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Clinical audit methodology was used to compare the treatment of alcohol misusers at risk of Wernicke's encephalopathy in an acute medical setting, and to assess the impact of providing information about best practice to prescribing doctors. All patients prescribed thiamine during an admission to an acute hospital trust over a 6-month period were identified, and data about their treatment episode were collected retrospectively. Hospital pharmacists then provided all prescribers with a flowchart summarising current prescribing guidelines, and prescribing patterns were re-audited 6 months later.
Over two audit periods, half of the patients prescribed thiamine whose case notes we examined had symptoms suggestive of Wernicke's encephalopathy, and another 30% were at high risk. Prescribing adhered to hospital guidelines only in 14% of cases, with the pharmacy-led intervention associated with a small but significant increase in the number of patients receiving adequate treatment for Wernicke's encephalopathy.
Wernicke's encephalopathy is relatively common in alcohol-dependent individuals admitted to hospital, and it is easily and cheaply managed. However, even when potential cases are identified, prescribing guidelines are followed in a minority of cases, even with prompting by a hospital pharmacist. This may be related to the limited research base concerning the optimum dosing schedule of thiamine, or fears about possible anaphylaxis when using parenteral preparations.
To determine the opinions of psychiatrists on mental illness among themselves and their colleagues a postal survey was conducted across the West Midlands.
Most psychiatrists (319/370, 86.2%) would be reluctant to disclose mental illness to colleagues or professional organisations (323/370, 87.3%). Their choices regarding disclosure and treatment would be influenced by issues of confidentiality (n=245, 66%), stigma (n=83, 22%) and career implications (n=128, 35%) rather than quality of care (n=60, 16%).
The stigma associated with mental illness remains prevalent among the psychiatric profession and may prevent those affected from seeking adequate treatment and support. Appropriate, confidential specialist psychiatric services should be provided for this vulnerable group, and for doctors as a whole, to ensure that their needs, and by extension those of their patients, are met.
To describe the experiences of psychiatric senior house officers (SHOs) of being on call. A survey of SHOs on three on-call rotas across south Birmingham was conducted to investigate their opinions about on-call work and to consider how time on call is spent.
SHOs in psychiatry gain a broad range of experience out of hours on a traditional on-call rota. On-call periods were valued as a learning experience and 63% of SHOs were confident in their decision-making while on call. However, on-call work was often viewed as isolating, and not all SHOs felt that they were working as part of a team when on call.
As changes to working patterns are introduced, for example in order to implement the European Working Time Directive, care must be taken to retain the positive aspects of current on-call systems. Such changes should be seen as an opportunity to improve working lives so that SHOs feel less isolated when providing out-of-hours cover.
A postal survey was conducted to ascertain the prevalence of bullying behaviour experienced by psychiatric trainees in the West Midlands. Questionnaires were sent to 232 junior doctors, 76% of whom responded.
In the preceding year, 47% of trainees had experienced one or more bullying behaviours. Only 46% reported that they knew whom to contact if they were bullied. Foreign doctors were significantly less likely to take action when bullied than local doctors.
Workplace bullying is commonly experienced by psychiatric trainees and other junior doctors in the National Health Service. This behaviour could have adverse effects for both the individual and the employer. To tackle this problem, awareness needs to be raised, and action is required at a number of levels.
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