The impact of a change in prescribing policy on antipsychotic prescribing in a general adult psychiatric hospital

2014 ◽  
Vol 31 (3) ◽  
pp. 167-173 ◽  
Author(s):  
J. Kelly ◽  
F. Kelly ◽  
K. Santlal ◽  
S. O’Ceallaigh
Keyword(s):  
Mental Health ◽  
Psychiatric Hospital ◽  
Antipsychotic Medication ◽  
High Dose ◽  
Evidence Based ◽  
Second Generation Antipsychotics ◽  
Before And After ◽  
Antipsychotic Prescribing ◽  
Clinically Significant ◽  
The Impact

ObjectivesTo examine the impact of a change in local prescribing policy on the adherence to evidence-based prescribing guidelines for antipsychotic medication in a general adult psychiatric hospital.MethodsAll adult in-patients had their clinical record and medication sheet reviewed. Antipsychotic prescribed, dose prescribed and documented indications for prescribing were recorded. This was done before and after the implementation of the change in hospital antipsychotic prescribing policy.ResultsThere were no significant differences in age, sex, Mental Health Act status, psychiatric diagnosis or documented indications for prescribing multiple or high dose antipsychotics between the two groups. There was an increase in the preferential prescribing of multiple second-generation antipsychotics (p=0.01) in the context of a significant reduction in the prescribing of multiple antipsychotics overall (p=0.02). There were no significant reductions in prescribing of mixed generations of antipsychotics (p=0.12), high dose antipsychotics (p=1.00) or as required (PRN) antipsychotics (p=0.74).ConclusionsChanges in local prescribing policy can improve adherence to quality prescribing guidelines and cause clinically significant improvements in patterns of prescribing in a general adult psychiatric hospital.

scholarly journals Lock-Down Effect on the Mental Health Status of Healthcare Workers During COVID-19 Pandemic

2021 ◽  
Vol 12 ◽  
Author(s):  
Weam Fageera ◽  
Fawzi Babtain ◽  
Ahmad S. Alzahrani ◽  
Hussain M. Khrad
Keyword(s):  
Mental Health ◽  
Healthcare Workers ◽  
Psychological Impact ◽  
Anxiety And Depression ◽  
Physical And Mental Health ◽  
High Exposure ◽  
Before And After ◽  
Patient Health ◽  
Clinically Significant ◽  
The Impact

Background: The psychological impact that outbreaks and pandemics could inflict on healthcare workers has been widely studied; yet, little is known about the impact of the lockdown measures.Objectives: To assess the magnitude of depression and anxiety among healthcare professionals before and after lifting of the lockdown restrictions in Saudi Arabia.Methods: Surveys targeting healthcare workers were circulated twice: during the lockdown, and 8 weeks after lifting of lockdown. Anxiety and depressive symptoms were assessed using Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales.Results: A total of 947 healthcare workers, with the mean age of (37 ± 8.9) responded to the surveys. Among these, 23–27% respondents reported clinically significant levels of anxiety and depression. Whereas, easing of the lockdown restrictions was shown to be associated with decreasing mean scores of PHQ-9 and GAD-7. The noted burden fell heavily on female workers, those with a current or a history of psychiatric disorders, suffering from chronic diseases, being in workplaces with high exposure to COVID-19 or in contact with COVID-19 patients, nurses, as well as those who were living with elderly and perceived their physical and mental health as “much worse” compared to the time before the pandemic.Conclusion: Our findings identified several predictors for anxiety and depression at different time-points of the pandemic. Thus, priority to psychological support measures might be needed for these groups.

scholarly journals What Will Be the Impact of the COVID-19 Quarantine on Psychological Distress? Considerations Based on a Systematic Review of Pandemic Outbreaks

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 101
Author(s):  
Marco Cavicchioli ◽  
Roberta Ferrucci ◽  
Matteo Guidetti ◽  
Maria Paola Canevini ◽  
Gabriella Pravettoni ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Psychological Distress ◽  
Evidence Based ◽  
The Novel ◽  
Ptsd Symptoms ◽  
Clinically Significant ◽  
Novel Coronavirus ◽  
Restrictive Measures ◽  
The Impact

Background: The novel coronavirus (SARS-CoV-2) and related syndrome (COVID-19) has led to worldwide measures with severe consequences for millions of people. In the light of the psychopathological consequences of restrictive measures detected during previous outbreaks, a systematic review was carried out to provide an evidence-based assessment of possible effects of the current COVID-19 quarantine on mental health. Methods: This review included studies that assessed mental health indexes (e.g., overall psychological distress, depressive and PTSD symptoms) during and after quarantine periods adopted to management different outbreaks (e.g., COVID-19, SARS, MERS). Results: Twenty-one independent studies were included for a total of 82,312 subjects. At least 20% of people exposed to restrictive measures for the management of pandemic infections reported clinically significant levels of psychological distress, especially PTSD (21%) and depressive (22.69%) symptoms. Overall, original studies highlighted relevant methodological limitations. Conclusions: Nowadays, almost one out of every five people is at risk of development of clinically significant psychological distress. Further research on mental health after the current COVID-19 quarantine measures is warranted.

scholarly journals The impact of a teacher-based positive education intervention on student wellbeing literacy

2021 ◽  
Vol 2 (1) ◽  
pp. 22-43
Author(s):  
Lea Waters ◽  
Matthew Charles Higgins
Keyword(s):  
Mental Health ◽  
Education Intervention ◽  
Positive Education ◽  
Post Intervention ◽  
Emotional Management ◽  
Strength Based ◽  
Before And After ◽  
Education Interventions ◽  
Written Descriptions ◽  
The Impact

Over the past decade, research has consistently found that positive education interventions have a beneficial effect on mental health outcomes for students, such as improvements in life satisfaction and reduction of anxiety. While it is encouraging to see these changes in student mental health, the research has not yet adequately explored whether positive education interventions change a student’s understanding of wellbeing itself. Wellbeing literacy is a new construct within the field of positive education and is defined as the ability to understand the concept and language of wellbeing. This study examines whether student language and understanding of wellbeing changes following an intervention that trains teachers in the core principles of positive education. Students across grades five, six and seven (ages 11–13; n = 231) from three Australian schools provided brief written descriptions of their understanding of wellbeing before and after their teachers undertook an eight-month positive education intervention. Thematic analysis was used as the methodological tool to analyze student language and understanding of wellbeing. Inferential frequency-based statistical analyses were used to compare the pre-intervention and post-intervention responses. The results revealed that student understanding of wellbeing evolved in four key ways to become more: (1) detailed; (2) strength based; (3) expanded/multidimensional; and (4) relational. Post-intervention understanding of wellbeing was significantly more likely to include aspects of emotional management, strengths, coping, mindfulness and self-kindness. Implications, limitations and future directions are discussed.

scholarly journals Psychiatric admission for homeless people: the impact of a specialist community mental health team

1997 ◽  
Vol 21 (5) ◽  
pp. 260-263 ◽  
Author(s):  
Martin Commander ◽  
Sue Odell ◽  
Sashi Sashidharan
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Homeless People ◽  
Discharge Process ◽  
Community Mental Health Team ◽  
Psychiatric Admission ◽  
Mental Health Team ◽  
Health Team ◽  
Before And After ◽  
The Impact

The difficulty in achieving good quality community mental health care for homeless people has received increasing attention during the last few years. Less consideration has been given to the provision of inpatient care. By comparing data collected before and after its inception, we examined the impact of a specialist community mental health team for homeless people on ‘no fixed abode’ admissions in Birmingham. Although the team was successfully involved in the admission and discharge process in a substantial proportion of cases, many admissions still took place out of hours and involved the police, while discharge was often against medical advice and occurred without follow-up. These findings and their implications for the provision of homeless services are discussed.

The frequency of references to decision-making capacity in reports to the NSW Mental Health Review Tribunal did not change after legislative reforms that promoted them

2020 ◽  
Vol 28 (2) ◽  
pp. 171-174
Author(s):  
Tim Foley ◽  
Christopher J Ryan
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Education Campaign ◽  
Mental Health Act ◽  
Decision Making Capacity ◽  
Before And After ◽  
Legislative Reforms ◽  
The Impact ◽  
Health Review

Objective: To assess the impact of a 2015 reform to the Mental Health Act 2007 (NSW) ( MHA) that was interpreted as requiring a reference to decision-making capacity (DMC) in reports to the NSW Mental Health Review Tribunal (MHRT). Method: A sample of reports to the MHRT were audited for references to the MHA’s treatment criteria and DMC in periods before and after the reforms, and the frequency of references between the two periods was compared. Results: The frequency of references to DMC did not change significantly after the reforms. (However, references to the ‘least restriction’ criterion increased markedly between the two periods). Conclusion: Despite legislative reforms and a supporting education campaign promoting the importance of consideration of DMC, references to DMC did not increase after the reforms.

scholarly journals What is the impact of research champions on integrating research in mental health clinical practice? A quasiexperimental study in South London, UK

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016107 ◽  
Author(s):  
Sherifat Oduola ◽  
Til Wykes ◽  
Dan Robotham ◽  
Tom K J Craig
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Intervention Group ◽  
Research Participation ◽  
Clinical Activity ◽  
Clinical Services ◽  
National Health Service Foundation ◽  
Apply Research ◽  
Before And After ◽  
The Impact

ObjectivesKey challenges for mental health healthcare professionals to implement research alongside clinical activity have been highlighted, such as insufficient time to apply research skills and lack of support and resources. We examined the impact of employing dedicated staff to promote research in community mental health clinical settings.DesignQuasiexperiment before and after study.SettingSouth London and Maudsley National Health Service Foundation Trust.Participants4455 patients receiving care from 15 community mental health teams between 1 December 2013 and 31 December 2014.Outcome measuresThe proportion of patients approached for research participation in clinical services where research champions were present (intervention group), and where research champions were not present (comparison group).ResultsPatients in the intervention group were nearly six times more likely to be approached for research participation (Adj. OR=5.98; 95% CI 4.96 to 7.22).ConclusionsInvesting in staff that promote and drive research in clinical services increases opportunities for patients to hear about and engage in clinical research studies. However, investment needs to move beyond employing short-term staff.

scholarly journals 1059. Impact of a Syndrome-Based Antimicrobial Stewardship Intervention on Anti-Pseudomonal β-Lactam Use, C. difficile Rates and Cost in an Urban Community Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S374-S375
Author(s):  
Alfredo J Mena Lora ◽  
Martin Cortez ◽  
Ella Li ◽  
Lawrence Sanchez ◽  
Rochelle Bello ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Treatment Guidelines ◽  
Urban Community ◽  
Audit And Feedback ◽  
Evidence Based ◽  
Days Of Therapy ◽  
Before And After ◽  
Prospective Audit And Feedback ◽  
The Impact

Abstract Background The use of anti-Pseudomonal β-lactam (APBL) agents has significantly increased in the past decade, carrying higher costs and contributing to antimicrobial pressure. Antimicrobial stewardship (ASP) can promote evidence-based antimicrobial selection and mitigate excess APBL use. We implemented a comprehensive ASP with syndrome-based prospective audit and feedback (PAF) at an urban community hospital. The goal of this study is to assess the impact of syndrome-based PAF on APBL use, C. difficile rates and cost. Methods ASP with all CDC core elements was implemented at a 151-bed community hospital in October 2017. Syndrome-based guidelines and PAF was established and overseen via direct communication with an ID physician. Days of therapy (DOT), cost and C. difficile rates were assessed 12 months before and after ASP. DOT for APBL and non-APBL utilization was tabulated by unit and paired t-test performed. Results Most cases reviewed by PAF (51%) were represented in our syndrome-based treatment guidelines (Figure 1). Soft tissue (33%) and intra-abdominal (24%) infections were the most common syndromes. Change to guideline was the most common PAF intervention (62%) followed by de-escalation (30%). At 12 months, total DOT/1,000 increased (392.5 vs. 404) while the proportion of parenteral antimicrobials used decreased (71% vs. 65%). Antibiotic expenditures decreased by 23%, with a reduction in APBL of 20% and non-APBL of 10% (Table 1). Statistically significant reductions APBL use in non-ICU settings (P = 0.0139) and statistically significant increases in non-APBL in ICU settings occurred (P = 0.0001) (Figure 2 and 3). C difficile rates decreased from 21% (3.27 vs. 2.56). Conclusion Syndrome-based PAF was successfully implemented. A reduction in APBL use was seen in non-ICU settings, where evidence-based de-escalation may be more feasible. APBL use remained high in the ICU but was guideline consistent. A rise in non-APBL use also occurred. Certain critical illness syndromes warrant APBLs, but PAF may promote culture-directed and syndrome-specific treatments. ASP increased guideline-based therapy and contributed to decreased broad-spectrum antimicrobial use, antimicrobial expenditures and C difficile rates. Syndrome based PAF can be successfully implemented in community settings. Disclosures All authors: No reported disclosures.

Educational intervention for physicians to address the risk of opioid abuse

2017 ◽  
Vol 13 (5) ◽  
pp. 303 ◽  
Author(s):  
Margaret K. Pasquale, PhD ◽  
Richard L. Sheer, BA ◽  
Jack Mardekian, PhD ◽  
Elizabeth T. Masters, MS, MPH ◽  
Nick C. Patel, PharmD, PhD ◽  
...  
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Patient Information ◽  
Opioid Abuse ◽  
High Dose ◽  
Opioid Use ◽  
Educational Materials ◽  
Patients At Risk ◽  
Ed Visits ◽  
The Impact

Objective: To evaluate the impact of a pilot intervention for physicians to support their treatment of patients at risk for opioid abuse.Setting, design and patients, participants: Patients at risk for opioid abuse enrolled in Medicare plans were identified from July 1, 2012 to April 30, 2014 (N = 2,391), based on a published predictive model, and linked to 4,353 opioid-prescribing physicians. Patient-physician clusters were randomly assigned to one of four interventions using factorial design.Interventions: Physicians received one of the following: Arm 1, patient information; Arm 2, links to educational materials for diagnosis and management of pain; Arm 3, both patient information and links to educational materials; or Arm 4, no communication.Main outcome measures: Difference-in-difference analyses compared opioid and pain prescriptions, chronic high-dose opioid use, uncoordinated opioid use, and opioid-related emergency department (ED) visits. Logistic regression compared diagnosis of opioid abuse between cases and controls postindex.Results: Mailings had no significant impact on numbers of opioid or pain medications filled, chronic high-dose opioid use, uncoordinated opioid use, ED visits, or rate of diagnosed opioid abuse. Relative to Arm 4, odds ratios (95% CI) for diagnosed opioid abuse were Arm 1, 0.95(0.63-1.42); Arm 2, 0.83(0.55-1.27); Arm 3, 0.72(0.46-1.13). While 84.7 percent had ≥ 1 psychiatric diagnoses during preindex (p = 0.89 between arms), only 9.5 percent had ≥ 1 visit with mental health specialists (p = 0.53 between arms).Conclusions: Although this intervention did not affect pain-related outcomes, future interventions involving care coordination across primary care and mental health may impact opioid abuse and improve quality of life of patients with pain.

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