Initiative to improve handover notes in a tertiary psychiatric hospital.

Clinical handover is an important process in hospital settings, but it is often carried out inadequately, posing potentially serious consequences for the patients. This project aimed to increase the effectiveness of handover notes when patients were transferred between a general psychiatric ward and other wards in a tertiary psychiatric hospital. Effective handover notes in this project were defined to have the following five components: brief psychiatric history, reason for the patient to be transferred, significant risk issues, reason for psychotropic medication change and active medical issues. Baseline measurement obtained from audits revealed that the completion rate of effective handover notes was only 27.27%, which could potentially compromise patient safety and staff work efficiency. To address this problem, a series of plan-do-study-act (PDSA) cycles was implemented to improve the handover process. The interventions included education to junior doctors, reminders to complete effective handover notes and implementation of a handover template. Following each PDSA cycle, data were gathered to assess whether an effect had been achieved and to identify ways to enhance interventions to maximise impact. After the final PDSA cycle, the percentage of effective handover notes among all transfer cases reached 90.50%. Postintervention feedback from inpatient team indicated that effective communication between different teams was ensured, and staff satisfaction and time savings were improved. This study highlights the importance of employing PDSA cycles to assess and refine interventions and the usefulness of structuring the content of key components of handover notes to obtain measurable improvements.

The Perspective of Key Stakeholders on the Impact of Reaccreditation in a Large National Mental Health Institute.

BACKGROUND: Obtaining and maintaining accreditation is an important component of high-quality mental health care services. However, research is lacking, and explanations for quantitative observations surrounding the sustainability of improvements are unfounded in qualitative data. The aim of this study was to explore how accreditation, specifically that provided by Joint Commission International, affects service quality at the Institute of Mental Health in Singapore to advance our understanding of its effects and the durability of improvements. METHODS: Researchers conducted 21 qualitative semistructured interviews with key informants to understand how obtaining reaccreditation was affecting the institute. The data were analyzed thematically to produce an understanding of the various ways in which accreditation improved care quality. RESULTS: Accreditation contributed to the improvement of care via several mechanisms. Although participants universally endorsed the positive impact of accreditation on safety, it was harder to pinpoint specific outcomes that improved because of it. Accreditation, however, had unintended consequences: Unnecessary processes arising from overinterpretation of standards led to several staff behaviors that might ultimately compromise the sustainability of new processes. CONCLUSION: Although accreditation drives improvement via clear mechanisms, policy makers must be aware of unintended consequences. Organizations struggling with accreditation must clearly communicate the rationale for the implementation of new processes linked to reaccreditation. With a clear purpose, changes may be more sustainable.

Vitamin D deficiency in long-term hospitalization psychiatric wards in an equatorial nation.

INTRODUCTION: Vitamin D deficiency and insufficiency have been shown to be prevalent in several populations, including in people who have a mental illness. Deficiency has been linked to specific mental health sequelae. Furthermore, deficiency may be perpetuated by medications routinely prescribed to people with severe mental illness. Therefore, symptoms of mental illness may be exacerbated by deficient levels of vitamin D, and treatments for mental illness may exacerbate deficiency. This study sought to determine the vitamin D levels of people hospitalized for a period longer than a year in an equatorial nation, Singapore. The inpatient population was then categorized according to levels to determine the need for supplementation. METHODS: Total 25-hydroxy vitamin D in serum and plasma levels were tested in 403 individuals in long-term psychiatric wards. Blood serum and plasma levels were classified into three groups. Regression models were constructed to test the associations between levels and clinical covariates. RESULTS: Forty (9.9%) people had vitamin D levels that were sufficient. A link was found between vitamin D levels and medications given for gastrointestinal illnesses (ß -2.48, p = .014, 95%CI -4.46 to-0.51) and between vitamin D levels and length of stay (ß -0.13, p = .027, 95%CI -0.24 to-0.01). No other relationships were statistically significant. DISCUSSION: Despite its geographic location and opportunities for regular outdoor activity, vitamin D deficiency, and insufficiency are prevalent among people hospitalized for long periods of time in an equatorial nation. The level of deficiency is comparable to those observed in other settings.

Psychiatric Advance Directives and their relevance to improving psychiatric care in Asian countries.

People with mental illness may be unable to provide critical input about the care they wish to receive during a psychiatric crisis because of altered mental states. It is therefore imperative that clinicians seek to understand service users' wishes for care while they are well and able to provide meaningful input into the discussion. Achieving such an end may be done by discussing and completing a psychiatric advance directive. However, very few Asian countries have legislation that supports such advance directives. The present article seeks to give physicians more information about advance psychiatric directives and the potential role they could play to improve the healthcare provided in Asia to people at risk of losing capacity due to a mental illness. The degree to which mental health legislation supports psychiatric advance directives is documented for each country of South East Asia and Eastern Asia.

Structural characterization of the α-mating factor prepro-peptide for secretion of recombinant proteins in Pichia pastoris.

The methylotrophic yeast Pichia pastoris has been used extensively for expressing recombinant proteins because it combines the ease of genetic manipulation, the ability to provide complex posttranslational modifications and the capacity for efficient protein secretion. The most successful and commonly used secretion signal leader in Pichia pastoris has been the alpha mating factor (MATα) prepro secretion signal. However, limitations exist as some proteins cannot be secreted efficiently, leading to strategies to enhance secretion efficiency by modifying the secretion signal leader. Based on a Jpred secondary structure prediction and knob-socket modeling of tertiary structure, numerous deletions and duplications of the MATα prepro leader were engineered to evaluate the correlation between predicted secondary structure and the secretion level of the reporters horseradish peroxidase (HRP) and Candida antarctica lipase B. In addition, circular dichroism analyses were completed for the wild type and several mutant pro-peptides to evaluate actual differences in secondary structure. The results lead to a new model of MATα pro-peptide signal leader, which suggests that the N and C-termini of MATα pro-peptide need to be presented in a specific orientation for proper interaction with the cellular secretion machinery and for efficient protein secretion.

Reducing transfers of psychiatric inpatients to emergency rooms of general hospitals in Singapore: a clinical practice improvement project.

OBJECTIVE: Patients admitted to a psychiatric hospital commonly suffer from comorbid medical problems which sometimes require urgent medical attention. Twenty-two percent of emergency medical transfers from the Institute of Mental Health (IMH) to the emergency rooms of general hospitals were preventable and could be managed at IMH itself. We undertook a quality improvement project to understand the reasons behind such preventable referrals and implemented changes to address this. METHODS: Using the model for improvement, we deconstructed our processes and analysed root causes for such preventable referrals. Thereafter changes were implemented with Plan-Do-Study-Act (PDSA) cycles to analyse their outcomes. RESULTS: During the 6-month study period, we achieved a 100% reduction in preventable referrals through strategies aimed at reducing pressure on our on-call physicians in the making of medical decisions, maximising usage of our medical resources, constant education and raising awareness of this issue. CONCLUSIONS: Reducing preventable transfer of inpatients from a psychiatric hospital to the emergency departments of general hospitals is a worthwhile endeavour. Such initiatives optimise use of healthcare resources, improve patient care and increase satisfaction.

The Control of Apoptosis and Drug Resistance in Ovarian Cancer Cells Which Overexpressed bcl-2 / 中国肿瘤生物治疗杂志

Objective: To investigate whether bcl-2 directly contributes to the development of drug resistance and apoptosis in o- varian cancer cell lines cells OC3. Methods: Retrovirus expression cector pLXSN-bcl-2 was constructed and was transfected to ovarian cancer cell line cells OC3 using Lipofectin,with empty vector pLXSN as a control. bcl-2 expession of transfected cells was analyzed by FACS and Western blot and Adr-induced cytotoxicity was measured by MTT assay. Apoptosis was also detected by PI DNA staining and DNA Ladder analysis.Results:pLXSN/bcl-2 transfected cells OC3/bcl-2 overexpressed bcl-2 and were resistant to Adr-induced cytotoxicity.The ability against Adr-induced apoptosis was increased. Conclusion: bcl-2 may play an important role in the resistance to Adr-inducing apoptosis, thereby increasing resistance of OC3/bcl-2 cells to chemotherapy.