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Kłosiewicz T, Cholerzyńska H, Zasada WA, Shadi A, Olszewski J, Konieczka P, Podlewski R, Puślecki M. Impact of Various Atrial Fibrillation Treatment Strategies on Length of Stay in the Emergency Department and Early Complications-3 Years of a Single-Center Experience. J Clin Med 2023; 13:190. [PMID: 38202197 PMCID: PMC10779744 DOI: 10.3390/jcm13010190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/29/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia presenting in emergency departments (EDs), vastly increasing mainly due to society's lifestyles leading to numerous comorbidities. Its management depends on many factors and is still not unified. Aims: The aim of this study was to compare different AF management strategies in the ED and to evaluate their influence on the length of stay (LOS) in the ED and their safety. We analyzed medical records over 3 years of data collection, including age, primary AF diagnosis, an attempt to restore sinus rhythm, complications, and length of stay. Patients were divided into three groups according to the treatment method received: only pharmacological cardioversion (MED), only electrical cardioversion (EC), and patients who received medications followed by electrical cardioversion (COMB). We included 599 individuals in the analysis with a median age of 71. The restoration of sinus rhythm and LOS were as follows: MED: 64.95%, 173 min; COMB: 87.91%, 295 min; SH: 92.40%, 180 min. The difference between the MED and EC strategies, as well as MED and COMB, was statistically significant (p < 0.001 in both). The total number of complications was 16, with a rate of 32.67%. The majority of them followed a drug administration, and the most common complication was bradycardia. Electrical cardioversion is a safe and effective treatment strategy in stable patients with AF in the ED. It is associated with a shortened LOS. Medication administration preceded the majority of complications.
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Affiliation(s)
- Tomasz Kłosiewicz
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Hanna Cholerzyńska
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Wiktoria Antonina Zasada
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Amira Shadi
- College of Emergency Physicians in Poland, 5 Truflowa Street, 62-070 Dopiewiec, Poland; (A.S.); (J.O.)
| | - Jakub Olszewski
- College of Emergency Physicians in Poland, 5 Truflowa Street, 62-070 Dopiewiec, Poland; (A.S.); (J.O.)
| | - Patryk Konieczka
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Roland Podlewski
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Mateusz Puślecki
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
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Napoli G, Garzitto M, Magliulo V, Carnemolla R, Anzallo C, Balestrieri M, Colizzi M. Changes in Revolving-Door Mental Health Hospitalizations during the COVID-19 Pandemic: A 5-Year Chart Review Study. J Clin Med 2023; 12:jcm12072681. [PMID: 37048764 PMCID: PMC10095521 DOI: 10.3390/jcm12072681] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023] Open
Abstract
This study assessed changes in revolving-door (RD) mental health hospitalizations during the COVID-19 pandemic. A 5-year retrospective hospital chart review was performed, collecting revolving-door hospitalization, sociodemographic, and clinical data. Out of 1036 patients, 5.69% had RD hospitalizations, which accounted for 10.38% of all recorded hospitalizations. Further, a higher number of RD hospitalizations occurred following the pandemic outbreak, which is unlikely to have been a result of the confounding effect of trimester and month of hospitalization. Finally, several sociodemographic and clinical characteristics recurred more frequently in the context of RD hospitalizations, such as being younger, being compulsorily admitted, being an absconding patient, and being referred by a public service. Certain diagnostic categories occurred more frequently among RD hospitalizations, including psychotic, personality, and substance use disorders, as well as intellectual disability. Patients with specific characteristics are more likely to incur in RD hospitalizations, requiring the implementation of supportive treatment plans, especially following the pandemic outbreak.
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Affiliation(s)
- Giovanni Napoli
- General Hospital Psychiatric Unit, Department of Mental Health, Friuli Centrale Health University Authority, 33100 Udine, Italy
| | - Marco Garzitto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Vincenzo Magliulo
- General Hospital Psychiatric Unit, Department of Mental Health, Friuli Centrale Health University Authority, 33100 Udine, Italy
| | - Rossana Carnemolla
- General Hospital Psychiatric Unit, Department of Mental Health, Friuli Centrale Health University Authority, 33100 Udine, Italy
| | - Calogero Anzallo
- General Hospital Psychiatric Unit, Department of Mental Health, Friuli Centrale Health University Authority, 33100 Udine, Italy
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
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Dias RDL, Shalaby R, Agyapong B, Obuobi-Donkor G, Adu MK, Eboreime E, Obeng Nkrumah S, Sridharan S, Simon P, Taylor B, Henderson N, White MD, Maguire H, Gray G, Rahman F, Fair J, Wadden N, Sulyman M, Williams O, Akinkunmi O, Edem D, Arenella P, Morrison J, Awara M, Natarajan A, Nunes A, Hajek T, O’Donavan C, Uher R, Wang J, Rusak B, Wozney L, Sampalli T, Grant D, Tomblin Murphy G, Warford J, Hodder S, Boe R, Agyapong VIO. Augmenting Mental Health Support for Patients Accessing Different Degrees of Formal Psychiatric Care through a Supportive Text Messaging Program: Protocol for a Randomized Controlled Trial. Methods Protoc 2023; 6:mps6010019. [PMID: 36827506 PMCID: PMC9959317 DOI: 10.3390/mps6010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Patients feel more vulnerable when accessing community mental health programs for the first time or after being discharged from psychiatric inpatient units. Long wait times for follow-up appointments, shortage of mental health professionals, lack of service integration, and scarcity of tailored support can weaken their connection to the health care system. As a result, patients can present low adherence, dissatisfaction with treatment, and recurrent hospitalizations. Finding solutions to avoid unnecessary high-cost services and providing tailored and cost-effective mental health interventions may reduce the health system burden and augment patient support. We propose implementing an add-on, supportive text messaging service (Text4Support), developed using cognitive-behavioural therapy (CBT) principles to augment mental health support for patients attending to or being discharged from psychiatric care in Nova Scotia, Canada. This randomized controlled trial aims to investigate the effectiveness of Text4Support in improving mental health outcomes and overall mental well-being compared with usual care. We also will examine the intervention's impact on health services utilization and patient satisfaction. The results from this study will provide evidence on stepped and technology-based mental health care, which will contribute to generating new knowledge about mental health innovations in various clinical contexts, which is not only helpful for the local context but to other jurisdictions in Canada and abroad that are seeking to improve their health care.
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Affiliation(s)
- Raquel da Luz Dias
- Department of Psychiatry, Nova Scotia Health, Halifax, NS B3H 2E2, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Belinda Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Gloria Obuobi-Donkor
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Medard K. Adu
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | | | - Sanjana Sridharan
- Department of Psychiatry, Nova Scotia Health, Halifax, NS B3H 2E2, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Patryk Simon
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Bryanne Taylor
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Neal Henderson
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Mathew D. White
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Hugh Maguire
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Gerald Gray
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Faisal Rahman
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Janah Fair
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Nadine Wadden
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Mutiat Sulyman
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Olugbenga Williams
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Oluseye Akinkunmi
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Dorothy Edem
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Pamela Arenella
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Jason Morrison
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Mahmoud Awara
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Anand Natarajan
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Abraham Nunes
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Tomas Hajek
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Claire O’Donavan
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Rudolf Uher
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Mental Health and Addictions Program, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - JianLi Wang
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Nova Scotia Health Innovation Hub, Halifax, NS B3S 0H6, Canada
| | - Benjamin Rusak
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Lori Wozney
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Mental Health and Addictions Program, IWK Health, Halifax, NS B3K 6R8, Canada
| | - Tara Sampalli
- Nova Scotia Health Innovation Hub, Halifax, NS B3S 0H6, Canada
| | - Doris Grant
- Nova Scotia Health Innovation Hub, Halifax, NS B3S 0H6, Canada
| | | | - Jordan Warford
- Nova Scotia Health Innovation Hub, Halifax, NS B3S 0H6, Canada
| | - Samantha Hodder
- School of Nursing, Cape Breton University, Cape Breton, NS B1M 1A2, Canada
| | - Rachel Boe
- Addictions and Mental Health, Horizon Health Network, Fredericton, NB E3B 4R3, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, Nova Scotia Health, Halifax, NS B3H 2E2, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Correspondence: or
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Shalaby R, Spurvey P, Knox M, Rathwell R, Vuong W, Surood S, Urichuk L, Snaterse M, Greenshaw AJ, Li XM, Agyapong VIO. Clinical Outcomes in Routine Evaluation Measures for Patients Discharged from Acute Psychiatric Care: Four-Arm Peer and Text Messaging Support Controlled Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073798. [PMID: 35409483 PMCID: PMC8997547 DOI: 10.3390/ijerph19073798] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/10/2022]
Abstract
Background: Peer support workers (PSW) and text messaging services (TxM) are supportive health services that are frequently examined in the field of mental health. Both interventions have positive outcomes, with TxM demonstrating clinical and economic effectiveness and PSW showing its utility within the recovery-oriented model. Objective: To evaluate the effectiveness of PSW and TxM in reducing psychological distress of recently discharged patients receiving psychiatric care. Methods: This is a prospective, rater-blinded, pilot-controlled observational study consisting of 181 patients discharged from acute psychiatric care. Patients were randomized into one of four conditions: daily supportive text messages only, peer support only, peer support plus daily text messages, or treatment as usual. Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM), a standardized measure of mental distress, was administered at four time points: baseline, six weeks, three months, and six months. MANCOVA was used to assess the impact of the interventions on participants’ scores on four CORE-OM subscales across the three follow-up time points. Recovery, clinical change, and reliable change in CORE-OM all-item analysis were examined across the four groups, and the prevalence of risk symptoms was measured. Results: A total of 63 patients completed assessments at each time point. The interaction between PSW and TxM was predictive of differences in scores on the CORE-OM functioning subscale with a medium effect size (F1,63 = 4.19; p = 0.045; ηp2 = 0.07). The PSW + TxM group consistently achieved higher rates of recovery and clinical and reliable improvement compared to the other study groups. Additionally, the text message group and the PSW + TxM group significantly reduced the prevalence of risk of self/other harm symptoms after six months of intervention, with 27.59% (χ2(1) = 4.42, p = 0.04) and 50% (χ2(1) = 9.03, p < 0.01) prevalence reduction, respectively. Conclusions: The combination of peer support and supportive text messaging is an impactful intervention with positive clinical outcomes for acute care patients. Adding the two interventions into routine psychiatric care for patients after discharge is highly recommended.
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Affiliation(s)
- Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (A.J.G.); (X.-M.L.)
| | - Pamela Spurvey
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Michelle Knox
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Rebecca Rathwell
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Wesley Vuong
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Shireen Surood
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Liana Urichuk
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Mark Snaterse
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Andrew J. Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (A.J.G.); (X.-M.L.)
| | - Xin-Min Li
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (A.J.G.); (X.-M.L.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (A.J.G.); (X.-M.L.)
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Correspondence:
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Holzinger F, Oslislo S, Kümpel L, Resendiz Cantu R, Möckel M, Heintze C. Emergency department consultations for respiratory symptoms revisited: exploratory investigation of longitudinal trends in patients' perspective on care, health care utilization, and general and mental health, from a multicenter study in Berlin, Germany. BMC Health Serv Res 2022; 22:169. [PMID: 35139850 PMCID: PMC8830011 DOI: 10.1186/s12913-022-07591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Only few studies of emergency department (ED) consulters include a longitudinal investigation. The EMACROSS study had surveyed 472 respiratory patients in eight inner-city EDs in Berlin in 2017/2018 for demographic, medical and consultation-related characteristics. This paper presents the results of a follow-up survey at a median of 95 days post-discharge. We aimed to explore the post hoc assessment of ED care and identify potential longitudinal trends. METHODS The follow-up survey included items on satisfaction with care received, benefit from the ED visit, potential alternative care, health care utilization, mental and general health, and general life satisfaction. Univariable between-subject and within-subject statistical comparisons were conducted. Logistic regression was performed for multivariable investigations of determinants of dropout and of retrospectively rating the ED visit as beneficial. RESULTS Follow-up data was available for 329 patients. Participants of lower education status, migrants, and tourists were more likely to drop out. Having a general practitioner (GP), multimorbidity, and higher general life satisfaction were determinants of response. Retrospective satisfaction ratings were high with no marked longitudinal changes and waiting times as the most frequent reason for dissatisfaction. Retrospective assessment of the visit as beneficial was positively associated with male sex, diagnoses of pneumonia and respiratory failure, and self-referral. Concerning primary care as a viable alternative, judgment at the time of the ED visit and at follow-up did not differ significantly. Health care utilization post-discharge increased for GPs and pulmonologists. Self-reported general health and PHQ-4 anxiety scores were significantly improved at follow-up, while general life satisfaction for the overall sample was unchanged. CONCLUSIONS Most patients retrospectively assess the ED visit as satisfactory and beneficial. Possible sex differences in perception of care and its outcomes should be further investigated. Conceivable efforts at diversion of ED utilizers to primary care should consider patients' views regarding acceptable alternatives, which appear relatively independent of situational factors. Representativeness of results is restricted by the study focus on respiratory symptoms, the limited sample size, and the attrition rate. TRIAL REGISTRATION German Clinical Trials Register ( DRKS00011930 ); date: 2017/04/25.
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Affiliation(s)
- Felix Holzinger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.
| | - Sarah Oslislo
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
| | - Lisa Kümpel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
| | - Rebecca Resendiz Cantu
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Charitéplatz 1, Berlin, 10117, Germany
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Charitéplatz 1, Berlin, 10117, Germany
| | - Christoph Heintze
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
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Jain S, Jaygopal M, Malhotra S, Purkayastha A, Singhal S. Factors affecting stress levels in attendants accompanying patients to emergency department. J Emerg Trauma Shock 2022; 15:116-123. [PMID: 36353404 PMCID: PMC9639734 DOI: 10.4103/jets.jets_156_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction: Staff in emergency departments work in an environment where they are continuously exposed to situations with aggressive patients and their caretakers. With increasing incidents of reported violence, the present study was conducted to identify factors associated with stress levels among patients’ attendants. Methods: A prospective, cross-sectional, observational study was conducted among 256 attendants of patients presenting to Emergency Department (ED). Signs of stress and imminent violence were recorded using STAMP method at initial encounter. Stress levels were assessed using Perceived Stress Scale 10 and Visual Analog Scale at the end of 2 h during patient's stay in emergency department. Factors associated with stress were studied using linear regression analysis. There was a follow-up to estimate the level of stress, to identify risk factors and types of violence in the sample population. Results: 98.9% of attendants exhibited some form of stress. Age of <40 years, female gender, single marital status, lower educational background, lack of previous experience with ED, perceived long waiting time, and first-degree relatives were the significant risk factors associated with high stress. Verbal aggression was the most common and frequent form of aggression. Noncritically ill patient attendants, no previous experience with EDs, graduates, middle age group, perceived long waiting time, and poor patient response to treatment were found to be risk factors for impending violence. Conclusion: Stress was exhibited in majority of caregivers. Further programs are needed to strengthen training for ED staff to identify early and impending violence and to develop coping mechanisms for well-being of both attendants and health-care professionals.
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Au TY, Assavarittirong C. The overview of utilizing complementary therapy to relieve stress or anxiety in emergency department patients: animal-assisted therapy, art therapy, and music therapy. Ment Health (Lond) 2021. [DOI: 10.32437/mhgcj.v4i2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The Emergency Department could be a stressful environment for patients. Anxiety and depression may develop due to the atmosphere, in addition to patients’ concerns for their health conditions. The condition could potentially affect the experience of the patient in the Emergency Department and the quality of life after the visit. Pharmacological therapy could be administered to the patients. However, adverse effects may be associated with the treatment. Less aggressive complementary treatment approaches are presented in this article. Controlled clinical trials and randomized pilot studies of different complementary therapies, including animal-assisted therapy, art therapy, and music therapy, were conducted. The complementary therapies discussed in this article showed positive outcomes for patients with hospital-induced anxiety and has no adverse effect reported. Hence, hospitals may consider introducing complementary therapies, such as those mentioned in this study, to improve the patients’ experiences in the Emergency Department
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Shafiq M, Malhotra R, Teo I, Ozdemir S, Kanesvaran R, Malhotra C. Trajectories of physical symptom burden and psychological distress during the last year of life in patients with a solid metastatic cancer. Psychooncology 2021; 31:139-147. [PMID: 34432911 DOI: 10.1002/pon.5792] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/13/2021] [Accepted: 08/11/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To delineate the trajectories of physical symptoms and psychological distress among patients with a solid metastatic cancer during the last year of life. METHODS We used data of 345 decedents from a prospective cohort of 600 patients with a Stage IV solid cancer. Using group-based trajectory modelling, we assessed (a) demographic (age, gender, education, cancer site) predictors of trajectory membership, (b) shift in trajectories associated with planned and unplanned hospitalizations, emergency room visits and chemotherapy, and (c) the association between trajectory membership and place of death. RESULTS We identified three trajectories of physical symptoms-"persistent mild" (56%), "progressive moderate" (36%), and "progressive severe" (8%), and two for psychological distress-"persistent mild" (72%) and "progressive distress" (28%). Females (β = 1.40 [SE = 0.55], p-value = 0.01) and highly educated patients (β = 1.46 [SE = 0.62], p-value = 0.02) were more likely to experience progressive severe symptoms compared to persistent mild symptoms. Older patients were less likely (β = -1.01 [SE = 0.33], p-value = 0.003), while those with gynecological cancers (β = 1.51 [SE = 0.65], p-value = 0.02) were more likely to experience progressive distress compared to persistent mild distress. Planned and unplanned hospitalizations, emergency room visits, and chemotherapy were associated with a worsening in trajectories. Patients with higher distress were more likely to die in a hospice compared to a hospital. CONCLUSIONS Interventions to improve physical symptoms and distress can focus on patients at risk of being in worse trajectories and at critical time points in the last year of life-hospitalizations, emergency room visits, and chemotherapy.
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Affiliation(s)
| | | | - Irene Teo
- Duke-NUS Medical School, Singapore, Singapore.,National Cancer Centre Singapore, Singapore, Singapore
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- Duke-NUS Medical School, Singapore, Singapore
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Woodhead C, Martin P, Osborn D, Barratt H, Raine R. Health system influences on potentially avoidable hospital admissions by secondary mental health service use: A national ecological study. J Health Serv Res Policy 2021; 27:22-30. [PMID: 34337981 PMCID: PMC8772012 DOI: 10.1177/13558196211036739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives Potentially avoidable hospital admissions (PAAs) are costly to health services and potentially harmful for patients. This study aimed to compare area-level PAA rates among people using and not using secondary mental health services in England and to identify health system features that may influence between-area PAA variation. Methods National ecological study using linked English hospital admissions and secondary mental health services data (2016–2018). We calculated two-year average age-sex standardised area-level PAA rates according to primary admission diagnoses for 12 physical conditions, among, first, secondary mental health service users with any non-organic diagnosis, and, second, people not in contact with secondary mental health services. We used penalised regression analyses to identify predictors of area-level variation in PAA rates. Results Area-level PAA rates were over four times greater in the mental health group, at 7,594 per 100,000 population compared to 1,819 per 100,000 in the comparator group. Common predictors of variation were greater density of older age groups (lower PAA rates), higher underlying population morbidity of chronic obstructive pulmonary disease and, to a lesser extent, urbanity (higher PAA rates). For both groups, health system factors such as the number of general practitioners per capita or ambulance despatch rates were significant but weak predictors of variation. Mental health diagnosis data were available for half of secondary mental health care records only and sensitivity analyses found that urbanity remained the sole significant predictor for PAAs in this group. Conclusions Findings support the need for improved management of physical conditions for secondary mental health service users. Understanding and predicting variation in PAAs among mental health service users is constrained by availability of data on mental health diagnosis, physical health care and needs.
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Affiliation(s)
- Charlotte Woodhead
- Lecturer Society and Mental Health, ESRC Centre for Society and Mental Health, Department of Psychological Medicine, King's College London, UK
| | - Peter Martin
- Lecturer Applied Statistics, NIHR ARC North Thames, Department of Applied Health Research, 4919University College London, University College London, UK
| | - David Osborn
- Professor of Psychiatric Epidemiology, Department of Epidemiology and Applied Clinical Research, Division of Psychiatry, University College London and Camden and Islington NHS Foundation Trust, UK
| | - Helen Barratt
- Senior Clinical Research Associate, NIHR ARC North Thames, Department of Applied Health Research, 4919University College London, University College London, UK
| | - Rosalind Raine
- Professor of Health Care Evaluation, NIHR ARC North Thames, Department of Applied Health Research, 4919University College London, University College London, UK
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Castello LM, Airoldi C, Baldrighi M, Bortoluzzi S, Cammarata LM, Franchetti Pardo L, Gardino CA, Payedimarri AB, Giorchino M, Pistone G, Stampini V, Avanzi GC, Faggiano F. Effectiveness and feasibility of smoking counselling: a randomized controlled trial in an Italian emergency department. Eur J Public Health 2021; 32:119-125. [PMID: 34252178 PMCID: PMC8807080 DOI: 10.1093/eurpub/ckab114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND 5A's counselling is recommended for screening and treating patients with smoking addiction. The emergency department (ED) setting might be a suitable environment for conducting interventions for smoking cessation. The present study aims to determine the feasibility and effectiveness on smoking cessation of 5A's counselling administered to ED patients by nurses. METHODS Parallel group randomized trial assessing 5A's counselling for smoking cessation vs. usual care at a University Hospital in the North of Italy. The primary end-point was prevalence of tobacco-free patients. The secondary outcomes at 6- and 12-month follow-up were (i) consecutive past 30-day smoking abstinence; (ii) past 7-day 50%, or more, decrease in daily tobacco consumption over baseline; and (iii) number of attempts to quit smoking. RESULTS A total of 480 patients were randomized to intervention (n = 262) or usual care (n = 218). Intention to treat analysis displayed no differences in primary and secondary outcomes between groups. A slight but not statistically significant enhancement in cessation was recorded in the intervention group [relative risk (RR) = 1.04, 95% confidence interval (CI) = 0.58-1.87] at 6 months, whereas a reversed observation at 12 months (RR = 0.86, 95% CI = 0.50-1.47). Similar results were obtained for the secondary outcomes. Per protocol analysis increased the size of the results. Of the 126 smokers receiving counselling, 18 were visited and treated at the local smoking cessation centre, with 12 of them successfully completing the treatment. CONCLUSION The results of this study indicate that the ED is not a suited environment for 5A's counselling.
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Affiliation(s)
- Luigi Mario Castello
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy.,Emergency Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Marco Baldrighi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy.,Emergency Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Sara Bortoluzzi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | | | - Livia Franchetti Pardo
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Clara Ada Gardino
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy.,Emergency Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Anil Babu Payedimarri
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Matteo Giorchino
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Giovanni Pistone
- Centro per il Trattamento del Tabagismo, Local Health Unit, Novara, Italy
| | - Viviana Stampini
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy.,Emergency Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Fabrizio Faggiano
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
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11
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Jackson A, Rogerson M, Le Grande M, Thompson D, Ski C, Alvarenga M, Amerena J, Higgins R, Raciti M, Murphy BM. Protocol for the development and validation of a measure of persistent psychological and emotional distress in cardiac patients: the Cardiac Distress Inventory. BMJ Open 2020; 10:e034946. [PMID: 32532770 PMCID: PMC7295398 DOI: 10.1136/bmjopen-2019-034946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Distress is experienced by the majority of cardiac patients, yet no cardiac-specific measure of distress exists. The aim of this project is to develop and validate the Cardiac Distress Inventory (CDI). Using the CDI, health professionals will be able to identify key clusters of psychological, emotional and social concern to address with patients, postcardiac event. METHODS AND ANALYSIS An item pool will be generated through: identification of items by a multidisciplinary group of clinician researchers; review of generic and condition-specific distress measures; focus group testing with cardiac rehabilitation professionals; feedback from patients. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) criteria will be used to inform the development of the methodology for determining the CDI's psychometric properties. The item pool will be tested with 400 cardiac patients and responses subjected to exploratory factor analysis, Rasch analysis, construct validity testing and latent class analysis. Receiver operating characteristic analysis will be used to identify the optimal CDI cut-off score for distinguishing whether a person experiences clinically significant distress. ETHICS AND DISSEMINATION Approved by the Monash Health Human Research Ethics Committee (approval number-RES-19-0000631L-559790). The CDI will be made available to clinicians and researchers without charge. The CDI will be translated for use internationally. Study findings will be shared with cardiac patient support groups; academic and medical communities via publications and presentations; in the training of cardiac secondary prevention professionals; and in reports to funders. Authorship for publications will follow the uniform requirements for manuscripts submitted to biomedical journals.
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Affiliation(s)
- Alun Jackson
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Michelle Rogerson
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
| | - Michael Le Grande
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - David Thompson
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Chantal Ski
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Marlies Alvarenga
- School of Health and Life Sciences, Federation University Australia - Berwick Campus, Berwick, Victoria, Australia
- Monash Cardiovascular Research Centre, MonashHeart, Melbourne, Victoria, Australia
| | - John Amerena
- Cardiac Services, Barwon Health, Geelong, Victoria, Australia
- Deakin School of Medicine, Geelong, Victoria, Australia
| | - Rosemary Higgins
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Michela Raciti
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
| | - Barbara M Murphy
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- Deakin University Faculty of Health, Burwood, Victoria, Australia
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Faessler L, Brodbeck J, Schuetz P, Haubitz S, Mueller B, Perrig-Chiello P. Medical patients' affective well-being after emergency department admission: The role of personal and social resources and health-related variables. PLoS One 2019; 14:e0212900. [PMID: 30893347 PMCID: PMC6426177 DOI: 10.1371/journal.pone.0212900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/12/2019] [Indexed: 12/20/2022] Open
Abstract
Background Medical emergency admissions are critical life events associated with considerable stress. However, research on patients’ affective well-being after emergency department (ED) admission is scarce. This study investigated the course of affective well-being of medical patients following an ED admission and examined the role of personal and social resources and health-related variables. Methods In this longitudinal survey with a sample of 229 patients with lower respiratory tract infections and cardiac diseases (taken between October 2013 and December 2014), positive and negative affect was measured at ED admission (T1) and at follow-up after 7 days (T2), and 30 days (T3). The role of personal and social resources (emotional stability, trait resilience, affect state, and social support) as well as health-related variables (self-rated health, multimorbidity, and psychological comorbidity) in patients’ affective well-being was examined by controlling for demographic characteristics using regression analyses. Results The strength of the inverse correlation between positive and negative affect decreased over time. In addition to health-related variables, higher negative affect was predicted by higher psychological comorbidity over time (T1–T3). In turn, lower positive affect was predicted by lower self-rated health (T1–T2) and higher multimorbidity (T3). In terms of personal and social resources, lower negative affect was predicted by higher emotional stability (T2), whereas higher positive affect was predicted by stronger social support (T1–T2). Conclusion Knowledge about psychosocial determinants–personal and social resources and health-related variables–of patients’ affective well-being following ED admission is essential for designing more effective routine screening and treatment.
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Affiliation(s)
- Lukas Faessler
- Institute of Psychology, University of Bern, Bern, Switzerland
- * E-mail:
| | | | - Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
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