BJPsych Bulletin最新文献

Medical Royal Colleges publish obituaries to record and celebrate the lives of colleagues after their deaths. Who is included in this roll of honour, the preferred literary style, and the organisation of the commissioning and publishing all vary between colleges. Since obituaries have fashions, shaped by culture and practical considerations, it is worthwhile, from time to time, for institutions to review the approaches they take. This paper draws on practices past and present, including those of national newspapers and Royal Colleges, to stimulate further discussion on the subject.

Aims and method: Involvement in clinical mental health research can be a challenge for services isolated from academic institutions, limiting opportunities for patients to receive innovative interventions and for clinicians to explore interest in research. We aimed to increase mental health research capacity in Somerset NHS Foundation Trust via a range of initiatives from collaboration between a senior clinician and research and development colleagues.

Results: Over the course of the project, the number of participants recruited to National Institute for Health and Care Research-adopted mental health and dementia research projects quadrupled over a 2-year period, from 57 to 232, and the number of projects hosted rose from 9 to 23. A total of 165 clinicians signed up to receive information about ongoing studies.

Clinical implications: We found considerable appetite for becoming involved in research among mental health clinicians, and were able to provide opportunities for research experience as well as access to innovative studies for local patients.

Aims and method: A collaborative evaluation of remote consultations in mental health services was undertaken by mental health service providers, experts by experience, academic institutions and a Health Innovation Network in south London, UK. 'Learning healthcare systems' thinking was applied. Workstream 1 reviewed international published evidence; workstream 2 synthesised findings from three health provider surveys of the perceptions and experiences of staff, patients and carers; and workstream 3 comprised an electronic survey on local projects.

Results: Remote consultations can be acceptable to patients and staff. They improve access for some while restricting access for others, with digital exclusion being a key concern. Providing tailored choice is key.

Clinical implications: The collaboration generated learning to inform choices by healthcare providers to embed or adapt remote delivery. A key output was freely downloadable survey questions for assessing the quantity and quality of appointments undertaken by phone or video or face to face.

Modern management has much to learn from ancient wisdoms. Management structures based on corporate trends were transferred from business to services such as healthcare to promote cost-efficiency and productivity. In this article, I argue that the short-term approach of corporate leaders being brought into healthcare for 'transformation' has led to a trail of service dismemberment with no discernible clinical gain for those we seek to serve. Bhagwad Gita, the ancient Hindu scripture on right conduct, is an exemplar of how the primary aim of leaders should be to provide better service rather than serve personal interests or those of the 'business' of healthcare.

Aims and method: Artificial intelligence ambient voice technology (AI AVT), which uses a large language model to summarise clinical dialogue into electronic notes and GP letters, has emerged. We conducted a mixed-methods, pre-post (manual versus AVT-assisted documentation) service development pilot to evaluate its use in a child and adolescent out-patient clinic.

Results: The median administration time per clinical encounter reduced from 27 min (manual) to 10 min (AVT) (P < 0.001). On average, AVT-assisted documentation required only 45% of the time for manual documentation (P < 0.001). Clinician-rated accuracy, quality and efficiency were significantly higher for AVT-assisted documentation. Patient acceptance was high, with 97% reporting that clinicians were not distracted by note-taking. Thematic analysis from focus groups identified positive effects derived from AVT (improved productivity and clinician well-being), but was balanced by barriers (technological limitations).

Clinical implications: Integration of AVT into clinical workflows can significantly alleviate documentation burden, reduce cognitive strain and free up clinical capacity.

Aims and method: There is a pressing need for standardised and comprehensive research frameworks to evaluate both the therapeutic benefits and risks of dependency and misuse associated with medical cannabis. We address the issue of abuse potential or misuse liability by examining research data and what amounts to existing clinical dogma for validity and generalisability. We undertook a broad scoping approach to exploring recent literature, focusing on clinical studies that investigated abuse/misuse and dependence among users of medical and/or recreational cannabis and cannabinoids. The search provided over 350 articles, mostly (∼90%) dated post 2002. Abstract analysis narrowed the selection to under 50 papers, according to their relevance as judged by the authors, an experienced clinician and a public health toxicologist.

Results: We identified and commented upon some broad assumptions within the abuse liability literature that included (a) a standard cannabis formulation; (b) standard routes of administration and standard potency dosing; (c) a standard pattern of use; (d) a standard user or patient; and (e) a standard vulnerability to misuse or dependence.

Clinical implications: Unpacking and questioning these assumptions leads to the conclusion that far more rigorous language and research design are needed to address the question of cannabis abuse definitively but, based on the best available evidence, it appears that the abuse liability of medically supervised cannabis is comparable to any other class of widely used and well-regulated pharmaceutical agents.

Welfare assessments can harm the mental health of neurodivergent individuals and people with intellectual disabilities, yet this remains under-recognised in clinical practice. This article integrates three perspectives: media reporting on private profit in UK disability assessments; a clinical case of an autistic man whose deterioration was triggered by Personal Independence Payment and Universal Credit reassessment; and research on the experiences of people with learning disabilities. Common themes include fear, shame, loss of agency and reactivated trauma. Psychiatrists should view welfare systems as determinants of mental health, adopt trauma-informed, neurodiversity-aware approaches and support patients through advocacy and interdisciplinary collaboration.