scholarly journals Audit of psychiatric discharge summaries: completing the cycle

2004 ◽  
Vol 28 (9) ◽  
pp. 329-331 ◽  
Author(s):  
Isabelle Crossan ◽  
David Curtis ◽  
Yong-Lok Ong
Keyword(s):  
Clinical Practice ◽  
Clinical Audit ◽  
Audit And Feedback ◽  
Clinical Implications ◽  
Considerable Variability ◽  
Clinical Tool ◽  
Barriers To Change ◽  
Adult Psychiatry ◽  
Psychiatric Department ◽  
Discharge Summaries

Aims and MethodTo examine and attempt to improve the recording of information within psychiatric discharge summaries in an adult psychiatry department, by means of audit and feedback. Psychiatric discharge summaries from an acute adult psychiatric department were examined to determine the recording of ten selected items. Following feedback and discussion, the audit was repeated after 6 months.ResultsFifty-one discharge summaries were examined on the first occasion and 53 on the second. There was considerable variability in the standard of recording across the selected items, but the patterns of recording were similar at both stages. No improvement was found in the recording of information at the second audit.Clinical ImplicationsAudit and feedback alone may have little effect in changing clinical practice. This study examines the experience of undertaking clinical audit from a trainee's perspective, illustrates barriers to change and highlights the possible limitations of audit as a clinical tool.

scholarly journals The use of operationalised criteria for inclusion on a Care Programme Approach register

2001 ◽  
Vol 25 (5) ◽  
pp. 172-174 ◽  
Author(s):  
M. Phipot ◽  
H. Hales ◽  
B. Sheehan ◽  
S. Reeves ◽  
M. Lawlor
Keyword(s):  
Clinical Practice ◽  
Clinical Audit ◽  
Clinical Governance ◽  
Clinical Implications ◽  
Policy Feedback ◽  
Retrospective Case ◽  
Care Programme ◽  
Minimum Standards ◽  
Audit Cycle ◽  
Service Policies

Aims and MethodTo determine the rates at which clinical teams within one NHS trust placed older people on a Care Programme Approach (CPA) register and to examine the degree to which clinicians' use of the register conformed to trust policy. Two retrospective case notes surveys were carried out 6 months apart within a completed audit cycle.ResultsConsultant teams varied considerably in their application of the CPA policy. Feedback to clinicians after the first survey had a variety of effects on subsequent use of the CPA register.Clinical ImplicationsHealth service policies exist to reduce variation in clinical practice and to ensure minimum standards. Clinical audit may be a useful tool in identifying irrational variation within the framework of clinical governance.

scholarly journals Mind the gap – using clinical audit to minimise medication information errors at hospital discharge

2010 ◽  
Vol 34 (6) ◽  
pp. 248-250
Author(s):  
Ashok Kumar Jainer ◽  
Fabida Noushad ◽  
Tim Coupe ◽  
Chaya Rekha Mupiri ◽  
Anoop Saraf
Keyword(s):  
General Practitioner ◽  
Health Risks ◽  
Clinical Audit ◽  
Discharge Summary ◽  
Clinical Implications ◽  
Medication Information ◽  
Retrospective Audit ◽  
Information Errors ◽  
Patient Confidence ◽  
Discharge Summaries

Aims and methodWe conducted a retrospective audit of 100 discharge summaries to evaluate the accuracy of medication recording and the recording of as required (PRN) prescribing, and to see whether or not general practitioners were advised on how long to continue the latter. After a formal guideline was introduced we conducted a re-audit.ResultsThere was an improvement in summaries recording medication correctly (from 64 to 83%). The number of summaries with one or more missing medications halved and PRN sedative prescribing reduced from 18 to 3%, but provision of advice on the latter did not improve.Clinical implicationsAccurate recording of medication in the discharge summary is an important element of the transfer of patient care to the general practitioner. Medication errors may pose serious health risks and undermine patient confidence in the service. The clinical audit and interventions implemented helped to reduce errors in medication recording in discharge summaries.

scholarly journals Cognitive therapy training for psychiatrists: impact on individual clinical practice

2004 ◽  
Vol 28 (4) ◽  
pp. 117-119 ◽  
Author(s):  
G. Swift ◽  
I. Durkin ◽  
C. Beuster
Keyword(s):  
Clinical Practice ◽  
Cognitive Therapy ◽  
Response Rate ◽  
Postal Questionnaire ◽  
Clinical Implications ◽  
Previous Survey ◽  
Therapy Training ◽  
Training And Supervision ◽  
Improved Outcomes ◽  
Therapy Sessions

Aims and MethodWe aimed to survey how psychiatrists with in-depth training in cognitive therapy use these skills. A postal questionnaire based on a previous survey was sent to all psychiatrists who are accredited members of the British Association for Behavioural and Cognitive Psychotherapies.ResultsThere was a 94% response rate. Psychiatrists in non-psychotherapy posts used formal cognitive therapy, with an average of 20% of new patients compared with 65% for those in psychotherapy posts, and were less satisfied with the extent to which they were able to use their skills (20%v. 80%). A total of 85% of respondents described themselves as being involved in teaching, training and supervision of cognitive therapy.Clinical ImplicationsUnless psychiatrists are planning on working in specialised psychotherapy posts, they are unlikely to use cognitive therapy training in formal therapy sessions. Further research is needed to determine whether cognitive therapy training for psychiatrists translates into improved outcomes for patients.

A Review of Virtual Week for Prospective Memory Assessment: Clinical Implications

2009 ◽  
Vol 10 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Peter G. Rendell ◽  
Julie D. Henry
Keyword(s):  
Clinical Practice ◽  
Psychometric Properties ◽  
Prospective Memory ◽  
Functional Independence ◽  
Clinical Implications ◽  
Memory Assessment

AbstractIt is now recognised that prospective memory (PM) failures are commonly observed in clinical groups, and have important implications for functional independence. However, well-validated measures of PM have traditionally been lacking, making this construct difficult to assess in clinical practice. Rendell and Craik's (2000) Virtual Week measure was developed as an indicator of PM, and has been shown to have good psychometric properties and be sensitive to the effects of normal and abnormal adult ageing, as well as various forms of pathology. In this article, an overview of Virtual Week's characteristics is presented, and the literature relating to use of this measure in various populations reviewed. The potential implications of the development of a new computerised version of Virtual Week for clinical practice are discussed.

scholarly journals Variation between services in polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients

2002 ◽  
Vol 26 (11) ◽  
pp. 418-420 ◽  
Author(s):  
Maria Harrington ◽  
Paul Lelliott ◽  
Carol Paton ◽  
Maria Konsolaki ◽  
Tom Sensky ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Antipsychotic Drugs ◽  
Service Level ◽  
Case Mix ◽  
Clinical Implications ◽  
High Dose ◽  
Prescribing Practice ◽  
Acute Psychiatric Wards ◽  
High Doses

Aims and MethodA 1-day census provided an opportunity to examine the variation between 44 mental health services in the frequency of prescribing high doses and polypharmacy of antipsychotic drugs to in-patients on acute psychiatric wards.ResultsThe proportion of patients prescribed a high dose ranged 0–50% and simultaneous use of more than one antipsychotic drug ranged 12–71%. A number of case-mix variables explained 26% and 40%, respectively, of the variance between services on these two indicators of prescribing practice.Clinical ImplicationsServices with high rates of prescription of high dose or polypharmacy might consider a review of clinical practice and of service-level factors that might affect prescribing.

scholarly journals Cardiac myxoma as a potential trigger of takotsubo cardiomyopathy: A brief review on mechanistic and clinical perspectives

2021 ◽  
Author(s):  
Kenan Yalta ◽  
Ugur Ozkan ◽  
Tülin Yalta ◽  
Ertan Yetkin
Keyword(s):  
Clinical Practice ◽  
Takotsubo Cardiomyopathy ◽  
Myocardial Dysfunction ◽  
Cardiac Myxoma ◽  
The Other ◽  
Clinical Implications ◽  
Transient Form ◽  
Cardiac Neoplasms ◽  
Potential Trigger ◽  
Cardiac Myxomas

In clinical practice, cardiac myxomas constitute the majority of benign cardiac neoplasms, and might potentially present with a variety of embolic, obstructive as well as constitutional symptoms. On the other hand, these neoplasms might be potentially associated with the evolution of takotsubo cardiomyopathy (TTC) that is universally considered as a transient form of acute myocardial dysfunction. Accordingly, the present paper primarily aims to focus on potential mechanisms and associated clinical implications of TTC evolution in the setting of cardiac myxomas.

scholarly journals Improving the assessment of risk of violence: a clinical audit of case note documentation

2001 ◽  
Vol 25 (7) ◽  
pp. 250-252 ◽  
Author(s):  
Michael Campbell ◽  
Robert Chaplin
Keyword(s):  
Risk Assessment ◽  
Clinical Audit ◽  
Training Session ◽  
Clinical Implications ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
Health Team ◽  
Retrospective Audit ◽  
Changes In Risk ◽  
Made In

Aims and MethodsTo improve the rate of documentation of risk in new referrals to a community mental health team. A retrospective audit of 46 case notes was followed by a training session on risk of violence. The following 50 case notes were studied for changes in risk assessment.ResultsPrior to the study there were very low rates of documentation of risk of violence. Significant improvements were made in 45% of the items in the history and mental state although not in the formulation of a risk assessment statement.Clinical ImplicationsIt is possible to improve the risk of violence documentation with no extra time, resources or paperwork and with true multi-disciplinary involvement.

scholarly journals Reconciling the information needs of clinicians, managers and commissioners – a pilot project

2001 ◽  
Vol 25 (11) ◽  
pp. 423-425 ◽  
Author(s):  
Matthew Broadbent
Keyword(s):  
Clinical Practice ◽  
Information Needs ◽  
Pilot Project ◽  
Information Model ◽  
Clinical Implications ◽  
Clinical Settings ◽  
Accurate Data ◽  
Clinical Model

Aims and MethodClinicians are often required, by managers, to provide information that does not appear relevant to clinical practice. Rooted in compromise, an outcome-based information model that supports practice and also provides information for managers was developed. A 9–month pilot project at three sites in South-East London took place to test the feasibility of this model in real clinical settings.ResultsAccurate data were reliably collected. Clinicians at participating sites agreed the model produced potentially useful information and, on condition that support is provided, continue to collect data voluntarily.Clinical ImplicationsThis is not an exclusively clinical model. However, because it also fulfils management needs there is a better chance that clinicians will get the support they need.

P-740 Socio-cultural and clinical implications of ‘routine’ AMH testing in India: Insights from an interview study with the healthcare professionals (HCPs)

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
P Satalkar ◽  
V Provoost
Keyword(s):  
Clinical Practice ◽  
Fertility Preservation ◽  
Healthcare Professionals ◽  
Screening Tool ◽  
Clinical Implications ◽  
Age Difference ◽  
Indian Women ◽  
Fertility Treatments ◽  
Indian Context ◽  
Cultural Implications

Abstract Study question How do Indian healthcare professionals describe their clinical experience with and perspectives on AMH testing in Indian women seeking fertility treatments including fertility preservation? Summary answer The HCPs cautioned against AMH testing as a screening tool in presumed fertile Indian women due to its anticipated impact on women’s arranged-marriage prospects. What is known already AMH test is being increasingly used to assess women’s ovarian reserve (OR) while planning fertility treatments or to guide decisions about fertility preservation (FP). There is weak evidence suggesting that serum AMH level and fertility treatment outcomes vary in different population groups. Surveys with women in reproductive age (e.g. the US, Ireland, the Netherlands) indicate that a majority wants to know their OR to aid reproductive decision making. As yet, both globally and in an Indian context, there are only few qualitative studies exploring the views of HCPs on the OR assessment in clinical practice and its socio-cultural implications. Study design, size, duration This paper reports the findings of an exploratory qualitative research aimed at understanding whether and how elective fertility preservation could influence reproductive autonomy of Indian women. Between June 2018 and April 2019, IVF specialists and obstetricians practicing in ten cities across five Indian states were interviewed in English (language commonly spoken) using a semi-structured interview guide. The discussion about OR assessment with AMH-testing was initiated by the participants indicating its significance in their clinical practice. Participants/materials, setting, methods The study sample included 17 male and 15 female HCPs, the majority (18/32) was practicing in Mumbai. Twenty-six of them were in private practice while six worked as OBGYNs in publicly funded teaching hospitals. Twenty-six participants were interviewed in their clinics and the remaining six using Skype or telephone. After several rounds of immersive reading, the interview sections on OR and AMH-test were analyzed inductively using Braun and Clarke’s thematic analysis. Main results and the role of chance Several participants reported that many of their patients present with decreased OR (DOR) at a younger age and need higher dosages of hormones for ovulation induction compared to the dosages mentioned in international guidelines. They corroborated this experience with a few peer-reviewed articles indicating a six-years age difference in OR of Indian women undergoing IVF compared to Spanish women. A majority of participants advocated for the rational use of OR assessment in IVF patients but warned against its indiscriminate use or interpretation out of context due to concerns about overdiagnosis of ovarian factor infertility and overtreatment with IVF with donor eggs. Although the physicians who had performed elective FP perceived AMH test as a simple, affordable and empowering tool to guide FP decisions, most participants were critical of using AMH-test as a screening tool in young, presumed fertile women completing university education. They were concerned that a diagnosis of DOR as a result of such screening in this population in the Indian context will adversely impact women’s chances of marriage and might further increase pressure on women to get married and complete their childbearing early even if they are not ready for it. Limitations, reasons for caution This is the first qualitative study assessing views of Indian HCPs on AMH testing. These results are indicative rather than a representation of views of Indian HCPs. Almost half of the contacted HCPs did not respond to interview requests; we do not know whether they had different views. Wider implications of the findings The insights on clinical implications of AMH testing in India are relevant to other societies beyond the Euro-American and Australian context where AMH testing will increase in the future. The socio-cultural implications of ‘routine’ AMH testing in India urges us to be aware of similar implications in other cultural contexts. Trial registration number Not applicable

Developmental disorders of the brain

2019 ◽  
pp. 971-982
Author(s):  
Colin Ferrie ◽  
Daniel Warren ◽  
Atul Tyagi
Keyword(s):  
Clinical Practice ◽  
Corpus Callosum ◽  
Developmental Disorders ◽  
Clinical Implications ◽  
Brain Malformations ◽  
Genetic Abnormalities ◽  
Genetic Mechanisms ◽  
Posterior Fossa Malformations ◽  
And Migration ◽  
The Brain

Prenatal and postnatal development of the brain is controlled by a multiplicity of genetic mechanisms. Genetic abnormalities and environmental insults are responsible for a bewildering array of developmental disorders associated with brain malformations. Classic embryology remains key to understanding these, and an appreciation of the processes of gastrulation, dorsal and ventral induction, neuronal differentiation, proliferation, histogenesis, and migration and myelination will help the neurosurgeon understand the conditions likely to be encountered in clinical practice. In this chapter the more common and many less common brain malformations are reviewed. These include anencephaly, holoprosencephaly, septo-optic dysplasia, schizencephaly, grey matter heterotopias, lissencephaly/pachygyria, polymicrogyria, porencephaly, developmental anomalies of the corpus callosum, microcephaly, hemimegalencephaly, and posterior fossa malformations. The emphasis is on promoting an understanding of concepts and on clinical implications, rather than on imparting detail.

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