scholarly journals Are the rapid tranquilisation nice guidelines adhered to, in patients with agitated/aggressive behavior? a QIP

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S184-S185
Author(s):  
Asha Dhandapani ◽  
Sathyan Soundararajan ◽  
Rajvinder Sambhi
Keyword(s):  
Intensive Care Unit ◽  
Physical Health ◽  
Health Monitoring ◽  
Positive Reinforcement ◽  
Nice Guidelines ◽  
North Wales ◽  
Rapid Tranquilisation ◽  
The Difference ◽  
The Uk ◽  
Open Wards

AimsTo explore whether the NICE guidelines for rapid tranquilisation are adhered to in the Psychiatric intensive care unit (PICU/ Tryweryn).MethodData were collected by core trainees. Standards were taken from NICE guidelines NG10. All patients who had received rapid tranquilisation, that were in PICU from August 2019 to February 2020 were considered in this a.ResultDuring the first PDSA, we discussed with the staff in the ward regarding the protocol. Prior to actually starting the second audit, the adherence was noted to be low. However following persistence and having created a protocol jointly with the ward manager, we could see the difference. The staff were appreciated for their efforts in maintaining 100% adherence. The same was intended to be continued with some positive reinforcement from the auditing team. Over the first 2 months, 12 patients received Rapid Tranquilisation. Out of these 12, we randomly selected 4 patients to find the adherence of the NICE guidelines to be 100 per cent. The predictions regarding the adherence to protocol showed that the PDSA was successful.During the second PDSA, the adherence was 100% again. The adherence to the protocol has been followed for not just the sample that was selected, but for the entire set of patients who received the Rapid Tranquilisation. Following this QIP, we formatted the proforma which included the services to be provided/ actions to be taken, Post Rapid Tranquilisation physical health monitoring and response to medication.ConclusionThe utilisation of de-escalation techniques and behavioural support plans that was person-centred in turn brought down the rate of Rapid Tranquilisation successfully. Thus placing our PICU as having the least restraints in the UK in 2019 (Second least 3/ month). Our PICU was awarded the prestigious Nursing Times Team of the Year Award for their pioneering work.Following this QIP, we then formatted the proforma for Rapid Tranquilisation which included the services to be provided/ actions to be taken, Post Rapid Tranquilisation physical health monitoring and patients response to medication. The PICU will continue to maintain this 100% standard and we would then consider extending the Audit to both Open wards and PICU in entire North Wales.

scholarly journals Physical health monitoring in dementia and associations with ethnicity: a descriptive study using electronic health records

BJGP Open ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. bjgpopen20X101080
Author(s):  
Cini Bhanu ◽  
Mary Elizabeth Jones ◽  
Kate Walters ◽  
Irene Petersen ◽  
Jill Manthorpe ◽  
...  
Keyword(s):  
Primary Care ◽  
Physical Health ◽  
Influenza Vaccination ◽  
Ethnic Groups ◽  
Health Monitoring ◽  
Black People ◽  
Good Care ◽  
People With Dementia ◽  
The Uk ◽  
Comorbidity Status

BackgroundGood physical health monitoring can increase quality of life for people with dementia, but the monitoring may vary and ethnic inequalities may exist.AimTo investigate UK primary care routine physical health monitoring for people with dementia by: (a) ethnic groups, and (b) comorbidity status.Design & settingA retrospective cohort study was undertaken using electronic primary care records in the UK.MethodPhysical health monitoring was compared in people with dementia from white, black, and Asian ethnic groups and compared those with ≥1 comorbidity versus no comorbidity, from 1 April 2015 to 31 March 2016. Using the Dementia:Good Care Planning framework and expert consensus, good care was defined as receiving, within 1 year: a dementia review; a blood pressure (BP) check (at least one); a GP consultation (at least one); a weight and/or body mass index (BMI) recording (at least one); and an influenza vaccination.ResultsOf 20 821 people with dementia, 68% received a dementia review, 80% at least one BP recording, 97% at least one GP contact, 48% a weight and/or BMI recording, and 81% an influenza vaccination in 1 year. Compared with white people, black people were 23% less likely and Asian people 16% less likely to have weight recorded (adjusted incidence rate ratio [IRR] = 0.77, 95% confidence interval [CI] = 0.60 to 0.98/0.84, 0.71 to 1.00). People without comorbidities were less likely to have weight recorded (adjusted IRR = 0.74, 95% CI = 0.69 to 0.79) and BP monitored (adjusted IRR = 0.71, 95% CI = 0.68 to 0.75).ConclusionEthnic group was not associated with differences in physical health monitoring, other than weight monitoring. Comorbidity status was associated with weight and BP monitoring. Physical health monitoring in dementia, in particular nutrition, requires improvement.

scholarly journals An audit during COVID-19: monitoring of CMHT-patient contact and physical health assessments in a rural Welsh setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S85-S85
Author(s):  
Shreya Jauhari ◽  
Fran Foster
Keyword(s):  
Clinical Practice ◽  
Physical Health ◽  
Health Monitoring ◽  
Primary Objective ◽  
Patient Contact ◽  
Current Clinical Practice ◽  
Nice Guidelines ◽  
Face To Face ◽  
Health Checks ◽  
Secondary Objective

AimsThe enforcement of lockdowns and restrictions on non-essential contact have changed Community Mental Health Team (CMHT) practice. Therefore, this audit carried out its 4th cycle of physical health monitoring for patients on antipsychotics with severe mental illness (SMI) under the CMHT during the period of the COVID-19 pandemic in order to observe its impact on physical health monitoring. In addition, with the increased use of telepsychiatry substituting routine face-to-face appointments during the pandemic, this audit also reviews the effect of lockdown on maintenance of contact between CMHT and people with SMI.Primary Objective: to compare the current clinical practice with the standards derived from NICE guidelines which include parameters like weight, body-mass index, blood pressure, ECG and blood tests, then compare with the previous three audit cycles, which collected identical data.Secondary Objective: to monitor amount of contact between healthcare staff and people with SMI on antipsychotics during the three months of Welsh lockdown and compare current clinical practice with the clinical practice achieved in the identical period in 2019.MethodMethod for Primary Objective: Clinical practice on physical health checks were split into 10 standards derived from the NICE guidelines (NICEQS80, Quality Standard 6). Data collection surrounding physical health checks of patients on antipsychotics from 26th June 2019 to 26th June 2020 were collected and compared with the previous three audit cycles, which collected identical data.Method for Secondary Objective: Retrospective data surrounding amount and type of contact between CMHT and people with SMI was collected from 26th March 2020 to 26th June 2020, a period of enforced lockdown in Wales, and compared with the identical period in 2019.ResultThe audit iterates trends over the last 4 cycles (2016/2017, 2017/2018, 2018/2019 and 2019/2020). The current audit cycle increased in 2/10 standards and decreased in 8/10 standards, compared with the average compliance in the 3 previous audit cycles. Out of the 10 derived standards, certain standards fared worse than others.There was a 79% increase in the number of staff-patient contact during the lockdown period. The majority of the contact in 2019 was face-to-face (84.31%), however, as expected, in 2020 the majority of the contact was non face-to-face (61.75%). However, this was accompanied by an 85.79%ConclusionDespite being in a pandemic, patient contact was maintained. Physical health monitoring has decreased in the majority of standards, therefore greater attention is needed to address this. Recommendations are provided in the audit.

scholarly journals Audit on monitoring physical health of patients on mood stabilisers following NICE guidelines

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S104-S105
Author(s):  
Sathyan Soundararajan ◽  
Asha Dhandapani ◽  
Claire Jones
Keyword(s):  
Physical Health ◽  
Practice Guidelines ◽  
Health Monitoring ◽  
Good Practice ◽  
Patient Case ◽  
Nice Guidelines ◽  
Blood Tests ◽  
Retrospective Audit ◽  
Clinical Records

AimsThe aim is to find out if the physical health monitoring is adhered to in accordance with NICE guidelines in individuals with Intellectual disability who are on mood stabilisers and known to LD services.MethodWe sought to explore if the physical health monitoring for prescribing mood stabilisers in a sample of people with ID was consistent with good practice guidelines.We collected the data by reviewing the clinical records of individuals with LD who were under the care of mental health services in the CLDT- Wrexham and prescribed a mood stabiliser drug. We also contacted the patient's carers who came to outpatients and by calling the GP surgery and enquiring about the details. We also assessed the Welsh clinical portal in order to assess the blood tests.Data were collected by trainee doctors in Psychiatry. This was a retrospective audit, looking at data from Learning Disability psychiatry caseload. We identified about 16 patients on mood stabilisers.ResultPhysical health monitoring for prescribing mood stabilisers was almost consistent with good practice guidelines. This has shown that the majority of the monitoring has complied. There are few lacunae, such as Thyroid function not being monitored every 6 months for patients on Lithium, Serum Carbamazepine levels not being monitored as per guidelines with 1 patient not having blood done at all whilst on Carbamazepine. Moreover, the details are not readily available for the Consultant/ team when needed, thus making it very tedious for them to search/ contact the GP, etc.ConclusionMedications such as mood stabilisers can increase the risk further if the patient's physical health is not monitored regularly. This can lead to compromised quality of life for the patient and in some cases increased morbidity. Hence we have come up with a proforma that can be attached to patient case notes. This will serve as a record for us and prompt for physical monitoring. We will keep a database online with reminders set. This is to ensure a continuity of care for the patients.

ATTITUDE TO OPEN ACCESS IN RUSSIAN SCHOLARLY COMMUNITY: 2018. SURVEY RESULTS AND ANALYSIS

2018 ◽  
Vol 1 (1) ◽  
pp. 6-21 ◽  
Author(s):  
I. K. Razumova ◽  
N. N. Litvinova ◽  
M. E. Shvartsman ◽  
A. Yu. Kuznetsov
Keyword(s):  
Open Access ◽  
Open Access Publishing ◽  
Scholarly Community ◽  
Research Areas ◽  
Survey Results ◽  
The Difference ◽  
Policies And Programs ◽  
The Uk ◽  
High Level ◽  
Access Policies

Introduction. The paper presents survey results on the awareness towards and practice of Open Access scholarly publishing among Russian academics.Materials and Methods. We employed methods of statistical analysis of survey results. Materials comprise results of data processing of Russian survey conducted in 2018 and published results of the latest international surveys. The survey comprised 1383 respondents from 182 organizations. We performed comparative studies of the responses from academics and research institutions as well as different research areas. The study compares results obtained in Russia with the recently published results of surveys conducted in the United Kingdom and Europe.Results. Our findings show that 95% of Russian respondents support open access, 94% agree to post their publications in open repositories and 75% have experience in open access publishing. We did not find any difference in the awareness and attitude towards open access among seven reference groups. Our analysis revealed the difference in the structure of open access publications of the authors from universities and research institutes. Discussion andConclusions. Results reveal a high level of awareness and support to open access and succeful practice in the open access publications in the Russian scholarly community. The results for Russia demonstrate close similarity with the results of the UK academics. The governmental open access policies and programs would foster the practical realization of the open access in Russia.

scholarly journals THE VALUE OF ROBUST STATISTICAL FORECASTS IN THE COVID-19 PANDEMIC

2021 ◽  
Vol 256 ◽  
pp. 19-43
Author(s):  
Jennifer L. Castle ◽  
Jurgen A. Doornik ◽  
David F. Hendry
Keyword(s):  
Structural Change ◽  
Measurement Errors ◽  
Epidemiological Models ◽  
Short Term ◽  
Data Measurement ◽  
Policy Interventions ◽  
Changing Trends ◽  
Technological Advances ◽  
The Difference ◽  
The Uk

The Covid-19 pandemic has put forecasting under the spotlight, pitting epidemiological models against extrapolative time-series devices. We have been producing real-time short-term forecasts of confirmed cases and deaths using robust statistical models since 20 March 2020. The forecasts are adaptive to abrupt structural change, a major feature of the pandemic data due to data measurement errors, definitional and testing changes, policy interventions, technological advances and rapidly changing trends. The pandemic has also led to abrupt structural change in macroeconomic outcomes. Using the same methods, we forecast aggregate UK unemployment over the pandemic. The forecasts rapidly adapt to the employment policies implemented when the UK entered the first lockdown. The difference between our statistical and theory based forecasts provides a measure of the effect of furlough policies on stabilising unemployment, establishing useful scenarios had furlough policies not been implemented.

scholarly journals Gender inequality in COVID-19 times: evidence from UK prolific participants

2021 ◽  
pp. 1-27
Author(s):  
Sonia Oreffice ◽  
Climent Quintana-Domeque
Keyword(s):  
Mental Health ◽  
Gender Inequality ◽  
Gender Gap ◽  
Gender Gaps ◽  
Health Concerns ◽  
Unemployment Rates ◽  
Future State ◽  
Multiple Dimensions ◽  
The Difference ◽  
The Uk

Abstract We investigate gender differences across multiple dimensions after 3 months of the first UK lockdown of March 2020, using an online sample of approximately 1,500 Prolific respondents’ residents in the UK. We find that women's mental health was worse than men along the four metrics we collected data on, that women were more concerned about getting and spreading the virus, and that women perceived the virus as more prevalent and lethal than men did. Women were also more likely to expect a new lockdown or virus outbreak by the end of 2020, and were more pessimistic about the contemporaneous and future state of the UK economy, as measured by their forecasted contemporaneous and future unemployment rates. We also show that between earlier in 2020 before the outbreak of the Coronavirus pandemic and June 2020, women had increased childcare and housework more than men. Neither the gender gaps in COVID-19-related health and economic concerns nor the gender gaps in the increase in hours of childcare and housework can be accounted for by a rich set of control variables. Instead, we find that the gender gap in mental health can be partially accounted for by the difference in COVID-19-related health concerns between men and women.

scholarly journals Impact of Relaxing Covid-19 Social Distancing Measures on Rural North Wales: A Simulation Analysis

2020 ◽  
Vol 8 ◽  
Author(s):  
Rhodri P. Hughes ◽  
Dyfrig A. Hughes
Keyword(s):  
Simulation Analysis ◽  
Model Averaging ◽  
Incidence Rates ◽  
Mortality Data ◽  
Rural Regions ◽  
Social Distancing ◽  
North Wales ◽  
The Uk ◽  
Sigmoidal Growth ◽  
Related Mortality

Background: Social distancing policies aimed to limit Covid-19 across the UK were gradually relaxed between May and August 2020, as peak incidences passed. Population density is an important driver of national incidence rates; however peak incidences in rural regions may lag national figures by several weeks. We aimed to forecast the timing of peak Covid-19 mortality rate in rural North Wales.Methods: Covid-19 related mortality data up to 7/5/2020 were obtained from Public Health Wales and the UK Government. Sigmoidal growth functions were fitted by non-linear least squares and model averaging used to extrapolate mortality to 24/8/2020. The dates of peak mortality incidences for North Wales, Wales and the UK; and the percentage of predicted mortality at 24/8/2020 were calculated.Results: The peak daily death rates in Wales and the UK were estimated to have occurred on the 14/04/2020 and 15/04/2020, respectively. For North Wales, this occurred on the 07/05/2020, corresponding to the date of analysis. The number of deaths reported in North Wales on 07/05/2020 represents 33% of the number predicted to occur by 24/08/2020, compared with 74 and 62% for Wales and the UK, respectively.Conclusion: Policies governing the movement of people in the gradual release from lockdown are likely to impact significantly on areas–principally rural in nature–where cases of Covid-19, deaths and immunity are likely to be much lower than in populated areas. This is particularly difficult to manage across jurisdictions, such as between England and Wales, and in popular holiday destinations.

scholarly journals The contribution of changes to tax and social security to stalled life expectancy trends in Scotland: a modelling study

2020 ◽  
pp. jech-2020-214770
Author(s):  
Elizabeth Richardson ◽  
Martin Taulbut ◽  
Mark Robinson ◽  
Andrew Pulford ◽  
Gerry McCartney
Keyword(s):  
Life Expectancy ◽  
Social Security ◽  
Tax Credits ◽  
The Difference ◽  
Group Sex ◽  
The Uk ◽  
Social Security Benefits ◽  
The Impact ◽  
Welfare Reforms ◽  
Detrimental Impact

BackgroundLife expectancy (LE) improvements have stalled, and UK tax and welfare ‘reforms’ have been proposed as a cause. We estimated the effects of tax and welfare reforms from 2010/2011 to 2021/2022 on LE and inequalities in LE in Scotland.MethodsWe applied a published estimate of the cumulative income impact of the reforms to the households within Scottish Index of Multiple Deprivation (SIMD) quintiles. We estimated the impact on LE by applying a rate ratio for the impact of income on mortality rates (by age group, sex and SIMD quintile) and calculating the difference between inflation-only changes in benefits and the reforms.ResultsWe estimated that changes to household income resulting from the reforms would result in an additional 1041 (+3.7%) female deaths and 1013 (+3.8%) male deaths. These deaths represent an estimated reduction of female LE from 81.6 years to 81.2 years (−20 weeks), and male LE from 77.6 years to 77.2 years (−23 weeks). Cuts to benefits and tax credits were modelled to have the most detrimental impact on LE, and these were estimated to be most severe in the most deprived areas. The modelled impact on inequalities in LE was widening of the gap between the most and least deprived 20% of areas by a further 21 weeks for females and 23 weeks for males.InterpretationThis study provides further evidence that austerity, in the form of cuts to social security benefits, is likely to be an important cause of stalled LE across the UK.

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