Lancashire Care NHS Foundation Trust

<h3>Background</h3> The unique needs of someone with a learning disability at the end-of-life are well understood (LeDeR Annual Report Learning from Lives and Deaths: people with a learning disability and autistic people. LeDeR Autism and learning disability partnership, King’s College London; 2022; Care Quality Commission. A different ending: addressing inequalities in end of life care. CQC: 2016). Challenges may include communication difficulties, diagnostic overshadowing, co-morbidities, and problems in expressing wishes. Services have improved but the late recognition of palliative care needs still occurs. <h3>Aim</h3> To support high quality personalised palliative and end of life care for people with a learning disability in a region of Lancashire, to reduce health inequalities, through developing a champions scheme (Skills for Health. Champions for Learning Disabilities: Enable Care and Home Support – End of Life Project. 2011). <h3>Methods</h3> Staff identified across hospice (clinical/non-clinical) and learning disability services, invited to become champions; learning disability champions in the hospice and palliative and end of life care champions in learning disability services. Roles and responsibilities aligned with the Ambitions for Palliative and End of Life Care Framework (National Palliative and End of Life Care Partnership. 2021). Full day induction included lived experience, introduction to learning disabilities and palliative and end of life care and simulation covering compassionate conversation and pain assessment. Monthly shared learning was developed, with difficult conversations, prognosticating, adapting communication/language and history of learning disabilities and a rights-based approach, delivered to date. <h3>Results</h3> Induction day evaluation demonstrated increased confidence supporting someone with a learning disability including at the end of life and meeting individualised needs. Confidence adapting communication style increased from 7.4/10 to 8.1/10, whilst meeting the communication needs of someone with a learning disability increased from 6.3/10 to 7.6/10. The opportunity to network, develop shared learning and improve clinical care was valued. Evaluation is planned for the monthly sessions and exploring case studies, where the impact of the scheme is truly realised. <h3>Conclusion</h3> Our champions scheme provides a forum for collaboration and shared learning, developing skills, with increased confidence caring for those with a learning disability at the end of life or supporting those with learning disabilities in our employment. Ongoing evaluation is required to realise the impact. We plan to evaluate the scheme more formally and consider expanding across our region.

Healthcare professionals' attitudes toward chronic pain patients can contribute to stigma, affecting care and patient outcomes. This study examined whether psychological flexibility moderates the relationship between stigma vulnerability (i.e. patient characteristics that invite stigma) and enacted stigma (i.e. discriminatory behaviors) among healthcare professionals. A cross-sectional study recruited 239 National Health Service (NHS) staff from six UK NHS Trusts. Participants were randomly assigned one of four vignettes manipulating patient stigma vulnerability (high vs. low) and gender. Enacted stigma outcomes (e.g. perceived deception, pain attribution) were assessed via Likert scales. Psychological flexibility and inflexibility were measured using the Acceptance and Action Questionnaire - Stigma (AAQ-S). Robust ANOVA tested main effects and moderation. Psychological flexibility did not significantly moderate the stigma vulnerability - enacted stigma relationship (p >0.05). However, higher psychological inflexibility was associated with greater enacted stigma, U = 3133, p = .017 suggesting its role in stigma-related behaviors. The AAQ-S flexibility and inflexibility subscales showed distinct associations with stigma outcomes. Psychological inflexibility plays a role in stigma-related behaviors and may be a target for interventions to reduce healthcare provider bias in chronic pain care. Further research is needed to examine these mechanisms and their implications.

Objective:To identify competencies required for effective collaborative working within Primary Care Networks (PCNs).Methods:An online questionnaire about roles within PCN teams, importance of collaboration and experiences of connection and conflict within teams, was sent to Mental Health Practitioners (MHPs) and PCN/Practice Managers from several teams across Lancashire. Semi-structured interviews with similarly themed questions were conducted with MHPs, General Practitioners (GPs), and PCN/Practice Managers and analysed using reflexive thematic analysis. Questionnaire and interview data were combined, and themes were mapped onto 3 competency constructs (knowledge, skills and abilities, and personal characteristics).Results:Subthemes that were considered important to effective collaborative working in PCNs included: knowledge around shared goals, expectations, and role clarity; skills in communication and relationship building; embodiment of personal characteristics such as being engaged, accepting, and supportive.Conclusion:Clinical implications for promoting collaboration between staff working within PCN settings include meetings and joint training between PCN and NHS Trusts to establish network goals and expectations, regular team meetings and opportunities for face-to face activity to promote understanding of different roles and relationship building.

ABSTRACTObjectivesPeople with severe mental illness experience poor oral health, compared to the general population. They experience inequity in accessing dental services. This randomised controlled trial evaluated the acceptability and feasibility of a link work intervention to support people with severe mental illness to access a routine dental appointment.MethodsThis was a feasibility randomised controlled trial across three sites with 1:1 allocation to Treatment as usual (TAU) or TAU plus a link work intervention (ISRCTN13650779). Participants were adults accessing mental health services who had not attended a routine dental appointment in the past 3 years. The intervention comprised up to six sessions with a link worker. Participants completed self‐report assessments and an optional dental examination at baseline and after nine months. Dental visiting data were obtained through self‐report and the NHS Business Services Authority (BSA).ResultsOne hundred and sixty‐one participants were referred into the trial, resulting in 79 out of the target 84 randomisations (94.0%) over 7 months. There were high levels of engagement with the intervention. Dental visiting data were available for 84.8% of participants (95% CI: 75.3%, 91.1%). Uptake of the optional dental examination within the research assessment battery was low (follow‐up: 12.7%; 95% CI: 7.0%, 21.8%). There were no serious adverse events attributable to the intervention or trial procedures. There were substantially higher rates of dental attendance after nine months in the link work intervention arm, compared to TAU, in both the self‐report (91.7% vs. 26.7%) and NHS BSA (55.3% vs. 12.1%) data. There was also a signal of improved self‐reported oral health‐related quality of life favouring the link work intervention arm.ConclusionsThe trial procedures and link work intervention were found to be feasible, acceptable and safe. The intervention showed promise in terms of clinical outcomes. The effectiveness of the intervention requires evaluation in a larger trial.Trial RegistrationNCT05545228

IntroductionCOPE investigated the prevalence, patterns and determinants of prisoner self-harm during the COVID-19 pandemic, compared with pre-pandemic. The project used the natural experiment of the pandemic to understand effects of prison environments on self-harm.MethodsCOPE was a mixed-methods study involving all prisons within England and Wales. Participants included 80 437 prisoners identified from routine data sources, 71 (ex)prisoners consulted and 89 staff interviewed (average experience: 18.5 years). The main outcome measure was the rate of self-harm incidents reported. Secondary measures included qualitative assessments of prisoner and staff experiences related to self-harm during the pandemic. Qualitative outcomes were derived from thematic grouping of inmate consultation responses and framework analysis of staff responses. The exposure was the pandemic period from March 2020 to December 2021.ResultsThere were gender differences in prisoner self-harm rates during the pandemic. In women’s prisons, the pandemic was associated with a 7% overall increase in self-harm (95% CI 2% to 13%) and a 43% increase in self-harm requiring hospitalisation (11% to 83%). Conversely, men’s prisons saw an 8% self-harm decrease (6% to 11%) and a 21% decrease in self-harm hospitalisation. Policy interventions, for example, in-cell telephones and additional phone credit were linked to reduced self-harm in men’s prisons. Introducing video visits was associated with an increase in self-harm in women’s and men’s prisons. Qualitative analysis revealed a complex interplay of factors influencing these outcomes, including tension between the risk of mental health deterioration because of greater isolation and the perceived safety benefits of a restricted regime.ConclusionsThe pandemic, and policy changes, were associated with changes in prisoner self-harm. Distinct patterns emerged between genders underscoring the need for gender-specific prison policies, especially during crisis management. Furthermore, the complex relationship between policy implementation and self-harm highlighted the importance of tailoring prison environments to effectively address the population’s diverse needs.

ABSTRACT Background The Oxford Cognitive Screen (OCS) was specifically designed for acute stroke survivors and to be inclusive of aphasia, neglect, motor impairments. However, reduced visual acuity (VA), including lack of access to required reading glasses, can impact completion rates and performance. The aim of the study was to evaluate contrast enhanced OCS-tasks for completion rates and equivalence to the original version. Methods Adult stroke survivors were asked to complete two versions (standard and adapted) of two tasks (broken hearts cancellation and trails) in a randomized order, to determine relative completion rates and equivalency. A bedside vision assessment, completed by an orthoptist was collected, including near and distance VA with required refractive correction if available. Two groups were created based on near VA; normal near VA (≥0.2LogMAR) and reduced near VA (<0.2LogMAR). Results Five hundred participants were recruited, 56.8% male, mean age 70.62 years. Mean near VA was 0.278 (SD0.277) LogMAR. The broken hearts and trails tasks were completed by 2.2% (p=0.041) and 0.4% (p=0.791) more participants respectively with the adapted version. Participants completing both versions with good near VA were used to analyze equivalence. All the lower and upper bounds of the two one-sided test of equivalence fell within the range of 0.5SD for all scores, indicating that the means are equivalent. Analysis of impairment detection revealed fair to good agreement. Conclusion The adapted version is suitable for stroke survivors with reduced near VA to complete the assessment. In the presence of good VA, the tasks were deemed to be equivalent.

With its strong line defense and an essential nutrient in the dermatological field in treating various skin conditions. Antioxidants have always been a topic of interest with their antitumorigenic effects or in protecting cells from reactive oxygen species. One of the most important antioxidants in the body is vitamin E, with its lipid-solubility and regenerative mechanism. This article review focuses on various uses of vitamin E in its systemic form. Numerous clinical trials have been testing various dosages across all ages of the population, such as atopic dermatitis, vitiligo, and other diseases, along with the newest technologies used to bring out the effectiveness of this unique molecule.

Child sexual abuse (CSA) is a pervasive global issue impacting children worldwide, with alarming statistics highlighting its prevalence. In England and Wales alone, a staggering 103,055 cases of CSA were recorded in the year ending 2022, marking a concerning 15% increase from figures reported in 2021. Studies indicate that approximately one in ten children under the age of 16 in the UK endure CSA, with girls experiencing it at a higher rate (1 in 6) than boys (1 in 20). The repercussions of CSA extend far beyond childhood, with victims more likely to grapple with mental health challenges in adulthood. Research suggests that about two-thirds of CSA victims experience mental or emotional issues as a result, underscoring the profound and lasting impact of such trauma. Specifically, there is a noted association between CSA and post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD), with repeated abuse heightening the likelihood of developing CPTSD. Boumpa et al. (2022) conducted a recent systematic review and meta-analysis aimed at further elucidating the correlation between CSA and lifetime psychiatric diagnoses, shedding light on this critical area of study. This commentary endeavours to conduct a critical appraisal of the methodologies employed in the review conducted by Boumpa et al. (2022) and to extend the discussion of the findings within the realm of social work practice.

PurposeThis paper aims to focus on concerns unique to international medical graduates (IMGs) and doctors from global majority groups pursuing a career in psychiatry in the UK. It specifically addresses challenges affecting the differential attainment of IMGs in passing the Clinical Assessment of Skills and Competencies (CASC) examination – the final assessment for attaining Membership of the Royal College of Psychiatrists, affording entry to specialty training programmes.Design/methodology/approachReflections are provided on learning from a CASC examination preparatory course specifically developed for IMGs in psychiatry, particularly those from global majority groups. The rationale for the course is set out as well as some of the challenges in designing and developing the course.FindingsBy reflecting on the experience of developing the course, the intersection of medical education, differential attainment and cultural disparities in training is addressed, alongside the role of group practice in exam preparation and support tailored to the needs of IMGs from global majority groups.Originality/valueThe reflections provided illuminate possible means of innovation to support the progression of IMGs and doctors from global majority backgrounds in the CASC, as a high stakes examination in medical training, and to support action to improve overall outcomes for this community in the field of psychiatry.

In children, HIV infection presents with grave consequences, including a predisposition to emotional and behavioural problems (EBP). These are mental health problems affecting thoughts, emotions, behaviours and relationships, and may be categorised into emotional problems (EP) and behavioural problems (BP). Studies have shown a high burden of EBP in children; however, knowledge gaps still exist regarding the burden of EBP on HIV-infected children. Our study seeks to address these gaps by determining the prevalence and type of EBP among HIV-infected children. This cross-sectional and comparative study enrolled 386 participants (193 subjects and 193 controls). The subjects were HIV-infected children aged 2-15 years attending the Paediatric HIV Clinic of Federal Medical Centre, Umuahia. The controls were age and sex-matched HIV-negative children attending primary or secondary schools in Umuahia. Sociodemographic characteristics were assessed, and EBP was determined using the strengths and difficulties questionnaire. Sixty-one subjects (31.6%) had EBP compared to 15 controls (7.8%) and this difference was significant (p<0.001). The subjects were three times more likely to have EBP than the controls (aOR=3.03; CI=1.17-7.82). The EBP type showed that, while there was no significant difference in the multivariate analysis of the behavioural problems, emotional problems were significantly higher in the subjects than in the controls (p = 0.001). The subjects were six times more likely to have emotional problems than the controls (aOR=6.26; CI=2.80-13.97). There is a high burden of EBP among HIV-infected children in Umuahia with emotional problems as the common type.