scholarly journals Collaborative diagnosis between clinician and patient: why to do it and what to consider

2019 ◽  
Vol 25 (4) ◽  
pp. 214-222 ◽  
Author(s):  
Corinna Hackmann ◽  
Jon Wilson ◽  
Amorette Perkins ◽  
Hannah Zeilig
Keyword(s):  
Mental Healthcare ◽  
Evidence Base ◽  
Unintended Consequences ◽  
Learning Objectives ◽  
Common Finding ◽  
Diagnostic Process ◽  
List Type ◽  
Potential Barriers ◽  
Diagnostic Label ◽  
Collaborative Diagnosis

SUMMARYThis article discusses findings from the literature and our own research related to the experience of the diagnostic process in mental healthcare, primarily from the perspective of patients, and it focuses on the benefits of collaboration. A common finding throughout our research is that, if a diagnostic process is undertaken, the majority of patients want to be actively involved and feel valued in it. This helps ensure that they find the process and the resulting diagnosis to be meaningful, informative and useful. We believe that collaboration could also mitigate some of the reported negative unintended consequences of diagnosis, including feeling stigmatised, labelled and disempowered. Our work has led us to conceive of diagnosis as having two overarching elements: the diagnostic process and the resulting diagnostic label. This article focuses specifically on the diagnostic process; we do not consider here the debate surrounding the evidence base for the validity of psychiatric classification.LEARNING OBJECTIVESAfter reading this article you will be able to: •understand patients' experiences of the diagnostic process•achieve a shared and collaborative diagnostic process with patients•reflect on potential barriers and facilitators to collaborative diagnosis in your own practice.DECLARATION OF INTERESTNone.

Electronic Communication, Telehealth, and Social Media

2018 ◽  
Author(s):  
Muniya S. Khanna ◽  
Tommy Chou
Keyword(s):  
Social Media ◽  
Rural Communities ◽  
Unmet Need ◽  
Mental Healthcare ◽  
Evidence Base ◽  
Intervention Delivery ◽  
Safety Issues ◽  
Video Teleconferencing ◽  
Empirically Supported ◽  
Traditional Service

Explosive growth of communication technologies and increased ubiquity of Internet access in both urban and rural communities and particularly in youth have occurred. Coupled with concerns regarding limitations to traditional service provision models, researchers and practitioners are looking to affordable, acceptable technologies to expand the reach of evidence-based care and reduce barriers to intervention and unmet need in areas with few providers. This chapter describes the present literature on use of video teleconferencing, web-based programs, social media, and smartphone apps to enhance mental health intervention delivery, psychiatric assessment, and training and supervision. The strengths of the various delivery methods are discussed for providing empirically supported mental healthcare, focusing on implications related to science and practice with children and families. Outlined also are current limitations, risks, and challenges to technology-mediated services, including the significant gaps in the evidence base underlying these technologies and the legal, ethical, and safety issues that remain.

scholarly journals Self-fill oxygen technology: benefits for patients, healthcare providers and the environment

Breathe ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Phyllis Murphie ◽  
Nick Hex ◽  
Jo Setters ◽  
Stuart Little
Keyword(s):  
Positive Impact ◽  
Healthcare Providers ◽  
Cost Savings ◽  
Cost Effective ◽  
Evidence Base ◽  
Environmental Benefits ◽  
List Type ◽  
Potential Cost ◽  
Unlimited Supply ◽  
Technology Benefits

“Non-delivery” home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers.Educational aimsProvide update for oxygen prescribers on options for home oxygen provision.Provide update on the evidence base for available self-fill oxygen technologies.Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems.

The impact of electronic health records on diagnosis

Diagnosis ◽  
2017 ◽  
Vol 4 (4) ◽  
pp. 211-223 ◽  
Author(s):  
Mark L. Graber ◽  
Colene Byrne ◽  
Doug Johnston
Keyword(s):  
Safety Concern ◽  
Diagnostic Error ◽  
The United States ◽  
Unintended Consequences ◽  
Diagnostic Process ◽  
Health It ◽  
Health Care Information ◽  
Health Care Information Technology ◽  
Electronic Health ◽  
The Impact

AbstractDiagnostic error may be the largest unaddressed patient safety concern in the United States, responsible for an estimated 40,000–80,000 deaths annually. With the electronic health record (EHR) now in near universal use, the goal of this narrative review is to synthesize evidence and opinion regarding the impact of the EHR and health care information technology (health IT) on the diagnostic process and its outcomes. We consider the many ways in which the EHR and health IT facilitate diagnosis and improve the diagnostic process, and conversely the major ways in which it is problematic, including the unintended consequences that contribute to diagnostic error and sometimes patient deaths. We conclude with a summary of suggestions for improving the safety and safe use of these resources for diagnosis in the future.

scholarly journals Metabolic syndrome in psychiatry: advances in understanding and management

2014 ◽  
Vol 20 (2) ◽  
pp. 101-112 ◽  
Author(s):  
Cyrus S. H. Ho ◽  
Melvyn W. B. Zhang ◽  
Anselm Mak ◽  
Roger C. M. Ho
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Psychiatric Disorders ◽  
Psychiatric Patients ◽  
Learning Objectives ◽  
List Type ◽  
Type Number ◽  
Unhealthy Lifestyle ◽  
Definition Of ◽  
The Relationship

SummaryMetabolic syndrome comprises a number of cardiovascular risk factors that increase morbidity and mortality. The increase in incidence of the syndrome among psychiatric patients has been unanimously demonstrated in recent studies and it has become one of the greatest challenges in psychiatric practice. Besides the use of psychotropic drugs, factors such as genetic polymorphisms, inflammation, endocrinopathies and unhealthy lifestyle contribute to the association between metabolic syndrome and a number of psychiatric disorders. In this article, we review the current diagnostic criteria for metabolic syndrome and propose clinically useful guidelines for psychiatrists to identify and monitor patients who may have the syndrome. We also outline the relationship between metabolic syndrome and individual psychiatric disorders, and discuss advances in pharmacological treatment for the syndrome, such as metformin.LEARNING OBJECTIVES•Be familiar with the definition of metabolic syndrome and its parameters of measurement.•Appreciate how individual psychiatric disorders contribute to metabolic syndrome and vice versa.•Develop a framework for the prevention, screening and management of metabolic syndrome in psychiatric patients.

scholarly journals Dystonia Management: What to Expect From the Future? The Perspectives of Patients and Clinicians Within DystoniaNet Europe

2021 ◽  
Vol 12 ◽  
Author(s):  
Marenka Smit ◽  
Alberto Albanese ◽  
Monika Benson ◽  
Mark J. Edwards ◽  
Holm Graessner ◽  
...  
Keyword(s):  
Information Exchange ◽  
Wide Spectrum ◽  
Neurological Diseases ◽  
Evidence Base ◽  
Diagnostic Process ◽  
Reference Network ◽  
Novel Treatments ◽  
European Reference Network ◽  
Specialized Care ◽  
The Central Nervous System

Improved care for people with dystonia presents a number of challenges. Major gaps in knowledge exist with regard to how to optimize the diagnostic process, how to leverage discoveries in pathophysiology into biomarkers, and how to develop an evidence base for current and novel treatments. These challenges are made greater by the realization of the wide spectrum of symptoms and difficulties faced by people with dystonia, which go well-beyond motor symptoms. A network of clinicians, scientists, and patients could provide resources to facilitate information exchange at different levels, share mutual experiences, and support each other's innovative projects. In the past, collaborative initiatives have been launched, including the American Dystonia Coalition, the European Cooperation in Science and Technology (COST—which however only existed for a limited time), and the Dutch DystonieNet project. The European Reference Network on Rare Neurological Diseases includes dystonia among other rare conditions affecting the central nervous system in a dedicated stream. Currently, we aim to broaden the scope of these initiatives to a comprehensive European level by further expanding the DystoniaNet network, in close collaboration with the ERN-RND. In line with the ERN-RND, the mission of DystoniaNet Europe is to improve care and quality of life for people with dystonia by, among other endeavors, facilitating access to specialized care, overcoming the disparity in education of medical professionals, and serving as a solid platform to foster international clinical and research collaborations. In this review, both professionals within the dystonia field and patients and caregivers representing Dystonia Europe highlight important unsolved issues and promising new strategies and the role that a European network can play in activating them.

scholarly journals Alternative medicine under the Mental Health Care Act, 2017: Future implications and concerns

2022 ◽  
Vol 07 (01) ◽  
pp. 37-41
Author(s):  
Ramdas Ransing ◽  
Sujita Kumar Kar ◽  
Vikas Menon
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Alternative Medicine ◽  
Mental Healthcare ◽  
Evidence Base ◽  
Evidence Based ◽  
Insufficient Evidence ◽  
Indian Government ◽  
Evidence Based Care

In recent years, the Indian government has been promoting healthcare with an insufficient evidence base, or which is non-evidence-based, alongside delivery of evidence-based care by untrained practitioners, through supportive legislation and guidelines. The Mental Health Care Act, 2017, is a unique example of a law endorsing such practices. In this paper, we aim to highlight the positive and negative implications of such practices for the delivery of good quality mental healthcare in India.

scholarly journals Tailoring surgical interventions to treat obstructive sleep apnoea: one size does not fit all

Breathe ◽  
2018 ◽  
Vol 14 (3) ◽  
pp. e84-e93 ◽  
Author(s):  
Priya Sethukumar ◽  
Bhik Kotecha
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Evidence Base ◽  
Sleep Apnoea ◽  
Good Effect ◽  
Surgical Approaches ◽  
List Type ◽  
Drug Induced ◽  
Surgical Interventions ◽  
Obstructive Sleep ◽  
New Treatments

While continuous positive airway pressure (CPAP) remains the gold standard treatment of choice in patients with moderate or severe obstructive sleep apnoea (OSA), surgery has been established as a means to improve compliance and facilitate the use of CPAP, both of which are potential pitfalls in the efficacy of this treatment modality. In a minority of cases, with obvious oropharyngeal anatomical obstruction, corrective surgery may completely alleviate the need for CPAP treatment. In this review, we summarise clinical assessment, surgical options, discuss potential new treatments, and outline the importance of investigating and addressing the multiple anatomical levels that can contribute to OSA. Research into effectiveness of these procedures is rapidly accumulating, and surgery can be an effective treatment. However, given the myriad of options available and multiple levels of anatomical pathology that can present, it is imperative that correctly selected patients are matched with the most appropriate treatment for the best outcomes.Key pointsOSA is an increasingly prevalent disorder which has significant systemic effects if left untreated.Anatomical abnormalities can be corrected surgically to good effect with a growing and robust evidence base.Drug-induced sleep endoscopy is a key tool in the otolaryngologist's armamentarium to tailor specific surgery to address specific anatomical concerns, and to facilitate appropriate patient selection.Multilevel surgical approaches are often indicated instead of a “one size fits all” model.Educational aimsTo discuss how to assess patients presenting with OSA in clinic, from an otorhinolaryngology perspective.To discuss the indications for intervention.To provide an overview of nonsurgical interventions for treating OSA, with evidence.To discuss the different surgical modalities available for treatment of OSA, with evidence.

scholarly journals Sleep disorders in psychiatry

2018 ◽  
Vol 24 (4) ◽  
pp. 273-283 ◽  
Author(s):  
Hugh Selsick ◽  
David O'Regan
Keyword(s):  
Mental Health ◽  
Sleep Disorders ◽  
Sleep Medicine ◽  
Sleep Apnoea ◽  
Learning Objectives ◽  
List Type ◽  
Obstructive Sleep ◽  
Psychiatric Conditions ◽  
Respiratory Conditions ◽  
Broad Understanding

SUMMARYSleep medicine is a truly multidisciplinary field that covers psychiatric, neurological and respiratory conditions. As the field has developed it has become increasingly clear that there is a great deal of overlap between sleep and psychiatric disorders and it is therefore essential for psychiatrists to have some knowledge of sleep medicine. Even those disorders, such as obstructive sleep apnoea, that may seem to be outside the remit of psychiatry can have complex and important interactions with psychiatric conditions. In this article we give a brief overview of the range of sleep disorders a psychiatrist might encounter, how they are recognised, investigated and treated, and how they relate to psychiatric conditions.LEARNING OBJECTIVES•Be aware of the range of sleep disorders that might be encountered in psychiatric practice•Understand how these sleep disorders affect mental health•Have a broad understanding of how these disorders are investigated and treatedDECLARATION OF INTERESTH.S. has accepted speaker fees from Janssen Pharmaceuticals.

Prevention and education evidence review: Gambling-related harm

2021 ◽  
Author(s):  
Margo Hilbrecht ◽  
Sally M. Gainsbury ◽  
Nassim Tabri ◽  
Michael J. A. Wohl ◽  
Silas Xuereb ◽  
...  
Keyword(s):  
At Risk ◽  
Research Evidence ◽  
Grey Literature ◽  
Evidence Base ◽  
Unintended Consequences ◽  
Evidence Based ◽  
Negative Consequences ◽  
Age Cohorts ◽  
Gambling Harm ◽  
Harm Prevention

This report supports an evidence-based approach to the prevention and education objective of the National Strategy to Reduce Harm from Gambling. Applying a public health policy lens, it considers three levels of measures: universal (for the benefit of the whole population), selective (for the benefit of at-risk groups), and indicated (for the benefit of at-risk individuals). Six measures are reviewed by drawing upon a range of evidence in the academic and grey literature. The universal level measures are “Regulatory restriction on how gambling is provided” and “Population-based safer gambling/responsible gambling efforts.” Selective measures focus on age cohorts in a chapter entitled, “Targeted safer gambling campaigns for children, youth, and older adults.” The indicated measures are “Brief internet delivered interventions for gambling,” “Systems and tools that produced actual (‘hard’) barriers and limit access to funds,” and “Self-exclusion.” Since the quantity and quality of the evidence base varied by measure, appropriate review methods were selected to assess publications using a systematic, scoping, or narrative approach. Some measures offered consistent findings regarding the effectiveness of interventions and initiatives, while others were less clear. Unintended consequences were noted since it is important to be aware of unanticipated, negative consequences resulting from prevention and education activities. After reviewing the evidence, authors identified knowledge gaps that require further research, and provided guidance for how the findings could be used to enhance the prevention and education objective. The research evidence is supplemented by consultations with third sector charity representatives who design and implement gambling harm prevention and education programmes. Their insights and experiences enhance, support, or challenge the academic evidence base, and are shared in a separate chapter. Overall, research evidence is limited for many of the measures. Quality assessments suggest that improvements are needed to support policy decisions more fully. Still, opportunities exist to advance evidence-based policy for an effective gambling harm prevention and education plan.

05 Co-design of a logic model describing components, mechanisms of change and expected impacts of case management for people who frequently call ambulance services

2021 ◽  
Vol 38 (9) ◽  
pp. A3.1-A3
Author(s):  
Rabeea’h Aslam ◽  
Robert Cole ◽  
Berni Diethart ◽  
Adrian Edwards ◽  
Bethan M Edwards ◽  
...  
Keyword(s):  
Case Management ◽  
Evidence Base ◽  
Professional Staff ◽  
Logic Model ◽  
Prehospital Emergency Care ◽  
Mechanisms Of Change ◽  
Clear Understanding ◽  
List Type ◽  
Management Approaches ◽  
The Uk

BackgroundMulti-agency case management is being introduced by ambulance services and their partners in the UK to try to identify and address the needs of those who call 999 ambulance services frequently. However, there is a lack of evidence about what works well in this setting and how. Based on current nationally agreed definitions, calling frequently is defined as 5 or more times in a month, or 12 or more times in a three-month period. The STRETCHED study (STRategies to manage Emergency ambulance Telephone Callers with sustained High needs – an Evaluation using linked Data) study seeks to evaluate clinical and cost-effectiveness, safety, and efficiency of case management for people who frequently call the emergency ambulance service.We developed a logic model to describe key components, mechanisms of change and expected impacts of cross-sectoral case management approaches to the management of people who call 999 frequently.MethodWe conducted a stakeholder event with 37 people from Wales, England and Northern Ireland including patient representatives and professional staff involved in commissioning, planning and delivering case management for people who call 999 services frequently. The aggregated responses from the participants was used as the basis for developing a logic model.ResultsComponents: dedicated staff time for case management, availability and knowledge of relevant services for referral, multidisciplinary collaboration, organisational support, and clear information sharing protocolsMechanisms: provision of space for a clear understanding of reasons for calling, tailoring of multi–sectoral management to individual needs, offering therapeutic support and assistance in development of self–efficacyImpacts: improvement in access to appropriate and timely care, increase in efficiency and accessibility of the healthcare system, reduction in emergency calls, costs and mortalityConclusionCase management is a developing area of provision in prehospital emergency care for people who call ambulance services frequently. Our logic model provides a firm foundation for evaluation to build the urgently needed evidence base for case management of people who call ambulance services frequently.

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