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Assessment of Knowledge About Frailty Syndrome Among Doctors and Its Intervention: A Literature Review
- Jiann Lin Loo, Manjula Simiyon, Catrin Thomas, Shona Ginty, Wamiqur Rehman Gajdhar, Sioned Mai Griffiths, Mohammed Ibrahim Hassan Ibrahim
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S49
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Aims
Under-detection of frailty syndrome or sarcopenia can result in significant mortality and morbidity among elderly patients, especially in old-age mental health settings. Therefore, it is crucial to ensure doctors are equipped with the competency of early identification and management of frailty syndrome. To date, there is limited information about any systematic approaches to assess and improve the knowledge, attitude, and practice of doctors about frailty syndrome. This literature review is aimed to identify the tools used to assess the knowledge of doctors about frailty syndrome and the available educational intervention to improve doctors’ knowledge.
MethodsA literature search was performed in Google Scholar, PubMed, SCOPUS, Ovid, and EMBASE using the keywords of “frailty syndrome” AND “knowledge” AND “doctors”. Data collected included the assessment tool used to understand the knowledge level and the intervention used to improve the knowledge. The inclusion criteria were: studies published in English in the last 10 years which assessed the knowledge of doctors about frailty syndrome.
ResultsThere were five studies fulfilling the inclusion criteria after the title and abstract screening, two from the Americas, two from Europe, and one from Australia.
The target group of studies involved general practitioners and doctors working in the primary healthcare setting (three), orthopaedic surgeons (one), and doctors working in the trauma setting (one). Two of the studies included non-medical healthcare practitioners as their participants.
One study used qualitative semi-structured individual interviews, two used a self-report questionnaire, one combined knowledge testing and self-report questionnaire, and one study compared the clinical assessment with a validated tool.
Only one study provided an educational intervention, i.e., a single-day training course conducted by three geriatricians.
ConclusionDespite a comprehensive search, there were limited studies identified on this topic. The methods used to assess doctors’ knowledge about frailty syndrome are heterogeneous and no standardised tool has been identified in the process. There is only one study using educational intervention to improve knowledge, which was found to be effective and sustainable based on the change in self-perception, i.e. Kirkpatrick Level 1 of evaluation. There is a need to develop systematic assessment approaches or tools and training modules to improve the knowledge of doctors about frailty syndrome. Nevertheless, this review is limited only to studies published in English.
A Qualitative Study Exploring the Role of Hindsight Bias in the Process of Reviewing Clinical Practice Prior to Adverse Incidents
- Irene Hadjioannou, Emily Lewis, Leo Scott, Catrin Thomas, Alberto Salmoiraghi, Rajan Nathan
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S76
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To explore the effect of hindsight bias on retrospective reviews of clinical decision making prior to adverse incidents to inform future approaches to incident investigations.
MethodsWe have undertaken focus groups with doctors of varying grades across the North West of England and North Wales. A vignette based on a real-life case from the publicly available NHS England Homicide Independent Investigation report database was presented to each group in one of three versions which differed in terms of the ending of the vignettes (i.e. suicide, homicide, no adverse incident). Using a semi-structured interview approach, the group participants were encouraged by the facilitators to reflect on issues relating to risk and risk management. All groups were provided with the same vignette which initially made no reference to the outcome and asked to comment on matters of risk and risk management. Halfway through the discussion, one of the three outcomes was disclosed, and further group discussion was held. The recorded interviews were transcribed and thematic analysis was undertaken using an adapted Framework Method.
ResultsPreliminary results (n = 10) indicate that participants identified the potential for significant harm, particularly to others, and identified evidence of key psychopathological and historical correlates to support assertive management of risk and admission to hospital.
Whilst knowledge of the outcome did not lead to participants changing their favoured management plans, it did alter how they appraised the case and led to participants constructing “narrative” explanations for the outcome given. The level of conviction participants held for their management plan reduced when their expectations about the outcome were confounded.
Participants presented with the suicide outcome vignette described their difficulties appraising risk to others and their over-sensitivity to that risk. Participants faced with the ‘no adverse outcome’ vignette perceived the original management plan far more favourably in hindsight. The groups that were presented with the homicide outcome vignette initially focused on both risks to self and others as well as the perceived need for further information. Following knowledge of the outcome, there was a tendency to highlight parts of the letter pertaining to risk to others which they previously had not given as much attention.
ConclusionThe initial analysis of our data confirms the findings from previous studies that hindsight colours the appraisal of adverse events. However, this study is novel in that it describes the nature of the thought processes underpinning the influence of hindsight on appraisals of risk.
Assessing the Impact of Pre-Existing Mental Health and Neurocognitive Disorders on the Mortality and Severity of COVID-19 in Those Aged Over 18 Years: A Systematic Review and Meta-Analysis
- Catrin Thomas, Laura Williams, Asha Dhandapani, Sarmishtha Bhattacharyya
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S75-S76
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Since the coronavirus disease 2019 (COVID-19) pandemic began, evidence suggests that people with underlying mental health disorders have worse outcomes from COVID-19 infection. Our aim was to assess the impact of COVID-19 infection on people with pre-existing mental health or neurocognitive disorder including COVID-19 related mortality and severity.
MethodsWe conducted systematic searches of PubMed, EMBASE, and Cochrane library for articles published between 1 December 2019 and 15 March 2021. The language was restricted to English. We included all case control, cohort and cross sectional studies that reported raw data on COVID-19 associated mortality and severity in participants aged 18 years or older with a pre-existing mental health or neurocognitive disorder compared to those without. Three independent reviewers extracted data according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Methodological quality and risk of bias were assessed using the 9-star Newcastle-Ottawa Scale. We calculated the odds ratio as the summary measure along with the corresponding 95% confidence intervals. The random effects model was used to calculate the overall pooled risk estimates. COVID-19 related mortality was the primary outcome measure. The secondary outcome measure was COVID-19 related severity, defined as intensive care unit admission or use of mechanical ventilation.
ResultsFifteen studies were included in the meta-analysis comprising of 8,021,164 participants. There was a statistically significant increased risk of mortality for participants with a pre-existing mental health or neurocognitive disorder compared to those without (OR = 2.18, 95% CI = 1.63–2.90, P < .00001). Increased mortality risk was found on subgroup analysis for participants with pre-existing schizophrenia (OR = 2.55, 95% CI = 1.38–4.71, P = .003) and dementia (OR = 3.83, 95% CI = 2.42–6.06, P < .00001). There was no statistically significant difference in the severity of illness when comparing the two groups. There was a statistically significant increase in the number of participants with comorbid diabetes and chronic lung disease in those with a pre-existing mental health or neurocognitive disorder compared to those without.
ConclusionThe results show that people over 18 years with a pre-existing mental health or neurocognitive disorder have an increased risk of mortality from COVID-19 and are more likely to have comorbid diabetes and chronic lung disease. These results highlight the need for better physical health monitoring and management for this group of people and better integration of mental and physical health services, as well as adding to the evidence that they should be prioritised in the ongoing COVID-19 vaccination schedules worldwide.
The Evaluation of North Wales SPiCE: Special Preparation in CASC Examination
- Jiann Lin Loo, Catrin Thomas, Manjula Simiyon, Rahul Malhotra, Nikhil Gauri Shankar, Sarmishtha Bhattacharyya
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S26
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As part of the effort to support core psychiatry trainees in North Wales to prepare for their CASC (Clinical Assessment and Skill Competency) exam, the North Wales SPiCE (Special Preparation in CASC Examination) Project has been initiated. This article aims to evaluate the SPiCE based on medical educational principles.
MethodsA total of five candidates preparing for the CASC exam expressed interest and an organising committee was set up. Examiners consisted of a consultant and four specialist registrars while role players were recruited from non-exam sitting junior trainees. Five mock CASC stations were written and role-players were calibrated accordingly. The stations included: History taking for a patient with FTD (frontotemporal lobe dementia), MSE (Mental state examination) of a patient with mania and psychosis, explanation of CBT (cognitive-behavioural therapy), breaking bad news of NMS (neuroleptic malignant syndrome), and explanation of ECT (electroconvulsive therapy). The mock exam was conducted virtually using Microsoft TeamsTM. The specialist registrars’ performances in feedback provision were assessed for their teaching using the AOT (Assessment of Teaching) form by the consultants. For core trainees who had played the part of organising committee members and role players, their volunteerism and educational management experience were assessed using the DONCS (Direct Observation of Non-clinical Skill) form by specialist trainees.
ResultsAll five candidates passed all the stations (consists of both borderline pass, pass) in the mock exam with 25% improvements in confidence level were seen among candidates in four stations, i.e. ECT explanation, breaking bad news of NMS, CBT explanation, and MSE of a patient with mania and psychosis. All candidates feel the SPiCE programme was useful in helping their final preparation and they would recommend it to other candidates. Four of the candidates sat for the immediate CASC diet after the SPiCE received a pass result. All specialist registrars received positive AOT feedback for their teaching and all non-exam sitting junior trainees received positive DONCS feedback for their spirit of volunteerism and collaborative teamwork.
ConclusionThe main strength of the SPiCE project is it utilises existing resources and volunteerism of the organising committee while its main limitation is it has only five stations rather than 16 stations in the real exam. Although the mock exam has improved the confidence of candidates and the majority of candidates pass the exam immediately after that, the causal link between the SPiCE and candidates’ results cannot be conclusively established given all candidates have a good baseline.
Adherence to Public Health England (PHE) guidance for the use of personal protective equipment (PPE) in north Wales mental health unit- a regional audit
- Asha Dhandapani, Sathyan Soundararajan, Alberto Salmoiraghi, Shona Ginty, Tajnin Mitu, Justina Akinlua, Catrin Thomas, Rahul Malhotra, Zeenish Azhar, Haseeb Bhutta, Hanani Taib, Nikhil Gauri Shankar, Vikram Bhangu, Gathoni Kamau, Elizabeth Chamberlain, Anna Mackenzie, Henrik PAHLEN, Hannah Lock, Aniis Rymansaib, Pauline Mclean, Rodrigo Trujillo, Manjula Simiyon, Adam Chappell, Agnieszka Gross, Gaynor Gaskell
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S318
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To ensure that the PPE guidance is strictly adhered to.
To ensure that patient care is not compromised.
To help us in areas of need in order to educate the staff regarding the techniques of PPE and thus ensure patient and staff safety and care during the pandemic.
MethodNovel coronavirus 2019 was first described in December 2019 in Wuhan in China. Since those initial few cases, it has rapidly proliferated to a global pandemic, putting an inordinate amount of strain on healthcare systems around the world. We believe that the technique of donning and doffing if followed as per PHE guidelines would be of help in both preventing the infection and improve the care and safety of both patients and staff.
This Audit includes both In-patient and Out-patient units in Psychiatric services across North Wales. Data were collected from 19 units out of 39. We observed covertly 325 staff members belonging to various cadres. Apart from the Donning and Doffing techniques, we also observed the availability of designated areas for this purpose and the availability of PPE as well.
Data collection was by junior and senior doctors from various sites of the mental health unit in North Wales. A proforma was provided, the standards were based on PHE guidelines.
ResultIt was noted that just about 50% of the staff followed donning as per guidance. Amongst all three sites, the Central team showed a better adherence with 85% of them donning PPE correctly. whereas only 22% adhered to donning in the West team.
Only 21% of them managed to doff PPE as per guidance amongst all 3 centres in North Wales.
It was also noted that there are no designated areas to Don and Doff in outpatient units. Staff, in general, seem to not adhere to the guidance of utilising a mask, especially when within 2 meters distance of other staff.
ConclusionWe will be presenting the Audit at the regional meeting. After discussion with the infection prevention control team and Health and safety lead, we intend to improvise the wards with designated areas for donning and doffing. Teaching sessions for the staff in all three sites, reminders in various areas of the community mental health units and inpatient units.
We are hoping that these recommendations will help us in achieving our aim of health and safety during this pandemic.
Audit of antipsychotic prescribing and monitoring for the management of behavioural and psychological symptoms of dementia
- Catrin Thomas, Sharmi Bhattacharyya, Elizabeth Bond
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S108-S109
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To assess the use of a piloted shorter version of the local Checklist for Antipsychotic Initiation and Review (CAIR) form by an Older Persons Community Mental Health Team (OPCMHT), and to assess whether the National Institute for Health and Care Excellence (NICE) guideline on use of antipsychotics for the management of behavioural and psychological symptoms of dementia (BPSD) is being adhered to.
MethodRetrospective audit analysing notes of all patients currently open to the OPCMHT that are prescribed an antipsychotic medication for the management of BPSD. Patients with a diagnosis of any subtype of dementia and prescribed any antipsychotic were included. Data collected from paper notes using an audit proforma.
ResultThe total number of patients was 11. The most common diagnosis was Alzheimer's disease (45%), followed by mixed type dementia (36%), vascular dementia (9%) and Lewy Body dementia (9%). The majority of the patients reside in their own home (64%) whilst the remaining 36% reside in a residential home for the elderly and mentally infirm. The CAIR form was present in 73% of the patient's notes, however only 37% had the new, piloted, shorter version of the CAIR form. Of the CAIR forms present, only 63% were fully completed. There was documented evidence that 100% of patients had an assessment of underlying causes of their challenging behaviour; that non-pharmacological interventions were tried first; and that target symptoms were identified. There was evidence of a discussion with the patient or carer about the risks and benefits of antipsychotic use for all patients, however the details of the discussion was often vague. All patients had a review of the antipsychotic medication within the last three months.
ConclusionThere was evidence that pre-prescribing assessments are being undertaken for all patients. There needs to be clearer documentation of the discussions had with patients and carers about the risks and benefits of using antipsychotic medications for management of BPSD. A teaching session was held at the team meeting to highlight the risks and benefits. The team will ensure that they provide a health board approved leaflet to each patient and carer following their discussion. Only 73% of the patients had a CAIR form in their notes and the team favour the original version. The team will revert back to using the original version of the CAIR form as it has more space allocated to document ongoing reviews. We will re-audit in 6 months time.
Influence of laser interference patterning on microstructure and friction behavior of gold/yttria-stabilized zirconia nanocomposite thin films
- Rodolphe Catrin, Thomas Gries, Brice Raillard, Frank Mücklich, Sylvie Migot, David Horwat
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- Journal:
- Journal of Materials Research / Volume 27 / Issue 6 / 28 March 2012
- Published online by Cambridge University Press:
- 07 February 2012, pp. 879-885
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- 28 March 2012
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Laser interference patterning (LIP) and the hereby induced microstructure modifications have been investigated in gold/yttria-stabilized zirconia nanocomposite films. Transmission electron microscopy was used to study the influence of the laser treatment on the structure and microstructure of the samples. The impact of LIP on the friction coefficient has been evidenced. The initial microstructure consisted of gold nanograins homogeneously distributed in the yttria-stabilized zirconia matrix. A noticeable growth and coalescence of gold nanograins occurred near the surface in specific regions. Simultaneously, a foamy morphology, mostly consisting of gold crystals, was formed at the surface and is responsible for a drastic diminution of the friction coefficient after patterning. Furthermore, the influence of the film topography on the friction behavior is analyzed using Abbott–Firestone curves. In contrast to thermal annealing, the laser treatment proposed here is a fast procedure to partially relocate gold at the film surface and provide a local solid lubrication.
Microstructure of sputter-deposited noble metal-incorporated oxide thin films patterned by means of laser interference
- Rodolphe Catrin, Thomas Gries, David Horwat, Sylvie Migot, Frank Muecklich
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1339 / 2011
- Published online by Cambridge University Press:
- 22 June 2011, mrss11-1339-s01-04
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- 2011
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Laser interference patterning-induced microstructural modifications have been investigated in two noble metal-incorporated oxide thin film systems: Pd0.25Pt0.75Ox and gold-incorporated yttria-stabilized zirconia - Au-YSZ. Transmission electron microscopy was used to investigate the influence of the laser treatment on the microstructure of the samples. In the case of Pd0.25Pt0.75Ox, the formation of a nanocomposite arrangement resulted from the precipitation of metal nanograins in the oxide matrix triggered by laser irradiation. In Au-YSZ, the starting microstructure consisted of gold nanograins embedded in a YSZ matrix. A noticeable growth and coalescence of gold nanograins occurred near the surface in the region of maximum interference. Simultaneously, a foamy morphology, mostly consisting of gold crystals, was formed at the film surface. In contrast to thermal annealing, the laser treatment proposed here is a fast procedure to partially relocate gold at the film surface and provide a local solid lubrication.