January 11, 2013
Aging and Long Term Care (Abridged) CE Course (3 hours) ### Additional contributors to this study include Gauri N. Savla, PhD, Wesley K. Thompson, PhD, Ipsit V. Vahia, MD, Danielle K. Glorioso, MSW, A'verria Sirkin Martin, PhD, Barton W. Palmer, PhD, David Rock, BA, and Shahrokh Golshan, PhD, UC San Diego; and Helena C. Kraemer, PhD, professor of biostatistics in psychiatry at Stanford University. This work was supported, in part, by NIMH grants T32 MH-019934 and P30 MH-066248, by NIH National Center for Research Support grant UL1 RR-031980, by the John A. Hartford Foundation, and by the Sam and Rose Stein Institute for Research on Aging.
January 08, 2013
Aging and Long Term Care CE Course “Adolescents and young adults can feel very frightened and alone when their bodies are no longer responding to medical interventions and decisions are being made around them,” said Wiener. “Allowing them to be involved in decisions, and to document how they wish to be remembered, enhances the trust in parent and medical provider relationships and provides them with the opportunity to give meaning to their life.” The product of a collaboration between clinical research teams representing two different areas of focus within NIH’s research hospital—pediatric oncology and psychiatry—Voicing My CHOICES can be used to help patients, families, caregivers, and health care providers. Voicing My CHOICES is available from Aging With Dignity (www.agingwithdignity.org), a nonprofit that provides the advanced directive document for adults, Five Wishes. References Wiener L, Zadeh S, Battles H, Baird K, Ballard E, Osherow J, Pao M. Allowing adolescents and young adults to plan their end-of-life care. Pediatrics. 2012 Nov;130(5):897-905. doi: 10.1542/peds.2012-0663. Epub 2012 Oct 8. Wiener L, Ballard E, Brennan T, Battles H, Martinez P, Pao M. How I wish to be remembered: the use of an advance care planning document in adolescent and young adult populations. Journal of Palliative Medicine. 2008 Dec;11(10):1309-13.
January 06, 2013
Aspira Continuing Education Online Courses Background Each year as many as 5 to 8 percent of U.S. children and young adults attempt suicide, according to the U.S. Centers for Disease Control and Prevention. In 2010, 4867 youths between ages 10 and 24 died by suicide, making it the second leading cause of death for people in this age group. Most individuals who die by suicide have visited a health care provider 3 months to 1 year before their death. Typically these patients saw an emergency department (ED) nurse and physician for some other health concern such as abdominal pain or headaches. These at-risk individuals often go unrecognized by ED staff who either lack the time or training to properly screen patients. The Joint Commission, a leading U.S.-based nonprofit healthcare accreditation organization, and the American Academy of Pediatrics have previously recommended the creation and use of suicide screening tools for adult and pediatric patient populations. To date there are no screening instruments to assess suicide risk in children and adolescents who visit EDs for medical or surgical reasons. “Many families use the emergency department as their sole contact in the healthcare system,” said Lisa M. Horowitz, Ph.D., M.P.H., lead author of the study. “Most people don’t show up to the emergency department and say ‘I want to kill myself.’ Rather they show up with physical complaints and do not discuss their suicidal thoughts. But studies have shown that if you ask directly, the majority will tell you. Nurses and physicians need to know what questions to ask.” Horowitz, a clinician and researcher with NIMH, and her colleagues developed a quick questionnaire that ED nurses and physicians could use to assess suicide risk among youth. Their study tested 17 candidate questions in 524 patients ages 10 to 21 years who visited one of three academically-affiliated pediatric EDs and had either psychiatric problems—suicidal ideation, intense anxiety, post-traumatic stress disorder—or medical/surgical concerns—gastrointestinal diseases, sickle cell anemia, cystic fibrosis. The questions—focusing on suicidal thoughts and behavior—were reviewed and revised by a panel of mental health clinicians, health services researchers, and survey specialists. The patients also completed one of two versions of the Suicidal Ideation Questionnaire (SIQ), the “gold standard,” 30-question suicide-screening tool that is used by pediatric and adolescent psychiatrists, but which is too long for ED visits and requires additional training. As part of the study’s safety plan, individuals whose responses indicated that they were at risk for attempting suicide were referred to mental health professionals—social workers, psychiatrists, psychologists—for further evaluation Suicide Prevention CE Course Results of the Study Of the 17 candidate questions, four (used as a set) stood out as having the most accuracy for predicting suicide attempts: current thoughts of being better off dead, current wish to die, current suicidal ideation, and history of suicide attempt. Positive responses to 1 or more of these 4 questions identified 97% of the youth at risk for suicide, regardless of whether these patients came in for psychiatric or general medical concerns. Based on results from the new questionnaire, 18.7% of the ED patients (98 of the 524) screened positive for suicide risk; most of whom had come to the ED with psychiatric concerns (84 of the 524). Elevated suicide risk was detected in 4.1% of the ED patients (14 of the 344) with medical/surgical concerns. Had it not been for the new screening tool, the suicide risk in these 14 patients most likely would have gone undetected. Significance The instrument based on these 4 questions, called the Ask Suicide-Screening Questions (ASQ), is the first time such a screen has been validated for pediatric and young adult patients evaluated in EDs for medical/surgical reasons. Although the number of these patients identified as high risk for suicide is small, the screen takes less than 2 minutes to administer. The tool is freely available and accessible online (pdf). What’s Next Additional research assessing the impact of suicidal screening in pediatric EDs on referral rates to mental health services and future suicidal behavior are needed. The accuracy of the ASQ among diverse demographic populations also needs examination. Additionally, a cost-benefit analysis for the screening tool is needed, as is research studying its use in other healthcare settings such as in-patient and out-patient care. Reference Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff EA, Ginnis K, Cannon E, Joshi P, Pao M. Ask Suicide-Screening Questions (ASQ). A Brief Instrument for the Pediatric Emergency Department. Archives of Pediatrics and Adolescent Medicine. December 2012. 166(12):1170–1176.