scholarly journals Monitoring lithium therapy in a CMHRS during the COVID-19 pandemic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S187-S187
Author(s):  
Katherine Gardner ◽  
Charles Shuttleworth
Keyword(s):  
At Risk ◽  
Risk Category ◽  
First Year ◽  
Junior Doctors ◽  
North East ◽  
Routine Monitoring ◽  
Safety Alert ◽  
Effective Manner ◽  
National Patient ◽  
Reminder Letters

AimsThe COVID-19 pandemic has presented a challenge in ensuring that routine monitoring can still be offered and occur in a safe and effective manner. Our aim was to continue the regular physical health monitoring of North East Hampshire CMHRS patients who are prescribed lithium during the COVID-19 pandemic, and to achieve above 90% compliance for the monitoring standards. Lithium monitoring clinics have been established in our CMHRS since 2017, Lithium is a high-risk medication as recognised by a National Patient Safety Alert in 2009. Previous annual POMH-UK audits have identified suboptimal monitoring of Lithium patients at local and national levels.MethodThe ‘Plan-Do-Study-Act’ (PDSA) approach was utilised and a ‘QI Bundle’ formed. A database of patients who are prescribed lithium has been created and maintained. Synchronised standardised reminder letters are sent to the patients twice yearly. NICE recommends that patients on lithium have their lithium levels checked every 3 months for the first year and then at least every 6 months, plus TFTs, U&Es, calcium and weight every 6 months (or more frequently if impaired). The Specialist Pharmacist Service advise that during the COVID-19 pandemic, if patients are not in the at-risk category then monitoring intervals can be extended by up to 3 months, but that patients in the at-risk category should have their normal monitoring intervals continued.Lithium clinics have been held every April and October since 2017 by the Junior Doctors allocated to NE Hampshire CMHRS. This year they were conducted via telephone appointment or face to face where safe to do so with clinician in full PPE. An audit was subsequently carried out in December 2020 to assess our patient's compliance with the aforementioned NICE recommendations for lithium monitoring, the results of which were compared to previous annual audits.ResultSeventeen patients were currently prescribed lithium within the NE Hampshire CMHRS. Over 90% compliance with monitoring was achieved in December 2020 apart from the checking of calcium levels which was slightly below target at 82%, and weight which was at 88%. There was no significant reduction in monitoring standards obtained compared to data from the previous three years.ConclusionRoutine monitoring for our patients who are prescribed Lithium was effectively and safely continued during the pandemic. Above 90% compliance with lithium monitoring standards was nearly obtained across all areas. We will continue to offer lithium monitoring twice yearly.

scholarly journals Assessment of risk of developing diabetes using Indian diabetes risk score in the urban field practice area of Rajarajeswari Medical College and Hospital, Bangalore

2019 ◽  
Vol 7 (1) ◽  
pp. 170
Author(s):  
Nazia N. Shaik ◽  
Swapna M. Jaswanth ◽  
Shashikala Manjunatha
Keyword(s):  
At Risk ◽  
High Risk ◽  
Risk Score ◽  
Diabetes Risk ◽  
Low Risk ◽  
Risk Category ◽  
Moderate Risk ◽  
Medical College ◽  
Field Practice ◽  
Diabetes Risk Score

Background: Diabetes is one of the largest global health emergencies of the 21st century. As per International Federation of Diabetes some 425 million people worldwide are estimated to have diabetes. The prevalence is higher in urban versus rural (10.2% vs 6.9%). India had 72.9 million people living with diabetes of which, 57.9% remained undiagnosed as per the 2017 data. The objectives of the present study were to identify subjects who at risk of developing Diabetes by using Indian diabetes risk score (IDRS) in the Urban field practice area of Rajarajeswari Medical College and Hospital (RRMCH).Methods: A cross sectional study was conducted using a Standard questionnaire of IDRS on 150 individuals aged ≥20 years residing in the Urban field practice area of RRMCH. The subjects with score <30, 30-50, >or =60 were categorized as having low risk, moderate risk and high risk for developing diabetes type-2 respectively.Results: Out of total 150 participants, 36 (24%) were in high-risk category (IDRS≥60), the majority of participants 61 (41%) were in the moderate-risk category (IDRS 30–50) and 53 (35%) participants were found to be at low-risk (<30) for diabetes. Statistical significant asssociation was found between IDRS and gender, literacy status, body mass index (p<0.0000l).Conclusions: It is essential to implement IDRS which is a simple tool for identifying subjects who are at risk for developing diabetes so that proper intervention can be carried out at the earliest to reduce the burden of diabetes.

Cryptodiaporthe populea. [Descriptions of Fungi and Bacteria].

1973 ◽  
Author(s):  
C. Booth
Keyword(s):  
Geographical Distribution ◽  
Western Europe ◽  
First Year ◽  
Severe Damage ◽  
North East ◽  
Conidial State ◽  
Wide Range ◽  
East Russia ◽  
Second Year ◽  
Old Trees

Abstract A description is provided for Cryptodiaporthe populea. Information is included on the disease caused by the organism, its transmission, geographical distribution, and hosts. HOSTS: Poplar, willow. A wide range of poplar species are more or less susceptible, with members of the tacamahacca and algeros groups principally affected. Populus alba var. pyramidalis is very susceptible in Britain and P. alba and P. tremula are tolerant; complete resistance is unknown in the genus: The fungus has been recorded on cricket bat willow in Belgium. DISEASE: Dothichiza canker, Dorhichiza dieback, poplar canker. The conidial state is the form of this fungus most commonly found associated with the dieback or canker of poplar. The fungus is a wound parasite unable to invade sound bark tissues, although very small wounds, such as scars left by bud scales, may permit infection (38, 341). Infection usually occurs in the winter, when bark moisture and turgor are lowest (36, 673; 37, 684). First signs are a discoloration of the cortex under the bark, which develops to a sunken, dead patch of bark, often at the base of twigs or at the junction of first-year and second-year wood. The lesion may have an unpleasant odour and later develops black, globular, pycnidia on the surface. The lesion may heal over in a single season but it can spread to cause severe damage or death of the host. Injury is believed to be due to toxin formation as well as physical girdling by the canker (35, 797; 38, 103). The crowns of old trees or young plants in nurseries and plantations are mainly affected. The disease may be distinguished from that caused by Valsa sordida Nits. by its larger conidia and larger and less frequent stromata in infected tissues. GEOGRAPHICAL DISTRIBUTION: Europe (all western Europe excluding Portugal, Norway, Yugoslavia, Rumania, Bulgaria, Poland, Estonia, Ukraine and south-east Russia). Near East (Turkey, Cyprus). North America (east Canada, north-east USA). South America (Argentina) (CMI Map 344, ed. 2, 1968). TRANSMISSION: Mainly by airborne splash-dispersed conidia.

From Medical Student to Medical Resident

2017 ◽  
pp. 145-169 ◽  
Author(s):  
Warren G. McDonald ◽  
Matt Martin ◽  
Lenard D. Salzberg
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Mental Health Problems ◽  
Medical Profession ◽  
Health Problems ◽  
Medical Residents ◽  
First Year ◽  
Practical Training ◽  
Systematic Screening ◽  
Health Distress

The transition from medical school to board-certified medical practice includes a period of intense, practical training known as medical residency. Medical residents are at risk for greater mental health distress than the general population. Interns, which are first year residents, are most at risk for, at worst, depression and suicidal ideation, and, at best, negative outlooks on the medical profession. Risk factors include role transition, decreased sleep, relocation, isolation, stigma toward mental health problems and treatment, and health care industry changes. Untreated mental health problems can lead to burnout later during a physician's career. Residents thrive on social and organisational support which can include systematic screening and treatment of mental health problems. Although research regarding best practices for addressing mental health problems during residency is limited, we offer four core strategies for preventing and addressing mental health problems in medical residents: education, screening, treatment, and support.

scholarly journals Levels of household mold associated with respiratory symptoms in the first year of life in a cohort at risk for asthma.

2002 ◽  
Vol 110 (12) ◽  
Author(s):  
Janneane F Gent ◽  
Ping Ren ◽  
Kathleen Belanger ◽  
Elizabeth Triche ◽  
Michael B Bracken ◽  
...  
Keyword(s):  
At Risk ◽  
Respiratory Symptoms ◽  
First Year ◽  
First Year Of Life

scholarly journals Impact of Malnutrition on Low Muscle Mass in Community-Dwelling Older People in Singapore: Findings from the SHIELD study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 80-80
Author(s):  
Siew Ling Tey ◽  
Samuel Teong Huang Chew ◽  
Yatin Berde ◽  
Geraldine Baggs ◽  
Choon How How ◽  
...  
Keyword(s):  
At Risk ◽  
Nutritional Status ◽  
Bone Mass ◽  
Older People ◽  
Muscle Mass ◽  
Community Dwelling ◽  
Risk Category ◽  
Calf Circumference ◽  
Factors Associated ◽  
Community Dwelling Older People

Abstract Objectives Malnutrition contributes to loss of muscle mass. There is limited information on the prevalence of low muscle mass in community-dwelling older people who are (not) at risk of malnutrition. Factors associated with muscle mass are also not well characterized. This cross-sectional study aimed to determine the prevalence of low appendicular skeletal muscle mass index (ASMI; ASM/height2) in older people with normal nutritional status (Malnutrition Universal Screening Tool, MUST risk category = low) and those at risk of malnutrition (MUST risk category = medium or high), and to determine factors associated with ASMI. Methods Strengthening Health In ELDerly through nutrition (SHIELD) is a study involving 1211 (400 with normal nutritional status and 811 at risk of malnutrition) community-dwelling older people aged ≥65 years in Singapore. Low ASMI was determined by bioelectrical impedance analysis (Asian Working Group for Sarcopenia, 2014). Results One in five (20.6%) nourished participants had low ASMI vs. four in five (81.3%) participants at risk of malnutrition had low ASMI (P &lt; 0.0001). Older people with low ASMI were more likely to be admitted to the hospital, had longer length of stay, 25-hydroxyvitamin D deficiency, and lower education level, compared to those with normal ASMI (all P ≤ 0.0472). In the multiple linear regression model, age (coefficient, b = −0.013 kg/m2; P &lt; 0.001), gender (female: b = −0.963 kg/m2; P &lt; 0.001), calf circumference (b = 0.042 kg/m2; P &lt; 0.001), bone mass (b = 0.593 kg/m2; P &lt; 0.001), BMI (b = 0.129 kg/m2; P &lt; 0.001), and Physical Activity Scale for the Elderly (PASE) score (b = 0.001 kg/m2; P = 0.048) were associated with ASMI. Conclusions Community-dwelling older people at risk of malnutrition had four-fold greater risk of having low ASMI as compared to nourished counterparts. Increasing age was associated with lower ASMI, whereas calf circumference, bone mass, BMI, PASE score, and being male were positively associated with ASMI. These findings highlight the importance of screening for low muscle mass and maintaining muscle health as part of the overall malnutrition management in this population group. Funding Sources The Economic Development Board of Singapore, Abbott Nutrition, and Changi General Hospital funded this study.

scholarly journals Getting Past the Gateway: An Exploratory Case on Using Utilitarian Scientific Literacy to Support First-Year Students At-Risk of Leaving STEM

2019 ◽  
Vol 9 (4) ◽  
pp. 265
Author(s):  
Chambers ◽  
Salter ◽  
Muldrow
Keyword(s):  
At Risk ◽  
Scientific Literacy ◽  
Student Experiences ◽  
Control Group ◽  
First Year ◽  
Students At Risk ◽  
First Year Students ◽  
Stem Pipeline ◽  
Literacy Course ◽  
The Impact

First-year students who enter college pursuing a STEM degree still face challenges persisting through the STEM pipeline (Chen, 2013; Leu, 2017). In this case study, researchers examine the impact of a utilitarian scientific literacy based academic intervention on retention of first-year students in STEM using a mixed methods approach. A sample (n = 116) of first-year students identified as at-risk of not persisting in STEM were enrolled in a for credit utilitarian scientific literacy course. Participants of the semester long course were then compared with a control group of first-year students identified as at-risk of persisting in STEM. A two-proportion z test was performed to assess the mean differences between students and participants of the course were given a survey to gauge student experiences. Quantitative results (φ 0.34, p < 0.05) indicate that the utilitarian scientific literacy course had a statistically significant impact on retention among first-year students at-risk of persisting in STEM. Moreover, qualitative data obtained from participant responses describe internal and external growth as positive outcomes associated with the intervention.

Mortality and breeding failure of little penguins, Eudyptula minor, in Victoria, 1995 - 96, following a widespread mortality of pilchard, Sardinops sagax

2000 ◽  
Vol 51 (4) ◽  
pp. 355 ◽  
Author(s):  
Peter Dann ◽  
F. I. Norman ◽  
J. M. Cullen ◽  
F. J. Neira ◽  
A. Chiaradia
Keyword(s):  
At Risk ◽  
Breeding Season ◽  
Breeding Success ◽  
Egg Laying ◽  
First Year ◽  
Breeding Failure ◽  
Food Species ◽  
Intestinal Parasitism ◽  
Western Victoria

In May 1995, numbers of little penguins, Eudyptula minor, coming ashore declined at Phillip Island and St Kilda concurrently with deaths of many penguins in western Victoria and a massive mortality of one of their food species (pilchard) throughout southern Australia. Among 1926 dead penguins reported were 131 banded birdsrecovered from Phillip Island (86% adults and 14% first-year birds), 26 from Rabbit Island and six from St Kilda. The number of banded penguins found dead per number of adult Phillip Island birds at risk was 2.3% in 1995 compared with an annual mean of 0.7% for 1970–93. Of 29 corpses autopsied, at least 26 died of starvation associated with mild–severe gastro-intestinal parasitism. Following the pilchard mortality, egg-laying by penguins in the subsequent breeding season (1995–96) was ~2 weeks later than the long-term mean and 0.3 chicks were fledged per pair compared with the long-term mean of 1.0. Unlike previous years, few penguins were recorded in Port Phillip Bay in September–October 1995, a period when pilchard schools were infrequently seen. It is concluded that the increase in penguin mortality in northern Bass Strait and the significant reduction in breeding success were associated with the widespread pilchard mortality.

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