Responding to a Tragedy: Evaluation of a Postvention Protocol Among Adult Psychiatry Residents

Abstract Objective In a time of “zero suicide” initiatives and rising suicide rates, resident physicians are particularly susceptible to the psychological and professional ramifications of patient suicide. An adult psychiatry residency program developed and implemented a postvention protocol to address the impact of patient suicide among resident physicians. The current study is a formal evaluation of a training program’s postvention protocol from June 2018 to April 2020. Methods Process and outcome indicators were identified to assess protocol implementation and effectiveness. Process indicators included were postvention protocol adherence. Outcome indicators were perceived helpfulness of postvention protocol–related supports, occupational and general health measures, posttraumatic growth, and posttraumatic stress symptoms following resident participation in the postvention protocol. Results Study response rate was 97% (n = 57/59) and 81% completed the entire survey (n = 48/59). Twenty percent of residents (n = 10/48) experienced patient suicide during residency. Postvention protocol adherence was between 57 and 100%. Protocol-related supports, such as speaking with attendings who had previously experienced an adverse event, were more helpful than other supports (p < 0.01). Compared to residents who had not experienced patient suicide, mean work empowerment, burnout, mental health, and quality of life scores were not significantly different from residents who participated in the postvention protocol (p > 0.05). Posttraumatic growth was positively correlated with self-determination at work (p = 0.01). Conclusions The postvention protocol was helpful to residents and potentially effective at mitigating the psychological and professional consequences of patient suicide. Study findings may inform standardization of postvention protocols among psychiatry training programs.

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Анализ «Методики разработки нормативов допустимых сбросов веществ и микроорганизмов в водные объекты для водопользователей» в общем контексте водоохранного законодательства (в порядке обсуждения)

Vodosnabzhenie i sanitarnaia tehnika ◽

10.35776/mnp.2020.02.05 ◽

2020 ◽

Author(s):

I. Saakian ◽

Aleksandr, Grigor’ev ◽

E. Kravets ◽

E. Rudakov ◽

A. Faddeev ◽

...

Keyword(s):

Water Quality ◽

Water Bodies ◽

Anthropogenic Factors ◽

Water Protection ◽

Best Available Technologies ◽

Process Indicators ◽

Water Users ◽

Quality Of Water ◽

Protection Legislation ◽

The Impact

Выполнен анализ действующей редакции Методики разработки нормативов допустимых сбросов веществ и микроорганизмов в водные объекты для водопользователей , утвержденной приказом Минприроды России от 17 декабря 2007 г. 333, на предмет непротиворечивости и соответствия нормам водоохранного законодательства. Выявлена неопределенность применения Методики в условиях воздействия на качество воды природных и антропогенных факторов, не зависящих от конкретного водопользователя. Положения Методики противоречат принципам нормирования воздействия на водные объекты на основе наилучших доступных технологий, что было показано на примерах утвержденных технологических показателей содержания загрязняющих веществ в сточных водах различных отраслей промышленности. Анализ системы нормирования допустимых воздействий на водные объекты и географической дифференциации нормативов качества воды в пределах Российской Федерации вместе с системой целевых показателей качества воды также показал несоответствие Методики основным принципам водоохранного законодательства.The analysis of the current edition of the Methods of developing standards for permissible discharges of substances and microorganisms into water bodies for water users , approved by the Order of the Ministry of Natural Resources of Russia dated December 17, 2007 No. 333 for consilience and compliance with the regulations of the water protection legislation, is carried out. Uncertainty of the application of the Methods in the conditions of the impact of natural and anthropogenic factors that are independent of a specific water user on the quality of water has been identified. The provisions of the Methods contradict the principles of regulating the impact on water bodies based on the best available technologies shown on the examples of approved process indicators of the concentrations of various industrial pollutants in wastewater. An analysis of the system of regulating the permissible impact on water bodies and the geographical differentiation of water quality standards within the boundaries of the Russian Federation, together with the system of water quality targets, also showed that the Methods do not comply with the basic principles of the water protection legislation.

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The impact of strict and forced confinement due to the COVID-19 pandemic on positive functioning variables, emotional distress, and posttraumatic growth in a Spanish sample

European Journal of Psychotraumatology ◽

10.1080/20008198.2021.1918900 ◽

2021 ◽

Vol 12 (1) ◽

pp. 1918900

Author(s):

Marta Miragall ◽

Rocío Herrero ◽

M Dolores Vara ◽

Laura Galiana ◽

Rosa M Baños

Keyword(s):

Posttraumatic Growth ◽

Emotional Distress ◽

Positive Functioning ◽

The Impact

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Considering the Impact of Early Trauma on Coping and Pathology to Predict Posttraumatic Growth Among 9-1-1 Telecommunicators

Journal of Interpersonal Violence ◽

10.1177/0886260517716942 ◽

2017 ◽

Vol 35 (21-22) ◽

pp. 4709-4731 ◽

Cited By ~ 2

Author(s):

Melissa J. London ◽

Mary C. Mercer ◽

Michelle M. Lilly

Keyword(s):

Posttraumatic Growth ◽

Childhood Trauma ◽

Indirect Effect ◽

Structural Equation ◽

Structural Equation Models ◽

Trauma Exposure ◽

First Responders ◽

Lifetime Trauma ◽

Early Trauma ◽

The Impact

Recent research has demonstrated that first responders may report posttraumatic growth (PTG), positive psychological changes that arise in the aftermath of a trauma. Less is known regarding the perception of PTG among 9-1-1 telecommunicators, a group of first responders exposed to a high degree of lifetime trauma, including duty-related trauma as well as early and non-duty-related trauma. Moreover, the impact of childhood trauma on the processes involved in the perception of growth is less clear. While some distress is needed to facilitate processes that lead to the perception of PTG, it has been suggested that positive associations between PTG and pathology reflect avoidant coping or represent an illusory component of PTG. Structural equation models were used to examine early trauma exposure, coping, and pathology in predicting PTG among 9-1-1 telecommunicators ( N = 788). In separate models using active and avoidant forms of coping, childhood trauma exposure had an indirect effect on PTG through coping. In a model considering both forms of coping, childhood trauma had an indirect effect on PTG through psychopathology, but not through coping. The results show that early trauma exposure leads to the perception of growth through pathways indicative of both adaptive and maladaptive coping processes.

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The impact of suicide on community mental health teams: findings and recommendations

Psychiatric Bulletin ◽

10.1192/pb.26.2.50 ◽

2002 ◽

Vol 26 (2) ◽

pp. 50-52 ◽

Cited By ~ 21

Author(s):

Stuart Linke ◽

Jenny Wojciak ◽

Samantha Day

Keyword(s):

Mental Health ◽

Community Mental Health ◽

Adverse Effects ◽

Clinical Implications ◽

Professional Lives ◽

Patient Suicide ◽

Personal Impact ◽

Sources Of Support ◽

Team Functioning ◽

The Impact

Aims and MethodThe study investigated the personal impact of patient suicides on the members of community mental health teams and the sources of support utilised for coping with adverse effects.ResultsForty-four questionnaires were returned. Eighty-six per cent of staff reported having had at least one patient suicide, with an average of 4.2 suicides. The majority of staff reported that patient suicides had significant adverse effects on their personal and professional lives. Some of the effects were long-lasting (greater than 1 month). Staff found that peer support, reviews, dedicated staff meetings and support from senior colleagues were of most value.Clinical ImplicationsStaff require skilled and dedicated support following a patient suicide in order to minimise its detrimental effects on personal, professional and team functioning.

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Communicating Guideline Recommendations Using Graphic Narrative Versus Text-Based Broadcast Screensavers: Design and Implementation Study (Preprint)

10.2196/preprints.27171 ◽

2021 ◽

Author(s):

Lauren Sinnenberg ◽

Craig A Umscheid ◽

Frances S Shofer ◽

Damien Leri ◽

Zachary F Meisel

Keyword(s):

Clinical Practice ◽

High Volume ◽

Suppressive Therapy ◽

Guideline Recommendation ◽

Graphic Narrative ◽

Design And Implementation ◽

Resident Physicians ◽

Graphic Narratives ◽

The One ◽

The Impact

BACKGROUND The use of graphic narratives, defined as stories that use images for narration, is growing in health communication. OBJECTIVE The aim of this study was to describe the design and implementation of a graphic narrative screensaver (GNS) to communicate a guideline recommendation (ie, avoiding low-value acid suppressive therapy [AST] use in hospital inpatients) and examine the comparative effectiveness of the GNS versus a text-based screensaver (TBS) on clinical practice (ie, low-value AST prescriptions) and clinician recall. METHODS During a 2-year period, the GNS and the TBS were displayed on inpatient clinical workstations. The numbers of new AST prescriptions were examined in the four quarters before, the three quarters during, and the one quarter after screensavers were implemented. Additionally, an electronic survey was sent to resident physicians 1 year after the intervention to assess screensaver recall. RESULTS Designing an aesthetically engaging graphic that could be rapidly understood was critical in the development of the GNS. The odds of receiving an AST prescription on medicine and medicine subspecialty services after the screensavers were implemented were lower for all four quarters (ie, GNS and TBS broadcast together, only TBS broadcast, only GNS broadcast, and no AST screensavers broadcast) compared to the quarter prior to implementation (odds ratio [OR] 0.85, 95% CI 0.78-0.92; OR 0.89, 95% CI 0.82-0.97; OR 0.87, 95% CI 0.80-0.95; and OR 0.81, 95% CI 0.75-0.89, respectively; P<.001 for all comparisons). There were no statistically significant decreases for other high-volume services, such as the surgical services. These declines appear to have begun prior to screensaver implementation. When surveyed about the screensaver content 1 year later, resident physicians recalled both the GNS and TBS (43/70, 61%, vs 54/70, 77%; P=.07) and those who recalled the screensaver were more likely to recall the main message of the GNS compared to the TBS (30/43, 70%, vs 1/54, 2%; P<.001). CONCLUSIONS It is feasible to use a graphic narrative embedded in a broadcast screensaver to communicate a guideline recommendation, but further study is needed to determine the impact of graphic narratives on clinical practice.

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An audit: fitness to drive assessment in inpatients of general adult and old age psychiatry

BJPsych Open ◽

10.1192/bjo.2021.538 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S200-S201

Author(s):

Ismail Khan ◽

Nneamaka Asiodu ◽

Dr Divyanish ◽

Anum Yaqoob ◽

Hasanain Qureshi

Keyword(s):

Old Age ◽

Social Withdrawal ◽

Data Collection Tool ◽

Fitness To Drive ◽

Good Medical Practice ◽

Adult Psychiatry ◽

Old Age Psychiatry ◽

Duty To Inform ◽

The Impact ◽

Physical Health Screening

AimsTo determine if fitness to drive is assessed on admission and discharge, if applicable, and for this to be documented during clerking and on discharge notifications.To determine if patients are being educated about the impact of their condition on the ability to safely drive.To ascertain if patients are aware of the duty to inform the DVLA if they for any reason are not fit to drive.BackgroundRisk factors include social, behavior and iatrogenic factors such as social withdrawal, increased likelihood of substance abuse and side effects of anti-psychotic medication.MethodThis trust wide audit involved the random sampling of a total of 71 case notes, 4 case notes per Consultant team in general adult psychiatry and old age psychiatry across Dudley and Walsall sites (total of 3 sites). A data collection tool was developed and included relevant questions regarding fitness to drive. Data were collected between October and December 2019.Result18/49 patients had physical health screening prior to medication initiation.ConclusionAn important aspect of good medical practice is to educate patients about their condition, this includes their fitness to drive as this can be affected both by their diagnosis and medication. It is clear that clinicians also need to be educated about this responsibility to ensure assessment is performed especially on inpatient discharge.

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Mining for Posttraumatic Growth (PTG) in Sexual Minority Women Who Survive Intimate Partner Violence: A Conceptual Perspective

Behavioral Sciences ◽

10.3390/bs8090077 ◽

2018 ◽

Vol 8 (9) ◽

pp. 77 ◽

Cited By ~ 1

Author(s):

Elisabeth Counselman-Carpenter ◽

Alex Redcay

Keyword(s):

Intimate Partner Violence ◽

Posttraumatic Growth ◽

Sexual Minority ◽

Partner Violence ◽

Intimate Partner ◽

Minority Women ◽

Traumatic Experiences ◽

Sexual Minority Women ◽

The Impact ◽

The Relationship

This theoretical paper explores the need to use posttraumatic growth (PTG) as a framework when studying sexual minority women (SMW) who are survivors of intimate partner violence (IPV) to examine the relationship between risk factors such as stress, anxiety and alcohol use and to understand the role of protective factors through mining for the presence of posttraumatic growth (PTG). Despite a call for continued research in this highly vulnerable population, representative studies of SMW and PTG remain extremely limited. Research that examines the relationship between IPV, behavioral health issues, and posttraumatic growth would provide the opportunity to develop tailored intervention models and opportunities for program development to decrease isolation and increase factors of posttraumatic growth. In particular, the impact of how interpersonal relationships as potential mediators and/or outcomes of posttraumatic growth (PTG) needs to be explored more thoroughly. PTG is a valuable framework for vulnerable populations such as sexual minority women because it focuses on how transformative change may result from traumatic experiences such as surviving IPV.

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Resident Physician Experience and Duration of Electronic Health Record Use

Applied Clinical Informatics ◽

10.1055/s-0041-1732403 ◽

2021 ◽

Vol 12 (04) ◽

pp. 721-728

Author(s):

A. Jay Holmgren ◽

Brenessa Lindeman ◽

Eric W. Ford

Keyword(s):

Care Delivery ◽

Well Being ◽

Early Career ◽

Ambulatory Setting ◽

Care Experience ◽

Resident Physicians ◽

Physician Time ◽

After Hours ◽

Electronic Health ◽

The Impact

Abstract Background Electronic health records (EHRs) demand a significant amount of physician time for documentation, orders, and communication during care delivery. Resident physicians already work long hours as they gain experience and develop both clinical and socio-technical skills. Objectives Measure how much time resident physicians spend in the EHR during clinic hours and after-hours, and how EHR usage changes as they gain experience over a 12-month period. Methods Longitudinal descriptive study where participants were 622 resident physicians across postgraduate year cohorts (of 948 resident physicians at the institution, 65.6%) working in an ambulatory setting from July 2017 to June 2018. Time spent in the EHR per patient, patients records documented per day, and proportion of EHR time spent after-hours were the outcome, while the number of months of ambulatory care experience was the predictor. Results Resident physicians spent an average of 45.6 minutes in the EHR per patient, with 13.5% of that time spent after-hours. Over 12 months of ambulatory experience, resident physicians reduced their EHR time per patient and saw more patients per day, but the proportion of EHR time after-hours did not change. Conclusion Resident physicians spend a significant amount of time working in the EHR, both during and after clinic hours. While residents improve efficiency in reducing EHR time per patient, they do not reduce the proportion of EHR time spent after-hours. Concerns over the impact of EHRs on physician well-being should include recognition of the burden of EHR usage on early-career physicians.

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The impact of general practitioners’ gender on process indicators in Hungarian primary healthcare: a nation-wide cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-027296 ◽

2019 ◽

Vol 9 (9) ◽

pp. e027296 ◽

Cited By ~ 1

Author(s):

Nóra Kovács ◽

Orsolya Varga ◽

Attila Nagy ◽

Anita Pálinkás ◽

Valéria Sipos ◽

...

Keyword(s):

Primary Care ◽

Primary Healthcare ◽

Cross Sectional Study ◽

Gender Effect ◽

Sectional Study ◽

Cross Sectional ◽

Process Indicators ◽

Wide Cross ◽

The Impact

ObjectivesThe objectives of our study were (1) to investigate the association between gender of the general practitioner (GP) and the quality of primary care in Hungary with respect to process indicators for GP performance and (2) to assess the size of the gender impact.Study designA nation-wide cross-sectional study was performed in 2016.Setting and participantsThe study covered all general medical practices in Hungary (n=4575) responsible for the provision of primary healthcare (PHC) for adults. All GPs in their private practices are solo practitioners.Main outcome measuresMultilevel logistic regression models were used to analyse the association between GP gender and process indicators of PHC, and attributable proportion (AP) was calculated.Results48% of the GPs (n=2213) were women in the study. The crude rates of care provided by female GPs were significantly higher for seven out of eight evaluated indicators than those provided by male GPs. Adjusted for practice, physician and patient factors, GP gender was associated with the haemoglobin A1c (HbA1c) measurement: OR=1.18, 95% CI (1.14 to 1.23); serum creatinine measurement: OR=1.14, 95% CI (1.12 to 1.17); lipid measurement: OR=1.14, 95% CI (1.11 to 1.16); eye examination: OR=1.06, 95% CI (1.03 to 1.08); mammography screening: OR=1.05, 95% CI (1.03 to 1.08); management of patients with chronic obstructive pulmonary disease: OR=1.05, 95% CI (1.01 to 1.09) and the composite indicator: OR=1.08, 95% CI (1.07 to 1.1), which summarises the number of care events and size of target populations of each indicator. The AP at the specific indicators varied from 0.97% (95% CI 0.49% to 1.44%) of influenza immunisation to 8.04% (95% CI 7.4% to 8.67%) of eye examinations.ConclusionFemale GP gender was an independent predictor of receiving higher quality of care. The actual size of the gender effect on the quality of services seemed to be notable. Factors behind the gender effect should receive more attention in quality improvement particularly in countries where the primary care is organised around solo practices.

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