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.

Vitamin D in corticosteroid-naïve and corticosteroid-treated Duchenne muscular dystrophy: what dose achieves optimal 25(OH) vitamin D levels?

2016 ◽  
Vol 101 (10) ◽  
pp. 957-961 ◽  
Author(s):  
Nahla Alshaikh ◽  
Andreas Brunklaus ◽  
Tracey Davis ◽  
Stephanie A Robb ◽  
Ros Quinlivan ◽  
...  
Keyword(s):  
Vitamin D ◽  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Vitamin D Deficiency ◽  
Case Note ◽  
Retrospective Case ◽  
Toxic Level ◽  
Vitamin D Levels ◽  
25 Oh Vitamin D ◽  
Case Note Review

AimAssessment of the efficacy of vitamin D replenishment and maintenance doses required to attain optimal levels in boys with Duchenne muscular dystrophy (DMD).Method25(OH)-vitamin D levels and concurrent vitamin D dosage were collected from retrospective case-note review of boys with DMD at the Dubowitz Neuromuscular Centre. Vitamin D levels were stratified as deficient at <25 nmol/L, insufficient at 25–49 nmol/L, adequate at 50–75 nmol/L and optimal at >75 nmol/L.Result617 vitamin D samples were available from 197 boys (range 2–18 years)—69% from individuals on corticosteroids. Vitamin D-naïve boys (154 samples) showed deficiency in 28%, insufficiency in 42%, adequate levels in 24% and optimal levels in 6%. The vitamin D-supplemented group (463 samples) was tested while on different maintenance/replenishment doses. Three-month replenishment of daily 3000 IU (23 samples) or 6000 IU (37 samples) achieved optimal levels in 52% and 84%, respectively. 182 samples taken on 400 IU revealed deficiency in 19 (10%), insufficiency in 84 (47%), adequate levels in 67 (37%) and optimal levels in 11 (6%). 97 samples taken on 800 IU showed deficiency in 2 (2%), insufficiency in 17 (17%), adequate levels in 56 (58%) and optimal levels in 22 (23%). 81 samples were on 1000 IU and 14 samples on 1500 IU, with optimal levels in 35 (43%) and 9 (64%), respectively. No toxic level was seen (highest level 230 nmol/L).ConclusionsThe prevalence of vitamin D deficiency and insufficiency in DMD is high. A 2-month replenishment regimen of 6000 IU and maintenance regimen of 1000–1500 IU/day was associated with optimal vitamin D levels. These data have important implications for optimising vitamin D dosing in DMD.

scholarly journals Variation in clinical care associated with weekend admission and discharge in psychiatric in-patient units: retrospective case-note review

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Ryan Williams ◽  
Lorna Farquharson ◽  
Ellen Rhodes ◽  
Mary Dang ◽  
Natasha Lindsay ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Psychiatric Hospital ◽  
Depressive Disorders ◽  
Clinical Care ◽  
Case Note ◽  
Weekend Effect ◽  
Standards Of Care ◽  
Retrospective Case ◽  
Case Note Review

Background Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends. Aims To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the ‘working week’. Method Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses. Results In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39–0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46–0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30–0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50–0.97). Conclusions There is no evidence of a ‘weekend effect’ for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.

scholarly journals Clinical and laboratory characteristics of clozapine-treated patients with schizophrenia referred to a national immunodeficiency clinic reveals a B-cell signature resembling common variable immunodeficiency (CVID)

2020 ◽  
Vol 73 (9) ◽  
pp. 587-592 ◽  
Author(s):  
Mark James Ponsford ◽  
Rachael Steven ◽  
Kathyrn Bramhall ◽  
Mathew Burgess ◽  
Sonali Wijetilleka ◽  
...  
Keyword(s):  
Common Variable Immunodeficiency ◽  
Antibody Deficiency ◽  
Case Note ◽  
Retrospective Case ◽  
Clozapine Therapy ◽  
Clozapine Treatment ◽  
Immunoglobulin Replacement ◽  
Common Variable ◽  
Case Note Review ◽  
Drug Cessation

AimsAn association between antibody deficiency and clozapine use in individuals with schizophrenia has recently been reported. We hypothesised that if clozapine-associated hypogammaglobulinaemia was clinically relevant this would manifest in referral patterns.MethodsRetrospective case note review of patients referred and assessed by Immunology Centre for Wales (ICW) between January 2005 and July 2018 with extraction of clinical and immunological features for individuals with diagnosis of schizophrenia-like illness.Results1791 adult patients were assessed at ICW during this period; 23 patients had a psychiatric diagnosis of schizophrenia or schizoaffective disorder. Principal indications for referral were findings of low calculated globulin and immunoglobulins. Clozapine was the single most commonly prescribed antipsychotic (17/23), disproportionately increased relative to reported use in the general schizophrenia population (OR 6.48, 95% CI: 1.79 to 23.5). Clozapine therapy was noted in 6/7 (86%) of patients subsequently requiring immunoglobulin replacement therapy (IgRT). Marked reduction of class-switched memory B cells (CSMB) and plasmablasts were observed in clozapine-treated individuals relative to healthy age-matched controls. Clozapine duration is associated with CSMB decline. One patient discontinued clozapine, with gradual recovery of IgG levels without use of IgRT.ConclusionsOur findings are consistent with enrichment of clozapine-treatment within schizophrenic individuals referred for ICW assessment over the last 13 years. These individuals displayed clinical patterns closely resembling the primary immunodeficiency common variable immunodeficiency, however appears reversible on drug cessation. This has diagnostic, monitoring and treatment implications for psychiatry and immunology teams and directs prospective studies to address causality and the wider implications for this patient group.

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