scholarly journals Psychiatrists should investigate their patients less

2021 ◽  
pp. 1-4
Author(s):  
Matthew Butler ◽  
Fraser Scott ◽  
Biba Stanton ◽  
Jonathan Rogers
Keyword(s):  
Clinical Assessment ◽  
Clinical Management ◽  
Incidental Findings ◽  
Psychotropic Medications ◽  
Cardiometabolic Health ◽  
Psychiatric Ward ◽  
Blood Tests ◽  
Hospital Protocols ◽  
Health Hospital ◽  
Targeted Approach

Summary Psychiatrists often order investigations such as blood tests, neuroimaging and electroencephalograms for their patients. Rationales include ruling out ‘organic’ causes of psychiatric presentations, providing baseline parameters before starting psychotropic medications, and screening for general cardiometabolic health. Hospital protocols often recommend an extensive panel of blood tests on admission to a psychiatric ward. In this Against the Stream article, we argue that many of these investigations are at best useless and at worst harmful: the yield of positive findings that change clinical management is extremely low; special investigations are a poor substitute for a targeted history and examination; and incidental findings may cause anxiety and further unwarranted investigation. Cognitive and cultural reasons why over-investigation continues are discussed. We conclude by encouraging a more targeted approach guided by a thorough bedside clinical assessment.

scholarly journals Prevalence, Clinical Management, and Natural Course of Incidental Findings on Brain MR Images: The Population-based Rotterdam Scan Study

Radiology ◽  
2016 ◽  
Vol 281 (2) ◽  
pp. 507-515 ◽  
Author(s):  
Daniel Bos ◽  
Marielle M. F. Poels ◽  
Hieab H. H. Adams ◽  
Saloua Akoudad ◽  
Lotte G. M. Cremers ◽  
...  
Keyword(s):  
Clinical Management ◽  
Incidental Findings ◽  
Population Based ◽  
Natural Course ◽  
Mr Images ◽  
Brain Mr Images

scholarly journals Risk of arrhythmia induced by psychotropic medications: a proposal for clinical management

2014 ◽  
Vol 35 (20) ◽  
pp. 1306-1315 ◽  
Author(s):  
S. Fanoe ◽  
D. Kristensen ◽  
A. Fink-Jensen ◽  
H. K. Jensen ◽  
E. Toft ◽  
...  
Keyword(s):  
Clinical Management ◽  
Psychotropic Medications

Oxford Textbook of Attention Deficit Hyperactivity Disorder

2018 ◽  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Clinical Assessment ◽  
Attention Deficit ◽  
Clinical Management ◽  
Best Practice ◽  
Clinical Presentation ◽  
Hyperactivity Disorder ◽  
Dsm 5 ◽  
Key Topics

The Oxford Textbook of Attention Deficit Hyperactivity Disorder provides an authoritative, multidisciplinary text displaying the latest research developments in the diagnosis, assessment, and management of patients with ADHD. Organized into eight key sections, this textbook covers the aetiology, pathophysiology, epidemiology, clinical presentation, comorbidity, clinical assessment, and clinical management of ADHD. Individual chapters address key topics, such as the clinical assessment of ADHD in adults and different presentations of ADHD. They contain information on best practice, current diagnostic guidelines, including DSM-5 and ICD-11, and key up-to-date references for further reading.

Non-Heart Beating Organ Donation: A Case Study

2005 ◽  
Vol 15 (11) ◽  
pp. 467-475
Author(s):  
John Stirling
Keyword(s):  
Organ Donation ◽  
Clinical Assessment ◽  
Clinical Management ◽  
Organ Donor ◽  
Potential Donor ◽  
Heart Beating ◽  
Donation Process ◽  
Donor Transplant

The aim of this case study is to discuss the clinical management of a non-heart beating organ donor. This case study will concentrate in particular on the clinical assessment of the potential donor patient undertaken by the donor transplant coordinator (DTC) and the donation process up to the time of transplantation. The author will also describe the differences between heart beating and non-heart beating donors and discuss how transplantation can benefit renal recipient patients.

scholarly journals Dry Eye Disease: Emerging Approaches to Disease Analysis and Therapy

2019 ◽  
Vol 8 (9) ◽  
pp. 1439 ◽  
Author(s):  
Mostafa Heidari ◽  
Farsad Noorizadeh ◽  
Kevin Wu ◽  
Takenori Inomata ◽  
Alireza Mashaghi
Keyword(s):  
Dry Eye ◽  
Clinical Assessment ◽  
Clinical Management ◽  
Treatment Strategies ◽  
Dry Eye Disease ◽  
Eye Disease ◽  
Recent Past ◽  
New Developments ◽  
Ocular Disorders ◽  
Disease Analysis

Dry eye disease (DED) is among the most common ocular disorders affecting tens of millions of individuals worldwide; however, the condition remains incompletely understood and treated. Valuable insights have emerged from multidisciplinary approaches, including immunometabolic analyses, microbiome analyses, and bioengineering. Furthermore, we have seen new developments in clinical assessment approaches and treatment strategies in the recent past. Here, we review the emerging frontiers in the pathobiology and clinical management of DED.

Clinical investigation

2010 ◽  
pp. 3559-3570
Author(s):  
Michael Doherty ◽  
Peter C. Lanyon
Keyword(s):  
Synovial Fluid ◽  
Light Microscopy ◽  
Septic Arthritis ◽  
Clinical Assessment ◽  
Clinical Management ◽  
Ultrasound Guidance ◽  
Clinical Investigation ◽  
Polarized Light ◽  
Polarized Light Microscopy ◽  
Imaging Markers

Laboratory and imaging markers are an adjunct to competent clinical assessment and should not be used as a substitute. Tests should only be ordered if the results will alter diagnosis, prognosis, or clinical management. Synovial fluid examination—this is the key investigation to confirm the diagnosis of either acute crystal or septic arthritis. Fluid can usually be obtained by direct aspiration from any peripheral joint, or alternatively under ultrasound guidance. The identification of crystals requires compensated polarized light microscopy....

scholarly journals Chronic lymphocytic leukaemia masquerading as a labial lump

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-227328
Author(s):  
Wei How Lim ◽  
Eleni Mayson ◽  
Vincent P Lamaro
Keyword(s):  
Chronic Lymphocytic Leukaemia ◽  
Disease Progression ◽  
Intravenous Immunoglobulin ◽  
Clinical Assessment ◽  
Clinical Evidence ◽  
Lymphocytic Leukaemia ◽  
Immunoglobulin A ◽  
Blood Tests ◽  
Genital Area ◽  
History Of

We report a case of an 82-year-old woman who presented with a 2-week history of a left labial lump. She had a history of chronic lymphocytic leukaemia (CLL) for several years and remained stable without clinical evidence of disease progression. She was observed with regular blood tests and clinical assessment. She was hypogammaglobulinaemic from the CLL and due to frequent symptomatic infections requiring hospitalisation, was commenced on monthly intravenous immunoglobulin. A tissue biopsy of the labial lump confirmed involved CLL in the genital area and further investigations and management followed.

scholarly journals Improving physical health form completion on a general inpatient adult ward

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S227-S228
Author(s):  
Brandon Wong ◽  
Anjna Vekaria
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Mental Health Problems ◽  
Electronic Record ◽  
Psychiatric Ward ◽  
Excel Spreadsheet ◽  
Record Keeping ◽  
Blood Tests ◽  
Cholesterol Levels ◽  
Adult Psychiatry

AimsThe government's Five Year Forward View Plan for Mental Health has set a target for 280,000 people with severe mental health problems to be offered screening and appropriate intervention based on physical health risk stratification, including obesity, diabetes and heart disease. As such, physical health review for patients on a general inpatient adult psychiatry ward includes routine blood tests for cholesterol levels and HbA1c. They are recorded together in a Physical Health (PH) Form in the patient's electronic record and used to stratify cardiovascular risk factors and risk of diabetes. If a patient declines these blood tests it should be recorded on the PH form.This study aims to improve the completion of Physical Health forms to ≥95% by within a 4-month period on a general adult inpatient psychiatric ward.MethodPH form completion was measured using Tableau Software for a 4-week period as a baseline then fortnightly during the study. PH form completion required HbA1c and cholesterol levels to be inputted, or to be marked as declined where the patient had declined these tests. Potential interventions were discussed by clinicians and implemented using PDSA cycles with iterative changes tested and analysed. PH form completion was re-audited monthly for a 6-month period.ResultBaseline data showed 61.54% of patients had physical health forms completed (n = 26; 61.54% with HbA1c, 76.92% with cholesterol completed). Iterative changes and improvements included; (i) paper list to track PH form completion, (ii) table on Microsoft Word, (iii) Excel spreadsheet, and (iv) a conditionally formatted Excel spreadsheet. The conditionally formatted Excel spreadsheet was colour-coded to show completed elements as green and incomplete elements as red.Paper lists increased PH completion to 84.85% (n = 33). Word table increased PH completion to 96.43% (n = 28). Excel spreadsheet had PH completion of 96.67% (n = 30). Colour coded excel spreadsheet increased PH completion to 100% (n = 28). This was used as standard practice with sustained 100% completion in November (n = 34) and December (n = 39). The improvement was sustained to January 2021, although there was a decrease to 97.7% (n = 30).ConclusionIt was hypothesised an intervention to track completion of PH forms would improve completion rate. The use of a colour-coded conditionally formatted Excel spreadsheet improved PH form completion to 100% within an 8-week period and a sustained increase of >95% 6 months after the study began. This study recommends the use of such an electronic record keeping system to assist with PH form completion.

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