the service/ year and reduce the number of readmissions/ patientsConclusionThese results suggest that it is possible to lower length of stay by increasing the rate of refeeding and this in turn allows more patients access to hospital care for their eating disorder.
Identifying Gaps for Service Provision in Children and Young People With Learning Disability and Challenging Behaviours And/or Mental Health Needs
Authors: Yi Nu Nu , Watkins Joanne , Welch Colin , Chowdhury Zak , Illaiee Sam 
Published: June 2022

AimsChildren and adolescents with learning disability need multi-disciplinary input when they present with challenging behaviours or mental health disorders. This patient group needs specialist skills from the clinicians and professionals to support and meet their needs. There is no commissioned Child and Adolescent Learning Disability Mental Health Service (CAMHS) in Waltham Forest and support comes from Specialist Tier 3 generic CAMHS which comprises of Emotional Difficulties Pathway, Neurodevelopmental Disorders Pathway and recently developed Behaviour Pathway which mostly comprises of specialist parenting training/interventions. To identify gaps in service provision for children and young people with learning disability presenting with challenging behaviours and/or mental health needs in Waltham Forest as there is no formally funded CAMHS learning disability service in the locality.MethodsAll children and young people under 18 with learning disability under Waltham Forest CAMHS with ASD/ADHD and other neurodevelopmental disorders who meet the project criteria are included. Project criteria include 1) Main diagnosis of Learning Disability (Including clients with Learning difficulty (global), likely to have low IQ with cognitive impairment.), with or without associated other Neurodevelopmental disorders (e.g., ASD, ADHD or tics) or other mental health disorders and 2) Engages in challenging behaviours. Challenging behaviours defined as behaviours significantly limiting engagement in daily & family life, education and/or social activities, and have persisted for at least a period of 3 months. Data were collected from electronic recoding system of individual patients; using a data collection sheet on level of learning disability; comorbid neurodevelopmental or emotional and mental health disorders; profession of allocated clinician; joint working with discipline; involvement with social care; allied health professionals input; presenting difficulties and severity; CETR or hospital admissions; referral to National services; What interventions offered (Medications, Behaviour assessment and/or interventions); if medications offered, was it used as first line and how long for; parents’ view on medication management.ResultsAs we have expected, medication management were used as first line and there were limited offers of behaviour support. Joint working with social care, speech therapy and occupational therapy but with limited input especially occupational therapy in cases with high sensory needs. It was unclear with the cognitive assessment and diagnosing the learning disability in the population under 16s.ConclusionThere is a service gap for CAMHS learning disability population and more joint working needed among relevant health professionals.
The Effect of the First Coronavirus Lockdown on Psychiatric Outpatient Attendance, a North Fife Survey
Authors: Adegbite Adebola , Howson George 
Published: June 2022

AimsThere has been a significant change in the way we see patients during psychiatric consultations, this has led to challenges we face in delivering safe and effective care to patients under our care. “Telepsychiatry” has been used in literature from countries like Australia and India, there is very little around coming from the UK but there appears to be many ongoing research making the rounds. It is interesting to know that the existing literature on remote/virtual consultations during the COVID-19 pandemic are on the rise. The idea of this study was conceived during outpatient clinics after making an observation that many patients were likely to miss their appointments when they had telephone appointments compared to video consultations. This prompted a study to know if this is more likely to be observed in other outpatient clinics. The purpose of this study was to establish if virtual/remote consulting has affected patient attendance rate and whether this is also affected by the type of virtual consultation.MethodsThe data were collected using the “2020 stats sheets” for inpatient appointments between North Fife consultants from January to October 2020. This was registered with the NHS Fife clinical effectiveness team in January 2021.ResultsThe results were categorized for the purpose of this survey as January – March (Pre-lockdown) and April – October (lockdown). It is important to note that some face-to-face appointments occurred during lockdown because there were emergency assessments and drug monitoring appointments scheduled.The results of this survey showed that there was a clear reduction in clinic appointments made during lockdown compared to pre-lockdown and slight observable improvement in attendance rates during the lockdown. There was no statistical significance seen using t-test comparing attendance rates between video and telephone consultations including new patient virtual consultations.ConclusionThe large sample size over this period suggests that the results are reliable and valid, we can therefore say virtual/telephone consultation does not affect attendance. It should be noted that the attendance rate may be a good indicator but we should also consider patient/clinician satisfaction, communication quality/effectiveness and other factors which could influence patient's compliance to outpatient follow-up. It is important to acknowledge the lack of a control group and the COVID-19 pandemic were major cofounding factors. Mental health services should continue the use of virtual consultation post-pandemic and possibly integrate it with in person consultations (hybrid), this may help with attendance rate of patients with difficulty attending face-to-face appointments.