scholarly journals Community-oriented psychiatric care

1989 ◽  
Vol 13 (1) ◽  
pp. 26-27 ◽  
Author(s):  
Joseph Connolly ◽  
Isaac Marks
Keyword(s):  
Psychiatric Care ◽  
Community Care ◽  
Multidisciplinary Teams ◽  
Role Changes ◽  
Hard Evidence ◽  
The Uk

The College is debating how to train psychiatrists for community care (CC) that is spreading – ahead of hard evidence of its value for certain problems in the UK. Much future psychiatry will be practised in the community outside hospital within multidisciplinary teams not always led by a psychiatrist, and wherein the lead-rôle changes frequently within a single meeting depending on whose expertise and readiness to accept responsibility emerge.

How multidisciplinary are multidisciplinary case reviews in cancer care? Feasibility analysis of a theory-driven team decision-making fidelity framework

2019 ◽  
Author(s):  
Tayana Soukup ◽  
Ged Murtagh ◽  
Ben W Lamb ◽  
James Green ◽  
Nick Sevdalis
Keyword(s):  
Decision Making ◽  
Cancer Care ◽  
Recent Decade ◽  
Individual Case ◽  
Multidisciplinary Teams ◽  
Final Decision ◽  
Political Climate ◽  
Implementation Framework ◽  
Feasibility Evaluation ◽  
The Uk

Background Multidisciplinary teams (MDTs) are a standard cancer care policy in many countries worldwide. Despite an increase in research in a recent decade on MDTs and their care planning meetings, the implementation of MDT-driven decision-making (fidelity) remains unstudied. We report a feasibility evaluation of a novel method for assessing cancer MDT decision-making fidelity. We used an observational protocol to assess (1) the degree to which MDTs adhere to the stages of group decision-making as per the ‘Orientation-Discussion-Decision-Implementation’ framework, and (2) the degree of multidisciplinarity underpinning individual case reviews in the meetings. MethodsThis is a prospective observational study. Breast, colorectal and gynaecological cancer MDTs in the Greater London and Derbyshire (United Kingdom) areas were video recorded over 12-weekly meetings encompassing 822 case reviews. Data were coded and analysed using frequency counts.Results Eight interaction formats during case reviews were identified. case reviews were not always multi-disciplinary: only 8% of overall reviews involved all five clinical disciplines present, and 38% included four of five. The majority of case reviews (i.e. 54%) took place between two (25%) or three (29%) disciplines only. Surgeons (83%) and oncologists (8%) most consistently engaged in all stages of decision-making. While all patients put forward for MDT review were actually reviewed, a small percentage of them (4%) either bypassed the orientation (case presentation) and went straight into discussing the patient, or they did not articulate the final decision to the entire team (8%). Conclusions Assessing fidelity of MDT decision-making at the point of their weekly meetings is feasible. We found that despite being a set policy, case reviews are not entirely MDT-driven. We discuss implications in relation to the current eco-political climate, and the quality and safety of care. Our findings are in line with the current national initiatives in the UK on streamlining MDT meetings, and could help decide how to re-organise them to be most efficient.

scholarly journals Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Hasselberg ◽  
K. H. Holgersen ◽  
G. M. Uverud ◽  
J. Siqveland ◽  
B. Lloyd-Evans ◽  
...  
Keyword(s):  
Mental Health ◽  
Multidisciplinary Teams ◽  
Evidence Based ◽  
Crisis Resolution ◽  
Health Crisis ◽  
The Core ◽  
Crisis Resolution Teams ◽  
Fidelity Scale ◽  
The Uk ◽  
Evidence Based Model

Abstract Background Crisis resolution teams (CRTs) are specialized multidisciplinary teams intended to provide assessment and short-term outpatient or home treatment as an alternative to hospital admission for people experiencing a mental health crisis. In Norway, CRTs have been established within mental health services throughout the country, but their fidelity to an evidence-based model for CRTs has been unknown. Methods We assessed fidelity to the evidence-based CRT model for 28 CRTs, using the CORE Crisis Resolution Team Fidelity Scale Version 2, a tool developed and first applied in the UK to measure adherence to a model of optimal CRT practice. The assessments were completed by evaluation teams based on written information, interviews, and review of patient records during a one-day visit with each CRT. Results The fidelity scale was applicable for assessing fidelity of Norwegian CRTs to the CRT model. On a scale 1 to 5, the mean fidelity score was low (2.75) and with a moderate variation of fidelity across the teams. The CRTs had highest scores on the content and delivery of care subscale, and lowest on the location and timing of care subscale. Scores were high on items measuring comprehensive assessment, psychological interventions, visit length, service users’ choice of location, and of type of support. However, scores were low on opening hours, gatekeeping acute psychiatric beds, facilitating early hospital discharge, intensity of contact, providing medication, and providing practical support. Conclusions The CORE CRT Fidelity Scale was applicable and relevant to assessment of Norwegian CRTs and may be used to guide further development in clinical practice and research. Lower fidelity and differences in fidelity patterns compared to the UK teams may indicate that Norwegian teams are more focused on early interventions to a broader patient group and less on avoiding acute inpatient admissions for patients with severe mental illness.

scholarly journals How paradata can illuminate technical, social and professional role changes between the Poverty in the UK (1967/1968) and Poverty and Social Exclusion in the UK (2012) surveys

2016 ◽  
Vol 51 (6) ◽  
pp. 2457-2473
Author(s):  
Rosalind Edwards ◽  
Ann Phoenix ◽  
David Gordon ◽  
Karen Bell ◽  
Heather Elliott ◽  
...  
Keyword(s):  
Social Exclusion ◽  
Professional Role ◽  
Role Changes ◽  
The Uk

scholarly journals The NeST (Neoadjuvant systemic therapy in breast cancer) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
I. Whitehead ◽  
◽  
G. W. Irwin ◽  
F. Bannon ◽  
C. E. Coles ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Tumour Response ◽  
Multidisciplinary Teams ◽  
Diverse Range ◽  
Radiological Monitoring ◽  
Original Tumour ◽  
Neoadjuvant Systemic Therapy ◽  
Axillary Node Clearance ◽  
The Uk

Abstract Background Neoadjuvant systemic therapy (NST) is increasingly used in the treatment of breast cancer, yet it is clear that there is significant geographical variation in its use in the UK. This study aimed to examine stated practice across UK breast units, in terms of indications for use, radiological monitoring, pathological reporting of treatment response, and post-treatment surgical management. Methods Multidisciplinary teams (MDTs) from all UK breast units were invited to participate in the NeST study. A detailed questionnaire assessing current stated practice was distributed to all participating units in December 2017 and data collated securely usingREDCap. Descriptive statistics were calculated for each questionnaire item. Results Thirty-nine MDTs from a diverse range of hospitals responded. All MDTs routinely offered neoadjuvant chemotherapy (NACT) to a median of 10% (range 5–60%) of patients. Neoadjuvant endocrine therapy (NET) was offered to a median of 4% (range 0–25%) of patients by 66% of MDTs. The principal indication given for use of neoadjuvant therapy was for surgical downstaging. There was no consensus on methods of radiological monitoring of response, and a wide variety of pathological reporting systems were used to assess tumour response. Twenty-five percent of centres reported resecting the original tumour footprint, irrespective of clinical/radiological response. Radiologically negative axillae at diagnosis routinely had post-NACT or post-NET sentinel lymph node biopsy (SLNB) in 73.0 and 84% of centres respectively, whereas 16% performed SLNB pre-NACT. Positive axillae at diagnosis would receive axillary node clearance at 60% of centres, regardless of response to NACT. Discussion There is wide variation in the stated use of neoadjuvant systemic therapy across the UK, with general low usage of NET. Surgical downstaging remains the most common indication of the use of NAC, although not all centres leverage the benefits of NAC for de-escalating surgery to the breast and/or axilla. There is a need for agreed multidisciplinary guidance for optimising selection and management of patients for NST. These findings will be corroborated in phase II of the NeST study which is a national collaborative prospective audit of NST utilisation and clinical outcomes.

scholarly journals A study to improve the quality of writing clinic letters to patients attending the outpatient clinic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S211-S211
Author(s):  
Irangani Mudiyanselage ◽  
Madhvi Belgamwar
Keyword(s):  
Outpatient Clinic ◽  
Standards Of Care ◽  
Multidisciplinary Teams ◽  
Patient Centered ◽  
Second Person ◽  
County Mental Health ◽  
Hospital Doctors ◽  
The Uk ◽  
To Receive

AimsIn many countries (including the UK and Australia) it is still common practice for hospital doctors to write letters to patients’ general practitioners (GPs) following outpatient consultations, and for patients to receive copies of these letters. However, experience suggests that hospital doctors who have changed their practice to include writing letters directly to patients have more patient centred consultations and experience smoother handovers with other members of their multidisciplinary teams. (Rayner et al, BMJ 2020)The aim of the study was to obtain patient's views to improve the quality of clinical letters sent to them, hence the level of communication and standards of care.MethodAn anonymous questionnaire was designed and posted to collect information from patients attending one of the South County Mental Health outpatient clinic in Derbyshire. 50 random patients were selected between March to November 2020. Patients were asked to provide suggestions to improve the quality of their clinic letters written directly to them and copies sent to their GPs.ResultOut of 50 patients 48% (n = 24) responded. Majority of patients (92%) expressed their wish to receive their clinic letters written directly to them and 79% preferred to be addressed as a second person in the letters. More than half (54%, N = 13) of them would like to have letter by post. Majority of them (92%, N = 22) wished to have their letter within a week of their consultations.Patients attending clinics felt that the communication could be better improved through writing clearly: a) reflection of what was discussed during the consultation b) updated diagnosis c) a clear follow-up plan d) current level of support e) medication change f) emergency contact numbers g) actions to be carried out by their GP and further referrals should there be any.ConclusionPatients in community prefer to have their clinic letters directly addressing them in second person. It was noted that the letters needed to reflect accurately on what was discussed during the consultation in order to have patient centered consultations. This in turn would improve communication and thus rapport, trust and overall therapeutic relationship.

scholarly journals Locked doors or sentinel nurses?

2000 ◽  
Vol 24 (9) ◽  
pp. 327-328 ◽  
Author(s):  
Bob Adams
Keyword(s):  
Psychiatric Care ◽  
Acute Psychiatric Wards ◽  
The Uk ◽  
Locked Doors ◽  
Park Hospital ◽  
The Doors

Towards the end of 1998 we decided to introduce a facility to lock the doors of the acute psychiatric wards at Bootham Park Hospital, York. At first sight this would appear to be a retrograde step for modern psychiatric care in the UK. But this was a reasoned and planned move which has resulted in improved care for patients overall.

The changing context of advanced practice nursing within the UK community care setting

2021 ◽  
Vol 26 (12) ◽  
pp. 581-586
Author(s):  
Barry Hill ◽  
Sadie Diamond-Fox ◽  
Aby Mitchell
Keyword(s):  
Community Care ◽  
Advanced Practice Nursing ◽  
Advanced Practice ◽  
Advanced Level ◽  
The Public ◽  
Independent Prescribing ◽  
Consultation Skills ◽  
The Uk ◽  
Additional Education ◽  
And Training

Advanced practice nursing (APN) roles have developed partly to address demand and workforce issues. In community care settings and general practice, an advanced nursing practitioner is generally understood to mean a nurse who has undertaken additional education and training in clinical assessment, including history-taking and physical examination, clinical reasoning and independent prescribing, so they can safely manage patients presenting with undifferentiated and undiagnosed conditions. Capabilities in the Skills for Health framework cover everything from communication and consultation skills, practising holistically and personalised care, to working with colleagues and in teams. The framework is intended to ensure advanced nursing practitioners work to an advanced level. It is also designed to support them to demonstrate and evidence their capabilities to service commissioners, employers, people accessing healthcare and the public.

scholarly journals The new evidence-based policy: public participation between ‘hard evidence’ and democracy in practice

2020 ◽  
Vol 16 (2) ◽  
pp. 209-227
Author(s):  
Helen Pallett
Keyword(s):  
Public Participation ◽  
Science Policy ◽  
Policy Making ◽  
Ethnographic Study ◽  
Evidence Based ◽  
Advantages And Disadvantages ◽  
Evidence Based Policy ◽  
Hard Evidence ◽  
The Government ◽  
The Uk

Background:Debates about evidence-based policy (EBP) were revived in the UK in the 2010s in the context of civil service reform and changing practices of policy making, including institutionalisation of public participation in science policy making. Aims and objectives:This paper aims to explore this revival of interest in EBP in the context of the Government-funded public participation programme Sciencewise, which supports and promotes public dialogues in science policy making. It is based on in-depth ethnographic study of the programme during 2013, considering the impacts on Sciencewise practices and working understandings of engaging in the EBP debate. There is a particular focus on the advantages and disadvantages of categorising public participation as a source of evidence-based policy as opposed to presenting participation as a democratic act which is separate from discussions of EBP. Key conclusions:At different times Sciencewise actors moved between these stances in order to gain credibility and attention for their work, and to situate the outcomes of public participation processes in a broader policy context. In some instances the presentation of outputs from public participation processes as legitimate evidence for policy gave them greater influence and enriched broader discussions about the meaning and practice of open policy. However, it also frequently led to their dismissal on methodological grounds, inhibiting serious engagement with their outputs and challenging internal frameworks for evaluation and learning.

Self-Inflicted Stab Wounds: A Single-Center Experience from 2010 to 2016

2019 ◽  
Vol 85 (6) ◽  
pp. 272-578
Author(s):  
Stephen O'Brien ◽  
Mark D. Nicolas ◽  
Neal Bhutiani ◽  
Jessica E. Schucht ◽  
Brian Stollo ◽  
...  
Keyword(s):  
Psychiatric Care ◽  
Discharge Planning ◽  
Operative Intervention ◽  
Multidisciplinary Teams ◽  
Psychiatric Facility ◽  
Stab Wounds ◽  
Single Center Experience ◽  
Level I ◽  
Stab Injuries ◽  
Outpatient Psychiatric Care

Despite low mortality rates, self-inflicted stab wounds (SISWs) can result in significant morbidity and often reflect underlying substance abuse and mental health disorders. This study aimed to characterize demographics, comorbidities, and outcomes seen in self-inflicted stabbings and compare these metrics to those seen in assault stabbings. A Level I trauma center registry was queried for patients with stab injuries between January 2010 and December 2015. Classification was based on whether injuries were SISWs or the result of assault stab wounds (ASWs). Demographic, injury, and outcome measures were recorded. Differences between genders, ethnicities, individuals with and without psychiatric comorbidities, and SISW and ASW patients were assessed. Within the SIWS cohort, no differences were found when comparing age, gender, or race, including need for operative intervention. However, patients with psychiatric histories were less likely to have a positive toxicology test on arrival than those without psychiatric histories (22% vs. 0%, P = 0.04). When compared with 460 ASW patients, SISW were older (41 vs. 35, P < 0.001), more likely to be white (92% vs. 64%, P < 0.001), more likely to have a psychiatric history (15% vs. 4%, P < 0.001), require operative intervention (65% vs. 50%, P = 0.008), and be discharged to a psychiatric facility (47% vs. 0.2%, P < 0.001). SISW patients have higher rates of psychiatric illness and an increased likelihood to require operative intervention as compared with ASW patients. This population demonstrates an acute need for both inpatient and outpatient psychiatric care with early involvement of multidisciplinary teams for treatment and discharge planning.

Sign in / Sign up

Export Citation Format

Share Document