scholarly journals Audit examining memantine initiation in dementia patients in an older adult service in the north west

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S69-S69
Author(s):  
Irina Casapu ◽  
Ste Dickinson ◽  
Chirag Shroff ◽  
Sofia Almeida ◽  
Kieran McSharry
Keyword(s):  
Renal Function ◽  
Electronic Records ◽  
North West ◽  
Nice Guideline ◽  
Decision Context ◽  
The North ◽  
Health And Social Care ◽  
Common Diagnosis ◽  
Nice Guidance ◽  
The Right

AimsDementia is a progressive condition inflicting significant costs for health and social care services. In December 2017, there were 456,739 people on GP registers with a formal diagnosis of dementia. Making the right choice of anti-dementia medication with essential monitoring is one important aspect of care. Thus, the aim of this audit was to identify if current practice at Mossley Hill inpatients and outpatients service for older adults in Liverpool, was in accordance with the NICE Guideline NG97 (Dementia: assessment, management and support for people living with dementia and their carers). Additionally, we aimed to evaluate whether Memantine was commenced according to BNF/SPC recommendations about e-GFR and whether this was documented on patient records, as well as to highlight areas of improvement.MethodAn audit was carried out for all patients for whom Memantine was initiated, between June and August 2019. Sixty-nine patients were identified through trust Pharmacy records. Data were collected retrospectively, reviewing local electronic records (ePEX, RIO) and GP referrals. This included age, sex, diagnosis, indication for starting Memantine, decision context, prescriber, documentation of renal function status and communication of decision to the GP. Findings were compared to NICE guidance NG97 and presented at the local audit meeting with a view to recommend strategies for improvement.ResultResults indicated that most of the patients were female (64%) with the most common diagnosis being Alzheimer's disease (75%). Recurrent reasons for initiating Memantine were: contraindication for AChE treatment (25%); illness progression on AChE (22%); and severe dementia on initial presentation (23%). Usually, the decision to start Memantine treatment was made in MDT or after prescriber clinical review. In 68% of the reviewed cases, renal function status was documented. Patients' GP was informed of medication change in 86% of cases.ConclusionTo conclude, in the majority of cases Memantine initiation was in line with NICE guidance. However, documentation can be improved, so as to facilitate future audit. We recommended creating a checklist for prescribing Memantine that could be integrated within the electronic records system.

scholarly journals A reflection about the social and technological aspects in flood risk management – the case of the Italian Civil Protection

2010 ◽  
Vol 10 (1) ◽  
pp. 109-119 ◽  
Author(s):  
M. del Carmen Llasat ◽  
F. Siccardi
Keyword(s):  
Land Use Planning ◽  
Warning System ◽  
Modern Society ◽  
Civil Protection ◽  
North West ◽  
The North ◽  
The Social ◽  
Ground Effects ◽  
The Individual ◽  
The Right

Abstract. The right of a person to be protected from natural hazards is a characteristic of the social and economical development of the society. This paper is a contribution to the reflection about the role of Civil Protection organizations in a modern society. The paper is based in the inaugural conference made by the authors on the 9th Plinius Conference on Mediterranean Storms. Two major issues are considered. The first one is sociological; the Civil Protection organizations and the responsible administration of the land use planning should be perceived as reliable as possible, in order to get consensus on the restrictions they pose, temporary or definitely, on the individual free use of the territory as well as in the entire warning system. The second one is technological: in order to be reliable they have to issue timely alert and warning to the population at large, but such alarms should be as "true" as possible. With this aim, the paper summarizes the historical evolution of the risk assessment, starting from the original concept of "hazard", introducing the concepts of "scenario of event" and "scenario of risk" and ending with a discussion about the uncertainties and limits of the most advanced and efficient tools to predict, to forecast and to observe the ground effects affecting people and their properties. The discussion is centred in the case of heavy rains and flood events in the North-West of Mediterranean Region.

scholarly journals Reimagining Undergraduate Health and Social Care Education: A Workforce Fit for Purpose in a Changing Landscape of Care. A Position Paper

2017 ◽  
Vol 26 (2) ◽  
pp. 145-166 ◽  
Author(s):  
Martin King ◽  
Alison Chambers ◽  
Eula Miller ◽  
Angela Hook ◽  
Laura Jackson ◽  
...  
Keyword(s):  
Social Care ◽  
Undergraduate Curriculum ◽  
Position Paper ◽  
North West ◽  
The North ◽  
Key Stakeholders ◽  
Health And Social Care ◽  
Care Models ◽  
Professional Health ◽  
Key Issues

NHS England’s Five Year Forward View outlines new care models and the need for a workforce that has the skills, values, and competencies to deliver this vision. This is a position paper detailing the context, method, and intentions of a Health Education England funded project led by Manchester Metropolitan University in the North West of England, which the authors see as making a key contribution to addressing issues of illness, crisis, and loss in the changing landscape of health and social care provision in England. Using an action research methodology and drawing together key stakeholders from the sector, the project aims to explore the potential for creating a professional health and social care graduate workforce which meets the needs of an integrated service delivery landscape by identifying key issues to be addressed when redeveloping the undergraduate curriculum.

scholarly journals 402 - An audit of Lithium Prescribing Practices in an Old Age PsychiatryService highlighting renal impairment in this cohort

2021 ◽  
Vol 33 (S1) ◽  
pp. 29-30
Author(s):  
L. Valentine ◽  
J. Cannon ◽  
S. Marmion ◽  
M. Corcoran ◽  
M. Cryan ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Old Age ◽  
Best Practice ◽  
Bipolar Affective Disorder ◽  
Prescribing Practices ◽  
Lithium Level ◽  
North West ◽  
The North ◽  
Increased Risk

AbstractAims:To compare Lithium prescribing practices in a Psychiatry of Old Age (POA) Service in the North-West ofIreland among adults aged 65 years and over with best practice guidelines.Methods:Review of the literature informed development of audit standards for Lithium prescribing. These included National Institute for Clinical Excellent (NICE) 2014 guidelines, The British National Formulary(2019) and Maudsley Prescribing Guidelines (2018). Data was collected retrospectively, using an audit-specific data collection tool, from clinical files of POA team caseload, aged 65 years or more and prescribed Lithium over the past year.Results:At the time of audit in February 2020, 18 patients were prescribed lithium, 67% female, average age 74.6 years. Of those prescribed Lithium; 50% (n=9) had depression, 44% (n=8) had bipolar affective disorder (BPAD) and 6% (n=1) schizoaffective disorder.78% (n= 14) of patients met the NICE standard of 3-monthly lithium level. Lithium levels were checkedon average 4.5 times in past year, average lithium level was 0.61mmol/L across the group and 39% (n=7) had lithium level within recommended therapeutic range (0.6-0.8mmol/L).83% of patients (n=15) met the NICE standards of 3 monthly renal tests. Taking into consideration mostrecent blood test results, 100% (n=18) had abnormal renal function.Half (n=9) were initiated on lithium by POA service and of these, 56% (n=5) had documented renal impairment prior to initiation. Of patients on long term lithium at time of referral (n=9), almost half (n=4) had a documented history of lithium toxicity.Conclusions:The results of this audit highlight room for improvement in lithium monitoring of older adults attending POA service. Furthermore, all patients prescribed lithium had impaired renal function. This is an important finding given the associations between those admitted to hospital with COVID-19 and co- morbid kidney disease and increased risk of inpatient death.Our findings highlight the need for three monthly renal function monitoring in elderly prescribed lithiumgiven the additive adverse effects of increasing age and lithium on the kidney. Close working with specialised renal services to provide timely advice on renal management for those with renal impairment prescribed lithium is important to minimise adverse patient outcomes.

The Half-Breed “Rising” of 1875

2021 ◽  
Vol 102 (s1) ◽  
pp. s90-s100
Author(s):  
George F.G. Stanley
Keyword(s):  
The South ◽  
Hudson's Bay Company ◽  
North West ◽  
The North ◽  
The Government ◽  
State Of Affairs ◽  
The Right ◽  
Hostile Attitude ◽  
Hudson’S Bay Company

In July 1875, the Hon. Alexander Morris, lieutenant-governor of Manitoba and the north-west, received a letter from Lawrence Clarke, the Hudson’s Bay Company factor at Fort Carlton, informing him that a serious state of affairs had arisen on the south branch of the Saskatchewan and strongly pressing for a detachment of the mounted police. This letter mentioned the establishment of a permanent half-breed settlement at St. Laurent and stated that the half-breeds had “assumed to themselves the right to enact laws, rules and regulations for the Government of the Colony and adjoining country of a most tyrannical nature, which the minority of the settlers are perforce bound to obey or be treated with criminal severity.” The “president” of this government was Gabriel Dumont, who was alleged to have coerced various “freemen” and Indians on the plains by seizing the property of, and levying fines upon, those who refused to acknowledge his authority. The letter continued with a statement that the Indians, too, were assuming a hostile attitude and urged that “unless we have a certain protective force stationed at or near Carlton, the ensuing Winter, I cannot answer for the result, serious difficulties will assuredly arise and life and property be endangered.”

A new species of Boholina (Copepoda, Calanoida, Boholinidae) from Ganghwa Island in western Korea

2013 ◽  
Vol 94 (3) ◽  
pp. 537-545 ◽  
Author(s):  
Seong Yong Moon ◽  
Ho Young Soh
Keyword(s):  
New Species ◽  
Endopodal Segment ◽  
Width Ratio ◽  
Spine Length ◽  
North West ◽  
The North ◽  
Length Width ◽  
Distal Spine ◽  
The Right ◽  
A New Species

A new species of Boholina, B. ganghwaensis sp. nov. is described, based on specimens collected from burrows of the manicure crab, Cleistostoma dilatatum, in the tidal flat of Ganghwa Island in western Korea. The new species is closely similar to B. purgata and B. parapurgata by having a pointed process on the posterior angles of the second and third pedigerous somites and a similar rostrum in the female, but can be distinguished from its congeners by the following characters: in females by the genital double-somite with small hook-like process on each gonoporal plate, the setation of the distal endopodal segment of mandible, the basis and first endopodal segment of the maxillule incompletely separated, the inner distal spine/outer terminal spine length ratio on P5; and in males by the distal spine present on the posterior surface of the basis of both P5 and the length/width ratio of the endopod of the right P5. This is the first Bololina species recorded from the north-west Pacific.

The Ancient Road Systems of the Central and Northern Ager Faliscus. (Notes on Southern Etruria, 2)

1957 ◽  
Vol 25 ◽  
pp. 67-203 ◽  
Author(s):  
M. W. Frederiksen ◽  
J. B. Ward Perkins
Keyword(s):  
Northern Limit ◽  
The West ◽  
North West ◽  
The Road ◽  
North East ◽  
The North ◽  
Arterial Road ◽  
Road Systems ◽  
The Right ◽  
North Western

The modern Via Cassia, now as in antiquity the great arterial road up through the heart of south-eastern Etruria, after crossing the Fosso dell'Olgiata less than a kilometre to the west of the north-western gate of Veii, climbs steadily for about 7 km. to cross the Monti Sabatini, the line of extinct volcanic craters that runs eastwards from Lake Bracciano, forming a natural northern boundary to the Roman Campagna. After cutting through the southern crest of the crater of Baccano, with its magnificent views southwards and eastwards over Rome towards Tivoli, Palestrina and the Alban Hills, the road drops into the crater, skirts round the east side of the former lake, and climbs again to the far rim, before dropping once more into the head of the Treia basin, on its way to Monterosi and Sutri.From this vantage-point a whole new landscape is spread out before one (pl. XLVII). To the west and north-west, the tangle of volcanic hills that forms the northern limit of the Monti Sabatini, rising at its highest point to the conical peak of Monte Rocca Romana (612 m.); beyond and to the right of those, past Monterosi and filling the whole of the north-western horizon, some 10–15 km. distant, the spreading bulk of Monte Cimino (1053 m.), with its characteristically volcanic, twin-peaked profile; to the north and north-east, the gently rolling woods and fields of the Faliscan plain, deceptively smooth, stretching away to the distant Tiber.

scholarly journals Considérations physiques sur le passage Nord-ouest; by the same. Communicated by the Right Hon. the Earl of Minto, G. C. B. F. R. S

1837 ◽  
Vol 3 ◽  
pp. 484-484
Keyword(s):  
Sea Water ◽  
Freezing Point ◽  
Atmospheric Temperature ◽  
North West ◽  
The North ◽  
The Mean ◽  
Coppermine River ◽  
The Right ◽  
North Latitude

The author of this memoir, considering that the practicability of a North-west Arctic passage must depend on the mean summer atmospheric temperature of the most northern point of the continent of America being above that at which the congelation of sea water takes place, applies himself to the determination of these temperatures. The results of his calculations are given in a table, exhibiting the extreme and the mean temperatures of the atmosphere for each of the summer months, from May to September, at all degrees of latitude, from 60° to 80° inclusive. According to this table, the temperature of zero, which is about the freezing point of sea water, prevails, at 60° of latitude, on the 10th of May; at 61° lat. on the 20th of May; at 63°, on the 1 st of June; at 65°, on the 10th of June; at 67°, on the 20th of June; and at 71°, during the whole of the months of July and August. The author concludes that navigators can reach, without danger of being obstructed by ice, the latitude of 71° during these latter months: and that since the American continent does not probably extend beyond 70° north latitude a passage to the North-west is then open. He recommends, however, that instead of attempting it by the dangerous navigation of the polar sea, a coasting voyage between the continent and the numerous islands which exist in that ocean should be undertaken; or, what he thinks still more promising of success, an expedition by land for exploring the country intervening between the Coppermine River and Hudson’s Bay.

scholarly journals Art. VII.—On the Identification of Nagarahara, with reference to the Travels of Hiouen-Thsang

1881 ◽  
Vol 13 (2) ◽  
pp. 183-207
Author(s):  
William Simpson
Keyword(s):  
The Other ◽  
Left Bank ◽  
The West ◽  
North West ◽  
The North ◽  
South West ◽  
The Right ◽  
Small Valley ◽  
Kabul River ◽  
The Way

On leaving for India to accompany the army into Afghanistan in 1878, Colonel Yule, among other hints of places of interest of an archæological character to be looked out for, mentioned Nagarahara, the capital of the Jelalabad Valley in the Buddhist period. In the time of Hiouen-Thsang the district bore the same name as the capital, and it had no king of its own, but belonged to Kapisa, a city situated somewhere in the direction of Kabul. The district of Nagarahara extended to about 600 Chinese Li, from east to west, which would be over 100 miles. This might reach from about Jugduluck to the Khyber, so that in this last direction it would thus border on Gandara, and on the other extremity would touch Kapisa, which was also the name of the district as well as the capital of that name. The Valley of Jelalabad is small in comparison to that of the province which formerly belonged to it. From Darunta on the west to Ali-Boghan on the east is fifteen miles, but, on the left bank of the Kabul River, the flat land of Kamah extends the valley on that side, about five or six miles further to the east. The termination of the Valley at this place is called Mirza Kheyl, a white rocky ridge comes down close to the river, and there are remains of Buddhist masonry on it, with caves in the cliff below. On the right bank opposite Mirza Kheyl is Girdi Kas, which lies in a small valley at the northern end of a mass of hills which terminates the Jelalabad Valley on that side at Ali-Boghan, separating it from the Chardeh Plain, which again extends as far as Basawul. I got a kind of bird's-eye view of this one day from a spur of the Sufaid Koh, 8,000 feet high, near to Gundumuck, and the Jelalabad Valley and the Chardeh Plain seemed to be all one, the hills at Girdi Kas appearing at this distance to be only a few slight mounds lying in the middle of this space, which would be altogether about 40 miles in extent. When in the Jelalabad Valley, the Girdi Kas hills are undoubtedly the eastern barrier, while the Siah Koh Range is the western. The Siah Koh Range trends to the south-west, and then turns due west, forming a distinct barrier on the north till it is lost at Jugduluck; there are only some low-lying ridges between Futteeabad and Gundumuck, but they are so small that it might be said to be a continuous valley all the way from Ali-Boghan to the plain of Ishpan. The eastern end of the Siah Koh Range terminates at Darunta, which is the north-west corner of the Jelalabad Valley. The Kabul River, instead of going round the extreme end of this range, has, by some curious freak, found a way through the rocky ridge so close to the extremity, that it leaves only what might be called one vertebra of this stony spine beyond. The river here has formed for itself a narrow gorge through perpendicular cliffs, in which it flows, from the district of Lughman, into the level plain of the Jelalabad Valley. The Surkhab pours down from the Sufaid Koh, starting close to Sikaram, the highest point of the range, which our surveyors found to be 15,600 feet above the sea. It passes over the western end of the Ishpan plain, towards the Siah Koh Range, and it then keeps to the contour of its base all the way to the Jelalabad Valley, and joins the Kabul River about two miles below Darunta.

§ VII.—The Lion Gate and Grave Circle Area

1923 ◽  
Vol 25 ◽  
pp. 9-146
Author(s):  
A. J. B. Wace ◽  
W. A. Heurtley
Keyword(s):  
The West ◽  
West Side ◽  
North West ◽  
The North ◽  
North Eastern ◽  
Pass Through ◽  
The Right

The ancient approach to the Lion Gate (Fig. 1) probably began at the north-west angle of the circuit wall, and thence gradually ascended to the gate itself. Thus all possible assailants would have to pass through the fire from the west side of the north-west angle, even before they reached the court-like area directly before the gate. Here they would be faced with a triple fire, from the gate, from the great rectangular bastion (1) which flanks the gate on the west, and from the wall immediately to the east of the gate. Exactly the same defensive plan is provided for the so-called Postern Gate in the northern circuit wall not far from the original north-eastern angle. Some have suggested that the terrace wall (2), which is called a kyklopische Stützmauer by Steffen, and juts below the north-west corner of the rectangular bastion, is part of the ancient roadway, which mounted here in zigzags, and then turned abruptly to the right to enter the gate.

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