UK Clinical Setting Research Articles

A medication assessment tool to evaluate adherence to medication guideline criteria in cancer pain management

AbstractObjectiveThe medication assessment tool for cancer pain management (MAT-CP) is a novel tool for measuring quality of drug use in chronic pain management in relation to guideline standards, and has been developed and tested in Norway with UK collaboration. The present paper describes the revision of the assessment tool for use in the UK, and its subsequent validation.SettingThree hospitals and one hospice in Scotland, UK.MethodThe MAT-CP was field-tested to produce preliminary data on its applicability in a UK clinical setting. The tool was then modified by peer review among clinical specialists before and after a pilot. The revised tool was further validated by wider application to a study sample of cancer inpatients. The outcome was the evaluation of the tool's utility in relation to clinical documentation in terms of applicability, clarity, reliability and perceived relevance of each criterion. The findings also included a quantification of adherence to the guideline criteria.Key findingsThe revised tool comprised 37 criteria covering six different aspects of cancer pain management. The field testing and pilot informed the modification of the MAT-CP to optimise its clarity and utility when applied to patients' clinical documentation. The revised tool was tested on 101 cancer patients experiencing pain (56 males), mean (standard deviation) age 68.9 (13.5) years. Overall guideline adherence was 68% (n = 1850 applicable criteria). Good inter-rater reliability (Cohen's kappa κ = 0.92) was demonstrated in the application. The preliminary application of the tool during validation and field-testing has highlighted several issues for further study.ConclusionA clinical tool to examine prescribing in cancer pain management that was designed for use in Norway has been revised for use in UK clinical settings. Reliability, face and content validity have been informed by applying the tool to patient data in clinical settings.

Minimising metabolic and cardiovascular risk in schizophrenia: diabetes, obesity and dyslipidaemia

People with schizophrenia are at greater risk of obesity, Type 2 diabetes, dyslipidaemia and hypertension than the general population. This results in an increased incidence of cardiovascular disease (CVD) and reduced life expectancy, over and above that imposed by their mental illness through suicide. Several levels of evidence from data linkage analyses to clinical trials demonstrate that treatment-related metabolic disturbances are commonplace in this patient group, and that the use of certain second-generation antipsychotics may compound the risk of developing the metabolic syndrome and CVD. In addition, smoking, poor diet, reduced physical activity and alcohol or drug abuse are prevalent in people with schizophrenia and contribute to the overall CVD risk. Management and minimization of metabolic risk factors are pertinent when providing optimal care to patients with schizophrenia. This review recommends a framework for the assessment, monitoring and management of patients with schizophrenia in the UK clinical setting.