scholarly journals Serum lithium test requesting across three UK regions: An evaluation of adherence to monitoring guidelines

2021 ◽  
Author(s):  
Ceri Parfitt ◽  
Christopher J Duff ◽  
Jonathan Scargill ◽  
Lewis Green ◽  
David Holland ◽  
...  
Keyword(s):  
Mental Health ◽  
Therapeutic Range ◽  
Models Of Care ◽  
Health Condition ◽  
University Hospitals ◽  
Testing Frequency ◽  
Acute Hospitals ◽  
Clinical Biochemistry Laboratory ◽  
The University ◽  
Laboratory Information Systems

Abstract Background: Bipolar disorder is the fourth most common mental health condition, affecting ~1% of UK adults. Lithium is an effective treatment for prevention of relapse and hospital admission, and is widely recommended as a first-line treatment. We previously showed in other areas that laboratory testing patterns are variable with sub-optimal conformity to guidance. We therefore examined lithium results and requesting patterns relative to monitoring recommendations.Methods: Data on serum lithium levels and intervals between requests were extracted from Clinical Biochemistry laboratory information systems at the University Hospitals of North Midlands, Salford Royal Foundation Trust and Pennine Acute Hospitals from 2012-2018 (46,555 requests; 3,371 individuals). Data were examined with respect to region/source of request, age and sex.Results: Across all sites, lithium levels on many requests were outside the recommended UK therapeutic range (0.4-0.99 mmol/L); 19.2% below the range and 6.1% above the range (median [Li]: 0.60 mmol/L). A small percentage were found at the extremes (3.2% at <0.1mmol/L, 1.0% at ≥1.4mmol/L). Most requests were from general practice (56.3%) or mental health units (34.4%), though those in the toxic range (≥1.4 mmol/L) were more likely to be from secondary care (63.9%). For requesting intervals, there was a distinct peak at 12 weeks, consistent with guidance for those stabilised on lithium therapy. There was no peak at 6 months, as recommended for those aged <65 years on unchanging therapy, though re-test intervals in this age group were more likely to be longer. There was a peak at 0-7 days, reflecting those requiring closer monitoring (e.g. treatment initiation, toxicity). However, for those with initial lithium concentrations within the BNF range (0.4-0.99 mmol/L), 69.4% of tests were requested outside expected testing frequencies.Conclusions: Our data showed: (a) lithium levels are often maintained at the lower end of the recommended therapeutic range, (b) patterns of lithium results and testing frequency were comparable across three UK sites with differing models of care and, (c) re-test intervals demonstrate a noticeable peak at the recommended 3-monthly, but not at 6-monthly intervals. Many tests were repeated outside expected frequencies, indicating the need for measures to minimise inappropriate testing.

scholarly journals Serum lithium test requesting across three UK regions: An evaluation of adherence to monitoring guidelines

2020 ◽  
Author(s):  
Ceri Parfitt ◽  
Christopher J Duff ◽  
Jonathan Scargill ◽  
Lewis Green ◽  
David Holland ◽  
...  
Keyword(s):  
Mental Health ◽  
Therapeutic Range ◽  
Models Of Care ◽  
Health Condition ◽  
University Hospitals ◽  
Testing Frequency ◽  
Acute Hospitals ◽  
Clinical Biochemistry Laboratory ◽  
The University ◽  
Laboratory Information Systems

Abstract Background: Bipolar disorder is the fourth most common mental health condition, affecting ~1% of UK adults. Lithium is an effective treatment for prevention of relapse and hospital admission, and is widely recommended as a first-line treatment. We previously showed in other areas that laboratory testing patterns are variable with sub-optimal conformity to guidance. We therefore examined lithium results and requesting patterns relative to monitoring recommendations.Methods: Data on serum lithium levels and intervals between requests were extracted from Clinical Biochemistry laboratory information systems at the University Hospitals of North Midlands, Salford Royal Foundation Trust and Pennine Acute Hospitals from 2012-2018 (46,555 requests; 3,371 individuals). Data were examined with respect to region/source of request, age and sex.Results: Across all sites, lithium levels on many requests were outside the recommended UK therapeutic range (0.4-0.99 mmol/L); 19.2% below the range and 6.1% above the range (median [Li]: 0.60 mmol/L). A small percentage were found at the extremes (3.2% at <0.1mmol/L, 1.0% at ≥1.4mmol/L). Most requests were from general practice (56.3%) or mental health units (34.4%), though those in the toxic range (≥1.4 mmol/L) were more likely to be from secondary care (63.9%). For requesting intervals, there was a distinct peak at 12 weeks, consistent with guidance for those stabilised on lithium therapy. There was no peak at 6 months, as recommended for those aged <65 years on unchanging therapy, though re-test intervals in this age group were more likely to be longer. There was a peak at 0-7 days, reflecting those requiring closer monitoring (e.g. treatment initiation, toxicity). However, for those with initial lithium concentrations within the BNF range (0.4-0.99 mmol/L), 69.4% of tests were requested outside expected testing frequencies.Conclusions: Our data showed: (a) lithium levels are often maintained at the lower end of the recommended therapeutic range, (b) patterns of lithium results and testing frequency were comparable across three UK sites with differing models of care and, (c) re-test intervals demonstrate a noticeable peak at the recommended 3-monthly, but not at 6-monthly intervals. Many tests were repeated outside expected frequencies, indicating the need for measures to minimise inappropriate testing.

scholarly journals Serum lithium test requesting across three UK regions: An evaluation of adherence to monitoring guidelines

2020 ◽  
Author(s):  
Ceri Parfitt ◽  
Christopher J Duff ◽  
Jonathan Scargill ◽  
Lewis Green ◽  
David Holland ◽  
...  
Keyword(s):  
Mental Health ◽  
Therapeutic Range ◽  
Models Of Care ◽  
Health Condition ◽  
University Hospitals ◽  
Testing Frequency ◽  
Acute Hospitals ◽  
Clinical Biochemistry Laboratory ◽  
The University ◽  
Laboratory Information Systems

Abstract Background: Bipolar disorder is the fourth most common mental health condition, affecting ~1% of UK adults. Lithium is an effective treatment for prevention of relapse and hospital admission, and is widely recommended as a first-line treatment. We previously showed in other areas that laboratory testing patterns are variable with sub-optimal conformity to guidance. We therefore examined lithium results and requesting patterns relative to monitoring recommendations.Methods: Data on serum lithium levels and intervals between requests were extracted from Clinical Biochemistry laboratory information systems at the University Hospitals of North Midlands, Salford Royal Foundation Trust and Pennine Acute Hospitals from 2012-2018 (46,555 requests; 3,371 individuals). Data were examined with respect to region/source of request, age and sex.Results: Across all sites, lithium levels on many requests were outside the recommended UK therapeutic range (0.4-0.99 mmol/L); 19.2% below the range and 6.1% above the range (median [Li]: 0.60 mmol/L). A small percentage were found at the extremes (3.2% at <0.1mmol/L, 1.0% at ≥1.4mmol/L). Most requests were from general practice (56.3%) or mental health units (34.4%), though those in the toxic range (≥1.4 mmol/L) were more likely to be from secondary care (63.9%). For requesting intervals, there was a distinct peak at 12 weeks, consistent with guidance for those stabilised on lithium therapy. There was no peak at 6 months, as recommended for those aged <65 years on unchanging therapy, though re-test intervals in this age group were more likely to be longer. There was a peak at 0-7 days, reflecting those requiring closer monitoring (e.g. treatment initiation, toxicity). However, for those with initial lithium concentrations within the BNF range (0.4-0.99 mmol/L), 69.4% of tests were requested outside expected testing frequencies.Conclusions: Our data showed: (a) lithium levels are often maintained at the lower end of the recommended therapeutic range, (b) patterns of lithium results and testing frequency were comparable across three UK sites with differing models of care and, (c) re-test intervals demonstrate a noticeable peak at the recommended 3-monthly, but not at 6-monthly intervals. Many tests were repeated outside expected frequencies, indicating the need for measures to minimise inappropriate testing.

scholarly journals Serum lithium test requesting across three UK regions: an evaluation of adherence to monitoring guidelines

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ceri Parfitt ◽  
Christopher J. Duff ◽  
Jonathan Scargill ◽  
Lewis Green ◽  
David Holland ◽  
...  
Keyword(s):  
Mental Health ◽  
Therapeutic Range ◽  
Models Of Care ◽  
Health Condition ◽  
University Hospitals ◽  
Testing Frequency ◽  
Acute Hospitals ◽  
Clinical Biochemistry Laboratory ◽  
The University ◽  
Laboratory Information Systems

Abstract Background Bipolar disorder is the fourth most common mental health condition, affecting ~ 1% of UK adults. Lithium is an effective treatment for prevention of relapse and hospital admission, and is widely recommended as a first-line treatment. We previously showed in other areas that laboratory testing patterns are variable with sub-optimal conformity to guidance. We therefore examined lithium results and requesting patterns relative to monitoring recommendations. Methods Data on serum lithium levels and intervals between requests were extracted from Clinical Biochemistry laboratory information systems at the University Hospitals of North Midlands, Salford Royal Foundation Trust and Pennine Acute Hospitals from 2012 to 2018 (46,555 requests; 3371 individuals). Data were examined with respect to region/source of request, age and sex. Results Across all sites, lithium levels on many requests were outside the recommended UK therapeutic range (0.4–0.99 mmol/L); 19.2% below the range and 6.1% above the range (median [Li]: 0.60 mmol/L). A small percentage were found at the extremes (3.2% at < 0.1 mmol/L, 1.0% at ≥1.4 mmol/L). Most requests were from general practice (56.3%) or mental health units (34.4%), though those in the toxic range (≥1.4 mmol/L) were more likely to be from secondary care (63.9%). For requesting intervals, there was a distinct peak at 12 weeks, consistent with guidance for those stabilised on lithium therapy. There was no peak at 6 months, as recommended for those aged < 65 years on unchanging therapy, though re-test intervals in this age group were more likely to be longer. There was a peak at 0–7 days, reflecting those requiring closer monitoring (e.g. treatment initiation, toxicity). However, for those with initial lithium concentrations within the BNF range (0.4–0.99 mmol/L), 69.4% of tests were requested outside expected testing frequencies. Conclusions Our data showed: (a) lithium levels are often maintained at the lower end of the recommended therapeutic range, (b) patterns of lithium results and testing frequency were comparable across three UK sites with differing models of care and, (c) re-test intervals demonstrate a noticeable peak at the recommended 3-monthly, but not at 6-monthly intervals. Many tests were repeated outside expected frequencies, indicating the need for measures to minimise inappropriate testing.

scholarly journals The pattern of serum lithium test requesting across three UK regions: a service evaluation of adherence to monitoring guidelines.

2020 ◽  
Author(s):  
Anthony Fryer ◽  
Ceri Parfitt ◽  
Christopher J Duff ◽  
Jonathan Scargill ◽  
Lewis Green ◽  
...  
Keyword(s):  
Mental Health ◽  
Therapeutic Range ◽  
Service Evaluation ◽  
Models Of Care ◽  
Health Condition ◽  
University Hospitals ◽  
Acute Hospitals ◽  
Clinical Biochemistry Laboratory ◽  
The University ◽  
Laboratory Information Systems

Abstract Background Bipolar disorder is the fourth most common mental health condition, affecting ~1% of UK adults. Lithium is an effective treatment for prevention of relapse and hospital admission, and is widely recommended as a first-line treatment. We previously showed in other areas that laboratory testing patterns are variable with sub-optimal conformity to guidance. We therefore examined lithium results and requesting patterns relative to monitoring recommendations. Methods Data on lithium levels and intervals between requests were extracted from Clinical Biochemistry laboratory information systems at the University Hospitals of North Midlands, Salford Royal Foundation Trust and Pennine Acute Hospitals from 2012-2018 (46,555 requests; 3,371 individuals). Data were examined with respect to region/source of request, age and sex. Results Lithium levels on many requests were outside the recommended UK therapeutic range (0.4-0.99 mmol/L); 19.2% below the range and 6.1% above the range (median [Li]: 0.60 mmol/L). A small percentage were found at the extremes (3.2% at <0.1mmol/L, 1.0% at >1.4mmol/L). These findings were comparable across all sites. Most requests were from general practice (56.3%) or mental health units (34.4%), though those in the toxic range (≥1.4 mmol/L) were more likely to be from acute care or other secondary care units (63.9%). For requesting interval, there was a distinct peak at 12 weeks, consistent with guidance for those stabilised on lithium therapy. There was no peak evident at 6 months, as recommended for those aged <65 years on unchanging therapy. There was a peak at 0-7 days, reflecting those requiring closer monitoring (e.g. treatment initiation or for toxicity). However, for those with initial lithium concentrations within the BNF range (0.4-0.99 mmol/L), 69.4% of tests were requested outside expected testing frequencies. Conclusions Our data showed: (a) lithium levels are often maintained at the lower end of the recommended therapeutic range, (b) patterns of lithium results and testing frequency were comparable across three UK sites with differing models of care and, (c) re-test intervals demonstrate a noticeable peak at the recommended 3-monthly, but not at 6-monthly intervals. Many tests were repeated outside expected frequencies, indicating the need for additional work to minimise inappropriate testing.

scholarly journals An analysis of lithium requesting across three hospital trusts in the UK: many people are managed with lithium levels below the current nice guidance lower limit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S29-S29
Author(s):  
Adrian Heald ◽  
Ceri Parfitt ◽  
Chris Duff ◽  
Jonathan Scargill ◽  
Lewis Green ◽  
...  
Keyword(s):  
Lithium Concentration ◽  
Models Of Care ◽  
Health Condition ◽  
Monthly Interval ◽  
Therapeutic Window ◽  
University Hospitals ◽  
Acute Hospitals ◽  
Nice Guidance ◽  
The Uk ◽  
The University

AimsThis study examined lithium results and requesting patterns over a 6-year period, and compared these to guidance.BackgroundBipolar disorder is the 4th most common mental health condition, affecting ~1% of UK adults. Lithium is an effective treatment for prevention of relapse and hospital admission, and is recommended by NICE as a first-line treatment.We have previously shown in other areas that laboratory testing patterns are highly variable with sub-optimal conformity to guidance.MethodLithium requests received by Clinical Biochemistry Departments at the University Hospitals of North Midlands, Salford Royal Foundation Trust and Pennine Acute Hospitals from 2012–2018 were extracted from Laboratory Information and Management Systems (46,555 requests; 3,371 individuals). We categorised by request source, lithium concentration and re-test intervals.ResultMany lithium results were outside the NICE therapeutic window (0.6–0.99mmol/L); 49.3% were below the window and 6.1% were above the window (median [Li]:0.61mmol/L). A small percentage were found at the extremes (3.2% at <0.1mmol/L, 1.0% at >1.4mmol/L). Findings were comparable across all sites.For requesting interval, there was a distinct peak at 12 weeks, consistent with guidance for those stabilised on lithium therapy. There was no peak evident at 6 months, as recommended for those <65 years old on unchanging therapy. There was a peak at 0–7 days, reflecting those requiring closer monitoring (e.g. treatment initiation or results suggesting toxicity).However, 77.6% of tests were requested outside expected testing frequencies.ConclusionWe showed: (a) lithium levels are often maintained at the lower end of the NICE recommended therapeutic range (and the BNF range: 0.4-1.0mmol/L); (b) patterns of lithium results and testing frequency are comparable across three sites with differing models of care; (c) re-test intervals demonstrate a noticeable peak at the recommended 3-monthly interval, but not at 6-monthly intervals; (d) Many tests were repeated outside these expected frequencies (contrary to NICE guidance).

scholarly journals Interview with Ian Cumming

2006 ◽  
Vol 5 (3) ◽  
pp. 75-76
Author(s):  
Andrew Severn
Keyword(s):  
Postgraduate Medical Education ◽  
Primary Care Trust ◽  
Chief Executive ◽  
Future Prospects ◽  
University Hospitals ◽  
Medical Education And Training ◽  
Acute Hospitals ◽  
Deputy Chairman ◽  
The University ◽  
And Training

Ian Cumming was, at his appointment to the Lancaster Acute Hospitals Trust 11 years ago, the youngest chief executive in the NHS. The Journal finds him upbeat in his assessment of the future prospects for the University Hospitals of Morecambe Bay (UHMB), and in his role as deputy chairman of the Postgraduate Medical Education and Training Board (PMETB), an unrepentant and pragmatic reformer. His move this month to head the new North Lancashire Primary Care Trust offers him new opportunities to see through some of his more ambitious plans for Morecambe Bay.

scholarly journals Keep Calm and Study Abroad: The Effect of Learning Abroad on Student Mental Health

2016 ◽  
Vol 27 (1) ◽  
pp. 1-16 ◽  
Author(s):  
Amber Bathke ◽  
Yang-Hyang (Ryoka) Kim
Keyword(s):  
Mental Health ◽  
Study Abroad ◽  
International Education ◽  
Online Survey ◽  
Health Condition ◽  
Support Network ◽  
Health Conditions ◽  
Student Mental Health ◽  
Mental Health Conditions ◽  
The University

This research set out to discover whether statistics would support the belief in the international education field that the stress of going abroad (adjusting to a new culture, missing home, being away from support network, etc.) can trigger mental health conditions in students participating in learning abroad programs. The study sought to glean on overall picture of student mental health abroad, as well as determine the percentage of students studying abroad who reported experiencing a diagnosed mental health condition while abroad, the nature of these diagnosed mental health conditions, the frequency of relapse/recurrence of existing conditions while abroad, the frequency and type of treatment received, and local attitude toward mental health conditions. The research was conducted by means of an online survey administered by the University of Minnesota’s Office of Measurement Services, which was sent by email to people who had participated in study abroad through the University of Minnesota’s Learning Abroad Center between Summer 2009 and Spring 2012, a total of 7,191 students. As the Learning Abroad Center, while serving University of Minnesota students first and foremost, also acts as a program provider recruiting students nationally, the participants’ home institutions were likely dozens of universities nationwide (though home institution information was not collected). We received 613 responses for a response rate of 8.52%. The data from the survey suggest, surprisingly, that in general, student mental health actually improves while abroad, an in fact, that skills learned during an international experience may contribute to improved mental health upon return.

Integrating Legacy Laboratory Information Systems into a Client-Server World: The University of Minnesota Clinical Workstation (CWS) Project

1995 ◽  
Vol 34 (03) ◽  
pp. 289-296 ◽  
Author(s):  
B. H. Sielaff ◽  
D. P. Connelly ◽  
K. E. Willard
Keyword(s):  
Information Systems ◽  
Clinical Decision ◽  
Database Management System ◽  
University Of Minnesota ◽  
Client Server ◽  
Clinical Workstation ◽  
Future Hospital ◽  
The Cost ◽  
The University ◽  
Laboratory Information Systems

Abstract:The development of an innovative clinical decision-support project such as the University of Minnesota’s Clinical Workstation initiative mandates the use of modern client-server network architectures. Preexisting conventional laboratory information systems (LIS) cannot be quickly replaced with client-server equivalents because of the cost and relative unavailability of such systems. Thus, embedding strategies that effectively integrate legacy information systems are needed. Our strategy led to the adoption of a multi-layered connection architecture that provides a data feed from our existing LIS to a new network-based relational database management system. By careful design, we maximize the use of open standards in our layered connection structure to provide data, requisition, or event messaging in several formats. Each layer is optimized to provide needed services to existing hospital clients and is well positioned to support future hospital network clients.

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