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This study assesses newly qualified doctors’ confidence in practising clinical skills related to the assessment and management of mental health conditions and how this correlates with other areas of medicine. We conducted a national survey of 1311 Foundation Year 1 doctors in the UK. Survey items assessed confidence recognising mentally unwell patients, conducting a mental state examination, assessing cognition and mental capacity, formulating a psychiatric diagnosis and prescribing psychotropic medications.
A substantial proportion of surveyed doctors lacked confidence in their clinical skills related to mental health and prescribing psychotropic medications. Network analysis revealed that items corresponding to mental health were highly correlated, suggesting a potential generalised lack of confidence in mental healthcare.
We identify areas of lack of confidence in some newly qualified doctors’ ability to assess and manage mental health conditions. Future research might explore how greater exposure to psychiatry, integrated teaching and clinical simulation might better support medical students for future clinical work.
This paper uses the Current Population Survey to study older workers' transitions out of employment and into retirement during the first year of the pandemic. We find that, among workers ages 55 to 79, the likelihood of leaving employment over the course of a year rose by 6.7 percentage points, a 43-percent increase over baseline. Workers without a college degree, Asian–Americans, those whose jobs were not amenable to social distancing, and part-time workers saw disproportionate impacts. In contrast, the likelihood of retiring increased by 1 percentage point, and there was no immediate retirement boom for full-time workers under 70.
The impact of Indigenous populations on historical fire regimes has been controversial and beset by mismatches in the geographic scale of paleofire reconstructions and the scale of land-use behaviors. It is often assumed that anthropogenic burning is linearly related to population density and not different cultural practices. Here we take an off-site geoarchaeology strategy to reconstruct variability in historical fire regimes (<1000 years ago) at geographic scales that match the archaeological, ethnohistorical, and oral tradition evidence for variability in the intensity of Indigenous land use by two different cultural groups (Ancestral Pueblo and Western Apache). We use multiple, independent proxies from three localities in ponderosa pine (Pinus ponderosa) forests in east-Central Arizona to reconstruct fire regime variability during four phases of cultural use of different intensities. Elevated charcoal with domesticate pollen (Zea spp.) but otherwise unchanged forest pollen assemblages characterized intensive land use by Ancestral Pueblo people during an early phase, suggesting fire use to support agricultural activities. By contrast, a phase of intensive pre-reservation Western Apache land use corresponded to little change in charcoal, but had elevated ash-derived phosphorus and elevated grass and ruderal pollen suggestive of enhanced burning in fine fuels to promote economically important wild plants.
To evaluate the provision of recommended medical equipment on forensic psychiatric inpatient wards in Mersey Care's secure division, as outlined by the Care Quality Commission (CQC) in their 2019 guidance “Brief Guide: Physical Healthcare In Mental Health Settings”. It has been documented that people with severe and enduring mental illness are at risk of dying on average 15 to 20 years earlier than people without, two thirds of which are due to avoidable physical illnesses. It was our aim to use these data to improve the provision of physical healthcare equipment on the wards of Mersey Care's secure division, in turn allowing for the safe assessment of patients in the acute setting, and the monitoring their chronic health conditions.
We conducted a closed loop, two cycle audit of all forensic inpatient wards in Mersey Care's secure division measuring the provision of physical health equipment against the CQC's 2019 guidance. The intervention was to present our findings and implement physical health equipment boxes in the clinic rooms on the wards. Low, medium, high, and secure learning disability (LD) wards were audited, with a control sample of non-secure wards (addiction, old age, general adult, and LD non-secure) in the initial cycle for comparison.
On initial audit, the mean availability of equipment across the secure division was 66% (range 50.9%-88.9%), and 75% across our sample of wards in the non-secure divisions (range 61.1%-88.9%). Following the intervention in the secure units, the mean availability increased to 73.5% (range 72.2%-77.8%). The mean percentage increase in equipment availability following intervention was 12.5% (range -12.5% to 41.8%).
Following the intervention, the re-audit conducted found an overall improvement with 73.5% of recommended equipment available. Despite this improvement in equipment availability in the secure unit wards, the equipment is still less available than on the non-secure control wards. Due to this, further intervention and another re-audit have been planned. In the second cycle, significant items such as disposable gloves, pulse oximeters, sphygmomanometers, thermometers and stethoscopes were available across all wards. This was an improvement from the initial audit and allows for the safe assessment of patients in the acute setting.
Previous research suggests the prevalence of mental health conditions among medical inpatients may be as high as 38%. Anecdotally, junior doctors report lacking the confidence, knowledge and skills to assess and treat patients with psychiatric conditions. Identifying this unmet need offers potential to improve standards of care and achieve parity of esteem between psychiatric and medical conditions within the general hospital. Aims:
To assess self-reported preparedness of newly-qualified Foundation Doctors to care for patients with acute or chronic psychiatric symptoms in comparison to physical health conditions.
In September of each year (2017, 2018, 2019), a survey was cascaded to all incoming Foundation Year 1 Doctors. For each respective year there were 1673, 961 & 1301 respondents. Respondents were asked to rate their agreement with statements on a Likert scale. Statements pertaining to mental health included “a) I am competent in acute mental health care provision, b) I am competent in chronic mental health care provision” and “I feel confident in prescribing the following drugs; c) drugs for mental health problems”. Comparison statements assessed confidence caring for medically unwell patients, performing practical procedures and prescribing drugs for physical health conditions.
Preparedness for acute and chronic mental health were lower than both physical health comparison items; preparedness to care for patients with critical illness (acute: r = 0.794, p < 0.001, chronic: r = 0.556, p < 0.001) and preparedness to perform practical procedures (acute: r = 0.724, p < 0.001, chronic: r = 0.433, p < 0.001).
Confidence prescribing mental health drugs was lower than all other comparison items (simple analgesia: r = 0.854, bronchodilators: r = 0.789, antimicrobials: r = 0.772, inhaled steroids: r = 0.720, intravenous fluids: r = 0.702, oral anti-diabetics: r = 0.611, anticoagulants: r = 0.515, narcotics: r = 0.514, insulin: r = 0.206; p < 0.001)
These results identify a disparity in foundation doctors’ self-reported preparedness to treat acute and chronic mental health conditions and prescribe psychotropic medications, compared to a variety of physical health domains. To our knowledge this is the first large-scale study to empirically test a potential discrepancy between newly-qualified doctors’ preparedness to treat patients’ mental and physical health needs. Medical school education and foundation training may therefore present a fruitful opportunity to improve care for patients with psychiatric conditions within general hospital settings.
Patients often have very different ideas from clinicians about what they want treatments to achieve. Their views on what outcomes are important are not always reflected in trials.
To elicit the views of people who self-harm on the most commonly used outcome measures and to identify the outcomes that matter to them.
We conducted in-depth interviews with 18 people with histories of self-harm, recruited from hospital and community settings. We conducted thematic analysis using a framework approach and used visual mapping to arrive at our final analysis and interpretation.
Participants' accounts contained a number of challenges to the validity and meaningfulness of current trial outcome measures. Five broad issues emerged: (a) relationship between frequency and severity of self-harm; (b) behavioural substitution; (b) self-management skills; (d) the role of self-harm as survival tool and affect regulator, and (e) strategic self-presentation. We show how these affect the visibility and measurability of commonly used outcomes. The outcomes that mattered to participants focused on positive achievements in three domains: (a) general functioning and activities of everyday living; (b) social participation, and (c) engagement with services. Participants conceptualised these as both measures and means of sustained improvement.
Our findings suggest that current self-harm trial science rests on flawed assumptions about the relationship between mental states and behaviours and about our ability to measure both. Greater understanding of the outcomes that matter to people who self-harm is needed to inform both intervention development and trial design.
Bears are iconic animals; they are totemic of the non-human world, symbols of multiple human-cultural manifestations of nature. In human culture, bears have played a number of roles; gods, monsters, kings, fools, brothers, lovers, dancers, medicine, food and pest. They are seen as protectors of the forest; symbols of masculinity; the strength of a fighter, football team or army; a comfort for our children; political bargaining chips; an economic indicator; the first casualty/poster boy of global warming; symbols for conservation; worthy adversaries for a hunter's rifle; prize photography subjects for nature tourists or the last bastion of wilderness. Bears offer a unique insight into a multiplicity of paradigms that explore human-non-human animal relationships. Bear totems reinforce and maintain our connection to the natural world.
Bears and humans have shared a similar geographic journey; as we colonised the world from Africa, bears did so from Europe (albeit a few thousand years earlier), with the brown bear being found most frequently where our species also found hospitable conditions. The ecology of (early) Homo sapiens and Ursus arctos (brown bear) are matched closely: dietary requirements, habitat choice and environmental tolerances. There are many stories that permeate from the past describing our ancestral eaves-dropping on bear foods (and medicines). There are stories of cultures that gathered berries in the same fields as bears and fished on the same rivers: a time when bears and people respected one another's personal space. This is true of some cultures to the present day.
Myths, legends and folklore have informed generations of our and bears’ place in the world. Oral histories passed through generations and through ever-changing norms of communication. From imagined fireside tales to blue-chip documentaries in the 21st century, bears have always been good for us to reflect upon; to ponder our lives in relation to their world, to define our own world, one seemingly at odds to the lives of the other. Bears interweave with many of our cultures.
Cave paintings, sculptures, stories of half-men and monsters, how we perceive bear species can have a huge impact on their survival. Our attitudes towards animals, people and places will shape the face of our planet, our climate and our survival.