2908 results in BJPsych Open
Say NO to Online Mindfullness - a wellBEHing Initiative
- Hannah Campling, Mashal Iftikhar
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S15
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Trainees in Barnet, Enfield and Haringey (BEH) Mental Health Trust reported feeling isolated and burnt out after COVID-19. Offers of "online mindfulness" or "resilience training", as a substitute for in-person gatherings, felt very inadequate. Well-being initiatives are known to improve staff morale, mental health, patient care, recruitment and retention of trainees. We created and delivered a pilot well-being programme to improve the well-being of trainee psychiatrists working within BEH between September 2022 and January 2023.
MethodsWe developed a WellBEHing brand for our trust and a committee of trainees dedicated to improving the well-being of themselves and their colleagues.
We ran a focus group for all trainees to submit ideas for sessions and activities they would enjoy.
We developed a programme of monthly WellBEHing events during protected well-being time, that was funded by medical education and the local division.
We surveyed trainees pre and post WellBEHing autumn/winter programme to record the impact on their sense of well-being. We also collected qualitative data on their experiences of being part of a WellBEHing community.
ResultsPrior to the WellBEHing autumn/winter programme we surveyed 40 trainees in BEH and only 12.5% of them rated their well-being as good or great. 35% of trainees felt unvalued or uncared about at work.
At the end of the autumn/winter WellBEHing programme 73% of trainees felt valued at work, with 60% of trainees feeling "happy and cared for".
Some of the qualitative feedback showed the impact well-being events can have on trainees “Seeing everyone in person, and being able to do so during the working day made me feel that BEH values me enough as an employee to prioritise my well-being. The quiz was also excellent and had clearly had a lot of effort put into it.”
ConclusionMeaningful well-being initiatives take time, effort and funding. They require the support of management and consultants. Our results demonstrate that when well-being is designed and led by trainees, they feel valued and cared for as employees. We are beginning the second phase of project development where we will focus on making the programme sustainable and embedded in trainee life at BEH long-term.
Functional Cognitive Disorder and Mild Cognitive Impairment: A Thin Line
- Jide Jeje, Akinkunmi Odutola, Lawal Qudus, Olusegun Sodiya, Modupe Ogungbayi, Aishwarya Prabhu
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- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S124
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Functional cognitive disorders (FCDs) refer to conditions where patients present with persistent problematic subjective memory complaints that are not consistent with their observed level of cognitive functioning. The demonstrated symptoms are also not in keeping with a recognized psychiatric or neurodegenerative process. FCD is likely to be underdiagnosed in clinical practice with the place-holder label of mild cognitive impairment being used in some cases due to lack of clarity about its symptomatology. In this paper, we describe two cases whose presentations were suggestive of FCDs.
MethodsMrs X, 53 years old female not previously known to mental health services referred for increasing difficulties with her memory over 2 years which she believed was impacting her activities of daily living. She has a history of ischaemic heart disease, fibromyalgia, Insulin-dependent diabetes mellitus, depression, and polycystic ovarian syndrome. On assessment MOCA = 15/30, and MMSE = 25/30.
Mr Y, 57 years old male not known to mental health services. Although, has been treated for anxiety and depression by GP. He presented with a 3-year history of struggling with his memory. He reported being forgetful of appointments and he has to paste sticky papers on the fridge for reminders. Similarly, he has a diagnosis of Fibromyalgia and essential hypertension. On Assessment MOCA – 19/30 and MMSE – 25/30.
ResultsFCDs can be quite challenging because the clinical picture overlaps with other neurodegenerative conditions. Typically, patients report issues around memory function in the absence of relevant neuropathology and with evidence of inconsistency between symptoms reported and observations at assessment. Regarding our cases, the primary presenting issues were increasing difficulties with memory, and forgetfulness. Other noteworthy observations were a mismatch between their scores in the MOCA, MMSE, their level of functioning, and reported memory problems. Neurological examinations and neuroimaging were not suggestive of any neurodegenerative disorders. A differential diagnosis of functional cognitive disorder was considered due to the discrepancies between symptoms reported, the level of their functioning, observations at assessments as well as absence of relevant neuropathology on imaging.
ConclusionFCD is a condition that is common in clinical practice but underdiagnosed. Hence, it is imperative that clinicians keep this diagnosis in mind when patients present with memory difficulties that do not meet the diagnostic criteria for dementia and is not due to a recognized medical or psychiatric condition. Correctly identifying and diagnosing FCD can positively impact patient outcomes.
Findings of Recruitment and Retention Survey – Consultants’ Perspective
- Sajid Mahmood, Girish Kunigiri
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- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S58-S59
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Recruitment and retention of medical staff is a national issue. Low level of staff means challenges in provision of adequate and efficient patientcare. There is a lack of flexibility for clinicians to get time for Supported Programmed Activity (SPA). Burn out of existing clinicians and loosing good will is common which increases patients’ complaint and potential risk of near misses and serious incidents. Leicestershire Partnership NHS Trust (LPT) has significant challenge like many other neighbouring Trusts in term of recruitment and retention of consultant psychiatrists. The aim of this research was to find out proportion of consultant psychiatrists satisfied with current job and to explore their views on current difficulties and ways to support and retain them within their current Trust.
MethodsIt was a cross-sectional survey. The target population was consultant psychiatrists working in LPT. An online questionnaire was developed for data collection. Data were gathered through open (free text) and close (options provided) questions. Information was collected regarding job satisfaction, positive and negative of job, difficulties and challenges in current role, willingness to continue work within Trust and if they would recommend friends or colleagues to join LPT. Results are reported in percentages for descriptive statistics.
ResultsAbout 34% of the responders (n = 38) were satisfied with their current job, whereas about 45% reported unsatisfied or very unsatisfied. Regarding quality of admin support, nearly 40% were unsatisfied. Similarly, about 1/3 of the responders reported un-satisfaction with available office and clinic space for clinical and admin activities. Nearly 2/3 reported not getting adequate time for SPA activities, instead 37.5% reported 5 or more hours per week spending over their contracted hours. Over 97% said, their job can be more rewarding by acknowledging their contribution, involving them in Trust activities, provision of adequate clinic space, reducing case load with enhance recruitment. Surprisingly 71.1% reported thought of leaving LPT in the last six months and only 28.9% clearly stated, they would stay within Trust and also recommend a friend or a colleague to join.
ConclusionMajority of the consultant psychiatrists were unsatisfied with their current job and reported thought of leaving Trust in the last six months. There is an urgent need to address the highlighted challenges and early discussion with them in term of what local Trust can offer and support them to ensure their retention and enhance recruitment while they are being advocate for the LPT.
The Patient's Guide to Buvidal: A Service Improvement of a Digital Repository of Patient Information for Patients Taking Buvidal in Wales
- Devon Ward
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- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S145
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Buvidal is being used with patients with opioid dependence. Only 35% of patients read the paper patient information leaflet, which could be improved by condensing the information, making it accessible and relevant. Therefore, the aim was to create a series of informative videos answering important questions for patients taking Buvidal and then evaluate their perceived efficacy.
MethodsData were collected from a questionnaire taken by patients taking Buvidal and healthcare professionals (HCPs) working in Substance Misuse Psychiatry in Wales. The results and preferences were analysed and the information was used to create 5 videos addressing the questions the participants thought were the most important. A second questionnaire was sent out alongside the videos to the original participants to gauge their utility. The Patient's Guide to Buvidal can be accessed on YouTube: shorturl.at/afjl3.
ResultsAll participants reported that the videos would be useful in answering their questions about Buvidal. Participants ranked the use of Buvidal, the effect of comorbidities and other substances on taking Buvidal and side effects as the most important topics to be covered in the videos. Understanding and confidence increased in a mean of 80% of the topic areas discussed. HCPs reported an increase in 9 out of the 12 topic areas, whereas patients reported an increase in 7. There was no statistically significant difference between prescriber and patient confidence (t(22) = 0.197, p=0.05). 100% of the participants stated they enjoyed the videos and preferred them to the patient information leaflet.
ConclusionThe digital repository could be a valuable addition to the holistic care of patients taking Buvidal to improve their understanding of important questions and topic areas. The use of one long video using YouTube's bookmark feature may be preferred by patients to easily navigate the videos. In the future, new medications and routes may benefit from videos like this targeted at HCPs as well.
Improving the Knowledge, Skills and Confidence of Clinicians Towards Mental Health: An Educational Intervention Based on Reflective Practice
- Meda Alinia
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- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S12-S13
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Mental illness-related stigma, including that which exists in the healthcare system creates serious barriers to access and quality care. People with lived experience of a mental illness commonly report feeling devalued, dismissed, and dehumanized by many of the health professionals with whom they come into contact. While working in the mental health liaison team in a local general hospital I have experienced first-hand these issues. We decided to organise regular reflective sessions for staff to reflect on what the barriers are to being able to manage patients with mental illness better on the wards, raise mental health awareness, improve staff communication skills, and offer teaching sessions to improve the staff knowledge of psychiatric pathology.
MethodsBefore starting, we offered a feedback form to staff to ascertain the value of the project.
To ascertain that the learning has taken place, we have delivered a post-session formative quiz to assess the staff's knowledge of managing patients with mental illness.
To determine the effectiveness of the project, we decided to use Kirkpatrick's evaluation model and assess the first two levels of the programme outcome: (1) learner satisfaction- through staff feedback; (2) measures of learning- knowledge gained showed in the formative post-session quiz.
ResultsThe sessions were carried out on 2 wards in the general hospital
• Ward 1: 4 sessions; number of attendees: 12
• Ward 2: 4 sessions; number of attendees: 5
The student evaluation was done through a quiz offered to the participants at the end of each session.
9 quiz questionnaires were completed on ward 1:
Correct answers: Q1- 67%; Q2- 89%; Q3- 0%; Q4- 100%.
5 quiz questionnaires were completed on ward 2:
Correct answers: Q1- 20%; Q2- 60%; Q3- 0%; Q4- 40%.
The programme evaluation was done through a feedback form offered to the participants at the end of each session.
12 forms were completed on ward 1: 50% strongly agreed that the session was useful to their practice; 70% were quite confident in caring for patients with mental illness following the session.
5 forms were completed on ward 2: 20% strongly agreed that the session was beneficial; 75% were quite confident in caring for patients with mental illness following the session.
ConclusionDifficult to implement a culture change.
Following a meeting with the stakeholders, we agreed on delivering monthly reflective sessions to the staff in their allocated “team time” where attendance is mandatory and we will also take part in a developmental teaching programme for band 5 nursing staff
We are in the process of extending our project to the Emergency department
Audit of DNA & Disengagement of Patients in West Essex Community MH Teams
- Rosy Purakayastha
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S178-S179
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Non-attendances (DNAs) and cancellations are a very costly waste of resource within the NHS and so it is important to have a focused plan of action to proactively manage them. The Trust recognises that people may choose not to attend appointments, or discontinue contact with the services we provide for them. There will be occasions where a person's non-attendance is an indicator that :
• they may be at risk to themselves or others through deterioration in their mental health, or other issues preventing them from attending.
• Therefore, any failure of planned contact should be regarded as a potentially serious matter and should lead to an assessment of potential risk. Hence we aimed this study to see if trust policy of DNA and disengagement is being followed.
MethodsData were collected for 51 patients who missed their scheduled appointment between February and August 2021, using a predesigned questionnaire tool.
ResultsOut of the 51 patients, 37 of them Did not attend the initial assessment whereas 14 of them did not attend follow-up appointments.
18 patients had the diagnosis of depression, 9 of then had anxiety as the diagnosis and 8 had the diagnosis of personality disorder. Please see figure above for distribution of Mental Health diagnosis.
98.1% patients were notified adequately and for all the patients, letter was sent to the patient and the GP.
In 50.9% cases Risk Assessment was completed (although 37 patient did not attend, they were already known to our services). In 25% of cases, risk assessment was updated.
Review of the Contingency plan was done in case of 26 patients.
Out of the 51 patients, family was contacted for only 3 patients. Remaining 48 patients other known contacts were contacted in 4 cases.
Out of the remaining 44 patients, 3 patients were referred for home visits or AHMP.
Out of the remaining 41 patients, police/welfare check was done for 4 of them.
The remaining 31 patients were discharged from the services after they did not respond to our multiple correspondences including phone calls and letters.
ConclusionThough trust policy is being followed to a good extent in regards to adequately notifying and contacting service user, offer another appointment and informing GP, we are failing to adhere to trust policy in regards to updating risk assessments, review crisis plans or doing welfare checks.
A Quality Improvement Project: Improving the Presentation of Assessments Within a Liaison Psychiatry Department
- Shivali Jain, Natalie Maalouf, Khalil Hassanally, Raman Rashwany, Asha Faldu, Krishna Amin
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- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S107
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This Quality Improvement Project (QIP) was undertaken within a Liaison Psychiatry (LP) department at a district general hospital in North West London. The current service model has LP nurses and junior doctors providing first contact with patients, and subsequently discussing assessments with the team psychiatrists. A need for effective communication when presenting clinical cases has emerged given high rates of staff turnover. The aims of this QIP were; (1) To assess the quality of presentations within the multidisciplinary team (2) to deliver a targeted teaching session focused on frameworks for assessment presentation and (3) to evaluate the effectiveness of the intervention.
MethodsThe ‘SBAR: Situation, Background, Assessment, Recommendation’ communication tool already used widely within healthcare was adapted for LP by an MDT including doctors, senior nurses and pharmacist.
A survey was designed with MDT input to collect data about the content of presentations using adapted Likert scales, a quantitative global score and qualitative data highlighting areas for improvement. Over two weeks, senior team members completed surveys for every patient discussion.
A targeted teaching session was delivered on the adapted LP SBAR including: presenting complaint, current medical issues, referral question, psychiatric background, mental state examination, delirium/cognitive screening, risk assessment, impression and management plan. The session included breakout groups with clinical vignettes to practice presenting. All team members filled in a pre- and post-intervention surveys rating their confidence in presenting assessments and received copies of teaching materials.
Data were collected over a 2-week period post-intervention using the same methodology as pre-intervention. Post-intervention data were presented to the MDT and feedback was sought for improvement in the next cycle.
ResultsPre-intervention data (n=30) indicated a risk assessment, impression and plan were often missed from presentations.
Following targeted teaching, team members felt more confident presenting assessments, formulating impressions, and management plans. Post-intervention data (n=22) showed an improvement in inclusion of all key information covered in the LP SBAR except management plans. The percentage of presentations with a global score ≥7 increased from 41% to 57%.
ConclusionThis ‘Plan, Do, Study, Act’ cycle has modestly improved the quality of assessment presentations within LP and has identified a critical need for communication tools within LP. We will perform another cycle in February 2023 given the high turnover of staff and continue to seek feedback from the MDT on the effectiveness of this targeted teaching session to continue to improve the presentation of assessments in LP.
Physical Health Monitoring in Patients on Antipsychotics: A Clinical Audit
- Alice O'Donnell, Jayanta Chatterjee
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- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S173
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Patients with serious mental illness are more likely to suffer from serious physical health conditions, including: obesity, diabetes, heart failure and stroke. This, combined with the side effects of antipsychotic medication including weight gain and cardiac changes, means that patients with psychosis under the Early Intervention Services (EIS) taking antipsychotics require regular physical health monitoring, as per NICE guidelines. This includes: yearly BMI, blood pressure, ECG, blood tests (FBC, U+E, lipids, HbA1c, prolactin, LFT), alcohol status and smoking status. Our audit aims to assess the compliance of physical health checks for patients on antipsychotic medication under the EIS first episode psychosis team.
MethodsPatients on our caseload (for >6 months) between 01/2022 and 01/2023 (n=36) were included in this audit, and relevant data were collected using electronic records (i.e. carenotes and affinity). Data were recorded and stored electronically, and analysed using Excel and GraphPad. Patient information was discussed with their lead practitioner to ensure data collected was accurate. Our audit standard was set at 100%.
ResultsIn terms of BMI, 91.67% (n=33) of patients had a recorded BMI, with 19.44% (n=7) of our patients being overweight and 19.44% (n=7) being classified as obese. Of the patients classified as overweight or obese (n=14), 85.71% (n=12) had received advice about their diet or exercise. Blood pressure measurements were available for 86.11% (n=31), and 13.89% (n=5) of these patients were found to have hypertension. Information relating to patients' alcohol, smoking and recreational drug use was recorded in 97.22% (n=35) of our patients.
Qrisk data were not collected in 22.73% (n=5) of patients who were eligible for measurement (n=22). Furthermore, ECG tests were not recorded in 72.22% of patients (n=26). Compliance with blood tests was less than the desired standard, with 75% (n=27) of patients having an up to date FBC, U+E, lipids and HbA1c measurement.
ConclusionSpecific areas of physical health monitoring are carried out to a high standard in the EIS service, but there are areas which warrant improvement, particularly Qrisk and ECG monitoring. The EIS team is to re-audit these outcomes in 3 months' time, after presentation of results to the team and physical health check clinics are employed.
A Systematic Review of Cognitive Behavioural Therapy as a Non-Pharmacological Intervention for School Aged Children With ADHD
- Aoife Journeaux
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- BJPsych Open / Volume 9 / Issue S1 / July 2023
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- 07 July 2023, pp. S56-S57
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The aim of this poster is to illustrate a systematic review exploring Cognitive Behavioural Therapy (CBT) as a Non-Pharmacological Intervention for School Aged Children with Attention Deficit Hyperactivity Disorder (ADHD). CBT is a common behavioural intervention in several child and adolescent psychopathologies as reported by Ramsay (2010); Solanto et al. (2010); Ramsay (2012); and Lopez et al. (2018). It is recommended as a non-pharmacological intervention alongside parent training, in school-aged children with a moderate severity of ADHD symptoms (National Institute for Health Care and Excellence [NICE] 2018b). This systematic review aimed to evaluate the effects of CBT as an intervention for ADHD in school-aged children. The research objective was to assess the effects of CBT in reducing the core symptoms of ADHD.
MethodsA search strategy was developed and a search of four databases initially yielded 1100 results. The search was then limited to randomised controlled trials (RCT) which evaluated the efficacy of CBT compared with treatment as usual, no treatment, and waitlist, in school-aged children. Inclusion criteria included participants who were diagnosed by a medical professional, and participants under the age of 18 in full-time, mainstream education. Those with co-morbid autism or tic disorder and those with an intellectual disability were excluded.
ResultsSix RCTs met the inclusion criteria. The age range of participants was 8–18 years. The medication status of participants varied across the included studies. A narrative synthesis of the results included assessment of methodological quality and risk of bias. Jadad scores were used alongside the Cochrane Risk of Bias Tool (RoB 2) for RCTs, to assess the quality of evidence. The studies all included different modalities of CBT intervention and a variety of measurement tools.
ConclusionThe findings support the use of CBT as a non-pharmacological intervention to reduce the severity of ADHD symptoms in adolescents. However, as there were no available studies that included children aged under 8 years, the findings cannot support the use of CBT in the reduction of severity of ADHD symptoms in this group. Methodological issues within the study designs mean the findings need to be treated with caution. Future research is warranted that includes larger sample sizes and younger children with longer follow-up periods. Different modalities of CBT should be explored with and without pharmacological interventions. There is also a case for exploring modalities of CBT that are suitable for targeting in the younger age range of children.
EVALUATION of VIDEO CONSULTATIONS in COMMUNITY MENTAL HEALTH SETTING- Pilot Project of Service Evaluation
- Sadia Tabassum Javaid, Ravindra Belgamwar
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- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S96-S97
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To evaluate the overall experience and satisfaction with Attend Anywhere video consultations in adult CMHT. The increased use of the digital world is evident via Ofcom Tele Report 2019. UK Government's Five Year Forward View and initiatives, such as ‘Digital First’, aim to reduce face-to-face consultations. Past reports have shown video consultations to be non-inferior to face-to-face consultations in systematic reviews and qualitative studies.The contagious nature of the COVID-19 outbreak limited face-to-face consultations. This led to video consultations via Attend Anywhere (AA). AA is accessed anywhere via the web on Google or Safari with a good internet connection. It provides a single, consistent entry point with an online waiting area on the service's webpage.
Methods1. Two separate questionnaires were designed, one each for service users and staff, to capture relevant information at the end of AA consultation. Additional clinical questions for staff included.
2. Data were collected anonymously for 2 months from 1st April 2020.
ResultsTotal respondent 44= 20 service users and 24 staff.
1. For Service Users:
The respondents’ age range was 19-62 years, 80% females. The majority were follow-ups with three new assessments. About half of them had previous contact with the staff. 15 consultations were carried out by the doctor, four by the psychologist, and one was a joint doctor-psychologist consultation.
95% reported their overall experience to be very good-good. 90% found it easy to use: 95% said they would use it again.
2. For Staff:
The respondents’ age range was 30-50 years, 87% females. The majority were follow-up assessments with one-third new. 16/24 respondents were doctors and eight psychologists. 58% had a previous meeting with service users.
83% reported the overall experience as very good to good: one third felt it's time-saving. 100% reported it's easy to use, would re-use and recommend to others.
For clinical questions, the responses were very good-good as Rapport 87%; Risk assessment 83%; care plan 83%; History taking 78%; Mental state/Cognition 66% and providing support 65%.
ConclusionOverall, the majority of respondents at an Adult CMHT found video consultations easy to use with readiness to use them again. Video consultations offer several advantages over telephone reviews, e.g. for developing rapport, assessing mental state, etc.
These data are limited to the pilot project and a detailed review is planned for qualitative information with a larger cohort. Following this successful pilot and promising results, video consultations have been rolled out to other trust clinical areas.
Is Balint Group Work Improve Doctor-Patient Relationships Among Psychiatry Residents
- Mansoureh Kiani Dehkordi, Fatemeh Sadat Bateni, Najmeh Shahini, Fatemeh Babaie, Shakiba Gholamzad, Negar Kiani Yousefzadeh, Ali Nazeri Astaneh, Morvarid Ohadi
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- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S27
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One of the effective interventions in reducing stress and burnout and increasing the job satisfaction and relationship of doctors is participation in Balint groups. The purpose of this study is to design, implement and evaluate the use of Balint groups in improving doctor-patient relationships among first-year psychiatry residents at the University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran.
MethodsThis study was a pretest-posttest study conducted in 2022. First-year psychiatry residents at USWR were invited to join a Balint group through the Department of Psychiatry, and then they were called to attend an interview. During the interview, the inclusion and exclusion criteria for the study were reviewed. The requirements for participating in an online Balint group, including having a strong internet connection and the ability to work and communicate properly with the group, as well as ethical considerations such as the ability to keep confidential information within the group were examined.
12 group meetings were held for 6 months. The group leader had previously led various Balint groups for medical staff. Due to the COVID-19 pandemic, the sessions were held online on Skype.
The participants completed the demographic information questionnaire, the Jefferson Scale of Physician Empathy, and the patient communication questionnaire before and after participating in the Balint group. Next, data analysis was done using SPSS software version 25.
ResultsThe average (standard deviation) age of the participants in the study was 30.70 (±4.54) years. Ten Participants included both male and female first-year psychiatry residents, eight of which were females, and eight were married. They all worked at the university. 70% had a high interest and 30% had an average interest in their field. Intra-group comparisons using the paired t-test showed that the the participants’ scores in the following areas significantly increased after the intervention: verbal communication skills (t=−6.26, P < 0.001), non-verbal communication skills (t=−9.76, P < 0.001) and total communication skills (t = −5.72, P <0.001). Also the results showed a significant increase in the scores of the Jefferson Scale of Physician Empathy after the intervention (t =−10.67, P < 0.001).
ConclusionThe results of the present study showed that participating in Balint group work can have a significant effect on the communication skills and the level of empathy among psychiatry residents. The results of this study are in line with Parker and Leggett's study (2012) and confirm the effectiveness of the Balint group work . Also, the results of this study are consistent with the studies of Airagnes et al. (2014) and Gajree (2021) and show that adding the Balint group work to the Iranian psychiatry residency curriculum can be useful.
Balint group work, psychiatry residency, doctor-patient relationship, empathy.
Health Care Professionals’ Perspectives of Early Intervention in Psychosis Services: A Qualitative Study
- Michelle Rickett, Tom Kingstone, Veenu Gupta, David Shiers, Paul French, Belinda Lennox, Carolyn Chew-Graham
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S68
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An Early Intervention in Psychosis (EIP) service offers treatment in the community to people with a first episode of psychosis. EIP is meant to be given for three years; after this time, those who are well are discharged to their GP, while those with ongoing symptoms and care needs are transferred to a general community mental health team. People can become unwell at this time of change and might benefit from longer treatment with EIP. We also know that some people who are well could possibly have been discharged back to their GP earlier. The EXTEND programme aims to develop a more tailored approach to EIP services based on the needs of each individual and understand the health, social, and cost-benefits of this approach.
MethodsThis qualitative study sits within a larger programme of work. Ethics and HRA approvals gained. Semi-structured interviews were conducted with health care professionals from primary and specialist care, managers and commissioners, to understand why and how decisions about duration of EIP care are made. Interviews have been transcribed and thematic analysis using principles of constant comparison is being conducted. Patient and public involvement is key to all stages of the study.
ResultsFive interviews with General Practitioners and twelve interviews with EIP healthcare professionals, managers and commissioners have been conducted. Initial analysis suggests that access to EIP services can be challenging. Initial engagement is needed before therapy can begin. Decisions about duration of care can depend upon availability of access to Community Mental Health teams. Discharge planning rarely involves communication between primary and specialist care, and this can be a difficult transition, particularly when discharge is back to primary care. The pathway back into mental health care following discharge can be difficult. Trusting relationships between service users and EIP professionals are key to the success of EIP care. Healthcare professionals would value - and in some cases are given - flexibility to extend EIP care beyond 3 years.
We have developed a model to illustrate the patient journey through the EIP service which will be presented for the first time at the conference.
ConclusionThis research provides a framework to understand decision-making around duration of care, discharge planning and practices, and post-discharge support for EIP service users. The next phase of the study will be interviews with service users and carers to explore their experiences of EIP services, duration of care and discharge planning.
Co-Production of a Digital Symptom Self-Management Resource for Patients With Functional Neurological Disorder
- Miten Sudra, In Woo Lee, Giruchaandan Mohanarajah, Methushaa Suthanthirakumaran, Verity Williams, Alan Dunlop, Ranya Alschamaa, Wendy Collison, Rafey Faruqui
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S112
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Patients with Functional Neurological Disorder (FND) experience neurological symptoms which may impair motor control, sensory function, or awareness. Long waiting lists before treatment mean the risk of relapse during this period is high. A lack of knowledge around FND also results in a lower quality of life. Therefore, it is important patients with FND receive appropriate psychoeducation to empower them to understand and manage their symptoms. We aimed to strengthen our symptom self-management booklet for patients in a community neuropsychiatry setting, using a co-production model and taking forward improvements into a digital audiovisual format.
MethodsWe used co-production as part of a quality improvement project (QIP) at East Kent Neuropsychiatry Service to identify improvements to our existing symptom self-management booklet and apply these in the production of a digital resource. Initially, the symptom self-management booklet was distributed to 10 patients, awaiting further assessment and treatment, chosen by the multidisciplinary team following triage appointments. Two weeks later, 7 patients reviewed the booklet with 4 medical students by phone and qualitative and quantitative feedback was obtained from patients and carers. Quantitative feedback was collected using an adapted 20-point Ensuring Quality Information for Patients (EQIP) tool. Informed by this feedback, scripts were developed for the audiovisual resource. The scripts were further reviewed by a medical student, 2 multidisciplinary team members and 3 Trust Communications Department members.
ResultsThe first QIP cycle highlighted the importance of the symptom self-management booklet. Most patients had used the booklet. Patients found it a helpful source of information. Two patients noticed a considerable improvement in their quality of life, others did not due to the short length of booklet use. . EQIP tool demonstrated an improved score of 80.51% compared to previous round of feedback (53.33%). Carers identified the booklet as reassuring. Additional links to external information was identified as an area for development.
Patient feedback informed the development of scripts for the audiovisual resource. Consultation with the Trust Communications Department identified three themes of improvement: accessibility to patients, increased clarity and concise language, and an appropriate visual format, therefore scripts were further refined.
ConclusionOur QIP shows the value of a psychoeducation and symptom self-management tool for FND patients which was positively received by patients and carers. Collaborating with patients in the digitalisation of this information allows for a more accessible resource which effectively addresses patient concerns and empowers symptom self-management.
Emotional Lability Secondary to Androgen Deprivation Therapy for Prostate Cancer: A Case Report
- Mary Keenan, Atiqa Rafiq
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S124
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Prostate cancer accounts for more than a quarter (27%) of male cancer cases, making it the most common form of cancer in UK males. Androgen deprivation therapy (ADT) is the mainstay of treatment for prostate cancer. Its aim is to reduce the level of androgens which stimulate cancer cell growth, in turn reducing prostate cancer symptom burden over longer periods. Although the clinical benefits of androgen deprivation therapy have been well documented, the physical, and in particular psychological, side effects of this treatment are lesser reported and can be debilitating.
MethodsWe present the case of an 84 year old male referred to Old Age Psychiatry outpatients for a one year history of low mood and tearfulness with no response to two antidepressant trials. The patient was receiving six-monthly injections of Decapeptyl (Triptorelin), a hormone therapy for prostate cancer. The patient's main presenting complaint was of bouts of tearfulness that were difficult to control and often mood incongruent. He reported low energy and reduced motivation; however other biological depressive symptoms were not endorsed.
ResultsDepression and marked emotional lability have been reported by men who receive ADT for prostate cancer. This can be a cause of confusion or shame for patients, subsequently impacting interpersonal relationships and social functioning. Other side effects of ADT can lead to further negative psychological effects, including weight gain, gynaecomastia and genital shrinkage. It is possible that the side effects of this treatment are poorly recognized by clinicians initiating and managing it.
ConclusionIn conclusion, patients commencing ADT should be informed of the possibility of psychological side effects and encouraged to report any symptoms that arise. It is important for urologists, psychiatrists and GPs to be mindful of the possible link between this treatment and new onset mood and emotional symptoms in patients.
Establishing a Memorial Trust Overseas (Kashmir) for the Promotion of Health, Awareness and Education
- Zafrina Majid
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- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S30
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To promote physical and mental health in underprivileged communities; (II) to increase awareness on health matters in the community and students.
MethodsMay 25th 2011, remains etched in author's mind. Her brother, Dr Syed Arshad Abbas, had a fatal accident while on duty. In 2012 family established a Memorial Trust. Since then, the following are provided:
1. A free medical health camp twice a year. Patients receive free consultation, free medication and referral to secondary or tertiary services.
2. An ambulance service available all times.
3. Two blood donation events, 2012 in collaboration with Red Cross and 2022, in collaboration with an international charity and the hospital of Baramulla.
4. Sponsorship to students, from primary school to university, with a mentoring scheme for university students.
5. Mental Health awareness programme every year in different Universities.
Results1. To date, 3122 patients were seen at the camps. Medical and psychiatric specialist services are offered face to face or virtual. Depression, Anxiety Disorder and PTSD are the most prevalent disorders. There is an increase in substance use in youth. Polypharmacy is common practice.
2. Ambulance catered for 2404 patients. The first patient was an 11-year-old boy, with acute abdomen. He was transferred to tertiary hospital and operated within three hours.
3. Second blood donation event has broken the World Record of number of donations in one day. A database of regional donors was set up. Screening has identified two women with anaemia, highlighted health inequalities which were reported to local government.
4. Sponsored and mentored university students have completed their degrees and secured placements in tertiary hospitals.
5. Mental Health awareness programme identified the need for counselling services in universities and need for similar programmes.
ConclusionThis project has given an opportunity to turn loss into positive and a grief into hope. It will help family to move on by providing to the local community. Being a medic trained in UK the author was able to utilize skills into serving her home community, put vision into action and fulfil Hippocratic oath.
A Digital Solution to Improve Safety of Valproate Prescribing in Mental Health
- Ashma Mohamed, Alison Marshall, Nikki Smith, Anna Smith, Barbara Sowa, Sue England, Sarah Long
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- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S103
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Valproate is a licensed medicine prescribed within mental health settings for bipolar disorder. It is a known teratogen, affecting approximately 20,000 people and costing the NHS £181 billion. This was a multidisciplinary project involving Surrey Heartlands Medicines Safety Team and Surrey and Borders Partnership NHS Foundation Trust, who developed a solution to reduce human suffering and cost by adhering to the Medicines and Healthcare Products Regulatory Agency (MHRA) valproate regulations through a clinical and digital redesign. The aim was to identify females in primary and secondary care across Surrey who take valproate for mental illness and to implement a pregnancy prevention programme for them by July 2022, using a digital clinical pathway supporting clinicians in the implementation process.
MethodsThe method used was a combination of the Model for Improvement, the sequence for improvement from East London NHS Foundation Trust, UX design, and Agile project management. A valproate working group was formed with professionals from multiple disciplines to identify, understand and solve the problem. The solution was designed through co-production and project management methods that ensured a patient-centric solution.
ResultsA digital registry of all females of childbearing potential who are prescribed valproate was created. A bespoke electronic GP referral form for valproate reviews was implemented. A one-stop valproate dashboard was developed to support documentation. A live digital visualisation feature was added within the secondary care electronic patient record to ensure compliance with MHRA guidelines. Easy-to-read materials for females with learning disabilities and sensitively worded appointment letters that inform patients of the risks and importance of attending annual reviews were created. In addition, collaboration with the National Valproate Patient Safety Officer allowed the implementation of Systematized Nomenclature of Medicine Clinical Terms (SNOMED) codes to simplify the exchange of clinical information between systems.
ConclusionThe project has the potential to reduce harm and improve the patient experience, serving as a template for other medications with strong regulatory controls. Collaboration between primary and secondary care, clinicians, pharmacists and digital colleagues, and co-design with people prescribed valproate were essential to the success of the project. Ongoing work is required to ensure valproate-related materials are available in an accessible format for every person prescribed valproate. Valproate has also been implicated in paternal adverse effects, and this project solution is future-proofed to identify men on valproate. Through this work, people will only be treated with valproate in a way that safeguards the health of unborn children.
Improving Physical Health Monitoring on an Inpatient Dementia Assessment Unit – a Quality Improvement Project
- Ivan Shanley, Fatma Ghoneim, Nadeera Attanayake, Jennifer Ford, Alina Kutraite, Thembisa Nkungu, Elle Maccabe
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S109
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Meadowview Ward is a dementia assessment unit based at Thurrock Community Hospital as part of Essex Partnership University NHS Foundation Trust. Patients with advanced dementia are routinely admitted with significant physical comorbidities and, as such, robust physical health monitoring is required. Members of the nursing team felt that it would be helpful to formalise the approach to physical health monitoring in order to allow all members of the multidisciplinary team to be aware of the necessary requirements. It was decided to formulate a physical health monitoring prompt sheet to facilitate discussion regarding physical health during ward rounds.
MethodsA multidisciplinary discussion took place to identify the areas of monitoring which should be routinely highlighted in ward rounds. Items labelled as routine monitoring requirements were also listed. A prompt sheet was then devised which divided ward round discussion into nursing and medical feedback, with each section having specific areas for discussion (for example oral intake, recent blood results, any pending investigations). This included prompts for other staff groups including physiotherapists and occupational therapists. A section was also added regarding ongoing monitoring requirements, such as routine outpatient appointments and whether transport had been booked.
In order to assess the impact of the introduction of the prompt sheet a questionnaire was provided to members of the multidisciplinary team who regularly attend ward round. This assessed their perception of the quality of physical health monitoring both before and after the introduction of the prompt sheet, the impact of the sheet on ward rounds and whether they wished the intervention to continue.
ResultsThere was a significant increase in staff satisfaction with physical health monitoring on the ward (n=7, P = 0.0065). 100% of staff surveyed rated the introduction of the prompt sheet as “strongly helpful” and that they “strongly agree” the use of the prompt sheet should continue. An initial concern from the team had been the potential for the use of the sheet to delay ward rounds, however 57% of respondents reported no impact on ward round duration and 43% felt it strongly expedites assessments.
ConclusionThe introduction of the physical health monitoring prompt sheet has been widely perceived as a success within our multidisciplinary team. It has also demonstrated the effectiveness of a multidisciplinary approach to quality improvement projects, ensuring the wide variety of expertise within teams is utilised.
A Service Evaluation of Workload Monitoring for the Psychiatric Resident On-Call Rota
- James O'Neill, Anna Taylor, Sharon Nightingale
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S139
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The Psychiatric Resident On-Call (PROC) rota provides medical cover for all inpatients across Leeds and York Partnership NHS Foundation Trust outside normal working hours. With the introduction of a new regional inpatient CAMHS unit in August 2021, a service evaluation project was undertaken to establish if the current medical provision was sufficient to meet the increased demand of expanding services.
MethodsWorkload monitoring was undertaken for 28 days during August and September 2022 for all evening, weekend, night and bank holiday shifts. Data collection documents in the form of Microsoft Excel spreadsheets were sent to one doctor to co-ordinate for all PROC doctors on each shift. For each 30-minute period, the number of doctors engaged in clinical activity was documented and the average number working at that time, as well as standard deviation, was calculated.
Results51 out of 56 on-call shifts were accounted for during the workload monitoring period by returning of a completed data collection document. Workforce demand for the remaining five shifts was estimated from reviewing handover document with listed times of call-out and expected duration for each job.
Data showed that workload was consistent throughout weekend shifts, but slowed around the time of handover. This is likely due to the end of shift being used to complete documentation, and the start of shift being used to assign roles and plan the shift ahead. In addition, lengthy non-urgent tasks may not have been appropriate to undertake if a PROC was due to shortly end their shift.
Patterns of night-shift working suggested a steady demand during the early hours of the shift, but a reduction during early hours of the morning, with trough levels being observed between 04:00 and 05:00 in the morning. No significant differences were observed between evening and night shifts across weekdays or weekends.
ConclusionAssessing the above data led the authors to conclude two changes to workforce provision which may increase efficiency of workload. The first was to implement a cross-over role which could bridge periods of handover and ensure that a medic is still available to respond to tasks despite the change in workforce around these times. The second was to rebalance allocated provisions so that less medics were on shift during early hours of the morning, when demand was lowest, and re-allocated to evenings or weekends where demand appeared to be greater.
Provision of Climate Emergency Teaching for Psychiatry Trainees: A Deanery Wide Quality Improvement Project
- Rosa Roberts, Olivia Etter
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S35
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In 2021, The Royal College of Psychiatrists declared a climate emergency, stating that “The disruption to life posed by climate and ecological degradation is a crisis which presents an unprecedented threat to human health”. In 2022 the College released an updated curriculum for both Core Trainees and Higher Trainees, which included the requirement that trainees “demonstrate an understanding of the principles of sustainability and how they underpin sustainable psychiatric practice”. We aimed both to understand whether Core Psychiatry Trainees (CTs) are meeting the new sustainability curriculum requirements and to increase awareness of the connections between the climate crisis and mental health.
MethodsWe used an electronic questionnaire to survey CTs baseline understanding of the climate emergency and sustainable practices in psychiatry, with reference to clauses included in the 2022 curriculum and Silver Guide. An educational module on the climate emergency was planned and delivered to CTs in 2022 and 2023. Content included sustainable practices in psychiatry and the relevance of the climate crisis to mental healthcare. Feedback was gathered afterwards.
ResultsThe questionnaire showed 44% of CTs surveyed disagreed or felt neutral that they could demonstrate an understanding of the principles of sustainability and 56% disagreed or strongly disagreed that they understand how the mental healthcare system can work to reduce potential negative impacts of healthcare on the environment. Feedback from the initial teaching day in 2022 included the following suggested improvements 1) Highlighting the relevance to psychiatry 2) Holding the day in person 3) Avoiding sessions with too many facts. These suggestions were incorporated into the second teaching day, along with the new College Silver guide curriculum requirements. 32 CTs attended the second teaching day (16 in person and 16 online), with some overlap in attendees from the previous year. Feedback from the second day was very positive. Respondents particularly found the session on young people and eco-distress useful, and reported finding the day ‘educational’, ‘insightful’, ‘practical’ and ‘accessible’. Further suggested improvements were to incorporate a nature based intervention into the day.
ConclusionOur findings showed psychiatry trainees find educational sessions on the climate crisis and psychiatry necessary and useful for their practice. This project gives an insight into how to provide this teaching in way that is reflective of the scale and urgency of the issue whilst also providing practical advice, optimism and active hope for the future.
Dealing With Out of Hours Emergencies - A film Project
- Prakriti Pokharel, Claire Jones
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S32-S33
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The aim of the project is to support new psychiatric trainees identify common and serious physical health issues on psychiatric wards out of hours; along with the appropriate management and escalation.
MethodsThe project began in March 2021, supporting our Medical Education Team with a film project to be shown at induction. Doctors coming to psychiatry jobs come from many different clinical roles. Feedback was received that trainees were unhappy managing medical emergencies in psychiatric hospitals. Most new trainees don't necessarily have knowledge of the capabilities and limitations of care on a psychiatric ward.
A survey completed from two trainee rotations regarding the most common physical health issues they encountered and the challenges they faced was used to narrow down to 3 film scenarios, incorporating a comprehensive list of clinical cases that could be encountered on call. We included physical health and mental health emergencies, use of MHA & capacity assessments. We worked with a production company producing scripts and expanded on the scenarios with the help of medical and nursing staff to ensure the scenarios remain relevant, and as realistic as possible to existing trainees. The final stage of the project was November 2021 which involved filming with the production company and professional actors who brought our concept to life. Post-production, we presented them during trust academic program to launch the videos in mid-2022.
ResultsThe videos were received positively and quantitative scores completed by a questionnaire before and after showing the videos showed an improvement in confidence in assessing, managing and treating patient with physical health issues and those with physical health complications of their mental health in a psychiatric hospital from 39% to 88% (response rate 62/90).
Conclusion/recommendationsWe are proud to report that these videos are now being used during every junior doctor induction and can be referred to if a refresher on that topic is required later.
We are excited about this innovative method of training using high-quality videos to ensure trainee engagement. We hope it will form a baseline for further discussions and teaching around the topics derived from the scenarios. The videos were designed to last many years and so we hope will be of benefit to current and future trainees of all levels. This successful project will be expanded further and we are in the process of developing other scenarios that can be used for training.