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The shift to massified higher education has resulted in surges in the recruitment of staff and students from more diverse backgrounds, without ensuring the necessary concomitant changes in institutional and pedagogical cultures. Providing a genuinely inclusive and ‘safer’ higher education experience in this context requires a paradigm shift in our approaches to learning and teaching in higher education. Creating safer spaces in classrooms is a necessary building block in the transformation and decolonisation of higher education cultures and the development of cultural competency for all staff and graduates. This paper outlines an approach to crafting safer spaces within the classroom, focusing on a case study of strategies for teaching and learning about race, racism and intersectionality employed by the authors in an undergraduate Indigenous Studies unit at an urban Australian university.
OBJECTIVES/GOALS: This study has two primary aims: 1) evaluate points of success and failure in connecting hepatitis C virus (HCV) positive homeless patients to care following a preliminary positive rapid HCV test result, and 2) describe the barriers cited by patients who drop out at each step in the care continuum. METHODS/STUDY POPULATION: A retrospective longitudinal analysis of adult (18 years or older) homeless individuals accessing shelter at six homeless shelters in New Orleans, LA was conducted. Every patient who came through a testing site received a survey collecting information on demographics, barriers to healthcare, and recent utilization of health services. A retrospective chart review of hospital and homeless clinic medical records was used to track patient linkage to care and their progress through the HCV care continuum. We defined successful linkage to care as attendance at the first scheduled follow-up appointment for treatment with a primary care physician. RESULTS/ANTICIPATED RESULTS: A total of 1719 unique patients were identified from August 2016 through August 2019 which included 36% self-identified as African American/Black, 55% identified as White and 8% identified as mixed-race or other. A total of 24% of individuals reported no insurance coverage while 66% of patients reported having insurance. Overall, 85 patients reported they experienced no barriers to healthcare. Of those who reported barriers, 44% reported trouble with finances or insurance, 22% transportation, 18% personal drug use, 9% personal alcohol use, and 7% reported a distrust of healthcare providers or the system. Other barriers included long wait times, distance, and recent incarceration. DISCUSSION/SIGNIFICANCE OF IMPACT: Although screening for HCV is readily available, barriers exist which prevent diagnosis and treatment. We implemented a HCV testing and linkage-to-care program between local homeless shelters and health centers in New Orleans in an effort to reduce HCV-related morbidity and mortality.
To reduce unneeded red blood cell transfusions and to avoid surgery-induced anemia, it is important to have accurate and timely assessment of intraoperative blood loss. This chapter briefly outlines the American Society of Anesthesiologists and the AABB guidelines regarding assessment and management of blood loss. It describes the primary methods for determining blood loss, including visual assessment, photometric analysis, gravimetric blood loss determination, blood loss formulas using hemoglobin and hematocrit monitoring, and imaging analysis. The chapter concludes with a summary comparing the major advantages and disadvantages of each blood loss monitoring methodology.
Recent international communicable disease crises have highlighted the need for countries to assure their preparedness to respond effectively to public health emergencies. The objective of this study was to critically review existing tools to support a country’s assessment of its health emergency preparedness. We developed a framework to analyze the expected effectiveness and utility of these tools. Through mixed search strategies, we identified 12 tools with relevance to public health emergencies. There was considerable consensus concerning the critical preparedness system elements to be assessed, although their relative emphasis and means of assessment and measurement varied considerably. Several tools identified appeared to have reporting requirements as their primary aim, rather than primary utility for system self-assessment of the countries and states using the tool. Few tools attempted to give an account of their underlying evidence base. Only some tools were available in a user-friendly electronic modality or included quantitative measures to support the monitoring of system preparedness over time. We conclude there is still a need for improvement in tools available for assessment of country preparedness for public health emergencies, and for applied research to increase identification of system measures that are valid indicators of system response capability.
Risperidone the first atypical antipsychotic available in a long-acting injection formulation. In the United Kingdom is licensed to use in psychosis in patients tolerant of oral Risperidone and the Summary of Product Characteristics clearly defines the methods of initiation and titration.
We performed a naturalistic observation of 25 patients belonging to 3 different community mental health teams and one in-patient facility that have been prescribed Risperidone long-acting injection (RLAI) and collected data about immediate prior use of antipsychotic medication, patient preference, compliance with treatment, documentation of effectiveness and tolerance of Risperidone oral, supplementation with Risperidone oral during the first three weeks, initial dose, intervals between dose changes, monitoring of benefits and side-effects, and reasons for discontinuation.
Only 7/25 patients have been prescribed oral Risperidone prior to the injectable formulation and none had received clozapine. 13/25 received oral supplementation during initiation, 3/25 dose was changed in less than 4 weeks intervals. 14/25 non-compliance was suspected and only 2/25 patients stated a preference for an injectable formulation. 17/25 continued to receive RLAI and those discontinued in 3/25 due to patient refusal, 1/25 not tolerated, 1/25 patient did not attend treatment, 1/25 not effective, 1/25 patient deceased, 1/25 no reason was specified.
prescribing of RLAI did not follow the recommendation from the manufacturers mainly during initiation. Non-compliance with previous medication was the main reason for use of an injectable formulation but use of RLAI seems to be associated with low discontinuation rates.
Risperidone is the first atypical antipsychotic available in a long-acting injection formulation. in United Kingdom, it is licensed for use in treatment of psychosis in patients tolerant of oral Risperidone. the Summary of Product Characteristics clearly defines the methods of initiation and titration.
We performed a naturalistic observational study of 61 patients suffering with psychosis. the cohort comprised patients being prescribed Risperidone long-acting Injection (RLAI) within various Community Mental Health Teams and Assertive Outreach Team of the Trust. the data was collected related to three broad areas: reasons for choice of RLAI, initiation and titration of RLAI, continuation of RLAI.
• 35/61 patients have been prescribed oral atypical antipsychotic (including 16/61 being prescribed oral Risperidone) prior to the injectable formulation and 3/61 had received Clozapine.
• In 12/61 non-compliance was suspected and only 11/25 patients stated a preference for an injectable formulation.
• 33/61 received oral supplementation during initiation.
• 29/61 were initiated on dose of RLAI commensurate with the current dose of oral Risperidone
• In 35/61, dose was changed in less than 4 weeks intervals.
• 43/61 continued to receive RLAI. 18/61 discontinued due to patient refusal (6/18), patient not tolerated (3/18), not effective (2/18), patient non-attendance (1/18), patient moved area (1/18), other reasons (2/18), no reasons specified (3/18).
Prescribing of RLAI did not follow recommendation from manufacturers during initiation and titration. Non-Compliance with previous medication was main reason for use of RLAI. However, discontinuation with RLAI was primarily related to refusal/intolerance of treatment.
[Improvement in daily accessible risk assessments]
We show enhanced patient safety through a quality improvement methodology project in an intensive psychiatric care unit of a psychiatric hospital in southwest of Scotland. This is a project as part of the national patient safety programme in mental health. The Scottish Patient Safety Programme for Mental Health aims to systematically reduce harm experienced by people using mental health services in Scotland, by supporting frontline staff to test, gather real-time data and reliably implement interventions, before spreading across their catchment area.
Multidisciplinary staff worked together in improving recording of daily electronic and paper based risk assessments from a baseline of 20% to nearly 100% over a sixth month period. We expect better quality risk management by readily accessible risk assessments and safe practise through enhanced safety perception by the patients as well as staff. Patient and staff safety perception tools were designed to measure impact of improvement in risk management. We have seen drop in the number of critical incidents and challenging situations requiring restraint following coordinated approach to risk assessment and easy access to key information. We have been successful as the frontline staff became part of the process of change and this has enabled sustained improvement.
In the UK, mental illness is a major source of disease burden costing in the region of £105 billion pounds. mHealth is a novel and emerging field in psychiatric and psychological care for the treatment of mental health difficulties such as psychosis.
To develop an intelligent real-time therapy (iRTT) mobile intervention (TechCare) which assesses participant's symptoms in real-time and responds with a personalised self-help based psychological intervention, with the aim of reducing participant's symptoms. The system will utilise intelligence at two levels:
– intelligently increasing the frequency of assessment notifications if low mood/paranoia is detected;
– an intelligent machine learning algorithm which provides interventions in real-time and also provides recommendations on the most popular selected interventions.
The aim of the current project is to develop a mobile phone intervention for people with psychosis, and to conduct a feasibility study of the TechCare App.
The study consists of both qualitative and quantitative components. The study will be run across three strands:
– qualitative work;
– test run and intervention refinement;
– feasibility trial.
Preliminary analysis of qualitative data from Strand 2 (test run and intervention refinement) in-depth interviews with service users (n = 2) and focus group with health professionals (n = 1), highlighted main themes around security of the device, multimedia and the acceptability of psychological interventions being delivered via the TechCare App.
Research in this area can be potentially helpful in addressing the demand on mental health services globally, particularly improving access to psychological interventions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The early intervention service (EIS) approach is based on therapeutic interactions, which promote service user recovery from first episode psychosis. Collaborative therapeutic work between the service user and case manager depends on good communication. This can be a challenge for people with psychosis as the process of thought can be disrupted or stimulus misinterpreted leading to communication errors.
The objective is to develop an interactive tool that can assist service user's communication of distress, whilst employing a psychoeducational approach to the use of an informal therapeutic measurement scale; subjective units of distress (SUDs) and early warning signs (EWS). The ApTiC mobile intervention will include ten numerically graded emoticons from low to extreme distress. Each emoticon is associated with specific individualised service user descriptors and linked to an individually agreed action plan and level of response to be offered by a staff member.
The aim of the present study will be to examine the feasibility and acceptability of the ApTic mobile intervention in preparation for a larger randomised controlled trial.
Phase one: qualitative research to inform the development of the complimentary tool and mobile app (qualitative). Phase two: a 12-week rater-blinded randomized control trial of ApTiC compared to routine EIS case management (quantitative).
The qualitative data will be presented.
It is expected that once validated, the SUDs based ApTiC will enhance rapport and understanding thus improving the recovery approach to well-being and hopefully preventing relapse or the involvement of the crisis team or hospital admissions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Infants with isolated atrial septal defects are usually minimally symptomatic, and repair is typically performed after infancy. Early repair may be considered if there is high pulmonary blood flow and reduced respiratory reserve or early signs of pulmonary hypertension. Our aim was to review the characteristics and outcomes of a cohort of patients who underwent infant repair at our institute.
The study included 56 infants (28 female, 19 trisomy 21) with isolated atrial septal defect (age: 8 months (1.5–12), weight: 6 kg (2.8–7.5), echo Qp/Qs: 1.9 ± 0.1) who underwent surgical closure (20 fenestrated). Three groups were identified: 1) chronic lung disease and pulmonary hypertension (group A: n = 28%); 2) acutely unwell infants with pulmonary hypertension but no chronic lung disease (group B: n = 20, 36%); and 3) infants with refractory congestive heart failure without either pulmonary hypertension or chronic lung disease (group C: n = 9, 16%).
Post-operatively, pulmonary hypertension infants (47/56) showed improvement in tricuspid annular plane systolic excursion z-score (p < 0.001) and right ventricular systolic/diastolic duration ratio (p < 0.05). All ventilator (14.3%) or oxygen-dependent (31.6%) infants could be weaned within 2 weeks after repair. One year later, weight z-score increased in all patients and by +1 in group A, +1.3 in group B and +2 in group C. Over a median follow-up of 1.4 years, three patients died, four patients continued to have pulmonary hypertension evidence and two remained on targeted pulmonary hypertension therapy.
Atrial septal defect repair within the first year may improve the clinical status and growth in infants with early signs of pulmonary hypertension or those requiring respiratory support and facilitate respiratory management.
This chapter examines the reception of Augustine’s “Confessions” in the Enlightenment through three major lexicographical works: Pierre Bayle’s Historical and Critical Dictionary; Chevalier de Jaucourt’s entry in the Encyclopédie, “Church Fathers”; and Voltaire’s Questions on the Encyclopedia. All of them deliberately misappropriate Augustine's account of his life as a sinner in order to undermine aspects of his theology, and, by extension, the theology of Jansenism in their own era.
The government collects a barrage of information through censuses, registration, licenses, permits, and geographical information, so official information is a ubiquitous part of contemporary life. The sociology of official statistics analyzes this activity (Starr 1987: 7). The overall thrust of this work shows that official information gathering is socially constructed, that is, it is influenced by social and historical conditions, and it influences the reality that it supposedly describes.
Quality improvement and patient safety (QIPS) competencies are increasingly important in emergency medicine (EM) and are now included in the CanMEDS framework. We conducted a survey aimed at determining the Canadian EM residents’ perspectives on the level of QIPS education and support available to them.
An electronic survey was distributed to all Canadian EM residents from the Royal College and Family Medicine training streams. The survey consisted of multiple-choice, Likert, and free-text entry questions aimed at understanding familiarity with QIPS, local opportunities for QIPS projects and mentorship, and the desire for further QIPS education and involvement.
Of 535 EM residents, 189 (35.3%) completed the survey, representing all 17 medical schools; 77.2% of respondents were from the Royal College stream; 17.5% of respondents reported that QIPS methodologies were formally taught in their residency program; 54.7% of respondents reported being “somewhat” or “very” familiar with QIPS; 47.2% and 51.5% of respondents reported either “not knowing” or “not having readily available” opportunities for QIPS projects and QIPS mentorship, respectively; 66.9% of respondents indicated a desire for increased QIPS teaching; and 70.4% were interested in becoming involved with QIPS training and initiatives.
Many Canadian EM residents perceive a lack of QIPS educational opportunities and support in their local setting. They are interested in receiving more QIPS education, as well as project and mentorship opportunities. Supporting residents with a robust QIPS educational and mentorship framework may build a cohort of providers who can enhance the local delivery of care.
The Canadian Resident Matching Service (CaRMS) selection process has come under scrutiny due to the increasing number of unmatched medical graduates. In response, we outline our residency program's selection process including how we have incorporated best practices and novel techniques.
We selected file reviewers and interviewers to mitigate gender bias and increase diversity. Four residents and two attending physicians rated each file using a standardized, cloud-based file review template to allow simultaneous rating. We interviewed applicants using four standardized stations with two or three interviewers per station. We used heat maps to review rating discrepancies and eliminated rating variance using Z-scores. The number of person-hours that we required to conduct our selection process was quantified and the process outcomes were described statistically and graphically.
We received between 75 and 90 CaRMS applications during each application cycle between 2017 and 2019. Our overall process required 320 person-hours annually, excluding attendance at the social events and administrative assistant duties. Our preliminary interview and rank lists were developed using weighted Z-scores and modified through an organized discussion informed by heat mapped data. The difference between the Z-scores of applicants surrounding the interview invitation threshold was 0.18-0.3 standard deviations. Interview performance significantly impacted the final rank list.
We describe a rigorous resident selection process for our emergency medicine training program which incorporated simultaneous cloud-based rating, Z-scores, and heat maps. This standardized approach could inform other programs looking to adopt a rigorous selection process while providing applicants guidance and reassurance of a fair assessment.
In Defense of Property: begins by cataloging various types of property and the ways in which Indigenous and European conceptions of property differ. It then proceeds to illustrate ways in which those conceptions have been stereotyped, thus leading to mistaken assumptions about the incompatibility of the two approaches. Carpenter, Katyal, and Riley conclude that using the concepts of fiduciary duty and stewardship found in both approaches can supply a foundation for bridging the different conceptions of property.