scholarly journals Service innovations

2004 ◽  
Vol 28 (8) ◽  
pp. 298-300
Author(s):  
Richard Hodgson ◽  
Susan E. Smith ◽  
Richard C. Strange ◽  
Anthony A. Fryer
Keyword(s):  
Side Effects ◽  
Adverse Drug Events ◽  
Case Note ◽  
Clinical Implications ◽  
General Psychiatry ◽  
Medication Dosage ◽  
Extensive Metabolism ◽  
Preliminary Study ◽  
Further Development ◽  
Case Note Review

Aims and MethodThere are few descriptions in the literature of pharmacogenetic applications in psychiatry. We describe the relevance of pharmacogenetics to clinical psychiatry using a case-note review of the first 55 patients to have their cytochrome P450 (CYP2D6) status assessed in a general psychiatry clinic.ResultsThe distribution of genotypes for CYP2D6 was the same as in the general population. A smaller number of reported side-effects (P=0.01) and higher medication dosages (P=0.001) were significantly associated with the extensive metabolism genotype.Clinical ImplicationsThis preliminary study suggests that CYP2D6 status may have an influence on medication dosage and adverse drug events reported by patients. Recommendations for further development are suggested.

The use of haematological screening tests in acute psychogeriatric admissions

1995 ◽  
Vol 12 (1) ◽  
pp. 34-36
Author(s):  
Niall Quigley ◽  
Oscar Daly
Keyword(s):  
Clinical Management ◽  
Patient Management ◽  
Case Note ◽  
Screening Tests ◽  
Abnormal Result ◽  
General Psychiatry ◽  
Case Note Review ◽  
Abnormal Results

AbstractObjective: Case notes on 116 patients aged 65 or more admitted to a general psychiatry hospital over a three month period were examined to assess the current use of haematological screening tests.Method: Retrospective justification for tests performed, rate of abnormal results, and consequences for patient management were assessed by case note review.Results: A total of 200 screening tests, 105 of which appeared justified, were performed; 66 patients were screened, of whom 85% had at least one abnormal result. Those who were older were less likely to be screened. There was no relationship between diagnosis and being screened. Of the 90 abnormal results received, less then one third affected clinical management.Conclusions: The financial and other costs of screening tests are discussed. The current use of haematological screening tests in this population appears erratic and often adds little to patient management.

scholarly journals Opening the ‘black box’: liaison psychiatry services and what they actually do

2016 ◽  
Vol 40 (4) ◽  
pp. 175-180 ◽  
Author(s):  
Elspeth Guthrie ◽  
Aaron McMeekin ◽  
Rachel Thomasson ◽  
Sylvia Khan ◽  
Sally Makin ◽  
...  
Keyword(s):  
Medication Management ◽  
Black Box ◽  
Case Note ◽  
Clinical Implications ◽  
Liaison Psychiatry ◽  
Site Specific ◽  
Service Setting ◽  
Different Types ◽  
Assessment And Treatment ◽  
Case Note Review

Aims and methodTo develop a simple, pragmatic typology to characterise the nature of liaison interventions delivered by a liaison service in a National Health Service setting. We carried out a retrospective electronic case-note review of referrals to a ward-based liaison psychiatry service.ResultsThree hundred and forty-four patients were referred to the service over a 12-month period. Ten different types of liaison interventions were identified, with the most common interventions being diagnosis (112 patients, 32.6%), medication management (57 patients, 16.6%), risk assessment and treatment (56 patients, 16.3% each). Mental Health Act work accounted for the greatest number of contacts per patient (median 7).Clinical implicationsThere are inherent limitations in any single-site observational study, as site-specific results cannot be generalised to other liaison services. The intervention categories we developed, however, are easy to use and will provide a way of comparing and benchmarking the range of interventions delivered by different liaison psychiatry services.

scholarly journals Daytime night attire as a therapeutic intervention in an acute adult psychiatric in-patient unit

2008 ◽  
Vol 32 (6) ◽  
pp. 221-224 ◽  
Author(s):  
Camilla Langan ◽  
Colm McDonald
Keyword(s):  
Case Note ◽  
Medical Documentation ◽  
Clinical Implications ◽  
Negative Attitudes ◽  
High Prevalence ◽  
Psychiatric Units ◽  
Self Harm ◽  
The Republic ◽  
The Right ◽  
Case Note Review

Aims and MethodDressing in-patients in night attire during daytime is currently practised in many in-patient psychiatric units, despite the lack of evidence to support its benefit in reducing absconding or self-harm. Using a triangulation design, we investigated the prevalence of, attitudes towards and associations of this practice in an acute psychiatric in-patient setting in the Republic of Ireland.ResultsCase-note review revealed a high prevalence of this practice (57%) and its significant association with involuntary admission. Nursing staff believed that using night attire was effective at reducing absconding and self-harm, and that only voluntary patients should retain the right to choose their clothes. Most patients interviewed were uncomfortable in night clothes and indicated that they should be entitled to choose what to wear.Clinical ImplicationsNight attire is regularly used for risk-management, despite lack of evidence supporting its efficacy and negative attitudes towards it in many patients. This practice and the reasons for its implementation deserve medical documentation.

scholarly journals Characteristics of admissions considered inappropriate by junior psychiatrists

1999 ◽  
Vol 23 (1) ◽  
pp. 34-37 ◽  
Author(s):  
Peter Y. Elwood
Keyword(s):  
Demographic Characteristics ◽  
Case Note ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Admission Process ◽  
Personality Disordered ◽  
Case Note Review

Aims and methodThe aim of the study was to identify medical and socio-demographic characteristics of admissions considered inappropriate by psychiatrists. Appropriateness of admission was assessed by questionnaire. Medical and socio-demographic characteristics of each admission were obtained by case note review.ResultsTwenty-five per cent of admissions were considered inappropriate. These patients showed high levels of adverse socio-demographic characteristics and commonly were diagnosed as personality disordered or as substance misusers. Junior doctors commonly admitted patients despite considering admission inappropriate.Clinical implicationsRegular audit of the admission, process should be encouraged.

scholarly journals Prescribing and monitoring of carbamazepine and valproate – a case note review

2000 ◽  
Vol 24 (5) ◽  
pp. 174-177 ◽  
Author(s):  
David M. Taylor ◽  
Kate Starkey ◽  
Saira Ginary
Keyword(s):  
Trough Level ◽  
Clinical Governance ◽  
Case Note ◽  
Clinical Implications ◽  
Evidence Based ◽  
Plasma Level Monitoring ◽  
Psychiatric Units ◽  
Level Monitoring ◽  
Case Note Review

Aims and MethodTo evaluate prescribing and monitoring of carbamazepine and valproate to patients in secondary care psychiatric units. Review of prescription cards and medical case notes.ResultsPrescribing details for 433 patients were recorded. Both carbamazepine and valproate were widely prescribed for indications not listed in their product licences. Plasma level monitoring was not frequently undertaken, particularly with valproate. Where plasma levels were measured, apparently sub-therapeutic prescribing was found to be common. For the majority of samples, it could not be established that a true trough level had been taken. Monitoring of blood function was highly variable. Overall, the quality of both prescribing and monitoring was poor.Clinical ImplicationsPatients may receive sub-therapeutic treatment or experience unnecessary adverse effects. Prescribing and monitoring need to be more evidence-based in line with the ideals of clinical governance.

scholarly journals Patient or client? The opinions of people attending a psychiatric clinic

2000 ◽  
Vol 24 (12) ◽  
pp. 447-450 ◽  
Author(s):  
C. W. Ritchie ◽  
D. Hayes ◽  
D. J. Ames
Keyword(s):  
Medical Staff ◽  
Case Note ◽  
Psychiatric Practice ◽  
Psychiatric Clinic ◽  
Clinical Implications ◽  
Case Note Review

Aims and MethodThe use of the term ‘client’ has become increasingly popular among non-medical staff in psychiatric practice. We sought to describe the preferences and attitudes of people attending a psychiatric clinic to the terms patient and client. A questionnaire and case note review was employed.Results147 people completed the questionnaire, of these 77% preferred the term patient. There was no subgroup that preferred the term client. Attitudes towards the two terms were significantly different, with a greater antipathy demonstrated towards the term client.Clinical ImplicationsThe majority of people attending a psychiatric clinic prefer the use of the term patient; the term client is disliked.

scholarly journals New long-stay patients in a psychiatric admission ward setting

2005 ◽  
Vol 29 (12) ◽  
pp. 452-454 ◽  
Author(s):  
Colin Cowan ◽  
Philippa Walker
Keyword(s):  
Patient Care ◽  
Descriptive Study ◽  
Case Note ◽  
Living Alone ◽  
Clinical Implications ◽  
Retrospective Case ◽  
Psychiatric Admission ◽  
Admission Ward ◽  
Early Readmission ◽  
Case Note Review

Aims and MethodThis is a descriptive study of the admissions of new long-stay patients and their outcome in a district with minimal access to longer-stay in-patient beds. Cases were identified through an ongoing in-patient census and information was gathered by retrospective case-note review.ResultsThirty-nine new long-stay admissions were identified. High rates of living alone, early readmission following previous discharge and use of the Mental Health Act 1983 were noted. The 39 admissions occupied 12% of the unit's capacity. Four patients returned to a family residence but 27 went into residential or in-patient care. Of those discharged to settings not providing patient care, 48% were readmitted in the year after discharge.Clinical ImplicationsNew long-stay admissions continue to absorb a high proportion of the bed resources of an in-patient unit for their numbers and these patients are at risk of unsuccessful discharge.

scholarly journals Continuity of supply of psychiatric medicines for newly received prisoners

2011 ◽  
Vol 35 (7) ◽  
pp. 244-248 ◽  
Author(s):  
Lamiece Hassan ◽  
Jane Senior ◽  
Dawn Edge ◽  
Jenny Shaw
Keyword(s):  
Mental Health ◽  
Health Policy ◽  
Clinical Assessment ◽  
Mental Health Policy ◽  
Case Note ◽  
Additional Stress ◽  
Clinical Implications ◽  
Psychiatric Medication ◽  
Retrospective Case ◽  
Case Note Review

Aims and methodA retrospective case-note review was undertaken at five English prisons between June 2008 and March 2009 to estimate the proportion of psychiatric medicines (antidepressants, antipsychotics and hypnotics/anxiolytics) reported at prison reception that are discontinued on entry to prison.ResultsOf the 1006 records sampled, the review showed that 18% of prisoners had been prescribed psychiatric medication before being placed in custody. Altogether, 240 separate psychiatric medicines were recorded among prisoners at reception. Of these, 47% were not prescribed during the first week of custody. In only 11% of cases where medication was discontinued had psychiatric assessment been completed.Clinical implicationsPrison mental health policy states that psychiatric medication should not be withdrawn in custody without proper clinical assessment. Denial of medication in the absence of clinical assessment during early custody has the potential to create additional stress in individuals during a period of increased vulnerability and risk.

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