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Psychiatry requires a unique blend of knowledge, skills and attitudes, with important ethical and philosophical issues intrinsic to the specialty. Although teaching is an important part of training and working as a psychiatrist, this is often carried out without any specific training in educational theory or practice. This book teaches readers how to apply educational theory in this complex setting to provide the best possible learning experience for students. Chapters are short and focused, allowing the busy psychiatrist or other professional involved in undergraduate psychiatry teaching to pick it up, absorb some of the principles, and start applying them straight away to improve their teaching. Contributions from individuals with lived experience throughout the book provide insight into the patient experience and how this can be sensitively and effectively incorporated into undergraduate teaching and the benefits that can be gained from doing so.
The concurrent assessment and treatment of mental health disorders and palliative illnesses is complex. Affective disorders are more prevalent in people who need palliative care. Identifying the most suitable place of care and multi-professional multidisciplinary teams to provide support can be challenging and bewildering for professionals and patients. Mental health clinicians may be left with a sense of therapeutic nihilism, while palliative care teams can feel limited by the mental health resources available for treating those living with significant physical and mental health needs. We discuss the fictional case of a gentleman with metastatic bowel cancer who has developed symptoms of depressive disorder and identify how taking a pragmatic patient-centred approach can offer a route through potential dilemmas when seeking to provide individualised care based on needs. We used lay person experience alongside our own experiences of novel mechanisms for cross-specialty working in order to direct psychiatric trainees’ approaches to such cases.
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.
The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.
The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
Self-harm is a common presentation to acute hospitals, associated with increased risk of completed suicide. Safety plans are increasingly recommended to help patients recognise and prevent escalation of self-harm behaviours.
This project aimed to improve quality and documentation of safety planning for patients admitted at an acute general hospital due to self-harm, who were assessed by Liaison Psychiatry. We aimed to increase the number of patients given written safety plans on discharge by 50%.
The PDSA cycle model of quality improvement was used. A retrospective audit of clinical records was conducted over 3 months to establish baseline documentation of safety planning (n = 51). A template for a self-harm crisis plan, used in other areas of the Trust, was adopted, to be adapted to each patient. A leaflet for sources of crisis support and patient feedback form were developed and distributed to clinicians in the team. Data collection was repeated one month later (n = 48). The second set of interventions involved a training session for clinicians on developing safety plans in collaboration with patients, and a poster highlighting the process to be undertaken when discharging a patient admitted with self-harm.
Following initial interventions, 20% of patients had completed safety plans and 50% received advice, an increase of 20% and 40% respectively. The second PDSA cycle showed increase in numbers to 38% and 67% respectively.
Creating a crisis plan with a hospital-specific leaflet for the Liaison Psychiatry team increased the number of patients discharged with safety plans in place. 86% of patients who participated in safety-planning found the process helpful and felt likely to use the plan in future crises. This is an area of ongoing quality improvement which can be implemented in other hospitals to better equip patients with skills and support to reduce self-harm/suicide attempts.
Harvest weed seed control (HWSC) is a weed management technique that intercepts and destroys weed seeds before they replenish the soil weed seedbank and can be used to control herbicide-resistant weeds in global cropping systems. Wild radish (Raphanus raphanistrum L.) is a problematic, globally distributed weed species that is considered highly susceptible to HWSC, as it retains much of its seed on the plant during grain harvest. However, previous studies have demonstrated that R. raphanistrum is capable of adapting its life cycle, in particular its flowering time, to allow individuals more time to mature and potentially shed seeds before harvest, thereby evading HWSC interception. This study compared the vegetative growth plus physiological and ecological fitness of an early-flowering R. raphanistrum biotype with an unselected genetically related biotype to determine whether physiological costs of early flowering exist when in competition with wheat (Triticum aestivum L.). Early flowering time adaptation in R. raphanistrum did not change the relative growth rate or competitive ability of R. raphanistrum. However, the height of first flower was reduced in the early flowering time–selected population, indicating that this population would retain more pods below the typical harvest cutting height (15 cm) used in HWSC. The presence of wheat competition (160 to 200 plants m−2) increased flowering height in the early flowering time–selected population, which would likely increase the susceptibility of early-flowering R. raphanistrum plants to HWSC. Overall, early-flowering adaption in R. raphanistrum is a possible strategy to escape being captured by the HWSC; however, increasing crop competition is likely to be an effective strategy to maintain the effectiveness of HWSC.