Intensive Services Research Articles

Mortality in Treatment-seeking Older Adults Receiving Medications for Opioid Use Disorder.

Older adults (OAs; age 55+ years) are increasingly seeking specialty treatment of opioid use disorder. Previous analyses of the Treatment Episode Data Set-Discharges (TEDS-D) database have reported higher rates of in-treatment mortality for those receiving medications for opioid use disorder (MOUD). We evaluate current trends in mortality for treatment-seeking OAs. Using the 2020 TEDS-D, logistic regression predicted in-treatment mortality for OAs from planned MOUD, service level, and interaction terms. Of the 26,993 OA treatment discharges, 679 people were discharged due to death (2.52%). OAs with MOUD (3.65%, 95% confidence interval [CI], 3.37%-3.95%) were significantly more likely to discharge due to death than those without MOUD (0.82%; 95% CI, 0.66%-1.01%). Most records were for nonintensive outpatient (83.7%; n = 22,588), which had the highest mortality (2.89%; 95% CI, 2.68%-3.11%); intensive services (n = 4405) had a mortality rate of 0.61% (95% CI, 0.42%-0.89%). Among OAs, planned MOUD with nonintensive outpatient services had a mortality rate of 4.17% (95% CI, 3.56%-4.9%). This TEDS-D analysis extends previous literature highlighting a significant interaction between planned MOUD and service intensity on in-treatment mortality for OAs. Additional research is needed to address the causal mechanisms behind these interactions and inform the delivery of safe effective care in the growing OA population.

Forms of interaction between the National Medical Research Center for Anesthesiology and Critical Care Medicine (for adults) and the regions of the Russian Federation

In order to implement the Federal Project “Development of a Network of National Medical Research Centers and Implementation of Innovative Medical Technologies”, the National Medical Research Center (NMRC) on the “Anesthesiology and Intensive Care (for adults)” was established in 2021 on the basis of the Sechenov First Moscow State Medical University (Sechenov University), designed to perform organizational and methodological management of specialized units of medical organizations of regions of the Russian Federation. Aim. Evaluate the contribution of Sechenov University to the implementation of the federal project “Development of a network of medical research centers and the introduction of innovative medical technologies” using the unique experience of the NMRC as an example.. Materials and methods. Analysis of the results of NMRC visits to the regions of the Russian Federation. Reports review of medical organizations of the regions of the Russian Federation. The involvement of medical personnel of the regions in the system of continuous medical education, including scientific and practical events carried out by NMRC, and the demand for the use of telemedical consultations were assessed. Results. During 17 months of the NMRC work 15 of on-site inspections in the regions of Russian Federation were carried out in order to analyze the level of anesthesiology and intensive care services in the regions of Russian Federation, 2577 telemedical consultations were provided, and 15 interactive educational modules for the portal of continuous medical and pharmaceutical education of Ministry of Health of Russia were prepared. Conclusion. The main forms of NMRC’s interaction with the regions of the Russian Federation are organizational and methodological, scientific and educational support of the representatives of healthcare practitioners and regional healthcare authorities. The NMRC activities are aimed at improving the quality of medical care in the field of anesthesiology and intensive care in the regions of the Russian Federation and the formation of a value-oriented approach in modern health care.

The feasibility and acceptability of a physician-led ICU follow-up service: A prospective cohort study

BackgroundIncreased recognition of post–intensive care syndrome has led to widespread development of intensive care follow-up services internationally. ObjectiveThe objective of this study was to determine the feasibility and acceptability of an intensive care unit (ICU) follow-up clinic in Australia for patients and their caregivers and to describe satisfaction with this service. MethodsThis was a prospective cohort study in a mixed tertiary ICU in Australia. Eligible patients were adults admitted to the ICU for 7 days or more and/or ventilated for 48 h or more, as well as their primary caregiver. Patients and their primary caregivers were invited to attend a follow-up clinic 4–8 weeks after hospital discharge. The clinic appointment was attended by an ICU physician and nurse, with multidisciplinary support. Feasibility and acceptability were defined as the proportion of clinic attendance and frequency of interventions initiated at the clinic. Satisfaction was measured by a 5-point satisfaction survey (very dissatisfied to very satisfied). The burden of ongoing disease was reported via multiple validated instruments. ResultsFrom April 2020–July 2021, 386 patients met the inclusion criteria. Only 146 patients were approached for consent due to site staffing limitations. Eighty-three patients and 32 caregivers consented to attend the clinic. Seventy percent (54/77) of patients attended scheduled appointments and 50% (16/32) of caregivers. For patients, 23 medical referrals were made, 8 patients had medication changes, and 10 patients were offered social work support. Satisfaction surveys were completed by 65% (35/54) of attending patients; 97% (34) patients reported either being ‘very satisfied’ or ‘satisfied’ with the service. All responding caregivers (10) were either ‘very satisfied’ or ‘satisfied’ with the clinic. ConclusionThere were a large number of patients meeting the inclusion criteria to the ICU follow-up clinic, and clinic attendance was moderate for patients but lower for caregivers. Reported satisfaction with the service was high for both patients and their caregiver.

Critical illness survivors' experiences of attending an intensive care unit follow-up service: a systematic review protocol.

The objective of this review is to explore critical illness survivors' experiences of attending an intensive care unit (ICU) follow-up service. A significant proportion of critical illness survivors will require ICU follow-up care to support adverse symptoms in health domains, including cognition, mental health, and physical and social function. While there is consensus on the need for ICU follow-up services, systematic reviews to date have not identified any significant impact of ICU follow-up services on clinical health outcomes. An understanding of survivors' experiences of attending an ICU follow-up service may improve the effectiveness and design of such services. This review will include studies that explore the experiences of adult ( 18 years of age) critical illness survivors who attended an ICU follow-up service following discharge from an ICU, regardless of the admitting diagnosis or ICU length of stay. This review will be conducted in line with the JBI methodological framework for qualitative systematic reviews. Electronic databases, including MEDLINE, CINAHL, PsycINFO, Embase, and Web of Science Core Collection, will be searched to identify relevant studies for inclusion in the review. Studies will be screened by 2 independent reviewers. Critical appraisal, data extraction, and data synthesis will be completed by 2 independent reviewers using a meta-aggregation method for data synthesis. Confidence in the research findings will be assessed and assigned a ConQual score. PROSPERO CRD42023404585.

Contrasting innovation dynamics of professional-technological knowledge intensive business services in metropolitan areas

Formulation of the problem. The study examines knowledge-intensive business services (KIBS) firms' capability to access, process, and transform information into innovation. KIBS are defined as facilitators, carriers of knowledge, and sources of innovation for other sectors. KIBS play an important role in the production, use, and transfer of knowledge to the manufacturing sector. KIBS activities do not demonstrate a uniform structure within themselves, so a dual classification as professional services (P-KIBS) and technological services (T-KIBS) based on functioning and input has been developed. KIBS activities are concentrated in large cities. Major cities or capitals have well-developed infrastructure, public administration centers, advanced social activities, and numerous research institutes and universities. All of them attract a highly skilled population. Regarding metropolitan city economic growth, KIBS stand out because of their high added value, high income, high innovation returns, and high financial capacity, and they contribute to development. The purpose. The present study aims to reveal the innovative capacities and dynamics of P-KIBS and T-KIBS firms operating in the metropolitan area of Ankara, Turkey's capital city. To reach this aim, Turkey's capital city Ankara is analyzed by using the results of a questionnaire applied to 410 small and medium-sized (SMEs) KIBS firms, 146 of which are P-KIBS firms and other 264 are T-KIBS firms. Methods. In the course of the research and preparation of the article, the authors used several scientific methods, both philosophical and general scientific, as well as specific scientific methods. In particular, the methods of analysis and synthesis, induction and hypothetical-deductive method, mathematical-statistical and spatial analysis, methods of grouping and classification, questionnaires and surveys, etc., were used. The results. There are notable differences between the P-KIBS and T-KIBS firms, considering their spatial distribution patterns and the dynamics of their innovation processes. The spatial distribution patterns of the KIBS firms were revealed. While T-KIBS activities demonstrate a spatial clustering tendency independent of the CBD, the P-KIBS firms prefer to locate within the CBD or its vicinity. KIBS sectors generally prefer to be situated by high-income residents, new settlements, secure and prestigious areas close to large public institutions such as ministries and general directorates. It was revealed that the T-KIBS firms are most densely located in the CBD and newly developing business districts of Balgat and Söğütözü, and in the Technology Development Zones of Ankara. P-KIBS firms, on the other hand, are more widely spread in the Çankaya and Yenimahalle districts. It was found that advances in information and communication technologies have a varied impact on the location selection preferences of P-KIBS and T-KIBS enterprises. According to the research results, the factors influencing the clustering of P-KIBS companies and T-KIBS firms were identified and determined. There is a significant relationship between the innovative P-KIBS and T-KIBS firms and their collaboration with other institutions. As a result of the the study, it has been determined that there is a significant relationship between collaboration, R&D, intrafirm and extrafirm social relationships on the innovation of KIBS firms and also contrasting innovation dynamics related to different classes of KIBS in metropolitan areas.

Award for Distinguished Professional Contributions to Applied Research: Jennifer C. Wolff.

This award is given to a psychologist whose research has led to important discoveries or developments in the field of applied psychology. "Jennifer C. Wolff serves multiple roles as a licensed psychologist in Massachusetts and Rhode Island. She is an associate professor at The Warren Alpert Medical School of Brown University, a staff psychologist at Rhode Island Hospital and Bradley Hospital, and director of the Adolescent Mental Health Collaborative. Dr. Wolff's program of research involves three primary aims: (a) delineating social, cognitive, and affective mechanisms underlying adolescent psychopathology; (b) translating these findings into treatments; and (c) implementing these treatments in real-world settings. She focuses on emotional and behavioral dysregulation as well as suicide prevention. Her current projects include large-scale data collection in the inpatient setting and improving routine practices and quality of care in inpatient and community settings. She also investigates the use of technology in dissemination and implementation research. Dr. Wolff has pioneered a cognitive behavioral therapy program for inpatient adolescents that includes scaling to train hospital staff. She is an active member of the American Psychological Association, the Association for Behavioral and Cognitive Therapies, and the Division 53 Special Interest Group for Acute, Intensive, and Residential Services. She has served as a peer reviewer/ad hoc reviewer and has authored or coauthored several articles and book chapters. Dr. Wolff's work demonstrates an exceptional combination of clinical practice and applied research and is therefore well-deserving of this distinguished award." (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cluster analysis to identify the profiles of individuals with compromised bone health versus unfortunate wrist fractures within the Canadian Longitudinal Study of Aging (CLSA) database

SummaryWe used cluster analysis to determine the profiles of individuals who sustained wrist fractures. We found two groups: (1) young and active and (2) older and less active. This information may be used to identify individuals who require further bone health interventions to optimize healthy aging.IntroductionDistal radial fractures (DRF) are the most common of all fractures, with 6% of males and 33% of females having one at some point in their lifetime. We hypothesize that DRF consists of two subpopulations: one with compromised bone health that is early in the osteoporosis (OP) trajectory and another which are active and healthy and suffer a misfortune fracture due to their high activity levels or risk-taking behaviors. The latter is likely to recover with a minimal disability, while the former may signal a negative health trajectory of disability and early mortality.ObjectiveTo determine the profiles of individuals who sustained wrist fractures using cluster analysis within the Comprehensive Cohort of the Canadian Longitudinal Study on Aging (CLSA) database considering factors that reflect bone health and activity levels.MethodsWe included all the individuals who had a wrist fracture within the CLSA comprehensive cohort of the database (n = 968). The baseline data was used for this analysis. A 2-step cluster analysis was used to identify profiles that were both statistically and clinically meaningful. Variables that were used in the cluster analysis include demographic variables, physical activity status indicators, general health indicators, mobility indicators, bone health indicators, comorbid conditions, and lifestyle factors.ResultsWe were able to identify two distinct profiles that were statistically and clinically meaningful confirming our hypothesis. One cluster included a predominantly younger cohort, who are physically active, with less comorbid conditions, better bone health, and better general health, while the opposite was true of the first cohort.ConclusionWe were able to identify two clusters—a healthy profile and a bone health compromised profile. This information may be used to identify the subgroup of people who should be targeted in the future for more intensive preventive health services to optimize healthy aging.

Machine learning models for early prediction of mortality risk in patients with burns: A single center experience

Mortality rate is considered as the most important outcome measure for assessing the severity of burn injury. A scale or model that accurately predicts burn mortality can be useful to determine the clinical course of burn injuries, discuss treatment options and rehabilitation with patients and their families, and evaluate novel, innovative interventions for the injuries. This study aimed to use machine learning models to predict the mortality risk of patients with burns after their first admission to the center and to compare the performances of these models. Overall, 1064 patients hospitalized in burn intensive care and burn service units between 2016 and 2022 were included in the study. In total, 40 parameters, including demographic characteristics and biochemical parameters of all patients, were analyzed in the study. Furthermore, the dataset was randomly divided into two clusters with 70% of the data used for artificial neural networks (ANNs) training and 30% for model success testing. The ANN model proposed in this study showed high success across all machine learning methods tried in different variants, with an accuracy of 95.92% in the test set. Machine learning models can be used to predict the mortality risk of patients with burns. This study may help validate the use of machine learning models for applications in clinical practice. Conducting multicenter studies will further contribute to the literature.

Application of Good Governance Principles in Digital-Based Services in the Department of Capital Investment and One-Door Integrated Services of Gorontalo City

This research aims to discover the principles of good governance in digital-based services at the Gorontalo City Investment and One-Stop Integrated Service Office. The method uses descriptive research with a qualitative approach and data collection techniques through observation, interviews, and documentation derived from primary and secondary data. This research uses data analysis techniques through data collection techniques, data reduction, data presentation and conclusion drawing. The results showed that the principles of Good Goverance in the One-Stop Integrated Service Investment Office of Gorontalo City, seen from the indicators of transparency, equality/justice, and community participation, have yet to be achieved. This is due to unclear requirements and periods for permit completion, nepotism in the service, and lack of public participation in socialization held by the agency. It is suggested that the government provide appropriate and proper intensive services to all people who come to the Gorontalo City Investment and One-Stop Integrated Service Office and improve the SICANTIK service system so that the purpose of holding SICANTIK can be achieved following what is expected by bathubs, govemment and the community

Crisis spreading in multinational firms’ network: the dual influence of local interactions

This study investigates the characteristics of multinational firm’s interactions within and across activity sectors and the impact of intra-urban connections, during crisis propagation. By employing data that reflect ownership relations aggregated on the city level, we constructed the partial-multiplex, directed network of cities, divided into five layers by activity sector. The network was examined in two states: one excluding intra-urban interactions and one including them. The difference between these two states highlight the significant role of intra-urban networking processes in the global economy. The five layers differ both structurally and in terms of vulnerability during crisis propagation. The Knowledge Intensive Services (KIS) layer is the densest and most populous layer of all and its firms are more likely to be owners than subsidiaries. Using a simple stochastic Susceptible-Infected-Recovered (SIR) model, we simulated a crisis diffusion on the network of cities. Our results revealed that in the absence of intra-urban connections, KIS was both the most vulnerable and most influential layer in crisis propagation. The inclusion of intra-urban links sets off a complex interplay of factors that affect diffusion outcomes in nuanced ways: while it generally enhances the impact of the crisis and the influence across layers becomes rather homogeneous it can also have a protective effect, in cases of very dense and well-connected layers, such as KIS.

Linking Medicare-Medicaid Claims for Patient-Centered Outcomes Research Among Dual-Eligible Beneficiaries.

Evaluation of Medicare-Medicaid integration models' effects on patient-centered outcomes and costs requires multiple data sources and validated processes for linkage and reconciliation. To describe the opportunities and limitations of linking state-specific Medicaid and Centers for Medicare & Medicaid Services administrative claims data to measure patient-centered outcomes for North Carolina dual-eligible beneficiaries. We developed systematic processes to (1) validate the beneficiary ID linkage using sex and date of birth in a beneficiary ID crosswalk, (2) verify dates of dual enrollment, and (3) reconcile Medicare-Medicaid claims data to support the development and use of patient-centered outcomes in linked data. North Carolina Medicaid beneficiaries with full Medicaid benefits and concurrent Medicare enrollment (FBDE) between 2014 and 2017. We identified need-based subgroups based on service use and eligibility program requirements. We calculated utilization and costs for Medicaid and Medicare, matched Medicaid claims to Medicare service categories where possible, and reported outcomes by the payer. Some services were covered only by Medicaid or Medicare, including Medicaid-only covered home and community-based services (HCBS). Of 498,030 potential dual enrollees, we verified the linkage and FBDE eligibility of 425,664 (85.5%) beneficiaries, including 281,174 adults enrolled in Medicaid and Medicare fee-for-service. The most common need-based subgroups were intensive behavioral health service users (26.2%) and HCBS users (10.8%) for adults under age 65, and HCBS users (20.6%) and nursing home residents (12.4%) for adults age 65 and over. Medicaid funded 42% and 49% of spending for adults under 65 and adults 65 and older, respectively. Adults under 65 had greater behavioral health service utilization but less skilled nursing facility, HCBS, and home health utilization compared with adults 65 and older. Linkage of Medicare-Medicaid data improves understanding of patient-centered outcomes among FBDE by combining Medicare-funded acute and ambulatory services with Medicaid-funded HCBS. Using linked Medicare-Medicaid data illustrates the diverse patient experience within FBDE beneficiaries, which is key to informing patient-centered outcomes, developing and evaluating integrated Medicare and Medicaid programs, and promoting health equity.

Reduction of Mental Health-Related Emergency Department Admissions for Youth and Young Adults Following a Remote Intensive Outpatient Program: Quality Improvement Analysis.

Pediatric mental health emergency department (ED) visits are increasing at 6% to 10% per year, at substantial cost, while 13% of youth with psychiatric hospitalizations are readmitted in the following weeks. Hospitals do not have the resources to meet escalating youth's mental health needs. Intensive outpatient (IOP) programs, which provide multiple hours of care each week, have the power to reduce the number of patients in need of hospitalized care and provide a step-down option for patients discharging from ED's in order to prevent readmissions. The purpose of this program evaluation was to assess (1) whether youth and young adult ED admission rates decreased following participation in a remote IOP program and (2) whether there were differences in readmission rates between youth and young adults by gender identity, sexual orientation, race, or ethnicity. Data were collected from intake and 3-month postdischarge surveys for 735 clients who attended at least 6 sessions of a remote IOP program for youth and young adults. Patients reported if they had been admitted to an ED within the previous 30 days and the admission reason. Over half (407/707, 57.6%) of clients were adolescents and the rest were young adults (300/707, 42.4%; mean age 18.25, SD 4.94 years). The sample was diverse in gender identity (329/687, 47.9% female; 196/687, 28.5% male; and 65/669, 9.7% nonbinary) and sexual orientation (248/635, 39.1% heterosexual; 137/635, 21.6% bisexual; 80/635, 10.9% pansexual; and 170/635, 26.8% other sexual orientation) and represented several racial (9/481, 1.9% Asian; 48/481, 10% Black; 9/481, 1.9% Indigenous; 380/481, 79% White; and 35/481, 7.2% other) and ethnic identities (112/455, 24.6% Hispanic and 28/455, 6.2% other ethnic identity). Mental health-related ED admissions significantly decreased between intake and 3 months after discharge, such that 94% (65/69) of clients with a recent history of mental health-related ED admissions at IOP intake reported no mental health-related ED admissions at 3 months after discharge from treatment (χ21=38.8, P<.001). There were no differences in ED admissions at intake or in improvement at 3 months after discharge by age, gender, sexuality, race, or ethnicity. This study documents a decrease in ED admissions between intake and 3 months after discharge among both youth and young adults who engage in IOP care following ED visits. The similar outcomes across demographic groups indicate that youth and young adults experience similar decreases after the current tracks of programming. Future research could conduct a full return-on-investment analysis for intensive mental health services for youth and young adults.

Association Between Clinician-Level Factors and Patient Outcomes in Virtual and In-Person Outpatient Treatment for Substance Use Disorders: Multilevel Analysis.

The use of virtual treatment services increased dramatically during the COVID-19 pandemic. Unfortunately, large-scale research on virtual treatment for substance use disorder (SUD), including factors that may influence outcomes, has not advanced with the rapidly changing landscape. This study aims to evaluate the link between clinician-level factors and patient outcomes in populations receiving virtual and in-person intensive outpatient services. Data came from patients (n=1410) treated in a virtual intensive outpatient program (VIOP) and an in-person intensive outpatient program (IOP), who were discharged between January 2020 and March 2021 from a national treatment organization. Patient data were nested by treatment providers (n=58) examining associations with no-shows and discharge with staff approval. Empathy, comfort with technology, perceived stress, resistance to change, and demographic covariates were examined at the clinician level. The VIOP (β=-5.71; P=.03) and the personal distress subscale measure (β=-6.31; P=.003) were negatively associated with the percentage of no-shows. The VIOP was positively associated with discharges with staff approval (odds ratio [OR] 2.38, 95% CI 1.50-3.76). Clinician scores on perspective taking (β=-9.22; P=.02), personal distress (β=-9.44; P=.02), and male clinician gender (β=-6.43; P=.04) were negatively associated with in-person no-shows. Patient load was positively associated with discharge with staff approval (OR 1.04, 95% CI 1.02-1.06). Overall, patients in the VIOP had fewer no-shows and a higher rate of successful discharge. Few clinician-level characteristics were significantly associated with patient outcomes. Further research is necessary to understand the relationships among factors such as clinician gender, patient load, personal distress, and patient retention.

Relationship of angiopoietin-2 level with the prognosis of the COVID-19 disease.

COVID-19 infection is associated with coagulopathy. There is increased expression of markers such as E-selectin or angiopoietin-2 upon the activation of endothelin. The aim of this study was to determine whether there was a difference in angiopoietin-2 levels among patients with a diagnosis of COVID-19 who need to be hospitalized in the intensive care units (ICUs) or service. COVID-19 infected patients admitted in the hospital were included in this study. In addition to the routine biochemical parameters of patients in ICUs and services, 5 cc blood samples were collected and angiopoietin-2 was analyzed. Demographic data of the patients, biochemical parameters at the time of hospitalization, places and durations of hospitalization as well as their ways of being discharged from hospital were recorded. 180 patients who presented to our hospital's emergency service and were hospitalized with a diagnosis of COVID-19 were included in our study. 137 patients (76.1%) were hospitalized in the service and 43 (23.9%) were hospitalized in ICU. The angiopoietin-2 level was determined to be significantly high in the patients hospitalized in ICUs (p = 0.018). When the cut-off value of angiopoetin-2 in predicting the ICU hospitalization was assumed as 64.5 ng/L, its sensitivity was determined to be 59% and its specificity was found to be 42%. We concluded that angiopoietin-2 level in COVID-19 patients upon their presentation to the hospital might be an important parameter in predicting and ascertaining their place of hospitalization.

Key Issues in the First Year of Transition for a Large Medicaid-Funded Children's Service.

Behavioral Health Rehabilitation Service (BHRS) is a comprehensive service for Pennsylvania's Medicaid-enrolled youth and their families. In 2021, BHRS transitioned to Intensive Behavioral Health Service (IBHS) through state-wide policy change. To assess impact, the largest behavioral health managed care organization in the state compared service utilization in BHRS in 2019 versus IBHS in 2021. Results show that significantly more youth received non-Applied Behavior Analysis (non-ABA) services in BHRS (n = 13,795) than IBHS (n = 10,083) and more youth were discharged during the measurement period for BHRS versus IBHS (47% vs. 44%). Significantly more youth received ABA through IBHS versus BHRS (n = 4,385 vs. n = 2,690). The number of youth served in therapeutic service in IBHS did not indicate improved access during this first year of transition; however, more youth received evidence based treatments through IBHS indicating higher quality care for some youth and families.

A qualitative study on the implementation of a transdiagnostic cognitive behavioral therapy for children in a child welfare residential treatment program

BackgroundYouth with severe emotional or behavioral issues who are involved with child welfare authorities are sometimes placed in intensive care services in a residential treatment program. Evidence-based psychotherapies are often used in residential treatments, but there is very little research on how to adapt psychotherapy for residential treatment. ObjectiveTo describe the implementation of a transdiagnostic cognitive behavioral therapy (the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children) in a residential treatment program for children. Participants and settingStaff (n = 20) at a residential facility in Calgary, Canada. MethodsA combination of qualitative interviews and focus groups were conducted before and after therapy to identify barriers and facilitators to implementation. Data were analyzed and reported using the Consolidated Framework for Implementation Research and the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies. ResultsModifications were made to the program including creating inclusive language, integrating relevant content targeting pediatric irritability, delivering sessions online for caregivers, and using additional staff to support youth to learn and practice the application of the content and behavioral interventions. Key barriers to implementation of the Unified Protocol included staff turnover and the difficulty of sustaining a critical mass of knowledge surrounding the Unified Protocol. The major facilitators to implementation were the perceived quality of the program and advantages of the program to children and their caregivers. ConclusionsThis study supports the feasibility and acceptability of providing transdiagnostic cognitive behavioral therapies for children in residential treatment and provides a template for how to implement evidence-based practice in residential treatment.

Beyond words: A reflection from health professionals around the meaning of ‘hear me, don’t blame me’ in relation to meeting the needs of young people with learning disabilities and autism spectrum conditions

This article is a reflective piece written by the Intensive Positive Behaviour Support Service (iPBS) in South Wales. The iPBS team works with children and young people with learning disabilities and/or autism spectrum conditions, that communicate their unmet needs in ways that may challenge and are at risk of their support networks breaking down. The team works within the Positive Behaviour Support Framework and is shaped by attachment and trauma-informed research and practice. The main aims of the service are to understand unmet needs and to improve quality of life.The iPBS team completed a 1-hour reflection considering ‘hear me, don’t blame me’ and what this means to them, their roles and the service as a whole. Three key overarching themes were identified using thematic analysis: service structure, skills, and approach. The team hopes that the themes identified through this exercise will influence future iPBS processes and service delivery. The reflections explored in this article may also be beneficial for parents/carers and professionals working with a united aim of meeting the needs of children and young people presenting with behaviours of concern; beyond words. Clinical implications of the reflective piece are discussed and recommendations for other services to have their own reflections are provided.

Clinical features of febrile seizures in children with COVID-19: an observational study from a tertiary care hospital in China.

Febrile seizures are a common neurologic manifestation in children with coronavirus disease 2019 (COVID-19). Compared to seasonal respiratory viruses, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a pronounced neurological impact, with the result that febrile seizures with COVID-19 may exhibit unique clinical features. We conducted a retrospective study in a tertiary care hospital in China. We collected medical record information on febrile seizures with COVID-19, including demographic characteristics, clinical features, laboratory tests, and disease burden. Subsequently, the data were then analyzed descriptively. A total of 103 children diagnosed with febrile seizures and positive COVID-19 PCR results were included in our study. Among them, 81 (78.6%) were males and 22 (21.4%) were females. The age of onset of febrile seizures ranged from 14 to 57 months, with a mean age of 34.9 ± 6.24 months. Complex febrile seizures were observed in 34 (33%) cases. Antiseizure medications were administered to 24 (23.3%) patients. Laboratory tests showed a white blood cell count of (27.05 ± 8.20) × 103/µl, a neutrophil count of (20.09 ± 5.66) × 103/µl and a lymphocyte count of (6.44 ± 1.86) × 103/µl. A creatine kinase level was significantly elevated, with a mean value of (412.00 ± 158.96) U/L. The mean length of stay was 4.36 days. Twelve patients (11.7%) required intensive care services, but there were no deaths or patients remaining on antiseizure medications after discharge. In the post-epidemic era of COVID-19, pediatric clinicians should be aware of the changing clinical features of febrile seizures associated with COVID-19. The average age of onset has increased, with a higher proportion of males. Length of stay and hospitalization costs did not increase significantly. The prognosis remained favorable, although a small number of children required intensive care services during the acute phase.

5.21 Clinical Predictors of Intensive Psychiatric Service Use in Patients With Neurodevelopmental Disorders: Results From a Multidisciplinary Neurogenetics Clinic

5.21 Clinical Predictors of Intensive Psychiatric Service Use in Patients With Neurodevelopmental Disorders: Results From a Multidisciplinary Neurogenetics Clinic

Reliability and Validity of the Spanish Adaptation of the Stanford Proxy Test for Delirium in Two Clinical Spanish-Speaking Communities

Delirium is the most prevalent neuropsychiatric syndrome experienced by patients admitted to inpatient clinical units, occurring in at least 20% of medically hospitalized patients and up to 85% of those admitted to critical care units. Although current guidelines recommend the implementation of universal prevention strategies, the use of management strategies largely depends on constant surveillance and screening. This allows for the timely diagnosis and correction of its underlying causes and implementation of management strategies. It was to adapt and analyze the Spanish adaptation of the Stanford Proxy Test for Delirium (S-PTDsv) instrument for its use among Spanish-speaking populations. The S-PTD is an instrument consisting of 13 observational items to be completed by a clinician observer, usually the patient's nurse. The completion of the questionnaire takes about 1 minute and does not require the active participation of the person evaluated, which has important clinical advantages compared to other available instruments (e.g., the Confusion Assessment Method). The psychometric properties of the S-PTDsv were evaluated in a population of 123 patients using a quantitative, cross-sectional design. All subjects were over 18 years of age and hospitalized in various inpatient medico-surgical and intensive care unit services, either at the Barcelona Clinical Hospital (Barcelona, Spain) or the UC-Christus Health Network Clinical Hospital (Santiago, Chile, S.A.). The ultimate diagnosis of delirium was made by a member of the Psychiatry Consult Service by means of an independent neuropsychiatric evaluation based on the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, published in 2013, which is the latest version of the diagnostic manual. All study tests were performed by study personnel who were blinded to each other's test results within an hour of each other. In the receiver operator characteristic (ROC) curve analysis, the S-PTDsv demonstrated excellent classification qualities when compared with the DSM-5 as the classification reference standard. Using a cutoff point of ≥3, the S-PTDsv had a sensitivity of 94% and a specificity of 97%. The area under the curve indicator was equal to 0.95, suggesting the S-PTDsv has an excellent overall performance in accurately identifying cases of delirium. Accordingly, the S-PTDsv's positive predictive value=0.93, and the negative predictive value=0.97. The internal reliability measured with Cronbach's alpha was 0.96. Confirmatory factor analysis revealed a 1-dimensional structure with high loadings (>0.72), demonstrating that all items similarly contribute to the total diagnostic dimension, suggesting adequate construct validity. This provided evidence of convergent validity. The performance of the S-PTDsv, as compared to a blinded neuropsychiatric assessment based on DSM-5, indicates that it is an effective instrument for the detection of delirium, in the Spanish-speaking populations. These results are comparable and consistent with previously published studies in the English language version.