Algorithmic Prediction of Restraint and Seclusion in an Inpatient Child and Adolescent Psychiatric Population

2020 ◽  
pp. 107839032097101
Author(s):  
Stefani R. Magnowski ◽  
Dalton Kick ◽  
Jessica Cook ◽  
Brian Kay
Keyword(s):  
At Risk ◽  
Treatment Plan ◽  
Psychiatric Hospitals ◽  
Child And Adolescent ◽  
Client Characteristics ◽  
Predictive Algorithm ◽  
Proactive Approach ◽  
Tree Modeling ◽  
Behavioral Emergencies ◽  
Psychiatric Population

BACKGROUND: Restraint and seclusion in an inpatient child and adolescent psychiatric population adversely affects the overall value and safety of care. Due to adverse events, negative outcomes, and associated costs, inpatient psychiatric hospitals must strive to reduce and ultimately eliminate restraint and seclusion with innovative, data-driven approaches. AIM: To identify patterns of client characteristics that are associated with restraint and seclusion in an inpatient child and adolescent psychiatric population. METHOD: A machine learning application of fast-and-frugal tree modeling was used to analyze the sample. RESULTS: The need for restraint and seclusion were correctly predicted for 73% of clients at risk (sensitivity), and 76% of clients were correctly predicted as negative or low risk (specificity), for needing restraint and seclusion based on the following characteristics: having a disruptive mood dysregulation disorder and/or attention-deficit hyperactivity disorder diagnosis, being 12 years old or younger, and not having a depressive and/or bipolar disorder diagnosis. CONCLUSION: The client characteristics identified in the predictive algorithm should be reviewed on admission to recognize clients at risk for restraint and seclusion. For those at risk, interventions should be developed into an individualized client treatment plan to facilitate a proactive approach in preventing behavioral emergencies requiring restraint and seclusion.

scholarly journals Implementation of a QTc-interval monitoring protocol by pharmacists to decrease cardiac risk in at-risk patients in an acute care inpatient psychiatric facility

2019 ◽  
Vol 9 (2) ◽  
pp. 82-87 ◽  
Author(s):  
Nicole M. Daniel ◽  
Kim Walsh ◽  
Henry Leach ◽  
Lauren Stummer
Keyword(s):  
At Risk ◽  
Acute Care ◽  
Medical Center ◽  
Intervention Group ◽  
Psychiatric Hospitals ◽  
Control Group ◽  
Qtc Interval ◽  
Psychiatric Facility ◽  
End Point ◽  
Monitoring Protocol

Abstract Introduction Many medications commonly prescribed in psychiatric hospitals can cause QTc-interval prolongation, increasing a patient's risk for torsades de pointes and sudden cardiac death. There is little guidance in the literature to determine when an electrocardiogram (ECG) and QTc-interval monitoring should be performed. The primary end point was improvement of the appropriateness of ECGs and QTc-interval monitoring of at-risk psychiatric inpatients at Barnabas Health Behavioral Health Center (BHBH) and Monmouth Medical Center (MMC) following implementation of a standardized monitoring protocol. The secondary end point was the number of pharmacist-specific interventions at site BHBH only. Methods Patients who met the inclusion criteria were assessed using a standardized QTc-prolongation assessment algorithm for ECG appropriateness. A retrospective analysis of a control group (no protocol) from January 1, 2016, to July 17, 2017, was compared with a prospective analysis of the intervention group (with protocol) from December 11, 2017, to March 11, 2018. Results At BHBH, appropriate ECG utilization increased 25.5% after implementation of a standardized protocol (P = .0172) and appropriate omission of ECG utilization improved by 26% (P < .00001). At MMC, appropriate ECGs decreased by 5%, and appropriate ECG omissions increased by 28%, neither of which were statistically significant (P = 1.0 and P = .3142, respectively). There was an increase in overall pharmacist monitoring. Discussion The study demonstrated that pharmacist involvement in ECG and QTc-interval monitoring utilizing a uniform protocol may improve the appropriateness of ECG and QTc-interval monitoring in patients in an acute care inpatient psychiatric hospital.

scholarly journals The reform of Italian forensic psychiatric hospitals and its impact on risk assessment and management

2018 ◽  
Author(s):  
Vittorio De Luca ◽  
Pieritalo Maria Pompili ◽  
Giovanna Paoletti ◽  
Valeria Bianchini ◽  
Federica Franchi ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Treatment Plan ◽  
Psychiatric Hospitals ◽  
Assessment Tools ◽  
Residential Home ◽  
Security Measures ◽  
Lazio Region ◽  
History Of ◽  
Forensic Psychiatric

Italy has a consolidated history of de-institutionalization, and it was the first country to completely dismantle psychiatric hospitals, in order to create small psychiatric inwards closer to the community (i.e. in general hospitals). Nevertheless, it took the nation nearly 40 years to end the process from the beginning of de-institutionalization, definitely closing all of the forensic hospitals, which was not addressed by the first Italian psychiatric reform. This paper describes the establishment of new facilities substituting old forensic hospitals, called Residences for the Execution of Security Measures (REMS), which are a paradigm shift in terms of community-based residential home, and are mainly focused on treatment and risk assessment, rather than custodial practices. The use of modern assessment tools, such as the Aggressive Incident Scale (AIS) and the Hamilton Anatomy of Risk Management (HARM), is crucial in order to point out the focus and consistent instruments of the treatment plan. A preliminary analysis of data from the first 2 years of activity, considering severely ill patients who have been treated for more than 12 months, is then described for two REMSs in the Lazio region, close to Rome. Encouraging results suggest that further research is needed in order to assess clinical elements responsible for a better outcome, and to detect follow-up measures of violence or criminal relapse after discharge.

Introduction

2016 ◽  
Author(s):  
Phillip Kleespies
Keyword(s):  
At Risk ◽  
Children And Adolescents ◽  
Crisis Intervention ◽  
Suicide Risk ◽  
The Elderly ◽  
Integrative Approach ◽  
Emergency Intervention ◽  
Interpersonal Victimization ◽  
Behavioral Emergencies ◽  
Psychological Risks

This book is about behavioral emergencies and the association between interpersonal victimization and subsequent suicidality and/or risk for violence toward others. Section I focuses on the differences between behavioral crises and behavioral emergencies and presents an integrative approach to crisis intervention and emergency intervention. Section II discusses the evaluation of suicide risk, risk of violence, and risk of interpersonal victimization in children and adolescents. Sections III and IV explore behavioral emergencies with adults and the elderly, while Section V deals with certain conditions or behaviors that may either need to be differentiated from a behavioral emergency, or understood as relevant to possibly heightening risk. Section VI describes treatments for patients with recurrent or ongoing risks, and Section VII is devoted to legal, ethical, and psychological risks faced by clinicians who work with patients who might be at risk to themselves or others.

Changes in the Administrative Incidence of Schizophrenia

1991 ◽  
Vol 159 (6) ◽  
pp. 811-816 ◽  
Author(s):  
Glynn Harrison ◽  
J. E. Cooper ◽  
Richard Gancarczyk
Keyword(s):  
At Risk ◽  
Psychiatric Hospitals ◽  
Case Register ◽  
Admission Rates ◽  
First Onset ◽  
Administrative Incidence ◽  
Substantial Decline ◽  
The Uk ◽  
Different Parts ◽  
First Admission

First-admission rates to psychiatric hospitals, and data from certain psychiatric case registers suggest that there may have been a substantial decline in the administrative incidence of schizophrenia in recent years. However, data from the Nottingham case register show that rates for first-onset schizophrenia remained stable between 1975 and 1987. It is suggested that variations in trends between different parts of the UK may be partly explained by differences in the proportion of migrants and their children in the population at risk.

Homeless at risk of mortality: A proactive approach to vulnerable “repeaters”

1998 ◽  
Vol 24 (6) ◽  
pp. 546-550
Author(s):  
Mary Ann Ferguson ◽  
Christine W. Ragosta
Keyword(s):  
At Risk ◽  
Proactive Approach ◽  
Risk Of Mortality

A Pilot Study of Panic Attacks in a Child and Adolescent Psychiatric Population

1990 ◽  
Vol 35 (6) ◽  
pp. 526-528 ◽  
Author(s):  
Susan Bradley ◽  
Rod Wachsmuth ◽  
Richard Swinson ◽  
Garry Hnatko
Keyword(s):  
Pilot Study ◽  
Child And Adolescent ◽  
Panic Attacks ◽  
Psychiatric Population

scholarly journals Suicidal patients — the effect on staff

1989 ◽  
Vol 13 (9) ◽  
pp. 495-496 ◽  
Author(s):  
J. C. Rossiter
Keyword(s):  
At Risk ◽  
Hospital Admission ◽  
Social Contract ◽  
Suicidal Behaviour ◽  
Psychiatric Hospitals ◽  
Population At Risk ◽  
Discharged Patients ◽  
Suicidal Patients

Although psychiatric hospitals contain a population at risk of suicidal behaviour compared to the community at large, suicide in hospital in-patients and recently discharged patients is relatively rare. It has been suggested that hospital admission itself reduces the risk of suicide (Tenroche et al, 1984). Factors considered important are a calm ward routine carried out by staff confident in the immediate future, and the opportunities for social contract offered by the ward environment.

scholarly journals Clinical Validation and Treatment Plan Evaluation Based on Auto-Delineation of the Clinical Target Volume for Prostate Cancer Radiotherapy

2022 ◽  
Author(s):  
Jing Shen ◽  
Yinjie TAO ◽  
Hui GUAN ◽  
Hongnan ZHEN ◽  
Lei HE ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
At Risk ◽  
Organs At Risk ◽  
Treatment Plan ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Target Volume ◽  
Ct Scans ◽  
Dice Similarity Coefficient ◽  
Treatment Plans

Abstract Purpose Clinical target volumes (CTV) and organs at risk (OAR) could be auto-contoured to save workload. The goal of this study was to assess a convolutional neural network (CNN) for totally automatic and accurate CTV and OAR in prostate cancer, while also comparing anticipated treatment plans based on auto-contouring CTV to clinical plans. Methods From January 2013 to January 2019, 217 computed tomography (CT) scans of patients with locally advanced prostate cancer treated at our hospital were collected and analyzed. CTV and OAR were delineated with a deep learning based method, which named CUNet. The performance of this strategy was evaluated using the mean Dice similarity coefficient (DSC), 95th percentile Hausdorff distance (95HD), and subjective evaluation. Treatment plans were graded using predetermined evaluation criteria, and % errors for clinical doses to the planned target volume (PTV) and organs at risk(OARs) were calculated. Results The defined CTVs had mean DSC and 95HD values of 0.84 and 5.04 mm, respectively. For one patient's CT scans, the average delineation time was less than 15 seconds. When CTV outlines from CUNetwere blindly chosen and compared to GT, the overall positive rate in clinicians A and B was 53.15% vs 46.85%, and 54.05% vs 45.95%, respectively (P>0.05), demonstrating that our deep machine learning model performed as good as or better than human demarcation Furthermore, 8 testing patients were chosen at random to design the predicted plan based on the auto-courtoring CTV and OAR, demonstrating acceptable agreement with the clinical plan: average absolute dose differences of D2, D50, D98, Dmean for PTV are within 0.74%, and average absolute volume differences of V45, V50 for OARs are within 3.4%. Without statistical significance (p>0.05), the projected findings are comparable to clinical truth. Conclusion The experimental results show that the CTV and OARs defined by CUNet for prostate cancer were quite close to the ground reality.CUNet has the potential to cut radiation oncologists' contouring time in half. When compared to clinical plans, the differences between estimated doses to CTV and OAR based on auto-courtoring were small, with no statistical significance, indicating that treatment planning for prostate cancer based on auto-courtoring has potential.

Diabetic Ketoacidosis in a Child with Acute Surgical Abdomen

2018 ◽  
Author(s):  
Rahul Baijal ◽  
Carlos J. Campos
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Diabetic Ketoacidosis ◽  
Cerebral Edema ◽  
Clinical Presentation ◽  
Treatment Plan ◽  
Diagnosis And Treatment ◽  
Surgical Patient ◽  
Children At Risk ◽  
Acid Base

Management of the pediatric surgical patient in diabetic ketoacidosis (DKA) is particularly challenging given the electrolyte and acid-base abnormalities, compounded with the risk of cerebral edema. This chapter highlights the risk factors, diagnosis, and treatment plan, for the pediatric surgical patient who presents in DKA. This chapter will help the reader identify children at risk for DKA, understand the clinical presentation and pathophysiology of DKA, identify children at risk for cerebral edema, manage cerebral edema in children with DKA, manage DKA in children, and understand the anesthetic implications in children with DKA.

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