Clinical audit on nice guidance on anticholinesterases in a memory clinic

2011 ◽  
Vol 26 (S2) ◽  
pp. 829-829
Author(s):  
S. Bangar ◽  
R. Powell
Keyword(s):  
Mental Health ◽  
Clinical Audit ◽  
Mmse Score ◽  
Clinical Excellence ◽  
Memory Clinic ◽  
Baseline Mmse Score ◽  
Nice Guidance

IntroductionThe National Institute for Clinical Excellence (NICE) has laid down certain guidelines for prescribing Anti-cholinesterases in patients with dementia. Keeping in mind the NICE guidance, an audit was conducted to see whether these were followed.Aims and objectivesTo ascertain the level of compliance to the NICE guidance and ensure they are adhered to.MethodThe data was collected from patients attending the memory clinic at Park Royal Centre for Mental Health in Central London over a six month period. Sixteen patients were randomly selected for this audit. The baseline MMSE score was recorded and also the medication prescribed.ResultsThe baseline MMSE score in all the 16 (100%) patients was above the recommended score of 12.The MMSE score was done in 12(75%) patients during follow up at 4–6 months.Of the 12 available MMSE scores at follow up, none were below 12 and hence continued treatment.In 2 (12.5%) patients there was an improvement, in 6 (37.5%) patients there was a fall and in 4 (25%) patients there was no change in the MMSE score at follow up.ConclusionIt was found that the NICE guidance was followed in most (75%) patients.

scholarly journals Naturalistic audit of NICE criteria for the use of cholinesterase inhibitors

2005 ◽  
Vol 29 (11) ◽  
pp. 410-412 ◽  
Author(s):  
Steve Simpson ◽  
Diane Beavis ◽  
Adrian Leddy ◽  
Sue Ball ◽  
Ian Johnson
Keyword(s):  
Old Age ◽  
Cholinesterase Inhibitors ◽  
Mmse Score ◽  
Clinical Excellence ◽  
Adverse Outcomes ◽  
Response To Treatment ◽  
Health Authorities ◽  
Antidementia Drugs ◽  
Nice Guidance ◽  
State Examination

Aims and MethodIn 2001 the National Institute for Clinical Excellence (NICE) produced guidance for the treatment of Alzheimer's disease. NICE encourages the withdrawal of medication when the Mini-Mental State Examination (MMSE) score reaches 12 and advises against the treatment of patients with cholinesterase inhibitors if the MMSE score is below 12. Most health authorities have rigorously enforced these guidelines, which has put old age psychiatrists in a difficult position. Our prospective 12 week audit of consecutive patients examines the response to treatment of patients treated both in accordance with and outside of NICE criteria. We also investigated the effect of stopping the medication according to NICE's recommendation.ResultsOur results suggest that patients outside the NICE criteria respond better than those within the criteria. More disturbingly, when the medication was stopped owing to the MMSE score falling below 12, we found a very high mortality rate (5 out of 25, 20%) or acute deterioration (12 out of 25, 48%). This suggests that the medication is beneficial in the later stages and should not be stopped purely because of the stage of dementia.Clinical ImplicationsIf we are to prevent unnecessary suffering, greater freedom is needed by old age psychiatrists in the use of these antidementia drugs. Patients with severe dementia may benefit from acute treatment. The withdrawal of medication in line with NICE guidance is poor clinical practice and likely to have adverse outcomes in a large proportion of cases.

scholarly journals The clinical effectiveness of a cognitive behavioural therapy intervention in a work setting: a 5-year retrospective analysis of outcomes

2018 ◽  
Vol 23 (4) ◽  
pp. 360-372
Author(s):  
David Hitt ◽  
Tayyeb Tahir ◽  
Lyndon Davies ◽  
Jo Delahay ◽  
Mark Kelson
Keyword(s):  
Mental Health ◽  
Cognitive Behavioural Therapy ◽  
Clinical Excellence ◽  
Clinical Effectiveness ◽  
Positive Outcome ◽  
Behavioural Therapy ◽  
Funding Agency ◽  
Cognitive Behavioural ◽  
Significant Difference

Background The National Institute for Health and Clinical Excellence (NICE) guidance recommends Cognitive Behavioural Therapy (CBT) as part of multidisciplinary occupational mental health interventions for people with long-term or recurrent short-term sickness absence from work (NICE, 2009). Despite this, there is a paucity of data for both randomised trials for CBT and literature that supports the transferability of CBT into occupational environments. Aims This service evaluation aimed to evaluate the clinical effectiveness of CBT by analysing data from a partnership scheme between a local authority and a local heath board using a routine employee population. Methods A clinical cohort of 81 employees referred through the partnership scheme completed CBT over a 5-year period via a CBT nurse therapist. A sample of 76 employees was included in the evaluation who completed pre-/post-measures to establish outcome. Of these, 30 were followed up at a 3-year point, completing the same measures. Results Each of the clinical measures yielded significant outcomes at 95% confidence intervals, and large effect sizes using Cohen’s d both at post-test and follow-up. No significant difference was shown between post-treatment and follow-up outcomes. CBT was demonstrated to be clinically effective within an occupational mental health setting. Conclusions In conclusion, partnership schemes with a focus on mental health between public sector agencies can have a positive outcome for the funding agency as well as individual employees.

TP3-9 Assessment of seizures in over 75-year olds: a clinical audit

2019 ◽  
Vol 90 (3) ◽  
pp. e20.3-e21
Author(s):  
ZT Ahmed ◽  
A Rather
Keyword(s):  
Current Practice ◽  
Clinical Audit ◽  
Data Entry ◽  
Integrated Approach ◽  
Initial Assessment ◽  
National Audit ◽  
Retrospective Audit ◽  
Specialist Referral ◽  
Nice Guidance

ObjectivesThis audit evaluates the assessment of first seizures in over 75-year-olds within our centre using NICE guidance (CG137) as our standard. This is in response to the National Audit of Seizure management in Hospitals which revealed significant deficits in current practice.DesignA retrospective audit design was used.SubjectsWe reviewed patient records of 74 patients over the age of 75 who presented to A+E with their first seizure between 1 st January and 30th April 2017.MethodsData entry took place between 14th November and 22nd January when follow-up information should have been available. A proforma based on current NICE guidance was used to evaluate initial assessment, investigations and specialist review.Results38 females and 36 males were assessed with an average age of 83 years (range 76–95). NICE recommends that all patients are seen by a specialist within 2 weeks, however only 38% of our patients met this standard. Only 65% of patients indicated for an EEG had one and 34% waited longer than the recommended 4 weeks. Neuroimaging was optimal with 95% of patients receiving an MRI within 4 weeks. In contrast, blood glucose was only measured in 47% of patients and only 51% had a 12-lead ECG despite recommendations that these investigations should be performed routinely.ConclusionsThere is a lack of comprehensive A+E assessments and specialist referral for older people both within our centre and nationally. A more thorough and integrated approach is needed to improve outcomes and optimise care.

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis
Keyword(s):  
Mental Health ◽  
Mental Disease ◽  
Brain Disorders ◽  
Social Stressors ◽  
Labor Education ◽  
Mental Diseases ◽  
Long Term Follow Up ◽  
Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

Gestational diabetes mellitus: are mothers being followed-up? A retrospective study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697469
Author(s):  
Rebecca Ward ◽  
Fahmy W Hanna ◽  
Ann Shelley-Hitchen ◽  
Ellen Hodgson ◽  
Adrian Heald ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Median Time ◽  
Post Partum ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Tertiary Referral Centre ◽  
Alternative Approach ◽  
Nice Guidance ◽  
History Of

BackgroundWomen with gestational diabetes (GDM) have an elevated risk of developing type 2 diabetes (T2DM). NICE Guidance recommends women who develop GDM are screened 6 weeks post-partum and annually thereafter.AimTo evaluate conformity to guidance of screening in women with GDM by 6-week post-partum fasting plasma glucose (FPG) and annual FPG and determine time between delivery and development of T2DM.MethodRecords at a tertiary referral centre were used to identify women (n = 54) diagnosed with GDM by antenatal oral glucose tolerance test between July 1999 and January 2007. Data from laboratory records were used to collect investigations of glycaemic status during the follow-up period (median follow-up 12.4 years, range 9.5–17.1 years).ResultsOf 252 women, 102 (40.2%) did not have a FPG at 6 weeks (+/−2 weeks). Of these, median time to first test was 1.2 years (range 0.04–10.8 years), with only 43.1% followed-up within 1 year. In those who had a 6-week FPG, 17 (11.3%) women had no further tests. A total of 84 (33% of those with gestational diabetes in the index pregnancy) women were diagnosed with T2DM; median time from delivery to diagnosis was 5.2 years (range 0.35–15.95). We found the only significant factor for a follow-up test at 1-year post-partum was the use of insulin.ConclusionOur data suggest an alternative approach is needed for monitoring women with a history of GDM. This needs to be appropriate for a generally healthy group in which traditional screening mechanisms may not be adequate or sufficient.

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