BIOSOFT HELP FILES

Poor Quality in the management of suicide in Primary Care
The limited understanding of how to assess and treat people with SI was apparent in some of the interviews in this UK study, although there was substantial variability between physicians. However, similar gaps in knowledge are also evident in other studies involving primary care professionals. An observational study of primary care providers in the Netherlands showed SI was assessed in only 44% of clinically depressed patients and 66% of new-onset depression patients. The frequent lack of suicide risk prevention policies in primary care practices is also apparent, and even when they do exist, there may be uncertainty regarding what they entail. Julie Goldstein Grumet, director of US Health and Behavioral Health Initiatives for the Suicide Prevention Resource Center and the director of the Zero Suicide Institute, published preliminary research data in the Jan. 2019 Journal of Health Care Compliance. Less than one-third of healthcare providers (n=15,000) who completed an optional self-test for the Zero Suicide initiative in the USA reported feeling knowledgeable about suicide risk warning signs. Similarly, only 1 in 3 knew their organization's procedures for patients at increased risk or felt confident in their ability to respond to a suicidal patient. Although standardized tools, instruments, and rubrics do not provide a clear indication of imminent suicidal risk, the American Psychiatric Association Clinical Guidelines for Evaluating Suicidality suggests these tools can be useful as prompts when interviewing to ensure thoroughness in the questions asked during the risk assessment. Grumet et al. reported that only 35.5% of the providers stated they use any of these available tools when screening or assessing. Furthermore, only one-third of the healthcare professionals responsible for delivering treatment (n = 4,101) indicated they "strongly agreed" when self-rating their level of confidence or comfort in treating patients with elevated suicide risk.

Ref - Harmer B, Lee S, Duong TVH, Saadabadi A. Suicidal Ideation. 2021 Aug 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 33351435. Accessed 6:26 PM 1/6/2022

Also referred to as "spells", "altered mental states", "funny turns",

Nonconvulsive status epilepticus (NCSE) is an underrecognized condition in the elderly.
Patients with NCSE often have impaired consciousness but do not show classic ictal or convulsive motor findings;
an electroencephalogram (EEG) is required for diagnosis and management. Frequently, NCSE occurs in the setting
of acute medical conditions. In a recent retrospective analysis of 1048 patients with “spells” or altered mental
status, 7% were found to have NCSE, and another 13% demonstrated epileptiform discharges.

Defined as an ongoing state of seizures, or multiple seizures without convulsions, and without return to baseline for at least 30 minutes,1 the clinical features of NCSE are highly variable. They include cognitive impairment, speech arrest, subtle facial, trunk, or limb twitches, head or eye deviation, autonomic signs (like unilateral mydriasis, paroxysmal hypertension, or arrhythmias), automatisms, and bizarre behaviors including wandering, hallucinations, fear, and ecstasy. These features can challenge diagnosis, as such symptoms may arise from other conditions. NCSE diagnosis is confirmed by EEG demonstration of ongoing ictal activity.1

Sutter R, Rüegg S, Kaplan PW. Epidemiology, diagnosis, and management of nonconvulsive status epilepticus: Opening Pandora's box. Neurol Clin Pract. 2012 Dec;2(4):275-286. doi: 10.1212/CPJ.0b013e318278be75. PMID: 30123679; PMCID: PMC5829470.

1)      Patient education and information provision provide the cornerstones of modern health care.  They are essential for patient empowerment, ethical and legal treatment provisions, informed choice, informed consent, and shared decision-making.

1. Digital health, and electronic health records in particular, create opportunities
for improving care coordination and person-centeredness. However,
digital health is a major source of professional dissatisfaction and clinician
burnout (NASEM 2021 Pa 15).

NASEM 2021. National Academies of Sciences, Engineering, and Medicine 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press. https://doi.org/10.17226/25983.
D://LIBRARY/IOM-Howto_Deliver_High_Quality_Primary_care.pdf

2. US adoption of HIT as a path to improved quality of patient care (patient centredness, effectiveness,
safety, timelines, efficiency, and equity ) has been promoted by the medical community (HIT has face validity)
Kim GJ, Lehmann CU, Council on Clinical Information Technology. Pediatric Aspects of Inpatient Health Information Technology Systems.
Paediatrics 2008;122;e1287-e1296. DOI :10.1542/peds.2008-2963.

3. The implementation of HIT cannot be considered in terms of applications (such as electronic health
records, computerized physician order entry) alone but must be considered globally in terms of technical
(HIT applications), organizational (structures and care workflows) and cultural (stakeholders) aspects of
what is best.
Kim GJ, Lehmann CU, Council on Clinical Information Technology. Pediatric Aspects of Inpatient Health Information Technology Systems.
Paediatrics 2008;122;e1287-e1296. DOI :10.1542/peds.2008-2963.

4. The HL7 Child Health Functional Profile for EHR Systems (Child Health Profile) is designed to assist children's healthcare providers and associated IT vendors in creating functionality that ensures safe and reliable care of children through the effective use of information technology.

5. Core Functionality for a eBHT in Paediatrics: Key areas include vaccination, child
development, physiologic medication dosing, pediatric disease management, pediatric norms,
and the relationship between pediatric patients and their caregivers, including adolescent privacy.

Dufendach KR, Eichenberger JA, McPheeters ML, Temple MW, Bhatia HL, Alrifai MW, Potter SA, Weinberg ST, Johnson KB, Lehmann CU. Core Functionality in Pediatric Electronic Health Records. Technical Brief No. 20. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2012-00009-I.) AHRQ Publication No.15-EHC014-EF. Rockville, MD: Agency for Healthcare Research and Quality; April 2015. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

6. The
Office of the National Coordinator for Health
Information Technology (ONC) defines an
EMR is a digital version of paper charts in a
clinician’s office that contains the medical and
treatment history of patients in one practice
(Garrett & Seidman, 2011). However, the information
contained in the EMR does not travel
easily out of the practice. The terms EMR and
electronic health records (EHR) are sometimes
used interchangeably. However, these terms
actually refer to different aspects. The ONC
differentiates between the definitions of EMR
and EHR by saying that EHRs are designed to
reach out beyond the health organization that
originally collects and compiles the information,
and they focus on the total health of the
patient. In addition, according to Garets and
Davis (2006), an EMR is a legal record created
in hospitals and ambulatory environments and
is the source of data for the EHR. An EHR is a
broader technology that provides the capability
to share medical information among healthcare
stakeholders. It also supports the flow of patient
information through various modalities of care
engaged by the individual.

Garrett, P., & Seidman, J. (2011). EMR vs EHR: What is the difference? Retrieved from http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/
Garets, D., & Davis, M. (2006). Electronic medical records vs. electronic health records: Yes, there is a difference. Policy white paper, HIMSS Analytics, Chicago, IL.