bluuebunny/crossref_metadata_2025_split huggingface dataset:
Structural and Functional Thalamic Changes in Progressive Supranuclear Palsy
Authors: Tan Sean YW , Jones P Simon , Whiteside David J , Rowe James , Rittman Timothy 
Published: June 2022

AimsStudies of thalamic structure and function in Progressive Supranuclear Palsy (PSP) suggest it may play a role in key aspects of the clinical syndrome. This study examined thalamic changes across PSP phenotypes investigating (i) thalamic atrophy (ii) thalamic functional connectivity and (iii) the relationship between thalamic structural and functional connectivity changes with clinical severity.MethodsParticipants92 participants with PSP [63 PSP-Richardson's Syndrome (RS), 24 PSP-cortical, 5 PSP-subcortical] and 104 age-matched controls were recruited from the Cambridge Centre for Parkinson's Plus Disorders cohort. Clinical assessments and imaging were conducted within 1 year of diagnosis.Structural AnalysisThalamic volumes (TVs) were obtained using FreeSurfer. Bayesian multiple regression (brms, R) was used to model (i) mean TVs (ii) group differences in mean TVs (iii) relationships between Z-standardised clinical scores and TVs with age, gender, and total grey matter as covariates.Functional AnalysisVoxel-wise seed-based functional connectivity of the thalamus used the Functional Magnetic Resonance Imaging Expert Analysis Tool (FEAT) in FMRIB's Software Library (FSL). Inter-group differences and relationships between clinical scores and functional connectivity for each group were assessed using a general linear model with age and gender as covariates.ResultsStructural AnalysisTVs for all PSP subgroups were smaller than controls. No differences between PSP subgroups were detected. There was evidence for a relationship between TVs for the entire PSP group and Revised Addenbrooke's Cognitive Examination (ACER) scores [ß = 0.28, 95% credible interval (CI) = 0.04–0.53]. Subgroup analysis showed evidence for a relationship between ACER scores and TVs in PSP-RS [ß = 0.33, 95% CI = 0.09–0.57] and PSP-cortical [ß = 0.46, 95% CI = 0.12–0.83] phenotypes. A negative influence of TVs on total PSP rating scale scores was found for the PSP cohort a whole [ß = −0.51, 95% CI = −1.00 – −0.02].Functional AnalysisPSP patients as a group showed decreased thalamic functional connectivity in higher cortical regions. Subgroup analysis revealed decreased connectivity in those areas compared to controls but in distinct distributions and magnitude. Increased thalamic connectivity with the middle temporal gyrus correlated with ACER scores for PSP patients as a group and in the PSP-cortical subtype.ConclusionThalamic volume loss is a prominent aspect of PSP and is associated with a wide network of changes in functional connectivity that may be distinct between PSP subtypes. Changes in thalamic structure and function predict clinical severity, particularly in PSP-RS and PSP-cortical subtypes.
Emotional Dysregulation and Altered Reward Processing in Self-Harm
Authors: Yavuz Emre , Rodrigues Rachel , Di Simplicio Martina 
Published: June 2022

AimsSelf-Harm (SH) is defined as “any act of self-injury or poisoning carried out by a person irrespective of their motivation”. SH increases the risk of adverse outcomes including suicide attempts, necessitating early intervention. The most widely reported reason for SH is to relieve negative affect (NA), with NA precipitating SH engagement. SH participants show altered reward processing, particularly reward hypersensitivity. NA could trigger reward hypersensitivity and therefore SH engagement. However, the interaction between NA and reward processing in SH remains unclear.Aim: To investigate whether those who SH show differences in processing SH stimuli compared to healthy controls (HCs) following NA induction.Hypothesis: NA induction will result in SH participants having significantly shorter reaction latency (RL) and significantly greater reaction accuracy (RA) in the SH condition of the Incentive Delay task (IDT) than HCs.Methods16–25-year-old SH (n = 35) and HC (n = 20) participants were recruited on social media. Participants completed the Trier Social Stress Test, to induce NA, followed by the IDT. In the latter, participants were cued to respond to a target as quickly as possible, and on responding were shown images of either a SH act (SH condition), people socializing (social condition) or money (monetary condition), where each condition had control trials where a neutral image was shown, which participants also had to respond to (SH neutral, social neutral and monetary neutral conditions respectively). RA was the percentage of IDT trials in which participants responded within the target's presentation time. RL in the IDT was the time (seconds) between the target appearance and the participant's response.ResultsA linear mixed effects model showed no significant main effect of group on RL (SH vs HC), condition (Social, SH or Monetary) or group x condition interaction (p > 0.05). There was a significant main effect of condition on RA (p < 0.05) but not group or group x condition interaction (p > 0.05). Past-week SH frequency and RA were significantly and positively correlated in social, social neutral and monetary conditions (p < 0.05).ConclusionOverall, there was a non-significant effect of NA on reward processing. However, as greater past-week SH frequency was significantly associated with greater RA, understanding how reward processing and NA interact in SH can provide greater insight into its triggers. Given this study's limited sample size and cross-sectional nature, future studies should investigate how NA and reward processing interact longitudinally and in larger samples to understand how SH can be reduced.
A Pilot Project to Introduce the Compassionate Approach to Living Mindfully for Prevention of Disease (Calmpod) in Weight Management in a Forensic Intellectual Disability Unit
Authors: Amiola Ayomipo , Temple Phil , Dickerson Helen , Langdon Peter , Hanson Petra , Thomas Thoral , Tharian Reena , Barber Thomas , Menon Vinod , Alexander Regi 
Published: June 2022

AimsAbout 28% of the UK population are obese and a further 36.2% are overweight. The prevalence of both in those with mental illness and/or intellectual disability (ID) is much higher. Several therapeutic approaches have been tried, with varying efficacy. Recently a three-session intervention which uses mindfulness techniques (The compassionate approach to living mindfully for prevention of disease- CALMPOD) was used in a tertiary obesity service in the West Midlands and shown significant benefits. Our aim was to assess the suitability of this intervention in mental illnesses and/or intellectual disability services.MethodsThree pre-pilot focus group discussions involving multispecialty professionals and service users were held involving four psychiatrists, three service users, two psychologists, one physician, one endocrinologist, one bariatric surgeon and one pharmacist to identify key aspects of the CALMPOD programme for adaption to psychiatry and/or psychiatry of ID wards. Based on this, CALMPOD was modified by two psychologists with relevant experience. The modified CALMPOD was piloted in a medium secure forensic in-patient unit for people with ID. A post-pilot focus group discussion involving two psychiatrists, one occupational therapist and three service users was held after completion of the pilot to discuss lessons learned.ResultsInvitations sent to 17 in-patients. The mean BMI was 34.76%, 76% were obese, 6% were over-weight and 18% in the normal range of weight. 3 patients attended the three-session programme (17%). All 3 were in the obese category, all had had individual weight management input – i.e. seen by dietician, weight management included in care plans. The post-pilot focus group discussions identified 6 key themes.ConclusionEmerging themes from the pilot were (a) Patients and staff recognise that the programme was ‘necessary’ and ‘useful’, but the challenge is how to ‘start attending regularly’. Once in, participants ‘tended to stay on’. (b) A visible publicity campaign is needed to spread awareness of the programme and its ‘newness’. This would help with staff ‘buy in’ from all wards and departments. (c) The key message should be ‘living healthily’ and ‘feeling better’, not just weight loss. (d) Staff and/or patients’ family members participating in the programme would be more motivating. (e) The content of the programme needs further modifying with an emphasis on shared activities, calories counting and less emphasis on definitions. (f)Calorie counts and exercise trackers need ‘more fun and interactive elements.Based on these recommendations a revised CALMPOD- ID programme, co-produced with service users, is now being introduced in the service.
Heard, Valued, Empowered: Utilising a Quality Improvement Framework to Improve Trainee Experience
Authors: Andargachew Elizabeth , Pearson-Stuttard Ben , Mowatt Louise 
Published: June 2022

AimsFeedback from doctors in training (DiT) through the Scottish Training Survey has highlighted poor trainee experience within Psychiatry at St. John's Hospital, Livingston. Research suggests that a healthy, happy and engaged workforce experiences lower levels of burnout and provides higher quality patient care. Our aim was to improve the experience of DiT working within the department and thereby improve patient care.MethodsWe utilised the Wellbeing, Conditions and Rota Evaluation (WeCaRE) framework. This is a user-friendly quality improvement (QI) framework designed to improve trainee experience. As part of WeCaRE, questionnaires and ‘what matters to you’ conversations were undertaken with ten DiT (foundation doctors, GP trainees, and core psychiatry trainees). From the issues raised, trainees were empowered to co-create change ideas and use Plan-Do-Study-Act (PDSA) cycles to address the issues. Finally, the questionnaire was repeated to complete the loop.This approach created an open, listening environment with clear communication channels from trainees to consultants and management. This allowed us to identify themes for improvement. These included induction, education opportunities, clinical supervision and escalation policies.In collaboration with trainees, three improvement teams were formed, each of which addressed an issue through a PDSA cycle. These were:
1.Unclear referral pathway to Psychiatry resulting in inefficiency. The team co-created a flowchart identifying how to appropriately refer to Psychiatry, which has reduced the number of inappropriate bleeps.2.Unclear escalation policies and consultant cover. The trainees worked with the multidisciplinary team to generate a clear escalation pathway.3.Significant variation in content and documentation of clerking – the data collected helped drive change through the utilisation of an electronic clerking checklist.Other issues were raised and quickly addressed without requiring a PDSA cycle. Such issues included provision of on-call rooms, parking spaces, improvements to induction, starting a Balint Group for trainees, and changing the mode of administration of Pabrinex.ResultsDuring the five-month period those who experienced joy in work several times a week or more increased from 0%-86%. Those who always felt a valued member of the team increased from 29%- 86%. Those with overall job satisfaction increased from 0%-75%ConclusionDiT experience comprises more than rota compliance. It includes well-being, psychological support, professional development, teamship and more. This project has demonstrated considerable improvement in trainee experience through utilising the WeCaRE framework. This highlights the power of listening to, valuing and empowering trainees, whilst utilising data as a vehicle to drive change.
Communication Skills in Group Psychoeducation
Authors: Ayub Muhammad , Afridi M. Iqbal 
Published: June 2022

AimsTo Improve the mental health of psychiatric inpatients and caregivers. To improve communication skills of postgraduate trainees.MethodsSetting; Consented, monitoring and observation of communication skills during weekly, inpatient Psychoeducation sessions at Department of Psychiatry and Behavioural Sciences, JPMC, Karachi.Data collection; Retrospective, communication skill records of postgraduate trainees from last 10 sessions from July 2019 to October, 2020. Based on a 13-items self-made questionnaire for communication skill. The overall communication skills of each postgraduate trainee were recorded from excellent, very good, good, improvement needed and lots of improvement needed category based on their performance.ResultsCurrent practice showed that communication skills of 70% of postgraduate trainees were recorded as very good communication skill, 30% into excellent while none was noticed in another category.Re-audit: It was started soon after implementation of action plan from November, 2019 to January, 2020, with monitoring of weekly inpatient psychoeducation sessions similarly as done previously. The result of reaudit concluded significant improvement in individual and overall communication skill which were recorded as very good 50% and excellent 50% and none had other poorer categories of communications Skills.ConclusionIndividual feedbacks to doctors immediately after the psychotherapy session according to the audit tool questionnaire to improve current communication skills.
Have You Seen the NEWS Today? - a QI Project
Authors: Birgi Harleen Kaur 
Published: June 2022

AimsThe main focus of this QIP was to improve the documentation of NEWS (National early warning scores) and subsequent escalation as appropriate in an Old Age Psychiatric Ward setting. This would in turn lead to improved Physical health outcomes, especially in the COVID-19 pandemic.MethodsThe NEWS chart is based on a simple aggregate scoring system in which a score is allocated to physiological measurements, when patients present to, or are being monitored in hospital. This will ensure that patients who are deteriorating, or at risk of deteriorating, will have a timely initial assessment. This should supplement clinical judgement in assessing the patient's condition.Early detection and escalation of deteriorating NEWS leads to improved patient outcomes and referral to the appropriate specialties, for subsequent management.The initial phase of the QIP comprised of retrospective data collection surrounding the recognition and documentation of NEWS on an 18-bedded Old age Psychiatric ward. This period spanned the 2nd wave of the pandemic, from November- December.Potential interventions were implemented in the form of raising NEWS awareness by educating nursing staff via teaching sessions, displaying posters all over the ward and nursing station. Team also reviewed all NEWS charts everyday during ward management rounds which served as a daily reminder for the staff measuring the observations.NEWS of & greater than 3 was defined as the threshold for escalation.Following change implementation, data were collected to capture the progress made over a month.ResultsAnalysis of data pre and post- interventions displayed a significant improvement in escalation of unwell patients from 26% to 60%.ConclusionImproved outcomes and early detection of potentially deteriorating patients, leading to early transfer of patients to an Acute Medical setting and better overall management.Raised awareness and understanding of physical health management in Mental Health nurses.The QIP was presented at the Trust QI Forum meeting and was met by and overwhelmingly positive response. In order to enhance NEWS recording an electronic format is now being adapted. There is also a consideration around providing regular NEWS teaching sessions to all inpatient staff across the trust.
Journey to Perinatal Mental Health Services in Northern Ireland
Authors: Connolly Helen , Anderson Julie 
Published: June 2022

AimsThe case for perinatal psychiatry as a subspecialty is strong. In the context of perinatal mental illness consideration has to be given to; differences in presentation, the need to account for mother and baby and the risks associated with inadequate treatment. Specialist services improve outcomes, reduce risks and save money. Despite the government's agenda of preventative healthcare, service provision has been inequitable across the UK. Here we detail the journey towards the development of new Community Perinatal Mental Health Services in Northern Ireland (NI).MethodsIn NI the first embers of a perinatal service were ignited by Dr Janine Lynch approximately 15 years ago when she established a small community perinatal team in Belfast Health and Social Care Trust (BHSCT). Her commitment and foresight regarding training inspired others, resulting in high levels of interest among trainees. From this grew a dedicated group of consultants committed to supporting service development across NI.A multidisciplinary regional perinatal mental health forum was formed leading the development of a Northern Ireland Care Pathway in 2012. In partnership with women with lived experience, this forum led the bid for perinatal service development across the province.ResultsFollowing years of campaigning the need for services was recognised in both the Bamford Review (2012) and RQIA Perinatal Review (2017). A commitment for funding for specialist teams, across all five health and social care trusts, was outlined in the Mental Health Action Plan in May 2020. Funding was finally approved in January 2021.Significant work has gone into training to ensure there is a workforce ready to deliver services with focus on upskilling all professionals who deliver care to mums during the perinatal period. A competency framework has been developed to compliment this.It is important to recognise the support and commitment of many members of the college Perinatal Faculty throughout this journey.ConclusionCommunity perinatal mental health services are at an exciting juncture in NI. Each of the trusts have made a commitment to the development of services under the co-ordination of the Public Health Agency. Several have progressed to recruitment of key staff with the aspiration for services to go live before the end of the year. There will be an overarching, integrated approach, co-ordinated by the new Regional Perinatal Network.As newly recruited consultants we look forward to working in partnership to address this long-standing health inequality and improve the outcome for women and their babies in NI.
Improving the Training Experience of International Medical Graduates (Imgs): A Survey of Psychiatry Trainees in the Yorkshire & Humber Deanery (West/East/North)
Authors: Elisha-Aboh Christiana , Onwuchekwa Ogba , Watts Rahul , Pillai Anilkumar , Davies Sara 
Published: June 2022

AimsThere are over 72 000 licensed IMGs in the UK who fill up crucial shortages in the NHS and provide diversity. In 2020 there were more IMGs than local graduates joining the General Medical Council register with over half (54%) identifying as Black and Minority Ethnic doctors. There are ongoing and extensive conversations about the best approach to tackle differential attainment between IMGs and local graduates. The aims were to identify what the perceived differences were between local graduates and IMGs in various domains and recognise what measures could be taken to improve the issues identified.MethodsThis survey utilised the Typeform survey software to ask 23 questions and was left open for 3 months. Participation in the survey was voluntary and anonymized and included feedback from both Core Trainees and Higher Trainees. Initial emails, texts and chats with the survey link and reminders were sent to the Medical Education departments and trainee groups. The qualitative and quantitative data from all 33 respondents were analysed.Results90.9% (30) of participants felt there were issues of differential attainment between IMGs and local graduates and felt that the gaps in differential attainment could be addressed by mentoring, networking, IMG lead roles, education of trainers and better support systems. 57.6% (19) of IMGs stated that they had felt bullied, undermined, treated unfairly, or intimidated; with only 29% (9) attempting to challenge this due to the fear of retribution, concerns about accountable, cultural and communication barriers. All respondents felt induction programmes, focusing on IMGs and cultural diversity would be helpful for all trainees, with 93.9% (31) of respondents recommending that more education was needed for trainers. 57.6% (19) stated that they had considered relocating outside the UK after training because they felt they would be better valued elsewhere. 90.9% (30) suggested that a book for IMGs would be a welcomed development. 87.9% (29) recommended that having IMG leads was important for offering well-being support, play a safeguarding role, offer pastoral care, and contribute to induction and education; with 68.8% (22) recommending the person was a College trainer.ConclusionThese findings highlight several challenges IMGs training in the UK face and must navigate to be successful. A greater awareness of their hurdles is critical to maximising what potentials lie within. As the numbers of IMGs within the system continue to rise, there is an even greater need to support and address the concerns this survey underscores.
A Quality Improvement Project to Evaluate Satisfaction With Alternatives to Face to Face Consultation in a Learning Disability Service
Authors: Elmasry Eslam , Bright Catherine 
Published: June 2022

AimsCOVID-19 pandemic has had a great impact on all groups in society. People with intellectual disability (ID)/learning disability (LD) are especially vulnerable. As a result, restrictions were put in place to protect this group, including limiting face to face visits/consultations. Restrictions on usual activities of people with learning disability are likely to induce stress leading to an escalation in challenging behaviors. Regular assessments and follow-ups are essential to evaluate the patients and provide the best care, so virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultationsAim: Evaluation of the service provided during the COVID-19 pandemic including virtual clinics.MethodsA questionnaire was designed to evaluate the patients and their careers’ satisfaction with the virtual clinics, seeking their feedback about positives and limitations of the service and exploring their preferences for future clinical contact. Data were collected during May 2021. Different professions including (psychiatrists, psychologists, nurses, occupational therapists and speech and language therapists) in community services for adults with learning disabilities in Aneurin Bevan University Health Board have participated in the survey. The questionnaires were filled by service users, their carers or by the service provider.Numbers of DNA (Did not attend) across the whole service during May 2021 were compared to DNAs in May 2018, 2019 and 2020.Results140 surveys were completed. Patients and their carers were happy with many aspects of the service provided through the pandemic. It was reported that virtual clinics are an efficient way to meet with professional carers and families where there are difficulties bringing patients to clinics, however home visits were preferred for assessing patients.No noticeable change in DNA rates has been identified.ConclusionVirtual clinics have been well tolerated by patients and their carers during the pandemic and have provided an extremely efficient tool to overcome the restrictions which were imposed.Carers and patients expressed satisfaction with clinic appointments provided remotely.