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Collateral History-Taking on Acute General Adult and Older Person Inpatient Wards: A Quality Improvement Project
- Joanna Steptoe, Harlene Deol, Joanna Male, Erica Riviere, Roisin McCarthy
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S183
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Aims
To investigate current practice of collateral history-taking on inpatient adult and older person wards in Leicestershire Partnership Trust. COVID-19 visiting restrictions raised concerns that the collateral history may be side-lined due to the physical absence of carers. Collateral history is important in developing a working diagnosis and assessing level of function, and is part of ongoing assessment and formulation.
MethodsAn initial audit of 46 patient records from 3 inpatient wards (2 adult and 1 functional old age) was carried out in January 2021 when visiting restrictions were in place. In response, a questionnaire was distributed and 2 focus groups of junior doctors conducted later in 2021; the aim being to explore factors affecting collateral history taking. A re-audit was completed in October 2022 when visiting was reinstated. 48 patient records were audited. Old Age organic wards for dementia assessment were not included in data collection, as collateral history-taking is unavoidable for initial assessment of those presenting with significant cognitive impairment.
ResultsIn 2021 and 2022, 33% and 38% of sampled patients had a collateral history taken in the first 14 days of admission. Where a collateral history was omitted, only 10% and 13% were attempted and 46% and 27% planned. Associated themes were identified from the questionnaire and focus groups including consent; accessibility of contact details; lack of confidence and variability in history-taking; accountability/ clarity on whose role it is to complete the task; lack of time/space and poor consensus on how to document a collateral history.
ConclusionThe results of the re-audit continue to show poor collateral history completion early in admission for both old age and adult inpatient wards despite reinstatement of visiting after the COVID-19 pandemic. Numerous issues affect the completion and documentation of good quality of collateral histories within inpatient settings of Leicestershire Partnership Trust. These have been categorised into staff, system, environmental and other factors.
This audit forms part of a wider quality improvement project. The proposed actions are as follows:
1. To share findings locally via the Trust Audit and Quality Improvement department, Trust email and Consultant Medical Advisory Committee;
2. To improve education through Trust induction, regular bitesize teaching and development of a crib sheet to be placed on each ward;
3. To consider wider quality improvement projects in line with themes identified above;
4. To undertake a further re-audit in November 2023.
Anxiety levels among health care workers within Irish mental health services during COVID-19: a survey
- Ibrahim Elimam, Mary McCarthy, Roisin Cooney, Alin Dumitrescu
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S247
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Aims
The aim of this survey was to assess any fluctuations in anxiety levels experienced by mental health workers during the COVID-19 pandemic and the association between these changes and variables of information dissemination, risk management, and managerial support.
MethodA survey was created to assess variables of information dissemination, risk management, and managerial support. The GAD-7 was employed as measure for anxiety during and pre the pandemic The survey was conducted online via an anonymised questionnaire and disseminated by management through the heads of various disciplines within the mental health work force, using the local email portal in the Cork region. It was made available for research participation for a period of one month(JULY).
Following this stage, the reported data were analysed utilizing paired samples t-test, Pearson's correlations, and a hierarchical regression. Demographic variables were controlled for during analysis.
Result102 mental health healthcare workers participated in the survey (81.2% Female, 18.8% Male). The mean GAD-7 total scores for Pre-COVID-19 doubled in the during COVID-19 condition. The largest effect can be seen on the GAD-7 facet of “feeling afraid as if something awful might happen” with pre-COVID-19 GAD-7 mean scores more than quadrupling during COVID-19 conditions.
Managerial support had a moderate negative relationship with GAD-7 scores during the COVID-19 pandemic. Information dissemination total scores also had a moderate positive correlation with managerial support total scores and perceived risk/safety total scores. There was no correlation found between the GAD-7 total scores during COVID-19 pandemic and Information dissemination total scores nor Risk/safety total scores. Childcare was a concern for 64% of staff that it was applicable to; 45% of these staff considered altering work hours; 17% reported issues from management regarding these requests.
ConclusionMental health workers have seen a dramatic increase in anxiety since the COVID-19 pandemic, particularly in the context of expecting something bad to happen. Managerial support appears to be a protective factor for increased anxiety levels in this population. Childcare has been a predominant concern and altering working hours to accommodate this has been problematic for almost 1 in 5 mental health workers. Staff satisfaction with information dissemination positively affects perceived managerial support and perceived risk management.
This study is limited by the utilization of a novel self-created measure for examining variables specific to the COVID-19 pandemic and to the employment of a retrospective measure to obtain baseline anxiety scores of staff members before the pandemic.
The role of fruit and vegetables in the diets of children in Europe: current state of knowledge on dietary recommendations, intakes and contribution to energy and nutrient intakes
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- Róisín McCarthy, Laura Kehoe, Albert Flynn, Janette Walton
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue 4 / November 2020
- Published online by Cambridge University Press:
- 13 August 2020, pp. 479-486
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Fruit and vegetables (F&V) play an important role in the prevention of obesity and other chronic diseases and low intakes have been highlighted as one of the risk factors attributing to global mortality in adults. The childhood years are a critical period during which eating behaviours and food preferences evolve, providing an opportunity to develop and foster healthy eating practices, which carry into adulthood. This review aimed to summarise dietary guidelines relating to F&V, intakes of F&V and the contribution of F&V to energy and nutrient intakes in school-aged children in Europe. The current review showed a paucity of data in relation to guidelines specific for children for F&V consumption. Where guidelines were available, they ranged from 100 to 500 g or one to three portions of F&V daily (with variations in the categorisations). A key finding was the lack of data on estimates of F&V intakes in school-aged children across Europe. Where data were available, intakes ranged from 221 to 404 g/d and were generally below the WHO recommendation of at least 400 g/d. F&V contributed low proportions of energy intake (6–9%) but made significant contributions to intakes of dietary fibre (19–37%), vitamin A (26–46%), vitamin C (32–83%) and potassium (16–27%); however, they also contributed to intakes of total (25–50%) and free sugar (7–11%). This review has highlighted the need for more data on estimates of F&V intakes in school-aged children in Europe and a need for continued promotion of F&V consumption to increase intakes in this age group.
Characterising the plant based component of the Irish diet in terms of its nutritional quality
- Gráinne Kent, Laura Kehoe, Róisín McCarthy, Breige A. McNulty, Anne P. Nugent, Albert Flynn, Janette Walton
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E562
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A diet rich in plant-based foods with fewer animal products may offer improved health and environmental benefits. There is little consensus on the definition for a plant-based diet in the literature with some defining it as one rich in vegetables, legumes, fruits, wholegrains, nuts and seeds, excluding animal foods and with heavy restrictions on processed foods. Other definitions make no reference to the inclusion/exclusion of processed foods and refer only to the exclusion of all animal foods from the total diet. This study aimed to examine the nutritional quality of the Irish diet using each of these plant-based diet definitions.
A 4-day semi-weighed food record collected food intake data from 1500 Irish adults (18–90y) in the National Adult Nutrition Survey (NANS). Nutrient intake was analysed using WISP© based on UK and Irish food composition databases. All foods and beverages consumed in the NANS were categorised (included/excluded) into the two definitions; 1.plant-based component of the diet and 2.total diet excluding all animal components. The plant-based component included vegetables, legumes, fruits, wholegrains, nuts and seeds and excluded all animal foods and processed foods. The second categorisation included all non-animal foods regardless of processing. Nutritional quality was assessed by estimating energy-adjusted intakes of macronutrients, saturated fat, free sugars, dietary fibre and sodium. Stastical analysis was conducted using SPSS© v24.
The plant-based component of the diet provided 309 ± 214kcal/d (1.3 ± 0.9MJ/d) comprising of 68% carbohydrate, 20% fat and 12% protein. Mean intakes of saturated fat and free sugars from the plant-based component of the diet were 5% of energy (%E) and 1%E, respectively. Mean intakes of dietary fibre and sodium were 70g/10MJ and 1855mg/10MJ, respectively.
Allowing for inclusion of processed foods, mean energy intake from the total diet excluding all animal foods was 1051 ± 411kcal/d (4.4 ± 1.7MJ/d) comprising of 66% carbohydrate, 23% fat and 10% protein. Mean intakes of saturated fat and free sugars were 7%E and 14%E, respectively. Mean intakes of dietary fibre and sodium were 40g/10MJ and 2642mg/10MJ, respectively.
Overall, the macronutrient profile of the plant-based component of the diet and the total diet excluding animal foods were similar. However, the plant-based component of the diet was of higher nutritional quality; providing lower intakes of saturated fat, free sugar and sodium and higher intakes of dietary fibre compared to the total diet excluding animal foods. This study highlights the variability in nutritional quality between different definitions of plant based-diets.