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Aims and method To investigate whether a psychiatry-specific virtual on-call training programme improved confidence of junior trainees in key areas of psychiatry practice. The programme comprised one 90 min lecture and a 2 h simulated on-call shift where participants were bleeped to complete a series of common on-call tasks, delivered via Microsoft Teams. Results Thirty-eight trainees attended the lecture, with a significant improvement in confidence in performing seclusion reviews (P = 0.001), prescribing psychiatric medications for acute presentations (P < 0.001), working in section 136 suites (places of safety) (P = 0.001) and feeling prepared for psychiatric on-call shifts (P = 0.002). Respondents reported that a virtual on-call practical session would be useful for their training (median score of 7, interquartile range 5–7.75). Eighteen participants completed the virtual on-call session, with significant improvement in 9 out of the 10 tested domains (P < 0.001). Clinical implications The programme can be conducted virtually, with low resource requirements. We believe it can improve trainee well-being, patient safety, the delivery of training and induction of rotating junior doctors during the COVID-19 pandemic and it supports the development and delivery of practical training in psychiatry.

Aims and method To investigate whether a psychiatry-specific virtual on-call training programme improved confidence of junior trainees in key areas of psychiatry practice. The programme comprised one 90 min lecture and a 2 h simulated on-call shift where participants were bleeped to complete a series of common on-call tasks, delivered via Microsoft Teams. Results Thirty-eight trainees attended the lecture, with a significant improvement in confidence in performing seclusion reviews (P =0.001), prescribing psychiatric medications for acute presentations (P <0.001), working in section 136 suites (places of safety) (P = 0.001) and feeling prepared for psychiatric on-call shifts (P = 0.002). Respondents reported that a virtual on-call practical session would be useful for their training (median score of 7, interquartile range 5-7.75). Eighteen participants completed the virtual on-call session, with significant improvement in 9 out of the 10 tested domains (P<0.001). Clinical implications The programme can be conducted virtually, with low resource requirements. We believe it can improve trainee well-being, patient safety, the delivery of training and induction of rotating junior doctors during the COVID-19 pandemic and it supports the development and delivery of practical training in psychiatry. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has affected how clinical examinations are conducted, resulting in the Royal College of Psychiatrists delivering the Clinical Assessment of Skills and Competence virtually. Although this pragmatic step has allowed for progression of training, it has come at the cost of a significantly altered examination experience. This article aims to explore the fairness of such an examination, the difference in trainee experience, and the use of telemedicine to consider what might be lost as well as gained at a time when medical education and delivery of healthcare are moving toward the digitised frontier.

Aims and method This review aims to clarify the evidence on the effectiveness of telepsychiatry following the COVID-19 pandemic. We conducted a literature review of three databases (Cochrane Library, PubMed and PsycINFO), using the terms virtual consultation/telepsychiatry/video consultation AND psychiatry/mental illness. Results We identified 325 eligible papers and conducted a thematic analysis resulting in five themes: patient and clinical satisfaction, diagnostic reliability, outcomes, technology and professional guidance. The most significant factors linked to effectiveness of telepsychiatry were patient and clinician satisfaction and adequate technology to facilitate examination of the patient. Clinical implications The consistent diagnostic reliability, satisfactory clinical outcomes and patient satisfaction linked to telepsychiatry favour its continued use once the pandemic ends. The main barrier is reluctance among clinicians and lack of professional guidance. We recommend education on the uses of telepsychiatry among clinicians, and the provision of professional guidance for its use from medical bodies and organisations.

Aims and method This review aims to clarify the evidence on the effectiveness of telepsychiatry following the COVID-19 pandemic. We conducted a literature review of three databases (Cochrane Library, PubMed and PsycINFO), using the terms virtual consultation/telepsychiatry/video consultation AND psychiatry/mental illness. Results We identified 325 eligible papers and conducted a thematic analysis resulting in five themes: patient and clinical satisfaction, diagnostic reliability, outcomes, technology and professional guidance. The most significant factors linked to effectiveness of telepsychiatry were patient and clinician satisfaction and adequate technology to facilitate examination of the patient. Clinical implications The consistent diagnostic reliability, satisfactory clinical outcomes and patient satisfaction linked to telepsychiatry favour its continued use once the pandemic ends. The main barrier is reluctance among clinicians and lack of professional guidance. We recommend education on the uses of telepsychiatry among clinicians, and the provision of professional guidance for its use from medical bodies and organisations. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has affected how clinical examinations are conducted, resulting in the Royal College of Psychiatrists delivering the Clinical Assessment of Skills and Competence virtually. Although this pragmatic step has allowed for progression of training, it has come at the cost of a significantly altered examination experience. This article aims to explore the fairness of such an examination, the difference in trainee experience, and the use of telemedicine to consider what might be lost as well as gained at a time when medical education and delivery of healthcare are moving toward the digitised frontier. [ABSTRACT FROM AUTHOR]

Recently, there has been growing interest in artificial intelligence (AI) to improve efficiency and personalisation of mental health services. So far, the progress has been slow, however, advancements in deep learning may change this. This paper discusses the role for AI in psychiatry, in particular (a) diagnosis tools, (b) monitoring of symptoms, and (c) delivering personalised treatment recommendations. Finally, I discuss ethical concerns and technological limitations. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers (HCWs) have faced considerable pressures during the COVID-19 pandemic. For some, this has resulted in mental health distress and disorder. Although interventions have sought to support HCWs, few have been evaluated. Aims: We aimed to determine the effectiveness of the 'Foundations' application (app) on general (non-psychotic) psychiatric morbidity. Method: We conducted a multicentre randomised controlled trial of HCWs at 16 NHS trusts (trial registration number: EudraCT: 2021-001279-18). Participants were randomly assigned to the app or wait-list control group. Measures were assessed at baseline, after 4 and 8 weeks. The primary outcome was general psychiatric morbidity (using the General Health Questionnaire). Secondary outcomes included: well-being; presenteeism; anxiety; depression and insomnia. The primary analysis used mixed-effects multivariable regression, presented as adjusted mean differences (aMD). Results: Between 22 March and 3 June 2021, 1002 participants were randomised (500:502), and 894 (89.2%) followed-up. The sample was predominately women (754/894, 84.3%), with a mean age of 44⋅3 years (interquartile range (IQR) 34–53). Participants randomised to the app had a reduction in psychiatric morbidity symptoms (aMD = −1.39, 95% CI −2.05 to −0.74), improvement in well-being (aMD = 0⋅54, 95% CI 0⋅20 to 0⋅89) and reduction in insomnia (adjusted odds ratio (aOR) = 0⋅36, 95% CI 0⋅21 to 0⋅60). No other significant findings were found, or adverse events reported. Conclusions: The app had an effect in reducing psychiatric morbidity symptoms in a sample of HCWs. Given it is scalable with no adverse effects, the app may be used as part of an organisation's tiered staff support package. Further evidence is needed on long-term effectiveness and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background ‘POD Adventures’ is a gamified problem-solving intervention delivered via smartphone app, and supported by non-specialist counsellors for a target population of secondary school students in India during the COVID-19 pandemic. Aims To evaluate the feasibility and acceptability of undertaking a randomised controlled trial of POD Adventures when delivered online with telephone support from counsellors. Method We conducted a parallel, two-arm, individually randomised pilot-controlled trial with 11 secondary schools in Goa, India. Participants received either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes were assessed at two timepoints: baseline and 6 weeks post-randomisation. Results Seventy-nine classroom sensitisation sessions reaching a total of 1575 students were conducted. Ninety-two self-initiated study referrals (5.8%) were received, but only 11 participants enrolled in the study. No intervention arm participants completed the intervention. Outcomes at 6 weeks were not available for intervention arm participants (n = 5), and only four control arm participants completed outcomes. No qualitative interviews or participant satisfaction measures were completed because participants could not be reached by the study team. Conclusions Despite modifications to address barriers arising from COVID-19 restrictions, online delivery was not feasible in the study context. Low recruitment and missing feasibility and acceptability data make it difficult to draw conclusions about intervention engagement and indicative clinical outcomes. Prior findings showing high uptake, adherence and engagement with POD Adventures when delivered in a school-based context suggest that an online study and delivery posed the biggest barriers to study participation and engagement.

The prescribing of psychotropic medications for people with an intellectual disability has changed. In many locations across England, antidepressants have become the most widely prescribed psychotropic. In the context of the current NHS England STOMP programme to reduce inappropriate psychotropic prescribing for people with intellectual disability, there is an urgent need to understand whether this change reflects evidence-based use of the medications involved. There has been little analysis into the benefits or problems associated with the change and whether it is of concern. This paper offers a variety of possible explanations and opportunities to improve clinical practice and policy. [ABSTRACT FROM AUTHOR]

Many examinations are now delivered online using digital formats, the migration to which has been accelerated by the COVID-19 pandemic. The MRCPsych theory examinations have been delivered in this way since Autumn 2020. The multiple choice question formats currently in use are highly reliable, but other formats enabled by the digital platform, such as very short answer questions (VSAQs), may promote deeper learning. Trainees often ask for a focus on core knowledge, and the absence of cueing with VSAQs could help achieve this. This paper describes the background and evidence base for VSAQs, and how they might be introduced. Any new question formats would be thoroughly piloted before appearing in the examinations and are likely to have a phased introduction alongside existing formats. [ABSTRACT FROM AUTHOR]

SUMMARY: Measuring outcomes is becoming an increasingly standard (and highly complex) part of what mental health services are expected to do. Practising psychiatrists will need to have a good understanding of approaches to outcome measurement: used well, they have the potential to amplify the patient voice, promote good-quality services and facilitate research. We discuss what constitutes an outcome measure, the different ways that such measures can be obtained and the mechanisms for assessing the quality and appropriateness of an outcome measure. We outline the rapidly evolving research and policy context regarding outcome measurement, with particular reference to the UK's National Health Service. We also consider the potential pitfalls to outcome measurement, such as added clinical burden, inappropriate incentivisation of behaviour and incorrect interpretation of results. We discuss ways that such difficulties can be avoided or their effects mitigated. [ABSTRACT FROM AUTHOR]

Summary: Personalised prediction models promise to enhance the speed, accuracy and objectivity of clinical decision-making in psychiatry in the near future. This editorial elucidates key ethical issues at stake in the real-world implementation of prediction models and sets out practical recommendations to begin to address these. [ABSTRACT FROM AUTHOR]

Summary: The dystopian scenario of an 'artificial intelligence takeover' imagines artificial intelligence (AI) becoming the dominant form of intelligence on Earth, rendering humans redundant. As a society we have become increasingly familiar with AI and robots replacing humans in many tasks, certain jobs and even some areas of medicine, but surely this is not the fate of psychiatry?Here a computational neuroscientist (Janaina Mourão-Miranda) and psychiatrist (Justin Taylor Baker) suggest that psychiatry as a profession is relatively safe, whereas psychiatrists Christian Brown and Giles William Story predict that robots will be taking over the asylum. [ABSTRACT FROM AUTHOR]

Downloading a mobile health (m-health) app on your smartphone does not mean you will ever use it. Telling another person about an app does not mean you like it. Using an online intervention does not mean it has had an impact on your well-being. Yet we consistently rely on downloads, clicks, ‘likes’ and other usage and popularity metrics to measure m-health app engagement. Doing so misses the complexity of how people perceive and use m-health apps in everyday life to manage mental health conditions. This article questions commonly used behavioural metrics of engagement in mental health research and care, and proposes a more comprehensive approach to measuring in-app engagement.

BackgroundResearch in schizophrenia and pregnancy has traditionally been conducted in small samples. More recently, secondary analysis of routine healthcare data has facilitated access to data on large numbers of women with schizophrenia.AimsTo discuss four scientific advances using data from Canada, Denmark and the UK from population-level health registers and clinical data sources.MethodNarrative review of research from these three countries to illustrate key advances in the area of schizophrenia and pregnancy.ResultsHealth administrative and clinical data from electronic medical records have been used to identify population-level and clinical cohorts of women with schizophrenia, and follow them longitudinally along with their children. These data have demonstrated that fertility rates in women with schizophrenia have increased over time and have enabled documentation of the course of illness in relation with pregnancy, showing the early postpartum as the time of highest risk. As a result of large sample sizes, we have been able to understand the prevalence of and risk factors for rare outcomes that would be difficult to study in clinical research. Advanced pharmaco-epidemiological methods have been used to address confounding in studies of antipsychotic medications in pregnancy, to provide data about the benefits and risks of treatment for women and their care providers.ConclusionsUse of these data has advanced the field of research in schizophrenia and pregnancy. Future developments in use of electronic health records include access to richer data sources and use of modern technical advances such as machine learning and supporting team science.

BackgroundDigitally enabled services can contribute to the support, treatment and prevention of mental health difficulties; however, questions remain regarding how we can most usefully harness such technology in primary and secondary mental healthcare settings.AimsTo identify barriers and facilitators to enable the potential of digital mental health in England, Scotland, Wales and Northern Ireland.MethodA three-round Delphi exercise was carried out online with 16 participants from across the four nations of the UK representing the following stakeholder groups: service providers, health professionals, policymakers, lived experience, small and medium enterprises and academics. Qualitative data were collected in the first round (80 fragments) that were then coded to produce a 26-item round-two questionnaire for participant rating. Participants were given the opportunity to reconsider their scores in light of the group responses in round three.ResultsEight statements under the following five themes reached consensus with median scores between 8 and 10 (i.e. important/very important): co-production; the human element; data security; funding; and regulation.ConclusionsThe Delphi process allowed consensus to be achieved regarding the factors that experts consider important for harnessing technology in primary and secondary mental healthcare. Knowledge of these factors can help users and providers of mental health services negotiate how best to move forward with digitally enabled systems of care.

BackgroundAdolescents are digital natives, with the majority now owning their own smartphones and having internet access. Although the internet and smartphone applications (apps) can provide mental health support, little is known about how young adolescents use digital technology for mental health purposes. There are many digital health resources available for young people, but the assumption that they will be open to use them has been largely untested.AimsWe aimed to explore how adolescents with and without raised symptoms of anxiety, depression and problematic eating use the internet on smartphones/tablets and mental health apps.MethodThe Bristol Online Survey tool was used to deliver an online survey to 775 girls aged 11–16 years, attending a state-funded secondary school in the south-west of England. The survey was completed in class during the winter term of 2017.ResultsA total of 98.7 and 97.4% used the internet and apps, respectively, although only 6% had used any mental health apps. Of those with raised mental health symptoms, 15–17% used or were using a mental health app, with 48.5% reporting that they would not use a mental health app.ConclusionsYoung female adolescents are avid users of the internet and apps but are not using digital technology for mental health purposes. Addressing concerns about digital technology are necessary to maximise the effect it can have on child and adolescent mental health.Declaration of interestNone.

Workshops are used in many psychiatric teaching and learning contexts, from undergraduate to continuing professional development. Most psychiatrists have at some time attended a workshop. However, the terms workshop, tutorial and smallgroup teaching are used indiscriminately. It is therefore important to reflect on what characterises a workshop, the learning theories behind their development and what learning needs workshops best meet. We give an outline of the evidence for workshops in medical education and review the principles governing how to conduct workshops and the use of technology to enhance their delivery. Data collected from an undergraduate psychiatry course delivered in an Irish university are used to illustrate how applying these principles contributes to optimising the use of workshops from both the learners' and facilitators' perspective. [ABSTRACT FROM AUTHOR]

Persons living with HIV report experiencing disproportionally severe and chronic pain and worry. However, no objective biomarkers of these subjective experiences have been developed. To address the lack of objective measures and assist in treatment planning, this study examined whether digital biomarkers of pain severity, pain chronicity and worry could be developed, using passive wearable sensors that continuously monitor movement. Results suggest that digital biomarkers can predict pain severity (r[35] = 0.690), pain chronicity (74.63% accuracy) and worry severity (r[65] = 0.642) with high precision, suggesting that objective digital biomarkers alone accurately capture internal symptom experiences in persons living with HIV.Declaration Of Interest: N.C.J. is the owner of a free application published on the Google Play Store entitled 'Mood Triggers'. He does not receive any direct or indirect revenue from his ownership of the application (i.e. the application is free, there are no advertisements and the data is only being used for research purposes). C.O. has no conflicts to declare. [ABSTRACT FROM AUTHOR]

Ecosystem stewardship is an important goal of crop production management. The developing question has been the feasibility and profitability of best management practices (BMPs) associated with stewardship goals. Treatment-effects empirical estimates show that soybean crop ecosystem stewardship is likely to benefit from precision agriculture's (PA) information technologies to varying degrees. After accounting for the effect of overhead expenditures on technology adoption, and input costs on operating costs and profits, we show PA technologies also affect at least six BMPs. In one comprehensive framework, PA technologies affect profits, and improve crop production management through BMPs, with benefits for ecosystem stewardship. [ABSTRACT FROM AUTHOR]

Background: 'POD Adventures' is a gamified problem-solving intervention delivered via smartphone app, and supported by non-specialist counsellors for a target population of secondary school students in India during the COVID-19 pandemic., Aims: To evaluate the feasibility and acceptability of undertaking a randomised controlled trial of POD Adventures when delivered online with telephone support from counsellors., Method: We conducted a parallel, two-arm, individually randomised pilot-controlled trial with 11 secondary schools in Goa, India. Participants received either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes were assessed at two timepoints: baseline and 6 weeks post-randomisation., Results: Seventy-nine classroom sensitisation sessions reaching a total of 1575 students were conducted. Ninety-two self-initiated study referrals (5.8%) were received, but only 11 participants enrolled in the study. No intervention arm participants completed the intervention. Outcomes at 6 weeks were not available for intervention arm participants ( n = 5), and only four control arm participants completed outcomes. No qualitative interviews or participant satisfaction measures were completed because participants could not be reached by the study team., Conclusions: Despite modifications to address barriers arising from COVID-19 restrictions, online delivery was not feasible in the study context. Low recruitment and missing feasibility and acceptability data make it difficult to draw conclusions about intervention engagement and indicative clinical outcomes. Prior findings showing high uptake, adherence and engagement with POD Adventures when delivered in a school-based context suggest that an online study and delivery posed the biggest barriers to study participation and engagement.

This article examines the role of knowledge codification. The study employs a competence-based approach to the firm to analyze the recent destabilization of internal labor markets. Findings shows that increasing knowledge codification made possible by the diffusion of information and communication technologies has made competences less dependent on individuals. Moreover, knowledge has been increasingly incorporated in firms, which has played an essential role in lowering the relative cost of human resource management strategies based on external labor flexibility.

Despite decades of suicide research, our ability to predict suicide has not changed. Why is this the case? We outline the unique challenges facing suicide research. Borrowing successful strategies from other medical fields, we propose specific research directions that aim to translate scientific findings into meaningful clinical impact. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 pandemic has led to unprecedented disruption to the normal way of life for people around the globe. Social distancing, self-isolation or shielding have been strongly advised or mandated in most countries. We suggest evidence-based ways that people can maintain or even strengthen their mental health during this crisis. [ABSTRACT FROM AUTHOR]

Developing a realistic multifactorial model of human performance in psychiatry will better inform interventions targeting clinician overwork and burnout, which contribute to risk and error in medicine. This heralds a new approach, allowing better detection by individuals, colleagues and automated systems, to responding to degraded performance in psychiatry. [ABSTRACT FROM AUTHOR]

In the last decade, few countries have figured prominently as cases of late-late developers that achieved worldwide success with their Information Technology (IT) industries. This paper focuses on the Israeli case and argues that uniquely in that group, and in contradiction to the model proposed by late development theories, Israel's competitive advantage in the IT industries, is in Research and Development (R&D). The paper's main arguments are that (a) the declared aim of Israel's industrial policy has been to develop a "science-based" industrial system similar to what we see in Israel today; (b) however, these policies, focused on diffusion and not on creation of capabilities, were successful only because of the existence of an already sophisticated and extensive R&D capability in the universities — markedly different from other Newly Industrialized Countries. Looking at the present the paper concludes that the same operational model that led Israel's IT industry to success might now be undermining its future growth. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has brought untold tragedies. However, one outcome has been the dramatically rapid replacement of face-to-face consultations and other meetings, including clinical multidisciplinary team meetings, with telephone calls or videoconferencing. By and large this form of remote consultation has received a warm welcome from both patients and clinicians. To date, human, technological and institutional barriers may have held back the integration of such approaches in routine clinical practice, particularly in the UK. As we move into the post-pandemic phase, it is vital that academic, educational and clinical leadership builds on this positive legacy of the COVID crisis. Telepsychiatry may be but one component of 'digital psychiatry' but its seismic evolution in the pandemic offers a possible opportunity to embrace and develop 'digital psychiatry' as a whole.

Use of social media by people with mental health problems, and especially those who are prone to self-harm, has potential advantages and disadvantages. This poses a dilemma about how and by how much the form and content of social media sites should be regulated. Unfortunately, participation in the public debate about this dilemma has been restricted and high-profile discussion of necessary action has been focused almost entirely on how much suppression of content is justified. Professional bodies, including the Royal College of Psychiatrists, should be doing much more than they are to shape how the debate is conducted.

Digital phenotyping (such as using live data from personal digital devices on sleep, activity and social media interactions) to monitor and interpret people's current mental state is a newly emerging development in psychiatry. This article offers an imaginary insight into its future potential for both psychiatrist and patient.

Aims and methodImplementation of evidence-based psychosocial interventions in accordance with National Institute of Health and Care Excellence guidelines and quality standards has been incomplete. This project involved allocation of adults under mental health services to six guideline categories, completion of a clinician- and patient-rated outcome measure, and individual assessment against clinical standards. RESULTS: In the first 3 months of the project, 5048 patients were allocated to a pathway and 3734 (73%) were assessed against at least one of the relevant standards. All were assessed using the Health of the Nation Outcome Scales (91-93% of scales completed) and 1866 (36%) completed the patient-rated outcome measure, DIALOG.Clinical implicationsClinicians will allocate patients to pathways, complete outcome measures and assess against standards, providing data to guide practice, service design and costing of mental health systems with supporting technology to assist data entry and presentation. This has the potential to provide much improved and readily accessible information about individual outcomes and standards for people with mental health problems and those working with them. It could also provide a method for payment for services which directly support good clinical practice.Declaration of interestNone.

SummaryCate Bailey outlines the origin and goals of the new trainees' section of the BJPsych Bulletin. 'Praxis' will involve two components. The first will be clinically inspired and problem based. Trainees will have an opportunity to collaborate with experts from different disciplines to examine how existing literature and knowledge can be applied to practice, with a clinical scenario forming the basis for discussion. The second component will be made up of commissioned or proposed editorial-type articles on subjects which fall broadly under the heading of personal and professional development. This will offer a space for reflection on relevant contemporary topics such as resilience, burnout, supervision, and patient involvement and co-production.Declaration of interestC.B. is editor of the BJPsych Bulletin trainees' section.

Background: Adolescents are digital natives, with the majority now owning their own smartphones and having internet access. Although the internet and smartphone applications (apps) can provide mental health support, little is known about how young adolescents use digital technology for mental health purposes. There are many digital health resources available for young people, but the assumption that they will be open to use them has been largely untested., Aims: We aimed to explore how adolescents with and without raised symptoms of anxiety, depression and problematic eating use the internet on smartphones/tablets and mental health apps., Method: The Bristol Online Survey tool was used to deliver an online survey to 775 girls aged 11-16 years, attending a state-funded secondary school in the south-west of England. The survey was completed in class during the winter term of 2017., Results: A total of 98.7 and 97.4% used the internet and apps, respectively, although only 6% had used any mental health apps. Of those with raised mental health symptoms, 15-17% used or were using a mental health app, with 48.5% reporting that they would not use a mental health app., Conclusions: Young female adolescents are avid users of the internet and apps but are not using digital technology for mental health purposes. Addressing concerns about digital technology are necessary to maximise the effect it can have on child and adolescent mental health., Declaration of Interest: None.