Female Ward Research Articles

Wharton’s Revision of Guardian-Ward Romance Fiction in Summer

Abstract This article analyzes the way that Wharton’s Summer both engages with and revises a relatively common trope of popular nineteenth- and early twentieth-century American fiction centered on romance, the romance between a male guardian and his female ward. To do so, it also analyzes the trope in a range of those other novels, including William J. Locke’s 1905 The Morals of Marcus Ordeyne (so popular that it became a play and then a motion picture), Jean Webster’s 1912 Daddy Long-Legs, and Ethel M. Kelley’s 1917 Turn About Eleanor. Each of these other novels generally obscures or indeed celebrates the uneven power dynamics and age relationships of such couplings, sometimes to quite remarkable degrees, and in ways that foreground the “romantic” elements of the romance fiction genre. In Summer, Wharton, by partially but not entirely revising them, instead recasts the conventions of a guardian-ward romance to force the logical and emotional contradictions of the hierarchies of power coercively inherent in the limited female autonomy of such wards to the surface.

Staff and service users' experiences of the self-harm pathway on an acute inpatient ward

Background/Aims A female acute inpatient mental health ward developed a care pathway to support women who self-harm during their admission. This service evaluation was the first to explore staff and patients' experiences of the care pathway using qualitative methods. Methods Semi-structured interviews were completed with eight staff members and five patients. Thematic analysis was used to analyse the interview data. Results Themes that developed from staff interviews were about effects on staff and staff support, enabling patients to manage self-harm autonomously and the ward environment. Themes developed from patient interviews included enabling engagement, putting skills into practice and least restrictive practice. Staff and patients viewed the pathway as effective in reducing self-harm incidents and levels of restriction on the ward. Conclusions The pathway was viewed positively by staff and patients, although improvements could be considered to increase its efficacy.

COVID-19 in Princess Marina Hospital, Botswana: An Outbreak Investigation.

The Princess Marina Hospital in Gaborone, Botswana, had an outbreak of COVID-19 from early August 2020. The aim of this paper was to describe the outbreak investigation. The investigation's specific objectives were to describe the COVID-19 cases in terms of person, place, and time (PPT) and to determine measures to prevent further transmission of the infection. The data reported herein were collected over a 3-month period from beginning of August to end of October 2020. The investigation included all COVID-19 cases i.e. both patients and healthcare workers. It followed the steps of an outbreak investigation. These included assembling an investigation team comprising both the hospital and DHMT staff. All the wards reported their confirmed cases to the infection control team who in turn prepared line lists and case reports. Epicurves were produced from date of positive result. A total of 193 cases were reported, of which 110 (57.0%) were patients and 83 (43.0%) were healthcare workers. The median age was 35 years. Females accounted for 154 (79.8%) participants. Most of the wards were affected. The wards with the highest numbers of cases were female medical ward (39), emergency department (24), gynecology ward (17), and pediatric medical ward (10). Control measures included restricting movement into the hospital as well as clinical screening at all entry points. Furthermore, all patients were tested before admission into the wards. Surveillance of COVID-19 cases was continued beyond the 3 months reported in this paper. COVID-19 can spread rapidly in hospital settings affecting both patients and healthcare workers. Outbreak investigations including describing cases in terms of person, place, and time are critical if the most effective and efficient control measures are to be implemented.

Understanding the Healthcare Practitioners’ Experience in Managing Women with Postnatal Depression: A Qualitative Study in Malaysia

INTRODUCTION: Postnatal depression is largely underdiagnosed in many low-and middle-income countries, including Malaysia. Healthcare practitioners’ perceptions towards postnatal depression were identified as one of the main barriers to seeking help. Objective: This study aimed to explore the perceptions of healthcare practitioners about postnatal depression, and their experience in managing women with postnatal depression in Malaysia. Materials and methods: Eighteen healthcare practitioners (5 head nurses, 9 nurses, and 4 doctors) working in maternal and child health clinics and a female psychiatric ward in Kuala Lumpur were individually interviewed following a generic qualitative research design. Interview data were transcribed verbatim, and the transcripts were analyzed using framework analysis. Results: Healthcare practitioners reported that their management of women with postnatal depression was limited by the absence of a specific screening tool, and presence of stigma associated with postnatal depression. Discussion and conclusion: Healthcare practitioners were found to be aware of poor maternal mental health provision within their clinical setting and are ready to contribute to developing protocols to improve maternal mental health. As its diagnosis and treatments vary from general depression, there should be a specific direction addressed in the policy to assist in actions for managing postnatal depression. Professional training and continuous education on postnatal depression are a fundamental component in fostering quality of care, and public awareness as well as improving stigma within the Malaysian healthcare system.

An Overview Evaluation of Bacterial Infection and Bacterial Contamination at the Hospital Environment and Antibiogram for the Isolated Pathogens at Al Kufra Teaching Hospital, Libya

Background/Aims: Infectious diseases are the major public health problem worldwide. The medical services into the Southern Libyan sub-Saharan hospitals do not receive much attention in knowing the infection rates of pathogenic bacteria coming to the hospital, as well as there is not much information available about the hospital infection control application system. This study was performed to evaluate the infectious disease received to Al Kufra teaching hospital and determination the hospital risk factors involved in hospital-acquired infection. Materials and Methods: The screening was performed to investigate the distribution of potential pathogens among 157 samples collected from the four hospital wards including intensive care unit, the pediatric ward, male and female surgical ward from the hospitalizes patients, medical staff and hospital workers, and across different hospital facilities. Results: The bedsores swabs and urine samples showed 100% of infection, followed by sputum, stool, surgical wounds, and cerebrospinal fluid (85.8%, 67%, 62.5%, and 42.9%), respectively. Most of the hospital facilities showed 100% of contamination. The results showed Staphylococcus aureus colonized 40 (77%) of the total nasal swabs, other samples detected Bacillus cereus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis, Escherichia coli 0157. The sensitivity of Gram-positive organisms to the antibiotics showed resistance to Penicillin G (90.1%) and Amoxicillin + Clavulanic acid (82.7%), Methicillin (65.5%) and Vancomycin (65.5%). For Gram-negative organisms, the isolates showed resistance to tetracycline and colistin (62.5%) for each. Conclusion: The bacterial outbreak in the clinical and environmental samples of Al Kufra Teaching Hospital was relatively high. To control bacterial infection and hospital contamination, several instructions need to be carried out to protect the hospital staff and patients from being infected.

Assessment of Bed Utilization Indicators of Medicine Ward of a Tertiary Level Hospital: A Cross-sectional Study in Eastern India

Background: Efficient hospital bed utilization is an important function of hospital administrators. Scarcity of beds, overcrowding, and flooring are often the picture of tertiary hospitals. Objectives: This study aims to find out hospital bed utilization indicators such as average daily census, bed occupancy rate (BOR), average length of stay (ALS), bed turnover rate (BTR), and bed turnover interval (BTI) in Medicine ward of a tertiary hospital in West Bengal, India. Methods: A descriptive cross-sectional study was conducted in acute male and female as well as chronic male and female wards under medicine department of a tertiary hospital in West Bengal from June to August 2018.The record of active beds, patient days, daily admissions and discharge were reviewed for May 2018 by complete enumeration method from admission, discharge and death registers and recorded in a pre-designed pretested checklist. Average daily census, BOR, ALS, BTR, and BTI were computed using standard formula. Pabon Lasso model was used to analyse the performance of the nedicine ward. Results: Average daily census, ALS, BOR, BTR, BTI in medicine ward were 261.81 patients, 8 days, 108.55%, 4.22 patients/ bed and -0.63 days respectively. Pabon Lasso graph reflected high BOR and high discharges per bed (productivity) in acute medicine wards reflecting good quantitative performance in contrast to chronic medicine wards with low discharges per bed (productivity or BTR) and higher ALS. Conclusion: Medicine ward reflected higher BOR and ALS but lower BTR (productivity) as per the Pabon Lasso graph. Efforts must be made to reduce ALS in chronic medicine wards.

Medication errors in Najran, Saudi Arabia: Reporting, responsibility, and characteristics: A cross-sectional study

BackgroundMedication error is a preventable adverse effect of medical care, whether or not it is evident or harmful to the patient. Disclosure of medication errors and improvement of patient safety are inexorably related, and they provide one of the strongest reasons to report and disclose errors, including near misses in which no harm comes to the patient. This study aimed to identify medication errors at the southern province of Saudi Arabia. MethodsA cross-sectional retrospective study was conducted by reviewing all medical records in the King Khaled Hospital in Najran, Saudi Arabia. Medication errors related information were extracted from the electronic medical system for the duration between 2018 and 2020. ResultsDuring the study period of 2018 to 2020, a total of 4860 medication errorswere identified. More than half of the reported medicationerrors (66.9%) were linked to ordering, prescribing, or transcribing medications. The most commonly reported medicationerrors connected to ordering/prescribing/transcribing were inappropriate dosage, dosage units, and therapeutic duplication of medication. The most commonly reported medication errors linked to administration were missing documentation during administration, not performing independent double-checks during the administration of high alert medications, and the administration of look-alike sound-alike (LASA) medications. The intensive care unit (ICU), female medical ward, and male medical ward were the most commonly reported locations for medication errors. Pharmacists detected more than half of the reported medication errors. Physicians were found to be responsible for 66.0% of reported medication errors, followed by nurses. ConclusionMedication errors are common in hospital settings in Saudi Arabia's southern provinces. Efforts should be made to improve drug ordering, prescribing, and transcription in hospital settings. To guarantee optimum practices, the entire medical team should take responsibility for the patient's optimal medication administration.

The impact of pharmacists’ interventions in female internal medicine ward at university-based hospital on cost savings and cost avoidance

The impact of pharmacists’ interventions in female internal medicine ward at university-based hospital on cost savings and cost avoidance

A Case Report on Schizophrenia with Autoimmune Encephalitis

Schizophrenia is a severe mental illness with a high death rate and significant societal implications. Curative treatments are not available due to a lack of understanding of its etiopathogenesis. The mild encephalitis hypothesis of schizophrenia, established primarily by Karl Bechter and Norbert Müller, is one of the new research hypotheses. According to this theory, a significant subset of schizophrenia patients suffers from a mild but persistent form of encephalitis caused by a variety of etiology ranging from viral infections to traumas to autoimmune illnesses. This inflammatory method is believed to occur in the start or during the course of the disease.
 The authors present case of a 65-year-old female got admitted in female psychiatric ward AVBR Hospital Sawangi Meghe, Wardha Maharashtra with chief complaint of forgetfulness, interest in environment decline, unable to communicate, poor performance at work, muttering to self, sleep disturbance, seeing people which are not seen other, fearfulness. all necessary investigation done, in mental status examination founded impairment in memory, disorientation cognitive function impairment, RBC count 3.82, WBC count 5300, Hb% 12, calcium 8.1, urea 26, creatinine 0.6, sodium 142, potassium 4.0. Alkaline phosphate 89. HIV, HBSAG non-reactive, A large number of white blood cells in the CSF An MRI that reveals evidence of brain inflammation. There was a slight increase in antinuclear antibody (1: 40 titer). Blood and CSF were positive for oligoclonal bands. The patient was received symptomatic treatment antianxiety, antipsychotic drug alleviates hallucinations and delusion. 
 Disturbances of consciousness and orientation, catatonia, speech dysfunction, focal neurological signs, epileptic seizures/EEG abnormalities or autonomic dysfunction are warning signs in psychiatric patients which should always induce cerebrospinal fluid analysis with determination of antineuronal autoantibodies. Currently established immunotherapy strategies are summarised, taking into account international expert advice. Guided by clinical warning signs, our qualitative review enables rapid and reliable diagnosis of definite autoimmune encephalitis. This is of high relevance for the affected individuals, since early and sufficiently intense immunotherapy often leads to a good prognosis despite severe illness.

Perception of music and its cultural elements on acute post-mastectomy pain management among Nigerian women: an exploratory qualitative study.

This study aimed to explore the cultural elements of music in relation to pain management among women who have undergone mastectomy. An exploratory qualitative study with in-depth interviews. Using the purposive sampling technique, 20 participants were recruited for the study. The interviews were conducted face to face at the surgical out-patient clinic and female surgical ward. Data collection continued until data saturation was reached. The inductive approach was used to analyse the data, and the concepts were organised into themes. The consolidated criteria for reporting qualitative research guidelines (COREQ) were used to report this study. The participants were between 28 and 83years old and mostly diagnosed with stage III breast cancer. Three main themes emerged from the data analysis, including pain experienced after mastectomy, culture and music, and the perception of music for postoperative pain management after mastectomy. In this study, the knowledge of participants and the utilisation of music for pain management remains inadequate, but the participants perceived that music could be useful for pain control after mastectomy when the language and religion of the patient and the meaningfulness of the music were considered when introducing and selecting the music. This study will help open and extend the conversation about the utilisation and cultural elements of music that can be used clinically for pain management after mastectomy.

Fungal Airsporal Contamination of Different Hospital Environments in Lagos, Nigeria

Hospital infections caused by fungi have been frequently reported in hospitalized patients, with a high morbidity and mortality, making it increasingly important to the awareness of air quality. This study is designed to isolate, identify and investigate the occurrence of airborne fungal spores present in various working environments of some selected hospitals within Lagos State, Nigeria. Air samples at six working area (reception, out-patient, male ward, female ward, maternity ward and operating theatre) of the selected hospitals were obtained on triplicate of Sabouraud dextrose agar plates, every week days for six consecutive weeks. Isolated fungi were subsequently identified using both microscopic and macroscopic characteristics. Seven species of fungi belonging to three genera were recovered during this study period; Aspergillus niger, A. flavus, A. fumigatus, A. species, Candida species, Penicillium citrinum and P. species. The most abundant fungus encountered in this study is A. niger with P. species being the least isolated fungus from all the investigated hospitals. Of the six working areas sampled in the eight hospitals, the reception and out-patient areas appeared to record the highest occurrence of encountered fungi while the examined operating theatre rooms had the least fungal airsporal contaminant. It was gathered from this study that despite the daily cleaning of the investigated hospital working environments with different antiseptic and disinfectants, fungal contaminant was observed throughout the sampled period. We thereby conclude that the hospital environments are continuously monitored in order to identify and eliminate the sources of these fungal spores.

Case Report on Paranoid Schizophrenia with Capgras Syndrome

Paranoid is the most common delusion in people living with schizophrenia spectrum disorders which are present in about half of all people seeking treatment for a psychotic disorder. Schizophrenia is a persistent mental illness characterized by a wide range of symptoms, including delusions, hallucinations, disorganized speech or behavior, and cognitive impairment. Capgras syndrome is a form of the delusional belief in which a person has been replaced by an imposter. It can be seen in mental disorders as well as in central nervous system diseases in the form of neurodegenerative and non- neurodegenerative diseases The Capgras Syndrome is not an unusual condition, but an infrequent one which is possibly often unnoticed. A 48- years- old woman was admitted in female psychiatric ward with known case of paranoid schizophrenia with capgras syndrome. In the present case, the treatment approach was mainly somatic therapy i.e. psychopharmacotherapy, Electro convulsive Therapy (ECT) and psychological therapy. Psychiatric nurses have to play an important role to identify the symptoms and they should think critically, take action immediately to provide care to such type of patients.

Carcinoma of Tail of Pancreas: A Case Report

Background: A typical manifestation of pancreatic tail cancer is large intestinal obstruction with perforation. Clinically the cancer of pancreas is usually complicated to diagnose. Most cancer patients are not having symptoms throughout during the initial stages of the cancer, which often leads to a delay in diagnosis. Treatment choices include surgery, chemotherapy, and palliative care. It is more common in African-Americans, slightly more common in men.
 Case Presentation: A female patient of 40 years from Wardha was admitted to Female surgery Ward, Unit-3, AVBRH on 18th December with a chief complaint of pain in epigastric region since 2weeks. Patient was apparently all right 2 months back then she was complaining of pain in the epigastric region which was insidious in onset, gradually progressive in nature, burning type of pain with radiating to left upper back. No history of fever, nausea vomiting, clay-coloured stools. After that patient was undergone on routine investigation in that total WBC count was increased i.e., 13000/cu mm and haemoglobin level were decreased i.e., 9.7gm%, liver biopsy revealed that metastasis of Adenocarcinoma probably of pancreatic origin, Computed tomography and ultrasound and it revealed that heterogenous iso-echoic mass in the tail of pancreas based on investigation she was diagnosed as a case of Carcinoma tail of pancreas and she was undergone on treatment of antibiotic before chemotherapy .after that chemotherapy treatment was done for management of pain.
 Conclusion: Pancreatic adenocarcinoma presents differently from large intestinal cancer and should be explored in the differential diagnosis of large intestinal obstruction.

A Case Report on Alzheimers Dementia

Background: Dementia is one of the most difficult medical and economic concerns that our society faces today. There are currently very few treatments available for those suffering with dementia. There are no medications available that can stop or reverse brain tissue deterioration. This is primarily due to a lack of understanding of how dementia develops.
 Aim: To improve the individual with dementias quality of life, followed by caregiver support. To minimize burden of this disease on caregivers.
 Presentation of Case: The authors present case of a 65-year-old female got admitted in female psychiatric ward AVBR Hospital Sawangi Meghe Wardha Maharashtra with chief complaint of forgetfulness, interest in environment decline, unable to communicate, poor performance at work, muttering to self, sleep disturbance, seeing people which are not seen other, fearfulness. all necessary investigation done, in mental status examination founded impairment in memory, disorientation cognitive function impairment, RBC count 3.82, WBC count 5300, Hb% 12, calcium 8.1, urea 26, creatinine 0.6, sodium 142, potassium 4.0. Alkaline phosphate 89. HIV, HBSAG non-reactive, Positron emission tomography finding that atrophy in the left temporal lobe or posterior region of the partial lobes. Positron emission tomography (PET) is a widely used imaging technique in many clinical applications including tumor detection and neurological disorder diagnosis. In particular, amyloid PET plays a significant role in dementia diagnosis. 
 Results: The patient was received symptomatic treatment antidepressant, antianxiety, antipsychotic drug alleviates hallucinations and delusion. severity of Symptoms was minimized. 
 Discussion: patient received treatment such antipsychotic drug according to symptom, not only antipsychotic drug is important but also other therapy are important to minimized symptoms such reorientation training, daily routine, occupation therapy, Nutrition and Body Weight, Mood changes are best controlled by keeping a calm environment with fixed daily routine. It is advisable to have some identification bracelet or card always in their possession. The doors of the house should be securely locked so that the patients cannot leave unnoticed.
 Conclusion: Patient received symptomatically treatment benzodiazepine antidepressant, antipsychotic to alleviate hallucinations and delusions, anticonvulsant to control seizures. Donepezil, galantamine, Memantine. Patient condition improved through reorientation training, therapy other and severity of symptoms was minimized.

A Case Report on: CA Bladder

Introduction: Urinary bladder cancer is a global health problem. Carcinosarcoma of bladder is a very rare abnormal growth of cells and tissues called as tumors and it consist of malignant epithelial and sarcomatoids components. It mostly occurs at aging. Presentation of disease with hematuria i.e. blood in urine and painful urination i.e. dysuria. Pelvic radiation and cyclophosphamide therapy are the risk factors responsible for carcinoma of bladder.
 Clinical Findings: Severe abdominal pain, fever (Temperature- 1000 F), weakness, Anemia (Hemoglobin- 10.6gm %).
 Diagnostic Evaluation: Blood test Hemoglobin -10.6 gram %, Total Red blood cell count- 3.4 million/cumm, Hematocrit- 21.45, Total White blood cells count- 12,000 per microliter. In ultrasonography it was found that, a mass present on the right lateral wall of the urinary bladder.
 Therapeutic Intervention: Hemoglobin was raised by blood transfusion, Inj. Ceftriaxone 1gm Intravenously BD, Inj. Pantoprazole 40 mg Intravenously BD, radiation therapy and chemotherapy.
 Outcome: As compared to prior condition patient’s present condition show improvement. Fever was reduced and relieved abdominal pain by treatment and procedure transurethral resection of bladder tumor. With the help of blood transfusion Hemoglobin % increased from 10.6 to 11.5gm%.
 Conclusion: My client was admitted to female surgery ward, at Acharya Vinoba Bhave Rural Hospital Sawangi (Meghe), Wardha with an unknown case of Ca bladder. On admission her condition was poor. So on clinical manifestation, specific and routine investigation was done and after proper treatment her condition was found improved than previous. Here we have to emphasize on early diagnosis and proper treatment strategies helps to improve patient’s prognosis. It also helps to prevent morbidity and mortality.

PREVALENCE AND SOCIODEMOGRAPHIC PROFILE OF THE SUICIDES IN RAIGARH DISTRICT OF CHHATTISGARH, INDIA

Objective- To estimate the suicide prevalence rate on the basis of Indoor Patients of Late Shree Lakhiram Agrawal Memorial Govt. Medical College, Raigarh Chhattisgarh. The present study sample Method- were selected among admitted patient of department of Internal medicine at late Shree Lakhiram Agrawal Memorial Government Medical College and associated Kirodimal Government Hospital, Raigarh, Chhattisgarh, India. Patient committed suicide which were admitted in ICU and medical ward (female and male ward) selected in present study. Total number of patient admitted during January 2020 to June 2020 were ICU 194, male medical ward 1864 and female medical ward 1697 respectively. The total number of admitted patients in this duration was 3755. Result- ndings of study had shown age mean of those person committed in suicide had 28.32 (sd= 11.08) years old and range of the age 14 to 60 years in both genders. Gender wise discrimination are different in age of suicide attempts person in both sex, the female patients mean of age are 27-yearold (sd=10.60), and the range of the age was 14 to 60 years, while the male patient mean of age are 29.60 (sd=11.46) years old, and range of age are 15 to 60 years. The prevalence rate of suicide in Raigarh district of Chhattisgarh, India is 3.40. Suicide continues to be a major Conclusionsignicant problem of India and worldwide. This prevalence rate can be useful in improving prevention and planning of management programme for suicide.

A case report on pemphigus foliaceus

Pemphigus Foliaceus (PF) is second most common autoimmune vesicular disease in the pemphigus family characterized by superficial blisters of the skin and rarely mucous membranes which rupture to produce scaly, crusted lesions. A 54 year old female patient admitted in female derma ward in tertiary care hospital, with the chief complaints of painful ruptured blisters all over the body with crusty, scaly patches associated with serous discharge and itching since 15 days. A positive Nikolsky’s sign is when the skin shears off easily when the surface is wiped sideways with a cotton swab or a finger. Based on both subjective and objective evidence, this case is assessed as Pemphigus Foliaceus. The plan incudes Corticosteroids, Immunosuppressants, Antibiotics, Vitamin A & D supplements, IV fluids, calcium and aminoacids supplements, antivirals and antifungals (if needed), proper wound management and finally plasmapheresis.

Impact-of-medication-reconciliation-by-clinical-pharmacist-during-hospital-admission-of-patients-with-chronic-kidney-disease-ckd-stage-iv-v-in-hospital-raub-pahang

Medication errors are more likely to occur during patient’s transition of care. There was very little information about impact of medication reconciliation activities done for patients with chronic kidney disease (CKD) Stage IV-V during admission stage in Malaysian Primary Hospitals. The objective of this study is to evaluate the impact of clinical pharmacist’s medication reconciliation activities during hospital admission of patients with CKD stage IV-V. This cross-sectional study was carried out in two multidisciplinary wards (male & female ward) in Hospital Raub, Pahang over 12 months with ethical approval. A clinical pharmacist was assigned to enroll potential study subjects in both wards. Patients over 18 years old who had previous history of CKD Stage IV-V were included in the study after obtaining informed consent. Medication reconciliation was carried out by the clinical pharmacist within 24 working hours during the admission of study subjects. All detected medication discrepancies were further classified as “intended” or “unintended” after discussion with the prescribing medical officer. The Severity Level of each unintended medication discrepancy was rated by a visiting medical specialist. Twelve patients with CKD stage V were recruited to the study. A total of 49 medication discrepancies were identified and most (89.8%) were found to be unintended. The most common unintended medication discrepancy identified was omission error. Most of the unintended medication discrepancies (59.1%) was rated as “No potential harm”, while 40.9% were rated as “Potential for monitoring and/or Intervention to preclude harm”. None of the unintended medication discrepancy was rated as “Potential harm”. In conclusion, medication discrepancies were common during admission of patients with late-stage chronic kidney disease in a primary hospital. Medication reconciliation performed by clinical pharmacist during admission has a potential role in preventing potential harms that may arise from unintentional medication discrepancies.

Has vitamin D had its day? An audit of vitamin D, prolactin and HBA1C monitoring over one year in an in-patient secure service

AimsTo ensure that service users in in-patient secure services have prolactin, vitamin D and HbA1c monitoring as per current best practice guidance.BackgroundService users prescribed antipsychotic medication are at risk of developing raised prolactin levels and metabolic syndrome. In both sexes, long-standing hyperprolactinaemia can lead to low bone mineral density with an increased risk of developing osteoporosis.In recent years there has been increasing controversy on the increase in Vitamin D monitoring despite the poor evidence for complications from vitamin D deficiency in adults. Not undertaking this test in the absence of symptoms will potentially reduce anxiety for service users could save £17 per test and £50 for a 12-week course of Vitamin D supplementation. Local and national guidance indicate Vitamin D monitoring should only be done in symptomatic people.MethodFifty-five service users in the five in-patient wards had their electronic records and pathology results reviewed over a one-year period. All service users were expected to have a minimum of an annual HbA1c and prolactin level but to only have vitamin D monitoring if symptomatic for deficiency.ResultAlthough 100% of service users in MSU were tested, vitamin D testing was consistently undertaken without documented clinical evidence of deficiency. The ranges across all units were: prolactin (72- 1384mU/L), HbA1c (30–90 mmol/mol) and vitamin D (15–124 nmol/L). Local reference ranges are prolactin (53- 360mU/L), HbA1c (<48 mmol/mol) and Vitamin D (50–120 nmol/L).Prolactin levels were highest on the male medium secure wards.The other two units had significantly less testing with prolactin and HbA1c levels being the least measured (18% of service users on male LSU and 23% on the female ward respectively). Vitamin D testing on these two wards were 38% on the female ward and 18% on the male ward for both tests.ConclusionNorthside House has a dedicated physical health team and this is likely to explain its 100% score. However, vitamin D testing was being undertaking automatically rather than based on symptoms.The recommendation is to add prolactin and HbA1c to the physical screens done before CPA meetings for all service users prescribed an antipsychotic but to stop Vitamin D testing in the absence of clinical symptoms of vitamin D deficiency.

Clinical audit of the inclusion of the Lester Tool details in discharge documents at Foss Park Hospital, York

AimsPatients with serious mental health illnesses die on average 15–20 years before the rest of the general population. Anti-psychotic medication, lifestyle and difficulty accessing healthcare services all have a detrimental effect on their life expectancy. To improve outcomes for these patients the Lester Tool; a method to assess the cardiovascular health of patients and implement change, was developed. Including the Lester Tool information in discharge letters allows transfer of information to other care providers (mainly GP's) who can implement and monitor any interventions made, improving outcomes for our patients. With this in mind, discharge documents should contain all of the information listed in the Lester Tool.We aimed to check if 100% of data required by the Lester Tool is included in discharge documents of the inpatients at Foss Park Hospital.Method20 patients from each of the male and female wards at Foss Park hospital, discharged in September or October 2020, were identified. A review of the discharge documents established whether the smoking status, BMI, ECG, blood pressure and blood results of each patient were recorded.ResultOf the 40 discharges, none had 100% compliance. On average across both wards; only 23% of the Lester tool information was included in the documents. On the female ward, 40% had none of data recorded, while on the male ward, 15% had none of the data recorded. Across both wards, not a single patient had details about their cholesterol ratio recorded, only 50% of BMI's were recorded and only 27% had a smoking status included.ConclusionOur results have shown that compliance with the Lester Tool falls short of what is expected. As a result, information about the physical health of our patients is not being communicated effectively with other care providers. This in turn can prevent patients being offered interventions needed to improve their cardiovascular health.Identifying this shortcoming in the transfer of information will allow us to educate the staff in our organisation and ensure that all the necessary physical health details will be included in future discharge documents. The result being improved outcomes and longer life expectancy of patients with serious mental illnesses, satisfying the purpose of the Lester Tool.