Suicidal Thoughts and Behaviours Among Autistic Adults Presenting to the Psychiatric Emergency Department: An Exploratory Chart Review.

Despite increasing attention on suicidality in autistic people, we know little about suicidal presentations when autistic individuals present to hospital emergency departments (ED). We conducted an exploratory retrospective chart review of suicidal thoughts and behaviours (STB) of autistic adults who presented to a psychiatric ED. The analysis included 16 charts over a 10-week period. Findings highlight that reported STB were not always the presenting issue. Life transitions and interpersonal conflicts were common antecedents, and active rumination about STB was distressing and fatiguing. Findings imply that ED visits serve as important opportunities for suicidal risk reduction for autistic individuals, through implementation of strategies for identification of STB such as active screening, and the provision of suicide resources tailored to autistic people.

Lymphatic vessels in human adipose tissue.

Despite being considered present in most vascularised tissues, lymphatic vessels have not been properly shown in human adipose tissue (AT). Our goal in this study is to investigate an unanswered question in AT biology, regarding lymphatic network presence in tissue parenchyma. Using human subcutaneous (S-) and visceral (V-) AT samples with whole mount staining for lymphatic specific markers and three-dimensional imaging, we showed lymphatic capillaries and larger lymphatic vessels in the human VAT. Conversely, in the human SAT, microcirculatory lymphatic vascular structures were rarely detected and no initial lymphatics were found.

The efficacy of kinesiology taping for improving gross motor function in children with cerebral palsy: A systematic review.

BACKGROUND: Kinesiology taping is an increasingly popular technique used as an adjunct to physiotherapy intervention for children with cerebral palsy (CP), but as yet we do not have a review of the available evidence as to its efficacy. OBJECTIVES: To critically appraise and establish best available evidence for the efficacy of truncal application of kinesiology taping combined with physiotherapy, versus physiotherapy alone, on gross motor function (GMF) in children with CP. METHOD: Seven databases were searched using the terms CP, kinesio taping and/or kinesiology tape and/or taping, physiotherapy and/or physical therapy and GMF. Only randomised controlled trials (RCTs) were included and appraised using the PEDro scale. Revman© Review Manager was used to combine effects for GMF in sitting, standing and activities of daily living. RESULTS: Five level IIB RCTs that scored 3-6/8 on the PEDro scale were included. Meta-analysis showed that taping was effective for improving GMF in sitting and standing as measured by the Gross Motor Function Measure (B) (p < 0.001) and (D) (p < 0.001), respectively. CONCLUSION: There is moderate evidence to support kinesiology taping applied to the trunk as an effective intervention when used as an adjunct to physiotherapy to improve GMF in children with CP, especially those with GMF Classification Scale levels I and II, and particularly for improving sitting control. CLINICAL IMPLICATIONS: Kinesiology taping is a useful adjunct to physiotherapy intervention in higher functioning children with CP. Current evidence however is weak and further research into methods of truncal application is recommended.

Thiamine prescribing practices within university-affiliated hospitals: a multicenter retrospective review.

BACKGROUND: Patients with suspected thiamine deficiency should receive treatment with parenteral thiamine to achieve the high serum thiamine levels necessary to reverse the effects of deficiency and to circumvent problems with absorption common in the medically ill. OBJECTIVE: To quantify rates of parenteral administration of thiamine across university-affiliated hospitals and to identify factors associated with higher rates of parenteral prescribing. DESIGN: Multicenter, retrospective observational study of thiamine prescriptions. METHODS: Prescriptions for thiamine were captured from computerized pharmacy information systems across participating centers, providing information concerning dose, route, frequency, and duration of thiamine prescribed from January 2010 to December 2011. SETTING: Fourteen university-affiliated tertiary care hospitals geographically distributed across Canada, including 48,806 prescriptions for thiamine provided to 32,213 hospitalized patients. RESULTS: Parenteral thiamine accounted for a statistically significant majority of thiamine prescriptions (57.6%, P < 0.001); however, oral thiamine constituted a significant majority of the total doses prescribed (68.4%, z = 168.9; P < 0.001). Protocols prioritizing parenteral administration were associated with higher rates of parenteral prescribing (61.3% with protocol, 45.8% without protocol; P < 0.001). Patients admitted under psychiatry services were significantly more likely to be prescribed oral thiamine (P < 0.001). CONCLUSIONS: Although parenteral thiamine accounted for a statistically significant majority of prescriptions, oral thiamine was commonly prescribed within academic hospitals. Additional strategies are needed to promote parenteral thiamine prescribing to patients with suspected thiamine deficiency.

Outcomes for patients with the same disease treated inside and outside of randomized trials: a systematic review and meta-analysis.

BACKGROUND: It is unclear whether participation in a randomized controlled trial (RCT), irrespective of assigned treatment, is harmful or beneficial to participants. We compared outcomes for patients with the same diagnoses who did ("insiders") and did not ("outsiders") enter RCTs, without regard to the specific therapies received for their respective diagnoses. METHODS: By searching the MEDLINE (1966-2010), Embase (1980-2010), CENTRAL (1960-2010) and PsycINFO (1880-2010) databases, we identified 147 studies that reported the health outcomes of "insiders" and a group of parallel or consecutive "outsiders" within the same time period. We prepared a narrative review and, as appropriate, meta-analyses of patients' outcomes. RESULTS: We found no clinically or statistically significant differences in outcomes between "insiders" and "outsiders" in the 23 studies in which the experimental intervention was ineffective (standard mean difference in continuous outcomes -0.03, 95% confidence interval [CI] -0.1 to 0.04) or in the 7 studies in which the experimental intervention was effective and was received by both "insiders" and "outsiders" (mean difference 0.04, 95% CI -0.04 to 0.13). However, in 9 studies in which an effective intervention was received only by "insiders," the "outsiders" experienced significantly worse health outcomes (mean difference -0.36, 95% CI -0.61 to -0.12). INTERPRETATION: We found no evidence to support clinically important overall harm or benefit arising from participation in RCTs. This conclusion refutes earlier claims that trial participants are at increased risk of harm.

A dinâmica de grupo como estratégia de ensino-aprendizagem na disciplina de gerenciamento de enfermagem / La dinamica de grupo como una estrategia de enseñanza-aprendizaje en la disciplina de gestión de enfermería / A group dynamic as a strategy for teaching-learning in a nursing management course

Objective: To describe and evaluate the participation of academics and identify their perception about the importance of group dynamics for learning Nursing Management. Method: A qualitative and exploratory approach. The data were collected in the School of Nursing of the Federal Fluminense University, through a questionnaire. The subjects are 31 academicians of the 6th period, in the discipline of Management in Health Care I, in the second half of 2011, after approval by the Ethics Committee of the Faculty of Medicine of the same university, under N. 162/11. Results: Three thematic categories: Group dynamics as a strategy for teamwork, as an interaction strategy and as a teaching-learning strategy. Conclusion: The dynamics contributed to the team work as well as to the interaction with the teachers, for the understanding the discipline taught, reflecting the importance of this strategy in nursing education.

Objetivo: Descrever e avaliar a participação dos acadêmicos e identificar a percepção dos mesmos quanto à importância da dinâmica de grupo para o aprendizado da gerência em Enfermagem. Método: Abordagem qualitativa e exploratória. Os dados foram coletados na Escola de Enfermagem da Universidade Federal Fluminense, por meio de questionário. Os sujeitos são 31 acadêmicos do 6° período, que cursaram a disciplina Gerenciamento da Assistência em Saúde I, no segundo semestre de 2011, após aprovação pelo Comitê de Ética da Faculdade de Medicina da referida universidade, sob nº 162/11. Resultados: Três categorias temáticas: A dinâmica de grupo como estratégia para o trabalho em equipe; como estratégia de interação e como estratégia de ensino-aprendizado. Conclusão: A dinâmica contribuiu tanto para o trabalho em equipe, quanto para a interação com os professores, bem como para o entendimento da disciplina ministrada, traduzindo a importância dessa estratégia na formação do enfermeiro.

Objetivo: Describir y evaluar la participación de académicos e identificar su percepción de la importancia de la dinámica de grupo para el aprendizaje de la gestión de enfermería. Método: Enfoque cualitativo y exploratorio. Los datos fueron recolectados en la Escuela de Enfermería de la Universidad Federal Fluminense, a través de un cuestionario. Los sujetos son de 31 académicos del sexto semestre, en la disciplina de Gestión en Salud I, en el segundo semestre de 2011, tras su aprobación por el Comité de Ética de la Facultad de Medicina de la misma universidad, bajo N º 162/11. Resultados: Tres categorías temáticas: dinámicas de grupo como estrategia de trabajo en equipo, como estrategia de interacción y como estrategia de enseñanza-aprendizaje. Conclusión: La dinámica contribuyó tanto al trabajo en equipo, la forma de interactuar con los profesores, así como para la comprensión de la materia de estudio, lo que refleja la importancia de esta estrategia en la educación de enfermería.

Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials.

OBJECTIVES: To identify factors that differentiate between effective and ineffective computerised clinical decision support systems in terms of improvements in the process of care or in patient outcomes. DESIGN: Meta-regression analysis of randomised controlled trials. DATA SOURCES: A database of features and effects of these support systems derived from 162 randomised controlled trials identified in a recent systematic review. Trialists were contacted to confirm the accuracy of data and to help prioritise features for testing. MAIN OUTCOME MEASURES: "Effective" systems were defined as those systems that improved primary (or 50% of secondary) reported outcomes of process of care or patient health. Simple and multiple logistic regression models were used to test characteristics for association with system effectiveness with several sensitivity analyses. RESULTS: Systems that presented advice in electronic charting or order entry system interfaces were less likely to be effective (odds ratio 0.37, 95% confidence interval 0.17 to 0.80). Systems more likely to succeed provided advice for patients in addition to practitioners (2.77, 1.07 to 7.17), required practitioners to supply a reason for over-riding advice (11.23, 1.98 to 63.72), or were evaluated by their developers (4.35, 1.66 to 11.44). These findings were robust across different statistical methods, in internal validation, and after adjustment for other potentially important factors. CONCLUSIONS: We identified several factors that could partially explain why some systems succeed and others fail. Presenting decision support within electronic charting or order entry systems are associated with failure compared with other ways of delivering advice. Odds of success were greater for systems that required practitioners to provide reasons when over-riding advice than for systems that did not. Odds of success were also better for systems that provided advice concurrently to patients and practitioners. Finally, most systems were evaluated by their own developers and such evaluations were more likely to show benefit than those conducted by a third party.

Measuring patient outcomes: a primer.

When designing a study, it is important to select appropriate instruments to measure health outcomes. An investigator must have a comprehensive understanding of the disease and its effects on patient health to inform instrument selection. We provide a brief introduction of different ways that health is defined and the properties of a good measurement tool (reliability, validity, sensitivity to change). We describe patient-reported outcomes (PROs) and methods to improve their interpretability, and we include strategies to reduce bias in health measurement and considerations that may improve the feasibility of measuring outcomes in a research study.

The private cost of long-term care in Canada: where you live matters.

Canadians expect the same access to health care whether they are rich or poor, and wherever they live, often without direct charge at the point of service. However, we find that the private cost of long-term care differs greatly across the country, and within provinces, we find substantial variation, depending on income level, marital status, and, in Quebec alone, on assets owned. A non-married person with average income would pay more than twice as much in the Atlantic provinces as in Quebec, while a couple with one in care would pay almost four times as much in Newfoundland as in Alberta.