Fifteen-minute consultation: Bruising in the premobile child

2021 ◽  
pp. edpract-2021-321661
Author(s):  
Fiona Wallace ◽  
Julie-Ann Collins ◽  
Nishanthi Talawila Da Camara ◽  
Alison Mary Kemp ◽  
Ingrid Prosser ◽  
...  
Keyword(s):  
Physical Abuse ◽  
Multidisciplinary Team ◽  
Emergency Departments ◽  
Evidence Base ◽  
Case Vignette

A bruise in a premobile infant is an uncommon finding and often results in referral to the paediatric or emergency departments, acknowledging the potential for physical abuse in this vulnerable cohort. Our role as clinicians is to undertake a thorough assessment, consider potential differentials and organise appropriate investigations, with involvement of the wider multidisciplinary team. In this article, we use a case vignette to discuss how one would approach a bruise in the premobile infant including the evidence base.

scholarly journals Development of an intervention to increase adherence to nebuliser treatment in adults with cystic fibrosis: CFHealthHub

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
M. A. Arden ◽  
M. Hutchings ◽  
P. Whelan ◽  
S. J. Drabble ◽  
D. Beever ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Development Strategy ◽  
Treatment Adherence ◽  
Behaviour Change ◽  
Multidisciplinary Team ◽  
Treatment Plan ◽  
Controlled Trial ◽  
Intervention Development ◽  
Evidence Base ◽  
Behaviour Change Techniques

Abstract Background Cystic fibrosis (CF) is a life-limiting genetic condition in which daily therapies to maintain lung health are critical, yet treatment adherence is low. Previous interventions to increase adherence have been largely unsuccessful and this is likely due to a lack of focus on behavioural evidence and theory alongside input from people with CF. This intervention is based on a digital platform that collects and displays objective nebuliser adherence data. The purpose of this paper is to identify the specific components of an intervention to increase and maintain adherence to nebuliser treatments in adults with CF with a focus on reducing effort and treatment burden. Methods Intervention development was informed by the Behaviour Change Wheel (BCW) and person-based approach (PBA). A multidisciplinary team conducted qualitative research to inform a needs analysis, selected, and refined intervention components and methods of delivery, mapped adherence-related barriers and facilitators, associated intervention functions and behaviour change techniques, and utilised iterative feedback to develop and refine content and processes. Results Results indicated that people with CF need to understand their treatment, be able to monitor adherence, have treatment goals and feedback and confidence in their ability to adhere, have a treatment plan to develop habits for treatment, and be able to solve problems around treatment adherence. Behaviour change techniques were selected to address each of these needs and were incorporated into the digital intervention developed iteratively, alongside a manual and training for health professionals. Feedback from people with CF and clinicians helped to refine the intervention which could be tailored to individual patient needs. Conclusions The intervention development process is underpinned by a strong theoretical framework and evidence base and was developed by a multidisciplinary team with a range of skills and expertise integrated with substantial input from patients and clinicians. This multifaceted development strategy has ensured that the intervention is usable and acceptable to people with CF and clinicians, providing the best chance of success in supporting people with CF with different needs to increase and maintain their adherence. The intervention is being tested in a randomised controlled trial across 19 UK sites.

scholarly journals Neuropsychological aspects of psychogenic nonepileptic seizures

2007 ◽  
Vol 13 (4 suppl 1) ◽  
pp. 24-27
Author(s):  
Mirna Wetters Portuguez ◽  
Danielle Irigoyen da Costa ◽  
Sabine Possa Marroni ◽  
Vanessa Pagliarini ◽  
Karin Vieira
Keyword(s):  
Sexual Abuse ◽  
Physical Abuse ◽  
Multidisciplinary Team ◽  
Emotional Abuse ◽  
Epileptic Seizures ◽  
Mental Processes ◽  
Psychogenic Nonepileptic Seizures ◽  
Therapeutic Procedures ◽  
Nonepileptic Seizures ◽  
The Brain

Psychogenic nonepileptic seizures (PNES) may be defined as paroxysmal changes in behavior that are similar to epileptic seizures but are not associated with quantifiable alterations in the electrical activity of the brain. At the Epilepsy Surgery Program (ESP) of the São Lucas Hospital at PUCRS (HSL-PUCRS), we studied 52 individuals (37 females and 15 males) with a diagnosis of PNES, associated (57%) or not (23%) with refractory epileptic seizures. We found emotional abuse (100%), physical abuse (80%), emotional neglect (80%), physical negligence (70%) and sexual abuse (30%), mood (40%) and anxiety disorders (50%), as the main psychological components in such population. Although the medical and psychosocial impact of PNES can be estimated as significant, the absence of specialized services for its treatment is striking. Multiple diagnostic and therapeutic procedures and the participation of a specialized multidisciplinary team – where neuropsychology functions as a link between the mental processes/psychopathologies and the brain – are required to ensure proper management of such cases.

scholarly journals Managing anorexia from a dietitian's perspective

2009 ◽  
Vol 68 (3) ◽  
pp. 281-288 ◽  
Author(s):  
Annette Cockfield ◽  
Ursula Philpot
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Multidisciplinary Team ◽  
Best Practice ◽  
Tube Feeding ◽  
Evidence Base ◽  
Inpatient Setting ◽  
Team Approach ◽  
Normal Behaviour ◽  
Weight Restoration

Anorexia nervosa has the highest mortality rate of any psychiatric condition and its management is complex and multi-faceted, requiring a multidisciplinary team approach. Dietitians are an important part of the multidisciplinary team, offering objective nutritional advice with the aim of helping the patient to develop an improved relationship with food. Refeeding patients with a low body weight requires careful management; nonetheless, refeeding the low-weight patient with anorexia presents many additional complications, largely of a psychological nature. Treatment plans need to consider psychological, physical, behavioural and psycho-social factors relating to anorexia nervosa. Currently, there is no consistent approach and a paucity of evidence to support best practice for weight restoration in this group of patients. Tube feeding is utilised at varying BMI in anorexia nervosa, mainly in an inpatient setting. However, its use should be seen as a last resort and limited to a life-saving intervention. Weight restoration is best managed by an experienced dietitian within a specialist eating disorders team, using normal foods. This approach is ideal for nutrition rehabilitation, promoting skills for eating and normal behaviour and providing a longer-term solution by challenging unhelpful coping strategies from the onset. Dietitians have a unique mix of skills and knowledge in numerous areas including nutrition, physiology, psychology, sociology and behaviour change, which can be applied to support patients with thoughts and behaviours around food, weight and appetite. Further research is required into the effectiveness of dietetic interventions in eating disorders in order to establish an evidence base for best practice.

scholarly journals Sentinel surveillance of child maltreatment cases presenting to Canadian emergency departments

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Aimée Campeau ◽  
Lil Tonmyr ◽  
Erik Gulbransen ◽  
Martine Hébert ◽  
Steven McFaull ◽  
...  
Keyword(s):  
Content Analysis ◽  
Sexual Assault ◽  
Child Maltreatment ◽  
Physical Abuse ◽  
Health Care Professionals ◽  
Emergency Departments ◽  
Sentinel Surveillance ◽  
Surveillance Program ◽  
Additional Information ◽  
Injury Event

Abstract Background The Canadian Hospitals Injury Reporting Prevention Program (CHIRPP) is a sentinel surveillance program that collects and analyzes data on injuries and poisonings of people presenting to emergency departments (EDs) at 11 pediatric and eight general hospitals (currently) across Canada. To date, CHIRPP is an understudied source of child maltreatment (CM) surveillance data. This study: (1) describes CM cases identified in the CHIRPP database between1997/98 to 2010/11; (2) assesses the level of CM case capture over the 14-year period and; (3) uses content analysis to identify additional information captured in text fields. Methods We reviewed cases of children under 16 whose injuries were reported as resulting from CM from 1997/98 to 2010/11. A time trend analysis of cases to assess capture was conducted and content analysis was applied to develop a codebook to assess information from text fields in CHIRPP. The frequency of types of CM and other variables identified from text fields were calculated. Finally, the frequency of types of CM were presented by age and gender. Results A total of 2200 CM cases were identified. There was a significant decrease in the capture of CM cases between 1999 and 2005. Physical abuse was the most prevalent type (57%), followed by sexual assault (31%), unspecified maltreatment (7%), injury as the result of exposure to family violence (3%) and neglect (2%). Text fields provided additional information including perpetrator characteristics, the use of drugs and/or alcohol during the injury event, information regarding the involvement of non-health care professionals, whether maltreatment occurred during a visitation period with a parent and, whether the child was removed from their home. Conclusions The findings from this initial study indicate that CHIRPP could be a complimentary source of CM data. As an injury surveillance system, physical abuse and sexual assault were better captured than other types of CM. Text field data provided unique information on a number of additional details surrounding the injury event, including risk factors.

Self-harm presentations in emergency departments: staff attitudes and triage

2019 ◽  
Vol 28 (22) ◽  
pp. 1468-1476 ◽  
Author(s):  
Sithandazile Masuku
Keyword(s):  
Emergency Departments ◽  
Formal Education ◽  
Evidence Base ◽  
Public Health Issue ◽  
Service Improvement ◽  
Staff Attitudes ◽  
Services Research ◽  
Negative Attitudes ◽  
History Of ◽  
Self Harm

Addressing the rising incidence of self-harm and the demand this places on emergency departments (EDs) are UK Government healthcare priorities. A history of self-harm is linked with suicide risk, so self-harm is a public health issue. The ED is the first point of contact for many people who self-harm so it plays a pivotal role in access to services. Research has highlighted difficulties around triage and assessment in EDs of patients who self-harm, especially frequent attenders. The evidence base on patient experience related to addressing negative staff attitudes is lacking, despite their potent nature and impact on care. Limited knowledge of self-harm aetiology and clinical inexperience have been found to be fundamental to nurses' negative attitudes when dealing with patients who self-harm. This has been linked to negative patient outcomes, including a reluctance to engage with services. This article acknowledges positive changes that have been made and highlights the importance of the triage stage, which is a potential service improvement area, where it would be possible to start and drive positive change in the care of people who self-harm. To address knowledge gaps in education and management, clinical understanding of the aetiology of self-harm should be improved with the aid of education on self-harm cycles. Nurses should also be made aware of common myths surrounding self-harm, as these are barriers to care. Recommendations for practice include partnership working and the urgent need for formal education on this topic for all health professionals working in EDs.

scholarly journals Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness

2020 ◽  
Vol 9 (1) ◽  
pp. e000572 ◽  
Author(s):  
Fahmy W F Hanna ◽  
Basil G Issa ◽  
Simon C Lea ◽  
Cherian George ◽  
Anurag Golash ◽  
...  
Keyword(s):  
Multidisciplinary Team ◽  
Adrenal Incidentaloma ◽  
Automatic Generation ◽  
Evidence Base ◽  
University Hospital ◽  
Endocrine Disorders ◽  
Adrenal Incidentalomas ◽  
Health Economic Analysis ◽  
European Guidelines ◽  
Management Plans

IntroductionAdrenal incidentalomas are lesions that are incidentally identified while scanning for other conditions. While most are benign and hormonally non-functional, around 20% are malignant and/or hormonally active, requiring prompt intervention. Malignant lesions can be aggressive and life-threatening, while hormonally active tumours cause various endocrine disorders, with significant morbidity and mortality. Despite this, management of patients with adrenal incidentalomas is variable, with no robust evidence base. This project aimed to establish more effective and timely management of these patients.MethodsWe developed a web-based, electronic Adrenal Incidentaloma Management System (eAIMS), which incorporated the evidence-based and National Health Service–aligned 2016 European guidelines. The system captures key clinical, biochemical and radiological information necessary for adrenal incidentaloma patient management and generates a pre-populated outcome letter, saving clinical and administrative time while ensuring timely management plans with enhanced safety. Furthermore, we developed a prioritisation strategy, with members of the multidisciplinary team, which prioritised high-risk individuals for detailed discussion and management. Patient focus groups informed process-mapping and multidisciplinary team process re-design and patient information leaflet development. The project was partnered by University Hospital of South Manchester to maximise generalisability.ResultsImplementation of eAIMS, along with improvements in the prioritisation strategy, resulted in a 49% reduction in staff hands-on time, as well as a 78% reduction in the time from adrenal incidentaloma identification to multidisciplinary team decision. A health economic analysis identified a 28% reduction in costs.ConclusionsThe system’s in-built data validation and the automatic generation of the multidisciplinary team outcome letter improved patient safety through a reduction in transcription errors. We are currently developing the next stage of the programme to proactively identify all new adrenal incidentaloma cases.

scholarly journals Efficiency measures of emergency departments: an Italian systematic literature review

2021 ◽  
Vol 10 (3) ◽  
pp. e001058
Author(s):  
Danilo Di Laura ◽  
Lucia D'Angiolella ◽  
Lorenzo Mantovani ◽  
Ginevra Squassabia ◽  
Francesco Clemente ◽  
...  
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Emergency Departments ◽  
Critical Role ◽  
Evidence Base ◽  
Healthcare Systems ◽  
Cochrane Library ◽  
Number Of Patients ◽  
The World

Life expectancy globally increased in the last decades: the number of people aged 65 or older is consequently projected to grow, and healthcare demand will increase as well. In the recent years, the number of patients visiting the hospital emergency departments (EDs) rocked in almost all countries of the world. These departments are crucial in all healthcare systems and play a critical role in providing an efficient assistance to all patients. A systematic literature review covering PubMed, Scopus and the Cochrane Library was performed from 2009 to 2019. Of the 718 references found in the literature research, more than 25 studies were included in the current review. Different predictors were associated with the quality of EDs care, which may help to define and implement preventive strategies in the near future. There is no harmonisation in efficiency measurements reflecting the performance in the ED setting. The identification of consistent measures of efficiency is crucial to build an evidence base for future initiatives. The aim of this study is to review the literature on the problems encountered in the efficiency of EDs around the world in order to identify an organisational model or guidelines that can be implemented in EDs to fill inefficiencies and ensure access optimal treatment both in terms of resources and timing. This review will support policy makers to improve the quality of health facilities, and, consequently of the entire healthcare systems.

scholarly journals Sentinel surveillance of child maltreatment cases presenting to Canadian emergency departments

2019 ◽  
Author(s):  
Aimée Campeau ◽  
Lil Tonmyr ◽  
Erik Gulbransen ◽  
Martine Hébert ◽  
Steven McFaull ◽  
...  
Keyword(s):  
Content Analysis ◽  
Sexual Assault ◽  
Child Maltreatment ◽  
Physical Abuse ◽  
Health Care Professionals ◽  
Emergency Departments ◽  
Sentinel Surveillance ◽  
Surveillance Program ◽  
Additional Information ◽  
Injury Event

Abstract Background: The Canadian Hospitals Injury Reporting Prevention Program (CHIRPP) is a sentinel surveillance program that collects and analyzes data on injuries and poisonings of people presenting to emergency departments (EDs) at 11 pediatric and eight general hospitals (currently) across Canada. To date, CHIRPP is an understudied source of child maltreatment (CM) surveillance data. This study: (1) describes CM cases identified in the CHIRPP database between1997/98 to 2010/11; (2) assesses the level of CM case capture over the 14-year period and; (3) uses content analysis to identify additional information captured in text fields. Methods: We reviewed cases of children under 16 whose injuries were reported as resulting from CM from 1997/98 to 2010/11. A time trend analysis of cases to assess capture was conducted and content analysis was applied to develop a codebook to assess information from text fields in CHIRPP. The frequency of types of CM and other variables identified from text fields were calculated. Finally, the frequency of types of CM were presented by age and gender. Results: A total of 2 200 CM cases were identified. There was a significant decrease in the capture of CM cases between 1999 and 2005. Physical abuse was the most prevalent type (57%), followed by sexual assault (31%), unspecified maltreatment (7%), injury as the result of exposure to family violence (3%) and neglect (2%). Text fields provided additional information including perpetrator characteristics, the use of drugs and/or alcohol during the injury event, information regarding the involvement of non-health care professionals, whether maltreatment occurred during a visitation period with a parent and, whether the child was removed from their home. Conclusions: The findings from this initial study indicate that CHIRPP could be a complimentary source of CM data. As an injury surveillance system, physical abuse and sexual assault were better captured than other types of CM. Text field data provided unique information on a number of additional details surrounding the injury event, including risk factors.

scholarly journals Sentinel surveillance of child maltreatment cases presenting to Canadian emergency departments

2019 ◽  
Author(s):  
Aimée Campeau ◽  
Lil Tonmyr ◽  
Erik Gulbransen ◽  
Martine Hébert ◽  
Steven McFaull ◽  
...  
Keyword(s):  
Content Analysis ◽  
Sexual Assault ◽  
Child Maltreatment ◽  
Physical Abuse ◽  
Health Care Professionals ◽  
Emergency Departments ◽  
Sentinel Surveillance ◽  
Surveillance Program ◽  
Additional Information ◽  
Injury Event

Abstract Background: The Canadian Hospitals Injury Reporting Prevention Program (CHIRPP) is a sentinel surveillance program that collects and analyzes data on injuries and poisonings of people presenting to emergency departments (EDs) at 11 pediatric and eight general hospitals (currently) across Canada. To date, CHIRPP is an understudied source of child maltreatment (CM) surveillance data. This study: (1) describes CM cases identified in the CHIRPP database between1997/98 to 2010/11; (2) assesses the level of CM case capture over the 14-year period and; (3) uses content analysis to identify additional information captured in text fields. Methods: We reviewed cases of children under 16 whose injuries were reported as resulting from CM from 1997/98 to 2010/11. A time trend analysis of cases to assess capture was conducted and content analysis was applied to develop a codebook to assess information from text fields in CHIRPP. The frequency of types of CM and other variables identified from text fields were calculated. Finally, the frequency of types of CM were presented by age and gender. Results: A total of 2 200 CM cases were identified. There was a significant decrease in the capture of CM cases between 1999 and 2005. Physical abuse was the most prevalent type (57%), followed by sexual assault (31%), unspecified maltreatment (7%), injury as the result of exposure to family violence (3%) and neglect (2%). Text fields provided additional information including perpetrator characteristics, the use of drugs and/or alcohol during the injury event, information regarding the involvement of non-health care professionals, whether maltreatment occurred during a visitation period with a parent and, whether the child was removed from their home. Conclusions: The findings from this initial study indicate that CHIRPP could be a complimentary source of CM data. As an injury surveillance system, physical abuse and sexual assault were better captured than other types of CM. Text field data provided unique information on a number of additional details surrounding the injury event, including risk factors.

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