Psychiatric comorbidity among hospital medicine patients is common and often complicates care delivery and compromises outcomes. Team-based, proactive consultation–liaison (CL) psychiatry has been ...shown to reduce hospital length of stay (LOS) and care costs, but staff satisfaction with this model has not been explored in detail. Here we evaluate its impact on hospital medicine provider and nurse satisfaction.
We implemented a team-based proactive CL service that reviews all admitted hospital medicine patients across 3 units for psychiatric comorbidity and provides unit-wide integrated mental health care. Hospital medicine staff completed surveys before and after a 6-month pilot phase: 10-item provider surveys covered resource adequacy, safety, time for healthcare improvements, and burnout; 26-item nurse surveys included the same 10 items plus 8 on behavioral health assessment competency and 8 on intervention competency. Additionally, we characterized psychiatric comorbidity, calculated consultation latency and volume and also average LOS during these 6 months.
The provider response rate was 57% (20/35 before; 21/37 after) and roughly a third for nurses (32/~90 and 31/~90, respectively). Providers rated 9 of 10 items as improved, including one on burnout. Nursing satisfaction improved similarly but with lower effect sizes. During the pilot (n = 1590), 71% had chart-identified psychiatric comorbidity. Consultation latency decreased by 0.86 days; consultation rate increased nearly 3-fold; and average LOS decreased by 0.33 days.
Team-based proactive CL psychiatry enhances provider and nurse satisfaction and may even reduce provider burnout. We also confirmed that this model is associated with reduced average LOS.
•Proactive CL psychiatry improves hospital medicine provider and nurse satisfaction.•This model may even mitigate burnout among hospital medicine providers.•Two thirds of hospital medicine patients had evidence of psychiatric morbidity.•This model is associated with reduced consult latency and higher consult rates.•We replicate the finding that proactive CL is associated with reduced length of stay.
Importance of bone attack prevention HAGINO, Hiroshi
Japanese Journal of Oral and Maxillofacial Surgery,
2023/10/20, Letnik:
69, Številka:
10
Journal Article
Odprti dostop
Since hip and vertebral fractures cause deterioration of quality of life and life expectancy, we call them ‟ Bone Attack , ” and awareness of the importance of osteoporosis treatment is being ...promoted. In Japan, the diagnostic criteria for osteoporosis consist of bone mineral density and a history of fragility fractures. To prevent Bone Attack, it is necessary to increase the screening uptake rate for primary fracture prevention and to implement secondary fracture prevention. Osteoporosis drugs are used according to fracture risk among six drugs with evidence of fracture-preventing effects.
How do archivists who find themselves in dual librarian/archivist positions approach library instruction and reference services? This case study examines the instructional experiences of an archivist ...serving in an interim role as a liaison librarian to a public affairs college at a large, public university in the United States. Utilizing action research methodology to study and inform their instruction approach and philosophy, the archivist created an instructional model which incorporates archival principles and concepts into a landscape mapping exercise. Archivists can make material contributions to library instruction through their unique knowledge, skills, and perspectives.
Les traitements de la dépression comprennent un mode de vie adapté, l’activité physique, les psychothérapies, les médicaments antidépresseurs et thymorégulateurs, la neuromodulation, les ...chronothérapies et les cures thermales. Les traitements médicamenteux utilisés dans le traitement de l’EDC sont les traitements antidépresseurs et les thymorégulateurs. Pour un épisode d’intensité légère, une psychothérapie est indiquée. Elle doit être associée à un antidépresseur (inhibiteur de la recapture de la sérotonine) pour les épisodes d’intensité moyenne et sévère. L’évaluation du risque suicidaire est essentielle tout au long de l’épisode dépressif. Il est recommandé de surveiller au début de traitement antidépresseur un comportement suicidaire, un virage de l’humeur évoquant une bipolarité sous-jacente. L’efficacité du traitement est évaluée après 4 à 8 semaines. La durée totale du traitement antidépresseur d’un EDC se situe entre 6 mois et 1 an après rémission, dans le but de prévenir les rechutes. Le recours à la psychiatrie de liaison, véritable dispositif de soins au sein de l’hôpital général, est fortement recommandé pour un meilleur dépistage et le traitement de la dépression, diminuant ainsi les durées de séjour hospitalier, améliorant le pronostic de la dépression. Cet article a pour objectif de donner aux cliniciens une synthèse des données validées sur l’efficacité/tolérance des traitements de la dépression, et de proposer une conduite à tenir pratique sur les principales situations cliniques quotidiennes : traiter les comorbidités, tenir compte des interactions médicamenteuses les plus fréquentes, gérer le syndrome sérotoninergique, conduire un sevrage en antidépresseur et gérer le traitement chez la personne âgée.
Treatments for depression include an adapted lifestyle, physical activity, psychotherapies, antidepressant and mood stabilizing drugs, neuromodulation, chronotherapy, spa treatments. Drug treatments used for major depressive episode are antidepressants and mood stabilizers. For a mild episode, psychotherapy is indicated. It should be combined with an antidepressant (serotonin reuptake inhibitor) for moderate and severe episodes. Suicide risk assessment is essential throughout the depressive episode. It is recommended to monitor at the start of antidepressant treatment for suicidal behavior, a change in mood suggesting an underlying bipolar disorder. The effectiveness of the treatment is evaluated after 4 to 8 weeks. The total duration of antidepressant treatment for an EDC is between 6 months and 1 year after remission, in order to prevent relapses. The use of liaison psychiatry, a real healthcare system within the general hospital, is strongly recommended for better screening and treatment of depression, thus reducing the length of hospital stays, improving the prognosis of depression. The aim of this article is to provide clinicians with a summary of validated data on the efficacy/tolerance of treatment for depression, and to suggest practical action to be taken on the main daily clinical situations: treating comorbid conditions, taking into account interactions drugs, manage the serotonin syndrome, lead to withdrawal from antidepressants, manage treatment in the elderly.
The Coronavirus Disease 2019 (COVID-19) can affect mental health in different ways. There is little research about psychiatric complications in hospitalized patients with COVID-19. The aim of the ...study was to describe the psychiatric clinical profile and pharmacological interactions in COVID-19 inpatients referred to a Consultation-Liaison Psychiatry (CLP) unit. This is a cross-sectional study, carried out at a tertiary hospital in Spain, in inpatients admitted because of COVID-19 and referred to our CLP Unit from March 17,2020 to April 28,2020. Clinical data were extracted from electronic medical records. The patients were divided in three groups depending on psychiatric diagnosis: delirium, severe mental illness (SMI) and non-severe mental illness (NSMI). Of 71 patients included (median ICR age 64 54–73 years; 70.4% male), 35.2% had a delirium, 18.3% had a SMI, and 46.5% had a NSMI. Compared to patients with delirium and NSMI, patients with SMI were younger, more likely to be institutionalized and were administered less anti-COVID19 drugs. Mortality was higher among patients with delirium (21.7%) than those with SMI (0%) or NSMI (9.45%). The rate of side effects due to interactions between anti-COVID19 and psychiatric drugs was low, mainly drowsiness (4.3%) and borderline QTc prolongation (1.5%). Patients affected by SMI were more often undertreated for COVID-19. However, the rate of interactions was very low, and avoidable with a proper evaluation and drug-dose adjustment. Half of the patients with SMI were institutionalized, suggesting that living conditions in residential facilities could make them more vulnerable to infection.
to evaluate orthogeriatric and nurse-led fracture liaison service (FLS) models of post-hip fracture care in terms of impact on mortality (30 days and 1 year) and second hip fracture (2 years).
...Hospital Episode Statistics database linked to Office for National Statistics mortality records for 11 acute hospitals in a region of England.
patients aged over 60 years admitted for a primary hip fracture from 2003 to 2013.
each hospital was analysed separately and acted as its own control in a before-after time-series design in which the appointment of an orthogeriatrician or set-up/expansion of an FLS was evaluated. Multivariable Cox regression (mortality) and competing risk survival models (second hip fracture) were used. Fixed effects meta-analysis was used to pool estimates of impact for interventions of the same type.
of 33,152 primary hip fracture patients, 1,288 sustained a second hip fracture within 2 years (age and sex standardised proportion of 4.2%). 3,033 primary hip fracture patients died within 30 days and 9,662 died within 1 year (age and sex standardised proportion of 9.5% and 29.8%, respectively). The estimated impact of introducing an orthogeriatrician on 30-day and 1-year mortality was hazard ratio (HR) = 0.73 (95% CI: 0.65-0.82) and HR = 0.81 (CI: 0.75-0.87), respectively. Following an FLS, these associations were as follows: HR = 0.80 (95% CI: 0.71-0.91) and HR = 0.84 (0.77-0.93). There was no significant impact on time to second hip fracture.
the introduction and/or expansion of orthogeriatric and FLS models of post-hip fracture care has a beneficial effect on subsequent mortality. No evidence for a reduction in second hip fracture rate was found.
A Review of: O’Toole, E., Barham, R., & Monahan, J. (2016). The impact of physically embedded librarianship on academic departments. portal: Libraries and the Academy, 16(3), 529-556. ...http://dx.doi.org/10.1353/pla.2016.0032 Objective – To examine whether liaison librarian interactions increase when librarians are physically embedded in their liaison areas. Design – Natural experiment using quantitative measures. Setting – A large, public university in the United States of America. Subjects – Liaison librarian reference interactions. Methods – This research is organized around four primary research questions that examine the effect of liaison librarian physical, co-located embeddedness on the following: 1) the frequency of walk-up reference transactions of the embedded location versus the service desk; 2) the frequency of reference and instructional transactions with liaison areas after the implementation of embedded services; 3) the frequency of walk-up transactions at embedded sites compared to the number of reference and instructional transactions after embeddedness began; and 4) liaison librarian participation in new collaborative or integrative activities with their liaison areas. Researchers used data collected between Fall 2012 and Spring 2014 and compared this to data collected in the pre-embedded period for Fall 2010 to Fall 2011. Data sources included the library’s locally developed reference services statistics tracking tool, individual librarians’ calendar appointment records, and librarian performance agreements. The analysis uses descriptive statistics. Main Results – Researchers discovered a decrease in the frequency of liaison librarians’ walk-up reference transactions at the service desk, as tracked by transactions per hour, occurring before the transition, during the transition, and after the transition to embedded librarianship. They note a decrease of 45% in the number of walk-up interactions at service points for the three librarians involved in the study from the pre-embeddedness service period during Fall 2010 as compared to Spring 2012. The data show this decline through Spring 2013 before rebounding in Fall 2013 and Spring 2014. They identified a median decline of three transactions per hour at the service desk from the pre-embeddedness to post-embeddedness periods. They identified an increase of 371% in the number of email transactions following the implementation of embedded librarianship as compared to the pre-embeddedness period. Telephone interactions declined overall during the research period, though they were already in decline before the transition to embeddedness began. The overall number of face-to-face reference appointments increased during the transition to embeddedness and continued to rise during the post-embeddedness period, with a 275% increase in the median number of appointments between pre- and post-embeddedness periods. The new embeddedness service did not have as significant an impact on the frequency of information literacy instruction sessions, with a small increase of 11.5% between the pre- and post-embeddedness periods, but it did spur the creation of online course research guides, which saw an increase of 54%. Regarding the third research question, researchers totalled the combined numbers of reference transactions by phone, email, and appointment, and compared those against walk-up interactions and also against instruction activities. In both cases, they did not discover any apparent impact of embeddedness and the frequency of these activities. The final research question addressed whether embeddedness led to liaison librarians having new collaborative and integrative activities with their subject areas. The researchers indicate that the liaison librarians “indeed experienced novel interactions with their assigned departments that fall into both categories” (p. 547). They highlight several types of activities experienced by the liaison librarians in the study, such as participating in the grant proposal process, assisting department projects, and involvement in student activities. Conclusion – This library’s expanded embedded library services led to an increased frequency of reference interactions, instruction opportunities, and opportunities for new collaborative and integrative activities between the liaison librarian and their subject area. This study reveals several opportunities for future research around embedded services as well as models of embeddedness, including opportunities to address impact and benefits of such services on the liaison areas.
To identify patients at a high risk for primary and secondary osteoporotic fractures using fracture risk assessments performed using the current method and the proposed method, in an acute care ...hospital and to identify departments where high-risk patients are admitted. This retrospective study included patients aged 40–90 years who were hospitalized at Fujita Health University Hospital. We collated the clinical data and prescriptions of all study participants. We also gathered data pertaining to risk factors according to Fracture Risk Assessment Tool (FRAX). Of the 1,595 patients, the mean number of major osteoporotic fracture risk predicted using FRAX was 11.73%. The department of rheumatology showed the highest fracture risk (18.55 ± 16.81) and had the highest number of patients on medications that resulted in reduced bone mineral density (1.07 ± 0.98 medication). Based on the FRAX, the proportion of patients in the high-risk group in this department was significantly higher compared with those in the remaining departments with respect to glucocorticoid administration, rheumatoid arthritis, and secondary osteoporosis. However, the departments included in the high-risk group were not necessarily the same as the departments included in the top group, based on the administered medications. FRAX score is calculated based on various risk factors; however, only glucocorticoid corresponds to medications. We should focus on medication prescription patterns in addition to FRAX to improve fracture risk assessment in hospital-wide surveillance. Therefore, we recommend the use of FRAX along with the prescribed medications to identify departments that admit high-risk patients.
Introduction
Delirium is characterized as a short-term consciousness and cognition disturbance which tends to fluctuate during the course of the day. It is a common and serious problem, mainly in ...hospitalized older adults, potentially avoidable and often poorly recognized.
Objectives
We propose an analysis on the theme through a work that evaluates the requests for psychiatric consultation made in a district hospital in Portugal during the course of 12 months.
Methods
We identified all patients on the requests for psychiatric consultation and obtained a demographic, clinical and consultation requests by medical specialties data and conducted statistical analysis using Excel.
Results
We identified 106 consultation requests, in which 41 cases were eventually diagnosed as delirium. Most (83%) were hyperactive delirium, 12% were hypoactive delirium and 5% were mixed delirium. Incidence was higher in males (59%) and in those aged between 66 and 80 years old (56.1%). Most consultation requests were made by Internal Medicine (46.3%), followed by General Surgery (26.8%), Pulmonology (14.6%), Orthopedics (9.8%) and Neurology (2.5%). Finally, we analyzed which symptoms mentioned in the request made physicians consider requesting a psychiatric evaluation. Approximately half of the cases (48.8%) reported psychomotor agitation, followed by temporal/spatial disorientation (41.5%) and aggressive behaviour (17.1%).
Conclusions
We highlight a still notorious lack of proper identification of delirium, resulting in symptoms being incorrectly interpreted as a psychiatric disorder. This may cause a delay in the adequate diagnosis and management of the condition, increasing the morbidity and mortality of patients.
Disclosure
No significant relationships.
Psychosocial Assessment in the Emergency Department Xanthopoulou, Penny; Ryan, Mary; Lomas, Matthew ...
Crisis : the journal of crisis intervention and suicide prevention,
07/2022, Letnik:
43, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Background: In the United Kingdom, suicide risk is assessed in
the emergency department (ED) in a face-to-face assessment with psychiatric
liaison practitioners. This study aimed to explore patient ...experiences of
psychosocial assessment after presenting with self-harm/suicidality.
Method: A total of 28 patients were interviewed within 2
weeks of ED attendance for self-harm/suicidality. Interviews were transcribed
and analyzed using inductive thematic analysis. Results: People
described two different experiences. A therapeutic interaction was about the
"person" and made people feel their life mattered and instilled
hope for the future. This was characterized by: unscripted conversation; warmth
promoting disclosure; psychological exploration of feelings; validation of
distress; and a coproduced care plan. A formulaic assessment was about the
"risk" and made people feel their life did not matter and hopeless
about the future. This was characterized by: feeling judged and not worthy of
help; a focus on risk and form filling; a trivial treatment plan; and loss of
trust in services. Limitations: Our study comprised a single ED
and used a non-diverse sample. Conclusion: Psychosocial
assessment in the ED impacts on hope for people in crisis. A focus on
therapeutic communication that is about the person, as well as the risk,
improves patient experience, decreases distress, and instills hope that life is
worth living.
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