There’s a renewed focus on physical health for people with mental health conditions. In Yorkshire & Humber, a team were tasked with improving patient safety, outcomes and experiences through training and simulation.

Recognising and Assessing Medical Problems in Psychiatric Settings (RAMPPS) provides opportunities to assess and manage deteriorations in physical health in a safe environment, where learner needs are paramount. It reflects the way situations unfold in real life with Health Care Assistants, Nurses and Psychiatric Trainees working together.

RAMPPS aims to improve effective communication, clinical, safety and collaborative skills.

Scenarios test technical competencies around measurement and interpretation of observations, communication, handover of information and team dynamics.

Scenarios are based upon real-life incidents from psychiatric inpatient wards. Using high-fidelity manikins, part-task trainers, remote simulation technology and standardised patient-actors, we produced simulations akin to real-life.

The RAMPPS course can be run in various ways:

• -Large simulation centres with scenarios running concurrently

• -Smaller simulation centres with live video

• -In-situ with equipment taken to a ward

Confidence in competencies forms the core of paired pre- and post-course questionnaires; delegates act as their own control.

Chi-square analysis of results shows a significant increase in confidence for doctors, nurses and health care assistants in core competency areas including communication, collaboration, clinical skills and organisational aspects of care.

RAMPPS is an effective and new way to incorporate effective simulation training in psychiatry. It can be adapted to the arrangement of the localities whilst retaining its core principles.

Residency is a crucial period in the medical education continuum. Studies have shown the importance of a good developmental relationship (mentoring) as a key factor for professional success in medicine. Israeli organizational culture at academic health centers does not support a formal mentoring program.

This study is part of a research program aimed at improving residency in Israel by understanding the characteristics of Israeli residents.

Identify the personal, academic and organizational qualities perceived by Israeli residents to be most important in a mentor.

Israeli psychiatric residents were asked to complete 2 anonymous questionnaires that assess the relative importance of qualities for a good mentor on a five-point Likert scale: the 34-item Ideal Mentor Scale(IMS) and the 40-item Qualities of a Good Mentor Scale (QGMS).

A total of 63 residents from 13 programs completed the questionnaires. In the IMS most emphasis was on the Integrity subscale representing a mentoring style that embodies respectfulness, empowers to make deliberate, conscious choices, exhibits virtue and principled action and is worthy of emulation as a role model over an academic guide, supervisor, researcher or friend. This tendency was marked in centrally located training programs over peripheral ones. QGMS shows this tendency increase the more years the resident in residency.

The Israeli resident seems to need a nurturing parental mentor, someone to believe in him and see his unique potential over an academic mentor promoting research. This tendency is discussed as a part of the historical change in medical education.

The European Federation of Psychiatric Trainees (EFPT) brings together trainee organisations from across Europe. Founded in 1993, the Federation now has over thirty member nations. The EFPT conducts transnational research, orchestrates an exchange programme, promotes recruitment and helps establish new national trainee organisations.

To deliver a Europe-wide forum for psychiatric trainee organisations to collaborate effectively.

1. 1) Evaluate 2014 Forum

2. 2) Identify ways to improve

The fulcrum of the EFPT's activities is the annual Forum, which brings together representatives of member organisations for five days of work, fun and intercultural learning. In 2014 the Forum took place in London. A local organising committee was established to develop the programme. Funding was obtained from various sources, including the Royal College of Psychiatrists and Maudsley Charity. The programme included site visits, by country reports, working group sessions and finally the Annual General Meeting. A survey was sent to all delegates to evaluate the Forum.

85% of delegates who responded rated the Forum very good or excellent. 70% said that the inspiration to improve training in their own countries was very good or excellent. Free-form responses identified friendly interactions with colleagues from different countries, international networking and the scientific content as highlights. Suggested improvements included writing up country reports and providing a toolkit to prepare potential delegates.

The EFPT provides a mechanism for communication between national trainee organisations. Trainees highly value the opportunity afforded by the annual Forum to network with colleagues in an inspiring atmosphere of mutual collaboration.

The importance of monitoring MetS in people with schizophrenia has been reiterated by consensus panels throughout the world. However, health screening remains limited.

The NB MetS Protocol was developed to address the needs of this population by monitoring metabolic risk factors.

The relationship between MetS, subjective quality of life (QoL) and global functioning were examined. The MetS Protocol enabled us to participate in a group of experts in schizophrenia. This meeting resulted in a Catalan Consensus Statement.

The MetS Protocol was set up by adapting the resources of the community mental health team, without specific additional funding. For our goal, 76 patients with schizophrenia and schizoaffective disorder were interviewed to obtain sociodemographic data, lifestyle habits, psychopathology (PANSS), global functioning (GAF), subjective QoL (EQ-5D) and the anthropometric measures and blood test results. MetS was defined by the NCEP criteria.

The prevalence of MetS was 36.8% and was correlated with higher body mass index (BMI), older age, inactive employment status and better self-care (due to increased awareness of self-image). Patients with MetS who engaged in physical activity reported a subjective perception of better health.

It is well known that there is no specific best model, but national guidance should be adapted to meet local needs. This has implications for treatment planning at the individual and organizational levels in order to improve the subjective QoL of the patients. The future plan is to develop individualized lifestyle programs for high-risk individuals identified with metabolic syndrome.

About half of the patientsundergoing surgery is chronically medicated and a significant percentage of them is treated with psychotropicdrugs. Therefore, it is importantto focus on psychiatricmedication during the perioperative period in order to decrease the risk ofintra- and postoperative complications.

This review aims to develop updated guidelines on perioperative managementof psychotropic drugs in patientsundergoing elective surgery.

Review of literature collected from online medical databases under the issue.

The literature collected revealed mostlynon-systematic reviews, uncontrolledtrials and case reports. Considering factors related to duration/extent of surgical intervention, physical status of the patient receiving the intervention, type of anesthesia/drug interaction and routeof administration of medicines, the authors issuerecommendations on the management ofthe following drugclasses: mood stabilizers; antidepressants;antipsychotics; drugs used in the treatment of anxietydisorders; psychostimulant drugsand drugs used inthe treatment of opioid dependence.

Knowledge of about the management of psychotropic drugs around the surgery is ofgreat importance for psychiatrists working in liaison services as well as forall medical doctors leading with surgical patients, namely surgeons and anesthetists. Following the recommendations yielded by thisreview will allow professionals to take preventive actions andthus decreasing risks regarding psychiatric patientsundergoing surgery.

Clinical decision support systems (CDSS) are computer systems that deal with scientific knowledge and patient data in order to offer clinical guidance. The utility of CDSS in mental health can be viewed in terms of enhancing both the diagnosis and treatment processes.

Our purpose is to design AI-CARE as a CDSS that relies primarily on the evidence-based clinical guidelines and individual patient data, with the aim to elaborate on this information and offer regimen choices to clinicians for better mental health care.

We aim to develop an interactive tool that can be used for effective decision making by psychiatrists and other health professionals. The longitudinal course of Bipolar I Disorder (BDI) is the subject of our implementation.

We developed AI-CARE based on the medical knowledge of the domain expert and clinical guidelines for BDI. The ontology developed describes the domain concepts as well as the time evolution of BDI symptoms. The clinical guidelines are encoded in the form of Rules. Patient data constitutes the input of our system initializing the Ontology on which the developed rules are applied.

The approach of AI-CARE allows individualized diagnosis and treatment decisions as output of the examined case based on the applied rules. AI-CARE provides recommendations about the best therapeutic treatment, notifications and alerts.

We present the AI-CARE as a CDSS for BDI. AI-CARE platform enables clinicians to monitor the subject’s actual state and retrieve recommendations on the best treatment, while providing notifications for critical mood shifts of the patient.

Doctors working in a tertiary psychiatric hospital will have to treat acute medical ailments e.g. hypotension, seizures, in addition to psychiatric conditions. In our setting, doctors on call duty will attend to acute medical conditions for the psychiatric inpatients and decide which cases need a referral out for further treatment at the medical emergency department.

To investigate the sentiments of medical officers working in a tertiary psychiatric hospital with regards to management of acute medical conditions.

An anonymous online survey was sent to 67 medical officers working in a tertiary psychiatric hospital to explore their sentiments with regards to managing acute medical conditions whilst on call duty. 3 of the questions were 'Do you feel confident managing acute medical conditions?”, 'Would you be more inclined to refer a patient out for medical treatment if he/she wasn’t from your own ward.” and 'I feel unsure managing medical conditions of patients not directly under my care.”

39 (58%) medical officers completed the survey. 72% felt confident about managing acute medical conditions. 51% felt unsure managing medical conditions of patients not directly under their care whilst 62% would be more inclined to refer such patients out.

Most medical officers working in our tertiary psychiatry hospital feel confident about managing acute medical conditions. The confidence drops however if the patients were not under their direct care prior to the call duty and they would be more inclined to refer such patients to the medical emergency department for treatment.

Psychiatric patients who have difficulty remembering medication names experience problems communicating with their doctors about medication-related issues. Consequently, doctors often lack confidence in knowing which specific medications their patients are communicating issues about.

To evaluate the use of medication picture charts as visual aids during outpatient clinic consultations in improving the confidence of doctors in knowing which specific medications patients are communicating issues about.

To evaluate the use of visual aids during outpatient clinic consultations in improving the confidence of doctors in knowing which specific medications patients are communicating issues about.

A survey involving 7 doctors running outpatient psychiatric clinics was carried out in 2 phases. In Phase 1, no visual aids were used. In Phase 2, doctors were given a medication picture chart to use at their discretion. Doctors categorised each patient they had seen into 4 levels of approximate confidence (100%, 75%, 50%, <20%) that they knew which specific medication the patient was communicating issues about. A comparison between the proportion of patients falling into each category in the 2 phases was made.

The use of a medication picture chart in outpatient clinic consultations was associated with a 30.45% increase in patients falling into the 100% confidence group.

Using visual aids such as medication picture charts improves the confidence of doctors in knowing which specific medications patients are communicating issues about. Further studies are needed to determine if this translates to increased doctor-patient concordance on medication regimes and improved medication safety.

To optimize the quality of mental healthcare by developing quality assurance tools including clinical practice guidelines and quality indicators.

To describe quality assurance initiatives in German mental healthcare.

Review of quality assurance initiatives and their current status.

In national and regional initiatives, evidence- and consensus-based clinical practice guidelines and quality indicators are being developed. As examples, the cross-sectoral quality indicators of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and the update process of the German clinical practice and disease management guideline on schizophrenia will be described. A discussion of the critical issues in psychiatric quality indicator and guideline development and implementation will be included.

Evidence- and consensus-based approaches are crucial to the development of relevant and valid instruments for quality assurance. One of the main challenges is the implementation of clinical practice guidelines and their evaluation by means of quality indicators as well as the establishment of a common framework of standardized quality indicators that address relevant quality aspects in mental healthcare.

Handover allows the transfer of responsibility for patient care between healthcare professionals. In 2011, The Royal College of Physicians (RCOP) outlined a set of standards for a ‘good handover’. Poor quality handover leads to error and is a preventable cause of patient harm.

The aim of this audit was to analyse the handover process on a 26-bedded general adult inpatient ward, and make recommendations from the findings to improve patient-safety based upon these standards.

During 14 handovers, quantitative information was collected on duration, attendees and content of information, graded against the RCOPs standards.

In 100% of handovers, 1 nurse and 2 doctors were present. Members from other professional bodies attended less often (14-79%). Information duplicated on consecutive days ranged between 27% and 42%. The handover process met 50% of the RCOP’s standards.

Handover process is embedded in the hospital culture and is recognised as a multidisciplinary activity. However, inconsistent attendance did not provide equal opportunity for the transfer of information or result in clear arrangements for ongoing care, which was felt to be a risk to patient safety. A system of fluid and transferable data on documentation should be in place.

It was agreed that a computerised handover-sheet available to all professionals to review and access during the course of the day would be in place. A suitable time to maximise attendance was agreed. Re-audit following these recommendations would form a robust framework to implement these changes across the Unit.

Routine Outcome Monitoring (ROM) is a new phenomenon in the mental healthcare system. Its introduction into daily clinical practice has not been straightforward. This study examines practical examples of the embedding of this innovation and its effective acceptance in clinical practice.

A case history illustrates how ROM was implemented in a large mental health hospital in The Netherlands. During implementation a number of weak points in the implementation process emerged. An intense analysis of the organization of the care process, in the context of care pathways and operations management, offered explanations of what went wrong in this case. Future improvements are suggested from an operations management viewpoint.

For the improved implementation of ROM in the mental healthcare sector implementation must be widely participatory, the process must be continuously monitored, and a leading, well-informed clinician must be appointed as process manager to guide the implementation process.

Feedback is an essential part of Routine Outcome Monitoring. Little is known about the effect of feedback provided to the clinician and patient during treatment. A review of the available literature about feedback given to clinician and patient on treatment outcomes in general psychiatry showed a small, almost negligible effect of the provision of feedback. However, Lambert c.s. found that giving feedback about patient-progress that deviated from the expected outcome in a psychotherapeutic setting was associated with a significant improvement afterwards.

To investigate the effect of feedback on treatment outcomes in a general psychiatric outpatient clinic for mood and anxiety disorders in the Netherlands.

a field study in which more attention was paid to the implementation of feedback than usual. Clinicians were trained in interpreting treatment outcomes and explaining them to their patients. The feedback procedure was then monitored. Three groups of patients were distinguished (1) a group of patients who received obligatory protocolled feedback, (2) a group of patients of whom their clinicians voluntary could view the received feedback and had to fill in GAF and CGI scores concerning te progress of their treatment and (3) a group that received neither feedback nor GAF or CGI scores. All three groups completed relevant outcome measures.

from the 176 patients 26 % received feedback from their clinician. Their progress was measured regularly. Even with extra attention paid to the implementation, it appears that providing feedback to the clinician and patient has little effect on treatment outcomes.

Evidence supports the hypothesis that the patient-psychiatrist relationship is a central feature of psychiatric care. It is also known that patient treatment satisfaction will result in improved adherence; therefore, the aim of this study was to investigate the relationship between patient treatment satisfaction and continuity of psychiatric care.

The objective of this study was to evaluate the extent to which the continuity of psychiatric care is related to patient satisfaction.

This research was conducted as an observational, non-experimental survey of all the patients who attend the NZOZ Centrum Terapii DIALOG in Warsaw, Poland. Patient satisfaction was assessed by using the 10-point subjective scale (1- lowest, 10 – highest level of satisfaction).

A total of 160 patients met the inclusion criteria; 92 of them have visited a psychiatrist less than 5 times, 68 of them visited psychiatrist 5 times or more. The probability of the patient’s recommendation of the psychiatrist as calculated by the NPS method was 72,83% of the patients that have visited psychiatrist less than 5 times and 64,71% of the patients that have visited a psychiatrist 5 times or more. The average level of satisfaction was 9,16 points for the first group, and 8,89 points for the second group.

The results of this study show the adverse correlation between continuity of psychiatric care and patient satisfaction. Further investigation should be made on how to prevent a decline in the level of patient satisfaction during continuous psychiatric care.

Life charting seems to be an increasing trend in psychiatric care, and the essential idea is that patients’ life histories are of primary interest for diagnosis, care and treatment and it can also be a helpful tool in the progress of communication.

Patients with a history of suicide behavior were assessed as well as female patients with experiences of physical, emotional and/or sexual abuse in general psychiatric care, in urban areas in Sweden.

To create and to evaluate the life course of patients seeking general psychiatric care

We used the Hägerstand (1985) Time Geography model, and constructed the life charts together with the patient using a computer program covering both time and geographical aspects. Manifest content analysis was used for analyzing the life charts.

Stressful events as well as social capacities was identified across the life course and provided rich information regarding the lived lives of patients seeking general psychiatric care. The life charts have a therapeutic value due to its focus on both stressful events and capacities. The use of Time Geography life charting can also be a helpful tool in the progress of communication as well as an apparatus for identifying stressful and prosperous life periods.

A profound knowledge of the patients was illustrated and therefor preventive strategy can be formulated.

Constipation is a very common and one of the most persistent side effects of opioids. In many cases constipation causes severe discomfort and puts limitations on methadone maintenance treatment (MMT). Conventional laxatives are not always effective and do not address the pathophysiological basis of constipation. It was suggested that opioid receptor antagonists with low oral bioavailability e.g. naloxone might reverse constipation while not affecting the course of MMT.

The aim of the study is to assess the feasibility and effectiveness of oral naloxone for methadone-induced constipation in MMT patients.

1. 1. To assess the changes in bowel functioning in constipated patients receiving oral naloxone

2. 2. To describe the opioid withdrawal symptoms due to oral naloxone administration

3. 3. To evaluate the changes in quality of life in patients receiving oral naloxone

Randomized placebo-controlled trial (n=20).

Five patients were enrolled into the study. All of them completed the 16-day study protocol. Mild opioid withdrawal symptoms (perspiration) that lasted for several hours were observed once in 3 out of 5 patients and did not affect the MMT. Constipation reversal was achieved in 4 out of 5 patients as well as significant reduction of laxative use. Over the course of the study substantial improvement in quality of life was observed in those patients whose constipation was relieved.

The preliminary results indicate that oral naloxone is a feasible treatment for constipation in MMT patients. Definite conclusions and evaluation of placebo effects will be possible after completion of the study and unblinding.