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.

Ethnicity and outcome of psychosis

1999 ◽  
Vol 175 (1) ◽  
pp. 34-42 ◽  
Author(s):  
Nicky Goater ◽  
Michael King ◽  
Eleanor Cole ◽  
Gerard Leavey ◽  
Eric Johnson-Sabine ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Black People ◽  
Incidence Rates ◽  
Psychotic Illness ◽  
Term Outcome ◽  
Cross Sectional ◽  
Long Term Outcome ◽  
Course Of Illness ◽  
The Uk ◽  
Asian People

BackgroundAn excess of psychotic illness in Black people has been found in cross-sectional studies. Little is known about the outcome of psychosis in different ethnic groups in the UK.AimsTo compare the incidence, nature and long-term outcome of psychosis in different ethnic groups.MethodA five-year, prospective study of an epidemiological cohort of people with a first contact for psychosis.ResultsAge-standardised incidence rates for schizophrenia and non-affective psychosis were higher for Black and Asian people than Whites. Stability of diagnosis and course of illness were similar in all ethnic groups. During the fifth year, Black people were more likely than others to be detained, brought to hospital by the police and given emergency injections.ConclusionsThe nature and outcome of psychotic illness is similar in all ethnic groups but Black people experience more adverse contacts with services later in the course of illness.

Improving physical health of patients with mental health problems

2011 ◽  
Vol 26 (S2) ◽  
pp. 1234-1234
Author(s):  
F. Cheema ◽  
J. Graham ◽  
D. Moffat ◽  
C. Gordon
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Community Mental Health ◽  
Physical Health ◽  
Health Monitoring ◽  
Mental Health Problems ◽  
Health Problems ◽  
Community Mental Health Service ◽  
Individual Parameter ◽  
Mental Health Difficulties

It is well recognised that individuals with severe mental health difficulties have increased risks of significant physical health problems and that some of the treatments for mental health problems can cause physical health difficulties as side effects. It is also known that people with mental health difficulties do not present themselves regularly for physical health monitoring as suggested by national and international guidelines. We show how a secondary care community mental health service cooperated with primary care general medical services to increase the take up of physical health monitoring by patients with severe and enduring mental health problems.Staff in the community mental health team which served a rural/small urban population identified patients with severe and enduring mental health difficulties or those patients on medications linked to physical problems and contacted the primary care physicians responsible for the patients’ general care with patient details and encouraged patient attendance for physical health monitoring. Physical monitoring included blood pressure, ECG, glucose, thyroid, lipids, height and weight. Post-intervention attendance figures show an increase of 30% in patients attending physical health reviews compared with pre-intervention figures. The intervention has been now rolled out to a larger catchment area of 25000 persons.[Physical health monitoring by individual parameter]

scholarly journals A Qualitative 5-Country Comparison of the Perceived Impacts of COVID-19 on People Living with Dementia and Unpaid Carers

2021 ◽  
Author(s):  
Clarissa Giebel ◽  
Katarzyna Lion ◽  
Maria Mackowiak ◽  
Rabih Chattat ◽  
PN Suresh Kumar ◽  
...  
Keyword(s):  
Public Health ◽  
Physical Health ◽  
Support Services ◽  
Public Health Problem ◽  
Emotional Impact ◽  
Global Public Health ◽  
Global Comparison ◽  
People With Dementia ◽  
Informal Carers ◽  
The Uk

Abstract Background Emerging evidence shows an impact of the COVID-19 pandemic on people living with dementia and informal carers, without any evidence-based global comparison to date. The aim of this international study was to explore and compare the perceived impact of COVID-19 and associated public health restrictions on the lives of people living with dementia and informal carers and access to dementia care across five countries. Methods Informal carers and people living with dementia who were residing in the community in the UK, Australia, Italy, India, and Poland were interviewed remotely between April and December 2020. Participants were asked about their experiences of the pandemic and how restrictions have impacted on their lives and care. Transcripts were analysed by researchers in each country using inductive thematic analysis. Results Fifteen people living with dementia and 111 informal carers participated across the five countries. Four themes emerged: (1) Limited access and support; (2) Technology and issues accessing remote support; (3) Emotional impact; and (4) Decline of cognitive and physical health reported by carers. Whilst variations were noted, the pandemic has indirectly affected people with dementia and carers across all five countries. The pandemic removed access to social support services and thus increased carer burden. Remote services were not always provided and were very limited in benefit and usability for those with dementia. As a result, carers appeared to notice reduced cognitive and physical health in people with dementia. Particular differences were noted between India and Poland vs. the UK, Italy, and Australia, with less impact on care provision in the former due to limited uptake of support services pre-pandemic based on cultural settings. Conclusions The pandemic has amplified dementia as a global public health problem, and people affected by the condition need support to better access vital support services to live well.

scholarly journals Antipsychotic monitoring in dementia: quality of completion of antipsychotic monitoring forms in an older adult mental health service

2021 ◽  
pp. 1-7
Author(s):  
Helen Anderson ◽  
Anna Kolliakou ◽  
Daniel Harwood ◽  
Nicola Funnell ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Health Monitoring ◽  
Psychological Symptoms ◽  
Antipsychotic Treatment ◽  
Pharmacological Interventions ◽  
Health Records ◽  
People With Dementia ◽  
Adult Mental Health Service

Aims and method To support safe prescribing of antipsychotics in dementia, antipsychotic monitoring forms were embedded into our electronic health records. We present a review of the data collected on these forms to assess prescribing and identify areas for improvement in our practice and processes. Data were extracted from the structured fields of antipsychotic initiation and review forms completed between 1 January 2018 and 31 January 2020. Results We identified gaps in practice where improvements could be made, mainly with regard to physical health monitoring (and particularly electrocardiograms, performed in only 50% of patients) and the low (less than 50%) recorded use of non-pharmacological interventions for behavioural and psychological symptoms of dementia. In addition, antipsychotic treatment was continued despite lack of benefit in almost 10% of reviews. Clinical implications We advocate for recommendations on physical health monitoring of people with dementia taking antipsychotics to be added to the National Institute for Health and Care Excellence guidance on dementia and the Prescribing Observatory for Mental Health (POMH-UK) national audit.

scholarly journals Haematological abnormalities in new-onset rheumatoid arthritis and risk of common infections: a population-based study

Rheumatology ◽  
2019 ◽  
Vol 59 (5) ◽  
pp. 997-1005 ◽  
Author(s):  
Elena Nikiphorou ◽  
Simon de Lusignan ◽  
Christian Mallen ◽  
Kaivan Khavandi ◽  
Jacqueline Roberts ◽  
...  
Keyword(s):  
Primary Care ◽  
Influenza Vaccination ◽  
Proportional Hazards ◽  
Population Based ◽  
Infection Risk ◽  
Cox Proportional Hazards ◽  
Population Based Study ◽  
Cox Proportional Hazards Models ◽  
The Uk ◽  
Common Infections

Abstract Objectives To describe the prevalence of haematological abnormalities in individuals with RA at the point of diagnosis in primary care and the associations between haematological abnormalities, vaccinations and subsequent risk of common infections. Methods We studied 6591 individuals with newly diagnosed RA between 2004 and 2016 inclusive using the UK Royal College of General Practitioners Research and Surveillance Centre primary care database. The prevalence of haematological abnormalities at diagnosis (anaemia, neutropenia and lymphopenia) was established. Cox proportional hazards models were used to evaluate the association between each haematological abnormality and time to common infections and the influence of vaccination status (influenza and pneumococcal vaccine) on time to common infections in individuals with RA compared with a matched cohort of individuals without RA. Results Anaemia was common at RA diagnosis (16.1% of individuals), with neutropenia (0.6%) and lymphopenia (1.4%) less so. Lymphopenia and anaemia were associated with increased infection risk [hazard ratio (HR) 1.18 (95% CI 1.08, 1.29) and HR 1.37 (95% CI 1.08, 1.73), respectively]. There was no evidence of an association between neutropenia and infection risk [HR 0.94 (95% CI 0.60, 1.47)]. Pneumonia was much more common in individuals with early RA compared with controls. Influenza vaccination was associated with reduced risk of influenza-like illness only for individuals with RA [HR 0.58 (95% CI 0.37, 0.90)]. Conclusion At diagnosis, anaemia and lymphopenia, but not neutropenia, increase the risk of common infections in individuals with RA. Our data support the effectiveness of the influenza vaccination in individuals with RA.

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 Perceptions of disadvantage, ethnicity and psychosis

2008 ◽  
Vol 192 (3) ◽  
pp. 185-190 ◽  
Author(s):  
Claudia Cooper ◽  
Craig Morgan ◽  
Majella Byrne ◽  
Paola Dazzan ◽  
Kevin Morgan ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Black People ◽  
Religious Affiliation ◽  
Population Based ◽  
First Episode ◽  
Black African ◽  
Episode Psychosis ◽  
African Caribbean ◽  
The Uk ◽  
Control Study

BackgroundPeople from Black ethnic groups (African-Caribbean and Black African) are more prone to develop psychosis in Western countries. This excess might be explained by perceptions of disadvantage.AimsTo investigate whether the higher incidence of psychosis in Black people is mediated by perceptions of disadvantage.MethodA population-based incidence and case-control study of first-episode psychosis (Aetiology and Ethnicity in Schizophrenia and Other Psychoses (ÆSOP)). A total of 482 participants answered questions about perceived disadvantage.ResultsBlack ethnic groups had a higher incidence of psychosis (OR=4.7, 95% CI 3.1–7.2). After controlling for religious affiliation, social class and unemployment, the association of ethnicity with psychosis was attenuated (OR=3.0, 95% CI 1.6–5.4) by perceptions of disadvantage. Participants in the Black non-psychosis group often attributed their disadvantage to racism, whereas Black people in the psychosis group attributed it to their own situation.ConclusionsPerceived disadvantage is partly associated with the excess of psychosis among Black people living in the UK. This may have implications for primary prevention.

Does ethnicity influence dementia, stroke and mortality risk? Evidence from the UK Biobank

2021 ◽  
Author(s):  
Bruno Bonnechère ◽  
Jun Liu ◽  
Alexander Thomson ◽  
Najaf Amin ◽  
Cornelia van Duijn
Keyword(s):  
Risk Factors ◽  
Black People ◽  
Final Analysis ◽  
Uk Biobank ◽  
White People ◽  
People With Dementia ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
The Difference ◽  
The Uk

Abstract The number of people with dementia and stroke, which are heritable diseases, is increasing worldwide. There is increasing evidence that there are clinically relevant genetic differences across ethnicities. This study aims to quantify risk factors of dementia, stroke, and mortality in Asian and black participants compared to whites. 272,660 participants from the UKBiobank were included in the final analysis, among whom the vast majority are white (97.80%), followed by Asian (1.35%), and black (0.84%) participants. After adjusting for risk factors, black participants have an increased risk of dementia and stroke compared to whites participants, while Asians did not. The risk of mortality is not different in blacks and white participants but Asians have a decreased risk. This study highlights the difference in the risk of dementia and stroke in black people living in the UK compared to white people.

scholarly journals Identifying People with Dementia in Electronic Primary Care Records in the UK

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Kang ◽  
S Lewis ◽  
J Gladman ◽  
V Wardt ◽  
J Gibson
Keyword(s):  
Primary Care ◽  
Incidence Rates ◽  
Health Improvement ◽  
Annual Review ◽  
Presenile Dementia ◽  
Broad Definition ◽  
Diagnostic Codes ◽  
People With Dementia ◽  
Definition Of ◽  
The Uk

Abstract Background Many epidemiological questions need to be answered regarding dementia, including the causes, prognosis, comorbidities, and treatment of the condition and complications. A routine electronic primary care dataset provides a way of investigating some of the complicated factors with rich information. However, there has been concern regarding whether dementia is recorded well enough. Methods This study has therefore explored this by conducting a systematic review to understand how dementia has been identified previously in primary care databases in the UK, and added to this by exploring additional terms and symptoms, and medications that might be helpful in identifying people with dementia. The study estimated the prevalence and incidence rates of dementia in The Health Improvement Network (THIN) database and compared with other longitudinal studies using the comprehensive list of diagnostic codes. Results The estimated incidence rates per 1,000 person-years for the 60+ age group who had any of the first diagnosis among the Quality Outcomes Framework (QOF) defined codes, Other diagnoses, Dementia symptoms and Prescribed medications were 2.5, 4.7, and 15.9 in 1995, 2004, and 2015 respectively. The estimated prevalence were 2.8, 3.2, and 10.2 in 1995, 2004, and 2015 respectively. Conclusions The codes related to dementia symptoms (represented by mini-mental state examination, the six item cognitive impairment test, referral to memory clinic and behaviour assessment) seem to cover a broad definition of dementia or pre-existing dementia population in the UK primary care records. At least, using of the Other diagnoses (represented by dementia annual review, senile/presenile dementia and dementia monitoring) in addition to the QOF defined codes, and Prescribed medications were evidenced that will not missing out a number of people with dementia. Key messages The codes related to dementia symptoms seem to cover a broad definition of dementia or pre-existing dementia population in electronic primary care records in the UK. Nevertheless, the codes about non-specific or temporary symptoms may need to be used carefully as it is possible for memory or cognitive function to be impaired temporarily due to other factors.

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