285 Piloting and implementing an acute neurology service

2018 ◽  
Vol 89 (10) ◽  
pp. A43.2-A43
Author(s):  
Thomas Peukert
Keyword(s):  
Royal Victoria Hospital ◽  
Pilot Project ◽  
Neurological Symptoms ◽  
List Type ◽  
The Past ◽  
Rapid Access ◽  
Early Results ◽  
Number Of Patients ◽  
Neurology Clinic ◽  
Set Up

Over the past decade, the number of patients attending the emergency department (ED) at the Royal Victoria Hospital Belfast, with neurological symptoms, has doubled. Typically, over 50% of these patients would subsequently be admitted to hospital. In 2013, a pilot project was conducted with the aim of evaluating the effectiveness of a rapid access neurology clinic on reducing such admissions.A dedicated neurology clinic was set up offering 12 slots per week. Patients were seen within 10 days of ED staff booking them into the clinics. Early results indicated that within the first month 28 admissions were avoided. As a result rapid access neurology clinics were rolled out. Two acute neurologists were appointed and since 2015, 3 rapid access clinics run per week (15 slots). In addition to the rapid access clinics, the acute neurology team also offer two additional services:Reviewing all patients who have been admitted under the medical take with neurological symptomsPatients who attend ED overnight but require urgent evaluation/tests can be sent home and will be seen the next morning by the acute neurology teamAnalysis indicates approximately 1250 admissions are avoided each year with an estimated cost saving of over £2 million.

scholarly journals Off-label prescribing of quetiapine in HMP Elmley, a Category B remand prison: a re-audit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S85-S85
Author(s):  
Nosa Igbinomwanhia ◽  
Kathleen McCurdy
Keyword(s):  
Mental Health ◽  
Royal College ◽  
Health Assessment ◽  
List Type ◽  
Physical And Mental Health ◽  
Off Label ◽  
The Past ◽  
Number Of Patients ◽  
Prescribing Practice ◽  
Potential Risks

AimsThis was a re-audit of off-label prescribing of quetiapine in order to identify the number of patients on off-label quetiapine in HMP Elmley, to monitor compliance by the Mental Health Inreach Team (MHIRT) psychiatrists with the Royal College of Psychiatrists guideline on off-license prescribing, to compare findings with the baseline audit and to identify areas for improvement.MethodAll patients on quetiapine in HMP Elmley were identified and their electronic patient record was reviewed against the standards outlined in the Royal College of Psychiatrists “Use of licensed medicines for unlicensed applications in psychiatric practice (2nd edition).ResultThere were 60 residents on off-license quetiapine prescription in HMP Elmley.Of this number, four had their prescription initiated by a general practitioner, either while in prison or in the community. Two residents were on quetiapine first prescribed while they were on admission in hospital. 5 patients had been initiated by the MHIRT psychiatrists. 38 residents were commenced off-license quetiapine by another psychiatrist, either while they were in the community or in another prison. In 17 patients, electronic records were inadequate to determine who had prescribed the quetiapine.The number of inmates prescribed off-label quetiapine in HMP Elmley had dropped from 82 to 60 in the 1 year since the initial audit. Of these figures, prescriptions initiated by the MHIRT psychiatrists, had dropped from 28.1% (23/82) to 8.3% (5/60).For those prescribed quetiapine by the HMP Elmley psychiatrists, notes were audited against the RCPsych guidelines: Licensed medication was considered first in 80.0%Risks and benefits were considered and documented in 80.0%The benefits and potential risks were explained to patient in 80.0%There was documentation of informed consent in 80.0%Quetiapine was started at a low dose and monitored in 100%No residents required withdrawal of medication due to ineffectiveness or adverse effects.Baseline physical health assessment was performed in 80.0%, though all had an ECG done.ConclusionOver the past year there has been an improvement in off-label antipsychotic prescribing practice within the MHIRT.However, the number of off-label antipsychotic prescriptions still remains high throughout the prison. There should be continued effort at minimizing off-label prescribing within the MHIRT, monitored by auditing. However, work needs to be done jointly with other prescribers, such as GP colleagues, in order to avoid unnecessary prescriptions and to monitor regularly the physical and mental health of those on off-label quetiapine.

Mega-Doses of Behaviour Therapy for Treatment-Resistant Agoraphobics*

1983 ◽  
Vol 28 (2) ◽  
pp. 105-108 ◽  
Author(s):  
Morton S. Rapp ◽  
Martyn R. Thomas ◽  
Eleanor C. Reyes
Keyword(s):  
Effective Treatment ◽  
Cost Effective ◽  
Pilot Project ◽  
Treatment Resistant ◽  
Behaviour Therapy ◽  
The Past ◽  
Cost Effective Treatment ◽  
Intensive Program ◽  
Set Up

This was a pilot project set up to test the feasibility of effectively and inexpensively treating agoraphobic patients who had not responded to adequate trials of behaviour therapy (and other therapy) in the past. We employed a quantitatively intensive program of exposure therapy, calisthenics and muscular relaxation, and have explained the rationales for the choice of each treatment. The results were gratifying in four of the five patients, with follow-up to three years. This pilot project enabled us to set up a cost-effective treatment for all forms of agoraphobia which is as efficient as other programs described. It has also highlighted the fact that some patients exist who may do poorly on schedules of behaviour therapy which are adequate for some patients, and yet may do well if the amount of treatment is drastically increased.

Prediction of root damaging during mechanical shaking of fruit trees

2014 ◽  
Vol 10 (1) ◽  
pp. 1-15
Author(s):  
Z. Láng
Keyword(s):  
Field Experiments ◽  
Calculated Data ◽  
Fruit Trees ◽  
List Type ◽  
Structure Model ◽  
Root Damage ◽  
Set Up ◽  
Simple Tree ◽  
The Given ◽  
Cherry Trees

The possible effect of shaker harvest on root damage of 10-year-old cherry trees was studied on a simple tree structure model. The model was composed of elastic trunk and rigid main roots, the ends of which were connected to the surrounding soil via springs and dumping elements. Equations were set up to be able to calculate the relation between shaking height on the trunk and strain in the roots. To get the data for root break and their elongation at different shaking heights on the trunk, laboratory and field experiments were carried out on cherry trees and on their roots. Having evaluated the measured and calculated data it could be concluded that root damage is to be expected even at 3.6% strain and the risk of it increases with increased trunk amplitudes, i.e.with the decrease of shaking heightat smaller stem diameters (i.e. in younger plantation), andif the unbalanced mass of the shaker machine is too large for the given tree size.

Identify Compounds' Target Against Alzheimer's Disease Based on In-Silico Approach

2019 ◽  
Vol 16 (3) ◽  
pp. 193-208 ◽  
Author(s):  
Yan Hu ◽  
Guangya Zhou ◽  
Chi Zhang ◽  
Mengying Zhang ◽  
Qin Chen ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Small Molecule ◽  
Characteristic Curve ◽  
Machine Learning Algorithms ◽  
Learner Model ◽  
Mao B ◽  
Number Of Patients ◽  
Sar Model ◽  
Set Up

Background: Alzheimer's disease swept every corner of the globe and the number of patients worldwide has been rising. At present, there are as many as 30 million people with Alzheimer's disease in the world, and it is expected to exceed 80 million people by 2050. Consequently, the study of Alzheimer’s drugs has become one of the most popular medical topics. Methods: In this study, in order to build a predicting model for Alzheimer’s drugs and targets, the attribute discriminators CfsSubsetEval, ConsistencySubsetEval and FilteredSubsetEval are combined with search methods such as BestFirst, GeneticSearch and Greedystepwise to filter the molecular descriptors. Then the machine learning algorithms such as BayesNet, SVM, KNN and C4.5 are used to construct the 2D-Structure Activity Relationship(2D-SAR) model. Its modeling results are utilized for Receiver Operating Characteristic curve(ROC) analysis. Results: The prediction rates of correctness using Randomforest for AChE, BChE, MAO-B, BACE1, Tau protein and Non-inhibitor are 77.0%, 79.1%, 100.0%, 94.2%, 93.2% and 94.9%, respectively, which are overwhelming as compared to those of BayesNet, BP, SVM, KNN, AdaBoost and C4.5. Conclusion: In this paper, we conclude that Random Forest is the best learner model for the prediction of Alzheimer’s drugs and targets. Besides, we set up an online server to predict whether a small molecule is the inhibitor of Alzheimer's target at http://47.106.158.30:8080/AD/. Furthermore, it can distinguish the target protein of a small molecule.

PP159 Telemedicine In Paraguay: Contributions Of The Institute Of Health Sciences Research, National University Of Asunción

2020 ◽  
Vol 36 (S1) ◽  
pp. 18-18
Author(s):  
Ronald Rivas ◽  
Pedro Galván
Keyword(s):  
Public Health ◽  
Biomedical Engineering ◽  
List Type ◽  
Telemedicine System ◽  
Cellular Telephony ◽  
Imaging Department ◽  
Number Of Patients ◽  
Computed Tomography Scans ◽  
National University ◽  
Development And Validation

IntroductionThe modalities of telemedicine that have been developed and applied so far by the Department of Biomedical Engineering and Imaging at the National University of Asunción (IICS-UNA) are as follows: (i) telediagnosis: the remote sending of data, signals, and images for diagnostic purposes; (ii) general telediagnostic imaging; (iii) telemonitoring (including telemetry): remote monitoring of vital parameters to provide automatic or semi-automatic surveillance or alarm services in emergencies, epidemiology, or tele-public health; and (iv) tele-education: the use of telematic networks to provide virtual platforms for educating and training health professionals.MethodsWe conducted a comprehensive review of the scientific works developed by the IICS-UNA in order to evaluate the systematic implementation of Telemedicine in Paraguay. Documents, pilot projects (satellite telegraphy), telediagnostic research, telematics, tele-education, published articles, and statistical data (number of patients attending or studies performed, etcetera) relating to the implementation of the National Telemedicine System by the Ministry of Public Health and Social Welfare since 1999 were reviewed.ResultsImplementation of the telemedicine system has meant that 472,038 patients have attended referral centers nationwide, with 297,999 electrocardiographs, 165,323 computed tomography scans, and 8,697 electroencephalograms being conducted. Projects developed within the framework of the Telemedicine Research Line have included the following: (i)Development and validation of a clinical telemicroscopy system based on cellular telephony;(ii)Implementation of a telemetry system for temperature monitoring of the collection of biological samples from a biomedical research center; and(iii)Production and development of a virtual campus at the National University of Asunción.ConclusionsGiven the current healthcare environment, developing a line of research based on telemedicine is a proactive step, since telemedicine provides an alternative solution to the problem of access to the health system. That is why the IICS-UNA Biomedical Engineering and Imaging Department has developed telemedicine as one of its main lines of research.

scholarly journals Task shifting in the care for patients with hand osteoarthritis. Protocol for a randomized controlled non-inferiority trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ingvild Kjeken ◽  
Kjetil Bergsmark ◽  
Ida K. Haugen ◽  
Toril Hennig ◽  
Merete Hermann-Eriksen ◽  
...  
Keyword(s):  
Health Care ◽  
Disease Activity ◽  
Primary Outcome ◽  
Hand Osteoarthritis ◽  
List Type ◽  
Specialist Care ◽  
Randomized Controlled ◽  
Number Of Patients ◽  
Specialist Health Care ◽  
And Function

Abstract Background Current health policy states that patients with osteoarthritis (OA) should mainly be managed in primary health care. Still, research shows that patients with hand OA have poor access to recommended treatment in primary care, and in Norway, they are increasingly referred to rheumatologist consultations in specialist care. In this randomized controlled non-inferiority trial, we will test if a new model, where patients referred to consultation in specialist health care receive their first consultation by an occupational therapy (OT) specialist, is as safe and effective as the traditional model, where they receive their first consultation by a rheumatologist. More specifically, we will answer the following questions: What are the characteristics of patients with hand OA referred to specialist health care with regards to joint affection, disease activity, symptoms and function? Is OT-led hand OA care as effective and safe as rheumatologist-led care with respect to treatment response, disease activity, symptoms, function and patient satisfaction? Is OT-led hand OA care equal to, or more cost effective than rheumatologist-led care? Which factors, regardless of hand OA care, predict improvement 6 and 12 months after baseline? Methods Participants will be patients with hand OA diagnosed by a general practitioner and referred for consultation at one of two Norwegian departments of rheumatology. Those who agree will attend a clinical assessment and report their symptoms and function in validated outcome measures, before they are randomly selected to receive their first consultation by an OT specialist (n = 200) or by a rheumatologist (n = 200). OTs may refer patients to a rheumatologist consultation and vice versa. The primary outcome will be the number of patients classified as OMERACT/OARSI-responders after six months. Secondary outcomes are pain, function and satisfaction with care over the twelve-month trial period. The analysis of the primary outcome will be done by logistic regression. A two-sided 95% confidence interval for the difference in response probability will be formed, and non-inferiority of OT-led care will be claimed if the upper endpoint of this interval does not exceed 15%. Discussion The findings will improve access to evidence-based management of people with hand OA. Trial registration ClinicalTrials.gov, NCT03102788. Registered April 6th, 2017, https://clinicaltrials.gov/ct2/show/NCT03102788?term=Kjeken&draw=2&rank=1 Date and version identifier: December 17th, 2020. First version.

scholarly journals Personal Carbon Trading—Lost in the Policy Primeval Soup?

2021 ◽  
Vol 13 (8) ◽  
pp. 4592
Author(s):  
Fabio Bothner
Keyword(s):  
Ghg Emissions ◽  
Emission Trading ◽  
Political Agenda ◽  
Carbon Trading ◽  
Multiple Streams ◽  
Policy Proposal ◽  
The Past ◽  
Multiple Streams Approach ◽  
Carbon Taxation ◽  
Set Up

The number of emission trading and carbon taxation schemes implemented has grown rapidly over the past decade. Together, they cover approximately 16% of global greenhouse gas (GHG) emissions. Although more than two-thirds of global GHG emissions are related to household consumption, approaches that directly target households, such as personal carbon trading (PCT), do not play a role in the fight against climate change. This is especially puzzling as measures taken so far are not sufficient to reach the 2 °C target. One clue to solving this puzzle comes from political science in the form of the multiple streams approach, which defines criteria that a policy proposal must meet to become part of the political agenda. Based on these criteria, this article conducts a systematic review on PCT to clarify why PCT does not play a role in the reduction of GHG emissions. The results show that there are three main problems with the PCT proposal. First, scholars often criticize the set-up costs as well as the running costs of such a system. Second, there is no clear consensus within the research community on public acceptance of PCT. Third, it is still unclear whether politicians are receptive to PCT or not.

scholarly journals Collaborative digital platform France – Cuba: oncorehabilitation in reproductive and sexual health

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Thierry Almont ◽  
Louis Bujan ◽  
Clarisse Joachim ◽  
Guillaume Joguet ◽  
Mylène Vestris ◽  
...  
Keyword(s):  
Sexual Health ◽  
Cancer Registries ◽  
Cancer Surveillance ◽  
Practical Training ◽  
List Type ◽  
Digital Platform ◽  
Reproductive And Sexual Health ◽  
The Caribbean ◽  
Collaborative Platform ◽  
Set Up

Abstract Background In the French West-Indies, few studies have been performed on fertility and sexual problems in cancer survivors, which are frequent and recurring issues reported by surveys on unmet needs. Additionally, mutualizing human and material resources and promoting cooperation through a collaborative platform are the most appropriate response to complex health pathways in the Caribbean territories. Implementation of such a collaborative platform will help to launch a strategic Caribbean partnership to transfer theoretical and technical skills and care standards in oncofertility and oncosexuality. Methods We propose to set up a collaborative digital platform to strengthen, from the French expertise, Cuban health professionals’ knowledge, know-how, and skills in oncofertility and oncosexuality. The project will be coordinated by a coordinating, scientific, and supervisory committee, and the main activities will include: Theoretical training in e-learning adapted to low-speed Internet. Practical training in fertility preservation and sexual rehabilitation. Digital multidisciplinary consultation meetings for medical decisions to be taken for complex clinical cases. The platform will benefit from a recurrent evaluation, by the two cancer registries of Martinique and Cuba, with the following performance indicators: number of Cuban professionals trained, number of professionals sensitized, hourly volumes (or number of training courses provided), satisfaction of trained professionals, number of e-RCPs carried out online and number of missionaries supported. These indicators will be set up and analyzed by the registers. This project meets the Cuban and French health policies (cancer plans and national sexual health strategies) and will be implemented in liaison with the Health Agencies of both countries and the Embassy of France in Cuba. Discussion This project aims to provide support through bilateral exchanges to improve reproductive and sexual health in Cuba’s cancer patients. This collaboration will be based on a long-lasting French expertise and a solid Cuban health system. Consequently, this collaborative digital platform will contribute to data collection for cancer surveillance, and the two participating countries will ultimately be identified in the Caribbean as having centers of competence and excellence in oncofertility and oncosexuality with care standards.

scholarly journals Medical Adjuvants in the Treatment of Surgically Refractory Arteriovenous Malformations of the Head and Face: Case Report and Review of Literature

2021 ◽  
pp. 1-7
Author(s):  
Vaidya Govindarajan ◽  
Joshua D. Burks ◽  
Evan M. Luther ◽  
John W. Thompson ◽  
Robert M. Starke
Keyword(s):  
Arteriovenous Malformations ◽  
Mtor Inhibitors ◽  
Molecular Target ◽  
Review Of Literature ◽  
Review Of The Literature ◽  
Early Results ◽  
Number Of Patients ◽  
Initiation Of Therapy ◽  
The Brain ◽  
Radiographic Improvement

<b><i>Background:</i></b> Arteriovenous malformations (AVMs) of the brain and face present unique challenges for clinicians. Cerebral AVMs may induce hemorrhage or form aneurysms, while facial AVMs can cause significant disfigurement and pain. Moreover, facial AVMs often draw blood supply from arteries providing critical blood flow to other important structures of the head which may make them impossible to treat curatively. Medical adjuvants may be an important consideration in the management of these patients. <b><i>Summary:</i></b> We conducted a systematic review of the literature to identify other instances of molecular target of rapamycin (mTOR) inhibitors used as medical adjuvants for the treatment of cranial and facial AVMs. We also present 2 cases from our own institution where patients were treated with partial embolization, followed by adjuvant therapy with rapamycin. After screening a total of 75 articles, 7 were identified which described use of rapamycin in the treatment of inoperable cranial or facial AVM. In total, 21 cases were reviewed. The median treatment duration was 12 months (3–24.5 months), and the highest recorded dose was 3.5 mg/m<sup>2</sup>. 76.2% of patients demonstrated at least a partial response to rapamycin therapy. In 2 patients treated at our institution, symptomatic and radiographic improvement were noted 6 months after initiation of therapy. <b><i>Key Messages:</i></b> Early results have been encouraging in a small number of patients with inoperable AVM of the head and face treated with mTOR inhibitors. Further study of medical adjuvants such as rapamycin may be worthwhile.

scholarly journals Maudsley International: improving mental health and well-being around the world

2018 ◽  
Vol 15 (3) ◽  
pp. 49-51 ◽  
Author(s):  
Nick Bouras ◽  
Silvia Davey ◽  
Tracey Power ◽  
Jonathan Rolfe ◽  
Tom Craig ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Care ◽  
Well Being ◽  
Building Capacity ◽  
The Past ◽  
Health And Social Care ◽  
The World ◽  
Set Up ◽  
Health And Well Being ◽  
And Training

Maudsley International was set up to help improve people's mental health and well-being around the world. A variety of programmes have been developed by Maudsley International over the past 10 years, for planning and implementing services; building capacity; and training and evaluation to support organisations and individuals, professionals and managers to train and develop health and social care provisions. Maudsley International's model is based on collaboration, sharing expertise and cultural understanding with international partners.

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