bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatric, Neurophysical and Neurocognitive Sequelae of Post-Acute COVID-19 Syndrome: A Systematic Review
Authors: Vincent Arun , Ofovwe Oghenefejiro , Gschwandtner Manfred , Shergill Sukhi , Faruqui Rafey 
Published: June 2022

AimsCOVID-19 causes cognitive, neurophysical and psychiatric sequalae that persist beyond the acute illness. These appear to be independent of the direct impact on respiratory function although the impact of multiorgan, especially brain pathology, may be a contributory factor – as may psycho-social effects of the disease. We performed a systematic review of literature to assess the sequelae of post-acute COVID-19 syndrome to better understand the need for dedicated interventions to improve functioning.MethodsWe conducted a systematic review of reports included in MEDLINE, PsycINFO, and EMBASE. We searched for cohort studies exploring psychiatric and neuro-cognitive sequelae of post-acute COVID-19 in adults with a sample size of at least 100. The search was conducted on 4 February 2022. Findings are reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two authors independently assessed the included studies’ methodological quality using The National Institute of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies and all records were rated as good or fair.ResultsOur search identified 66 records and 14 met protocol requirements. The studies varied in sample size ranging from 100 to 3762 participants. Time to follow-up ranged from 1–12 months. Main symptoms identified by a majority of the studies were; Fatigue (25% to 85%) and Sleep problems (20% to 79%). Psychiatric symptoms; Anxiety (19% to 56%), Depression (11% to 47%), PTSD (6% to 43%) and altered sense of reality (3% to 15%). Neuro-cognitive symptoms; Cognitive dysfunction (25% to 85%), brain fog (12% to 81%), memory problems (24% to 73%), concentration difficulties (25% to 54%), and attention deficit (27%).Female sex, advanced age, pre-morbid asthma or COPD, increased disease severity, high BMI and new neurological complications during hospitalisation were some of the identified risk factors for persistent symptoms in post-acute COVID-19. One study identified male sex as a risk factor for moderate to severe PTSD. Current evidence suggests that symptoms decrease over time.ConclusionThere is clear evidence of neuro-physical, psychiatric and neurocognitive sequelae in post-acute COVID-19 syndrome. Differences in assessing and reporting findings makes it difficult to synthesize meaningful information. Identifying and formulating standardised assessments for outcome measures and reporting systems would be useful in future research. Further research into symptoms of post-acute COVID-19, to understand the pathophysiology will better enable us to raise public awareness, introduce preventative measures and incorporate appropriate treatment strategies for rehabilitation.
Frequency of Diagnostic Classification Systems’ Usage by Mental Health Professionals in Day-to-Day Clinical Practice
Authors: Vrigkou Eleni , Stamatakis Robert , Umla-Runge Katja 
Published: June 2022

AimsDiagnostic classification systems (DCSs) are medical models constructed by experts with the purpose of facilitating diagnostic processes. Specifically in psychiatry, DCSs serve as mental health professionals’ major diagnostic tool. Several studies, however, suggest that mental health professionals may not systematically apply the DCSs in day-to-day practice. The primary aim of this secondary research was to assess the actual frequency of DCSs’ application in psychiatric practice. All DCSs were considered. The secondary aims were to investigate the mode of DCSs’ application (e.g., assign diagnosis, inform treatment, administrative/billing or teaching purposes), and to assess if DCSs’ usage patterns vary depending on the clinicians’ specific occupation (e.g., psychiatrists, psychologists) and country of employment.MethodsThe bibliographic databases of MEDLINE Via Ovid, PsycInfo, Web of Science and Global Health were searched from 1/2000–12/2020. All primary studies assessing DCSs’ frequency of application by mental health professionals were eligible for inclusion. The search yielded nine eligible articles. The total number of participants from all included studies was 10,388. The study samples were diverse, including practitioners from a wide variety of geographical locations, languages, and income-level countries.ResultsThe results of the study showed that 69% (95%CI = 58–80%) of the responders use DCSs “often, almost always or always” in day-to-day practice. Regarding the mode of DCSs’ application, responders stated that they use DCSs most frequently for administrative/billing purposes and assigning a diagnosis. The study's results also showed that 68% (95%CI = 45–90%) of psychiatrists and 74% (95%CI = 43–100%) of psychologists use the DCSs “often, almost always or always”. Subgroup analysis based on responders’ country of employment suggest that the frequency of “often, almost always or always” DCSs’ usage (according to World Health Organization regions) were: for the Region of the Americas 75.3%, for the African Region 73.5%, for the Western Pacific Region 71.6%, for the European Region 69.4%, for the South-East Asia Region 66.8%, and for the Eastern Mediterranean Region 57.1%.ConclusionThe study's outcomes indicate that DCSs are integrated into the daily practices of mental health professionals worldwide. Further research is needed, however, in order to assess in more depth DCSs’ application practices (e.g., comparative usage of different DCSs, types of mental disorders, patients and settings where DCSs are more frequently applied). Such findings could be valuable, since they can be used to help appraise the quality of DCSs’ actual use, the impact of DCSs on clinical care and public health, and also to aid design more effective mechanisms for DCSs’ further implementation.
A Scoping Review on Barriers to Mental Healthcare in Canada as Identified by Healthcare Providers
Authors: Wang Jeffrey , Pasyk Stanislav , Slavin-Stewart Claire , Olagunju Andrew 
Published: June 2022

AimsMental illness is among the leading causes of disability globally, however the treatment gap is wide even for developed countries. The perspectives of patients and mental healthcare providers are critical to understanding barriers to adequate mental healthcare and developing scalable solutions that improve access and quality of services. However, the views of providers are relatively understudied, precipitating our review to collate and synthesize their perspectives on the barriers to mental healthcare in Canada.MethodsWe searched MEDLINE/PubMed and PsychINFO for studies with findings in Canada published in English from 2000–2021 with terms for mental health, psychiatry, barriers, and referrals. Included studies were evaluated with the National Institutes of Health Study Quality Assessment Tools and Critical Appraisal Skills Programme.Results631 papers were screened, finding 20 eligible studies, including 13 qualitative, one cross-sectional, one retrospective, and five mixed-methods studies. Through inductive content analysis, five themes of barriers emerged: (1) patient accessibility (19% of studies), (2) health systems availability and complexity (31%), (3) training/education (25%), (4) work conditions (21%), and (5) cultural sensitivity (4%). Among barriers discussed, common challenges included a lack of resources for both patients and providers, gaps in continuing education for primary care providers, and health systems challenges such as difficulty securing referrals, unclear intake criteria, and confusion due to overload of contacts.ConclusionHealth systems face a multi-faceted set of challenges to improving access to mental healthcare that will require solutions from various stakeholders. Understanding these barriers is critical in focusing initiatives to improve mental health care, both in Canada and in countries facing similar challenges.
Introduction of ECT Discharge Summary- a Quality Improvement Project to Improve Communication Between Treating and Referring Clinicians and Aiming Better Patient Care
Authors: Ahmad Ayesha , Khan Adnan , Abiodun Yetunde 
Published: June 2022

AimsThere was an initial QIP done in 2019 highlighting the deviation and deficits from ECTAS Guidelines. We tried to make positive change by introducing checklists and assessments. We were able to reach our goal but noted that collating information was a time taking task. More ever, documents were not always accessible as patients come to Mid Essex ECT clinic from other parts of Trust as well as from Private inpatient settings which meant that we did not have records for those patients. We noticed clear lack of communication between out of area referring and treating clinician regarding treating team's view about patient progress, assessment results and recommendations for future ECT need, which we thought could be improved by generating discharge summary of each patient as end of treatment.MethodsWe conducted retrospective audit for all treated patients in ECT clinic in 2020(n = 18,re-audited in 2021 and 2022(n = 13) to see documentation, including Consent documents; Form 5(consent) in case of capacity, T4/T6/S62, Documentation of Memory assessment, as well as MADRS assessment before and during the procedure. We started generating ECT discharge summaries in November 2021 and collected data for all patients (13) till 6th February 2022.ResultsDocumentation of Legal Status: 5% in 2020 vs.100% in 2021* and 2022Written consent /form 5: 95% in 2020 vs. 100% in 2021* and 2022Documented Mini-ACE: 5% in 2020 vs. 100% in 2021* and 2022Doc. MADRS assessment; 0% in 2020 vs. 100% in 2021* and 2022*(excluding patients who did not complete the treatment)ConclusionThe audit results of 2020 showed improvement however assessments done during treatment were not accessible to referring clinicians or to patients. Introduction of discharge summary helped to give snapshot of patient's weekly progress, weekly objective assessment scores which helped the referring clinicians to get idea about patient's improvement and resulted in improved communication as well as patient and carer satisfaction.Small actions can have big impact on the way patient care is delivered. We believe that going through process of auditing helped us to improve our practice and make a positive change in terms of delivering better care.
Improving Awareness and Accessibility of Well-being Resources Among Core Psychiatric Trainees in the West Midlands Deanery- a Quality Improvement Project
Authors: Asiodu Nneamaka , Williams Ellen , Narula Amitav 
Published: June 2022

AimsSupporting the mental health and well-being of psychiatrists impacts on the quality of patient care delivered, and crucially for trainees, on retention to the profession. Our aim was to survey core trainees to gauge their awareness, access and use of well-being resources.Methods111 core trainees in the West Midlands deanery were invited to complete an anonymous online survey during November 2020. Quantitative data were analysed using Google Forms and Microsoft Excel. Qualitative data were reviewed by all team members to identify relevant themes.ResultsOnly 14% of trainees felt well informed about the well-being resources available to them, 57% who attended local trust induction and 82% who attended deanery induction did not think nor recall if the topic had been covered. Despite this, trainees were aware of a range of resources, with the most known being BMA Wellbeing (58.3%), Psychiatrists’ Support Service (44.4%) and the local Peer Support Unit (30.6%). Just 14% of trainees reported using a well-being resource during their training.ConclusionOur results suggest that more work needs to be done at local trust and deanery level to make well-being a priority during induction and improve awareness of available resources. At least one trainee reported they would not seek help, due to concerns about the impact on their training progression, and stigma may be an under-reported barrier to accessing these resources.We hope to use our results to improve signposting, and to collate a resource easily accessible and applicable to all trainees in the deanery.
QIP: Liaison Psychiatry Outcome Measures at University College Hospital in London
Authors: Auyeung Ariana , Patel Lisa 
Published: June 2022

AimsThe purpose of this quality improvement project was to improve the collection of outcomes in the Liaison Psychiatry (LP) department at the University College Hospital in London (UCLH). To achieve this, the Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP) was used to gather data and evidence on clinical and other patient-related outcomes provided by the department. The FROM-LP was created to provide a consistent way to compare the quality and performance of Liaison Psychiatry services across the NHS. It was developed in 2015 and is based on the most widely used measurement frameworks for assessing quality and performance of services.MethodsThis project implemented the FROM-LP, using the Identify and Rate the Aim of the Contact (IRAC) tool and the Clinical Global Impression – Improvement scale (CGI-I) from September to November 2021 in the UCLH Liaison Psychiatry department. The PDSA (plan, do, study, and act) cycle was used to carry out this quality improvement project and the data were collected by two foundation year doctors.The IRAC scale identified ten categories for the aim of contact by LP and a rating on whether the aim was fully achieved, partially achieved, or not achieved after patient contact. The CGI-I scale was used to rate whether a patient had improved upon discharge by LP. Data were also collected on the demographics of patients, the specialty teams that referred to LP, whether legal frameworks were used, and where patients were discharged to.ResultsThis project improved the collection of outcome data in the department from 0% to 98.16%, indicating an improvement of outcomes measurement by >98%. Other outcomes collected showed that patients were predominantly 21–30 years of age and referred to community mental health teams when discharged. The IRAC tool showed most patients were referred for assessment and diagnosis, with the majority of these aims marked as ‘fully achieved’. The CGI-I tool showed most patients were ‘much improved’ upon discharge.ConclusionThe collection of these outcomes led to the creation of an outcomes measure form on the primary electronic software system (Carenotes) utilized by the department and local trust. This electronic form is now currently being used by the Liaison Psychiatry department at UCLH for their patients and makes this improvement sustainable while providing an easier means to continue collecting data. Ultimately, the collection of these outcomes will guide future changes and improvements for both the liaison psychiatry department and its patients.
Improving the Referral Process Between Acute Wards and the Psychiatry Department at Tameside General Hospital
Authors: Bann Claudia , Yeung Sharon , Fish Emmalene 
Published: June 2022

AimsThe project aims to address the barriers faced by the acute hospital and the psychiatry department in the referral process for a psychiatric opinion, at Tameside General Hospital (TGH). The Care Quality Commission (CQC) undertook a review of how people's mental health needs were met in acute hospitals in 2017 and concluded that there were barriers to this, for multifactorial reasons. Examples included: acute hospital staff not feeling adequately prepared to treat mental health conditions and lack of mental health care services 24/7. The current referral process at TGH for the acute hospital doctors requesting a psychiatric opinion presents a challenge for the referring doctor and psychiatry doctor in receipt of the referral. Many at the acute hospital have found the process of referral unclear, and many in the psychiatric department have found that referrals seldom contain sufficient information to determine whether a psychiatric review is required and whether it needs to be prioritised.MethodsTo understand the specific difficulties encountered during the referral process, two questionnaires were created. One for TGH acute trust doctors and one for the psychiatry doctors, asking what the perceived barriers were and how these could be overcome. Data were collected between September and October 2021.ResultsWe obtained results from 17 acute trust doctors. The results revealed that most referring doctors found the referral process unclear. 100% agreed that they would benefit from guidance with the referral process e.g., a psychiatry specific referral form and/or a flow chart outlining the referral process. All responders wanted guidance around the roles and responsibilities of the psychiatric team in relation to the hospital setting.We obtained results from 7 psychiatry doctors. Most were not satisfied with the referrals received. 100% would like to see a specific psychiatry referral form implemented in the acute hospital.ConclusionKey findings were: the referral process is unclear, acute trust doctors don't feel well enough equipped to manage mental health concerns, referrals don't contain sufficient patient information, and that the acute trust doctors don't know where to ask for help. The project reflected earlier CQC findings.After discussion with the acute trust, our action plan includes creating a psychiatry-specific referral form, to be distributed together with a flow chart which directs acute trust doctors to the appropriate source for psychiatric opinions. We also aim to join departmental and junior doctor teachings regularly to distribute and educate on the process.
Improving Access and Confidence in Learning Lessons From Serious Incidents: A Quality Improvement Project Aimed at Junior Doctors
Authors: Beyers Cornelia , Parkinson Eleanor , Harsh Rajendra , Nardeosingh Sameer , Oseji Dolapo , Packham Alice , Conway Nick , Rowe Renarta , Scally Ruth , Rochelle-Bates Joshua , Awais Onaiza , Surti Farhaana 
Published: June 2022

AimsBirmingham and Solihull Mental Health Foundation Trust (BSMHFT) previously developed some methods of learning lessons following serious incidents. However, despite various systems available, frontline junior doctors were not regularly exposed to important learning opportunities. This potentially resulted in doctors not being aware of learning from serious incidents, and not feeling embedded within the organisation, with potential effects on their training experience. As we identified an unmet need within the Trust in learning lessons from serious incidents amongst junior doctors, we aimed to improve access and confidence in learning from serious incidents by starting a Quality Improvement project on this theme.MethodsThe current approach involved a comprehensive quarterly bulletin circulated by email to staff. An initial survey confirmed that this was not very effective in delivering learning lessons information to junior doctors.Using a QI driver diagram, we identified potential areas for change. Selected change ideas were sequentially trialled including shortened email bulletins, supervision templates and remote learning lessons sessions. Initial PDSAs highlighted difficulties with communication via email, with many trainees failing to read/engage with this format.ResultsThe use of remote interactive learning sessions yielded positive results, with improvement in the confidence in learning from Serious incidents. We therefore continued to refine this method to wider groups.During the COVID-19 pandemic we experienced multiple setbacks and created a timeline tosupport team morale, maintain team energy, visualise progress and motivate the team. We therefore managed to persevere and strengthened the group by recruiting members to the team and complete the project.ConclusionThe team have been able to create a sustainable, effective and interactive short teaching session which has shown to be effective in engaging trainees in this vital area and help us meet our aim. This format further has the potential to be refined and implemented locally and nationally.
Restructuring Patient Review and Allocation in a South London Home Treatment Team
Authors: Boardman-Pretty Theo , Tweed John , Day Camilla , Stephenson Lucy , Quinn Jalon , Rifkin Larry 
Published: June 2022

AimsLambeth Home Treatment Team (LHTT) provides short-term intensive community psychiatric care to a diverse South London population. The high turnover of patients requires a streamlined process to review and discuss their progress. We aimed to discuss patients in more frequent, targeted and shorter meetings, and to improve continuity of medical care using a ‘named doctor’ system. We assessed impact on length of stay with LHTT, on staff time as well as on both patient and staff satisfaction.MethodsThe system of once-weekly day-long discussions of entire caseload was replaced by twice-weekly discussions of new and concerning patients only. The system of medical reviews was changed from ad hoc to MDT-agreed allocation to a specific doctor for the duration of LHTT stay.Data on duration of treatment and caseload size were taken from regular LHTT statistical reports. Staff and patient questionnaires assessed impact on satisfaction and time spent in review discussions.ResultsQualitative reports of staff experience revealed that the new system was felt to provide better continuity of care, better time efficiency (less time spent learning about new patients) and improved learning experiences for doctors in training. Downsides included lack of ‘automatic second opinion’ when a patient was reviewed by a different doctor, felt to be mitigated by more frequent discussions in MDT reviews when needed.Patient feedback showed no significant change was noted in overall experience of LHTT, although patients were more likely to feel involved in their care (88% said ‘definitely’ compared to 68% before the change).Time spent discussing patients in clinical review meetings reduced from an average of 38.5 to 28.5 person-hours per week.Average caseload reduced from 57 to 42. However, duration of treatment increased from 18.8 days to 20.4 days.ConclusionThe reduction in staff time in reviews suggests that the system had been appropriately streamlined. While caseload size reduced, duration of stay slightly increased, so the new system was not found to have had a significant impact on objective measures of patient care.Staff feedback was generally favourable, highlighting continuity of care and time efficiency. Patient feedback, while good both before and after our change, suggested a greater feeling of involvement in their care, possibly due to clearer communication and discussion of plan from the start of LHTT care.
Lithium Monitoring Within NHS Forth Valley 2020
Authors: Carbarns Amy 
Published: June 2022

AimsThe aim of this audit is to improve the monitoring of appropriate parameters in patients within the health board who are prescribed lithium, including lithium level, urea and electrolytes, thyroid function tests, calcium. It will also look at whether the same patients are appropriately referred to renal services.MethodsA retrospective review of electronic patient records of 100% of the patients in Forth Valley Health Board who have collected a lithium prescription in the 6 months between March and August 2020.Results69% of patients had a lithium level checked within the time period set out in the NICE guideline. Only 43% complied with the guideline on renal referral and 63% on calcium. Compliance with assessment of urea and electrolytes was better at 90%, and thyroid function tests at 85%.ConclusionPart of the decline in compliance with guidelines is likely in relation to the availability of face-to-face appointments during the pandemic, and reduction in outpatient appointments. As a result of this there is a planned further audit looking at how lithium monitoring is reviewed in outpatient psychiatry. This is intended to increase the involvement of psychiatry and the patient in ensuring appropriate monitoring is completed rather than relying solely on the GP.