Off-hours admission and mortality in two pediatric intensive care units without 24-h in-house senior staff attendance

To compare risk-adjusted mortality of children non-electively admitted during off-hours with risk-adjusted mortality of children admitted during office hours to two pediatric intensive care units (PICUs) without 24-h in-house attendance of senior staff. Prospective observational study, performed between January 2003 and December 2007, in two PICUs without 24-h in-house attendance of senior staff, located in tertiary referral children's hospitals in the Netherlands. Standardized mortality rates (SMRs) of patients admitted during off-hours were compared to SMRs of patients admitted during office hours using Pediatric Index of Mortality (PIM1) and Pediatric Risk of Mortality (PRISM2) scores. Office hours were defined as week days between 8:00 a.m. and 6:00 p.m., with in-house attendance of senior staff, and off-hours as week days between 6:00 p.m. and 8:00 a.m., Saturdays, Sundays and public holidays, with one resident covering the PICU and senior staff directly available on-call. Of 3,212 non-elective patients admitted to the PICUs, 2,122 (66%) were admitted during off-hours. SMRs calculated according to PIM1 and PRISM2 did not show a significant difference with those of patients admitted during office hours. There was no significant effect of admission time on mortality in multivariate logistic regression with odds ratios of death in off-hours of 0.95 (PIM1, 95% CI 0.71-1.27, p = 0.73) and 1.03 (PRISM2, 95% CI 0.76-1.39, p = 0.82). Off-hours admission to our PICUs without 24-h in-house attendance of senior staff was not associated with higher SMRs than admission during office hours when senior staff were available in-house

Validity of symptom reports of asylum seekers in a psychiatric hospital: A descriptive study

Our study involved three samples (N=85; N=38, and N=27) of asylum seekers in a Dutch psychiatric hospital. We looked at how often they reported severe dissociative episodes (i.e., not recognizing oneself in a mirror; seeing traumatic images in a mirror) and whether these symptoms were related to deviant performance on Symptom Validity Tests (SVTs), notably items from the Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2005) and a forced-choice task modeled after the Morel Emotional Numbing Test (MENT; Morel, 1998). We also examined whether poor language proficiency and the presence of incentives to exaggerate symptoms might affect scores on SVTs. Dissociative target symptoms were reported by considerable percentages of patients (27-63%). Patients who reported these symptoms had significantly more often deviant scores on SVT items compared with those who did not report such symptoms. With a few exceptions, deviant scores on SVT items were associated with incentives rather than poor language skills. We conclude that the validity of self-reported symptoms in this target group should not be taken for granted and that SVTs may yield important information

Standard Symptom Inventories for Asylum Seekers in a Psychiatric Hospital:Limited Utility Due to Poor Symptom Validity

We examined symptom validity in two samples (Ns = 27 and 35) of asylum seekers who had been admitted to a psychiatric facility. Considerable proportions over-endorsed atypical symptoms (63 and 83%, respectively) and underperformed on a simple forced-choice task requiring the identification of basic emotions (41 and 71%, respectively). Over-endorsement and underperformance were unrelated to Dutch language proficiency but were related to raised scores on standard symptom inventories commonly used to assess psychiatric symptoms of asylum seekers. This pattern of findings casts doubts on attempts to monitor symptom severity and treatment progress in psychiatric asylum seekers without taking symptom validity into account