PHYSICAL HEALTH ASSESSMENT AND MEDICINES RECONCILIATION ON ADMISSION TO AN ACUTE MENTAL HEALTH UNIT: A QUALITY IMPROVEMENT PROJECT

Individuals with mental health disorders are at greater risk of physical health problems. Medicines reconciliation reduces medication errors on admission. The aim of this project was to improve compliance with the completion of physical health assessments and medicines reconciliation forms by using a set standard stating that all patients must have the above completed at the point of admission to an acute mental health unit. The notes for all inpatients were reviewed for evidence of completed physical assessments and medicines reconciliation forms. This was done at three different time points: baseline, 2 months after the introduction of recommendations (1st intervention) and 2 months later when an online system of record keeping was trialled (2nd intervention). At baseline (n=33), 16 (49%) had a physical examination, 15 (46%) had an ECG, 17 (52%) had baseline bloods and 4 (12%) had a completed medicine reconciliation form. After the 2nd intervention (n=31), 25 (81%) had a physical examination, 25 (81%) had an ECG, 23 (74%) had baseline bloods and 23 (74%) had a completed medicine reconciliation form. Physical health assessments and medicines reconciliation are important aspects of patient care. The interventions introduced have improved the quality of practice at an acute mental health unit

PHYSICAL HEALTH ASSESSMENT AND MEDICINES RECONCILIATION ON ADMISSION TO AN ACUTE MENTAL HEALTH UNIT: A QUALITY IMPROVEMENT PROJECT

Individuals with mental health disorders are at greater risk of physical health problems. Medicines reconciliation reduces medication errors on admission. The aim of this project was to improve compliance with the completion of physical health assessments and medicines reconciliation forms by using a set standard stating that all patients must have the above completed at the point of admission to an acute mental health unit. The notes for all inpatients were reviewed for evidence of completed physical assessments and medicines reconciliation forms. This was done at three different time points: baseline, 2 months after the introduction of recommendations (1st intervention) and 2 months later when an online system of record keeping was trialled (2nd intervention). At baseline (n=33), 16 (49%) had a physical examination, 15 (46%) had an ECG, 17 (52%) had baseline bloods and 4 (12%) had a completed medicine reconciliation form. After the 2nd intervention (n=31), 25 (81%) had a physical examination, 25 (81%) had an ECG, 23 (74%) had baseline bloods and 23 (74%) had a completed medicine reconciliation form. Physical health assessments and medicines reconciliation are important aspects of patient care. The interventions introduced have improved the quality of practice at an acute mental health unit

Lifestyle modifications and nonpharmacologic interventions to improve outcomes in psoriatic arthritis: A systematic review

Purpose Psoriatic arthritis (PsA) is a multisystem inflammatory disorder associated with significant mortality and morbidity, including functional impairment and psychological disability. Although evidence-based treatment recommendations are available for the use of drug treatments in PsA, there is little guidance for health professionals on nonpharmacologic and psychological interventions that may be useful in PsA. The objective of this systematic review (SR) was to identify how lifestyle modifications and the use of nonpharmacologic and psychological interventions may improve the outcomes of patients with PsA. Methods Studies were included if they evaluated adults diagnosed with PsA and included exposure to nonpharmacologic interventions, psychological interventions, and lifestyle modifications. The outcomes used needed to have been validated in PsA. A systematic literature search was run on May 28, 2021, in the Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), EMBASE, Global Health, MEDLINE, and PsycINFO databases to identify articles related to lifestyle modifications and nonpharmacologic or psychological interventions for adults with PsA published between 2010 and 2021. Two review authors independently screened and selected full-text studies for inclusion in the SR. Risk of bias was assessed with either the Risk of Bias 2 (ie, RoB 2) tool or Critical Appraisal Skills Program checklist depending on the study type. Findings The search strategy identified 26,132 references. Eight studies examining lifestyle modifications and the effect on PsA were eligible to be included in the SR. Three of the 8 studies were randomized controlled trials, and 5 were nonrandomized studies. Three studies assessed physical activity, 3 assessed diet, 1 study assessed smoking, and another study assessed mud bath therapy. There was large heterogeneity between studies, and the measures of disease activity, and psychological and functional outcomes varied widely between studies. Implications Although this SR identified 8 relevant studies, these studies did not provide high-quality evidence to guide patients for non-drug treatments of PsA. The effectiveness of these interventions has therefore not been established. We found that physical activity seems to have a positive impact on disease activity and psychological well-being. Further well-designed research studies are needed to develop treatment recommendations. PROSPERO identifier: CRD42021257404

Lifestyle modifications and nonpharmacological interventions to improve outcomes in psoriatic arthritis. A systematic review

Purpose Psoriatic arthritis (PsA) is a multisystem inflammatory disorder associated with significant mortality and morbidity, including functional impairment and psychological disability. Although evidence-based treatment recommendations are available for the use of drug treatments in PsA, there is little guidance for health professionals on nonpharmacologic and psychological interventions that may be useful in PsA. The objective of this systematic review (SR) was to identify how lifestyle modifications and the use of nonpharmacologic and psychological interventions may improve the outcomes of patients with PsA. Methods Studies were included if they evaluated adults diagnosed with PsA and included exposure to nonpharmacologic interventions, psychological interventions, and lifestyle modifications. The outcomes used needed to have been validated in PsA. A systematic literature search was run on May 28, 2021, in the Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), EMBASE, Global Health, MEDLINE, and PsycINFO databases to identify articles related to lifestyle modifications and nonpharmacologic or psychological interventions for adults with PsA published between 2010 and 2021. Two review authors independently screened and selected full-text studies for inclusion in the SR. Risk of bias was assessed with either the Risk of Bias 2 (ie, RoB 2) tool or Critical Appraisal Skills Program checklist depending on the study type. Findings The search strategy identified 26,132 references. Eight studies examining lifestyle modifications and the effect on PsA were eligible to be included in the SR. Three of the 8 studies were randomized controlled trials, and 5 were nonrandomized studies. Three studies assessed physical activity, 3 assessed diet, 1 study assessed smoking, and another study assessed mud bath therapy. There was large heterogeneity between studies, and the measures of disease activity, and psychological and functional outcomes varied widely between studies. Implications Although this SR identified 8 relevant studies, these studies did not provide high-quality evidence to guide patients for non-drug treatments of PsA. The effectiveness of these interventions has therefore not been established. We found that physical activity seems to have a positive impact on disease activity and psychological well-being. Further well-designed research studies are needed to develop treatment recommendations. PROSPERO identifier: CRD42021257404

COVID-19 in patients with autoimmune diseases : characteristics and outcomes in a multinational network of cohorts across three countries

Patients with autoimmune diseases were advised to shield to avoid COVID-19, but information on their prognosis is lacking. We characterised 30-day outcomes and mortality after hospitalisation with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza. A multinational network cohort study was conducted using electronic health records data from Columbia University Irving Medical Center (CUIMC) (United States [US]), Optum [US], Department of Veterans Affairs (VA) (US), Information System for Research in Primary Care-Hospitalisation Linked Data (SIDIAP-H) (Spain), and claims data from IQVIA Open Claims (US) and Health Insurance and Review Assessment (HIRA) (South Korea). All patients with prevalent autoimmune diseases, diagnosed and/or hospitalised between January and June 2020 with COVID-19, and similar patients hospitalised with influenza in 2017-2018 were included. Outcomes were death and complications within 30 days of hospitalisation. We studied 133 589 patients diagnosed and 48 418 hospitalised with COVID-19 with prevalent autoimmune diseases. Most patients were female, aged ≥50 years with previous comorbidities. The prevalence of hypertension (45.5-93.2%), chronic kidney disease (14.0-52.7%) and heart disease (29.0-83.8%) was higher in hospitalised vs diagnosed patients with COVID-19. Compared with 70 660 hospitalised with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2% to 4.3% vs 6.3% to 24.6%). Compared with influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality