A closed loop audit of clerking psychiatric histories in an acute psychiatric inpatient unit

AimsAn accurate and complete history is a key component of a medical consultation. Evidence suggests that up to 80% of diagnosis may be made entirely off the patient history. The aim of this closed loop audit was to examine the effects of a clerking pro forma on the quality of doctors clerking histories of new patients admitted to an acute psychiatric inpatient unit, against standards suggested in the New Oxford Textbook of Psychiatry.MethodData for this audit were gathered by finding the initial clerking history for inpatients at The Orchard on ECR and RIO. The clerking histories of the 18 inpatients present on 12.10.20 were initially audited. These standards recommend in the in the New Oxford Textbook of Psychiatry include; Patient Identification (ID), Presenting Complaint (PC), History of Presenting Complaint (HPC), Psychiatric history, Medical history, Family history, Forensic history, Social history, Personal history, Premorbid personality, Mental state exam (MSE). After analysis of the results of the first loop, a clerking pro forma was created and distributed to junior doctors to implement. The clerking histories for the subsequent 18 patients to be admitted were then audited and compared.ResultThe results of the first audit cycle were poor. Only patient identification and presenting complaint were present in 100% of clerked histories. Concerningly, only 72% of the histories included the patients’ medical histories, forensic histories were included 44% of the time, and social history just 39% of the time.The implementation of a clerking history proforma showed improvements in all areas of clerking. Patient ID, PC, HPC, psychiatric history and MSE were now present in 100% of clerked histories. Forensic history showed a statistically significant improvement from 44% to 73% [X2(1) = 5.9; p = 0.015]. Social history showed a statistically significant improvement from 39% to 78% [X2(1) = 5.6; p = 0.018]. Premorbid personality showed a statistically significant improvement from 44% to 89% [X2(1) = 8.0; p = 0.005]. Personal history showed a non-statistically significant improvement from 39% to 56%, as did medical history from 72% to 94%, and family history from 39% to 61%.ConclusionIn conclusion, the implementation of a clerking history pro-forma has significantly improved the quality and completeness of clerking histories gathered by doctors at The Orchard. This is hopefully increase diagnostic accuracy and improve the quality of care of patients in the hospital.

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Patient access to psychiatric records: experience in an in-patient unit

Psychiatric Bulletin ◽

10.1192/pb.19.2.87 ◽

1995 ◽

Vol 19 (2) ◽

pp. 87-90 ◽

Cited By ~ 9

Author(s):

Nick Kosky ◽

Tom Burns

Keyword(s):

Educational Attainment ◽

Maintenance Treatment ◽

Junior Doctor ◽

Psychiatric Inpatient ◽

Inpatient Unit ◽

Therapeutic Relationships ◽

Patient Access ◽

Psychiatric Inpatient Unit ◽

Lower Educational Attainment

Forty of 46 consecutive admissions to a psychiatric inpatient unit were encouraged to read their admission notes and discuss them with the Junior doctor. The offer was withheld for two patients with organic impairment. Twenty-eight patients (including 12 on compulsory admissions) accepted the offer. The 12 who refused were characterised by overall lower educational attainment. Diagnosis raised only a few problems, prognosis and maintenance treatment being the focus of most discussions. There was no evidence of a deterioration in the quality of notes or therapeutic relationships as a consequence of access. Only in one case was the exercise judged ‘harmful’, but ‘useful or essential’ in 22. Possible benefits for both patients and doctor are explored.

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Effects of Treatment and Alternative Care on Length of Stay on a General Hospital Psychiatric Unit — Results of an Audit

The Canadian Journal of Psychiatry ◽

10.1177/070674379303800111 ◽

1993 ◽

Vol 38 (1) ◽

pp. 39-45 ◽

Cited By ~ 10

Author(s):

François M. Mai ◽

Jean-Yves Gosselin ◽

Lily Varan ◽

Luc Bourgon ◽

Joaquin Ruiz Navarro

Keyword(s):

Health Care ◽

Quality Of Care ◽

Length Of Stay ◽

Psychiatric Inpatient ◽

Medical Audit ◽

Prolonged Stay ◽

System A ◽

Psychiatric Inpatient Unit ◽

The Mean

Quality controls are becoming an important part of our health care system. A medical audit is one way of evaluating quality of care, and this paper describes the results of an audit conducted to investigate the reasons for a prolonged stay on a psychiatric inpatient unit. The results showed a decrease in the mean length of stay over a five year period, although the figure remained substantially above provincial norms. A review of the hospital charts of a random sample of one in six patients whose hospital stay exceeded 30 days was carried out. It revealed that in 50.0% of cases the reasons were “medically acceptable,” in 10.3% the reasons were “medically unacceptable” and in 39.7% the reasons were “social and administrative” and beyond the control of the treating psychiatrist. The implication of these results are discussed.

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Participant Reactions to Suicide-Focused Research

Crisis ◽

10.1027/0227-5910/a000650 ◽

2020 ◽

Vol 41 (5) ◽

pp. 367-374

Author(s):

Sarah P. Carter ◽

Brooke A. Ammerman ◽

Heather M. Gebhardt ◽

Jonathan Buchholz ◽

Mark A. Reger

Keyword(s):

Medical Records ◽

Research Study ◽

Small Sample Size ◽

Psychiatric Inpatient ◽

Small Sample ◽

Inpatient Unit ◽

Online Laboratory ◽

Psychiatric Inpatient Unit ◽

Before And After ◽

Participant Reactions

Abstract. Background: Concerns exist regarding the perceived risks of conducting suicide-focused research among an acutely distressed population. Aims: The current study assessed changes in participant distress before and after participation in a suicide-focused research study conducted on a psychiatric inpatient unit. Method: Participants included 37 veterans who were receiving treatment on a psychiatric inpatient unit and completed a survey-based research study focused on suicide-related behaviors and experiences. Results: Participants reported no significant changes in self-reported distress. The majority of participants reported unchanged or decreased distress. Reviews of electronic medical records revealed no behavioral dysregulation and minimal use of as-needed medications or changes in mood following participation. Limitations: The study's small sample size and veteran population may limit generalizability. Conclusion: Findings add to research conducted across a variety of settings (i.e., outpatient, online, laboratory), indicating that participating in suicide-focused research is not significantly associated with increased distress or suicide risk.

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The Quality of Pro Forma Earnings: An Examination of the Adverse Selection Component of the Bid-Ask Spread Around Earnings Announcements*

SSRN Electronic Journal ◽

10.2139/ssrn.1266800 ◽

2008 ◽

Author(s):

Qianyun Huang ◽

Terrance R. Skantz

Keyword(s):

Adverse Selection ◽

Earnings Announcements ◽

Bid Ask Spread ◽

Pro Forma Earnings ◽

Pro Forma

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Creation of physiologic rhythm by closed loop stimulation in heart failure patients with severe chronotropic incompetence: worldwide first results of a pilot study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0803 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Proff ◽

B Merkely ◽

R Papp ◽

C Lenz ◽

P.J Nordbeck ◽

...

Keyword(s):

Heart Rate ◽

Closed Loop ◽

Funding Source ◽

Chronotropic Incompetence ◽

First Results ◽

The Mean ◽

Group 2 ◽

Group 1

Abstract Background The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI. Purpose This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients. Methods A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL. Results Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13). Conclusion First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG

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P3 A closed loop audit on pre-operative anaemia in major elective orthopaedic surger

BJS Open ◽

10.1093/bjsopen/zrab032.002 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Chan Hee Koh ◽

Nicolai Gruner-Hegge ◽

Dancho Ignatov ◽

Aneesul Shakir ◽

Chan Hee Koh

Keyword(s):

Closed Loop ◽

Perioperative Management ◽

Consensus Statement ◽

Preoperative Assessment ◽

Action Plans ◽

International Consensus ◽

Change In Practice ◽

International Consensus Statement ◽

Preoperative Anaemia

Abstract Introduction The international consensus statement on perioperative management of anaemia advises that patients with haemoglobin (Hb) <130 be treated before undergoing elective operations. The advantages include reduced risk of acute kidney injuries, infections and transfusions, and quicker recovery. Methods Data was collected prospectively from 127 consecutive patients undergoing elective arthroplasties at Hinchingbrooke hospital. Baseline compliance with the consensus statement was first assessed in May 2018, and the results presented at a clinical governance meeting. Departmental action plans included early identification of anaemia and treatment to Hb 130, delaying operations where necessary. We then reassessed compliance in May 2019. Results There was a statistically significant change in practice (p = 0.036). The proportion of patients undergoing arthroplasties despite Hb < 130 reduced from 38% to 21%. Those operated with Hb < 120 decreased from 14% to 0%. The proportion of preoperative anaemias that were appropriately investigated during preoperative assessment increased from 11% to 80% (p < 0.001). The increase in attempted treatment of preoperative anaemia prior to surgery however was not significant (7% vs 20%; p = 0.279). Discussion Implementation of departmental action plans resulted in substantial improvements to clinical practice. For those that underwent arthroplasties despite mild preoperative anaemia, it may have been felt that delays in improvement to quality of life for treatment may be unacceptable, or the causes (e.g. chronic disease) difficult to treat. Further action plans should involve even earlier identification of anaemia, involving primary care at the point of referral.

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The experience of parents faced with the admission of their adolescent to a child and adolescent psychiatric inpatient unit. A qualitative study with focus groups

Current Psychology ◽

10.1007/s12144-021-01901-6 ◽

2021 ◽

Author(s):

Beatriz Merayo-Sereno ◽

Aránzazu Fernández-Rivas ◽

Keyth Lany de Oliveira-Silva ◽

Francisco-Javier Sánchez-Andérez ◽

Eva Sesma-Pardo ◽

...

Keyword(s):

Focus Groups ◽

Psychiatric Hospitalization ◽

Emotional Experience ◽

Psychiatric Inpatient ◽

Health Behavior Change ◽

Child And Adolescent ◽

Inpatient Unit ◽

Entire Family ◽

Parental Experience ◽

Psychiatric Inpatient Unit

AbstractThe admission of an adolescent to a child and adolescent psychiatric inpatient unit has a serious impact on the entire family unit. The emotional experience of those primary caregivers has been scarcely studied qualitatively despite being recommended by previous research. This study aims to examine the experience of parents of adolescents with mental health needs that required psychiatric hospitalization in a child and adolescent unit. Qualitative cross-sectional research was carried out under the recommendations of Grounded Theory with three Focus Groups of parents (N = 22) of adolescents who required psychiatric hospitalization in a child and adolescent ward. The COREQ quality criteria were applied. The parental experience implies a high level of emotional suffering modulated by feelings of guilt, stigma, parental awareness of their child’s illness and the passage of time. The use of Prochaska’s and Diclemente’s trans-theoretical model of health behavior change is useful in understanding the parental experience.

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Converting MST to TSP Path by Branch Elimination

Applied Sciences ◽

10.3390/app11010177 ◽

2020 ◽

Vol 11 (1) ◽

pp. 177

Author(s):

Pasi Fränti ◽

Teemu Nenonen ◽

Mingchuan Yuan

Keyword(s):

Spanning Tree ◽

Closed Loop ◽

Minimum Spanning Tree ◽

Travelling Salesman Problem ◽

Open Loop ◽

Travelling Salesman ◽

Elimination Algorithm ◽

Number Of Iterations ◽

Number Of Branches

Travelling salesman problem (TSP) has been widely studied for the classical closed loop variant but less attention has been paid to the open loop variant. Open loop solution has property of being also a spanning tree, although not necessarily the minimum spanning tree (MST). In this paper, we present a simple branch elimination algorithm that removes the branches from MST by cutting one link and then reconnecting the resulting subtrees via selected leaf nodes. The number of iterations equals to the number of branches (b) in the MST. Typically, b << n where n is the number of nodes. With O-Mopsi and Dots datasets, the algorithm reaches gap of 1.69% and 0.61 %, respectively. The algorithm is suitable especially for educational purposes by showing the connection between MST and TSP, but it can also serve as a quick approximation for more complex metaheuristics whose efficiency relies on quality of the initial solution.

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1178 J, 527 nm near diffraction limited laser based on a complete closed-loop adaptive optics controlled off-axis multi-pass amplification laser system

High Power Laser Science and Engineering ◽

10.1017/hpl.2021.3 ◽

2021 ◽

Vol 9 ◽

Author(s):

Deen Wang ◽

Xin Zhang ◽

Wanjun Dai ◽

Ying Yang ◽

Xuewei Deng ◽

...

Keyword(s):

Laser Beam ◽

Adaptive Optics ◽

Closed Loop ◽

Focal Spot ◽

Beam Quality ◽

Laser System ◽

Diffraction Limit ◽

Kdp Crystal ◽

Main Amplifier

Abstract A 1178 J near diffraction limited 527 nm laser is realized in a complete closed-loop adaptive optics (AO) controlled off-axis multi-pass amplification laser system. Generated from a fiber laser and amplified by the pre-amplifier and the main amplifier, a 1053 nm laser beam with the energy of 1900 J is obtained and converted into a 527 nm laser beam by a KDP crystal with 62% conversion efficiency, 1178 J and beam quality of 7.93 times the diffraction limit (DL). By using a complete closed-loop AO configuration, the static and dynamic wavefront distortions of the laser system are measured and compensated. After correction, the diameter of the circle enclosing 80% energy is improved remarkably from 7.93DL to 1.29DL. The focal spot is highly concentrated and the 1178 J, 527 nm near diffraction limited laser is achieved.

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