scholarly journals Cardiac monitoring in memory clinics: national survey of UK practice

2021 ◽  
pp. 1-6
Author(s):  
George Crowther ◽  
Noura Ahmed ◽  
Deepa Kasa ◽  
Zoe Goff ◽  
Muzahir H. Tayebjee
Keyword(s):  
Patient Safety ◽  
Clinical Skill ◽  
Acetylcholinesterase Inhibitors ◽  
Service Level ◽  
Cardiac Monitoring ◽  
National Guidelines ◽  
Cardiac Side Effects ◽  
Prescribing Practice ◽  
Memory Clinics ◽  
Electrocardiogram Ecg

Aims and method People diagnosed with dementia are often started on acetylcholinesterase inhibitors (AChEIs). As AChEIs can be associated with cardiac side-effects, an electrocardiogram (ECG) is sometimes requested before treatment. Previous work has suggested there is little consensus as to when or how ECGs should be obtained. This can create inconsistent practice, with patient safety, economic and practical repercussions. We surveyed 305 UK memory clinic practitioners about prescribing practice. Results More than 84% of respondents completed a pulse and cardiac history before prescribing AChEIs. Opinion was divided as to who should fund and conduct ECGs. It was believed that obtaining an ECG causes patients inconvenience and delays treatment. Despite regularly interpreting ECGs, 76% of respondents did not update this clinical skill regularly. Clinical implications The variation in practice observed has service-level and patient implications and raises potential patient safety concerns. Implementing national guidelines or seeking novel ways of conducting cardiac monitoring could help standardise practice.

scholarly journals A survey of memory clinic practice in Scotland

2008 ◽  
Vol 32 (12) ◽  
pp. 467-469 ◽  
Author(s):  
Jane Foy
Keyword(s):  
Memory Clinic ◽  
National Guidelines ◽  
Common Component ◽  
Prescribing Practice ◽  
Memory Clinics ◽  
Assessment Techniques ◽  
Old Age Psychiatry ◽  
Clinical Autonomy ◽  
Clinic Practice ◽  
The Cost

Aims and MethodA questionnaire survey of all memory clinics in Scotland to obtain information about clinic characteristics, assessment techniques and prescribing practice.ResultsMemory clinics are a common component of old age psychiatry services within Scotland. There is variability in clinic characteristics, assessment techniques and treatment approaches. Most clinicians appear to rely on their own clinical judgement rather than national guidelines when making decisions about investigations and the prescription of anti-dementia medications.Clinical ImplicationsThere is considerable variation in memory clinic practice across the country. Would standardisation of practice ensure equity in service provision/patient care? However, would such standardisation be at the cost of clinical autonomy?

scholarly journals Cardiovascular monitoring with acetylcholinesterase inhibitors: a clinical protocol

2007 ◽  
Vol 13 (3) ◽  
pp. 178-184 ◽  
Author(s):  
Jeremy P. Rowland ◽  
John Rigby ◽  
Adam C. Harper ◽  
Rosalind Rowland
Keyword(s):  
Cardiovascular Risk ◽  
Acetylcholinesterase Inhibitors ◽  
Risk Groups ◽  
Cardiac Monitoring ◽  
Serious Adverse Events ◽  
Ache Inhibitors ◽  
Cardiovascular Side Effects ◽  
Published Evidence ◽  
Memory Clinics ◽  
Pre Treatment

There has been significant anxiety among prescribers regarding the potential for cardiac adverse effects associated with acetylcholinesterase (AChE) inhibitors in Alzheimer's disease. There is no consensus on how to manage this cardiovascular risk, and memory clinics vary widely in their practice. Review of published evidence reveals that the incidence of cardiovascular side-effects is low, and that serious adverse events are rare. Intensive cardiovascular screening such as pre-treatment electrocardiograms or 24 h cardiac monitoring is not justified. Furthermore, there are no high-risk groups to target. This article suggests pragmatic guidelines for managing cardiovascular risk in patients receiving AChE inhibitors. The guidelines are intended to be easy to incorporate into routine clinical practice in a memory clinic.

scholarly journals A National Memory Clinic Survey to Assess Provision for People from Diverse Ethnic Backgrounds in England and Wales

2021 ◽  
Vol 18 (4) ◽  
pp. 1456
Author(s):  
Shovanne Brown ◽  
Gill Livingston ◽  
Naaheed Mukadam
Keyword(s):  
Linguistic Diversity ◽  
National Policy ◽  
Diagnostic Procedures ◽  
Assessment Tools ◽  
National Guidelines ◽  
England And Wales ◽  
Memory Problems ◽  
Minority Ethnic Groups ◽  
Memory Clinics ◽  
Minority Ethnic

English national guidelines regarding dementia assessment and management recommend consideration of cultural and linguistic diversity when assessing people with cognitive complaints. To date there has been no assessment of adherence to these guidelines. We aimed to assess whether current services provided in memory assessment services (MAS) adhere to national policy, in their approach to the assessment and management of individuals with memory problems from minority ethnic backgrounds. We sent a survey to 213 memory services in England and Wales. Twenty MAS from seven regions responded to the survey. We found that 80% (16) provided translated resources, 70% (14) used cognitive assessment tools that are culturally sensitive and appropriate, and 65% (13) showed good use of sufficiently skilled and knowledgeable interpreters. Communication barriers, particularly language, were raised as a potential obstacle to diagnosing minority ethnic patients. Memory clinics appear to reflect national policy for the assessment and management of memory problems in minority ethnic patients. However, only a minority of services responded and they may be more engaged in considering these populations. We need wider knowledge of practice to explore how guidelines support healthcare professional’s assessment of patients from minority ethnic groups in memory service diagnostic procedures.

scholarly journals Variation between services in polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients

2002 ◽  
Vol 26 (11) ◽  
pp. 418-420 ◽  
Author(s):  
Maria Harrington ◽  
Paul Lelliott ◽  
Carol Paton ◽  
Maria Konsolaki ◽  
Tom Sensky ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Antipsychotic Drugs ◽  
Service Level ◽  
Case Mix ◽  
Clinical Implications ◽  
High Dose ◽  
Prescribing Practice ◽  
Acute Psychiatric Wards ◽  
High Doses

Aims and MethodA 1-day census provided an opportunity to examine the variation between 44 mental health services in the frequency of prescribing high doses and polypharmacy of antipsychotic drugs to in-patients on acute psychiatric wards.ResultsThe proportion of patients prescribed a high dose ranged 0–50% and simultaneous use of more than one antipsychotic drug ranged 12–71%. A number of case-mix variables explained 26% and 40%, respectively, of the variance between services on these two indicators of prescribing practice.Clinical ImplicationsServices with high rates of prescription of high dose or polypharmacy might consider a review of clinical practice and of service-level factors that might affect prescribing.

scholarly journals A closed audit reviewing the electrocardiograms of patients presenting to the memory assessment team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S30-S30
Author(s):  
Joseph Heath ◽  
Maroulla Anderson ◽  
Jonathan Miles-Stokes
Keyword(s):  
Side Effects ◽  
Acetylcholinesterase Inhibitors ◽  
Left Ventricular ◽  
Cardiac Conduction ◽  
North West ◽  
Cardiac Side Effects ◽  
Memory Assessment ◽  
The North ◽  
Conduction Disorders ◽  
Clinically Significant

AimsTo review the ECGs of all patients referred to MAT services over the preceding 5 year period.BackgroundNeurodegenerative conditions such as Alzheimer's Disease can be treated with Acetylcholinesterase Inhibitors (AChEI) to slow down cognitive decline. Side effects of AChEIs include bradycardia, syncope and cardiac conduction disorders. An electrocardiograms (ECG) is completed prior to memory assessment team (MAT) medical assessments to screen for those who may be at risk of the cardiac side effects of AChEIs. ECGs may be included in the initial referral to the service or completed by the MAT. Given the predominantly elderly population referred to the MATs service, other incidental abnormalities are to be expected. Not all MAT referrals that are screened by memory nurses reach the threshold to be reviewed by the medical team and therefore not all ECGs are routinely reviewed, potentially missing clinically significant abnormalities.ResultA total of 1795 patients were identified as being referred to a single mental health unit in the North West on England over a five-year period. 781 (44%) of the patients had an ECG completed by the MAT, of which 452 (58%) showed an abnormality. Significant abnormalities that were previously unknown to the patients’ primary care provider include eight cases of Atrial Fibrillation (AF), four cases of Trifasciular Block, and 19 cases of Left Ventricular Hypertrophy (LVH). 64 (8%) of patients who had an ECG by the MAT had a bradycardia.ConclusionIn addition to identifying abnormalities that could interfere with memory medication, this audit showed that over half of the ECGs completed by the MAT had an atypical trace. Cardiology was consulted to identify which abnormalities were considered clinically significant and if not already known, the general practitioner (GP) was informed. A change in the local service means that all ECGs completed by the MAT are now screened at point of filling into the notes, so any future abnormalities are identified and followed up immediately.

scholarly journals Nurses’ Adherence to Patient Safety Principles: A Systematic Review

2020 ◽  
Vol 17 (6) ◽  
pp. 2028 ◽  
Author(s):  
Mojtaba Vaismoradi ◽  
Susanna Tella ◽  
Patricia A. Logan ◽  
Jayden Khakurel ◽  
Flores Vizcaya-Moreno
Keyword(s):  
Systematic Review ◽  
Patient Safety ◽  
Quantitative Methods ◽  
Healthcare Providers ◽  
Cardiac Monitoring ◽  
Care Process ◽  
Care Practice ◽  
Qualitative And Quantitative Methods ◽  
Systemic Factors ◽  
Care Improvement

Background: Quality-of-care improvement and prevention of practice errors is dependent on nurses’ adherence to the principles of patient safety. Aims: This paper aims to provide a systematic review of the international literature, to synthesise knowledge and explore factors that influence nurses’ adherence to patient-safety principles. Methods: Electronic databases in English, Norwegian, and Finnish languages were searched, using appropriate keywords to retrieve empirical articles published from 2010–2019. Using the theoretical domains of the Vincent’s framework for analysing risk and safety in clinical practice, we synthesized our findings according to ‘patient’, ‘healthcare provider’, ‘task’, ‘work environment’, and ‘organisation and management’. Findings: Six articles were found that focused on adherence to patient-safety principles during clinical nursing interventions. They focused on the management of peripheral venous catheters, surgical hand rubbing instructions, double-checking policies of medicines management, nursing handover between wards, cardiac monitoring and surveillance, and care-associated infection precautions. Patients’ participation, healthcare providers’ knowledge and attitudes, collaboration by nurses, appropriate equipment and electronic systems, education and regular feedback, and standardization of the care process influenced nurses’ adherence to patient-safety principles. Conclusions: The revelation of individual and systemic factors has implications for nursing care practice, as both influence adherence to patient-safety principles. More studies using qualitative and quantitative methods are required to enhance our knowledge of measures needed to improve nurse’ adherence to patient-safety principles and their effects on patient-safety outcomes.

scholarly journals An Analysis of the Effects of Noisy Electrocardiogram Signal on Heartbeat Detection Performance

2020 ◽  
Vol 7 (2) ◽  
pp. 53
Author(s):  
Ziti Fariha Mohd Apandi ◽  
Ryojun Ikeura ◽  
Soichiro Hayakawa ◽  
Shigeyoshi Tsutsumi
Keyword(s):  
Stress Test ◽  
Hospital Setting ◽  
Detection Performance ◽  
Cardiac Monitoring ◽  
Ecg Signal ◽  
Daily Life Activities ◽  
Detection Algorithms ◽  
Beat Detection ◽  
Electrocardiogram Ecg ◽  
The Relationship

Heartbeat detection for ambulatory cardiac monitoring is more challenging as the level of noise and artefacts induced by daily-life activities are considerably higher than monitoring in a hospital setting. It is valuable to understand the relationship between the characteristics of electrocardiogram (ECG) noises and the beat detection performance in the cardiac monitoring system. For this purpose, three well-known algorithms for the beat detection process were re-implemented. The beat detection algorithms were validated using two types of ambulatory datasets, which were the ECG signal from the MIT-BIH Arrhythmia Database and the simulated noise-contaminated ECG signal with different intensities of baseline wander (BW), muscle artefact (MA) and electrode motion (EM) artefact from the MIT-BIH Noise Stress Test Database. The findings showed that signals contaminated with noise and artefacts decreased the potential of beat detection in ambulatory signal with the poorest performance noted for ECG signal affected by the EM artefacts. In conclusion, none of the algorithms was able to detect all QRS complexes without any false detection at the highest level of noise. The EM noise influenced the beat detection performance the most in comparison to the MA and BW noises that resulted in the highest number of misdetections and false detections.

Rapid onset Mitoxantrone-induced cardiotoxicity in secondary progressive multiple sclerosis

2003 ◽  
Vol 9 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Jagannadha R Avasarala ◽  
Anne H Cross ◽  
David B Clifford ◽  
Barry A Singer ◽  
Barry A Siegel ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Rapid Onset ◽  
Progressive Multiple Sclerosis ◽  
Left Ventricular ◽  
Secondary Progressive Multiple Sclerosis ◽  
Cardiac Monitoring ◽  
Cardiac Complications ◽  
Cardiac Side Effects ◽  
Secondary Progressive ◽  
Fourth Dose

Mitoxantrone is a recently appro ved drug for patients with secondary progressive multiple sclerosis (SPMS). However, cardiac side effects limit Mitoxantrone use in SPMS and its lifetime cumulative dose should not exceed 140 mg/m2. A dditionally, Mitoxantrone is contraindicated for use in SPMS patients with a baseline left ventricular ejectio n fraction (LVEF) of-50%. The goal of this study was to monitor LVEF more frequently than ordinarily recommended since experience with Mitoxantrone use in SPMS patients is limited. A n unexpected decline in LVEF in one of the SPMS patients being treated with Mitoxantrone prompted further investigation into this finding. In our clinic, 47 patients on Mitoxantrone were followed prospectively; 28 of 47 patients had received a minimum of three doses and underwent a repeat LVEF evaluation prior to their fourth dose of Mitoxantrone. O f these 28 patients, five of 28 (17.8%) had a significant decline in LVEF from baseline. It is suggested that more stringent cardiac monitoring guidelines than current Food and Drug A dministration (FDA) recommendations be used to avert potential cardiac complications in SPMS patients on Mitoxantrone.

scholarly journals Comparison of Pegfilgrastim Prescribing Practice to National Guidelines at a University Hospital Outpatient Oncology Clinic

2013 ◽  
Vol 9 (4) ◽  
pp. 203-206 ◽  
Author(s):  
Geralyn E. Waters ◽  
Patricia Corrigan ◽  
Mandy Gatesman ◽  
Thomas J. Smith
Keyword(s):  
Primary Prophylaxis ◽  
University Hospital ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Hospital Outpatient ◽  
Prescribing Practice

At one institution, approximately one half of primary prophylaxis pegfilgrastim was not indicated per published guidelines, highlighting a need to change prescribing practices, to reduce costs without harming patients.

Neonatal Formulary

2020 ◽  
Author(s):  
Sean Ainsworth
Keyword(s):  
Patient Safety ◽  
Drug Metabolism ◽  
Drug Interactions ◽  
General Information ◽  
Drug Prescribing ◽  
National Guidelines ◽  
Young Infants ◽  
Cochrane Database ◽  
Drug Storage ◽  
Neonatal Population

Neonatal Formulary bridges a gap between a standard formulary (stating doses, indications, etc.) and a standard neonatal textbook by expanding information about the conditions for which each drug is used. Much of drug use during pregnancy, lactation, and in neonates and young infants is ‘off license’ (i.e. using licensed drugs but for an indication that is outside the licensed use—in many cases simply because the studies and the licensing application did not include data about neonatal use). The book offers information to allow practitioners to make informed choices whether to use such a drug or not by presenting data from published studies to support such a use. Part 1 concentrates on drug prescribing and drug administration, presenting general information on drug storage, drug licensing, and drug prescribing. It also explains to the reader why the metabolism of drugs differs in premature and sick infants and why the practice of extrapolating doses from adult studies is wrong. Patient safety, excipients, and therapies that affect drug metabolism (such as therapeutic hypothermia) are also covered. Part 2 consists of drug monographs for over 250 drugs that may find use in the neonatal population but which nonetheless may also find use outside the neonatal unit. Each monograph is divided into sections covering use, pharmacology, treatment, drug interactions, or other administration information, supply, and administration, and references. The monographs also contain links to Cochrane Database of Systematic Reviews and national guidelines supported by bodies such as the National Institute for Health and Care Excellence or the Royal Colleges. Part 3 contains brief notes on a range of additional drugs and groups of drugs that are often taken by mothers during pregnancy, labour, or during breast feeding where effects on either the fetus or infant can be seen. This information will help to provide safe and effective prescribing of drugs to all mothers and their babies.

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