-
International Journal of Environmental... Jul 2019Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital...
Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.
Topics: Delivery of Health Care; Humans; Patient Discharge; Patient Readmission
PubMed: 31295933
DOI: 10.3390/ijerph16142457 -
Journal of the American Academy of... May 2024As child psychiatrists, it is our job to ask questions, and many of us would say we are really good at it. We work with our patients to open up about their experiences,...
As child psychiatrists, it is our job to ask questions, and many of us would say we are really good at it. We work with our patients to open up about their experiences, discussing fear, sadness, hope, and joy. By modeling this ability to open up in the office, we help guide children and adolescents through using other skills rather than avoidance. Although avoidance has its place at times, we help show our patients the connection between anxiety and avoidance. This necessity to embrace and challenge fears can be a difficult skill for our patients and also their families. Children bring forward questions that parents may want to avoid, fearing the answer might be more difficult for the child than the rejection of having the question avoided all together. As someone who works with children with chronic illnesses, this avoidance of the question can in fact increase the fear and anxiety of the child or adolescent. When talking to children, often they will express a greater fear than the reality of the situation because they determine that if their parent is avoiding the question, it must be really bad. This same struggle with avoidance can be true for us as child psychiatrists as well. The necessity to take on roles of leadership or run a team often presents itself, but excuses can come up to help us avoid these roles. We might say we are not properly trained, we did not go into medicine to do those responsibilities, or we are too busy. By avoiding these responsibilities, we are setting ourselves up for more frustration. As teams struggle, we have to follow the lead of others without the same clinical knowledge, which may result in additional errors. We must remember to practice what we preach and to identify the cost of avoidance.
Topics: Humans; Child; Adolescent; Child Psychiatry; Fear; Avoidance Learning; Anxiety; Physician-Patient Relations
PubMed: 38387792
DOI: 10.1016/j.jaac.2024.02.004 -
Neurology India 2021To analyze the common problems in shunt surgery and measures to avoid them. Management of hydrocephalus takes up as much as 50% of a pediatric ' 'neurosurgeon's time,... (Review)
Review
BACKGROUND AND OBJECTIVE
To analyze the common problems in shunt surgery and measures to avoid them. Management of hydrocephalus takes up as much as 50% of a pediatric ' 'neurosurgeon's time, and these are notoriously prone to complications. In this article, the author analysis his series of ventriculoperitoneal shunts and discusses his technique, nuances and avoidance of shunt complications.
METHODS AND MATERIALS
The author will review common issues related to hydrocephalus shunt management with a review of 549 procedures and associated complications.
RESULTS
Key features and basic principles of complication avoidance in shunt surgery is provided. The analysis looks into the complications and ways to avoid them based on the author's experience.
CONCLUSIONS
Specific measures may be adopted to minimize or avoid these complications. These will be discussed based on the author's series and experiences.
Topics: Child; Humans; Hydrocephalus; Prostheses and Implants; Ventriculoperitoneal Shunt
PubMed: 35103008
DOI: 10.4103/0028-3886.332256 -
Psychiatry Research Mar 2021Social avoidance in young patients is a clinically worrisome phenomenon that characterizes impending schizophrenia, but that also constitutes a core phenomenon in... (Review)
Review
Social avoidance in young patients is a clinically worrisome phenomenon that characterizes impending schizophrenia, but that also constitutes a core phenomenon in avoidant personality disorder (AvPD), schizoid personality disorder (ScPD), and in autism spectrum disorder (ASD). Especially in the absence of any other clinically relevant phenomena, understanding the origins of social avoidance may be one the most challenging tasks in assessing whether adolescents and young adults are at risk for developing schizophrenia. Descriptive and psychometric assessments only allow to comment on the absence or the presence of this phenomenon, but do not capture the origins and the meaning of social avoidance. Based on a narrative review, we highlight the importance of a phenomenological approach to unveil the Gestalt of social avoidance in these mental disorders, including and appraisal of the underlying mental structures and attachment styles. The phenomenological approach allows to distinguish the Gestalt of social avoidance between AvPD, ScPD, ASD, and beginning schizophrenia, to ensure correct diagnostic labelling and optimal treatment, and to avoid unwarranted stigmatization.
Topics: Adolescent; Autism Spectrum Disorder; Humans; Personality Disorders; Psychometrics; Schizoid Personality Disorder; Schizophrenia; Social Behavior; Young Adult
PubMed: 33465524
DOI: 10.1016/j.psychres.2021.113718 -
Frontiers in Psychology 2019Pedestrians are commonly engaged in other activities while walking. The current study assesses (1) whether pedestrians are sufficiently aware of their surroundings to...
Pedestrians are commonly engaged in other activities while walking. The current study assesses (1) whether pedestrians are sufficiently aware of their surroundings to successfully negotiate obstacles in a city, and (2) whether various common walking practices affect awareness of obstacles and, or, avoidance behavior. To this end, an obstacle, i.e., a signboard was placed on a pavement in the city centre of Utrecht, the Netherlands. The behavioral measure consisted of the distance to the signboard before pedestrians moved to avoid it. After passing, participants were interviewed to obtain thought samples, self-reported route familiarity, a confirmation of secondary task engagement, and to assess awareness through recall and recognition of the signboard and its text. In this study 234 pedestrians participated. More than half of the participants (53.8%) was unaware of the signboard, still none of them had bumped into it. Mind wandering, being engaged in secondary tasks such as talking with a companion or using a mobile phone, and being familiar with a route, did not affect awareness nor avoidance behavior. In conclusion, despite being very common there was no evidence that necessarily results in risk. The absence of awareness does not imply any absence of cognitive and perceptual processing. Pedestrians are still capable of successfully avoiding obstacles in their path, even in visually more challenging environments such as a city centre. It is argued that this is because walking consists of highly automated, skilled behavior.
PubMed: 31456719
DOI: 10.3389/fpsyg.2019.01846 -
Computational Psychiatry (Cambridge,... 2020Anxiety disorders are characterized by a range of aberrations in the processing of and response to threat, but there is little clarity what core pathogenesis might...
Anxiety disorders are characterized by a range of aberrations in the processing of and response to threat, but there is little clarity what core pathogenesis might underlie these symptoms. Here we propose that a particular set of unrealistically pessimistic assumptions can distort an agent's behavior and underlie a host of seemingly disparate anxiety symptoms. We formalize this hypothesis in a decision theoretic analysis of maladaptive avoidance and a reinforcement learning model, which shows how a localized bias in beliefs can formally explain a range of phenomena related to anxiety. The core observation, implicit in standard decision theoretic accounts of sequential evaluation, is that the potential for avoidance should be protective: if danger can be avoided later, it poses less threat now. We show how a violation of this assumption - via a pessimistic, false belief that later avoidance will be unsuccessful - leads to a characteristic, excessive propagation of fear and avoidance to situations far antecedent of threat. This single deviation can explain a range of features of anxious behavior, including exaggerated threat appraisals, fear generalization, and persistent avoidance. Simulations of the model reproduce laboratory demonstrations of abnormal decision making in anxiety, including in situations of approach-avoid conflict and planning to avoid losses. The model also ties together a number of other seemingly disjoint phenomena in anxious disorders. For instance, learning under the pessimistic bias captures a hypothesis about the role of anxiety in the later development of depression. The bias itself offers a new formalization of classic insights from the psychiatric literature about the central role of maladaptive beliefs about control and self-efficacy in anxiety. This perspective also extends previous computational accounts of beliefs about control in mood disorders, which neglected the sequential aspects of choice.
PubMed: 34036174
DOI: 10.1162/cpsy_a_00026 -
Neuropsychopharmacology : Official... Apr 2022Avoiding stimuli that predict danger is required for survival. However, avoidance can become maladaptive in individuals who overestimate threat and thus avoid safe... (Review)
Review
Avoiding stimuli that predict danger is required for survival. However, avoidance can become maladaptive in individuals who overestimate threat and thus avoid safe situations as well as dangerous ones. Excessive avoidance is a core feature of anxiety disorders, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). This avoidance prevents patients from confronting maladaptive threat beliefs, thereby maintaining disordered anxiety. Avoidance is associated with high levels of psychosocial impairment yet is poorly understood at a mechanistic level. Many objective laboratory assessments of avoidance measure adaptive avoidance, in which an individual learns to successfully avoid a truly noxious stimulus. However, anxiety disorders are characterized by maladaptive avoidance, for which there are fewer objective laboratory measures. We posit that maladaptive avoidance behavior depends on a combination of three altered neurobehavioral processes: (1) threat appraisal, (2) habitual avoidance, and (3) trait avoidance tendency. This heterogeneity in underlying processes presents challenges to the objective measurement of maladaptive avoidance behavior. Here we first review existing paradigms for measuring avoidance behavior and its underlying neural mechanisms in both human and animal models, and identify how existing paradigms relate to these neurobehavioral processes. We then propose a new framework to improve the translational understanding of maladaptive avoidance behavior by adapting paradigms to better differentiate underlying processes and mechanisms and applying these paradigms in clinical populations across diagnoses with the goal of developing novel interventions to engage specific identified neurobehavioral targets.
Topics: Animals; Anxiety; Anxiety Disorders; Avoidance Learning; Humans; Models, Animal; Obsessive-Compulsive Disorder
PubMed: 35034097
DOI: 10.1038/s41386-021-01263-4 -
Human Nature (Hawthorne, N.Y.) Mar 2021Cross-cultural sex differences in mobility and harm avoidance have been widely reported, often emphasizing fitness benefits of long-distance travel for males and high...
Cross-cultural sex differences in mobility and harm avoidance have been widely reported, often emphasizing fitness benefits of long-distance travel for males and high costs for females. Data emerging from adults in small-scale societies, however, are challenging the assumption that female mobility is restricted during reproduction. Such findings warrant further exploration of the ontogeny of mobility. Here, using a combination of machine-learning, mixed-effects linear regression, and GIS mapping, we analyze range size, daily distance traveled, and harm avoidance among Hadza foragers during middle childhood and adolescence. Distance traveled increased with age and, while male adolescents had the longest daily ranges, average daily distance traveled by each sex was similar. We found few age- or sex-related patterns in harm-avoidant responses and a high degree of individual variation. When queried on the same issues, children and their parents were often in alignment as to expectations pertaining to harm avoidance, and siblings tended to behave in similar ways. To the extent that sex differences in mobility did emerge, they were associated with ecological differences in physical threats associated with sex-specific foraging behaviors. Further, we found no strong association between harm avoidance and mobility. Young Hadza foragers of both sexes are highly mobile, regardless of how harm avoidant they are. Taken together, our findings indicate that the causal arrows between harm avoidance and mobility must be evaluated in ecologically specific frameworks where cultural expectations of juvenile mobility can be contextualized.
Topics: Adolescent; Adult; Child; Exercise; Female; Harm Reduction; Humans; Male; Reproduction; Sex Characteristics; Sexual Behavior
PubMed: 33945076
DOI: 10.1007/s12110-021-09390-z