Alcohol Problems - the Role of Liaison PsychiatryAlex Thomson
This document discusses the role of liaison psychiatry in treating alcohol use disorders. It begins by providing statistics on alcohol consumption and alcohol-related hospital admissions and costs in the local area. It then describes what liaison psychiatry is and its scope. National guidance calls for dedicated in-house liaison psychiatry services in every hospital. A local pilot program established liaison psychiatry teams to provide assessment, treatment and referral for patients with alcohol issues. The document presents some case examples and outlines current referral pathways and plans for future expansion and integration of liaison psychiatry services.
This document discusses alcohol withdrawal, including its goals, evaluation and treatment. It describes the symptoms of withdrawal which can range from minor (insomnia, anxiety) to severe (delirium tremens). It recommends correcting fluid/electrolyte abnormalities and using a tapering regimen of benzodiazepines like chlordiazepoxide or diazepam to safely manage withdrawal symptoms. Adjunct medications like clonidine may also help. Close monitoring is needed as untreated severe withdrawal can be life-threatening.
Case studies and practical experience - alcohol problems in the workplaceiCAADEvents
Presentation given at iCAAD Sweden February 2018 by Frederick Sparring MD, Specialist in occupation medecin, MRO responsible for alcohol and drug rehabilitation at Avonova
Between 2001-2002 and 2012-2013, rates of high-risk drinking and alcohol use disorder (AUD) in the United States increased significantly. High-risk drinking rose by 29.2% and AUD prevalence grew by 49.4%. These increases were greatest among women, older adults, racial/ethnic minorities, and those with lower education and income. The number of people meeting criteria for AUD who were also high-risk drinkers doubled from 46.5% to 54.5%, highlighting the role of high-risk drinking in the rise of AUD. The findings indicate a public health crisis and urgency for education, destigmatization, and treatment efforts focused on high-risk groups.
Assessment of substance use disorders 010915Tom Wilson
A presentation on screening and assessment of substance use disorders made to the Leadership in Rehabilitation Counseling Graduate Program at the Boise Campus of the University of Idaho, Boise campus.
Tobacco use remains a major public health issue and is disproportionately impacting those with mental health conditions, as smoking prevalence has not changed in 20 years for this group. The document outlines strategies to address high smoking rates among those with mental health conditions, including implementing clinical guidelines on smoking cessation support, harm reduction, and engaging mental health services and providers. Reducing smoking among those with mental health conditions is a priority to improve health outcomes and reduce health inequalities.
The document discusses Clinician Group's My Mind Lab psychological assessment tool. It can be used to screen Medicare patients annually for depression, alcohol use, and other behavioral health issues. The automated assessment evaluates patients for depression, anxiety, PTSD, and bipolar disorder based on DSM-5 criteria. It provides immediate results to help physicians identify underlying mental health conditions contributing to physical symptoms or slowing recovery. Regular screening using this tool can improve early detection, treatment, and patient outcomes.
Alcohol Problems - the Role of Liaison PsychiatryAlex Thomson
This document discusses the role of liaison psychiatry in treating alcohol use disorders. It begins by providing statistics on alcohol consumption and alcohol-related hospital admissions and costs in the local area. It then describes what liaison psychiatry is and its scope. National guidance calls for dedicated in-house liaison psychiatry services in every hospital. A local pilot program established liaison psychiatry teams to provide assessment, treatment and referral for patients with alcohol issues. The document presents some case examples and outlines current referral pathways and plans for future expansion and integration of liaison psychiatry services.
This document discusses alcohol withdrawal, including its goals, evaluation and treatment. It describes the symptoms of withdrawal which can range from minor (insomnia, anxiety) to severe (delirium tremens). It recommends correcting fluid/electrolyte abnormalities and using a tapering regimen of benzodiazepines like chlordiazepoxide or diazepam to safely manage withdrawal symptoms. Adjunct medications like clonidine may also help. Close monitoring is needed as untreated severe withdrawal can be life-threatening.
Case studies and practical experience - alcohol problems in the workplaceiCAADEvents
Presentation given at iCAAD Sweden February 2018 by Frederick Sparring MD, Specialist in occupation medecin, MRO responsible for alcohol and drug rehabilitation at Avonova
Between 2001-2002 and 2012-2013, rates of high-risk drinking and alcohol use disorder (AUD) in the United States increased significantly. High-risk drinking rose by 29.2% and AUD prevalence grew by 49.4%. These increases were greatest among women, older adults, racial/ethnic minorities, and those with lower education and income. The number of people meeting criteria for AUD who were also high-risk drinkers doubled from 46.5% to 54.5%, highlighting the role of high-risk drinking in the rise of AUD. The findings indicate a public health crisis and urgency for education, destigmatization, and treatment efforts focused on high-risk groups.
Assessment of substance use disorders 010915Tom Wilson
A presentation on screening and assessment of substance use disorders made to the Leadership in Rehabilitation Counseling Graduate Program at the Boise Campus of the University of Idaho, Boise campus.
Tobacco use remains a major public health issue and is disproportionately impacting those with mental health conditions, as smoking prevalence has not changed in 20 years for this group. The document outlines strategies to address high smoking rates among those with mental health conditions, including implementing clinical guidelines on smoking cessation support, harm reduction, and engaging mental health services and providers. Reducing smoking among those with mental health conditions is a priority to improve health outcomes and reduce health inequalities.
The document discusses Clinician Group's My Mind Lab psychological assessment tool. It can be used to screen Medicare patients annually for depression, alcohol use, and other behavioral health issues. The automated assessment evaluates patients for depression, anxiety, PTSD, and bipolar disorder based on DSM-5 criteria. It provides immediate results to help physicians identify underlying mental health conditions contributing to physical symptoms or slowing recovery. Regular screening using this tool can improve early detection, treatment, and patient outcomes.
Delirium tremens (DT) is a severe form of alcohol withdrawal that can be fatal if not promptly recognized and treated. It involves excessive nervous system excitability and is characterized by agitation, confusion, hallucinations, fever, and autonomic symptoms. Chronic heavy alcohol use affects neurotransmitter systems in the brain like GABA and glutamate. When alcohol is stopped, this can cause symptoms like tremors, seizures, and delirium as the brain adapts. The CIWA-Ar scale is used to assess alcohol withdrawal severity and guide treatment decisions.
This document summarizes substance use disorders. It defines substances such as alcohol, opioids, cannabinoids, sedatives/hypnotics, cocaine, caffeine, hallucinogens, and tobacco. It describes how to identify substance use disorders through self-report data, analysis of bodily fluids, clinical signs and symptoms, and informant history. It then explains different classifications of substance use disorders including acute intoxication, harmful use, dependence syndrome, tolerance, withdrawal states, psychotic disorders, amnesic syndromes, and residual/late onset psychotic disorders. It provides examples of each classification.
Demography and epidemiology of psychiatric disorders in elderlyRavi Soni
This document discusses the demography and epidemiology of psychiatric disorders in elderly populations. It begins with an introduction to geriatric psychiatry and outlines some key statistics on aging populations globally and in India. Specifically:
- The proportion of those aged 60 and older is projected to increase dramatically in India, from 8% currently to over 20% by 2050.
- Psychiatric morbidity is high in elderly populations, with estimates ranging from 17-43% suffering from mental health problems in various Indian studies.
- Common disorders discussed include dementia, depression, anxiety, bipolar disorder, and others. Dementia prevalence is estimated to be around 3.5 million people currently in India, and this number is expected to rise dramatically with
This document discusses various screening tools used to assess alcohol, nicotine, and other drug use. It provides descriptions of 10 tools for assessing alcohol use, including the AUDIT, MAST, CAGE, and others. It also discusses 3 tools for assessing nicotine use and 7 tools for assessing other drug use, such as the DAST for drugs and OTI and SDS for opiates. Each assessment tool is briefly described, including the number of items, what aspects of use or dependence it assesses, and examples of validated uses in clinical settings.
Registered with the New York State Board of Pharmacy since 2015, Dr. Nechama Rothberger possesses an extensive background in emergency medicine and critical care. Dr. Nechama Rothberger works as an emergency department clinical pharmacist for the Maimonides Medical Center. In this role, she dispenses medication related care to patients with diverse injuries and illnesses, including overdoses and poisoning.
Substance abuse disorders are now classified as mental disorders according to the DSM-5. Addiction changes the brain in fundamental ways and causes compulsive drug-seeking behaviors that override the ability to control impulses. Approximately 21.5 million Americans had a substance use disorder in the past year, including alcohol and illicit drugs. Co-occurring mental health and substance use disorders are common, with 7.9 million people having both in the past year. Integrated treatment that addresses both disorders together is most effective for those with co-occurring disorders.
Here are some suggested questions for the student:
1. Can you tell me more about how the bruise on her cheek happened?
2. Who was with her at the time?
3. What kind of injuries has she had before in previous visits to ED?
4. Can you describe your home life - is it just the two of you living together?
5. I'd like to examine her fully to check for any other injuries. Is that okay with you?
6. I have a responsibility to ensure her safety. If I have any concerns, I may need to involve other services like social work. How do you feel about that?
7. The number and type of visits
The document discusses various substance use disorders and their diagnostic criteria, including substance dependence, abuse, and the biological and psychological factors involved. It also reviews the treatment approaches of 12-step programs and relapse prevention as well as details on specific substances like alcohol, cocaine, cannabis, hallucinogens, opioids, sedatives, and more.
The document discusses alcohol and substance abuse. It begins by listing commonly abused substances like alcohol, tramadol, marijuana, and caffeine. It then notes that the region with the highest rates of abuse is the Northwest region of Nigeria. Some true statements about substance abuse are that cocaine is the most widely used illegal drug, marijuana may be a gateway drug, and men should drink no more than 21 units of alcohol per week. Risk factors for substance abuse include peer pressure, low self-esteem, and dysfunctional families. The document outlines the magnitude of alcohol and substance abuse in Nigeria and discusses various substances that are commonly abused as well as the causes and health effects of alcohol and substance abuse.
case presentation on alcohol withdrawal syndromeRumana Hameed
This document presents a case of a 55-year-old male patient admitted for alcohol withdrawal syndrome. The patient has a history of chronic alcohol use and a shrunken left eye for 3 months. On examination, the patient has an enopthalus left eye and is incoherent. Lab tests show diffuse cerebral atrophy and pthysis bulbi of the left eye. The patient is assessed with alcohol withdrawal syndrome and left eye pthysis bulbi. The treatment plan includes thiamine, chlordiazepoxide, benfortiamine, antibiotics, pantoprazole, dextrose fluids, and multivitamins. Potential drug interactions and adverse effects of the medications are discussed. Lifestyle counseling addresses avoiding triggers
- The document discusses dual diagnosis, which is when a person has both a substance misuse issue and a mental health disorder. It is common for the causes and symptoms to overlap.
- Dual diagnosis is a major issue, with around 3/4 of prisoners and 75-80% of drug/alcohol service users also experiencing mental health problems. Only 62% of drug users with mental health issues receive treatment.
- Having both a substance use disorder and mental illness leads to worse health outcomes and difficulties accessing care. The document advocates for services to better coordinate and meet people's full range of needs.
This document provides an overview of the management of schizophrenia according to the 11th Post Graduate Course in 2005 at the Institute of Psychiatry in Rawalpindi, Pakistan. It discusses the biological, psychological, and social aspects of schizophrenia management. Biologically, it describes the use of antipsychotic medications including both typical and atypical antipsychotics. Psychologically, it emphasizes individual psychotherapy, family education, and cognitive behavioral therapy. Socially, it stresses the importance of rehabilitation, social and vocational training, and case management.
Zaid Hjab
college of health and medical technology - baghdad/Physiotherapy and Rehabilitation Department
Alcohol is the most commonly abused substance in most parts of the world
and is associated with significant morbidity and mortality. While common in the
general population, alcohol use disorders are even more frequent in hospital
patients, including 25%–50% of medical-surgical patients and up to 50%–60% of
psychiatric inpatients in some settings. People who misuse alcohol are commonly
referred to as “alcoholic” by the lay public.
There are two to three men for each woman with an alcohol use disorder,
and the usual age at onset is between ages 16 and 30. Onset is earlier in men than
women, although the medical complications progress more rapidly in women.
People in certain occupations are prone to alcohol use disorder, including
bartenders, construction workers, and writers. Other groups prone to alcoholism
include individuals who use tobacco; those with mood and anxiety disorders; those
with antisocial personality disorder; and those with a gambling disorder.
A lecture by Dr Imran Waheed, Consultant Psychiatrist, outlining the approach towards the diagnosis and management of schizophrenia, with particular reference to primary care. Delivered in March 2013 in Birmingham, UK.
Suicide by Patient in health care organization occupies 2nd position In all 12 sentinel events reported to Joint commission on accreditation of health care organization (JCI).
How Hospital administrator should handle this Problem.
This document discusses substance use disorders and different categories of abused substances. It defines substance intoxication, withdrawal, abuse, and dependence according to DSM-IV criteria. It then outlines 11 criteria for substance use disorder and notes changes in the DSM-5 definition. The document proceeds to describe characteristics of five categories of substances - depressants, stimulants, opioids, hallucinogens/PCP, and cannabis. Specific substances like alcohol, cocaine, amphetamines, nicotine, caffeine, heroin, LSD, and marijuana are discussed. Inhalants are also covered.
A DSM 5 Update: Substance - Related And Addictive DisordersChat 2 Recovery
Within the next year, most insurance providers will be expecting all claims to include the new DSM-5 nomenclature. It is imperative for all mental health professionals to be comfortable with the new diagnostic criteria and recording procedures. This presentation provides participants with a clear understanding of the revisions made in the category of Substance - Related and Addictive Disorders from the DSM-IV to the DSM-5.
Topics presented by Nick Lessa, CEO of Inter-Care: an addiction treatment program in New York City.
Includes:
Changes in the diagnostic criteria from the DSM–IV to the DSM-5
The distinction between Substance Use Disorders and the Substance - Induced Disorders
Recording procedures for Substance Related Disorders
Delirium tremens (DT) is a severe form of alcohol withdrawal that can be fatal if not promptly recognized and treated. It involves excessive nervous system excitability and is characterized by agitation, confusion, hallucinations, fever, and autonomic symptoms. Chronic heavy alcohol use affects neurotransmitter systems in the brain like GABA and glutamate. When alcohol is stopped, this can cause symptoms like tremors, seizures, and delirium as the brain adapts. The CIWA-Ar scale is used to assess alcohol withdrawal severity and guide treatment decisions.
This document summarizes substance use disorders. It defines substances such as alcohol, opioids, cannabinoids, sedatives/hypnotics, cocaine, caffeine, hallucinogens, and tobacco. It describes how to identify substance use disorders through self-report data, analysis of bodily fluids, clinical signs and symptoms, and informant history. It then explains different classifications of substance use disorders including acute intoxication, harmful use, dependence syndrome, tolerance, withdrawal states, psychotic disorders, amnesic syndromes, and residual/late onset psychotic disorders. It provides examples of each classification.
Demography and epidemiology of psychiatric disorders in elderlyRavi Soni
This document discusses the demography and epidemiology of psychiatric disorders in elderly populations. It begins with an introduction to geriatric psychiatry and outlines some key statistics on aging populations globally and in India. Specifically:
- The proportion of those aged 60 and older is projected to increase dramatically in India, from 8% currently to over 20% by 2050.
- Psychiatric morbidity is high in elderly populations, with estimates ranging from 17-43% suffering from mental health problems in various Indian studies.
- Common disorders discussed include dementia, depression, anxiety, bipolar disorder, and others. Dementia prevalence is estimated to be around 3.5 million people currently in India, and this number is expected to rise dramatically with
This document discusses various screening tools used to assess alcohol, nicotine, and other drug use. It provides descriptions of 10 tools for assessing alcohol use, including the AUDIT, MAST, CAGE, and others. It also discusses 3 tools for assessing nicotine use and 7 tools for assessing other drug use, such as the DAST for drugs and OTI and SDS for opiates. Each assessment tool is briefly described, including the number of items, what aspects of use or dependence it assesses, and examples of validated uses in clinical settings.
Registered with the New York State Board of Pharmacy since 2015, Dr. Nechama Rothberger possesses an extensive background in emergency medicine and critical care. Dr. Nechama Rothberger works as an emergency department clinical pharmacist for the Maimonides Medical Center. In this role, she dispenses medication related care to patients with diverse injuries and illnesses, including overdoses and poisoning.
Substance abuse disorders are now classified as mental disorders according to the DSM-5. Addiction changes the brain in fundamental ways and causes compulsive drug-seeking behaviors that override the ability to control impulses. Approximately 21.5 million Americans had a substance use disorder in the past year, including alcohol and illicit drugs. Co-occurring mental health and substance use disorders are common, with 7.9 million people having both in the past year. Integrated treatment that addresses both disorders together is most effective for those with co-occurring disorders.
Here are some suggested questions for the student:
1. Can you tell me more about how the bruise on her cheek happened?
2. Who was with her at the time?
3. What kind of injuries has she had before in previous visits to ED?
4. Can you describe your home life - is it just the two of you living together?
5. I'd like to examine her fully to check for any other injuries. Is that okay with you?
6. I have a responsibility to ensure her safety. If I have any concerns, I may need to involve other services like social work. How do you feel about that?
7. The number and type of visits
The document discusses various substance use disorders and their diagnostic criteria, including substance dependence, abuse, and the biological and psychological factors involved. It also reviews the treatment approaches of 12-step programs and relapse prevention as well as details on specific substances like alcohol, cocaine, cannabis, hallucinogens, opioids, sedatives, and more.
The document discusses alcohol and substance abuse. It begins by listing commonly abused substances like alcohol, tramadol, marijuana, and caffeine. It then notes that the region with the highest rates of abuse is the Northwest region of Nigeria. Some true statements about substance abuse are that cocaine is the most widely used illegal drug, marijuana may be a gateway drug, and men should drink no more than 21 units of alcohol per week. Risk factors for substance abuse include peer pressure, low self-esteem, and dysfunctional families. The document outlines the magnitude of alcohol and substance abuse in Nigeria and discusses various substances that are commonly abused as well as the causes and health effects of alcohol and substance abuse.
case presentation on alcohol withdrawal syndromeRumana Hameed
This document presents a case of a 55-year-old male patient admitted for alcohol withdrawal syndrome. The patient has a history of chronic alcohol use and a shrunken left eye for 3 months. On examination, the patient has an enopthalus left eye and is incoherent. Lab tests show diffuse cerebral atrophy and pthysis bulbi of the left eye. The patient is assessed with alcohol withdrawal syndrome and left eye pthysis bulbi. The treatment plan includes thiamine, chlordiazepoxide, benfortiamine, antibiotics, pantoprazole, dextrose fluids, and multivitamins. Potential drug interactions and adverse effects of the medications are discussed. Lifestyle counseling addresses avoiding triggers
- The document discusses dual diagnosis, which is when a person has both a substance misuse issue and a mental health disorder. It is common for the causes and symptoms to overlap.
- Dual diagnosis is a major issue, with around 3/4 of prisoners and 75-80% of drug/alcohol service users also experiencing mental health problems. Only 62% of drug users with mental health issues receive treatment.
- Having both a substance use disorder and mental illness leads to worse health outcomes and difficulties accessing care. The document advocates for services to better coordinate and meet people's full range of needs.
This document provides an overview of the management of schizophrenia according to the 11th Post Graduate Course in 2005 at the Institute of Psychiatry in Rawalpindi, Pakistan. It discusses the biological, psychological, and social aspects of schizophrenia management. Biologically, it describes the use of antipsychotic medications including both typical and atypical antipsychotics. Psychologically, it emphasizes individual psychotherapy, family education, and cognitive behavioral therapy. Socially, it stresses the importance of rehabilitation, social and vocational training, and case management.
Zaid Hjab
college of health and medical technology - baghdad/Physiotherapy and Rehabilitation Department
Alcohol is the most commonly abused substance in most parts of the world
and is associated with significant morbidity and mortality. While common in the
general population, alcohol use disorders are even more frequent in hospital
patients, including 25%–50% of medical-surgical patients and up to 50%–60% of
psychiatric inpatients in some settings. People who misuse alcohol are commonly
referred to as “alcoholic” by the lay public.
There are two to three men for each woman with an alcohol use disorder,
and the usual age at onset is between ages 16 and 30. Onset is earlier in men than
women, although the medical complications progress more rapidly in women.
People in certain occupations are prone to alcohol use disorder, including
bartenders, construction workers, and writers. Other groups prone to alcoholism
include individuals who use tobacco; those with mood and anxiety disorders; those
with antisocial personality disorder; and those with a gambling disorder.
A lecture by Dr Imran Waheed, Consultant Psychiatrist, outlining the approach towards the diagnosis and management of schizophrenia, with particular reference to primary care. Delivered in March 2013 in Birmingham, UK.
Suicide by Patient in health care organization occupies 2nd position In all 12 sentinel events reported to Joint commission on accreditation of health care organization (JCI).
How Hospital administrator should handle this Problem.
This document discusses substance use disorders and different categories of abused substances. It defines substance intoxication, withdrawal, abuse, and dependence according to DSM-IV criteria. It then outlines 11 criteria for substance use disorder and notes changes in the DSM-5 definition. The document proceeds to describe characteristics of five categories of substances - depressants, stimulants, opioids, hallucinogens/PCP, and cannabis. Specific substances like alcohol, cocaine, amphetamines, nicotine, caffeine, heroin, LSD, and marijuana are discussed. Inhalants are also covered.
A DSM 5 Update: Substance - Related And Addictive DisordersChat 2 Recovery
Within the next year, most insurance providers will be expecting all claims to include the new DSM-5 nomenclature. It is imperative for all mental health professionals to be comfortable with the new diagnostic criteria and recording procedures. This presentation provides participants with a clear understanding of the revisions made in the category of Substance - Related and Addictive Disorders from the DSM-IV to the DSM-5.
Topics presented by Nick Lessa, CEO of Inter-Care: an addiction treatment program in New York City.
Includes:
Changes in the diagnostic criteria from the DSM–IV to the DSM-5
The distinction between Substance Use Disorders and the Substance - Induced Disorders
Recording procedures for Substance Related Disorders
The document discusses the evolution of mental health services from the 20th to 21st century. It describes how quality of care, community-based services, and clinical governance were prioritized in restructuring an Irish mental health service based on a mission of independent, human rights-based and recovery-focused care. Key metrics like length of stay, readmission rates, and user satisfaction improved under this new model.
This document summarizes a 2001 report on the burden of schizophrenia and suicide in Australia. It discusses the purpose and topics covered in the original report, including an executive summary on the high financial costs of schizophrenia to both the healthcare system and individuals. Direct costs were estimated at $661 million in 2001, with indirect costs adding another $722 million. The report also examines schizophrenia from a clinical perspective, noting the disorder involves breakdowns in thought, emotion and behavior. It further discusses associated issues like high rates of disability, unemployment, social stigma, and increased risk of suicide.
Risk profiling, multiple long term conditions & complex patients, integrated ...Dr Bruce Pollington
Dr Bruce Pollington web-ex presentation to LTC QIPP programme
Utilising risk profiling, and risk stratification to identify patients with multiple long term conditions requiring complex care through integrated care teams.
This document provides an overview of alcohol use and related health issues. It notes that alcohol is the most misused substance globally, consuming over 15% of national health budgets. Alcohol is linked to 50% of murders, 40% of violent acts, and more than 30% of rapes. While only 5-7% abuse alcohol, 10-20 million people need treatment. The majority of alcohol is consumed by men ages 20-29, with daily or near daily use reported by over 55% of female consumers and 68% of male consumers. On average, men and women consume 4.9 drinks containing 62 ml of alcohol during typical drinking occasions. Most countries focus on tertiary treatment for dependence rather than primary prevention or early intervention
Heart failure is the leading cause of death in the US, yet accounts for less than 20 percent of hospice admissions. The goal of this webinar is to teach healthcare professionals to recognize what were once routine and manageable exacerbations as signs of unstable terminal illness, and to understand why hospice improves quality of life when proven treatments no longer can can.
A Change in Behavior: Delirium, Terminal Restlessness, or Dementia, A Pragmat...VITAS Healthcare
This webinar leverages evidence-based data to help physicians and healthcare professionals differentiate delirium, terminal restlessness and dementia-related agitation in patients as they near the end of life.
This document discusses valuing mental health in the NHS. It notes that mental health issues are very common, impacting outcomes and costs. Parity is needed between treating mental and physical health issues. The document provides statistics on the prevalence and impact of various mental health conditions. It discusses how mental health issues increase costs for long term physical conditions. Integrated care pathways and prevention/early intervention can deliver cost savings. More work is needed to achieve parity, such as ensuring equal access to assessments and treatments for mental and physical issues. The NHS aims to support value-based commissioning through various programs and specifications. FT networks are asked to help transform services by sharing best practices to improve access, integration and outcomes nationwide.
This presentation about ‘Valuing Mental Health’ by Dr Geraldine Strathdee, National Clinical Director of Mental Health, NHS England, was delivered to the Foundation Trust Network on 16 October 2013.
Geraldine covers:
- Why does the NHS need to value mental health: The impact of mental health on outcomes and costs
- Parity between mental health and physical health: What would it mean in practice
- Fast tracking Value in the NHS: What role can the Foundation Trust Network have in delivering it?
Audit of Inclusion Health in the Emergency Department.
Audit of the emergency care for the homeless population at City and Sandwell Hospitals, Birmingham.
This document summarizes a managed alcohol program model for addressing the needs of homeless individuals consuming non-beverage alcohol in London, Ontario. Key points:
1. Existing emergency and social services are overburdened by this population, costing over $1.5 million annually.
2. Managed alcohol programs in other cities have significantly reduced emergency visits and improved health outcomes through providing housing, healthcare, and regulated alcohol access.
3. The document recommends establishing a similar 16-20 bed program in London, led by nurses and social workers, to reduce costs and improve lives.
This document summarizes a managed alcohol program model that has been implemented in three Ontario communities. The model provides housing and continuous on-site healthcare for chronically homeless individuals with long-term alcohol dependence who consume non-beverage alcohol. It has significantly reduced emergency services utilization and costs while improving health outcomes. The document recommends establishing a similar 16-20 bed program in London to address the needs of a population that places high costs on local emergency and social services through their frequent use of these resources to manage health issues related to their homelessness and alcohol dependence.
The document discusses patient safety and adverse events in hospitals. It notes that studies show between 3-17% of hospital patients experience adverse events, with an average of 10%. Many medical errors are due to systemic problems rather than individual negligence. About half of adverse events can be prevented. Common adverse events include medication errors, wrong-site surgery, and falls. Reporting adverse events is important to learn from failures and improve the healthcare system. Factors like fatigue, understaffing, and poor systems can contribute to errors. An effective reporting system focuses on learning, has a wide scope, and recommends systems changes rather than punishing individuals.
Presented April 2016. A review of available health data on veterans living in North Central Texas (third largest population of veterans in the United States). Presentation includes data on veterans and mental health, substance abuse and sexual health outcomes. Also includes a review of comorbidities among veterans living with HIV, and a sample of evidence concerning the interrelationship between mental health and incarceration. Finally, a source for help - Veterans Coalition of North Central Texas as a resource for veterans and their families needing access to mental health services and a strong social support community.
Presentation delivered by Steven Fuller, MD, Vice President and Corporate Medical Director, Presbyterian Senior Living at the marcus evans Long-Term Care & Senior Living CXO Summit 2019 held in Orlando, FL
objectives are understanding the scop of substance abuse in the elderly and realize the future implications of substance abuse in the baby bommer cohorot and understanding the definition of alcohol dependance and how to recognize them and much more
welcome to :
http://www.ethanolabuse.com
Transforming Urgent and Emergency Care: Safer, Better, Faster mckenln
Dr. Steve Lloyd is a principal GP, clinical lead for 111/OOH services, and chair of several clinical groups focused on urgent and emergency care. He discusses challenges facing emergency and urgent care systems, including increased demand exacerbating strain on hospitals. Medicine, society, and patients have changed, but the NHS has changed little. While attendances have increased only slightly, emergency admissions have risen significantly, especially in older populations, and it is estimated that 20-30% of admissions of people over 75 could potentially be avoided with high-quality decision making and sufficient community services. Ongoing developments to address these challenges include implementing the urgent and emergency care review, establishing regional project management offices, allocating capital funding, developing new payment
This document discusses improving the patient experience in primary health care. It outlines issues with the current system such as fragmented care, access problems, and feelings of disempowerment among patients. Data shows many patients experience long wait times, lack of communication between providers, and doctors not spending enough time with them. The document calls for a more coordinated, comprehensive, and consumer-centered primary health care system to address these issues.
Similar to Alcohol Problems in the Acute Hospital (20)
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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5. Alcohol also affects every part of the hospital
Surgery
Complications, Higher mortality,
Longer stay, Readmissions
Obstetrics
Poor antenatal engagement,
complications, parenting issues
Wards
Complications, Higher mortality,
Longer stay, Readmissions
Ambulance
High callout rates, Frequent users
Outpatients
Emergency Dept
DNA rates, poor compliance, poor
response, higher morbidity
High rates of attendances, Frequent
users, Reattendances, “Mental
Health”, Violence & aggression
6. ...but it’s hard to know the extent of the issue
Because alcohol problems are so pervasive and widespread,
no specialty or dept takes an interest or responsibility
...except Addiction Psychiatry – but in traditional models of care this is usually
located away from the hospital, possibly with an “inreach worker” or two
7. Alcohol problems are not coded in Hospital
Episode Statistics
All these different
conditions are recorded
– but not specified as
“caused by alcohol”
8. Here’s what we know about
acute & unscheduled care
1
Emergency Dept
Attendances
2
Non-dependent (high risk)
hospital admissions
3
Alcohol dependent
hospital admissions
10. NPH and CMH combined have
210,525
4,050
?
Total ED attendances per year
Total ED attendances per week
Alcohol-attributable fraction not known
11. York ED did a casenote review and found:
9.8%
of attendances were alcohol-related
Between 21:00 and 09:00, this rose to
Alcohol was involved in
19.7%
45%
of “mental health” attendances
Kelly G et al. Emerg Med J 2013
12. “Although 553 patients had evidence of
alcohol in their attendance, it was only coded
as such in 46 computer records”
These attendances get coded
as “falls”, “chest pain”,
“seizure”, “collapse” etc.
Unless you LOOK for alcohol problems you
won’t find it in the statistics
13. The Institute of Alcohol Studies did a National ED Survey
(2004) and estimated that:
40-70%
of ED attendances are alcohol-related
14. Applying these rates to our figures, we get:
210,525
4,050
9.8%=
397
Total ED attendances per year
Total ED attendances per week
Alcohol-attributable
attendances per week
15. 2
Non-dependent (high risk)
hospital admissions
3
Alcohol dependent
hospital admissions
Estimates come from the
Local Alcohol Profiles for
England 2010-11
16. Across our two boroughs there are:
7,095
25
110
35,628
97
Alcohol-specific and Alcoholattributable admissions per year
Alcohol-specific admissions
per week
Alcohol-attributable admissions
per week
Alcohol-attributable bed-days
per year
Acute hospital beds occupied by
people with alcohol-attributable
conditions every single day
18. Delirium Tremens / Seizures
DT
Treatment
not
reviewed
9
Developed
DT in
Hospital
8
DT on
Admission
5
DT
Treatment
reviewed
4
Did not
have DT
13
People who develop delirium tremens
during treatment for acute alcohol
withdrawal should have their
withdrawal drug regimen reviewed.
People who develop delirium tremens should be offered oral lorazepam as
first-line treatment.
5 / 13
People who develop withdrawal seizures during treatment for acute alcohol
withdrawal should have their withdrawal drug regimen reviewed.
1/1
1 / 12
Phenytoin should not be offered to treat alcohol withdrawal seizures.
19. Length of Stay
6
Median 5.5 days
Mean 6.25 days
Range 1-28 days
4
2
0
1-2
3-4
5-6
Length of Stay
7-8
6
9 - 10
11+
Median 4.5 days
Mean 4.5 days
Range 1-7 days
4
2
0
1-2
3-4
5-6
7-8
Duration of Detox
9 - 10
11 +
20. Prolongation of admission by detox
8
12
10
6
8
4
6
4
2
2
0
0
0
1
2
3
4
5
6
7
>7
Days from Last Non-detox Treatment/Investigation to Discharge
0
>=1
Days from End of Detox to Discharge
So needing alcohol detox prolongs LOS
21. In Summary...
400
135
25
ED attendances every week
Alcohol-related admissions / week
Admissions directly due to alcohol
•High complication rates
•Longer stays
•Poor engagement with community services
?
Reattendance / readmission rates also
likely to be high
24. Mean units per drinking session
25
20
To avoid one ED attendance in
subsequent 12m:
-9 needed to be screened
-2 needed to be referred
15
10
5
0
0m
6m
12m
1
ED – Identification
and Brief Advice
27. 3
Transfer pathways to specialist
addiction unit
4w: 71% Engaged with community alcohol team; 43% with Mutual Aid
3m: 51% Engaged with community alcohol team; 28% with Mutual Aid
28. National guidance recommends on-site
provision of addiction services for alcohol
“All patients presenting to acute services with a
history of potentially harmful drinking, should be
referred to alcohol support services”
“Each hospital should have a 7-day Alcohol
Specialist Nurse Service... to provide
comprehensive physical and mental
assessments, Brief Interventions and access
to services within 24 hours of admission”
“A multidisciplinary Alcohol Care Team, led by a consultant with
dedicated sessions, should be established in each acute hospital
and integrated across primary and secondary care.”
30. Current Staff
One liaison psychiatrist
One alcohol specialist nurse (across both hospitals!)
0.4WTE alcohol liaison nurse (Compass – Harrow patients only)
Current Projects
Review of alcohol detoxification guidelines
Transfer pathway to specialist addiction unit
Psychiatric Assessment Lounge
Frequent Attenders Project
Training – junior doctors
Audit – NICE Guidance
32. Next Steps
1.
2.
3.
4.
5.
Formal Partnerships with community addiction services
Establish alcohol steering group / forum
7-day Alcohol Nurse Specialist Service in both hospitals
Alcohol Care Team with dedicated consultant sessions
Establish detox pathways – addictions unit /
ambulatory care
6. 7-day Identification and Brief Advice Team in ED
7. Psychosocial programme in hospital