Standards of lithium monitoring in mental health trusts in the UK

<p>Abstract</p> <p>Background</p> <p>Lithium is a commonly prescribed drug with a narrow therapeutic index, and recognised adverse effects on the kidneys and thyroid. Clinical guidelines for the management of bipolar affective disorder published by The National Institute for Health and Clinical Excellence (NICE) recommend checks of renal and thyroid function before lithium is prescribed. They further recommend that all patients who are prescribed lithium should have their renal and thyroid function checked every six months, and their serum lithium checked every three months. Adherence to these recommendations has not been subject to national UK audit.</p> <p>Methods</p> <p>The Prescribing Observatory for Mental Health (POMH-UK) invited all National Health Service Mental Health Trusts in the UK to participate in a benchmarking audit of lithium monitoring against recommended standards. Data were collected retrospectively from clinical records and submitted electronically.</p> <p>Results</p> <p>436 clinical teams from 38 Trusts submitted data for 3,373 patients. In patients recently starting lithium, there was a documented baseline measure of renal or thyroid function in 84% and 82% respectively. For patients prescribed lithium for a year or more, the NICE standards for monitoring lithium serum levels, and renal and thyroid function were met in 30%, 55% and 50% of cases respectively.</p> <p>Conclusions</p> <p>The quality of lithium monitoring in patients who are in contact with mental health services falls short of recognised standards and targets. Findings from this audit, along with reports of harm received by the National Patient Safety Agency, prompted a Patient Safety Alert mandating primary care, mental health and acute Trusts, and laboratory staff to work together to ensure systems are in place to support recommended lithium monitoring by December 2010.</p

Rebuffing Royals? Afrikaners and the royal visit to South Africa in 1947’

This article traces the responses of Afrikaners to the symbolism and political purposes of the 1947 royal visit to Southern Africa, the first post-war royal tour and the first visit of a reigning sovereign to the Union of South Africa. Taking place in the aftermath of a war that had caused bitter political divisions within Afrikaner ranks and stimulated radical populist nationalism, a royal tour intended to express the crown's gratitude for South Africa's participation in that war was bound to be contentious. Drawing on press accounts, biographies, autobiographies and archival sources, this article argues that the layered reactions of Afrikaners demonstrate that, even on the eve of the National Party's electoral victory on a republican and apartheid platform, attitudes towards monarchy and the British connection were more fluid and ambiguous than either contemporary propaganda or recent accounts have allowed. The diverse meanings attributed to this iconic royal tour reveal a process of intense contestation and reflection about South Africa's place in an empire that was in the throes of post-war redefinition and transformation, and confirm recent characterisations of the 1940s as one of manifold possibilities such that outcomes, like the electoral victory of the National Party in the following year, was far from pre-determined