Oxleas NHS Foundation Trust

Background: Challenging behaviour is prevalent on acute psychiatric wards, negatively affecting staff, patients, and ward environments. Restrictive practices target inpatient violence but can be traumatising and dehumanising. Team case formulation increases staff understanding of challenging behaviour and generates strategies to reduce it, but research is limited. Methodology: This two-phase study investigated feasibility, acceptability, and effectiveness of team case formulation sessions with ward staff to reduce inpatient violence and challenging behaviour. In Phase 1, highly aggressive inpatients from five acute wards were either the focus of psychologist-led case formulation sessions (cases; N = 24) or were controls (N = 24). Post-formulation sessions, ward staff (N = 21) completed a feedback survey and change in patients’ violent and challenging behaviour was measured after staff-led interventions. In Phase 2, staff experiences were explored using in-depth semi-structured interviews and surveys (N = 12). Results: In Phase 1, case formulation appeared feasible, given adherence to implementation strategy and staff feedback, and staff-rated challenging behaviour reduced in cases, compared to controls. However, there were difficulties measuring change in violent incidents using electronic health records. In Phase 2, staff reported that formulation increased empathy for patients and sessions provided a space for stress-management and collaborative reflection, but they identified implementation barriers. Conclusion: Data-driven case formulation appears feasible, acceptable, and effective to reduce challenging behaviour. Findings suggest that it is helpful for patients, staff, and ward environments; data can meaningfully inform inpatient care; and both in-person and video call are viable methods of delivery.

There is a historic crisis in waiting times in the UK's National Health Service. Crisis brings both a call for judgement - a response to the question 'what has gone wrong?' - and a call to action, such as better management, more resources, strategies to mitigate staff burnout, or even a shift in access commitments to reduce demand. However, not all forms of waiting are a sign of service inefficiency or failure, or a form of abandonment or lack of care. Instead, we argue that all healthcare entails waiting, and other forms of elongated time such as pausing to observe, staying alongside patients at end of life, enduring or even encouraging the repeated presentations of those with medically unexplained symptoms, delaying treatment to see what time will bring the situation, or stopping treatment as an ethical intervention. In this paper, we offer three examples of care practices that require waiting, demanding considerable patience on the part of patients and healthcare workers: care for the chronically unwell in general practice; care of young people in mental health crisis; and care for trans and gender-questioning young people. When time is represented as a finite linear resource to be used efficiently, 'streamlining', speeding up systems, and making cuts to 'wasteful' practices seem like obvious solutions. But we argue that it is only by reckoning with the complex relationality and fundamental untimeliness of the care that runs alongside even the most timely interventions, that we can understand what it means to wait in and for the NHS, and what resources might be needed for the service and its users to flourish.

AimHospitalisation for heart failure (HF) carries a high risk of readmission and adverse patient outcomes. We noticed a higher rate of readmissions for HF patients in a tertiary cardiac centre in Doha, Qatar. This study is focused on using a multidisciplinary and quality improvement approach to reduce the HF patients’ 30-day readmission rate to the high dependency unit C in Heart Hospital, Doha, Qatar, by 10% by December 2020 and 20% by December 2021.MethodsIn collaboration with the Institute for Healthcare Improvement, we worked on this initiative as a multidisciplinary team and tested several changes. A model for improvement framework was used and rapid, weekly, plan-do-study-act cycles were applied to test changes. Multiple measures were implemented serially, which included follow-up telephone consultations by a HF clinical nurse specialist 1 week after hospital discharge, early follow-up in a dedicated HF clinic (within 2 weeks of discharge), the availability of medical guidance over the telephone, comprehensive health coaching and education, patient functional activity engagement and cardiac depression screenings.ResultsThe readmission rate reduced from 25.5% in 2019 to 5.6% in 2021 (p<0.001). The results achieved have been sustained over time, with readmission rates recorded at 7.87% to date. The study demonstrated a decrease in 30-day readmission rates for HF patients after implementing a multidisciplinary quality improvement initiative.ConclusionsReducing readmission rates underscores the importance of comprehensive patient education, tailored care plans, consistent follow-up and integrated team-based care in managing HF patients. The success of this initiative highlights the potential of multidisciplinary strategies in improving patient outcomes in chronic conditions like HF.

Abstract Background This cross-sectional study aimed to assess the socio-demographic, anthropometric, and patient characteristics of 94 Yoruba speakers aged 60 years and older, and to validate the Yoruba version of the Clinical Frailty Scale (CFS). Methods This study used a cross-sectional design with a purposive sampling technique and a sample size of 94 participants. This study also made use of the World Health Organisation methodologic guidelines on cultural adaptation of clinical scales. Convergent validity was assessed by evaluating the context that the Clinical frailty scale (CFS) relates to the Edmonton frailty scale, using the Spearman rank correlation coefficient. The known group validity was assessed using one-way ANOVA. Results The mean age of participants was 70.81 ± 8.11 years, with a mean BMI of 27.04 ± 5.61. The cohort included 38 males (44.4%) and 56 females (59.6%). Educational attainment varied, with 20.2% having no education and 9.6% holding postgraduate degrees. The validated CFS has excellent content validity (S-CVI/AVE = 0.96; S-CVI-UA = 0.78). Convergent validity demonstrated a moderate correlation between the CFS and the Edmonton Frail Scale (Spearman’s rho = 0.61, p &amp;lt; 0.01). Known-group validity indicated significant associations between frailty, age (p = 0.02), and BMI (p = 0.007). Conclusion The Yoruba version of the CFS is a valid tool for assessing frailty in elderly Yoruba-speaking populations.

Background Tinel’s test is commonly used in the diagnosis of carpal tunnel syndrome (CTS) despite its questionable diagnostic test accuracy (DTA). This systematic review investigated the DTA of Tinel’s test in CTS using electrodiagnosis as the reference standard and explored the heterogeneity between included studies. Methods Prospective studies evaluating Tinel’s test in adults with CTS were included. The principal measures were sensitivity and specificity. A literature search was conducted for studies published up to 7 June 2024. The methodological quality was assessed using the QUADAS-2 tool. Narrative synthesis of study results and heterogeneity was undertaken. Meta-analysis was not conducted due to the high variability in diagnostic thresholds. Results Fifteen out of 4099 identified studies met the inclusion criteria. Patient selection scored ‘high’ in risk of bias and applicability concerns. Examiner blinding was poorly reported. Sensitivity varied from 30 to 89%. Specificity varied from 41 to 100%. Heterogeneity was found across all studies in participant selection criteria, Tinel’s test performance, electrodiagnostic criteria, and diagnostic thresholds. Conclusions Tinel’s test demonstrated variable diagnostic accuracy in CTS. Due to poor methodological quality and high variability among the studies, more DTA studies are necessary. PROSPERO Protocol number CRD42020218165 dated 27 November 2020.

ABSTRACT Objective Extant research on mental health within Muslim communities reveals inequalities, with religio-cultural beliefs viewed as influencing experience, access to care, and treatment outcomes. Additionally, religious affiliation is a prominent marker of social identity amongst Muslim migrant communities. This study examined whether acculturative approaches and identity influence perceptions of mental ill health within a Muslim migrant community. Method Semi-structured interviews were conducted with 11 Australian Muslim youth – six of whom were recent immigrants and five who were Australian-born/raised. Data was analysed using reflexive thematic analysis. Results Two main themes were identified: 1) making sense of mental health, and 2) the influence of social representations. Sub-themes included: 1a) defining mental health, 1b) perceived determinants, 2a) “emotional” vs “factual”, and 2b) education through experience: personal encounters with mental illness. Conclusion Overall, faith and religion played an important role in conceptualisations of mental health for young Australian Muslims – alluding to the necessity of faith-sensitive mental health services for ethnic and religious minority communities.

High levels of service user satisfaction are viewed as a reliable indicator of a service providing good care and treatment. There has been limited research looking into levels of satisfaction in forensic mental health settings with most work focused on staff satisfaction in these settings. This study examined service users' levels of satisfaction with a forensic mental health service in the United Kingdom. The service covered two sites; one a purpose-built secure unit and the other based in an old cottage hospital. Thirty-nine in-patients completed a 60-item validated forensic satisfaction scale. The scale measured seven domains of satisfaction as well as reporting an overall satisfaction score. The results indicated the service users were reasonably satisfied with the care and treatment they received. The domains of rehabilitation, safety, staff interaction and overall care showed the highest level of satisfaction. The high rehabilitation satisfaction score demonstrated the importance of meaningful activities for users accessing forensic services and may have been influenced by the security measures on the wards. The high safety domain score indicated respondents felt safe and secure within the wards and were likely to be influenced by positive interpersonal interactions. Good staff interaction was also an important factor in helping service users feel safe on the wards. These interactions are likely to be associated with longer periods of admission in secure services allowing therapeutic relationships to develop. Financial advice/support was the one domain that recorded negative satisfaction levels. Financial literacy training may help develop money management skills.

AimsTelevision is a medium through which an audience can gain insight into the nuances of psychiatric practice. Nonetheless, the psychoeducational benefits are dependent on accurate portrayals. “The Sopranos” has received critical acclaim from various professional psychiatric bodies for its artistic depiction of psychoanalysis and the psychotherapeutic relationship. The series follows Tony Soprano, a middle-aged Italian-American male engaged in organized crime. He is referred to his psychiatrist, Dr Melfi, by his family physician after suffering debilitating panic attacks. Melfi accepts the referral despite Tony's chequered past, employing a holistic approach to his care. We aimed to analyse the psychotherapeutic relationship between Tony Soprano and his psychiatrist, using a biopsychosocial approach.MethodsSeason 1 of “The Sopranos” was identified by a facilitator and utilized for discussion. The season was viewed individually and virtual case-based dialogues took place between the author and facilitator examining the psychotherapeutic relationship using the biopsychosocial model.ResultsThe Sopranos coincided with the popularity of the serotonin theory of depression in the US, promoted by the pharmaceutical industry. Tony Soprano is pharmacologically treated for panic attacks, anxiety and depression. This sparked thematic discussion around symptom control, medication efficacy and adverse effects. Melfi balances the application of medication alongside understanding the psychological roots of symptoms, deprescribing when necessary.Themes pertaining to conflict between Freud's id, ego and superego persisted, manifesting cognitive dissonance most prominently in relation to Tony's line of work. Symbolism of ducks guided understanding of Tony's biggest fear – losing his family. Projective testing was explored, alluding to the Rorschach test. Scenes depicting transference and countertransference were present, the former representing Tony's unmet needs from female figures in his life. Eventually, Tony's distress induces internally generated pseudohallucinations.Tony's tender treatment of his children offsets his volatile relationship with his parents, particularly his mother who habitually antagonizes her son. His personal and professional life are intertwined, with mental health stigma evident in both realms as Tony seeks help surreptitiously to maintain his credibility.Conclusion“The Sopranos” depicts the psychotherapeutic relationship between a man suffering from mental illness and his therapist. This layered and accurate portrayal can provide a case-based reference for psychoeducational discussion, and give rise to further discussions of psychiatric themes within film and television.

The access of indecent images of children (IIOC) is an increasing societal problem; no longer resolvable by law enforcement alone. This research aimed to explore the views of individuals who accessed IIOC, regarding their offending pathways and what they believed could have prevented their offending or encouraged desistance. The qualitative analysis highlights a lack of deterrents for online offending, and the importance of education around legality, consequences, accountability and access to confidential help to prevent online offending. Recommendations regarding IIOC prevention strategies are considered in light of the findings.

Researching the stigma associated with less common mental health conditions: an update from the Time to Change campaign