We have raised awareness of the importance of recognizing AFFs to guide management.
Premenstrual syndrome (PMS) is characterised by cyclical physical, behavioural and psychological symptoms occurring during the luteal phase of the menstrual cycle (the time between ovulation and the onset of menstruation). The symptoms disappear or significantly regress by the end of menstruation. Premenstrual dysphoric disorder (PMDD) is a more severe variant of premenstrual syndrome. PMS is common and severe symptoms can have detrimental effects on a woman's quality of life. GPs play a key role in the diagnosis and management of these conditions. This article aims to provide an overview of the current evidence and guidelines for recognising and managing PMS in general practice.
AimsAssess if variation exists for routine blood tests performed on admission, evaluate compliance with MPFT guidelines when performing routine admission blood tests, compare results with the previous audit completed in October/November 2020 and identify strategies to improve and standardise admission blood tests.MethodsRetrospective blood result data were collected for all admissions to Norbury House (PICU) at St George's Hospital in Stafford over a two month period. For the original audit, this was between October and November 2020, following which a staff education programme raised awareness of trust guidelines regarding admission blood tests. This was then re-audited in May and June 2021 to assess its impact. Patients transferred from acute wards were included but repeat admissions were omitted. Data analysis was completed through Microsoft Excel.Results17 patients were included in the audit in October and November 2020 while 13 patients were included for the May and June 2021 audit. As per trust guidelines, the number of patients having the appropriate admission blood tests increased to 69% in 2021. Certain mandatory blood tests were requested far more regularly such as TFTs increasing from 71% in 2020 to 100% in 2021. Other vital blood tests on admission also increased substantially, such as Glucose increasing from 6% of admissions in 2020 to 69% in 2021 and Prolactin increasing from 77% in 2020 to 100% in 2021. All mandatory blood tests either increased in frequency or maintained a 100% completion rate, with the exception of Calcium which decreased slightly from 94% in 2020 to 92% in 2021.In the 2020 audit, unnecessary blood tests were requested for 88% of patients which was reduced substantially to just 21% of admissions in the 2021 audit. The total number of unnecessary tests also greatly reduced from 23 tests in total in 2020 to 3 in 2021.ConclusionIt is vital that patients being admitted to the PICU have the appropriate blood tests completed on admission, as they may be prescribed psychotropic medication that impacts their physical health and may have been self-neglecting prior to admission. Although the audit shows that the interventions completed following the last review have been hugely successful in improving compliance with trust guidelines and reducing waste of NHS resources, there is still significant room for improvement through the continual education of staff. This should then be re-audited again in Spring 2022 to ensure that the improvement continues.
AimsThis quality improvement project aims to improve the quality of information provided in the referrals from the older adult psychiatry department to radiology when requesting neuroradiological imaging.The secondary outcome aims to standardise information on the referral proforma. We hypothesise that this improved referral proforma will lead to improved quality of reporting from the radiology department, which will form the second stage of this quality improvement project.A further area of interest of this exercise is to establish whether standardised radiological scoring systems are requested in the referral, as these can be utilised as a means to standardise reported information.MethodRetrospective electronic case analysis was performed on 50 consecutive radiology referrals for a period of 3 months from November 2019 to January 2020. Data were obtained from generic MRI and CT referral proforma and entered into a specifically designed data collection tool. Recorded were patient demographics, provisional diagnosis, modality of imaging, use of ACE-III cognitive score, radiological scoring systems, and inclusion and exclusion criteria.ResultResults from 50 referrals have shown: 60% were male, 40% female. Average patient age of 74, ranging from 49 to 95. 58% were referred for CT head with 42% for MRI head. More than half of referrals quoted the ACE-III score. 26% of referrals stated exclusion criteria such as space occupying lesions, haemorrhages or infarcts. 10% of referrals requested specific neuro-radiological scoring scales. Specific scales which were requested included GCA (global cortical atrophy), MTA scale (medial temporal atrophy), Koedam scale (evidence of parietal atrophy) and Fazekas (evidence of vascular changes). Only 80% of referrals included the patients GP details on the referral form.Conclusion1. This quality improvement initiative has highlighted that the current level of information in referring patient to radiology is variable and dependent on the referrer.2. All referrals should state exclusion criteria as per the NICE guidelines on neuroimaging in diagnosis of dementia.3. Preliminary evidence suggests that requesting specific radiological rating scales could improve the quality of information received in the imaging report. The second part of this quality improvement initiative will aim to explore the impact of requesting these scales routinely.
AimsThe aim of this quality improvement evaluation project is to establish the standard of current practice in relation to reviewing confusion inducing drugs (CIDs) at the time of referral, as it has been hypothesised that these medications contribute to short term cognitive impairment. This is essential in order to establish the validity of the diagnostic processes of dementia syndrome in the memory assessment services.BackgroundIt has long been established that anti-cholinergic medications (ACMs) have contributed to short-term cognitive impairment in patients taking them. This is compounded with the fact that these medications may be continued without review, for longer than was originally intended. The impact of polypharmacy, subsequent anti-cholinergic burden, and the overlapping presence of delirium, may call into question the validity of a diagnosis of dementia in patients who have not been correctly vetted during the course of their assessment. This quality improvement evaluation aims to assess whether patients’ medications are being reviewed before diagnosing a memory disorder. This is in accordance with guidance set out by the NG97 NICE guidelines, The Royal College of Psychiatrists Memory Service National Accreditation Programme (MSNAP), and the National Institute on Ageing and Alzheimer's Association (NIA-AA).MethodAll new referrals to the memory assessment service during July and August 2019 were systematically reviewed and data extracted from the memory referral document and entries on RIO from first point of contact. The following data were recorded: patient ID, GPCOG/6CIT score, final diagnosis, CID prescriptions and CID review.ResultThe results were collated using a data-set of 216 patients (136 females and 80 males,) of which the mean age was 79 years. It was noted that 36% of patients had not had any sort of cognitive assessment before referral, which identifies an area for improvement. However the most substantial finding was that only 10 patients (5%) had a CID prescription review documented in the RIO notes.ConclusionOur data suggest that in our memory assessment service, only a small proportion of patients are having a documented review of their CIDs prior to diagnosis of dementia. In order to improve this and thus improve compliance with guidelines from the Royal College of Psychiatrists MSNAP and the NIA-AA, measures will be taken to issue each dementia support worker and nurse with a CID prescription review card, which will list those medications to consider and flag for review.
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