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Prevolnik Rupel V, Jagger B, Fialho LS, et al., 2021, Standard set of patient-reported outcomes for personality disorder, Quality of Life Research, Vol: 30, Pages: 3485-3500, ISSN: 0962-9343
PurposeThe purpose of the article is to present standard set of outcomes for people with personality disorder (PD), in order to facilitate patient outcome measurement worldwide.MethodsThe International Consortium for Health Outcomes Measurement (ICHOM) gathered a multidisciplinary international working group, consisting of 16 experts, including clinicians, nurses, psychologists, methodologists and patient representatives, to develop a standard set of outcome measures for people with PD. The Delphi method was used to reach consensus on the scope of the set, outcome domains, outcome measures, case-mix variables and time points for measuring outcomes in service users. For each phase, a project team prepared materials based on systematic literature reviews and consultations with experts.ResultsThe working group decided to include PD, as defined by International Classification of Diseases 11th revision (ICD-11). Eleven core outcomes and three optional outcomes across four health domains (mental health, behaviour, functioning and recovery) were defined as those relevant for people with PD. Validated measures for the selected outcomes were selected, some covering more than one outcome. Case-mix variables were aligned to other ICHOM mental health standard sets and consisted of demographic factors and those related to the treatment that people received. The group recommended that most outcomes are measured at baseline and annually.ConclusionThe international minimum standard set of outcomes has the potential to improve clinical decision making through systematic measurement and comparability. This will be key in improving the standard of health care for people with PD across the world.
Romeu D, Guthrie E, Czoski-Murray C, et al., 2021, Experiences of people seen in an acute hospital setting by liaison mental health services: responses from an online survey, Publisher: CAMBRIDGE UNIV PRESS, Pages: S346-S346, ISSN: 2056-4724
Venturelli R, Ntouva A, Porter J, et al., 2021, Use of AUDIT-C alcohol screening tool in NHS general dental practices in North London, BRITISH DENTAL JOURNAL, ISSN: 0007-0610
Codling D, Hood C, Bassett P, et al., 2021, Delirium screening and mortality in patients with dementia admitted to acute hospitals, Aging and Mental Health, Vol: 25, Pages: 889-895, ISSN: 1360-7863
Objectives: Delirium is associated with increased mortality in older adults. National guidance recommends that all people with dementia who are admitted to hospital are screened for delirium. However, the impact of screening for delirium among inpatients with dementia has not been examined. This study aims to examine this relationship.Methods: Secondary analysis of data from 10,047 patients admitted to 199 hospitals in England and Wales that took part in the third round of the National Audit of Dementia. Data on patients with dementia who died during their admission were compared with those who survived. We calculated odds of mortality among those who were screened for delirium, received cognitive testing, and, in those with delirium, an expert clinical review.Results: The mean age of study patients was 84 years (SD = 7.9), 40.1% were male and 82.1% white British. 1,285 patients (12.8%) died during their admission to hospital. Overall, 4,466 (44.5%) patients were screened for delirium, of whom 2,603 (58.6%) screened positive. The odds of mortality were lower in patients who underwent delirium screening (OR: 0.79, 95% confidence interval (CI): 0.69-0.90) and in those receiving cognitive testing (OR: 0.71, 95%CI: 0.61-0.82).Conclusion: These results demonstrate that, among people with dementia who are admitted to hospital, screening for delirium and assessment of cognitive functioning are associated with lower mortality. While we cannot be certain that these associations are causal, the findings support efforts that are being made to increase levels of screening for delirium among people with dementia who are admitted to hospital.
Khajuria A, Tomaszewski W, Fleming S, et al., 2021, Workplace factors associated with mental health of healthcare workers during the COVID-19 pandemic: an international cross-sectional study, BMC Health Services Research, Vol: 21, Pages: 1-11, ISSN: 1472-6963
BACKGROUND:The association of workplace factors on mental health of healthcare workers (HCWs) during the COVID-19 pandemic needs to be urgently established. This will enable governments and policy-makers to make evidence-based decisions. This international study reports the association between workplace factors and the mental health of HCWs during the pandemic.METHODS:An international, cross-sectional study was conducted in 41 countries. The primary outcome was depressive symptoms, derived from the validated Patient Health Questionnaire-2 (PHQ-2). Multivariable logistic regression identified factors associated with mental health outcomes. Inter-country differences were also evaluated. RESULTS:A total of 2,527 responses were received, from 41 countries, including China (n=1,213; 48.0%), UK (n=891; 35.3%), and USA (n=252; 10.0%). Of all participants, 1343 (57.1%) were aged 26 to 40 years, and 2021 (80.0%) were female; 874 (34.6%) were doctors, and 1367 (54.1%) were nurses. Factors associated with an increased likelihood of depressive symptoms were: working in the UK (OR=3.63; CI=[2.90-4.54]; p<0.001) and USA (OR=4.10; CI=[3.03-5.54]), p<0.001); being female (OR=1.74; CI=[1.42-2.13]; p<0.001); being a nurse (OR=1.64; CI=[1.34-2.01]; p<0.001); and caring for a COVID-19 positive patient who subsequently died (OR=1.20; CI=[1.01-1.43]; p=0.040). Workplace factors associated with depressive symptoms were: redeployment to Intensive Care Unit (ICU) (OR=1.67; CI=[1.14-2.46]; p=0.009); redeployment with perceived unsatisfactory training (OR=1.67; CI=[1.32-2.11]; p<0.001); not being issued with appropriate personal protective equipment (PPE) (OR=2.49; CI=[2.03-3.04]; p<0.001); perceived poor workplace support within area/specialty (OR=2.49; CI=[2.03-3.04]; p<0.001); and perceived poor mental health support (OR=1.63; CI=[1.38-1.92]; p<0.001).CONCLUSION:This is the first international study, demonstrating that workplace factors, including PPE availabil
Hood C, Morris A, Corrado O, et al., 2021, IMPACT OF COVID 19 PANDEMIC ON HOSPITAL CARE FOR PEOPLE WITH DEMENTIA-FEEDBACK FROM HOSPITAL LEADS AND CARERS, Publisher: OXFORD UNIV PRESS, ISSN: 0002-0729
Spong AJ, Clare ICH, Galante J, et al., 2021, Brief psychological interventions for borderline personality disorder. A systematic review and meta-analysis of randomised controlled trials, Clinical Psychology Review, Vol: 83, Pages: 101937-101937, ISSN: 0272-7358
BACKGROUND: People with Borderline Personality Disorder (BPD) have limited access to long term psychological therapies. Briefer interventions have been developed but trial evidence to support their use has not been reviewed. AIMS: To examine whether psychological interventions for adults with BPD of six months duration or less improve symptoms, mood, self-harm, suicidal behaviour, and service use. METHODS: The protocol was prospectively registered (PROSPERO CRD42017063777). Database searches were conducted up to April 2020. Inclusion, data extraction and risk of bias were assessed in duplicate. We identified 27 randomised controlled trials. We conducted random-effects meta-analyses sub-grouping data into delivery method, additional support, and comparison type. RESULTS: High levels of bias were found for attrition and reporting. Heterogeneity was high in some pooled data. Borderline symptom reductions were greatest for interventions including additional support (SMD. -1.23, 95% C.I. -2.13, -0.33). Planned generic support may be as effective as specialist interventions for borderline symptoms (SMD = -0.11, 95% C.I. -0.51, 0.29) and social functioning (SMD = -0.16., 95% C.I. -0.65, 0.33). Follow-up was limited and direct comparison with post-intervention results was unreliable. CONCLUSIONS: Short-term interventions may be effective. Access to additional support has an impact on outcomes. It is unclear if symptomatic change is sustained.
Tyrer P, Wang D, Tyrer H, et al., 2021, Influence of apparently negative personality characteristics on the long-term outcome of health anxiety: Secondary analysis of a randomized controlled trial., Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 15, Pages: 72-86, ISSN: 1932-8621
BACKGROUND: It is known that personality has an influence on the outcome of mental state disorders, but detailed studies on its long-term impact are few. We examined the influence of personality status on the 8-year outcome of health anxiety and its relationship to the effects of cognitive behaviour therapy in a randomized controlled trial. AIMS: This study aims to examine both the usefulness of the diagnosis of personality disorder and an additional measure of pathological dependence, in predicting the outcome of medical patients with health anxiety treated with cognitive behaviour therapy. Because the influence of personality is often shown in the long term, these assessments covered the period of 8 years after randomization. An additional aim is to examine the costs of different levels of personality dysfunction in each treatment group. METHOD: Personality dysfunction, using both ICD-10 and ICD-11 classifications of severity, was assessed at baseline by interview in a randomized controlled trial. Patients were also assessed for pathological dependence using the Dependent Personality Questionnaire, also scored along a severity dimension. Four hundred forty-four patients from medical clinics with pathological health anxiety were treated with a modified form of cognitive behaviour therapy for health anxiety (CBT-HA) or standard care. Total costs over follow-up were calculated from hospital data and compared by personality group. RESULTS: At baseline, 381 (86%) had some personality dysfunction, mainly at the lower level of personality difficulty (not formally a disorder). One hundred eighty four (41%) had a personality disorder. A similar proportion was found with regard to dependent personality. Using the ICD-10 classification, 153 patients (34.6%) had a personality disorder, with 83 (54.2%) having anxious or dependent personality disorder, 20 (13.1%) having an anankastic disorder, but also with 66 (43.1%) having mixed disorder. During initial treatment, those
Baldwin DS, Dang M, Farquharson L, et al., 2021, Quality of English inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the National Clinical Audit of Anxiety and Depression., Comprehensive Psychiatry, Vol: 104, ISSN: 0010-440X
BACKGROUND: Clinical audit is a sustained cyclical quality improvement process seeking to improve patient care and outcomes by evaluating services against explicit standards and implementing necessary changes. National audits aim to improve population-level clinical care by identifying unwarranted variations and making recommendations for clinicians, managers and service commissioners. The National Clinical Audit of Anxiety and Depression aimed to improve clinical care for people admitted to English hospitals for treatment of anxiety and depression, to provide comparative data on quality of care, and to support local quality improvement initiatives by identifying and sharing examples of best practice. PROCEDURES: Thirteen standards were developed based on NICE guidelines, literature review and feedback from a steering committee and reference group of service users and carers. All providers of NHS inpatient mental health services in England were asked to submit details of between 20 and 100 eligible service users/patients admitted between April 2017 and September 2018. To ascertain data reliability, participating services re-audited 5 sets of case-notes with a second auditor, and the coordinating team checked 10 randomly-selected sets of case-notes from 3 services, also selected at random. The reference group and steering committee identified key findings and developed a series of recommendations, which were discussed in regional quality improvement workshops and on-line webinars. FINDINGS: Data from 3795 case notes were analysed. A sizeable proportion of records indicated that at least one important aspect of initial assessment was not documented. Many service users/patients who could have benefited from an intervention targeted at optimising physical health did not receive it. Only a minority (39%) were referred for psychological therapy. Use of outcome measures varied considerably but no single outcome measure was being used routinely. Most individuals had a care
Williams R, Farquharson L, Rhodes E, et al., 2021, Impact of substance use disorder on quality of inpatient mental health services for people with anxiety and depression, Journal of Dual Diagnosis, Vol: 17, Pages: 80-93, ISSN: 1550-4263
INTRODUCTION: Substance use disorders (SUD) are commonly comorbid with anxiety and depressive disorders, and are associated with poor treatment outcomes.The mechanisms underlying this association remain unclear–one possibility is that patients with anxiety/depressive disorders and SUD receive poorer treatment.Concerns have been raised about the quality of inpatient care received by patients with SUD. OBJECTIVES: To examine the quality of care received by inpatients with an anxiety or depressive disorder, comparing sub-groups with or without a comorbid SUD. METHOD: Retrospective case-note review of 3,795 patients admitted to inpatient psychiatric wards in England. Data were gathered on all acute admissions with anxiety/depressive illness over a 6 month period, for a number of measures of quality of care derived from national standards. Association of co-existing SUD with a variety of quality of care outcomes (relating to assessment, care planning, medication management, psychological therapies, discharge, crisis planning and follow-up) was investigated using multivariable regression analyses. RESULTS: 543(14.3%) patients in the study had a secondary diagnosis of a SUD. Patients with SUD were less likely to have had care plans that were developed jointly, (i.e.,with input from both patient and clinician; OR= 0.76, 95% CI [0.55,0.93], p =.034),and less likely to have had their medication reviewed either during the admission (OR = 0.83, 95% CI [0.69, 0.94], p=.030) or at follow-up after discharge (OR= 0.58, 95% CI [0.39,0.86], p=.007). Carers of patients with SUD were less likely to have been provided with information about available support services (OR= 0.79, 95% CI [0.57, 0.98], p=.047). Patients with SUD were less likely to have received adequate (at least 24 hours) notice in advance of their discharge (OR= 0.72, 95% CI [0.54,0.96], p=.033), as were their carers (OR= 0.63, 95% CI [0.41,0.85], p=.007). They were less likely to have a crisis plan in place at th
Fonagy P, Yakeley J, Gardner T, et al., 2020, Mentalization for Offending Adult Males (MOAM): study protocol for a randomized controlled trial to evaluate mentalization-based treatment for antisocial personality disorder in male offenders on community probation, Trials, Vol: 21, ISSN: 1745-6215
BackgroundAntisocial personality disorder (ASPD), although associated with very significant health and social burden, is an under-researched mental disorder for which clinically effective and cost-effective treatment methods are urgently needed. No intervention has been established for prevention or as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment that has shown some promising preliminary results for reducing personality disorder symptomatology by specifically targeting the ability to recognize and understand the mental states of oneself and others, an ability that is compromised in people with ASPD. This paper describes the protocol of a multi-site RCT designed to test the effectiveness and cost-effectiveness of MBT for reducing aggression and alleviating the wider symptoms of ASPD in male offenders subject to probation supervision who fulfil diagnostic criteria for ASPD.MethodsThree hundred and two participants recruited from a pool of offenders subject to statutory supervision by the National Probation Service at 13 sites across the UK will be randomized on a 1:1 basis to 12 months of probation plus MBT or standard probation as usual, with follow-up to 24 months post-randomization. The primary outcome is frequency of aggressive antisocial behaviour as assessed by the Overt Aggression Scale – Modified. Secondary outcomes include violence, offending rates, alcohol use, drug use, mental health status, quality of life, and total service use costs. Data will be gathered from police and criminal justice databases, NHS record linkage, and interviews and self-report measures administered to participants. Primary analysis will be on an intent-to-treat basis; per-protocol analysis will be undertaken as secondary analysis. The primary outcome will be analysed using hierarchical mixed-effects linear regression. Secondary outcomes will be analysed using mixed-effects linear regression, mixed
Barnicot K, Michael C, Trione E, et al., 2020, Psychological interventions for acute psychiatric inpatients with schizophrenia-spectrum disorders: A systematic review and meta-analysis, Clinical Psychology Review, Vol: 82, ISSN: 0272-7358
BACKGROUND: Acute inpatient psychiatric wards are important yet challenging environments in which to implement psychological interventions for people with schizophrenia-spectrum disorders. No meta-analysis to date has evaluated whether psychological interventions are effective in this context. METHODS: We systematically searched Embase, Medline and PsycInfo databases for randomised controlled trials (RCTs) of psychological interventions implemented in acute inpatient psychiatric settings with individuals with schizophrenia-spectrum disorders. We conducted random effects meta-analyses of between-groups outcomes at post-intervention and relapse/re-hospitalisation rates by follow-up. RESULTS: Twenty-nine trials were suitable for meta-analysis. Psychological interventions improved post-intervention positive symptoms, social functioning and treatment compliance and reduced the risk of relapse/ re-hospitalisation, relative to control conditions. Analyses of specific intervention effects found positive effects of psychoeducation on several key outcomes (power > 80%) and preliminary evidence for positive effects of acceptance and commitment therapy (ACT), cognitive behaviour therapy (CBT) and metacognitive training (MCT) on some outcomes (power < 80%). CONCLUSION: Psychological interventions can be helpful for acute inpatients with schizophrenia-spectrum disorders. However, risk of bias was often high or unclear, and some analyses were underpowered. Further research should use more rigorous RCT designs and publish meta-analysable data on positive symptoms, general psychopathology, relapse/ re-hospitalisation, social functioning and treatment compliance.
Botham J, Clark A, Steare T, et al., 2020, Community interventions for people with complex emotional needs that meet the criteria for ‘personality disorder’ diagnoses: a systematic review of economic evaluations
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Diagnoses of “personality disorder” are prevalent among people using community secondary mental health services. Whilst the effectiveness of a range of community-based treatments have been considered, as the NHS budget is finite, it is also important to consider the cost-effectiveness of those interventions.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>To assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs that meet criteria for a diagnosis of “personality disorder” to inform healthcare policy making.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>Systematic review (PRESPORO #: CRD42020134068) of five databases, supplemented by reference list screening and citation tracking of included papers. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of ‘personality disorder’ in community mental health settings published between before 18 September 2019. Study quality was assessed using the CHEERS statement. Narrative synthesis was used to summarise study findings.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Eighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified which evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>There is no robust economic evidence to support a single intervention or mod
Williams R, Farquharson L, Rhodes E, et al., 2020, Impact of co-morbid personality disorder on quality of inpatient mental health services for people with anxiety and depression, Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 14, Pages: 336-349, ISSN: 1932-8621
IntroductionConcerns have been raised about the quality of inpatient care received by patients with a diagnosis of personality disorder.ObjectivesThe aim of this study was to examine the quality of care received by inpatients with an anxiety or depressive disorder, comparing subgroups with or without a co‐morbid personality disorder.MethodWe used a retrospective case‐note review of 3 795 patients admitted to inpatient psychiatric wards in England, utilizing data from the National Clinical Audit of Anxiety and Depression. Data were gathered on all acute admissions with an anxiety or depressive disorder over a 6‐month period, for a number of measures reflecting quality of care derived from national standards. Association of coexisting personality disorder with quality of care was investigated using multivariable regression analyses.ResultsFour hundred sixteen (11.0%) of the patients had a co‐co‐morbid diagnosis of personality disorder. Patients with personality disorder were less likely to have been asked about prior responses to treatment in their initial assessment (odds ratio (OR) = 0.67, 95% confidence interval (CI) 0.50 to 0.89, p = 0.007). They were less likely to receive adequate notice in advance of their discharge (OR = 0.87, 95% CI 0.65 to 0.98, p = 0.046). They were more likely to be prescribed medication at the point of discharge (OR = 1.52, 95% CI 1.02 to 2.09, p = 0.012) and less likely to have been provided with information about the medicines they were taking (OR = 0.86, 95% CI 0.69 to 0.94, p = 0.048). In addition, the carers of patients with co‐morbid personality disorder were less likely to have been provided with information about available support services (OR = 0.73, 95% CI 0.51 to 0.93, p = 0.045).ConclusionWe found evidence of poorer quality of care for patients with co‐morbid personality disorder who were admitted to psychiatric hospital for treatment of anxiety or depressive disorders, highlighting the need for improved clinical care in
Rek K, Thielmann I, Henkel M, et al., 2020, A psychometric evaluation of the Standardized Assessment of Severity of Personality Disorder (SASPD) in nonclinical and clinical German samples., Psychological Assessment, Vol: 32, Pages: 984-990, ISSN: 1040-3590
The Standardized Assessment of Severity of Personality Disorder (SASPD) is a 9-item self-report screening instrument and was developed to assess personality disorder (PD) severity according to the initial proposal of ICD-11. Our aim was to investigate the psychometric properties of the German version of the SASPD in nonclinical and clinical samples. A total of 1,991 participants (N = 888 from nonclinical and N = 1,103 from clinical samples) provided ratings on the SASPD as well as other measures of psychopathology and personality. We examined the SASPD regarding its factor structure, internal consistency, and construct validity. A unidimensional structure of the SASPD provided inadequate model fit, whereas a 3-factor solution provided good fit in both the nonclinical and clinical samples. Internal consistency of the SASPD total score was acceptable in the clinical and nonclinical samples based on this multifactorial model. In terms of convergent validity, SASPD scores correlated fairly with other measures of PD severity across samples. Discriminant validity with measures of general symptom distress and measures of (normal) personality traits was mixed. In addition, the SASPD scores predicted levels of PD severity above and beyond a measure of symptom distress. The SASPD captures some theoretically expected features of PD severity. However, the multidimensional structure and limited convergent and discriminant validity may hamper future usage of the SASPD as a short screening tool of PD severity according to ICD-11. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Deb S, Crawford M, Sharp D, et al., 2020, Risperidone versus placebo for aggression following traumatic brain injury: a feasibility randomised controlled trial, BMJ Open, Vol: 10, ISSN: 2044-6055
Objectives: To conduct a feasibility randomised controlled trial of risperidone for the treatment of aggression in adults with traumatic brain injury (TBI).Design: Multi-centre, parallel design, placebo controlled (1:1 ratio) double-blind feasibility trial with an embedded process evaluation. No statistical comparison was performed between the two study groups.Setting Four neuropsychiatric and neurology outpatient clinics in London and Kent, UK. Participants Our aim was to recruit 50 TBI patients over 18 months. Follow up participants at 12 weeks using a battery of assessment scales to measure changes in aggressive behaviour (MOAS-primary outcome, IRQ) as well as global functioning (GOS-E, CGI) and quality of life (EQ-5D-5L, SF-12), mental health (HADS) and medication adverse effects (UKU).Results: Six participants were randomised to the active arm of the trial and eight to the placebo arm over a 10-month period (28% of our target). Two participants withdrew because of adverse events. Twelve out of 14 (85.7%) patients completed a follow up assessment at 12 weeks. At follow up, the scores of all outcome measures improved in both groups. Placebo group showed numerically better score change according to the primary outcome MOAS. No severe adverse events were reported. The overall rate of adverse events remained low. Data from the process evaluation suggest that existence of specialised TBI Follow-up clinics, availability of a dedicated database of TBI patients’ clinical details, simple study procedures and regular support to participants would enhance recruitment and retention in the trial. Feedback from participants showed that once in the study, they did not find the trial procedure onerous.Conclusions: It was not feasible to conduct a successful randomised trial of risperidone versus placebo for post-TBI aggression using the methods we deployed in this study. It is not possible to draw any definitive conclusion about risperidone’s efficacy from such a s
Jayasena CN, Sharma A, Abbara A, et al., 2020, Burdens and awareness of adverse self-reported lifestyle factors in men with sub-fertility: a cross-sectional study in 1149 men., Clinical Endocrinology, Vol: 93, Pages: 312-321, ISSN: 0300-0664
BACKGROUND: There are no current pharmacological therapies to improve sperm quality in men with sub-fertility. Reducing the exposure to lifestyle risk factor (LSF) is currently the only intervention for improving sperm quality in men with sub-fertility. No previous study has investigated what proportion of men with sub-fertility are exposed to adverse lifestyle factors. Furthermore, it is not known to what extent men with sub-fertility are aware of lifestyle factors potentially adversely impacting their fertility. METHODS: A cross-sectional anonymous questionnaire-based study on self-reported exposure and awareness of LSF was conducted in 1149 male partners of couples investigated for sub-fertility in a tertiary andrology centre in London, UK. RESULTS: Seventy-percent of men investigated for sub-fertility had ≥1 LSF, and twenty-nine-percent had ≥2 LSF. Excessive alcohol consumption was the most common LSF (40% respondents). Seventeen-percent of respondents used recreational drugs (RD) regularly, but only 32% of RD users believed RD impair male fertility. Twenty-five-percent of respondents were smokers, which is higher than the UK average (20%). Twenty-seven percent of respondents had a waist circumference (WC) >36inches (91cm), and 4% had WC >40inches (102cm). Seventy-nine-percent of respondents wanted further lifestyle education to improve their fertility. CONCLUSIONS: Our data suggest that men with sub-fertility are: (1) exposed to one or more LSF; (2) have incomplete education about how LSF may cause male sub-fertility; (3) want more education about reducing LSF. Further studies are needed to investigate the potential of enhanced education of men about LSF to treat couples with sub-fertility.
Williams R, Farquharson L, Rhodes E, et al., 2020, Variation in clinical care associated with weekend admission and discharge in psychiatric inpatient units, BJPsych Open, Vol: 6, ISSN: 2056-4724
BackgroundQuestions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends.AimsTo compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the ‘working week’.MethodRetrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses.ResultsIn total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39–0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46–0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30–0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50–0.97).ConclusionsThere is no evidence of a ‘weekend effect’ for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.
Crawford MJ, Thana L, Evans R, et al., 2020, Switching antipsychotic medication to reduce sexual dysfunction in people with psychosis: the REMEDY RCT, HEALTH TECHNOLOGY ASSESSMENT, Vol: 24, Pages: 1-+, ISSN: 1366-5278
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Barnicot K, Allen K, Hood C, et al., 2020, Older adult experience of care and staffing on hospital and community wards: a cross-sectional study, BMC Health Services Research, Vol: 20, ISSN: 1472-6963
BackgroundRecent major concerns about the quality of healthcare delivered to older adults have been linked to inadequate staffing and a lack of patient-centred care. Patient experience is a key component of quality care - yet there has been little research on whether and how staffing levels and staffing types affect satisfaction amongst older adult hospital inpatients. This study aimed to evaluate the association between registered nurse and healthcare assistant staffing levels and satisfaction with care amongst older adult hospital inpatients, and to test whether any positive effect of higher staffing levels is mediated by staff feeling they have more time to care for patients.MethodsSurvey data from 4928 inpatients aged 65 years and older and 2237 medical and nursing staff from 123 acute and community medical wards in England, United Kingdom (UK) was collected through the Royal College of Psychiatrist’s Elder Care Quality Mark. The cross-sectional association between staffing ratios and older adult patient satisfaction, and mediation by staff perceived time to care, was evaluated using multi-level modelling, adjusted for ward type and with a random effect for ward identity.ResultsHigher numbers of patients per healthcare assistant were associated with poorer patient satisfaction (adjusted β = − 0.32, 95% CI − 0.55 to 0.10, p < 0.01), and this was found to be partially mediated by all ward staff reporting less time to care for patients (adjusted β = − 0.10, bias-corrected 95% CI − 1.16 to − 0.02). By contrast, in both unadjusted and adjusted models, the number of patients per registered nurse was not associated with patient satisfaction.ConclusionsOlder adult hospital patients may particularly value the type of care provided by healthcare assistants, such as basic personal care and supportive communication. Additionally, higher availa
Saraiva S, Guthrie E, Walker A, et al., 2020, The nature and activity of liaison mental services in acute hospital settings: a multi-site cross sectional study, BMC Health Services Research, Vol: 20, Pages: 308-308, ISSN: 1472-6963
BACKGROUND: To describe the clinical activity patterns and nature of interventions of hospital-based liaison psychiatry services in England. METHODS: Multi-site, cross-sectional survey. 18 acute hospitals across England with a liaison psychiatry service. All liaison staff members, at each hospital site, recorded data on each patient they had face to face contact with, over a 7 day period. Data included location of referral, source of referral, main clinical problem, type of liaison intervention employed, staff professional group and grade, referral onto other services, and standard assessment measures. RESULTS: A total of 1475 face to face contacts from 18 hospitals were included in the analysis, of which approximately half were follow-up reviews. There was considerable variation across sites, related to the volume of Emergency Department (ED) attendances, number of hospital admissions, and work hours of the team but not to the size of the hospital (number of beds). The most common clinical problems were co-morbid physical and psychiatric symptoms, self-harm and cognitive impairment. The main types of intervention delivered were diagnosis/formulation, risk management and advice. There were differences in the type of clinical problems seen by the services between EDs and wards, and also differences between the work conducted by doctors and nurses. Almost half of the contacts were for continuing care, rather than assessment. Eight per cent of all referrals were offered follow up with the LP team, and approximately 37% were referred to community or other services. CONCLUSIONS: The activity of LP services is related to the flow of patients through an acute hospital. In addition to initial assessments, services provide a wide range of differing interventions, with nurses and doctors carrying out distinctly different roles within the team. The results show the volume and diversity of LP work. While much clinical contact is acute and confined to the inpatient episod
Deb S, Crawford M, Limbu B, et al., 2020, Short-term PsychoEducation for Carers To Reduce Over Medication of people with intellectual disabilities (SPECTROM): study protocol, BMJ Open, Vol: 10, ISSN: 2044-6055
Introduction Psychotropic medications that are primarily licenced for the treatment of psychiatric disorders are used widely (32%–85%) among people with intellectual disabilities (ID) often for the management of problem (challenging) behaviour in the absence of a psychiatric disorder. Care staff play a pivotal role in the prescribing process. Currently, no staff training programme exists to address the issue of overprescribing of psychotropic medication in people with ID, thus highlighting an urgent need for developing a psychoeducational programme (PEP) specifically designed to address this issue. We propose to develop a PEP for care staff using the methodology described in the UK Medical Research Council guide for complex interventions.Methods and analysis The development of the PEP will involve (1) gathering information on available relevant training programmes, (2) running four focus groups with care staff and other professionals to establish the content and format of the PEP, and (3) organising a co-design event involving all relevant stakeholders to discuss the format of the PEP. A core project team will develop the PEP under guidance from the PEP Development Group which will consist of 10–12 relevant stakeholder representatives. Feedback from selected stakeholders on a draft PEP will allow us to refine the PEP before implementation. The PEP will have web-based modules supplemented by face to face training sessions. When the final draft is ready, we will field test the PEP on six to eight care staff from community care homes for people with ID. After completing the field test, we will run a focus group involving participants in the PEP to get feedback on the PEP.Ethics and dissemination Ethics approval for this study was waived by the UK Health Regulatory Authority as the study does not collect any patient related information and only include care staff outside the UK NHS. This will be the first ever such universally freely available PEP supported
Sanatinia R, Crawford MJ, Quirk A, et al., 2020, Identifying features associated with higher-quality hospital care and shorter length of admission for people with dementia: a mixed-methods study, Health Services and Delivery Research, Vol: 8, Pages: 1-92, ISSN: 2050-4349
<jats:sec id="abs1-1"><jats:title>Background</jats:title><jats:p>Concerns have repeatedly been expressed about the quality of inpatient care that people with dementia receive. Policies and practices have been introduced that aim to improve this, but their impact is unclear.</jats:p></jats:sec><jats:sec id="abs1-2"><jats:title>Aims</jats:title><jats:p>To identify which aspects of the organisation and delivery of acute inpatient services for people with dementia are associated with higher-quality care and shorter length of stay.</jats:p></jats:sec><jats:sec id="abs1-3"><jats:title>Design</jats:title><jats:p>Mixed-methods study combining a secondary analysis of data from the third National Audit of Dementia (2016/17) and a nested qualitative exploration of the context, mechanism and outcomes of acute care for people with dementia.</jats:p></jats:sec><jats:sec id="abs1-4"><jats:title>Setting</jats:title><jats:p>Quantitative data from 200 general hospitals in England and Wales and qualitative data from six general hospitals in England that were purposively selected based on their performance in the audit.</jats:p></jats:sec><jats:sec id="abs1-5"><jats:title>Participants</jats:title><jats:p>Quantitative data from clinical records of 10,106 people with dementia who had an admission to hospital lasting ≥ 72 hours and 4688 carers who took part in a cross-sectional survey of carer experience. Qualitative data from interviews with 56 hospital staff and seven carers of people with dementia.</jats:p></jats:sec><jats:sec id="abs1-6"><jats:title>Main outcome measures</jats:title><jats:p>Length of stay, quality of assessment and carer-rated experience.</jats:p></jats:sec><jats:sec id="abs1-7&q
Day C, Briskman J, Crawford MJ, et al., 2020, An intervention for parents with severe personality difficulties whose children have mental health problems: a feasibility RCT., Health Technology Assessment, Vol: 24, Pages: 1-188, ISSN: 1366-5278
BACKGROUND: The children of parents with severe personality difficulties have greater risk of significant mental health problems. Existing care is poorly co-ordinated, with limited effectiveness. A specialised parenting intervention may improve child and parenting outcomes, reduce family morbidity and lower the service costs. OBJECTIVES: To develop a specialised parenting intervention for parents affected by severe personality difficulties who have children with mental health problems and to conduct a feasibility trial. DESIGN: A pragmatic, mixed-methods design to develop and pilot a specialised parenting intervention, Helping Families Programme-Modified, and to conduct a randomised feasibility trial with process evaluation. Initial cost-effectiveness was assessed using UK NHS/Personal Social Services and societal perspectives, generating quality-adjusted life-years. Researchers collecting quantitative data were masked to participant allocation. SETTING: Two NHS mental health trusts and concomitant children's social care services. PARTICIPANTS: Parents who met the following criteria: (1) the primary caregiver of the index child, (2) aged 18-65 years, (3) have severe personality difficulties, (4) proficient in English and (5) capable of providing informed consent. Index children who met the following criteria: (1) aged 3-11 years, (2) living with index parent and (3) have significant emotional/behavioural difficulties. Exclusion criteria were (1) having coexisting psychosis, (2) participating in another parenting intervention, (3) receiving inpatient care, (4) having insufficient language/cognitive abilities, (5) having child developmental disorder, (6) care proceedings and (7) index child not residing with index parent. INTERVENTION: The Helping Families Programme-Modified - a 16-session intervention using structured, goal-orientated strategies and collaborative therapeutic methods to improve parenting, and child and parent functioning. Usual care - standard care au
Crawford MJ, Thana L, Parker J, et al., 2020, Structured Psychological Support for people with personality disorder: feasibility randomised controlled trial of a low-intensity intervention, BJPsych Open, Vol: 6, ISSN: 2056-4724
BackgroundNational guidance cautions against low-intensity interventions for people with personality disorder, but evidence from trials is lacking.AimsTo test the feasibility of conducting a randomised trial of a low-intensity intervention for people with personality disorder.MethodSingle-blind, feasibility trial (trial registration: ISRCTN14994755). We recruited people aged 18 or over with a clinical diagnosis of personality disorder from mental health services, excluding those with a coexisting organic or psychotic mental disorder. We randomly allocated participants via a remote system on a 1:1 ratio to six to ten sessions of Structured Psychological Support (SPS) or to treatment as usual. We assessed social functioning, mental health, health-related quality of life, satisfaction with care and resource use and costs at baseline and 24 weeks after randomisation.ResultsA total of 63 participants were randomly assigned to either SPS (n = 33) or treatment as usual (n = 30). Twenty-nine (88%) of those in the active arm of the trial received one or more session (median 7). Among 46 (73%) who were followed up at 24 weeks, social dysfunction was lower (−6.3, 95% CI −12.0 to −0.6, P = 0.03) and satisfaction with care was higher (6.5, 95% CI 2.5 to 10.4; P = 0.002) in those allocated to SPS. Statistically significant differences were not found in other outcomes. The cost of the intervention was low and total costs over 24 weeks were similar in both groups.ConclusionsSPS may provide an effective low-intensity intervention for people with personality disorder and should be tested in fully powered clinical trials.
Day C, Briskman J, Crawford MJ, et al., 2020, Randomised feasibility trial of the helping families programme-modified: an intensive parenting intervention for parents affected by severe personality difficulties, BMJ OPEN, Vol: 10, ISSN: 2044-6055
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Barnicot K, Crawford M, 2019, Conclusions and questions from a non-randomised comparison of routine clinical services implementing different treatment models for borderline personality disorder, Psychological Medicine, Vol: 49, Pages: 2812-2814, ISSN: 0033-2917
Crawford M, Huddart D, Craig E, et al., 2019, Impact of secondary care financial incentives on the quality of physical healthcare for people with psychosis: a longitudinal controlled study, British Journal of Psychiatry, Vol: 215, Pages: 720-725, ISSN: 0007-1250
Background: Concerns have repeatedly been expressed about the quality of physical health care that people with psychosis receive. Aims: To examine whether the introduction of a financial incentive for secondary care services led to improvements in the quality of physical health care for people with psychosis.Method: Longitudinal data were collected over an eight-year period on the quality of physical health care that people with psychosis received from 56 Trusts in England before and after the introduction of the financial incentive. Control data were also collected from six Health Boards in Wales where a financial incentive was not introduced. We calculated the proportion of patients whose clinical records indicated that they had been screened for seven key aspects of physical health and whether they were offered interventions for problems identified during screening. Results: Data from 17947 people collected prior to (2011 and 2013) and following (2017) the introduction of the financial incentive in 2014 showed that the proportion of patients who received high quality physical health care in England rose from 12.85% to 31.65% (difference = 18.80, 95% CI =17.37 - 20.21). The proportion of patients who received high quality physical health care in Wales during this period rose from 8.40% to 13.96% (difference = 5.56, 95% CI =1.33 - 10.10). Conclusions: The results of this study suggest that financial incentives for secondary care mental health services are associated with marked improvements in the quality of care that patients receive. Further research is needed to examine their impact on aspects of care that are not incentivised.
Smith C, Hewison J, West RM, et al., 2019, Liaison psychiatry-measurement and evaluation of service types, referral patterns and outcomes (LP-MAESTRO): a protocol., BMJ Open, Vol: 9, Pages: 1-8, ISSN: 2044-6055
INTRODUCTION: We describe the protocol for a project that will use linkage of routinely collected NHS data to answer a question about the nature and effectiveness of liaison psychiatry services in acute hospitals in England. METHODS AND ANALYSIS: The project will use three data sources: (1) Hospital Episode Statistics (HES), a database controlled by NHS Digital that contains patient data relating to emergency department (ED), inpatient and outpatient episodes at hospitals in England; (2) ResearchOne, a research database controlled by The Phoenix Partnership (TPP) that contains patient data relating to primary care provided by organisations using the SystmOne clinical information system and (3) clinical databases controlled by mental health trusts that contain patient data relating to care provided by liaison psychiatry services. We will link patient data from these sources to construct care pathways for patients who have been admitted to a particular hospital and determine those patients who have been seen by a liaison psychiatry service during their admission.Patient care pathways will form the basis of a matched cohort design to test the effectiveness of liaison intervention. We will combine healthcare utilisation within care pathways using cost figures from national databases. We will compare the cost of each care pathway and the impact of a broad set of health-related outcomes to obtain preliminary estimates of cost-effectiveness for liaison psychiatry services. We will carry out an exploratory incremental cost-effectiveness analysis from a whole system perspective. ETHICS AND DISSEMINATION: Individual patient consent will not be feasible for this study. Favourable ethical opinion has been obtained from the NHS Research Ethics Committee (North of Scotland) (REF: 16/NS/0025) for Work Stream 2 (phase 1) of the Liaison psychiatry-measurement and evaluation of service types, referral patterns and outcomes study. The Confidentiality Advisory Group at the Health Resea
Lei H, Barnicot K, Maynard E, et al., 2019, Factors influencing use of community treatment orders and quality of care that people receive: results of a national survey in England and Wales, BJPsych Bulletin, Vol: 43, Pages: 227-235, ISSN: 2056-4694
Aims and method: We conducted a secondary analysis of data from the National Audit of Psychosis to identify factors associated with use of community treatment orders (CTOs) and assess the quality of care that people on CTOs receive.Results: Between 1.1 and 20.2% of patients in each trust were being treated on a CTO. Male gender, younger age, greater use of in-patient services, coexisting substance misuse and problems with cognition predicted use of CTOs. Patients on CTOs were more likely to be screened for physical health, have a current care plan, be given contact details for crisis support, and be offered cognitive-behavioural therapy.Clinical implications: CTOs appear to be used as a framework for delivering higher-quality care to people with more complex needs. High levels of variation in the use of CTOs indicate a need for better evidence about the effects of this approach to patient care.Declaration of interest: None.
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