The program was rated as being highly valued across all modalities of evaluation. Members of the referring team believe that access to a geriatric psychiatrist has broadened the team's knowledge base, its use of assessment tools, and increased their ability to better construct their patients' treatment plans.
Objective: Studies have reported that medical trainees do not get sufficient direct observation. Our study aimed to determine the frequency of direct observation and the enablers and barriers to direct observation in the department of psychiatry at a large Canadian university.Method: Focus groups and interviews explored the role and use of direct observation, followed by a survey both of faculty and of residents.Results: Direct observation was used in various contexts in the residents' last rotation. Missed opportunities are identified. Enablers include financial compensation, guidelines, and a discussion at the beginning of each clinical rotation. Barriers are identified at the resident, faculty, and administrative levels. Conclusions:Direct observation is used in many contexts in psychiatric training. While there are barriers which limit its use, our data indicate numerous potential enablers and missed opportunities for more observation. W W WObjectif : Des études ont conclu que les stagiaires en médecine n'obtiennent pas suffisamment d'observation directe. Notre étude visait à déterminer la fréquence de l'observation directe ainsi que les outils et les obstacles de l'observation directe au département de psychiatrie d'une grande université canadienne.Méthode : Des groupes de discussion et des entrevues ont exploré le rôle et l'usage de l'observation directe, suivis d'un sondage pour les professeurs et les résidents.Résultats : L'observation directe a été utilisée dans divers contextes du dernier stage des résidents. Les occasions ratées ont été identifiées. Les outils sont notamment la rémunération, les lignes directrices, et une discussion au début de chaque stage clinique. Les obstacles sont identifiés au niveau des résidents, des professeurs, et de l'administration.Conclusions : L'observation directe est utilisée dans de nombreux contextes de la formation psychiatrique. Bien que des obstacles en limitent l'usage, nos données indiquent de nombreux outils potentiels et des occasions ratées de plus d'observation.
This paper reviews the use of sleep-promoting medications in nursing home residents with reference to risks versus benefits. Up to two-thirds of elderly people living in institutions experience sleep disturbance. The aetiology of sleep disturbance includes poor sleep hygiene, medical and psychiatric disorders, sleep apnoea, periodic limb movements and restless leg syndrome. One key factor in the development of sleep disturbance in the nursing home is the environment, particularly with respect to high levels of night-time noise and light, low levels of daytime light, and care routines that do not promote sleep. Clinical assessment should include a comprehensive medical, psychiatric and sleep history including a review of prescribed medications. Nonpharmacological interventions for insomnia are underutilised in many clinical settings despite evidence that they are often highly effective. International studies suggest that 50-80% of nursing home residents have at least one prescription for psychotropic medication. Utilisation rates vary dramatically from country to country and from institution to institution. The most commonly prescribed medications for sleep are benzodiazepines and nonbenzodiazepine hypnotics (Z-drugs). The vast majority of studies of these medications are short-term, i.e. < or =2 weeks, although some longer extension trials have recently been carried out. Clinicians are advised to avoid long-acting benzodiazepines and to use hypnotics for as brief a period as possible, in most cases not exceeding 2-3 weeks of treatment. Patients receiving benzodiazepines are at increased risk of daytime sedation, falls, and cognitive and psychomotor impairment. Zaleplon, zolpidem, zopiclone and eszopiclone may have some advantages over the benzodiazepines, particularly with respect to the development of tolerance and dependence. Ramelteon, a novel agent with high selectivity for melatonin receptors, has recently been approved in the US. Use of the antidepressant trazodone for sleep in nondepressed patients is somewhat controversial. Atypical antipsychotics should not be used to treat insomnia unless there is also evidence of severe behavioural symptoms or psychosis.
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