bluuebunny/crossref_metadata_2025_split huggingface dataset:
Follow-Up of New SSRI Prescriptions for Depression and Anxiety in Primary Care
Authors: Hughes Stephen 
Published: June 2022

AimsThe aim of the audit was to review the follow-up of new SSRI prescriptions for anxiety and depression in a primary care setting and to evaluate this against relevant guidance, including that provided by NICE. NICE guidelines recommend initial follow-up for patients newly prescribed SSRIs for depression at either 1 week or 2 weeks dependent on patients age and the perceived risk of suicide or self-harm.MethodsAn audit was carried out of new SSRI prescriptions and subsequent follow-up for 52 patients in a primary care practice in North Derbyshire covering the period January to August/September 2021.The audit used patient notes which were manually reviewed to assess the initial consultation, prescription, documented suicide/self-harm risk assessment and follow-up plans. The length to initial follow-up and the number of subsequent follow-up appointments were also assessed.ResultsThe audit found that the median time to initial follow-up was 14.5 days for patients aged 18–30 years with only 12% compliant with the NICE recommendation of 1 week to follow-up. The median time to initial follow-up was 17.5 days for patients aged >30 years with only 19% compliant with the NICE recommendation of 2 weeks to follow-up. There were no significant differences in follow-up between males and females. 96% and 77% of initial consultations included a documented suicide risk assessment for patients aged 18–30 years and >30 years respectively. 88% of the new SSRI prescriptions were for sertraline 50 mg.ConclusionThe above findings were presented to the clinical team at the primary care practice meeting with reminders of the NICE recommendations for follow-up and how these vary between different patient groups. The practice will carry out a repeat audit in 12 months.
Do We Know if You Drive? a Quality Improvement Project Improving Compliance With DVLA Guidelines
Authors: McDade-Kumar Mia , Bashir Zainab , Aziz Humaira , Hughes Kealy , Ormerod Sara 
Published: June 2022

AimsBackground: The Driving & Vehicle Licensing Agency (DVLA) states: “Doctors and other healthcare professionals should: advise individuals on the impact of their medical condition for safe driving ability and also advise the individual on their legal requirement to notify DVLA of any relevant condition”. Within mental health, the guidance states that depression or anxiety associated with “Significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts” must be reported to the DVLA. Aims: Identify whether information was collected on driving status of patients presenting with depression/anxiety and self harm. Identify whether accurate advice was provided and documented. Implement changes that would improve compliance with guidance.MethodsWe reviewed notes to collect baseline data for 3 weeks prior to commencing interventions, then weekly for 2 months from November 2021. Cases were defined as: those presenting to Liaison Psychiatry (LP) with an act of self-harm either on antidepressants or with a confirmed diagnosis of depression/anxiety on their record. Each week, the notes of 10 cases were reviewed for evidence of documentation of driving status and advice regarding DVLA guidelines.Weekly InterventionsWeek 1: Email communication to team highlighting the guidance, responsibilities and where to document.Week 2: Driving status discussed in handover daily to increase awareness and identify/address concerns.Week 3: Repeat email to team.Week 4: DVLA guidance posters placed in LP office.Week 12: Teaching session by Occupational therapist from regional driving assessment centre.ResultsData were analysed for 90 patients over 9 weeks. 52% were female, and average age was 33 years. Relevant documentation was only made on week 1 (10%) and week 4 (20%). No documentation of either driving status or advice given were made in any of the other weeks analysed.ConclusionAchieving compliance with guidance was difficult. Email communication was the most effective intervention. A group discussion to identify drivers of poor compliance found that clinicians failed to ask as the questions were not routine practice, and some voiced concerns about the potential implications of advice (worsening therapeutic relationship or increasing social isolation/implications for employment). Future plans include adding a prompt about driving on the electronic risk assessment, and specific training in the staff induction.
Paediatric Psychosocial Emergencies in Two Inner-City London Hospitals: Review of the Current Management and Critical Evaluation Using NICE Self-Harm Quality Standards (QS34)
Authors: Ozer Mikail , Thrasher Isil , Sekaran Raj 
Published: June 2022

AimsThe paediatric wards support many children presenting with psychosocial crises. This has been increasing in recent years. NICE quality standards recommend that children who have self-harmed receive: a comprehensive psychosocial assessment, are assessed within 24 hours of referral if at high risk of suicide, a collaboratively developed risk management plan and monitoring to reduce risk of further self-harm. We aim to measure the number of referrals made by hospitals for acute psychiatric presentations and the adherence to the above quality standards by the Service for Adolescent and Families in Enfield.MethodsWe retrospectively audited inpatients referred by North Middlesex hospital and Barnet hospital. Referral data were collected over 5 years. Data collected between April 2018 and March 2019 were evaluated to review good practice and adherence to the NICE quality standards. For each patient, we collected data on whether they have had a comprehensive psychosocial assessment, if the assessment was completed within 24 hours, 7-day follow-up review and a documented risk assessment.ResultsThere has been a 141% increase in hospital referrals to the service from 2014/15 to 2018/19. The service had 130 referrals between April 2018 and March 2019. 72% of referrals came from North Middlesex hospital and 28% were from Barnet hospital. Ages were between 5 and 18. Girls formed 74% of all presentations. 87% of patients presented with deliberate self-harm, suicidal ideation or suicide attempt. Of all referrals 100% had a comprehensive psychosocial assessment, 93% were seen within 24 hours of being referred, 97% had a documented risk assessment and 92% had a 7-day follow-up review.ConclusionSelf-harm and suicidal ideation in children are rising, especially among girls aged 13 to 16 years (increased by 68% between 2011 and 2014). The gender inequality in our referrals further supports these findings. Higher rates of self-harm have been shown in more deprived areas and could be associated with gang involvement, bullying, abuse, gender identity and family issues. We have developed an assessment protocol and safety plan, are liaising with hospitals daily to arrange assessments and follow-up. Paediatric nurses have been trained in the time to talk programme and a full-time crisis liaison nurse has been employed. This will be re-audited to measure effectiveness of interventions.
Developing a New Neuromodulation Treatment Pathway for the Treatment of Depression
Authors: Papadopoulos Andreas , Maynard Nathan , Lawton Samuel , Earle Tiff , De Souza Stephen , Oke Sarah , Yeandle Jane 
Published: June 2022

AimsTo ensure an appropriate treatment pathway is available to patients diagnosed with Depression a STEPPED care model where different types of intervention are offered depending on the patient's experienced severity of Depression. However, a great percentage of patients continue to experience disabling symptoms and fall into the Treatment Resistant Depression (TRD) category. There was a need to review the options available within local Mental Health Services (MHS) for the treatment of patients with depression and TRD.MethodsA new clinical pathway was designed to provide access to patients to emerging treatments, such as EsKetamine, Vagal Nerve Stimulation (VNS) and repetitive Transcranial Magnetic Stimulation (rTMS). After calculating the local impact of depression to patients, trust resources and society we extrapolated our calculations to neighbouring Trusts covering the South West. A newly developed business plan demonstrating the need for new treatment options and the benefits, financial and otherwise, was presented and underwent various approvals levels by the Trust Governance and Executive Committees and local commissioning groups, before being able to proceed. Within the original business plan, rTMS and VNS were offered in addition to the existing ECT as parts of a new treatment pathway. We are now in the process of incorporating EsKetamine and Transcranial Direct Current Stimulation (tDCS). The clinic was set up in March 2020, just at the beginning of the pandemic, which halted operations for quite a few months before being able to resume recentlyResultsWe have managed to treat patients with both VNS and rTMS from our Trust, as well from surrounding areas. Patients have already experienced benefits in the recovery from symptoms. The new service has provided another line of support for colleagues in offering bespoke treatment plans to their patients and patients have appreciated having access to new non-traditional treatment options.ConclusionAlthough there has been a primary result in improving patient care, income generation is also possible by positioning the Trust in the forefront of new therapeutics and allowing the provision of service to expand to neighbouring Trusts and private patients. Other benefits are associated with the Trust's reputations and kudos being enhanced and include the forging of new pathways within the developing alliance with General Hospitals, increased ‘visibility’ for training and research opportunities, improved patient satisfaction and improved CQC standing.
Co-Produced for Use: Developing an Information and Symptom Self-Management Resource for People With Functional Neurological Disorder (FND)
Authors: Ramchandani Jai , Manson Cameron , Mushtaq Amina , Williams Verity , Pickard Maxwell , Dunlop Alan , Faruqui Rafey 
Published: June 2022

AimsPatients with Functional Neurological Disorder (FND) often endure low quality of life. Understanding the diagnosis is critical to management, but patients with FND do not always receive appropriate information about their condition. The patient journey through healthcare services can be complex, with often long waits for specialist attention. Creating psychoeducation resources for patients is important to improve patient experience and outcomes. We developed a symptom self-management patient education booklet with an FND symptom recording template, using a co-production model, in a community neuropsychiatry setting.MethodsWe used co-production as part of a quality improvement project (QIP) at East Kent Neuropsychiatry Service, to produce a patient education booklet with symptom self-management information and a symptom recording template. The QIP cycle involved input from 11 participants. Initially, 3 medical students and 4 multi-disciplinary team members adapted an existing booklet, removing medical jargon and simplifying diagrams. The adapted booklet was distributed to patients with FND who were attending psychoeducation/Cognitive Behavioural Therapy group sessions. One week later, four patients discussed the booklet with a medical student facilitator; both quantitative and qualitative feedback was obtained. Feedback was gathered using an adapted 20 point Ensuring Quality of Information for Patients (EQIP) tool. Patient responses were recorded, and qualitative themes identified.ResultsFour themes were found from qualitative feedback during co-production: need for a glossary; an expanded resource list; more diagrams to simplify text; and for the booklet to also address family, friends, and carers. The EQIP questionnaire feedback emphasised that the booklet contained too much medical jargon and that it didn't personally address the reader. On average patients scored the booklet 53.33% using the EQIP questionnaire.The booklet was further adapted and a glossary, further diagrams and a section addressing family, friends, and carers was added. Further resources were added and the text was simplified for clarity.ConclusionThis QIP shows the value of co-producing information for an underserved patient population. Patient psychoeducation is a key part of treatment; involving patients at an early stage of the development of information and self-management tools will increase their acceptability to patients and improve the accessibility of patient psychoeducation.
Collaborating With Children and Young People: A New Model for Co-Production
Authors: Ravishankar Aarthi , Biggin-Lamming James , Holliday Tom , Fraser Lauren 
Published: June 2022

AimsChildhood and adolescence is a time in which the patterns and foundations for future health are laid. The World Health Organisation advocate for providing opportunities for children and young people (CYP) to meaningfully participate in the design and delivery of services. Co-production, in which professionals and citizens collaborate together in an equal partnership, is recommended as an approach to achieve this and is linked to better community relations. Few co-production models exist that are specific to CYP and address the relevant practical and ethical challenges. We propose a new framework which can be used by organisations wishing to engage in meaningful collaboration with CYP.To create a model for co-production with consideration of the specific needs of CYP.MethodsThe following methodology was used:
i)Identification of common themes from ten existing co-production frameworksii)Detailed analysis of three co-production frameworks with reference to CYPiii)Identification of key issues from critique of the literatureResultsThe key themes incorporated into the model using the above methodology were as follows: Purpose, Assets, Capabilities, Reciprocity, Networks and Relationships, Power, Catalysts, Diversity and Inclusion and Safety and Protection. This co-production framework can be used by organisations that wish to meaningfully collaborate with CYP and assess the depth of co-production of their initiatives.ConclusionThe new model takes into account the socio-cultural challenges that must be considered when co-producing with CYP including power relations, safety and diversity and inclusion. We advocate for the model being tested, validated and further developed ideally with the collaboration of CYP.
Understanding the Psychological Impact of Lockdown: Combining Quantitative and Qualitative Analysis of Emergency Presentations
Authors: Scurr Tom 
Published: June 2022

AimsThe pandemic of the COVID-19 variant caused a near-global lockdown, and the psychological impact of the direct effects of the virus, along with the resulting lockdown periods cannot be overestimated. Referrals made to the Liaison Psychiatry service at Derriford hospital during the 2020 lockdown were audited to better understand effects on patients’ mental health and resulting emergency presentations to services. These data were then used to identify areas for improvement, in order to tailor services to better support the population during recovery from the current lockdown, and for planning for future similar events.MethodsReferrals to the Derriford Liaison Psychiatry service between the 1st and 12th of May 202 were audited, totalling 106 referrals and a subsequent 87 assessments. Quantitative data on patient demographics, presentation, and outcomes was extracted from assessments along with qualitative data on patients’ subjective experiences from the initial lockdown period for thematic analysis. Routine data were used for comparator time periods from 2019, and during the second 2021 lockdown.ResultsDespite a lower number of presentations to ED during the first lockdown, the data demonstrate a higher acuity in presentations with more referrals for admission under section. The lockdown is shown to have particularly affected those with pre-existing psychiatric and physical comorbidity, along with specific patient groups. Thematic analysis confirms this, showing the diverse factors contributing to emergency presentations and demonstrating the increased stress of life in the home under lockdown. Comparisons between the qualitative and quantitative data confirm that patient experiences directly match both the routinely collected data and prior research. The project also revealed a reliance on private and third sector organisations for signposting on from assessments, and highlighted frequent changes to services during lockdown as a source of confusion for both patients and staff.ConclusionThe scale of impact identified affirms that exploration of the lockdown's contribution to presentation should be routine, particularly for identified at-risk patient groups. Areas frequently highlighted by patients can be used to fully explore the impact of lockdown on presentation during assessment. Patient information for self-referral needs to be regularly updated given frequent changes in service provision. Staff also need to be kept up to date on changing service structure at handover meetings.
Improving Efficiency and Quality of Handover in the Mental Health Liaison Team (MHLT): A Focus on Achieving Team Buy-In
Authors: Velani Bharat , Jobanputra Sagar , Ukachukwu Chiemezie , Osundina Adeagbo , Karunaratne Niranga , Deb Tanya 
Published: June 2022

AimsTo Reduced Mental Health Liaison Team (MHLT) handover time to less than 30 minutes within one month and to improve the quality of handover. The non-medical staff have been part of the team for many years, whilst medical staff have recently changed or are on short rotations. Previous changes have not been well sustained. Much of the initial enthusiasm for this project was coming from the medical staff members. We felt that it was important to fully explore the driving human factors to achieve sustainable buy-in.MethodsThe total period of the project was 7 weeks. First two weeks were used for daily baseline data-collection and informal and formal discussions with team members to formulate driver diagram and change ideas. Two “Plan, Do, Study, Act” (PDSA) cycles with two intervention points at week 3 and week 4.ResultsKey human factors identified in the MHLT were burnout and emotional fatigue, core team values (cohesion, flexibility, and camaraderie), and disillusion with authority and imposed change. Contributing factors to burnout and emotional fatigue were long and short-term staff sickness, chronic under-staffing, and systemic changes in the general hospital due to the COVID-19 pandemic. The human factors were used to guide key decisions in methodology and creation of change ideas. These decisions included: Avoidance of surveys and questionnaires (staff request), limiting the total number of changes, any additional administration to be undertaken by medical staff, and avoiding a rigid handover system. Following 2 PDSA cycles, there were improvements in average length of handover from 44 minutes (2-week baseline data) to 30 minutes (4-weeks post second intervention). When compared to the baseline data there were also improvements in the average number of interruptions (7 vs 2), availability of key information (69% vs 92%), allocation of staff member (80% vs 95%) and allocation of review date (83% vs 95%). No difference in the average number of patients for handover discussion between 2-week baseline data (15) and the 5 weeks after (15).ConclusionThe aims for the Quality Improvement Project were met and a plan has been set to re-audit in both 6 months and 1 years’ time to test sustainability of change. Sudden illness and effects of the COVID-19 pandemic have led to short and long-term staff shortage, contributing to burnout and emotional fatigue. Attention to the unique human factors involved in team dynamics and staff morale can help achieve buy-in and real change.
Ekbom Syndrome: A Case Report
Authors: Absy Nadine , Saleh Nur , Sharman Dima Al 
Published: June 2022

AimsEkbom's syndrome (ES), also called delusional parasitosis, is a condition where the patient has an unshakable belief and a perception of being infested with parasites. ES is thought to mainly affect postmenopausal females and because patients are usually mono-symptomatic, they usually seek care from dermatologists. It is advocated to form a liaison between dermatology and psychiatry to ensure a full range of differential diagnoses, in order to form the most suitable management plan.MethodsCase reportResultsAn 87-year-old widow was referred to the outpatient psychiatric clinic of King Abdullah University Hospital by a dermatologist because of generalized chronic pruritus that she believes is caused by a bug infestation. The symptoms started one year prior to presentation (soon after an ischemic stroke) with the perception that macroscopic parasites were crawling over her body, biting her face, head, and hands, and entering her eyes. She tried various strategies to eradicate the parasites with no benefit. Psychiatric examination findings included hypochondriac delusional ideas and dysphoria. When her general medical condition and her medications were reviewed, it was found that she had been diagnosed with hypertension and ischemic heart disease. She was taking anti-hypertensive drugs and blood thinners. After haloperidol 5 mg daily was added, she had a progressive clinical improvement.ConclusionES is a neuropsychiatric syndrome that can follow primary psychotic or depressive disorders, dementia, or other organic diseases. Consultation-liaison by psychiatrists and dermatologists will be useful to assure timely referral. Better awareness of such an illness by general physicians, early recognition, good rapport, and empathic treatment are the cornerstones of management in such cases.