Erick Hung

Search and Rescue in Yosemite National Park: A 10-Year Review

Abstract Objective.—To describe the general characteristics and epidemiology of search and rescue (SAR) in Yosemite National Park (YNP) and identify possible areas for intervention directed at reduction in use of these services. Methods.—Yosemite Search and Rescue (YOSAR) personnel record every search and rescue mission on a Search and Rescue Incident Report. The information contained in these reports was used to perform a retrospective review of all SAR missions within YNP during the 10-year study period between January 1990 and December 1999. Results.—YOSAR performed 1912 SAR missions, assisting 2327 individuals and recording 2077 injuries and illnesses. Popular trails in and around Yosemite Valley collectively accounted for 25% of all individuals needing SAR services. Lower extremity injuries and dehydration/hypovolemia/hunger were commonly identified reasons to need SAR services. The duration of SAR missions averaged 5 hours, used 12 SAR personnel, and cost

A Method for Evaluating Competency in Assessment and Management of Suicide Risk

4400. Helicopter was the primary mode of transport in 28% of SAR incidents. There were 112 fatalities, yielding a SAR case fatality rate of 4.8%. The majority of fatalities occurred while hiking/snowshoeing, with falling the most common mechanism of lethal injury. Conclusions.—Day-hikers in and around Yosemite Valley use a large portion of SAR services, with lower extremity injuries and dehydration/hypovolemia/hunger the most common reasons. It seems reasonable to direct future intervention to prevention of these commonly identified problems in this particular population of Park visitors.

Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal

ObjectiveAlthough health professionals increasingly are expected to be able to assess and manage patients’ risk for suicide, few methods are available to evaluate this competency. This report describes development of a competency-assessment instrument for suicide risk-assessment (CAI—S), and evaluates its use in an objective structured clinical examination (OSCE).MethodsThe authors developed the CAI—S on the basis of the literature on suicide risk-assessment and management, and consultation with faculty focus groups from three sites in a large academic psychiatry department. The CAI—S structures faculty ratings regarding interviewing and data collection, case formulation and presentation, treatment-planning, and documentation. To evaluate the CAI—S, 31 faculty members used it to rate the performance of 31 learners (26 psychiatric residents and 5 clinical psychology interns) who participated in an OSCE. After interviewing a standardized patient, learners presented their risk-assessment findings and treatment plans. Faculty used the CAI—S to structure feedback to the learners. In a subsidiary study of interrater reliability, six faculty members rated video-recorded suicide risk-assessments.ResultsThe CAI—S showed good internal consistency, reliability, and interrater reliability. Concurrent validity was supported by the finding that CAI—S ratings were higher for senior learners than junior learners, and were higher for learners with more clinical experience with suicidal patients than learners with less clinical experience. Faculty and learners rated the method as helpful for structuring feedback and supervision.ConclusionThe findings support the usefulness of the CAI—S for evaluating competency in suicide risk-assessment and management.

Developing a scalable training model in global mental health: pilot study of a video-assisted training Program for Generalist Clinicians in Rural Nepal

BackgroundMental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation.Partnerships networkWe describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community.ConclusionsWe propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal.

A Novel Department-Based Faculty Fellowship to Promote Scholarship in Medical Education

Background. In low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks. Our objective is to develop and test a video-assisted training model addressing the shortcomings of traditional programs that affect scalability: failing to train all clinicians, disrupting clinical services, and depending on specialists. Methods. We implemented the program -video lectures and on-site skills training- for all clinicians at a rural Nepali hospital. We used Wilcoxon signed-rank tests to evaluate pre- and post-test change in knowledge (diagnostic criteria, differential diagnosis, and appropriate treatment). We used a series of ‘Yes’ or ‘No’ questions to assess attitudes about mental illness, and utilized exact McNemars test to analyze the proportions of participants who held a specific belief before and after the training. We assessed acceptability and feasibility through key informant interviews and structured feedback. Results. For each topic except depression, there was a statistically significant increase (Δ) in median scores on knowledge questionnaires: Acute Stress Reaction (Δ = 20, p = 0.03), Depression (Δ = 11, p = 0.12), Grief (Δ = 40, p < 0.01), Psychosis (Δ = 22, p = 0.01), and post-traumatic stress disorder (Δ = 20, p = 0.01). The training received high ratings; key informants shared examples and views about the trainings positive impact and complementary nature of the programs components. Conclusion. Video lectures and on-site skills training can address the limitations of a conventional training model while being acceptable, feasible, and impactful toward improving knowledge and attitudes of the participants.

Resources for teaching neuroethics.

This report is a retrospective analysis of a novel departmentbased educational scholarship program for faculty. Its purpose is to stimulate other departments to consider replicating or adapting this modest-cost fellowship model to benefit their own faculty educators. Existing models for developing education scholarship amongst physician educators range from individual, informal reflective practices to formal longitudinal fellowships [1] and are organized at the levels of medical schools (academies, educator-scholar programs), hospitals (academies), national specialty organizations (educator-focused programs within specialty organizations), and national medical specialty educator organizations [2–7]. This report is the first known to describe a single department-based faculty fellowship in education scholarship and documents its education scholarship output and impact on academic careers.

Frontotemporal Dementia and Mania

The rapidly evolving field of neuroethics is concerned with the ethical questions that new technologies will pose about autonomy, privacy, the definition of normal, and individuality.