Greg Fairbrother

Prevalence and Predictors of Metabolic Syndrome Among Patients Attending an Outpatient Clozapine Clinic in Australia

OBJECTIVE This study aimed to determine the prevalence and predictors of metabolic syndrome in an outpatient clozapine clinic in Australia. METHODS Metabolic syndrome is a cluster of some of the most dangerous cardiovascular risk factors, and its high prevalence in people with mental illness has been demonstrated. Patients attending a clozapine clinic were screened for the following: age, gender, ethnicity, waist circumference, blood pressure, high-density lipoprotein level, low-density lipoprotein level, blood sugar levels, total cholesterol level, triglycerides level, weight, body mass index, insulin resistance level, length of time on clozapine, clozapine dose, smoking status, family history of diabetes and cardiovascular disease, and personal history of polycystic ovarian syndrome. All the variables that were found to be significantly associated with metabolic syndrome were entered into a multivariate logistic regression analysis. RESULTS Seventy-three patients were screened for metabolic syndrome using the International Diabetes Federations (2007) definition. Forty-five (61.6%) patients met the criteria for the syndrome. Increased blood sugar level, high diastolic blood pressure, older age, increased waist circumference, raised triglycerides level, and higher body mass index emerged as significant predictors of metabolic syndrome in the sample. CONCLUSIONS This study adds further support for the systematic screening for metabolic syndrome in patients receiving clozapine. The need for intervention programs which screen for and address the modifiable risk factors of metabolic syndrome is discussed.

Profiling police presentations of mental health consumers to an emergency department

Public mental health systems have been called on to better meet the needs of consumers presenting to health services with the police, yet few studies have examined police presentations among mental health consumers in large public mental health systems. This study was designed to determine the frequency profile and characteristics of consumers of mental health services brought in by police to an emergency department (ED) in Sydney, Australia. Using data from the emergency department information system and obtaining the psychiatric assessment from the medical record, we have examined trends and characteristics in mental health presentations brought in by the police to a general ED between 2003 and 2005. The sample consisted of 542 consumers with a mental health problem brought in by the police to the ED of a 350-bed community hospital. The characteristics of this group were compared with those of all mental health related ED presentations for the same period using logistic regression. Results indicated that police presentations are likely to be young males who are unemployed, have past and present alcohol and other drugs use, present after hours, and are admitted to hospital as a result of their presentation. These consumers are likely to have a presenting problem of a psychotic disorder, less likely to have a presenting problem of depression and/or anxiety, and given a triage code of three or higher. The study results highlight the importance of the availability of 24-hour access to mental health care to ensure a quick care delivery response. Police presentations to EDs with mental health issues are an indicator of significant impact on health services, especially with the current overcrowding of EDs and the associated long waiting times. Systems need to be developed that facilitate collaboration between EDs, hospital security, police services, mental health, and ambulance services.

The Blue Card: a hand-held health record card for mental health consumers with comorbid physical health risk.

Objective: We aimed to determine the effectiveness of a hand-held record (the ‘Blue Card’) for seriously mentally ill consumers by investigating effects on consumer knowledge of physical health risk factors, consumer involvement in care and communication with healthcare professionals. Method: Consumers were given and educated in the use of the Blue Card, which contained information regarding their physical health. Consumers completed a pre- and post-knowledge questionnaire and commented on the effectiveness of the Blue Card with respect to their knowledge of physical health risks. Results: Statistically significant improvements in consumer knowledge were shown at the 3-month follow-up, with high retention of the Blue Card being demonstrated. Consumers that used the card described their use of the card positively. Conclusions: The results are very encouraging. Further studies of this low-cost intervention are warranted to establish its effectiveness and utility.

Models of care choices in today’s nursing workplace: where does team nursing sit?

This paper provides an overview of the developmental history of models of care (MOC) in nursing since Florence Nightingale introduced nurse training programs in a drive to make nursing a discipline-based career option. The four principal choices of models of nursing care delivery (primary nursing, individual patient allocation, team nursing and functional nursing) are outlined and discussed, and recent MOC literature reviewed. The paper suggests that, given the ways work is being rapidly reconfigured in healthcare services and the pressures on the nursing workforce projected into the future, team nursing seems to offer the best solutions.