Patient Self-Harm in the Emergency Department: An Evidence- Based Approach

Violence, deliberate self harm, and suicide in emergency departments and hospitals is likely to remain a significant problem for health care systems well into the future. Understanding how to confront, intervene, and manage episodes of patient deliberate self harm is extremely important, and can be life-saving. Here, through a clinical vignette, and a discussion of deliberate self harm we will highlight the importance of the direct observation of such patients, containment procedures (seclusion and physical restraints), and the use of pharmacological adjuncts. We hope that this concise, practically-oriented review will provide our readers with foundational understanding of the topic, including the most important theoretical and clinical considerations

Expanding the Whipple Accelerated Recovery Pathway (WARP) To All Patients Undergoing Pancreaticoduodenectomy (PD)

Introduction: Pancreaticoduodenectomy (PD) is a complex abdominal procedure with high rates of perioperative morbidity. The Whipple Accelerated Recovery Pathway (WARP) was developed for highly selected patients undergoing PD to reduce hospital length of stay (LOS) and time to adjuvant therapy (TTAT), without increasing post-operative complications (POC) or readmission rates (RR). The purpose of this study was to determine if WARP could be implemented for all-risk patients undergoing PD. Methods: A single-institution, retrospective analysis of 281 patients implemented on the WARP between 2017-2020 was performed. 119 patients were categorized as WARP-eligible (WEPs) according to original inclusion criteria, and 162 were deemed WARP-ineligible (WIPs). Primary endpoints include LOS, TTAT, RR, and POC. Data was collected from Epic and a multivariate analysis with logistic regression was performed. Results: 28 POC were found in WEPs (23.5%) compared to 73 POC in WIPs (45.1%) (p\u3c0.05). Delayed gastric emptying (DGE) and post-operative pancreatic fistulas (POPF) were higher in WIPs: DGE was found in 10.2% of WEPs vs. 26.2% of WIPs (p\u3c0.05), while POPF was found in 5.1% of WEPs vs. 21% of WIPs (p\u3c0.05). Mean LOS was 5 days for WEPs vs. 6 days for WIPs (p\u3c0.05). TTAT was 55 days for WEPs, compared to 63 days in WIPs (p\u3c0.05). RR was 12.6% for WEPs and 23.5% for WIPs (p\u3c0.05). Discussion: WARP results in lowered POC, TTAT, LOS, and RR, cutting costs to patients. WARP may be expanded to all PD patients; however, WIPs may benefit from additional modifications that are specific for patient risk factor

Conduct disorder in girls: neighborhoods, family characteristics, and parenting behaviors

<p>Abstract</p> <p>Background</p> <p>Little is known about the social context of girls with conduct disorder (CD), a question of increasing importance to clinicians and researchers. The purpose of this study was to examine the associations between three social context domains (neighborhood, family characteristics, and parenting behaviors) and CD in adolescent girls, additionally testing for race moderation effects. We predicted that disadvantaged neighborhoods, family characteristics such as parental marital status, and parenting behaviors such as negative discipline would characterize girls with CD. We also hypothesized that parenting behaviors would mediate the associations between neighborhood and family characteristics and CD.</p> <p>Methods</p> <p>We recruited 93 15–17 year-old girls from the community and used a structured psychiatric interview to assign participants to a CD group (n = 52) or a demographically matched group with no psychiatric disorder (n = 41). Each girl and parent also filled out questionnaires about neighborhood, family characteristics, and parenting behaviors.</p> <p>Results</p> <p>Neighborhood quality was not associated with CD in girls. Some family characteristics (parental antisociality) and parenting behaviors (levels of family activities and negative discipline) were characteristic of girls with CD, but notll. There was no moderation by race. Our hypothesis that the association between family characteristics and CD would be mediated by parenting behaviors was not supported.</p> <p>Conclusion</p> <p>This study expanded upon previous research by investigating multiple social context domains in girls with CD and by selecting a comparison group who were not different in age, social class, or race. When these factors are thus controlled, CD in adolescent girls is not significantly associated with neighborhood, but is associated with some family characteristics and some types of parental behaviors. However, the mechanisms underlying these relationships need to be further investigated. We discuss possible explanations for our findings and suggest directions for future research.</p

Mind the Gap: the Relationship Between Gender, Financial Inclusion and Financial Literacy

Ambitious plans for sustainable development in Ethiopia since the mid-2000s have significantly improved the financial inclusion of women along with the wider financially excluded population. However, the critical question about the gender gap is still at stake. To analyse the current status of financial inclusion and financial literacy, we have to develop a more comprehensive method since available research tends to focus on a limited number of factors, which are primarily relevant in developed economies. Building on the existing literature, the first part of this research developed a new conceptualisation of financial literacy and financial inclusion, incorporating a pragmatic perspective. A comprehensive questionnaire was designed to examine financial literacy and financial inclusion and used to collect data on a number of variables. Jimma (the second largest city of Ethiopia with strategic economic and geopolitical interests, as opposed to the capital, the home of international/big corporations, and its surrounding towns were chosen as the sampling population. The second part is the empirical analysis of the collected data using various statistical techniques. Since the questionnaire included the standard methods of measuring financial literacy, the usefulness of the method developed here was demonstrated through a comparative study. The questionnaire answers were interpreted into numerical data for statistical analysis by Stata. Various analytical methods were employed to evaluate the reliability of the proposed scale and standard measures. Since the ratio of financially excluded women in Ethiopia overshadows those who are financially included, the equal ratio of male/female participants was used in the present study. It was found that amongst women who are financially included, there is no significant gender gap in terms of financial literacy. In other words, financial inclusion is associated with a wider set of cultural barriers rather than the lack of financial literacy per se. A positive correlation between trust, financial literacy and inclusion was found. The results have implications for policy, most notably, that policies to increase financial inclusion have to go beyond finance itself to incorporate other socio-economic factors, such as equal access to education