The Physician

AI in NHS and Social Care

2024-02-27T09:41:08-08:00

This commentary explores the potential of AI in transforming the NHS and social care in the UK to address challenges like health disparities and chronic diseases. It outlines various applications of AI in different healthcare domains, including pre-hospital health monitoring, elective care waiting lists, triaging, online treatment, diagnosis, imaging, electronic prescribing, and customizing treatment. Leveraging AI can identify vulnerable populations and reduce health disparities. However, it also emphasises the need for further research and careful consideration of ethical and privacy concerns to maximise the benefits of AI integration in healthcare. Overall, AI offers innovative solutions to enhance healthcare delivery and improve public health outcomes.

Impact of Diagnostic Uncertainty in Modern Psychiatry

2024-09-07T22:47:39-07:00

Diagnosis remains a crucial aspect of treatment, prognosis, and recovery, and therefore indispensable for any progress in medicine. Psychiatry, the branch of medicine focused on mental health, has evolved significantly over the decades. However, more than any other branch of medicine, psychiatry is still in a stage of early evolution – defining diagnosis and treatment, and its delivery to patients. Despite research investment, funding of specialist institutions and development of a highly qualified workforce, the progress in alleviating the mental distress in the community remains disappointingly suboptimal. It is thought that the significant expansion of diagnoses in psychiatry, often without firm scientific evidence, is one of the reasons behind the apparent lack of progress in provision of adequate mental health services.

Diagnosing psychiatric conditions remains a complex and nuanced process. Unlike other medical specialties, psychiatry lacks definitive biological markers for most conditions, relying heavily on subjective assessments, patient self-reports, and behavioural observations. This introduces several diagnostic dilemmas that challenge even the most experienced clinicians.

As the advent of disease specific treatment protocol heightens the necessity of accurate diagnostic procedures, this article explores the familiar challenges in modern psychiatric diagnosis and highlights their implications for patients as well as healthcare providers. Despite promising research, no single biological marker has yet been unequivocally identified for mental disorder.

Advance Consent for Interventional Radiology Procedures

2024-12-21T23:40:33-08:00

Background

Advance consent is crucial for patients undergoing Interventional radiology (IR) procedures with potential serious harm. Two previous audits at our hospital revealed issues with obtaining consent before the day of the procedure, leading to the implementation of a consent clinic. Subsequently, a new electronic patient record (EPR) system was introduced. This third audit cycle assessed whether these changes improved the advance consent rates for vascular IR procedures.

Method

We retrospectively reviewed 53 patients who underwent vascular IR procedures in January 2023, noting whether each procedure was inpatient or outpatient, urgent or elective, and the procedure type. These results were compared with previous cycles to evaluate adherence to consent standards.

Results

Among the 53 patients, there was an even split between inpatient and outpatient procedures, as well as between urgent and elective procedures. 27 patients underwent lower limb angiogram/angioplasty, 19 had fistula work, and 7 underwent other procedures. 77% of patients consented in advance or had the consent process initiated beforehand.

Conclusion

An improvement in advance consent rates was noted compared to previous cycles (14% → 63% → 77%) following the implementation of consent clinics and the new EPR system. However, 33% of patients, primarily those undergoing fistula work, still consented on the day of the procedure. This audit highlights the benefit of the new EPR system and the need to continue consent clinics, emphasizing the importance of advance consent, especially for fistula procedures.

Importance of Hypoglycaemia Kits in Mental Health Settings

2023-11-22T08:32:20-08:00

Hypoglycaemia management kits (HMKs) are increasingly recognised as a crucial component of care in mental health hospitals, particularly for patients with diabetes or those on medications that affect glucose metabolism. Emerging evidence suggests that the implementation of HMKs in these settings has significant benefits in both clinical and psychological outcomes. Properly stocked kits, which typically include glucose tablets, glucagon, and syringes, enable quick and effective treatment of hypoglycaemic events, reducing the risk of severe complications such as seizures, coma, or death.

Studies show that patients with mental health conditions, especially those taking antipsychotic medications, are at increased risk of developing metabolic disturbances, including hypoglycaemia. HMKs help mitigate these risks, improving patient safety and contributing to better management of comorbid conditions. Additionally, the presence of these kits can alleviate anxiety among patients and staff, enhance confidence in managing medical emergencies, and reduce the burden on healthcare professionals by preventing preventable hospitalizations.

While data on long-term outcomes is still limited, current evidence supports the integration of HMKs into standard care protocols within mental health hospitals as a means of improving both physical and mental health outcomes, and promoting a more holistic, patient-centred approach to care. Further research is needed to refine guidelines and assess the cost-effectiveness of HMK use in this population.

Secondary Prevention of Osteoporotic Fracture with IV Zoledronate

2024-12-07T02:52:25-08:00

Osteoporotic fractures are a significant global public health concern, particularly in aging populations. They contribute to substantial morbidity, mortality, and healthcare costs, with over 300,000 fragility fractures annually in the UK, costing approximately £4.4 billion. Hip fractures are the most severe, with a one-year mortality rate of 20–30%. Effective secondary prevention strategies are essential to reduce the burden on healthcare systems.

Zoledronate, a third-generation bisphosphonate, effectively reduces recurrent fracture risk, improves bone mineral density, and lowers mortality, with the advantage of annual dosing for better adherence.

This quality improvement initiative was aimed to enhance secondary prevention through a local protocol promoting intravenous (IV) zoledronate post-hip fracture, in line with the National Osteoporosis Guideline Group (NOGG). Retrospective analysis of 64 patients (mean age 73 years) revealed a significant increase in IV zoledronate prescriptions from 14% to 61% after protocol implementation.

This study demonstrates that local protocols, supported by multidisciplinary team (MDT) education and tools such as Fracture Liaison Services (FLS) and the National Hip Fracture Database (NHFD), have improved osteoporosis management across NHS hospitals. However, challenges persist, including limited FLS coverage, suboptimal treatment adherence, and resource constraints. Addressing these barriers is critical to optimising care for elderly patients at risk of recurrent fractures.