A survey of psychiatrists’ attitudes towards the physical examination

The effectiveness of collaborative teaching in an introductory online radiology session for master of nursing students

AIM

The study aimed to evaluate the effectiveness of the collaborative teaching of a multi- disciplinary team on the introductory online radiology session for the Master of Nursing students.

BACKGROUND

The teaching method for basic radiology reading for the Master of Nursing program was delivered via a 4-hour didactic face-to-face lesson and was ineffective as evidenced by the students' feedback and evaluation. Therefore, a multi-disciplinary team consisting of nursing, medical and radiology staff developed a 4-week online radiology session to enhance knowledge, attitudes and confidence of the Master of Nursing students in interpreting basic chest radiographs, abdominal radiographs and computed tomographic brain scans.

METHODS

A quasi-experimental study design using pre-test and post-test was adopted. The effectiveness of the online radiology session was evaluated on the students' knowledge, attitudes, and confidence. Forty Master of Nursing program students completed the pre-test and post-test questionnaires (response rate 74%) and responded to the open-ended questions in the post-test. IBM-SPSS was used to analyse the quantitative data and quantifying qualitative data technique was used to analyse the qualitative data.

RESULTS

The participants demonstrated an improvement in knowledge and confidence mean scores of the post-test compared to pre-test. There was improved self-rated proficiency in reading and interpreting a film radiograph but no difference in the way they perceived the importance of radiological investigations vis-à-vis the physical examination and routine laboratory testing. Quantifying quantitative data technique showed that majority of participants appreciated the learning process as it could be done at their own pace and the lectures could be replayed again. However, participants hoped for improved interaction with the tutor during learning and the use of real-life cases in the scenarios.

CONCLUSION

Collaborative teaching using an online radiology session shows promise over a traditional didactic method of teaching but requires further refinement in terms of participant interaction and the use of case examples.

Cancer and severe mental illness in low- and middle-income countries: The challenges and outlook for the future

OBJECTIVE

Patients with severe mental illness (SMI) face health inequalities that lead to under treatment of diseases such as cancer and result in increased mortality. There is literature addressing this issue for SMI patients in high-income countries but few for those in low- and middle-income countries. This review aims to draw attention to the health inequalities and the compounding factors faced by SMI patients in low- and middle-income countries. The relevance of integration of psycho-oncology in the care of SMI patients with cancer is integral to reduce disparities and address varied contributory factors.

METHODS

The literature review was conducted by searching through two databases which includes PubMed and Google Scholar. We searched for articles using keyword search terms: severe mental illness, SMI, schizophrenia, bipolar disorder, cancer, low- middle-income countries, low- and middle-income countries, psycho-oncology, HPV vaccine, cancer incidence, cancer mortality, cancer control, cancer screening, cancer treatment and palliative care.

RESULTS

A total of 80 research articles were included in our literature review. We found that there was an increased requirement for adapting to the changing disease landscape in low- and middle-income countries. An improvement on aspects such as vaccination, screening and prevention is necessary, and also efforts to change social stance towards SMI is crucial.

CONCLUSION

There is an increase incidence of cancer in low- and middle-income countries, and the number of patients with SMI in low- and middle-income countries is also rising. This is due to social, psychological, economical and healthcare factors. Low- and middle-income countries must consider improving these aspects in order to adapt to the changing landscape.

Physical Examination Skills Among Chief Residents in Psychiatry: Practices, Attitudes, and Self-Perceived Knowledge

OBJECTIVES

The authors investigated the attitudes, self-perceived competence, and the need for a dedicated curriculum on physical examination skills among chief residents in psychiatry.

METHODS

A voluntary 28-item web-based questionnaire was distributed to psychiatry chief residents in the USA between January 2019 and February 2019.

RESULTS

Of 181 chief residents, 79 (response rate, 44%) completed the online survey. The majority of chief residents want to improve their physical exam skills (64%) and believe that there should be a targeted curriculum aimed at incorporating these skills into everyday psychiatric practice (63%). However, most (57%) chief residents reported that they only conduct physical exams on a few selected patients (< 25% of the time) and almost half (48%) last used a stethoscope a year ago, if not longer. Self-perceived competence and comfort level with neurology-related exam findings was especially low: only 35% could identify discrepant neurological findings and 33% elicit Hoover's sign of leg paresis. A significant majority (86%) believed that performing a physical exam would not interfere with the therapeutic relationship.

CONCLUSIONS

Although chief residents in psychiatry believe that developing competence in physical examinations is important to their education, the current educational landscape does not support the development of these skills. Future educational strategies should focus on addressing this need.

Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people

BACKGROUND

Since people with mental illness are more likely to die from cancer, we assessed whether people with mental illness undergo less cancer screening compared with the general population.

METHODS

In this systematic review and meta-analysis, we searched PubMed and PsycINFO, without a language restriction, and hand-searched the reference lists of included studies and previous reviews for observational studies from database inception until May 5, 2019. We included all published studies focusing on any type of cancer screening in patients with mental illness; and studies that reported prevalence of cancer screening in patients, or comparative measures between patients and the general population. The primary outcome was odds ratio (OR) of cancer screening in people with mental illness versus the general population. The Newcastle-Ottawa Scale was used to assess study quality and I² to assess study heterogeneity. This study is registered with PROSPERO, CRD42018114781.

FINDINGS

47 publications provided data from 46 samples including 4 717 839 individuals (501 559 patients with mental illness, and 4 216 280 controls), of whom 69·85% were women, for screening for breast cancer (k=35; 296 699 individuals with mental illness, 1 023 288 in the general population), cervical cancer (k=29; 295 688 with mental illness, 3 540 408 in general population), colorectal cancer (k=12; 153 283 with mental illness, 2 228 966 in general population), lung and gastric cancer (both k=1; 420 with mental illness, none in general population), ovarian cancer (k=1; 37 with mental illness, none in general population), and prostate cancer (k=6; 52 803 with mental illness, 2 038 916 in general population). Median quality of the included studies was high at 7 (IQR 6-8). Screening was significantly less frequent in people with any mental disease compared with the general population for any cancer (k=37; OR 0·76 [95% CI 0·72-0·79]; I²=98·53% with publication bias of Egger's p value=0·025), breast cancer (k=27; 0·65 [0·60-0·71]; I²=97·58% and no publication bias), cervical cancer (k=23; 0·89 [0·84-0·95]; I²=98·47% and no publication bias), and prostate cancer (k=4; 0·78 [0·70-0·86]; I²=79·68% and no publication bias), but not for colorectal cancer (k=8; 1·02 [0·90-1·15]; I²=97·84% and no publication bias).

INTERPRETATION

Despite the increased mortality from cancer in people with mental illness, this population receives less cancer screening compared with that of the general population. Specific approaches should be developed to assist people with mental illness to undergo appropriate cancer screening, especially women with schizophrenia.

FUNDING

None.

Monitoring and Treating Metabolic Abnormalities in Patients with Early Psychosis Initiated on Antipsychotic Medications

Antipsychotic medications carry an established lifetime risk of metabolic syndrome. This retrospective chart review evaluated feasibility of a metabolic monitoring clinical decision support tool (CDST) for weight, lipid, blood glucose, and blood pressure management of 163 clients in an early psychosis outpatient clinic over 2 years. Each parameter had at least 98 (60.1%) clients with a recorded value, the most being documented for weight with 112 (68.7%) clients. CDST adherence ranged from at least 54.3-100% for non-pharmacologic interventions (e.g. clinic counseling, referral to health program or primary care) and at least 33.3-100% for pharmacologic interventions (e.g. metformin). Though no baseline cardiometabolic abnormalities were identified, dyslipidemia and obesity were later found in 37 (22.7%) and 35 (21.5%) clients, respectively. Only 14 (8.6%) clients were prescribed medications for cardiometabolic abnormalities by psychiatrists in the clinic. Increasing focus on physical health is needed to better this population's long-term prognosis.