scholarly journals An assessment of referrals to a liaison psychiatry team within a large district general hospital – Completing the Cycle

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S102-S103
Author(s):  
Ivan Shanley ◽  
Sophie Tillman ◽  
Shruti Lodhi ◽  
Shazia Shabbir
Keyword(s):  
Risk Assessment ◽  
Marked Improvement ◽  
Free Text ◽  
Psychiatric History ◽  
Clinical Question ◽  
Liaison Psychiatry ◽  
Psychiatry Department ◽  
Referral Form ◽  
Park Hospital

AimsIn 2019 members of the Liaison Psychiatry Department at Frimley Park Hospital completed an audit of the referrals to the service1. The quality of referrals was found to be highly variable, for example only 28% included a risk assessment and frequently omitted both past psychiatric and past medical histories. As such an intervention was designed involving three parts;Multidisciplinary education of staffNew and more readily available referral guidelinesNew referral formThis re-audit seeks to complete the audit cycle and assess the impact of the intervention.MethodThe first 50 referrals to the Liaison Psychiatry Department of Frimley Park Hospital during February 2021 were assessed using the following criteria:Staff type, referral source, physically fit for assessment, physical cause ruled out, drugs / alcohol involved, appropriate reason for referral, clinical question asked, did final diagnosis match referral diagnosis, risk assessment included, information about admission included, past psychiatric history included and past medical history included.The percentage of referrals received for each criterion (e.g. the percentage with a risk assessment completed) was then derived from the data.ResultThere has been a marked improvement in a variety of areas. The percentage of referrals containing a risk assessment increased from 28% to 96%. This is likely due to the risk box now requiring an entry prior to being able to submit the referral form. Similarly the percentage containing past psychiatric history has risen from 38.8% to 90%. Previously 46.2% of referrals contained a working diagnosis which was not consistent with the clinical picture, but again this has improved, with 60% of initial diagnoses now matching the final outcome. There are however areas for improvement. Only 14% of referrals contained a specific clinical question, which is lower than the 20% achieved previously. This may be because the new referral form does not provide a specific free text box for this.ConclusionThe intervention yielded a marked improvement in the quality of referrals received by the Liaison Psychiatry Department at Frimley Park Hospital, and it is the intention to continue to use the current process. Based on the new results we will look to make small adjustments, for example adding a free text box for a specific clinical question and emphasising the importance of this information.

An Ayurvedic Visual Rehabilitation In Lebers Congenital Amaurosis - Prospective Case Study

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Dr. Vidhyasri M ◽  
Dr. S. M. Pasha
Keyword(s):  
Marked Improvement ◽  
Clinical Case ◽  
Treatment Plan ◽  
Visual Disability ◽  
Visual Rehabilitation ◽  
Potential Risks ◽  
The Subject ◽  
Slow Frequency

Introduction: This is the case report of child who was diagnosed with LCA reported with complaints of large-amplitude, slow-frequency, roving nystagmus, frequent tendency to press on his eyes, enopthalmos, with completely normal ophthalmoscopic examination with normal appearing optic nerve and retina and has a non recordable ERG; considering this condition under the lines of Vataja Nanatmaja Vyadhi treatment was structured to render effective visual rehabilitation which showed marked results. Methods: 4 years old male child who was diagnosed with lebers congenital amaurosis was brought by his parents to Eye OPD, GAMC, Bengaluru. The presentation of this case includes bibliographic review of the subject, presentation of a clinical case and description of the importance of Ayurvedic prespective of handling of these patients. Results: The child showed improvement in fixing for light and also nystagmus showed marked improvement and there were considerable behavioural changes observed. Discussion: It is important to deepen the environment of the disease to know the possible implications in Ayurvedic management, recognize the magnitude of visual disability that our patient presents for the establishment of the treatment plan and provide an integral care of excellence in an interdisciplinary way in favor of visual rehabilitation of our patients and also help to restore quality of life with no potential risks of side effects.

scholarly journals Life with Parkinson’s Disease During the COVID-19 Pandemic: The Pressure Is “OFF”

2021 ◽  
pp. 1-5
Author(s):  
Trine HØrmann Thomsen ◽  
Susanna M. Wallerstedt ◽  
Kristian Winge ◽  
Filip Bergquist
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Motor Symptom ◽  
Free Text ◽  
Symptom Scores ◽  
Related Quality ◽  
Health Related ◽  
Potential Impact ◽  
Swedish Cohort

People with Parkinson’s disease (PwP) have been suggested to be more vulnerable to negative psychological and psycho-social effects of the COVID-19 pandemic. Our aim was to assess the potential impact of the COVID-19 pandemic in PwP. A Danish/Swedish cohort of 67 PwP was analysed. Health-related quality of life (HRQL), depression, anxiety, apathy, sleep and motor symptom-scores were included in the analysis. Additionally, the Danish participants provided free-text descriptions of life during the pandemic. Overall, the participants reported significantly better HRQL during the COVID-19 period compared with before. Reduced social pressure may be part of the explanation. Despite worsened anxiety, night sleep improved.

scholarly journals P083 A rheumatology carousel: three-year results from an open-access teaching workshop designed for core rheumatology assessments for undergraduate medical students

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Pritesh Mistry ◽  
James Bateman ◽  
Helen Foss ◽  
Muhamad Jasim
Keyword(s):  
Medical Students ◽  
Open Access ◽  
Clinical Teaching ◽  
Lesson Plan ◽  
Clinical History ◽  
Teaching Staff ◽  
Free Text ◽  
Undergraduate Medical Students ◽  
Core Conditions

Abstract Background/Aims  Medical students need to gain patient contact to develop their skills in history taking and examinations. In year three, undergraduate students typically rotate across various hospitals and specialties and are expected to have dedicated rheumatology exposure for history and examination competencies. Rheumatology as an out-patient specialty can limit opportunities for medical students to have broad exposure to rheumatological conditions. Methods  In January 2018, we designed an annual rheumatology half-day teaching workshop (‘Rheumatology Carousel’) using a combination of lecture-based teaching and small group based guided clinical history and examination stations, aimed at third-year medical students from the University of Birmingham. This covered key presentations in rheumatology: axial spondyloarthropathy, rheumatoid arthritis, systemic sclerosis (connective tissue disease), osteoarthritis, and vasculitis. Each station required a Clinical Teaching Fellow or Rheumatology ST trainee, overseen by one consultant facilitator. We designed patient proforma’s incorporating consent, demographics, key clinical history, therapy, and examination findings. We produced a written patient guide, and consultants invited appropriate patients to volunteer for the day. We designed a one-hour lecture-based tutorial. A lesson plan and schedule were created outlining faculty requirements; including time, roles, and faculty numbers. We invited five to six patients to each session, with a plan of four to five focussed examinations. We designed the carousel to accommodate up to 40 students, split into two groups running over a day. Focussed examinations involved students in groups of four, with each student being a lead examiner in at least one station, each station lasting 20 minutes. Best practice examination techniques for each condition were assessed and emphasised. Following a debrief, we collected feedback from students, faculty, and patients (online and written feedback), using Likert scores for teaching content, and quality of the session delivery. Results  The carousel ran in February 2018, 19, and 20. The sessions were positively evaluated by students, faculty, and patients. In total, 93 students attended, 89/93 completed feedback. Satisfaction scores (mean; SD; range) were high (1-strongly disagree, 5-strongly agree) for content (4.8; 0.49, range 3-5) and quality of delivery (4.7; 0.54; 3-5). All patients who participated volunteered to return for future teaching sessions, with several patients attending all three years. Free text feedback indicated students valued structured exposure to core conditions and called for more sessions of this nature. Conclusion  This sustainable reproducible intervention ensures students have structured exposure to important rheumatological conditions. The methodology allows reproducible sessions that are positively evaluated despite rotating clinical teaching staff. We have made all our teaching materials, logistical plan, and scheduling tools available as open access resources under a Creative Commons license for free re-use and adaptation by any healthcare professional, via a web link. We plan to record an electronic version to distribute post the COVID-19 pandemic. Disclosure  P. Mistry: None. J. Bateman: None. H. Foss: None. M. Jasim: None.

The Use of Breathing Exercises in the Treatment of Chronic, Nonspecific Low Back Pain

2017 ◽  
Vol 26 (5) ◽  
pp. 452-458 ◽  
Author(s):  
Barton E. Anderson ◽  
Kellie C. Huxel Bliven
Keyword(s):  
Quality Of Life ◽  
Low Back Pain ◽  
Back Pain ◽  
Lung Function ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Low Back ◽  
Bottom Line ◽  
Breathing Exercises

Clinical Scenario:Research has shown a link between poor core stability and chronic, nonspecific low back pain, with data to suggest that alterations in core muscle activation patterns, breathing patterns, lung function, and diaphragm mechanics may occur. Traditional treatment approaches for chronic, nonspecific low back pain focus on exercise and manual therapy interventions, however it is not clear whether breathing exercises are effective in treating back pain.Focused Clinical Question:In adults with chronic, nonspecific low back pain, are breathing exercises effective in reducing pain, improving respiratory function, and/or health related quality of life?Summary of Key Findings:Following a literature search, 3 studies were identified for inclusion in the review. All reviewed studies were critically appraised at level 2 evidence and reported improvements in either low back pain or quality of life following breathing program intervention.Clinical Bottom Line:Exercise programs were shown to be effective in improving lung function, reducing back pain, and improving quality of life. Breathing program frequencies ranged from daily to 2–3 times per week, with durations ranging from 4 to 8 weeks. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain when such treatments align with the clinician’s own judgment and clinical expertise and the patient’s preferences and values.Strength of Recommendation:Grade B evidence exists to support the use of breathing exercises in the treatment of chronic, nonspecific low back pain.

Hospital end-of-life care: families’ free-text notes

2020 ◽  
pp. bmjspcare-2020-00239
Author(s):  
Sandra Kurkowski ◽  
Johannes Radon ◽  
Annika R Vogt ◽  
Martin Weber ◽  
Stephanie Stiel ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Of Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Qualitative Content Analysis ◽  
Free Text ◽  
Life Care ◽  
Quality Aspects ◽  
Care Of The Dying

BackgroundPalliative care strives to improve quality of life for patients with incurable diseases. This approach includes adequate support of the patients’ loved ones. Consequently, loved ones have personal experiences of providing end-of-life care for their next. This is a resource for information and may help to investigate the loved ones’ perspectives on need for improvements.AimTo identify further quality aspects considered important by loved ones to improve the quality of care at the end of life as an addition to quantitative results from the Care of the Dying Evaluation for the German-speaking area (CODE-GER) questionnaire.DesignWithin the validation study of the questionnaire ‘Care of the Dying Evaluation’ (CODETM) GER, loved ones were asked to comment (free text) in parallel on each item of the CODE-GER. These free-text notes were analysed with the qualitative content analysis method by Philipp Mayring.Setting/participantsLoved ones of patients (n=237), who had died an expected death in two university hospitals (palliative and non-palliative care units) during the period from April 2016 to March 2017.Results993 relevant paragraphs were extracted out of 1261 free-text notes. For loved ones, important aspects of quality of care are information/communication, respect of the patient’s and/or loved one’s will, involvement in decision-making at the end of life (patient’s volition) and having the possibility to say goodbye.ConclusionsIt is important for loved ones to be taken seriously in their sorrows, to be informed, that the caregivers respect the patients’ will and to be emotionally supported.Trial registration numberThis study was registered at the German Clinical Trials Register (DRKS00013916).

scholarly journals Nutritional Evaluation and Risk Assessment of the Exposure to Essential and Toxic Elements in Dogs and Cats through the Consumption of Pelleted Dry Food: How Important Is the Quality of the Feed?

Toxics ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 133
Author(s):  
Ana Macías-Montes ◽  
Manuel Zumbado ◽  
Octavio P. Luzardo ◽  
Ángel Rodríguez-Hernández ◽  
Andrea Acosta-Dacal ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Inductively Coupled Plasma ◽  
Reference Value ◽  
Inorganic Elements ◽  
Inductively Coupled ◽  
Icp Ms ◽  
Plasma Mass Spectrometry ◽  
Dry Food ◽  
Hazard Indexes

Dry feed for pets lacks specific legislation regarding maximum residue limits for inorganic elements. The aim of the present study was to determine the content of 43 inorganic elements in dog and cat feed, studying whether there were differences according to the supposed quality of the food and performing the risk assessment for health. Thirty-one and thirty packages of pelleted dry food for cats and dogs, respectively, were analyzed. After acidic microwave-assisted digestion, elements were detected and quantified by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). In general, we did not observe important differences in the content of elements according to the supposed quality of the brand. Among trace elements, selenium and manganese are above the dietary reference value. Arsenic and mercury showed the highest acute hazard indexes, which make them risk factors for the health of dogs and cats. Aluminum, uranium, antimony and vanadium contents were above the toxic reference value and showed the highest acute hazard indexes. It is necessary to improve the legislation regarding the food safety of pets, for their health and to protect the rights of consumers.

scholarly journals Key Elements for Judging the Quality of a Risk Assessment

2016 ◽  
Vol 124 (8) ◽  
pp. 1127-1135 ◽  
Author(s):  
Penelope A. Fenner-Crisp ◽  
Vicki L. Dellarco
Keyword(s):  
Risk Assessment

scholarly journals Accuracy and Reproducibility of Acoustic Tomography Significantly Increase with Precision of Sensor Position

2017 ◽  
Vol 2 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Steffen Rust
Keyword(s):  
Risk Assessment ◽  
Norway Spruce ◽  
Cross Sections ◽  
Acoustic Tomography ◽  
Model Operator ◽  
Sensor Position ◽  
Complex Shapes ◽  
Source Of Error ◽  
Sensor Positions

Acoustic tomograms are widely used in tree risk assessment. They should be accurate,repeatable and comparable between consecutive measurements. Previous work has failed to address the effects of different approaches to record sensor positions, operators and models of tomograph on the resulting tomograms.In this study, three operators used the two most common sonic tomographmodels to measure seven cross-sections of Norway spruce trees, whichwere felled after the measurement. We evaluated the effects of model, operator, and different approaches to measure sensor positions on the quality of the tomograms.The largest source of error was the position of sensors, affectingestimated stress wave velocity, the shape of the tomogram, and the sizeof the defect.To produce accurate and repeatable tomograms of trees with complex shapes,it is essential to measure the sensor positions precisely.

scholarly journals Improving the quality of GP referrals to the Croydon Assessment & Liaison Team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S205-S205
Author(s):  
Gabriella Lewis ◽  
Lucia Chaplin ◽  
Gareth Knott ◽  
Alexandra Coull ◽  
Lamide Sobamowo
Keyword(s):  
Random Sample ◽  
Gold Standard ◽  
Relevant Information ◽  
Post Intervention ◽  
Significant Difference ◽  
Referral Form ◽  
Patient Assessments ◽  
New Form ◽  
Intervention Uptake

AimsTo increase the percentage of GP referrals to the Croydon Assessment & Liaison (A&L) Team deemed to be of ‘good quality’. The A&L Team receives a large number of referrals daily from GPs, and it was identified that many of these referrals did not include important and relevant information, leading to delays in patient assessments.MethodA questionnaire was distributed to A&L MDT members to collect information about what information they consider important in a GP referral. The project team reviewed the results of the questionnaire, along with current policies and guidelines, to create a set of criteria by which to assess the quality of GP referrals, as there was no pre-existing gold standard available. A random sample of 6 GP referrals per week stratified by locality was collected and assessed against these criteria.Using Plan-Do-Study-Act (PDSA) methodology change ideas were generated, and a GP referral form was identified as an important intervention to adopt. A previously-developed draft form was updated after a round of consultations with various stakeholders including Assessment & Liaison staff, GPs and the CCG. The new GP referral form was uploaded to the GP DSX electronic referrals platform and GP practices were also emailed directly to encourage them to use the new form.The proportion of GP referrals deemed to be of good quality was compared pre and post-intervention. Uptake of the new GP referral form was recorded as a process measure, and the length of time taken to discuss referrals at A&L daily referrals meetings as a counterbalance measure.ResultAt baseline 33% of GP referrals were deemed to be of good quality using the developed criteria. This improved to 58% after implementation of the new referral form in January 2021. There was poor overall uptake of the form, with only 32.5% of GP referrals utilising the new form so far, however of the referrals received on the new form 69% fulfilled the criteria for good quality. Comparison of length of discussion required for referrals with and without the new form showed no significant difference (7.7 and 7.6 minutes respectively).ConclusionImplementation of a standardised GP referral form was effective at increasing the proportion of referrals deemed to be of good quality. However, further PDSA cycles focused on improving uptake of the form will be required.

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