Multidisciplinary residential home intervention to improve outcomes for frail residents

Abstract Background Residential homes provide accommodation and assistance with personal care only and are not required to have registered nurses on site. However, their residents often have a combination of comorbidity, polypharmacy, frailty and mental-health conditions with poor access to healthcare to meet these needs. Integrated healthcare for older people is a key NHS priority in the Long-Term Plan and the Five-Year Forward View. We describe development and implementation of multi-disciplinary intervention to integrate healthcare and promote interprofessional education. Methods A multi-disciplinary residential home quality improvement project in two cycles by a team comprising senior and trainee general practitioners, trainees in geriatrics, psychiatry, pharmacist and residential home senior staff. The intervention was underpinned by the framework for enhanced health in care homes including Comprehensive Geriatric Assessment (CGA) and mental-health review. Each intervention session included an educational presentation by a team member consideration of each resident in a pre-evaluation multi-disciplinary discussion followed by a structured clinical assessment and discussion of proposed management. Results Three residential homes participated with a total 34 residents receiving intervention. In one residential home, there was a 75% reduction in admissions for those reviewed and a reduction in overall admission costs. Polypharmacy was reduced by an average of 2 medications per resident across the three sites. There was a 63% increase in cardio-pulmonary resuscitation decisions and 76% increase in advance care planning discussions. Conclusion This was an effective model for multi-disciplinary trainees working with a perceived impact on physical and mental health, and valuable opportunities for sharing learning.

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Multidisciplinary residential home intervention to improve outcomes for frail residents

10.21203/rs.3.rs-279485/v1 ◽

2021 ◽

Author(s):

Anna Steel ◽

Helen Hopwood ◽

Elizabeth Goodwin ◽

Elizabeth L Sampson

Keyword(s):

Mental Health ◽

Residential Home ◽

Physical And Mental Health ◽

Improvement Project ◽

Cardio Pulmonary Resuscitation ◽

Poor Access ◽

Advance Care ◽

Perceived Impact ◽

Health Review

Abstract BackgroundResidential homes provide accommodation and assistance with personal care only and are not required to have registered nurses on site. However, their residents often have a combination of comorbidity, polypharmacy, frailty and mental-health conditions with poor access to healthcare to meet these needs. Integrated healthcare for older people is a key NHS priority in the Long-Term Plan and the Five-Year Forward View. We describe development and implementation of multi-disciplinary intervention to integrate healthcare and promote interprofessional education.MethodsA multi-disciplinary residential home quality improvement project in two cycles by a team comprising senior and trainee general practitioners, trainees in geriatrics, psychiatry, pharmacist and residential home senior staff. The intervention was underpinned by the framework for enhanced health in care homes including Comprehensive Geriatric Assessment (CGA) and mental-health review. Each intervention session included an educational presentation by a team member consideration of each resident in a pre-evaluation multi-disciplinary discussion followed by a structured clinical assessment and discussion of proposed management.ResultsThree residential homes participated with a total 34 residents receiving intervention. In one residential home, there was a 75% reduction in admissions for those reviewed and a reduction in overall admission costs. Polypharmacy was reduced by an average of 2 medications per resident across the three sites. There was a 63% increase in cardio-pulmonary resuscitation decisions and 76% increase in advance care planning discussions.ConclusionThis was an effective model for multi-disciplinary trainees working with a perceived impact on physical and mental health, and valuable opportunities for sharing learning.

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Queensland Family Cohort: a study protocol

BMJ Open ◽

10.1136/bmjopen-2020-044463 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044463

Author(s):

Danielle Borg ◽

Kym Rae ◽

Corrine Fiveash ◽

Johanna Schagen ◽

Janelle James-McAlpine ◽

...

Keyword(s):

Mental Health ◽

Family Environment ◽

Biological Samples ◽

Local Governments ◽

Financial Stability ◽

Federal State ◽

Physical And Mental Health ◽

Future Health ◽

The Impact

IntroductionThe perinatal–postnatal family environment is associated with childhood outcomes including impacts on physical and mental health and educational attainment. Family longitudinal cohort studies collect in-depth data that can capture the influence of an era on family lifestyle, mental health, chronic disease, education and financial stability to enable identification of gaps in society and provide the evidence for changes in government in policy and practice.Methods and analysisThe Queensland Family Cohort (QFC) is a prospective, observational, longitudinal study that will recruit 12 500 pregnant families across the state of Queensland (QLD), Australia and intends to follow-up families and children for three decades. To identify the immediate and future health requirements of the QLD population; pregnant participants and their partners will be enrolled by 24 weeks of gestation and followed up at 24, 28 and 36 weeks of gestation, during delivery, on-ward, 6 weeks postpartum and then every 12 months where questionnaires, biological samples and physical measures will be collected from parents and children. To examine the impact of environmental exposures on families, data related to environmental pollution, household pollution and employment exposures will be linked to pregnancy and health outcomes. Where feasible, data linkage of state and federal government databases will be used to follow the participants long term. Biological samples will be stored long term for future discoveries of biomarkers of health and disease.Ethics and disseminationEthical approval has been obtained from the Mater Research Ethics (HREC/16/MHS/113). Findings will be reported to (1) QFC participating families; (2) funding bodies, institutes and hospitals supporting the QFC; (3) federal, state and local governments to inform policy; (4) presented at local, national and international conferences and (5) disseminated by peer-review publications.

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Health of mothers of children with a life-limiting condition: a comparative cohort study

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-320655 ◽

2021 ◽

pp. archdischild-2020-320655

Author(s):

Lorna K Fraser ◽

Fliss EM Murtagh ◽

Jan Aldridge ◽

Trevor Sheldon ◽

Simon Gilbody ◽

...

Keyword(s):

Mental Health ◽

Cohort Study ◽

Secondary Care ◽

Incidence Rates ◽

Health Conditions ◽

Clinical Practice Research Datalink ◽

Physical And Mental Health ◽

Term Condition ◽

Limiting Condition

ObjectiveThis study aimed to quantify the incidence rates of common mental and physical health conditions in mothers of children with a life-limiting condition.MethodsComparative national longitudinal cohort study using linked primary and secondary care data from the Clinical Practice Research Datalink in England. Maternal–child dyads were identified in these data. Maternal physical and mental health outcomes were identified in the primary and secondary care datasets using previously developed diagnostic coding frameworks. Incidence rates of the outcomes were modelled using Poisson regression, adjusting for deprivation, ethnicity and age and accounting for time at risk.ResultsA total of 35 683 mothers; 8950 had a child with a life-limiting condition, 8868 had a child with a chronic condition and 17 865 had a child with no long-term condition.The adjusted incidence rates of all of the physical and mental health conditions were significantly higher in the mothers of children with a life-limiting condition when compared with those mothers with a child with no long-term condition (eg, depression: incidence rate ratio (IRR) 1.21, 95% CI 1.13 to 1.30; cardiovascular disease: IRR 1.73, 95% CI 1.27 to 2.36; death in mothers: IRR 1.59, 95% CI 1.16 to 2.18).ConclusionThis study clearly demonstrates the higher incidence rates of common and serious physical and mental health problems and death in mothers of children with a life-limiting condition. Further research is required to understand how best to support these mothers, but healthcare providers should consider how they can target this population to provide preventative and treatment services.

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Effects of Enhanced Foster Care on the Long-term Physical and Mental Health of Foster Care Alumni

Yearbook of Psychiatry and Applied Mental Health ◽

10.1016/s0084-3970(08)79276-4 ◽

2009 ◽

Vol 2009 ◽

pp. 63-64

Author(s):

A. Mack

Keyword(s):

Mental Health ◽

Foster Care ◽

Physical And Mental Health ◽

Foster Care Alumni

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An audit of admission clerking of patients in Heddfan, Adult Mental Health Unit in BCUHB - north Wales

BJPsych Open ◽

10.1192/bjo.2021.238 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S75-S75

Author(s):

Asha Dhandapani ◽

Sathyan Soundararajan ◽

Manjula Simiyon ◽

Vinila Zachariah ◽

Rajvinder Sambhi

Keyword(s):

Mental Health ◽

Physical Examination ◽

Junior Doctors ◽

Physical And Mental Health ◽

Improvement Project ◽

North Wales ◽

History Of ◽

Mental Health Unit ◽

State Examination ◽

Source Of Information

AimsTo ensure admission clerking includes salient features needed for the management of both physical and mental health of the patient and also to aid in administrative purposes.MethodThe audit included a team of doctors reviewing the admission clerking notes for 50 patients in the General Adult Psychiatric unit in-patient ward.We created a standard questionnaire-based on Intended learning outcome of core training in psychiatry CT1-CT3 from Royal College of Psychiatry and standard textbooks.Our aim is to achieve 100 % compliance in clerkingResultIt was noted that only 30% wrote their GMC number, 4% added route of admission of the patient and a mere 8% filled the Consultants name. Though almost everyone had written the presenting complaints, the other aspects such as history of presenting illness, medical and family history, Allergy status and substance misuse history were missing in many clerking notes. None of them had filled in details of personal history and very few did a risk assessment.Further lacuna was noted with Mental state examination. Physical examination was also noted to be incomplete. While more than 50% had completed the Blood investigations and ECG, half of them had not documented it and that meant searching in the entire file. A mere 20% filled the nursing observation level whilst none had completed the formulation in the notes.ConclusionAdmission clerking is a vital source of information that would be needed for the formulation of patients diagnosis and future management.Apart from this, it also is needed for further continuity of care.Hence this vital source of information will need to be shared with the junior doctors who will be clerking the patient and seeing them in the first instance.We, therefore, intend to create a complete clerking proforma along with physical health proforma to aid us in this respect.We will audit initially in the first round and then plan to introduce a proforma for Clerking and physical examination based on the findings.We will re-audit to see if the standards are achieved after using the proforma and will consider a Quality improvement project based on this topic

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Cognitive, physical, and mental health outcomes between long-term cannabis and tobacco users

Addictive Behaviors ◽

10.1016/j.addbeh.2017.12.009 ◽

2018 ◽

Vol 79 ◽

pp. 178-188 ◽

Cited By ~ 10

Author(s):

M.E. Lovell ◽

R. Bruno ◽

J. Johnston ◽

A. Matthews ◽

I. McGregor ◽

...

Keyword(s):

Mental Health ◽

Health Outcomes ◽

Mental Health Outcomes ◽

Physical And Mental Health

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Emotional Responses to Stressors in Everyday Life Predict Long-Term Trajectories of Depressive Symptoms

Annals of Behavioral Medicine ◽

10.1093/abm/kaz057 ◽

2019 ◽

Vol 54 (6) ◽

pp. 402-412 ◽

Cited By ~ 1

Author(s):

Ruixue Zhaoyang ◽

Stacey B Scott ◽

Joshua M Smyth ◽

Jee-Eun Kang ◽

Martin J Sliwinski

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Everyday Life ◽

Emotional Responses ◽

Physical And Mental Health ◽

Latent Growth ◽

Assessment Approach ◽

Ecological Momentary

Abstract Background Individuals’ emotional responses to stressors in everyday life are associated with long-term physical and mental health. Among many possible risk factors, the stressor-related emotional responses may play an important role in future development of depressive symptoms. Purpose The current study examined how individuals’ positive and negative emotional responses to everyday stressors predicted their subsequent changes in depressive symptoms over 18 months. Methods Using an ecological momentary assessment approach, participants (n = 176) reported stressor exposure, positive affect (PA), and negative affect (NA) five times a day for 1 week (n = 5,483 observations) and provided longitudinal reports of depressive symptoms over the subsequent 18 months. A multivariate multilevel latent growth curve model was used to directly link the fluctuations in emotions in response to momentary stressors in everyday life with the long-term trajectory of depressive symptoms. Results Adults who demonstrated a greater difference in stressor-related PA (i.e., relatively lower PA on stressor vs. nonstressor moments) reported larger increases in depressive symptoms over 18 months. Those with greater NA responses to everyday stressors (i.e., relatively higher NA on stressor vs. nonstressor moments), however, did not exhibit differential long-term changes in depressive symptoms. Conclusions Adults showed a pattern consistent with both PA and NA responses to stressors in everyday life, but only the stressor-related changes in PA (but not in NA) predicted the growth of depressive symptoms over time. These findings highlight the important—but often overlooked—role of positive emotional responses to everyday stressors in long-term mental health.

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An Assessment of Long-Term Physical and Emotional Quality of Life of Persons Injured on 9/11/2001

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16061054 ◽

2019 ◽

Vol 16 (6) ◽

pp. 1054 ◽

Cited By ~ 3

Author(s):

Robert Brackbill ◽

Howard Alper ◽

Patricia Frazier ◽

Lisa Gargano ◽

Melanie Jacobson ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Health Status ◽

Physical Health ◽

Injury Severity ◽

Mental Health Status ◽

Physical And Mental Health ◽

Component Score

Fifteen years after the disaster, the World Trade Center Health Registry (Registry) conducted The Health and Quality of Life Survey (HQoL) assessing physical and mental health status among those who reported sustaining an injury on 11 September 2001 compared with non-injured persons. Summary scores derived from the Short Form-12 served as study outcomes. United States (US) population estimates on the Physical Component Score (PCS-12) and Mental Component Score (MCS-12) were compared with scores from the HQoL and were stratified by Post-traumatic Stress Disorder (PTSD) and injury status. Linear regression models were used to estimate the association between both injury severity and PTSD and PCS-12 and MCS-12 scores. Level of injury severity and PTSD history significantly predicted poorer physical health (mean PCS-12). There was no significant difference between injury severity level and mental health (mean MCS-12). Controlling for other factors, having PTSD symptoms after 9/11 predicted a nearly 10-point difference in mean MCS-12 compared with never having PTSD. Injury severity and PTSD showed additive effects on physical and mental health status. Injury on 9/11 and a PTSD history were each associated with long-term decrements in physical health status. Injury did not predict long-term decrements in one’s mental health status. Although it is unknown whether physical wounds of the injury healed, our results suggest that traumatic injuries appear to have a lasting negative effect on perceived physical functioning.

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COVID-19: it happens to nurses too—a case study

British Journal of Community Nursing ◽

10.12968/bjcn.2020.25.12.594 ◽

2020 ◽

Vol 25 (12) ◽

pp. 594-597

Author(s):

Grace McDonald ◽

Louise L Clark

Keyword(s):

Mental Health ◽

Intensive Care Unit ◽

Physical And Mental Health ◽

Post Discharge ◽

Social Approach ◽

Charge Nurse ◽

Icu Discharge ◽

Health Complications

The COVID-19 pandemic will have long-term ramifications for many patients, including those who work in the NHS and have been victims of the disease. This short case study describes the journey of an emergency department (ED) charge nurse who contracted COVID-19 and was hospitalised in the intensive care unit (ICU). Post-discharge, he experienced a multitude of physical and mental health complications, which ultimately impacted on each other. Therefore, a bio-psycho-pharmaco-social approach to care is recommended from admission through ICU, discharge and beyond. From this and other narratives, it appears that COVID-19 patients are not adequately followed up after ICU discharge, something that must be considered going forward.

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