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Audit of Quality and Effectiveness of Clinical Note Entries on a Women’s Low/Medium Secure Forensic Psychiatry Inpatient Unit
Aims: This audit aims to assess adherence to the ‘CRAMS’ criteria in clinical records for patients on a blended low/medium secure women’s forensic ward. In response to feedback from a CQC Mental Health Act Review that some daily entries in patient notes included insufficient detail to properly inform decisions on care (particularly with regard to qualitative information regarding leave), the service adopted the CRAMS criteria for these entries, which specify that information on 11 points relating to care plan, risk, activity, mental state, and Section 17 leave should be included. Methods: Data were collected from daily electronic patient record entries for ten randomly selected patients on two different weeks – in total 140 entries were examined in this initial sample. Each of these entries was assessed to determine if it contained each of the 11 aspects of the CRAMS criteria. Following the initial data collection, findings were disseminated and discussed with the team, an information sheet was produced, and CRAMS was discussed at daily team huddles with the aim of improving adherence. A further sample of 140 records was examined a year following the initial cycle, using the same methodology. Results: The initial cycle of the audit found that from the 140 clinical note entries that were examined, a total of 814/1540 (52.9%) of CRAMS criteria were met. This included: 212/420 (50.5%) criteria pertaining to care planning. 99/140 (70.7%) criteria pertaining to risk. 153/280 (54.6%) criteria pertaining to activity undertaken. 209/420 (49.8%) criteria pertaining to mental state. 141/280 (50.3%) criteria pertaining to S17 leave. The second cycle of the audit found that a total of 1120/1540 (71.6%) of CRAMS criteria were met. This included: 305/420 (72.6%) criteria pertaining to care planning. 105/140 (75.0%) criteria pertaining to risk. 198/280 (70.7%) criteria pertaining to activity undertaken. 296/420 (70.5%) criteria pertaining to mental state. 198/280 (70.7%) criteria pertaining to S17 leave. Conclusion: The audit showed a significant improvement in adherence to the CRAMS criteria following the action plan enacted following the initial cycle. However, there were still numerous entries in which the full CRAMS criteria were not met. The ward team continues to discuss CRAMS as part of morning briefings to sustain and build upon this improvement, and the adoption of an electronic template to help further build on this once the Trust moves to a new electronic patient record system has been discussed.
Journal Article
Guidelines on the management of abnormal liver blood tests
These updated guidelines on the management of abnormal liver blood tests have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines, which this document supersedes, were written in 2000 and have undergone extensive revision by members of the Guidelines Development Group (GDG). The GDG comprises representatives from patient/carer groups (British Liver Trust, Liver4life, PBC Foundation and PSC Support), elected members of the BSG liver section (including representatives from Scotland and Wales), British Association for the Study of the Liver (BASL), Specialist Advisory Committee in Clinical Biochemistry/Royal College of Pathology and Association for Clinical Biochemistry, British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN), Public Health England (implementation and screening), Royal College of General Practice, British Society of Gastrointestinal and Abdominal Radiologists (BSGAR) and Society of Acute Medicine. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. These guidelines deal specifically with the management of abnormal liver blood tests in children and adults in both primary and secondary care under the following subheadings: (1) What constitutes an abnormal liver blood test? (2) What constitutes a standard liver blood test panel? (3) When should liver blood tests be checked? (4) Does the extent and duration of abnormal liver blood tests determine subsequent investigation? (5) Response to abnormal liver blood tests. They are not designed to deal with the management of the underlying liver disease.
Journal Article
Models of madness : psychological, social, and biological approaches to psychosis
\"This second edition of Models of Madness challenges those who hold to simplistic, pessimistic and often damaging theories and treatments of madness. In particular it challenges beliefs that madness can be explained without reference to social causes and challenges the excessive preoccupation with chemical imbalances and genetic predispositions as causes of human misery, including the conditions that are given the name 'schizophrenia'. This edition updates the now extensive body of research showing that hallucinations, delusions etc. are best understood as reactions to adverse life events and that psychological and social approaches to helping are more effective and far safer than psychiatric drugs and electroshock treatment. A new final chapter discusses why such a damaging ideology has come to dominate mental health and, most importantly, how to change that.\" -- Publisher's description.
Book
A protocol for the evaluation of the PneumoWave biosensor in supported accommodation settings: A study on feasibility and acceptability (RESCU-2)
People who overdose on opioids when they are alone or unmonitored are at heightened risk of death as other people do not know they should provide an emergency response. Wearable technology provides an opportunity to continuously measure respiratory function and ultimately send an alert if respiratory depression occurs.
This study evaluates the feasibility and acceptability of PneumoWave DC in UK homeless hostels or supported accommodation settings (equivalent to Housing First in the USA) for individuals at high risk of opioid overdose. The PneumoWave system consists of a wearable biosensor that is affixed to the chest and records chest motion and which, in future, could potentially provide early detection of respiratory depression and trigger overdose response.
RESCU-2 is a non-randomised, observational trial conducted in supported accommodation facilities across the UK. 50 participants who currently use opioids and live in homeless hostels in England and Scotland will wear the PneumoWave biosensor for varying periods to collect data over 2,000 participant-days. The biosensor will be linked via Bluetooth to a hub for continuous respiratory data collection. Self-reported drug use during the trial will be measured using drug diaries. Quantitative acceptability data will be measured using structured satisfaction surveys, while qualitative acceptability data will be obtained from interviews and focus groups with both residents and staff. Statistical analysis will include descriptive evaluation of feasibility outcomes, while qualitative data will undergo thematic analysis. The primary objectives of the study are: 1) feasibility of the study protocol within the hostel setting; 2) acceptability and usability of the device among people who use opioids and live in hostels; 3) acceptability of the device among staff who work in hostels and respond to overdose events. Primary outcomes are recruitment, total hours of usable data collected and successful recording of key outcome measures, among others. Trial registration: ISRCTN12060022.
Findings will inform the feasibility of future integration of chest biosensor technology into hostel settings, assessing participant adherence, usability, and acceptability among people who use substances and staff. Insights gained will support the design of future trials and further development of remote monitoring technologies for overdose prevention and response strategies.
Journal Article
The Justice of Constantine
As the first Christian emperor of Rome, Constantine the Great has long interested those studying the establishment of Christianity. But Constantine is also notable for his ability to control a sprawling empire and effect major changes.The Justice of Constantineexamines Constantine's judicial and administrative legislation and his efforts to maintain control over the imperial bureaucracy, to guarantee the working of Roman justice, and to keep the will of his subjects throughout the Roman Empire.
John Dillon first analyzes the record of Constantine's legislation and its relationship to prior legislation. His initial chapters also serve as an introduction to Roman law and administration in later antiquity. Dillon then considers Constantine's public edicts and internal communications about access to law, trials and procedure, corruption, and punishment for administrative abuses. How imperial officials relied on correspondence with Constantine to resolve legal questions is also considered. A study of Constantine's expedited appellate system, to ensure provincial justice, concludes the book.
Constantine's constitutions reveal much about the Theodosian Code and the laws included in it. Constantine consistently seeks direct sources of reliable information in order to enforce his will. In official correspondence, meanwhile, Constantine strives to maintain control over his officials through punishment; trusted agents; and the cultivation of accountability, rivalry, and suspicion among them.
eBook
Wolverine
\"Marvel's favorite mutant, by one of his most explosive creators! Dark corners, dead bodies, and drug dealers--that's a typical day for Logan when he isn't hanging with the X-Men. But when reality is rewritten by the events of House of M, it proves a revelatory experience--and sets Wolverine on a path to uncover his origins! But who has been hiding in the shadows, pulling Logan's strings for decades? Armed with the one weapon that can kill him, Logan embarks on the first leg of a long and bloody quest for vengeance!\"--Page [4] of cover, volume 1.
Book
Antisense oligonucleotide-directed liver therapy: a new tool in the MASH armamentarium?
MASLD is characterised by fat accumulation within hepatocytes and requires the coexistence of at least one cardiometabolic risk factor. 1 The natural history and pathophysiological perturbations underpinning the development and progression of MASLD are evolving, 2 with increasingly targeted precision therapies being developed. A key secondary endpoint was the relative change in hepatic steatosis from baseline by MRI-derived proton density fat fraction (MRI-PDFF). In particular, the small sample size did not allow for adequate powering for registrational endpoints, although the effect size was large enough to meet statistical significance.
Journal Article