Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents

Purpose The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. Predictors of patient endorsement of suicidality and provider documentation of follow-up were examined. Methods A prospective cohort study was conducted to examine the implementation of a CDSS that screened adolescent patients for suicidality and provided follow-up recommendations to providers. The intervention was implemented for patients aged 12–20 years in two primary care clinics in Indianapolis, Indiana. Results The sample included 2,134 adolescent patients (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Just over 6% of patients screened positive for suicidality. A positive endorsement of suicidality was more common among patients who were female, depressed, and seen by an adolescent−medicine board-certified provider as opposed to general pediatric provider. Providers documented follow-up action for 83% of patients who screened positive for suicidality. Documentation of follow-up action was correlated with clinic site and Hispanic race. The majority of patients who endorsed suicidality (71%) were deemed not actively suicidal after assessment by their provider. Conclusions Incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care is feasible and well utilized by providers. Female gender and depressive symptoms are consistently associated with suicidality among adolescents, although not all suicidal adolescents are depressed. Universal use of a multi-item suicide screener that assesses recency might more effectively identify suicidal adolescents

Mindfulness as an Effective Strategy for Anxiety Relief in Adolescent Patients

Anxiety disorders affect 6.8 million adults over the age of 18 in the United States, and anxiety disorders are the most common mental health illness in children. Risk Factors for anxiety disorders in young adults include the following: -Shyness, or behavioral inhibition, in childhood -Being of the female sex -Having few economic resources -Exposure to stressful life events in childhood -Anxiety disorders in close biological relatives -Parental history of mental disorders -Elevated afternoon cortisol levels in the saliva Teens and young adults increasingly suffer from anxiety disorders with the CDC reporting the rate of anxiety disorders among 3 to 17 year olds in the range of 3% with current symptoms to 4.7% having ever reported having anxiety. Mindfulness or the ability to be fully present, aware of where we are and what we’re doing, and not overwhelmed by what’s going on around us, can be effective means to manage stress and anxiety symptoms. Primary care physicians can introduce and practice mindfulness strategies within patient visits in addition to or replacement for management with medications.https://scholarworks.uvm.edu/fmclerk/1349/thumbnail.jp

Sleep Disturbances and Fatigue in Adolescents with Cancer Receiving Chemotherapy

Sleep disturbances and fatigue are frequently complained by adolescents with cancer. These problems will lead to a variety of changes that may affect adolescents’ development. However, there is very limited data concerning adolescents with cancer in Indonesia. The research aims to explore sleep disturbances and fatigue in adolescents with cancer who are receiving chemotherapy. The research applies a qualitative design with phenomenology approach. Data were collected using in-depth interviews with seven adolescents with cancer in Jakarta, Bogor, and Bekasi. The interviews involved open questions on seven aspects, consisting of level of fatigue, responses to psychological drives, sleep disturbances, sleep disruption due to illness and chemotherapy, disruptions in some aspects of daily life, responses to problematic situations, and general perspective on life. Participants stated that chemotherapy induced sleep disturbances and fatigue, and this situation greatly influenced their overall quality of life. These problems are interrelated to each other and may affect the success of chemotherapy program. In terms of nursing, this research also shows the importance of developing a more effective system for managing sleep disturbances and fatigue during chemotherapy program

The change in adolescent patients’ attitude towards psychotropic medications due to patient education

The objective of the study was to examine if patient education through a medication group can positively influence the attitude of the adolescent patients towards psychotropic medications. The study was conducted in an inpatient psychiatric clinic called Young Adult Program (YAP) at Foothills Medical Centre, Calgary, Alberta, Canada. All the patients were 13-18 years old and on prescribed psychotropic medications. Hogan Drug Attitude Inventory was used to measure the attitude of adolescent patients. A higher score in the questionnaire indicates more positive attitude and higher chance of compliance. 23 patients filled out the questionnaire prior to the 6-week long medication group and 18 patients filled out the questionnaire after the medication group. On average, adolescent patients’ attitude towards psychotropic medications became more negative (-9.2%) after attending the medication group. Adverse effects during the period of workshop (6 weeks), time constrain in the post-treatment workshop, ambivalence in answering questions, more awareness etc. could have made adolescent patients’ attitude more negative. The patients were taught about various kinds of psychotropic medications, their side-effects, compliance and safety. Studies have suggested that the rate of compliance with psychotropic medications decreases from 50% in the first year to 15% in the second year (1). Since the rate of compliance with psychotropic medications decreases over time it can be inferred that the attitude of patients towards psychotropic medication becomes more negative gradually. However, due to the lack of comparative literature it is not clear if patient education through the medication group was able to impede the progression of negative attitude in adolescent patients. Patient education was not certainly able to reverse the trend and make the attitude positive on average. Health care providers might have to come up with more innovating ways to positively influence adolescent patients’ attitude towards psychotropic medications

Plantaris tendon autograft successfully restores patellar stability in adolescent isolated medial patellofemoral ligament reconstruction – preliminary results

Patellar instability is highly represented in adolescent patients. For a group of patients with patellar instability, isolated medial patellofemoral ligament reconstruction (MPFLR) is a standard treatment option. Although gracilis tendon (GRT) autograft has been frequently used, the optimal surgical approach and graft source for this procedure is yet to be established. The use of plantaris tendon (PLT) autograft in isolated MPFLR has never been compared to GRT autograft. The purpose of this study is to determine whether a four-folded PLT autograft used for isolated anatomic MPFLR in adolescent patients restores patellar stability

The Value of the Vestibular/Ocular Motor Screening (VOMS) in Evaluating Adolescent Patients with Concussions

OBJECTIVE To determine the VOMS can differentiate between typical and protracted recoveries in adolescent patients