Megan E. Pailler

Feasibility and Effects of a Web-Based Adolescent Psychiatric Assessment Administered by Clinical Staff in the Pediatric Emergency Department

OBJECTIVES To determine the adoption rate of the Web-based Behavioral Health Screening-Emergency Department (BHS-ED) system during routine clinical practice in a pediatric ED, and to assess this systems effect on identification and assessment of psychiatric problems. DESIGN Descriptive design to evaluate the feasibility of a clinical innovation. SETTING The ED of an urban tertiary care childrens hospital. PARTICIPANTS Adolescents from 14 to 18 years of age, without acute or critical injuries or illness, presenting with nonpsychiatric symptoms. INTERVENTION The ED clinical staff initiated the use of the BHS-ED system, which identifies and assesses adolescents for depression, suicidal ideation, posttraumatic stress, substance use, and exposure to violence. Treating clinicians reviewed results and followed routine care practices thereafter. MAIN OUTCOME MEASURES Adoption rate of the BHS-ED system by nursing staff, identification rates of occult psychiatric problems, and social worker or psychiatrist assessment. Data were collected for 19 months before implementation of the BHS-ED system and for 9 months during implementation. RESULTS Of 3979 eligible patients, 1327 (33.4%) were asked by clinical staff to get screened using the BHS-ED; of these 1327 patients, 857 (64.6%) completed the screening and 470 (35.4%) refused. During implementation, identification of adolescents with psychiatric problems increased significantly (4.2% vs 2.5%; odds ratio [OR], 1.70; 95% confidence interval [CI], 1.38-2.10), as did ED assessments by a social worker or psychiatrist (2.5% vs 1.7%; OR, 1.47; 95% CI, 1.13-1.90). Of the 857 patients who were screened with the BHS-ED, 90 (10.5%) were identified as having psychiatric problems (OR, 4.58; 95% CI, 3.53-5.94), and 71 (8.3%) were assessed (OR, 5.12; 95% CI, 3.80-6.88). CONCLUSIONS In a busy pediatric ED, computerized, self-administered adolescent behavioral health screening can be incorporated into routine clinical practice. This can lead to small but significant increases in the identification of unrecognized psychiatric problems.

Structuring survivorship care: discipline-specific clinician perspectives.

IntroductionSeveral models for survivorship care are prominent within the cancer literature; however, there is little empirical research that examines what oncology clinicians perceive to be the best approach to caring for cancer survivors, what services survivorship programs should include, and how prepared they feel to care for cancer survivors.MethodsAn IRB approved web-based survey of all clinical staff was conducted at a NCI designated comprehensive cancer center with a 49.8% response rate (N = 377). Data were summarized using frequencies and relative frequencies, and pairwise tests of statistical significance were utilized to evaluate differences between clinician type groups.ResultsOverall, the largest proportion of respondents preferred a disease-specific survivorship model (37.6%). This preference was specifically observed in oncology physicians and nurses. When asked where specific survivorship services should be provided, respondents indicated a preference for services directly related to survivors’ medical treatment (i.e. information about late effects) to be delivered in a disease-specific survivorship clinic, and ancillary services (i.e. nutrition and fertility counseling) to be housed in a centralized comprehensive survivorship clinic. Physicians felt that they have significantly more information, training, and resources to care for cancer survivors than did oncology nurses.Discussion/conclusionThese results indicate that oncology clinicians prefer a combination of survivorship care delivery models where continuing medical needs are met in disease-specific clinics, and comprehensive wellness services are offered in a centralized comprehensive survivorship clinic. Results also suggest that planning for survivorship initiatives should include additional resources, education, and training for clinical staff.Implications for cancer survivorsThese findings underscore the need for a universally accepted definition of cancer survivorship, and support a model for delivering care to cancer survivors that is a blend of the disease-specific and comprehensive survivorship programs.

Computerized behavioral health screening in the emergency department.

Review the stated learning objectives of the CME articles and determine if these objectives match your individual learning needs. 2. Read the articles carefully. Do not neglect the tables and other illustrative materials, as they have been selected to enhance your knowledge and understanding. 3. The following quiz questions have been designed to provide a useful link between the CME articles in the issue and your everyday practice. Read each question, choose the correct answer, and record your answer on the CME REGISTRATION FORM at the end of the quiz. Retain a copy of your answers so that they can be compared with the correct answers should you choose to request them. 4. Type your full name and address and your date of birth in the space provided on the CME REGISTRATION FORM. 5. Complete the evaluation portion of the CME REGISTRATION FORM. Forms and quizzes cannot be processed if the evaluation portion is incomplete. The evaluation portion of the CME REGISTRATION FORM will be separated from the quiz upon receipt at PEDIATRIC ANNALS. Your evaluation of this activity will in no way affect the scoring of your quiz. 6. Your answers will be graded, and you will be advised whether you have passed or failed. Unanswered questions will be considered incorrect. A score of at least 80% is required to pass. Your certificate will be mailed to you at the mailing address provided. Upon receiving your grade, you may request quiz answers. Contact our customer service department at (856) 994-9400. 7. Be sure to complete the CME REGISTRATION FORM on or before March 31, 2012. After that date, the quiz will close. Any CME REGISTRATION FORM received after the date listed will not be processed. 8. This activity is to be completed and submitted online only. Indicate the total time spent on the activity (reading article and completing quiz). Forms and quizzes cannot be processed if this section is incomplete. All participants are required by the accreditation agency to attest to the time spent completing the activity. CME ACCREDITATION This CME activity is primarily targeted to pediatricians, osteopathic physicians, pediatric nurse practitioners, and others allied to the field. There are no specific background requirements for participants taking this activity. Learning objectives are found at the beginning of each CME article. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council …

Evaluation and Refinement of a Prostate Cancer Treatment Seminar

Supporters We would like to offer very special thanks to the following companies and organizations for their educational grants: Exhibitors We would also like to thank the following companies & organizations for exhibiting at the conference: Cancer knows no borders. It is the second leading cause of death in developed countries and is among the three leading causes of death for adults in developing and newly industrialized countries. Approximately 12.5% of all deaths are caused by cancer. Thats more than the percentage of deaths caused by HIV/AIDS, tuberculosis, and malaria put together. Cancer is a public health problem worldwide. It affects all people: the young and old, the rich and poor, men, women, and children. Cancer is a leading cause of death worldwide and the total number of cases is increasing. The number of global cancer deaths is projected to increase 45% from 2007 to 2030 (from 7.9 million to 11.5 million deaths), influenced in part by an increasing and aging global population. Every year almost 7 million people die of cancer worldwide and nearly 75% of cancer-related deaths occur in developing countries where resources are limited. Effective patient and professional education is an essential component for the war against cancer that is common to the entire disease spectrum-prevention, detection, diagnosis, treatment, research, and survivorship. Past meetings of the AACE, EACE, and CPEN individually and collectively, have witnessed the presentation of numerous cancer education initiatives and programs that have varied widely across the cancer continuum. The focus of this years meeting will be to explore how the exchange of cancer education in research and practice can generate synergy to decrease the burden of cancer among populations with diverse needs in the United States and globally. Ideas focused on how to treat cancer have existed for thousands of years and from those baseline approaches, a variety of treatment theories and practices have formed over time. Many of these early theoretical models have given rise to the refined practices we enjoy today. The evolution of the journey from theory to practice has continued to spawn global research in cancer prevention, treatment, long-term survivorship, and education throughout the cancer spectrum. Evaluating new culturally-and time-relevant practices begins by exploring the theoretical framework upon which the practice is based. Theories and best practices in communication are cornerstone to better understanding how to meet the changing needs of our audience. As our ability to communicate changes, …

Adjustment to Acute Leukemia: The Impact of Social Support and Marital Satisfaction on Distress and Quality of Life Among Newly Diagnosed Patients and Their Caregivers

Little is known about the specific patterns of adjustment among newly diagnosed acute leukemia patients and their caregivers. This study examined the trajectories of patient and caregiver distress over time as well as the extent to which marital satisfaction and social support moderated these trajectories among those with significant-other caregivers. Forty six patient-caregiver dyads provided ratings at four time points: within 1 week of diagnosis (T1), 2 week follow-up (T2), 6 week follow-up (T3) and 12 week follow-up (T4). As anticipated, patients and caregivers reported higher levels of distress around the time of diagnosis than they did during subsequent time points. Marital satisfaction was a significant predictor of distress among patients, whereas among caregivers, social support predicted distress and quality of life. Results support the inclusion of relational variables such as social support and relationship satisfaction in the assessment of newly diagnosed patients and families in order to best identify those at risk for distress over time.