scholarly journals Variation in clinical care associated with weekend admission and discharge in psychiatric in-patient units: retrospective case-note review

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Ryan Williams ◽  
Lorna Farquharson ◽  
Ellen Rhodes ◽  
Mary Dang ◽  
Natasha Lindsay ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Psychiatric Hospital ◽  
Depressive Disorders ◽  
Clinical Care ◽  
Case Note ◽  
Weekend Effect ◽  
Standards Of Care ◽  
Retrospective Case ◽  
Case Note Review

Background Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends. Aims To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the ‘working week’. Method Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses. Results In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39–0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46–0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30–0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50–0.97). Conclusions There is no evidence of a ‘weekend effect’ for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.

Vitamin D in corticosteroid-naïve and corticosteroid-treated Duchenne muscular dystrophy: what dose achieves optimal 25(OH) vitamin D levels?

2016 ◽  
Vol 101 (10) ◽  
pp. 957-961 ◽  
Author(s):  
Nahla Alshaikh ◽  
Andreas Brunklaus ◽  
Tracey Davis ◽  
Stephanie A Robb ◽  
Ros Quinlivan ◽  
...  
Keyword(s):  
Vitamin D ◽  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Vitamin D Deficiency ◽  
Case Note ◽  
Retrospective Case ◽  
Toxic Level ◽  
Vitamin D Levels ◽  
25 Oh Vitamin D ◽  
Case Note Review

AimAssessment of the efficacy of vitamin D replenishment and maintenance doses required to attain optimal levels in boys with Duchenne muscular dystrophy (DMD).Method25(OH)-vitamin D levels and concurrent vitamin D dosage were collected from retrospective case-note review of boys with DMD at the Dubowitz Neuromuscular Centre. Vitamin D levels were stratified as deficient at <25 nmol/L, insufficient at 25–49 nmol/L, adequate at 50–75 nmol/L and optimal at >75 nmol/L.Result617 vitamin D samples were available from 197 boys (range 2–18 years)—69% from individuals on corticosteroids. Vitamin D-naïve boys (154 samples) showed deficiency in 28%, insufficiency in 42%, adequate levels in 24% and optimal levels in 6%. The vitamin D-supplemented group (463 samples) was tested while on different maintenance/replenishment doses. Three-month replenishment of daily 3000 IU (23 samples) or 6000 IU (37 samples) achieved optimal levels in 52% and 84%, respectively. 182 samples taken on 400 IU revealed deficiency in 19 (10%), insufficiency in 84 (47%), adequate levels in 67 (37%) and optimal levels in 11 (6%). 97 samples taken on 800 IU showed deficiency in 2 (2%), insufficiency in 17 (17%), adequate levels in 56 (58%) and optimal levels in 22 (23%). 81 samples were on 1000 IU and 14 samples on 1500 IU, with optimal levels in 35 (43%) and 9 (64%), respectively. No toxic level was seen (highest level 230 nmol/L).ConclusionsThe prevalence of vitamin D deficiency and insufficiency in DMD is high. A 2-month replenishment regimen of 6000 IU and maintenance regimen of 1000–1500 IU/day was associated with optimal vitamin D levels. These data have important implications for optimising vitamin D dosing in DMD.

scholarly journals 1229 Standardising Consent for General Surgical Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Mamun ◽  
E Charles
Keyword(s):  
Informed Consent ◽  
Hernia Repair ◽  
General Surgery ◽  
Case Note ◽  
Surgical Patients ◽  
Standards Of Care ◽  
Retrospective Case ◽  
Incision And Drainage ◽  
Consent Forms ◽  
Surgical Practice

Abstract Aim Informed consent requires all material risks to be discussed, as per Montgomery vs Lanarkshire 2015. This audit was based on the latest RCS England guidelines on consenting patients. We aimed to assess our adherence and to introduce standardised procedure-specific consent stickers to ensure the highest standards of care, which were reproducible. Method We undertook two retrospective case note reviews of patients undergoing emergency and elective general surgery procedures from 01/01-15/06 and 01/10-30/11 in 2020. RCS Good Surgical Practice 3.5.1 “Consent” details the standards for this audit. We included patients undergoing appendicectomy, cholecystectomy, incision and drainage and hernia repair (inguinal, umbilical, and incisional). We did not audit laparotomy due to variability in procedural risks precluding a specific sticker and we excluded patients unable to give consent. Results Our initial audit of 82 patients highlighted the variability between practitioners in the material risk discussion. Different patients undergoing the same procedures were being consented differently with significant omissions. We designed procedure specific-consent stickers to be used when consenting to address this imbalance and made these stickers available on surgical wards. A re-audit of 50 patients showed increase from 41% to 88% in documentation of material risks. While only 34% of the audited consent forms featured the stickers, those forms that did have the stickers on had 100% material risk documentation. Conclusions We saw an improvement in material risk discussion by implementing procedure-specific consent stickers. This supports the growing need for standardising consent across General Surgery to reduce variability. We will next aim to design laparotomy stickers.

scholarly journals Improving pain management for children having dental extractions under general anaesthesia

2020 ◽  
Vol 102 (9) ◽  
pp. 733-736
Author(s):  
S Marshall ◽  
A Ondhia ◽  
C Mearns ◽  
T Kandiah
Keyword(s):  
Pain Management ◽  
General Anaesthesia ◽  
Case Note ◽  
Standards Of Care ◽  
Day Case ◽  
Full Compliance ◽  
Analgesic Regimen ◽  
High Standards ◽  
Audit Standards ◽  
Case Note Review

Children provided with general anaesthesia for dental extractions at East Surrey Hospital were audited to determine the percentage of children who were prescribed adequate pain management in accordance with guidance published by the Association of Paediatric Anaesthetists of Great Britain and Ireland. Three audit cycles were completed. Data were collected retrospectively through case note review. The results from the first cycle showed that only 47% of children were prescribed with a recommended analgesic regimen. Implementation of change included the development of a protocol for analgesic delivery, which was disseminated to the anaesthetic and dental teams. Full compliance with the audit standards was then demonstrated in the second and third cycles. This audit demonstrates the importance of multidisciplinary collaboration in order to provide high standards of care for children undergoing dental extractions under general anaesthesia. The protocol developed could be applied to other surgical day case procedures for children to improve the patient experience.

Abstract P352: Racial Disparity in Post-stroke Readmission - a South Carolina Perspective

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Pratik Y Chhatbar ◽  
Jihad S Obeid ◽  
Daniel T Lackland ◽  
Suzanne P Burns ◽  
Joy N Buie ◽  
...  
Keyword(s):  
South Carolina ◽  
Quality Of Care ◽  
African Americans ◽  
Racial Disparity ◽  
Clinical Care ◽  
University Of South Carolina ◽  
Readmission Rates ◽  
Post Stroke ◽  
Medical University

Background: Readmissions after acute hospitalizations are a cause of both risk and expense, and many of them are potentially preventable. Importantly, risk-standardized hospital readmission rates are sometimes used as a yardstick of the quality of care offered. However, racial variability in readmissions might involve factors beyond quality of care and has not been studied extensively. During our pilot investigation using 90-day post-stroke readmissions data at Medical University of South Carolina (MUSC), we found significant disparities between African Americans and Caucasians. Objective: To identify differences in readmissions between African Americans and other races and determine preventable readmissions from a pragmatic viewpoint. Methods: We obtained deidentified data from Health Sciences South Carolina (HSSC) Clinical Data Warehouse (CDW). The data was comprised of three institutions: Medical University of South Carolina (MUSC), Palmetto Health and Greenville Hospital System University Medical Center. The data consisted of on adult admissions with index diagnosis considered as an ischemic stroke (or closely related) using International Classification of Diseases, Ninth and Tenth Revision (ICD-9, ICD-10) codes between January 2011 and April 2017. Of these, we will determine readmission and reason for readmission over 90-day period. Readmission can be hospital or emergency room readmission. Results: Our database contains 32,548 patients who have been provided clinical care for stroke. Out of these patients 8,308 (25.5%), 23,085 (70.9%) and 1,155 (3.5%) are African Americans, Caucasians and others, respectively. We will present weekly readmission trends over 90 days and evaluate if there are disparities across races. We will apply chi-square test and Student’s t-test to determine statistical significance. For weekly readmission trends over 90 days, we will apply Kolmogorov-Smirnov test to identify difference in readmission patterns across races. We will also identify confounders like socioeconomic status and age and their influence in the racial disparity. Conclusions: From a single center retrospective data, we found that 90-days readmission rates involve African Americans in a disproportionate manner. This multicenter data analysis will further shed light on the etiology of readmission, confounders and the care offered.

scholarly journals Clinical and laboratory characteristics of clozapine-treated patients with schizophrenia referred to a national immunodeficiency clinic reveals a B-cell signature resembling common variable immunodeficiency (CVID)

2020 ◽  
Vol 73 (9) ◽  
pp. 587-592 ◽  
Author(s):  
Mark James Ponsford ◽  
Rachael Steven ◽  
Kathyrn Bramhall ◽  
Mathew Burgess ◽  
Sonali Wijetilleka ◽  
...  
Keyword(s):  
Common Variable Immunodeficiency ◽  
Antibody Deficiency ◽  
Case Note ◽  
Retrospective Case ◽  
Clozapine Therapy ◽  
Clozapine Treatment ◽  
Immunoglobulin Replacement ◽  
Common Variable ◽  
Case Note Review ◽  
Drug Cessation

AimsAn association between antibody deficiency and clozapine use in individuals with schizophrenia has recently been reported. We hypothesised that if clozapine-associated hypogammaglobulinaemia was clinically relevant this would manifest in referral patterns.MethodsRetrospective case note review of patients referred and assessed by Immunology Centre for Wales (ICW) between January 2005 and July 2018 with extraction of clinical and immunological features for individuals with diagnosis of schizophrenia-like illness.Results1791 adult patients were assessed at ICW during this period; 23 patients had a psychiatric diagnosis of schizophrenia or schizoaffective disorder. Principal indications for referral were findings of low calculated globulin and immunoglobulins. Clozapine was the single most commonly prescribed antipsychotic (17/23), disproportionately increased relative to reported use in the general schizophrenia population (OR 6.48, 95% CI: 1.79 to 23.5). Clozapine therapy was noted in 6/7 (86%) of patients subsequently requiring immunoglobulin replacement therapy (IgRT). Marked reduction of class-switched memory B cells (CSMB) and plasmablasts were observed in clozapine-treated individuals relative to healthy age-matched controls. Clozapine duration is associated with CSMB decline. One patient discontinued clozapine, with gradual recovery of IgG levels without use of IgRT.ConclusionsOur findings are consistent with enrichment of clozapine-treatment within schizophrenic individuals referred for ICW assessment over the last 13 years. These individuals displayed clinical patterns closely resembling the primary immunodeficiency common variable immunodeficiency, however appears reversible on drug cessation. This has diagnostic, monitoring and treatment implications for psychiatry and immunology teams and directs prospective studies to address causality and the wider implications for this patient group.

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