Documenting the decision-making process for initiation of pharmacological VTE prophylaxis in patients admitted to an adult psychiatry ward background

2017 ◽  
Vol 41 (S1) ◽  
pp. S615-S615
Author(s):  
G. Sikka ◽  
N. Mistry
Keyword(s):  
Blood Clot ◽  
Venous Blood ◽  
Assessment Data ◽  
Nice Guidelines ◽  
Vte Prophylaxis ◽  
Adult Psychiatry ◽  
Competing Interest ◽  
To Receive ◽  
Calf Pain ◽  
Learning Points

BackgroundVenous thromboembolism (VTE) is a condition that causes a blood clot to form within the venous blood system. If this blood clot forms in the peripheral venous system, it can cause symptoms such as calf pain and swelling. If this clot becomes dislodged, it may travel through the vessels into the pulmonary artery which can have much more severe consequences.ObjectivesThere has been a great deal of effort in recent years to increase the percentage of in-patients receiving a VTE assessment; and for those patients to receive appropriate VTE prophylaxis. VTE is a significant cause of inpatient deaths. This audit aims to compare current working practice to local standards and identify learning points.MethodVTE assessment data were collected from two acute psychiatric in-patient wards within a specified, random date range in 2016. Data was collected by checking paper admission documentation. NICE guidelines also state that all patients should be assessed for VTE on admission, with a standard of 100%.ResultsOverall, 6.25% of general adult psychiatry patients had a VTE assessment done within 24 hours of admission.ConclusionThis audit shows that the necessary standards are not met. Importance of these assessments will be communicated during induction programmes for all staff and the results of this audit communicated to current staff on all in-patient psychiatry wards.Disclosure of interestThe authors have not supplied their declaration of competing interest.

VTE and physical health assessment upon admission to acute functional and organic psychiatric in-patient wards: An audit

2017 ◽  
Vol 41 (S1) ◽  
pp. S479-S479
Author(s):  
N. Mistry ◽  
G. Sikka
Keyword(s):  
Physical Health ◽  
Blood Clot ◽  
Venous Blood ◽  
Health Assessment ◽  
Nice Guidelines ◽  
Vte Prophylaxis ◽  
Health And Wellbeing ◽  
Competing Interest ◽  
To Receive ◽  
Calf Pain

IntroductionVenous thromboembolism (VTE) is a condition that causes a blood clot to form within the venous blood system. If this blood clot forms in the peripheral venous system it can cause symptoms such as calf pain and swelling. If this clot becomes dislodged, it may travel through the vessels into the pulmonary artery which can have much more severe consequences.ObjectivesThere has been a great deal of effort in recent years to increase the percentage of in-patients receiving a VTE assessment; and for those patients to receive appropriate VTE prophylaxis. VTE is a significant cause of inpatient deaths. This audit aims to compare current working practice to local standards and identify learning points.MethodsVTE and physical health assessment data was collected by checking electronic admission summaries from three acute psychiatric in-patient wards on a random date in 2016. The local pathway for the management of physical health and wellbeing states that the VTE assessment and Physical Health Assessment should be completed within 6 hours of admission. NICE guidelines also state that all patients should be assessed on admission, with a standard of 100%.Results60% of patients had a VTE assessment and 54% of patients had a physical health assessment done within 6 hours of admission.ConclusionsThis audit shows that the necessary standards are not met. Importance of these assessments has been communicated during induction programmes for all staff.Disclosure of interestThe authors have not supplied their declaration of competing interest.

EP.FRI.771 National audit on VTE prophylaxis for lower limb injuries treated in a plaster cast

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Georgios Karagiannidis ◽  
Omar Toma
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Lower Limb ◽  
Plaster Cast ◽  
Junior Doctors ◽  
National Audit ◽  
Lower Limb Injuries ◽  
Nice Guidelines ◽  
Vte Prophylaxis ◽  
Limb Injuries

Abstract Aims Audit to assess Orthopaedic departments’ compliance with NICE guidelines on Venous thromboembolism (VTE) prophylaxis published in 2010, specifically looking at VTE practices for patients with lower limb injuries treated in a plaster cast. Methods A telephonic survey was carried out on junior doctors within orthopaedic departments of 66 hospitals across all regions of England. A questionnaire was completed regarding VTE risk assessment, prophylaxis and hospital guidelines etc. Data collected from August 2016 till February 2017. Results 83% (n = 55) of trusts routinely give VTE prophylaxis to these patients. 96% (n = 64) give Chemoprophylaxis of some sort. Formal VTE assessments are performed in 81% (n = 54) and 77% (n = 51) have a local VTE prophylaxis policy. Conclusions We conclude that Orthopaedic departments across England have increased compliance with NICE guidelines for VTE prophylaxis. However there is considerable variation in practice, especially in duration and chemoprophylaxis agent. We attribute this to the lack of specific NICE guidelines for this cohort of patients. We aim that this study can influence NICE to introduce added guidance that will standardise practice.

Duloxetine augmentation in resistant obsessive compulsive disorder: Surveying a new medication for challenges in treatment of OCD

2017 ◽  
Vol 41 (S1) ◽  
pp. S415-S415
Author(s):  
A. Mowla
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Primary Outcome Measure ◽  
Controlled Clinical Trial ◽  
Double Blind Study ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Compulsive Disorder ◽  
Significant Difference ◽  
Competing Interest ◽  
To Receive

IntroductionUp to 50% of patients with OCD have failed to respond in SSRI trials, so looking for pharmacological alternatives in treatment of obsessive compulsive disorder (OCD) seems necessary.ObjectivesSurveying duloxetine augmentation in treatment of resistant OCD.AimsStudy the effects of serotonin-norepinephrine enhancers for treatment of OCD.MethodsThis augmentation trial was designed as an 8-week randomized controlled, double blind study. Forty-six patients suffering from OCD who had failed to respond to at least 12 weeks of treatment with a selective serotonin reuptake inhibitor (fluoxetine, citalopram or fluvoxamine) were randomly allocated to receive duloxetine or sertraline plus their current anti OCD treatment. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure.ResultsForty-six patients (24 of 30 in duloxetine group and 22 of 27 in sertraline group) completed the trial. Both groups showed improvement over the 8-week study period (mean Y-BOCS total score at week 8 as compared with baseline: P < 0.001 and P < 0.001) without significant difference (P = 0.861). Those receiving duloxetine plus their initial medications experienced a mean decrease of 33.0% in Y-BOCS score and the patients with sertraline added to their initial medication experienced a mean decrease of 34.5% in Y-BOCS.ConclusionsOur double blind controlled clinical trial showed duloxetine to be as effective as sertraline in reducing obsessive and compulsive symptoms in resistant OCD patients. However, it needs to be noted that our study is preliminary and larger double blind placebo controlled studies are necessary to confirm the results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A Population Service Evaluation of the ADHD Pathway of Children and Young People's Services, Malta

2017 ◽  
Vol 41 (S1) ◽  
pp. S222-S223
Author(s):  
A. Saliba ◽  
D. Agius ◽  
E. Sciberras ◽  
N. Camilleri
Keyword(s):  
Neurodevelopmental Disorder ◽  
Reliability And Validity ◽  
Service Evaluation ◽  
Assessment Process ◽  
Retrospective Case ◽  
Pharmacological Management ◽  
Nice Guidelines ◽  
Case File ◽  
Mean Waiting Time ◽  
Competing Interest

IntroductionADHD is the commonest neurodevelopmental disorder in young people (YP) aged 5–18 years. YP with untreated ADHD are 5 times more likely to develop co-morbid psychiatric disorders.ObjectivesTo carry out a population service evaluation of the assessment process and management of YP with ADHD at Child and Young People's Service (CYPS), Malta age 0–16 years for 2014.AimsTo describe the service input, assessment and treatment of YP attending CYPS and compare to ADHD NICE guidelines 2008.MethodsAll patients diagnosed with ADHD at CYPS throughout 2014 were included. The incidence of YP with ADHD on treatment age 3–16 years in Malta was calculated. Information was collected from; (i) retrospective case file review and (ii) methylphenidate and atomoxetine registry and compared with NICE guidelines.ResultsOne hundred and thirty-six YP were diagnosed with ADHD. The minimum 12-month incidence of ADHD on treatment (3–16 years) in Malta was 553 per 100,000. Pre-diagnosis assessments were more frequently performed by other YP services (n = 97, 71.3%, P ≤ 0.01). A psychiatrist or paediatrician confirmed the diagnosis in 113 (83.1%). Sixty-two (45.3%) of YP were prescribed medication, 50 (36.8%) were referred for parental skills course and 55 (40.4%) psychotherapy. Mean waiting time for first appointment was 187.6 days (CI ± 26.9, 0–720), and first specialist review was 301.0 days (CI ± 34.4, 0–800) (1–3).ConclusionsThe incidence for YP (3–16 years) with ADHD on treatment was lower than the US. Since most pre-diagnostic assessments were carried out by other services, this raised the question about the reliability and validity. We recommend a diagnostic MDT meeting following the multimodal assessment to diagnose ADHD. Medication prescribing followed NICE overall, standardising non-pharmacological management is required.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Audit of patients with intellectual disabilities accessing a specialist neuropsychiatry service for epilepsy management

2017 ◽  
Vol 41 (S1) ◽  
pp. S352-S352
Author(s):  
A. Adetoki
Keyword(s):  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Total Sample ◽  
Best Interest ◽  
Nice Guidelines ◽  
Specialist Services ◽  
Co Morbidity ◽  
Planning Processes ◽  
Competing Interest ◽  
Equity Of Access

IntroductionEpilepsy is a frequent co-morbidity in patients with intellectual disabilities, some of whom require specialist services. The National institute for health and care excellence (NICE) has recommended that there should be equity of access to high quality of care regardless of the existence of a diagnosis of intellectual disability.ObjectivesTo observe current practice with regards to NICE guidelines for epilepsy care in patients with intellectual disability.AimsTo identify the level of compliance with NICE guidelines and provide evidence which may inform care planning processes.MethodsA retrospective review of the electronic and paper-based records of a total sample of intellectually disabled patients who accessed a specialist neuropsychiatry service for the management of epilepsy during a six-month period was carried out.ResultsThe records of 21 patients whose ages ranged from 20 to 58 years were audited. The waiting period ranged from 4 weeks to 46 weeks. There was evidence of Carer involvement in the management of 100% of the patients and seizure improvement since referral was documented in 66%. Non- medication treatment was offered in 67% of cases. Evidence of special considerations in view of patient's intellectual disability was recorded in 24%, best interest considerations in 24% and capacity assessment in 19%.ConclusionsThere is a significant improvement in the symptoms of 66% of patients in this audit. However there is room for improvement and a more specific plan for patients with intellectual disabilities should facilitate this.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

scholarly journals Neurodevelopment disorders in adolescence and transition into adulthood

2017 ◽  
Vol 41 (S1) ◽  
pp. 914-914
Author(s):  
A. Moscoso
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Strong Predictor ◽  
Psychiatric Morbidity ◽  
Later Life ◽  
Transitional Period ◽  
Adult Psychiatry ◽  
Competing Interest ◽  
Therapeutic Tools ◽  
Time Specific

The transitional period from adolescence into adulthood is an important developmental stage, known to be a risk factor for mental health problems. Neuropsychiatric disorders are the main cause of disability for young people aged 10–24 years and they seem to precede mental health disorders in adults. Since persistence of an adolescent episode is a strong predictor of outcome, giving proper care during critical stages might prevent later life psychiatric morbidity arising from adolescent-onset disorders. Mental health services for adolescents have evolved from non-specific secondary treatment to more extensive treatment goals, where prevention and early diagnosis take place; at the same time, specific therapeutic tools for adolescents are increasing and put into practice. In Europe, both child and adolescent psychiatrists (CAP) and adult psychiatrists treat adolescents, and for a few countries, the specialty of adolescent psychiatry exists. In this symposium, we propose to address new strategies to treat adolescents with defying pathologies that often pose problems; we will do it through the scope of CAP and adult psychiatry.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals Building national associations for psychiatry trainees: The MENTA recipe for success

2017 ◽  
Vol 41 (S1) ◽  
pp. 912-912
Author(s):  
T.M. Gondek
Keyword(s):  
Working Group ◽  
Task Force ◽  
Child And Adolescent Psychiatry ◽  
Early Career ◽  
Psychiatric Training ◽  
European Federation ◽  
Adult Psychiatry ◽  
Umbrella Organization ◽  
Competing Interest ◽  
Work Done

European Federation of Psychiatric Trainees (EFPT) is an umbrella organization for national psychiatric trainee associations in Europe, aiming to develop collaboration between psychiatric trainees. EFPT states that organised trainee interest is crucial in promoting high quality psychiatric training, therefore it promotes that both general adult psychiatry and child and adolescent psychiatry trainees are represented by national trainee association in each European country. The Maintaining and Establishing a National Trainee Association Working Group (MENTA WG), a permanent EFPT working group, has been created to assist trainees in building a local trainee organization. MENTA WG supports organising meetings, helps manage the problems of functioning of an association, sends letters of support to national decision makers, helps prepare the organization's bylaws and facilitates the process of application for full EFPT membership. The group also helps reactivate the inactive associations and assists them in expansion and developing new initiatives. MENTA WG maintains close collaboration with the European Psychiatric Association Early Career Psychiatrists Committee (EPA ECPC) Task Force on Meetings and Associations and other organizations dedicated to early career psychiatrists, such as the Young Psychiatrists’ Network. In the last few years, due to the work done within MENTA WG, the EFPT family has grown and welcomed new official members, such as: Poland, Spain and Slovakia. Currently, we are planning on supporting trainees in Moldova, Bulgaria and Kosovo to establish new official organizations in these countries. We also expand our activities beyond Europe and offer counselling for psychiatric trainees from such countries as Australia or South Africa.Disclosure of interestThe author has not supplied his declaration of competing interest.

Psychiatric treatment-associated stigmatization as viewed through eyes of rural health clinic patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S740-S741
Author(s):  
D. Sendler ◽  
A. Markiewicz
Keyword(s):  
Trend Analysis ◽  
Rural Health ◽  
Rural Community ◽  
Psychiatric Treatment ◽  
Mental Disease ◽  
Psychiatric Patients ◽  
Qualitative Interviews ◽  
Health Clinic ◽  
Competing Interest ◽  
To Receive

IntroductionHaving a mental disease is frequently a stigmatizing experience for patients. We know little about urban inhabitants who travel to rural health clinics to receive mental treatment.ObjectivesRecruit and interview urban-based psychiatric patients who, to avoid stigmatization; travel to rural community clinics with the intention of receiving treatment.MethodsStudy included participants (n = 32) who exchanged treatment in government subsidized city clinics for rural community centers. Qualitative interviews lasting thirty minutes were recorded and transcribed for content analysis. MAXQDA, version 12, was used to annotate transcripts with topic specific nodes, followed by cluster theme and trend analysis.ResultsTrend analysis yielded three areas of concern for subsidized urban psychiatry: cost/insurance, lack of staff professionalism, and family-driven ostracism. Seven respondents cited cost as the main factor, influencing the choice of rural-based care over city clinic. Patients with stable income, but without insurance (n = 14), felt unwelcome in city clinics as their ability to pay was frequently questioned by supporting staff. Lack of trained social workers caused additional distress, as participants could not receive access to additional resources. Only four patients said that their psychiatrists acknowledged poor clinic environment and encouraged remaining in treatment. For 18 respondents, family demanded that they receive treatment in rural clinic so that no one finds out about their mental disease.ConclusionIn large urban clinics, stigma in psychiatry comes in many flavors, especially projected by unprofessional clinic staff and ashamed family. Lack of support forces patients to travel to rural premises to receive unbiased, stress-free care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Venous Thromboembolism in Critically Ill Cirrhotic Patients: Practices of Prophylaxis and Incidence

Thrombosis ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Hasan M. Al-Dorzi ◽  
Hani M. Tamim ◽  
Abdulaziz S. Aldawood ◽  
Yaseen M. Arabi
Keyword(s):  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Critically Ill ◽  
Cox Regression ◽  
Mechanical Prophylaxis ◽  
Cox Regression Analysis ◽  
Vte Prophylaxis ◽  
Pharmacologic Prophylaxis ◽  
Cirrhotic Patients ◽  
To Receive

Objectives. We compared venous thromboembolism (VTE) prophylaxis practices and incidence in critically ill cirrhotic versus noncirrhotic patients and evaluated cirrhosis as a VTE risk factor. Methods. A cohort of 798 critically ill patients followed for the development of clinically detected VTE were categorized according to the diagnosis of cirrhosis. VTE prophylaxis practices and incidence were compared. Results. Seventy-five (9.4%) patients had cirrhosis with significantly higher INR (2.2 ± 0.9 versus 1.3 ± 0.6, P<0.0001), lower platelet counts (115,000 ± 90,000 versus 258,000 ± 155,000/μL, P<0.0001), and higher creatinine compared to noncirrhotic patients. Among cirrhotics, 31 patients received only mechanical prophylaxis, 24 received pharmacologic prophylaxis, and 20 did not have any prophylaxis. Cirrhotic patients were less likely to receive pharmacologic prophylaxis (odds ratio, 0.08; 95% confidence interval (CI), 0.04–0.14). VTE occurred in only two (2.7%) cirrhotic patients compared to 7.6% in noncirrhotic patients (P=0.11). The incidence rate was 2.2 events per 1000 patient-ICU days for cirrhotic patients and 3.6 events per 1000 patient-ICU days for noncirrhotics (incidence rate ratio, 0.61; 95% CI, 0.15–2.52). On multivariate Cox regression analysis, cirrhosis was not associated with VTE risk (hazard ratio, 0.40; 95% CI, 0.10–1.67). Conclusions. In critically ill cirrhotic patients, VTE incidence did not statistically differ from that in noncirrhotic patients.

Sign in / Sign up

Export Citation Format

Share Document