bluuebunny/crossref_metadata_2025_split huggingface dataset:
How to involve carers in the acute care: An online training for clinicians across four sites in England
Authors: Petkari E. , Kouroupa A. , Giacco D. 
Published: September 2022

IntroductionInvolving carers in the care of people with severe mental illness is known to bring positive treatment and psychosocial outcomes. However, evidence-based procedures to guide clinicians on how to involve carers in the acute care are lacking.ObjectivesTo provide an online training to clinicians working in the acute care regarding the organisation of a standardised meeting with the service user and their carer within the first week of hospitalisation, and explore their views after its implementation.MethodsWe trained six clinicians across four urban and rural sites in England, asked them to incorporate the meeting in their routine care provision and interviewed them to explore their experiences.ResultsClinicians reported training advantages such as ease of use, comprehensiveness and transferable skills, and meeting advantages such as shared goals development and acknowledgement of carer involvement value. They also mentioned challenges related to organisational/time constraints, expectations management, and distance to the hospital for carers. Clinicians suggested to further focus on carer motivation to engage, to use skills throughout admission rather than in a one-off session, and to provide a structured meeting summary. Those experiences were shared across sites, indicating similar benefits and challenges, not depending on the specific setting characteristics.Conclusions
Providing structured training to clinicians may increase carer involvement in routine care in acute settings. Given the workload in such settings training endeavours should be brief and include skills that clinicians can apply to facilitate shared goal development and expectations management. The use of online meetings may allow increased carer participation in the acute care.DisclosureNo significant relationships.
Ethnic inequalities in treatment with clozapine
Authors: Fonseca De Freitas D. , Patel I. , Kadra-Scalzo G. , Pritchard M. , Shetty H. , Broadbent M. , Patel R. , Downs J. , Segev A. , Khondoker M. , Maccabe J. , Bhui K. , Hayes R. 
Published: September 2022

IntroductionEthnic disparities in treatment with clozapine, the antipsychotic recommended for treatment-resistant schizophrenia (TRS), have been reported. However, these investigations frequently suffer from potential residual confounding. For example, few studies have restricted the analyses to TRS samples and none has controlled for benign ethnic neutropenia.ObjectivesThis study investigated if service-users’ ethnicity influenced clozapine prescription in a cohort of people with TRS.MethodsInformation from the clinical records of South London and Maudsley NHS Trust was used to identify a cohort of service-users with TRS between 2007 and 2017. In this cohort, we used logistic regression to investigate any association between ethnicity and clozapine prescription while adjusting for potential confounding variables, including sociodemographic factors, psychiatric multimorbidity, substance use, benign ethnic neutropenia, and inpatient and outpatient care received.Results
We identified 2239 cases that met the criteria for TRS. Results show that after adjusting for confounding variables, people with Black African ethnicity had half the odds of being treated with clozapine and people with Black Caribbean or Other Black background had about two-thirds the odds of being treated with clozapine compared White British service-users. No disparities were observed regarding other ethnic groups, namely Other White background, South Asian, Other Asian, or any other ethnicity.ConclusionsThere was evidence of inequities in care among Black ethnic groups with TRS. Interventions targeting barriers in access to healthcare are recommended.DisclosureDuring the conduction of the study, DFdF, GKS, and RH received funds from the NIHR Maudsley Biomedical Research Centre. For other activities outside the submitted work, DFdF received research funding from the UK Department of Health and Social Care, Janss
Burnout and associated factors among Tunisian medical interns and residents
Authors: Zouari A. , Guermazi F. , Tabib F. , Ben Abdallah M. , Hentati S. , Baati I. , Masmoudi J. 
Published: September 2022

IntroductionBurnout is an occupational psychological syndrome induced by chronic stress defined by three dimensions: emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA).ObjectivesEstimate burnout among residents and interns in Tunisia. Identify factors related to burnout.MethodsWe conducted a cross-sectional, descriptive, and analytical study between March 1 and April 15, 2021. Data collection among young physicians was done by a self-questionnaire published online. The assessment of the degree of burnout was done by the Maslach Burnout Inventory (MBI).ResultsThe total number of participants was 56 of which 71.4% were women. The average age was 26.76 years. The pourcentage of the married was 21.4% of which 58.3% had children. 30.4% had parents in charge. Most of the participants worked in university hospitals and 75% of them in a medical department. Residents represented 64.3% of the participants. Number of working hours exceeded 40 hours per week in 60.7% of the cases with an average number of shifts per month estimated at 4.71±2.36. According to MBI, 94.6% of the participants had a score in favor of burnout, of which 19.6% was severe. The number of hours worked per week and the number of shifts per month were significantly associated with the presence of a burnout syndrome with respective correlation factors of 0.027 and 0.047.ConclusionsMost residents and interns suffered from burnout with a variable degree of severity. The workload with a greater number of working hours and on-call duty favored the emergence of this burnout.DisclosureNo significant relationships.
job satisfaction and its impact on resilience: a cross-sectional study of Tunisian interns and residents in medicine
Authors: Tabib F. , Guermazi F. , Zouari A. , Hentati S. , Baati I. , Masmoudi J. 
Published: September 2022

IntroductionPreventing burnout and promoting resilience are important to the well-being of health care professionals and the quality of patient care. Indeed, it’s a promising way to mitigate the negative effects of stressors and allow professional growth.Objectivesstudy the association between job satisfaction and resilience in medical interns and residents.MethodsAs part of a descriptive and analytical cross-sectional study, interns and medical residents completed an online self-questionnaire using ’Google Forms’. It collected socio-demographic data and assessed the level of job satisfaction using a 5-point Likert-type scale for each item. The Brief Resilience Scale (BRS) was used to assess the level of resilience.ResultsThe total number of participants was 56, of which 64.3% were medical residents.75% of the participants worked in a medical department and most had a number of shifts per month ≥4. The average years of practice was 2.27±1.23 years. Participants expressed dissatisfaction at work with salary (69.6%), task allocation and organization (66.1%), availability of resources (66.1%), comfort (57.1%), safety (53.6%) and supervision (50%). Referring to the BRS scale, higher resilience scores were objectified in male participants (p=0.002). The level of resilience decreased with the number of years of practice (p=0.039). Good satisfaction by management and recognition at work could enhance the level of resilience (p=0.029 and p=0.043 respectively).ConclusionsThe results of our study suggest that dissatisfaction with work-related aspects may influence the level of resilience. These results deserve special attention to improve job satisfaction and preserve resilience.DisclosureNo significant relationships.
A UK Perspective on Pain and Atypical Performance - When the Maths doesn’t Add up!
Authors: Hall V. 
Published: September 2022

This presentation provides an overview of factors that can cause symptom exaggeration and/or fabrication in chronic pain. It will explore how symptom and performance validity tests can be applied to chronic pain in the context of a malingering framework and the problems of implementing this in the UK through a case example.DisclosureNo significant relationships.
Measurement-Based Care in Treatment of Substance Use Disorders
Authors: Samokhvalov A. , Levitt E. , Mackillop J. 
Published: September 2022

IntroductionMeasurement-Based Care (MBC) is an emerging healthcare model with a number of potential advantages over traditional approaches for the treatment of substance use disorder (SUD). Despite SUD treatment programs being theoretically well suited for the implementation of MBC, its uptake has been minimal, which in turn limits further research, knowledge synthesis, and translation into clinical practice.ObjectivesThe goal of this knowledge synthesis project is to stimulate greater consideration of MBC models in addictions programs, with three interrelated objectives: 1. To summarize the existing evidence from research literature 2. To complement the literature findings with the data from our clinical research and quality improvement projects 3. To explore potential risks and difficulties of MBC implementation in the SUD treatment programsMethodsNarrative review. Knowledge synthesis.ResultsTo date, only two published randomized controlled trials, which along with the data from our pragmatic clinical research, support the wider implementation of MBC in the substance abuse treatment settings, but also indicate the high need for larger-scale clinical trials and quality improvement programs. Potential barriers to the implementation of MBC for SUD are outlined at the patient, provider, organization, and system levels, as well as challenges associated with the use of MBC programs for clinical research. Critical thinking considerations and risk mitigation strategies are offered toward advancing MBC for SUD beyond the current nascent state.ConclusionsThe state-of-the-art of MBC in SUD care settings reviewed and the strategies for further development from adminsitrative, clinical, and research prospectives outlined.DisclosureNo significant relationships.
Perceived barriers and facilitating factors prior to the implementation of a lifestyle focused approach in the treatment of inpatients with mental illness
Authors: Van Schothorst M. , Den Bleijker N. , De Vries N. , Van Harten P. , Deenik J. 
Published: September 2022

IntroductionDespite the increasing evidence for the efficacy of lifestyle interventions for people with mental illness (MI), there has been little change in routine clinical care. There are several factors that can complicate or facilitate the implementation of a lifestyle intervention. Gaining insight into such factors can contribute to effective integration into clinical practice.Objectives

To assess the perceived barriers and facilitating factors of healthcare professionals (HCPs) and inpatients of psychiatric wards for the use of a lifestyle focused approach, prior to its implementation.MethodsBaseline data from an open cohort cluster randomized stepped wedge study. Barriers and facilitators with regards to the intervention, HCPs and inpatients, and the organization were assessed with the measurement instrument for determinants of innovations, online, or through a semi-structured interview.Results
Initial results show that inpatients (N=167) experience both barriers and facilitating factors with regards to themselves and the innovation. They perceive the innovation as complex and see few personal benefits, but indicate that they consider it part of their treatment. Healthcare workers (N=77) perceive facilitating factors related to themselves and the organization, such as expected support, but were not sufficiently aware of the content of the innovation. More detailed exploration of relationships with demographic and disease-related factors are currently being conducted.ConclusionsThese findings provide insight into the perceived barriers and facilitators of inpatients and HCPs regarding a lifestyle focused approach, prior to its implementation. More insight into relationships with demographic and disease-related factors can benefit application into routine clinical care.DisclosureNo significant relationships.
Prevalence of Maternal Psychological Distress in pregnant women who receipt prenatal diagnosis of fetal Central Nervous System (CNS) anomalies
Authors: Falamesca C. , Cappelletti S. , Vicario R. , Amante P.G. , Correale C. , Vigevano F. , Caforio L. , Grimaldi Capitello T. 
Published: September 2022

IntroductionWomen receiving a prenatal diagnosis of fetal anomalies are a high-risk population for psychological distress leading to mood disorders. Even so, to date we have no evidence of studies who investigated the levels of maternal anxiety and depression in pregnant women receiving a prenatal diagnosis of fetal CNS anomalies.Objectives

The aim of this study was to assess the prevalence of anxiety and depression levels in a pilot sample of pregnant women at the Prenatal Diagnostic Unit of the Bambino Gesù Children Hospital.MethodsWe collected data among 43 women who receipt fetal brain anomaly diagnosis (mean age: 35 yrs, SD ± 6.3, range 19-48 yrs; mean week at first access 26w, SD ± 3.9, range 18-33w). Prenatal diagnosis including: ventriculomegaly (37.2%), posterior cranial fossa (23.3%), choroid plexus cysts (11.6%), anomalies of CC (7%) and other (20.9%). Pregnancies with assisted reproductive technology were 14%. We use the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorders (GAD-7) questionnaires to assess anxious-depressive symptoms.Resultsshowed a rate of mild-to-severe anxious depressive symptoms by 60.5% and 48.8% respectively. In detail: 41.9% mild, 14% moderate and 4.7% of severe anxiety. Meanwhile, 41.9% mild and 7% moderate depression. The prevalence of comorbid depressive and anxiety symptoms was 39.5% among the entire sample.ConclusionsPreliminary data showed a high prevalence of anxious depressive symptoms and comorbidity among pregnant with CNS fetal anomalies. Women receiving a fetal CNS anomaly diagnosis may need additional psychological support or counselling.DisclosureNo significant relationships.
The validity of clinicians’ diagnoses: Is it bread and butter?
Authors: Stevens A. 
Published: September 2022

Major depression has become one of the most frequent diagnoses in Germany. It is also quite prominent in cases referred for medicolegal assessment in insurance, compensation or disability claims. This report evaluates the validity of clinicians’ diagnoses of major depression in a sample of claimants. In 2015, n = 127 consecutive cases were examined for medicolegal assessment. All had been diagnosed with major depression by clinicians. All testees underwent a psychiatric interview, a physical examination, they answered questionnaires for depressive symptoms according to DSM-5, embitterment disorder, post-concussion syndrome (PCS) and unspecific somatic complaints. Performance and symptom validity tests were administered. Only 31% of the sample fulfilled the diagnostic criteria for DSM-5 major depression according to self-report, while none did so according to psychiatric assessment. Negative response bias was found in 64% of cases, feigned neurologic symptoms in 22%. Symptom exaggeration was indiscriminate rather than depression-specific. By self-report (i.e. symptom endorsement in questionnaires), 64% of the participants qualified for embitterment disorder and 93% for PCS. In conclusion, clinicians’ diagnoses of depression seem frequently erroneous. The reasons are improper assessment of the diagnostic criteria, confusion of depression with bereavement or embitterment and a failure to assess for response bias.DisclosureNo significant relationships.
Patient adherence to out-patient psychiatric care for neurotic and affective disorders (Should I stay, or should I go?)
Authors: Soboļevs A. , Kozlova K. , Tērauds E. , Sīle L. 
Published: September 2022

IntroductionReferral is not a necessity for a patient who wants to get psychiatrist consultation in Latvia. The good thing about it is the availability and the possibility to consult with highest educated mental health specialist for any person in society without barriers. On the other hand, there is an overwhelming work load for psychiatrists.ObjectivesTo explore the prevalence of self-referred patients in out-patient care and the adherence to psychiatrist recommendations.Methods

The medical documentation of all consecutive first-time out-patient center “Pardaugava” psychiatrist patients over the period of 01.01.2020. to 30.04.2020. with one year follow-up was analyzed.Results236 patients were included in the study, 31.2% of them were men. The average age was 49 (SD ± 22.65) years. Patients with Affective (F3X) and Neurotic (F4X) disorders were self-referred more often compared to Organic mental (F0X) disorder or other spectrum patients (83.3% and 77.5% vs 33.3% or 56.0%, p<0.001). Median appointment count was 4, higher in F4X (6) and lower in F3X patients (2). Majority of F4X patients (61,6%) did not follow the recommendations or stopped seeing psychiatrist, while only 13,7% were persistent. Сonversely, 48,4% of F3X patients followed the recommendations and only 43,5% stopped. In comparison, other spectrum patients followed recommendations in 32.0% of cases and ignored - in 56.6%.ConclusionsPatients were actively self-referring themselves to psychiatrist. Highest adherence to psychiatrist recommendations was found in patients with affective disorders compared to other spectrum patients. In contrast, adherence was the lowest in patients with neurotic disorders.DisclosureNo significant relationships.
Care pathways for people with major depressive disorder
Authors: Strawbridge R. , Young A. ,   Major Depressive Disorder Working Group
Published: September 2022

Introduction

Major depressive disorder (MDD) is a leading cause of disability worldwide, in part due to its high prevalence and high rates of comorbidities, recurrence, chronicity and treatment-resistance. These indicate that MDD is treated suboptimally despite a multitude of effective interventions and well-regarded best-practice treatment guidelines. To improve the management of MDD, the nature and extent of ‘gaps’ in care pathways need to be understood.ObjectivesWe aimed to: 1. Identify ‘treatment gaps’ and patient needs along the care pathway, and determine the extent of these gaps (i.e. discrepancy between best- and current-practice). 2. Propose policy recommendation on how minimise treatment gaps for MDD.MethodsCare pathway analysis: A set of relevant treatment gaps were agreed upon, a priori, based on gold-standard stepped-care guidelines. Data was gathered from a variety of sources in six countries (UK, Sweden, Germany, Italy, Portugal, Hungary). Policy recommendations: To attain expert consensus on proposed recommendations, a modified-Delphi approach was undertaken with a multidisciplinary panel of experts across Europe.ResultsTaken together, data indicated that: ˜50% of episodes are undiagnosed, lifetime delay to treatment averages ˜4 years, ˜25-50% of patients are treated at any one time, ˜30-65% are followed up within 3 months of treatment, ˜5-25% can access psychiatric services. 28 specific recommendations to optimise pathways were made to enhance MDD detection (pathway entry), increase multimodal treatment, facilitate continuity of follow-up after treatment and increase access to specialist care.ConclusionsThere are concerning treatment gaps in depression care across Europe, from the proportion of people not being diagnosed to those stagnating in primary care with impairing, persistent illness.DisclosureNo significant relationships.
Film-based resources for grief management in medical education
Authors: Tei S. , Fujino J. 
Published: September 2022

IntroductionGrief and bereavement are commonplace in clinical practice but have become a more pervasive issue because of the coronavirus 2019 pandemic. Consequently, the need for investigations, learning, and education about complicated grief and prolonged grief have been highlighted. Meanwhile, film-based teaching resources concerning grief care have been employed to complement curricula in medical education.ObjectivesTo explore how the grieving experience can be better communicated and mitigated, and explain how a film-based resource can be applied to improve the understanding of this issue.MethodsWe reviewed and analyzed the meaning and cause of complicated, prolonged, disenfranchised grief, as well as related experiences (e.g., survivor guilt) featured in selected films. We discussed the interpretation of these films with medical students and faculty, based on a previously described approach [1].ResultsWe recaptured the roles of empathic communications and resilience skills in grief care. They bring a sense of coherence (SOC) or meaning to life by prompting the sharing of grief experiences, helping to reconstruct and contextualize a person’s loss, and assuaging feelings of worthlessness and hopelessness. Incidentally, recent studies have suggested that complicated and prolonged grief involves alterations in brain functioning of the reward system.ConclusionsThis film-based approach utilizes vicarious experiences to better understand grief management. It allows the learner to more easily recognize that SOC, flexible situation-adjusted empathy, and the sharing of resources for improved communication to promote self-care are essential for patients, their families, as well as psychiatrists themselves. [1] Sondheimer, A. The life stories of children and adolescents. Acad Psychiatry. 2000:24(4):214–24.DisclosureNo significant relationships.
Cardiorespiratory fitness and self-reported physical activity levels of referring mental healthcare professionals, and their attitudes and referral practices related to exercise and somatic care
Authors: Deenik J. , Koomen L. , Scheewe T. , Van Deursen F. , Cahn W. 
Published: September 2022

IntroductionPhysical activity (PA) interventions can improve mental and physical health in people with mental illness, especially when delivered by qualified exercise professionals. Also, the behaviour, engagement and support of referring mental healthcare professionals (HCP) seems essential, but research is scarce.ObjectivesStudying the physical fitness and PA of HCP and the relationship with their attitudes and referral practices related to PA interventionsMethodsHCP at the Dutch Association for Psychiatry conference (2019) were invited to an online questionnaire (demographic/work characteristics, stress, PA levels, knowledge/attitudes regarding PA and referral practices) and cycle ergometer test. Linear and logistic regression were used to study the strongest associations.Results115 HCP completed the questionnaire. 40 also completed the ergometer test. 43% (n=50) met the national PA guidelines (≥150min moderate-to-vigorous PA and ≥2x bone/muscle-strengthening exercises a week). Women, HCP in training and HCP with more stress were less active and less likely to meet PA guidelines. HCP with personal experience with an exercise professional were more active and met guidelines more often. Knowledge/attitudes on physical health and PA were positive. Patients were more often referred to PA interventions by HCP who met PA guidelines (OR=2.56, 95%BI=0.85–7.13) or had higher beliefs that exercise professionals can increase adherence to PA interventions (OR=3.72, 95%BI=1.52–9.14).ConclusionsIt’s positive that HCP report importance and relevance of PA in mental healthcare. Although there is strong evidence for PA interventions in the treatment of people with mental illness, referral to such interventions can partly depend on the PA behaviour and attitude of patients’ physician/clinician.DisclosureNo significant relationships.