scholarly journals The impact of the COVID-19 pandemic on referrals to liaison psychiatry services at University Hospital Hairmyres, NHS Lanarkshire

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S46-S47
Author(s):  
Cristina Paton ◽  
James Hills ◽  
Rekha Hegde
Keyword(s):  
Community Services ◽  
University Hospital ◽  
Direct Result ◽  
Secondary Effects ◽  
Liaison Psychiatry ◽  
Nursing Service ◽  
Self Harm ◽  
Local Emergency Department ◽  
One Year ◽  
The Impact

AimsThe COVID-19 pandemic has led to sweeping public health restrictions with predictable impact on mental health. In Scotland, lockdown measures during the first wave of the pandemic commenced on 23rd March 2020 and only began to ease after 29th May 2020. The aim of this study was to evaluate the impact of the first wave of the COVID-19 pandemic on the number and type of referrals made to the adult psychiatric liaison nursing service (PLNS) at University Hospital Hairmyres, NHS Lanarkshire.MethodWe collated all of the archived referrals made by our local emergency department to the PLNS at University Hospital Hairmyres for adults (aged 18–65 years) during the period of the first COVID-19 national lockdown (April-July 2020) and the corresponding period one-year prior (April-July 2019) to analyse differences in referral numbers and demographics. Additionally, for referrals made during 2020, we conducted a qualitative review of electronic records to determine the reason for referral, contributory stressors to presentation, and in particular any effect from COVID-19.ResultA total of 549 referrals were made over the study period, with 320 in 2019 and 229 in 2020, a decrease of almost 30%. In 2019, referrals fell each month from April (n = 89) to July (n = 74), while this trend was reversed in 2020, rising from April (n = 45) to near-usual levels by July (n = 68). Compared to baseline, referrals in April 2020 were for a higher proportion of men (62.2%). On qualitative analysis, 26 records (11.3%) could not be found. Otherwise, the most common reasons for referral were suicidal ideation (43.3%) and/or deliberate self-harm (39.9%). Many patients presented with comorbid substance misuse (54.2%) and the majority were not known to community services (64.5%). COVID-19 was implicated in 48 referrals (23.6%), but only 2 of these arose as a direct result of infection.ConclusionWe have observed clear differences in the pattern of referrals made to the adult PLNS during the first COVID-19 national lockdown. COVID-19 was implicated in a minority of referrals, but most were related to secondary effects of lockdown restrictions rather than COVID-19 infection. Possible reasons for fewer referrals during this time could be non-presentation through fears of contracting COVID-19 or altruistic avoidance of putting “pressure on the NHS”. Further studies would be insightful; in particular, equivalent analysis of contacts with community services; and qualitative patient perspectives regarding reasons for non-presentation during this time.

Self-harm in the very old one year later: has anything changed?

2019 ◽  
Vol 31 (11) ◽  
pp. 1559-1568 ◽  
Author(s):  
Anne Pamela Frances Wand ◽  
Brian Draper ◽  
Henry Brodaty ◽  
Carmelle Peisah
Keyword(s):  
General Practitioner ◽  
Community Services ◽  
The Self ◽  
Teaching Hospitals ◽  
Very Old ◽  
Inquiry Approach ◽  
Wish To Die ◽  
Self Harm ◽  
One Year

AbstractObjectives:To follow-up a cohort of older people who self-harmed, their carer, and general practitioner (GP) and examine their reflections on the self-harm, care experiences, and outcomes.Design:Qualitative in-depth interviews.Setting:Two teaching hospitals and associated community services.Participants:Twelve-month follow-up of participants aged 80 or older who self-harmed, their nominated carers, and GPs.Measurements:A geriatric psychiatrist gathered data through patient and carer interviews using a narrative inquiry approach and from medical records. Interviews were audio recorded and transcribed. N-VIVO facilitated data organization for thematic analysis. Questionnaires sent to the patient’s GP examined their perspectives and aspects of care relating to the self-harm.Results:Nineteen patients (63% baseline sample), 29 carers (90.6%), and 11 GPs (36.7%) were available at follow-up. Themes emerging from patients were “denial and secrets;” “endless suffering;” “more invalidation;” “being heard;” and “miserable in care.” Themes from carer interviews were “denial and secrets;” “patient’s persistent wish to die;” “abandonment by clinicians;” “unending burden for the carer;” and “distress regarding placement.” General practitioner themes were “the problem is fixed;” “the troops have arrived;” and “I understand.”Conclusions:Factors contributing to self-harm persisted at follow-up. Positive and negative responses were identified in the older person’s system, highlighting areas for potential intervention. A conceptual framework for understanding self-harm in the very old was derived that emphasized the importance of understanding individual needs, the interpersonal context of the older person, and carer burden. Interventions should improve communication, facilitate shared understanding of perspectives, and provide support at all levels.

scholarly journals Increased Risk of Graves´ophthalmopathy in Patients With Increasing TRAb After Radioiodine Treatment and the Impact of CTLA4 on TRAb Titres

2021 ◽  
Author(s):  
Bushra Shahida ◽  
Kleoniki Tsoumani ◽  
Tereza Planck ◽  
Vijayachitra Modhukur ◽  
Pernilla Asp ◽  
...  
Keyword(s):  
Previous Treatment ◽  
University Hospital ◽  
P Value ◽  
Graves Ophthalmopathy ◽  
Increased Risk ◽  
Orbital Tissue ◽  
One Year ◽  
The Impact ◽  
The Relationship

Abstract Introduction. Treatment of Graves´ disease (GD) with radioiodine increases the risk of developing Graves´ ophthalmopathy (GO) but the link between thyroid and orbital tissue remains undefined.The aim was to investigate the relationship between GO and TRAb after treatment with radioiodine and to define the impact of risk genes.Methods. GD patients without ophthalmopathy or previous treatment with radioiodine were prospectively included at treatment with radioiodine for hyperthyroidism. A follow-up was performed one year later for registration of GO development. The study was performed at a University Hospital Clinic; referral center of all patients treated with radioiodine in the south of Sweden. The main outcome measures were development of TRAb, anti-TPO, anti-TG after three months and GO after 12 months and relationship to the genetic background (HLA, CTLA-4, CYR61).Results. Three months of radioiodine TRAb increased in two thirds of patients (p<0.0005) but not in the other third. Anti-TPO was associated with TRAb (R=0.362, p <0.0001) but not anti-TG. At follow-up one year later (n=204) 32 patients developed GO with a proportion of 70% in the group increasing in TRAb and 30 % in the group with unchanged or lower TRAb (p-value <0.0005). Patients with GO had higher levels of TRAb than patients without GO. CTLA-4 (rs231775 SNP) was significantly (p<0.005) associated with TRAb levels above the median three months after radioiodine.Conclusions. The increase in TRAb after treatment with radioiodine is associated with GO and a genetic variation in CTLA-4 is associated with higher levels of TRAb.

scholarly journals Extending the liaison psychiatry service in a large hospital in the UK: a before and after evaluation of the economic impact and patient care following ED attendances for self-harm

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016906 ◽  
Author(s):  
Brent C Opmeer ◽  
William Hollingworth ◽  
Elsa M R Marques ◽  
Ruta Margelyte ◽  
David Gunnell
Keyword(s):  
Working Hours ◽  
Psychosocial Assessment ◽  
Favourable Effect ◽  
Liaison Psychiatry ◽  
Large Hospital ◽  
Before And After ◽  
Self Harm ◽  
Mean Cost ◽  
The Impact ◽  
Patient Attendance

ObjectivesTo evaluate the impact of an expansion of liaison psychiatry services (LPS) on patient management, outcomes and treatment costs for emergency department (ED) attendances for self-harm.DesignRetrospective before and after cohort study using routinely collected Self-Harm Surveillance Register data.SettingA large hospital in South West England.SubjectsPatients attending the ED for self-harm.InterventionsExtension of the LPS’ working hours from 9:00 to 17:00, Monday to Friday to 8:00 to 22:00, 7 days a week, following a £250 000 annual investmentMain outcome measuresNumber and characteristics of ED attendances for self-harm. The before and after cohorts were compared in terms of key process measures, including proportion of patients receiving a psychosocial assessment, average length of hospital stay, waiting times for assessment, proportion of patients who self-discharged without an assessment, levels of repeat self-harm attendances and mean cost per patient attendance.Results298 patients attended ED for self-harm on 373 occasions between January and March 2014, and 318 patients attended on 381 occasions between January and March 2015. The proportion of ED attendances where patients received a psychosocial assessment increased from 57% to 68% (p=0.003), median waiting time decreased by 3 hours and 14 min (p=0.017), and the proportion of episodes where patients self-discharged without a psychosocial assessment decreased from 20% to 13% (p=0.022). The mean cost per patient attendance was marginally lower after the intervention (−£84; 95% CI −£254 to £77).ConclusionsThe extended LPS seems to have had a favourable effect on the management and outcomes of self-harm patients. The cost of extending the LPS’ working hours might be partially offset by more efficient assessment and discharge. The impact of the extended LPS on the care of hospitalised patients with mental health problems other than self-harm requires further evaluation.

scholarly journals Placenta praevia in Najran University hospital: incidence and risk factors

2017 ◽  
Vol 6 (5) ◽  
pp. 1758
Author(s):  
Sana B. Mustafa ◽  
Abdulhadi M. Elbashir ◽  
Adil Y. Waddad ◽  
Abdelrahman M. A. Ibrahim
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Significant Risk ◽  
Placenta Praevia ◽  
University Hospital ◽  
Age Group ◽  
Cross Sectional ◽  
Care Clinic ◽  
One Year ◽  
The Impact

Background: Placenta praevia is a source of drastic pregnancy, fetal and neonatal complications. There was variable incidence in the literature in different parts of the world and within the same country regions. We carried out this study to find the impact in our area and the possible risk factors for this serious obstetric problem.Methods: This study is a cross-sectional descriptive, one-year retrospective one-year prospective study, carried out from April 2014 to April 2016. All pregnant women attended the antenatal care clinic in Najran University Hospital during the study period, were included.Results: The incidence of placenta praevia was found to be 2.7%. AMONG the study group, the most affected age group was between 20-29 years. Previous placenta praevia and previous caesarean  section were the significant risk factors P=0.00 and 0,017 repectively.Conclusions: The incidence of placenta praevia in Najran KSA in this study was high, compared to other regions in Saudi Arabia and the majority of the international figures. Caesarean section and previous placenta praevia were the significant risk factors for placenta praevia in this study.

scholarly journals Common Presenting Problems for Young People Attending the Emergency Department

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Dhurgshaarna Shanmugavadivel ◽  
Rebecca Sands ◽  
Damian Wood
Keyword(s):  
Emergency Department ◽  
Young People ◽  
Clinical Pathways ◽  
University Hospital ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Presenting Problems ◽  
Self Harm ◽  
The Common ◽  
One Year

Objective. To determine the common presenting problems for young people attending the emergency department. Design. A retrospective review of electronic patient records of all young people between the ages of 13 and 17 who attended a UK University Hospital ED between 07/02/2007 and 06/02/2008 (n=10455). Results. All emergency department attendances for young people over a one-year period were studied in order to determine the common presenting problems. There were a total of 10455 attendances by 8303 young people. The presenting problem in 7505 (71.8%) was classified as injury. Of the remainder the commonest presenting problems reported for young people were abdominal pain (480, 16.3%), self-harm (314, 10.6%), fits, faints and funny turns (308, 10.4%), breathing difficulty (213, 7.2%), and intoxication (178, 6.0%). Ten presenting problems accounted for 72% of noninjury related attendances. Conclusions. Clinical guidelines and pathways developed for young people attending the emergency department should target the commonest presenting problems. In our cohort ten presenting problems account for almost three-quarters of all noninjury attendances for young people. The presenting problems are different to those described in younger children in previous studies. These results will inform the development of clinical pathways in order to improve emergency care.

The Impact of a Liaison Psychiatry Service on Patterns of Referral in a General Hospital

1987 ◽  
Vol 150 (1) ◽  
pp. 83-87 ◽  
Author(s):  
A. Brown ◽  
A. F. Cooper
Keyword(s):  
Retrospective Study ◽  
General Hospital ◽  
Referral Rate ◽  
Hospital Inpatient ◽  
Liaison Psychiatry ◽  
Deliberate Self Harm ◽  
Self Harm ◽  
Inpatient Population ◽  
The Impact

A retrospective study of psychiatric referrals from a general hospital inpatient population was carried out for three separate years, 1973, 1976 and 1979. Reorganisation of the liaison service to the responsibility of one consultant team was associated with changes in referral rate and disposal. In particular, there was a significant increase in the referral rate of patients from medical and surgical wards who were not involved in acts of deliberate self-harm.

scholarly journals Repetition of deliberate self-poisoning in rural Sri Lanka

2018 ◽  
Author(s):  
PHGJ Pushpakumara ◽  
SUB Thennakoon ◽  
TN Rajapakse ◽  
Ranil Abeysinghe ◽  
AH Dawson
Keyword(s):  
Sri Lanka ◽  
Time History ◽  
High Sensitivity ◽  
Life Time ◽  
Deliberate Self Harm ◽  
Self Harm ◽  
One Year ◽  
The One ◽  
The Impact ◽  
Lethal Means

AbstractRepetition of deliberate self harm is an important predictor of subsequent suicide. Repetition rates in Asian countries appear to be significantly lower than in western high income countries. The reason for these reported differences is not clear and has been suggested to due methodological differences or the impact of access to more lethal means of self harm. This prospective study determines the rates and demographic pattern of deliberate self-poisoning, suicide and fatal and non fatal repeated deliberate self-poisoning in rural Sri Lanka.Details of deliberate self poisoning admission in all hospitals (n=46) and suicides reported to all the police stations (n=28) of a rural district were collected for 3 years, 2011-2013. Demographic details of the cohort of deliberate self-poisoning patients admitted to all hospitals in 2011 (N=4022), were screened to link with patient records and police reports of successive two years with high sensitivity using a computer program and manual matching was performed with higher specificity. Life time repetition was assessed in a randomly selected subset of DSP patients (n=438).There were 15,914 DSP admissions and 1078 suicides during the study period. Within the study area the deliberate self poisoning and suicide population incidences were, 248.3/100,000 and 20.7/100,000 in 2012. Repetition rate for four weeks, one-year and two-years were 1.9% (95% CI 1.5-2.3%), 5.7% (95% CI 5.0 to 6.4) and 7.9% (95% CI 7.1 to 8.8) respectively. The median interval between two attempts were 92 (IQR 10 - 238) and 191 (IQR 29 - 419.5) days for the one and two-year repetition groups. The majority of patients used the same poison in the repeat attempt. Age and hospital stay of individuals with repetitive events were not significantly different from those who had no repetitive events. The two-year rate for suicide following DSP was 0.7% (95% CI 0.4-0.9%). Reported life time history of deliberate self harm attempts was 9.5% (95% CI 6.7-12.2%).The low comparative repetition rates in rural Sri Lanka was not explained by higher rates of suicide or access to more lethal means or differences in methodology.

scholarly journals COVID-19 and its effect on emergency presentations to a tertiary hospital with self-harm in Ireland

2020 ◽  
pp. 1-7 ◽  
Author(s):  
A. McIntyre ◽  
K. Tong ◽  
E. McMahon ◽  
A. M. Doherty
Keyword(s):  
Substance Misuse ◽  
Tertiary Hospital ◽  
Acute Hospital ◽  
University Hospital ◽  
Psychiatric Diagnoses ◽  
Peak Period ◽  
Age And Gender ◽  
Self Harm ◽  
And Gender ◽  
The Impact

Objectives: This study aimed to assess the impact of COVID-19 on presentations to an acute hospital with self-harm. Methods: All presentations to University Hospital Galway with self-harm were assessed during the peak period of the coronavirus crisis in Ireland, over the 3 months from 1 March to 31 May 2020. These data were compared with presentations in the same months in the 3 years preceding (2017–2019). Data were obtained from the anonymised service database. Results: This study found that in 2020, the rate of presentation with self-harm dropped by 35% from March to April and rose by 104% from April to May, peaking from mid-May. When trends over a 4-year period were examined, there was a significantly higher lethality of attempt (p < 0.001), and significant differences in diagnosis (p = 0.031) in 2020 in comparison with the three previous years. The increased lethality of presentations remained significant after age and gender were controlled for (p = 0.036). There were also significant differences in the underlying psychiatric diagnoses (p = 0.018), notably with a significant increase in substance misuse disorders presenting during the 2020 study period. Conclusions: COVID-19 showed a reduction in self-harm presentations initially, followed by a sharp increase in May 2020. If a period of economic instability follows as predicted, it is likely that this will further impact the mental health of the population, along with rates of self-harm and suicidal behaviours. There is a need for research into the longer-term effect of COVID-19 and lockdown restrictions, especially with respect to self-harm.

The Impact of a Dedicated Sedation Team on the Incidence of Complications in Paediatric Procedural Analgosedation

2021 ◽  
Author(s):  
Sofia Apostolidou ◽  
Mirna Kintscher ◽  
Gerhard Schoen ◽  
Dominique Singer ◽  
Chinedu Ulrich Ebenebe ◽  
...  
Keyword(s):  
Adverse Events ◽  
Tertiary Care ◽  
University Hospital ◽  
Complication Rates ◽  
Significant Difference ◽  
Therapeutic Procedures ◽  
Registration Number ◽  
American Society ◽  
One Year ◽  
The Impact

Abstract Demands in procedural sedation and analgesia in children are growing as the number of diagnostic and minor therapeutic procedures performed on paediatric patients outside the operating room setting has increased. We established a specialized interdisciplinary team of paediatric anaesthesiologists and paediatric intensivists (Children’s Analgosedation Team, CAST) for diagnostic and therapeutic procedures and aimed to analyse the incidence and risk factors of adverse events. A retrospective analysis of data collected in the first year after implementation of the interdisciplinary CAST at our tertiary care university hospital was conducted. Within one year, 784 procedural sedations were performed by the CAST. 7.4% of the patients were infants < 1 year of age. 53% of the patients were classified as American Society of Anesthesiologists (ASA) status III or IV. Most children received propofol (79%) and for painful procedures, additional esketamine (48%). Adverse events occurred in 51 patients (6.5%), most frequently apnoea (1.7%), airway obstruction (1%), and problems with the intravenous access (1%). Cancellation of the procedure occurred in four cases (0.5%). Lack of experience (OR 0.60; 95% CI 0.42-0.81) and increasing propofol dosage of 1mg kg-1 (OR 1.33; 95% CI 1.17-1.55) were identified as predictors for adverse events. ASA classification did not reveal a significant difference in complication rates. Conclusion: Increasing dosage of propofol and lack of experience were associated with adverse events in paediatric analgosedation for brief diagnostic or therapeutic procedures. Trial registration number: NCT04760249 (retrospectively registered on February 7th, 2021)

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