scholarly journals Pilot study of the use of handheld 6-lead ECG for patients on acute general adult mental health wards who refuse traditional 12-lead ECG

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S11-S11
Author(s):  
Paul M Briley ◽  
Sudheer Lankappa
Keyword(s):  
Mental Health ◽  
Qt Interval ◽  
Cardiac Rhythm ◽  
Full Range ◽  
Standard Operating Procedure ◽  
Junior Doctors ◽  
Feedback Form ◽  
Less Invasive ◽  
Adult Mental Health ◽  
Electrode Contact

AimsTo assess patient and clinician acceptability of handheld 6-lead ECG, for obtaining information about cardiac rhythm and electrical intervals, in acute general adult mental health ward inpatients who refuse traditional 12-lead ECG.BackgroundIn a previous audit of patients admitted to four acute general adult mental health wards, we found that 1 in 4 patients refused 12-lead ECG for at least two weeks, with 1 in 6 refusing throughout their entire stay. ECG refusers were significantly more likely to have a psychotic illness than non-refusers and were thus more likely to benefit from medications that carry a risk of prolonging the QT interval. Less invasive, handheld, 6-lead ECG, which includes measurement of lead II (the lead used to define traditional QT-interval cut-off values) is available on the NHS supply chain. Whilst not providing the full range of information that 12-lead ECG is able to provide, handheld 6-lead ECG might be an acceptable alternative in patients who would otherwise never have any form of ECG performed.MethodWe developed a Standard Operating Procedure for use of handheld 6-lead ECG and provided training for junior doctors on the four wards that were the subject of our original audit. These doctors were then able to offer the device to patients on their wards who refused 12-lead ECG. Doctors completed a short feedback form each time a handheld ECG was offered.ResultSo far, handheld 6-lead ECGs have been offered to 17 patients who refused 12-lead ECGs. Mean age (± SD) was 36.1 (± 12.6) years, and 4 of these patients were female. 13 patients (76%) accepted a handheld ECG. One of these attempts failed due to patient agitation. Attempts took a mean of 7 (± 5.4) minutes. 54% of recordings were described as “very easy” by clinicians, whereas 15%, 23% and 8% were described as “somewhat easy”, “intermediate”, and “somewhat difficult”, respectively. Clinician difficulties focussed on patient movement with impact on electrode contact and trace quality. Where answered (N = 10), 90% of patients stated they would recommend a handheld ECG to others. Patients liked the speed of the process, that it felt “less scary”, and that it was less invasive and did not involve removing clothing.ConclusionOur initial findings from this pilot suggest that handheld 6-lead ECG may be acceptable, both to clinicians and patients, as a means of obtaining information on cardiac rhythm and electrical intervals for patients who refuse 12-lead ECGs.

What Outcomes to Measure in Routine Mental Health Services, and How to Assess Them: A Systematic Review

2002 ◽  
Vol 36 (6) ◽  
pp. 743-753 ◽  
Author(s):  
Mike Slade
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Mental Health Services ◽  
Health Services ◽  
Outcome Assessment ◽  
Full Range ◽  
Step Method ◽  
Adult Mental Health ◽  
Patient Level ◽  
Routine Outcome Assessment

Objective: Routine outcome assessment in adult mental health services involves the ongoing assessment of patient-level outcomes. Use of outcomes to inform treatment is widely recommended, but seldom implemented. The goals of this review were (i) to identify principles that have been proposed for implementing routine outcome assessment, (ii) to identify the full range of outcome domains that have been proposed for assessment, and (iii) to synthesize proposals for specific outcome domains into emergent categories. Method: A systematic review of published and unpublished research was undertaken, using electronic databases, research registers, conference proceedings, expert informants and the World Wide Web. For goal (i) studies were included that proposed principles for implementing routine outcome assessment. For goal (ii) studies were included that identified at least two patient-level outcome domains for patients using adult mental health services and made some reference to a broader literature base. Results: Six thousand four hundred publications matched initial search criteria. Seven distinct sets of principles for choosing patient-level outcomes were located, which showed a fair degree of consensus. Sixteen outcome domain proposals were identified, which were synthesized into seven emergent categories: wellbeing, cognition/emotion, behaviour, physical health, interpersonal, society and services. Conclusions: The findings from this review were used to develop a four-step method for adult mental health services wishing to implement routine outcome assessment.

Development of the Shift Smartphone App to Support the Emotional Wellbeing of Junior Doctors: Design of a Prototype and Results of Usability and Acceptability Testing (Preprint)

2020 ◽  
Author(s):  
Isabelle Counson ◽  
Alexandra Bartholomew ◽  
Joanna Crawford ◽  
Katherine Petrie ◽  
Geetanjali Basarkod ◽  
...  
Keyword(s):  
Mental Health ◽  
User Experience ◽  
Help Seeking ◽  
Pilot Trial ◽  
User Involvement ◽  
Health Behaviours ◽  
Junior Doctors ◽  
User Centered Design ◽  
Emotional Wellbeing ◽  
Prototype Development

BACKGROUND Junior doctors report higher levels of psychological distress than more senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health applications (mHealth apps) may be utilised to help overcome these barriers to assist the emotional wellbeing of this population and encourage help-seeking. OBJECTIVE We describe the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior doctors to seek information about, and help for, wellbeing and mental health concerns that is sensitive to workplace settings. METHODS A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior doctors, using principles of user-centered design. These four phases were: I) Needs assessment, based on interviews with 12 junior doctors; II) Prototype development with user experience feedback from two junior doctors; III) Evaluation, consisting of a pilot trial with 22 junior doctors to assess usability and acceptability of the initial prototype; and IV) Redesign, including user experience workshops with 51 junior doctors. RESULTS Qualitative results informed the content and design of Shift to ensure the app was tailored to junior doctors’ needs. The Shift app prototype contained cognitive-behavioural, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function visualising patterns of daily variations in mood and health behaviours. Pilot testing revealed possible issues with the organisation of the app content, which were addressed in a thorough restructuring and redesign of Shift with the help of junior doctors across three user experience workshops. CONCLUSIONS The current research demonstrates the importance of ongoing end-user involvement in the creation of a specialised mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are first steps in addressing the mental health and support-seeking needs of junior doctors, although further research is required to validate its effectiveness and appropriateness on a larger scale.

scholarly journals Medical Studies during the COVID-19 Pandemic: The Impact of Digital Learning on Medical Students’ Burnout and Mental Health

2021 ◽  
Vol 18 (1) ◽  
pp. 349
Author(s):  
Panagiotis Zis ◽  
Artemios Artemiadis ◽  
Panagiotis Bargiotas ◽  
Antonios Nteveros ◽  
Georgios M. Hadjigeorgiou
Keyword(s):  
Mental Health ◽  
Medical Students ◽  
Emotional Exhaustion ◽  
Short Form ◽  
Maslach Burnout Inventory ◽  
Junior Doctors ◽  
Digital Learning ◽  
Student Survey ◽  
Medical Studies ◽  
The Impact

Objectives: The aim of this ecological study was to investigate what the impact of digital learning due to the COVID-19 pandemic was on the burnout and overall mental health (MH) of medical students. Background: During the unprecedented era of the COVID-19 pandemic, the majority of countries worldwide adopted very strong measures. Universities closed their doors, and education continued through digital learning lectures. Methods: An anonymous questionnaire was administered to all 189 eligible candidates before and during the COVID-19 pandemic. Mental health was assessed via the MH domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory—Student Survey (MBI-SS). Results: The overall response rate was 81.5%. The overall burnout prevalence did not differ significantly between the two periods (pre-COVID-19 18.1% vs. COVID-19 18.2%). However, the burnout prevalence dropped significantly in year 4 (pre-COVID-19 40.7% vs. COVID-19 16.7%, p = 0.011), whereas it increased significantly in year 6 (pre-COVID-19 27.6% vs. COVID-19 50%, p = 0.01). When looking at each MBI-SS dimension separately, we found that emotional exhaustion decreased significantly in year 4 but increased in year 6, and cynicism increased in all years. The overall MH deteriorated significantly between the two periods (pre-COVID-19 58.8 ± 21.6 vs. COVID-19 48.3 ± 23, p < 0.001). Conclusions: Digital learning in medical studies carries significant risks. Not only does the MH deteriorate, but cynicism levels also increase. Emotional exhaustion was found to increase particularly in final year students, who struggle with the lack of clinical experience just before they start working as qualified junior doctors.

scholarly journals Leviathans reprised: Adult Mental Health Centres

2021 ◽  
Vol 55 (2) ◽  
pp. 132-134
Author(s):  
Jeffrey CL Looi ◽  
Stephen R Kisely ◽  
Stephen Allison ◽  
Tarun Bastiampillai ◽  
William Pring
Keyword(s):  
Mental Health ◽  
Adult Mental Health ◽  
Health Centres
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