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Sample records for emergency services psychiatric

  1. Psychiatric service users' experiences of emergency departments

    DEFF Research Database (Denmark)

    Carstensen, Kathrine; Lou, Stina; Jensen, Lotte Groth

    2017-01-01

    Background: There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users’ experiences regarding general EDs is limited. Aim: To identify and summarize current, qualitative evidence rega...... the discomfort. Overall, the results of this review speak in favour of integrated EDs where service users’ needs are more likely to be recognized and accommodated....

  2. Conceptions of mobile emergency service health professionals concerning psychiatric emergency

    Directory of Open Access Journals (Sweden)

    Diego Bonfada

    2012-06-01

    Full Text Available Under the Brazilian Psychiatric Reformation, assistance to psychological seizures represents a challenge for the emergency services. Therefore, the objective of this paper is the analysis of the conceptions of health professionals who work at the Mobile Emergency Service in Natal on psychiatric emergency care. This paper is, then, a qualitative study that used interviews as tools for collecting information. By using thematic analysis, the speeches were grouped into three categories: the stigma on patients and the professionals' fear of services interventions in psychiatric emergencies; having psychiatric emergencies regarded as harmful to patients and others' security; psychiatric emergencies being taken as patients' aggressiveness or severe depression. The data collected indicate that the interviewed professionals' ideas are supported by elements associated with the ideology that insanity implies social segregation and dangerousness. Thus, the survey prompted reflection on relevant issues to the process of psychiatric reformation implementation.

  3. Who's boarding in the psychiatric emergency service?

    Science.gov (United States)

    Simpson, Scott A; Joesch, Jutta M; West, Imara I; Pasic, Jagoda

    2014-09-01

    When a psychiatric patient in the emergency department requires inpatient admission, but no bed is available, they may become a "boarder." The psychiatric emergency service (PES) has been suggested as one means to reduce psychiatric boarding, but the frequency and characteristics of adult PES boarders have not been described. We electronically extracted electronic medical records for adult patients presenting to the PES in an urban county safety-net hospital over 12 months. Correlative analyses included Student's t-tests and multivariate regression. 521 of 5363 patient encounters (9.7%) resulted in boarding. Compared to non-boarding encounters, boarding patient encounters were associated with diagnoses of a primary psychotic, anxiety, or personality disorder, or a bipolar manic/mixed episode. Boarders were also more likely to be referred by family, friends or providers than self-referred; arrive in restraints; experience restraint/seclusion in the PES; or be referred for involuntary hospitalization. Boarders were more likely to present to the PES on the weekend. Substance use was common, but only tobacco use was more likely associated with boarding status in multivariate analysis. Boarding is common in the PES, and boarders have substantial psychiatric morbidity requiring treatment during extended PES stays. We question the appropriateness of PES boarding for seriously ill psychiatric patients.

  4. Triage in psychiatric emergency services in Copenhagen

    DEFF Research Database (Denmark)

    Sæbye, Ditte; Høegh, Erica Bernt; Knop, Joachim

    2017-01-01

    Inspired by the Australasian triage system, a regional psychiatric triage system was introduced in the psychiatric emergency units (PEUs) in Copenhagen in 2011. Our aim of the study is to determine the characteristics of the patient according to the defined triage criteria and check...

  5. Psychiatric emergency services in Copenhagen 2012

    DEFF Research Database (Denmark)

    Moltke, Katinka; Høegh, Erica B; Sæbye, Ditte

    2015-01-01

    BACKGROUND: Since the first publication of the psychiatric emergency units (PEUs) in Copenhagen 1985, outpatient facilities have undergone considerable changes. Our aim is to examine how these changes have influenced the activities in the PEUs in the same catchment area. METHODS: We conducted...... the 27-year follow-up period. In 1985, 20.7% of the visits ended up without any referrals, compared with 4.8% in 2012. The rate of acute admissions into a psychiatric ward was 60.8% in 2012 compared with 35.65% in 1985. CONCLUSION: The extension of the psychiatric outpatients' facilities since 1985 has...... reduced the number of visits in the PEUs considerably. The results have shown a change of diagnostic distribution and more severe conditions requiring acute admissions for emergency treatment. Close collaboration with the patients' families, GPs, social authorities and specialized psychiatric outpatient...

  6. Adolescents and Dual Diagnosis in a Psychiatric Emergency Service.

    Science.gov (United States)

    Matali, José Luis; Andión, Oscar; Pardo, Marta; Iniesta, Raquel; Serrano, Eduard; San, Luis

    2016-03-02

    In recent years, both the prevalence of drug use and related child and adolescent psychiatric emergencies have risen sharply. There are few studies about the impact on child and adolescent emergency services. This study has a twofold aim. The first is to describe the prevalence of substance use disorders, mental disorders and dual diagnosis (substance use problems plus mental disorder) in adolescents in psychiatric emergency service. The second is to analyze clinical and healthcare differences between patients with dual diagnosis and patients with a mental disorder without substance use disorder.We retrospectively reviewed 4012 discharge forms for emergencies treated at the psychiatric emergency department during the period 2007-2009. We obtained a sample of 1795 visits. This sample was divided into two groups: the dual diagnosis group (n = 477) and the psychiatric disorder group (n = 1318).The dual diagnosis group accounted for 26.5% of psychiatric emergencies analyzed. Compared to the psychiatric disorder group,the dual diagnosis group had significantly more conduct disorders, social problems, involuntariness in the visit, less hospital admissions and less connection with the healthcare network.Adolescents with a dual diagnosis account for a high percentage of visits at child and adolescent psychiatric emergency services. This patient group requires specialized care both at emergency services and in specific units. Accordingly, these units should play a triple role when handling dual diagnosis: detection, brief treatment and referral to a specialised unit.

  7. Police referrals at the psychiatric emergency service in Taiwan.

    Science.gov (United States)

    Wang, Jen-Pang; Wu, Chia-Yi; Chiu, Chih-Chiang; Yang, Tsu-Hui; Liu, Tzong-Hsien; Chou, Pesus

    2015-12-01

    The police are the frontline workers in crisis situations involving patients with severe mental illness and act as a primary referral source for psychiatric emergency services (PES) in the community. The aims of this study were to investigate the distribution and characteristics of police referral among psychiatric patients in Taiwan. The study cohort consisted of patients who visited the PES of Taipei City Psychiatric Center from January 2009 to December 2010. The associations between the factors of demographics, clinical characteristics, and psychiatric service utilization and police referral were evaluated. Among the 7656 psychiatric emergency visits, 3029 (39.6%) were referred by the police. These patients referred by police were more likely to be male and aged between 30 to 49 years. Clinical factors related to police referrals including a higher triage assessment level, chief problems included violence, disturbance, substance use, less anxiety, and a diagnosis of unspecified psychosis. The triage assessment level and chief problems assessed by nurses were major predictors. These patients tended to be referred from the catchment area and during the nighttime shift, were discharged during the daytime shift, and stayed longer in the PES. Disposition arrangements such as discharge against medical advice and involuntary admission were also associated with police referrals. Patients referred by the police to the PES were those with more severe psychiatric problems and illnesses assessed by psychiatric nurses and psychiatrists. They tended to have more complex service utilization at the PES. © 2015 Wiley Publishing Asia Pty Ltd.

  8. Effects of a dedicated regional psychiatric emergency service on boarding of psychiatric patients in area emergency departments.

    Science.gov (United States)

    Zeller, Scott; Calma, Nicole; Stone, Ashley

    2014-02-01

    Mental health patients boarding for long hours, even days, in United States emergency departments (EDs) awaiting transfer for psychiatric services has become a considerable and widespread problem. Past studies have shown average boarding times ranging from 6.8 hours to 34 hours. Most proposed solutions to this issue have focused solely on increasing available inpatient psychiatric hospital beds, rather than considering alternative emergency care designs that could provide prompt access to treatment and might reduce the need for many hospitalizations. One suggested option has been the "regional dedicated emergency psychiatric facility," which serves to evaluate and treat all mental health patients for a given area, and can accept direct transfers from other EDs. This study sought to assess the effects of a regional dedicated emergency psychiatric facility design known at the "Alameda Model" on boarding times and hospitalization rates for psychiatric patients in area EDs. Over a 30-day period beginning in January 2013, 5 community hospitals in Alameda County, California, tracked all ED patients on involuntary mental health holds to determine boarding time, defined as the difference between when they were deemed stable for psychiatric disposition and the time they were discharged from the ED for transfer to the regional psychiatric emergency service. Patients were also followed to determine the percentage admitted to inpatient psychiatric units after evaluation and treatment in the psychiatric emergency service. In a total sample of 144 patients, the average boarding time was approximately 1 hour and 48 minutes. Only 24.8% were admitted for inpatient psychiatric hospitalization from the psychiatric emergency service. The results of this study indicate that the Alameda Model of transferring patients from general hospital EDs to a regional psychiatric emergency service reduced the length of boarding times for patients awaiting psychiatric care by over 80% versus

  9. Who’s Boarding in the Psychiatric Emergency Service?

    Directory of Open Access Journals (Sweden)

    Scott A. Simpson

    2014-09-01

    Full Text Available Introduction: When a psychiatric patient in the emergency department requires inpatient admission, but no bed is available, they may become a “boarder.” The psychiatric emergency service (PES has been suggested as one means to reduce psychiatric boarding, but the frequency and characteristics of adult PES boarders have not been described. Methods: We electronically extracted electronic medical records for adult patients presenting to the PES in an urban county safety-net hospital over 12 months. Correlative analyses included Student’s t-tests and multivariate regression. Results: 521 of 5363 patient encounters (9.7% resulted in boarding. Compared to non-boarding encounters, boarding patient encounters were associated with diagnoses of a primary psychotic, anxiety, or personality disorder, or a bipolar manic/mixed episode. Boarders were also more likely to be referred by family, friends or providers than self-referred; arrive in restraints; experience restraint/ seclusion in the PES; or be referred for involuntary hospitalization. Boarders were more likely to present to the PES on the weekend. Substance use was common, but only tobacco use was more likely associated with boarding status in multivariate analysis. Conclusion: Boarding is common in the PES, and boarders have substantial psychiatric morbidity requiring treatment during extended PES stays. We question the appropriateness of PES boarding for seriously ill psychiatric patients. [West J Emerg Med. 2014;15(6:669-674

  10. Usage of psychiatric emergency services by asylum seekers

    DEFF Research Database (Denmark)

    Reko, Amra; Bech, Per; Wohlert, Cathrine

    2015-01-01

    predominantly male and married. The group consisted primarily (61%) of failed asylum seekers. Most patients (81%) presented with relevant mental health problems. The main reasons for presenting to the acute psychiatric emergency service were suicidal ideation and/or behaviour (60%). The most frequent diagnosis...... by asylum seekers in Denmark shows some of the acute mental health needs asylum seekers present with. The findings of high levels of suicidal ideation and possible diagnostic difficulties are discussed, as well as possible improvements of the referral and psychiatric evaluation processes....

  11. Who’s Boarding in the Psychiatric Emergency Service?

    Science.gov (United States)

    Simpson, Scott A.; Joesch, Jutta M.; West, Imara I.; Pasic, Jagoda

    2014-01-01

    Introduction When a psychiatric patient in the emergency department requires inpatient admission, but no bed is available, they may become a “boarder.” The psychiatric emergency service (PES) has been suggested as one means to reduce psychiatric boarding, but the frequency and characteristics of adult PES boarders have not been described. Methods We electronically extracted electronic medical records for adult patients presenting to the PES in an urban county safety-net hospital over 12 months. Correlative analyses included Student’s t-tests and multivariate regression. Results 521 of 5363 patient encounters (9.7%) resulted in boarding. Compared to non-boarding encounters, boarding patient encounters were associated with diagnoses of a primary psychotic, anxiety, or personality disorder, or a bipolar manic/mixed episode. Boarders were also more likely to be referred by family, friends or providers than self-referred; arrive in restraints; experience restraint/seclusion in the PES; or be referred for involuntary hospitalization. Boarders were more likely to present to the PES on the weekend. Substance use was common, but only tobacco use was more likely associated with boarding status in multivariate analysis. Conclusion Boarding is common in the PES, and boarders have substantial psychiatric morbidity requiring treatment during extended PES stays. We question the appropriateness of PES boarding for seriously ill psychiatric patients. PMID:25247041

  12. Substance Misuse in the Psychiatric Emergency Service; A Descriptive Study

    Directory of Open Access Journals (Sweden)

    Yves Chaput

    2014-01-01

    Full Text Available Substance misuse is frequently encountered in the psychiatric emergency service (PES and may take many forms, ranging from formal DSM-IV diagnoses to less obvious entities such as hazardous consumption. Detecting such patients using traditional screening instruments has proved problematic. We therefore undertook this study to more fully characterize substance misuse in the PES and to determine whether certain variables might help better screen these patients. We used a prospectively acquired database of over 18,000 visits made to four PESs during a 2-year period in the province of Quebec, Canada. One of the variables acquired was a subjective rating by the nursing staff as to whether substance misuse was a contributing factor to the visit (graded as direct, indirect, or not at all. Substance misuse accounted for 21% of all diagnoses and alcohol was the most frequent substance used. Patients were divided into those with primary (PSM, comorbid (CSM or no substance misuse (NSM. Depressive disorders were the most frequent primary diagnoses in CSM, whereas personality and substance misuse disorders were frequent secondary diagnoses in PSM. Although many variables significantly differentiated the three groups, few were sufficiently detailed to be used as potential screening tools. Those situations that did have sufficient details included those with a previous history of substance misuse, substance misuse within 48 hours of the visit, and visits graded by the nursing staff as being directly and/or indirectly related to substance misuse. Variables related to substance misuse itself were the primary predictors of PSM and, less significantly, CSM. The nursing staff rating, although promising, was obtained in less than 30% of all visits, rendering its practical use difficult to assess.

  13. Emergency presentations to an inner-city psychiatric service for children and adolescents.

    NARCIS (Netherlands)

    Dil, L.M.; Vuijk, P.J.

    2012-01-01

    Psychiatric emergency services for children and adolescents vary in process, structure and outcome. There are few systematic studies on the type and prevalence of psychiatric problems encountered, related circumstances or resulting interventions. Evidence in these areas is important in evaluation of

  14. Understanding the assistance dynamic of the psychiatric emergency service using the fourth generation assessment

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    Aline Aparecida Buriola

    2017-12-01

    Full Text Available A study to comprehend the requests, concerns, and questions of professionals about the assistance dynamic of a psychiatric emergency service. We conducted a case study, using the Fourth Generation assessment method, with 15 participants. We collected data using documental analysis, semi-structured interview and observation and, we used the constant comparative method for analysis. Therefore, two thematic axes arose: a Comprehending the assistance dynamic of the Psychiatric emergency service and, b The disarticulation of the psychosocial attention network as a barrier to satisfaction with the assistance in the psychiatric emergency. We considered that the assistance dynamic in the Psychiatric Emergency extrapolated the simple, unique character of stabilizing patients with acute mental disorders, once it directs the user’s flow to the adequate treatment in the psychosocial attention network.

  15. [Suicidal behaviour and attempted suicide occurring during assessment by the outreach psychiatric emergency service].

    Science.gov (United States)

    de Winter, R F P; de Groot, M H; van Dassen, M; Deen, M L; de Beurs, D P

    The outreach emergency psychiatric service plays an important role in recognising, arranging interventions and preventing suicide and suicidal behaviour. However, little is known about the assessments that members of the emergency team make when faced with patients showing suicidal behaviour. AIM: To describe the relationships that are revealed between patient characteristics, suicidal thoughts and attempted suicide during assessments made by the emergency psychiatric service in The Hague. METHOD: The emergency service kept a detailed record of 14,705 consultations. We compared the characteristics of patients who had suicidal thoughts with those of patients who had no such thoughts and we also compared the characteristics of patients who had attempted to commit suicide with those of patients who had not. We drew these comparisons by using logistic regression models, adjusting for clustering. RESULTS: 32.2% of the patients showed signs of suicidal behaviour and 9.2 % appeared likely to attempt suicide. Suicidal behaviour occurred most often in patients with depression. Suicidal patients were more often admitted to hospital than were non-suicidal patients and they were more likely to have been referred by a general practitioner or a general hospital. Medication was the most frequent means employed in attempts to commit suicide. CONCLUSION: In about one third of the consultations of the outreach emergency psychiatric service, the patient showed suicidal behaviour. The actions and the policy of the emergency psychiatric service with regard to suicidal behaviour were diverse and dependent on factors that could change over the course of time.

  16. Waiting room crowding and agitation in a dedicated psychiatric emergency service.

    Science.gov (United States)

    El-Mallakh, Rif S; Whiteley, Amanda; Wozniak, Tanya; Ashby, McCray; Brown, Shawn; Colbert-Trowel, Danya; Pennington, Tammy; Thompson, Michael; Tasnin, Rokeya; Terrell, Christina L

    2012-05-01

    Emergency department crowding is a growing problem that impacts patient care and safety. The effect of crowding has not been examined in emergency psychiatric services. The association between patient census and use of restraints, seclusion, and anti-agitation medications as needed was examined for 1 month. A total of 689 patients were seen in 31 days. The average hourly census was 6.8 ± 2.8 (range 0 to 18). There were 33 incidences of seclusion or restraint and an additional 15 instances of medications administered for agitation. The use of seclusion, restraint, or medication for agitation was significantly associated with census (r2 = 0.3, F = 5.47, P = .036). Crowding in emergency psychiatric waiting rooms may increase the need for seclusion, restraint, or medications for agitation.

  17. A comprehensive psychiatric service

    DEFF Research Database (Denmark)

    Wang, A G

    1984-01-01

    A comprehensive psychiatric service was established in 1969 in the Faroe Islands. This service was created as a department of a general hospital. The spheres covered by this department, operating in the midst of the community were: acute and chronic patients, a liaison-psychiatric service...

  18. Mental Disorders among Children and Adolescents Admitted to a French Psychiatric Emergency Service

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    Laurent Boyer

    2013-01-01

    Full Text Available The aim of this study was to describe the characteristics of children and adolescents admitted to the psychiatric emergency department (ED of a French public teaching hospital over a six-year study period (2001–2006. Data for all episodes of care in the psychiatric ED from January 1, 2001, to December 31, 2006, delivered to adolescents aged less than 18 years were retrospectively analyzed. During the six-year study period, 335 episodes of care in the psychiatric ED were experienced by 264 different adolescents. They accounted for 2.0% of the 16,754 care episodes of the ED; 164 patients (62.1 were female and the average age was 16.5 (SD = 1.6. The neurotic, stress-related, and somatoform disorders were the most frequent (25.4% and concerned mainly anxiety disorders (15.2%. The frequency of the absence of psychiatric diagnosis (22.7% was high. A total of 48 children and adolescents (18.2% benefited from more than one episode of care. Several factors were associated to a higher number of visits to the ED: substance use, schizophrenia, disorders of adult personality and behaviour, disorders occurring in childhood and adolescence, and dual diagnosis. In conclusion, mental health disorders in children and adolescents are a serious problem associated with several potentially modifiable factors.

  19. Psychiatric Emergency Services - Can Duty-Hour Changes Help Residents and Patients?

    Science.gov (United States)

    Brainch, Navjot; Schule, Patrick; Laurel, Faith; Bodic, Maria; Jacob, Theresa

    2018-04-14

    Limitations on resident duty hours have been widely introduced with the intention of decreasing resident fatigue and improving patient outcomes. While there is evidence of improvement in resident well-being and education following such initiatives, they have inadvertently resulted in increased number of hand-offs between clinicians leading to potential errors in patient care. Current literature emphasizes need for more specialty/setting-specific scheduling, while considering residents' opinions when implementing duty-hour reforms. There are no reports examining the impact of duty-hour changes on residents or patients in psychiatric emergency service (PES) settings. Our purpose was to assess the impact of a recent scheduling change and decrease in overall duty hours, on resident well-being and sense of burnout, while also evaluating changes to patient wait-time and length of stay (LOS) in PES. Residents completed Maslach Burnout Inventory and anonymous surveys focusing on: fatigue, sleep, life outside work for shifts - regular (8 am-8 pm) and swing shifts (12 pm-10 pm). Data from the electronic medical records were collected for 6 months pre- and post-schedule change (January 2016-February 2017), for LOS and patient wait-time. Residents' preference for shifts was split. However, 86% reported getting enough sleep during swing shifts, while 83% reported lack of sleep during regular shifts. The average patient wait-time and LOS significantly decreased from 169 to 147 and 690 to 515 min, respectively. The change to swing shifts significantly impacts LOS and patient wait-time. The short shifts demonstrated an improvement in well-being for residents, but were not the singular factor for overall resident satisfaction.

  20. Crisis Reliability Indicators Supporting Emergency Services (CRISES): A Framework for Developing Performance Measures for Behavioral Health Crisis and Psychiatric Emergency Programs.

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    Balfour, Margaret E; Tanner, Kathleen; Jurica, Paul J; Rhoads, Richard; Carson, Chris A

    2016-01-01

    Crisis and emergency psychiatric services are an integral part of the healthcare system, yet there are no standardized measures for programs providing these services. We developed the Crisis Reliability Indicators Supporting Emergency Services (CRISES) framework to create measures that inform internal performance improvement initiatives and allow comparison across programs. The framework consists of two components-the CRISES domains (timely, safe, accessible, least-restrictive, effective, consumer/family centered, and partnership) and the measures supporting each domain. The CRISES framework provides a foundation for development of standardized measures for the crisis field. This will become increasingly important as pay-for-performance initiatives expand with healthcare reform.

  1. VIDEOCARE: Decentralised psychiatric emergency care through videoconferencing

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    Trondsen Marianne V

    2012-12-01

    Full Text Available Abstract Background Today the availability of specialists is limited for psychiatric patients in rural areas, especially during psychiatric emergencies. To overcome this challenge, the University Hospital of North Norway has implemented a new decentralised on-call system in psychiatric emergencies, by which psychiatrists are accessible by videoconference 24/7. In September 2011, the new on-call system was established in clinical practice for patients and health staff at three regional psychiatric centres in Northern Norway. Although a wide variety of therapies have been successfully delivered by videoconference, there is limited research on the use of videoconferenced consultations with patients in psychiatric emergencies. The aim of this study is to explore the use of videoconference in psychiatric emergencies based on the implementation of this first Norwegian tele-psychiatric service in emergency care. Methods/design The research project is an exploratory case study of a new videoconference service in operation. By applying in-depth interviews with patients, specialists and local health-care staff, we will identify factors that facilitate and hinder use of videoconferencing in psychiatric emergencies, and explore how videoconferenced consultations matter for patients, professional practice and cooperation between levels in psychiatric care. By using an on-going project as the site of research, the case is especially well-suited for generating reliable and valid empirical data. Discussion Results from the study will be of importance for understanding of how videoconferencing may support proper treatment and high-quality health care services in rural areas for patients in psychiatric emergencies.

  2. Clinical Profile and Sex Differences in Brazilian Children and Adolescents Receiving Psychiatric Services in the Emergency Department.

    Science.gov (United States)

    Tonezer, Jordana; Muller, Thomaz; Rocha, Gibsi Possapp; Recondo, Rogéria; Nogueira, Eduardo Lopes; Spanemberg, Lucas

    2015-06-27

    We present a survey of sex differences and socio-demographic and clinical variables in children and adolescents receiving a psychiatric consultation service in an emergency department (ED). This observational, retrospective, and cross-sectional study included all records of patients (age, services in an ED in a 4-year period (January 2010 to December 2013). Two hundred fifty-nine records of children and adolescents were located. The mean age of the participants was 14.19 years, and most subjects were female (59.5%) and had private health insurance (83.7%). Most participants (87.4%) were accompanied by their parents. The main complaints were suicide attempts (21.8%) and psychomotor agitation/aggressiveness (21.8%). Unipolar depression (37.8%) and adjustment, reactive, and anxiety disorders (13.7%) were the most prevalent diagnoses. Most patients received an indication of psychiatric hospitalization (51.7%). Females had more suicide attempts than males (28.3% vs 12.4%) and less psychomotor agitation/aggressiveness than males (15.5% vs 31.4%). Females also exhibited more unipolar depression (47.6% vs 23.5%), fewer psychotic disorders (4.2% vs 16.3%), and substance use/misuse (1.4% vs 13.3%) than males. Males needed more psychiatric medication during evaluation (37.9% vs 19.2%). This survey of the profile of pediatric patients evaluated by a psychiatric service in an ED in Brazil was the first of its kind. The large percentage of patients referred for hospitalization highlights the importance of specialized psychiatry care for this age group in this facility, which is a common entry point for mental health care.

  3. Psychiatric Services • In Matabeleland

    African Journals Online (AJOL)

    1974-05-04

    May 4, 1974 ... To provide some basis for planning psychiatric services in Matabeleland, a ... medicine. and at the same time up-grade mental health services.' Tn the .... We present a survey of some of the changes in a population of African ...

  4. 42 CFR 415.184 - Psychiatric services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Psychiatric services. 415.184 Section 415.184 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Psychiatric services. To qualify for physician fee schedule payment for psychiatric services furnished under...

  5. Managing psychiatric emergencies in persons with mental health ...

    African Journals Online (AJOL)

    Background: Psychiatric emergencies are commonly encountered by the emergency room team where non-mental health specialists are often the first care providers. Materials and Methods: The study took place at the University of Ibadan Health Service, it was a descriptive cross-sectional study and participants were ...

  6. Psychiatric emergencies (part II): psychiatric disorders coexisting with organic diseases.

    Science.gov (United States)

    Testa, A; Giannuzzi, R; Sollazzo, F; Petrongolo, L; Bernardini, L; Dain, S

    2013-02-01

    In this Part II psychiatric disorders coexisting with organic diseases are discussed. "Comorbidity phenomenon" defines the not univocal interrelation between medical illnesses and psychiatric disorders, each other negatively influencing morbidity and mortality. Most severe psychiatric disorders, such as schizophrenia, bipolar disorder and depression, show increased prevalence of cardiovascular disease, related to poverty, use of psychotropic medication, and higher rate of preventable risk factors such as smoking, addiction, poor diet and lack of exercise. Moreover, psychiatric and organic disorders can develop together in different conditions of toxic substance and prescription drug use or abuse, especially in the emergency setting population. Different combinations with mutual interaction of psychiatric disorders and substance use disorders are defined by the so called "dual diagnosis". The hypotheses that attempt to explain the psychiatric disorders and substance abuse relationship are examined: (1) common risk factors; (2) psychiatric disorders precipitated by substance use; (3) psychiatric disorders precipitating substance use (self-medication hypothesis); and (4) synergistic interaction. Diagnostic and therapeutic difficulty concerning the problem of dual diagnosis, and legal implications, are also discussed. Substance induced psychiatric and organic symptoms can occur both in the intoxication and withdrawal state. Since ancient history, humans selected indigene psychotropic plants for recreational, medicinal, doping or spiritual purpose. After the isolation of active principles or their chemical synthesis, higher blood concentrations reached predispose to substance use, abuse and dependence. Abuse substances have specific molecular targets and very different acute mechanisms of action, mainly involving dopaminergic and serotoninergic systems, but finally converging on the brain's reward pathways, increasing dopamine in nucleus accumbens. The most common

  7. Changes in monthly unemployment rates may predict changes in the number of psychiatric presentations to emergency services in South Australia.

    Science.gov (United States)

    Bidargaddi, Niranjan; Bastiampillai, Tarun; Schrader, Geoffrey; Adams, Robert; Piantadosi, Cynthia; Strobel, Jörg; Tucker, Graeme; Allison, Stephen

    2015-07-24

    To determine the extent to which variations in monthly Mental Health Emergency Department (MHED) presentations in South Australian Public Hospitals are associated with the Australian Bureau of Statistics (ABS) monthly unemployment rates. Times series modelling of relationships between monthly MHED presentations to South Australian Public Hospitals derived from the Integrated South Australian Activity Collection (ISAAC) data base and the ABS monthly unemployment rates in South Australia between January 2004-June 2011. Time series modelling using monthly unemployment rates from ABS as a predictor variable explains 69% of the variation in monthly MHED presentations across public hospitals in South Australia. Thirty-two percent of the variation in current month's male MHED presentations can be predicted by using the 2 months' prior male unemployment rate. Over 63% of the variation in monthly female MHED presentations can be predicted by either male or female prior monthly unemployment rates. The findings of this study highlight that even with the relatively favourable economic conditions, small shifts in monthly unemployment rates can predict variations in monthly MHED presentations, particularly for women. Monthly ABS unemployment rates may be a useful metric for predicting demand for emergency mental health services.

  8. Refugee children have fewer contacts to psychiatric healthcare services

    DEFF Research Database (Denmark)

    Barghadouch, Amina; Kristiansen, Maria; Jervelund, Signe Smith

    2016-01-01

    and psychiatrists in private practice. Results: Between 1 January 1996 and 30 June 2012, 3.5 % of the refugee children accessed psychiatric healthcare services compared to 7.7 % of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95 % CI 0.40–0.45) among refugee boys...... and 0.35 (95 % CI 0.33–0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services. Conclusions: Refugee children used fewer psychiatric healthcare services than Danish...

  9. Emergency psychiatric care for children and adolescents: a literature review.

    Science.gov (United States)

    Janssens, Astrid; Hayen, Sarah; Walraven, Vera; Leys, Mark; Deboutte, Dirk

    2013-09-01

    Over the years, increasing numbers of children and adolescents have sought help for acute psychiatric problems. The responses to this treatment-seeking behavior are heterogeneous in different settings and nations. This review aimed to provide an answer to the questions "which care should be offered to children and adolescents presenting with a psychiatric emergency or crisis and how should it be organized." We committed a literature review to find out if any recommendations can be made regarding the organization of emergency care for children and adolescents with acute mental health problems. The lack of a clear definition of emergencies or urgencies hampered this review; we note the differences between adult and child or adolescent psychiatry. The theoretical models of care found in the literature are built up from several process and structural components, which we describe in greater detail. Furthermore, we review the main service delivery models that exist for children and adolescents. Currently, emergency psychiatric care for children and adolescents is practiced within a wide range of care models. There is no consensus on recommended care or recommended setting for this population. More research is needed to make exact recommendations on the standardization of psychiatric care for young people in emergency settings.

  10. Psychosocial stressors contributing to emergency psychiatric service utilization in a sample of ethno-culturally diverse clients with psychosis in Toronto.

    Science.gov (United States)

    Rotenberg, Martin; Tuck, Andrew; McKenzie, Kwame

    2017-09-02

    Understanding the psychosocial stressors of people with psychoses from minority ethnic groups may help in the development of culturally appropriate services. This study aimed to compare psychosocial factors associated with attendance at an emergency department (ED) for six ethnic groups. Preventing crises or supporting people better in the community may decrease hospitalization and improve outcomes. A cohort was created by retrospective case note analysis of people of East-Asian, South-Asian, Black-African, Black-Caribbean, White-North American and White-European origin groups attending a specialized psychiatric ED in Toronto with a diagnosis of psychosis between 2009 and 2011. The psychological or social stressors which were linked to the presentation at the ED that were documented by the attending physicians were collected for this study. Logistic regression models were constructed to analyze the odds of presenting with specific stressors. Seven hundred sixty-five clients were included in this study. Forty-four percent of the sample did not have a psychiatrist, and 53% did not have a primary care provider. Social environmental stressors were the most frequent psychosocial stressor across all six groups, followed by issues in the primary support group, occupational and housing stressors. When compared to White-North American clients, East-Asian and White-European origin clients were less likely to present with a housing stressor, while Black-African clients had decreased odds of presenting with primary support group stressor. Having a primary care provider or psychiatrist were predominantly protective factors. In Toronto, moving people with chronic mental health conditions out of poverty, increasing the social safety net and improving access to primary care and community based mental health services may decrease many of the stressors which contribute to ED attendance.

  11. Psychiatric Evaluation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychiatric Evaluation Workgroup

    Directory of Open Access Journals (Sweden)

    Keith R. Stowell

    2012-04-01

    Full Text Available It is difficult to fully assess an agitated patient, and the complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. Nonetheless, emergency clinicians must perform an initial mental status screening to begin this process as soon as the agitated patient presents to an emergency service. For this reason, the psychiatric evaluation of the agitated patient can be thought of as a two-step process. First a brief evaluation must be aimed at determining the most likely cause of agitation, so as to guide preliminary interventions to calm the patient. Once the patient is calmed, more extensive psychiatric assessment can be completed. The goal of the emergency assessment of the psychiatric patient is not necessarily to obtain a definitive diagnosis. Rather, ascertaining a differential diagnosis, determining safety, and developing an appropriate treatment and disposition plan are the goals of the assessment. This article will summarize what components of the psychiatric assessment can and should be done at the time the agitated patient presents. The complete psychiatric evaluation of the patient whose agitation has been treated successfully is beyond the scope of this paper and Project BETA, but will be outlined briefly to give the reader an understanding of what a full psychiatric assessment would entail. Other issues related to the assessment of the agitated patient in the emergency setting will also be discussed. [West J Emerg Med. 2012;13(1:11–16.

  12. Emergency Medical Services

    Science.gov (United States)

    ... need help right away, you should use emergency medical services. These services use specially trained people and ... emergencies, you need help where you are. Emergency medical technicians, or EMTs, do specific rescue jobs. They ...

  13. Establishment of a local psychiatric service

    DEFF Research Database (Denmark)

    Wang, A G

    1981-01-01

    of senile psychoses. The total increase amounts to 2.4 times the admission rates of psychiatric cases to the General Hospital and 4.4 times the admission rates to the Psychiatric Hospital in Nykøbing in the last years prior to the start of the local service. The outpatient department has grown steadily...... patients were referred to the local General Hospital and about half of the patients in each diagnostic group were sent on the Psychiatric Hospital in Nykøbing on Zealand, Denmark. Since the establishment of the department, admissions have increased in all diagnostic groups, especially in the group...

  14. Establishment of a local psychiatric service

    DEFF Research Database (Denmark)

    Wang, A G

    1981-01-01

    patients were referred to the local General Hospital and about half of the patients in each diagnostic group were sent on the Psychiatric Hospital in Nykøbing on Zealand, Denmark. Since the establishment of the department, admissions have increased in all diagnostic groups, especially in the group...... of senile psychoses. The total increase amounts to 2.4 times the admission rates of psychiatric cases to the General Hospital and 4.4 times the admission rates to the Psychiatric Hospital in Nykøbing in the last years prior to the start of the local service. The outpatient department has grown steadily...

  15. PREVALENCE OF ALCOHOLISM IN HOSPITALIZATIONS OF PSYCHIATRIC EMERGENCY

    Directory of Open Access Journals (Sweden)

    Robsmeire Calvo Melo Zurita

    2013-03-01

    Full Text Available The psychiatric emergency is used to treat people with mental disordersworking 24 hours followed the new model of mental health care recommended by theMinistry of Health, creating care options, with a focus centered on reintegration of the patientto their social and family. The study aimed to characterize the hospitalizations of patients inthe Psychiatric Emergency Municipal Hospital of Maringa in the period January 2009 to June2010. Were selected and included a total of 1548 hospitalizations, behavioral disorder due toalcohol use. Predominance in male admissions with 88.6%, the predominant age group inboth sexes was 41-51 years with 59.75%, with the majority of hospitalizations of patientsliving in Maringá. Referred to the Psychiatric Hospital were46.18% of hospitalizations,diagnosed mostly in mental and behavioral disorders due to alcohol use,CID-10 F10, with720 (46.51% of admissions. The legal framework of the Psychiatric Reform, ratified,guaranteeing the universal right to access and assistance as well as to its completeness;decentralization of the service model, configuring networks care more attentive toinequalities, setting fair and democratic way of their actions to needs of the population

  16. Possibilities and limits of multiprofessional attention in the care of psychiatric emergencies: analytical study

    Directory of Open Access Journals (Sweden)

    Fernanda Lima de Paula

    2017-05-01

    Full Text Available Goal: to analyze the possibilities and limits of multiprofessional care in the attention to psychiatric emergencies. Method: it is an analytical study of the type integrative review of the comprehensive literature. Searches were conducted in the Latin American and Caribbean Literature (LILACS and Nursing Database (BDENF databases and in the ScieLo Virtual Library, with the use of Descriptors in Health Sciences (DECs: “Emergency Services, Psychiatric”, “Forensic Psychiatry”, “Psychiatric Rehabilitation”, in the period from 2007 to 2017. Results: after data analysis, two thematic categories emerged: “Possibilities and limits in multiprofessional care for patients in crisis” and “The continuity of care to the patient in crisis by the multiprofessional team”. The studies point out fragility in the management of the multiprofessional team of care to the patients in psychiatric crisis. Therefore, in the substitutive services to the psychiatric hospital, it is necessary to strengthen the care and bonding tools for continuity of treatment after the cases of psychiatric emergency of these patients. Conclusion: this research provided a deepening of the knowledge regarding the challenges of the multiprofessional team in the care of analytical psychiatric emergencies and in relation to the patient in crisis, considering the main multiprofessional actions, understanding how this approach is done and patient follow-up. Descriptors: Emergency Services, Psychiatric. Forensic Psychiatry. Psychiatric Rehabilitation.

  17. Web of Objects Based Ambient Assisted Living Framework for Emergency Psychiatric State Prediction

    Science.gov (United States)

    Alam, Md Golam Rabiul; Abedin, Sarder Fakhrul; Al Ameen, Moshaddique; Hong, Choong Seon

    2016-01-01

    Ambient assisted living can facilitate optimum health and wellness by aiding physical, mental and social well-being. In this paper, patients’ psychiatric symptoms are collected through lightweight biosensors and web-based psychiatric screening scales in a smart home environment and then analyzed through machine learning algorithms to provide ambient intelligence in a psychiatric emergency. The psychiatric states are modeled through a Hidden Markov Model (HMM), and the model parameters are estimated using a Viterbi path counting and scalable Stochastic Variational Inference (SVI)-based training algorithm. The most likely psychiatric state sequence of the corresponding observation sequence is determined, and an emergency psychiatric state is predicted through the proposed algorithm. Moreover, to enable personalized psychiatric emergency care, a service a web of objects-based framework is proposed for a smart-home environment. In this framework, the biosensor observations and the psychiatric rating scales are objectified and virtualized in the web space. Then, the web of objects of sensor observations and psychiatric rating scores are used to assess the dweller’s mental health status and to predict an emergency psychiatric state. The proposed psychiatric state prediction algorithm reported 83.03 percent prediction accuracy in an empirical performance study. PMID:27608023

  18. College Student Utilization of a Comprehensive Psychiatric Emergency Program

    Science.gov (United States)

    Mitchell, Sharon L.; Kader, Mahrin; Haggerty, Melinda Z.; Bakhai, Yogesh D.; Warren, Calvert G.

    2013-01-01

    The authors sought to identify college students at risk for experiencing a mental health crisis that warranted a psychiatric evaluation at a hospital and/or a psychiatric hospitalization. A retrospective chart review of college students evaluated at a comprehensive psychiatric emergency program during a 1-year period was conducted. Demographic…

  19. Suicide with psychiatric diagnosis and without utilization of psychiatric service

    Directory of Open Access Journals (Sweden)

    Wong Paul WC

    2010-07-01

    Full Text Available Abstract Background Considerable attention has been focused on the study of suicides among those who have received help from healthcare providers. However, little is known about the profiles of suicide deceased who had psychiatric illnesses but made no contact with psychiatric services prior to their death. Behavioural model of health service use is applied to identify factors associated with the utilization of psychiatric service among the suicide deceased. Methods With respect to completed suicide cases, who were diagnosed with a mental disorder, a comparison study was made between those who had (contact group; n = 52; 43.7% and those who had not made any contact (non-contact group; n = 67; 56.3% with a psychiatrist during the final six months prior to death. A sample of 119 deceased cases aged between 15 and 59 with at least one psychiatric diagnosis assessed by the Structured Clinical Interview for DSM-IV-TR (SCID I were selected from a psychological autopsy study in Hong Kong. Results The contact and non-contact group could be well distinguished from each other by "predisposing" variables: age group & gender, and most of the "enabling", and "need" variables tested in this study. Multiple logistic regression analysis has found four factors are statistically significantly associated with non-contact suicide deceased: (i having non-psychotic disorders (OR = 13.5, 95% CI:2.9-62.9, (ii unmanageable debts (OR = 10.5, CI:2.4-45.3, (iii being full/partially/self employed at the time of death (OR = 10.0, CI:1.6-64.1 and (iv having higher levels of social problem-solving ability (SPSI (OR = 2.0, CI:1.1-3.6. Conclusion The non-contact group was clearly different from the contact group and actually comprised a larger proportion of the suicide population that they could hardly be reached by usual individual-based suicide prevention efforts. For this reason, both universal and strategic suicide prevention measures need to be developed specifically in non

  20. The Impact of Psychiatric Patient Boarding in Emergency Departments

    Directory of Open Access Journals (Sweden)

    B. A. Nicks

    2012-01-01

    Full Text Available Objectives. Studies have demonstrated the adverse effects of emergency department (ED boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits from January 2007-2008. The main outcomes were ED length of stay (LOS and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1% requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years, with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039–1140 versus 340 min, CI (304–375; <0.001 when compared to non-psychiatric admissions. The financial impact of psychiatric boarding accounted for a direct loss of ($1,198 compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients per psychiatric patient, and decreasing financial revenue.

  1. Predictors of psychiatric boarding in the pediatric emergency department: implications for emergency care.

    Science.gov (United States)

    Wharff, Elizabeth A; Ginnis, Katherine B; Ross, Abigail M; Blood, Emily A

    2011-06-01

    Patients who present to the emergency department (ED) and require psychiatric hospitalization may wait in the ED or be admitted to a medical service because there are no available inpatient psychiatric beds. These patients are psychiatric "boarders." This study describes the extent of the boarder problem in a large, urban pediatric ED, compares characteristics of psychiatrically hospitalized patients with boarders, and compares predictors of boarding in 2 ED patient cohorts. A retrospective cohort study was conducted in 2007-2008. The main outcome measure was placement into a psychiatric facility or boarding. Predictors of boarding in the present analysis were compared with predictors from a similar study conducted in the same ED in 1999-2000. Of 461 ED patient encounters requiring psychiatric admission, 157 (34.1%) boarded. Mean and median boarding duration for the sample were 22.7(SD, 8.08) and 21.18 hours, respectively. Univariate generalized estimating equations demonstrated increased boarding odds for patients carrying Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnoses of autism, mental retardation, and/or developmental delay (P = 0.01), presenting during the weekend (P = 0.03) or presenting during months without school vacation (P = 0.02). Suicidal ideation (SI) significantly predicted boarding status, with increased likelihood of boarding for severe SI (P = 0.02). Age, race, insurance status, and homicidal ideation did not significantly predict boarding in the 2007-2008 patient cohort, although they did in the earlier study. Systemic factors and SI predicted boarding status in both cohorts. Suicidal patients continue to board. Limits within the system, including timing of ED presentation and a dearth of specialized services, still exist, elevating the risk of boarding for some populations. Implications for pediatric ED psychiatric care delivery are discussed.

  2. Serviço de Emergência Psiquiátrica em hospital geral: estudo retrospectivo Servicio de emergencia psiquiátrica en hospital general: estudio retrospectivo Emergency psychiatric service in general hospitals: a retrospective study

    Directory of Open Access Journals (Sweden)

    Fernando Sérgio Pereira de Sousa

    2010-09-01

    SEPHG, 43,45% de tales pacientes fueron derivados al CAPS-ad. Se desprende de los resultados cuán imprescindibles son los servicios de salud mental.The Emergency Psychiatric Service in General Hospitals (SEPHG, acronym in Portuguese is a service included in the psychiatric reform movement. The purpose of the present study was to characterize patients with psychological distress treated at the Dr. Estevam SEPHG, located in Sobral, Ceará state. This exploratory study was performed using documental analyses with a quantitative approach, and involved 191 clients treated at the referred SEPHG from January to December 2007. Data collection was performed using a client register book, which contained information obtained from the patients' medical record. There was a predominance of male patients (70.15%, aged 30-49 years (48.71% and single (74.86%. Most patients were from the city of Sobral (69.64%. In 42.40% of cases, the diagnosis was of alcohol use/abuse. Most clients (66.50% sought the service voluntarily. After being evaluated at the SEPHG, 43.45% of patients were referred to the local Center for Psychosocial Care -Alcohol and other Drugs. The results emphasize the importance of mental health.

  3. The impact of psychiatric patient boarding in emergency departments.

    Science.gov (United States)

    Nicks, B A; Manthey, D M

    2012-01-01

    Objectives. Studies have demonstrated the adverse effects of emergency department (ED) boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits) from January 2007-2008. The main outcomes were ED length of stay (LOS) and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1%) requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years), with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039-1140) versus 340 min, CI (304-375); P boarding accounted for a direct loss of ($1,198) compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients) per psychiatric patient, and decreasing financial revenue.

  4. Psychiatric boarding incidence, duration, and associated factors in United States emergency departments.

    Science.gov (United States)

    Nolan, Jason M; Fee, Christopher; Cooper, Bruce A; Rankin, Sally H; Blegen, Mary A

    2015-01-01

    Boarding, especially among psychiatric patients, has been characterized as a significant cause of ED crowding, but no quantitative analysis has described boarding nationally. This study determines the incidence, duration, and factors associated with ED boarding in the United States. 2008 National Hospital Ambulatory Medical Care Survey ED data were stratified by visit type (psychiatric vs. non-psychiatric), boarding status, and patient and hospital characteristics. Boarding was defined as a visit with an ED length of stay >6 hours, and boarding time as ED length of stay minus 6 hours. Pearson's chi-square tests describe hospital and patient characteristics stratified by boarding status. Multilevel multivariable logistic and linear regressions determine associations with boarding and boarding time. While 11% of all ED patients boarded, 21.5% of all psychiatric ED patients boarded. Boarding was also more prolonged for psychiatric ED patients. Controlling for confounders, odds of boarding for psychiatric patients were 4.78 (2.63-8.66) times higher than non-psychiatric, and psychiatric patients boarded 2.78 (1.91-3.64) hours longer than non-psychiatric. US EDs experienced high proportions and durations of boarding with psychiatric patients disproportionately affected. Additional research concerning mental health care services and legislation may be required to address ED psychiatric patient boarding. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  5. Clinically useful predictors for premature mortality among psychiatric patients visiting a psychiatric emergency room

    DEFF Research Database (Denmark)

    Aagaard, Jørgen; Buus, Niels; Wernlund, Andreas Glahn

    2016-01-01

    OBJECTIVE: The aim of this study was to examine changes in the distribution of causes of death and mortality rates among psychiatric patients visiting a psychiatric emergency room (PER), to determine clinically useful predictors for avoiding premature mortality among these patients and to discuss...... linked to the Cause of Death Register and the Central Psychiatric Research Register, and logistic predictor analyses for premature death were performed. RESULTS: The standardised mortality ratio (SMR) of all visitors compared to the general Danish population was approximately 5. Overall, patients...

  6. "Boarding" Psychiatric Patients in Emergency Rooms: One Court Says "No More".

    Science.gov (United States)

    Appelbaum, Paul S

    2015-07-01

    "Boarding" involuntary psychiatric patients in medical emergency rooms is common in many parts of the United States. The practice, driven by a shortage of alternative resources, including limited inpatient capacity, can result in patients' being held for days without treatment or a hospital room, often in busy corridors or treatment rooms. A recent challenge to this practice led the Washington Supreme Court to declare it illegal and resulted in the appropriation of substantial funding to create new psychiatric beds. Centralized psychiatric crisis services, with appropriate payment models, may offer another approach to reducing the need for holding patients awaiting inpatient admission.

  7. Epigenetics: An Emerging Framework for Advanced Practice Psychiatric Nursing.

    Science.gov (United States)

    DeSocio, Janiece E

    2016-07-01

    The aims of this paper are to synthesize and report research findings from neuroscience and epigenetics that contribute to an emerging explanatory framework for advanced practice psychiatric nursing. Discoveries in neuroscience and epigenetics reveal synergistic mechanisms that support the integration of psychotherapy, psychopharmacology, and psychoeducation in practice. Advanced practice psychiatric nurses will benefit from an expanded knowledge base in neuroscience and epigenetics that informs and explains the scientific rationale for our integrated practice. © 2015 Wiley Periodicals, Inc.

  8. Behavioral Emergencies: Special Considerations in the Geriatric Psychiatric Patient.

    Science.gov (United States)

    Aftab, Awais; Shah, Asim A

    2017-09-01

    This article reviews psychiatric considerations and common psychiatric emergencies in the elderly. The elderly are vulnerable to medication side-effects because of pharmacokinetic changes from aging, and require lower doses and slower titration. They are a high-risk group for suicide, with more serious intent, fewer warning signs, and more lethality. Prompt diagnosis and treatment of delirium in emergency settings is essential, given association with worse outcomes when undiagnosed. Pharmacologic options with demonstrable efficacy for agitation in dementia are limited to antipsychotics, which are, however, associated with an increased risk of mortality; behavioral interventions are universally recommended as first-line measures. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. [A naturalistic study: 100 consecutive episodes of acute agitation in a psychiatric emergency department].

    Science.gov (United States)

    Pascual, J C; Madre, M; Puigdemont, D; Oller, S; Corripio, I; Díaz, A; Faus, G; Perez, V; Alvarez, E

    2006-01-01

    Psychomotor agitation is a common event in psychiatric emergency services (PES) with a prevalence of approximately 10 %. There is no general consensus on to how to manage psychomotor agitation; benzodiazepines, typical antipsychotics and now atypical antipsychotics have demonstrated similar efficacy. The aim of our study was to describe the epidemiology and clinical management of agitation in "real-life" in a psychiatric emergency service. A naturalistic study was performed in acutely agitated patients recruited consecutively in a psychiatric emergency service. Demographics, clinical and therapeutic characteristics were analyzed. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Pragmatic variables such as the need for second pharmacological intervention and the need for physical restraints were assessed. The study included 100 patients with psychomotor agitation. Mean age was 36.2 % and 54% were women. The most prevalent diagnoses were psychotic disorder (48 %) and personality disorder (24 %). Physical restraint was required in 39 % of patients and 52 % accepted oral treatment. Haloperidol was the most frequent oral treatment and olanzapine was the most frequent intramuscular treatment. A naturalistic approach provides data based on clinical reality in psychiatric emergency services. Strict research designs of clinical trials of efficacy imply sample selection biases and are generally distanced from the clinical reality. Atypical antipsychotics have become the first-line treatment in acute agitation

  10. Suicide Mortality of Suicide Attempt Patients Discharged from Emergency Room, Nonsuicidal Psychiatric Patients Discharged from Emergency Room, Admitted Suicide Attempt Patients, and Admitted Nonsuicidal Psychiatric Patients

    Science.gov (United States)

    Choi, Jae W.; Park, Subin; Yi, Ki K.; Hong, Jin P.

    2012-01-01

    The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients…

  11. Predictors of psychiatric boarding in the emergency department.

    Science.gov (United States)

    Misek, Ryan K; DeBarba, Ashley E; Brill, April

    2015-01-01

    The emergency psychiatric care is system is overburdened in the United States. Patients experiencing psychiatric emergencies often require resources not available at the initial treating facility and frequently require transfer to an appropriate psychiatric facility. Boarding of psychiatric patients, defined as a length of stay greater than four hours after medical clearance, is ubiquitous throughout emergency departments (EDs) nationwide. Boarding is recognized as a major cause of ambulance diversions and ED crowding and has a significant adverse impact on healthcare providers, patient satisfaction, and hospital costs. We sought to identify differences between patients who boarded versus patients who did not board, to identify factors amenable to change and identify interventions that could lead to a decrease in overall psychiatric patient length of stay and improve patient care. This study is a retrospective multicenter cohort study of all patients assessed to require inpatient psychiatric hospitalization at two community EDs in Illinois from July 1, 2010 through June 30, 2012. We identified 671 patients and collected insurance status, sex, age, time of arrival, time of disposition and time of transfer. There was a statistically significant difference in the insurance status between the cohort of patients boarding in the ED compared to non-boarders prior to inpatient psychiatric admission. Our study identified 95.4% of uninsured patients who were boarded in the ED, compared to 71.8% of Medicare/Medicaid patients and 78.3% of patients with private insurance (χ(2)=50.6, df=2, pboarded significantly longer than Medicare/Medicaid and privately insured patients. Patients with private insurance boarded longer than those with Medicare/Medicaid. Patients transferred to publicly funded facilities had significantly longer ED length of stay than patients transferred to private facilities.

  12. Postpartum psychiatric emergency visits: a nested case-control study.

    Science.gov (United States)

    Barker, Lucy Church; Kurdyak, Paul; Fung, Kinwah; Matheson, Flora I; Vigod, Simone

    2016-12-01

    Mental health conditions are one of the most common reasons for postpartum emergency department (ED) visits. Characteristics of women using the ED and their mental health service use before presentation are unknown. We characterized all women in Ontario, Canada (2006-2012), who delivered a live born infant and had a psychiatric ED visit within 1 year postpartum (n = 8728). We compared those whose ED visit was the first physician mental health contact since delivery to those who had accessed mental health services on specific indicators of marginalization hypothesized to be associated with lower likelihood of mental health contact prior to the ED visit. For 60.4 % of women, this was the first physician mental health contact since delivery. The majority were presenting with a mood or anxiety disorder, and only 13.6 % required hospital admission. These women were more likely to have material deprivation and residential instability than women with contact (Q5 vs. Q1 aORs 1.30, 95 % CI 1.12-1.50; 1.17, 95 % CI 1.01-1.36), to live in rural vs. urban areas (aOR 1.58, 95 % CI 1.38-1.80), and to be low vs. high income quintile (aOR 1.18, 95 % CI 1.01-1.38). The frequent use of ED services as the first point of contact for mental health concerns suggests that interventions to improve timely and equitable access to effective outpatient postpartum mental health care are needed. Marginalized women are at particularly high risk of not having accessed outpatient services prior to an ED visit, and therefore, future research and interventions will specifically need to consider the needs of this group.

  13. Substance misuse in youth admitted to a psychiatric emergency unit ...

    African Journals Online (AJOL)

    , A J Flisher, R Allin, J A Laubscher. Abstract. Objectives. To investigate the pattern of substance misuse in youth admitted to a psychiatric emergency unit of a 'major hospital, and to compare regular users of cannabis,methaqualone and ...

  14. Weather conditions influence the number of psychiatric emergency room patients

    Science.gov (United States)

    Brandl, Eva Janina; Lett, Tristram A.; Bakanidze, George; Heinz, Andreas; Bermpohl, Felix; Schouler-Ocak, Meryam

    2017-12-01

    The specific impact of weather factors on psychiatric disorders has been investigated only in few studies with inconsistent results. We hypothesized that meteorological conditions influence the number of cases presenting in a psychiatric emergency room as a measure of mental health conditions. We analyzed the number of patients consulting the emergency room (ER) of a psychiatric hospital in Berlin, Germany, between January 1, 2008, and December 31, 2014. A total of N = 22,672 cases were treated in the ER over the study period. Meteorological data were obtained from a publicly available data base. Due to collinearity among the meteorological variables, we performed a principal component (PC) analysis. Association of PCs with the daily number of patients was analyzed with autoregressive integrated moving average model. Delayed effects were investigated using Granger causal modeling. Daily number of patients in the ER was significantly higher in spring and summer compared to fall and winter (p psychiatric patients consulting the emergency room. In particular, our data indicate lower patient numbers during very cold temperatures.

  15. Psychiatric Case Management in the Emergency Department.

    Science.gov (United States)

    Turner, Stephanie B; Stanton, Marietta P

    2015-01-01

    The care of the mentally ill has reached a real crisis in the United States. There were more than 6.4 million visits to emergency departments (EDs) in 2010, or about 5% of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse (). That is up 28% from just 4 years earlier, according to the latest figures available from the Agency for Healthcare Research and Quality in Rockville, MD. Using a method called scoping, the purpose of this article is to examine the range, extent, and evidence available regarding case management as an intervention in the ED to manage mental health patients, to determine whether there is sufficient quantity and quality of evidence on this topic to conduct a meta-analysis, and to identify relevant studies that balance comprehensiveness with reasonable limitations. One solution for ensuring that the costs are contained, efficiency is maintained, and quality outcomes are achieved is the placement of a case manager in the ED. According to , because the majority of hospital admissions come through the ED, it makes sense to have case managers located there to act as gatekeepers and ensure that patients who are admitted meet criteria and are placed in the proper bed with the proper status. From the scoping techniques implemented in this study, the authors came to the conclusion that case management has been and can be used to effectively treat mental health patients in the emergency room. A good number of patients with psych mental health issues are frequent visitors and repeat visitors. Case management has not been used very often as a strategy for managing patients through the ED or for follow-up after the visit. Hospitals that have developed a protocol for managing these patients outside the main patient flow have had successful results. Staff training and development on psych mental health issues have been helpful in the ED. While there are not a large number of studies available on this topic

  16. Psychiatric Evaluation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychiatric Evaluation Workgroup

    OpenAIRE

    Stowell, Keith R; Florence, Peter; Harman, Herbert J; Glick, Rachel L

    2012-01-01

    It is difficult to fully assess an agitated patient, and the complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. Nonetheless, emergency clinicians must perform an initial mental status screening to begin this process as soon as the agitated patient presents to an emergency setting. For this reason, the psychiatric evaluation of the agitated patient can be thought of as a 2-step process. First, a brief evaluati...

  17. Covert medication in psychiatric emergencies: is it ever ethically permissible?

    Science.gov (United States)

    Hung, Erick K; McNiel, Dale E; Binder, Renée L

    2012-01-01

    Covert administration of medications to patients, defined as the administration of medication to patients without their knowledge, is a practice surrounded by clinical, legal, ethics-related, and cultural controversy. Many psychiatrists would be likely to advocate that the practice of covert medication in emergency psychiatry is not clinically, ethically, or legally acceptable. This article explores whether there may be exceptions to this stance that would be ethical. We first review the standard of emergency psychiatric care. Although we could identify no published empirical studies of covert administration of medicine in emergency departments, we review the prevalence of this practice in other clinical settings. While the courts have not ruled with respect to covert medication, we discuss the evolving legal landscape of informed consent, competency, and the right to refuse treatment. We discuss dilemmas regarding the ethics involved in this practice, including the tensions among autonomy, beneficence, and duty to protect. We explore how differences between cultures regarding the value placed on individual versus family autonomy may affect perspectives with regard to this practice. We investigate how consumers view this practice and their treatment preferences during a psychiatric emergency. Finally, we discuss psychiatric advance directives and explore how these contracts may affect the debate over the practice.

  18. Decreasing Psychiatric Admission Wait Time in the Emergency Department by Facilitating Psychiatric Discharges.

    Science.gov (United States)

    Stover, Pamela R; Harpin, Scott

    2015-12-01

    Limited capacity in a psychiatric unit contributes to long emergency department (ED) admission wait times. Regulatory and accrediting agencies urge hospitals nationally to improve patient flow for better access to care for all types of patients. The purpose of the current study was to decrease psychiatric admission wait time from 10.5 to 8 hours and increase the proportion of patients discharged by 11 a.m. from 20% to 50%. The current study compared pre- and post-intervention data. Plan-Do-Study-Act cycles aimed to improve discharge processes and timeliness through initiation of new practices. Admission wait time improved to an average of 5.1 hours (t = 3.87, p = 0.006). The proportion of discharges occurring by 11 a.m. increased to 46% (odds ratio = 3.42, p planning processes and timeliness in a psychiatric unit significantly decreased admission wait time from the ED, improving access to psychiatric care. Copyright 2015, SLACK Incorporated.

  19. Psychiatric evaluation of the agitated patient: consensus statement of the american association for emergency psychiatry project Beta psychiatric evaluation workgroup.

    Science.gov (United States)

    Stowell, Keith R; Florence, Peter; Harman, Herbert J; Glick, Rachel L

    2012-02-01

    It is difficult to fully assess an agitated patient, and the complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. Nonetheless, emergency clinicians must perform an initial mental status screening to begin this process as soon as the agitated patient presents to an emergency setting. For this reason, the psychiatric evaluation of the agitated patient can be thought of as a 2-step process. First, a brief evaluation must be aimed at determining the most likely cause of agitation, so as to guide preliminary interventions to calm the patient. Once the patient is calmed, more extensive psychiatric assessment can be completed. The goal of the emergency assessment of the psychiatric patient is not necessarily to obtain a definitive diagnosis. Rather, ascertaining a differential diagnosis, determining safety, and developing an appropriate treatment and disposition plan are the goals of the assessment. This article will summarize what components of the psychiatric assessment can and should be done at the time the agitated patient presents to the emergency setting. The complete psychiatric evaluation of the patient whose agitation has been treated successfully is beyond the scope of this article and Project BETA (Best practices in Evaluation and Treatment of Agitation), but will be outlined briefly to give the reader an understanding of what a full psychiatric assessment would entail. Other issues related to the assessment of the agitated patient in the emergency setting will also be discussed.

  20. Psychiatric Services in Dubai (A Short Descriptive Report)

    Science.gov (United States)

    Al Mualla, Saoud

    2011-01-01

    The paper gives an account of psychiatric services in Dubai (U.A.E). It describes the unique demographic constitution of Dubai and its complex health system. It also discusses the reasons behind the primitiveness of psychiatry in comparison to other medical specialties and services, especially considering the wealth of Dubai. The paper then goes…

  1. Price elasticity of demand for psychiatric consultation in a Nigerian psychiatric service.

    Science.gov (United States)

    Esan, Oluyomi

    2016-12-01

    This paper addresses price elasticity of demand (PED) in a region where most patients make payments for consultations out of pocket. PED is a measure of the responsiveness of the quantity demanded of goods or services to changes in price. The study was done in the context of an outpatient psychiatric clinic in a sub -Saharan African country. The study was performed at the University College Hospital (UCH), Ibadan, Nigeria. Aggregate data were collected on weekly clinic attendance over a 24-month period October 2008 - September 2010 representing 12 months before, to 12months after a 67% increase in price of outpatient psychiatric consultation. The average weekly clinic attendance prior to the increase was compared to the average clinic attendance after the price increase. Arc-PED for consultation was also estimated. Clinic attendance dropped immediately and significantly in the weeks following the price increase. There was a 34.4% reduction in average weekly clinic attendance. Arc-PED for psychiatric consultation was -0.85. In comparison to reported PED on health care goods and services, this study finds a relatively high PED in psychiatric consultation following an increase in price of user fees of psychiatric consultation.

  2. [Psychomotor agitation, pharmaceutical sedation and psychiatric emergency in psychotic patients].

    Science.gov (United States)

    Passamar, M; Tellier, O; Vilamot, B

    2011-12-01

    Psychomotor agitation, very common among psychiatric emergencies, raises the question of pharmaceutical sedation, its indications, and its issues, notably with regard to the observance in postemergency. A new approach to sedation places it within its therapeutic aim and also takes into account the sometimes harmful impact on the course of the patient's care. A pretherapeutical, analysis both clinical and environmental is crucial. The time spent on the initial meeting and assessment is essential. The evolution of professional practices in mental health allows us to distinguish three kinds of sedation (vigilance, behaviour and psychical) that guide the choice and the mode of psychotropic drug use. The harmful effects of an ever-increasing use of sedation is debated. The use of atypical antipsychotics and injectable forms is argued. Early psychical sedation is preferable to the obsolete practice of vigilance sedation and to behavioural sedation with its limited indications. The use of excessive or prolonged sedation might have a detrimental effect on the care offered after psychiatric emergency treatment. Copyright © 2011. Published by Elsevier Masson SAS.

  3. 42 CFR 440.160 - Inpatient psychiatric services for individuals under age 21.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient psychiatric services for individuals... Definitions § 440.160 Inpatient psychiatric services for individuals under age 21. “Inpatient psychiatric... physician; (b) Are provided by— (1) A psychiatric hospital that undergoes a State survey to determine...

  4. Psychiatric Services in Matabeleland | Buchan | South African ...

    African Journals Online (AJOL)

    ... while about 20% of patients in hospital and 18% of patients discharged are epileptic. At least 34% of patients discharged have been admitted more than once. From these figures it is suggested that a followthrough service aimed at reducing the number of schizophrenic and epileptic readmissions would be a practical first ...

  5. Emergency Medical Service (EMS) Stations

    Data.gov (United States)

    Kansas Data Access and Support Center — EMS Locations in Kansas The EMS stations dataset consists of any location where emergency medical services (EMS) personnel are stationed or based out of, or where...

  6. Workers safety in public psychiatric services: problems, laws and protections.

    Science.gov (United States)

    Carabellese, F; Urbano, M; Coluccia, A; Gualtieri, G

    2017-01-01

    The dramatic case of murder of a psychiatrist during her service in her public office (Centro di Salute Mentale of Bari-Libertà) has led the authors to reflect on the safety of workplaces, in detail of public psychiatric services. It is in the light of current legislation, represented by the Legislative Decree of April 9th, 2008 no. 81, which states the implementing rules of Law 123/2007. In particular, the Authors analyzed the criticalities of the application of this Law, with the aim of safeguarding the health and safety of the workers in all psychiatric services (nursing departments, outpatient clinics, community centers, day care centers, etc.). The Authors suggest the need to set up an articulated specific organizational system of risk assessment of psychiatric services, that can prevent and protect the workers from identified risks, and finally to ensure their active participation in prevention and protection activities, in absence of which specific profiles of responsibility would be opened up to the employers.

  7. Nurses of the psychiatric service as the specific occupational group

    Directory of Open Access Journals (Sweden)

    Klimentova I.V.

    2016-06-01

    Full Text Available The demand for psychiatric services in modern health care system will increase due to the growth in number of mental diseases. The role of nurses in prevention, treatment and rehabilitation of mental illness has a number of features. These features are related to care of patients with high level of aggressiveness, behavioral deviations, and problems in self-service. Differences in procedure practice and communicative space specialize and make narrower the nurses' professional practice in psychiatry and determine appearance of specific mechanisms and norms bound up with the necessity of supervision of patients while respecting their rights. Personnel's oversight functions, deviant behavior of patients, high degree of closure of psychiatric medical institutions — are the reasons for specialization of nurses' professional group in psychiatry, forming special mechanisms of maintaining tolerance to patients in professional sphere of this community.

  8. Factors predicting adherence with psychiatric follow-up appointments for patients assessed by the liaison psychiatric team in the emergency department.

    LENUS (Irish Health Repository)

    Agyapong, Vincent I O

    2010-01-01

    Several factors may predict adherence with psychiatric follow-up appointment for patients seen in the emergency department (ED) by liaison psychiatric teams. Awareness of these factors would allow for interventions targeted at vulnerable groups.

  9. NIH Roundtable on Opportunities to Advance Research on Neurologic and Psychiatric Emergencies.

    Science.gov (United States)

    D'Onofrio, Gail; Jauch, Edward; Jagoda, Andrew; Allen, Michael H; Anglin, Deirdre; Barsan, William G; Berger, Rachel P; Bobrow, Bentley J; Boudreaux, Edwin D; Bushnell, Cheryl; Chan, Yu-Feng; Currier, Glenn; Eggly, Susan; Ichord, Rebecca; Larkin, Gregory L; Laskowitz, Daniel; Neumar, Robert W; Newman-Toker, David E; Quinn, James; Shear, Katherine; Todd, Knox H; Zatzick, Douglas

    2010-11-01

    for development of (1) a research infrastructure for the rapid identification, consent, and tracking of research subjects that incorporates innovative informatics technologies, essential for future research; (2) diagnostic strategies and tools necessary to understand key populations and the process of medical decisionmaking, including the investigation of the pathobiology of symptoms and symptom-oriented therapies; (3) collaborative research networks to provide unique opportunities to form partnerships, leverage patient cohorts and clinical and financial resources, and share data; (4) formal research training programs integral for creating new knowledge and advancing the science and practice of emergency medicine; and (5) recognition that emergency care is part of an integrated system from emergency medical services dispatch to discharge. The NIH Roundtable "Opportunities to Advance Research on Neurological and Psychiatric Emergencies" created a framework to guide future emergency medicine-based research initiatives. Emergency departments provide the portal of access to the health care system for most patients with acute neurologic and psychiatric illness. Emergency physicians and colleagues are primed to investigate neurologic and psychiatric emergencies that will directly improve the delivery of care and patient outcomes. Copyright © 2010. Published by Mosby, Inc.

  10. Psychiatric patients' satisfaction in the therapeutic residence services: A positive experience of psychiatric deinstitutionalization

    Directory of Open Access Journals (Sweden)

    Rafael Gustavo Maluf

    Full Text Available This study investigated the satisfaction level of psychiatric patients in the therapeutic residential services of Barbacena-MG. Total population comprised 154 individuals, of which 45 were sampled. Subjects were interviewed with the SATIS-BR scale and a sociodemographic questionnaire. Results showed a high degree of satisfaction with the service for the global score and its three dimensions staff competence and understanding, help received, infrastructure. Results were not related to sociodemographic and clinical variables analyzed individually. Multivariate analysis indicated higher satisfaction for literate patients and for those that underwent some other form of treatment (e.g., hydrogymnastics and fitness activities besides medications or occupational therapy. We conclude that the therapeutic residence services appear to be a viable alternative for mental health public policy, from the patients' perspective.

  11. The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities.

    Science.gov (United States)

    Ascoli, Micol; Palinski, Andrea; Owiti, John Arianda; De Jongh, Bertine; Bhui, Kamaldeep S

    2012-09-28

    Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering "culture" in the presentation and expression of mental distress. The narratives reveal an overall "culture of understanding cultural issues" and specific "cultures of care". These emerged as necessary foci of intervention to improve service user outcomes. Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery.

  12. Frequent visitors at the psychiatric emergency room - A literature review.

    Science.gov (United States)

    Schmidt, Manuela

    2018-03-01

    Frequent visitors at the psychiatric emergency room (PER) constitute a small subgroup of patients, yet they are responsible for a disproportionate number of visits and thus claim considerable resources. Their needs are often left unmet and their repetitive visits reflect their dissatisfaction as well as that of PERs' staff. Motivated by these dilemmas, this study systematically reviews the literature about frequent visitors at PER and seeks to answer two questions: What characterizes frequent visitors at PER in the literature? and What characterizes PER in the literature? Based on 29 studies, this paper offers answers to the two questions based on a strength weakness opportunities and threats (SWOT) analysis. The results of the review and subsequent analysis of the literature revealed the multiplicity and complexity of frequent visitors' characteristics and how they appear to converge. Commonalities were more difficult to identify in PER characteristics. In some cases, this happened because the characteristics were poorly described or were context specific. As a result, it was not easy to compare the studies on PER. Based on SWOT and the findings of the analysis, the paper proposes new venues of research and suggests how the field of mental health might develop by taking into account its opportunities and threats.

  13. Financial Services and Emerging Markets

    NARCIS (Netherlands)

    B. Karreman (Bas)

    2011-01-01

    textabstractThis study addresses the organization and strategy of firms in emerging markets with an explicit application to financial services. Given the relevance of a well-functioning financial system for economic growth, understanding the organization and strategy of firms contributing to the

  14. 42 CFR 424.14 - Requirements for inpatient services of inpatient psychiatric facilities.

    Science.gov (United States)

    2010-10-01

    ... psychiatric facilities. 424.14 Section 424.14 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Certification and Plan Requirements § 424.14 Requirements for inpatient services of inpatient psychiatric... requirements differ from those for other hospitals because the care furnished in psychiatric hospitals is often...

  15. 42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

    Science.gov (United States)

    2010-10-01

    ... under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... Services of Inpatient Psychiatric Facilities § 412.405 Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. The prospective payment system...

  16. Psychiatric worker and family members: pathways towards co-operation networks within psychiatric assistance services

    Directory of Open Access Journals (Sweden)

    Silvia Carbone

    2014-03-01

    Full Text Available The family’s role in patient care was greatly altered by Law 180. This law, introduced in Italy in 1978, led to a gradual phasing out of custodial treatment for psychiatric patients. This different mindset, which views the family as an alternative to institutionalization, leads to it being seen as an essential entity in the setting up of community service dynamics. We interviewed health professionals in order to understand obstacles of collaboration between family members and mental health care workers. The goal was to uncover actions that promote collaboration and help build alliances between families and psychiatric workers. Results showed that health professionals view the family as a therapeutic resource. Despite this view, family members were rarely included in patient treatment. The reasons is: the structures have a theoretical orientation of collaboration with the family but, for nurses not are organized a few meeting spaces with family members. Services should create moments, such as multi-family groups or groups of information, managed by nurses and not only by doctors. These occasions it might facilitate the knowledge between professionals and family members.

  17. Clinical features and therapeutic management of patients admitted to Italian acute hospital psychiatric units: the PERSEO (psychiatric emergency study and epidemiology survey

    Directory of Open Access Journals (Sweden)

    Russo Federico

    2007-11-01

    Full Text Available Abstract Background The PERSEO study (psychiatric emergency study and epidemiology is a naturalistic, observational clinical survey in Italian acute hospital psychiatric units, called SPDCs (Servizio Psichiatrico Diagnosi e Cura; in English, the psychiatric service for diagnosis and management. The aims of this paper are: (i to describe the epidemiological and clinical characteristics of patients, including sociodemographic features, risk factors, life habits and psychiatric diagnoses; and (ii to assess the clinical management, subjective wellbeing and attitudes toward medications. Methods A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period. Results Almost half of patients (46% showed an aggressive behaviour at admission to ward, but they engaged more commonly in verbal aggression (38%, than in aggression toward other people (20%. A total of 78% of patients had a psychiatric diagnosis at admission, most frequently schizophrenia (36%, followed by depression (16% and personality disorders (14%, and no relevant changes in the diagnoses pattern were observed during hospital stay. Benzodiazepines were the most commonly prescribed drugs, regardless of diagnosis, at all time points. Overall, up to 83% of patients were treated with neuroleptic drugs and up to 27% received more than one neuroleptic either during hospital stay or at discharge. Atypical and conventional antipsychotics were equally prescribed for schizophrenia (59 vs 65% during stay and 59 vs 60% at discharge, while atypical drugs were preferred in schizoaffective psychoses (72 vs 49% during stay and 70 vs 46% at discharge and depression (41 vs 32% during stay and 44 vs 25% at discharge. Atypical neuroleptics were slightly preferred to conventional ones at hospital discharge (52 vs 44%. Polypharmacy was in general widely used. Patient attitudes toward medications were on average positive and self

  18. Sociodemographic profile and psychiatric diagnosis of patients referred to consultation-liaison psychiatric services of general hospital psychiatric unit at a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Shri Gopal Goyal

    2017-01-01

    Full Text Available Context: Previous studies have reported high psychiatric comorbidity with physical illness. However, referral rate to consultation-liaison (C-L psychiatry from other departments is very low. There is a paucity of literature from India in this subspecialty of psychiatry. Aims: This study was conducted to assess the sociodemographic profile and psychiatric diagnosis of patients referred to C-L psychiatric services at a tertiary care center. Settings and Design: This was a descriptive cross-sectional study conducted in a tertiary care multispecialty teaching institution. Patients and Methods: The study population comprised all the patients who were referred for psychiatric consultation from other departments to C-L services of psychiatry department for 2 months. Information was collected using semi-structured pro forma, and diagnosis was made based on the International Classification of Diseases-10 criteria. Results: A total of 160 patients were referred for C-L psychiatric services. Majority of the patients were in the age group of 31–45 years, married, educated matriculation or beyond, belonged to Hindu religion, nuclear family, and residing in urban area. The maximum referrals were from internal medicine department (17.5 followed by nephrology (15.0% and neurology (10.6%. The most common psychiatric diagnosis was depression (12% followed by delirium (8%. The most common reason for seeking psychiatric consultation was psychiatric clearance of prospective kidney donor and bone marrow transplant/stem cell transplant recipient. Conclusions: Psychiatric comorbidity may present with chronic physical illness. The C-L psychiatry would play a major role in the management of psychiatric comorbidity.

  19. Screening for Sexual Orientation in Psychiatric Emergency Departments

    Directory of Open Access Journals (Sweden)

    Currier, Glenn W.

    2015-01-01

    Full Text Available Introduction: Our goal was to explore whether emergency department (ED patients would disclose their sexual orientation in a research evaluation and to examine demographic and clinical characteristics of patients by self-identified sexual orientation. Methods: Participants (n=177 presented for psychiatric treatment at three urban EDs in New York City, Rochester, NY, and Philadelphia, PA. Participants were interviewed in the context of a larger study of a standardized suicide risk assessment. We assessed participants’ willingness to answer questions regarding sexual orientation along three dimensions: a self-description of sexual orientation, a self-description of sexual attraction, and the gender of any prior sexual partners. Results: No participants (0/177 refused to respond to the categorical question about sexual orientation, 168/177 (94.9% agreed to provide information about prior sexual partners, and 100/109 (91.7% provided information about current sexual attraction toward either gender. Of all 177 participants, 154 (87.0% self-identified as heterosexual, 11 (6.2% as bisexual, 10 (5.6% as gay or lesbian, and 2 (1.1% indicated they were not sure. As compared with heterosexual patients, lesbian, gay and bisexual (LGB patients were significantly younger and more likely to be non-white, but did not differ significantly in terms of education, income, employment, or religious affiliation or participation. Further, LGB participants did not differ from self-identified heterosexual participants for lifetime suicide attempt rate or lifetime history of any mood, substance-related, psychotic spectrum, or other Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV Axis I disorder. Of self-identified heterosexual participants 5.6% (5/89 reported sexual attraction as other than ‘only opposite sex,’ and 10.3% (15/142 of sexually active ‘heterosexual’ participants reported previous same-gender sexual partners. Conclusion

  20. Prevalence of burnout among public health nurses in charge of mental health services and emergency care systems in Japan.

    Science.gov (United States)

    Imai, Hirohisa; Nakao, Hiroyuki; Nakagi, Yoshihiko; Niwata, Satoko; Sugioka, Yoshihiko; Itoh, Toshihiro; Yoshida, Takahiko

    2006-11-01

    The Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout. A questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs. Prevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of "restriction". Prevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.

  1. [Suicidal behavior: a psychiatric emergency situation, suicide prevention: a psychiatric obligation].

    Science.gov (United States)

    Wolfersdorf, M; Schneider, B; Schmidtke, A

    2015-09-01

    In German psychiatry suicidal behavior is seen as sign of a psychiatric crisis in a person in the context of psychopathology, psychodynamics and psychosocial situation. Psychiatric disorders are found in up to 90% of people who commit suicide and the time span following the decision to commit suicide is often very short, within 24 h. Suicide prevention is a central duty and obligation in psychiatry and psychotherapy. This article gives an overview on the current state of knowledge on suicide from a clinical point of view.

  2. [Emergence of early childhood trauma in adult psychiatric symptomatology].

    Science.gov (United States)

    Bouras, G; Lazaratou, E

    2012-06-01

    DNA methylation and brain development. Supporting the family and break the silence that frequently covers the traumatic events and feelings, will give the opportunity for the elaboration of all these aspects which could capture and imprison the subject in a dramatic circle of psychopathology. Moreover, the effectiveness of early interventions and child psychotherapy is now a common ground, so we have to use all our clinical instruments (dialogue, symbolic play, drawing, storytelling) in order to help the child and have the best possible result. Finally, concerning clinical practice, the emergence of early childhood trauma in adult psychiatric symptomatology is so frequent that mental health experts should take it into serious account while developing an appropriate clinical treatment for such patients.

  3. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.

    Science.gov (United States)

    2010-10-01

    ... other than psychiatric hospitals. 424.13 Section 424.13 Public Health CENTERS FOR MEDICARE & MEDICAID... other than psychiatric hospitals. (a) Content of certification and recertification. Medicare Part A pays for inpatient hospital services of hospitals other than psychiatric hospitals only if a physician...

  4. EMTALA and patients with psychiatric emergencies: a review of relevant case law.

    Science.gov (United States)

    Lindor, Rachel A; Campbell, Ronna L; Pines, Jesse M; Melin, Gabrielle J; Schipper, Agnes M; Goyal, Deepi G; Sadosty, Annie T

    2014-11-01

    Emergency department (ED) care for patients with psychiatric complaints has become increasingly challenging given recent nationwide declines in available inpatient psychiatric beds. This creates pressure to manage psychiatric patients in the ED or as outpatients and may place providers and institutions at risk for liability under the Emergency Medical Treatment and Labor Act (EMTALA). We describe the patient characteristics, disposition, and legal outcomes of EMTALA cases involving patients with psychiatric complaints. Jury verdicts, settlements, and other litigation involving alleged EMTALA violations related to psychiatric patients between the law's enactment in 1986 and the end of 2012 were collected from 3 legal databases (Westlaw, Lexis, and Bloomberg Law). Details about the patient characteristics, disposition, and reasons for litigation were independently abstracted by 2 trained reviewers onto a standardized data form. Thirty-three relevant cases were identified. Two cases were decided in favor of the plaintiffs, 4 cases were settled, 10 cases had an unknown outcome, and 17 were decided in favor of the defendant institutions. Most patients in these 33 cases were men, had past psychiatric diagnoses, were not evaluated by a psychiatrist, and eventually committed or attempted suicide. The most frequently successful defense used by institutions was to demonstrate that their providers used a standard screening examination and did not detect an emergency medical condition that required stabilization. Lawsuits involving alleged EMTALA violations in the care of ED patients with psychiatric complaints are uncommon and rarely successful. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  5. Exploring registered Psychiatric Nurses' responses towards Service Users with a diagnosis of borderline personality disorder.

    LENUS (Irish Health Repository)

    McGrath, Bridget

    2012-01-01

    This study explored registered psychiatric nurses\\' (RPNs\\') interactions and level of empathy towards service users with a diagnosis of borderline personality disorder (BPD). A qualitative approach was used, and 17 RPNs were interviewed using a semistructured interview schedule incorporating the "staff-patient interaction response scale" (SPIRS). Four themes emerged following data analysis: "challenging and difficult," "manipulative, destructive and threatening behaviour," "preying on the vulnerable resulting in splitting staff and other service users," and "boundaries and structure." Additionally, low levels of empathy were evident in the majority of participants\\' responses to the SPIRS. The findings provide further insight on nurses\\' empathy responses and views on caring for service users with BPD and further evidence for the need for training and education for nurses in the care of service users diagnosed with BPD.

  6. Exploring Registered Psychiatric Nurses' Responses towards Service Users with a Diagnosis of Borderline Personality Disorder

    Directory of Open Access Journals (Sweden)

    Bridget McGrath

    2012-01-01

    Full Text Available This study explored registered psychiatric nurses' (RPNs' interactions and level of empathy towards service users with a diagnosis of borderline personality disorder (BPD. A qualitative approach was used, and 17 RPNs were interviewed using a semistructured interview schedule incorporating the “staff-patient interaction response scale” (SPIRS. Four themes emerged following data analysis: “challenging and difficult,” “manipulative, destructive and threatening behaviour,” “preying on the vulnerable resulting in splitting staff and other service users,” and “boundaries and structure.” Additionally, low levels of empathy were evident in the majority of participants' responses to the SPIRS. The findings provide further insight on nurses' empathy responses and views on caring for service users with BPD and further evidence for the need for training and education for nurses in the care of service users diagnosed with BPD.

  7. Evaluating psychiatric nursing competencies applied to emergency settings: A pilot role delineation study.

    Science.gov (United States)

    Mello, Joanna J; Bell, Janice F; Siegel, Elena O; Ward, Deborah H

    2016-03-01

    Despite increasing emergency department (ED) use for psychiatric emergencies, limited evidence exists to clearly identify the competencies necessary of emergency nurses to care for this population. 1. To define the specialized skill and knowledge of emergency nurses by examining the frequency with which recommended psychiatric nursing competencies are performed in the ED setting. 2. To assess emergency nurses' rankings of importance and self-efficacy related to recommended psychiatric nursing competencies in order to explore their relevance to emergency nursing. Emergency nurses (n = 75) completed a survey ranking the frequency, importance and self-efficacy of 15 psychiatric nursing competencies. Data analysis revealed competency relevance and regression analysis demonstrated factors that may contribute to self-efficacy. Nurses reported performing psychiatric competencies frequently (mean scores of 0.64 to 3.04). Importance rankings were highest (mean scores of 1.81 to 3.67). Self-efficacy mean scores ranged from 0.89 to 3.47. Frequency and importance of activities predicted higher self-efficacy scores. Younger age and competencies often, and existing competencies appear applicable. As frequency and importance of competencies influence self-efficacy, practice and interventions to underscore the importance of competencies may improve self-efficacy. Younger and less experienced nurses might require more support. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities

    Directory of Open Access Journals (Sweden)

    Ascoli Micol

    2012-09-01

    Full Text Available Abstract Introduction Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. Results These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering “culture” in the presentation and expression of mental distress. The narratives reveal an overall “culture of understanding cultural issues” and specific “cultures of care”. These emerged as necessary foci of intervention to improve service user outcomes. Conclusion Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery.

  9. Interpreter services in emergency medicine.

    Science.gov (United States)

    Chan, Yu-Feng; Alagappan, Kumar; Rella, Joseph; Bentley, Suzanne; Soto-Greene, Marie; Martin, Marcus

    2010-02-01

    Emergency physicians are routinely confronted with problems associated with language barriers. It is important for emergency health care providers and the health system to strive for cultural competency when communicating with members of an increasingly diverse society. Possible solutions that can be implemented include appropriate staffing, use of new technology, and efforts to develop new kinds of ties to the community served. Linguistically specific solutions include professional interpretation, telephone interpretation, the use of multilingual staff members, the use of ad hoc interpreters, and, more recently, the use of mobile computer technology at the bedside. Each of these methods carries a specific set of advantages and disadvantages. Although professionally trained medical interpreters offer improved communication, improved patient satisfaction, and overall cost savings, they are often underutilized due to their perceived inefficiency and the inconclusive results of their effect on patient care outcomes. Ultimately, the best solution for each emergency department will vary depending on the population served and available resources. Access to the multiple interpretation options outlined above and solid support and commitment from hospital institutions are necessary to provide proper and culturally competent care for patients. Appropriate communications inclusive of interpreter services are essential for culturally and linguistically competent provider/health systems and overall improved patient care and satisfaction. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  10. Psychiatric patient disposition agreement between the emergency physician and the psychiatry consultant.

    Science.gov (United States)

    Chakravarthy, Bharath; Menchine, Michael; Thompson, Daniel E; Rajeev, Sindhya; Santos, Barbara-Jean

    2013-01-01

    Mental illness is prevalent, disabling, and costly. Emergency department (ED) visits for mental health-related reasons are on the increase. Determine the level of agreement between emergency physicians and psychiatrists regarding psychiatric patient disposition. We conducted a prospective, observational study at a private university hospital ED from October 2008-April 2009 using a convenience sample of patients of all ages with psychiatric complaints who received formal psychiatric consultation during their ED visit. The emergency physician completed a data sheet prior to psychiatric consultation, assessing the likelihood of admission for psychiatric evaluation. We evaluated the positive predictive value (PPV) and negative predictive value (NPV) of the emergency physician admission decision for all patients before psychiatric consultation, compared with the patients' actual disposition as determined by the consulting psychiatrist. The study captured 230 subjects, 53% of whom were suicidal patients. 74% of patients were eventually admitted. The emergency physician decision to admit for inpatient psychiatric evaluation had a PPV of 87.3% (CI 81.4-91.9%) and an NPV of 66.7% (CI 52.9-78.6%) compared to the psychiatrist decision for the total sample, and a PPV of 90% (CI 82.4-95.1%) and an NPV of 69.6% (CI 47.1-86.8%) for suicidal patients. Additionally, the κ score, a measure of agreement between emergency physician disposition decision and psychiatrist disposition decision, was 0.530 (Cl 0.404-0.656). 95% of patients with an ED assessment of "definitely admit" were eventually admitted by the psychiatrist. Emergency physician disposition has a high PPV (87.3%) and a moderate NPV (66.7%) compared to psychiatrist disposition.

  11. Correlates of Length of Stay and Boarding in Florida Emergency Departments for Patients With Psychiatric Diagnoses.

    Science.gov (United States)

    Smith, Joseph L; De Nadai, Alessandro S; Storch, Eric A; Langland-Orban, Barbara; Pracht, Etienne; Petrila, John

    2016-11-01

    Length of stay (LOS) and boarding in the emergency department (ED) for psychiatric patients have been the subject of concern, given the problems with crowding and excessive wait times in EDs. This investigation examined correlates of LOS and boarding in Florida EDs for patients presenting with psychiatric complaints from 2010 to 2013. Utilizing the Florida ED discharge database, the authors examined the association of LOS and boarding with hospital and encounter factors for adult patients presenting with a primary psychiatric diagnosis (N=597,541). The mean LOS was 7.77 hours. Anxiety disorders were the most frequent psychiatric complaint and were associated with the lowest mean LOS compared with other diagnoses (pboarding (a stay of more than six or more hours in the ED). Extended LOS was endemic for psychiatric patients in Florida EDs.

  12. Emergency and Disaster Information Service

    Science.gov (United States)

    Boszormenyi, Zsolt

    2010-05-01

    The Hungarian National Association of Radio Distress-Signalling and Infocommunications (RSOE) operates Emergency and Disaster Information Service (EDIS) within the frame of its own website which has the objective to monitor and document all the events on the Earth which may cause disaster or emergency. Our service is using the speed and the data spectrum of the internet to gather information. We are monitoring and processing several foreign organisation's data to get quick and certified information. The EDIS website operated together by the General-Directorate of National Disaster Management (OKF) and RSOE, in co-operation with the Crisis Management Centre of the Ministry of Foreign Affairs, provides useful information regarding emergency situations and their prevention. Extraordinary events happening in Hungary, Europe and other areas of the World are being monitored in 24 hours per day. All events processed by RSOE EDIS are displayed real time - for the sake of international compatibility - according to the CAP protocol on a secure website. To ensure clear transparency all events are categorized separately in the RSS directory (e.g. earthquake, fire, flood, landslide, nuclear event, tornado, vulcano). RSOE EDIS also contributes in dissemination of the CAP protocol in Hungary. Beside the official information, with the help of special programs nearly 900-1000 internet press publication will be monitored and the publication containing predefined keywords will be processed. However, these "news" cannot be considered as official and reliable information, but many times we have learnt critical information from the internet press. We are screening the incoming information and storing in a central database sorted by category. After processing the information we are sending it immediately via E-Mail (or other format) for the organisations and persons who have requested it (e.g. National Disaster Management, United Nations etc.). We are aspiring that the processed data

  13. Invisible victims: battered women in psychiatric and medical emergency rooms.

    Science.gov (United States)

    Keller, L E

    1996-01-01

    Violence against women by their male partners is widespread and infrequently identified as a causal factor in multiple physical and psychological problems of female patients in medical and psychiatric settings. Three main countertransferences that interfere with accurate identification of battered women are described: (1) counter- identification, (2)countertransference rage, and (3) countertransference helplessness. Battering men and battered women are found in all levels of society, although younger, lower income, less-educated men who have observed parental violence in their own home are at higher risk of abusing their spouses. Additionally, antisocial personality disorder, depression, and/or alcohol and drug abuse increase the risk of male violence in the home. Contrary to popular belief, the husband-to-wife violence is usually motivated by his need to control her rather than a result of his loss of control. Battered women show no consistent prebattering risk markers, except for a history of parental violence in their family of origin. Violence against women by their male partners is a serious public health problem that has not been adequately addressed by the medical and psychiatric professions. Myths and clinical realities of battered women are described and detailed recommendations for clinical inquiry and evaluation of level of danger are given.

  14. How to improve psychiatric services: a perspective from critical psychiatry.

    Science.gov (United States)

    de Silva, Prasanna

    2017-09-02

    Concern has been expressed from both within and outwith psychiatry about the relative lack of improvement of mental health services. Critical psychiatry is an emerging school of thought, mainly the product of practicing clinicians, which could be useful in remedying this situation. This article outlines, for psychiatrists and doctors of other specialities, practices which could be improved, and the competencies required to achieve this, in terms of knowledge, skills and attitudes.

  15. Postsecondary Students With Psychiatric Disabilities Identify Core Services and Key Ingredients to Supporting Education Goals.

    Science.gov (United States)

    Biebel, Kathleen; Mizrahi, Raphael; Ringeisen, Heather

    2017-10-26

    Accessing and successfully completing postsecondary educational opportunities may be challenging for those living with psychiatric disabilities. This exploratory study highlights the experiences of individuals with psychiatric disabilities participating in postsecondary educational support initiatives. Investigators conducted case studies with 3 education support initiatives across the United States. Focus groups revealed what concrete supported education services were helpful and key ingredients in delivering education supports. Access to specialists, mindfulness techniques, help with time management and procrastination, and facilitating classroom accommodations were identified as critical. Developing authentic relationships with supported education staff, flexibility in service delivery and access to student peers living with psychiatric disabilities were noted as key ingredients in service delivery. Incorporating the voice of students with psychiatric disabilities into supported education services can increase access, involvement, and retention, therein providing more supports to students with psychiatric disabilities achieving their postsecondary education goals. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  16. Outsourcing mental health care services? The practice and potential of community-based farms in psychiatric rehabilitation

    NARCIS (Netherlands)

    Iancu, S.C.; Zweekhorst, M.B.M.; Veltman, D.J.; van Balkom, A.J.L.M.; Bunders-Aelen, J.G.F.

    2015-01-01

    Psychiatric rehabilitation supports individuals with mental disorders to acquire the skills needed for independent lives in communities. This article assesses the potential of outsourcing psychiatric rehabilitation by analysing care farm services in the Netherlands. Service characteristics were

  17. Emergency Health Services Selected Bibliography.

    Science.gov (United States)

    Health Services and Mental Health Administration (DHEW), Bethesda, MD.

    This annotated bibliography contains books, journal articles, visual aids, and other documents pertaining to emergency health care, which are organized according to: (1) publications dealing with day-to-day health emergencies that occur at home, work, and play, (2) documents that will help communities prepare for emergencies, including natural…

  18. State of Acute Agitation at Psychiatric Emergencies in Europe: The STAGE Study.

    Science.gov (United States)

    San, Luis; Marksteiner, Josef; Zwanzger, Peter; Figuero, María Aragüés; Romero, Francisco Toledo; Kyropoulos, Grigorios; Peixoto, Alberto Bessa; Chirita, Roxana; Boldeanu, Anca

    2016-01-01

    Agitation is an array of syndromes and types of behaviors that are common in patients with psychiatric disorders. In Europe, the estimation of prevalence of agitation has been difficult due to the lack of standard studies or systematic data collection done on this syndrome. An observational, cross-sectional, multicenter study aimed to assess the prevalence of agitation episodes in psychiatric emergencies in different European countries. For 1 week, all episodes of acute agitation that were attended to at the psychiatric emergency room (ER) or Acute Inpatient Unit (AIU) in the 27 participating centers were registered. The clinical characteristics and management of the agitation episode were also described. A descriptive analysis was performed. A total of 334 agitation episodes out of 7295 psychiatric emergencies were recorded, giving a prevalence rate of 4.6% (95% CI: 4.12-5.08). Of them, 172 [9.4% (95% CI: 8.2-10.9)] were attended at the ER and 162 [2.8% (95% CI: 2.4-3.3)] at AIU. Only data from 165 episodes of agitation (those with a signed informed consent form) was registered and described in this report. The most common psychiatric conditions associated with agitation were schizophrenia, bipolar disorder and personality disorder. The management of agitation included from non-invasive to more coercive measures (mechanical, physical restraint or seclusion) that were unavoidable in more than half of the agitation episodes (59.5%). The results show that agitation is a common symptom in the clinical practice, both in emergency and inpatient psychiatric departments. Further studies are warranted to better recognize (using a standardized definition) and characterize agitation episodes.

  19. Psychiatric and Medical Management of Marijuana Intoxication in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Bui, Quan M.

    2015-05-01

    Full Text Available We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient’s psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care. [West J Emerg Med. 2015;16(3:414–417.

  20. Level of Agitation of Psychiatric Patients Presenting to an Emergency Department

    OpenAIRE

    Zun, Leslie S.; Downey, La Vonne A.

    2008-01-01

    Objectives: The primary purpose of this study was to determine the level of agitation that psychiatric patients exhibit upon arrival to the emergency department. The secondary purpose was to determine whether the level of agitation changed over time depending upon whether the patient was restrained or unrestrained.

  1. Patient aggression in psychiatric services: the experience of a ...

    African Journals Online (AJOL)

    aggression is often the focus of many research reports.1-4. Attitudes are ... Objective: Aggression is a common feature in psychiatric in-patient units in Africa. The attitudes ..... qualitative study focusing on the characterization and perception of.

  2. Fire Service Emergency Management Handbook

    Science.gov (United States)

    1985-01-01

    Adapted from Formulating Public Policy in Emergency Management Course Book and ResourceMRanual for Public OTTicials, ILMA Emergency Management Institute...659-2447 (202) 785-2757 Christian Reformed World Relief Presbyterian Church in U.S. Committee General Assemby Mission Board C. Neil Molenaar 341 Ponce...Healer, Mind as Slayer. New York: Delta Books , 1977. 86B:6 B-45 4) Mitchell, J.T., & Resnik, HLP: Emergency Response to Crisis: A Crisis Intervention

  3. Psychiatric disorders and health service utilization in unemployed youth

    OpenAIRE

    2010-01-01

    Abstract Aim Youth unemployment is associated with increased levels of anxiety, depression, alcohol abuse, reduced self-esteem and satisfaction with life. Up to date data based on standardized psychiatric diagnostic assessments in adolescent or young adult unemployment is very scarce. To our knowledge, this study has, for the first time, assessed both Axis-I (non-personality) and Axis-II (personality) psychiatric disorders and related constructs in a pres...

  4. Race and psychiatric services in post-apartheid South Africa: a preliminary study of psychiatrists' perceptions.

    Science.gov (United States)

    Kohn, Robert; Szabo, Christopher P; Gordon, Alan; Allwood, Clifford W

    2004-03-01

    The primary objective of this study was to examine the perception of the quality of psychiatric services five years after apartheid, and specifically whether care for black patients had improved. A survey was distributed to South African psychiatrists during a national congress and by mail. The questionnaire focused on the quality of psychiatric care in general, for black and white patients, the racial composition of each respondent's psychiatric practice currently, and the racial composition of the psychiatric practice during apartheid. Psychiatric services in South Africa were viewed as deteriorating. The end of apartheid has done little to improve the quality of psychiatric care for both black and white patients. Although less pronounced, racial inequality in psychiatric care continues to exist. Psychiatric practices continue to be overrepresented with white patients. There remains a differential in quality of psychiatric care and further monitoring should continue. Continued efforts to improve racial equality and the need for greater awareness of cultural issues need to be addressed. Limitations of this study included possible social desirability bias, use of subjective rather than objective measures, and a survey that was limited in scope.

  5. Emergency Medical Services - Multiple Languages

    Science.gov (United States)

    ... Well-Being 11 - Emergency Room - Amarɨñña / አማርኛ (Amharic) MP3 Siloam Family Health Center Arabic (العربية) Expand Section ... Well-Being 11 - Emergency Room - myanma bhasa (Burmese) MP3 Siloam Family Health Center Dari (دری) Expand Section ...

  6. [Psychiatric emergencies: guidelines for the treatment of agitation].

    Science.gov (United States)

    Majorana, M; Todini, L; Luciani, A; Orso, L

    2012-07-01

    Psychomotor agitation represents a common phenomenon in emergency psychiatry settings. The awareness of its clinical manifestations and the early management can permit the control over a potentially dangerous behavior that could otherwise convert itself into a violent one. Health professionals should be able to adopt de-escalation strategies, structured to achieve the stabilization of patients' aggressiveness and motor agitation. When abnormal behaviors persist clinicians should be competent in the adoption of the most adequate psychopharmacological treatment for patient de-escalation. In this work we analyze psychomotor agitation treatment guide-lines.

  7. [Psychiatric treatment of deliberate self-harm in the out-of-hours services].

    Science.gov (United States)

    Walby, Fredrik A; Ness, Ewa

    2009-04-30

    Patients who harm themselves are often considered difficult to treat. There are no evidence-based approaches available for the emergency setting. General practitioners should nevertheless be able to offer interventions directed towards emotional needs in self-harm patients. In this article we suggest how to intervene in such situations. Based on experience from Oslo psychiatric out-of-hours service and with elements from Dialectic Behavioural Therapy, we present a five-step model for treatment of these patients in an out-of-hours service within the primary health care services. The aim of this model is to bring the patient out of the acute crisis and to arrange for further treatment. Assessment, validation or confirmation, problem-solving, avoiding unnecessary hospitalisation, and focus on continuing established treatment, are important elements in the proposed intervention. This can all be carried out in 60 - 90 min. The model may be suitable for training general practitioners to meet and care for patients with self-harm behaviour in the out-hours-services. We have positive experience with the intervention, but systematic research is necessary to assess the effect of the model.

  8. Refugee children have fewer contacts to psychiatric healthcare services: an analysis of a subset of refugee children compared to Danish-born peers.

    Science.gov (United States)

    Barghadouch, Amina; Kristiansen, Maria; Jervelund, Signe Smith; Hjern, Anders; Montgomery, Edith; Norredam, Marie

    2016-08-01

    Studies show a high level of mental health problems among refugee children. This study examined whether a subset of refugee children living in Denmark accessed psychiatric healthcare services more than those born in the country. This study compared 24,427 refugee children from Asia, The Middle East, Sub-Saharan Africa and former Yugoslavia, who obtained residency in Denmark between 1 January 1993 and 31 December 2010 with 146,562 Danish-born children, matched 1:6 on age and sex. The study looked at contacts with psychiatric hospitals as well as psychologists and psychiatrists in private practice. Between 1 January 1996 and 30 June 2012, 3.5 % of the refugee children accessed psychiatric healthcare services compared to 7.7 % of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95 % CI 0.40-0.45) among refugee boys and 0.35 (95 % CI 0.33-0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services. Refugee children used fewer psychiatric healthcare services than Danish-born children. This may indicate that refugee children experience barriers in accessing psychiatric healthcare systems and do not receive adequate assessment of their mental health and subsequent referral to specialist services.

  9. Differences between Irish and Australian psychiatric nurses' family-focused practice in adult mental health services

    LENUS (Irish Health Repository)

    Grant, Anne

    2016-04-01

    Psychiatric nurses\\' practice with parents who have mental illness, their children and families is an important issue internationally. This study provides a comparison of Irish and Australian psychiatric nurses\\' family-focused practices in adult mental health services. Three hundred and forty three nurses across Ireland and 155 from Australia completed the Family Focused Mental Health Practice Questionnaire. Cross-country comparisons revealed significant differences, in terms of family-focused skill, knowledge, confidence and practice. Australian psychiatric nurses engaged in higher family-focused practice compared to Irish nurses. The comparative differences between countries may be attributable to differences in training, workplace support and policy.

  10. Clinical and demographic profile of cancer patients in a consultation-liaison psychiatric service

    Directory of Open Access Journals (Sweden)

    Vanessa de Albuquerque Citero

    Full Text Available ABSTRACT CONTEXT: An almost 50% prevalence of psychiatric disorders among cancer patients has prompted a series of studies on consultation-liaison psychiatry. Nonetheless, there are few reports on the epidemiological factors involving comorbidity between cancer and psychiatric disorders. OBJECTIVE: To evaluate the epidemiological profile of cancer inpatients referred to the consultation-liaison psychiatric service in an oncology hospital during its first year of activity. TYPE OF STUDY: Descriptive study. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: 319 patients referred 412 times to the consultation-liaison psychiatry service. PROCEDURES: From August 97 to July 98, an appraisal was made of data on all admissions registered at the Hospital do Câncer, and also all referrals registered at the consultation-liaison psychiatry service. MAIN MEASUREMENTS: The demographics and patients' clinical data, the type and flow of the request, and the evaluation conducted by the service were analyzed and comparisons with the hospital data were made. The distribution of the number of referrals was used to construct a profile of patients who had repeatedly used the service. RESULTS: Psychiatric diagnoses were found in 59% of the cases. Forty-three percent of these required medication, 18.3% needed psychotherapy, 22.1% family intervention and 20.5% guidance from the staff. Over 22.8% of the consultations were reevaluations, mainly involving younger male patients with worst prognoses. These patients required lengthier and more elaborate intervention, and had higher prevalence of depressive and behavioral disorders. CONCLUSION: A younger and mainly male population of non-surgical oncological cases was referred to the consultation-liaison psychiatric service during its first year of activity. The psychiatric disorder prevalence was higher than expected, and consisted predominantly of mood disorders. We detected a priority group, namely the reevaluated

  11. Categorizing "frequent visitors" in the psychiatric emergency room: a semistructured interview study

    DEFF Research Database (Denmark)

    Buus, Niels

    2011-01-01

    Nurses can become demoralized and hostile toward frequent visitors in psychiatric emergency rooms because of the number of visits. The aim of this study was to develop more knowledge about the ways in which nurses categorize frequent visitors. Eleven nurses were interviewed, and their categorizing...... practices were examined from a social constructionist perspective. The results showed that the nurses did not categorize frequent visitors as particularly unlikeable or difficult to treat. Like other visitors, they could be categorized as difficult if they obstructed a smooth flow of successful referrals...... through the emergency room and/or there was poor rapport with the nurses....

  12. [Football, television and emergency services].

    Science.gov (United States)

    Miró, O; Sánchez, M; Borrás, A; Millá, J

    2000-04-15

    To know the influence of televised football on the use of emergency department (ED). We assessed the number, demographic characteristics and acuity of patients attended during the broadcast of football matches played by FC Barcelona during Champions' League (n = 12), and they were compared with days without televised football (n = 12). Televised football was associated with a decrease in visits to ED (-18%; p = 0.002). Such a decrease was observed for all ED units, but only for traumatology unit reached statistical significance (-28%; p = 0.006). Decay of ED visits were mainly due to a decrease of low-acuity consults (-30%; p = 0.04). There is a significant decrease on ED use associated with televised football.

  13. Emergency Medical Service (EMS): Rotorcraft Technology Workshop

    Science.gov (United States)

    Bauchspies, J. S.; Adams, R. J.

    1981-01-01

    A lead organization on the national level should be designated to establish concepts, locations, and the number of shock trauma air medical services. Medical specialists desire a vehicle which incorporates advances in medical technology trends in health care. Key technology needs for the emergency medical services helicopter of the future include the riding quality of fixed wing aircraft (reduced noise and vibration), no tail rotor, small rotor, small rotor diameter, improved visibility, crashworthy vehicle, IFR capability, more affordability high reliability, fuel efficient, and specialized cabins to hold medical/diagnostic and communications equipment. Approaches to a national emergency medical service are discussed.

  14. Assessment of Suicidal Behavior in a Psychiatric Emergency Room in Lisbon.

    Science.gov (United States)

    Marques, João Gama; Guerreiro, Diogo Frasquilho; Sampaio, Daniel

    2015-01-01

    Some studies alerted for the burden of suicidal attempters at emergency rooms. In this study we characterized the suicidal patients admitted to a Portuguese emergency room. For three years, all patients assessed by the first author after suicidal behaviour were included. Suicidal intentionality was evaluated with the Pierce Suicide Intent Scale. Clinical records were searched for follow-up status and satisfaction level was assessed through telephone call. From 120 included patients 70.8% were female, with mean age of 42.35 years. Pierce Suicide Intent Scale suicidal intentionality was low in 30.1%, medium in 59.3%, and high in 10.6% of the sample. The most important predictors of Pierce Suicide Intent Scale intentionality were male gender (p suicide (p Suicide Intent Scale is useful on suicidal behavior assessment at emergency rooms. Highly intentional suicidal behaviour is related to male sex, social problems and personal and familial psychiatric history. The quality of administrative records on this psychiatric emergency room setting are still unacceptable. The most important variables correlated with higher suicidal intentionality are the same described in other countries. Of the reachable patients, one fifth was satisfied with provided follow-up. We still need studies for better understanding of suicidal behaviour observed on this Portuguese emergency room.

  15. Pregnant adolescent women's perceptions of depression and psychiatric services in the United States.

    Science.gov (United States)

    Bledsoe, Sarah E; Rizo, Cynthia F; Wike, Traci L; Killian-Farrell, Candace; Wessel, Julia; Bellows, Anne-Marie O; Doernberg, Alison

    2017-10-01

    Adolescent mothers and their children are at high-risk for depression and the associated negative educational, social, health, and economic outcomes. However, few pregnant adolescent women with depression receive psychiatric services, especially low-income or racial/ethnic minority adolescent women. This qualitative study explores perceptions of depression, psychiatric services, and barriers to accessing services in a sample of low-income, pregnant racial/ethnic minority adolescent women. Our goal was to better understand the experiences of depression during pregnancy for these vulnerable adolescent women, and thereby improve their engagement and retention in services for perinatal depression. We recruited 20 pregnant adolescent women who screened positive for depression from 2 public health prenatal clinics in the southeastern United States. Participants were low-income and primarily racial/ethnic minority women between 14 and 20 years old. Data were collected through individual in-depth, ethnographically informed interviews. Generally, participants lacked experience with psychiatric services and did not recognize their symptoms as depression. However, participants perceived a need for mood improvement and were interested in engaging in services that incorporated their perspective and openly addressed stigma. Participants reported practical and psychological barriers to service engagement, but identified few cultural barriers. Family perceptions of psychiatric services served as both a barrier and support. Adolescent women are more likely to engage in psychiatric services if those services reduce practical and psychological barriers, promise relief from the symptoms perceived as most meaningful, and address underlying causes of depression. Culture may affect Latina adolescent women's perceptions of depression and services. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  16. On the potential for iatrogenic effects of psychiatric crisis services: The example of dialectical behavior therapy for adult women with borderline personality disorder.

    Science.gov (United States)

    Coyle, Trevor N; Shaver, Jennifer A; Linehan, Marsha M

    2018-02-01

    Although previous research has suggested that people with a history of using psychiatric crisis services are at higher risk for suicide, it is unclear whether this link is attributable to individual risk factors or iatrogenic effects of service utilization. We examined this question by analyzing data from a randomized controlled trial of dialectical behavior therapy (DBT), a treatment for highly suicidal individuals in which patients took advantage of crisis services less than those in the comparison condition. We hypothesized that crisis-service utilization during a treatment year, rather than pretreatment indicators of suicide risk, would be associated with higher suicide risk after treatment, and that DBT's treatment effects would be partially attributable to this association. Participants were 101 women (Mage = 29.3, 87% Caucasian) with recent suicidal and self-injurious behaviors meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association [APA], 1994) criteria for borderline personality disorder. We examined relationships between suicidal ideation (using the Suicide Behaviors Questionnaire; Linehan, 1981), number of suicide attempts (using the Suicide Attempt Self-Injury Interview; Linehan, Comtois, Brown, Heard, & Wagner, 2006), and number of psychiatric inpatient admissions and psychiatric emergency-room (ER) visits (using the Treatment History Interview; Linehan & Heard, 1987) from the years prior to, during, and following treatment. Treatment-year psychiatric ER visits were the sole predictor of the number of follow-up year suicide attempts. Treatment condition and pretreatment inpatient admissions predicted treatment-year psychiatric ER visits. Finally, there was evidence that DBT resulted in fewer suicide attempts at follow-up, in part because getting DBT led to fewer psychiatric ER visits. In this population and context, data suggest that crisis-service utilization conveys risk for suicide. DBT may

  17. What do you think of us? Evaluating patient knowledge of and satisfaction with a psychiatric outpatient service.

    LENUS (Irish Health Repository)

    Jabbar, F

    2011-03-01

    This study aimed to measure patient satisfaction with the care they were receiving; examine patients\\' knowledge of the psychiatric services in general; and identify variables associated with satisfaction.

  18. Design in mind: eliciting service user and frontline staff perspectives on psychiatric ward design through participatory methods.

    Science.gov (United States)

    Csipke, Emese; Papoulias, Constantina; Vitoratou, Silia; Williams, Paul; Rose, Diana; Wykes, Til

    2016-01-01

    Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users.

  19. Internet protocol-based emergency services

    CERN Document Server

    Schulzrinne, Henning

    2013-01-01

    Written by international experts in the field, this book covers the standards, architecture and deployment issues related to IP-based emergency services This book brings together contributions from experts on technical and operational aspects within the international standardisation and regulatory processes relating to routing and handling of IP-based emergency calls.  Readers will learn how these standards work, how various standardization organizations contributed to them and about pilot projects, early deployment and current regulatory situation. Key Featur

  20. [Psychiatric care act of Ukraine and issues concerning reformation of the mental health protection service].

    Science.gov (United States)

    Moskalenko, V F; Gorban', E N; Tabachnikov, S I; Syropiatov, O G; Shtengelov, V V

    2000-01-01

    An analysis was performed of the conception and content of a new Psychiatric Care Act by making a comparison with data from published literature and the present-day status of the mental health protection service. The main features of the crisis of psychiatry in Ukraine are characterized together with possible ways of resolving it. Main trends in reformation of the psychiatric service are identified that are to be secured by relevant acts of departmental and interdepartmental character based on law. Priority is emphasized to defence of the patients' rights and liberties together with a need for a guarantee of a highly skilled medical care to be provided for mental patients.

  1. The service needs of mothers with schizophrenia: a qualitative study of perinatal psychiatric and antenatal workers

    OpenAIRE

    Wan, Ming Wai; Moulton, Steff; Abel, Kathryn M.

    2008-01-01

    Objective: The study sought to (1) understand the perspectives of perinatal psychiatric and antenatal health service workers on the service and support needs of mothers with schizophrenia; (2) obtain their views on the feasibility and potential effectiveness of a proposed parenting intervention tailored for this group. Method: Twenty-eight perinatal psychiatry and antenatal service workers were interviewed using a semi-structured methodology, and anonymised verbatim transcripts analysed for c...

  2. Identifying barriers to emergency care services.

    Science.gov (United States)

    Cannoodt, Luk; Mock, Charles; Bucagu, Maurice

    2012-01-01

    This paper aims to present a review of published evidence of barriers to emergency care, with attention towards both financial and other barriers. With the keywords (financial) accessibility, barriers and emergency care services, citations in PubMed were searched and further selected in the context of the objective of this article. Forty articles, published over a period of 15 years, showed evidence of significant barriers to emergency care. These barriers often tend to persist, despite the fact that the evidence was published many years ago. Several publications stressed the importance of the financial barriers in foregoing or delaying potentially life-saving emergency services, both in poor and rich countries. Other publications report non-financial barriers that prevent patients in need of emergency care (pre-hospital and in-patient care) from seeking care, from arriving in the proper emergency department without undue delay or from receiving proper treatment when they do arrive in these departments. It is clear that timely access to life-saving and disability-preventing emergency care is problematic in many settings. Yet, low-cost measures can likely be taken to significantly reduce these barriers. It is time to make an inventory of these measures and to implement the most cost-effective ones worldwide. Copyright © 2011 John Wiley & Sons, Ltd.

  3. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Psychiatric Emergencies Small Group Module

    Directory of Open Access Journals (Sweden)

    Andrew King

    2017-07-01

    Full Text Available Audience: This curriculum created and implemented at The Ohio State University Wexner Medical Center was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction: In 2007, there were 12 million adult Emergency Department visits for mental health and substance abuse complaints. This represents 12.5% of all adult emergency department visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of psychiatric emergencies. The flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. Our curriculum utilizes an 18-month curricular cycle to cover the defined emergency medicine content. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of psychiatric emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group

  4. Antipsychotic Selection for Acute Agitation and Time to Repeat Use in a Psychiatric Emergency Department.

    Science.gov (United States)

    Gomez, Seth; Dopheide, Julie

    2016-11-01

    Early recognition and treatment of agitated patients is essential to avoid violence in the psychiatric emergency department (ED). Antipsychotics have established efficacy in managing agitation, yet little is known about how the choice of initial antipsychotic impacts time to repeat use and length of stay (LOS) in the psychiatric ED. To describe the impact of initial antipsychotic selection on time to repeat use and LOS in the psychiatric ED. A chart review identified 388 cases in which patients were administered an antipsychotic for agitation in the psychiatric ED between July 1 and August 31, 2014. Time to repeat use and LOS were compared for intramuscular (IM) haloperidol, other IM antipsychotics, and oral second-generation antipsychotics (SGAs) using the Kruskal-Wallis or Wilcoxon-Mann-Whitney test. Of the 388 cases, 31% (n=122) required repeat medications. Mean time to repeat use for IM haloperidol was 20.1±18.4 hours, which was not significantly different from mean time to repeat use in the groups receiving other IM antipsychotics or oral SGAs (P=0.35). The mean LOS was 29.7±28.7 hours for IM haloperidol, 30.3±36.9 hours for other IM antipsychotics, and 22.6±28.0 hours for oral SGAs. Significant differences in LOS between repeat and nonrepeat users of IM haloperidol and other IM antipsychotics were observed, but not among those who received oral SGAs. Mean time to repeat use ranged from 14 to 20 hours with IM haloperidol, other IM antipsychotics, and oral SGAs without significant differences in time to repeat use in the 3 different groups. Repeat users of IM antipsychotics had a significantly longer LOS in the ED compared with nonrepeat users of IM antipsychotics. However, patients who were initially administered oral SGAs did not have longer LOS in the ED even if a repeat dose was given.

  5. 75 FR 71441 - Universal Health Services, Inc. and Psychiatric Solutions, Inc.; Analysis of Agreement Containing...

    Science.gov (United States)

    2010-11-23

    ... entrants attempting to establish new psychiatric facilities or to expand their offerings in the relevant... to be a threat to themselves or others or unable to perform basic life functions, due to an acute... provide better service. New entry is unlikely to deter or counteract the anticompetitive effects of the...

  6. Enabling healthy living: Experiences of people with severe mental illness in psychiatric outpatient services.

    Science.gov (United States)

    Blomqvist, Marjut; Sandgren, Anna; Carlsson, Ing-Marie; Jormfeldt, Henrika

    2018-02-01

    It is well known that people with severe mental illness have a reduced life expectancy and a greater risk of being affected by preventable physical illnesses such as metabolic syndrome, cardiovascular disease and type 2 diabetes. There are still, however, only a few published studies focusing on what enables healthy living for this group. This study thus aimed to describe what enables healthy living among people with severe mental illness in psychiatric outpatient services. The data were collected in qualitative interviews (n = 16) and content analysis was used to analyze the data. The interviews resulted in an overall theme "Being regarded as a whole human being by self and others", which showed the multidimensional nature of health and the issues that enable healthy living among people with severe mental illness. Three categories emerged: (i) everyday structure (ii), motivating life events and (iii) support from significant others. The results indicate that a person with severe mental illness needs to be encountered as a whole person if healthy living is to be enabled. Attaining healthy living requires collaboration between the providers of care, help and support. Health care organizations need to work together to develop and provide interventions to enable healthy living and to reduce poor physical health among people with severe mental illness. © 2017 Australian College of Mental Health Nurses Inc.

  7. Predictors of mental health-related acute service utilisation and treatment costs in the 12 months following an acute psychiatric admission.

    Science.gov (United States)

    Siskind, Dan; Harris, Meredith; Diminic, Sandra; Carstensen, Georgia; Robinson, Gail; Whiteford, Harvey

    2014-11-01

    A key step in informing mental health resource allocation is to identify the predictors of service utilisation and costs. This project aims to identify the predictors of mental health-related acute service utilisation and treatment costs in the year following an acute public psychiatric hospital admission. A dataset containing administrative and routinely measured outcome data for 1 year before and after an acute psychiatric admission for 1757 public mental health patients was analysed. Multivariate regression models were developed to identify patient- and treatment-related predictors of four measures of service utilisation or cost: (a) duration of index admission; and, in the year after discharge from the index admission (b) acute psychiatric inpatient bed-days; (c) emergency department (ED) presentations; and (d) total acute mental health service costs. Split-sample cross-validation was used. A diagnosis of psychosis, problems with living conditions and prior acute psychiatric inpatient bed-days predicted a longer duration of index admission, while prior ED presentations and self-harm predicted a shorter duration. A greater number of acute psychiatric inpatient bed-days in the year post-discharge were predicted by psychosis diagnosis, problems with living conditions and prior acute psychiatric inpatient admissions. The number of future ED presentations was predicted by past ED presentations. For total acute care costs, diagnosis of psychosis was the strongest predictor. Illness acuity and prior acute psychiatric inpatient admission also predicted higher costs, while self-harm predicted lower costs. The development of effective models for predicting acute mental health treatment costs using existing administrative data is an essential step towards a workable activity-based funding model for mental health. Future studies would benefit from the inclusion of a wider range of variables, including ethnicity, clinical complexity, cognition, mental health legal status

  8. Emergent leadership among tenants with psychiatric disabilities living in supported housing.

    Science.gov (United States)

    Piat, Myra; Sabetti, Judith; Padgett, Deborah

    2018-06-01

    The overall aim of this study was to explore the experiences of people with psychiatric disabilities living as tenants in independent, supported apartments for the first time. Supported housing provides an alternative to structured, custodial housing models, such as foster homes, or board-and-care homes, for clients in public mental health systems. This article reports findings on how leadership emerged among tenants after making the transition from custodial to supported housing. Semi-structured interviews were conducted with tenants (n = 24) and included questions on their housing history, current living situation, relationships with staff, participation, and understanding or experience of leadership. Interviews were transcribed verbatim, codes generated, and a thematic analysis conducted using a constructivist approach. The findings revealed an understanding and appreciation of leadership among tenants, who identified six pathways to leadership in their housing as a response to unmet tenant needs. Most tenant leaders emerged outside of formal authority or power structures. Supported housing provides a unique social setting and empowering community where the potential of persons with psychiatric disabilities to assume leadership may be realized and further developed. Mental health professionals working in community housing networks are well placed to harness these face-to-face tenant communities, and their natural leaders, as an additional tool in promoting tenant recovery, mutual help, neighbourhood integration, and the broader exercise of citizenship. © 2017 Australian College of Mental Health Nurses Inc.

  9. Does Targeted Education of Emergency Physicians Improve Their Comfort Level in Treating Psychiatric Patients?

    Directory of Open Access Journals (Sweden)

    Brenda J Walker

    2012-12-01

    Full Text Available Introduction: We determined if targeted education of emergency physicians (EPsregarding the treatment of mental illness will improve their comfort level in treatingpsychiatric patients boarding in the emergency department (ED awaiting admission.Methods: We performed a pilot study examining whether an educational interventionwould change an EP’s comfort level in treating psychiatric boarder patients (PBPs. Weidentified a set of psychiatric emergencies that typically require admission or treatmentbeyond the scope of practice of emergency medicine. Diagnoses included majordepression, schizophrenia, schizoaffective disorder, bipolar affective disorder, generalanxiety disorder, suicidal ideation, and criminal behavior. We designed equivalentsurveys to be used before and after an educational intervention. Each survey consistedof 10 scenarios of typical psychiatric patients. EPs were asked to rate their comfort levelsin treating the described patients on a visual analogue scale. We calculated summaryscores for the non intervention survey group (NINT and intervention survey group (INTand compared them using Student’s t-test.Results: Seventy-nine percent (33/42 of eligible participants completed the preinterventionsurvey (21 attendings, 12 residents and comprised the NINT group. Fiftyfivepercent (23/42 completed the post-intervention survey (16 attendings, 7 residentscomprising the INT group. A comparison of summary scores between ‘NINT’ and ‘INT’groups showed a highly significant improvement in comfort levels with treating thepatients described in the scenarios (P = 0.003. Improvements were noted on separateanalysis for faculty (P = 0.039 and for residents (P = 0.012. Results of a sensitivityanalysis excluding one highly significant scenario showed decreased, but still importantdifferences between the NINT and INT groups for all participants and for residents, butnot for faculty (all: P = 0.05; faculty: P = 0.25; residents: P = 0

  10. Barriers to emergency obstetric care services

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique

    2014-01-01

    Introduction: Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore...... barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. Methods: A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced...... decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay...

  11. A brief intervention is sufficient for many adolescents seeking help from low threshold adolescent psychiatric services

    Directory of Open Access Journals (Sweden)

    Laukkanen Eila

    2010-09-01

    Full Text Available Abstract Background There has been a considerable increase in the need for psychiatric services for adolescents. Primary health care practitioners have a major role in detecting, screening and helping these adolescents. An intervention entitled SCREEN is described in this article. The SCREEN intervention was developed to help practitioners to detect and screen adolescent needs, to care for adolescents at the primary health care level and to facilitate the referral of adolescents to secondary care services in collaboration between primary and secondary health care. Secondly, the article presents the background and clinical characteristics of youths seeking help from the SCREEN services, and compares the background factors and clinical characteristics of those patients referred and not referred to secondary care services. Methods The SCREEN intervention consisted of 1 to 5 sessions, including assessment by a semi-structured anamnesis interview, the structured Global Assessment Scale, and by a structured priority rating scale, as well as a brief intervention for each adolescent's chosen problem. Parents took part in the assessment in 39% of cases involving girls and 50% involving boys. During 34 months, 2071 adolescents (69% females entered the intervention and 70% completed it. The mean age was 17.1 years for boys and 17.3 years for girls. Results For 69% of adolescents, this was the first contact with psychiatric services. The most common reasons for seeking services were depressive symptoms (31%. Self-harming behaviour had occurred in 25% of girls and 16% of boys. The intervention was sufficient for 37% of those who completed it. Psychosocial functioning improved during the intervention. Factors associated with referral for further treatment were female gender, anxiety as the main complaint, previous psychiatric treatment, self-harming behaviour, a previous need for child welfare services, poor psychosocial functioning and a high score in the

  12. Level of agitation of psychiatric patients presenting to an emergency department.

    Science.gov (United States)

    Zun, Leslie S; Downey, La Vonne A

    2008-01-01

    The primary purpose of this study was to determine the level of agitation that psychiatric patients exhibit upon arrival to the emergency department. The secondary purpose was to determine whether the level of agitation changed over time depending upon whether the patient was restrained or unrestrained. An observational study enrolling a convenience sample of 100 patients presenting with a psychiatric complaint was planned, in order to obtain 50 chemically and/or physically restrained and 50 unrestrained patients. The study was performed in summer 2004 in a community, inner-city, level 1 emergency department with 45,000 visits per year. The level of patient agitation was measured using the Agitated Behavior Scale (ABS) and the Richmond Agitation-Sedation Scale (RASS) upon arrival and every 30 minutes over a 3-hour period. The inclusion criteria allowed entry of any patient who presented to the emergency department with a psychiatric complaint thought to be unrelated to physical illness. Patients who were restrained for nonbehavioral reasons or were medically unstable were excluded. 101 patients were enrolled in the study. Of that total, 53 patients were not restrained, 47 patients were restrained, and 1 had incomplete data. There were no differences in gender, race, or age between the 2 groups. Upon arrival, 2 of the 47 restrained patients were rated severely agitated on the ABS, and 13 of 47 restrained patients were rated combative on the RASS. There was a statistical difference (p = .01) between the groups on both scales from time 0 to time 90 minutes. Scores on the agitation scales decreased over time in both groups. One patient in the unrestrained group became unarousable during treatment. This study demonstrated that patients who were restrained were more agitated than those who were not, and that agitation levels in both groups decreased over time. Some restrained patients did not meet combativeness or severe agitation criteria, suggesting either that use of

  13. Issues in casemix funding for acute inpatient psychiatric services and their relevance to mental health nursing.

    Science.gov (United States)

    Fanker, S

    1996-09-01

    With increased recognition by government, health administrators, and clinicians of the need to simultaneously contain health expenditure, improve the productivity and efficiency of health services and maintain quality of patient care, applications of casemix funding have been advocated as an alternative means of financing acute hospital care. Currently in Australia, the Commonwealth's casemix development program is encouraging the States and Territories to participate in certain casemix initiatives. Acute psychiatric hospital care and treatment have been excluded from the initial stages of the implementation of casemix in recognition of a number of inherent obstacles or challenges affecting the utility and accuracy of casemix in funding the psychiatric sector. Despite anecdotal claims that the reduced length of stay that often occurs under casemix payment systems may negatively impact upon the quality of care and patient outcomes, to date little empirical research has been directed towards measuring the potential impact of psychiatric casemix on the quality of patient care. Psychiatry cannot afford to ignore the casemix debate on account of its current exclusion from the early phases of implementation. To do so is to run the risk of having casemix imposed at some later stage in the absence of consultation. In the meantime it is vital that mental health professionals, including nurses, participate in the development and implementation of casemix, and contribute to research aimed at increasing or maximizing the relevance of casemix to the funding of psychiatric services.

  14. The emergence of psychiatric semiology during the Age of Revolution: evolving concepts of 'normal' and 'pathological'.

    Science.gov (United States)

    Londoño, Diego Enrique; Dening, Tom

    2016-06-01

    This article addresses some important questions in psychiatric semiology. The concept of a sign is crucial in psychiatry. How do signs emerge, and what gives them validity and legitimacy? What are the boundaries of 'normal' and 'pathological' behaviour and mental experiences? To address these issues, we analyse the characteristics and rules that govern semiological signs and clinical elements. We examine 'normality' from the perspective of Georges Canguilehm and compare the differences of 'normal' in physiology and psychiatry. We then examine the history and the philosophical, linguistic and medical-psychiatric origins of semiology during the eighteenth and nineteenth centuries (the Age of Revolution). The field of rhetoric and oratory has emphasized the importance of passions, emotions and language as applied to signs of madness. Another perspective on semiology, provided by Michel Foucault, lays stress on the concept of 'instinct' and the axis of voluntary-involuntary behaviour. Finally, we analyse how statistics and eugenics have played an important role in our current conceptualization of the norm and therefore the scientific discourse behind the established clinical signs. © The Author(s) 2016.

  15. Review of psychiatric services to mentally disordered offenders around the Pacific Rim.

    Science.gov (United States)

    Every-Palmer, Susanna; Brink, Johann; Chern, Tor P; Choi, Wing-Kit; Hern-Yee, Jerome Goh; Green, Bob; Heffernan, Ed; Johnson, Sarah B; Kachaeva, Margarita; Shiina, Akihiro; Walker, David; Wu, Kevin; Wang, Xiaoping; Mellsop, Graham

    2014-03-01

    This article was commissioned to collate and review forensic psychiatric services provided in a number of key Pacific Rim locations in the hope that it will assist in future dialogue about service development. The Board of the Pacific Rim College of Psychiatrists identified experts in forensic psychiatry from Australia, Canada, China, Hong Kong, Japan, Russia, Singapore, Taiwan, and the US. Each contributor provided an account of issues in their jurisdiction, including mental health services to mentally disordered offenders in prison, competence or fitness to stand trial, legal insanity as a defense at trial, diminished responsibility, and special forensic services available, including forensic hospitals and community forensic mental health services. Responses have been collated and are presented topic by topic and country by country within the body of this review. The availability of mental health screening and psychiatric in-reach or forensic liaison services within prisons differed considerably between countries, as did provisioning of community forensic mental health and rehabilitation services. Diversion of mentally disordered offenders to forensic, state, or hybrid hospitals was common. Legal constructs of criminal responsibility (insanity defense) and fitness to stand trial ("disability") are almost universally recognized, although variably used. Disparities between unmet needs and resourcing available were common themes. The legislative differences between contributing countries with respect to the mental health law and criminal law relating to mentally disordered offenders are relatively subtle. The major differences lie in operationalizing and resourcing forensic services. Copyright © 2013 Wiley Publishing Asia Pty Ltd.

  16. Understanding readmission to psychiatric hospital in Australia from the service users' perspective: a qualitative study.

    Science.gov (United States)

    Duhig, Michael; Gunasekara, Imani; Patterson, Sue

    2017-01-01

    Inpatient care is integral to balanced mental health systems, contributing to containment of risk associated with psychiatric crises and affording opportunities for treatment. However, psychiatric wards are not always safe and service users are often dissatisfied with the experience. Hence, and because inpatient care is the most costly component of mental health systems, minimising duration of admission and reducing risk of readmission are clinical and strategic priorities internationally. With (primarily quantitative) research to date focused on explaining readmission in terms of characteristics of individuals and services, understanding of the 'revolving door phenomenon' remains limited. Considering verstehen critical to addressing this messy problem, we examined readmission from the service users' perspective. Using grounded theory techniques, we inductively analysed data from interviews with 13 people readmitted to inpatient care within 28 days of discharge. Participants, including eight men, were recruited in 2013 from three psychiatric wards at a metropolitan hospital in Australia. Analysis supported description of readmission as a process, fundamentally related to insufficiency of internal, interpersonal and/or environmental resources to maintain community tenure. For the people in this study, admission to hospital was either the default coping mechanism or the culmination of counter-productive attempts to manage stressful circumstances. Readmission can appropriately be understood as one representation of a fundamental social malaise and the struggle of some people to survive in an apparently inhospitable world. The findings indicate that neither locating the 'problem of readmission' within an individual and promoting self-governance/self-control/self-regulation, nor identifying failures of specific services or sectors are likely to support the economic and ethical imperative of reducing psychiatric admissions. The findings of the study and limitations

  17. AN INFORMATION SERVICE MODEL FOR REMOTE SENSING EMERGENCY SERVICES

    Directory of Open Access Journals (Sweden)

    Z. Zhang

    2017-09-01

    Full Text Available This paper presents a method on the semantic access environment, which can solve the problem about how to identify the correct natural disaster emergency knowledge and return to the demanders. The study data is natural disaster knowledge text set. Firstly, based on the remote sensing emergency knowledge database, we utilize the sematic network to extract the key words in the input documents dataset. Then, using the semantic analysis based on words segmentation and PLSA, to establish the sematic access environment to identify the requirement of users and match the emergency knowledge in the database. Finally, the user preference model was established, which could help the system to return the corresponding information to the different users. The results indicate that semantic analysis can dispose the natural disaster knowledge effectively, which will realize diversified information service, enhance the precision of information retrieval and satisfy the requirement of users.

  18. Resident Workflow and Psychiatric Emergency Consultation: Identifying Factors for Quality Improvement in a Training Environment.

    Science.gov (United States)

    Blair, Thomas; Wiener, Zev; Seroussi, Ariel; Tang, Lingqi; O'Hora, Jennifer; Cheung, Erick

    2017-06-01

    Quality improvement to optimize workflow has the potential to mitigate resident burnout and enhance patient care. This study applied mixed methods to identify factors that enhance or impede workflow for residents performing emergency psychiatric consultations. The study population consisted of all psychiatry program residents (55 eligible, 42 participating) at the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles. The authors developed a survey through iterative piloting, surveyed all residents, and then conducted a focus group. The survey included elements hypothesized to enhance or impede workflow, and measures pertaining to self-rated efficiency and stress. Distributional and bivariate analyses were performed. Survey findings were clarified in focus group discussion. This study identified several factors subjectively associated with enhanced or impeded workflow, including difficulty with documentation, the value of personal organization systems, and struggles to communicate with patients' families. Implications for resident education are discussed.

  19. Strategies for preventing excess mortality after discharge from psychiatric emergency room

    DEFF Research Database (Denmark)

    Aagaard, Jørgen; Jensen, Mikkel

    2017-01-01

    AbstractPatients with severe mental illness have increased risk for severe physical diseases. In addition, there is evidence that this patient group is less likely to receive standard levels of care for most physical diseases, which may contribute to their shortened life expectancy. Further......, illness behaviour among individuals with schizophrenia is different as they are less likely to seek medical attention, which emphasise the need for increased awareness and early intervention when visiting an emergency psychiatric facility. Adults with severe mental illness have increased rates...... of substance abuse, which adversely affect their illness and outcome. Separate and parallel mental health and substance abuse treatment systems do not offer interventions that are integrated or personalised for the presence of substance abuse concurrent with severe mental illness. Therefore, the authors...

  20. The Forgotten Plague: Psychiatric Manifestations of Ebola, Zika, and Emerging Infectious Diseases.

    Science.gov (United States)

    Tucci, Veronica; Moukaddam, Nidal; Meadows, Jonathan; Shah, Suhal; Galwankar, Sagar C; Kapur, G Bobby

    2017-01-01

    The media and public health generally focus on the biological and physical ramifications of epidemics. Mental health issues that coincide with emerging diseases and epidemics are rarely examined and sometimes, even eschewed due to cultural considerations. Psychiatric manifestations of various infectious diseases, especially with a focus on Ebola Virus disease (EVD) and Zika Virus, are discussed in this commentary to illustrate the continued need of care after the resolution of the actual illness. Various infectious diseases have associations with mental illness, such as an increased risk of obsessive-compulsive disorders and Tourette syndrome in children with Group B streptococcal infection. Current EVD literature does not demonstrate a strong association of mental illness symptoms or diseases but there is a necessity of care that extends beyond the illness. Patients and their families experience depression, anxiety, trauma, suicidal ideation, panic and other manifestations. Zika virus has been associated neuronal injury, genetic alteration that affects fetal development and detrimental maternal mental health symptoms are being documented. While funding calls from the international community are present, there are no specific epidemiological data or fiscal estimates solely for mental health during or after infectious diseases epidemics or disasters that support health care providers and strengthen policies and procedures for responding to such situations. Therefore, those on the frontlines of epidemics including emergency physicians, primary care providers and infectious disease specialists should serve communicate this need and advocate for sustained and increased funding for mental health programs to heighten public awareness regarding acute psychiatric events during infectious diseases outbreaks and offer treatment and support when necessary.

  1. Emergency Department Telepsychiatry Service Model for a Rural Regional Health System: The First Steps.

    Science.gov (United States)

    Meyer, James D; McKean, Alastair J S; Blegen, Rebecca N; Demaerschalk, Bart M

    2018-05-09

    Emergency departments (EDs) have recognized an increasing number of patients presenting with mental health (MH) concerns. This trend imposes greater demands upon EDs already operating at capacity. Many ED providers do not feel they are optimally prepared to provide the necessary MH care. One consideration in response to this dilemma is to use advanced telemedicine technology for psychiatric consultation. We examined a rural- and community-based health system operating 21 EDs, none of which has direct access to psychiatric consultation. Dedicated beds to MH range from zero (in EDs with only 3 beds) to 6 (in an ED with 38 beds). We conducted a needs assessment of this health system. This included a survey of emergency room providers with a 67% response rate and site visits to directly observe patient flow and communication with ED staff. A visioning workshop provided input from ED staff. Data were also obtained, which reflected ED admissions for the year 2015. The data provide a summary of provider concerns, a summary of MH presentations and diagnosis, and age groupings. The data also provide a time when most MH concerns present to the ED. Based upon these results, a proposed model for delivering comprehensive regional emergency telepsychiatry and behavioral health services is proposed. Emergency telepsychiatry services may be a tenable solution for addressing the shortage of psychiatric consultation to EDs in light of increasing demand for MH treatment in the ED.

  2. Function assertive community treatment (FACT) and psychiatric service use in patients diagnosed with severe mental illness.

    Science.gov (United States)

    Drukker, M; van Os, J; Sytema, S; Driessen, G; Visser, E; Delespaul, P

    2011-09-01

    Previous work suggests that the Dutch variant of assertive community treatment (ACT), known as Function ACT (FACT), may be effective in increasing symptomatic remission rates when replacing a system of hospital-based care and separate community-based facilities. FACT guidelines propose a different pattern of psychiatric service consumption compared to traditional services, which should result in different costing parameters than care as usual (CAU). South-Limburg FACT patients, identified through the local psychiatric case register, were matched with patients from a non-FACT control region in the North of the Netherlands (NN). Matching was accomplished using propensity scoring including, among others, total and outpatient care consumption. Assessment, as an important ingredient of FACT, was the point of departure of the present analysis. FACT patients, compared to CAU, had five more outpatient contacts after the index date. Cost-effectiveness was difficult to assess. Implementation of FACT results in measurable changes in mental health care use.

  3. Marked reduction in length of stay for patients with psychiatric emergencies after implementation of a comanagement model.

    Science.gov (United States)

    Polevoi, Steven K; Jewel Shim, J; McCulloch, Charles E; Grimes, Barbara; Govindarajan, Prasanthi

    2013-04-01

    Patients with psychiatric emergencies often spend excessive time in an emergency department (ED) due to limited inpatient psychiatric bed capacity. The objective was to compare traditional resident consultation with a new model (comanagement) to reduce length of stay (LOS) for patients with psychiatric emergencies. The costs of this model were compared to those of standard care. This was a before-and-after study conducted in the ED of an urban academic medical center without an inpatient psychiatry unit from January 1, 2007, through December 31, 2009. Subjects were all adult patients seen by ED clinicians and determined to be a danger to self or others or gravely disabled. At baseline, psychiatry residents evaluated patients and made therapeutic recommendations after consultation with faculty. The comanagement model was fully implemented in September 2008. In this model, psychiatrists directly ordered pharmacotherapy, regularly monitored effects, and intensified efforts toward appropriate disposition. Additionally, increased attending-level involvement expedited focused evaluation and disposition of patients. An interrupted time series analysis was used to study the effects of this intervention on LOS for all psychiatric patients transferred for inpatient psychiatric care. Secondary outcomes included mean number of hours on ambulance diversion per month and the mean number of patients who left without being seen (LWBS) from the ED. A total of 1,884 patient visits were considered. Compared to the preintervention phase, median LOS for patients transferred for inpatient psychiatric care decreased by about 22% (p model was associated with a marked reduction in the LOS for this patient population. © 2013 by the Society for Academic Emergency Medicine.

  4. Emergency Department Length-Of-Stay For Psychiatric Visits Was Significantly Longer Than For Nonpsychiatric Visits, 2002-11.

    Science.gov (United States)

    Zhu, Jane M; Singhal, Astha; Hsia, Renee Y

    2016-09-01

    Despite increases in the use of emergency department (EDs) for mental health care, there are limited data on whether psychiatric patients disproportionately contribute to ED crowding. We conducted a retrospective analysis using a national database of ED visits in the period 2002-11 to describe trends in median and ninetieth-percentile length-of-stay for patients with psychiatric versus nonpsychiatric primary diagnoses. Psychiatric patients who visited the ED were transferred to another facility at six times the rate of nonpsychiatric patients. Median lengths-of-stay were similar for psychiatric and nonpsychiatric patients among those who were admitted to the hospital (264 versus 269 minutes) but significantly different for those who were admitted for observation (355 versus 279 minutes), transferred (312 versus 195 minutes), or discharged (189 versus 144 minutes). Overall, differences in ED length-of-stay between psychiatric and nonpsychiatric patients did not narrow over time. These findings suggest deficiencies in ED capacity for psychiatric care, which may necessitate improvements in both throughput and alternative models of care. Project HOPE—The People-to-People Health Foundation, Inc.

  5. Hand hygiene in emergency medical services.

    Science.gov (United States)

    Teter, Jonathan; Millin, Michael G; Bissell, Rick

    2015-01-01

    Hospital-acquired infections (HAIs) affect millions of patients annually (World Health Organization. Guidelines on Hand Hygiene in Healthcare. Geneva: WHO Press; 2009). Hand hygiene compliance of clinical staff has been identified by numerous studies as a major contributing factor to HAIs around the world. Infection control and hand hygiene in the prehospital environment can also contribute to patient harm and spread of infections. Emergency medical services (EMS) practitioners are not monitored as closely as hospital personnel in terms of hand hygiene training and compliance. Their ever-changing work environment is less favorable to traditional hospital-based aseptic techniques and education. This study aimed to determine the current state of hand hygiene practices among EMS providers and to provide recommendations for improving practices in the emergency health services environment. This study was a prospective, observational prevalence study and survey, conducted over a 2-month period. We selected participants from visits to three selected hospital emergency departments in the mid-Atlantic region. There were two data components to the study: a participant survey and hand swabs for pathogenic cultures. This study recruited a total sample of 62 participants. Overall, the study revealed that a significant number of EMS providers (77%) have a heavy bacterial load on their hands after patient care. All levels of providers had a similar distribution of bacterial load. Survey results revealed that few providers perform hand hygiene before (34%) or in between patients (24%), as recommended by the Centers for Disease Control and Prevention guidelines. This study demonstrates that EMS providers are potential vectors of microorganisms if proper hand hygiene is not performed properly. Since EMS providers treat a variety of patients and operate in a variety of environments, providers may be exposed to potentially pathogenic organisms, serving as vectors for the exposure of

  6. Psychiatric emergency "surge capacity" following acts of terrorism and mass violence with high media impact: what is required?

    Science.gov (United States)

    Claassen, Cindy; Kashner, T Michael; Kashner, Tetyana K; Xuan, Lei; Larkin, Gregory L

    2011-01-01

    Adequate preparedness for acts of terrorism and mass violence requires a thorough understanding of the postdisaster mental health needs of all exposed groups, including those watching such events from a distance. This study examined emergency psychiatric treatment-seeking patterns following media exposure to four national terrorist or mass casualty events. An event was selected for study if (a) it precipitated local front-page headlines for >5 consecutive days and (b) emergency service psychiatrists identified it as specifically precipitating help-seeking in the study hospital. Four events qualified: the Oklahoma City bombing (1995), the Columbine High School (1999) and Wedgewood Baptist Church (1999) shootings and the terrorist attacks of September 11, 2001. Time-series analyses were used to correct for autocorrelation in visit patterns during the postdisaster week, and equivalent time periods from years before and after each event were used as control years. Overall, disaster week census did not differ significantly from predisaster weeks, although 3-day nonsignificant decreases in visit rate were observed following each disaster. Treatment-seeking for anxiety-related issues showed a nonsignificant increase following each disaster, which became significant in the "all disaster" model (t=5.17; P=.006). Intensity of media coverage did not impact rate of help-seeking in any analysis. Although these sentinel US disasters varied in scope, method, geographic proximity to the study site, perpetrator characteristics, public response, sequelae and degree of media coverage, the extent to which they impacted emergency department treatment-seeking was minimal. Geographically distant mass violence and disaster events of the type and scope studied here may require only minimal mental health "surge capacity" in the days following the event. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. [Incidence of acute agitation and variation in acute agitation management by emergency services].

    Science.gov (United States)

    Casado Flórez, Isabel; Sánchez Santos, Luis; Rodríguez Calzada, Rafael; Rico-Villademoros, Fernando; Roset Arissó, Pere; Corral Torres, Ervigio

    2017-07-01

    To describe the management of acute agitation by Spanish emergency medical services (EMS) and assess the incidence of acute agitation. Observational descriptive study based on aggregate data from unpublished internal EMS reports. Seven participating emergency services received 4 306 213 emergency calls in 2013; 111 599 (2.6%, or 6.2 calls per 1000 population) were categorized as psychiatric emergencies. A total of 84 933 interventions (4.2%, or 4 per 1000 population) were required; 37 951 of the calls concerned agitated patients (1.9%, or 2 cases per 1000 population). Only 3 EMS mandated a specific procedure for their responders to use in such cases. The agitated patient is a common problem for EMS responders. Few teams apply specific procedures for managing these patients.

  8. Service innovation: a comparison of two approaches for physical screening of psychiatric inpatients.

    Science.gov (United States)

    Harrison, Mark Richard; McMillan, Catherine Frances; Dickinson, Timothy

    2012-06-01

    Psychiatric medications have clear links to obesity, diabetes, dyslipidaemia, hypertension, hyperprolactinaemia and movement disorders. These disorders are a common cause of morbidity and mortality in psychiatric patients but physical screening by health services is often haphazard. We report the findings of an audit of physical screening across two hospital wards. Each ward undertook a process of service improvement. One ward modified the admissions proforma and the other developed a discharge screening clinic. The effectiveness of each of these interventions was then compared through a reaudit of practice across both wards. At baseline, screening was performed inconsistently and infrequently. On average, the modified admissions proforma increased screening rates by 4.7% compared to 30.7% for discharge screening clinics. The discharge screening clinic demonstrated statistically significant improvements in screening rates and effectively delivered health promotion advice. Discharge screening clinics are significantly more likely than improved admissions procedures to detect clinically significant abnormalities. If these abnormalities are detected and treated then the long-term physical health of psychiatric patients may be improved.

  9. Exploring an Agenda of Accommodation and Support at a Disabilities Service Center for College Students with Psychiatric Disabilities

    OpenAIRE

    松田, 康子

    2016-01-01

    How useful are disability services in the current higher education for college students with psychiatric disabilities? The purpose of this research paper is to answer this question by exploring an agenda of accommodation and support at a disabilities service center for college students with psychiatric disabilities. Two studies were conducted using questionnaires to collect data from students (study 1) and staffs (teaching and clerical staff) (study 2) in higher education. The ...

  10. Emergence of Mobility Services in Urban China

    Institute of Scientific and Technical Information of China (English)

    Jean-Francois Doulet

    2010-01-01

    This article points out the limits of top-down strategies in China rooted in the construction of large-scale transportation facilities, primarily road networks. It helps to identify emerging trends that show a shift from a "hardware" approach, which focuses mainly on heavy in- frastructure investments, to a "software" approach, which rather relies on improving travel conditions. Based on the description of three existing mobility services that won awards in the 2010 "Better Mobility, Better Life" Prize for Innovative Urban Mobility Solutions, this article assesses these bottom-up, multi-participation strategies, and the effects of these "soft strategies" on improving travel conditions, reducing car dependency, building communities, etc. Finally, it concludes that these soft measures can contribute to the building of a harmonious society and low-carbon cities, and should receive more attention and support.

  11. Customer satisfaction measurement in emergency medical services.

    Science.gov (United States)

    Kuisma, Markku; Määttä, Teuvo; Hakala, Taisto; Sivula, Tommi; Nousila-Wiik, Maria

    2003-07-01

    The annual patient volume in emergency medical services (EMS) systems is high worldwide. However, there are no comprehensive studies on customer satisfaction for EMS. The authors report how a customer satisfaction survey on EMS patients was conducted, the results, and the possible causes for dissatisfaction. Two prospective customer satisfactions surveys were conducted in an urban EMS system. Consecutive patients treated by EMS received a postal questionnaire approximately two weeks after service. Satisfaction was measured in a scale from 1 (very poor) to 5 (excellent). Neither EMS personnel nor patients were made aware prospectively that patient satisfaction would be measured. Response rates to the surveys were 36.8% (432/1,175) in 2000 and 40.0% (464/1,150) in 2002. The mean general grades for the service were 4.6 and 4.5, respectively. Patients reported the highest degree of dissatisfaction when they were not taken to their hospital of choice, when they perceived that the paramedics were not able to meet their needs, and when paramedics did not introduce themselves or communicate directly with the patient's relatives. In high-volume calls (i.e., frequent chief complaints), the general satisfaction was highest in patients with arrhythmias, breathing difficulties, and hypoglycemia. Patients with drug overdose included the highest proportion of unsatisfied patients. None of the background variables (e.g., gender, transport decision, working shift) was statistically related to general patient satisfaction. This study shows that customer satisfaction surveys can be successfully conducted for EMS. EMS systems should consider routinely using customer satisfaction surveys as a tool for quality measurement and improvement.

  12. The appropriateness of emergency medical service responses in the ...

    African Journals Online (AJOL)

    The appropriateness of emergency medical service responses in the eThekwini district of KwaZulu-Natal, South Africa. PR Newton, R Naidoo, P Brysiewicz. Abstract. Introduction. Emergency medical services (EMS) are sometimes required to respond to cases that are later found not to be emergencies, resulting in high ...

  13. Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study.

    Science.gov (United States)

    Schön, Ulla-Karin; Grim, Katarina; Wallin, Lars; Rosenberg, David; Svedberg, Petra

    2018-12-01

    Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.

  14. 42 CFR 485.618 - Condition of participation: Emergency services.

    Science.gov (United States)

    2010-10-01

    ... Boards of Medicine and Nursing about issues related to access to and the quality of emergency services in... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Emergency services. 485.618 Section 485.618 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

  15. Financial incentives and psychiatric services in Australia: an empirical analysis of three policy changes.

    Science.gov (United States)

    Doessel, D P; Scheurer, Roman W; Chant, David C; Whiteford, Harvey

    2007-01-01

    Australia has a national, compulsory and universal health insurance scheme, called Medicare. In 1996 the Government changed the Medicare Benefit Schedule Book in such a way as to create different financial incentives for consumers or producers of out-of-hospital private psychiatric services, once an individual consumer had received 50 such services in a 12-month period. The Australian Government introduced a new Item (319) to cover some special cases that were affected by the policy change. At the same time, the Commonwealth introduced a 'fee-freeze' for all medical services. The purpose of this study is two-fold. First, it is necessary to describe the three policy interventions (the constraints on utilization, the operation of the new Item and the general 'fee-freeze'.) The new Item policy was essentially a mechanism to 'dampen' the effect of the 'constraint' policy, and these two policy changes will be consequently analysed as a single intervention. The second objective is to evaluate the policy intervention in terms of the (stated) Australian purpose of reducing utilization of psychiatric services, and thus reducing financial outlays. Thus, it is important to separate out the different effects of the three policies that were introduced at much the same time in November 1996 and January 1997. The econometric results indicate that the composite policy change (constraining services and the new 319 Item) had a statistically significant effect. The analysis of the Medicare Benefit (in constant prices) indicates that the 'fee-freeze' policy also had a statistically significant effect. This enables separate determination of the several policy changes. In fact, the empirical results indicate that the Commonwealth Government underestimated the 'savings' that would arise from the 'constraint' policy.

  16. The association between daily concentrations of air pollution and visits to a psychiatric emergency unit: a case-crossover study.

    Science.gov (United States)

    Oudin, Anna; Åström, Daniel Oudin; Asplund, Peter; Steingrimsson, Steinn; Szabo, Zoltan; Carlsen, Hanne Krage

    2018-01-10

    Air pollution is one of the leading causes of mortality and morbidity worldwide. Experimental studies, and a few epidemiological studies, suggest that air pollution may cause acute exacerbation of psychiatric disorders, and even increase the rate of suicide attempts, but epidemiological studies on air pollution in association with psychiatric disorders are still few. Our aim was to investigate associations between daily fluctuations in air pollution concentrations and the daily number of visits to a psychiatric emergency unit. Data from Sahlgrenska University Hospital, Gothenburg, Sweden, on the daily number of visits to the Psychiatric emergency unit were combined with daily data on monitored concentrations of respirable particulate matter(PM 10 ), ozone(O 3 ), nitrogen dioxides(NO 2 ) and temperature between 1st July 2012 and 31st December 2016. We used a case-crossover design to analyze data with conditional Poisson regression models allowing for over-dispersion. We stratified data on season. Visits increased with increasing PM 10 levels during the warmer season (April to September) in both single-pollutant and two-pollutant models. For example, an increase of 3.6% (95% Confidence Interval, CI, 0.4-7.0%) was observed with a 10 μg/m3 increase in PM 10 adjusted for NO 2 . In the three-pollutant models (adjusting for NO 2 and O 3 simultaneously) the increase was 3.3% (95% CI, -0.2-6.9). There were no clear associations between the outcome and NO 2 , O 3 , or PM 10 during the colder season (October to March). Ambient air particle concentrations were associated with the number of visits to the Psychiatric emergency unit in the warm season. The results were only borderline statistically significant in the fully adjusted (three-pollutant) models in this small study. The observation could be interpreted as indicative of air pollution as either exacerbating an underlying psychiatric disorder, or increasing mental distress, even in areas with comparatively low levels of

  17. Longitudinal Risk and Resilience Factors Predicting Psychiatric Disruption, Mental Health Service Utilization & Military Retention in OIF National Guard Troops

    Science.gov (United States)

    2009-04-01

    attrition over time. By learning about what predicts psychiatric problems and what hampers the use of psychiatric services, we can develop new ways to...prior to deployment. Pre-deployment alcohol use was associated with younger age, fewer years of education , being unmarried, personality, and PTSD...Research Forum . Page 16 Polusny, M. A., Erbes, C. R., Arbisi, P. A., Thuras, P., Reddy, M. K., Erickson, D., Murdoch, M., Rath, M., & Courage, C. (2008

  18. Telehone consultations: At the emergency service, Copenhagen County: Analysis of doctor-patient communication patterns

    DEFF Research Database (Denmark)

    Larsen, Jan-Helge; Risør, Ole

    1997-01-01

    Communications patterns, emergency service, out-of-hours service, telehpone consultations, video-supervision......Communications patterns, emergency service, out-of-hours service, telehpone consultations, video-supervision...

  19. Community orientation of services for persons with a psychiatric disability. Comparison between Estonia, Hungary and the Netherlands

    NARCIS (Netherlands)

    Prof. dr. Jean Pierre Wilken; Zsolt Bugarszki; Karin Hanga; Dagmar Narusson; Koidu Saia; Marju Medar

    2017-01-01

    This article explores the way mental health services and social services are orientated on assisting people with a psychiatric disability to participate in different areas of community life. A large research project about community participation in three different countries (Estonia, Hungary and the

  20. Economic Impact of Childhood Psychiatric Disorder on Public Sector Services in Britain: Estimates from National Survey Data

    Science.gov (United States)

    Snell, Tom; Knapp, Martin; Healey, Andrew; Guglani, Sacha; Evans-Lacko, Sara; Fernandez, Jose-Luis; Meltzer, Howard; Ford, Tamsin

    2013-01-01

    Background: Approximately one in ten children aged 5-15 in Britain has a conduct, hyperactivity or emotional disorder. Methods: The British Child and Adolescent Mental Health Surveys (BCAMHS) identified children aged 5-15 with a psychiatric disorder, and their use of health, education and social care services. Service costs were estimated for each…

  1. The chronic impact of work on suicides and under-utilization of psychiatric and psychosocial services.

    Science.gov (United States)

    Law, Yik Wa; Yip, Paul S F; Zhang, Yi; Caine, Eric D

    2014-10-01

    Work-related stress appears to be a contributing factor in the lives of employed people who kill themselves, particularly during economic downturns. However, few studies have compared them with working community controls who may be experiencing similar strains, in order to explore the role of mental disorders in these deaths and the implication of such strains on their service use pattern. We hypothesized that both work stress and mental illness were associated with suicides, and that mental illness served as the mediator between work stress and suicide. Based on the Behavioral Model, we also assumed work stress associated with their use of services. A sample of 175 employed individuals (suicides=63; controls=112) drawn from a psychological autopsy (PA) dataset was examined based on demographics and socioeconomic factors, psychiatric diagnoses and use of services, psychosocial factors, and life events. A mediator analysis was conducted to examine the impact of work on suicides. Suicides generally had depression and anxiety, debts, higher impulsivity and poorer social support in comparison to controls. Chronic impact from work, which was fully mediated by psychiatric illness, was found higher among those suicides that did not seek contact with clinical service providers. PA is a post-hoc cross-sectional comparison method which does not allow causal analyses. It is important to develop new approaches for engaging vulnerable individuals in the workplace before they become suicidal, as their depression and social isolation can serve to cut them off from help when they are most in need. Occupational mental health programs should be made available for employees and their families. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Emerging psychiatric syndromes associated with antivoltage-gated potassium channel complex antibodies.

    Science.gov (United States)

    Prüss, Harald; Lennox, Belinda R

    2016-11-01

    Antibodies against the voltage-gated potassium channel (VGKC) were first recognised as having a potential pathogenic role in disorders of the central nervous system in 2001, with VGKC antibodies described in patients with limbic encephalitis, and the subsequent seminal paper describing the clinical phenotype and immunotherapy treatment responsiveness in 13 patients with VGKC antibodies and limbic encephalitis in 2004. These initial case descriptions were of a progressive neuropsychiatric syndrome with abnormalities of mood, sleep and cognition recognised alongside the neurological symptoms of seizures and autonomic instability. The clinical syndromes associated with VGKC complex (VGKCC) antibodies have broadened considerably over the last 15 years, with multiple cases of more restricted 'formes fruste' presentations associated with VGKCC antibodies being described. However, the relevance of antibodies in these cases has remained controversial. The understanding of the pathogenic nature of VGKC antibodies has further advanced since 2010 with the discovery that VGKC antibodies are not usually antibodies against the VGKC subunits themselves, but instead to proteins that are complexed with the potassium channel, in particular leucine-rich, glioma-inactivated protein 1 (LGI1) and contactin-associated protein 2 (Caspr2). Antibodies against these proteins have been associated with particular, although overlapping, clinical phenotypes, each also including neuropsychiatric features. Our aim is to critically review the association between VGKCC, LGI1 and Caspr2 antibodies with isolated psychiatric presentations-with a focus on cognitive impairment, mood disorders and psychosis. We recommend that screening for VGKCC, LGI1 and Caspr2 antibodies be considered for those with neuropsychiatric presentations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  3. Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department: a comparison with routine attenders.

    Science.gov (United States)

    Williams, E R; Guthrie, E; Mackway-Jones, K; James, M; Tomenson, B; Eastham, J; McNally, D

    2001-03-01

    Seventy-seven frequent attenders at an emergency department (ED) in an inner-city hospital in the UK (defined as seven or more visits in the previous 12 months) were compared with 182 patients who were attending the same department on a routine basis. Patients completed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Short Form (SF)-36. Information was obtained on 64% of the frequent attenders and 45% underwent a detailed psychiatric assessment. Of the frequent attenders, 45% had psychiatric disorder and 49% had some form of an alcohol-related disorder. Compared with routine attenders, frequent attenders reported lower health status, had more psychiatric disorder (odds ratio: OR=8.2, 95% confidence interval: CI=3.8--18.1), had more general hospital admissions (OR=19.9, 95% CI=8.3--47.8), more psychiatric admissions (OR=167.5, 95% CI=9.5--2959.0), and more GP visits (95% CI for difference=-10.2 to -5.7). There was no evidence that frequent attenders had more somatisation than routine attenders. Specific treatment and management strategies need to be developed for this group of patients, although a substantial proportion may be difficult to engage in the treatment process.

  4. The service needs of mothers with schizophrenia: a qualitative study of perinatal psychiatric and antenatal workers.

    Science.gov (United States)

    Wan, Ming Wai; Moulton, Steff; Abel, Kathryn M

    2008-01-01

    The study sought to (1) understand the perspectives of perinatal psychiatric and antenatal health service workers on the service and support needs of mothers with schizophrenia; (2) obtain their views on the feasibility and potential effectiveness of a proposed parenting intervention tailored for this group. Twenty-eight perinatal psychiatry and antenatal service workers were interviewed using a semi-structured methodology, and anonymised verbatim transcripts analysed for content themes. Many respondents felt that women with schizophrenia received insufficient postnatal support. Perceived needs were: support with adjustment/coping; parenting skills and sensitivity training; maintaining mental health; continuity of care and community support; and encouraging bonding. Service integration/continuity and social stigma were recurring themes that impacted on recommendations, such as the need for interdisciplinary communication and mental health education for midwives. The parenting program was generally well received, although many raised concerns regarding patient involvement and specific intervention characteristics. The views of health workers are a valuable complement to the service user perspective. They highlight the needs of this high-risk group in their transition to motherhood, and how they might be met, as well as a need for staff training so that parenting interventions are better understood as positive prevention work.

  5. Health Services Utilization Patterns Associated with Emergency Department Closure

    DEFF Research Database (Denmark)

    Hansen, Kristian Schultz; Enemark, Ulrika; Foldspang, Anders

    2011-01-01

    , 1997-2003. Data were extracted from administrative registries including information on individual use of emergency services and other hospital care, contact with GPs and socioeconomic background. Health services' use by the Morsø population was measured before reduction in emergency room opening hours...... of substitute health services. By contrast, Morsø women compared to the rest of Viborg county reduced their use of GP services in terms of face-to-face visits (β = -0.08, P = 0.020), telephone consultations (β = -0.11, P = 0.007), home visits (β = -0.48, P = 0.009), and their inpatient hospital utilization (β...... = -0.12, P = 0.022) during the period when emergeny services were only available in the daytime. CONCLUSIONS: Emergency services at neighbouring hospitals (40 kilometres distance) were able to compensate, in part, for the decreased local emergency service provision. Concurrent changes in health care...

  6. Treatment needs, diagnoses and use of services for acutely admitted psychiatric patients in northwest Russia and northern Norway

    Directory of Open Access Journals (Sweden)

    Sørgaard Knut W

    2013-01-01

    Full Text Available Abstract Background We compared demography, diagnoses and clinical needs in acutely admitted psychiatric hospital patients in northwest Russia and northern Norway. Method All acutely admitted psychiatric patients in 1 psychiatric hospital in north-west Russia and 2 in northern Norway were in a three months period assessed with HoNOS and a Norwegian form developed to study acute psychiatric services (MAP. Data from a total of 841 patients were analysed (377 Norwegian, 464 Russian with univariate and multivariate statistics. Results Russian patients were more often males who had paid work. 2/3 were diagnosed with alcohol and organic disorders, and 70% reported problems related to sleep. Depression was widespread, as were problems associated with occupation. Many more Norwegian patients were on various forms of social security and lived in community supported homes. They had a clinical profile of affective disorders, use of drugs, suicidality and problems with activities involved of daily life. Slightly more Norwegian patients were involuntary admitted. Conclusion Acutely admitted psychiatric patients in North West Russia and Northern Norwegian showed different clinical profiles: alcohol, depression and organic disorders characterised Russian patients, affective disorders, suicidality and use of drugs characterised the Norwegians. Whereas Norwegian patients are mainly referred from GPs the Russians come via 1.line psychiatric services (“dispensaries”. Average length of stay for Russian patients was 2.5 times longer than that of the Norwegian.

  7. Servant Leadership Theory and the Emergency Services Student

    Science.gov (United States)

    Russell, Eric James

    2014-01-01

    This present case study explores the influence a servant leadership class had on a group of emergency service students' understanding of the roles and characteristics of a leader. The setting for the study was a state university in the Western United States. The six participants were undergraduate emergency services majors that underwent a 15-week…

  8. Psychiatric assessment of suicide attempters in Japan: a pilot study at a critical emergency unit in an urban area

    Directory of Open Access Journals (Sweden)

    Kishida Ikuko

    2007-11-01

    Full Text Available Abstract Background The incidence of suicide has increased markedly in Japan since 1998. As psychological autopsy is not generally accepted in Japan, surveys of suicide attempts, an established risk factor of suicide, are highly regarded. We have carried out this study to gain insight into the psychiatric aspects of those attempting suicide in Japan. Methods Three hundred and twenty consecutive cases of attempted suicide who were admitted to an urban emergency department were interviewed, with the focus on psychosocial background and DSM-IV diagnosis. Moreover, they were divided into two groups according to the method of attempted suicide in terms of lethality, and the two groups were compared. Results Ninety-five percent of patients received a psychiatric diagnosis: 81% of subjects met the criteria for an axis I disorder. The most frequent diagnosis was mood disorder. The mean age was higher and living alone more common in the high-lethality group. Middle-aged men tended to have a higher prevalence of mood disorders. Conclusion This is the first large-scale study of cases of attempted suicide since the dramatic increase in suicides began in Japan. The identification and introduction of treatments for psychiatric disorders at emergency departments has been indicated to be important in suicide prevention.

  9. Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services.

    Science.gov (United States)

    Brookman-Frazee, Lauren; Stadnick, Nicole; Chlebowski, Colby; Baker-Ericzén, Mary; Ganger, William

    2017-09-01

    Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.

  10. A Longitudinal Analysis of the Influence of a Peer Run Warm Line Phone Service on Psychiatric Recovery.

    Science.gov (United States)

    Dalgin, Rebecca Spirito; Dalgin, M Halim; Metzger, Scott J

    2018-05-01

    This article focuses on the impact of a peer run warm line as part of the psychiatric recovery process. It utilized data including the Recovery Assessment Scale, community integration measures and crisis service usage. Longitudinal statistical analysis was completed on 48 sets of data from 2011, 2012, and 2013. Although no statistically significant differences were observed for the RAS score, community integration data showed increases in visits to primary care doctors, leisure/recreation activities and socialization with others. This study highlights the complexity of psychiatric recovery and that nonclinical peer services like peer run warm lines may be critical to the process.

  11. Integrated Specialized Early-Course Psychosis Treatment Services - University Psychiatric Hospital Vrapce Model.

    Science.gov (United States)

    Ostojić, DraŽenka; Čulo, Ilaria; Silić, Ante; Kos, Suzana; Savić, Aleksandar

    2018-06-01

    First episode of psychosis presents a critical period in terms of numerous associated risks, but also possibilities for effective therapeutic interventions. There is a continued focus on early interventions in prodromal states and early course of frank psychosis, aimed at ensuring faster remission, reducing relapses, achieving better long-term functioning, and preventing adverse outcomes linked to untreated psychosis and chronic psychotic disorders. A number of different specialized treatment models and services exist trying to close knowledge gaps and provide clinical interventions to first-episode psychosis (FEP) patients, but there is still no generally accepted standard of care informing our every-day practice. FEP and early-course psychosis specialized treatment model developed in 2004 in University Psychiatric Hospital Vrapce rests on integration of care across different organization units and clinical presentation acuity levels and patient needs (intensive care, FEP inpatient unit, FEP outpatient services including day hospital). Such integration of FEP services allows for flexible entry point on multiple levels, earlier structuring of therapeutic alliance for those requiring inpatient care, reduction of risks associated with FEP, quicker formation of long-term treatment plans, reduction of delay in accessing specialized services, and a more coordinated diagnostic process and recruitment of FEP patient population. Detailed evaluations of outcomes and comparisons with different treatment models are necessary in order to assess strengths and weaknesses of each specific model and inform modifications to current practice models.

  12. Client evaluation of a specialist inpatient parent-infant psychiatric service.

    Science.gov (United States)

    Nair, Revi; Bilszta, Justin; Salam, Nilam; Shafira, Nadia; Buist, Anne

    2010-12-01

    The aim of this paper was to collect feedback on a specialist parent-infant psychiatric service in terms of client satisfaction with inpatient treatment, and the impact on health outcomes of providing written information about available support options in the community following discharge. Women (n = 37) from consecutive admissions between January 2006 and December 2007 were contacted by telephone and administered a service quality evaluation questionnaire. Women were happy with the quality of inpatient care provided but suggested areas of improvement included continuity of staff during the inpatient stay and better communication between inpatient and outpatient services post-discharge. At discharge, women were not confident with their ability in coping with motherhood but confidence with parenting skills increased post-discharge. Use of recommended post-discharge community support and/or health services was poor. As adherence with discharge recommendations was less than ideal, greater involvement of primary/community health care professionals, and active participation of clients and carers, in discharge planning is required. Increased emphasis on the practical skills of motherhood as well as opportunities to develop the mother-infant relationship may assist mothers in gaining confidence to interact with their baby and pick up infant cues.

  13. Shared care between specialised psychiatric services and primary care: The experiences and expectations of General Practitioners in Ireland.

    LENUS (Irish Health Repository)

    Agyapong, Vincent Israel Opoku

    2012-04-17

    Objective. The study aims to explore the views of General Practitioners in Ireland on shared care between specialised psychiatric services and primary care. Method. A self-administered questionnaire was designed and posted to 400 randomly selected General Practitioners working in Ireland. Results. Of the respondents, 189 (94%) reported that they would support a general policy on shared care between primary care and specialised psychiatric services for patients who are stable on their treatment. However, 124 (61.4%) reported that they foresaw difficulties for patients in implementing such a policy including: a concern that primary care is not adequately resourced with allied health professionals to support provision of psychiatric care (113, 53.2%); a concern this would result in increased financial burden on some patients (89, 48.8%); a lack of adequate cooperation between primary care and specialised mental health services (84, 41.8%); a concern that some patients may lack confidence in GP care (55, 27.4%); and that primary care providers are not adequately trained to provide psychiatric care (29, 14.4% ). Conclusion. The majority of GPs in Ireland would support a policy of shared care of psychiatric patients; however they raise significant concerns regarding practical implications of such a policy in Ireland.

  14. Profiles of referrals to a psychiatric service: a descriptive study of survivors of the Nairobi US Embassy terrorist bomb blast.

    Science.gov (United States)

    Ndetei, D M; Omar, A; Mutiso, V N; Ongecha, F A; Kokonya, D A

    2009-11-01

    To document the socio-demographic characteristics and psychiatric profiles of the survivors of the Nairobi United States Embassy terrorist bomb blast referred to a psychiatric and psychotherapy (counselling) service. This was a descriptive cross-sectional study. Clinical interviews and structured questionnaires for post-traumatic stress disorder (PTSD) and stress were administered. Survivors of the bomb blast referred to a psychiatric and psychotherapy service one year or more after the bombing were included in the study. These survivors had been treated using psychopharmacotherapy and individualised (not group) therapy/counselling. Eighty-three consecutive referrals to a psychiatric service participated in this study. There were more males and the sample was generally well educated. The referrals made contact with the referring agency for a number of reasons including seeking psychological, financial and medical assistance. All the patients reported varying degrees of psychiatric symptoms and functional impairment on various aspects of social occupational functioning. High scores for PTSD and other related stress were recorded one or more years after the bombing. Although the survivors indicated that initial counselling following the blast had helped them, they still scored high on PTSD suggesting that clinically, the initial counselling had little, if any impact on the development of PTSD. There is need for a holistic approach to the management of psychotrauma in individuals.

  15. Testing a user-driven approach in health promotion activities targeting users of psychiatric services

    DEFF Research Database (Denmark)

    Folmann Hempler, Nana; Saurbrey Pals, Regitze; Oest, Lone

    2017-01-01

    Compared to the general population, users of psychiatric services (users) are at higher risk of developing type 2 diabetes, which is associated with lifestyle behaviours. The aim of this study was to pilot test a new collaborative approach in health promotion targeting users. The approach is based...... with course participants and users. Professionals had to test at least one tool in a health promoting activity such as health checks, exercise etc. Data were collected through observations of health promoting activities (n=15) and questionnaires (n=54). Data were analysed using systematic text condensation...... and descriptive statistics. The majority of professionals found that the new approach to a moderate/high degree had improved their collaborative skills (89.3%) and Research Center of Health Promotionwas well-suited for their practice (93.5%). Observations showed that professionals successfully integrated...

  16. [Legal aspects of delegation and reorganisation of medical services in the psychiatric field].

    Science.gov (United States)

    Jordan, Wolfgang; Adler, Lothar; Bleich, Stefan; Cohrs, Stefan; von Einsiedel, Regina; Falkai, Peter; Grosskopf, Volker; Hauth, Iris; Steiner, Johann

    2011-11-01

    Current psychiatric-psychotherapeutic in-patient care takes place in an area of tension between increasing treatment requirements and the persistent lack of qualified staff. The optimisation of the diagnostic-therapeutic procedures in a clinic helps to reduce existing care deficits or to generate resources for future developments. The subject of delegation and substitution of medical services is considered in this context. Inadequate knowledge of the legal situation on the part of the decision makers impairs the indispensable trustful cooperation among the professions and adds to the uncertainty of all those concerned. The present paper outlines the legal, organisational and health policy aspects of delegation and the reorganisation of medical activities in the field of psychiatry. © Georg Thieme Verlag KG Stuttgart · New York.

  17. An audit of urgent referrals by the Procurator Fiscal to the Tayside Forensic Psychiatric Service.

    Science.gov (United States)

    White, T; Rutherford, H

    2005-10-01

    This study describes the demographic, offence and diagnostic characteristics of subjects referred by the Procurators Fiscal operating from three courts in Tayside, Scotland. A comparison is made of referrals made between 1988 to 1995 and 1997 to 1998. There was an increased rate of referral on an urgent basis over time, primarily involving patients already in contact with the psychiatric services, 37% of whom were detained and admitted to hospital. This urgent assessment ensured that mentally-disordered offenders were not remanded in custody simply for the preparation of a report, and it allowed an early assessment to be made regarding the suitability for diversion from prosecution. This outcome is compatible with guidelines issued by the Home Office in 1990 (Home Office, 1990).

  18. Inovasi Manajemen Pelayanan Publik Tim Emergency Service Kabupaten Bantaeng

    OpenAIRE

    Tamimi, Zindar

    2015-01-01

    Bantaeng an area that small territory, small population, small local revenues, frequent natural disasters, and frequent cases of fatal such as maternal mortality. To overcome this situation Local Government made Emergency Service Team. Emergency Service Teams provide services in new ways, namely by finding and serving the community in a proactive and integrated. This study uses exploratif qualitative method. Data collection techniques in research using interviews, observation, and documentati...

  19. Emergency Department Referrals for Adolescent Urgent Psychiatric Consultation: Comparison of Clinical Characteristics of Repeat-presentations and Single-presentation.

    Science.gov (United States)

    Roberts, Nasreen; Nesdole, Robert; Hu, Tina

    2018-01-01

    a) to examine the demographic and clinical characteristics of repeat-presentations to an adolescent urgent psychiatric clinic, and b) to compare them with single-time presentation. This 18-month retrospective study compared repeat-presenters to age and gender matched single-time presenters. Demographic variables included age gender and ethnicity. Clinical variables included reason for referral, family history, diagnosis, recommendations and compliance. Data were analyzed using descriptive statistics, McNemar's Chi-square tests for matched pairs, and conditional logistic regression. Of 624 assessments 24% (N=151) were repeat-presentations. Compared with single-presentation, repeat-presentation group had a higher proportion of Aboriginal youth (X2 (1) = 108.28 p presentation group had higher odds of past hospital admission (OR: 3.50, p presentations for urgent psychiatric consultation constitute a quarter of referrals to the urgent psychiatric clinic. Identifying and addressing factors that contribute to repeat-presentations may, assist in improving treatment compliance by ensuring focused interventions and service delivery for these youth. In turn, this will improve access to the limited urgent services for other youth.

  20. The crisis in United States hospital emergency services.

    Science.gov (United States)

    Harrison, Jeffrey P; Ferguson, Emily D

    2011-01-01

    Emergency services are critical for high-quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (U.S.) acute care hospital staffs ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers. Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities. U.S. acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, U.S. emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staffs ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state-of-the-art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement. This research uses the AHA annual surveys,which represent self-reported data by individual hospital staff. However, the AHA expendssignificant resources to validate reported information and the annual survey data are widely used for hospital research. The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure. This article has important information on US emergency service availability in the hospital industry.

  1. [Educational guidance for families with mentally ill parents: a bridge between youth welfare services and psychiatric care system].

    Science.gov (United States)

    Schrappe, Andreas

    2013-01-01

    In the last fifteen years a lot of services were established to assist children and their mentally ill parents. To improve the preventive and therapeutic interventions in favour of these families, the cooperation between all the institutions involved has to be enhanced. Family counselling centers can play an important role as a link between the psychiatric care system and the youth welfare services. By transferring the psychiatric terminology to the families' everyday language, the counsellors help the parents and the children to share their experiences with the parental illness. To implement a consultation-hour in a psychiatric clinic is an example of how educational guidance can close the gap between the two systems and strengthen the cooperation.

  2. Human trafficking and severe mental illness: an economic analysis of survivors' use of psychiatric services.

    Science.gov (United States)

    Cary, Maria; Oram, Siân; Howard, Louise M; Trevillion, Kylee; Byford, Sarah

    2016-07-19

    Previous studies have found a high prevalence of depression and post-traumatic stress disorder (PTSD) among survivors of human trafficking. European countries are required to assist trafficked people in their psychological recovery, but there are no rigorous data on the costs of doing so. The objectives of this study were to quantify the use of secondary mental health services by survivors of human trafficking; to estimate the cost of survivors' use of secondary mental health services provided by the UK National Health Service (NHS); and to identify factors that predict higher costs of mental health service provision. Historical cohort study of psychiatric patients who had experienced human trafficking. The South London and Maudsley NHS Trust (SLaM) Biomedical Research Centre Case Register Interactive Search (CRIS) database was used to identify anonymised full patient records of patients who had experienced human trafficking and who had accessed SLaM mental health services between 2007 and 2012. Data were extracted on socio-demographic and trafficking characteristics and contacts with mental health services. Total costs were calculated by multiplying each resource use item by an appropriate unit cost. Factors that predicted high mental health service costs were analysed using regression models. One hundred nineteen patients were included in the analysis. Mean total mental health service costs per patient were £27,293 (sd 80,985) and mean duration of contact with services was 1490 (sd 757) days (approximately 4 years). Regression analysis showed that higher costs were associated with diagnosis of psychotic disorder (p trafficking violence (p = 0.06). Patients diagnosed with psychotic disorders cost approximately £32,635 more than patients with non-psychotic disorders/psychological distress but no formal diagnosis and patients whose clinical notes documented pre-trafficking violence cost £88,633 more than patients for whom pre-trafficking violence was not

  3. Involuntary psychiatric attendances at an Australasian emergency department: A comparison of police and health-care worker initiated presentations.

    Science.gov (United States)

    Llewellin, Peter; Arendts, Glenn; Weeden, Jacqueline; Pethebridge, Andrew

    2011-10-01

    To identify any significant differences in the population of patients brought in to a hospital ED under involuntary mental health orders, based on whether the orders are initiated by police or health professionals. A retrospective analysis of consecutive presentations to a tertiary hospital ED with a co-located psychiatric emergency care centre over a 12 month period, with univariate and multivariate statistical comparisons. Two hundred and eighty-two patients (making 378 ED presentations) met the case definition and were analysed. Compared with patients on medical orders, patients on police orders had significantly more presentations related to violence, longer stays in ED and lower rates of admission to an inpatient bed, but were no more likely to require restraint or security intervention within the ED. Patients on police and medical orders differ considerably, but the impact of these differences on ED workload is small. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  4. Substance Use Disorders in Elderly Admissions to an Academic Psychiatric Inpatient Service over a 10-Year Period

    Directory of Open Access Journals (Sweden)

    Dennis Dombrowski

    2016-01-01

    Full Text Available Objective. There is a paucity of research on substance use disorders (SUDs in the elderly psychiatric population. This study examines SUDs in a geriatric psychiatry inpatient service over a 10-year period. Methods. Data from 1788 elderly psychiatric inpatients from a ten-year period was collected. Variables collected included psychiatric diagnoses, SUD, number of psychiatric admissions, and length of stay. Those with and without a SUD were compared using Chi-Square or Student’s t-test as appropriate using SPSS. Results. 11.7% (N=210 of patients had a SUD, and the most common substance was alcohol at 73.3% (N=154 or 8.6% of all admissions. Other SUDs were sedative-hypnotics (11%, opiate (2.9%, cannabis (1%, tobacco (1.4%, and unspecified SUD (38.6%. SUD patients were significantly younger, divorced, male, and less frequently readmitted and had shorter lengths of stay. The most common comorbid diagnoses were major depression (26.1%, bipolar disorder (10.5%, and dementia (17.1%. Conclusions. Over 10% of psychogeriatric admissions were associated with a SUD, with alcohol being the most common. Considering the difficulties in diagnosing SUD in this population and the retrospective study design, the true prevalence in elderly psychiatric inpatients is likely higher. This study adds to sparse literature on SUD in elderly psychiatric patients.

  5. Assessment of the Acute Psychiatric Patient in the Emergency Department: Legal Cases and Caveats

    Science.gov (United States)

    2014-05-01

    paranoid behavior. Notable in his evaluation were a blood alcohol level (BAL) of 0.203% and a positive urine screen for marijuana . The EP and social worker...1994; 24(4):672–677. 7. Dubin WR, Weiss KJ, Zeccardi JA. Organic brain syndrome: The psychiatric imposter. JAMA. 1993;249(1):60–62. 8. Tintinalli JE

  6. American Association for Emergency Psychiatry Task Force on Medical Clearance of Adult Psychiatric Patients. Part II: Controversies over Medical Assessment, and Consensus Recommendations

    Directory of Open Access Journals (Sweden)

    Michael P. Wilson

    2017-05-01

    Full Text Available Introduction: The emergency medical evaluation of psychiatric patients presenting to United States emergency departments (ED, usually termed “medical clearance,” often varies between EDs. A task force of the American Association for Emergency Psychiatry (AAEP, consisting of physicians from emergency medicine, physicians from psychiatry and a psychologist, was convened to form consensus recommendations for the medical evaluation of psychiatric patients presenting to U.S.EDs. Methods: The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED and then combined this with expert consensus. Consensus was achieved by group discussion as well as iterative revisions of the written document. The document was reviewed and approved by the AAEP Board of Directors. Results: Eight recommendations were formulated. These recommendations cover various topics in emergency medical examination of psychiatric patients, including goals of medical screening in the ED, the identification of patients at low risk for co-existing medical disease, key elements in the ED evaluation of psychiatric patients including those with cognitive disorders, specific language replacing the term “medical clearance,” and the need for better science in this area. Conclusion: The evidence indicates that a thorough history and physical examination, including vital signs and mental status examination, are the minimum necessary elements in the evaluation of psychiatric patients. With respect to laboratory testing, the picture is less clear and much more controversial.

  7. American Association for Emergency Psychiatry Task Force on Medical Clearance of Adult Psychiatric Patients. Part II: Controversies over Medical Assessment, and Consensus Recommendations.

    Science.gov (United States)

    Wilson, Michael P; Nordstrom, Kimberly; Anderson, Eric L; Ng, Anthony T; Zun, Leslie S; Peltzer-Jones, Jennifer M; Allen, Michael H

    2017-06-01

    The emergency medical evaluation of psychiatric patients presenting to United States emergency departments (ED), usually termed "medical clearance," often varies between EDs. A task force of the American Association for Emergency Psychiatry (AAEP), consisting of physicians from emergency medicine, physicians from psychiatry and a psychologist, was convened to form consensus recommendations for the medical evaluation of psychiatric patients presenting to U.S.EDs. The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED and then combined this with expert consensus. Consensus was achieved by group discussion as well as iterative revisions of the written document. The document was reviewed and approved by the AAEP Board of Directors. Eight recommendations were formulated. These recommendations cover various topics in emergency medical examination of psychiatric patients, including goals of medical screening in the ED, the identification of patients at low risk for co-existing medical disease, key elements in the ED evaluation of psychiatric patients including those with cognitive disorders, specific language replacing the term "medical clearance," and the need for better science in this area. The evidence indicates that a thorough history and physical examination, including vital signs and mental status examination, are the minimum necessary elements in the evaluation of psychiatric patients. With respect to laboratory testing, the picture is less clear and much more controversial.

  8. Emergências psiquiátricas na infância e adolescência Psychiatric emergencies in childhood and adolescence

    Directory of Open Access Journals (Sweden)

    Sandra Scivoletto

    2010-10-01

    Full Text Available OBJETIVO: A prevalência de transtornos psiquiátricos na infância/adolescência é de 10-15%. As causas mais frequentes de atendimentos psiquiátricos emergenciais nesta faixa etária são: alterações de comportamento sem diagnóstico estabelecido, comportamento suicida e depressão. O objetivo deste estudo é apresentar os principais aspectos clínicos e orientar a conduta inicial das emergências psiquiátricas na infância/adolescência. MÉTODO: Artigo de revisão não-sistemática. RESULTADOS: São apresentados aspectos clínicos relevantes para a avaliação psiquiátrica emergencial de crianças/adolescentes. As apresentações clínicas são divididas em grupos de sintomas relevantes, tanto por sua frequência, quanto pelo impacto para o paciente e sua família. Assim, são apresentadas as seguintes síndromes clínicas: comportamento agressivo, intoxicações, comportamento suicida, psicoses, transtornos ansiosos, transtornos alimentares e maus-tratos contra a crianças/adolescente. É descrita a conduta inicial recomendada para cada uma destas condições. CONCLUSÃO: Emergências psiquiátricas na infância/adolescência podem ser a reagudização ou a primeira manifestação de um transtorno psiquiátrico. A avaliação emergencial tem como objetivo identificar o diagnóstico, os riscos para a criança/adolescente, os fatores desencadeantes e mantenedores, e a presença de suporte familiar e social.OBJECTIVE: The prevalence of psychiatric disorders in childhood/adolescence is of 10-15%.The most frequent causes of psychiatric emergence attendances in this age are: behavioral disturbances, suicidal behavior, and depression.The objective of this study is to present themost relevant clinical issues and to guide the initial procedures of psychiatric emergencies in childhood/adolescence. METHOD: Non-systematic review. RESULTS: Relevant clinical issues for psychiatric emergency evaluation of children/adolescents are presented. Clinical

  9. Assessing the physical service setting: a look at emergency departments.

    Science.gov (United States)

    Steinke, Claudia

    2015-01-01

    To determine the attributes of the physical setting that are important for developing a positive service climate within emergency departments and to validate a measure for assessing physical service design. The design of the physical setting is an important and contributing factor for creating a service climate in organizations. Service climate is defined as employee perceptions of the practices, procedures, and behaviors that get rewarded, supported, and expected with regard to customer service and customer service quality. There has been research conducted which identifies antecedents within organization that promotes a positive service climate which in turn creates service-oriented behaviors by employees toward clients. The antecedent of the physical setting and its impact on perceptions of service climate has been less commonly explored. Using the concept of the physical service setting (which may be defined as aspects of the physical, built environment that facilitate the delivery of quality service), attributes of the physical setting and their relationship with service climate were explored by means of a quantitative paper survey distributed to emergency nurses (n = 180) throughout a province in Canada. The results highlight the validity and reliability of six scales measuring the physical setting and its relation to service. Respondents gave low ratings to the physical setting of their departments, in addition to low ratings of service climate. Respondents feel that the design of the physical setting in the emergency departments where they work is not conducive to providing quality service to clients. Certain attributes of the physical setting were found to be significant in influencing perceptions of service climate, hence service quality, within the emergency department setting. © The Author(s) 2015.

  10. Inpatient forensic-psychiatric care: Legal frameworks and service provision in three European countries.

    Science.gov (United States)

    Edworthy, Rachel; Sampson, Stephanie; Völlm, Birgit

    2016-01-01

    Laws governing the detention and treatment of mentally disordered offenders (MDOs) vary widely across Europe, yet little information is available about the features of these laws and their comparative advantages and disadvantages. The purpose of this article is to compare the legal framework governing detention in forensic psychiatric care in three European countries with long-established services for MDOs, England, Germany and the Netherlands. A literature review was conducted alongside consultation with experts from each country. We found that the three countries differ in several areas, including criteria for admission, review of detention, discharge process, the concept of criminal responsibility, service provision and treatment philosophy. Our findings suggest a profound difference in how each country relates to MDOs, with each approach contributing to different pathways and potentially different outcomes for the individual. Hopefully making these comparisons will stimulate debate and knowledge exchange on an international level to aid future research and the development of best practice in managing this population. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Bilingual children referred for psychiatric services: associations of language disorders, language skills, and psychopathology.

    Science.gov (United States)

    Toppelberg, Claudio O; Medrano, Laura; Peña Morgens, Liana; Nieto-Castañon, Alfonso

    2002-06-01

    To investigate (1) the prevalence of language deficits and disorders and (2) the relationship of bilingual language skills and psychopathology, in Spanish-English bilingual children referred for child and adolescent psychiatry services. Bilingual language skills, emotional/behavioral problems, sociodemographics, immigration variables, and nonverbal IQ were studied in 50 consecutively referred children. Estimated prevalence was high for language deficits (48%) and disorders (41%), with most cases (>79%) being of the mixed receptive-expressive type. In children with clinically significant emotional/behavioral problems, bilingual language skills were strongly and inversely correlated with problem scores, particularly global problems (r = -0.67, p or = -0.54; p language disorders and delays and (2) the close tie between poor language skills and emotional/behavioral problems. The data strongly suggest the clinical importance and feasibility of language assessment and the significance of receptive problems in bilingual children referred for psychiatric services. A safe approach is to fully assess language skills, rather than misattributing these children's language delays to normal bilingual acquisition processes.

  12. Air ambulance services--integrated emergency care.

    Science.gov (United States)

    Ferdinand, M

    1994-10-01

    In the name of cost-conscious care, air ambulance program directors and service contractors are seeing the dawn of integrated networks as a boon to their business. As integrated networks form, facilities will become increasingly specialized in the types of services they provide. Patients will need to be moved around the system, resulting in more frequent patient transport and more points of transfer. Many programs are considering aircraft replacement and additions, rather than leasing. Financial benefits could come on depreciation and the high resale value of aircraft. Unless reimbursement levels increase, more program mergers and affiliations may take place to spread and reduce cost. Air ambulance services will increasingly become part of a facility's strategic plan.

  13. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    OpenAIRE

    Langabeer, James R.; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-01-01

    Introduction Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. T...

  14. The appropriateness of emergency medical service responses in the ...

    African Journals Online (AJOL)

    2015-10-10

    Oct 10, 2015 ... in the eThekwini district of KwaZulu-Natal, South Africa ... Rescue, Faculty of Health Sciences, Durban University of Technology, South Africa ... Emergency medical services (EMS) are sometimes required to respond to cases ...

  15. Achievements in emergency medical rescue service, North-West ...

    African Journals Online (AJOL)

    2006-08-28

    Aug 28, 2006 ... In North-West province this process of provincialisation took place in ... Emergency Medical Rescue Service, Department of Health, North-West. Victor R .... recovery after CPR treatment should be started as soon as possible ...

  16. NIOSH Mobile Emergency Medical Service (EMS) Work Environment Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — The NIOSH Mobile Emergency Medical Service (EMS) Work Environment Laboratory is a 2005 Wheeled Coach Type III ambulance mounted on a Ford E-450 cut-away van chassis....

  17. Engagement-focused care during transitions from inpatient and emergency psychiatric facilities

    Directory of Open Access Journals (Sweden)

    Velligan DI

    2017-05-01

    Full Text Available Dawn I Velligan, Megan M Fredrick, Cynthia Sierra, Kiley Hillner, John Kliewer,† David L Roberts, Jim MintzDepartment of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, TX, USA†Dr John Kliewer passed away on April 5, 2017 Objectives: As many as 40% of those with serious mental illness (SMI do not attend any outpatient visits in the 30 days following discharge. We examined engagement-focused care (EFC versus treatment as usual in a university-based transitional care clinic (TCC with a 90-day program serving individuals with SMI discharged from hospitals and emergency rooms. EFC included a unique group intake process (access group designed to get individuals into care rapidly and a shared decision-making coach.Methods: Assessments of quality of life, symptomatology, and shared decision-making preferences were conducted at baseline, at 3 months corresponding to the end of TCC treatment and 6 months after TCC discharge. Communication among the patients and providers was assessed at each visit as was service utilization during and after TCC.Results: Subjective quality of life improved in EFC. Prescribers and patients saw communication more similarly as time went on. Ninety-one percent of patients wanted at least some say in decisions about their treatment.Conclusions: SDM coaching and improved access improve quality of life. Most people want a say in treatment decisions. Keywords: shared decision making, mental illness, community mental health, patient education

  18. 47 CFR 25.284 - Emergency Call Center Service.

    Science.gov (United States)

    2010-10-01

    ... mobile satellite service to end-user customers (part 25, subparts A-D) must provide Emergency Call Center... Center personnel must determine the emergency caller's phone number and location and then transfer or otherwise redirect the call to an appropriate public safety answering point. Providers of mobile satellite...

  19. Utilization of psychiatric services by female military personnel changes since admission of women to all German Armed Forces military careers.

    Science.gov (United States)

    Zimmermann, Peter; Ströhle, Andreas; Langner, Franziska; Lanczik, Mario

    2010-07-01

    In 2001, women were admitted to all military careers in the German Armed Forces. This study examines whether the utilization of psychiatric services of female military personnel has changed since then. The central medical database of German military personnel for the years 2000 and 2006 was analyzed. Between 2000 and 2006, the percentage (based on the average totals of male and female military personnel) of consultations of primary care unit surgeons for psychiatric problems increased significantly for both male and female military personnel, this increase being more apparent for women than for men. Stress-related disorders showed the greatest rise. In 2006, as opposed to 2000, the total proportion of both outpatient and inpatient mental health treatment provided to female military personnel was significantly higher than for males, particularly regarding stress-related, affective and personality disorders. Gender-specific aspects should be considered more intensely in preventive and therapeutic psychiatric supply in the German Armed Forces.

  20. Nursing service innovation: A case study examining emergency nurse practitioner service sustainability.

    Science.gov (United States)

    Fox, Amanda; Gardner, Glenn; Osborne, Sonya

    2018-02-01

    This research aimed to explore factors that influence sustainability of health service innovation, specifically emergency nurse practitioner service. Planning for cost effective provision of healthcare services is a concern globally. Reform initiatives are implemented often incorporating expanding scope of practice for health professionals and innovative service delivery models. Introducing new models is costly in both human and financial resources and therefore understanding factors influencing sustainability is imperative to viable service provision. This research used case study methodology (Yin, ). Data were collected during 2014 from emergency nurse practitioners, emergency department multidisciplinary team members and documents related to nurse practitioner services. Collection methods included telephone and semi-structured interviews, survey and document analysis. Pattern matching techniques were used to compare findings with study propositions. In this study, emergency nurse practitioner services did not meet factors that support health service sustainability. Multidisciplinary team members were confident that emergency nurse practitioner services were safe and helped to meet population health needs. Organizational support for integration of nurse practitioner services was marginal and led to poor understanding of service capability and underuse. This research provides evidence informing sustainability of nursing service models but more importantly raises questions about this little explored field. The findings highlight poor organizational support, excessive restrictions and underuse of the service. This is in direct contrast to contemporary expanding practice reform initiatives. Organizational support for integration is imperative to future service sustainability. © 2017 John Wiley & Sons Ltd.

  1. Mental health service use types among Asian Americans with a psychiatric disorder: considerations of culture and need.

    Science.gov (United States)

    Nguyen, Duy; Bornheimer, Lindsay A

    2014-10-01

    Despite levels of need that are comparable with other groups, relatively few Asian Americans receive mental health care. While studies have described the tendency for Asian Americans to delay care until mental health symptoms are severe, relatively little research has examined how the severity of symptoms impact mental health service use. This study uses publicly available data from the National Latino and Asian American Study (NLAAS) and focuses solely on Asian American respondents with a psychiatric disorder (n = 230). Unexpectedly, few Asian Americans with a psychiatric disorder received care in a medical setting. The perception of mental health needs increased the likelihood of using mental health specialist care. Social and systemic barriers together hinder mental health service use. Implications for addressing Asian American mental health service use within a changing health care environment are discussed.

  2. Outsourcing mental health care services? The practice and potential of community-based farms in psychiatric rehabilitation.

    Science.gov (United States)

    Iancu, Sorana C; Zweekhorst, Marjolein B M; Veltman, Dick J; van Balkom, Anton J L M; Bunders, Joske F G

    2015-02-01

    Psychiatric rehabilitation supports individuals with mental disorders to acquire the skills needed for independent lives in communities. This article assesses the potential of outsourcing psychiatric rehabilitation by analysing care farm services in the Netherlands. Service characteristics were analysed across 214 care farms retrieved from a national database. Qualitative insights were provided by five case descriptions, selected from 34 interviews. Institutional care farms were significantly larger and older than private care farms (comprising 88.8% of all care farms). Private, independent care farms provide real-life work conditions to users who are relatively less impaired. Private, contracted care farms tailor the work activities to their capacities and employ professional supervisors. Institutional care farms accommodate for the most vulnerable users. We conclude that collaborations with independent, contracted and institutional care farms would provide mental health care organizations with a diversity in services, enhanced community integration and a better match with users' rehabilitation needs.

  3. The development of a 'best practice' service for women in a medium-secure psychiatric setting: treatment components and evaluation.

    Science.gov (United States)

    Long, Clive G; Fulton, Barbara; Hollin, Clive R

    2008-01-01

    The inadequacy of inpatient facilities for women with severe psychiatric and co-morbid difficulties has been repeatedly documented. The establishment of effective therapeutic programmes for women in medium psychiatric facilities is also in their infancy, and little research has been undertaken. This article describes the development of a 'best practice' psychological treatment programme for women with a dual diagnosis. Emphasis is placed on the need to develop further intensive gender-specific services using an established model for effective therapeutic service development. In addition to a detailed description of the group therapy programme, staff training initiatives, methods for ensuring treatment integrity and a methodology for service evaluation is given. Copyright (c) 2008 John Wiley & Sons, Ltd.

  4. Manejo do paciente com transtornos relacionados ao uso de substância psicoativa na emergência psiquiátrica Management of patients with substance use illnesses in psychiatric emergency department

    Directory of Open Access Journals (Sweden)

    Ricardo Abrantes do Amaral

    2010-10-01

    Full Text Available OBJETIVO: Transtornos por uso de substâncias são prevalentes em setores de emergência gerais e psiquiátricos, atingindo taxas de 28% das ocorrências em prontos-socorros gerais. Todavia, profissionais dos setores de emergência identificam menos que 50% dos casos de problemas relacionados ao álcool. Este artigo visa fornecer base fundamentada em evidências para o tratamento específico a pacientes que preencham os critérios diagnósticos de transtornos por uso de substâncias e que se apresentam ao pronto-socorro em quadros de intoxicação ou abstinência. MÉTODO: Uma revisão sobre o tema foi realizada na base de dados Medline, usando-se os descritores "intoxicação aguda", "abstinência", "álcool", "cocaína", "cannabis", "opioides", "inalantes" e "manejo", tendo o inglês como idioma. RESULTADOS E CONCLUSÃO: O cuidado de pessoas com transtornos por uso de substâncias deve conter: avaliação completa (médica geral e psiquiátrica, tratamento dos quadros diagnosticados (abstinência, intoxicação e quadros clínicos que caracterizem uma emergência, sensibilização do paciente para realizar tratamento, se for necessário, e elaboração de encaminhamento.OBJECTIVE: Substance use disorders are prevalent in emergency departments in medical and psychiatric services, reaching rates of 28% of cases in medical emergency departments. However, professionals in the emergency department identify less than 50% of cases of alcohol-related problems. This article aims to provide evidence-based interventions for the specific treatment to patients who meet diagnostic criteria for substance use disorders and who present to emergency rooms during intoxication or abstinence. METHOD: A literature review was performed on Medline database, using the descriptors "acute intoxication", "withdrawal", "alcohol", "cocaine", "cannabis", "opioid", "inhalant", "management", using English as the language. RESULTS: AND CONCLUSION: The care of persons with

  5. A Comparison of Inpatient Adult Psychiatric Services in Italy and Canada.

    Science.gov (United States)

    Guaiana, Giuseppe; O'Reilly, Richard; Grassi, Luigi

    2018-05-03

    We examine the possibility the Organisation for Economic Co-operation and Development (OECD) bed count for Italy may be an underestimation of the actual beds available. We compared bedded services for mental disorders in two regions in Italy and Canada respectively. We found out that if we consider acute psychiatric beds only, the district of Ferrara has 30 beds (8.5 per 100,000) and the Middlesex and Elgin Counties have 89 beds (16.3 beds for 100,000). However, if we include the rehabilitation beds (that are located within a hospital setting in Ontario and in a residential community setting in Ferrara), we find that the district of Ferrara has 95 beds (27.0 per 100,000) and the Middlesex and Elgin Counties have 176 beds (32.3 per 100,000). As a result, the 10/100,000 beds rate for Italy reported by the OECD is an underestimate compared to figures reported for most other countries, as the beds included are hospital beds only.

  6. Self-harm and attempted suicide within inpatient psychiatric services: a review of the literature.

    Science.gov (United States)

    James, Karen; Stewart, Duncan; Bowers, Len

    2012-08-01

    Self harm is a major public health concern, yet there are considerable challenges in providing support for those who self harm within psychiatric inpatient services. This paper presents the first review of research into self harm within inpatient settings. Searches of the main electronic databases were conducted using key words for self harm and inpatient care. There was substantial variation in the rates of self-harm and attempted suicide between studies, but rates were highest on forensic wards. There was no evidence of differences in prevalence of self-harm between men and women; women, however, were at increased risk of attempting suicide. People were more likely to self-harm in private areas of the ward and in the evening hours, and often self-harmed in response to psychological distress, or elements of nursing care that restricted their freedom. Wards used a variety of strategies to prevent self-harm; however, there is little research into their effectiveness. © 2012 The Authors. International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

  7. Sociodemographic And Clinical Profile Of Men Assisted In A Psychiatric Detoxification Service In Natal, Rn, Brazil

    Directory of Open Access Journals (Sweden)

    Romeika Carla Ferreira de Sena

    2017-05-01

    Full Text Available Introduction: The male population has a high probability of abandoning treatment, avoidance of health services, great exposure to violence, mainly due to abusive use of alcohol and other drugs, and high crime rates also associated with this problem. Objective: To characterize the sociodemographic and clinical profile of men admitted to a Psychiatric Detoxification Hospital Unit for alcohol and drug abuse. Method: It is a cross-sectional and retrospective study, with data collection in 2015, with a temporal cut in patients´ records between 2008 and 2014, reaching a sample of 1,152 medical records. The data collection instrument was composed of a structured form. The data were analyzed in a descriptive way. Results: Regarding the age, the age group between 21 and 50 years old had 30.73% between six and ten days hospitalized, and 11.98% had readmissions. The main diagnoses for this disorders were linked to the use of opiates, cannabinoids, sedatives and hypnotics. Conclusion: The profile of internal and assisted men was characterized such as adults of productive age, residents of the metropolitan area of the city, with long periods of hospitalization, generally with improved type discharge, low readmission and diagnoses of mental disorders related to the excessive use of alcohol and other drugs.

  8. [Structure, organization and capacity problems in emergency medical services, emergency admission and intensive care units].

    Science.gov (United States)

    Dick, W

    1994-01-01

    clinical pictures. Cost effectiveness is clearly in favor of emergency medicine. Future developments will be characterized by the consequences of new health care legislation and by effects of financial stringencies on the emergency medical services.

  9. Production layout improvement in emergency services: a participatory approach.

    Science.gov (United States)

    Zanatta, Mateus; Amaral, Fernando Gonçalves

    2012-01-01

    Volunteer fire department is a service that responds emergency situations in places where there are no military emergency services. These services need to respond quickly, because time is often responsible for the operation success besides work environment and setup time interfere with the prompt response to these calls and care efficiency. The layout design is one factor that interferes with the quick setup. In this case, the spaces arrangement can result in excessive or unnecessary movements; also the equipment provision may hinder the selection and collection of these or even create movement barriers for the workers. This work created a new layout for the emergency assistance service, considering the human factors related to work through the task analysis and workers participation on the alternatives of improvement. The results showed an alternate layout with corridors and minimization of unusable sites, allowing greater flexibility and new possibilities of requirements.

  10. Motivations of persons with psychiatric disabilities to work in mental health peer services: a qualitative study using self-determination theory.

    Science.gov (United States)

    Moran, Galia Sharon; Russinova, Zlatka; Yim, Jung Yeon; Sprague, Catherine

    2014-03-01

    Individuals with psychiatric disabilities have low rates of employment and occupational rehabilitation success. Mental health peer services are a new occupational modality that opened a promising occupational path: persons with serious mental illnesses employed to provide support to others with psychiatric conditions. However challenges to successful peer work exist. Work motivation is central to understanding and supporting peer workers, yet little is known about sources of motivation to work as mental health peer providers. The aim of this study was to identify what drives individuals to mental health peer work using self determination theory (SDT). Motivations of 31 mental health peer workers were explored as part of a larger study. A theory driven approach was employed to emerging qualitative data using SDT concepts: external motivation and internally regulated motivations derived from basic needs (autonomy, competence, relatedness). External motivations included generic occupational goals and getting away from negative work experiences. Internal motivations corresponded with SDT basic needs: autonomy met-needs was reflected in having freedom to disclose and finding that work accords with personal values; competence met-needs was reflected in using personal experience as a resource to help others; and relatedness met-needs were reflected in having opportunity to connect intimately and reciprocate with consumers. This study identified external and internal motivations of persons with psychiatric disabilities to work as peer providers-a novel occupation in mental health. Employing personal experience and enabling peer contact emerge as major motivational tenets of mental health peer work. According to SDT instrumental occupational goals are considered more external than satisfaction of basic psychological needs. The study demonstrates the applicability of SDT in the design of autonomy supported environments to promote work engagement and sustenance of mental

  11. Disaster Monitoring and Emergency Response Services in China

    Science.gov (United States)

    Wu, J.; Han, X.; Zhou, Y.; Yue, P.; Wang, X.; Lu, J.; Jiang, W.; Li, J.; Tang, H.; Wang, F.; Li, X.; Fan, J.

    2018-04-01

    The Disaster Monitoring and Emergency Response Service(DIMERS) project was kicked off in 2017 in China, with the purpose to improve timely responsive service of the institutions involved in the management of natural disasters and man-made emergency situations with the timely and high-quality products derived from Space-based, Air-based and the in-situ Earth observation. The project team brought together a group of top universities and research institutions in the field of Earth observations as well as the operational institute in typical disaster services at national level. The project will bridge the scientific research and the response services of massive catastrophe in order to improve the emergency response capability of China and provide scientific and technological support for the implementation of the national emergency response strategy. In response to the call for proposal of "Earth Observation and Navigation" of 2017 National Key R&D Program of China, Professor Wu Jianjun, the deputy chairman of Faculty of Geographical Science of Beijing Normal University, submitted the Disaster Monitoring and Emergency Response Service (DIMERS) project, jointly with the experts and scholars from Institute of Remote Sensing and Digital Earth, Chinese Academy of Sciences, Wuhan University, China Institute of Earthquake Forecasting of China Earthquake Administration and China Institute of Water Resources and Hydropower Science. After two round evaluations, the proposal was funded by Ministry of Science and Technology of China.

  12. CK2—An Emerging Target for Neurological and Psychiatric Disorders

    Directory of Open Access Journals (Sweden)

    Julia Castello

    2017-01-01

    Full Text Available Protein kinase CK2 has received a surge of attention in recent years due to the evidence of its overexpression in a variety of solid tumors and multiple myelomas as well as its participation in cell survival pathways. CK2 is also upregulated in the most prevalent and aggressive cancer of brain tissue, glioblastoma multiforme, and in preclinical models, pharmacological inhibition of the kinase has proven successful in reducing tumor size and animal mortality. CK2 is highly expressed in the mammalian brain and has many bona fide substrates that are crucial in neuronal or glial homeostasis and signaling processes across synapses. Full and conditional CK2 knockout mice have further elucidated the importance of CK2 in brain development, neuronal activity, and behavior. This review will discuss recent advances in the field that point to CK2 as a regulator of neuronal functions and as a potential novel target to treat neurological and psychiatric disorders.

  13. [Characteristics of the emergency health service demand in Southern Brazil].

    Science.gov (United States)

    Carret, Maria Laura Vidal; Fassa, Anaclaudia Gastal; Paniz, Vera Maria Vieira; Soares, Patrícia Carret

    2011-01-01

    This study evaluated the demand of emergency health service. It was performed a descriptive analyses of 1647 adults that consulted at emergency public service of Pelotas, Brazil. Older subjects, non white skin color, lower schooling, without partner, and smokers presented higher prevalence of consultations at this service when compared with the general population. Individuals waited, on average, 15 minutes to have their consultations, exams were requested in more than 40% of the visits, and intravenous medication were administered in one third of the visits. Elderly waited longer before searching the service, but they had lowest awaiting time after arriving at emergency service and had higher percentage of regular doctor and social support. Elderly had more diagnosis related to circulatory system, while among the youngest, external causes were the most frequent. The low waiting average for consultation suggest this service provide an immediate care while the great number of ill-defined signs or symptoms indicate that the provided care is provisional. It is necessary to train emergency professionals to reduce the number of tests requested and to assure that either professional as the population is conscious about the importance of a continuity of care.

  14. Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence.

    Science.gov (United States)

    Rubio-Valera, Maria; Luciano, Juan V; Ortiz, José Miguel; Salvador-Carulla, Luis; Gracia, Alfredo; Serrano-Blanco, Antoni

    2015-03-04

    Agitation and containment are frequent in psychiatric care but little is known about their costs. The aim was to evaluate the use of services and costs related to agitation and containment of adult patients admitted to a psychiatric hospital or emergency service. Systematic searches of four electronic databases covering the period January 1998-January 2014 were conducted. Manual searches were also performed. Paper selection and data extraction were performed in duplicate. Cost data were converted to euros in 2014. Ten studies met inclusion criteria and were included in the analysis (retrospective cohorts, prospective cohorts and cost-of-illness studies). Evaluated in these studies were length of stay, readmission rates and medication. Eight studies assessed the impact of agitation on the length of stay and six showed that it was associated with longer stays. Four studies examined the impact of agitation on readmission and a statistically significant increase in the probability of readmission of agitated patients was observed. Two studies evaluated medication. One study showed that the mean medication dose was higher in agitated patients and the other found higher costs of treatment compared with non-agitated patients in the unadjusted analysis. One study estimated the costs of conflict and containment incurred in acute inpatient psychiatric care in the UK. The estimation for the year 2014 of total annual cost per ward for all conflict was €182,616 and €267,069 for containment based on updated costs from 2005. Agitation has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use. Evidence is scarce and further research is needed to estimate the burden of agitation and containment from the perspective of hospitals and the healthcare system.

  15. A Pilot Initiative to Deliver Community-based Psychiatric Services in Rural Haiti After the 2010 Earthquake.

    Science.gov (United States)

    Grelotti, David J; Lee, Amy C; Fils-Aimé, Joseph Reginald; Jean, Jacques Solon; Therosmé, Tatiana; Petit-Homme, Handy; Oswald, Catherine M; Raviola, Giuseppe; Eustache, Eddy

    2015-01-01

    Worldwide, there is a gap between the burden of mental distress and disorder and access to mental health care. This gap is particularly large in low- and middle-income countries (LMICs). After the 2010 earthquake in Haiti, the international health care organizations Partners in Health and Zanmi Lasante worked to expand local mental health services in rural Haiti. The aims of this study are to describe clinical characteristics of the patients served during a pilot project to deliver community-based psychiatric services in rural Haiti and to show how this experience complements the Mental Health Gap Action Programme ("mhGAP"), a tool developed by the World Health Organization to support mental health care delivery by nonspecialists in LMICs. The pilot was conducted in March 2011. A visiting psychiatrist traveled to rural Haiti and paired with local clinicians to evaluate patients and to support quality improvement practices in psychiatric care. Patients received a standard neuropsychiatric evaluation. mhGAP was an important clinical reference. To assess the experience, we conducted a retrospective chart review of outpatient encounters. Sixty-five patients presented with a wide range of common psychiatric, neurologic, and general medical conditions. Forty-nine of these patients (75%) reported primary problems subsumed by an mhGAP module. Fifteen patients (23%) reported headache as their chief complain, a condition that is not currently covered by mhGAP. Surprisingly, only 3 patients (5%), reported earthquake-related distress. Our clinical data reinforce the need for provision of standard psychiatric and neurologic services in LMICs. Such services ought to accompany interventions targeted specifically at disaster-related problems. Clinical situations falling outside existing mhGAP modules inspired the development of supplemental treatment protocols. These observations informed coordinated efforts at Zanmi Lasante to build a sustainable, integrated mental health system

  16. Medication adherence, work performance and self-esteem among psychiatric patients attending psychosocial rehabilitation services at Bangalore, India

    OpenAIRE

    Sailaxmi Gandhi; Rajitha Pavalur; Sivakumar Thanapal; Nirmala B Parathasarathy; Geetha Desai; Poornima Bhola; Mariamma Philip; Santosh K Chaturvedi

    2014-01-01

    Context: Work benefits mental health in innumerable ways. Vocational rehabilitation can enhance self-esteem. Medication adherence can improve work performance and thereby the individuals’ self-esteem. Aim: To test the hypothesis that there would be a significant correlation between medication adherence, work performance and self-esteem. Setting and Design: A quantitative, descriptive correlational research design was adopted to invite patients attending psychiatric rehabilitation services to ...

  17. Screening for Suicidal Ideation and Attempts among Emergency Department Medical Patients: Instrument and Results from the Psychiatric Emergency Research Collaboration

    Science.gov (United States)

    Allen, Michael H.; Abar, Beau W.; McCormick, Mark; Barnes, Donna H.; Haukoos, Jason; Garmel, Gus M.; Boudreaux, Edwin D.

    2013-01-01

    Joint Commission National Patient Safety Goal 15 calls for organizations "to identify patients at risk for suicide." Overt suicidal behavior accounts for 0.6% of emergency department (ED) visits, but incidental suicidal ideation is found in 3%-11.6%. This is the first multicenter study of suicide screening in EDs. Of 2,243 patients in…

  18. Determinants of Demand in the Public Dental Emergency Service.

    Science.gov (United States)

    Matsumoto, Maria Sa; Gatti, Marcia An; de Conti, Marta Hs; de Ap Simeão, Sandra F; de Oliveira Braga Franzolin, Solange; Marta, Sara N

    2017-02-01

    Although dental emergencies are primarily aimed at pain relief, in practice, dental emergency services have been overwhelmed by the massive inflow of patients with less complex cases, which could be resolved at basic levels of health care. They frequently become the main gateway to the system. We investigated the determinant factors of demand at the Central Dental Emergency Unit in Bauru, São Paulo, Brazil. The questionnaire was applied to 521 users to evaluate sociodemographic profile; factors that led users to seek the service at the central dental emergency; perception of service offered. About 80.4% of users went directly to the central dental emergency, even before seeking basic health units. The reasons were difficulty to be attended (34.6%) and incompatible time (9.8%). To the perception of the necessity of the service, responses were problem as urgent (78.3%) and pain was the main complaint (69.1%). The profile we found was unmarried (41.5%), male (52.2%), white (62.8%), aged 30 to 59 (52.2%), incomplete basic education (41.6%), family income up to 2 minimum wages (47.4%), and no medical/dental plan (88.9%). It was concluded that the users of central dental emergency come from all sectors of the city, due to difficult access to basic health units; they consider their complaint urgent; and they are satisfied with the service offered. To meet the profile of the user urgency's service so that it is not overloaded with demand that can be fulfilled in basic health units.

  19. Emergency medical service systems in Japan : Past, present, and future

    OpenAIRE

    Tanigawa, Koichi; Tanaka, Keiichi

    2006-01-01

    Emergency medical services are provided by the fire defense headquarter of the local government in Japan. We have a one-tiered EMS system. The ambulance is staffed by three crews trained in rescue, stabilization, transportation, and advanced care of traumatic and medical emergencies. There are three levels of care provided by ambulance personnel including a basic-level ambulance crew (First Aid Class one, FAC-1), a second level (Standard First Aid Class, SFAC), and the highest level (Emergenc...

  20. Effects of Ramadan on Forensic Cases Presenting to Emergency Service

    Directory of Open Access Journals (Sweden)

    F. Sarı Doğan

    2015-06-01

    Full Text Available The term "forensic case" is defined as disruption of physical and/or mental health of an individual due to external factors. Forensic cases are most frequently encountered in emergency services. Ramadan, the ninth month of Islamic calendar, is a month of fasting throughout which Muslims from all around the world worship by observing fasting. There are many studies focusing on the effects of fasting on health. The purpose of this study is to examine the effects of Ramadan on forensic cases presenting to emergency service.

  1. Guidelines for Induction and Intubation Sequence Fast in Emergency Service

    OpenAIRE

    Pérez Perilla, Patricia; Pontificia Universidad Javeriana-Hospital Universitario San Ignacio; Moreno Carrillo, Atilio; Pontificia Universidad Javeriana-Hospital Universitario San Ignacio; Gempeler Rueda, Fritz E.; Pontificia Universidad Javeriana-Hospital Universitario San Ignacio

    2012-01-01

    The rapid sequence intubation (RSI) is a procedure designed to minimize the time spent in securing the airway by endotracheal tube placement in emergency situations in patients at high risk of aspiration. Being clear about this situation, it is unquestionable the importance of education and training related to rapid sequence intubation to be made to the physicians responsible for the recovery rooms, emergency services and paramedics responsible for managing emergencies and disasters field . T...

  2. An Emergent Micro-Services Approach to Digital Curation Infrastructure

    OpenAIRE

    Abrams, Stephen; Kunze, John; Loy, David

    2010-01-01

    In order better to meet the needs of its diverse University of California (UC) constituencies, the California Digital Library UC Curation Center is re-envisioning its approach to digital curation infrastructure by devolving function into a set of granular, independent, but interoperable micro-services. Since each of these services is small and self-contained, they are more easily developed, deployed, maintained, and enhanced; at the same time, complex curation function can emerge from the str...

  3. Emergency healthcare process automation using mobile computing and cloud services.

    Science.gov (United States)

    Poulymenopoulou, M; Malamateniou, F; Vassilacopoulos, G

    2012-10-01

    Emergency care is basically concerned with the provision of pre-hospital and in-hospital medical and/or paramedical services and it typically involves a wide variety of interdependent and distributed activities that can be interconnected to form emergency care processes within and between Emergency Medical Service (EMS) agencies and hospitals. Hence, in developing an information system for emergency care processes, it is essential to support individual process activities and to satisfy collaboration and coordination needs by providing readily access to patient and operational information regardless of location and time. Filling this information gap by enabling the provision of the right information, to the right people, at the right time fosters new challenges, including the specification of a common information format, the interoperability among heterogeneous institutional information systems or the development of new, ubiquitous trans-institutional systems. This paper is concerned with the development of an integrated computer support to emergency care processes by evolving and cross-linking institutional healthcare systems. To this end, an integrated EMS cloud-based architecture has been developed that allows authorized users to access emergency case information in standardized document form, as proposed by the Integrating the Healthcare Enterprise (IHE) profile, uses the Organization for the Advancement of Structured Information Standards (OASIS) standard Emergency Data Exchange Language (EDXL) Hospital Availability Exchange (HAVE) for exchanging operational data with hospitals and incorporates an intelligent module that supports triaging and selecting the most appropriate ambulances and hospitals for each case.

  4. Use of newer technologies with existing service for family reintegration of unknown psychiatric patients: A case series.

    Science.gov (United States)

    Gowda, Guru S; Telang, Ashay; Sharath, Chandra Reddy; Issac, Thomas Gregor; Haripriya, Chintala; Ramu, Praveen Shivalli; Math, Suresh Bada

    2017-10-29

    Homeless Mentally Ill (HMI) patients pose a challenge in treatment, management and rehabilitation services. HMI patients are often difficult to engage in treatment, and associated with relapse and rehospitalization, even after recovery. Family plays an important role in treatment engagement and care of the mentally ill person in India. Here, we report two unknown psychiatric patients who were reintegrated to their families using newer technologies with existing service. Newer technologies have helped in early identification of HMI families and reintegration into them. The early reintegration reduced the unnecessary detention of HMI patients inside the hospital after recovery. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Barriers to formal emergency obstetric care services' utilization.

    Science.gov (United States)

    Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe

    2011-06-01

    Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be

  6. Psychiatric Disorders and Personality Profiles of Middle-Aged Suicide Attempters with no Evidence of Specific Psychopathological Profiles Referring to an Emergency Department

    Directory of Open Access Journals (Sweden)

    Serge Brand

    2017-10-01

    Full Text Available Objective: The aim of the present study was to assess socio-demographic and psychiatric characteristics of 40-65 years old suicide attempters referred to an emergency department within four hours of making their attempt.Method: We assessed a total of 93 suicide attempters (Mage=46.59 years referred to an emergency department. Patients completed questionnaires covering socio-demographic data, personality traits, mood, and impulsivity; experts rated patients’ psychiatric status.Results: Experts rated 85 (92.4% of the suicide attempters as having a psychiatric disorder. Based on self-ratings and compared to normative data, 42 (46.6% were psychopathologically ill. Suicide attempts were not related to impulsive personality traits, mood disorders, socio-demographic patterns or gender (gender-ratio: 1:1.58;f:m.Conclusions: The pattern of results suggests that further unknown factors were involved in pushing people to attempt suicide.

  7. Psychiatric Disorders and Personality Profiles of Middle-Aged Suicide Attempters with No Evidence of Specific Psychopathological Profiles Referred to an Emergency Department

    Science.gov (United States)

    Brand, Serge; Nejat, Mehri; Haghighi, Mohammad; Rahimi, Alireza; Jahangard, Leila; Sadeghi Bahmani, Dena; Bajoghli, Hafez; Holsboer-Trachsler, Edith; Ahmadpanah, Mohammad

    2017-01-01

    Objective: The present study aimed at assessing the sociodemographic and psychiatric characteristics of 40 to 65 year- old suicide attempters, who were referred to an emergency department within 4 hours of the attempt. Method: A total of 93 suicide attempters (Mean age=46.59 years) who were referred to an emergency department, were assessed in this study. Patients completed questionnaires covering sociodemographic data, personality traits, mood, and impulsivity. Psychiatric status of the patients was rated by experts. Results: Experts rated 85 (92.4%) of the suicide attempters as having a psychiatric disorder. Based on self-ratings and compared to normative data, 42 (46.6%) patients were psychopathologically ill. It was found that suicide attempts were not related to impulsive personality traits, mood disorders, sociodemographic patterns, or gender (gender-ratio: 1:1.58; f: m). Conclusion: The pattern of results suggests that further unknown factors were involved in pushing people to attempt suicide. PMID:29472951

  8. Psychiatric Disorders and Personality Profiles of Middle-Aged Suicide Attempters with No Evidence of Specific Psychopathological Profiles Referred to an Emergency Department.

    Science.gov (United States)

    Brand, Serge; Nejat, Mehri; Haghighi, Mohammad; Rahimi, Alireza; Jahangard, Leila; Sadeghi Bahmani, Dena; Bajoghli, Hafez; Holsboer-Trachsler, Edith; Ahmadpanah, Mohammad

    2017-10-01

    Objective: The present study aimed at assessing the sociodemographic and psychiatric characteristics of 40 to 65 year- old suicide attempters, who were referred to an emergency department within 4 hours of the attempt. Method: A total of 93 suicide attempters (Mean age=46.59 years) who were referred to an emergency department, were assessed in this study. Patients completed questionnaires covering sociodemographic data, personality traits, mood, and impulsivity. Psychiatric status of the patients was rated by experts. Results: Experts rated 85 (92.4%) of the suicide attempters as having a psychiatric disorder. Based on self-ratings and compared to normative data, 42 (46.6%) patients were psychopathologically ill. It was found that suicide attempts were not related to impulsive personality traits, mood disorders, sociodemographic patterns, or gender (gender-ratio: 1:1.58; f: m). Conclusion: The pattern of results suggests that further unknown factors were involved in pushing people to attempt suicide.

  9. Perceptions of psychosocial disability amongst psychiatric service users and caregivers in South Africa

    Directory of Open Access Journals (Sweden)

    Carrie Brooke-Sumner

    2014-12-01

    Objectives: This study aimed to use an explanatory model of illness framework to document experiences of illness, disability and recovery amongst service users with schizophrenia and their caregivers in a poorly resourced area in the North West Province. Data were used to provide recommendations for a contextually appropriate non-specialist facilitated group psychosocial rehabilitation intervention. Method: Eighteen in-depth individual interviews were conducted: nine with schizophrenia service users and nine with caregivers. Interviews were conducted by two trained field researchers; both clinical psychologists fluent in the first language of participants. All interviews were recorded, translated and transcribed. Data were thematically analysed using NVivo 9. Results: Participants linked the illness to witchcraft, poverty and stress. Family conflict was recognised in the course of the illness, causing stress and challenges for emotional well-being. Knowledge of diagnosis and biomedical treatment was minimal. Key factors recognised by service users as promoting recovery were the ability to work, and the support of traditional healers and religious structures. Conclusion: Based on the findings of this study, a group psychosocial rehabilitation intervention emerged as a recommendation, with the incorporation of psycho-education, adherence support, coping skills, and opportunities for income generation and productive activity. The importance of also enlisting the support of religious leaders and traditional healers in supporting recovery is emphasised.

  10. Children and adolescents in the Psychiatric Emergency Department: a 10-year survey in Copenhagen County

    DEFF Research Database (Denmark)

    Taastrøm, Annette; Klahn, Julie; Staal, Nina

    2014-01-01

    thorough analysis was performed, based on the individual emergency charts. Inter-rater reliability was high. Results: Visits increased nearly threefold during the period. Symptom score for 2003 and 2006 revealed that more than one third of the visitors had suicidal ideation. Depressive and anxiety symptoms...

  11. Rich Country, Poor People: the challenges of providing psychiatric services in the public and the private sectors in Papua New Guinea.

    Science.gov (United States)

    Muga, Florence

    2015-12-01

    To describe some of the challenges in the provision of psychiatric services in Papua New Guinea. Many of the challenges faced when providing mental health care are not clinical in nature, but rather a combination of social, cultural, economic and infrastructural factors that hinder the adequate provision of, and access to, psychiatric services in Papua New Guinea. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  12. Medical Emergency Workload of a Regional UK HEMS Service.

    Science.gov (United States)

    McQueen, Carl; Crombie, Nick; Cormack, Stef; Wheaton, Steve

    2015-01-01

    Regionalized trauma networks have been established in England to centralize specialist care at dedicated centers of excellence throughout the country. Helicopter emergency medical services (HEMS) in the West Midlands region have been redesigned to form an integrated component of such systems. The continued use of such valuable and scarce resources for medical emergencies requires evaluation. A retrospective review of mission data for a regional Air Ambulance Service in England over a two year period. Medical emergencies continue to contribute a large proportion of the overall workload of the service. Requirement for advanced interventions at the scene was rare, with less than 10% of patients attended by HEMS teams having care needs that fall beyond the scope of standard paramedic practice. Dynamic solutions are needed to ensure that HEMS support for cases of medical emergency are appropriately targeted to incidents in which clinical benefit is conferred to the patient. Intelligent tasking of appropriate resources has the potential to improve the HEMS response to medical emergencies while optimizing the availability of resources to respond to other incidents, most notably cases of major trauma. Copyright © 2015 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  13. Helicopter emergency medical service patient transport safe at night?

    NARCIS (Netherlands)

    Peters, J.H.; Wageningen, B. van; Hoogerwerf, N.; Biert, J.

    2014-01-01

    OBJECTIVE: Dutch helicopter emergency medical services are available 24/7. Working without daylight brings additional challenges, both in patient care and in-flight operation. We retrospectively evaluated the safety of this nighttime helicopter transportation of patients. METHODS: Our helicopter

  14. Helicopter Emergency Medical Services: effects, costs and benefits

    NARCIS (Netherlands)

    A.N. Ringburg (Akkie)

    2009-01-01

    textabstractAdvanced prehospital medical care with air transport was introduced in the Netherlands in May 1995. The fi rst helicopter Mobile Medical Team, also called Helicopter Emergency Medical Service (HEMS) was a joint venture initiative of the VU Medical Center in Amsterdam and the Algemene

  15. Three Types of Memory in Emergency Medical Services Communication

    Science.gov (United States)

    Angeli, Elizabeth L.

    2015-01-01

    This article examines memory and distributed cognition involved in the writing practices of emergency medical services (EMS) professionals. Results from a 16-month study indicate that EMS professionals rely on distributed cognition and three kinds of memory: individual, collaborative, and professional. Distributed cognition and the three types of…

  16. 75 FR 27917 - Emergency Medical Services Week, 2010

    Science.gov (United States)

    2010-05-18

    ... enhancing our country's preparedness and resilience. During Emergency Medical Services Week, we recommit to... physicians. From rural regions of our Nation to our busiest urban centers, EMS teams provide access to... to arrive at the scene of a crisis. These heroic professionals, volunteers, and citizens form a...

  17. Healthcare Service Auditing and Intervention in an Emergency ...

    African Journals Online (AJOL)

    A pre- and post-intevention randomized cross-sectional study was carried out from January to February and April to May 2001, respectively, to audit and intervene in the timeliness of health services delivery in an Emergency Paediatric Unit (EPU) of Jos University Teaching Hospital. A structured questionnaire was used to ...

  18. Assessment of emergency medical services in the Ashanti region of ...

    African Journals Online (AJOL)

    Deficient areas in need of development are governance, reliable revenue, public access, community integration, clinical care guidelines, research and quality assurance processes. Conclusions: The Ashanti Region has a growing and thriving emergency medical services system. Although many essential areas for ...

  19. Benchmarking online dispatch algorithms for Emergency Medical Services

    NARCIS (Netherlands)

    Jagtenberg, C.J.; Berg, P.L.; van der Mei, R.D.

    2016-01-01

    Providers of Emergency Medical Services (EMS) face the online ambulance dispatch problem, in which they decide which ambulance to send to an incoming incident. Their objective is to minimize the fraction of arrivals later than a target time. Today, the gap between existing solutions and the optimum

  20. Case Study – Idling Reduction Technologies for Emergency Service Vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Laughlin, Michael [Argonne National Lab. (ANL), Argonne, IL (United States); Owens, Russell J. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2016-01-01

    This case study explores the use of idle reduction technologies (IRTs) on emergency service vehicles in police, fire, and ambulance applications. Various commercially available IRT systems and approaches can decrease, or ultimately eliminate, engine idling. Fleets will thus save money on fuel, and will also decrease their criteria pollutant emissions, greenhouse gas emissions, and noise.

  1. 78 FR 30727 - Emergency Medical Services Week, 2013

    Science.gov (United States)

    2013-05-22

    .... During Emergency Medical Services Week, we pause to offer our gratitude to these remarkable men and women, whose dedication is fundamental to our society's well-being. In recent weeks, we have again seen the... thousand thirteen, and of the Independence of the United States of America the two hundred and thirty...

  2. Regional supply of outreach service and length of stay in psychiatric hospital among patients with schizophrenia: National case mix data analysis in Japan.

    Science.gov (United States)

    Niimura, Junko; Nakanishi, Miharu; Yamasaki, Syudo; Nishida, Atsushi

    2017-12-01

    Several clinical trials have demonstrated that linkage to an outreach service can prevent prolonged length of stay of patients at psychiatric hospitals. However, there has been no investigation of the association between length of stay in psychiatric hospital and regional supply of outreach services using national case mix data. The aim of this study was to clarify the relationship between length of stay in psychiatric hospital and regional supply of outreach services. We used data from the National Patient Survey in Japan, a nationally representative cross-sectional survey of inpatient care conducted every three years from 1996 to 2014. Data from 42,268 patients with schizophrenia who had been admitted to psychiatric hospitals were analyzed. After controlling for patient and regional characteristics, patients in regions with fewer number of visits for psychiatric nursing care at home had significantly longer length of stay in psychiatric hospitals. This finding implies that enhancement of the regional supply of outreach services would prevent prolonged length of stay in psychiatric hospitals. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Physiological scoring: an aid to emergency medical services transport decisions?

    Science.gov (United States)

    Challen, Kirsty; Walter, Darren

    2010-01-01

    Attendance at UK emergency departments is rising steadily despite the proliferation of alternative unscheduled care providers. Evidence is mixed on the willingness of emergency medical services (EMS) providers to decline to transport patients and the safety of incorporating such an option into EMS provision. Physiologically based Early Warning Scores are in use in many hospitals and emergency departments, but not yet have been proven to be of benefit in the prehospital arena. The use of a physiological-social scoring system could safely identify patients calling EMS who might be diverted from the emergency department to an alternative, unscheduled, care provider. This was a retrospective, cohort study of patients with a presenting complaint of "shortness of breath" or "difficulty breathing" transported to the emergency department by EMS. Retrospective calculation of a physiological social score (PMEWS) based on first recorded data from EMS records was performed. Outcome measures of hospital admission and need for physiologically stabilizing treatment in the emergency department also were performed. A total of 215 records were analyzed. One hundred thirty-nine (65%) patients were admitted from the emergency department or received physiologically stabilizing treatment in the emergency department. Area Under the Receiver Operating Characteristic Curve (AUROC) for hospital admission was 0.697 and for admission or physiologically stabilizing treatment was 0.710. No patient scoringemergency department to alternative, unscheduled, care providers.

  4. Patient expectations of emergency dental services: a qualitative interview study.

    Science.gov (United States)

    Anderson, R

    2004-09-25

    To describe the expectations of walk-in patients seeking emergency dental care out-of-hours. Consecutive patients attending two emergency dental clinics at weekends were interviewed prior to seeing the dentist. The audio-recorded interview transcripts were analysed using the "framework" method of applied qualitative data analysis. Forty-four walk-in emergency dental patients at a community-based dental clinic and a dental hospital emergency clinic at the weekend. In addition to symptom relief, the main desired outcome for emergency dental patients may be informational and psychological--especially reassurance that the problem is not serious, and reduced uncertainty about the cause of the pain. In general, patients' stated expectations for specific treatments (such as antibiotics, or tooth extraction) were not absolute: rather, they implied these expectations were conditional upon the dentist deciding they were necessary. Emergency dental services, some of which are still dominantly treatment-focused, should reflect that many emergency dental attenders want advice and reassurance as much as relief from symptoms. This reinforces the importance of effective and sympathetic dentist-patient communication within emergency or out-of-hours consultations. It also implies that dentists' skills in listening, explaining and reassuring should be captured in any patient satisfaction or outcome measure designed for this patient group.

  5. Psychiatric units in Brazilian general hospitals: a growing philanthropic field.

    Science.gov (United States)

    Botega, Neury José

    2002-06-01

    Some countries, mainly in North America and Europe, have adopted psychiatric wards in the general hospital as an alternative to the classic psychiatric hospital. In Brazil there are 6,169 general hospitals, 1.3% of which with a psychiatric unit. This service strategy is scarcely developed in the country and comprises only 4% of all psychiatric admissions. There was no information on the facilities and functioning of the psychiatric units in general hospitals. To determine the main characteristics of psychiatric units in Brazilian general hospitals and to assess the current trends in the services provided. A mailing survey assessed all 94 Brazilian general hospitals which made psychiatric admissions. A two-page questionnaire was designed to determine the main characteristics of each institution and of the psychiatric unit. Seventy-nine (84%) questionnaires were returned. In contrast to the 1970s and 1980s, in the last decade the installation of psychiatric units has spread to smaller philanthropic institutions that are not linked to medical schools. A fifth of hospitals admit psychiatric patients to medical wards because there is no specialist psychiatric ward. They try to meet all the local emergency demands, usually alcohol-dependent patients who need short term admission. This could signal the beginning of a program through which mental health professionals may become an integral part of general health services. The inauguration of psychiatric wards in philanthropic hospitals, as well as the admission of psychiatric patients in their medical wards, is a phenomenon peculiar to this decade. The installation of psychiatric services in these and other general hospitals would overcome two of major difficulties encountered: prejudice and a lack of financial resources.

  6. Evaluation of emergency department nursing services and patient satisfaction of services.

    Science.gov (United States)

    Mollaoğlu, Mukadder; Çelik, Pelin

    2016-10-01

    To identify nursing services and assess patient satisfaction in patients who present to the emergency department. Emergency nursing care is a significant determinant of patient satisfaction. Patient satisfaction is often regarded as a reliable indicator of the quality of services provided in the emergency department. This is a descriptive study. Eighty-four patients who presented to the university emergency department were included in the study. The study data were collected by the Patient Information Form and the Satisfaction Level Form. Emergency nursing services, including history taking, assessing vital signs, preparing the patient for an emergency intervention, oxygen therapy, drug delivery and blood-serum infusion were shown to be more commonly provided compared with other services such as counselling the patients and the relatives about their care or delivering educational and psychosocial services. However, 78·6% of the patients were satisfied with their nursing services. The highest satisfaction rates were observed in the following sub-dimensions of the Satisfaction Level Form: availability of the nurse (82·1%), behaviour of the nurse towards the patient (78·6%) and the frequency of nursing rounds (77·4%). The most common practices performed by nurses in the emergency department were physical nursing services. Patient satisfaction was mostly associated with the availability of nurses when they were needed. Our results suggest that in addition to the physical care, patients should also receive education and psychosocial care in the emergency department. We believe that this study will contribute to the awareness and understanding of principles and concepts of emergency nursing, extend the limits of nursing knowledge and abilities, and improve and maintain the quality of clinical nursing education and practice to train specialist nurses with high levels of understanding in ethical, intellectual, administrative, investigative and professional issues.

  7. Bystander Intervention Prior to The Arrival of Emergency Medical Services: Comparing Assistance across Types of Medical Emergencies.

    Science.gov (United States)

    Faul, Mark; Aikman, Shelley N; Sasser, Scott M

    2016-01-01

    To determine the situational circumstances associated with bystander interventions to render aid during a medical emergency. This study examined 16.2 million Emergency Medical Service (EMS) events contained within the National Emergency Medical Services Information System. The records of patients following a 9-1-1 call for emergency medical assistance were analyzed using logistic regression to determine what factors influenced bystander interventions. The dependent variable of the model was whether or not a bystander intervened. EMS providers recorded bystander assistance 11% of the time. The logistic regression model correctly predicted bystander intervention occurrence 71.4% of the time. Bystanders were more likely to intervene when the patient was male (aOR = 1.12, 95% CI = 1.12-1.3) and if the patient was older (progressive aOR = 1.10, 1.46 age group 20-29 through age group 60-99). Bystanders were less likely to intervene in rural areas compared to urban areas (aOR = 0.58, 95% CI = 0.58-0.59). The highest likelihood of bystander intervention occurred in a residential institution (aOR = 1.86, 95% CI = 1.85-1.86) and the lowest occurred on a street or a highway (aOR = 0.96, 95% CI = 0.95-0.96). Using death as a reference group, bystanders were most likely to intervene when the patient had cardiac distress/chest pain (aOR = 11.38, 95% CI = 10.93-11.86), followed by allergic reaction (aOR = 7.63, 95% CI = 7.30-7.99), smoke inhalation (aOR = 6.65, 95% CI = 5.98-7.39), and respiration arrest/distress (aOR = 6.43, 95% CI = 6.17-6.70). A traumatic injury was the most commonly recorded known event, and it was also associated with a relatively high level of bystander intervention (aOR = 5.81, 95% CI = 5.58-6.05). The type of injury/illness that prompted the lowest likelihood of bystander assistance was Sexual Assault/Rape (aOR = 1.57, 95% CI = 1.32-1.84) followed by behavioral/psychiatric disorder (aOR = 1.64, 95% CI = 1.57-1.71). Bystander intervention varies greatly on

  8. Sociodemografic and Clinical Characteristics of Suicidal Cases who Attempted to Emergency Services in Ankara

    Directory of Open Access Journals (Sweden)

    Selma ERCAN

    2016-04-01

    Full Text Available Objective: The aim of the study is to determine the sociodemografic and clinical characteristics of suicide attempted cases who were admitted to the emergency departments of the hospitals in the first six months of 2010 in Ankara. Methods: Data were obtained by examining the suicide attempted registration forms that were filled out in the emergency services of hospitals working for the Ministry of Health retrospectively. Results: The incidence of suicide attempts in women (76.5% is higher than men (23.5%. Suicide attempts are high in 15-24 group of age (59.3 %. The rate of suicide attempts is high in patients who were single (57.9 % and students who were in education level of secondary (44.6 % and high school (40.2 %. The most common hospitals that were applied are Ankara Training and Researsch Hospital (29.8% and Kecioren Training and Research Hospital (12.4%. Also Mamak (19.7% and Kecioren (17.2% are towns that cases were seen mostly. The most applied method of suicide attempted is the usage of drugs and toxic substances with the 96.2%. The increment ratio of the suicide attempts is seen paticularly from January to June. Family (16.0% and psychiatric disorder (15.2% are mainly stressors leading to suicide attempted. Discussion: All attempted suicide patients who applied to Emergency Department should be directed to Crisis Intervention Unit immediately and following-up the cases with psychiatric consultation must become obligatory as well as medical treatments. The findings have been discussed with the literature. [JCBPR 2016; 5(1.000: 5-12

  9. Cannabinoid Hyperemesis Syndrome and the Consulting Psychiatrist: A Case Study of Diagnosis and Treatment for an Emerging Disorder in Psychiatric Practice.

    Science.gov (United States)

    Kast, Kristopher A; Gershengoren, Liliya

    2018-01-01

    The increasing prevalence of cannabis use in the United States requires awareness of cannabis-related disorders and familiarity with treatment options. We present a case of cannabinoid hyperemesis syndrome that required psychiatric consultation for diagnostic clarification and effective treatment with intravenous haloperidol. Literature from emergency medicine, toxicology, and gastroenterology is reviewed, including proposed diagnostic criteria for cannabinoid hyperemesis syndrome and reported off-label treatment options, with a specific focus on clinical questions facing the practicing psychiatrist regarding this emerging disorder.

  10. Emergency service admissions of patients with burn injury

    Directory of Open Access Journals (Sweden)

    Sadiye Yolcu

    2013-09-01

    Full Text Available Objective: In this study, we aimed to investigate the propertiesof burn injured patients who admitted to our hospitalemergency service.Methods: Patients were detected from the hospital recordsof emergency service during six months period andwere divided into five groups according to their ages (60 years. Age, gender totalbody surface area (TBSA, mechanism of injury and theoutcome of emergency evaluation were recorded.Results: Totally 111619 patients admitted to our emergencyservice between 01.07.2011 and 31.12.2011. Duringsix months, 2349 males and 1960 females totally4309 patients were burn injured patients. 1773 patientswere between 0-10 years, 1083 patients were 11-20years, 735 patients were between 21 and 40, 361 patientswere between 41 and 60 and 357 patients were over 60years. Most of the patients were treated in the emergencyservice (90.1%. 0-10% TBSA patients constituted 94.2%.This ratio for burn area >40% was 0.6%. Hot liquid burn(vapored water, milk etc. was 60.2%. There was a significantrelation between mechanism of burn injury andage groups (p<0.05. No corrosive and sunburn injuriesdetermined in females. Age groups were related with hospitalization(p<0.05. The highest intensive care unit admissionwas found in the 0-10 age group (1.3%.Conclusion: Emergency service is the first admission departmentof burn injury patients. Knowing the propertiesof burn injury patients, would help hard-working emergencydoctors in triage of these patients. Also, reportingthe data of emergency service burn injury patients wouldbe helpful for further studies. J Clin Exp Invest 2013; 4(3: 285-288Key words: Burn injury, emergency service, total body surface area

  11. An Emergent Micro-Services Approach to Digital Curation Infrastructure

    Directory of Open Access Journals (Sweden)

    Stephen Abrams

    2010-07-01

    Full Text Available In order better to meet the needs of its diverse University of California (UC constituencies, the California Digital Library UC Curation Center is re-envisioning its approach to digital curation infrastructure by devolving function into a set of granular, independent, but interoperable micro-services. Since each of these services is small and self-contained, they are more easily developed, deployed, maintained, and enhanced; at the same time, complex curation function can emerge from the strategic combination of atomistic services. The emergent approach emphasizes the persistence of content rather than the systems in which that content is managemed, thus the paradigmatic archival culture is not unduly coupled to any particular technological context. This results in a curation environment that is comprehensive in scope, yet flexible with regard to local policies and practices and sustainable despite the inevitability of disruptive change in technology and user expectation.

  12. [The liaison psychiatry approach of the psychiatric crisis, urgencies and emergencies].

    Science.gov (United States)

    Tenconi, Juan Cristóbal

    2003-01-01

    The purpose of this paper is to differentiate crisis, emergencies and urgencies within the frame of Liaison psychiatry. It begins with the definition of each one of the terms, later the emphasis is put in the clinical characteristics of each one of these situations. These characteristics are determined by the patient and the therapeutic team. At last therapeutic guidelines are stated, which allow more precision in the intervention, in function of the direct involvement of these situations in the development and evolution of the patients.

  13. Emergency medical service providers' experiences with traffic congestion.

    Science.gov (United States)

    Griffin, Russell; McGwin, Gerald

    2013-02-01

    The population's migration from urban to suburban areas has resulted in a more dispersed population and has increased traffic flow, possibly resulting in longer emergency response times. Although studies have examined the effect of response times on time to definitive care and survival, no study has addressed the possible causes of slowed response time from the point of view of emergency medical services (EMS) first responders. To assess the variables most commonly associated with increased emergency response time as described by the opinions and views of EMS first responders. A total of 500 surveys were sent to randomly selected individuals registered as first responders with the Alabama Department of Public Health, and 112 surveys were returned completed. The survey included questions regarding roadway design, response to emergency calls, in-vehicle technology aimed at decreasing travel time, and public education regarding emergency response. Respondents reported traveling on city streets most often during emergency calls, and encountering traffic more often on interstates and national highways. Traffic congestion, on average, resulted in nearly 10min extra response time. Most agreed that the most effective in-vehicle technology for reducing response time was a pre-emptive green light device; however, very few reported availability of this device in their emergency vehicles. Public education regarding how to react to approaching emergency vehicles was stated as having the greatest potential impact on reducing emergency response time. The results of the survey suggest that the best methods for reducing emergency response times are those that are easy to implement (e.g., public education). Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Death of Dementia Patients in Psychiatric Hospitals and Regional Supply of Psychiatric Services: Study of the National Data from 1996 to 2014 in Japan.

    Science.gov (United States)

    Nakanishi, Miharu; Niimura, Junko; Yamasaki, Syudo; Nishida, Atsushi

    2017-01-01

    Japan designates psychiatric inpatient care for behavior management of individuals with dementia and for helping dementia patients discharge to home. However, there has been no examination of the effectiveness of this strategy. The present study investigated the association between dementia and the discharge destination of patients in psychiatric hospitals. Data from the National Patient Survey, which is a nationally representative cross-sectional survey of inpatient care, were used. The 96,420 patients with dementia or other mental illness who were discharged from psychiatric hospitals in September of every 3 years from 1996 to 2014 were included in analyses. Of the 96,420 discharged patients, 13,823 had dementia as the primary disease. Of the 13,823 dementia patients, 3,865 (28.0%) were discharged to home, 3,870 (28.0%) were admitted to a facility or other care settings, 3,574 (25.9%) were admitted to another hospital, and 2,514 (18.2%) died. Patients were more likely to die in psychiatric hospital if their primary disease was dementia, and they had resided in a region that provided fewer home visits for psychiatric nursing care or had available a larger number of psychiatric hospital beds per capita. Psychiatric inpatient care may be ineffective as a treatment for the challenging behaviors of dementia. A community mental health system for behavior management should be constructed in parallel with a reduction in the number of hospital beds allotted for psychiatric care.

  15. The State of Emergency Medical Services (EMS) Systems in Africa.

    Science.gov (United States)

    Mould-Millman, Nee-Kofi; Dixon, Julia M; Sefa, Nana; Yancey, Arthur; Hollong, Bonaventure G; Hagahmed, Mohamed; Ginde, Adit A; Wallis, Lee A

    2017-06-01

    Introduction Little is known about the existence, distribution, and characteristics of Emergency Medical Services (EMS) systems in Africa, or the corresponding epidemiology of prehospital illness and injury. A survey was conducted between 2013 and 2014 by distributing a detailed EMS system questionnaire to experts in paper and electronic versions. The questionnaire ascertained EMS systems' jurisdiction, operations, finance, clinical care, resources, and regulatory environment. The discovery of respondents with requisite expertise occurred in multiple phases, including snowball sampling, a review of published scientific literature, and a rigorous search of the Internet. The survey response rate was 46%, and data represented 49 of 54 (91%) African countries. Twenty-five EMS systems were identified and distributed among 16 countries (30% of African countries). There was no evidence of EMS systems in 33 (61%) countries. A total of 98,574,731 (8.7%) of the African population were serviced by at least one EMS system in 2012. The leading causes of EMS transport were (in order of decreasing frequency): injury, obstetric, respiratory, cardiovascular, and gastrointestinal complaints. Nineteen percent of African countries had government-financed EMS systems and 26% had a toll-free public access telephone number. Basic emergency medical technicians (EMTs) and Basic Life Support (BLS)-equipped ambulances were the most common cadre of provider and ambulance level, respectively (84% each). Emergency Medical Services systems exist in one-third of African countries. Injury and obstetric complaints are the leading African prehospital conditions. Only a minority (<9.0%) of Africans have coverage by an EMS system. Most systems were predominantly BLS, government operated, and fee-for-service. Mould-Millman NK , Dixon JM , Sefa N , Yancey A , Hollong BG , Hagahmed M , Ginde AA , Wallis LA . The state of Emergency Medical Services (EMS) systems in Africa. Prehosp Disaster Med. 2017;32(3):273-283.

  16. Mental health care in Italy: organisational structure, routine clinical activity and costs of a community psychiatric service in Lombardy region.

    Science.gov (United States)

    Fattore, G; Percudani, M; Pugnoli, C; Contini, A; Beecham, J

    2000-01-01

    The Magenta Community Mental Health Centre (CMHC) is the public agency responsible for providing adult psychiatric care to about 85,000 adult residents. In 1995, it had 1,145 clients and incurred costs of Euro 1.9 millions. Average cost per patient and per adult resident were Euro 1,661 and Euro 22.2, respectively. These values mask large variation across diagnosis: while patients with schizophrenia and related disorders had an average cost of Euro 3,771, those with neurotic and related disorders had an average cost of Euro 439. Patients with schizophrenia and related disorders (28% of the patients) absorbed about 60% of total costs and made extensive use of several types of services (hospital, outpatient, domiciliary, social and rehabilitative care). Since integrating different types of services is the key element of Italian psychiatric care, the new fee-for-service system adopted by the NHS to fund providers does not appear appropriate, particularly for schizophrenic patients.

  17. Noise exposure during prehospital emergency physicians work on Mobile Emergency Care Units and Helicopter Emergency Medical Services

    DEFF Research Database (Denmark)

    Hansen, Mads Christian Tofte; Schmidt, Jesper Hvass; Brøchner, Anne C

    2017-01-01

    BACKGROUND: Prehospital personnel are at risk of occupational hearing loss due to high noise exposure. The aim of the study was to establish an overview of noise exposure during emergency responses in Mobile Emergency Care Units (MECU), ambulances and Helicopter Emergency Medical Services (HEMS)....... initiatives. Although no hearing loss was demonstrated in the personnel of the ground-based units, a reduced function of the outer sensory hair cells was found in the HEMS group following missions.......BACKGROUND: Prehospital personnel are at risk of occupational hearing loss due to high noise exposure. The aim of the study was to establish an overview of noise exposure during emergency responses in Mobile Emergency Care Units (MECU), ambulances and Helicopter Emergency Medical Services (HEMS......). A second objective was to identify any occupational hearing loss amongst prehospital personnel. METHODS: Noise exposure during work in the MECU and HEMS was measured using miniature microphones worn laterally to the auditory canals or within the earmuffs of the helmet. All recorded sounds were analysed...

  18. Organization structure and the performance of hospital emergency services.

    Science.gov (United States)

    Georgopoulos, B S

    1985-07-01

    A comparative study of 30 hospital emergency departments (EDs) and nearly 1,500 individuals associated with them was conducted. Data were obtained from institutional records, physicians, patients, and other sources. The object was to investigate the relationship between the organization and performance of these health service systems. The study assessed the quality of medical care, the quality of nursing care, and the economic efficiency of hospital EDs. The results show substantial interinstitutional differences in these criteria. They also show a significant relationship between medical and nursing care, but not between the quality of care and economic efficiency. Differences in ED performance are related to medical staffing patterns, medical teaching affiliation, personnel training, scope of emergency services, number of patient visits processed, and hospital size and complexity. Not all of these variables, however, correlate positively with all three criteria of performance, nor are they equally important to each.

  19. Measuring disaster preparedness of local emergency medical services agencies

    OpenAIRE

    Elliott, Ross W.

    2010-01-01

    CHDS State/Local Approved for public release; distribution is unlimited Emergency Medical Services (EMS) plays a key role in disaster response. Yet, determining how much preparedness is enough to achieve an acceptable level of preparedness is challenging. After conducting an extensive literature review, it is evident no nationally accepted method exists to evaluate an EMS system's level of disaster preparedness systematically. Research was conducted to define the skills and equipmen...

  20. Emergency Medical Services Capacity for Prehospital Stroke Care

    Centers for Disease Control (CDC) Podcasts

    2013-09-05

    In this audio podcast, lead author and Preventing Chronic Disease’s 2013 Student Research Contest Winner, Mehul D. Patel, talks about his article on stroke care and emergency medical services.  Created: 9/5/2013 by Preventing Chronic Disease (PCD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 9/5/2013.

  1. A seamless ubiquitous emergency medical service for crisis situations.

    Science.gov (United States)

    Lin, Bor-Shing

    2016-04-01

    In crisis situations, a seamless ubiquitous communication is necessary to provide emergency medical service to save people's lives. An excellent prehospital emergency medicine provides immediate medical care to increase the survival rate of patients. On their way to the hospital, ambulance personnel must transmit real-time and uninterrupted patient information to the hospital to apprise the physician of the situation and provide options to the ambulance personnel. In emergency and crisis situations, many communication channels can be unserviceable because of damage to equipment or loss of power. Thus, data transmission over wireless communication to achieve uninterrupted network services is a major obstacle. This study proposes a mobile middleware for cognitive radio (CR) for improving the wireless communication link. CRs can sense their operating environment and optimize the spectrum usage so that the mobile middleware can integrate the existing wireless communication systems with a seamless communication service in heterogeneous network environments. Eventually, the proposed seamless mobile communication middleware was ported into an embedded system, which is compatible with the actual network environment without the need for changing the original system architecture. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Nurses' perception about risk classification in an emergency service

    Directory of Open Access Journals (Sweden)

    Cristiane Chaves de Souza

    2014-04-01

    Full Text Available Objective. Get to know how nurses perceive the accomplishment of risk classification in an emergency service. Methodology. In this qualitative study, 11 nurses were included with at least two months of experience in the risk classification of patients who visited the emergency service. Semistructured interviews were used to collect the information. The data were collected between August and December 2011. For data analysis, Bardin's theoretical framework was used. Results. The nurses in the study consider the risk classification as a work organization instruments that permits closer contact between nurses and patients. The nursing skills needed for risk classification were identified: knowledge about the scale used, clinical perspective, patience and agility. The availability of risk classification scales was the main facilitator of this work. The main difficulties were the disorganization of the care network and the health team's lack of knowledge of the protocol. Conclusion. Risk classification offers an opportunity for professional autonomy to the extent that it is the main responsible for regulating care at the entry door of the emergency services.

  3. Occupational injury rates in personnel of emergency medical services

    Directory of Open Access Journals (Sweden)

    Robert Gałązkowski

    2015-12-01

    Full Text Available [i][/i][b]Introduction and objectives. [/b]The system of emergency medical services (EMS in Poland was established in 2006. The risk of occupational injuries to EMS personnel is very high, irrespective of the country where they operate, as they face many hazards in their everyday work. The aim of this study is to describe the type, incidence and consequences of occupational accidents among the personnel of the National Emergency Medical Services in Poland (NEMS – land and air ambulance crews in 2008–2012. [b]Material and methods:[/b] The study reviewed all occupational accidents among the EMS personnel reported to the National Labour Inspectorate in 2008–2012. [b]Results[/b]: In the period reported, the number of accidents decreased from 32 in 2008 to just 6 in 2012. Traffic accidents predominated and most of the victims were male paramedics under 30 years of age. The most common injuries included multiple organ injuries and injuries of the cervical spine, chest and trunk. [b]Conclusions:[/b] The growing professional experience of the EMS personnel has a beneficial effect on occupational injury rates as they tend to decrease with longer employment. Occupational accidents are definitely more common among ambulance crews than in the personnel of other organizational units of the National Emergency Medical Services.

  4. Cancer patients, emergencies service and provision of palliative care

    Directory of Open Access Journals (Sweden)

    Bruno Miranda

    2016-06-01

    Full Text Available SUMMARY Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011 with a minimum length of hospital stay of two hours. Student’s t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%. 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%, breast (13.6% and prostate (10.5%; 70.7% were in advanced stages (IV, 47.1%; 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals.

  5. Designing smartphone mental health applications for emergency service workers.

    Science.gov (United States)

    Deady, M; Peters, D; Lang, H; Calvo, R; Glozier, N; Christensen, H; Harvey, S B

    2017-08-01

    Emergency service workers are often exposed to trauma and have increased risk of a range of mental health (MH) conditions. Smartphone applications have the potential to provide this group with effective psychological interventions; however, little is known about the acceptability and preferences regarding such initiatives. To describe the preferences and opinions of emergency service workers regarding the use of smartphone MH applications and to examine the impact of age on these preferences. Participants were recruited from four metropolitan Fire and Rescue NSW stations and responded to questionnaire items covering three key domains: current smartphone use, potential future use and preferences for design and content as well as therapeutic techniques. Overall, approximately half the sample (n = 106) claimed they would be interested in trying a tailored emergency-worker MH smartphone application. There were few differences between age groups on preferences. The majority of respondents claimed they would use an app for mental well-being daily and preferred terms such as 'well-being' and 'mental fitness' for referring to MH. Confidentiality, along with a focus on stress, sleep, exercise and resiliency were all considered key features. Behavioural therapeutic techniques were regarded most favourably, compared with other therapies. Emergency workers were interested in utilizing smartphone applications focused on MH, but expressed clear preferences regarding language used in promotion, features required and therapeutic techniques preferred. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  6. [Further challenges in collaboration and cross-specialization work in psychiatric services].

    Science.gov (United States)

    Sakano, Yuji; Nakamura, Touru; Nakajima, Kimihiro

    2011-01-01

    Using a case illustrating cognitive behavioral treatment for a patient with obsessive-compulsive disorder, clinical tips and challenges are described in the context of collaboration between multiple health professionals from different backgrounds in a psychiatric hospital. Furthermore, after reviewing the current status of education and training issues related to collaboration, and introducing the fundamental concept of cross-specialization work, existing tasks and future challenges involved in the education and training of multiple health professions are discussed.

  7. Developing an operational capabilities index of the emergency services sector.

    Energy Technology Data Exchange (ETDEWEB)

    Collins, M.J.; Eaton, L.K.; Shoemaker, Z.M.; Fisher, R.E.; Veselka, S.N.; Wallace, K.E.; Petit, F.D. (Decision and Information Sciences)

    2012-02-20

    In order to enhance the resilience of the Nation and its ability to protect itself in the face of natural and human-caused hazards, the ability of the critical infrastructure (CI) system to withstand specific threats and return to normal operations after degradation must be determined. To fully analyze the resilience of a region and the CI that resides within it, both the actual resilience of the individual CI and the capability of the Emergency Services Sector (ESS) to protect against and respond to potential hazards need to be considered. Thus, a regional resilience approach requires the comprehensive consideration of all parts of the CI system as well as the characterization of emergency services. This characterization must generate reproducible results that can support decision making with regard to risk management, disaster response, business continuity, and community planning and management. To address these issues, Argonne National Laboratory, in collaboration with the U.S. Department of Homeland Security (DHS) Sector Specific Agency - Executive Management Office, developed a comprehensive methodology to create an Emergency Services Sector Capabilities Index (ESSCI). The ESSCI is a performance metric that ranges from 0 (low level of capabilities) to 100 (high). Because an emergency services program has a high ESSCI, however, does not mean that a specific event would not be able to affect a region or cause severe consequences. And because a program has a low ESSCI does not mean that a disruptive event would automatically lead to serious consequences in a region. Moreover, a score of 100 on the ESSCI is not the level of capability expected of emergency services programs; rather, it represents an optimal program that would rarely be observed. The ESSCI characterizes the state of preparedness of a jurisdiction in terms of emergency and risk management. Perhaps the index's primary benefit is that it can systematically capture, at a given point in time, the

  8. The Barbados Emergency Ambulance Service: High Frequency of Nontransported Calls

    Directory of Open Access Journals (Sweden)

    Sherwin E. Phillips

    2012-01-01

    Full Text Available Objectives. There are no published studies on the Barbados Emergency Ambulance Service and no assessment of the calls that end in nontransported individuals. We describe reasons for the nontransport of potential clients. Methods. We used the Emergency Medical Dispatch (Medical Priority Dispatch System instrument, augmented with five local call types, to collect information on types of calls. The calls were categorised under 7 headings. Correlations between call types and response time were calculated. Results. Most calls were from the category medical (54%. Nineteen (19% percent of calls were in the non-transported category. Calls from call type Cancelled accounted for most of these and this was related to response time, while Refused service was inversely related (. Conclusions. The Barbados Ambulance Service is mostly used by people with a known illness and for trauma cases. One-fifth of calls fall into a category where the ambulance is not used often due to cancellation which is related to response time. Other factors such as the use of alternative transport are also important. Further study to identify factors that contribute to the non-transported category of calls is necessary if improvements in service quality are to be made.

  9. Comparison of the characteristics of suicide attempters with major depressive disorder and those with no psychiatric diagnosis in emergency departments of general hospitals in China.

    Science.gov (United States)

    Wei, Shengnan; Li, Haiyan; Hou, Jinglin; Chen, Wei; Chen, Xu; Qin, Xiaoxia

    2017-01-01

    Major depressive disorder (MDD) is a known major risk factor for suicide due to the high suicide mortality. However, studies comparing the characteristics of suicide attempters with major depressive disorder and those with no psychiatric diagnosis in China are very limited. This study examined and compared the sociodemographic and psychological characteristics of suicide attempters with MDD and those with no psychiatric diagnosis in emergency departments of general hospitals to better understand the risk factors for suicide attempts in China. All subjects were enrolled in the study between June 2007 and January 2008. A total of 127 suicide attempters-54 with MDD and 73 with no psychiatric diagnosis-were enrolled. The sociodemographic and clinical characteristics were compared between two groups using the statistical analysis performed using frequency distribution, Student's t test, Chi-square test, and Fisher's exact test and a logistic regression model. Suicide attempters with MDD were more likely to be more depressive, older, divorced or separated, unemployed, and living alone, and more likely to write a suicide note, have suicide ideation, and be motivated by reducing pain and burden. Suicide attempters with no psychiatric diagnosis were more likely to be younger and more impulsive, have self-rescue, and be motivated by threatening or taking revenge on others. Multivariate logistic regression analysis identified the following independent predictors of suicide attempts in individuals with MDD: a lower score on the quality of life scale, more years of education, and suicide ideation. The present study found both similarities and differences in the sociodemographic and clinical characteristics of suicide attempters with MDD and those with no psychiatric diagnosis in the emergency departments of general hospitals in China. These findings will help us to recognize the characteristics of suicide attempters in both groups and develop specific interventions for the two

  10. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments.

    Science.gov (United States)

    Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-11-01

    Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  11. [Factors related to patient satisfaction with hospital emergency services].

    Science.gov (United States)

    Parra Hidalgo, Pedro; Bermejo Alegría, Rosa María; Más Castillo, Adelia; Hidalgo Montesinos, María Dolores; Gomis Cebrián, Rafael; Calle Urra, José Eduardo

    2012-01-01

    To determine the perceived quality variables related to satisfaction and to identify the influence of sociodemographic factors on user satisfaction with hospital emergencies. A telephone survey was conducted with a specifically designed questionnaire for use in a sample of 3,600 users of hospital emergency services in nine public hospitals in 2008 and 2009. The adjusted model including all perceived quality and sociodemographic variables explained 47.1% of the variance (adjusted R(2)). Of all the independent variables included, only eight were significant in predicting the level of patient satisfaction. These variables were related to the patient's opinion of the relationship with medical staff (p = 0.041), nurses' and porters' professionalism (p = 0.010 and 0.022), infrastructure (cleanliness and comfort) (p = 0.033 and 0.008), information received at discharge (p = 0.000), waiting time in the emergency department (p = 0.000) and the perception of treatment-diagnosis without failure (p = 0.028). The variables influencing emergency patients' satisfaction were determined, allowing areas where corrective action could be introduced to be identified. In addition, possible confounding factors that should be controlled for when comparing results among distinct hospitals were identified. The emergency satisfaction questionnaire is a useful instrument to evaluate and improve quality of care. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

  12. How Much Time Do Unhospitalized Patients Applying for Emergency Services Stay in Emergency Department

    Directory of Open Access Journals (Sweden)

    Mansur Kürsad Erkuran

    2013-12-01

    Full Text Available INTRODUCTION: The patients applying to a emergency service may stay longer than necessary for diagnosis, monitoring and treatment. This can be due to the inadequacy of the treatment performed in emergency department or to the absence of the required unit in the hospital. In this study, we analyzed the waiting period of the patients who have not been hospitalized. METHODS: The patients applying to Bolu İzzet Baysal Public Hospital Emergency Unit between 24.11.2009 and 25.08.2011 have been studied regarding their application date, the season, and their waiting period in the emergency unit. The data have been analyzed using the statistics software Package for the Social Sciences (SPSS, Inc., Chicago, IL, version 17.0 for Windows. The chi-square χ2 test has been used for the determination of the percentage distribution and significance and p<0,05 has been considered significant. RESULTS: 4215 patients applying to Bolu İzzet Baysal Public Hospital Emergency Unit between 24.11.2009 and 25.08.2011 and monitored without hospitalization have been studied. The patients mainly presented during spring (p<0.05. The application occurred more often between 20.00 PM – 23.59 PM (p<0.005. The mean duration of the accept-standby of the patients in emergency unit was 09±12 (minimum 0 minute, maximum 130 minutes. The patients waited 0,26 ±70 minutes in emergency unit examination (minimum 0 minute, maximum 1292 minutes. The total waiting time in emergency unit was 52 ±100 minutes (minimum 10, maximum 1435 minutes. DISCUSSION AND CONCLUSION: In this study, we observed that the duration of the hospitalization in emergency unit is longer than the ideal duration.

  13. Parents in adult psychiatric care and their children: a call for more interagency collaboration with social services and child and adolescent psychiatry.

    Science.gov (United States)

    Afzelius, Maria; Östman, Margareta; Råstam, Maria; Priebe, Gisela

    2018-01-01

    A parental mental illness affects all family members and should warrant a need for support. To investigate the extent to which psychiatric patients with underage children are the recipients of child-focused interventions and involved in interagency collaboration. Data were retrieved from a psychiatric services medical record database consisting of data regarding 29,972 individuals in southern Sweden and indicating the patients' main diagnoses, comorbidity, children below the age of 18, and child-focused interventions. Among the patients surveyed, 12.9% had registered underage children. One-fourth of the patients received child-focused interventions from adult psychiatry, and out of these 30.7% were involved in interagency collaboration as compared to 7.7% without child-focused interventions. Overall, collaboration with child and adolescent psychiatric services was low for all main diagnoses. If a patient received child-focused interventions from psychiatric services, the likelihood of being involved in interagency collaboration was five times greater as compared to patients receiving no child-focused intervention when controlled for gender, main diagnosis, and inpatient care. Psychiatric services play a significant role in identifying the need for and initiating child-focused interventions in families with a parental mental illness, and need to develop and support strategies to enhance interagency collaboration with other welfare services.

  14. Psychiatric disorders in Norwegian 8- to 10-year-olds: an epidemiological survey of prevalence, risk factors, and service use

    DEFF Research Database (Denmark)

    Heiervang, Einar; Stormark, Kjell M; Lundervold, Astri J

    2007-01-01

    OBJECTIVE: The Bergen Child Study is a longitudinal study of child mental health from the city of Bergen, Norway. We present methods and results from the first wave of the study, focusing on prevalence of disorders, associations with risk factors, and the use of services. METHOD: The target......% of children with attention-deficit/hyperactivity disorder had been in contact with specialist mental health services, this was true for only 13% of those with pure emotional disorders. CONCLUSIONS: The overall prevalence of psychiatric disorders in children is relatively low in this Norwegian sample, when...... population included all 9,430 children attending grades 2 to 4 in Bergen schools during the academic year 2002/2003. The main screening instrument was the Strengths and Difficulties Questionnaire, whereas diagnoses were based on the Development and Well-Being Assessment. Information about child and family...

  15. Stigma, Social Structure, and the Biomedical Framework: Exploring the Stigma Experiences of Inpatient Service Users in Two Belgian Psychiatric Hospitals.

    Science.gov (United States)

    Sercu, Charlotte; Bracke, Piet

    2017-07-01

    The study discusses the stigma experiences of service users in mental health care, within the debate on the role of the biomedical framework for mental health care and power relations in society. Interview data of inpatient users ( n = 42) and care providers ( n = 43) from two Belgian psychiatric hospitals were analyzed using a constructivist grounded theory approach: Findings offer insight into how stigma experiences are affected by social structure. Stigma seemed to be related to the relation between care providers and service users their social position. The concept "mental health literacy" is used to frame this finding. In paying attention to the specific cultural and normative context, which influences the relationship between mental health literacy and stigma, it is further possible to cast some light on the meaning of the biomedical model for the construction and maintenance of power relations in mental health care and broader society.

  16. Cloud based emergency health care information service in India.

    Science.gov (United States)

    Karthikeyan, N; Sukanesh, R

    2012-12-01

    A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the

  17. Working styles of medicine professionals in emergency medical service

    Directory of Open Access Journals (Sweden)

    Lazarević Marija

    2015-01-01

    Full Text Available Introduction: Transactional analysis is a personality and communication theory established by psychiatrist Eric Berne, at the end of the fifties. Counter script is the way of life in accordance with parental imperative. The person with a counter-script has a compulsion to fulfill the required task in order to avoid the disaster of ban. There are five drivers that are considered essential, and these are: 'Be perfect!', 'Be strong!', 'Hurry up!', 'Please others!' and 'Work hard!' Objective: a Determination of the most dominant driver in this medical service. b Because of the specifics of this job which requires speed and humanity, the emphasis will be on doublet: 'Hurry up!' and 'Please others!' Method: The study was conducted on a group of subjects employed in a general service with medical emergency. The instrument used in the study was Julie Hay's questionnaire for diagnosing the working styles. Results: Statistical research was conducted on a sample of 30 subjects employed in the emergency medical service. Availability of all afore mentioned drivers was tested. The research hypotheses were formulated as follows: H0: The driver is not present among the employees in this service; H1: The driver is present among the employees in this service. Calculated value of the t-statistics for the driver 'Hurry up!' is 1.398; for the driver 'Be perfect!' 3.616; for the driver 'Please others!' 11.693; for the driver 'Work hard!' -0.673; and for the driver 'Be strong!' 3.880. Since the realizable value of the t-statistics for the drivers: 'Be perfect!' and 'Please others!' and 'Be strong!' is bigger than the critical value 1.699, and p<0.05 we reject the null hypothesis and we accept the alternative hypothesis on the significance level of 95%. For the drivers 'Hurry up!' and 'Work hard!' the values of t-statistics are lower than the critical value 1.699 for significance level of 95%, so the alternative hypothesis are not acceptable. Conclusion: The results of

  18. [Psychiatric patients at the police station in the southern South Holland region: assessment by the District Health Service forensic doctor].

    Science.gov (United States)

    Aardoom, H A; Huisman-Wolfs, M M; Nijs, H G T

    2002-09-21

    To describe the epidemiological characteristics of ambulant psychiatric patients who were either brought to the police station or who came by themselves, but who were not kept in a cell, as a basis for the development of a reception protocol. Descriptive. The data from the medical records from 2000 kept by the forensic doctors employed by the district health services for the Southern South Holland region were inventoried. On request by the police, the forensic doctors examined 203 clients. The majority of these were middle-aged men who did have a place of residence. The reason for police involvement was bizarre or confused behaviour in public. Half of the patients had received or were receiving some form of psychiatric treatment from the mental health service. In approximately half of the cases the forensic doctor found a solution together with the police. In the other half of the cases the forensic doctor asked the crisis intervention team at the mental health service for an evaluation. Two thirds of these patients were hospitalised and one third was sent away. Because examination by both the forensic doctor and the mental health service psychiatrist and other procedures were lengthy (up to 6 hours), patients had to spend a long time in a holding cell at the police station that was not designed for stays of this length of time, and often lacked toilet facilities. The forensic doctor treated about half the clients without the need of assistance from the crisis intervention psychiatrist. The temporary accommodation for these confused clients was inadequate.

  19. Perinatal and psychosocial circumstances associated with risk of attempted suicide, non-suicidal self-injury and psychiatric service use. A longitudinal study of young people.

    LENUS (Irish Health Repository)

    Young, Robert

    2011-11-18

    Abstract Background Past studies using large population based datasets link certain perinatal circumstances (birth weight, parity, etc) with mental health outcomes such as suicide, self-harm and psychiatric problems. Problematically, population datasets omit a number of social confounds. The aim of this study is to replicate past research linking perinatal circumstances and mental health (suicidality and use of psychiatric services) and to determine if such associations remain after adjusting for social circumstances. Methods A longitudinal school-based survey of 2157 young people (surveyed at age 11, 13, 15) followed up in early adulthood (age 19). At age 11 parents of participants provided information about perinatal circumstances (birth weight, birth complications, etc.) and psychiatric service use. Participants provided data about their mental health at age 15 (attempted suicide, suicidal thoughts) and at ages 19 (self-harm, psychiatric service use). In addition, data were collected about their social and psychosocial circumstances (gender, deprivation, religion, sexual behaviour, etc.). Results Predictably, social factors were linked to mental health outcomes. For example, those with same sex partners were more likely (OR 4.84) to self-harm than those without a same sex partner. With a single exception, in both unadjusted and adjusted models, perinatal circumstances were not or only marginally associated with mental health outcomes. The exception was the number of birth complications; young people with two or more complications were approximately 2-3 times more likely than those without complications to use psychiatric services. Conclusions While we failed to replicate results found using large population based datasets, some of our results are compatible with prior research findings. Further, evidence from this study supports the influence of perinatal circumstances (birth complications) on later psychiatric problems, or at least higher than expected contact

  20. Investigating emergency room service quality using lean manufacturing.

    Science.gov (United States)

    Abdelhadi, Abdelhakim

    2015-01-01

    The purpose of this paper is to investigate a lean manufacturing metric called Takt time as a benchmark evaluation measure to evaluate a public hospital's service quality. Lean manufacturing is an established managerial philosophy with a proven track record in industry. A lean metric called Takt time is applied as a measure to compare the relative efficiency between two emergency departments (EDs) belonging to the same public hospital. Outcomes guide managers to improve patient services and increase hospital performances. The patient treatment lead time within the hospital's two EDs (one department serves male and the other female patients) are the study's focus. A lean metric called Takt time is used to find the service's relative efficiency. Findings show that the lean manufacturing metric called Takt time can be used as an effective way to measure service efficiency by analyzing relative efficiency and identifies bottlenecks in different departments providing the same services. The paper presents a new procedure to compare relative efficiency between two EDs. It can be applied to any healthcare facility.

  1. Access to emergency care services: a transversal ecological study about Brazilian emergency health care network.

    Science.gov (United States)

    Rocha, T A H; da Silva, N C; Amaral, P V; Barbosa, A C Q; Rocha, J V M; Alvares, V; de Almeida, D G; Thumé, E; Thomaz, E B A F; de Sousa Queiroz, R C; de Souza, M R; Lein, A; Toomey, N; Staton, C A; Vissoci, J R N; Facchini, L A

    2017-12-01

    Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). Cross-sectional ecological study. Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  2. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    Directory of Open Access Journals (Sweden)

    James Robert Langabeer

    2016-11-01

    Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  3. Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept.

    Science.gov (United States)

    Choi, Bryan Y; Blumberg, Charles; Williams, Kenneth

    2016-03-01

    Mobile integrated health care and community paramedicine are models of health care delivery that use emergency medical services (EMS) personnel to fill gaps in local health care infrastructure. Community paramedics may perform in an expanded role and require additional training in the management of chronic disease, communication skills, and cultural sensitivity, whereas other models use all levels of EMS personnel without additional training. Currently, there are few studies of the efficacy, safety, and cost-effectiveness of mobile integrated health care and community paramedicine programs. Observations from existing program data suggest that these systems may prevent congestive heart failure readmissions, reduce EMS frequent-user transports, and reduce emergency department visits. Additional studies are needed to support the clinical and economic benefit of mobile integrated health care and community paramedicine. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  4. Euthanasia requests in a Canadian psychiatric emergency room: A case series: Part 1 of the McGill University euthanasia in psychiatry case series.

    Science.gov (United States)

    Benrimoh, David; Perreault, Antoine; Van Den Eynde, Frederique

    Euthanasia was decriminalized in Quebec in December 2015, and Canada-wide in June 2016. Both the Provincial and Federal legislation have limited the right to medical assistance in dying (MAID) to end-of-life cases; which makes MAID inaccessible to most patients solely suffering from psychiatric illness. While some end-stage anorexia nervosa or elderly patients may meet the end-of-life criterion because of their medical comorbidities or their age (Kelly et al., 2003), repeated suicide attempts or psychotic disorganization would not qualify since they would not be seen as elements of an illness leading to a foreseeable "natural death" (Canada, 2016). This is in contradiction to other jurisdictions, such as Belgium and the Netherlands as well as the eligibility criteria stated in the Supreme Court of Canada's decision in Carter v. Canada (Supreme Court of Canada, 2015). Here we analyze three cases of patients who presented to a psychiatric emergency department and requested MAID for psychiatric reasons. While none of the patients were eligible for MAID under Canadian law, we find that their demographics match closely that of patients granted MAID for psychiatric reasons in jurisdictions where that practice is allowed. Based on these cases, we comment on potentially negative consequences that may come from decriminalizing MAID for psychiatric reasons (such as an increased assessment burden on ED staff) and potentially positive consequences (such as encouraging suffering patients who had not consulted to seek care). While it is by no means our intention to take a political or moral stand on this important issue, or to conclusively weigh the negatives and positives of allowing MAID for psychiatric reasons, we do stress the importance of an active voice for psychiatry in this ongoing public debate. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Gender in relation to work motivation, satisfaction and use of day center services among people with psychiatric disabilities.

    Science.gov (United States)

    Eklund, Mona; Eklund, Lisa

    2017-05-01

    Day centres can prepare for open-market employment, and attendees' work motivation is key in this. Adopting a gender perspective, this study investigated (1) motivation for day centre attendance, satisfaction with the day centre services, number of hours spent there, and number and type of occupations performed; and (2) whether those factors were related with motivation for open-market employment. Women (n = 164) and men (n = 160) with psychiatric disabilities completed self-report questionnaires. There were no gender differences regarding satisfaction with the day centre services or number of hours spent there, but women engaged in more occupations. More women than men performed externally-oriented services and textile work, while men were in the majority in workshops. Externally oriented services, working in workshops, and low satisfaction with the day centre services were associated with higher motivation for employment. Women and men were equally motivated for employment. Women scored higher on motivation for attending the day centre, something that may deter transition into open-market employment. For men, less motivation for attending day centres may reduce their possibilities of gaining skills that can facilitate transitioning to open-market employment. Thus, the possibility for transitioning from day centre activities to open-market employment may be gendered.

  6. [New possibilities in emergency medical transportation and emergency services of Polish Medical Air Rescue].

    Science.gov (United States)

    Gałazkowski, Robert

    2010-01-01

    In Poland, two types of medical services are accomplished by the Medical Air Rescue (MAR) operating all over the country: emergency transport from the incident scene to hospital and inter-hospital transport. Helicopters or planes are used for this purpose. In 2009, helicopters performed 4359 flights to incidents and 1537 inter-hospital transports whereas planes performed 589 inter-hospital ambulance and 196 rescue flights. MAR operates from 17 bases of the Helicopter Emergency Medical Service (HEMS) and one airbase. Helicopters are mainly used when medical transport is emergent, within the operational region of a given base whereas planes when the distance between the present and target airports exceeds 250 km. In 2008, new modern aircraft were introduced to HEMS-helicopters EC 135. They fulfil all requirements of air transport regulations and are adjusted to visual (VFR) and instrumental (IFR) flights rules, at day and night. The medical cabin of EC 135 is ergonomic and functional considering the majority of rescue activities under life-saving circumstances. It is equipped with ventilator, defibrillator, infusion pumps etc. Defibrillators have 12-lead ECG, E(T)CO2, SpO2, NIBP, and IBP modules. Transport ventilators can work in a variety of ventilation modes including CMV, SIMV, SVV, BILEVEL, PCV, ASB, PPV and CPAP. The purchase of helicopters with modern avionic and medical configuration ensures high quality services of MAR for many years to come.

  7. Emergency medical service in the stroke chain of survival.

    Science.gov (United States)

    Chenaitia, Hichem; Lefevre, Oriane; Ho, Vanessa; Squarcioni, Christian; Pradel, Vincent; Fournier, Marc; Toesca, Richard; Michelet, Pierre; Auffray, Jean Pierre

    2013-02-01

    The Emergency Medical Services (EMS) play a primordial role in the early management of adults with acute ischaemic stroke (AIS). The aim of this study was to evaluate the role and effectiveness of the EMS in the stroke chain of survival in Marseille. A retrospective observational study was conducted in patients treated for AIS or transient ischaemic attack in three emergency departments and at the Marseille stroke centre over a period of 12 months. In 2009, of 1034 patients ultimately presenting a diagnosis of AIS or transient ischaemic attack, 74% benefited from EMS activation. Dispatchers correctly diagnosed 57% of stroke patients. The symptoms most frequently reported included limb weakness, speech problems and facial paresis. Elements resulting in misdiagnosis by dispatchers were general discomfort, chest pain, dyspnoea, fall or vertigo. Stroke patients not diagnosed by emergency medical dispatchers but calling within 3 h of symptom onset accounted for 20% of cases. Our study demonstrates that public intervention programmes must stress the urgency of recognizing stroke symptoms and the importance of calling EMS through free telephone numbers. Further efforts are necessary to disseminate guidelines for healthcare providers concerning stroke recognition and the new therapeutic possibilities in order to increase the likelihood of acute stroke patients presenting to a stroke team early enough to be eligible for acute treatment. In addition, EMS dispatchers should receive further training about atypical stroke symptoms, and 'Face Arm Speech Test' tests must be included in the routine questionnaires used in emergency medical calls concerning elderly persons.

  8. The impact of the Great East Japan earthquake on mandatory psychiatric emergency hospitalizations in Tokyo: a retrospective observational study.

    Science.gov (United States)

    Aoki, A; Aoki, Y; Harima, H

    2012-10-09

    On 11 March 2011, the eastern part of Japan was struck by a magnitude 9.0 quake. About 20 000 people were killed or were missing, and a nuclear crisis followed. In Tokyo, people were indirectly exposed to the earthquake and nuclear crisis by TV broadcast. The aim of our study was to evaluate the potential effect of the series of catastrophes on psychiatric emergency hospitalizations in Tokyo. Clinical records of patients who were mandatorily admitted to Tokyo Metropolitan Matsuzawa Hospital by law because of urgent risk to self or others were reviewed. Records regarding the 2 years of investigation, which include the 6 months after the earthquake, were reviewed. The six months after the earthquake were compared with the eighteen months before the earthquake in clinical and demographic data using independent t-tests or χ(2) tests. During the 6 months before and after the earthquake, 97 and 127 people were mandatorily admitted. χ(2) Tests demonstrated a significant increase in the number of patients after the earthquake (P = 0.045), attributable to the significant increase in the number of patients with schizophrenia after the earthquake (P = 0.011, 32 vs 56), whereas there were no significant differences in the number of patients with other diagnoses between those two periods. Independent t-tests revealed that patients admitted after the earthquake had marginally significantly shorter periods of education compared with those admitted before the earthquake (13.78 vs 12.82 years, P = 0.084). This work suggests that patients with schizophrenia were more sensitive to indirect exposure to the earthquake and that a shorter period of education was a potential risk factor.

  9. [Psychiatric case management. Chronic Disease Management application experience in a public Mental Health Service].

    Science.gov (United States)

    Pompili, Enrico; Silvestrini, Cristiana; Nicolò, Giuseppe; Pitino, Annalisa; Bernabei, Laura

    2014-01-01

    Aim of this study is to investigate the possible effectiveness of a specific program management needs of patients at high impact health care, case management (CM). The welfare impact is evaluated in terms of the severity of the presented disorder or to other characteristic factors of the individual patient, such as: adherence to the proposed treatments, possible resistance to drug treatment, cognitive structure, the presence of comorbid medical pathologies, abuse/addiction and, more generally, all bio-psycho-social functioning variables that can complicate the treatment of the patient. Twenty five outpatients with chronic schizophrenia (age mean 49,5 yrs) were evaluated through the Camberwell Assessment of Need (CAN20) and Life Skill Profile (LSP) before and after 1 year of CM treatment. General psychopathology was assessed by the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS). Demographic data were collected, as well as data related to the severity of the disorder: number of hospitalizations and number of switch in drug treatment in the year before the study. Between T0 and T1 there is a significant improvement on CGI-G, BPRS (total and HOST factor), LSP and CAN TOT in patients treated with CM. Moreover, in CM treated patients a 58% reduction of hospitalizations is noted in the year of study. There is a possible effectiveness of CM in improving patient's clinical and social needs in chronic psychiatric diseases. The CM reduces the number of hospitalizations.

  10. How urgent is urgent? Analysing urgent out-patient referrals to an adult psychiatric service.

    Science.gov (United States)

    Cubbin, S; Llewellyn-Jones, S; Donnelly, P

    2000-01-01

    It was noticed that over some years the number of referrals to the outpatient clinic (from various sources) which were marked 'urgent' had increased. We aimed to examine who makes these urgent referrals and the clinical factors associated with 'urgent' status. A sample of 201 referrals over a 26-month period was examined. Details of the referral requests were collected using a specially designed form. After each 'urgent' assessment, the referral was scored for appropriateness. This gave an indication of the agreement between referrer and clinic doctor as to what should constitute an ¤ urgent' referral. The majority of urgent referrals were from community psychiatric nurses, who, together with psychiatric social workers, make the most appropriate referrals. The more appropriate referrals clearly specified the clinical factors associated with urgent need for review. Patients regarded as suicidal were not associated with significantly higher appropriateness scores. Referrers should try and make 'urgent' outpatient requests as specific as possible: more clinical detail gives a clearer picture to the clinic doctor. Telephone consultations with general practitioners may help to ascertain a clearer picture of urgent requests if detail is lacking. Health professionals may all benefit from education in suicidal risk assessment. ( Int J Psych Clin Pract 2000; 4: 233 - 235).

  11. Short admission in an emergency psychiatry unit can prevent prolonged lengths of stay in a psychiatric institution Internação breve em unidade de emergência psiquiátrica pode prevenir permanência prolongada em instituições psiquiátricas

    Directory of Open Access Journals (Sweden)

    Régis Eric Maia Barros

    2010-06-01

    Full Text Available OBJECTIVE: Characterize and compare acute psychiatric admissions to the psychiatric wards of a general hospital (22 beds, a psychiatric hospital (80 and of an emergency psychiatry unit (6. METHOD: Survey of the ratios and shares of the demographic, diagnostic and hospitalization variables involved in all acute admissions registered in a catchment area in Brazil between 1998 and 2004. RESULTS: From the 11,208 admissions, 47.8% of the patients were admitted to a psychiatric hospital and 14.1% to a general hospital. The emergency psychiatry unit accounted for 38.1% of all admissions during the period, with a higher variability in occupancy rate and bed turnover during the years. Around 80% of the hospital stays lasted less than 20 days and in almost half of these cases, patients were discharged in 2 days. Although the total number of admissions remained stable during the years, in 2004, a 30% increase was seen compared to 2003. In 2004, bed turnover and occupancy rate at the emergency psychiatry unit increased. CONCLUSION: The increase in the number of psychiatric admissions in 2004 could be attributed to a lack of new community-based services available in the area beginning in 1998. Changes in the health care network did affect the emergency psychiatric service and the limitations of the community-based network could influence the rate of psychiatric admissions.OBJETIVO: Caracterizar e comparar internações psiquiátricas agudas em alas psiquiátricas no hospital geral (22 leitos, hospital psiquiátrico (80 e emergência psiquiátrica (6. MÉTODO: Foram analisadas todas as internações agudas entre 1998 e 2004 na região do estudo, com razões e proporções de variáveis demográficas, diagnósticas e das hospitalizações. RESULTADOS: Das 11.208 internações, 47,8% foram no hospital psiquiátrico e 14,1% no hospital geral. A emergência psiquiátrica realizou 38,1% das internações no período, com grande variabilidade da taxa de ocupa

  12. Reporting Helicopter Emergency Medical Services in Major Incidents

    DEFF Research Database (Denmark)

    Fattah, Sabina; Johnsen, Anne Siri; Sollid, Stephen J M

    2016-01-01

    OBJECTIVE: Research on helicopter emergency medical services (HEMS) in major incidents is predominately based on case descriptions reported in a heterogeneous fashion. Uniform data reported with a consensus-based template could facilitate the collection, analysis, and exchange of experiences...... variables were determined by consensus. These variables were formatted in a template with 4 main categories: HEMS background information, the major incident characteristics relevant to HEMS, the HEMS response to the major incident, and the key lessons learned. CONCLUSION: Based on opinions from European...

  13. Development and usability testing of a web-based decision support for users and health professionals in psychiatric services.

    Science.gov (United States)

    Grim, Katarina; Rosenberg, David; Svedberg, Petra; Schön, Ulla-Karin

    2017-09-01

    Shared decision making (SMD) related to treatment and rehabilitation is considered a central component in recovery-oriented practice. Although decision aids are regarded as an essential component for successfully implementing SDM, these aids are often lacking within psychiatric services. The aim of this study was to use a participatory design to facilitate the development of a user-generated, web-based decision aid for individuals receiving psychiatric services. The results of this effort as well as the lessons learned during the development and usability processes are reported. The participatory design included 4 iterative cycles of development. Various qualitative methods for data collection were used with potential end users participating as informants in focus group and individual interviews and as usability and pilot testers. Interviewing and testing identified usability problems that then led to refinements and making the subsequent prototypes increasingly user-friendly and relevant. In each phase of the process, feedback from potential end-users provided guidance in developing the formation of the web-based decision aid that strengthens the position of users by integrating access to information regarding alternative supports, interactivity between staff and users, and user preferences as a continual focus in the tool. This web-based decision aid has the potential to strengthen service users' experience of self-efficacy and control as well as provide staff access to user knowledge and preferences. Studies employing participatory models focusing on usability have potential to significantly contribute to the development and implementation of tools that reflect user perspectives. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  14. Triage in an adult emergency service: patient satisfaction

    Directory of Open Access Journals (Sweden)

    Pollyane Liliane Silva

    2016-06-01

    Full Text Available Abstract OBJECTIVE Assess the degree of patient satisfaction with triage in the adult emergency service of a public hospital. METHOD Exploratory, descriptive, cross-sectional study with a quantitative approach. Three hundred patients were interviewed and the data were analyzed using descriptive statistics based on sociodemographic variables and those related to patient satisfaction. RESULTS There was a predominance of women, with elementary education and a mean age of 41 years. Most of the interviewees reported being satisfied in regard to the following items: timely service, embracement, trust, environment (comfort, cleanliness and signage, humanization (courtesy, respect, and interest, timely referral/scheduling of appointments and care expectations. CONCLUSION There was a high level of patient satisfaction, evidenced by the strong association of user satisfaction with the items investigated.

  15. Quality of emergency rooms and urgent care services: user satisfaction.

    Science.gov (United States)

    Lima, Cássio de Almeida; Santos, Bruna Tatiane Prates dos; Andrade, Dina Luciana Batista; Barbosa, Francielle Alves; Costa, Fernanda Marques da; Carneiro, Jair Almeida

    2015-01-01

    To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself.

  16. Psychiatric symptom typology in a sample of youth receiving substance abuse treatment services: associations with self-reported child maltreatment and sexual risk behaviors.

    Science.gov (United States)

    Oshri, Assaf; Tubman, Jonathan G; Jaccard, James

    2011-11-01

    Latent profile analysis (LPA) was used to classify 394 adolescents undergoing substance use treatment, based on past year psychiatric symptoms. Relations between profile membership and (a) self-reported childhood maltreatment experiences and (b) current sexual risk behavior were examined. LPA generated three psychiatric symptom profiles: Low-, High- Alcohol-, and High- Internalizing Symptoms profiles. Analyses identified significant associations between profile membership and childhood sexual abuse and emotional neglect ratings, as well as co-occurring sex with substance use and unprotected intercourse. Profiles with elevated psychiatric symptom scores (e.g., internalizing problems, alcohol abuse and dependence symptoms) and more severe maltreatment histories reported higher scores for behavioral risk factors for HIV/STI exposure. Heterogeneity in psychiatric symptom patterns among youth receiving substance use treatment services, and prior histories of childhood maltreatment, have significant implications for the design and delivery of HIV/STI prevention programs to this population.

  17. Does a hostel's managing agency determine the access to psychiatric services of its residents?

    Science.gov (United States)

    Lucas, B; Audini, B; Chisholm, D; Knapp, M; Lelliott, P

    1998-10-01

    This study examines the effect of managing agency (local authority, private or voluntary) on the use of other health and social care services by residents in mental health hostels and group homes with different levels of staffing in England and Wales. The sample comprised 1323 residents in 275 facilities in eight districts. The measures of service use were number of days in hospital and number of other service contacts. There were highly significant differences between facilities with similar levels of staffing managed by different agencies. Residents in the voluntary sector used fewer community services overall; residents in low-staffed local authority facilities used more services than those in similar facilities managed by other agencies. These differences were not easily explained by differences in the social or clinical characteristics of residents. This suggests that there may be organisational factors, e.g. hostel staff, knowledge of services, which influence access to and use of community services.

  18. Treatment received, satisfaction with health care services, and psychiatric symptoms 3 months after hospitalization for self-poisoning

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    Grimholt Tine K

    2012-04-01

    Full Text Available Abstract Background Patients who self-poison have high repetition and high mortality rates. Therefore, appropriate follow-up is important. The aims of the present work were to study treatment received, satisfaction with health care services, and psychiatric symptoms after hospitalization for self-poisoning. Methods A cohort of patients who self-poisoned (n = 867 over a period of 1 year received a questionnaire 3 months after discharge. The Beck Depression Inventory (BDI, Beck Hopelessness Scale (BHS, and Generalized Self-Efficacy Scale (GSE were used. The participation rate was 28% (n = 242; mean age, 41 years; 66% females. Results Although only 14% of patients were registered without follow-up referrals at discharge, 41% reported no such measures. Overall, satisfaction with treatment was fairly good, although 29% of patients waited more than 3 weeks for their first appointment. A total of 22% reported repeated self-poisoning and 17% cutting. The mean BDI and BHS scores were 23.3 and 10.1, respectively (both moderate to severe. The GSE score was 25.2. BDI score was 25.6 among patients with suicide attempts, 24.9 for appeals, and 20.1 for substance-use-related poisonings. Conclusions Despite plans for follow-up, many patients reported that they did not receive any. The reported frequency of psychiatric symptoms and self-harm behavior indicate that a more active follow-up is needed.

  19. Energy, emissions and emergency medical services: Policy matters

    International Nuclear Information System (INIS)

    Brown, Lawrence H.; Blanchard, Ian E.

    2012-01-01

    Understanding the energy consumption and emissions associated with health services is important for minimizing their environmental impact and guiding their adaptation to a low-carbon economy. In this post-hoc analysis, we characterize the energy burden of North American emergency medical services (EMS) agencies and estimate the potential marginal damage costs arising from their emissions as an example of how and why health services matter in environmental and energy policy, and how and why environmental and energy policy matter to health services. We demonstrate EMS systems are energy intensive, and that vehicle fuels represent 80% of their energy burden while electricity and natural gas represent 20%. We also demonstrate that emissions from EMS operations represent only a small fraction of estimated health sector emissions, but for EMS systems in the United States the associated marginal damage costs are likely between $2.7 million and $9.7 million annually. Significant changes in the supply or price of energy, including changes that arise from environmental and energy policy initiatives designed to constrain fossil fuel consumption, could potentially affect EMS agencies and other health services. We encourage cross disciplinary research to proactively facilitate the health system's adaptation to a low-carbon economy. - Highlights: ► Estimated EMS-related emissions less than 1% of health sector emissions. ► Damage costs of U.S. EMS-related emissions estimated at $2.7 to $9.7 million. ► EMS energy burden is approximately 442 MJ per ambulance response. ► Approximately 80% of EMS energy burden is vehicle fuels. ► Energy supply, price and policy could impact EMS (and other health) services. ► Research needed to facilitate health services’ adaptation to a low carbon economy.

  20. The Organization of the Psychiatric Service and Criminality Committed by the Mentally Ill

    DEFF Research Database (Denmark)

    Kramp, Peter; Gabrielsen, Gorm

    2009-01-01

    Introduction: Over the past 40 years, a marked deinstitutionalisation in favour of social and community psychiatry has taken place in many countries. During this same period of time, there has been an increase in the number of mentally ill criminals. The purpose of this study is to analyse...... the correlations between the reorganization of the psychiatric treatment system, the growing number of forensic patients and the increase in serious crime, homicide, arson and violence associated with the mentally ill. Materials and methods: Using registers and other data sources, we estimated the annual positive......: The study is based on historical data, but the results are still valid. We have used two sets of data firstly the number of forensic patients and, secondly the reported number of crimes associated with the mentally ill. The uniformity of the results leads us to consider them for certain: That the decreasing...

  1. Services Use of Children and Adolescents before Admission to Psychiatric Inpatient Care.

    Science.gov (United States)

    Zechmeister-Koss, Ingrid; Winkler, Roman; Fritz, Corinna; Thun-Hohenstein, Leonhard; Tuechler, Heinz

    2016-06-01

    Although 20% of children and adolescents in Europe suffer from overt mental health problems, their illness-related service utilisation is often unknown. If at all, existing research has only addressed the health care sector while services requirements in mental health care go far beyond the health care system, including the social, the educational and the criminal justice system. This paper aims at describing the service contact patterns of children and adolescents within and outside the health care sector before they are admitted to a child and adolescent mental health hospital. Additionally, we evaluate the private out-of-pocket payments that occur for primary carers. A cohort of consecutive admissions to a child and adolescent hospital in Austria was prospectively analysed. We collected data on service use and out-of-pocket expenses before hospital admission from primary carers through face-to-face interviews using an adapted version of the European Child and Adolescent Mental Health Service Receipt Inventory (EU-CAMHSRI). Clinical data came from validated questionnaires (CBCL, YSR) and from the anamnestic documentation. Ninety percent from a cohort of 441 patients had some contact with services or took medication before they were admitted to hospital. Most often, services in the health care outpatient setting were used. Outside of the health care system, support in school, as well as counselling services, were used most frequently, whereas the persons hardly sought support in living or employment. Roughly 32,400 per 100 patients was spent privately, yet these out-of pocket expenses were very unevenly distributed. Service use and out-of-pocket spending increased with social status and were gender-specific. The more severe external behaviour symptoms were, the more non-health care services were used. Mentally ill children and adolescents use a broad range of services across sectors before admission to hospital. Service use is associated with specific symptoms of

  2. Absenteeism and its implications for nursing care in emergency services

    Directory of Open Access Journals (Sweden)

    Ione Carvalho Pinto

    2017-11-01

    Full Text Available The aim of this study was to identify the frequency of absenteeism among nursing teams and its determinants in healthcare emergency services. A cross-sectional study was carried out by means of secondary data from records of a coordination of human resources. Occurrences with 208 nursing professionals were identified. Univariate analysis was carried out with frequency calculation of the variables age, gender, professional category, workplace, and days and reasons for absenteeism. Fisher’s exact test was applied, fixing the error type I in 5%. The mean age of the participants was 47.2 years, with a prevalence of the female gender (79.8%. A total of 5,778 occurrences of absenteeism were found (mean of 28 per professional, and illness was the main determinant for absenteeism (2,671 occurrences; 46.2%. There was a prevalence of short-term absenteeism (3,020 occurrences; 52.3%. The findings observed in emergency services were similar, with a potential impact on planning, workforce, and quality of care.

  3. Training Librarians for 21st Century Repository Services: Emerging Trends

    Directory of Open Access Journals (Sweden)

    Helen Emasealu

    2016-05-01

    Full Text Available The paper reviewed the emerging roles of the 21st century librarians, charged with the responsibility to manage repository services across libraries in present-day information technology environment. Librarians need to be trained and empowered with requisite skills and knowledge needed for successful management of the ICT driven repository initiatives that the 21st century demands. Literature was reviewed on the roles and responsibilities of librarians, training needs and opportunities, career path and recruitment of librarians, and community support necessary for effective and efficient implementation and management of repository initiatives. This entails the ability to comprehend trends and change patterns which are essential for providing research focused and user-friendly models in open repository services that are based on thorough analytical understanding of the challenges of emerging trends. To achieve this requires the training and retraining of librarians to reposition them as information specialists in their career path. The role of the library as an integral part of its social environment is to educate the community about the existence of an open repository by building partnership with community-oriented research centres through seminars, workshops, symposium, training, and awareness programmes. The study recommends that librarians should strategize and collaborate with researchers to make open repository an essential research tool.

  4. A Psychiatric Primer for Programs Serving People with Developmental Disabilities. Monograph #101.

    Science.gov (United States)

    Dal Pozzo, Earlene; Bernstein, Gail S.

    Intended for personnel in programs serving persons with developmental disabilities, the booklet provides basic information about the major psychiatric disorders and their treatment. Five sections cover: the major disorders; medications--uses and problems; assessment; cooordination of services; and psychiatric emergencies. Major disorders such as…

  5. Evaluation of the alcohol use disorders identification test and the drug use disorders identification test among patients at a Norwegian psychiatric emergency ward.

    Science.gov (United States)

    Gundersen, Oystein Hoel; Mordal, Jon; Berman, Anne H; Bramness, Jørgen G

    2013-01-01

    High rates of substance use disorders (SUD) among psychiatric patients are well documented. This study explores the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) in identifying SUD in emergency psychiatric patients. Of 287 patients admitted consecutively, 256 participants (89%) were included, and 61-64% completed the questionnaires and the Mini-International Neuropsychiatric Interview (MINI), used as the reference standard. Both AUDIT and DUDIT were valid (area under the curve above 0.92) and reliable (Cronbach's alpha above 0.89) in psychotic and nonpsychotic men and women. The suitable cutoff scores for AUDIT were higher among the psychotic than nonpsychotic patients, with 12 versus 10 in men and 8 versus 5 in women. The suitable cutoff scores for DUDIT were 1 in both psychotic and nonpsychotic women, and 5 versus 1 in psychotic and nonpsychotic men, respectively. This study shows that AUDIT and DUDIT may provide precise information about emergency psychiatric patients' problematic alcohol and drug use. Copyright © 2013 S. Karger AG, Basel.

  6. Reported exposure to trauma among adult patients referred for psychological services at the Free State Psychiatric Complex, Bloemfontein

    Directory of Open Access Journals (Sweden)

    Laurisa van Zyl

    2017-10-01

    Objective: The study aimed to explore and describe the extent and nature of reported potentially traumatic events and associated variables in adult patients referred for psychological services at the Free State Psychiatric Complex (FSPC, Bloemfontein. Methods: In this cross-sectional study, demographic information, diagnostic morbidity and co-morbidity, and presence and type of reported trauma exposure reported by patients during the initial assessment were obtained from files of adult patients seen during a one-year period (2010 at the out-patient unit and the in-patient affective ward at the FSPC. Data were captured on data record forms by the researchers and analysed by means of descriptive statistics, univariate analysis and logistic regression (SAS version 9.1. Results: Of the 192 adults (71.9% White and 67.2% female referred for psychological services,75.5% were diagnosed with mood disorders, 17.2% with anxiety disorders, 22.4% with substance-related disorders and 20.9% with cluster B personality disorders or traits. A total of 145 (75.5% reported past trauma exposure. The most frequently reported types of trauma exposure were traumatic death/injury of a loved one (37.0%, physical assault (24.5%, witnessed/threatened violence (19.3%, and sexual assault (17.7%. Women were more likely to have been exposed to trauma than men (OR 4.02, 95% CI 1.87–8.62, in particular to traumatic death of a loved one (OR 3.13, physical assault (OR 4.08, or sexual assault (OR 5.43. Conclusions: The findings of this study contribute to current data regarding the prevalence of exposure to trauma and its possible association with mental illness. The importance of comprehensive trauma exposure screening in routine psychiatric interviewing practices is highlighted.

  7. Discrimination in relation to parenthood reported by community psychiatric service users in the UK: a framework analysis.

    Science.gov (United States)

    Jeffery, Debra; Clement, Sarah; Corker, Elizabeth; Howard, Louise M; Murray, Joanna; Thornicroft, Graham

    2013-04-20

    Experienced discrimination refers to an individual's perception that they have been treated unfairly due to an attribute and is an important recent focus within stigma research. A significant proportion of mental health service users report experiencing mental illness-based discrimination in relation to parenthood. Existing studies in this area have not gone beyond prevalence, therefore little is known about the nature of experienced discrimination in relation to parenthood, and how is it constituted. This study aims to generate a typology of community psychiatric service users' reports of mental illness-based discrimination in relation to becoming or being a parent. A secondary aim is to assess the prevalence of these types of experienced discrimination. In a telephone survey 2026 community psychiatric service users in ten UK Mental Health service provider organisations (Trusts) were asked about discrimination experienced in the previous 12 months using the Discrimination and Stigma Scale (DISC). The sample were asked if, due to their mental health problem, they had been treated unfairly in starting a family, or in their role as a parent, and gave examples of this. Prevalence is reported and the examples of experienced discrimination in relation to parenthood were analysed using the framework method of qualitative analysis. Three hundred and four participants (73% female) reported experienced discrimination, with prevalences of 22.5% and 28.3% for starting a family and for the parenting role respectively. Participants gave 89 examples of discrimination about starting a family and 228 about parenting, and these occurred in social and professional contexts. Ten themes were identified. These related to being seen as an unfit parent; people not being understanding; being stopped from having children; not being allowed to see their children; not getting the support needed; children being affected; children avoiding their parents; children's difficulties being blamed

  8. Eradicating Barriers to Mental Health Care Through Integrated Service Models: Contemporary Perspectives for Psychiatric-Mental Health Nurses.

    Science.gov (United States)

    Ellis, Horace; Alexander, Vinette

    2016-06-01

    There has been renewed, global interest in developing new and transformative models of facilitating access to high-quality, cost-effective, and individually-centered health care for severe mentally-ill (SMI) persons of diverse racial/ethnic, cultural and socioeconomic backgrounds. However, in our present-day health-service delivery systems, scholars have identified layers of barriers to widespread dispersal of well-needed mental health care both nationally and internationally. It is crucial that contemporary models directed at eradicating barriers to mental health services are interdisciplinary in context, design, scope, sequence, and best-practice standards. Contextually, nurses are well-positioned to influence the incorporation and integration of new concepts into operationally interdisciplinary, evidence-based care models with measurable outcomes. The aim of this concept paper is to use the available evidence to contextually explicate how the blended roles of psychiatric mental health (PMH) nursing can be influential in eradicating barriers to care and services for SMI persons through the integrated principles of collaboration, integration and service expansion across health, socioeconomic, and community systems. A large body of literature proposes that any best-practice standards aimed at eliminating barriers to the health care needs of SMI persons require systematic, well-coordinated interdisciplinary partnerships through evidence-based, high-quality, person-centered, and outcome-driven processes. Transforming the conceptual models of collaboration, integration and service expansion could be revolutionary in how care and services are coordinated and dispersed to populations across disadvantaged communities. Building on their longstanding commitment to individual and community care approaches, and their pivotal roles in research, education, leadership, practice, and legislative processes; PMH nurses are well-positioned to be both influential and instrumental in

  9. A Model Curriculum for an Emergency Medical Services (EMS Rotation for Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Michael Mancera

    2018-01-01

    Full Text Available Audience: This EMS curriculum is designed for Emergency Medicine residents at all levels of training. Introduction: Emergency Medicine (EM physicians have routine interaction with Emergency Medical Services (EMS in their clinical practice. Additionally, the American College of Graduate Medical Education (ACGME mandates that all Emergency Medicine resident physicians receive specific training in the area of EMS.1 Historically, EMS training for EM residents has been conducted in the absence of a standardized didactic curriculum. Despite advancements in the area of prehospital training, there remains wide inconsistency in EMS training experiences among EM residency training programs.2 To our knowledge a standardized and reproducible EMS curriculum for EM residents does not exist. Objectives: The aim of this curriculum is to provide a robust learning experience for EM residents around prehospital care and EMS that fulfills the ACGME requirements and which can be easily replicated and implemented in a variety of EM residency training programs. Method: The educational strategies used in this curriculum include didactics, asynchronous learning through online modules and a focused reading list, experiential learning through ride-alongs, structured small group discussion, supervised medical command shifts, and mentored practice in organizing and delivering didactics to EMS providers.

  10. Contemporary women's secure psychiatric services in the United Kingdom: A qualitative analysis of staff views.

    Science.gov (United States)

    Walker, T; Edge, D; Shaw, J; Wilson, H; McNair, L; Mitchell, H; Gutridge, K; Senior, J; Sutton, M; Meacock, R; Abel, K

    2017-11-01

    WHAT IS KNOWN ON THE SUBJECT?: Three pilot UK-only Women's Enhanced Medium Secure Services (WEMSS) was opened in 2007 to support women's movement from high secure care and provide a bespoke, women-only service. Evidence suggests that women's secure services are particularly challenging environments to work in and staffing issues (e.g., high turnover) can cause difficulties in establishing a therapeutic environment. Research in this area has focused on the experiences of service users. Studies which have examined staff views have focused on their feelings towards women in their care and the emotional burden of working in women's secure services. No papers have made a direct comparison between staff working in different services. WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?: This is the first study to explore the views and experiences of staff in the three UK WEMSS pilot services and contrast them with staff from women's medium secure services. Drawing upon data from eighteen semi-structured interviews (nine WEMSS, nine non-WEMSS), key themes cover staff perceptions of factors important for women's recovery and their views on operational aspects of services. This study extends our understanding of the experiences of staff working with women in secure care and bears relevance for staff working internationally, as well as in UK services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study reveals the importance of induction and training for bank and agency staff working in women's secure services. Further, regular clinical supervision should be mandatory for all staff so they are adequately supported. Introduction Women's Enhanced Medium Secure Services (WEMSS) is bespoke, gender-sensitive services which opened in the UK in 2007 at three pilot sites. This study is the first of its kind to explore the experiences of WEMSS staff, directly comparing them to staff in a standard medium secure service for women. The literature to date has focused on the experiences of

  11. Emergency medical services key performance measurement in Asian cities.

    Science.gov (United States)

    Rahman, Nik Hisamuddin; Tanaka, Hideharu; Shin, Sang Do; Ng, Yih Yng; Piyasuwankul, Thammapad; Lin, Chih-Hao; Ong, Marcus Eng Hock

    2015-01-01

    One of the key principles in the recommended standards is that emergency medical service (EMS) providers should continuously monitor the quality and safety of their services. This requires service providers to implement performance monitoring using appropriate and relevant measures including key performance indicators. In Asia, EMS systems are at different developmental phases and maturity. This will create difficultly in benchmarking or assessing the quality of EMS performance across the region. An attempt was made to compare the EMS performance index based on the structure, process, and outcome analysis. The data was collected from the Pan-Asian Resuscitation Outcome Study (PAROS) data among few Asian cities, namely, Tokyo, Osaka, Singapore, Bangkok, Kuala Lumpur, Taipei, and Seoul. The parameters of inclusions were broadly divided into structure, process, and outcome measurements. The data was collected by the site investigators from each city and keyed into the electronic web-based data form which is secured strictly by username and passwords. Generally, there seems to be a more uniformity for EMS performance parameters among the more developed EMS systems. The major problem with the EMS agencies in the cities of developing countries like Bangkok and Kuala Lumpur is inadequate or unavailable data pertaining to EMS performance. There is non-uniformity in the EMS performance measurement across the Asian cities. This creates difficulty for EMS performance index comparison and benchmarking. Hopefully, in the future, collaborative efforts such as the PAROS networking group will further enhance the standardization in EMS performance reporting across the region.

  12. NURSING PRACTICE AT A PSYCHIATRIC EMERGENCY SERVICE: EVALUATION USING FOURTH GENERATION ASSESSMENT

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    Aline Aparecida Buriola

    2016-01-01

    Full Text Available Estudio cualitativo que utilizó el marco de Evaluación de la Cuarta Generación y que tuvo como objetivo aprehender la percepción de los profesionales, usuarios y familiares, sobre la actuación del enfermero en un servicio de urgencias psiquiátricas. Los datos fueron recolectados de febrero a junio de 2014, junto con 15 profesionales, nueve usuarios y seis miembros de la familia. En la recogida de datos se llevó a cabo la observación de no participantes, la observación de participantes y las entrevistas individuales, a través del círculo hermenéutico-dialéctico, con análisis por el método comparativo constante. Los resultados se agruparon en dos temas principales: El enfermero como facilitador del cuidado multidisciplinario y humanizado; Acumulación de Actividades: limitación para los enfermeros trabajaren en el servicio de urgencias de psiquiatría. Se concluyó que uso del método Cuarta Evaluación Generación pone de manifiesto el empoderamiento de los actores como protagonistas del cambio y la actuación del enfermero es esencial para la humanización del cuidado y la dinámica del trabajo multidisciplinario.

  13. "Conversation" group in the Psychiatric service for the diagnosis and treatment of Caltagirone (Italy

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    Raffaele Barone

    2014-09-01

    Full Text Available The clinical device, introduced in clinical psychiatric hospital of Caltagirone, wants to be a crisis intervention for the patient and the entire family system. The "conversation group" with the participation of family members and professionals who want to make contact with their patients. Knowing the discomfort that the users bring in hospital, enables the development, comparison with others and with their stories, comments and different perspectives. In the space of the group the patient can admit the possibility of expressing content and see all the thoughts and feelings more destructive, to find a meaning to their crisis, their discomfort, in order to start a process of recovery. Within this space processes are activated mutual aid, sharing and reflections that mobilize resources for individual and family awareness and the development of transformative movements. A resonance in terms transformative is perceived by the whole micro-community of the department, influencing the climate, the processes of socialization among patients and between patients and their personal health, combating loneliness admission and burnout of health personnel. Keywords:Multifamily group; Mutual aid; Sharing and reflection; Multiple transfert; narrative medicine 

  14. Gender differences in the use of psychiatric outpatient specialist services in Tromsø, Norway are dependent on age: a population-based cross-sectional survey.

    Science.gov (United States)

    Hansen, Anne Helen; Høye, Anne

    2015-10-22

    Overall, men are less likely than women to seek health care services for mental health problems, but differences between genders in higher age groups are equivocal. The aim of the current study was to investigate the association between gender and the use of psychiatric outpatient specialist services in Norway, both in a general population and in a subpopulation with self-reported anxiety and/or depression. Using questionnaires from 12,982 participants (30-87 years) in the cross-sectional sixth Tromsø Study (2007-8) we estimated proportions reporting anxiety/depression, and proportions using psychiatric outpatient specialist services in a year. By logistic regressions we studied the association between gender and the use of psychiatric outpatient specialist services. Analyses were adjusted for age, marital status, income, education, self-reported degree of anxiety/depression, and GP visits last year. Analyses were also performed for genders separately. Anxiety/depression was reported by 21.5 % of women and 12.3 % of men in the general population. Visits to psychiatric outpatient services during one year were reported by 4.6 % of women and 3.3 % of men. The general population's probability of a visit was significantly lower among men compared to women in ages 30-49 years (odds ratio [OR] 0.58, confidence interval [CI] 0.39-0.84, p-value [p] = 0.004), whereas men used services slightly more than women in ages 50 years and over (OR 1.36, CI 1.00-1.83, p = 0.047). Among those with anxiety/depression 13.5 % of women and 10.5 % of men visited psychiatric outpatient services in a year. We found no statistically significant gender differences in the use of services in this subgroup. Other factors associated with services use in women with anxiety/depression were higher education, more severe anxiety/depression, and GP visits the last year, whereas in men only a more severe anxiety/depression was associated with psychiatric outpatient visits. Overall, the use of

  15. Incidence of emergency contacts (red responses to Norwegian emergency primary healthcare services in 2007 – a prospective observational study

    Directory of Open Access Journals (Sweden)

    Hansen Elisabeth

    2009-07-01

    Full Text Available Abstract Background The municipalities are responsible for the emergency primary health care services in Norway. These services include casualty clinics, primary doctors on-call and local emergency medical communication centres (LEMC. The National centre for emergency primary health care has initiated an enterprise called "The Watchtowers", comprising emergency primary health care districts, to provide routine information (patients' way of contact, level of urgency and first action taken by the out-of-hours services over several years based on a minimal dataset. This will enable monitoring, evaluation and comparison of the respective activities in the emergency primary health care services. The aim of this study was to assess incidence of emergency contacts (potential life-threatening situations, red responses to the emergency primary health care service. Methods A representative sample of Norwegian emergency primary health care districts, "The Watchtowers" recorded all contacts and first action taken during the year of 2007. All the variables were continuously registered in a data program by the attending nurses and sent by email to the National Centre for Emergency Primary Health Care at a monthly basis. Results During 2007 the Watchtowers registered 85 288 contacts, of which 1 946 (2.3% were defined as emergency contacts (red responses, corresponding to a rate of 9 per 1 000 inhabitants per year. 65% of the instances were initiated by patient, next of kin or health personnel by calling local emergency medical communication centres or meeting directly at the casualty clinics. In 48% of the red responses, the first action taken was a call-out of doctor and ambulance. On a national basis we can estimate approximately 42 500 red responses per year in the EPH in Norway. Conclusion The emergency primary health care services constitute an important part of the emergency system in Norway. Patients call the LEMC or meet directly at casualty clinics

  16. Follow-up study of female delinquent adolescents in a detention centre: effectiveness of psychiatric intervention as a mental health service.

    Science.gov (United States)

    Ariga, Michio; Uehara, Toru; Takeuchi, Kazuo; Ishige, Yoko; Nakano, Reiko; Mikuni, Masahiko

    2010-01-01

    of previous studies suggest that many female offenders have co-morbid psychiatric disorders, which require mental health services. However, few longitudinal studies examined subjects during incarceration or detention. This study compares depressive symptoms, abnormal eating behaviour and impulsivity before release from a detention centre and after incarceration, thereby indicating the effectiveness of psychiatric intervention in a Japanese detention centre. Of 64 young women, 36 were followed up. Self-report measures were used to assess depression, eating behaviour and impulsivity after incarceration and one month before release. s: Of the 36 participants, nine were diagnosed using the MINI-kids as needing mental health services. Those who received psychiatric intervention were diagnosed as having major depression and/or post-traumatic stress disorder. Significant main effects of intervention and effects of time were shown in the DSD. The EAT-26 score demonstrated the significance of the effects of time and interaction. In the BIS-11 scores, neither intervention nor time showed significant effects. Results of this study showed that the time course and psychiatric intervention contributed to recovery of depression and therapeutic intervention. The time course might reduce eating problems. Psychiatric intervention might be necessary for female juvenile detainees, which presents an important issue for future studies.

  17. Community mental health nurses’ experience of decentralised and integrated psychiatric-mental health care services in the Southern mental health region of Botswana (part 1

    Directory of Open Access Journals (Sweden)

    M.K. Maphorisa

    2002-09-01

    Full Text Available Since the inception of the decentralisation and integration of psychiatric mental health care services into the general health care delivery system in Botswana, there has never been a study to investigate what community mental health nurses are experiencing due to the policy. Many of these nurses have been leaving the scantily staffed mental health care services in increasing numbers to join other sectors of health or elsewhere since the beginning of the implementation of the policy. During the research study, phenomenological in-depth interviews were conducted with three groups of 12 community mental health nurses altogether. An open central question was posed to each group followed by probing questions to explore and describe these nurses’ experience of the decentralisation and integration of psychiatric-mental health care services. After the data was analysed, related literature was incorporated and guidelines for advanced psychiatric nurses were formulated and described to assist these nurses to cope with the decentralisation and integration of psychiatric-mental health care services. The guidelines were set up for the management of the community mental health nurses who are experiencing obstacles in the quest for mental health which also interfere with their capabilities as mental health care providers.

  18. Coercion in patients who at their first contact with the psychiatric services system were diagnosed within the schizophrenia-spectrum in Denmark. A register study

    DEFF Research Database (Denmark)

    Øhlenschlaeger, Johan; Nordentoft, Merete

    2008-01-01

    The level of use of coercive measures in patients diagnosed with a schizophrenia-spectrum disorder at their first contact with the psychiatric services system in Denmark is not known. The aim of the study was to investigate the level of use of coercive measures during first year of contact in thi...

  19. Multimedia Messaging Service teleradiology in the provision of emergency neurosurgery services.

    Science.gov (United States)

    Ng, Wai Hoe; Wang, Ernest; Ng, Ivan

    2007-04-01

    Neurosurgical emergencies constitute a significant proportion of workload of a tertiary neurosurgical service. Prompt diagnosis and emergent institution of definitive treatment are critical to reduce neurological mortality and morbidity. Diagnosis is highly dependent on accurate interpretation of scans by experienced clinicians. This expertise may not be readily available especially after office hours because many neurosurgical units are manned by middle-level neurosurgical staff with varying levels of experience in scan interpretation. Multimedia Messaging Service mobile phone technology offers a simple, cheap, quick, and effective solution to the problem of scan interpretation. An MMS takes only a few minutes to send and receive and allows senior doctors to view important images and make important clinical decisions to enhance patient management in an emergency situation. A mobile phone (with VGA camera and MMS capabilities) was provided to the neurosurgery registrar on call. The on-call mobile phone is passed on to the corresponding registrar on-call the next day. All consultants had personal mobile phones that are MMS-enabled. Relevant representative CT/MRI images can be taken directly from the mobile phone from the PACS off the computer screen. When only hard copies are available, the images can be taken off the light box. After a 12-month trial period, a questionnaire was given to all staff involved in the project to ascertain the usefulness of the MMS teleradiology service. The survey on the use of the MMS service in a tertiary neurosurgical service demonstrated that the technology significantly improved the level of confidence of the senior-level staff in emergent clinical decision making. Significantly, the MMS images were of sufficient quality and resolution to obviate the need to view the actual scans. The impact of MMS is less pronounced in the middle-level staff, but there was a trend that most of the junior staff found the service more useful. The MMS

  20. [Is the orientation of patients suffering from depressive disorder to the psychiatric emergencies by a general practitioner associated with the decision to hospitalize?

    Science.gov (United States)

    Chrétien, P; Caillet, P; Bouazzaoui, F; Kaladjian, A; Younes, N; Sanchez, S

    2018-03-02

    Depressive disorders affect nearly 350 million people worldwide and are the world's leading cause of incapacity. Patients who are depressed preferentially approach their general practitioner (GP), who is their first point of contact, in 50-60% of cases. The aim of our study is to assess whether the orientation of patients suffering from anxiety-depressive disorder towards a GP in a general emergency is a factor associated with hospitalization when compared to patients who present themselves spontaneously for the same disorders. Our secondary objective was to identify the different profiles of patients who were hospitalized for these disorders as an emergency. We conducted a cross-sectional study for the year 2015, targeting patients who presented as general emergencies at the centre hospitalier de Troyes and who had received a psychiatric diagnosis in the context of an anxiety or depressive disorder. Five hundred and twenty four patients were included. A univariate analysis showed that referral by the attending physician was associated with hospitalization in 57.9% vs. 42.1% cases (P=0.007), at an odds ratio at 1.98 [1.22-3.21] by multivariate analysis. Analysis by ascending hierarchical classification made it possible to identify 3 profiles for hospitalized patients: 1) patients with a known psychiatric history, a history of past or current follow-ups directed by a psychiatrist, with at least one psychotropic treatment, the presence of psychotic symptoms and a low suicidal risk compared to the rest of the study population; 2) patients without a psychiatric history, or a history of past or ongoing psychiatric follow-up and the absence of ongoing psychotropic treatment. These patients were referred by a GP (67% vs 23%, P<0.001) and their suicidal risk was higher (59% vs 26%, P<0.001); 3) patients about whom the psychiatrist had little information at the time of the emergency consultation. The relevance of GPs in orientation towards emergencies pleads in favor of a

  1. Consumer satisfaction with psychiatric services: The role of shared decision making and the therapeutic relationship.

    Science.gov (United States)

    Klingaman, Elizabeth A; Medoff, Deborah R; Park, Stephanie G; Brown, Clayton H; Fang, Lijuan; Dixon, Lisa B; Hack, Samantha M; Tapscott, Stephanie L; Walsh, Mary Brighid; Kreyenbuhl, Julie A

    2015-09-01

    Although dissatisfaction is a primary reason for disengagement from outpatient psychiatric care among consumers with serious mental illnesses, little is known about predictors of their satisfaction with medication management visits. The primary purpose of this study was to explore how dimensions of consumer preferences for shared decision making (i.e., preferences for obtaining knowledge about one's mental illness, being offered and asked one's opinion about treatment options, and involvement in treatment decisions) and the therapeutic relationship (i.e., positive collaboration and type of clinician input) were related to visit satisfaction. Participants were 228 Veterans with serious mental illnesses who completed a 19-item self-report questionnaire assessing satisfaction with visits to prescribers (524 assessments) immediately after visits. In this correlational design, a 3-level mixed model with the restricted maximum likelihood estimation procedure was used to examine shared decision-making preferences and therapeutic alliance as predictors of visit satisfaction. Preferences for involvement in treatment decisions was the unique component of shared decision making associated with satisfaction, such that the more consumers desired involvement, the less satisfied they were. Positive collaboration and prescriber input were associated with greater visit satisfaction. When consumers with serious mental illnesses express preferences to be involved in shared decision making, it may not be sufficient to only provide information and treatment options; prescribers should attend to consumers' interest in involvement in actual treatment decisions. Assessment and tailoring of treatment approaches to consumer preferences for shared decision making should occur within the context of a strong therapeutic relationship. (c) 2015 APA, all rights reserved).

  2. Consumer Satisfaction with Psychiatric Services: The Role of Shared Decision-Making and the Therapeutic Relationship

    Science.gov (United States)

    Klingaman, Elizabeth A.; Medoff, Deborah R.; Park, Stephanie G.; Brown, Clayton H.; Fang, Lijuan; Dixon, Lisa B.; Hack, Samantha M.; Tapscott, Stephanie L.; Walsh, Mary Brighid; Kreyenbuhl, Julie A.

    2017-01-01

    Objective Although dissatisfaction is a primary reason for disengagement from outpatient psychiatric care among consumers with serious mental illnesses, little is known about predictors of their satisfaction with medication management visits. The primary purpose of the present study was to explore how dimensions of consumer preferences for shared decision-making (i.e., preferences for obtaining knowledge about one’s mental illness, being offered and asked one’s opinion about treatment options, and involvement in treatment decisions) and the therapeutic relationship (i.e., positive collaboration and type of clinician input) were related to visit satisfaction. Methods Participants were 228 Veterans with serious mental illnesses who completed a 19-item self-report questionnaire assessing satisfaction with visits to prescribers (n=524 assessments) immediately after visits. In this correlational design, a 3-level mixed model with the restricted maximum likelihood estimation procedure was used to examine shared decision-making preferences and therapeutic alliance as predictors of visit satisfaction. Results Preferences for involvement in treatment decisions was the unique component of shared decision-making associated with satisfaction, such that the more consumers desired involvement, the less satisfied they were. Positive collaboration and prescriber input were associated with greater visit satisfaction. Conclusions and Implications for Practice When consumers with serious mental illnesses express preferences to be involved in shared decision-making, it may not be sufficient to only provide information and treatment options; prescribers should attend to consumers’ interest in involvement in actual treatment decisions. Assessment and tailoring of treatment approaches to consumer preferences for shared decision-making should occur within the context of a strong therapeutic relationship. PMID:25664755

  3. Medication Adherence, Work Performance and Self-Esteem among Psychiatric Patients Attending Psychosocial Rehabilitation Services at Bangalore, India.

    Science.gov (United States)

    Gandhi, Sailaxmi; Pavalur, Rajitha; Thanapal, Sivakumar; Parathasarathy, Nirmala B; Desai, Geetha; Bhola, Poornima; Philip, Mariamma; Chaturvedi, Santosh K

    2014-10-01

    Work benefits mental health in innumerable ways. Vocational rehabilitation can enhance self-esteem. Medication adherence can improve work performance and thereby the individuals' self-esteem. To test the hypothesis that there would be a significant correlation between medication adherence, work performance and self-esteem. A quantitative, descriptive correlational research design was adopted to invite patients attending psychiatric rehabilitation services to participate in the research. Data was collected from a convenience sample of 60 subjects using the 'Medication Adherence Rating scale', 'Griffiths work behaviour scale' and the 'Rosenberg's Self-esteem scale'. Analysis was done using spss18 with descriptive statistics, Pearsons correlation coefficient and multiple regression analysis. There were 36 males and 24 females who participated in this study. The subjects had good mean medication adherence of 8.4 ± 1.5 with median of 9.00, high mean self-esteem of 17.65 ± 2.97 with median of 18.0 and good mean work performance of 88.62 ± 22.56 with median of 93.0. Although weak and not significant, there was a positive correlation (r = 0.22, P = 0.103) between medication adherence and work performance; positive correlation between (r = 0.25, P = 0.067) medication adherence and self-esteem; positive correlation between (r = 0.136, P = 0.299) work performance and self-esteem. Multiple regression analysis showed no significant predictors for medication adherence, work performance and self-esteem among patients with psychiatric illness. Medication monitoring and strengthening of work habit can improve self-esteem thereby, strengthening hope of recovery from illness.

  4. [Mistakes and omissions in judicial reports prepared in emergency services].

    Science.gov (United States)

    Turla, Ahmet; Aydin, Berna; Sataloğlu, Neva

    2009-03-01

    We aimed in this study to determine any mistakes or omissions made while preparing judicial reports, which contribute to the judicial process. In this study, we evaluated as samples 351 judicial reports of victims who applied to the Emergency Service of Ondokuz Mayis University between January 1, 2005 and December 31, 2005 with respect to the judicial facts, and we recorded any mistakes or omissions of data in these reports. We determined that there was no record of age in 6% of the judicial reports, of examination time in 71.8%, of traumatic lesion or not in 30.5%, of the state of consciousness in 58.7%, and of the presence or not of life-threatening risks in 2.6%. The name of the physician who prepared the report was not provided in 8.0% of the reports. The most important omission is that none of the reports had the name, surname or signature of the person who had taken the prepared report. We concluded that, after graduation, it is necessary for physicians, who are responsible for both treating the patients and writing judicial reports, to attend in-service training programs. They must also be properly advised regarding their responsibilities in judicial cases.

  5. [Treatment of childhood injuries and violence in public emergency services].

    Science.gov (United States)

    Malta, Deborah Carvalho; Mascarenhas, Márcio Denis Medeiros; Neves, Alice Cristina Medeiros das; Silva, Marta Alves da

    2015-05-01

    This study aimed to analyze the profile of treatment for accidents and violence involving children under 10 years of age in Brazil in the year 2011. This was a cross-sectional descriptive study in 71 emergency services in the Brazilian Unified National Health System (SUS), located in the national capital and 24 state capitals. Data were obtained from the Ministry of Health's system of sentinel surveillance services for Violence and Accidents (VIVA Survey). The highest proportion of injuries (67.4%) occurred inside the child's home. Among unintentional injuries, falls were the most frequent (52.4%), followed by running into objects or persons (21.8%) and traffic injuries (10.9%), especially as passengers (bicycles were an important means of transportation involved in the injuries). The vast majority of unintentional injuries are avoidable, and educational measures should be adopted, especially with parents, teachers, the community, and health workers, calling attention to the risks and the adoption of safe behaviors in the home, at school, and in leisure-time activities. Cases of violence are subject to mandatory reporting, and prompt measures should be taken to protect victims.

  6. Contact with child and adolescent psychiatric services among self-harming and suicidal adolescents in the general population: a cross sectional study.

    Science.gov (United States)

    Tørmoen, Anita J; Rossow, Ingeborg; Mork, Erlend; Mehlum, Lars

    2014-01-01

    Studies have shown that adolescents with a history of both suicide attempts and non-suicidal self-harm report more mental health problems and other psychosocial problems than adolescents who report only one or none of these types of self-harm. The current study aimed to examine the use of child and adolescent psychiatric services by adolescents with both suicide attempts and non-suicidal self-harm, compared to other adolescents, and to assess the psychosocial variables that characterize adolescents with both suicide attempts and non-suicidal self-harm who report contact. Data on lifetime self-harm, contact with child and adolescent psychiatric services, and various psychosocial risk factors were collected in a cross-sectional sample (response rate = 92.7%) of 11,440 adolescents aged 14-17 years who participated in a school survey in Oslo, Norway. Adolescents who reported any self-harm were more likely than other adolescents to have used child and adolescent psychiatric services, with a particularly elevated likelihood among those with both suicide attempts and non-suicidal self-harm (OR = 9.3). This finding remained significant even when controlling for psychosocial variables. In adolescents with both suicide attempts and non-suicidal self-harm, symptoms of depression, eating problems, and the use of illicit drugs were associated with a higher likelihood of contact with child and adolescent psychiatric services, whereas a non-Western immigrant background was associated with a lower likelihood. In this study, adolescents who reported self-harm were significantly more likely than other adolescents to have used child and adolescent psychiatric services, and adolescents who reported a history of both suicide attempts and non-suicidal self-harm were more likely to have used such services, even after controlling for other psychosocial risk factors. In this high-risk subsample, various psychosocial problems increased the probability of contact with child and

  7. Use of Specialty Mental Health Services by Asian Americans with Psychiatric Disorders

    Science.gov (United States)

    Le Meyer, Oanh; Zane, Nolan; Cho, Young Il; Takeuchi, David T.

    2009-01-01

    Research suggests that Asian Americans underutilize mental health services but an understanding of the multiple factors involved in utilization has not been examined in a nationally representative sample. The current study analyzed data from the National Latino and Asian American Study (NLAAS) and examined 368 individuals with disorders to…

  8. Issues regarding the delivery of early intervention psychiatric services to the South Asian population in England.

    Science.gov (United States)

    Agius, Mark; Talwar, A; Murphy, S; Zaman, Rashid

    2010-06-01

    Little research has been done to ascertain how patients and families of South Asian origin access and use early intervention mental health services today. The aim of this retrospective study is to gain a better understanding of how well South Asian patients engage with standard psycho-social interventions. In June 2003 an audit was conducted amongst 75 patients from different ethnic groups in Luton. Measures of engagement with mental health services included; number of missed outpatient appointments over one year and compliance with medication regimes. The results of this audit showed that South Asian patients are more likely to miss appointments and refuse to take medication in comparison to their Caucasian or Afro- Caribbean counter-parts. Further analysis revealed that the Bangladeshi subgroup had missed more appointments and had a greater proportion of medication refusal in comparison to the other Asian subgroups. These results support the pioneering work by Dr Robin Pinto in the 1970s he observed that Asian patients perceive and utilise mental health services in a different way compared to the Caucasian population. The observations from our study depict the difficulties in engaging ethnic minority patients into existing services. Hence we argue that future interventions should be adapted and tailored to overcome cultural and language barriers with patients and their families.

  9. Emergency Medical Services Professionals’ Attitudes About Community Paramedic Programs

    Directory of Open Access Journals (Sweden)

    Robert J. Steeps

    2017-05-01

    Full Text Available Introduction: The number of community paramedic (CP programs has expanded to mitigate the impact of increased patient usage on emergency services. However, it has not been determined to what extent emergency medical services (EMS professionals would be willing to participate in this model of care. With this project, we sought to evaluate the perceptions of EMS professionals toward the concept of a CP program. Methods: We used a cross-sectional study method to evaluate the perceptions of participating EMS professionals with regard to their understanding of and willingness to participate in a CP program. Approximately 350 licensed EMS professionals currently working for an EMS service that provides coverage to four states (Missouri, Arkansas, Kansas, and Oklahoma were invited to participate in an electronic survey regarding their perceptions toward a CP program. We analyzed interval data using the Mann-Whitney U test, Kruskal-Wallis one-way analysis of variance, and Pearson correlation as appropriate. Multivariate logistic regression was performed to examine the impact of participant characteristics on their willingness to perform CP duties. Statistical significance was established at p ≤ 0.05. Results: Of the 350 EMS professionals receiving an invitation, 283 (81% participated. Of those participants, 165 (70% indicated that they understood what a CP program entails. One hundred thirty-five (58% stated they were likely to attend additional education in order to become a CP, 152 (66% were willing to perform CP duties, and 175 (75% felt that their respective communities would be in favor of a local CP program. Using logistic regression with regard to willingness to perform CP duties, we found that females were more willing than males (OR = 4.65; p = 0.03 and that those participants without any perceived time on shift to commit to CP duties were less willing than those who believed their work shifts could accommodate additional duties (OR = 0.20; p

  10. ARAC: a computer-based emergency dose-assessment service

    International Nuclear Information System (INIS)

    Sullivan, T.J.

    1990-01-01

    Over the past 15 years, the Lawrence Livermore National Laboratory's Atmospheric Release Advisory Capability (ARAC) has developed and evolved a computer-based, real-time, radiological-dose-assessment service for the United States Departments of Energy and Defense. This service is built on the integrated components of real-time computer-acquired meteorological data, extensive computer databases, numerical atmospheric-dispersion models, graphical displays, and operational-assessment-staff expertise. The focus of ARAC is the off-site problem where regional meteorology and topography are dominant influences on transport and dispersion. Through application to numerous radiological accidents/releases on scales from small accidental ventings to the Chernobyl reactor disaster, ARAC has developed methods to provide emergency dose assessments from the local to the hemispheric scale. As the power of computers has evolved inversely with respect to cost and size, ARAC has expanded its service and reduced the response time from hours to minutes for an accident within the United States. Concurrently the quality of the assessments has improved as more advanced models have been developed and incorporated into the ARAC system. Over the past six years, the number of directly connected facilities has increased from 6 to 73. All major U.S. Federal agencies now have access to ARAC via the Department of Energy. This assures a level of consistency as well as experience. ARAC maintains its real-time skills by participation in approximately 150 exercises per year; ARAC also continuously validates its modeling systems by application to all available tracer experiments and data sets

  11. A protocol for a pragmatic randomized controlled trial evaluating outcomes of emergency nurse practitioner service.

    Science.gov (United States)

    Jennings, Natasha; Gardner, Glenn; O'Reilly, Gerard

    2014-09-01

    To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness. Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care. Pragmatic randomized controlled trial at one site with 260 participants. This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours. Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce. Trial registration details: Australian and New Zealand Clinical Trials Registry dated 18th August 2013, ACTRN12613000933752. © 2014 John Wiley & Sons Ltd.

  12. Research and organizational issues for the implementation of family work in community psychiatric services.

    Science.gov (United States)

    Jones, Adrian; Scannell, Tony

    2002-04-01

    The need for evidence-based practice (EBP) to guide and develop mental health services remains fundamental for modern services. Aim. To discuss issues that impact upon implementation of EBP and practice development using family work (FW) as an example. A selection of the FW literature was reviewed drawing on sources including the Cochrane Library, Cinahl and Medline. Keywords used were FW, community mental health team and research design. Centralized policy initiatives and guidelines that are themselves guided by evidence of randomized controlled trials predominantly risk alienating practitioners and clients/carers. Family work has some demonstrable clinical benefits although models differ and the active therapeutic agent remains unclear. Its adoption into routine care is also hindered by a productivity management outlook that seeks to maximize stretched resources and whose values are likely to be internalized by practitioners. The dichotomous position of previous research and practice development make implementation of EBP difficult and highlights the need for strategic planning that embraces both factors. The current drive to increase EBP requires a bi-directional process of influence that allows individual practitioners and clients/carers to become producers of evidence and not simply recipients. The authors support wider adoption of case study research designs to reflect the unpredictable nature of mental health care. Adoption of assertive community treatment models within community services is most likely to promote the excellence management model and accommodate EBP such as FW.

  13. Chronic disruptive pain in emerging adults with and without chronic health conditions and the moderating role of psychiatric disorders: Evidence from a population-based cross-sectional survey in Canada.

    Science.gov (United States)

    Qadeer, Rana A; Shanahan, Lilly; Ferro, Mark A

    2017-10-01

    may be used as a numbing agent to blunt chronic disruptive pain. Findings from this study have implications for the integration and coordination of services to design strategies aimed at managing chronic disruptive pain and preventing pain-related disabilities later in life. Within the health system, healthcare providers should engage in dialogues about mental health and substance use regularly with emerging adults, be proactive in screening for psychiatric disorders, and continue to monitor the impact of pain on daily functioning. Given the age range of emerging adults, there is tremendous opportunity for clinicians to work cooperatively with colleagues in the education system to support emerging adults with and without CHCs. Overall, clinicians, researchers, educators, and those in social services should continue to be mindful of the complex interrelationships between physical and mental health and chronic disruptive pain and work cooperatively to optimize health outcomes and prevent pain-related disabilities among emerging adults. Copyright © 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  14. Psychiatric Boarding in Washington State and the Inadequacy of Mental Health Resources.

    Science.gov (United States)

    Bloom, Joseph D

    2015-06-01

    Psychiatric boarding is a term derived from emergency medicine that describes the holding of patients deemed in need of hospitalization in emergency departments for extended periods because psychiatric beds are not available. Such boarding has occurred for many years in the shadows of mental health care as both inpatient beds and community services have decreased. This article focuses on a 2014 Washington State Supreme Court decision that examined the interpretation of certain sections of the Washington state civil commitment statute that had been used to justify the extended boarding of detained psychiatric patients in general hospital emergency departments. The impact of this decision on the state of Washington should be significant and could spark a national debate about the negative impacts of psychiatric boarding on patients and on the nation's general hospital emergency services. © 2015 American Academy of Psychiatry and the Law.

  15. Impact of interventions for patients refusing emergency medical services transport.

    Science.gov (United States)

    Alicandro, J; Hollander, J E; Henry, M C; Sciammarella, J; Stapleton, E; Gentile, D

    1995-06-01

    To evaluate the effect of a documentation checklist and on-line medical control contact on ambulance transport of out-of-hospital patients refusing medical assistance. Consecutive patients served by four suburban ambulance services who initially refused emergency medical services (EMS) transport to the hospital were prospectively enrolled. In phase 1 (control phase), all patients who initially refused medical attention or transport had an identifying data card completed. In phase 2 (documentation phase), out-of-hospital providers completed a similar data card that contained a checklist of high-risk criteria for a poor outcome if not transported. In phase 3 (intervention phase), a data card similar to that used in phase 2 was completed, and on-line medical control was contacted for all patients with high-risk criteria who refused transport. The primary endpoint was the percentage of patients transported to the hospital. A total of 361 patients were enrolled. Transport rate varied by phase: control, 17 of 144 (12%); documentation, 11 of 150 (7%); and intervention, 12 of 67 (18%) (chi-square, p = 0.023). Transport of high-risk patients improved with each intervention: control, two of 60 (3%); documentation, seven of 70 (10%); and intervention, 12 of 34 (35%) (chi-square, p = 0.00003). Transport of patients without high-risk criteria decreased with each intervention: control, 15 of 84 (18%); documentation, four of 80 (5%); and intervention, 0 of 33 (0%) (p = 0.0025). Of the 28 patients for whom medical control was contacted, 12 (43%) were transported to the hospital, and only three of these 12 patients (25%) were released from the ED. Contact with on-line medical control increased the likelihood of transport of high-risk patients who initially refused medical assistance. The appropriateness of the decreased transport rate of patients not meeting high-risk criteria needs further evaluation.

  16. [Blood transfusion in emergency settings: French military health service experience].

    Science.gov (United States)

    Sailliol, A; Ausset, S; Peytel, E

    2010-12-01

    Blood transfusion is required in a number of emergency settings and the French military health service (FMHS) has issued specific guidelines for the treatment of war casualties. These guidelines take into account European standards and laws, NATO standards, and also public sentiment regarding transfusion. These guidelines reflect a determination to control the process and to avoid the improvisation frequently associated with wartime transfusion. The evolution in warfare (terrorism and bombing more frequent than gunshot) and the wide use of body armor have deeply changed the clinical presentation of war injuries. These now involve the extremities in 80% of cases, with extensive tissue damage and heavy blood loss. The FMHS recommends that war casualties with hemorrhagic shock be brought quickly to a medical treatment facility (MTF) after first-line treatment applied through buddy aid or by medics. In the MTF, before an early Medevac, a damage control surgery will be performed, with resuscitation using freeze-dried plasma, red blood cells and fresh whole blood. The French military blood bank is responsible for blood product supply, training and medical advice regarding transfusion therapy during wartime, as well as hemovigilance. All transfusion therapy practices are periodically assessed but research on whole blood pathogen reduction is being conducted in order to reduce the residual infectious risk associated with this product. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  17. Perception of stroke symptoms and utilization of emergency medical services

    Directory of Open Access Journals (Sweden)

    Maximiliano A. Hawkes

    Full Text Available ABSTRACT Lack of stroke awareness and slow activation of emergency medical services (EMS are frequently reported reasons for delayed arrival to the hospital. We evaluated these variables in our population. Methods Review of hospital records and structured telephone interviews of 100 consecutive stroke patients. Forward stepwise logistic regression was used for the statistical analysis. Results Seventy patients (75% arrived at the hospital 4.5 hours after stroke symptoms onset. The use of EMS did not improve arrival times. Most patients who recognized their symptoms did not use EMS (p < 0.02. Nineteen patients (20% were initially misdiagnosed. Eighteen of them were first assessed by non-neurologist physicians (p < 0.001. Conclusions Our population showed a low level of stroke awareness. The use of EMS did not improve arrival times at the hospital and the non-utilization of the EMS was associated with the recognition of stroke symptoms. There was a concerning rate of misdiagnosis, mostly by non-neurologist medical providers.

  18. Hand Washing Practices Among Emergency Medical Services Providers

    Directory of Open Access Journals (Sweden)

    Joshua Bucher

    2015-10-01

    Full Text Available Introduction: Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS workers, respectively. Methods: We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. Results: There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003. Providers who brought their own sanitizer were more likely to clean their hands. Conclusion: Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing.

  19. Hand Washing Practices Among Emergency Medical Services Providers.

    Science.gov (United States)

    Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

    2015-09-01

    Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003). Providers who brought their own sanitizer were more likely to clean their hands. Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing.

  20. The Role of Emergency Medical Service in CBR Incidents

    International Nuclear Information System (INIS)

    Castulik, P.

    2007-01-01

    Majority of Emergency Medical Services (EMS) have daily extensive experience with rescue of casualties having trauma injuries, resulting from conventional incidents. In the case of non-conventional incidents involving chemical, bacteriological or radiological (CBR) hazardous materials operational scene for all responders is begin to be more complicated due contamination of casualties, equipment and environment. Especially EMS personnel and receiving staff at the hospital have to work under very demanding condition due to burden of personal protective equipment (PPE) and awareness to avoiding cross-contamination during handling casualties. Those conditions require significantly different approaches for search and rescue of victims from incident site, through transportation and effective treatment at medical facilities. In cases when chemicals will be major hazard materials, the speed of rescue and treatment of victims is a major challenge. Each minute matter, and any delay of response could seriously complicated saving of lives and successful recovery of exposed victims. Success in rescue victims is finally measured thorough the ability of the first responders to save people... ALIVE..., no matter what surrounding condition is. The presentation is providing a view and suggestions on more rapid immediate medical response during non-conventional incidents. It names basic concept based on preparedness, early identification of CBR hazards through signs and symptoms of casualties, priorities of rescue procedures and care on-site, needs of decontamination, rapid evacuation casualties from a scene and immediate hospital response.(author)

  1. Emergency mobile care service: trauma epidemiology in prehospital care

    Directory of Open Access Journals (Sweden)

    Mateus Kist Ibiapino

    2017-06-01

    Full Text Available Objective: to characterize trauma victims assisted by the Mobile Emergency Care Service (SAMU 192 in the city of Ilhéus, Bahia, Brazil. Method: this is a descriptive and retrospective study in which 1,588 records of traumatic events were analyzed from the following variables: sex, age, day of the week, period of the day, trauma mechanism, topography and type of injuries, revised trauma score, type of mobile unit used, professional responsible for care, time to hospital care, procedures performed and deaths. Results: there was a predominance of male victims (69.5% and age between 18 and 37 (46.5%. Occurrences were concentrated at weekends (37.8% and in the evening (52.0%. It revealed traffic accidents (41.3% as the main mechanism of trauma, among which prevailed the involvement of motorcycles (73.0%. Regarding the topographic distribution of lesions, the majority affected the limbs (58.2%. The most adopted conducts in prehospital care were immobilization (26.3% and compression dressing (25.9%. The deaths accounted for 2.7% of the total sample. Conclusion: The population most affected by traumatic events in Ilhéus shown to be composed of young men involved in traffic accidents, mainly motorcyclists, during the weekends.

  2. The 2012 derecho: emergency medical services and hospital response.

    Science.gov (United States)

    Kearns, Randy D; Wigal, Mark S; Fernandez, Antonio; Tucker, March A; Zuidgeest, Ginger R; Mills, Michael R; Cairns, Bruce A; Cairns, Charles B

    2014-10-01

    During the early afternoon of June 29, 2012, a line of destructive thunderstorms producing straight line winds known as a derecho developed near Chicago (Illinois, USA). The storm moved southeast with wind speeds recorded from 100 to 160 kilometers per hour (kph, 60 to 100 miles per hour [mph]). The storm swept across much of West Virginia (USA) later that evening. Power outage was substantial as an estimated 1,300,000 West Virginians (more than half) were without power in the aftermath of the storm and approximately 600,000 citizens were still without power a week later. This was one of the worst storms to strike this area and occurred as residents were enduring a prolonged heat wave. The wind damage left much of the community without electricity and the crippling effect compromised or destroyed critical infrastructure including communications, air conditioning, refrigeration, and water and sewer pumps. This report describes utilization of Emergency Medical Services (EMS) and hospital resources in West Virginia in response to the storm. Also reported is a review of the weather phenomena and the findings and discussion of the disaster and implications.

  3. Teaching professionalism in the digital age on the psychiatric consultation-liaison service.

    Science.gov (United States)

    Baer, Wendy; Schwartz, Ann C

    2011-01-01

    The rapid emergence of social media, including Facebook and YouTube, have added a new dimension to defining, teaching, and role modeling professionalism in the medical field. Explicit and consistent role modeling of professional behaviors are needed to encourage the development of professional physicians. The purpose of this article is to investigate the challenges and opportunities at the interface of professionalism and social media for physicians. The medical literature via PubMed was reviewed with key words including "Facebook," "YouTube," "social media," "digital media," and key issues are discussed. Our residency program was surveyed regarding their experiences with digital media in medical practice and the findings are discussed. Sample topics and relevant, thought provoking questions generated from our practices are outlined. Case vignettes are offered to exemplify issues with regard to professionalism raised by digital and social media in medical practice. Social media sites offer great opportunity to widely distribute valuable health care information as well as provide physicians with a venue to de-stress. In this new digital age, trainees and lifelong learners must learn to be mindful of professionalism while using social media in order to protect their privacy as well as the image of physicians. Copyright © 2011 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  4. Discrimination attributed to mental illness or race-ethnicity by users of community psychiatric services.

    Science.gov (United States)

    Gabbidon, Jheanell; Farrelly, Simone; Hatch, Stephani L; Henderson, Claire; Williams, Paul; Bhugra, Dinesh; Dockery, Lisa; Lassman, Francesca; Thornicroft, Graham; Clement, Sarah

    2014-11-01

    This study assessed participants' experienced discrimination and their causal attributions, particularly to mental illness or race-ethnicity. In a cross-sectional study, 202 service users with severe mental illnesses were interviewed to assess their reported experiences of discrimination. The Major Experiences of Discrimination Scale assessed major experiences of discrimination and their recency and frequency across 12 life domains and perceived reasons (attributions). The Everyday Experiences of Discrimination Scale assessed ten types of everyday discrimination and attributions for these experiences. Most participants (88%) reported discrimination in at least one life domain, and 94% reported ever experiencing everyday discrimination. The most common areas of major discrimination were mental health care (44%), neighbors (42%), police (33%), employment (31%), and general medical care (31%). The most common attributions for major discrimination were mental illness (57%), race-ethnicity (24%), education or income (20%), or appearance (19%). Almost half (47%) attributed experiences of major discrimination to two or more causes. No differences were found between racial-ethnic groups in overall experienced discrimination or in main attributions to mental illness. However, compared with the mixed and white groups, participants in the black group were most likely to endorse race-ethnicity as a main attribution (pethnic groups, and discrimination based on race-ethnicity was prevalent for the mixed and black groups. There is a need for antidiscrimination strategies that combine efforts to reduce the experience of discrimination attributed to mental illness and to race-ethnicity for racial-ethnic minority groups.

  5. Influence of psychiatric morbidity and sociodemographic determinants on use of service in a catchment area in the city of São Paulo, Brazil.

    Science.gov (United States)

    Andrade, Laura Helena; Viana, Maria Carmen; Tófoli, Luis Fernando Farah; Wang, Yuan-Pang

    2008-01-01

    Recent population-based studies in Latin American and the Caribbean (LAC) countries brought evidence of the growing burden of mental illness in this region. The objective of this study is to examine determinants of health service utilization by individuals with psychiatric disorders in a defined area in the city of São Paulo, Brazil. Data were derived from São Paulo Catchment Area Study (SP-ECA), a cross-sectional household prevalence survey, based on a representative adult sample (N=1,464) living in two defined boroughs. The psychiatric diagnosis was assessed through the CIDI 1.1 interview, yielding ICD-10 diagnoses. The past-month use of health services--for general medical (GM) care and mental health (MH) care sectors--was investigated in their relationship with sociodemographic features, insurance coverage, GM conditions, and psychiatric morbidity. Nearly one-third (32.2%) of the total sample used health services in the last month: 29.0% attended GM care and 7.8% used MH care. Logistic regression models showed that being female, older than 60 years, having private insurance coverage, and presence of psychiatric morbidity increased the level GM care seeking in the total sample. For those with 12-month psychiatric disorders, the determinants for GM sector use were female gender, age 45-59 years old, and private insurance coverage, whereas separated, divorced, or widowed women had the highest odds (OR 9.9; 95% CI: 2.7-36.5) for using MH service. Low-income people were less likely to seek MH services. The major contribution of this article is to underscore the impact of MH on health care systems, in a LAC country where service use information is scarce. The main finding is that inequalities in the access to MH care occurred, with low-income people having less likelihood of receiving treatment for their mental disorder. Access to health service in this catchment area reflected the great degree of deregulation and lack of integration. Additional efforts should

  6. What is 5G? Emerging 5G Mobile Services and Network Requirements

    OpenAIRE

    Heejung Yu; Howon Lee; Hongbeom Jeon

    2017-01-01

    In this paper, emerging 5G mobile services are investigated and categorized from the perspective of not service providers, but end-users. The development of 5G mobile services is based on an intensive analysis of the global trends in mobile services. Additionally, several indispensable service requirements, essential for realizing service scenarios presented, are described. To illustrate the changes in societies and in daily life in the 5G era, five megatrends, including the explosion of mobi...

  7. Helicopter emergency medical services response to equestrian accidents.

    Science.gov (United States)

    Lyon, Richard M; Macauley, Ben; Richardson, Sarah; de Coverly, Richard; Russell, Malcolm

    2015-04-01

    Horse riding is a common leisure activity associated with a significant rate of injury. Helicopter emergency medical services (HEMS) may be called to equestrian accidents. Accurate HEMS tasking is important to ensure appropriate use of this valuable medical resource. We sought to review HEMS response to equestrian accidents and identify factors associated with the need for HEMS intervention or transport of the patient to a major trauma centre. Retrospective case review of all missions flown by Kent, Surrey & Sussex Air Ambulance Trust over a 1-year period (1 July 2011 to 1 July 2012). All missions were screened for accidents involving a horse. Call details, patient demographics, suspected injuries, clinical interventions and patient disposition were all analysed. In the 12-month data collection period there were 47 equestrian accidents, representing ∼3% of the total annual missions. Of the 42 cases HEMS attended, one patient was pronounced life extinct at the scene. In 15 (36%) cases the patient was airlifted to hospital. In four (10%) cases, the patient underwent prehospital anaesthesia. There were no specific predictors of HEMS intervention. Admission to a major trauma centre was associated with the rider not wearing a helmet, a fall onto their head or the horse falling onto the rider. Equestrian accidents represent a significant proportion of HEMS missions. The majority of patients injured in equestrian accidents do not require HEMS intervention, however, a small proportion have life-threatening injuries, requiring immediate critical intervention. Further research is warranted, particularly regarding HEMS dispatch, to further improve accuracy of tasking to equestrian accidents.

  8. Automobile Accidents Attended by Mobile Emergency Care Service

    Directory of Open Access Journals (Sweden)

    Ana Virgínia Gomes Barros

    2017-05-01

    Full Text Available Background: Automobile accidents are increasing every day and are becoming a serious public health problem due to the high morbidity and mortality rate. The goal of the current study was to characterise the traffic accidents attended by the Mobile Emergency Care Service (MECS in Ibiara, PB. Methods: This exploratory, descriptive, documentary study adopted a quantitative approach and analysis of data. The population consisted of all victims of traffic accidents attended by MECS in the city of Ibiara, PB, from June 2015 to June 2016. The following variables were studied: age, gender, time and day of the week the accident occurred, nature of the incident, substance ingested by the victim, wearing personal protective equipment (PPE or not, the anatomical lesions on the victim and the body regions hit during the accident. Results: The sample consisted of 49 accident victims, and the majority (81.6% were male, predominately 30 to 59 years. Events occurring at night (63.3% and during the week (65.3% predominated. The most frequent type of accident was motorcycle fall (71.4%, with almost half having consumed alcohol (46.9% and most not wearing PPE (77.6%. The regions of the body most affected were the lower limbs (67.3% and upper limbs (53.1%. Conclusion: The main factor/cause of these accidents was due to imprudence and violation of traffic laws, highlighting the need to invest in traffic education policies, to direct campaigns for the prevention of traffic accidents, as well as expand the surveillance of traffic laws by authorities.

  9. An intelligent IoT emergency vehicle warning system using RFID and Wi-Fi technologies for emergency medical services.

    Science.gov (United States)

    Lai, Yeong-Lin; Chou, Yung-Hua; Chang, Li-Chih

    2018-01-01

    Collisions between emergency vehicles for emergency medical services (EMS) and public road users have been a serious problem, impacting on the safety of road users, emergency medical technicians (EMTs), and the patients on board. The aim of this study is to develop a novel intelligent emergency vehicle warning system for EMS applications. The intelligent emergency vehicle warning system is developed by Internet of Things (IoT), radio-frequency identification (RFID), and Wi-Fi technologies. The system consists of three major parts: a system trigger tag, an RFID system in an emergency vehicle, and an RFID system at an intersection. The RFID system either in an emergency vehicle or at an intersection contains a controller, an ultrahigh-frequency (UHF) RFID reader module, a Wi-Fi module, and a 2.4-GHz antenna. In addition, a UHF ID antenna is especially designed for the RFID system in an emergency vehicle. The IoT system provides real-time visual warning at an intersection and siren warning from an emergency vehicle in order to effectively inform road users about an emergency vehicle approaching. The developed intelligent IoT emergency vehicle warning system demonstrates the capabilities of real-time visual and siren warnings for EMS safety.

  10. The selective use of emergency shipments for service-contract differentiation

    NARCIS (Netherlands)

    Alvarez, Elisa; van der Heijden, Matthijs C.; Zijm, Willem H.M.

    2013-01-01

    Suppliers of capital goods increasingly offer performance-based service contracts with customer-specific service levels. We use selective emergency shipments of spare parts to differentiate logistic performance: We apply emergency shipments in out-of-stock situations for combinations of parts and

  11. Characteristics of Emergency Services for the Elderly—A Regional Hospital Example

    Directory of Open Access Journals (Sweden)

    Ching-Lin Huang

    2009-12-01

    Conclusion: This study's primary goal was to investigate the most common clinical signs and symptoms of the various diseases most common in elderly patients, who presented to the emergency service, and the care of these patients in Hsinchu County to facilitate a more efficient and useful emergency medical service.

  12. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service.

    NARCIS (Netherlands)

    Gerritse, B.M.; Schalkwijk, A.; Pelzer, B.J.; Scheffer, G.J.; Draaisma, J.M.T.

    2010-01-01

    BACKGROUND: To determine the advanced life support procedures provided by an Emergency Medical Service (EMS) and a Helicopter Emergency Medical Service (HEMS) for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures

  13. A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel

    OpenAIRE

    Pourshaikhian, Majid; Abolghasem Gorji, Hassan; Aryankhesal, Aidin; Khorasani-Zavareh, Davood; Barati, Ahmad

    2016-01-01

    Context In spite of the high prevalence and consequences of much workplace violence against emergency medical services personnel, this phenomenon has been given insufficient attention. A systematic review can aid the development of guidelines to reduce violence. Objectives The research question addressed by this paper is, “What are the characteristics and findings of studies on workplace violence against emergency medical services...

  14. Academic performance of students who underwent psychiatric treatment at the students’ mental health service of a Brazilian university

    Directory of Open Access Journals (Sweden)

    Cláudia Ribeiro Franulovic Campos

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: University students are generally at the typical age of onset of mental disorders that may affect their academic performance. We aimed to characterize the university students attended by psychiatrists at the students’ mental health service (SAPPE and to compare their academic performance with that of non-patient students. DESIGN AND SETTING: Cross-sectional study based on review of medical files and survey of academic data at a Brazilian public university. METHODS: Files of 1,237 students attended by psychiatrists at SAPPE from 2004 to 2011 were reviewed. Their academic performance coefficient (APC and status as of July 2015 were compared to those of a control group of 2,579 non-patient students matched by gender, course and year of enrolment. RESULTS: 37% of the patients had had psychiatric treatment and 4.5% had made suicide attempts before being attended at SAPPE. Depression (39.1% and anxiety disorders/phobias (33.2% were the most frequent diagnoses. Severe mental disorders such as psychotic disorders (3.7% and bipolar disorder (1.9% were less frequent. Compared with non-patients, the mean APC among the undergraduate patients was slightly lower (0.63; standard deviation, SD: 0.26; versus 0.64; SD: 0.28; P = 0.025, but their course completion rates were higher and course abandonment rates were lower. Regarding postgraduate students, patients and non-patients had similar completion rates, but patients had greater incidence of discharge for poor performance and lower dropout rates. CONCLUSION: Despite the inclusion of socially vulnerable people with severe mental disorders, the group of patients had similar academic performance, and in some aspects better, than, that of non-patients.

  15. Academic performance of students who underwent psychiatric treatment at the students' mental health service of a Brazilian university.

    Science.gov (United States)

    Campos, Cláudia Ribeiro Franulovic; Oliveira, Maria Lilian Coelho; Mello, Tânia Maron Vichi Freire de; Dantas, Clarissa de Rosalmeida

    2017-01-01

    University students are generally at the typical age of onset of mental disorders that may affect their academic performance. We aimed to characterize the university students attended by psychiatrists at the students' mental health service (SAPPE) and to compare their academic performance with that of non-patient students. Cross-sectional study based on review of medical files and survey of academic data at a Brazilian public university. Files of 1,237 students attended by psychiatrists at SAPPE from 2004 to 2011 were reviewed. Their academic performance coefficient (APC) and status as of July 2015 were compared to those of a control group of 2,579 non-patient students matched by gender, course and year of enrolment. 37% of the patients had had psychiatric treatment and 4.5% had made suicide attempts before being attended at SAPPE. Depression (39.1%) and anxiety disorders/phobias (33.2%) were the most frequent diagnoses. Severe mental disorders such as psychotic disorders (3.7%) and bipolar disorder (1.9%) were less frequent. Compared with non-patients, the mean APC among the undergraduate patients was slightly lower (0.63; standard deviation, SD: 0.26; versus 0.64; SD: 0.28; P = 0.025), but their course completion rates were higher and course abandonment rates were lower. Regarding postgraduate students, patients and non-patients had similar completion rates, but patients had greater incidence of discharge for poor performance and lower dropout rates. Despite the inclusion of socially vulnerable people with severe mental disorders, the group of patients had similar academic performance, and in some aspects better, than, that of non-patients.

  16. Cost burden for accessing paediatric emergency services at a ...

    African Journals Online (AJOL)

    Verifiable information on various financial expenditures during emergency episode as well as respondents' perceptions and background socioeconomic status were collected. Proxy estimates for economic impacts were calculated based on single need per household for emergency care. Descriptive analysis of the data ...

  17. Service providers' perception of the quality of emergency obsteric ...

    African Journals Online (AJOL)

    Facility/staff themes which emerged as contributing to the poor care were; inadequate resources, inadequate staffing, poor teamwork, and inadequate knowledge/supervision. Conclusion The findings of this study reveal that health care workers rate the quality of emergency obstetric care they provide as poor. They were ...

  18. The appropriateness of emergency medical service responses in the ...

    African Journals Online (AJOL)

    2015-10-10

    Oct 10, 2015 ... P R Newton,1 MTech (Emergency Medical Care); R Naidoo,1 MSc (Cardiology); P Brysiewicz,2 PhD (Health Science). 1 Department of Emergency Medical Care and Rescue, Faculty of Health Sciences, Durban University of Technology, South Africa ..... tation, may include a straightforward refusal.

  19. Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil

    OpenAIRE

    Rocha, Thiago Augusto Hernandes; da Silva, N?bia Cristina; Amaral, Pedro Vasconcelos; Barbosa, Allan Claudius Queiroz; Rocha, Jo?o Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Thum?, Elaine; Thomaz, Erika B?rbara Abreu Fonseca; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Lein, Adriana; Lopes, Daniel Paulino; Staton, Catherine A.; Vissoci, Jo?o Ricardo Nickenig

    2017-01-01

    Background Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. Methods The present work can be classified as a c...

  20. Development of a Work Climate Scale in Emergency Health Services.

    Science.gov (United States)

    Sanduvete-Chaves, Susana; Lozano-Lozano, José A; Chacón-Moscoso, Salvador; Holgado-Tello, Francisco P

    2018-01-01

    An adequate work climate fosters productivity in organizations and increases employee satisfaction. Workers in emergency health services (EHS) have an extremely high degree of responsibility and consequent stress. Therefore, it is essential to foster a good work climate in this context. Despite this, scales with a full study of their psychometric properties (i.e., validity evidence based on test content, internal structure and relations to other variables, and reliability) are not available to measure work climate in EHS specifically. For this reason, our objective was to develop a scale to measure the quality of work climates in EHS. We carried out three studies. In Study 1, we used a mixed-method approach to identify the latent conceptual structure of the construct work climate . Thus, we integrated the results found in (a) a previous study, where a content analysis of seven in-depth interviews obtained from EHS professionals in two hospitals in Gibraltar Countryside County was carried out; and (b) the factor analysis of the responses given by 113 EHS professionals from these same centers to 18 items that measured the work climate in health organizations. As a result, we obtained 56 items grouped into four factors (work satisfaction, productivity/achievement of aims, interpersonal relationships, and performance at work). In Study 2, we presented validity evidence based on test content through experts' judgment. Fourteen experts from the methodology and health fields evaluated the representativeness, utility, and feasibility of each of the 56 items with respect to their factor (theoretical dimension). Forty items met the inclusion criterion, which was to obtain an Osterlind index value greater than or equal to 0.5 in the three aspects assessed. In Study 3, 201 EHS professionals from the same centers completed the resulting 40-item scale. This new instrument produced validity evidence based on the internal structure in a second-order factor model with four

  1. Development of a Work Climate Scale in Emergency Health Services

    Directory of Open Access Journals (Sweden)

    Susana Sanduvete-Chaves

    2018-01-01

    Full Text Available An adequate work climate fosters productivity in organizations and increases employee satisfaction. Workers in emergency health services (EHS have an extremely high degree of responsibility and consequent stress. Therefore, it is essential to foster a good work climate in this context. Despite this, scales with a full study of their psychometric properties (i.e., validity evidence based on test content, internal structure and relations to other variables, and reliability are not available to measure work climate in EHS specifically. For this reason, our objective was to develop a scale to measure the quality of work climates in EHS. We carried out three studies. In Study 1, we used a mixed-method approach to identify the latent conceptual structure of the construct work climate. Thus, we integrated the results found in (a a previous study, where a content analysis of seven in-depth interviews obtained from EHS professionals in two hospitals in Gibraltar Countryside County was carried out; and (b the factor analysis of the responses given by 113 EHS professionals from these same centers to 18 items that measured the work climate in health organizations. As a result, we obtained 56 items grouped into four factors (work satisfaction, productivity/achievement of aims, interpersonal relationships, and performance at work. In Study 2, we presented validity evidence based on test content through experts' judgment. Fourteen experts from the methodology and health fields evaluated the representativeness, utility, and feasibility of each of the 56 items with respect to their factor (theoretical dimension. Forty items met the inclusion criterion, which was to obtain an Osterlind index value greater than or equal to 0.5 in the three aspects assessed. In Study 3, 201 EHS professionals from the same centers completed the resulting 40-item scale. This new instrument produced validity evidence based on the internal structure in a second-order factor model with

  2. A study of a culturally focused psychiatric consultation service for Asian American and Latino American primary care patients with depression

    Directory of Open Access Journals (Sweden)

    Fava Maurizio

    2011-10-01

    Full Text Available Abstract Background Ethnic minorities with depression are more likely to seek mental health care through primary care providers (PCPs than mental health specialists. However, both provider and patient-specific challenges exist. PCP-specific challenges include unfamiliarity with depressive symptom profiles in diverse patient populations, limited time to address mental health, and limited referral options for mental health care. Patient-specific challenges include stigma around mental health issues and reluctance to seek mental health treatment. To address these issues, we implemented a multi-component intervention for Asian American and Latino American primary care patients with depression at Massachusetts General Hospital (MGH. Methods/Design We propose a randomized controlled trial to evaluate a culturally appropriate intervention to improve the diagnosis and treatment of depression in our target population. Our goals are to facilitate a primary care providers' ability to provide appropriate, culturally informed care of depression, and b patients' knowledge of and resources for receiving treatment for depression. Our two-year long intervention targets Asian American and Latino American adult (18 years of age or older primary care patients at MGH screening positive for symptoms of depression. All eligible patients in the intervention arm of the study who screen positive will be offered a culturally focused psychiatric (CFP consultation. Patients will meet with a study clinician and receive toolkits that include psychoeducational booklets, worksheets and community resources. Within two weeks of the initial consultation, patients will attend a follow-up visit with the CFP clinicians. Primary outcomes will determine the feasibility and cost associated with implementation of the service, and evaluate patient and provider satisfaction with the CFP service. Exploratory aims will describe the study population at screening, recruitment, and enrollment

  3. Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

    OpenAIRE

    Meaney Christopher; Moineddin Rahim; Agha Mohammad; Zagorski Brandon; Glazier Richard Henry

    2011-01-01

    Abstract Background Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions...

  4. Developing an active emergency medical service system based on WiMAX technology.

    Science.gov (United States)

    Li, Shing-Han; Cheng, Kai-An; Lu, Wen-Hui; Lin, Te-Chang

    2012-10-01

    The population structure has changed with the aging of population. In the present, elders account for 10.63% of the domestic population and the percentage is still gradually climbing. In other words, the demand for emergency services among elders in home environment is expected to grow in the future. In order to improve the efficiency and quality of emergency care, information technology should be effectively utilized to integrate medical systems and facilities, strengthen human-centered operation designs, and maximize the overall performance. The improvement in the quality and survival rate of emergency care is an important basis for better life and health of all people. Through integrated application of medical information systems and information communication technology, this study proposes a WiMAX-based emergency care system addressing the public demands for convenience, speed, safety, and human-centered operation of emergency care. This system consists of a healthcare service center, emergency medical service hospitals, and emergency ambulances. Using the wireless transmission capability of WiMAX, patients' physiological data can be transmitted from medical measurement facilities to the emergency room and emergency room doctors can provide immediate online instructions on emergency treatment via video and audio transmission. WiMAX technology enables the establishment of active emergency medical services.

  5. Student-selected component in the medical curriculum: investigations and psychiatric referral for paracetamol overdose in an accident and emergency department

    Directory of Open Access Journals (Sweden)

    Cowman JG

    2017-08-01

    Full Text Available James G Cowman, Manuel Bakheet Royal College of Surgeons in Ireland – Medical University of Bahrain, Manama, Bahrain Background: A student-selected component (SSC of the medical curriculum requires the student to be self-directed in locating and undertaking a placement in a clinical specialty of their choosing and completing a project. The clinical area for experience was an accident and emergency department, and our topic was a focused audit on the investigations and referral for paracetamol overdose. The purpose of this paper is twofold: to reflect on the education value to medical students of an SSC in a medical curriculum, and to highlight learning and understanding through completion of an audit.Materials and methods: An audit approach was applied. The aim of the project study was to investigate the level of compliance with best-practice guidelines for investigations and psychiatric referral in paracetamol overdose.Results: A total of 40 cases meeting the inclusion criteria were randomly selected. The sample had a mean age of 27 years, of whom 70.5% were female, and the ingested dose of paracetamol ranged from 0.864 to 80 g. Paracetamol abuse may present as intentional and unintentional overdose. In our study, 85% of cases were identified as intentional overdose and 76% had a history of psychiatric illness. Generally, medical management was compliant with guidelines, with some minor irregularities. The international normalized ratio was the most underperformed test.Conclusion: Our choice of topic, paracetamol overdose, contributed to our understanding of the breadth of factors to be considered in the emergency medical management of a patient. In this regard, we had the benefit of understanding how the diagnostic and therapeutic factors, when applied in accordance with best-practice guidelines, work very effectively. The SSC impacted positively on our cognitive, personal, and professional development. In facilitating the student with

  6. Cost Burden for Accessing Paediatric Emergency Services at a ...

    African Journals Online (AJOL)

    TNHJOURNALPH

    modalities and economic impacts for accessing paediatric ... Descriptive analysis of the data was done using SPSS ... being discharged home from the emergency ... their homes to the hospital. ..... respondents could be affected by recall bias.

  7. IAEA assistance services in the case of emergency

    International Nuclear Information System (INIS)

    Ouvrard, R.

    1991-01-01

    This paper provides a general outline of the convention on Early Notification of a Nuclear Accident and of the convention on Assistance in the case of a Nuclear Accident or Radiological Emergency. The purpose of these 2 conventions is to support and improve international cooperation in case of a nuclear accident or a radiological emergency involving transfrontier contamination and to provide the necessary legal framework for cooperation and assistance (4 figs) [fr

  8. Addams, Day, and Dewey: The Emergence of Community Service in American Culture.

    Science.gov (United States)

    Morton, Keith; Saltmarsh, John

    1997-01-01

    Chronicles the emergence of community service in the United States, beginning with the turn-of-the-century collision of capitalism and democracy which generated a crisis of community and profound rethinking of the meaning and practice of charity. Three service "paths" are identified: nonprofit human services organizations; active…

  9. Reassurance as a key outcome valued by emergency ambulance service users: a qualitative interview study.

    Science.gov (United States)

    Togher, Fiona J; O'Cathain, Alicia; Phung, Viet-Hai; Turner, Janette; Siriwardena, Aloysius Niroshan

    2015-12-01

    There is an increasing need to assess the performance of emergency ambulance services using measures other than the time taken for an ambulance to arrive on scene. In line with government policy, patients and carers can help to shape new measures of ambulance service performance. To investigate the aspects of emergency ambulance service care valued by users. Qualitative interview study. One of 11 ambulance services in England. Twenty-two users and eight of their spouses (n = 30). Users of the emergency ambulance service, experiencing different types of ambulance service response, valued similar aspects of their pre-hospital care. Users were often extremely anxious about their health, and the outcome they valued was reassurance provided by ambulance service staff that they were receiving appropriate advice, treatment and care. This sense of being reassured was enhanced by the professional behaviour of staff, which instilled confidence in their care; communication; a short wait for help; and continuity during transfers. A timely response was valued in terms of allaying anxiety quickly. The ability of the emergency ambulance service to allay the high levels of fear and anxiety felt by users is crucial to the delivery of a high quality service. Measures developed to assess and monitor the performance of emergency ambulance services should include the proportion of users reporting feeling reassured by the response they obtained. © 2014 John Wiley & Sons Ltd.

  10. emergency psychiatry and mental health policy: an international ...

    African Journals Online (AJOL)

    psychiatric care such as clinical implications, care in large cities, the rights of the patients and deinstitutionalisation. Further chapters examine care on different continents. Emergency psychiatric services in the United States, Canada, the Netherlands, France, Italy, Denmark, Belgium, Germany,. Spain, Greece and South ...

  11. Alcoholics and the emergency ward. Part I. Clinical characteristics.

    Science.gov (United States)

    Fialkov, M J

    1977-10-01

    A study of White and Black (Black, Cape Coloured and Asiatic) male alcoholics who attended the psychiatric emergency service unit at Groote Schuur Hospital, Cape Town, is presented. The psychosocial and clinical characteristics are described and compared. In addition, the associated physical and psychiatric morbidity is tabulated.

  12. assessment of emergency medical services in the ashanti region

    African Journals Online (AJOL)

    2015-09-01

    Sep 1, 2015 ... Background: We aimed to assess the structure, func- tion and performance of ... operated Facility-Based Ambulance Service (FBAS).4 ... National Disaster Management Organisation (Kumasi, .... Equipment and Medication. ✓.

  13. Emerging Issues and Models in College Mental Health Services

    Science.gov (United States)

    Locke, Ben; Wallace, David; Brunner, Jon

    2016-01-01

    This chapter provides a brief overview of the psychological issues facing today's college students, information about students receiving mental health services, and an evidence-based model describing the practice and functions of today's counseling centers.

  14. Assessment of Emergency Obstetric Care Services in Ibadan ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    ORIGINAL RESEARCH ARTICLE ... Nigeria's high maternal mortality has been attributed to poor utilization of obstetric care services to handle ... Poor obstetric outcome in middle and low-income ... Evidence also showed that access to.

  15. Improving feedback from outpatient medical appointments attended by escorted psychiatric patients in the North London Forensic Service.

    Science.gov (United States)

    McCurdy, Kathleen; Croxford, Anna

    2015-01-01

    It is well established that patients with mental illness are known to have a high level of morbidity and mortality compared to the general population. This is particularly prominent in long-stay psychiatric patients, such as those in secure settings. The Royal College of Psychiatrists recommends that psychiatrists should promote the physical health of their patients and liaise with other specialties. However, there is evidence that communication between psychiatry and other specialties is poor. A survey was carried out at the North London Forensic Service in June 2014. This looked at the views of clinical staff about the frequency and quality of feedback obtained when inpatients attend outpatient hospital appointments at local general hospitals. This survey highlighted the general perception among staff that feedback is poor, with 68.43% of respondents saying that they were "very unsatisfied" or "unsatisfied" with the level and quality of feedback. Clinical staff felt that many patients who attended hospital outpatient appointments, even when escorted by staff, returned with little or no feedback. This was confirmed by a baseline audit across 3 wards showing that details of the appointment (date, time, hospital, and specialty) were only documented in 54.5% of cases and the content of the appointment documented in even fewer cases. A form was designed by junior doctors that provided a simple framework of 6 questions to be answered at the outpatient clinic about the problem, diagnosis, and further actions needed. This was introduced and its impact assessed with a 3-month and 6-month audit of electronic notes, as well as a follow-up survey after 6 months. The audit showed significant improvement in the quality of feedback about the appointment at both the 3-month and 6-month point. The follow-up survey showed that 70% of respondents were aware of the form and 100% of those who were aware of the form had used it at least once and found it helpful. The general

  16. Are You Ready for Emergency Medical Services in Your Oral and Maxillofacial Surgery Office?

    Science.gov (United States)

    Rayner, Clive; Ragan, Michael R

    2018-05-01

    Efficient responses to emergencies in the oral and maxillofacial surgery office require preparation, communication, and thorough documentation of the event and response. The concept of team anesthesia is showcased with these efforts. Emergency medical services training and response times vary greatly. The oral and maxillofacial surgery office should be prepared to manage the patient for at least 15 minutes after making the call to 911. Patient outcomes are optimized when providers work together to manage and transport the patient. Oral and maxillofacial surgery offices should develop and rehearse emergency plans and coordinate these protocols with local Emergency medical services teams. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. ABC estimation of unit costs for emergency department services.

    Science.gov (United States)

    Holmes, R L; Schroeder, R E

    1996-04-01

    Rapid evolution of the health care industry forces managers to make cost-effective decisions. Typical hospital cost accounting systems do not provide emergency department managers with the information needed, but emergency department settings are so complex and dynamic as to make the more accurate activity-based costing (ABC) system prohibitively expensive. Through judicious use of the available traditional cost accounting information and simple computer spreadsheets. managers may approximate the decision-guiding information that would result from the much more costly and time-consuming implementation of ABC.

  18. 76 FR 29131 - Emergency Medical Services Week, 2011

    Science.gov (United States)

    2011-05-19

    ... public and private sector partners across the United States to make certain that all children... often make the difference between life and death. Emergency medical technicians (EMTs), paramedics, and first responders serve on the front lines of our health care and public health system. Working with them...

  19. Emerging markets for satellite data communications in the public service

    Science.gov (United States)

    Potter, J. G.

    1978-01-01

    The paper discusses some of the current and potential markets for satellite data communications as projected by the Public Service Satellite Consortium (PSSC). Organizations in the public service sector are divided into three categories, depending on their expected benefits and organizational changes due to increased satellite telecommunications use: A - modest institutional adjustments are necessary and significant productivity gains are likely; B - institutional requirements picture is promising, but more information is needed to assess benefits and risk; and C - major institutional adjustments are needed, risks are high but possible benefits are high. These criteria are applied to the U.S. health care system, continuing education, equipment maintenance, libraries, environmental monitoring, and other potential markets. The potential revenues are seen to be significant, but what is needed is a cooperative effort by common carriers and major public service institutions to aggregate the market.

  20. Retrospective evaluation of urological admissions to emergency service of a training and research hospital.

    Science.gov (United States)

    Topaktaş, Ramazan; Altın, Selçuk; Aydın, Cemil; Akkoç, Ali; Yılmaz, Yakup

    2014-12-01

    Many patients consult emergency services with urological complaints. The aim of this study was to investigate the epidemiology, clinical presentation and treatments of urological emergency cases in a training and research hospital. We retrospectively evaluated urological emergency patients referred to the emergency unit between July 2012 and July 2013 according to age, gender, affected organ, radiological imaging techniques and treatment. Among 141.844 emergency cases, 3.113 (2.19%) were urological emergencies and 53.2% of the patients were male (mean age: 49.1), and 46.8% of them were female (median age: 42.8). The most frequent illness was genitourinary infection constituting 41.2% of the cases followed by renal colic (36.9%). Among the urological emergencies 483 (15.5%) patients were hospitalized and 152 surgical operations were performed. The mostly performed procedure was the placement of a suprapubic catheter in 34 patients constituting (22.3%) of the cases. Totally eight patients were referred to another experienced health center due to different reasons. Most of the urological emergency patients do not require emergency surgical interventions however, timely identification and management of urological emergencies with in-depth clinical evaluation are important to prevent late complications. Therefore the doctors working in emergency services must be heedful of urological emergencies.

  1. Systematic Review Methodology for the Fatigue in Emergency Medical Services Project

    Science.gov (United States)

    2018-01-11

    Background: Guidance for managing fatigue in the Emergency Medical Services (EMS) setting is limited. The Fatigue in EMS Project sought to complete multiple systematic reviews guided by seven explicit research questions, assemble the best available e...

  2. Management of primary headache in emergency services of Santos and surrounding towns

    Directory of Open Access Journals (Sweden)

    Yara Dadalti Fragoso

    Full Text Available OBJECTIVES: Primary headaches are often seen by Clinicians on duty at Emergency Services. We have investigated the treatment of such patients by 43 medical doctors who have been working at Emergency Services in the city of Santos and surrounding towns for many years. RESULTS: We confirmed the high prevalence of primary headaches in Emergency Services. There seem to be diagnosis difficulties concerning differentiating attacks of migraine and tension type headache. We also observed that IV dipirone was the most frequently prescribed treatment for patients with primary headaches in this study. There is no protocol in the literature which recommends IV dipirone for the treatment of migraine attacks or other primary headaches. CONCLUSION: It would be advisable to perform controlled double blind studies in order to verify the advantages of IV dipirone in the treatment of intense attacks primary headaches. We concluded that headache management recycling programs could be of interest for doctors who regularly work at Emergency Services.

  3. Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007-2014

    DEFF Research Database (Denmark)

    Christensen, Erika Frischknecht; Bendtsen, Mette Dahl; Larsen, Thomas Mulvad

    2017-01-01

    ) to allow comparison by year, with 2007 as reference year. RESULTS: The annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48......: Population-based cohort study with linkage of Danish national registries. SETTING: The North Denmark Region in 2007-2014. PARTICIPANTS: Cohort of 148 757 patients transported to hospital by ambulance after calling emergency services. MAIN OUTCOME MEASURES: The number of emergency ambulance service patients......, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased....

  4. Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007-2014

    DEFF Research Database (Denmark)

    Christensen, Erika Frischknecht; Bendtsen, Mette Dahl; Larsen, Thomas Mulvad

    ) to allow comparison by year, with 2007 as reference year. RESULTS: The annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48......: Population-based cohort study with linkage of Danish national registries. SETTING: The North Denmark Region in 2007-2014. PARTICIPANTS: Cohort of 148 757 patients transported to hospital by ambulance after calling emergency services. MAIN OUTCOME MEASURES: The number of emergency ambulance service patients......, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased....

  5. Absence and Need for Fatigue Risk Management in Emergency Medical Services

    Science.gov (United States)

    2018-01-11

    Fatigue in the Emergency Medical Services (EMS) workplace is widespread. Reports of fatigue-related events that involve ambulance crashes, personnel injury, patient death, and other negative outcomes are on the rise (1-7). There is growing evidence t...

  6. Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services

    Science.gov (United States)

    2018-01-11

    Background: Administrators of Emergency Medical Services (EMS) operations lack guidance on how to mitigate workplace fatigue, which affects greater than half of all EMS personnel. The primary objective of the Fatigue in EMS Project was to create an e...

  7. Changing pattern of clinical profile of first-contact patients attending outpatient services at a general hospital psychiatric unit in India over the last 50 years

    Directory of Open Access Journals (Sweden)

    Mamta Sood

    2017-01-01

    Full Text Available Introduction: Over the last five decades, general hospital psychiatric units (GHPUs have become important mental health service setups in India. The present study reports on the changing clinical profile of the patients attending the GHPUs over the last five decades. Methodology: A total of 500 subjects, attending a GHPU were recruited prospectively for the study. The subjects were assessed using a semistructured proforma. A comparison was made with similar studies conducted in GHPU settings over the last five decades. Results: In the present study, neurotic, stress-related and somatoform disorders formed the commonest diagnostic group (33% followed by psychotic disorders (17% and mood disorders (15%. The diagnostic distribution is broadly similar to the studies done at different times in the last 5 decades, though there were lesser number of patients with mental retardation and organic brain syndrome. About 15% of the subjects did not have a psychiatric diagnosis. Conclusion: GHPUs in India attend to a broad range of patients with psychiatric disorders.

  8. What is 5G? Emerging 5G Mobile Services and Network Requirements

    Directory of Open Access Journals (Sweden)

    Heejung Yu

    2017-10-01

    Full Text Available In this paper, emerging 5G mobile services are investigated and categorized from the perspective of not service providers, but end-users. The development of 5G mobile services is based on an intensive analysis of the global trends in mobile services. Additionally, several indispensable service requirements, essential for realizing service scenarios presented, are described. To illustrate the changes in societies and in daily life in the 5G era, five megatrends, including the explosion of mobile data traffic, the rapid increase in connected devices, everything on the cloud, hyper-realistic media for convergence services and knowledge as a service enabled by big-data analysis, are examined. Based on such trends, we classify the new 5G services into five categories in terms of the end-users’ experience as follows: immersive 5G services, intelligent 5G services, omnipresent 5G services, autonomous 5G services and public 5G services. Moreover, several 5G service scenarios in each service category are presented, and essential technical requirements for realizing the aforementioned 5G services are suggested, along with a competitiveness analysis on 5G services/devices/network industries and the current condition of 5G technologies.

  9. Intelligent Medical Systems for Aerospace Emergency Medical Services

    Science.gov (United States)

    Epler, John; Zimmer, Gary

    2004-01-01

    The purpose of this project is to develop a portable, hands free device for emergency medical decision support to be used in remote or confined settings by non-physician providers. Phase I of the project will entail the development of a voice-activated device that will utilize an intelligent algorithm to provide guidance in establishing an airway in an emergency situation. The interactive, hands free software will process requests for assistance based on verbal prompts and algorithmic decision-making. The device will allow the CMO to attend to the patient while receiving verbal instruction. The software will also feature graphic representations where it is felt helpful in aiding in procedures. We will also develop a training program to orient users to the algorithmic approach, the use of the hardware and specific procedural considerations. We will validate the efficacy of this mode of technology application by testing in the Johns Hopkins Department of Emergency Medicine. Phase I of the project will focus on the validation of the proposed algorithm, testing and validation of the decision making tool and modifications of medical equipment. In Phase 11, we will produce the first generation software for hands-free, interactive medical decision making for use in acute care environments.

  10. 78 FR 44523 - Burned Area Emergency Response, Forest Service

    Science.gov (United States)

    2013-07-24

    ...-1121. If comments are sent by electronic means, please do not send duplicate comments via regular mail... Information Relay Service (FIRS) at 1-800-877-8339 between 8:00 a.m. and 8:00 p.m., Eastern Standard Time...

  11. 78 FR 34031 - Burned Area Emergency Response, Forest Service

    Science.gov (United States)

    2013-06-06

    ...;and investigations, committee meetings, agency decisions and rulings, #0;delegations of authority...-wildfire threats to human safety, property and critical natural or cultural resources on National Forest... efforts to improve cost efficiencies. These cost issues affect the Forest Service BAER program since...

  12. Theatre and emergency services rendered by generalist medical ...

    African Journals Online (AJOL)

    The 27 district hospitals were staffed by 147 full time, part-time and community service practitioners at the time of the study. The part-time practitioners had statistically significant more experience. Fifty percent of the respondents had done an ATLS or equivalent course, whilst only 5% were qualified family physicians.

  13. Emerging trends in the evolution of service-oriented and enterprise architectures

    CERN Document Server

    Zimmermann, Alfred; Jain, Lakhmi

    2016-01-01

    This book presents emerging trends in the evolution of service-oriented and enterprise architectures. New architectures and methods of both business and IT are integrating services to support mobility systems, Internet of Things, Ubiquitous Computing, collaborative and adaptive business processes, Big Data, and Cloud ecosystems. They inspire current and future digital strategies and create new opportunities for the digital transformation of next digital products and services. Services Oriented Architectures (SOA) and Enterprise Architectures (EA) have emerged as a useful framework for developing interoperable, large-scale systems, typically implementing various standards, like Web Services, REST, and Microservices. Managing the adaptation and evolution of such systems presents a great challenge. Service-Oriented Architecture enables flexibility through loose coupling, both between the services themselves and between the IT organizations that manage them. Enterprises evolve continuously by transforming and ext...

  14. Severe hypoglycaemia requiring the assistance of emergency medical services - frequency, causes and symptoms

    Czech Academy of Sciences Publication Activity Database

    Krnačová, V.; Kuběna, Aleš Antonín; Macek, K.; Bezděk, M.; Šmahelová, A.; Vlček, J.

    2012-01-01

    Roč. 156, č. 3 (2012), s. 271-277 ISSN 1213-8118 Grant - others:GA UK(CZ) SVV-2010-261-004 Keywords : regression trees * causes * symptoms * incidence * emergency medical service * severe hypoglycaemia Subject RIV: EI - Biotechnology ; Bionics Impact factor: 0.990, year: 2012 http://library.utia.cas.cz/separaty/2013/E/kubena-severe hypoglycaemia requiring the assistance of emergency medical services - frequency causes and symptoms.pdf

  15. 78 FR 801 - National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory...

    Science.gov (United States)

    2013-01-04

    ...The NHTSA announces a meeting of NEMSAC to be held in the Metropolitan Washington, DC, area. This notice announces the date, time, and location of the meeting, which will be open to the public. The purpose of NEMSAC, a nationally recognized council of emergency medical services representatives and consumers, is to provide advice and recommendations regarding Emergency Medical Services (EMS) to DOT's NHTSA and to the Federal Interagency Committee on EMS (FICEMS).

  16. Portuguese Adaptation and Input for the Validation of the Views on Inpatient Care (VOICE) Outcome Measure to Assess Service Users'Perceptions of Inpatient Psychiatric Care.

    Science.gov (United States)

    Palha, João; Palha, Filipa; Dias, Pedro; Gonçalves-Pereira, Manuel

    2017-11-29

    Patient satisfaction is an important measure of health care quality. Patients' views have seldom been considered in the construction of measures addressing satisfaction with inpatient facilities in psychiatry. The Views on Inpatient Care - VOICE - is a first service-user generated outcome measure relying solely on their perceptions of acute care, representing a valuable indicator of service users' perceived quality of care. The present study aimed to contribute to the validation of the Portuguese version of VOICE. The questionnaire was translated into Portuguese and applied to a sample of eighty-five female inpatients of a psychiatric institution. Data analysis focused on assessing reliability and exploring the impact of demographic and clinical variables on participants' satisfaction. Internal consistency of the questionnaire was high (α = 0.87). Participants' age and marital status were associated with differences in scores, with older patients and patients who were married or involved in a close relationship presenting higher satisfaction levels. The questionnaire demonstrated good internal consistency and acceptability, as well as construct validity. Further studies should expand the analysis of the psychometric properties of this measure e.g., test-retest reliability. The Portuguese version of VOICE is a promising tool to assess service users' perceptions of inpatient psychiatric care in Portugal.

  17. The importance of relationships in mental health care: A qualitative study of service users' experiences of psychiatric hospital admission in the UK

    Directory of Open Access Journals (Sweden)

    Slade Mike

    2008-04-01

    Full Text Available Abstract Background While a number of studies have looked at life on service users' experiences of life on psychiatric wards, no research exists that have approached these experiences from the user perspective since the introduction of community care. Methods This user-led study uses a participatory approach to develop an understanding of the processes and themes which define the user experience of hospitalisation. Nineteen service users who had all had inpatient stays in psychiatric hospitals in London were interviewed in the community. Results Relationships formed the core of service users' experiences. Three further codes, treatment, freedom and environment defined the role of hospital and its physical aspects. Themes of communication, safety, trust, coercion, and cultural competency contributed to the concept of relationships. Conclusion Relationships with an individual which comprised effective communication, cultural sensitivity, and the absence of coercion resulted in that person being attributed with a sense of trust. This resulted in the patient experiencing the hospital as a place of safety in terms of risk from other patients and staff. Barriers to positive relationships included ineffective and negative communication, a lack of trust, a lack of safety in terms of staff as ineffective in preventing violence, and as perpetrators themselves, and the use of coercion by staff. This unique perspective both acts as a source of triangulation with previous studies and highlights the importance of the therapeutic relationship in providing a safe and therapeutic milieu for the treatment of people with acute mental health problems.

  18. Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness.

    Science.gov (United States)

    Bhui, Kamaldeep; Aslam, Rabbea'h W; Palinski, Andrea; McCabe, Rose; Johnson, Mark R D; Weich, Scott; Singh, Swaran Preet; Knapp, Martin; Ardino, Vittoria; Szczepura, Ala

    2015-04-01

    Black and minority ethnic (BME) people using psychiatric services are at greater risk of non-engagement, dropout from care and not receiving evidence-based interventions than white British people. To identify effective interventions designed to improve therapeutic communications (TCs) for BME patients using psychiatric services in the UK, to identify gaps in the research literature and to recommend future research. Black African, black Caribbean, black British, white British, Pakistani and Bangladeshi patients in psychiatric services in the UK, or recruited from the community to enter psychiatric care. Some studies from the USA included Hispanic, Latino, Chinese, Vietnamese, Cambodian and African American people. Any that improve TCs between BME patients and staff in psychiatric services. The published literature, 'grey' literature, an expert survey, and patients' and carers' perspectives on the evidence base. Databases were searched from their inception to 4 February 2013. Databases included MEDLINE, Applied Social Sciences Index and Abstracts, The Cochrane Library, Social Science Citation Index, Allied and Complementary Medicine Database, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, EMBASE, The Campbell Collaboration and ProQuest for dissertations. Studies were included if they reported evaluation data about interventions designed to improve therapeutic outcomes by improving communication between BME patients and psychiatric professionals. Qualitative studies and reports in the grey literature were included only if they gave a critical evaluative statement. Two members of the team selected studies against pre-established criteria and any differences were resolved by consensus or by a third reviewer, if necessary. Data were extracted independently by two people and summarised in tables by specific study designs. Studies were subjected to a narrative synthesis that included a thematic analysis contrasting populations, countries and the

  19. 14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Helicopter hospital emergency medical....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... certificate holder may assign a helicopter flight crewmember, and no flight crewmember may accept an...

  20. Older adults and the emerging digital service delivery

    DEFF Research Database (Denmark)

    Siren, Anu; Knudsen, Sine Grønborg

    2017-01-01

    Based on data from a survey (n = 3291) and 14 qualitative interviews among Danish older adults, this study investigated the use of, and attitudes toward, information communications technology (ICT) and the digital delivery of public services. While age, gender, and socioeconomic status were...... associated with use of ICT, these determinants lost their explanatory power when we controlled for attitudes and experiences. We identified three segments that differed in their use of ICT and attitudes toward digital service delivery. As nonuse of ICT often results from the lack of willingness to use...... it rather than from material or cognitive deficiencies, policy measures for bridging the digital divide should focus on skills and confidence rather than on access or ability....

  1. Trends in levels of self-reported psychological distress among individuals who seek psychiatric services over eight years: a comparison between age groups in three population surveys in Stockholm County.

    Science.gov (United States)

    Kosidou, Kyriaki; Lundin, Andreas; Lewis, Glyn; Fredlund, Peeter; Dal, Henrik; Dalman, Christina

    2017-10-11

    Psychiatric service use has increased in Sweden and in other developed countries, particularly among young people. Possible explanations include lower threshold for help-seeking among young people, but evidence is scarce. We analysed the 2002, 2006 and 2010 Stockholm public health surveys for changes in the mean level of psychological distress among adult users of psychiatric in- and outpatient services in four age groups: 18-24, 25-44, 45-64 and ≥65 years. Psychological distress was measured via the 12-item General Health Questionnaire (GHQ-12), using the Likert scoring method 0-1-2-3. In- and out-patient psychiatric service use within 6 months from the surveys was obtained from registers. The mean level of distress among young adults 18-24 years who utilize psychiatric services decreased between 2002 (mean GHQ-12 score, 95% confidence interval 20.5, 18.1-23.0) and 2010 (16.2, 14.6-17.7), while it remained fairly stable in older age groups. Results were similar in sex-stratified analyses, although the decrease was statistically significant only among young women 18-24 years. At the end of the follow-up, the level of distress among patients was similar for all age-groups. There were no differences between age groups in the level of distress when seeking care at the end of the follow-up period, supporting that there is no age-specific over- or under-consumption of psychiatric care in later years. However, the lowered threshold for help-seeking among young adults over time might have contributed to increases in psychiatric service use in the young age group. Public health policy and service delivery planning should consider the needs of the widening group of young users of psychiatric services.

  2. Burnout syndrome in nursing professionals from urgency and emergency services

    OpenAIRE

    Portela, Nytale Lindsay Cardoso; Pedrosa, Aliny de Oliveira; Cunha, Juliane Danielly Santos; Monte, Luma Ravena Soares; Gomes, Raimundo Nonato Silva; Lago, Eliana Campêlo

    2015-01-01

    Objetivo: Analisar como os estudos científicos descrevem a síndrome de Burnout em profissionais de enfermagem de serviços de urgência e emergência. Métodos: Revisão integrativa de literatura realizada através das bases de dados BDENF, IBECS, LILACS, MEDLINE e SciELO, por meio dos descritores: esgotamento profissional and enfermagem. Das 3087 publicações selecionadas pelos descritores, apenas 11 artigos atenderam os critérios de inclusão e exclusão. Resultados: Dentre os artigos selecionados, ...

  3. Participatory Design in Emergency Medical Service: Designing for Future Practice

    DEFF Research Database (Denmark)

    Kristensen, Margit; Kyng, Morten; Palen, Leysia Ann

    2006-01-01

    address challenges identified by disaster sociologists when designing for major incidents. Through qualitative research and participatory design, we have ex-amined the features of EMS work and technology use in different emergency situations from the perspective of mul-tiple actors. We conceptualize...... victims in incidents—and particularly in major incidents, where on-site medical as-sessments is highly incomplete—as boundary objects over which the complex and imperfect work of coordination is done. As an outcome of our participatory design approach, we describe a set of designs in support of future EMS...

  4. Consultant-based otolaryngology emergency service: a five-year experience.

    Science.gov (United States)

    Barnes, M L; Hussain, S S M

    2011-12-01

    To present our experience of running a consultant-based otolaryngology emergency care service for more than five years. In 2003, we developed a system of consultant-based emergency service: consultants spent a week on-call providing a dedicated emergency service, with routine commitments cancelled. Our new system had advantages over traditional working practices in terms of consultant involvement, trainee education, continuity and efficiency. It also reduced disruption to elective commitments for both consultants and registrars. This system was fundamental to the successful review of all urgent (and in future elective) cases within target periods. Only 31 per cent of new referrals to the consultant emergency clinics required a further appointment. Good teamwork and flexibility in working arrangements have been essential to the success of this service. Given that health service changes have reduced junior trainee working hours and numbers, and that patients increasingly expect to be treated by trained doctors, our new consultant-based emergency service has merit. Although implementation in other units may differ, we recommend this new service, for the above reasons.

  5. Climate Change Consequences for Iowa'S Economy, Infrastructure, and Emergency Services

    OpenAIRE

    Swenson, David A.

    2011-01-01

    This is Chapter 6 in the state-mandated Regent's institution collaborative report, "Climate Change Impacts on Iowa, 2010: Report to the Governor and the Iowa General Assembly."Iowa's climate is changing, and that means Iowa's economy is changing. A changing Iowa economy will have consequences for agriculture, food production, Iowa's vaunted insurance agency, general energy use, Iowa's households, Iowa governments, and disaster services. This chapter profiles near and longer term consequences ...

  6. Shared decision-making for psychiatric medication: A mixed-methods evaluation of a UK training programme for service users and clinicians.

    Science.gov (United States)

    Ramon, Shulamit; Morant, Nicola; Stead, Ute; Perry, Ben

    2017-12-01

    Shared decision making (SDM) is recognised as a promising strategy to enhance good collaboration between clinicians and service users, yet it is not practised regularly in mental health. Develop and evaluate a novel training programme to enhance SDM in psychiatric medication management for service users, psychiatrists and care co-ordinators. The training programme design was informed by existing literature and local stakeholders consultations. Parallel group-based training programmes on SDM process were delivered to community mental health service users and providers. Evaluation consisted of quantitative measures at baseline and 12-month follow-up, post-programme participant feedback and qualitative interviews. Training was provided to 47 service users, 35 care-coordinators and 12 psychiatrists. Participant feedback was generally positive. Statistically significant changes in service users' decisional conflict and perceptions of practitioners' interactional style in promoting SDM occurred at the follow-up. Qualitative data suggested positive impacts on service users' and care co-ordinators confidence to explore medication experience, and group-based training was valued. The programme was generally acceptable to service users and practitioners. This indicates the value of conducting a larger study and exploring application for non-medical decisions.

  7. Predictors of aggression on the psychiatric inpatient service: self-esteem, narcissism, and theory of mind deficits.

    Science.gov (United States)

    Goldberg, Brett R; Serper, Mark R; Sheets, Michelle; Beech, Danielle; Dill, Charles; Duffy, Kristine G

    2007-05-01

    Aggressive behavior committed by inpatients has significant negative effects on patients, clinical staff, the therapeutic milieu, and inpatient community as whole. Past research examining nonpsychiatric patient groups has suggested that elevated self-esteem and narcissism levels as well as self-serving theory of mind (ToM) biases may be robust predictors of aggressive behavior. In the present study, we examined whether these constructs were useful in predicting aggressive acts committed by psychiatric inpatients. Severity of psychiatric symptoms, demographic variables and patients' anger, and hostility severity were also examined. We found patients who committed acts of aggression were differentiated from their nonaggressive counterparts by exhibiting significantly higher levels of self-esteem and narcissistic superiority. In addition, aggressors demonstrated self-serving ToM biases, attributing more positive attributes to themselves, relative to their perceptions of how others viewed them. Aggressors also showed increased psychosis, fewer depressive symptoms, and had significantly fewer years of formal education than their nonaggressive peers. These results support and extend the view that in addition to clinical variables, specific personality traits and self-serving attributions are linked to aggressive behavior in acutely ill psychiatric patients.

  8. 78 FR 49332 - National Emergency Medical Services Advisory Council (NEMSAC); Notice of Federal Advisory...

    Science.gov (United States)

    2013-08-13

    ... Departments of Transportation, Homeland Security, and Health & Human Services (4) Presentation and discussion... Public Good and Essential Service b. Research in Prehospital Care: Models for Success c. Emerging Digital.... Improving Internal NEMSAC Processes e. Safety (7) Other Business of the Council (8) Public Comment Period (3...

  9. Locating helicopter emergency medical service bases to optimise population coverage versus average response time

    NARCIS (Netherlands)

    Garner, A.A. (Alan A.); P.L. van den Berg (Pieter)

    2017-01-01

    textabstractBackground: New South Wales (NSW), Australia has a network of multirole retrieval physician staffed helicopter emergency medical services (HEMS) with seven bases servicing a jurisdiction with population concentrated along the eastern seaboard. The aim of this study was to estimate

  10. Emergency Contraception Education for Health and Human Service Professionals: An Evaluation of Knowledge and Attitudes

    Science.gov (United States)

    Colarossi, Lisa; Billowitz, Marissa; Breitbart, Vicki

    2010-01-01

    Objective: To assess the knowledge and attitudes of health care providers, health educators, and social service providers before and after a training session on emergency contraceptive pills. Design: A survey study using pre-post training measurements. Setting: Two hundred and twenty-three medical, social service, and health education providers in…

  11. Cross-cultural differences in the conceptualisation of patients' satisfaction with psychiatric services--content validity of the English version of the Verona Service Satisfaction Scale.

    Science.gov (United States)

    Henderson, Claire; Hales, Heidi; Ruggeri, Mirella

    2003-03-01

    The VSSS is a multi-dimensional questionnaire developed to address methodological concerns about measurement of satisfaction with services on the part of psychiatric patients. The acceptability, sensitivity, content validity and test-retest reliability of the original version of the VSSS, in Italian, have already been demonstrated [1, 2]. The internal consistency [3] and test-retest reliability [4] of the English translation have been shown to be within acceptable ranges. The content validity of the original 82-item and the 54-item English version has not yet been assessed. The aims of this study were to assess the content validity of the English translation of the VSSS and to compare it with that of the original version in Italian. We used data collected as part of the first wave (T1) of the PRiSM Psychosis Study [5] and repeated the methods used to assess the content validity of the original Italian version of the VSSS [1, 2]. Content elements derived from answers to four open questions were rated independently by CH and HH in terms of their equivalence to VSSS items or dimensions. were compared to those from the content validity study of the Italian version. Results Inter-rater agreement was very high. The largest proportion of the content elements of the answers were rated as equivalent or related to a questionnaire item or a dimension of the VSSS. The dimension 'Professionals' Skills and Behaviour' appears the most significant contributor to satisfaction, as it was most often related to content elements in answers to all four key questions (39.1 %). The second most frequently mentioned dimension was that of 'Types of Intervention' for three out of four open questions, while 'Access' was second most frequent for the fourth. Of the content elements, 17.2 % did not include items or dimensions covered by the VSSS; the three most frequently mentioned were other patients, food and security. The 82-item English version of the VSSS captures sharply most contents

  12. User violence towards nursing professionals in mental health services and emergency units

    Directory of Open Access Journals (Sweden)

    Bartolomé Llor-Esteban

    2017-01-01

    Full Text Available Workplace violence is present in many work sectors, but in the area of mental health, nurses have a higher risk due to the close relationship they have with users. This study analyzed hostile user statements against nursing professionals of Mental Health Services and Emergency Units in Health Service (MHS hospitals in Murcia, Spain, and determined the frequency of exposure to the different violent user behaviors. The study was carried out with a sample of 518 nursing professionals from four hospital services: Mental Health, Emergency Units, Medical Hospitalization, and Maternal-and-Child. The nursing staff of Mental Health and Emergency Units was the most exposed to violence. Non-physical violence was more frequent in Emergency Units, whereas physical violence was more frequent in Mental Health. Among the consequences of exposure to non-physical violence are workers’ emotional exhaustion and the presence of psychological distress.

  13. 42 CFR 456.482 - Medical, psychiatric, and social evaluations.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychiatric, and social evaluations. 456... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inpatient Psychiatric..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a recipient...

  14. Model of Emergency and Observation Nursing Services at the Community Health Center in East Java

    Directory of Open Access Journals (Sweden)

    Dwi Ananto Wibrata

    2017-07-01

    Full Text Available Public health centers as the spearhead of health services, also provide 'emergency and observation' nursing services, due to the high number of accidents in East Java. The purpose of this study was to develop the nurse's performance model in providing 'emergency and obeservation' nursing services at Puskesgadarsi ('Emergency and Observation' Community Health Center in East Java, using cross sectional design. The subjects of 120 nurses were selected by multi stage sampling technique. Data were collected through questionnaires and FGDs, and then analyzed using structural equation modeling to produce an model of ‘emergency and observation’ nursing service for nurses at Puskesgadarsi. Components of the model were reinforcing factors, personal factors, cognition factors, affection factors, commitment, interpersonal, reinforcement and nurse performance. Nurses can use this model in providing nursing services with due regard to their knowledge and skills, facilities and infrastructure, as well as interaction and self-reinforcement, so as to be able to perform nursing services 'emergency and observation' well.

  15. Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil.

    Science.gov (United States)

    Rocha, Thiago Augusto Hernandes; da Silva, Núbia Cristina; Amaral, Pedro Vasconcelos; Barbosa, Allan Claudius Queiroz; Rocha, João Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Thumé, Elaine; Thomaz, Erika Bárbara Abreu Fonseca; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Lein, Adriana; Lopes, Daniel Paulino; Staton, Catherine A; Vissoci, João Ricardo Nickenig; Facchini, Luiz Augusto

    2017-08-22

    Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. The present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals. The analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people. There is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access

  16. Examining the effects of a novel training program and use of psychiatric service dogs for military-related PTSD and associated symptoms.

    Science.gov (United States)

    Kloep, Megan L; Hunter, Richard H; Kertz, Sarah J

    2017-01-01

    This study explored an intensive 3-week training program and use of psychiatric service dogs for military-related posttraumatic stress disorder (PTSD) and associated symptoms. The sample included 2 separate cohorts of military veterans (n = 7 and n = 5) with prior diagnoses of PTSD. Participants completed self-report measures assessing PTSD, depression, perception of social support, anger, and overall quality of life 1 month prior to the training (baseline), at arrival to the training site, and 6-month follow-up. Results indicated that, for this sample, there was a statistically significant decrease in PTSD and depression symptoms from pre- to posttreatment, as well as 6-month follow-up. For most participants decreases were both clinically significant and reliable changes. Further, participants reported significant reductions in anger and improvement in perceived social support and quality of life. Limitations of the study include a lack of control group, a limitation of most naturalistic studies, as well as small sample size. Despite this, the findings indicate that utilizing psychiatric service dogs, coupled with an intensive trauma resilience training program for veterans with ongoing symptoms, is feasible as a complementary treatment for PTSD that could yield beneficial results in terms of symptom amelioration and improvement to overall quality of life. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  17. Mental health service utilization for psychiatric disorders among Latinos living in the United States: the role of ethnic subgroup, ethnic identity, and language/social preferences.

    Science.gov (United States)

    Keyes, K M; Martins, S S; Hatzenbuehler, M L; Blanco, C; Bates, L M; Hasin, Deborah S

    2012-03-01

    To examine aspects of Latino experience in the US as predicting service utilization for mood, anxiety, and substance disorders. Latino participants 18 and older in the NESARC (N = 6,359), a US national face to face survey. Outcomes were lifetime service utilization for DSM-IV lifetime mood/anxiety or substance disorders, diagnosed via structured interview (AUDADIS-IV). Main predictors were ethnic subgroup, ethnic identity, linguistic/social preferences, nativity/years in the US, and age at immigration. Higher levels of Latino ethnic identity and Spanish language/Latino social preferences predicted lower service utilization for mood disorders [ethnic identity OR = 0.52, language/social OR = 0.44] and anxiety disorders [ethnic identity OR = 0.67, language/social OR = 0.47], controlling for ethnic subgroup, disorder severity, time spent in the US, and economic and practical barriers Service utilization for alcohol/drug disorders was low across all Latino subgroups, without variation by examined predictors. Ethnic/cultural factors are strong determinants of service utilization for mood/anxiety, but not substance use disorders among Latinos in the US strategies to increase service utilization among Latinos with psychiatric disorders should be disorder specific, and recognize the role of ethnicity and identity as important components of a help-seeking model.

  18. Knowledge, Self-Confidence and Attitudes towards Suicidal Patients at Emergency and Psychiatric Departments: A Randomised Controlled Trial of the Effects of an Educational Poster Campaign

    Directory of Open Access Journals (Sweden)

    Renate van Landschoot

    2017-03-01

    Full Text Available Educational posters are used to enhance knowledge, attitudes and self-confidence of patients. Little is known on their effectiveness for educating health care professionals. As these professionals may play an important role in suicide prevention, the effects of a poster and accompanying evaluation and triage guide on knowledge, self-confidence and attitudes regarding suicidal thoughts and behaviours, were studied in a multicentre cluster randomised controlled trial, involving staff from 39 emergency and 38 psychiatric departments throughout Flanders (n = 1171. Structured self-report questionnaires assessed the knowledge, confidence and beliefs regarding suicidal behaviour management, and attitudes. Data were analysed through a Solomon four-group design, with random assignment to the different conditions. Baseline scores for knowledge and provider confidence were high. The poster and accompanying evaluation and triage guide did not have an effect on knowledge about suicide and self-confidence in suicidal behaviour management. However, the poster campaign appeared to be beneficial for attitudes towards suicidal patients, but only among staff from mental health departments that were assigned to the un-pretested condition. Given the limited effects of the poster campaign in the studied population with a relatively high baseline knowledge, the evaluation of this poster as part of a multimodal educational programme in a more heterogeneous sample of health care professionals is recommended.

  19. Burnout syndrome in nursing professionals from urgency and emergency services

    Directory of Open Access Journals (Sweden)

    Nytale Lindsay Cardoso Portela

    2015-07-01

    Full Text Available Objetivo: Analisar como os estudos científicos descrevem a síndrome de Burnout em profissionais de enfermagem de serviços de urgência e emergência. Métodos: Revisão integrativa de literatura realizada através das bases de dados BDENF, IBECS, LILACS, MEDLINE e SciELO, por meio dos descritores: esgotamento profissional and enfermagem. Das 3087 publicações selecionadas pelos descritores, apenas 11 artigos atenderam os critérios de inclusão e exclusão. Resultados: Dentre os artigos selecionados, 07 tratavam do estresse; 04 falavam da qualidade de vida e lazer; 01 abordava sobre os sintomas somáticos associados ao Burnout e 03 detalhavam sobre a síndrome de Burnout, abordando os fatores preditores e as dimensões sintomatológicas de acordo com o Maslach Burnout Inventory. Conclusão: Esse estudo é importante para que população, profissionais e gestores adquiram conhecimento acerca da síndrome, podendo contribuir para o desenvolvimento de estratégias de enfrentamento, que irão minimizar os riscos de desencadeamento do Burnout. Descritores: Esgotamento profissional, Enfermagem, Síndrome.

  20. Emerging new services for the gas and electricity economy

    International Nuclear Information System (INIS)

    Matas, Ch.

    2002-01-01

    This article reports on a postgraduate study at the Swiss Institute of Technology (EPFL) in Lausanne, Switzerland, addressing the prospects for new energy technologies and their development, according to bankers, industry managers and international organisations. The study merges macro-economic, financial and technological views and focusses especially on electricity and natural gas including cogeneration and decentralised, small and middle-size energy production units. The world energy market is changing pace, moving from various monopolies to a dynamic system, with growing decentralisation and networking. The study reveals that constraints are changing due to the economy globalization as well as to the growing internet-based economy, and that new prospects for the development of promising energy technologies are emerging. The demand for more specific energy products like for example uninterruptible power supplies will stimulate new sectors in the energy economy. Growing environmental concern will also be an important factor for the energy market remodelling. For the gas and electricity markets, a considerable rise in sales is expected

  1. Ecballium Elaterium Poisoning in Pediatric Emergency Service: A Case Report

    Directory of Open Access Journals (Sweden)

    Sinem Sarı Gökay

    2018-01-01

    Full Text Available Background Ecballium elaterium is the only species belonging to the genus Ecballium of Cucurbitaceae family. It is native to the Mediterranean region. Despite its side effects, E. elaterium has still been being used as an alternative treatment agent for sinusitis, cirrhosis, rheumatic diseases and hemorrhoids for its anti-inflammatory and cathartic actions. Herein we discuss a pediatric case showing gastrointestinal side effects after ingesting E. elaterium. Case Report: A six-year-old boy admitted to Çukurova University Medical Faculty Pediatric Emergency Department, Turkey, for vomiting one hour after ingesting a green plant which he had tasted to satisfy his curiosity. Physical examination, vital signs and laboratory tests revealed normal. The ingested plant was defined to be E. elaterium. Maintenance fluid infusion, 1 mg/kg ranitidine and sucralfate medications were commenced. During the follow-up, the patient developed numbness of the tongue and hyper-salivation, without any signs of uvular edema or other system findings. Further follow-up showed stable vital signs within the normal range with no additional complications. The patient was sent home with the cure and recommendations. Discussion: The plants and herbs that are used as agents of alternative or complementary medicine may as well be accidentally or curiously taken by children leading to unwanted intoxication cases. Pre-encounter actions to prevent such cases are as important as any post-exposure clinical interventions to impede the unwanted consequences. One such measure might be a more intensive public information policy underscoring the fact that plants have the potential to be noxious and may cause serious side effects and even death.

  2. Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

    Directory of Open Access Journals (Sweden)

    Meaney Christopher

    2011-08-01

    Full Text Available Abstract Background Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Methods Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS during our study interval (2003-2005 are obtained from the National Ambulatory Care Reporting System (NACRS. Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS which provides individual level medical, socio-demographic, psychological and behavioral information for

  3. Modeling factors influencing the demand for emergency department services in Ontario: a comparison of methods.

    Science.gov (United States)

    Moineddin, Rahim; Meaney, Christopher; Agha, Mohammad; Zagorski, Brandon; Glazier, Richard Henry

    2011-08-19

    Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency

  4. AGING ADULTS WITH INTELLECTUAL DISABILITIES: PERSPECTIVES ON EMERGING SERVICE CONCERNS

    Directory of Open Access Journals (Sweden)

    Matthew P. JANICKI

    2010-04-01

    Full Text Available With improved general health status many adults with intellectual disabilities (ID are living to old age, much like other adults. The World Health Organization has recognized the needs of this older population and identified the challenges they pose for governmental ministries and non-governmental organizations charged with planning, advocacy, financing, and delivery of specialty lifecare services and rehabilitation programs. These challenges include a range of issues normally confronting older adults, such as pensioning and financial security, changes in lifestyles associated with retirement and adaptations to living arrangements and housing, modifications in daily activities and community inclusion, changing physical and sensory abilities, and greater demands for support for aging families and other carers. As older adults with ID may also be affected by latelife or age-related conditions and begin to experience secondary impairments, these challenges may be more pronounced when encountered by NGOs located in countries with developing market economies. In these instances, the onus on promoting healthy aging will fall upon national entities which are responsible for targeting people with disabilities from infancy and childhood, and providing lifelong supports for adolescents, adults, and families. Ideally, if such efforts are undertaken early, they will lead to actions that can be undertaken to promote better health as people with ID age and ensure that the latter part of their lives are experienced as ‘quality of life years.’

  5. Psychiatric disorders in Norwegian 8- to 10-year-olds: an epidemiological survey of prevalence, risk factors, and service use

    DEFF Research Database (Denmark)

    Heiervang, Einar; Stormark, Kjell M; Lundervold, Astri J

    2007-01-01

    population included all 9,430 children attending grades 2 to 4 in Bergen schools during the academic year 2002/2003. The main screening instrument was the Strengths and Difficulties Questionnaire, whereas diagnoses were based on the Development and Well-Being Assessment. Information about child and family......%) were assessed with the Development and Well-Being Assessment in the second phase. The weighted prevalence for any DSM-IV psychiatric disorder was 7.0% (95% confidence interval 5.6%-8.5%). Disorders were associated with age, gender, learning difficulties, family type, and poverty. Although 75...

  6. Research into Australian emergency services personnel mental health and wellbeing: An evidence map.

    Science.gov (United States)

    Varker, Tracey; Metcalf, Olivia; Forbes, David; Chisolm, Katherine; Harvey, Sam; Van Hooff, Miranda; McFarlane, Alexander; Bryant, Richard; Phelps, Andrea J

    2018-02-01

    Evidence maps are a method of systematically characterising the range of research activity in broad topic areas and are a tool for guiding research priorities. 'Evidence-mapping' methodology was used to quantify the nature and distribution of recent peer-reviewed research into the mental health and wellbeing of Australian emergency services personnel. A search of the PsycINFO, EMBASE and Cochrane Library databases was performed for primary research articles that were published between January 2011 and July 2016. In all, 43 studies of primary research were identified and mapped. The majority of the research focused on organisational and individual/social factors and how they relate to mental health problems/wellbeing. There were several areas of research where very few studies were detected through the mapping process, including suicide, personality, stigma and pre-employment factors that may contribute to mental health outcomes and the use of e-health. No studies were detected which examined the prevalence of self-harm and/or harm to others, bullying, alcohol/substance use, barriers to care or experience of families of emergency services personnel. In addition, there was no comprehensive national study that had investigated all sectors of emergency services personnel. This evidence map highlights the need for future research to address the current gaps in mental health and wellbeing research among Australian emergency services personnel. Improved understanding of the mental health and wellbeing of emergency services personnel, and the factors that contribute, should guide organisations' wellbeing policies and procedures.

  7. Ethical values in emergency medical services: A pilot study.

    Science.gov (United States)

    Bremer, Anders; Herrera, María Jiménez; Axelsson, Christer; Martí, Dolors Burjalés; Sandman, Lars; Casali, Gian Luca

    2015-12-01

    ready to act optimally - especially if these perspectives are used in patient care. Research is needed to clarify how justice and rights are prioritized by ambulance services and whether or not these organization-related values are also implemented in patient care. © The Author(s) 2014.

  8. Career Choice and Longevity in U.S. Psychiatric-Mental Health Nurses.

    Science.gov (United States)

    Alexander, Robbi K; Diefenbeck, Cynthia A; Brown, Carlton G

    2015-06-01

    The demand for mental health services in the United States taxes the existing care continuum and is projected to increase as federal initiatives such as the Affordable Care Act and mental health parity improve access to, and coverage for, mental health services. Quality health care providers, such as psychiatric-mental health nurses, are needed to bolster the mental health system. Prior research has focused on the unpopularity of psychiatric nursing as a career choice for nursing students. The purpose of this study is to understand how seasoned psychiatric nurses came to choose and remain in the specialty; descriptive phenomenology is used. In a face-to-face interview, eight registered nurses described their experiences with psychiatric nursing as a student, their entry into psychiatric nursing, and factors related to their longevity in the specialty. Giorgi's Existential Phenomenological Research Method was employed to analyze the interview data. Three themes emerged related to career choice: Interest Developed Prior to or While in Nursing School, Personal Relevance, and Validation of Potential. Three themes emerged related to retention: Overcoming Stereotypes to Develop Career Pride, Positive Team Dynamics, and Remaining Hopeful. Nurse educators play an important role in identifying talent, validating capability, enhancing interest, and increasing students' confidence to pursue a psychiatric nursing career, while nursing administrators and clinical specialists play a key role in retention. Findings also stimulate pertinent questions surrounding the long-term viability of the psychiatric-mental health nursing specialty.

  9. Emerging solutions in reference services implications for libraries in the new millennium

    CERN Document Server

    Edwards, John D

    2013-01-01

    How can you enhance reference services without adding staff?Modern law librarians are under growing pressure to keep up with new technologies, deal instantly with the demands of patrons, keep the library safe and user-friendly, and generally offer the best possible service while keeping costs down. Emerging Solutions in Reference Services: Implications for Libraries in the New Millennium is a very practical guide for coping with rapidly changing technology and increasing demands for services. Its sane, well-researched advice and suggestions can help you deal with the hectic days and

  10. A retrospective chart review of the clinical and psychosocial profile of psychotic adolescents with co-morbid substance use disorders presenting to acute adolescent psychiatric services at Tygerberg Hospital

    Directory of Open Access Journals (Sweden)

    Anusha Lachman

    2012-05-01

    Full Text Available Background. A large number of adolescents meet criteria for ‘dual diagnosis’ (a psychiatric disorder plus co-morbid substance use disorder (SUD, which prolongs treatment response and complicates intervention strategies. The current service model in Cape Town divides the care of such patients into psychiatric treatment and a separate substance use intervention. Child and adolescent mental health services face the challenge of high rates of readmission of adolescents into psychiatric facilities before utilisation of community-based substance abuse services. Objective. There is a scarcity of available treatment guidelines for dual-diagnosis adolescents, and a lack of systematically documented epidemiological and clinical data in South African adolescent populations. Method. A retrospective chart review of adolescent psychiatric admissions to the Tygerberg Adolescent Psychiatric Unit during 2010 was conducted. Relevant epidemiological, clinical and demographic data for those presenting with a dual diagnosis (specifically psychotic disorders and SUD was recorded. Results. Results suggest a high prevalence of SUD among adolescents presenting with a first-episode psychosis. Statistically significant correlations with lower levels of education were found in those with ongoing substance abuse (specifically cannabis and methamphetamine, and a significant relationship between choice of debut drug and ongoing drug use was also demonstrated. Risk factors for SUD (psychosocial adversities, childhood trauma, family and community exposure to substances, early debut drug ages, risky sexual behaviours, and clinical psychiatric profiles of adolescents with dual diagnosis are described. Conclusions. This cohort had an enhanced risk as a result of genetic vulnerability and environmental availability of substances, and the findings emphasise the differences in presentation, choice of drugs of abuse and psychosocial difficulties of adolescents with a dual

  11. The perceived impact of an emergency department immediate reporting service: An exploratory survey

    International Nuclear Information System (INIS)

    Snaith, Beverly; Hardy, Maryann

    2013-01-01

    Background: Immediate reporting, commonly referred to as a ‘hot reporting’, has been advocated as a method of effectively supporting clinical decision making. However, its implementation nationally has been limited with poor understanding of its value in practice. Method: A cross sectional attitudinal survey was distributed to emergency department clinicians (medical and nursing staff) and radiographers to explore perceptions of an immediate reporting service in terms of its influence on professional role and autonomy, patient care and service quality. Results: A total of 87 (n = 87/155; 56.1%) completed questionnaires were returned. The findings suggest that significant support for immediate reporting exists. Immediate reporting is believed to improve service quality, reduce clinical errors and provide opportunity for image interpretation skills development. However, responses were not consistent across clinical professions and staff grades. Conclusion: The immediate reporting of emergency department images is perceived to benefit patient, emergency department clinicians and hospital organisation

  12. Major incidents in Kenya: the case for emergency services development and training.

    Science.gov (United States)

    Wachira, Benjamin W; Smith, Wayne

    2013-04-01

    Kenya's major incidents profile is dominated by droughts, floods, fires, terrorism, poisoning, collapsed buildings, accidents in the transport sector and disease/epidemics. With no integrated emergency services and a lack of resources, many incidents in Kenya escalate to such an extent that they become major incidents. Lack of specific training of emergency services personnel to respond to major incidents, poor coordination of major incident management activities, and a lack of standard operational procedures and emergency operation plans have all been shown to expose victims to increased morbidity and mortality. This report provides a review of some of the major incidents in Kenya for the period 2000-2012, with the hope of highlighting the importance of developing an integrated and well-trained Ambulance and Fire and Rescue service appropriate for the local health care system.

  13. Emergency residential care settings: A model for service assessment and design.

    Science.gov (United States)

    Graça, João; Calheiros, Maria Manuela; Patrício, Joana Nunes; Magalhães, Eunice Vieira

    2018-02-01

    There have been calls for uncovering the "black box" of residential care services, with a particular need for research focusing on emergency care settings for children and youth in danger. In fact, the strikingly scant empirical attention that these settings have received so far contrasts with the role that they often play as gateway into the child welfare system. To answer these calls, this work presents and tests a framework for assessing a service model in residential emergency care. It comprises seven studies which address a set of different focal areas (e.g., service logic model; care experiences), informants (e.g., case records; staff; children/youth), and service components (e.g., case assessment/evaluation; intervention; placement/referral). Drawing on this process-consultation approach, the work proposes a set of key challenges for emergency residential care in terms of service improvement and development, and calls for further research targeting more care units and different types of residential care services. These findings offer a contribution to inform evidence-based practice and policy in service models of residential care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service

    Directory of Open Access Journals (Sweden)

    Scheffer Gert J

    2010-03-01

    Full Text Available Abstract Background To determine the advanced life support procedures provided by an Emergency Medical Service (EMS and a Helicopter Emergency Medical Service (HEMS for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures restricted to the HEMS-physician and procedures for which the HEMS is more experienced than the EMS. Methods Prospective study of a consecutive group of children examined and treated by the HEMS of the eastern region of the Netherlands. Data regarding type of emergency, physiological parameters, NACA scores, treatment, and 24-hour survival were collected and subsequently analysed. Results Of the 558 children examined and treated by the HEMS on scene, 79% had a NACA score of IV-VII. 65% of the children had one or more advanced life support procedures restricted to the HEMS and 78% of the children had one or more procedures for which the HEMS is more experienced than the EMS. The HEMS intubated 38% of all children, and 23% of the children intubated and ventilated by the EMS needed emergency correction because of potentially lethal complications. The HEMS provided the greater part of intraosseous access, as the EMS paramedics almost exclusively reserved this procedure for children in cardiopulmonary resuscitation. The EMS provided pain management only to children older than four years of age, but a larger group was in need of analgesia upon arrival of the HEMS, and was subsequently treated by the HEMS. Conclusions The Helicopter Emergency Medical Service of the eastern region of the Netherlands brings essential medical expertise in the field not provided by the emergency medical service. The Emergency Medical Service does not provide a significant quantity of procedures obviously needed by the paediatric patient.

  15. Just-In-Time eTraining Applied To Emergency Medical Services

    OpenAIRE

    Vico Vela, Francisco José; Sánchez Canteli, Vicente; Lobo Fernández, Daniel; Fernández Rodríguez, Jose David; Bandera, César; Rivas, Ramón; Rosen, M.; Schlegel, M.

    2013-01-01

    While the applications of just-in-time training are more and more spread, the ubiquitous mobile technology has not found practical uses of this training strategy. As an original example of services for healthcare, we present in this work an application of eTraining that makes use of mobile telephones to transmit medical and on-site information content to emergency medical personnel that attend and emergency. The state-of-the-art in related technologies, overall architectu...

  16. Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities

    OpenAIRE

    Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

    2014-01-01

    Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed u...

  17. Challenges to effective crisis management: using information and communication technologies to coordinate emergency medical services and emergency department teams.

    Science.gov (United States)

    Reddy, Madhu C; Paul, Sharoda A; Abraham, Joanna; McNeese, Michael; DeFlitch, Christopher; Yen, John

    2009-04-01

    The purpose of this study is to identify the major challenges to coordination between emergency department (ED) teams and emergency medical services (EMS) teams. We conducted a series of focus groups involving both ED and EMS team members using a crisis scenario as the basis of the focus group discussion. We also collected organizational workflow data. We identified three major challenges to coordination between ED and EMS teams including ineffectiveness of current information and communication technologies, lack of common ground, and breakdowns in information flow. The three challenges highlight the importance of designing systems from socio-technical perspective. In particular, these inter-team coordination systems must support socio-technical issues such as awareness, context, and workflow between the two teams.

  18. How do we capture the emergency nurse practitioners' contribution to value in health service delivery?

    Science.gov (United States)

    Jennings, Natasha; Lutze, Matthew; Clifford, Stuart; Maw, Michael

    2017-03-01

    The emergency nurse practitioner is now a well established and respected member of the healthcare team. Evaluation of the role has focused on patient safety, effectiveness and quality of care outcomes. Comparisons of the role continue to focus on cost, with findings based on incomplete and almost impossible to define, recognition of contribution to service delivery by paralleled practitioners. Currently there is no clear definition as to how nurse practitioners contribute to value in health service delivery. Robust and rigorous research needs to be commissioned taking into consideration the unique hybrid nature of the emergency nurse practitioner role and focusing on the value they contribute to health care delivery.

  19. Who killed Rambhor?: The state of emergency medical services in India

    Directory of Open Access Journals (Sweden)

    Rajesh H Garg

    2012-01-01

    Full Text Available In India, the healthcare delivery system starts up from the sub-center at the village level and reaches up to super specialty medical centers providing state of the art emergency medical services (EMS. These highest centers, located in big cities, are considered the last referral points for the patients from nearby cities and states. As the incidents of rail and road accidents have increased in recent years, the role of EMS becomes critical in saving precious lives. But when the facilities and management of these emergency centers succumbs before the patient, then the question arises regarding the adequate availability and quality of EMS. The death of an unknown common man, Rambhor, for want of EMS in three big hospitals in the national capital of India put a big question on the "health" of the emergency health services in India. The emergency services infrastructure seems inadequate and quality and timely provision of EMS to critical patients appears unsatisfactory. There is lack of emergency medicine (EM specialists in India and also the postgraduation courses in EM have not gained foot in our medical education system. Creation of a Centralized Medical Emergency Body, implementation of management techniques, modification of medical curriculum, and fixing accountability are some of the few steps which are required to improve the EMS in India.

  20. Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services

    Directory of Open Access Journals (Sweden)

    Herwig Uwe

    2011-07-01

    Full Text Available Abstract Background The debate on appropriate financing systems in inpatient psychiatry is ongoing. In this context, it is important to control resource use in terms of length of stay (LOS, which is the most costly factor in inpatient care and the one that can be influenced most easily. Previous studies have shown that psychiatric diagnoses provide only limited justification for explaining variation in LOS, and it has been suggested that measures such as psychopathology might be more appropriate to predict resource use. Therefore, we investigated the relationship between LOS and psychopathological syndromes or symptoms at admission as well as other characteristics such as sociodemographic and clinical variables. Methods We considered routine medical data of patients admitted to the Psychiatric University Hospital Zurich in the years 2008 and 2009. Complete data on psychopathology at hospital admission were available in 3,220 inpatient episodes. A subsample of 2,939 inpatient episodes was considered in final statistical models, including psychopathology as well as complete datasets of further measures (e.g. sociodemographic, clinical, treatment-related and psychosocial variables. We used multivariate linear as well as logistic regression analysis with forward selection procedure to determine the predictors of LOS. Results All but two syndrome scores (mania, hostility were positively related to the length of stay. Final statistical models showed that syndromes or symptoms explained about 5% of the variation in length of stay. The inclusion of syndromes or symptoms as well as basic treatment variables and other factors led to an explained variation of up to 25%. Conclusions Psychopathological syndromes and symptoms at admission and further characteristics only explained a small proportion of the length of inpatient stay. Thus, according to our sample, psychopathology might not be suitable as a primary indicator for estimating LOS and contingent

  1. Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services

    Science.gov (United States)

    2011-01-01

    Background The debate on appropriate financing systems in inpatient psychiatry is ongoing. In this context, it is important to control resource use in terms of length of stay (LOS), which is the most costly factor in inpatient care and the one that can be influenced most easily. Previous studies have shown that psychiatric diagnoses provide only limited justification for explaining variation in LOS, and it has been suggested that measures such as psychopathology might be more appropriate to predict resource use. Therefore, we investigated the relationship between LOS and psychopathological syndromes or symptoms at admission as well as other characteristics such as sociodemographic and clinical variables. Methods We considered routine medical data of patients admitted to the Psychiatric University Hospital Zurich in the years 2008 and 2009. Complete data on psychopathology at hospital admission were available in 3,220 inpatient episodes. A subsample of 2,939 inpatient episodes was considered in final statistical models, including psychopathology as well as complete datasets of further measures (e.g. sociodemographic, clinical, treatment-related and psychosocial variables). We used multivariate linear as well as logistic regression analysis with forward selection procedure to determine the predictors of LOS. Results All but two syndrome scores (mania, hostility) were positively related to the length of stay. Final statistical models showed that syndromes or symptoms explained about 5% of the variation in length of stay. The inclusion of syndromes or symptoms as well as basic treatment variables and other factors led to an explained variation of up to 25%. Conclusions Psychopathological syndromes and symptoms at admission and further characteristics only explained a small proportion of the length of inpatient stay. Thus, according to our sample, psychopathology might not be suitable as a primary indicator for estimating LOS and contingent costs. This might be

  2. Service robotics: an emergent technology field at the interface between industry and services.

    Science.gov (United States)

    Ott, Ingrid

    2012-12-01

    The paper at hand analyzes the economic implications of service robots as expected important future technology. The considerations are embedded into global trends, focusing on the interdependencies between services and industry not only in the context of the provision of services but already starting at the level of the innovation process. It is argued that due to the various interdependencies combined with heterogenous application fields, the resulting implications need to be contextualized. Concerning the net labor market effects, it is reasonable to assume that the field of service robotics will generate overall job creation that goes along with increasing skill requirements demanded from involved employees. It is analyzed which challenges arise in evaluating and further developing the new technology field and some policy recommendations are given.

  3. Interprofessional collaboration between general physicians and emergency department services in Belgium: a qualitative study

    OpenAIRE

    Karam, Marlène; Tricas, Sandra Maria; Darras, Elisabeth; Macq, Jean

    2016-01-01

    Introduction: The use of emergency department (ED) services has known a significant rise in the past decade. Organizational factors, such as the models of after-hours primary medical care services, and the shortage of general practitioners (GPs) could explain this phenomena. But also demographic and societal elements combined with the problem of patient’s ‘inappropriate visits to the ED. In order to ensure continuity of care for patients, collaboration between GPs and EDs becomes increasingly...

  4. Building capacity in VA to provide emergency gynecology services for women.

    Science.gov (United States)

    Cordasco, Kristina M; Huynh, Alexis K; Zephyrin, Laurie; Hamilton, Alison B; Lau-Herzberg, Amy E; Kessler, Chad S; Yano, Elizabeth M

    2015-04-01

    Visits to Veterans Administration (VA) emergency departments (EDs) are increasingly being made by women. A 2011 national inventory of VA emergency services for women revealed that many EDs have gaps in their resources and processes for gynecologic emergency care. To guide VA in addressing these gaps, we sought to understand factors acting as facilitators and/or barriers to improving VA ED capacity for, and quality of, emergency gynecology care. Semistructured interviews with VA emergency and women's health key informants. ED directors/providers (n=14), ED nurse managers (n=13), and Women Veteran Program Managers (n=13) in 13 VA facilities. Leadership, staff, space, demand, funding, policies, and community were noted as important factors influencing VA EDs building capacity and improving emergency gynecologic care for women Veterans. These factors are intertwined and cross multiple organizational levels so that each ED's capacity is a reflection not only of its own factors, but also those of its local medical center and non-VA community context as well as VA regional and national trends and policies. Policies and quality improvement initiatives aimed at building VA's emergency gynecologic services for women need to be multifactorial and aimed at multiple organizational levels. Policies need to be flexible to account for wide variations across EDs and their medical center and community contexts. Approaches that build and encourage local leadership engagement, such as evidence-based quality improvement methodology, are likely to be most effective.

  5. Frequent users of emergency services: associated factors and reasons for seeking care

    Directory of Open Access Journals (Sweden)

    Aline Marques Acosta

    2015-04-01

    Full Text Available Aim: to identify the profile of frequent users of emergency services, to verify the associated factors and to analyze the reasons for the frequent use of the services. METHOD: An explanatory sequential type mixed method was adopted. Quantitative data were collected from the electronic medical records, with a sample of 385 users attended four or more times in an emergency service, during the year 2011. Qualitative data were collected through semi-structured interviews with 18 users, intentionally selected from the results of the quantitative stage. Quantitative data were analyzed using descriptive and inferential statistics and qualitative data using thematic analysis. RESULTS: It was found that 42.9% were elderly, 84.9% had chronic diseases, 63.5% were classified as urgent, 42.1% stayed for more than 24 hours in the service and 46.5% were discharged. Scheduled follow-up appointment, risk classification, length of stay and outcome were factors associated with frequent use. The reasons for seeking the services were mainly related to the exacerbation of chronic diseases, to easier access and concentration of technology, to the bond, and to the scheduled appointments. CONCLUSIONS: The results contribute to comprehending the repeated use of emergency services and provide additional data to plan alternatives to reduce frequent use.

  6. Provision of prehospital emergency medical services in Punjab, Pakistan: Case study of a public sector provider.

    Science.gov (United States)

    Sriram, Veena M; Naseer, Rizwan; Hyder, Adnan A

    2017-12-01

    The availability and quality of emergency medical services in low- and middle-income countries, including Pakistan, are extremely limited. New models for prehospital emergency medical services provision have recently emerged across multiple sectors, and research on these models is urgently needed to inform current and future emergency medical services systems in low-resource settings. The objective of this case study was to provide a comprehensive description of the organizational structure and service delivery model of a public sector provider in the Punjab Province of Pakistan, Rescue 1122, with a focus on operations in Lahore. We used case study methodology to systematically describe the organizational model of Rescue 1122. Qualitative data were collected during an in-person site visit to Lahore in June 2013. Three sources were utilized-semi-structured in-depth interviews, document review, and nonparticipant observation. Data were analyzed according to the health system "building blocks" proposed by the World Health Organization. Rescue 1122 is based on a legal framework that provides public financing for EMS, resulting in financial stability for the service. The organization has also reportedly taken positive steps in engaging with communities, and in coordinating across EMS, fire and rescue. We noted benefits and challenges in scaling up the service to all districts in Punjab. Finally, some areas of improvement include supply chain management and expanded data utilization. Our case study highlights key components of the model, areas for strengthening, and opportunities for further research. Rescue 1122 provides an example of a government-financed and operated emergency medical system in a low-resource setting. Copyright © 2017. Published by Elsevier Inc.

  7. Childhood Sexual Abuse, Adult Psychiatric Morbidity, and Criminal Outcomes in Women Assessed by Medium Secure Forensic Service

    Science.gov (United States)

    Dolan, Mairead; Whitworth, Helen

    2013-01-01

    There is little literature on childhood sexual abuse in women seen by forensic services. A cohort of 225 cases of women seen by forensic services in a medium secure unit in the UK were examined, and childhood sexual abuse and non-childhood sexual abuse cases were compared. Over half the sample had a history of childhood sexual abuse, and 5.6% of…

  8. Every Second Counts: Integrating Edge Computing and Service Oriented Architecture for Automatic Emergency Management

    Directory of Open Access Journals (Sweden)

    Lei Chen

    2018-01-01

    Full Text Available Emergency management has long been recognized as a social challenge due to the criticality of the response time. In emergency situations such as severe traffic accidents, minimizing the response time, which requires close collaborations between all stakeholders involved and distributed intelligence support, leads to greater survival chance of the injured. However, the current response system is far from efficient, despite the rapid development of information and communication technologies. This paper presents an automated collaboration framework for emergency management that coordinates all stakeholders within the emergency response system and fully automates the rescue process. Applying the concept of multiaccess edge computing architecture, as well as choreography of the service oriented architecture, the system allows seamless coordination between multiple organizations in a distributed way through standard web services. A service choreography is designed to globally model the emergency management process from the time an accident occurs until the rescue is finished. The choreography can be synthesized to generate detailed specification on peer-to-peer interaction logic, and then the specification can be enacted and deployed on cloud infrastructures.

  9. Is a maximum Revised Trauma Score a safe triage tool for Helicopter Emergency Medical Services cancellations?

    NARCIS (Netherlands)

    Giannakopoulos, Georgios F.; Saltzherr, Teun Peter; Lubbers, Wouter D.; Christiaans, Herman M. T.; van Exter, Pieternel; de Lange-de Klerk, Elly S. M.; Bloemers, Frank W.; Zuidema, Wietse P.; Goslings, J. Carel; Bakker, Fred C.

    2011-01-01

    Introduction The Revised Trauma Score is used worldwide in the prehospital setting and provides a snapshot of patient's physiological state. Several studies have shown that the reliability of the RTS is high in trauma outcomes. In the Netherlands, Helicopter Emergency Medical Services (HEMS) are

  10. Implementation of a High-Performance Cardiopulmonary Resuscitation Protocol at a Collegiate Emergency Medical Services Program

    Science.gov (United States)

    Stefos, Kathryn A.; Nable, Jose V.

    2016-01-01

    Out-of-hospital cardiac arrest (OHCA) is a significant public health issue. Although OHCA occurs relatively infrequently in the collegiate environment, educational institutions with on-campus emergency medical services (EMS) agencies are uniquely positioned to provide high-quality resuscitation care in an expedient fashion. Georgetown University's…

  11. Recovery and well-being among Helicopter Emergency Medical Service (HEMS) pilots

    NARCIS (Netherlands)

    Radstaak, M.; Geurts, S.A.E.; Beckers, D.G.J.; Brosschot, J.F.; Kompier, M.A.J.

    2014-01-01

    This study investigated the effects of a compressed working week with high cognitive and emotional work demands within the population of Dutch Helicopter Emergency Medical Service (HEMS) pilots. Work stressors were measured and levels of well-being were examined before, during and after a series of

  12. Hurricane Hugo: Emergency Preparedness Planning and Response for Mental Health Services.

    Science.gov (United States)

    Carter, Nancy C.; And Others

    This report describes how, in the aftermath of Hurricane Hugo, the South Carolina Department of Mental Health activated its Emergency Preparedness Plan to assist mental health centers and their staff in providing crisis counseling services to the general public. The first section explains the history and structure of the involvement by the…

  13. Contemporary methods of emergency repair works on transit pipelines. Repair works on in-service pipelines

    International Nuclear Information System (INIS)

    Olma, T.; Winckowski, J.

    2007-01-01

    The paper presents modern methods and relevant technologies of pipeline failure repairs, basing on TD Williamson technique for hermetic plugging of gas pipelines without interrupting service. Rules for management of emergency situations on the Polish Section of Yamal - Europe Transit Gas Pipeline are being discussed as well. (author)

  14. The Viability of Mobile Services (SMS and Cell Broadcast in Emergency Management Solutions: An Exploratory Study

    Directory of Open Access Journals (Sweden)

    Mahmoud Al-dalahmeh

    2018-01-01

    Full Text Available In this paper the path forward in location-based mobile phone warning systems is given against a concise backdrop of their deployment worldwide. Of relevance here is (i how the systems are implemented using legislation, contractual service level agreement instruments or a hybrid approach, (ii whether or not governments who deploy these systems will carry the cost of the deployment during an emergency or disaster, and (iii whether or not carrier participation is mandated. Of particular importance are also the underlying technologies of this kind of emergency systems. To date, the short message service and cell broadcast service have been the main technologies to be utilised by governments in the application of location-based services in modern emergency management solutions. However, these technologies will most certainly be superseded by newer, more powerful capabilities. A comprehensive list of requirements for the future location-based emergency systems is presented also in this paper. In essence, these are recommendations to be adhered to if robust solutions using new technologies are to be deployed in a nation state.

  15. The Influence of Servant Leadership Theory on the Emergency Services Student

    Science.gov (United States)

    Russell, Eric James

    2013-01-01

    The purpose of this qualitative case study was to explore how participation in a class on servant leadership influenced the emergency services student's understanding of the role and characteristics of a servant leader. The setting for the study was a state university in the Western United States, with the six participants being declared emergency…

  16. Validity of helicopter emergency medical services dispatch criteria for traumatic injuries: A systematic review

    NARCIS (Netherlands)

    A.N. Ringburg (Akkie); G. de Ronde (Gijs); S. Thomas (Siep); E.M.M. van Lieshout (Esther); P. Patka (Peter); I.B. Schipper (Inger)

    2009-01-01

    textabstractObjective. This review provides an overview of the validity of Helicopter Emergency Medical Services (HEMS) dispatch criteria for severely injured patients. Methods. A systematic literature search was performed. English written and peer-reviewed publications on HEMS dispatch criteria

  17. Prevalence and relief of pain in trauma patients in Emergency Medical Services

    NARCIS (Netherlands)

    Lisette Schoonhoven; T. Meijs; Sivera Berben; A. van Vugt; P. van Grunsven

    2011-01-01

    The aim of this study was to give insight in the prevalence of pain, and the (effect of) pain management according to the national emergency medical services analgesia protocol in trauma patients in the Netherlands. The retrospective document study included adult and alert trauma patients. Data

  18. Developing A Shared Service Unmanned Aerial Vehicle Capability For Regional Emergency Services

    Science.gov (United States)

    2016-09-01

    this deadline. Organizations looking to add UAVs to their emergency response toolkits still lack a legal framework to follow. In addition to...70 members potentially available in a perfect world. (The 2/3 availability factor is derived by the typical firefighter work schedule. Most career ...staffed by career firefighters volunteering during their off- duty time. As a result, the community where the member works is never short-staffed by the

  19. THE PREDICTOR FACTORS OF EMERGENCY NURSES' PERFORMANCES TO THE PROFESSIONAL SERVICES EXCELLENCE

    Directory of Open Access Journals (Sweden)

    Rina Annisa

    2017-10-01

    Full Text Available Emergency nurses’ performances remains long standing determinates of quality services rendered for patients admitted to get emergency treatments in the hospitals. It has been viewed as a dimension of professional services excellence. The purpose of this study focused on the predictive correlation of five predictors; namely human resources management, transformational leadership, incentives, hospital structure, and job rotation on the emergency nurses’ performance. This descriptive quantitative study used total sampling technique of 100 nurses in the Emergency Department, in four Government Hospital in Banjarmasin, Bajarbaru, and Martapura. All data obtained by administering questionnaires to the participances. The analytical procedure of multiple linear regression was utilized to determine the predicting strength correlation between the dependent and the independent variables. The result of Pearson product‑moment correlation coefficients revealed that positive correlation established between emergency nurses’ performances and human resources management, transformational leadership, incentives, hospital structure, and job rotation, as the independent variables. The summary of multiple linear regression analysis of all independent variables indicated that incentives was the most strongly predictor to the emergency nurses’ performances.

  20. Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Fiona Cocker

    2016-06-01

    Full Text Available Compassion fatigue (CF is stress resulting from exposure to a traumatized individual. CF has been described as the convergence of secondary traumatic stress (STS and cumulative burnout (BO, a state of physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment. Professionals regularly exposed to the traumatic experiences of the people they service, such as healthcare, emergency and community service workers, are particularly susceptible to developing CF. This can impact standards of patient care, relationships with colleagues, or lead to more serious mental health conditions such as posttraumatic stress disorder (PTSD, anxiety or depression. A systematic review of the effectiveness of interventions to reduce CF in healthcare, emergency and community service workers was conducted. Thirteen relevant studies were identified, the majority of which were conducted on nurses (n = 10. Three included studies focused on community service workers (social workers, disability sector workers, while no studies targeting emergency service workers were identified. Seven studies reported a significant difference post-intervention in BO (n = 4 or STS (n = 3. This review revealed that evidence of the effectiveness of CF interventions in at-risk health and social care professions is relatively recent. Therefore, we recommend more research to determine how best to protect vulnerable workers at work to prevent not only CF, but also the health and economic consequences related to the ensuing, and more disabling, physical and mental health outcomes.

  1. Eight months of emergency services by ambulance (with doctor on board) of the Emergency Department of Prato, Italy.

    Science.gov (United States)

    Olia, P M; Mollica, T V; Querci, A

    2002-11-01

    The aim of the present study was to analyse the types of calls attended by the authors in their ambulance, assigned to one sector of the urban area of Prato. We analysed 1060 consecutive calls carried out by our ambulance; 33 calls (3.1%), cancelled for various reasons, were excluded from statistical analysis. The calls regarded 1027 patients, 549 (53.5%) males and 478 (46.5%) females. 46% of calls concerned non trauma cases, 17% trauma cases and 7.2% transfers between hospitals. Calls in the non trauma group were for dyspnea (16.7%), unconsciousness (16.6%), chest pain (11.8%), cerebrovascular pathology (7.7%), mental disorders (7.1%), abdominal pain (5.1%), use of psychotropic substances (4%) and convulsions (3.2%). Support to patients with terminal cancer accounted for 2.3% of cases, metabolic disorders 2.2%, hypertensive events 2.1%, tachycardia 1.9%, vertigo 1.9%, allergies 1%, obstetric pathology 0.5% and cardiorespiratory resuscitation 2,2%. Thirteen point seven percent were miscellaneous, including poisonings, migraines, haemorrhages and flu syndromes. Trauma cases included road accidents (62.6%), falls (27%), aggression (6.9%), work-related accidents (3.5%). The percentage of trauma cases (17%) was similar to that reported for a Swedish urban area (20%). Cases of cardiorespiratory resuscitation were 1.65% of our calls, compared to 1.73% and 1.8% reported in Northeastern Germany and Taiwan. Although prehospital emergency medical services are organised differently in different countries, our data suggest that emergency medical services in our area have a percentage distribution of case types similar to services in other countries.

  2. Increased ICU resource needs for an academic emergency general surgery service*.

    Science.gov (United States)

    Lissauer, Matthew E; Galvagno, Samuel M; Rock, Peter; Narayan, Mayur; Shah, Paulesh; Spencer, Heather; Hong, Caron; Diaz, Jose J

    2014-04-01

    ICU needs of nontrauma emergency general surgery patients are poorly described. This study was designed to compare ICU utilization of emergency general surgery patients admitted to an acute care emergency surgery service with other general surgery patients. Our hypothesis is that tertiary care emergency general surgery patients utilize more ICU resources than other general surgical patients. Retrospective database review. Academic, tertiary care, nontrauma surgical ICU. All patients admitted to the surgical ICU over age 18 between March 2004 and June 2012. None. Six thousand ninety-eight patients were evaluated: 1,053 acute care emergency surgery, 1,964 general surgery, 1,491 transplant surgery, 995 facial surgery/otolaryngology, and 595 neurosurgery. Acute care emergency surgery patients had statistically significantly longer ICU lengths of stay than other groups: acute care emergency surgery (13.5 ± 17.4 d) versus general surgery (8.7 ± 12.9), transplant (7.8 ± 11.6), oral-maxillofacial surgery (5.5 ± 4.2), and neurosurgery (4.47 ± 9.8) (all psurgery patients: acute care emergency surgery 73.4% versus general surgery 64.9%, transplant 63.3%, oral-maxillofacial surgery 58.4%, and neurosurgery 53.1% (all p surgery patients: acute care emergency surgery 10.8% versus general surgery 4.3%, transplant 6.6%, oral-maxillofacial surgery 0%, and neurosurgery 0.5% (all p surgery patients were more likely interhospital transfers for tertiary care services than general surgery or transplant (24.5% vs 15.5% and 8.3% respectively, p surgery (13.7% vs 6.7% and 3.5%, all p surgery and general surgery, whereas transplant had fewer. Emergency general surgery patients have increased ICU needs in terms of length of stay, ventilator usage, and continuous renal replacement therapy usage compared with other services, perhaps due to the higher percentage of transfers and emergent surgery required. These patients represent a distinct population. Understanding their resource needs

  3. Migraine and its psychiatric comorbidities.

    Science.gov (United States)

    Minen, Mia Tova; Begasse De Dhaem, Olivia; Kroon Van Diest, Ashley; Powers, Scott; Schwedt, Todd J; Lipton, Richard; Silbersweig, David

    2016-07-01

    Migraine is a highly prevalent and disabling neurological disorder associated with a wide range of psychiatric comorbidities. In this manuscript, we provide an overview of the link between migraine and several comorbid psychiatric disorders, including depression, anxiety and post-traumatic stress disorder. We present data on psychiatric risk factors for migraine chronification. We discuss the evidence, theories and methods, such as brain functional imaging, to explain the pathophysiological links between migraine and psychiatric disorders. Finally, we provide an overview of the treatment considerations for treating migraine with psychiatric comorbidities. In conclusion, a review of the literature demonstrates the wide variety of psychiatric comorbidities with migraine. However, more research is needed to elucidate the neurocircuitry underlying the association between migraine and the comorbid psychiatric conditions and to determine the most effective treatment for migraine with psychiatric comorbidity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. A survey of quality gap of Khoramabad medical emergency services using SERVQUAL model

    Directory of Open Access Journals (Sweden)

    gholamreza Toushmal

    2015-05-01

    Full Text Available Background : Awareness of perceptions and expectations of receivers of health centers services, as well as determination of gap between these two subjects can play an important role in better services rendering of these centers. Thise survey was conducted to evaluate quality of emergency centers of Khorramabad city by use of SERVQUAL model in 2012. Materials and Methods: This analytic-descriptive research was carried out on 400 people receiving services of Khorramabad emergency centers, selected using continuous sampling method. Data was gathered using standard SERVQUAL questionnaire and then analyzed by SPSS software, descriptive and inferential statistics such as Kruskal-wallis, paired T test And ANOVA. Results: The results showed that there was negative gap of quality in all five dimensions of services (sensible thing, guarantee and trust, responsibility, and empathy. The most quality gap was in empathy aspect and the least belonged to politeness and trust, and this gap among all dimensions, exception for trust, was statistically significant. But no significant statistical relation was found between age, sex and educational level and quality gap score. Conclusion: Expectation of customers in all dimensions was higher than their perceptions, and it should promote the quality of all dimensions, specially empathy. It is suggested to evaluate services quality in these centers and other centers periodically to promote their quality of services.

  5. Assessment of client satisfaction on emergency department services in Hawassa University Referral Hospital, Hawassa, Southern Ethiopia.

    Science.gov (United States)

    Worku, Mesfin; Loha, Eskindir

    2017-06-27

    Satisfaction refers to a state of pleasure or contentment with an action, event or service, especially one that was previously desired. Regarding to client, satisfaction is the level of happiness that clients experience having used a service. It therefore reflects the gap between the expected service and the experience of the service, from the client's point of view. Information was unavailable regarding the level of satisfaction of patients towards emergency health care servicesat Hawassa University Referral Hospital thatserve a huge catchment area; and this study addressed this gap. Cross-sectional study was conducted from March 13 to May 15/2014. Systematic sampling method was used to enroll study participants. The data was collected by trained data collectors using pre-structured questionnaire. A total 407 clients were enrolled under this study with respondent rate of 96.9%. Nearly two third of study participants were male, 270 (66.3%). 86.7% of study participants were satisfied by services provided in Emergency Out Patient Department (OPD). The percentage of study satisfaction with physical examination by Doctor, nursing, laboratory and pharmacy services were 95.6%, 89.9%, 84.7% and 67.6%, respectively. Only 31.9% were satisfied with availability of drugs in the pharmacy. Regarding to staff courtesy, 91.7% of study participants were satisfied by the manner shown by the staffs working in Emergency OPD. The vast majority of the participants (97%) were satisfied with the courtesy of Medical laboratory personnel and the least satisfaction (79.4%) was recorded for security guards. This study showed low level of patient satisfaction in pharmacy services specifically due to unavailability of drugs due to lack of sustained supply of drugs.

  6. Experiences of military CRNAs with service personnel who are emerging from general anesthesia.

    Science.gov (United States)

    Wilson, John Tyler; Pokorny, Marie E

    2012-08-01

    We conducted this qualitative study to understand the experiences of military Certified Registered Nurse Anesthetists (CRNAs) working with service personnel who have traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) and are emerging from general anesthesia. This study is important because there are no studies in the literature that describe the experiences of anesthetists working with patients with these specific problems. The leading questions were: "Out of all the anesthesia cases both abroad and stateside (post 9/11/2001), have you noticed service members wake from general anesthesia (not utilizing total intravenous anesthesia (TIVA), in a state of delirium? If so, can you tell me your experiences and thought processes as to why it was occurring?" Five themes emerged: (1) Emergence delirium (ED) exists and to a much higher degree in the military than in the general population. (2) ED was much more prevalent in the younger military population. (3) TIVA was a superior anesthetic for patients thought to have TBI and/or PTSD. (4) Talking to all patients suspected of having TBI and/or PTSD before surgery and on emergence was vital for a smooth emergence. (5) There is something profound happening in regard to ketamine and PTSD and TBI.

  7. Treatment for cases of violence by Brazilian emergency services focusing on family relationships and life cycles.

    Science.gov (United States)

    Avanci, Joviana Quintes; Pinto, Liana Wernersbach; Assis, Simone Gonçalves de

    2017-09-01

    This article analyzes data regarding cases of domestic violence treated by the emergency services through the following: the sociodemographic characteristics of the people who were treated; the events themselves; the evolution of care (from childhood to old age by gender); and the factors that differentiate cases of domestic violence compared to those committed by non-family members. Data from 24 Brazilian state capitals and the Federal District were analyzed, comprising 86 emergency services: a total of 4,893 individuals were surveyed. Of those people who were treated by emergency services, 26.6% suffered domestic violence: 40.0% were children/adolescents, 57.2% were adults and 2.8% were elderly. The adjusted model, which compared victims of violence committed by other family members with those who were not family members, showed that males were less likely to suffer from domestic violence; those that had fewer years of education were at increased risk; and that women were more likely to commit domestic violence compared to the category of "both genders". This study reinforces the fact that health sector professionals need to be able to deal with domestic violence by providing support, performing good practices, abiding by care protocols, taking care of injuries, and facilitating access to other services.

  8. Using community partners to deliver low-cost and effective emergency management and business continuity services.

    Science.gov (United States)

    Thomas, Joan; Roggiero, Jean Paul; Silva, Brian

    2010-11-01

    Small to medium-sized organisations enhance their business mission as well as their communities by continuing to offer services in extreme circumstances. Developing emergency preparedness and business continuity plans that are cost-effective, comprehensive and operational for small to medium-sized organisations with limited resources requires a consistent, supportive, hands-on approach over time with professionals to create appropriate and sustainable strategies. Using a unique, multi-layered and applied approach to emergency preparedness training, organisations have successfully created plans that are effective and sustainable.

  9. [Differences between patients in consultation psychiatry and psychiatric inpatients].

    Science.gov (United States)

    Unterecker, Stefan; Maloney, Julia; Pfuhlmann, Bruno; Deckert, Jürgen; Warrings, Bodo

    2014-05-01

    To optimize psychiatric consultation service epidemiological information is needed. We compared data on gender, age and diagnoses of patients in the consultation service to psychiatric inpatients. In psychiatric consultation service patients are older (56.6 vs. 44.9 years, p psychiatric consultation service is contacted more often in cases of organic disorders, for females in adjustment disorders (p psychiatric consultation service is different for males and females with relevance for diagnostic and therapeutic procedures. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Composition of emergency medical services teams and the problem of specialisation of emergency medical services physicians in the opinions of occupationally active paramedics

    Directory of Open Access Journals (Sweden)

    Dorota Rębak

    2015-01-01

    Full Text Available Introduction: Emergency medicine includes prevention, prehospital care, specialised treatment, rehabilitation, and education. Aim of the research: The objective of the analysis was to determine the opinions of paramedics concerning the problem of the composition of emergency medical services (EMS teams and specialisation of EMS system physicians according to their education level and sense of coherence. Material and methods: The study was conducted among 336 occupationally active paramedics working in EMS teams delivering prehospital care in selected units in Poland. The study was conducted at Ambulance Stations and in Hospital Emergency Departments, which within their structure had an out-of-hospital EMS team. The study was conducted by the method of a diagnostic survey, and the research instrument was the Orientation to Life Questionnaire SOC-29 and a questionnaire designed by the author. Results: The respondents who had licentiate education relatively more frequently indicated paramedics with licentiate education level as persons most suitable to undertake medical actions (26.32% rather than physicians (21.05%. Paramedics with 2-year post-secondary school education relatively more often mentioned physicians (33.07% than those with licentiate education (17.32%. As many as 89.58% of the paramedics reported the need for a physician in the composition of the EMS team delivering prehospital care, while only 10.42% of them expressed an opinion that there should be teams composed of paramedics only. According to 30.65% of respondents, EMS team delivering prehospital care should include a physician with the specialty in emergency medicine, whereas 8.04% of respondents reported the need for a physician, irrespective of specialisation. However, 42.56% of the paramedics expressed an opinion that a physician is needed only in a specialist team with a specialisation in emergency medicine. The opinions of the paramedics concerning the need for a

  11. 38 CFR 17.1000 - Payment or reimbursement for emergency services for nonservice-connected conditions in non-VA...

    Science.gov (United States)

    2010-07-01

    ... for emergency services for nonservice-connected conditions in non-VA facilities. 17.1000 Section 17.1000 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-Va Facilities § 17.1000 Payment...

  12. American Psychiatric Nurses Association-Transitions in Practice Certificate Program: Bridging the Knowledge Gap in Caring for Psychiatric Patients Within the General Nursing Workforce.

    Science.gov (United States)

    Adams, Susie M; Black, Patricia

    2016-01-01

    The purpose of this article is to publicize an important new Web-based educational program. Recognizing the growing gap in psychiatric-mental health knowledge and the need to better prepare new graduates and nurses transitioning from other service lines into psychiatric inpatient nursing settings, the American Psychiatric Nurses Association developed a 15-hour, modularized curriculum to provide foundational psychiatric-mental health knowledge. This modularized curriculum, called American Psychiatric Nurses Association Transitions in Practice (ATP) focuses on the knowledge and skills to insure the success of nurses new to psychiatric-mental health nursing settings and to improve the overall care for persons with mental health and substance use disorders. The ATP program is also proving to be useful content for nurses in emergency departments, hospitals, and other health settings to improve their care of patients with psychiatric and mental health needs. A summary of the program modules and a toolkit with suggested measures for nurses, patients, and agency outcomes is described. Feedback from participants completing the ATP program within the first 6 months is overwhelmingly positive and holds promise for widespread application across a variety of health care settings.

  13. Ethical, legal and professional issues arising from social media coverage by UK Helicopter Emergency Medical Services.

    Science.gov (United States)

    Steele, Sarah; Adcock, Christopher; Steel, Alistair

    2016-01-01

    Social media (SoMe) are gaining increasing acceptance among, and use by, healthcare service deliverers and workers. UK Helicopter Emergency Medical Services (HEMS) use SoMe to deliver service information and to fundraise, among other purposes. This article examines UK HEMS use of SoMe between January and February 2014 to determine the extent of adoption and to highlight trends in use. The database of the Association of Air Ambulances, crosschecked with UK Emergency Aviation, was used to identify flying, charitable UK HEMS. This search identified 28 UK HEMS, of which 24 services met the criteria for selection for review. Using information harvested from the public domain, we then systematically documented SoMe use by the services. SoMe use by UK HEMS is extensive but not uniform. All selected UK HEMS maintained websites with blogs, as well as Facebook, Twitter, Wikipedia and JustGiving profiles, with the majority of services using Ebay for Charity, LinkedIn and YouTube. Some HEMS also held a presence on Pinterest, Google+, Instagram and Flickr, with a minority of services maintaining their own Rich Site Summary (RSS) feed. The SoMe adopted, while varied, allowed for increased, and different forms of, information delivery by HEMS to the public, often in real time. Such use, though, risks breaching patient confidentiality and data protection requirements, especially when information is viewed cumulatively across platforms. There is an urgent need for the continued development of guidance in this unique setting to protect patients while UK HEMS promote and fundraise for their charitable activities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. The Longitudinal Emergency Medical Technician (EMT) Attributes and Demographics Study (LEADS): The First 10 Years and a Look at Public Perception of Emergency Medical Services (EMS).

    Science.gov (United States)

    Crowe, Remle P; Bentley, Melissa A; Levine, Roger

    2016-12-01

    Crowe RP , Bentley MA , Levine R . The Longitudinal Emergency Medical Technician (EMT) Attributes and Demographics Study (LEADS): the first 10 years and a look at public perception of Emergency Medical Services (EMS). Prehosp Disaster Med. 2016;31(Suppl. 1):s1-s6.

  15. Understanding migraine and psychiatric comorbidity.

    Science.gov (United States)

    Seng, Elizabeth K; Seng, Cynthia D

    2016-06-01

    This article describes recent trends in our understanding of the role of psychiatric disorders in the experience and treatment of migraine, and the role of migraine in the experience and treatment of psychiatric disorders. Although the majority of studies evaluating psychiatric comorbidity in migraine have focused on depression, anxiety, and bipolar disorders are highly associated with migraine and relevant for prognosis and treatment planning. Comorbid psychiatric disorders may be associated with poorer treatment response for some acute pharmacotherapies; however, people with comorbid migraine and mood or anxiety disorders can achieve large responses to preventive pharmacologic and behavioral therapies. Emerging research is developing and evaluating behavioral treatments designed to manage cooccurring migraine and mood or anxiety disorders. Stigma related to psychiatric disorders has been well characterized, and could exacerbate extant migraine-related stigma. Anxiety and mood disorders are prevalent in people with migraine, although not ubiquitous. Psychiatric comorbidity is associated with greater migraine symptoms and disability; however, people with comorbid depression or anxiety are amenable to preventive migraine treatment. Research regarding migraine treatment strategies optimized for people with comorbid psychiatric disorders is critical to advancing care and reducing stigma for this important subpopulation of people with migraine.

  16. Opening of Psychiatric Observation Unit Eases Boarding Crisis.

    Science.gov (United States)

    Parwani, Vivek; Tinloy, Bradford; Ulrich, Andrew; D'Onofrio, Gail; Goldenberg, Matthew; Rothenberg, Craig; Patel, Amitkumar; Venkatesh, Arjun K

    2018-04-01

    The objective of this study was to evaluate the effect of a psychiatric observation unit in reducing emergency department (ED) boarding and length of stay (LOS) for patients presenting with primary psychiatric chief complaints. A secondary outcome was to determine the effect of a psychiatric observation unit on inpatient psychiatric bed utilization. This study was a before-and-after analysis conducted in a 1,541-bed tertiary care academic medical center including an adult ED with annual census over 90,000 between February 2013 and July 2014. All adult patients (age > 17 years) requiring evaluation by the acute psychiatry service in the crisis intervention unit (CIU) within the ED were included. Patients who left without being seen, left against medical advice, or were dispositioned to the pediatric hospital, hospice, or court/law enforcement were excluded. In December 2013, a 12-bed locked psychiatric observation unit was opened that included dedicated behavioral health staff and was intended for psychiatric patients requiring up to 48 hours of care. The primary outcomes were ED LOS, CIU LOS, and total LOS. Secondary outcomes included the hold rate defined as the proportion of acute psychiatry patients requiring subsequent observation or inpatient admission and the inpatient psychiatric admission rate. For the primary analysis we constructed ARIMA regression models that account for secular changes in the primary outcomes. We conducted two sensitivity analyses, first replicating the primary analysis after excluding patients with concurrent acute intoxication and second by comparing the 3-month period postintervention to the identical 3-month period of the prior year to account for seasonality. A total of 3,501 patients were included before intervention and 3,798 after intervention. The median ED LOS for the preintervention period was 155 minutes (interquartile range [IQR] = 19-346 minutes), lower than the median ED LOS for the postintervention period of 35

  17. Governing the captives: forensic psychiatric nursing in corrections.

    Science.gov (United States)

    Holmes, Dave

    2005-01-01

    TOPIC/PROBLEM: Since 1978, the federal inmates of Canada serving time have had access to a full range of psychiatric care within the carceral system. Five psychiatric units are part of the Federal Correctional Services. Nursing practice in forensic psychiatry opens up new horizons in nursing. This complex professional nursing practice involves the coupling of two contradictory socio-professional mandates: to punish and to provide care. The purpose of this article is to present the results of a grounded theory doctoral study realized in a multi-level security psychiatric ward of the Canadian Federal Penitentiary System. The theoretical work of the late French philosopher, Michel Foucault, and those of sociologist, Erving Goffman, are used to illuminate the qualitative data that emerged from the author's fieldwork. A Foucauldian perspective allows us to understand the way forensic psychiatric nursing is involved in the governance of mentally ill criminals through a vast array of power techniques (sovereign, disciplinary, and pastoral) which posited nurses as "subjects of power". These nurses are also "objects of power" in that nursing practice is constrained by formal and informal regulations of the penitentiary context. As an object of "governmental technologies", the nursing staff becomes the body onto which a process of conforming to the customs of the correctional milieu is dictated and inscribed. The results of this qualitative research, from a nursing perspective, are the first of their kind to be reported in Canada since the creation of the Regional Psychiatric Correctional Units in 1978.

  18. Electroconvulsive therapy in Brazil after the "psychiatric reform": a public health problem--example from a university service.

    Science.gov (United States)

    Ribeiro, Rafael Bernardon; Melzer-Ribeiro, Débora Luciana; Rigonatti, Sérgio Paulo; Cordeiro, Quirino

    2012-09-01

    The Brazilian public health system does not provide electroconvulsive therapy (ECT), which is limited to a few academic services. National mental health policies are against ECT. Our objectives were to analyze critically the public policies toward ECT and present the current situation using statistics from the Institute of Psychiatry of the University of São Paulo (IPq-HCFMUSP) and summary data from the other 13 ECT services identified in the country. Data regarding ECT treatment at the IPq-HCFMUSP were collected from January 2009 to June 2010 (demographical, number of sessions, and diagnoses). All the data were analyzed using SPSS 19, Epic Info 2000, and Excel. During this period, 331 patients were treated at IPq-HCFMUSP: 221 (67%) were from São Paulo city, 50 (15.2%) from São Paulo's metropolitan area, 39 (11.8%) from São Paulo's countryside, and 20 (6.1%) from other states; 7352 ECT treatments were delivered-63.0% (4629) devoted entirely via the public health system (although not funded by the federal government); the main diagnoses were a mood disorder in 86.4% and schizophrenia in 7.3% of the cases. There is an important lack of public assistance for ECT, affecting mainly the poor and severely ill patients. The university services are overcrowded and cannot handle all the referrals. The authors press for changes in the mental health policies.

  19. [Validation of a triage scale: first step in patient admission and in emergency service models].

    Science.gov (United States)

    Legrand, A; Thys, F; Vermeiren, E; Touwaide, M; D'Hoore, W; Hubin, V; Reynaert, M S

    2003-03-01

    At present, most emergency services handle the multitude of various demands in the same unity of place and by the same team of nurses aides, with direct consequences on the waiting time and in the handling of problems of varying degrees of importance. Our service examines other administrative models based on a triage of time and of orientation. In a prospective study on 679 patients, we have validated a triage tool inspired from the ICEM model (International Cooperation of Emergency Medicine) allowing patients to receive, while they wait, information and training, based on the resources provided, in order to deal with their particular medical problem. The validation of this tool was carried out in terms of its utilization as well as its reliability. It appears that, with the type of triage offered, there is a theoretical reserve of waiting time for the patients in which the urgency is relative, and which could be better used in the handling of more vital cases.

  20. Seeking and securing work: Individual-level predictors of employment of psychiatric survivors.

    Science.gov (United States)

    Hall, Peter V; Montgomery, Phyllis; Davie, Samantha; Dickins, Kevin; Forchuk, Cheryl; Jeng, Momodou S; Kersey, Melissa; Meier, Amanda; Lahey, Pam; Rudnick, Abraham; Solomon, Michelle; Warner, Laura

    2015-01-01

    For people with mental illness (psychiatric survivors), seeking and securing employment involves personal, social, and environmental factors. In Canada, psychiatric survivors are under-represented in the workforce, and services can help by tailoring their supports to help make the most gains in employment. Determine whether individual socio-demographic and health factors predict seeking and securing employment among psychiatric survivors. A community sample of psychiatric survivors from a Southwestern Ontario region participated in this study. Stepwise logistic regression was used to analyze data from 363 participants who had completed a variety of questionnaires to ascertain individual characteristics and employment outcomes. Health service utilization, living circumstances, homelessness, substance use issues, general health, social integration, ethnicity, having children under 18, and being a student emerged as significant predictors of seeking and securing work. Other commonly accepted human capital indicators, such as education and age, were not predictive of employment search behavior and outcomes. Individual characteristics that predict employment search and success outcomes for psychiatric survivors include aspects related to treatment and living circumstances, which stands in contrast to predictors of employment for the general population, suggesting that employment support services may need to be tailored to psychiatric survivors specifically.

  1. Public-private implementation of integrated emergency response services: Case study of GVK Emergency Management and Research Institute in Karnataka, India.

    Science.gov (United States)

    Sriram, Veena M; Gururaj, Gopalkrishna; Hyder, Adnan A

    2017-12-01

    Emergency medical services are important to the functioning of health systems, but these services tend to be neglected in low- and middle-income countries, such as India. In recent years, several models of pre-hospital emergency medical services have emerged in India. Research on these models holds important lessons for existing and future emergency medical service programs in low- and middle-income countries. Our objective was to provide a comprehensive description of the organizational structure and service delivery model of a public-private partnership in the southern Indian state of Karnataka, GVK Emergency Management and Research Institute, with a particular focus on its operations in Bengaluru. A case study methodology was used to explore systematically the organizational model of GVK Emergency Management and Research Institute in Karnataka. Qualitative data were collected through an in-person site visit to GVK Emergency Management and Research Institute headquarters in Bengaluru in July 2013. Three sources were used: in-depth, semistructured interviews, document review, and nonparticipant observation. Data were analyzed according to the health system "building blocks" proposed by the World Health Organization. The organization follows a standardized model across the states and union territories where they have contractual arrangements, including Karnataka. Processes for fleet maintenance, information systems/information technology and training, and deployment were well structured at the organizational level. The public-private partnership appears pro-poor in orientation; however, further demand-side research is required on the perspective of patients. Our study reveals a functional structure at the organizational level, which provides a key service at no cost to users. Detailed analyses of this nature can help inform global efforts for the development and strengthening of emergency medical services systems. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Mobile phone use for contacting emergency services in life-threatening circumstances.

    Science.gov (United States)

    Wu, Olivia; Briggs, Andrew; Kemp, Tom; Gray, Alastair; MacIntyre, Kate; Rowley, Jack; Willett, Keith

    2012-03-01

    The potential health benefits of mobile phone use have not been widely studied, except for telemedicine-type applications. This study seeks to determine whether initial contact with emergency services via a mobile phone in life-threatening situations is associated with potential health benefits when compared to contact via a landline. A record-linkage study was carried out in which data from all emergency dispatches for immediately life-threatening events from a United Kingdom county ambulance service were linked to the Patient Admission System at two major local hospitals. Mortality (at the scene, at the emergency department [ED], and during hospitalization); transfer to the ED; admission (inpatient care, and intensive care unit); and length of stay were analyzed for calls classified as Code Red (immediately life-threatening) by initial exposure (mobile phone vs. landline), while controlling for potential confounding variables. Of 354,199 ambulances dispatched to attend emergency incidents, 66% transported patients to the hospital while 2% stood down due to death at the scene. Mobile phone compared to landline reporting of emergencies resulted in significant reductions in the risk of death at the scene (odds ratio [OR] 0.77), but not for death in the ED or during inpatient admission. The risk of being transferred to the ED and subsequent inpatient admission were significantly lower with reporting from mobile phones compared to landline (OR 0.93 and OR 0.82, respectively). In this study, evidence of statistical association was demonstrated between the use of mobile phones to alert ambulance services in life-threatening situations and improved outcomes for patients. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers

    OpenAIRE

    Lee, Sungmin; Lee, Chanam; Rodiek, Susan

    2017-01-01

    Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS). Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 201...

  4. Factors influencing the suicide intervention skills of emergency medical services providers

    OpenAIRE

    Lygnugaryte-Griksiene, Aidana; Leskauskas, Darius; Jasinskas, Nedas; Masiukiene, Agne

    2017-01-01

    ABSTRACT Background: Lithuania currently has the highest suicide rate in Europe and the fifth highest worldwide. Aims: To identify the factors that influence the suicide intervention skills of emergency medical services (EMS) providers (doctors, nurses, paramedics). Method: Two hundred and sixty-eight EMS providers participated in the research. The EMS providers were surveyed both prior to their training in suicide intervention and six months later. The questionnaire used for the survey asses...

  5. Perception of the nursing staff about the nurse’s role in the emergency service

    Directory of Open Access Journals (Sweden)

    Mayckel da Silva Barreto

    2015-12-01

    Full Text Available Objective: to know the perception of the nursing staff about the nurse's role in emergency service. Methods: descriptive study of a qualitative approach. 30 nursing professionals participated and were active in a unit of Emergency. The data were subjected to Content Analysis, thematic modality. Results: the interviewees highlighted as nurses functions, the development of management activities; the leadership and supervision of nursing staff; and the care provided to seriously ill patients. From the perspective of nursing technicians, management activities receive great attention from nurses, rather than direct patient care. However, for nurses, managerial functions and leadership and supervision of staff converge for quality care. Conclusion: the importance of care work of nurses in emergency situations is perceived both by nursing technicians and by nurses. However, perceptions of their role as a manager still show up conflicting.

  6. Service delivery innovation for hospital emergency management using rich organizational modelling.

    Science.gov (United States)

    Dhakal, Yogit; Bhuiyan, Moshiur; Prasad, Pwc; Krishna, Aneesh

    2018-04-01

    The purpose of this article is to identify and assess service delivery issues within a hospital emergency department and propose an improved model to address them. Possible solutions and options to these issues are explored to determine the one that best fits the context. In this article, we have analysed the emergency department's organizational models through i* strategic dependency and rational modelling technique before proposing updated models that could potentially drive business process efficiencies. The results produced by the models, framework and improved patient journey in the emergency department were evaluated against the statistical data revealed from a reputed government organization related to health, to ensure that the key elements of the issues such as wait time, stay time/throughput, workload and human resource are resolved. The result of the evaluation was taken as a basis to determine the success of the project. Based on these results, the article recommends implementing the concept on actual scenario, where a positive result is achievable.

  7. Life Saving Apps: Linking Cardiac Arrest Victims to Emergency Services and Volunteer Responders.

    Science.gov (United States)

    Lim Choi Keung, Sarah N; Khan, Mohammed O; Smith, Christopher; Perkins, Gavin; Murphy, Paddie; Arvanitis, Theodoros N

    2016-01-01

    In cases of emergency, such as out-of-hospital cardiac arrests, the first few minutes are crucial for victims to receive care and have a positive outcome. However, emergency services often arrive on scene after those first few minutes, making any bridging solutions key. Finding a defibrillator or accessing a trained volunteer responder are some of the technological solutions that are being developed to support the chain of survival. This paper looks at technologies, in particular those linked to mobile apps that have been used to locate defibrillators and responder apps that enable responders to attend to nearby emergencies. We review a selection of apps and also assess the challenges and considerations for such apps.

  8. The national trajectory project of individuals found not criminally responsible on account of mental disorder. Part 5: how essential are gender-specific forensic psychiatric services?

    Science.gov (United States)

    Nicholls, Tonia L; Crocker, Anne G; Seto, Michael C; Wilson, Catherine M; Charette, Yanick; Côté, Gilles

    2015-03-01

    To state the sociodemographic characteristics, mental health histories, index offence characteristics, and criminal histories of male and female forensic psychiatric patients. Clinicians and researchers advocate that mental health and criminal justice organizations implement gender-specific services; however, few studies have sampled forensic patients to evaluate the extent to which men's and women's treatment and management needs are different. Data were collected from Review Board files from May 2000 to April 2005 in the 3 largest Canadian provinces. Using official criminal records, participants were followed for 3 to 8 years, until December 2008. The final sample comprised 1800 individuals: 15.6% were women and 84.4% were men. There were few demographic differences, but women had higher psychosocial functioning than men. Both men and women had extensive mental health histories; women were more likely diagnosed with mood disorders and PDs and men were more likely diagnosed with schizophrenia spectrum disorders and SUDs. The nature of the index offence did not differ by gender, except women were more likely to have perpetrated murders and attempted murders. For offences against a person, women were more likely to offend against offspring and partners and less likely to offend against strangers, compared with men. Women had significantly less extensive criminal histories than men. Not criminally responsible on account of mental disorder-accused women have a distinct psychosocial, clinical, and criminological profile from their male counterparts, which may suggest gender-specific assessment, risk management, and treatment in forensic services could benefit patients. The findings are also consistent with traditional models (Risk-Need-Responsivity) and ultimately demonstrate the importance of individual assessment and client-centred services.

  9. Eight-year incidence of psychiatric disorders and service use from adolescence to early adulthood: longitudinal follow-up of the Mexican Adolescent Mental Health Survey.

    Science.gov (United States)

    Benjet, Corina; Borges, Guilherme; Méndez, Enrique; Albor, Yesica; Casanova, Leticia; Orozco, Ricardo; Curiel, Teresa; Fleiz, Clara; Medina-Mora, María Elena

    2016-02-01

    Half of mental disorders have their first onset before adulthood when the presence of a disorder may be particularly disruptive to developmental milestones. Retrospective prevalence estimates have been shown to underestimate the burden of mental illness and scarce data are available on the incidence of disorders throughout the adolescent period, especially in developing countries. Thus, the objective was to determine the incidence of mental disorders in an 8-year period from adolescence to young adulthood, onset of service use and their predictors in a Mexican cohort. 1071 respondents from a representative two-wave panel sample participated in the Mexican Adolescent Mental Health Survey in 2005 and in the follow-up survey in 2013. Disorders were evaluated with the World Mental Health Composite International Diagnostic Interview. 37.9% experienced the onset of a psychiatric disorder and 28.4% sought services for the first time. Substance use disorders had the greatest incidence, followed by mood and behavior disorders, anxiety disorders and lastly eating disorders. Sex, age, school dropout, childhood adversities and prior mental disorders predicted the onset of new disorders. Being female, having more educated parents and most classes of disorder predicted first time service use. These findings contribute to a paradigm shift in conceptions of mental disorder similar to how we think of common physical afflictions as near universal experiences across the life course, but less frequent at any given moment. Adolescents are particularly vulnerable. Therefore, public health policy should focus on early universal promotion of positive mental health and structural determinants of mental health.

  10. Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

    Science.gov (United States)

    Galvagno, Samuel M.; Haut, Elliott R.; Zafar, S. Nabeel; Millin, Michael G.; Efron, David T.; Koenig, George J.; Baker, Susan P.; Bowman, Stephen M.; Pronovost, Peter J.; Haider, Adil H.

    2012-01-01

    Context Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted. Objective To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Design, Setting, and Participants Retrospective cohort study involving 223 475 patients older than 15 years, having an injury severity score higher than 15, and sustaining blunt or penetrating trauma that required transport to US level I or II trauma centers and whose data were recorded in the 2007–2009 versions of the American College of Surgeons National Trauma Data Bank. Interventions Transport by helicopter or ground emergency services to level I or level II trauma centers. Main Outcome Measures Survival to hospital discharge and discharge disposition. Results A total of 61 909 patients were transported by helicopter and 161 566 patients were transported by ground. Overall, 7813 patients (12.6%) transported by helicopter died compared with 17 775 patients (11%) transported by ground services. Before propensity score matching, patients transported by helicopter to level I and level II trauma centers had higher Injury Severity Scores. In the propensity score–matched multivariable regression model, for patients transported to level I trauma centers, helicopter transport was associated with an improved odds of survival compared with ground transport (odds ratio [OR], 1.16; 95% CI, 1.14–1.17; P<.001; absolute risk reduction [ARR], 1.5%). For patients transported to level II trauma centers, helicopter transport was associated with an improved odds of survival (OR, 1.15; 95% CI, 1.13–1.17; P < .001; ARR, 1.4%). A greater proportion (18.2%) of those transported to level I trauma centers

  11. Ground and Helicopter Emergency Medical Services Time Tradeoffs Assessed with Geographic Information.

    Science.gov (United States)

    Widener, Michael J; Ginsberg, Zac; Schleith, Daniel; Floccare, Douglas J; Hirshon, Jon Mark; Galvagno, Samuel

    2015-07-01

    We describe how geographic information systems (GIS) can be used to assess and compare estimated transport time for helicopter and ground emergency medical services. Recent research shows that while the odds of a trauma patient's survival increase with helicopter emergency medical services (HEMS), they may not increase to the extent necessary to make HEMS cost effective. This study offers an analytic tool to objectively quantify the patient travel time advantage that HEMS offers compared to ground emergency medical services (GEMS). Using helicopter dispatch data from the Maryland State Police from 2000-2011, we computed transport time estimates for HEMS and GEMS, compare these results to a reference transport time of 60 min, and use geospatial interpolation to extrapolate the total response times for each mode across the study region. Mapping the region's trauma incidents and modeling response times, our findings indicate the GIS framework for calculating transportation time tradeoffs is useful in identifying which areas can be better served by HEMS or GEMS. The use of GIS and the analytical methodology described in this study present a method to compare transportation by air and ground in the prehospital setting that accounts for how mode, distance, and road infrastructure impact total transport time. Whether used to generate regional maps in advance or applied real-time, the presented framework provides a tool to identify earlier incident locations that favor HEMS over GEMS transport modes.

  12. Evaluation of the polytrauma victim by the nursing staff in an emergency service of Santa Catarina

    Directory of Open Access Journals (Sweden)

    Leandro Sanceverino Mattos

    2012-06-01

    Full Text Available Objective: To investigate the actions developed by the nursing staff of a private hospital emergency service in the southern Santa Catarina (SC, related to primary and secondary evaluation of polytrauma victims. Methods: Research of a qualitative approach, the type of case study, performed with twelve nurses. Sample has been characterized as non-probabilistic intentional. Data collection has been performed using the techniques of semi-structured interview and participant observation. Data analysis has been developed using the technique of content analysis. Results: Analysis of nurses’ testimonies and the results of observation have showed that most participants comprehend the importance of adopting the ABCDE rule in primary evaluation - A (Air Way - airway permeability with safe administration of cervical collar; B (Breathing; C (Circulation - search for bleeding and control; D (Disability - neurological evaluation; e E (Exposure - patient’s body exposition seeking missed injuries - and the need of meticulous secondary evaluation of polytrauma victim. However, due to demand of urgency and agility in emergencies of this nature, the rule is not followed in a systematic way. Conclusion: It has been demonstrated the nursing staff’s concern over the following aspects: agility of service; immediate performance of examinations; communication between emergency service professionals; adequate perception of the general condition of the victim; and the reception to victim and family.

  13. [Assessment of quality indicators in pediatric poisoning in an emergency service].

    Science.gov (United States)

    Giménez Roca, C; Martínez Sánchez, L; Calzada Baños, Y; Trenchs Sainz de la Maza, V; Quintilla Martínez, J M; Luaces Cubells, C

    2014-01-01

    Assessment of quality indicators allows clinicians to evaluate clinical assistance with a standard, to detect deficiencies and to improve medical assistance. Patients who came to emergency services of a tertiary level hospital for suspicion of poisoning from January 2011 to June 2012 were assessed using 20 quality indicators of pediatric poisoning. Data collection was performed by retrospective review of clinical reports. A total of 393 patients were admitted for suspicion of poisoning (0.3% of all admissions).The standard was reached in 11 indicators and not reached in 6: administration of activated charcoal within 2hours of poison ingestion (standard=90%, result=83.5%); attention within the first 15minutes of arriving in the emergency service (standard=90%, result=60.4%); start of gastrointestinal decontamination within 20minutes of arrival in emergency services (standard=90%, result=29.7%); performing of electrocardiogram on the patients poisoned with cardiotoxic substances (standard=95%, result=87%); judicial communication of cases of poisoning that could conceal a crime (standard=95%, result=31.3%), and collection of the minimal set of information of poisoned patients (standard=90%, result=1.9%). Three indicators could not be evaluated as a consequence of the limited number of cases where they could be applied (de Pediatría. Published by Elsevier Espana. All rights reserved.

  14. Referral to the Hospital And Emergency Ambulance Service Uses Patterns of the Inmates and Convicts

    Directory of Open Access Journals (Sweden)

    Emine Oncu

    2014-03-01

    Full Text Available Aim: The purpose of this study was to determine the reasons for referral to the hospital and 112 emergency ambulance service uses patterns of the inmates and convicts in an E type prison. Material and Method: In this descriptive study, it was evaluated the prison records associated with referral to the hospital and 112 emergency ambulance service uses for one year in 2010- 2011. Of the statistical analysis, descriptive statistics, chi-square test and Fisher%u2019s Exact Test were used. Results: All inmates and convicts were man, the median of age was 30,0 (min 18- max 68 years and substance use was 34,5%. The number of prisoners were referred to the hospital 815, total referrals were 1491; (referrals ranged from one to six and most common in January; and according to frequency, reasons of the referral were eyes problems, musculoskeletal disorders and psychological problems. Emergency medical service was used for in medical causes (78,3%, accident, trauma and injuries (16,4%, suicide (5,3%. Discussion: Findings from the study show that prisoners are more likely to have suffered physical and mental health problems that compared to the rest of society and have significantly high substance use rates.

  15. The State of Leadership Education in Emergency Medical Services: A Multi-national Qualitative Study.

    Science.gov (United States)

    Leggio, William Joseph

    2014-10-01

    This study investigated how leadership is learned in Emergency Medical Services (EMS) from a multi-national perspective by interviewing EMS providers from multiple nations working in Riyadh, Kingdom of Saudi Arabia. A phenomenological, qualitative methodology was developed and 19 EMS providers from multiple nations were interviewed in June 2013. Interview questions focused on how participants learned EMS leadership as an EMS student and throughout their careers as providers. Data were analyzed to identify themes, patterns, and codes to be used for final analysis to describe findings. Emergency Medical Services leadership is primarily learned from informal mentoring and on-the-job training in less than supportive environments. Participants described learning EMS leadership during their EMS education. A triangulation of EMS educational resources yielded limited results beyond being a leader of patient care. The only course that yielded results from triangulation was EMS Management. The need to develop EMS leadership courses was supported by the findings. Findings also supported the need to include leadership education as part of continuing medical education and training. Emergency Medical Services leadership education that prepares students for the complexities of the profession is needed. Likewise, the need for EMS leadership education and training to be part of continuing education is supported. Both are viewed as a way to advance the EMS profession. A need for further research on the topic of EMS leadership is recognized, and supported, with a call for action on suggested topics identified within the study.

  16. Implementation of an acute care emergency surgical service: a cost analysis from the surgeon's perspective.

    Science.gov (United States)

    Anantha, Ram Venkatesh; Parry, Neil; Vogt, Kelly; Jain, Vipan; Crawford, Silvie; Leslie, Ken

    2014-04-01

    Acute care surgical services provide comprehensive emergency general surgical care while potentially using health care resources more efficiently. We assessed the volume and distribution of emergency general surgery (EGS) procedures before and after the implementation of the Acute Care and Emergency Surgery Service (ACCESS) at a Canadian tertiary care hospital and its effect on surgeon billings. This single-centre retrospective case-control study compared adult patients who underwent EGS procedures between July and December 2009 (pre-ACCESS), to those who had surgery between July and December 2010 (post-ACCESS). Case distribution was compared between day (7 am to 3 pm), evening (3 pm to 11 pm) and night (11 pm to 7 am). Frequencies were compared using the χ(2) test. Pre-ACCESS, 366 EGS procedures were performed: 24% during the day, 55% in the evening and 21% at night. Post-ACCESS, 463 operations were performed: 55% during the day, 36% in the evening and 9% at night. Reductions in night-time and evening EGS were 57% and 36% respectively (p cost-modelling analysis, post-ACCESS surgeon billing for appendectomies, segmental colectomies, laparotomies and cholecystectomies all declined by $67 190, $125 215, $66 362, and $84 913, respectively (p Cost-modelling analysis demonstrates that these services have cost-savings potential for the health care system without reducing overall surgeon billing.

  17. Tethered Balloon Technology in Design Solutions for Rescue and Relief Team Emergency Communication Services.

    Science.gov (United States)

    Alsamhi, Saeed Hamood; Ansari, Mohd Samar; Ma, Ou; Almalki, Faris; Gupta, Sachin Kumar

    2018-05-23

    The actions taken at the initial times of a disaster are critical. Catastrophe occurs because of terrorist acts or natural hazards which have the potential to disrupt the infrastructure of wireless communication networks. Therefore, essential emergency functions such as search, rescue, and recovery operations during a catastrophic event will be disabled. We propose tethered balloon technology to provide efficient emergency communication services and reduce casualty mortality and morbidity for disaster recovery. The tethered balloon is an actively developed research area and a simple solution to support the performance, facilities, and services of emergency medical communication. The most critical requirement for rescue and relief teams is having a higher quality of communication services which enables them to save people's lives. Using our proposed technology, it has been reported that the performance of rescue and relief teams significantly improved. OPNET Modeler 14.5 is used for a network simulated with the help of ad hoc tools (Disaster Med Public Health Preparedness. 2018;page 1 of 8).

  18. Understanding the value of mixed methods research: the Children's Safety Initiative-Emergency Medical Services.

    Science.gov (United States)

    Hansen, Matthew; O'Brien, Kerth; Meckler, Garth; Chang, Anna Marie; Guise, Jeanne-Marie

    2016-07-01

    Mixed methods research has significant potential to broaden the scope of emergency care and specifically emergency medical services investigation. Mixed methods studies involve the coordinated use of qualitative and quantitative research approaches to gain a fuller understanding of practice. By combining what is learnt from multiple methods, these approaches can help to characterise complex healthcare systems, identify the mechanisms of complex problems such as medical errors and understand aspects of human interaction such as communication, behaviour and team performance. Mixed methods approaches may be particularly useful for out-of-hospital care researchers because care is provided in complex systems where equipment, interpersonal interactions, societal norms, environment and other factors influence patient outcomes. The overall objectives of this paper are to (1) introduce the fundamental concepts and approaches of mixed methods research and (2) describe the interrelation and complementary features of the quantitative and qualitative components of mixed methods studies using specific examples from the Children's Safety Initiative-Emergency Medical Services (CSI-EMS), a large National Institutes of Health-funded research project conducted in the USA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. Demand and supply of emergency help: an economic analysis of Red Cross services.

    Science.gov (United States)

    Hackl, Franz; Pruckner, Gerald Josef

    2006-08-01

    This paper analyzes supply and demand side characteristics of (voluntary) Red Cross services in Austria. The demand side analysis is based on a contingent valuation study on people's willingness to pay for emergency treatment, transportation services and disaster relief activities. The supply side is identified by a high percentage of volunteers in the Red Cross organization which makes the provision of emergency help at low cost possible. We find that aggregate benefits of Red Cross services exceed their cost of production. Policy conclusions are drawn with respect to future recruitment and funding: whereas intrinsic motivation is important for the decision to volunteer, and financial incentives play a minor role in general, the young Red Cross activists work voluntarily for self-realization reasons and to continue their education. Age-specific recruitment strategies accompanied by word-of-mouth advertising are recommended to address potential volunteers. As long as the volunteering character of Red Cross services will be maintained and cost of production will not go up an increase of funds does not seem necessary in the future. Moreover, a radical chan