scholarly journals Implementing self-administration of insulin in hospital: a journey of discovery and innovation. Part 1: Culture and storage

2018 ◽  
Vol 18 (1) ◽  
pp. 18-21
Author(s):  
Vicki L Rowse
Keyword(s):  
Best Practice ◽  
Insulin Administration ◽  
Self Administration ◽  
Number Of Patients ◽  
And Storage ◽  
At Home

AbstractPatients with diabetes routinely manage their insulin at home, but when they are admitted to hospital it is common practice to take their insulin away and store it in the ward fridge. Medicines rounds and mealtimes are poorly aligned and, as a result, patients can have delayed doses and increased hypo- and hyperglycaemic episodes. Best practice states that patients should be offered self-administration of insulin, but it is not routine in most trusts. This paper reports on a project to increase the number of patients assessed and supported to administer their insulin in hospital, the reasons why the project was initially unsuccessful and the challenges of changing culture and beliefs around insulin administration. A second paper discusses steps taken to support changes in hospital trusts.

scholarly journals Implementing self-administration of insulin in hospital: a journey of discovery and innovation. Part 1: Culture and storage

2018 ◽  
Author(s):  
Vicki L Rowse
Keyword(s):  
Best Practice ◽  
Insulin Administration ◽  
Self Administration ◽  
Number Of Patients ◽  
And Storage ◽  
At Home

AbstractPatients with diabetes routinely manage their insulin at home, but when they are admitted to hospital it is common practice to take their insulin away and store it in the ward fridge. Medicines rounds and mealtimes are poorly aligned and, as a result, patients can have delayed doses and increased hypo- and hyperglycaemic episodes. Best practice states that patients should be offered self-administration of insulin, but it is not routine in most trusts. This paper reports on a project to increase the number of patients assessed and supported to administer their insulin in hospital, the reasons why the project was initially unsuccessful and the challenges of changing culture and beliefs around insulin administration. A second paper discusses steps taken to support changes in hospital trusts.

scholarly journals AB0237 INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH RITUXIMAB AND ANTI-TNF INHIBITOR

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1144.2-1144
Author(s):  
N. Zehraoui ◽  
R. Benaziez.Boutaleb ◽  
H. Hafirassou ◽  
F. Mechid ◽  
N. Bahaz ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Best Practice ◽  
Biological Therapy ◽  
Patient Characteristics ◽  
Inadequate Response ◽  
Tnf Inhibitor ◽  
Clinical Rheumatology ◽  
Number Of Patients ◽  
Serious Infections ◽  
Comparative Risk

Background:Biological therapies have significantly improved the management of rheumatoid arthritis (RA). These molecules are very effective, but are known for their specific risks, especially infectious. It depends on several factors including the type of molecule used.Objectives:The objective of our study is to compare the rate of infection in RA patients treated with rituximab and anti-TNFα.Methods:Prospective, observational, monocentric study. Were included RA patients (ACR / EULAR 2010 criteria) treated with rituximab and anti-TNFα (adalimumab, infliximab and Etanercept) after inadequate response to DMARDs.Demographic characteristics, comorbidities, association with methotrexate and corticosteroids were collected and compared for each group.The number, type and severity of the infections in both cases were noted.SPSS (Statistical Package for Social Science) was used for data analysis.Results:40 RA patients treated with rituximab and 31 patients who received anti-TNFα were included.Patient characteristics and Comparison of rate of infection in RA patients between the two groups are summarized in Table 1Table 1.ParametersRituximabAnti-TNFαpNumber of patients4031Average age (years)56,2846,060,01Sexratio0,140,110,7Average duration of evolution (years)15,8313,740,3Patients under corticosteroid (%)97,587,10,08Average corticosteroid dose6,415,480,3patients under methotrexate (%)37,545,20,5Diabetes (%)2016,10,7Patients with infection (%)32,551,60,1Number of infections18240,4Number of serious infections500,04Conclusion:The rate of infections in patients with RA treated with rituximab or anti-TNF was similar. However, the infections observed were more serious in patients with RA treated with rituximabReferences:[1]Fabiola Atzeni MD PhD and al. Infections and Biological Therapy in Patients with Rheumatic Diseases. IMAJ . VOL 18. march-APRIL 2016.[2]Huifeng Yun and al. Comparative Risk of Hospitalized Infection Associated with Biologic Agents in Rheumatoid Arthritis Patients Enrolled in Medicare. ARTHRITIS & RHEUMATOLOGY. Vol. 68, No. 1, January 2016, pp 56–66.[3]Manjari Lahiri and al. Risk of infection with biologic antirheumatic therapies in patients with rheumatoid arthritis. Best Practice & Research Clinical Rheumatology (2015) 1-16.Disclosure of Interests:None declared

scholarly journals P17 An audit of Trakcare discharge times for Laparoscopic Cholecystectomy

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Jacob Rapier ◽  
Steven Hornby ◽  
Jacob Rapier
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Initial Data ◽  
Best Practice ◽  
Average Length ◽  
Accurate Data ◽  
Day Case ◽  
Average Length Of Stay ◽  
Number Of Patients ◽  
Elective Laparoscopic Cholecystectomy

Abstract Introduction Nationally 61,220 Laparoscopic Cholecystectomies are carried out annually. Those carried out as day-cases reduce providers’ costs and increase income through the best practice tariff. The system in our trust to record discharges is ‘Trakcare’. The aim of this audit was to accurately measure the discharge times of patients undergoing elective Laparoscopic Cholecystectomies, to try and reduce the number of patients recorded as having an overnight stay by accurate data collection. Methods Initial data was collected for all elective Laparoscopic Cholecystectomy discharge times on Trakcare, over a 1 month period. This data was then re-audited prospectively both from Trakcare and discharges reported by nurses/patients. A comparison was then made of Trakcare against reported discharge times. Results Initially 54 operations were recorded, with 30 completed as day cases (55.6%). The re-audited data (on Trakcare) recorded 47 operations, with 15 completed as day cases (37.91%). Of these discharges we were able to capture 26 (55.32%) manually, and 11 were completed as day cases (42.31%). Measuring these 26 with the same operations on Trakcare we were unable to show a difference in the number of cases completed as a day case (11 vs 11), with only a 33 minute decrease in the average length of stay. Conclusion Trakcare is a reliable tool for measuring the date of discharge for patients. The recommendations in are: scheduling surgery for a time pre-13:00 shows a higher proportion of patients discharged the same day, and continue to use Trakcare to record discharge times.

The timing of insulin administration to hospital inpatients is unsafe: patient self-administration may make it safer

2008 ◽  
Vol 25 (3) ◽  
pp. 96-98 ◽  
Author(s):  
KK Gangopadhyay ◽  
AD Ebinesan ◽  
B Mtemererwa ◽  
C Marshall ◽  
AT Mcgettigan ◽  
...  
Keyword(s):  
Insulin Administration ◽  
Self Administration ◽  
Hospital Inpatients

scholarly journals Impact of Cooking Procedures and Storage Practices at Home on Consumer Exposure toListeria MonocytogenesandSalmonellaDue to the Consumption of Pork Meat

Risk Analysis ◽  
2017 ◽  
Vol 38 (4) ◽  
pp. 638-652 ◽  
Author(s):  
Alessandra De Cesare ◽  
Eva Doménech ◽  
Damiano Comin ◽  
Adele Meluzzi ◽  
Gerardo Manfreda
Keyword(s):  
Pork Meat ◽  
And Storage ◽  
At Home

The Casa da Índia and the Emergence of a Science of Administration in the Portuguese Empire

2018 ◽  
Vol 22 (5) ◽  
pp. 327-347 ◽  
Author(s):  
Ângela Barreto Xavier
Keyword(s):  
Early Modern ◽  
Critical Dimension ◽  
Systematic Research ◽  
Territorial Expansion ◽  
Record Keeping ◽  
Portuguese Empire ◽  
And Storage ◽  
At Home

Abstract The role played by archives in the making of a Portuguese science of imperial administration is scarcely known. Systematic research is still lacking on what literature suggests was a critical dimension in the management of the empire. By focusing on the Casa da Índia’s activities of production, record-keeping and retrieving of information and knowledge, this study intends to contribute to a better understanding of the links between empire and Portuguese early-modern archival experiences. For more than a century, the Casa da Índia was the institution responsible for the circulation and storage of commodities, information and people within the Portuguese empire, as well as the payment of duties and taxes. What challenges did territorial expansion entail for the Portuguese monarchy, and, in particular, for its archival organization and practices? How did the Casa da Índia register these imperial dynamics? Did its archive materialize the Empire at home? Finally, was its archive relevant to the emergence of a Portuguese science of imperial administration?

scholarly journals Pharmacy-based intervention in Wernicke's encephalopathy

2010 ◽  
Vol 34 (6) ◽  
pp. 234-238 ◽  
Author(s):  
Ed Day ◽  
Rhiannon Callaghan ◽  
Tarun Kuruvilla ◽  
Sanju George ◽  
Kerry Webb ◽  
...  
Keyword(s):  
Best Practice ◽  
Hospital Pharmacist ◽  
Wernicke’S Encephalopathy ◽  
Prescribing Patterns ◽  
Wernicke's Encephalopathy ◽  
Medical Setting ◽  
Adequate Treatment ◽  
Number Of Patients ◽  
The Impact ◽  
Alcohol Dependent

Aims and methodClinical audit methodology was used to compare the treatment of alcohol misusers at risk of Wernicke's encephalopathy in an acute medical setting, and to assess the impact of providing information about best practice to prescribing doctors. All patients prescribed thiamine during an admission to an acute hospital trust over a 6-month period were identified, and data about their treatment episode were collected retrospectively. Hospital pharmacists then provided all prescribers with a flowchart summarising current prescribing guidelines, and prescribing patterns were re-audited 6 months later.ResultsOver two audit periods, half of the patients prescribed thiamine whose case notes we examined had symptoms suggestive of Wernicke's encephalopathy, and another 30% were at high risk. Prescribing adhered to hospital guidelines only in 14% of cases, with the pharmacy-led intervention associated with a small but significant increase in the number of patients receiving adequate treatment for Wernicke's encephalopathy.Clinical implicationsWernicke's encephalopathy is relatively common in alcohol-dependent individuals admitted to hospital, and it is easily and cheaply managed. However, even when potential cases are identified, prescribing guidelines are followed in a minority of cases, even with prompting by a hospital pharmacist. This may be related to the limited research base concerning the optimum dosing schedule of thiamine, or fears about possible anaphylaxis when using parenteral preparations.

scholarly journals 244 Point Prevalence of Frailty and Confusion Exceeds the Capacity of a Single Ward - Specialist Geriatric Wards to Lead Best Practice

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Desmond O' Donnell ◽  
Anne O'Mahony ◽  
Alice O' Donoghue ◽  
Clare McMahon ◽  
Marie Doyle ◽  
...  
Keyword(s):  
Best Practice ◽  
Point Prevalence ◽  
Admission Criteria ◽  
Evidence Based ◽  
Geriatric Ward ◽  
Clinical Frailty Scale ◽  
Number Of Patients ◽  
Admission Status ◽  
Evidence Based Care ◽  
Paediatric Critical Care

Abstract Background Our Model 4 Hospital will open a Specialist Geriatric Ward in the coming months. This ward will focus on the provision of evidence-based care to confused and frail older adults. Careful selection of patients who would most benefit from this care will be vital to ensure success. We aim to determine the prevalence of frailty and confusion in our inpatient cohort to determine expected demand on this new service and to inform admission criteria. Methods All adult inpatients were screened for frailty (pre-admission status) using the Rockwood Clinical Frailty Scale (CFS). Point prevalence of confusion (combination of pre-existing dementia and incident delirium) was calculated by measuring 4AT scores on all adult inpatients (>16 years of age), with the exclusion of obstetric, paediatric, critical care and psychiatric wards. Eleven wards were visited by a team of six experienced geriatric practitioners during a one-week period in April 2019. Results In total, 257 patients were assessed. The median age was 74 years (16-99). The majority were male (54.9 %). 152 patients resided on a dedicated medical ward (59.1%). The point prevalence of pre-morbid frailty (CFS Score ≥ 5) was 39.9%. The point prevalence of confusion (4AT score ≥4) was 24.4%. Conclusion Our data show that frailty and delirium are highly prevalent in hospital inpatients. It is not feasible for this number of frail and confused patients to be cohorted in a single specialist area. It is therefore important that each hospital determine admission criteria to identify those at greatest need. Clearly, given the prevalence outlined here, there will be a large number of patients likely to benefit from but unable to access a Specialist Geriatric Ward. These wards therefore need to also serve as exemplars of best practice so that evidence-based care for this vulnerable cohort can be disseminated within an institution.

Food for thought

2019 ◽  
Vol 15 (6) ◽  
pp. 304-305
Author(s):  
Kate Scheer
Keyword(s):  
Best Practice ◽  
Cross Contamination ◽  
At Home

Kate Scheer considers the importance of applying best practice at home and abroad to prevent cross contamination

The Nithsdale Schizophrenia Surveys. VIII: Do Relatives Want Family Intervention – And Does It Help?

1991 ◽  
Vol 158 (1) ◽  
pp. 110-113 ◽  
Author(s):  
R. G. McCreadie ◽  
K. Phillips ◽  
J. A. Harvey ◽  
G. Waldron ◽  
M. Stewart ◽  
...  
Keyword(s):  
British Journal ◽  
Expressed Emotion ◽  
Family Intervention ◽  
Family Meetings ◽  
Number Of Patients ◽  
Before And After ◽  
At Home

Sixty-three relatives of 52 schizophrenics living at home were offered a package of treatments by professionals working in an everyday NHS setting: educational seminars, relatives' groups, and family meetings. Thirty-two relatives refused intervention. Of the 31 relatives who agreed, 14 attended neither the educational seminars nor the relatives' groups. Seventeen relatives had a mean of ten treatment sessions, but there was little change in their level of expressed emotion after intervention. The number of patients who relapsed was the same in the 18 months before and after intervention, although the total number of relapses fell after intervention.British Journal of Psychiatry (1991), 158, 110–113

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