scholarly journals The practice of lethal means restriction counseling in US emergency departments to reduce suicide risk: a systematic review of the literature

2021 ◽  
Vol 8 (S1) ◽  
Author(s):  
Amy A. Hunter ◽  
Susan DiVietro ◽  
Megan Boyer ◽  
Kristin Burnham ◽  
Danielle Chenard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Suicide Attempts ◽  
Healthcare Providers ◽  
Clinical Settings ◽  
Published Evidence ◽  
Adequate Education ◽  
The Us ◽  
Study Participants ◽  
Methods Of Suicide ◽  
Lethal Means

Abstract Background Suicide is a leading cause of death in the US. Lethal means restriction (LMR), which encourages limiting access and reducing the lethality of particular methods of suicide, has been identified as a viable prevention strategy. For this approach to be successful, adequate education about risks and means must be communicated to families and individuals at risk for suicide. This systematic review aims to identify LMR methods most commonly communicated by healthcare providers in the emergency department, and barriers to the delivery of such counseling. Methods The protocol for this systematic review is registered with PROSPERO (CRD42018076734). Included studies were identified through searching four databases (PubMed, Scopus, PsycInfo, and EBSCO). Studies were selected and coded independently by two researchers using the PICOS framework. Included studies examined LMR counseling delivered in the ED regardless of patient age, sex or race/ethnicity. Results A total of 1282 studies were screened; 9 met the inclusion criteria. Included studies were published from 1998 to 2020. Study participants were majority female, and safe firearm storage was the most common form of LMR counseling provided. Eight studies included counseling on multiple forms of lethal means, [e.g., alcohol, medication, and firearm storage] and one study focused solely on safe firearm storage. Two studies reported barriers limiting healthcare providers’ delivery of LMR counseling, including lack of specialized skills and skepticism regarding the effectiveness of LMR counseling. Conclusion There is limited published evidence that identifies the most effective methods and target populations for LMR counseling. Given the growing literature that provides evidence of gender differences in suicide modality (e.g., guns, medications, suffocation), LMR counseling should be multifaceted, to address common means of suicide in both men and women. Despite evidence that the majority of suicide attempts and half of completed suicides do not involve firearms, results showed that LMR counseling is frequently focused on promoting the safe storage of firearms. This highlights the need to include counseling focused on a variety of lethal means to reduce risk of suicide completion. Prospective studies should also aim to identify the most efficacious methods of delivering LMR counseling in the clinical settings.

scholarly journals Conversion therapies and access to transition-related healthcare in transgender people: a narrative systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022425 ◽  
Author(s):  
Talen Wright ◽  
Bridget Candy ◽  
Michael King
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Methodological Quality ◽  
Healthcare Providers ◽  
Case Series ◽  
Access Barriers ◽  
Health Consequences ◽  
Transgender People ◽  
Published Evidence ◽  
And Gender

ObjectivesConversion is a term for treatments that seek to suppress or change a person’s sexual orientation or gender. Our review focuses on transgender and gender-diverse (TGD) people. Our aims were to (1) describe the frequency, nature and structure of conversion practices; (2) document difficulties in accessing transition-related healthcare and (3) evaluate the mental health consequences of such practices and access barriers.MethodSystematic review and narrative synthesis using the Critical Appraisals Skills Programme and Joanne Briggs Institute critical appraisal tools. Data sources include Embase, MEDLINE, PsychINFO, PsychARTICLES and Web of Science between 1990 and June 2017.ParticipantsStudies were included that (1) document use of conversion therapies or access barriers to transition-related healthcare; and/or (2) describe how such therapeutic practices and access barriers have been applied and/or (3) evaluate the mental health impacts of such therapies and difficulties accessing transition-related healthcare. Two reviewers screened papers for eligibility. Data were then grouped according to the objectives. Narratives and themes were presented per study.ResultsSeven studies met inclusion criteria. Four reports were on ‘realignment’, involving case studies or case series. Two involved psychoanalysis, one self-exposure therapy and one open-ended play psychotherapy. All four studies concerning ‘realignment’ were of poor methodological quality. The other three studies explored access barriers from the view point of TGD youth, their parents and healthcare providers. All papers reported access barriers, such as inability to access puberty-delaying medications. The papers concerning barriers to access were of good methodological quality.ConclusionWe found limited published evidence on use, nature, structure and/or health consequences of conversion therapies and access barriers to transition in TGD people. However, reports of restriction to access may indicate a more widespread problem. Research is needed into TGD people’s experiences of conversion therapy and access barriers to transition-related healthcareTrial registration numberCRD42017062149.

scholarly journals Zika Pregnancy Surveillance: Transforming Data into Educational and Clinical Tools

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Kara Polen ◽  
Titilope Oduyebo ◽  
Jazmyn Moore ◽  
Sascha Ellinton ◽  
Regina Simeone ◽  
...  
Keyword(s):  
Public Health ◽  
Pregnant Women ◽  
Surveillance System ◽  
Healthcare Providers ◽  
Surveillance Data ◽  
Clinical Settings ◽  
Educational Materials ◽  
The Us ◽  
Clinical Tools ◽  
The Impact

ObjectiveTo describe how Zika virus (Zika) surveillance data informs and improves testing guidance, clinical evaluation and management of pregnant women and infants with possible Zika infectionIntroductionLittle was known about the maternal and fetal/infant effects of Zika infection before the 2015 outbreak in the Americas, which made it challenging for public health practitioners and clinicians to care for pregnant women and infants exposed to Zika. In 2016, CDC implemented a rapid surveillance system, the US Zika Pregnancy and Infant Registry, to collect information about the impact of Zika infection during pregnancy and inform the CDC response and clinical guidance. In partnership with state, tribal, local, and territorial health departments, CDC disseminated information from this surveillance system, which served as the foundation for educational materials and clinical tools for healthcare providers.MethodsThroughout the Zika response, CDC worked closely with health officers, epidemiologists, and clinical partners to seek expert input on the interpretation of emerging data and the evaluation and management of these vulnerable populations. In response to requests from clinical and public health partners, CDC created targeted educational materials and tools to facilitate the implementation of clinical guidance. These materials equipped healthcare providers with the information needed to care for pregnant women and infants with Zika infection. Examples of products developed included: 1) screening tools to identify pregnant women for whom testing is indicated; 2) an interactive web tool to assist with implementation and interpretation of Zika testing guidance (Pregnancy and Zika Testing Widget); 3) patient counseling scripts; and 4) videos to explain critical clinical concepts (e.g., measurement of infant head circumference). These tools were informally pre-tested with the target audiences prior to dissemination, specifically to assess usefulness in clinical settings. CDC disseminated these tools through the CDC website and through comprehensive outreach (e.g., webinars, calls, email alerts) to various audiences. Additionally, several professional organizations incorporated these tools into regular communication with their membership.ResultsThe US Zika Pregnancy and Infant Registry is currently monitoring infants from approximately 7,300 pregnancies in the US states and territories with laboratory evidence of Zika. Surveillance data provided valuable information, including clues toward the pattern of defects and other neurologic disabilities associated with congenital Zika infection, estimates of the risks associated with congenital infection, and timeframes of greatest risk during pregnancy, to help clinicians counsel pregnant patients with potential Zika exposure. CDC used these data to inform their clinical tools, particularly in pretest counseling materials and educational factsheets for healthcare providers to use with pregnant women with potential Zika exposure.After informal testing among healthcare providers, the tools received positive feedback regarding usefulness and applicability in clinical settings. Collectively, CDC’s Zika clinical tools were downloaded more than 300,000 times from CDC’s website. The Pregnancy and Zika Testing Widget was accessed and followed to an endpoint (e.g., Zika testing recommended) more than 17,000 times, with more than 75% of users self-identifying as clinicians.ConclusionsRapid implementation of Zika surveillance captured evolving data about the impact of Zika on pregnant women and their infants. These data informed the development of clinical tools for healthcare providers caring for and counseling patients with Zika exposure. These tools ensured pregnant women and infants were adequately monitored during the Zika outbreak. Health education materials and clinical tools based on surveillance data should be considered in future emergency responses, particularly when knowledge is rapidly evolving.ReferencesCDC Zika Pregnancy Website: https://www.cdc.gov/pregnancy/zika/materials/index.html 

Demographic Variation in Chronic Rhinosinusitis by Subtype and Region: A Systematic Review

2021 ◽  
pp. 194589242110562
Author(s):  
Cheng Ma ◽  
Neil K. Mehta ◽  
Shaun A. Nguyen ◽  
David A. Gudis ◽  
Amar Miglani ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Rhinosinusitis ◽  
Geographic Region ◽  
Demographic Differences ◽  
Heterogenous Group ◽  
Black Patients ◽  
The Us ◽  
High Level ◽  
Study Participants ◽  
White Patients

Background Chronic rhinosinusitis (CRS) describes a heterogenous group of diseases including CRS with (CRSwNP) or without nasal polyps (CRSsNP), aspirin-exacerbated respiratory disease (AERD), and allergic fungal rhinosinusitis (AFRS). It affects 10 to 15% of the US population and is more common in women and White patients. However, these estimates are based on survey and database studies with innate diagnostic inaccuracy. Additionally, few studies report subtype-specific demographics. We explore the demographic differences of CRS in the U.S. by subtype and region. Objective To characterize demographic differences between the CRS population and the overall US population, and also between different CRS subtype populations. Methods We performed a systematic review for articles reporting on US demographics of adults with CRS. Study participants were required to have been diagnosed using consensus criteria. Data on demographics, geographic region, and CRS subtype were analyzed. Results Our study analyzed 31 unique studies representing 8409 patients with 50.7% females and weighted mean age of 48.0 years. Compared to the overall US population, CRS patients were predominantly White (78.5%) and non-Hispanic (94.5%) with under-representation of other races. Grouped by subtype, CRSwNP affected a significantly higher proportion of men (59.8%). AFRS affected a significantly higher proportion of Black patients (53.8%) while CRSsNP was more prevalent in White patients (84.2%). When grouped by region, the South had a significantly higher proportion of female (53%) and Black (17.8%) CRS patients. The West had a significantly higher proportion of Asian (4.5%) and Hispanic (12.3%) patients. Conclusions Significant demographic differences exist in CRS patients based on subtype and region. These data provide an estimation of the demographic make-up of CRS, but further high-level demographic studies are needed.

scholarly journals Suicide in Parkinson’s disease

2019 ◽  
Vol 90 (7) ◽  
pp. 822-829 ◽  
Author(s):  
Melissa Deanna Shepard ◽  
Kate Perepezko ◽  
Martijn P G Broen ◽  
Jared Thomas Hinkle ◽  
Ankur Butala ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Suicide Attempts ◽  
Aggressive Treatment ◽  
Suicide Methods ◽  
Treatment Of Depression ◽  
Lethal Means ◽  
Risk Factors For Suicide

Persons with Parkinson’s disease (PwP) have many known risk factors for suicide and suicidal ideation (SI). Despite this, there is limited understanding of suicidality in this population. We conducted a systematic review to synthesise the available literature on suicidality in PwP and highlight areas for potential intervention and further research. We identified 116 articles discussing SI, suicidal behaviours, suicide attempts and/or fatal suicide in PwP. These articles describe prevalence, suicide methods, risk factors for suicide and SI and treatment of suicidality. In this review, we summarise the current literature and provide suggestions for how clinicians can identify and treat PwP who are at risk for suicide, for example, through aggressive treatment of depression and improved screening for access to lethal means.

Characteristics of the Frequency-Following Response to Speech in Neonates and Potential Applicability in Clinical Practice: A Systematic Review

2020 ◽  
Vol 63 (5) ◽  
pp. 1618-1635
Author(s):  
Céline Richard ◽  
Mary Lauren Neel ◽  
Arnaud Jeanvoine ◽  
Sharon Mc Connell ◽  
Alison Gehred ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cochrane Library ◽  
Neurodevelopmental Outcomes ◽  
Frequency Following Response ◽  
Ovid Medline ◽  
Published Evidence ◽  
Mesh Terms ◽  
Potential Applicability ◽  
Clinical Potential

Purpose We sought to critically analyze and evaluate published evidence regarding feasibility and clinical potential for predicting neurodevelopmental outcomes of the frequency-following responses (FFRs) to speech recordings in neonates (birth to 28 days). Method A systematic search of MeSH terms in the Cumulative Index to Nursing and Allied HealthLiterature, Embase, Google Scholar, Ovid Medline (R) and E-Pub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Web of Science, SCOPUS, COCHRANE Library, and ClinicalTrials.gov was performed. Manual review of all items identified in the search was performed by two independent reviewers. Articles were evaluated based on the level of methodological quality and evidence according to the RTI item bank. Results Seven articles met inclusion criteria. None of the included studies reported neurodevelopmental outcomes past 3 months of age. Quality of the evidence ranged from moderate to high. Protocol variations were frequent. Conclusions Based on this systematic review, the FFR to speech can capture both temporal and spectral acoustic features in neonates. It can accurately be recorded in a fast and easy manner at the infant's bedside. However, at this time, further studies are needed to identify and validate which FFR features could be incorporated as an addition to standard evaluation of infant sound processing evaluation in subcortico-cortical networks. This review identifies the need for further research focused on identifying specific features of the neonatal FFRs, those with predictive value for early childhood outcomes to help guide targeted early speech and hearing interventions.

Systematic review methodology for development: An example from microfinance

2018 ◽  
Vol 43 (1) ◽  
pp. 65-77 ◽  
Author(s):  
Carina Van Rooyen ◽  
Ruth Stewart ◽  
Thea De Wet
Keyword(s):  
Systematic Review ◽  
International Development ◽  
Health Sector ◽  
Evidence Based ◽  
Systematic Review Methodology ◽  
Development Interventions ◽  
The Us ◽  
Sub Saharan ◽  
The Impact ◽  
Evidence Based Decision Making

Big international development donors such as the UK’s Department for International Development and USAID have recently started using systematic review as a methodology to assess the effectiveness of various development interventions to help them decide what is the ‘best’ intervention to spend money on. Such an approach to evidence-based decision-making has long been practiced in the health sector in the US, UK, and elsewhere but it is relatively new in the development field. In this article we use the case of a systematic review of the impact of microfinance on the poor in sub-Saharan African to indicate how systematic review as a methodology can be used to assess the impact of specific development interventions.

Resilience Wellness Program for Suicide Prevention: Implementing the VA Whole Health Paradigm

2019 ◽  
Author(s):  
Amanda Vitale ◽  
Lauren Byma ◽  
Evan Podolak ◽  
Zhaoyu Wang ◽  
Shengnan Sun ◽  
...  
Keyword(s):  
Suicide Prevention ◽  
Suicide Attempts ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Integrative Health ◽  
Outpatient Program ◽  
Innovative Program ◽  
Measurement Based Care ◽  
The Us ◽  
Mental Health Programs

Suicide is a major public health problem in the US, specifically among Veterans. The Resilience and Wellness Center (RWC) is an innovative program focused on suicide prevention. The RWC targets vulnerable veterans by augmenting traditional treatments with complementary and integrative health interventions. One critical problem in suicide prevention is lack of engagement in traditional mental health programs, with stigma an oft-cited barrier. The RWC, an alternative paradigm, attempts to break through this barrier by addressing isolation through promoting group camaraderie and accountability, integral to the success of the program. This innovative program provides a unique opportunity to enhance life skills through Whole Health intervention, including: meditation, yoga, music therapy, exercise/dance etc. Specifically, the RWC is a four-week outpatient program, where admission is determined via hospital-wide consults. With a focus on Measurement Based Care, Veterans complete baseline and post-program assessments such as the Personal Health Questionnaire (PHQ9) and scales measuring: depression, hopelessness, sleep quality, and diet & nutrition. Data for 9 cohorts to date demonstrate significant improvements, with large treatment effects as evidenced by reduction in PHQ-9 totals and feelings of depression and hopelessness, especially for Veterans with histories of suicide attempts or ideation. Overall, Veterans found the RWC program experience favorable, with > 98% completing. The RWC can be rapidly deployed in the VHA by drawing on existing hospital services and clinics. According to participants, the RWC engages Veterans in building a partnership to pave the way towards a healthier, more sustainable lifestyle.

Sign in / Sign up

Export Citation Format

Share Document