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BackgroundDelirium is a complex condition, distressing for patients, family members and staff, and associated with poor outcomes. Despite high prevalence in the palliative care setting, it remains under-diagnosed. Delirium guideline-adherent care may both prevent and alleviate delirium. The best way to improve delirium-guideline adherence, and whether better adherence is reflected in reduced delirium, is not known. Prompt dissemination of feasibility findings is critical to avoid research waste.MethodsTo inform a definitive large study, working closely with Patient Public Involvement members, we conducted a co-design and feasibility study (ISRCTN55416525) to assess the feasibility of collecting data (delirium diagnosis;guideline-adherence) from clinical records. Clinical record data (evidence of: delirium using a validated chart-based instrument;guideline-adherent delirium care) was collected from 50 consecutive in-patient admissions at three hospices pre- and post-implementation of a co-designed implementation strategy (data collection completed 3 December 2022). Analysis: Pre-post comparison of percentages for continuous data (delirium outcomes);nominal data (raw count of guideline-adherent metrics).ResultsTarget clinical record data collection (n=300) was achieved within timeframe, despite data collection during COVID-19. Delirium prevalence was comparable pre-and post-implementation with two-thirds of patients having a delirium episode during admission. There was a reduction in the proportion of delirium-days during admission 62% to 49%. We observed modest post-implementation improvements in most guideline-adherent metrics: delirium diagnosis as documented by the clinical team 15% to 26%;evidence of reversibility 33% to 36%;delirium risk assessment 0% to 12.5%;screening on admission 21% to 35%.ConclusionData collection about delirium outcomes and guideline-adherence from hospice clinical records is feasible. Our findings show the disparity between need (high delirium-incidence) and documented action (low guideline-adherence). However, there is a signal of patient benefit even with small documented improvements which needs to be formally evaluated in a multi-site study of effectiveness of an implementation strategy for improving delirium guideline-adherence.
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SUMMARY: Poor research integrity is increasingly recognised as a serious problem in science. We outline some evidence for this claim and introduce the Royal College of Psychiatrists (RCPsych) journals' Research Integrity Group, which has been created to address this problem.
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Biomedical Research , Ethics, Research , HumansABSTRACT
BACKGROUND: People with severe mental illnesses (SMIs) are likely to face disproportionate challenges during a pandemic. They may not receive or be able to respond to public health messages to prevent infection or to limit its spread. Additionally, they may be more severely affected, particularly in low- and middle-income countries. METHODS: We conducted a telephone survey (May-June 2020) in a sample of 1,299 people with SMI who had attended national mental health institutes in Bangladesh and Pakistan before the pandemic. We collected information on top worries, socioeconomic impact of the pandemic, knowledge of COVID-19 (symptoms, prevention), and prevention-related practices (social distancing, hygiene). We explored the predictive value of socio-demographic and health-related variables for relative levels of COVID-19 knowledge and practice using regularized logistic regression models. FINDINGS: Mass media were the major source of information about COVID-19. Finances, employment, and physical health were the most frequently mentioned concerns. Overall, participants reported good knowledge and following advice. In Bangladesh, being female and higher levels of health-related quality of life (HRQoL) predicted poor and better knowledge, respectively, while in Pakistan being female predicted better knowledge. Receiving information from television predicted better knowledge in both countries. In Bangladesh, being female, accessing information from multiple media sources, and better HRQoL predicted better practice. In Pakistan, poorer knowledge of COVID-19 prevention measures predicted poorer practice. CONCLUSION: Our paper adds to the literature on people living with SMIs and their knowledge and practices relevant to COVID-19 prevention. Our results emphasize the importance of access to mass and social media for the dissemination of advice and that the likely gendered uptake of both knowledge and practice requires further attention.
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OBJECTIVES: To explore clinically important increases in depression/anxiety from before to during the first UK COVID-19 lockdown and factors related to this change, with a particular focus on ethnic differences. DESIGN: Pre-COVID-19 and lockdown surveys nested within two longitudinal Born in Bradford cohort studies. PARTICIPANTS: 1860 mothers with a child aged 0-5 or 9-13, 48% Pakistani heritage. MAIN OUTCOME MEASURES: ORs for a clinically important increase (5 points or more) in depression (eight item Patient Health Questionnaire (PHQ-8)) and anxiety (Generalised Anxiety Disorder Assessment (GAD-7)) in unadjusted regression analyses, repeated with exposures of interest separated by ethnicity to look for differences in magnitude of associations, and lived experience of mothers captured in open text questions. RESULTS: The number of women reporting clinically important depression/anxiety increased from 11% to 20% (95% CI 10%-13%; 18%-22%) and from 10% to 16% (95% CI 8%-11%; 15%-18%), respectively. Increases in depression/anxiety were associated with loneliness (OR=8.37, 95% CI 5.70 to 12.27; 8.50, 95% CI 5.71 to 12.65, respectively); financial (6.23, 95% CI 3.96 to 9.80; 6.03, 95% CI 3.82 to 9.51), food (3.33, 95% CI 2.09 to 5.28; 3.46, 95% CI 2.15 to 5.58) and housing insecurity (3.29, 95% CI 2.36 to 4.58; 3.0, 95% CI 2.11 to 4.25); a lack of physical activity (3.13, 95% CI 2.15 to 4.56; 2.55, 95% CI 1.72 to 3.78); and a poor partner relationship (3.6, 95% CI 2.44 to 5.43; 5.1, 95% CI 3.37 to 7.62). The magnitude of associations between key exposures and worsening mental health varied between ethnic groups.Responses to open text questions illustrated a complex interplay of challenges contributing to mental ill health including: acute health anxieties; the mental load of managing multiple responsibilities; loss of social support and coping strategies; pressures of financial and employment insecurity; and being unable to switch off from the pandemic. CONCLUSIONS: Mental ill health has worsened for many during the COVID-19 lockdown, particularly in those who are lonely and economically insecure. The magnitude of associations between key exposures and worsening mental health varied between ethnic groups. Mental health problems may have longer term consequences for public health and interventions that address the potential causes are needed.