scholarly journals Communication between secondary and primary care following self-harm: are National Institute of Clinical Excellence (NICE) guidelines being met?

2008 ◽  
Vol 7 (1) ◽  
Author(s):  
Jayne Cooper ◽  
Elizabeth Murphy ◽  
Rita Jordan ◽  
Kevin Mackway-Jones
Keyword(s):  
Primary Care ◽  
Clinical Excellence ◽  
Nice Guidelines ◽  
Self Harm

scholarly journals The prognosis of depression in late life versus mid-life: implications for the treatment of older adults

2005 ◽  
Vol 17 (4) ◽  
pp. 533-538 ◽  
Author(s):  
Hari Subramaniam ◽  
Alex J. Mitchell
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Nursing Homes ◽  
Late Life ◽  
Clinical Excellence ◽  
Late Life Depression ◽  
Medical Settings ◽  
Nice Guidelines ◽  
Primary Care Settings

Depression in late life is extremely common. Of those aged 65 years or older, 2–5% have syndromal depression, but up to 20% of elderly people have depressive symptoms (Horwath et al., 2002). Both syndromal and subsyndromal depression carry a high risk of long-term complications and both are associated with elevated risks of morbidity and mortality (Penninx et al., 1999). Despite repeated alerts, depression is consistently under-recognized in acute medical settings, in nursing homes and in primary care (Volkers et al., 2004). For reasons that are inadequately understood, late-life depression seems to be under-treated to an even greater extent than depression in mid-life (Mackenzie et al., 1999). This issue is particularly important, given that effective and safe treatments for depression are available (Bartels et al., 2003), even though the evidence regarding maintenance therapies in older people is inconsistent (Geddes et al., 2003; Wilson et al., 2003). Recent evidence suggests that a package of care can improve the care of older depressed patients in primary care settings (Bruce et al., 2004) and in nursing homes (Ciechanowski et al., 2004). This has led to the development of several clinical guidelines specifically for late-life depression (Baldwin et al., 2003; Charney et al., 2003; Lebowitzet al., 1997). Yet, in the recent National Institute of Clinical Excellence (NICE) guidelines for the management of depression in primary and secondary care, no distinction was made between early, middle and late-life depression (Malone and Mitchell, 2005).

scholarly journals Compliance with NICE guidelines in the management of self-harm

2010 ◽  
Vol 34 (9) ◽  
pp. 385-389 ◽  
Author(s):  
Diane Mullins ◽  
Siobhan MacHale ◽  
David Cotter
Keyword(s):  
Clinical Excellence ◽  
Psychosocial Assessment ◽  
Standards Of Care ◽  
Liaison Psychiatry ◽  
Single Male ◽  
Nice Guidelines ◽  
Accident And Emergency ◽  
Self Harm ◽  
Male Patients ◽  
Accident And Emergency Department

Aims and methodTo identify the provision of psychosocial assessments for all people attending an accident and emergency department in Ireland with a presentation indicative of self-harm over 12 months and to investigate whether the National Institute for Health and Clinical Excellence (NICE) guidelines for self-harm were met.ResultsA total of 834 attendances for self-harm were recorded. A psychosocial assessment was undertaken by a member of the liaison psychiatry team in 59% of attendances. Single male patients under 45 years of age represented 39% of those who did not receive a psychosocial assessment.Clinical implicationsSingle men under the age of 45 years represent a vulnerable group in which levels of psychosocial assessment need to be optimised in order to meet the NICE guidelines for standards of care.

Management of the Febrile Child

2012 ◽  
Vol 5 (10) ◽  
pp. 587-594
Author(s):  
Simon Glew ◽  
Joanna Finch
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Signs And Symptoms ◽  
Clinical Excellence ◽  
Febrile Child ◽  
Traffic Light ◽  
Nice Guidelines ◽  
Face To Face ◽  
Remote Assessment ◽  
Children Under 5

Between 20% and 40% of young children suffer a feverish illness each year and many of these will present to their general practitioner. Although the majority of these children have benign, self-limiting illness, infection remains the leading cause of death in children under the age of 5 years. Appropriate assessment, management and referral of the febrile child are important skills to acquire for doctors working in primary care. This article outlines the signs and symptoms of serious infective illness in children under 5 years of age and describes current National Institute for Health and Clinical Excellence (NICE) guidelines for feverish illness in children and the use of the ‘traffic-light’ risk score in the context of face-to-face and remote assessment.

scholarly journals An audit of risk assessments and management for self-harm and suicide in patients with depressive symptoms at a primary care practice in the UK

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S89-S89
Author(s):  
Win Let Oo
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Depressive Symptoms ◽  
Primary Care Practice ◽  
Significant Risk ◽  
Care Practice ◽  
Nice Guidelines ◽  
Increased Risk ◽  
Self Harm ◽  
The Impact

AimsOver 5 million adults in England are living with depression, with the highest prevalence rates recorded in the North West and North East of England, 12.88% and 11.53%, respectively (NHS Digital, 2019). Depression is also associated with the highest rates of self-harm and suicide (SH&S) (Singhal, Ross, Seminog, Hawton, & Goldarce, 2014). The impact of SH&S on a family ranges from shock and horror to, blame, secrecy and shame. Survivors may also be negatively judged or self-stigmatise (Cerel, Jordan, & Duberstein, 2008). Managing self-harm episodes has a significant financial implication for the NHS (Tsiachristas, et al., 2017). If high-risk individuals are identified and intervened early, it would not only save lives but also potentially reduce financial strains. The aim of the audit is to evaluate the performance of risk assessment and management of self-harm and suicide at the Reedyford Healthcare Group, Nelson, England, and to determine whether the primary care practice is meeting the standards of the National Institute for Health and Care Excellence (NICE) guidelines for adults with depression.MethodA retrospective audit of 62 patients presenting with depressive symptoms over 3 months was performed at the Reedyford Healthcare Group.Two criteria from the NICE guidelines for adults with depression were included with associated standards of 100%:All patients with depression should be assessed for suicidal ideation and intent by asking direct questions.A patient presenting with significant risk to self/others should be referred to specialist mental health services the same day, as soon as possible.Result42 patients were asked direct questions about SH&S. 2 patients presenting with immediate risk were urgently referred to specialist services. Nonetheless, all those patients at increased risk of suicide were given an increased level of support by the practice. The results indicated that the practice could improve, and a quality improvement approach has been planned.ConclusionThe assessment of risk in patients presenting with depression is vital. This audit shows that it is not always done in practice. The author has not found other published audits on this topic and suggests that this may be appropriate for a national audit. This is particularly prudent with the current concern regarding mental health in the COVID-19 pandemic.

An Investigation of West Sussex General Dental Practitioners’ Awareness, Attitudes and Adherence to NICE Dental Recall Guidelines

2012 ◽  
Vol os19 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Alison D van den Berg ◽  
Nikolaus OA Palmer
Keyword(s):  
Risk Factors ◽  
Periodontal Disease ◽  
Primary Care Trust ◽  
Clinical Excellence ◽  
Postal Questionnaire ◽  
Chi Square ◽  
Dental Services ◽  
Statistical Probability ◽  
Nice Guidelines ◽  
Dental Practitioners

Aims The overall aim of this study was to determine whether general dental practitioners (GDPs) in West Sussex were aware of and followed National Institute for Health and Clinical Excellence (NICE) guidelines on dental recalls. The study also aimed to identify factors in the GDPs’ practice of dentistry that could affect their adherence to NICE guidelines and to gain some insight into their views on this topic and how these might affect their adherence. Methods A postal questionnaire, which had previously been piloted, and an explanatory letter were sent to a random sample of 195 GDPs representing 50% of the GDPs contracted to the West Sussex Primary Care Trust. Those who did not respond were sent the questionnaire and letter for a second time. The questionnaire consisted of 50 questions that covered awareness of, attitudes towards and adherence to the NICE guidelines on dental recalls, risk factors, and the GDPs’ practising profile. Resulting data were entered into a database and, where appropriate, statistically tested with the chi-square test, with the level of statistical probability set at P<0.5. Results Data were obtained from the 50 questions in the questionnaires. Only key results are presented in this abstract. Ten of the 195 GDPs had either moved away from the area or were orthodontists. The final sample was therefore 185, of whom 117 returned questionnaires, a response rate of 63%. Seventy-three per cent of the respondents had qualified in United Kingdom. Sixty-five per cent were male. The mean age of respondents was 43 years. Seventy-one per cent worked as GDPs within the General Dental Services (GDS) or Personal Dental Services. Concerning NICE recall guidelines, 94% stated that they were aware of them, 61% said they agreed with them, and 64% that they adhered to them. Female GDPs were statistically far more likely to state that they followed NICE guidelines ( P=0.0043). Seventy per cent of GDPs reported that they still recalled their patients at six-month intervals and only 3% that they recalled their patients according to need. Eighty-five per cent reported taking radiographs at two-year intervals and/or according to patient need, and 68% that they gave oral hygiene advice six monthly or at every recall. Risk assessments were reported as being always carried out by 65% of responding GDPs for caries, 83% for periodontal disease, and 81% for oral cancer. Ninety per cent reported that they thought risk factors were relevant when setting the recall interval and 82% thought that six-monthly recalls allowed appropriate screening to take place. Conclusions Only 3% of responding GDPs recalled their patients according to patient need, in line with NICE recall guidelines, although the majority of GDPs agreed with the guidelines and stated that they adhered to them; however, this was in contrast to the 70% of GDPs who continued to recall at six-month intervals. The majority of GDPs thought that less frequent recalls would not allow for early caries, periodontal disease and oral malignancy diagnosis, and did not think that access to NHS dentistry would be improved. They also did not believe that excessive NHS money was spent on over-frequent dental examinations. There would appear to be significant obstacles to altering the recall habits of dentists because of the way that dentists practise.

scholarly journals COVID-19 infection and subsequent psychiatric morbidity, sleep problems and fatigue: analysis of an English primary care cohort of 226,521 positive patients

2021 ◽  
Author(s):  
Kathryn M Abel ◽  
Matthew J Carr ◽  
Darren M Ashcroft ◽  
Trudie Chalder ◽  
Carolyn A Chew-Graham ◽  
...  
Keyword(s):  
Primary Care ◽  
Sleep Problems ◽  
Psychiatric Morbidity ◽  
Negative Control ◽  
Control Analysis ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
Self Harm ◽  
Primary Hypothesis ◽  
Almost All

Objectives The primary hypothesis was that the risk of incident or repeat psychiatric illness, fatigue and sleep problems increased following COVID-19 infection. The analysis plan was pre-registered (https://osf.io/n2k34/). Design Matched cohorts were assembled using a UK primary care registry (the CPRD-Aurum database). Patients were followed-up for up to 10 months, from 1st February 2020 to 9th December 2020. Setting Primary care database of 11,923,499 adults (>16 years). Participants From 232,780 adults with a positive COVID-19 test (after excluding those with <2 years historical data or <1 week follow-up), 86,922 without prior mental illness, 19,020 with anxiety or depression, 1,036 with psychosis, 4,152 with fatigue and 4,539 with sleep problems were matched to up to four controls based on gender, general practice and year of birth. A negative control used patients who tested negative for COVID-19 and patients negative for COVID with an influenza diagnosis. Main Outcomes and Measures Cox proportional hazard models estimated the association between a COVID-19 positive test and subsequent psychiatric morbidity (depression, anxiety, psychosis, or self-harm), sleep problems, fatigue or psychotropic prescribing. Models adjusted for comorbidities, ethnicity, smoking and BMI. Results After adjusting for observed confounders, there was an association between testing positive for COVID-19 and almost all markers of psychiatric morbidity, fatigue and sleep problems. The adjusted hazard ratio (aHR) for incident psychiatric morbidity was 1.75 (95% CI 1.56-1.96). However, there was a similar risk of incident psychiatric morbidity for those with a negative COVID-19 test (aHR 1.57, 95% CI 1.51-1.63) and a larger increase associated with influenza (aHR 2.97, 95% CI 1.36-6.48). Conclusions There is consistent evidence that COVID-19 infection elevates risk of fatigue and sleep problems, however the results from the negative control analysis suggests that residual confounding may be responsible for at least some of the association between COVID-19 and psychiatric morbidity.

The NICE Guidelines and Pediatric Sedation in the United Kingdom

2018 ◽  
pp. 306-312
Author(s):  
Michael Sury ◽  
Sarah Greenaway
Keyword(s):  
United Kingdom ◽  
National Health Service ◽  
Clinical Excellence ◽  
Nice Guidelines ◽  
Safety And Efficacy ◽  
Government Organization ◽  
The United Kingdom ◽  
Pediatric Sedation ◽  
Consensus View ◽  
The Uk

Pediatric procedural sedation is required for children across the globe in a wide variety of circumstances. In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) is a government organization whose purpose is to provide guidelines to help ensure that patients receive effective, good-value healthcare across the whole of the National Health Service. In 2010 NICE published a guideline for the use of pediatric sedation. The overarching aims were to review the safety and efficacy of sedation for common procedures and to form a consensus view on the necessary resources to do this safely. This chapter summarizes the key recommendations and describes how pediatric sedation has since evolved in the UK.

Factors Affecting the Referral of Potentially Malignant Lesions from Primary Dental Care: A Pilot Study in South Yorkshire

2009 ◽  
Vol os16 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Paul R Brocklehurst ◽  
Sarah R Baker ◽  
Paul M Speight
Keyword(s):  
Primary Care ◽  
Oral Cancer ◽  
Early Stage ◽  
Essential Element ◽  
Poor Response ◽  
Clinical Excellence ◽  
Median Number ◽  
Cross Sectional Study ◽  
Postal Questionnaire ◽  
Cross Sectional

Aims Early diagnosis of oral cancer is an essential element of prevention, yet many patients present late, suggesting that criteria used for referral miss the small or early-stage lesions. The aims of this study were to determine what cues are used by primary care dentists when making the decision to refer a suspicious lesion, and to investigate their recent referral behaviour. Methods A cross-sectional study using a postal questionnaire was undertaken in a major conurbation in South Yorkshire. The questionnaire was sent to all 95 practices in the area concerned. Primary care dentists were asked to score a range of cues on a five-point scale and list their top ten. Experience of referrals made in the last 12 months was also recorded. Results Forty-two questionnaires were returned (44.2%). The cues that primary care dentists ‘agreed’ or ‘strongly agreed’ would initiate a referral were: ‘fixed’, ‘smokes >20 cigarettes/day’, ‘indurated’, ‘ragged borders’ and ‘ulceration’. The most cited top-ten cues were ‘ulcerated’, ‘fixed to underlying tissues’, ‘smoking’ and ‘indurated’. The median number of lesions referred was 0.77 per 1000 adult patients. Twenty-six dentists recorded their experience of 29 lesions. Of these, 17% had been found by the patient whereas 80% had been found at a routine dental examination. Seventy-nine per cent had been present for more than six weeks. Reasons for referral included atypical appearance (38%), ulceration (21%) and location (21%). Fifty-four per cent of primary care dentists described their relationship with secondary care as either ‘good’ or ‘excellent’. Conclusions The most cited cues related to established or advanced disease, not to ‘red’ and ‘white’ lesions, which the National Institute for Health and Clinical Excellence (NICE) recommend for early referral. Even allowing for the relatively poor response rate, this suggests that some small lesions of oral cancer are being missed.

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