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NAUSEA, PAIN, PREVENTIVE medicine, ACUPUNCTURE, CHI-squared test, EMERGENCY medical services, HOSPITAL emergency services, PATIENT satisfaction, PATIENT safety, RESEARCH funding, T-test (Statistics), U-statistics, PILOT projects, PATIENT refusal of treatment, VISUAL analog scale, DATA analysis software, DESCRIPTIVE statistics, and PREVENTION

Objective: To evaluate the feasibility of delivering acupuncture in an emergency department (ED) to patients presenting with pain and/or nausea. Methods: A feasibility study (with historical controls) undertaken at the Northern Hospital ED in Melbourne, Australia, involving people presenting to ED triage with pain (VAS 0–10) and/or nausea (Morrow Index 1–6) between January and August 2010 (n=400). The acupuncture group comprised 200 patients who received usual medical care and acupuncture; the usual care group comprised 200 patients with retrospective data closely matched from ED electronic health records. Results: Refusal rate was 31%, with ‘symptoms under control owing to medical treatment before acupuncture’ the most prevalent reason for refusal (n=36); 52.5% of participants responded ‘definitely yes’ for their willingness to repeat acupuncture, and a further 31.8% responded ‘probably yes’. Over half (57%) reported a satisfaction score of 10 for acupuncture treatment. Musculoskeletal conditions were the most common conditions treated n=117 (58.5%), followed by abdominal or flank pain n=49 (24.5%). Adverse events were rare (2%) and mild. Pain and nausea scores reduced from a mean±SD of 7.01±2.02 before acupuncture to 4.72±2.62 after acupuncture and from 2.6±2.19 to 1.42±1.86, respectively. Conclusions: Acupuncture in the ED appears safe and acceptable for patients with pain and/or nausea. Results suggest combined care may provide effective pain and nausea relief in ED patients. Further high-quality, sufficiently powered randomised studies evaluating the cost-effectiveness and efficacy of the add-on effect of acupuncture are recommended. [ABSTRACT FROM AUTHOR]

We developed a continous quality improvement (CQI) program for anesthesia services based on self- reporting of critical incidents and negative outcomes through a dichotomous (yes/no) response on the anes thesia record. Immediate case investigation provides data for systematic peer review of anesthesia man agement. Trend analysis of the database of critical incidents and negative outcomes identifies opportu nities for improvement. The CQI program resulted in the reporting of nearly twice as many problems re lated to anesthesia management (5% of all anes thetics) as did the checklist it replaced (2.7%). Esca lation of patient care (3.2%) and operational ineffi ciencies (2.2%) were more common than patient injury (1.5% of all anesthetics). Among the 537 cases with anesthesia management problems were 119 hu man errors and equipment problems (22%). Regional nerve blocks and airway management represented the most common problem areas. Improvement in anesthesia services was made through prompt imple mentation of strategies for problem prevention de vised by the practitioners themselves through peer review, literature review, and clinical investigations. [ABSTRACT FROM PUBLISHER]

SPASMS, SEIZURES (Medicine), EPILEPSY, MUSCLE cramps, BRAIN diseases, and DEVELOPMENTAL disabilities

Do early seizures beget seizures later in life? Clinical data and experimental observations seem to answer that question differently, with a no and a yes, respectively, which may stem from an inadequate readout of what experimental data actually do tell us and a possible simplification of what clinical data indicate. Using specific experimental examples, it is possible to show that in the developing brain, seizures do produce long-lasting alterations of neuronal excitability, although ongoing seizures are not observed in adults. The findings suggest that the long-lasting changes in developmental programs and network activity that seizures induce do not necessarily lead to epilepsy, unless other events that remain to be identified occur. [ABSTRACT FROM AUTHOR]

STUDENT counselors, AUTISM, AUTISTIC people, COMMUNITY health workers, AUTISM in children, PSYCHOMETRICS, and PEOPLE with disabilities

Introduction: Autism is included as a certifiable disability in the Indian Rights of Persons with Disability Act, 2016. The Indian Scale for Assessment of Autism (ISAA), developed by the Government of India and mandated for certifying disability, is a detailed instrument that needs trained mental health experts and takes time to administer. The current project was planned to develop a simple, easy to use screening tool based on the ISAA to identify possible cases in the community. Methods: The project is planned in three phases. During the first phase, data collected during the development of the ISAA (N = 433/436 children with autism) will be used to identify questions answered as frequently, mostly, and always. During the second phase, the psychometric properties of the screening tool based on these items will be evaluated among research participants recruited from hospitals and special schools (n = 100). In the third phase, the screening questionnaire will be administered in the community (n = 500). Results: The most frequently answered questions will be selected for inclusion in the proposed screening tool. The number of items in the screening tool will be kept as few as possible, with yes or no responses Discussion: Indian Autism Screening Questionnaire (IASQ) will be tested as a screening version of ISAA, which can be used by community health workers, teachers, or school counselors. The IASQ will not provide a diagnosis of autism. A positive screening result should be followed by a thorough assessment by a trained specialist. Analyzing the psychometric properties of the test can help ensure cost-effective screening of the community to identify autism. [ABSTRACT FROM AUTHOR]

SUICIDE prevention, MENTAL health services, SUICIDE, MEDICAL care, PSYCHIATRISTS, MENTAL health personnel, MENTAL depression, INTERPROFESSIONAL relations, and PSYCHIATRY

This article examines the role of psychiatrists in preventing suicide in Australia. It is noted that psychiatrists can help both in populations and in their patients but they cannot do it alone. It is recommended that primary care physicians need more training and education so that they can detect, engage in treatment and treat in collaboration patients with depression and substance abuse. Here again, psychiatrists can play a role through shared care models. Second, insufficient coordination between psychiatric services and addiction services was found in more than one-third of cases.