Rates of hospital presentation for self-harm have increased in recent years, and although clinical practice guidelines on clinical provision prioritize positive patient experiences, the quality of provision remains variable. This systematic review provides an updated and extended synthesis of qualitative research on the following: (a) patients’ experiences of treatment following presentation to hospital; and (b) patients’ perceptions of the impact of treatment on recurrent self-harm and/or suicidal ideation, and future help-seeking. Twenty-six studies were identified for inclusion in the final synthesis. Three meta-themes emerged: (a) individuals undertake extensive identity work when presenting with self-harm, navigating the process of becoming a patient, and negotiating the type of patient they want to be; (b) care ranges from gentle to hostile, with care at admission and discharge being particularly disorientating; and (c) negative experiences of clinical treatment may increase future self-harm. Emerging research gaps include the need for further theoretically informed qualitative research in this area.
ObjectiveWe aimed to compare adolescent mortality rates between different types of major trauma centre (MTC or level 1; adult, children’s and mixed).MethodsData were obtained from TARN (Trauma Audit Research Network) from English sites over a 6-year period (2012–2018), with adolescence defined as 10–24.99 years. Results are presented using descriptive statistics. Patient characteristics were compared using the Kruskal-Wallis test with Dunn’s post-hoc analysis for pairwise comparison and χ2 test for categorical variables.Results21 033 cases met inclusion criteria. Trauma-related 30-day crude mortality rates by MTC type were 2.5% (children’s), 4.4% (mixed) and 4.9% (adult). Logistic regression accounting for injury severity, mechanism of injury, physiological parameters and ‘hospital ID’, resulted in adjusted odds of mortality of 2.41 (95% CI 1.31 to 4.43; p=0.005) and 1.85 (95% CI 1.03 to 3.35; p=0.041) in adult and mixed MTCs, respectively when compared with children’s MTCs. In three subgroup analyses the same trend was noted. In adolescents aged 14–17.99 years old, those managed in a children’s MTC had the lowest mortality rate at 2.5%, compared with 4.9% in adult MTCs and 4.4% in mixed MTCs (no statistical difference between children’s and mixed). In cases of major trauma (Injury Severity Score >15) the adjusted odds of mortality were also greater in the mixed and adult MTC groups when compared with the children’s MTC. Median length of stay (LoS) and intensive care unit LoS were comparable for all MTC types. Patients managed in children’s MTCs were less likely to have a CT scan (46.2% vs 62.8% mixed vs 64% adult).ConclusionsChildren’s MTC have lower crude and adjusted 30-day mortality rates for adolescent trauma. Further research is required in this field to identify the factors that may have influenced these findings.
Objectives: Uncertainty regarding the legitimacy of functional neurological disorder (FND) remains among some health care professionals. Despite treatment guidelines and consensus recommendations, variability in clinical practice referral decisions persists. Evidence from other conditions suggests such clinical decision making is impacted by practitioners' implicit and explicit attitudes. We aimed to identify whether health care professionals hold implicit and/or explicit attitudes about the legitimacy of FND and whether these attitudes are associated with referral decision making. Design/Methods: We included 66 health care professionals who work with people with neurological conditions: n = 37 medical doctors, mainly neurologists (n = 18) and psychiatrists (n = 10), and n = 29 doctoral level practitioner psychologists. Participants completed an Implicit Association Test (IAT), Implicit Relational Assessment Procedure (IRAP), a referral decision-making vignette task and self-report measures of explicit attitudes on FND-legitimacy, therapeutic optimism and clinician confidence. Multiple Sclerosis (MS) was used as a comparator condition. Results: Participants self-reported strong explicit FND-legitimate and MS-legitimate attitudes but demonstrated an implicit FND-illegitimate/MS-legitimate bias. Deeper examination provided by the IRAP data indicated pro-FND-legitimate attitudes, but no bias for or against FND-illegitimate-contrasting the pro-MS-legitimate, anti-MS-illegitimate attitudes for the comparator condition. Attitudes about FND-illegitimacy were negatively associated
Burns are a relatively common injury in children accounting for over 50 000 emergency department attendances each year. An estimated 1 in 10 of these are due to maltreatment. These may present in the form of physical abuse or neglect with a reported ratio of 1:9. A burn associated with maltreatment may be a marker for future abuse or neglect and it is paramount that concerns are identified and addressed at the initial visit. Paediatricians need to be confident to identify safeguarding concerns specific to childhood burns and investigate accordingly. In this review, key variables that may aid in differentiating maltreatment from accidental burns are discussed in a case-based format, utilising up-to-date evidence to support the recommendations. Despite a proportion of burns resulting from physical abuse, the rate of child protection investigations in these patients are significantly lower than for children who present with other forms of physical injuries despite a similar proportion of positive findings. Our objective is to review the available evidence to support the safe assessment and management of children presenting with scalds or contact burns.
Background Therapeutic hypothermia (TH) is an established modality for the treatment of neonates with hypoxic-ischemic encephalopathy (HIE) grade II to III. Facility for total body cooling (TBC) was not available in our region (Malabar region, Kerala, South India, where highest delivery rate, compared to rest of India) even though there was significant incidence of perinatal asphyxia cases. In India 19.2% of NMR is caused by several intrapartum complications and asphyxia. In this region, significant proportion of delivery happens in private hospitals, which has financial implications.Objectives To share our experience with TBC and neuro-developmental outcomes of surviving babies and to prove that this treatment modality can be used with low cost devices in our region for the benefit of neonates with perinatal asphyxia. MethodsSetting: A tertiary referral center in Kerala with catchment population of seven million. This unit is accredited by Indian Academy of Pediatrics and National Neonatology Forum India. Methods This was a prospective study of 30 newborns admitted with HIE grade II to III for 2 years (from January 2016 to December 2017). TOBY trial UK and NNF India guideline for total body cooling were followed. Cooling device was used is a low cost device researched and made in India as phase changing material (PCM-'Mira cradle', cost $ 4300).
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