Study Objective-We evaluated the effectiveness of interventions for pediatric patients with suicide-related emergency department (ED) visits.Methods-We searched of MEDLINE, EMBASE, the Cochrane Library, other electronic databases, references, and key journals/conference proceedings. We included experimental or quasi-experimental studies that evaluated psychosocial interventions for pediatric suicide-related ED visits. Inclusion screening, study selection, and methodological quality were assessed by two CIHR Author ManuscriptCIHR Author Manuscript CIHR Author Manuscript independent reviewers. One reviewer extracted the data and a second checked for completeness and accuracy. Consensus was reached by conference; disagreements were adjudicated by a third reviewer. We calculated odds ratios (OR), relative risks (RR), or mean differences (MD) for each study's primary outcome with 95% confidence intervals (CI). Meta-analysis was deferred due to clinical heterogeneity in intervention, patient population, and outcome.Results-We included 7 RCTs and 3 quasi-experimental studies grouping and reviewing them according to intervention delivery: ED-based delivery (n=1), post-discharge delivery (n=6), and ED transition interventions (n=3). An ED-based discharge planning intervention increased the number of attended post-ED treatment sessions (MD=2.6; 95%CI:0.05,5.15). Of the 6 studies of post-discharge delivery interventions, one found increased adherence with service referral in patients who received community nurse home visits compared to simple placement referral at discharge (RR=1.28; 95%CI:1.06,1.56). The 3 ED transition intervention studies reported: (1) reduced risk of subsequent suicide following brief ED intervention and post-discharge contact (RR=0.10; 95%CI:0.03,0.41), (2) reduced suicide-related hospitalizations when ED visits were followed up with interim, psychiatric care (RR=0.41; 95%CI:0.28,0.60), and (3) increased likelihood of treatment completion when psychiatric evaluation in the ED was followed by attendance of outpatient sessions with a parent (OR=2.78; 95%CI:1.20,6.67).Conclusion-Transition interventions appear most promising for reducing suicide-related outcomes and improving post-ED treatment adherence. Use of similar interventions and outcome measures in future studies would enhance the ability to derive strong recommendations from the clinical evidence in this area.
Smartphones have potential as cognitive aids for adults with cognitive impairments. However, little is known about how patients and their care partners utilise smartphones in their day-to-day lives. We collected self-reported smartphone utilisation data from patients referred for neuropsychological evaluations (N = 53), their care partners (N = 44), and an Amazon Mechanical Turk control sample (N = 204). Patient participants were less likely to own a smartphone than controls, with increasing age associated with less utilisation of smartphone features in all groups. Of the patients who owned smartphones, spontaneous use of cognitive aid features (e.g., reminders and calendars) occurred on only a monthly-to-weekly basis; by comparison, patients reported utilising social/general features (e.g., email and internet) on a weekly-to-daily basis. Individuals referred for geriatric cognitive disorder evaluations were less likely to own and use smartphones than individuals referred for other reasons. Care partners reported using their smartphones more frequently than control group adults, with 55% of care partners endorsing utilising their device in caring for the patient. Building upon existing smartphone use habits to increase the use of cognitive aid features may be a feasible intervention for some patients, and including care partners in such interventions is encouraged.
Variables associated with early returns included young age, diagnosis, triage acuity, and parental stress. Future variable definition should include a deeper exploration of modifiable factors such as parental stress and patient education. These next steps may help direct interventions and resources to address needs in this group and possibly pre-empt the need to return.
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