Introducing artificial intelligence in acute psychiatric inpatient care: qualitative study of its use to conduct nursing observations.

BACKGROUND: All patients admitted to an acute inpatient mental health unit must have nursing observations carried out at night either hourly or every 15 minutes, to ascertain that they are safe and breathing. However, while this practice ensures patient safety, it can also disturb patients' sleep, which in turn can impact negatively on their recovery. OBJECTIVE: This article describes the process of introducing artificial intelligence ('digitally assisted nursing observations') in an acute mental health inpatient ward, to enable staff to carry out the hourly and the 15 minutes observations, minimising disruption of patients' sleep while maintaining their safety. FINDINGS: The preliminary data obtained indicate that the digitally assisted nursing observations agreed with the observations without sensors when both were carried out in parallel and that over an estimated 755 patient nights, the new system has not been associated with any untoward incidents. Preliminary qualitative data suggest that the new technology improves patients' and staff's experience at night. DISCUSSION: This project suggests that the digitally assisted nursing observations could maintain patients' safety while potentially improving patients' and staff's experience in an acute psychiatric ward. The limitations of this study, namely, its narrative character and the fact that patients were not randomised to the new technology, suggest taking the reported findings as qualitative and preliminary. CLINICAL IMPLICATIONS: These results suggest that the care provided at night in acute inpatient psychiatric units could be substantially improved with this technology. This warrants a more thorough and stringent evaluation.

A narrative review of the success of intramuscular gluteal injections and its impact in psychiatry.

There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding increase in the bioavailability of drugs when administered intramuscularly. This paper is a review of the variables that affect the success of intramuscular injections and the implications that these success rates have in psychiatry and general medicine. Studies have shown that the success rates of intended intramuscular injections vary between 32 and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition. These rates are found to be even lower for certain at-risk populations, such as obese patients and those on antipsychotic medications. The variables associated with an increased risk of injection failure include female sex, obesity, site of injection, and subcutaneous fat depth. New guidelines and methods are needed in order to address this challenge and ensure that patients receive optimum care. Looking forward, the best way to improve the delivery of intramuscular injections worldwide is to develop uniform algorithms or innovative medical devices to confirm or guarantee successful delivery at the bedside.

Role of clinical practice educators in an integrated community and mental health NHS foundation trust.

Clinical practice educators (CPEs) aim to provide support and education to clinical staff and students to improve their professional practice. This article examines the work of a team of six CPEs, who were employed by one large integrated mental health and community health NHS foundation trust that incorporates both mental and physical health services. It explores how the role of the CPE can have positive effects on clinical settings, and can improve the provision of evidence-based care for clinical staff and students on placement in the trust. The article provides examples of the work undertaken by the CPE team and considers the plans for its future development.

The effect of formulation excipients on the penetration and lateral diffusion of ibuprofen on and within the stratum corneum following topical application to humans.

Distribution profiles of topically applied drugs can be influenced by the presence of excipients. This study investigated the effect of common topical excipients on the simultaneous lateral diffusion and stratum corneum (SC) penetration of a model compound, ibuprofen (IBU) in humans. IBU solutions with and without propylene glycol (PG), polyethylene glycol 200 (PEG 200), and/or octisalate (OS) were dosed onto the forearm of participants. At various times, 10 "tape-strippings" were obtained with perforated concentric tapes and analyzed for IBU concentration and SC protein mass. Complimentary in vitro permeation studies assessed the effect of excipients on the percutaneous absorption of IBU across human skin. Following in vivo application, IBU displayed a greater tendency for lateral diffusion when applied with OS, whereas IBU resisted lateral diffusion when dosed with PG and PEG 200. After 24 h, 25.3 ± 8.0% and 55.5 ± 18.6% of IBU was recovered from the SC in vivo with and without excipients, respectively. There was a twofold-to threefold enhancement in IBU flux in vitro when applied with excipients. The lower IBU recovery from the SC when applied with excipients may be attributed to the permeation enhancement effects of these excipients. The ability of IBU to laterally diffuse appears to be dependent on formulation excipients.

Audit of physicians' adherence to a preprinted order set for community-acquired pneumonia.

BACKGROUND: Community-acquired pneumonia is the seventh leading cause of death in Canada. Previous studies have shown reductions in both mortality rate and length of hospital stay with the use of guideline-concordant empiric therapy and standardized preprinted orders. OBJECTIVES: The primary objective was to determine adherence to the preprinted order for community-acquired pneumonia at the University Hospital of Northern British Columbia (UHNBC). The study also had the following secondary objectives: to assess the appropriateness of prescribing of levofloxacin in relation to institutional recommendations; to determine adherence with recent guidelines from the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) for the treatment of community-acquired pneumonia; and to determine all-cause mortality, duration of IV antibiotic therapy, and length of stay for the various regimens reviewed. METHODS: A retrospective observational chart review was conducted of patients with community-acquired pneumonia who were admitted between November 2007 and February 2008. Exclusion criteria were designed to eliminate patients who did not have this condition. Descriptive statistics were used to assess adherence with the preprinted order. Secondary outcomes were analyzed with the Pearson χ(2) test, t tests, and analysis of variance. RESULTS: In total, the charts for 113 patients were reviewed, and 58 patients were included in the study. The preprinted order for community-acquired pneumonia was used for 25 (43%) of the 58 patients; however, for only 4 (7%) of these admissions were all sections of the preprinted order used correctly. No statistically significant differences in length of stay were found for any of the antibiotic combinations assessed. However, the proportion of patients treated according to the IDSA-ATS guidelines was significantly greater when the preprinted order was used (p = 0.012). In addition, use of the preprinted order encouraged assessment of the patient's pneumococcal vaccination status (9 [25%] of 25 patients versus 3 [9%] of 33 patients) and utilization of the pneumonia severity index (13 [52%] of 25 patients versus 0 [0%] of 33 patients). CONCLUSION: The preprinted order for community-acquired pneumonia at UHNBC was not being utilized to its fullest. However, when it was used, it increased guideline-concordant empiric therapy and encouraged assessment of patients' pneumococcal vaccination status and pneumonia severity index.