scholarly journals Telepsychiatry in intellectual disability psychiatry: literature review

2019 ◽  
Vol 43 (4) ◽  
pp. 167-173
Author(s):  
Giri Madhavan
Keyword(s):  
Intellectual Disability ◽  
Literature Review ◽  
Healthcare Providers ◽  
Cost Savings ◽  
Healthcare Systems ◽  
Psychiatric Services ◽  
Clinical Implications ◽  
Face To Face ◽  
Research And Innovation

Aims and MethodThe aims of this review were to explore the effectiveness and patient and provider acceptability of telepsychiatry consultations in intellectual disability, contrasting this with direct face-to-face consultations and proposing avenues for further research and innovation. Computerised searches of databases including AMED and EMBASE were conducted.ResultsFour USA studies of intellectual disability telepsychiatry services have been reported. The majority (75%) focused on children with intellectual disability. Sample sizes ranged from 38 to 900 participants, with follow-up from 1 to 6 years. Outcome measures varied considerably and included cost savings to patients and healthcare providers, patient and carer satisfaction and new diagnoses.Clinical implicationsThe innovations summarised suggest a requirement to further explore telepsychiatry models. Despite some promising outcomes, there is a relative dearth in the existing literature. Further studies in other healthcare systems are required before concluding that telepsychiatry in intellectual disability is the best approach for providing psychiatric services to this population.Declaration of interestNone.

Psychiatric out-patient services: origins and future

2006 ◽  
Vol 12 (5) ◽  
pp. 309-319 ◽  
Author(s):  
Helen Killaspy
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Alternative Model ◽  
Community Mental Health Services ◽  
Psychiatric Services ◽  
Early 20Th Century ◽  
Clinical Implications ◽  
Missed Appointments ◽  
Cost Implications

Psychiatric out-patient services originated in the early-20th century to enable triage of new referrals to the asylum in order to differentiate between treatable and untreatable cases. They evolved to provide community follow-up of patients discharged from hospital and assessment of those newly referred to psychiatric services. Non-attendance at out-patient appointments represents an enormous waste of clinical and administrative resources and has potentially serious clinical implications for those who are most psychiatrically unwell. The place of out-patient clinics in modern community mental health services is explored with reference to the reasons for, and clinical and cost implications of, missed appointments. An alternative model is described that incorporates recent UK government guidance on the roles and implementation of community mental health teams, liaison with primary care and new roles for consultant psychiatrists.

scholarly journals A prospective clinical, cost and environmental analysis of a clinician-led virtual urology clinic

2019 ◽  
Vol 101 (1) ◽  
pp. 30-34 ◽  
Author(s):  
S Miah ◽  
C Dunford ◽  
M Edison ◽  
D Eldred-Evans ◽  
C Gan ◽  
...  
Keyword(s):  
Carbon Footprint ◽  
Cost Savings ◽  
Environmental Benefits ◽  
Face To Face ◽  
Enterprise Value ◽  
Working Age ◽  
Mode Of Transport ◽  
Urology Clinic ◽  
Virtual Clinic

Introduction A virtual clinic is a form of telemedicine where contact between clinical teams and patients occur without face-to-face consultation. Our study aims to quantify the clinical, financial and environmental benefits of our virtual urology clinic. Material and methods We collected data prospectively from our weekly follow-up virtual clinic over a continuous four-month period between July and September 2017. Results In total, we reviewed 409 patients. Following virtual clinic consultation, 68.5% of our patients were discharged from further follow-up. The majority of our patients (male 57.7%, female 55.5%) were of working age. The satisfaction scores were high, at 90.1%, and there were no reported adverse events as a result of using the virtual clinic. Our calculated cost savings were £18,744, with a predicted 12-month cost saving of £56,232. The creation of additional face-to-face clinic capacity has created an estimated 12-month increase in tariff generation for our unit of £72,072. In total, 4623 travel miles were avoided by patients using the virtual clinic, with an estimated avoided carbon footprint of 0.35–1.45 metric tonnes of CO2e, depending on mode of transport. Our predicted 12-month avoided carbon footprint is 1.04–4.04 metric tonnes of CO2e. Conclusions Our virtual clinic model has demonstrated a trifecta of positive outcomes, namely, clinical, financial and environmental benefits. The environmental importance and benefits of a virtual clinic should be promoted as a social enterprise value when engaging stakeholders in setting up such a urological service. We propose the adoption of our virtual clinic model in those urological units considering this method of telemedicine.

scholarly journals Antidepressant use in adults with intellectual disability

2010 ◽  
Vol 34 (4) ◽  
pp. 123-126 ◽  
Author(s):  
Prem R. Rai ◽  
Mike Kerr
Keyword(s):  
Intellectual Disability ◽  
Side Effects ◽  
Clinical Outcome ◽  
Learning Disability ◽  
Clinical Improvement ◽  
Positive Outcome ◽  
Clinical Implications ◽  
Service Users ◽  
Antidepressant Use

Aims and methodTo study the use of antidepressants in adults with intellectual disability, focusing on medication type, indication, retention and clinical outcome. Case notes of all service users in a learning disability service were hand-searched to identify antidepressant usage, and those who had been treated with antidepressants and in whom at least 1 year of follow-up was possible were included in the study.ResultsA total of 241 treatment episodes were identified. The rates of positive outcome in terms of clinical improvement at 6 weeks, 6 months and 12 months were 49.4%, 48.1% and 49% respectively, and only 29 (12%) episodes of side-effects had been noted.Clinical implicationsAntidepressants are commonly prescribed in adults with intellectual disability. Approximately half did well in terms of clinical improvement.

scholarly journals Challenges In Telemedicine Implementation For Pregnancy Care During The Covid-19 Pandemic

2020 ◽  
Vol 5 (2) ◽  
pp. 100-109
Author(s):  
Yuliana Yuliana
Keyword(s):  
Literature Review ◽  
Stable Condition ◽  
Pregnant Patient ◽  
Review Literature ◽  
Transmission Risk ◽  
Inclusion Criteria ◽  
Face To Face ◽  
Pregnancy Care ◽  
Technical Issues

Background: COVID-19 pandemic condition made the consultation shifted from face to face consultation to telemedicine for mild, stable, and follow up cases. In stabile condition of pregnant patients, telemedicine implementation will be beneficial to reduce the COVID-19 transmission risk. The problems are not all patients can implement telemedicine and the reimbursement procedure was hard. The aim of this paper is to describe about challenges in telemedicine implementation for pregnancy care during the COVID-19 pandemic. Methods: this paper is a literature review, Literature was identified from the archives of PubMed, Scopus, and Elsevier. All the literature was published in 2020. The inclusion criteria were the literature should be peer-reviewed and related to the topic of the paper. Keywords were challenges, COVID-19, opportunities, pregnancy, and telemedicine. Results: from 18 articles in this literature review, it was found that challenges in telemedicine are reimbursement, infrastructure, confidentiality, and unfamiliarity for the pregnant patients. Conclusion: Telemedicine can be used for pregnant patient control consultation during the stable condition to minimize the risk of COVID-19 transmission. The implication of this paper is to give insight that telemedicine can be done for stable pregnancy condition to reduce the risk of COVID-19 transmission during the pandemic. The benefits of reducing COVID-19 risk transmission for baby and mother outweigh the challenges and problems such as reimbursement, confidentiality, and technical issues.

scholarly journals COVIDCare: A Digital Solution for Follow-up of Individuals with Suspected or Diagnosed COVID-19 (Preprint)

2020 ◽  
Author(s):  
Sofie H. Willems ◽  
Jyotsna Rao ◽  
Sailee Bhambere ◽  
Dipu Patel ◽  
Yvonne Biggins ◽  
...  
Keyword(s):  
Mobile Application ◽  
Health Management ◽  
Healthcare Providers ◽  
Healthcare Systems ◽  
Model Of Care ◽  
Web Based ◽  
Healthcare Application ◽  
Program Components ◽  
Digital Healthcare

BACKGROUND The coronavirus disease (COVID-19) pandemic has generated unprecedented and sustained health management challenges worldwide. Healthcare systems continue to struggle to support the needs of the majority of infected individuals that are either asymptomatic or have mild symptoms. OBJECTIVE To rapidly and safely address gaps in the healthcare support available from initially, and repeatedly, overwhelmed providers and systems. We sought to create a digital healthcare solution that could appropriately monitor and manage needs of individuals requiring self-isolation due to suspected or diagnosed COVID-19 with mild to moderate symptoms. METHODS A theoretically grounded multiplatform digital healthcare application was created to safely monitor and support this group of affected individuals based on rapidly emerging scientific guidance. The solution – COVIDCare – was designed to address this need and to be flexible enough to adapt to the evolving management requirements of various stakeholders to reduce COVID-19 infection rates, acute hospitalizations and mortality. RESULTS The COVIDCare multiplatform solution provides a hybrid model of care that includes mobile and online platforms, paired with direct clinician input. The patient mobile application includes four program components: 1) symptom management, 2) patient education, 3) wellbeing support, and 4) communication with healthcare providers. The clinician web-based portal includes secure, bi-directional, chat communication between the patient and clinician. CONCLUSIONS COVIDCare can flexibly address strategic needs of strained healthcare systems and is customizable to meet the needs of employers and public health stakeholders who continue to manage the lasting impact of the COVID-19 pandemic.

scholarly journals Implementation of vascular surgery teleconsultation during the COVID-19 pandemic: Insights from the outpatient vascular clinics in a tertiary care hospital in Qatar

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257458
Author(s):  
Hassan Al-Thani ◽  
Ahammed Mekkodathil ◽  
Ahmed Hussain ◽  
Ahmed Sharaf ◽  
Ahmed Sadek ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Tertiary Hospital ◽  
Care Hospital ◽  
Timely Manner ◽  
Virtual Communication ◽  
Face To Face ◽  
Medical Needs

Background The COVID-19 pandemic has sparked a surge in the use of virtual communication tools for delivering clinical services for many non-urgent medical needs allowing telehealth or telemedicine, to become an almost inevitable part of the patient care. However, most of patients with vascular disease may require face-to-face interaction and are at risk of worse outcomes if not managed in timely manner. Objective We aimed to describe the utilization of telemedicine services in the outpatient vascular surgery clinics in a tertiary hospital. Methods A retrospective analysis of data on all vascular outpatient encounters during 2019 and 2020 was conducted and compared to reflect the pattern of practice prior to and during the COVID-19 pandemic. Results The study showed that 61% of the total patient encounters in 2020 were reported through teleconsultation. Females were the majority of patients who sought the virtual vascular care. Consultations for the new cases decreased from 29% to 26% whereas, the follow-up cases increased from 71% to 74% in 2020 (p = 0.001). The number of procedures performed in the vascular outpatient clinics decreased by 46% in 2020 when compared to 2019. This decrease in procedures was more evident in the duration from February 2020 to April 2020 in which the procedures decreased by 97%. The proportion of procedures represented 22.6% of the total encounters in 2019 and 10.5% of the encounters during 2020, (p = 0.001). Conclusions Teleconsultation, along with supporting practice guidelines, can be used to maximize the efficiency of care in vascular surgery patients during the pandemic and beyond. Adoption of the ‘hybrid care’ which combines both virtual and in-person services as an ongoing practice requires evidence obtained through audits and studies on patients and healthcare providers levels. It is essential to establish a clear practice that ensures patient’s needs.

Escape-Motivated Bathroom Visits: Effects of Activity Scheduling, Cuing, and Duration-Fading in an Adult With Intellectual Disability

2017 ◽  
Vol 16 (5) ◽  
pp. 417-426 ◽  
Author(s):  
James K. Luiselli ◽  
Timothy Sobezenski
Keyword(s):  
Intellectual Disability ◽  
Behavioral Assessment ◽  
Fixed Time ◽  
Time Limit ◽  
Clinical Implications ◽  
Activity Scheduling ◽  
Baseline Phase ◽  
Reinforcing Effects ◽  
Day Habilitation

We report the case of a woman who had intellectual disability, made frequent bathroom requests, and spent excessive time in the bathroom at a day-habilitation center. Functional behavioral assessment suggested that frequency and duration of bathroom requests were escape-motivated. Intervention was directed at reducing the reinforcing effects of visiting the bathroom through (a) activity scheduling, (b) cuing the woman to exit the bathroom according to a fixed time limit, and (c) gradually reducing the time limit to an acceptable duration. Compared with a baseline phase, intervention was associated with decreased bathroom requests and duration of bathroom visits that were maintained at 2-month follow-up. We discuss clinical implications of these findings and recommendations to practitioners.

Psychopathology 8½ Years Post Parasuicide

Crisis ◽  
1999 ◽  
Vol 20 (3) ◽  
pp. 115-120 ◽  
Author(s):  
Stephen Curran ◽  
Michael Fitzgerald ◽  
Vincent T Greene
Keyword(s):  
Rating Scales ◽  
Psychiatric Morbidity ◽  
Parental Bonding ◽  
Social Maladjustment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Face To Face ◽  
Long Term Follow Up

There are few long-term follow-up studies of parasuicides incorporating face-to-face interviews. To date no study has evaluated the prevalence of psychiatric morbidity at long-term follow-up of parasuicides using diagnostic rating scales, nor has any study examined parental bonding issues in this population. We attempted a prospective follow-up of 85 parasuicide cases an average of 8½ years later. Psychiatric morbidity, social functioning, and recollections of the parenting style of their parents were assessed using the Clinical Interview Schedule, the Social Maladjustment Scale, and the Parental Bonding Instrument, respectively. Thirty-nine persons in total were interviewed, 19 of whom were well and 20 of whom had psychiatric morbidity. Five had died during the follow-up period, 3 by suicide. Migration, refusals, and untraceability were common. Parasuicide was associated with parental overprotection during childhood. Long-term outcome is poor, especially among those who engaged in repeated parasuicides.

Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

2020 ◽  
Author(s):  
Adam Lee ◽  
Adam Bajinting ◽  
Abby Lunneen ◽  
Colleen M. Fitzpatrick ◽  
Gustavo A. Villalona
Keyword(s):  
Literature Review ◽  
Retrospective Review ◽  
Review Of The Literature ◽  
Rare Presentation ◽  
Spontaneous Pneumomediastinum ◽  
Nonaccidental Trauma ◽  
Comprehensive Literature Review ◽  
Healthy Infants ◽  
History Of

AbstractReports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

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