scholarly journals LO34: System and patient level determinants of EMS offload delay

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S39
Author(s):  
G. Innes ◽  
D. Stewart ◽  
D. Wang ◽  
E. Lang
Keyword(s):  
Mental Health ◽  
Odds Ratio ◽  
Night Shift ◽  
Vital Signs ◽  
Care Needs ◽  
Fluid Bolus ◽  
Living Situation ◽  
Patient Level ◽  
Age Dependent ◽  
Offload Delay

Introduction: Arriving EMS patients often experience offload delay due to a lack of available care spaces. Arrival in an overcrowded ED is the primary cause of offload delay, but patient characteristics may also play a role. Our objective was to describe system and patient level determinants of offload delay. Methods: From July 2013 to June 2016, administrative data was collated from the four Calgary Zone adult EDs. All CTAS level 2 and 3 patients arriving by ambulance were eligible for study. To define patient complexity and illness severity, we captured patient demographic data, living situation (homecare/facility vs. independent), vital signs, complaint category (medical, cardiovascular, mental health/neuro, GI, trauma/MS, other), biochemical parameters (serum Na, K, creatinine, hemoglobin, WBC), patient care needs (IV fluid bolus, IV antibiotics, CT scan, admission) and mortality at 7 and 30 days. Results: 162,002 EMS patients were studied. Of these, 67,785 went to a care space within 15 minutes (minimal offload delay), 53,185 between 15 and 59 minutes (moderate offload delay), and 41,032 at ≥60 minutes (severe offload delay). Vital signs, biochemical and hematologic parameters did not differ between groups. ED site was a strong predictor of offload delay (odds ratio {OR}=1.0, 2.03, 2.14, 3.5 for the 4 EDs), as was arrival on weekday (OR=1.38) or night shift (OR=0.71). After adjusting for site, day and time of arrival, multivariate logistic regression models showed the following associations with offload delays of more than 15 minutes: male sex (OR=0.94), age (OR=1.01 per year of age), dependent living situation (OR=1.15), CTAS 3 acuity (OR=1.27), number of prior ED visits within a year (OR=1.06 per visit), and complaint category: general medical (1.0), cardiovascular (0.90), mental health/neuro (0.90), GI (0.85), trauma/MS (0.61). Odds ratio estimates were precise—all with p<0.001. Offload delay was associated with prolonged time to MD, increased EDLOS and higher LWBS/AMA rates. Delayed patients had similar rates of IV antibiotic use, but lower rates of IV fluid bolus, CT use, admission, and 7-day mortality. Conclusion: The strongest predictor of offload delay is arrival to a crowded ED, but patient factors including female sex, older age, dependent living status and repeat hospital use increase risk. Patients subjected to offload delay also appear to have lesser immediate care needs and lower short-term mortality.

scholarly journals Remote Patient Monitoring Using Radio Frequency Identification (RFID) Technology and Machine Learning for Early Detection of Suicidal Behaviour in Mental Health Facilities

Sensors ◽  
2021 ◽  
Vol 21 (3) ◽  
pp. 776
Author(s):  
Xiaohui Tao ◽  
Thanveer Basha Shaik ◽  
Niall Higgins ◽  
Raj Gururajan ◽  
Xujuan Zhou
Keyword(s):  
Mental Health ◽  
Machine Learning ◽  
Radio Frequency Identification ◽  
Patient Monitoring ◽  
Vital Signs ◽  
Remote Patient Monitoring ◽  
Rfid Technology ◽  
Rpm System ◽  
Frequency Identification ◽  
Remote Patient

Remote Patient Monitoring (RPM) has gained great popularity with an aim to measure vital signs and gain patient related information in clinics. RPM can be achieved with noninvasive digital technology without hindering a patient’s daily activities and can enhance the efficiency of healthcare delivery in acute clinical settings. In this study, an RPM system was built using radio frequency identification (RFID) technology for early detection of suicidal behaviour in a hospital-based mental health facility. A range of machine learning models such as Linear Regression, Decision Tree, Random Forest, and XGBoost were investigated to help determine the optimum fixed positions of RFID reader–antennas in a simulated hospital ward. Empirical experiments showed that Decision Tree had the best performance compared to Random Forest and XGBoost models. An Ensemble Learning model was also developed, took advantage of these machine learning models based on their individual performance. The research set a path to analyse dynamic moving RFID tags and builds an RPM system to help retrieve patient vital signs such as heart rate, pulse rate, respiration rate and subtle motions to make this research state-of-the-art in terms of managing acute suicidal and self-harm behaviour in a mental health ward.

Treatment alliance and needs of care concerning religiousness and spirituality: A follow-up study among psychiatric inpatients

2021 ◽  
pp. 002076402110230
Author(s):  
Joke C van Nieuw Amerongen-Meeuse ◽  
Arjan W Braam ◽  
Christa Anbeek ◽  
Jos WR Twisk ◽  
Hanneke Schaap-Jonker
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Structural Equation ◽  
Treatment Compliance ◽  
Health Clinic ◽  
Care Needs ◽  
Service Engagement ◽  
Treatment Alliance ◽  
Over Time

Background: Patient satisfaction with religious/spiritual (R/S) care during mental health treatment has been associated with a better treatment alliance. Aims: To investigate the longitudinal relations between (un)met R/S care needs and treatment alliance/compliance over a 6-month period. Method: 201 patients in a Christian (CC) and a secular mental health clinic completed a questionnaire (T0) containing an R/S care needs questionnaire, the Working Alliance Inventory (WAI) and the Service Engagement Scale (SES). After 6 months 136 of them took part in a follow-up (T1). Associations were analysed using hybrid linear mixed models and structural equation modelling. Results: R/S care needs decreased over time, but a similar percentage remained unanswered (e.g. 67% of the needs on R/S conversations in a secular setting). Over a 6-month period, met R/S care needs were associated with a higher WAI score (β = .25; p < .001), and unmet R/S care needs with lower WAI score (β = −.36; p < .001), which were mainly between subjects effects. Patients reporting a high score of unmet R/S care at baseline, reported a decrease in SES over time (β = −.13; p < .05). Conclusions: Satisfaction with R/S care among mental health patients is related to a better treatment alliance. When unmet R/S care needs persist, they precede a decrease in treatment compliance. Mental health professionals are recommended to assess the presence of R/S care needs and consider possibilities of R/S care especially in the first weeks of treatment.

scholarly journals Association between accessibility to elementary school and depression in older Adults: JAGES Study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Nishida ◽  
M Hanazato ◽  
K Kondo
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Elementary School ◽  
Odds Ratio ◽  
Local Community ◽  
Depression Scale ◽  
Later Life ◽  
Positive Effects ◽  
Intergenerational Exchange ◽  
Geographical Accessibility

Abstract Background The connection in a local community has diluted in an aging society, and the importance of intergenerational exchange has increased for older adults' health. Some positive effects of intergenerational exchange have reported. For example, a reciprocal intergenerational exchange contributes to better mental health in later life. However, there is little evidence of the relationship between neighborhood environments causing intergenerational exchange and the health status of older adults. This study investigated the association between geographical accessibility to elementary school, enhancing intergenerational exchange, and depression in older adults. Methods The data were retrieved from the Japan Gerontological Evaluation Study (JAGES) 2016, a population-based study of independently living people ≥65 years old. The dependent variable is depression evaluated by the Geriatric Depression Scale (GDS≥5). The geographical accessibility to elementary School is the distance between the representative points of their residences and the nearest elementary school. Logistic regression analysis calculates the odds ratio to determine the association between depression and accessibility to elementary school and compare models to examine the effect of intermediate factors. Results Overall, 20.4% of the participants had depression. Compared with the longest distance from elementary school (≥950m), the odds ratio was 0.91 (95% CI = 0.86, 0.96) for the nearest category (&lt;330m), 0.91 (95% CI = 0.87, 0.96) for the second-nearest (330-490m) and 0.94 (95% CI = 0.89, 0.99) for the third (490-670m) in model 1. After adjusting for intermediate factors, the odds ratio was 0.94 for the first and second-nearest groups. Conclusions Geographical accessibility to elementary school was associated with decreased depression for older adults. The result indicates that older adults' daily meetings with children around elementary schools can result in a positive effect on their mental health. Key messages Geographical accessibility to elementary school was associated with decreased depression for older adults. The neighborhood design enhancing intergenerational exchange might be useful for age-friendly cities.

scholarly journals Predictors of postpartum family planning in Rwanda: the influence of male involvement and healthcare experience

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pamela Williams ◽  
Nicole Santos ◽  
Hana Azman-Firdaus ◽  
Sabine Musange ◽  
Dilys Walker ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Status ◽  
Family Planning ◽  
Locus Of Control ◽  
Sample Size ◽  
Odds Ratio ◽  
Male Involvement ◽  
Mental Health Status ◽  
Respectful Maternity Care ◽  
Postpartum Family Planning

Abstract Background Strengthened efforts in postpartum family planning (PPFP) is a key priority to accelerate progress in reproductive, maternal, newborn, and child health outcomes. This secondary data analysis explores factors associated with PPFP uptake in Rwanda. The purpose of this study was to explore variables that may influence PPFP use for postpartum women in Rwanda including health facility type, respectful maternity care, locus of control, and mental health status. Methods This secondary analysis of data from a cluster randomized control trial used information abstracted from questionnaires administered to women (≥ 15 years of age) at two time points—one during pregnancy (baseline) and one after delivery of the baby (follow-up). The dependent variable, PPFP uptake, was evaluated against the independent variables: respectful care, locus of control, and mental health status. These data were abstracted from linked questionnaires completed from January 2017 to February 2019. The sample size provided 97% power to detect a change at a 95% significance level with a sample size of 640 at a 15% effect size. Chi-square testing was applied for the bivariate analyses. A logistic regression model using the generalized linear model function was performed; odds ratio and adjusted (by age group and education group) odds ratio with 95% confidence interval were reported. Results Of the 646 respondents, although 92% reported not wanting another pregnancy within the next year, 72% used PPFP. Antenatal care wait time (p =  < 0.01; Adj OR (Adj 95% CI) 21–40 min: 2.35 (1.46,3.79); 41–60 min: 1.50 (0.84,2.69); 61–450 min: 5.42 (2.86,10.75) and reporting joint healthcare decision-making between the woman and her partner (male) (p = 0.04; Adj OR (Adj 95% CI) husband/partner: 0.59 (0.35,0.97); mother and partner jointly: 1.06 (0.66,1.72) were associated with PPFP uptake. Conclusions These results illustrate that partner (male) involvement and improved quality of maternal health services may improve PPFP utilization in Rwanda.

scholarly journals Deterioration of housing environment and mental health of asylum seekers – a multi-level analysis

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Mohsenpour ◽  
L Biddle ◽  
K Bozorgmehr
Keyword(s):  
Mental Health ◽  
Internal Consistency ◽  
Odds Ratio ◽  
Asylum Seekers ◽  
Rapid Assessment ◽  
Living Environment ◽  
Generalized Anxiety ◽  
Rater Reliability ◽  
General Anxiety ◽  
Housing Environment

Abstract Background Asylum seekers arriving in Germany are assigned to a local district and an accommodation centre wherein. We developed and validated a six-item questionnaire for rapid assessment of housing deterioration and investigated its association with inhabitant mental health. Methods Using cross-sectional data from a state-wide survey in Germany, we applied a random-effects modelling approach to estimate the exposure effect of housing deterioration on depression and general anxiety among a random sample of asylum seekers, using validated instruments (GAD2/PHQ2) for outcome variables. Housing deterioration was assessed on six items (windows/glass, walls/roof, garbage, graffiti, outside spaces, overall living environment) resulting in a deterioration score as exposure of interest. Additionally, we assessed the instrument’s intra- and inter-rater reliability and internal consistency. Results Of the 412 asylum seekers living in 58 accommodation centres, 45.7% reported symptoms of depression and 45.0% suffered general anxiety. Most centres (76.7%) were based in urban municipalities and 45.7% of inhabitants were living in an accommodation centre hosting ≥51 inhabitants. Preliminary adjusted odds ratio for accommodation centres with highest deterioration (Q 4) was 2.07 (0.67-6.40) for generalized anxiety, compared to 1.17 (0.45-3.08) for centres with lowest deterioration (Q 1). For depression, preliminary odds ratio was 1.92 (0.87-4.27) compared to 1.26 (0.63-2.50). The validation study confirmed inter-/intra-rater reliability (Brennan-Prediger coefficient: 0.81 and 0.92, respectively) and internal consistency (Crohnbach’s α: 0.80). Conclusions There are higher odds ratios for generalized anxiety disorder and depression among asylum seekers based on higher deterioration of housing environment. A questionnaire for rapid deterioration assessment and identification of accommodations needing further evaluation has been developed and successfully validated. Key messages Deterioration of small-scale housing environment is associated with poorer mental health for asylum seekers living in accommodation centres. A highly reliable new tool has been developed for rapid assessment of deterioration status of accommodation centres and identification of those needing further evaluation.

scholarly journals Addressing the Role of Smart Robotic Health Assistants Within the Human-Machine Frontier of Geriatric Healthcare

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 409-410
Author(s):  
Nadia Firdausya ◽  
Alex Bishop ◽  
Barbara Carlson ◽  
Weihua Sheng
Keyword(s):  
Behavioral Intervention ◽  
Health Monitoring ◽  
Vital Signs ◽  
Case Managers ◽  
Health Care Information ◽  
Care Needs ◽  
Advisory Groups ◽  
Viable Solution ◽  
Robotic Assistant ◽  
Robot Assistant

Abstract Data for this study was acquired from three separate stakeholder focus group sessions involving nurse case managers (n = 5), social agency caseworkers (n = 5), and rural outreach providers (n = 5). Participants across all groups were asked to address the question: “When it comes to your work, what would you want a smart robot assistant to do for you?” Data from the three sessions were combined, transcribed verbatim, coded, and analyzed for thematic content. Three shared themes emerged, including health monitoring, behavioral intervention, and healthcare literacy. Relative to health monitoring, participants desired a robot that possessed functions in the form of “taking vital signs,” and “tracking water and food intake.” There was also a thematic agreement regarding behavioral intervention capabilities. Most notably, advisory stakeholders acknowledged a need for a smart robotic assistant to provide geriatric care recipients with “an alert or reminder to take medication.” This was viewed as an essential intervention for improving medication adherence. Healthcare literacy emerged as a final theme among advisory groups. In particular, participants noted that a smart robot should assist with bi-directional communication and translation of health care information and instructions as a way to “minimize impediments of care due to language barriers.” Findings will be further used to highlight how future integration of robotic health assistants represents a viable solution in helping geriatric healthcare workers work effectively alongside machines to meet the diverse care needs of older adults in both urban and rural settings.

scholarly journals Impact of the level of sickness on higher mortality in emergency medical admissions to hospital at weekends

2017 ◽  
Vol 22 (4) ◽  
pp. 236-242 ◽  
Author(s):  
Mohammed Mohammed ◽  
Muhammad Faisal ◽  
Donald Richardson ◽  
Robin Howes ◽  
Kevin Beatson ◽  
...  
Keyword(s):  
Early Warning ◽  
Odds Ratio ◽  
Vital Signs ◽  
Early Warning Score ◽  
Emergency Admissions ◽  
Clinical Assessments ◽  
Admission Time ◽  
Emergency Medical ◽  
Acute Hospitals ◽  
National Early Warning Score

Objective Routine administrative data have been used to show that patients admitted to hospitals over the weekend appear to have a higher mortality compared to weekday admissions. Such data do not take the severity of sickness of a patient on admission into account. Our aim was to incorporate a standardized vital signs physiological-based measure of sickness known as the National Early Warning Score to investigate if weekend admissions are: sicker as measured by their index National Early Warning Score; have an increased mortality; and experience longer delays in the recording of their index National Early Warning Score. Methods We extracted details of all adult emergency medical admissions during 2014 from hospital databases and linked these with electronic National Early Warning Score data in four acute hospitals. We analysed 47,117 emergency admissions after excluding 1657 records, where National Early Warning Score was missing or the first (index) National Early Warning Score was recorded outside ±24 h of the admission time. Results Emergency medical admissions at the weekend had higher index National Early Warning Score (weekend: 2.53 vs. weekday: 2.30, p < 0.001) with a higher mortality (weekend: 706/11,332 6.23% vs. weekday: 2039/35,785 5.70%; odds ratio = 1.10, 95% CI 1.01 to 1.20, p = 0.04) which was no longer seen after adjusting for the index National Early Warning Score (odds ratio = 0.99, 95% CI 0.90 to 1.09, p = 0.87). Index National Early Warning Score was recorded sooner (−0.45 h, 95% CI −0.52 to −0.38, p < 0.001) for weekend admissions. Conclusions Emergency medical admissions at the weekend with electronic National Early Warning Score recorded within 24 h are sicker, have earlier clinical assessments, and after adjusting for the severity of their sickness, do not appear to have a higher mortality compared to weekday admissions. A larger definitive study to confirm these findings is needed.

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