An examination of the profile and journey of patients with mental illness in the emergency department

© 2018 Objective: To examine the profile and journey of patients with mental illness in the emergency departments (ED) of a Local Health District in Australia. There is limited evidence around the patient profile and journey of people in who present to EDs with mental illness, and the aim of this study was to inform the development of a psychiatric emergency service model. Methods: The study design was a retrospective descriptive analysis of routinely collected data of two hospital EDs. Retrospective health care data of patients who presented to the EDs between July 2016 and June 2017 was analysed using descriptive and inferential statistics. Results: Mental health presentations (N = 4506) consisted of 3.44% of all presentations to the Emergency Department, mostly for anxiety and stress, comorbid alcohol and drug issues, and suicidality. Females were more likely to present, and significantly more likely to present multiple times (specifically for age groups 12–17 and over 65). Presenting issues were associated with age and gender for most diagnostic groups, but not with number of presentations, except for personality disorder. 24.83% were admitted to a mental health inpatient unit, 54.34% were referred to a mental health community team, 4.63% medically, and the remaining referred to alcohol and drug services, GPs, or NGOs. Length of stay was associated with gender (female), age (>65) and diagnosis (drug related and eating disorder). Conclusion: There is limited evidence around the patient profile and journey of people who present to EDs for mental health reasons, and this study contributes to this literature

Ring-fencing a budget for cancer drugs: is it fair?

Ring-fencing is defined as protecting funds for use in a specific area. In the NationalHealth Service in the UK, various methods to ring-fence cancer have beenemployed over the years; more recently the Cancer Drugs Fund in England hasenabled cancer drugs that would not normally be considered cost-effective to beprovided to patients. This has created variation in provision between England andthe devolved countries. While some would argue that ring-fencing allows majoradvances to be made in the treatment of a particular condition, others wouldargue that it is intrinsically unfair. In this debate, Graham and Cassidy have writtenan article arguing the affirmative position and Hughes and Duerden were invitedto respond directly to their arguments. As with all the RCPE's 'Currentcontroversies', the authors have been asked to take a deliberately polarisedposition and so the views they express may be somewhat overstated

Global Explorers: An Examination of Program Processes and Outcomes

This study utilizes longitudinal, mixed-method data drawn from participants in an environmental education/international immersion program for middle high-school students to study outcomes and processes associated with program participation. Studies of program outcomes and processes are important for better understanding the design and impact of youth programs. The first study investigated the relationships between experience types (i.e., indirect vs. direct) and learning outcomes (i.e., knowledge vs. attitudes). In other words, what is the difference in impacts between reading a book about the rain forest and actually traveling to the rain forest? Findings suggest that experience type plays a significant role in the type of learning outcomes as well as how these outcomes influence behavior. More specifically, direct experiences appear to catalyze knowledge in a way that facilitates future behavior development. The qualitative data also suggest that participants' perceptions of perceived freedom during the program moderated whether participation was experienced as direct or indirect. The second study employed a social development model (SDM) to understand the relationship between within program socialization processes and program outcomes. The model provided a good fit for the data and predicted a significant portion of the variance in environmental behavior after controlling for baseline levels of this outcome variable. Additionally, analysis of qualitative data produced a proposed model of shared activities and bonding that suggests youth valued experiences where adults participated with them as equals rather than as disciplinarians or administrators. The final study provided insights regarding the degree to which the program was implemented as originally planned and how the domains of implementation integrity influenced program outcomes. The findings suggest that of the measured implementation domains, only participant responsiveness was significantly related to program outcomes. Data also suggest that implementer efficacy can have differing impacts on program adherence. The qualitative data suggest that most participants positively perceived the program and felt it was well organized. In sum, the findings provide a holistic perspective of the processes and outcomes of this program. Rather than merely presenting an overview of program impacts, the study offers insights into the processes (e.g., socialization) and characteristics (e.g., experience types) that produced observed outcomes. Thus, the study presents a more complete picture of what individuals gained through their participation in this program as well as the processes that led to these gains

Promoting Supportive Relationships in Youth Programs: A Self-Determination Theory Perspective

Although research suggests that positive contact with non-parental adults is developmentally beneficial for youth; many adolescents do not have access to such relationships. It is important that adults structure existing relationships to optimize positive youth development. Relationships with adults, who support youth’s needs for autonomy, relatedness, and competence, provide youth with scaffolding as they navigate their way through adolescence. Self-Determination Theory offers a straight-forward approach to understanding the elements of contexts that best promote the development of supportive relationships. The purpose of this paper is to review the literature concerning youth-adult relationships, including their associated prevalence and developmental benefits across multiple contexts. These findings are then integrated into a framework of best practices for developing and supporting positive youth relationships with adults within youth program settings. Several theory-based recommendations are offered for youth program administrators and staff who wish to improve youth-adult relationships in their programs

Evaluating Youth Programs: An Overview of Practitioner Led Evaluations

Youth programs are prime contexts for the intentional facilitation of positive development. However, not all youth programs achieve positive outcomes equally. In order to promote the identification and dissemination of the characteristics and processes of effective youth programs, increased focus needs to be given to program evaluation. This article briefly reviews the main tenets of evaluation science in order to provide practitioners a roadmap for conducting their own evaluations. This includes an overview of different types of evaluations and key issues to consider when constructing an evaluation strategy such as targeting outcomes and developing program logic models

Point-of-Care Testing for Pharyngitis in the Pharmacy.

Pharyngitis (also known as sore throat) is a common, predominately viral, self-limiting condition which can be symptomatically managed without antibiotic treatment. Inappropriate antibiotic use for pharyngitis contributes to the development and spread of antibiotic resistance. However, a small proportion of sore throats caused by group A streptococcal (GAS) infection may benefit from the provision of antibiotics. Establishing the cause of infection is therefore an important step in effective antibiotic stewardship. Point-of-care (POC) tests, where results are available within minutes, can distinguish between viral and GAS pharyngitis and can therefore guide treatment in primary healthcare settings such as community pharmacies, which are often the first point of contact with the healthcare system. In this opinion article, the evidence for the use of POC testing in the community pharmacy has been discussed. Evidence suggests that pharmacy POC testing can promote appropriate antibiotic use and reduce the need for general practitioner consultations. Challenges to implementation include cost, training and 'who prescribes', with country and regional differences presenting a particular issue. Despite these challenges, POC testing for pharyngitis has become widely available in pharmacies in some countries and may represent a strategy to contain antibiotic resistance and contribute to antimicrobial stewardship

The Impact of Parental Involvement on a Structured Youth Program Experience: A Qualitative Inquiry

Parental involvement is an often proposed, but rarely researched, key element of youth programs. Questions remain regarding the impact of parental involvement on program processes and outcomes. Qualitative data were collected over a one-year period with youth participants (n=46), parents (n=26), and teachers (n=5) associated with an international immersion/service learning program for adolescents. Three main research questions guided the data analysis: (1) what role does parental involvement play in the youths’ experience in the program; (2) how does parental involvement in the program influence the parent/child relationship; and (3) what role does parental involvement play in terms of the program’s long-term impact on the youth participants? Findings suggest a relationship between parental involvement in youth programs and improved parent/child communication, bonding, and perceptions of one another. Findings also suggest that having a common ground experience prolonged the experience’s positive post-participation effects

The Impact of Parental Involvement on a Structured Youth Program Experience: A Qualitative Inquiry

Parental involvement is an often proposed, but rarely researched, key element of youth programs. Questions remain regarding the impact of parental involvement on program processes and outcomes. Qualitative data were collected over a one-year period with youth participants (n=46), parents (n=26), and teachers (n=5) associated with an international immersion/service learning program for adolescents. Three main research questions guided the data analysis: (1) what role does parental involvement play in the youths’ experience in the program; (2) how does parental involvement in the program influence the parent/child relationship; and (3) what role does parental involvement play in terms of the program’s long-term impact on the youth participants? Findings suggest a relationship between parental involvement in youth programs and improved parent/child communication, bonding, and perceptions of one another. Findings also suggest that having a common ground experience prolonged the experience’s positive post-participation effects

Measuring Life Skills: Standardizing the Assessment of Youth Development Indicators

While the development of life skills (e.g., communication, problem solving, etc.) is a commonly targeted youth program outcome, the lack of standardized conceptualizations and instrumentation make it difficult to compare impacts across programs and develop validated best practices. In order to promote a more unified approach to life skill development, literature reviews were conducted for 10 life skill domains to identify common definitions and, if available, appropriate outcome measures. Data were then collected from an ethnically diverse sample (N = 758) of elementary, middle, and high school aged youth for the 10 identified instruments. Analyses were conducted to ascertain the psychometric qualities of each measure, the interrelationships among measures, and the measures’ relationships with gender, ethnicity, and school level. Results are discussed in terms of their relevance to life skill theory and measurement

Susceptibility of hamsters to clostridium difficile isolates of differing toxinotype

Clostridium difficile is the most commonly associated cause of antibiotic associated disease (AAD), which caused ~21,000 cases of AAD in 2011 in the U.K. alone. The golden Syrian hamster model of CDI is an acute model displaying many of the clinical features of C. difficile disease. Using this model we characterised three clinical strains of C. difficile, all differing in toxinotype; CD1342 (PaLoc negative), M68 (toxinotype VIII) and BI-7 (toxinotype III). The naturally occurring non-toxic strain colonised all hamsters within 1-day post challenge (d.p.c.) with high-levels of spores being shed in the faeces of animals that appeared well throughout the entire experiment. However, some changes including increased neutrophil influx and unclotted red blood cells were observed at early time points despite the fact that the known C. difficile toxins (TcdA, TcdB and CDT) are absent from the genome. In contrast, hamsters challenged with strain M68 resulted in a 45% mortality rate, with those that survived challenge remaining highly colonised. It is currently unclear why some hamsters survive infection, as bacterial and toxin levels and histology scores were similar to those culled at a similar time-point. Hamsters challenged with strain BI-7 resulted in a rapid fatal infection in 100% of the hamsters approximately 26 hr post challenge. Severe caecal pathology, including transmural neutrophil infiltrates and extensive submucosal damage correlated with high levels of toxin measured in gut filtrates ex vivo. These data describes the infection kinetics and disease outcomes of 3 clinical C. difficile isolates differing in toxin carriage and provides additional insights to the role of each toxin in disease progression