Time Of Service Research Articles

Regional inequalities in waiting times: analysis of orthopedic appointments in Slovenia

Abstract Background Long waiting times for healthcare services are a priority issue in the Slovenian healthcare system. Over the past decade the system for monitoring waiting times has evolved and is currently linked to the eReferral system, which allows detailed monitoring of data in particular related to secondary care services, such as outpatient specialist visits. Our aim was to explore the differences in waiting times between Slovenian regions in the case of first orthopedic outpatient visits in order to identify potential causes or contributing factors. Methods The analysis was based on the data from the waiting list database on 1 January 2024. The database includes information on region of residence of the patient and the region where the provider is located. Data were available on the number of persons on the waiting list and on the average expected waiting time for them. Waiting times relate to each of three urgency levels, which are indicated on the referral (very fast, fast and ordinary). Results Average expected waiting times for first orthopedic outpatient visits differed considerably among residents of different regions, ranging from 159 day to 265 days (60% more). The regional differences were even larger if only “very fast” and “ordinary” referrals were considered. The share of appointments in each urgency referral level also varied considerably, for example the share of patients with a “very fast” referral ranged between 15,7% and 37,6%, depending on the patient region of residence. The Pearson correlation coefficient between the region of residence of patients and the region where the provider is located was 0,78. Conclusions Waiting times and referral patterns for first orthopedic outpatient visits for patients from different regions vary considerably. Despite a free choice of provider and public data on expected waiting times, the differences correlate closely with the geographic distribution of providers. Key messages • Waiting times for outpatient visits in orthopedics differ by Slovenian region, despite free choice of provider. • The assessment of inequalities is made more difficult by varying share of different urgency levels of referrals.

Fatigue dimples? – Fractured bulkhead ring bolts in a large gas turbine engine

Abstract Bulkhead ring fasteners, four in total, were found fractured in a large gas turbine engine after 1700 operating hours and a high number of engine starts and shut-downs for such a relatively short time in service. A metallurgical failure investigation was ordered by the client for determining the metallurgical cause of the cracking. The subject bolts failed due to high-stress low cycle fatigue fracture.

B-202 Clinical and analytical performance evaluation of Savanna RVP4 panel versus three methodologies

Abstract Background Rapid molecular diagnosis became a key solution for healthcare institutions across the world, after COVID-19 pandemic. It has enabled diagnosis based on improved quality, accuracy, analytical sensitivity, and turnaround times for laboratory services. It also has positioned this methodology as a trusted technology for point-of-care settings. These solutions also allow to consolidate combinations of different pathogen detection in panels. This study assessed the analytical and clinical performance of the novel Savanna RVP4 panel against other available methodologies. Methods A prospective study was performed, considering 84 patient samples obtained from nasopharyngeal swabs. Samples were processed in parallel after collection, using Savanna RVP4, and either QIAstat-Dx Respiratory SARS-CoV Panel (59 samples), Sansure iPonatic (10 samples) and BioFire® Respiratory 2.1 (RP2.1) Panel (15 samples). Samples were collected in either MTU, commercial or homemade PBS. Results Overall clinical sensitivity and specificity were 96.43% and 99.64%, respectively for the aggregated panels (Table 1). By technology, the overall clinical sensitivity and specificity were 93.75% and 99.51% versus QIAstat, 100% and 100% versus Biofire, respectively. For iPonatic comparisons, no positive samples were processed and 100% of specificity was obtained. Cycle threshold (Ct) values for positive samples were compared using box plots. Ct values also showed slighlty differences, where means were lower for RSV and Flu A in Savanna (22 and 22.9 respectively) versus other PCR assays (22.5 and 24.5 respectively). For SARS-CoV-2, Ct values were higher versus other methods (19.8 vs 13.6). Conclusions Results obtained with Savanna RVP4 were comparable to those obtained with other methodologies, correlating with patient clinical symptoms. Samples showing disagreement for QIAstat comparison panel, in Flu A and RSV assays, corresponded to the same patient samples for the two methodologies, where Ct obtained in QIAstat were above 33. This evaluation also provides strong evidence supporting PBS usage for samples processed in Savanna RVP.

Sampling Distribution and Point and Interval Estimation of Kelley’s Percentile Coefficient of Kurtosis

There is a robust measure for estimating kurtosis based on quantiles, developed by the American psychologist Truman Lee Kelley, but it is seldom used. This underutilization is likely because it is not available in any statistical package, including R program. Additionally, Kelley reported its standard error when the random variable is drawn from a normal distribution but did not establish its sampling distribution. The objective of this study is to determine its asymptotic sampling distribution and to develop an R script to provide point and interval estimates for this measure. The R program was chosen because it is freely available, developed by the mathematical community, and considered one of the most comprehensive statistical packages currently available. To determine the asymptotic sampling distribution, samples of 100, 500, 1000, 5000, 10000, and 20000 data points were generated from three symmetric distributions: uniform (platykurtic), normal (mesokurtic), and Laplace (leptokurtic). From these 18 source samples, 1000 samples were drawn by resampling with replacement to obtain 18 bootstrap sampling distributions. Normality was then determined using Grubbs (outliers), D’Agostino (symmetry), Anscombe-Glynn (mesokurtosis), and Anderson-Darling, Lilliefors, Shapiro-Francia, and D’Agostino-Belanger-D’Agostino (normality) tests. The script included tests for several assumptions to decide which confidence interval to use: Wald type (normal asymptotic) or bootstrap (Gaussian, percentile, and percentile bias-corrected and accelerated). As an example, the script was applied to a random sample drawn from the raised cosine distribution on waiting time in a social service. It was concluded that the asymptotic sampling distribution of Kelley’s kurtosis measure is normal and that this measure appears less specific than classical Pearson and Fisher measures in the presence of a distribution very close to normal. It is suggested to use this script, which may have practical and academic utility.

The Impact of Lean Management Implementation on Inpatient Discharge Prescription Services at Pertamina Central Hospital

Background: The lead time of inpatient discharge prescription services affects the overall discharge process. In 2022, lead times at Pertamina Central Hospital's Inpatient Pharmacy varied, requiring continuous efforts to meet target times and avoid disrupting discharge plans. This research aims to evaluate the impact of lean management on reducing these lead times. Methods: The study employs a combined quantitative and qualitative research design with an action research approach. It was conducted from March 4 to May 8, 2023, involving pharmacists, pharmaceutical technical personnel, compounders, and pharmacy couriers. Data analysis included measuring lead time changes pre- and post-lean management implementation and narrative analysis of qualitative findings. Results: After implementing lean management, the lead time for non-compounded prescriptions decreased from 42.6 to 25 minutes, with value added ratio (VAR) increasing from 18.9% to 27%. For compounded prescriptions, lead time dropped from 67 to 45.7 minutes, and VAR rose from 25.2% to 37.9%. The Mann-Whitney U test confirmed the significant difference in average lead time. Conclusion: The implementation of lean management in inpatient discharge prescription services has been proven to improve lead time and increase process efficiency (VAR).

Understanding the Scope of Acute Care Vascular Surgery at a Tertiary Academic Medical System

The restructuring of nonelective general surgery and nationwide implementation of the acute care surgery paradigm has improved patient outcomes and healthcare resource utilization. Although vascular surgery maintains one of the highest acuity rates among surgical specialties, the acute care vascular surgery (ACVS) practice model has not been widely accepted. In the present study, we investigate the scope and burden of ACVS at a tertiary academic medical system. All vascular surgical procedures performed at three hospitals comprising a large tertiary academic medical system were retrospectively queried through electronic medical records. Data were collected on procedure, acuity, timing of intervention, primary service, admission type, and total costs and charges. Patients were stratified by acuity of surgical intervention, with ACVS being defined as urgent or emergent operation. A total of 12,689 vascular surgeries were performed from 2018 to 2022. ACVS procedures comprised 22.1% of this total (n=2,803; 12.5% urgent, 9.6% emergent), with an annual burden ranging from 19.1% to 28.3%. Vascular surgeons served as primary surgeon in 91.3% of ACVS and cosurgeon in 8.7%. Fourteen separate surgical specialties requested acute vascular assistance, with the most frequently consulting specialties, including trauma or acute care surgery (ACS) (n=109, 3.9%) and cardiac surgery (n=74, 2.6%). ACVS cases were more frequently performed during after-hours (30.7% vs 11.6%) and on weekends (27.1% vs 2.0%) compared with elective vascular procedures (P<0.0001 each). The majority of ACVS cases originated from inpatient (n=2,353, 85.0%) and emergency department (n=379, 13.5%) consultations. Overall, ACVS generated $37.5 million in charges, accounting for 14% of total procedure-related charges over the study period. ACVS comprises a substantial portion of modern vascular practice and is associated with significant human and healthcare resource expenditure. These data support the development of practice models dedicated to acute vascular surgical care.

Undetected suicide attempts among U.S. soldiers: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

While previous studies have reported high rates of documented suicide attempts (SAs) in the U.S. Army, the extent to which soldiers make SAs that are not identified in the healthcare system is unknown. Understanding undetected suicidal behavior is important in broadening prevention and intervention efforts. Representative survey of U.S. Regular Army enlisted soldiers (n = 24 475). Reported SAs during service were compared with SAs documented in administrative medical records. Logistic regression analyses examined sociodemographic characteristics differentiating soldiers with an undetected SA v. documented SA. Among those with an undetected SA, chi-square tests examined characteristics associated with receiving a mental health diagnosis (MH-Dx) prior to SA. Discrete-time survival analysis estimated risk of undetected SA by time in service. Prevalence of undetected SA (unweighted n = 259) was 1.3%. Annual incidence was 255.6 per 100 000 soldiers, suggesting one in three SAs are undetected. In multivariable analysis, rank ⩾E5 (OR = 3.1[95%CI 1.6-5.7]) was associated with increased odds of undetected v. documented SA. Females were more likely to have a MH-Dx prior to their undetected SA (Rao-Scott χ21 = 6.1, p = .01). Over one-fifth of undetected SAs resulted in at least moderate injury. Risk of undetected SA was greater during the first four years of service. Findings suggest that substantially more soldiers make SAs than indicated by estimates based on documented attempts. A sizable minority of undetected SAs result in significant injury. Soldiers reporting an undetected SA tend to be higher ranking than those with documented SAs. Undetected SAs require additional approaches to identifying individuals at risk.

The Effect of Service Recovery and Situational Factors on Consumer Forgiveness

The purpose of this study is to (1) determine the effect of service recovery on consumer forgiveness, (2) determine the effect of situational factors on consumer forgiveness. The respondents of this research were 100 consumers of the Tirta Dharma Regional Drinking Water Company, Bengkulu City. The collected data was analyzed using multiple linear regression analysis. The results showed that service recovery has a positive effect on consumer forgiveness. That is, the better service recovery, the higher consumer forgiveness will be. Situational factors have a positive effect on consumer forgiveness. That is, the higher the situational factor of consumers the higher the consumer forgiveness. Implementing service recovery management is considered to have a significant impact on customer evaluation because customers tend to be more emotional when involved in service restoration than during the interactional time of service. When this is done well, a dissatisfied customer can become one of the most loyal customers who acts as public relations for the organization through word of mouth. Improve service quality so that the possibility of service failure can be avoided. With good service quality there will be a positive social environment talk of company services.

A Profit Maximization Problem of Equipment Rental and Scheduling with Split Services

This study addresses a scheduling problem arising from the “Rent Instead of Buy” business model where rental service platforms rent equipment from suppliers to satisfy customer requests in exchange for a lump-sum payment. Suppliers often implement piecewise linear concave charging policies to encourage longer rental duration. This policy prompts the platform to consolidate service periods into longer rental agreements for lower rental rates, potentially necessitating the splitting of a customer request among multiple facilities. We establish an integer programming model to maximize the platform’s profit, which is equal to the total revenue from serving customers minus the total rental and scheduling costs. To solve the problem, we propose two Dantzig-Wolfe decomposition reformulations and design branch-and-price algorithms accordingly. Furthermore, by exploiting the property of the concave rental cost functions, we derive the optimal structure regarding the start and end times of services, significantly reducing the subproblem’s search space. Numerical experiments based on real-life data validate the efficiency of the designed algorithms compared to commercial solvers and highlight the benefits of split services. Sensitivity analysis reveals that as the rental cost function becomes more segmented, more requests are split-serviced, but the times for splitting a request are seldom more than once.

Finite element analysis of grout-filled GFRP tube repaired corroded tubular offshore platforms

Abstract Steel tubular offshore platforms are exposed to aggressive marine conditions, which leads to inevitable corrosion and degradation of the structures after a long time of service. Repairing the corroded tubular structure is not easy, especially for the members that are beneath the sea level. The current paper aims to provide an alternative approach for the repairing of corroded steel tubular platforms, by which a novel method with grout-filled GFRP tube cladding the tubular members is proposed. The conception design of the method is introduced, and the repairing process is demonstrated in detail. Then the repairing efficiency of repaired joints and platforms with different corrosion rates is investigated with finite element analysis, which proves a satisfactory reinforcement on the strength of them. The enhanced ratio is up to 117% for the T-joint under compression, and 44% for the compression brace of the K-joint, 37% for the tension brace of the K-joint, 45% for the platform. Finite element models are developed to explore the influence of the GFRP tube thickness ratio and the cube strength of grout material on its strength and repair efficiency. Then the corresponding repair structure suggestions under each corrosion rate are put forward.

Applying lean production system philosophy to reduce patient waiting time in healthcare services: Simulation-based optimization and validations through experiment

Value stream mapping (VSM) is an initial and critical tool for deploying lean concepts in the manufacturing and service sectors, including hospitals. Therefore, the aim of this research is to analyze the current working environment of a radiology department, identify the wastes in the operations by mapping the current patient flow, and test the best possible improvement plan with the help of discrete event simulation modeling using the Arena platform to develop an optimum future map to mitigate the wastes. Therefore, the current patient flow in the x-ray section of a radiology department was mapped using VSM for two types of patients named routine (RP) and procedure (PP). VSM results highlighted a high waiting time (TWT) of 188 and 3732 min for RP and PP. A total of seven scenarios were developed and analyzed to determine the impact of changes on five key performance indicators. Simulation results of the current scenario showed that there were 567 patients coming out of the system with a lead time of 200 and 926 min for RP and PP. Total waiting time obtained for RP and PP was 177 and 860 min, with a maximum wait time of 31 min/patient and an average of 43 patients in the system (WIP). The simulation results of the seventh scenario provided the best results, with 6% improvement in the number of patients getting out of the system and 75% and 55% decreased lead time for RP and PP. Total waiting time for RP and PP was reduced by 80% and 60%, with WIP falling by 62%. Arena Optimizer showed that by adding a technician and radiologist to the system, the optimum patient waiting time in the queue would be 6 min, and the lead time for RP and PP would be (160) and (884 min), respectively. Based on it, a future VSM was created; it provided a reduction of 72% and 60% in (TWT) for RP and PP, which could improve the number of patients to be entertained by the radiology services without adding any new x-ray machines. The results of the present case provide healthcare planners with a road map to discover the waste in operations since the monetary investment and organizational dedication required drive out non-value activities. Therefore, simulation helps to select the best possible improvement strategy for the system without pausing and making physical changes in busy and complex units of hospitals.

Economic impact of a vision-based patient monitoring system across five NHS mental health trusts.

A vision-based patient monitoring system (VBPMS), Oxevision, has been introduced in approximately half of National Health Service (NHS) mental health trusts in England. A VBPMS is an assistive tool that supports patient safety by enabling non-contact physiological and physical monitoring. The system aims to help staff deliver safer, higher-quality and more efficient care. This paper summarises the potential health economic impact of using a VBPMS to support clinical practice in two inpatient settings: acute mental health and older adult mental health services. The economic model used a cost calculator approach to evaluate the potential impact of introducing a VBPMS into clinical practice, compared with clinical practice without a VBPMS. The analysis captured the cost differences in night-time observations, one-to-one continuous observations, self-harm incidents, and bedroom falls at night, including those resulting in A&E visits and emergency service callouts. The analysis is based on before and after studies conducted at five mental health NHS trusts, including acute mental health and older adult mental health services. Our findings indicate that the use of a VBPMS results in more efficient night-time observations and reductions in one-to-one observations, self-harm incidents, bedroom falls at night, and A&E visits and emergency service callouts from night-time falls. Substantial staff time in acute mental health and older adult mental health services is spent performing night-time observations, one-to-one observations, and managing incidents. The use of a VBPMS could lead to cost savings and a positive return on investment for NHS mental health trusts. The results do not incorporate all of the potential benefits associated with the use of a VBPMS, such as reductions in medication and length of hospital stay, plus the potential to avoid adverse events which would otherwise have a detrimental impact on a patient's quality of life.

Optimization of Outpatient Waiting Times to Improve the Achievements of National Quality Indicators at TNI AD 05.08.04 Hospital Lawang

The waiting time for outpatient services in a hospital is one of the important factors determining patient satisfaction with the hospital, so it is hoped that patients will not wait too long while in the hospital. This study aimed to optimize outpatient waiting times so that it can increase the achievement of national quality indicators at TNI AD 05.08.04 Hospital, Lawang. This study used fishbone diagrams, USG (Urgency, Seriousness, Growth), and SWOT Analysis (Strength, Weakness, Opportunity, Treats) to formulate problems and find solutions. The results of this study showed that priority problems in waiting time include: standard operating procedure (SOP) for outpatient service flow are still not available, the electronic medical record system is still often slow, and evaluation of national quality indicators is still not carried out routinely. Furthermore, the proposed strategy offered is the creation of SOP regarding the flow of outpatient services and routine outreach regarding the use of electronic medical records. With the implementation of these two strategies, it is hoped that they will be able to speed up waiting times for outpatient services, thus improving the achievement of national quality indicators.

Synergizing shared micromobility and public transit towards an equitable multimodal transportation network

This paper assesses the equity impacts of shared micromobility and investigates regulatory policies that improve transport equity and promote synergy between public transit and shared micromobility. We consider a multimodal transportation network, where a micromobility platform deploys docking stations and operates a fleet of micromobility vehicles to provide shared micromobility services and a public transit agency offers transit services over a transportation network. A market equilibrium model is developed to capture the intimate interactions among access and egress times of shared micromobility services, waiting times of transit services, the spatial distribution of docking stations, passenger demand, platform pricing and fleet sizing, vehicle repositioning and the micromobility platform profit. The platform decision problem is cast as a high-dimensional non-convex program. A solution method is proposed to efficiently compute the solution through problem reformulation and dimensionality reduction. Based on the proposed framework, we evaluate spatial equity in transport accessibility using the Gini index, and find that although shared micromobility improves overall transport accessibility, the benefits are not fairly distributed across different geographic zones, which leads to enlarged spatial inequity gaps after introducing shared micromobility. To promote transport equity, we investigate three policy directions: (a) to impose a vehicle density floor on shared micromobility; (b) to offer a subsidy on shared micromobility rides for first/last-mile connections; and (c) to promote collaboration between public transit and shared micromobility. We show that different regulatory policies have advantages and limitations. The minimum vehicle density requirement can simultaneously improve spatial equity and passengers’ surplus, but has limited equity improvements. In contrast, the subsidy on bundled services could significantly mitigate spatial inequity, but it hurts passengers and the platform profit. Compared to the other two policies, the transit-micromobility collaboration can lead to higher equity improvement, higher passenger surplus, while offering a guarantee on the platform profit, which turns out to be the most cost-effective approach. These insights are validated through realistic numerical studies for San Francisco.

Relationship of Emergency Ambulance Response Time to Australasian Triage Scale (ATS) Level in Non-Trauma Case Patients

Emergency ambulance is an emergency service carried out outside the hospital, both trauma and non-trauma, which is carried out to prevent death and further disability. This service is carried out by increasing the ambulance response time. Emergency ambulance response time in pre-hospital emergency services can impact the assessment of patient triage levels in the development of modern triage, one of which is the Australasian Triage Scale (ATS). This study aims to determine the relationship between emergency ambulance response time and the Australasian Triage Scale (ATS) triage level in non-trauma case patients in Samarinda. The design of this study used a quantitative method, namely descriptive correlation, using a cross-sectional research design. The population in this study was 78 patients. Sampling used the total sampling technique. The instruments used in this study were observation sheets, stopwatches (response time), and the Australasian Triage Scale (ATS). This study was conducted for 3 months from March to May in Public Hospital Samarinda in 2024. Meanwhile, the person correlation test results found a p-value of 0.000&lt;0.05, which means there is a relationship between the emergency ambulance response time to ATS Triage and an r-value of 0.767 where the strength of the relationship is high/strong. With a positive correlation result, the direction of the relationship is in the same direction. This means that the faster the emergency ambulance response time, the better (lower) the emergency condition of non-trauma patients based on the ATS triage level.

Gender Differences in Defibrillator Practices in Out-of-Hospital Cardiac Arrest

Objectives Disparities remain in survival after out-of-hospital cardiac arrest (OHCA) for women compared to men. Our objective was to evaluate differences in automated external defibrillator (AED) use before Emergency Medical Services (EMS) arrival and time from arrival to initial EMS defibrillation by EMS-assessed gender (women or men). Methods This was a secondary analysis of adult non-traumatic, EMS-treated OHCA cases in the Portland Cardiac Arrest Epidemiologic Registry from 2018 to 2021. Emergency Medical Services-witnessed cardiac arrests were excluded and the primary outcomes were pre-EMS AED application and the time from EMS arrival to first defibrillation among patients in a shockable rhythm at first rhythm assessment without pre-EMS AED application. We examined pre-EMS AED application rates overall and separately for law enforcement, in cases where they were on-scene before EMS without a lay bystander AED applied, and lay responders, in cases where law enforcement had not applied an AED. We used multivariable logistic and linear regressions to adjust for potential confounders, including age, arrest location, witness status, bystander CPR, year, and time from dispatch to EMS arrival. We accounted for clustering by county of arrest using a mixed-effects approach. Results Of the 3,135 adult, EMS-treated non-traumatic OHCAs that were not witnessed by EMS, 3,049 had all variables for analysis, of which 1,011 (33.2%) were women. The adjusted odds (adjusted odds ratio [95% CI]) for any pre-EMS placement of an AED was significantly higher for men compared to women (1.40 [1.05–1.86]). These odds favoring men remained when examining law enforcement AED application (1.89 [1.16–3.07]), but not lay bystander AED application (1.19 [0.83–1.71]). Among patients still in arrest on EMS arrival, with a shockable initial EMS rhythm, and without pre-EMS AED application, the time from EMS arrival on-scene to initial defibrillation was significantly longer for women compared to men (+0.81 min [0.22–1.41 min]). Conclusions Women with OHCA received lower rates of pre-EMS AED application and delays in initial EMS defibrillation compared to men.

Behavior Mapping Study of The Layout of Drug Service Room in Outpatient Pharmacy of X Hospital

The quality of pharmaceutical services is related to patient satisfaction and the short waiting times for their accomplished drug in pharmacy installation. This research was conducted to describe the prescription service process in the outpatient pharmacy at X Hospital by observing the flow of drug dispensing and officer movement along with the time required for the process, with the environment behavior study and value stream mapping as the observation method. This action research was conducted by collecting qualitative and quantitative data. Data collection was carried out by observation (time allocation, time for drug service activities), interviews, focus group discussion (FGD), and Behavior Mapping. The results of value stream mapping showed that non-value added was greater than value-added, 78.5% versus 21.5%. Behavior mapping showed a physical trace in a stack of prescription files in all POSs during the service process. The longest process time occurred at post 4, which is during drug preparation, while the longest interval time was interval time 4, which is waiting for the re-check process. Other factors cause the waiting time for drug services to be lengthened. The spatial structure of pharmacy depot block A was less effective. The waiting time was still long. The researchers suggest that the space be regulated again and continued to the next action research cycle, up to the effective drug services, so that the waiting times can be short.

A comparison of patient ratings and staff ratings of disability using the World Health Organisation Disability Assessment Schedule in individuals with psychotic spectrum disorders who are forensic psychiatric inpatients.

Psychosocial rehabilitation in forensic psychiatric services requires sound measurement of patient and staff perceptions of psychosocial function. The recommended World Health Organisation Disability Assessment Schedule 2.0 (WHODAS), designed for this, has not been examined with offender patients. To examine patient and staff WHODAS ratings of secure hospital inpatients with psychosis, any differences between them and explore associations with other clinical factors. Seventy-three patients self-rated on the WHODAS after 3months as inpatients. An occupational therapist interviewed the patient's primary nurse and care team at about the same time (staff ratings). Scores were calculated according to the WHODAS manual. WHODAS scores and interview-rated symptom severity, cognitive measures, daily antipsychotic dose and duration of care were compared. Patient ratings indicated less disability than staff ratings for total score and for the domains of understanding and communicating, getting along and life activities. Self-care and participation ratings were similar. Patients were more likely to rate themselves as disabled in getting around (mobility). Only one-fifth of patient- and staff- ratings (16, 22%) were similar, while for nearly a third of the patients (23, 32%) self-ratings were higher than staff ratings. More severe positive symptoms were associated with higher self-rated WHODAS disability after accounting for treatment duration, negative symptoms, cognitive score and antipsychotic dose. No variable accounted for the staff/patient differences in ratings. Our mean WHODAS score findings echoed those in other patient samples-of patient underestimation of disability, linked to severity of symptoms. In this study using the WHODAS for the first time in a forensic mental health secure inpatient service, however, we found that, by comparing individuals, half of the patients reported equivalent or greater disability than did staff. Future research should focus on elucidating from patients what contributes to their self-ratings. Understanding their thought processes in rating may enhance rehabilitation planning.

The Association of Mental Health Symptoms to Post-Traumatic Nightmares Among Treatment Seeking Active Duty Service Members.

Posttraumatic nightmares (PTNs) are common among service members with a history of combat or mission-related trauma and are associated with decreased well-being. Unfortunately, beyond establishing an association between mental health symptoms and PTNs, the existing literature fails to provide a more comprehensive understanding of factors associated with PTNs. The effectiveness of current recommended treatments is frequently debated, with the literature varying in levels of support. Treatment of PTN is complicated, given their association with a number of mental health difficulties including posttraumatic stress disorder (PTSD), anxiety, and depression. The present study sought to better delineate the association of these difficulties with PTNs, in an effort to inform and improve treatments for the nation's service members. This study utilized de-identified data collected during standard procedures for an interdisciplinary intensive outpatient program for service members with a history of traumatic brain injury and/or psychological health conditions (N = 1,550). Study analyses were performed under a Walter Reed National Military Medical Center institutional review board-approved protocol. Three cross-sectional forward likelihood ratio logistic regressions predicting the presence of PTNs were conducted while controlling for the alpha-blocker prazosin, as it is recommended for the treatment of PTSD-associated nightmares. Separate models were created for posttraumatic stress symptoms (PTSS), depression, and anxiety because of multicollinearity concerns. Additional variables considered for inclusion were psychological symptoms (e.g., suicide ideation, postconcussive symptoms), satisfaction with life, sleep (e.g., pain that disrupts sleep, early awakenings, sleepiness), demographics (e.g., sex, race/ethnicity, marital status, age), and military characteristics (e.g., rank, branch, special operator status, time in service). PTSS (odds ratio [OR]: 1.13), anxiety (OR: 1.19), and depression (OR: 1.19) were associated with increased odds of PTNs when controlling for prazosin. Each of the final models accounted for a significant amount of variance in the presence/absence of PTN. The included variables differed across models. The PTSS model included pain that disrupted sleep, postconcussive symptoms, special operator status, and early awakenings. The anxiety model included postconcussive symptoms, pain that disrupted sleep, special operator status, and prazosin use. The depression model included postconcussive symptoms, pain that disrupted sleep, special operator status, difficulty falling asleep within 30 min, and prazosin use. Although most variables were associated with an increased odds of PTNs, postconcussive symptoms in the PTSS model and special operator status in all 3 models were associated with decreased odds of PTNs. These findings are illustrated in Tables2 to 4. Findings support the association of PTSS, anxiety, and depression to PTNs, and, importantly, suggest that other factors may be equally or more important in understanding PTNs. Notably, increased odds of PTNs were observed among patients with pain that disrupts their sleep. The cross-sectional nature of the study allows examination of these co-occurring symptoms as they would present in the clinic, potentially informing assessment and treatment strategies; however, it precludes consideration of temporal relationships. Results highlight the importance of considering comorbid symptoms and relevant military characteristics to gain a more complete understanding of PTNs. Future research utilizing longitudinal methods are needed to inform the temporal/causal aspects of these relationships.

Pilot of a text messaging system to monitor caregivers' and children's mental health recovery after pediatric traumatic injury.

Pediatric traumatic injury (PTI) is associated with a high risk for psychiatric sequelae. Most trauma centers do not adequately address the emotional needs of children and their caregivers. Technology-based programs offer a low-cost and low-burden opportunity to track and potentially enhance families' emotional recovery following PTI. This feasibility pilot project was designed to examine caregivers' usage of and feedback on a text message-based symptom monitoring service. Participants included 25 caregivers of PTI patients under age 12. Caregivers received up to four texts daily for 30 days postdischarge from the automated system: one symptom-based question to capture the current mental health status of the caregiver and child, respectively, and a corresponding educational tip each time a symptom was endorsed. Data analyses describe the number of questions to which caregivers responded on behalf of themselves and their children. A semistructured qualitative interview was used to assess caregivers' reactions and suggested improvements for the service. Almost all caregivers (91.1%) responded to at least one text message, and two thirds (66.6%) responded to over half of the messages. Themes from the qualitative interviews indicated that caregivers perceived the timing and content of the text messaging service facilitated their own and their child's emotional recovery following PTI. Caregivers suggested that the service could be improved by providing an option to interact directly with mental health care providers. Text message-based symptom monitoring services offer an opportunity to bridge the gap in mental health services during the acute recovery phase for families of traumatically injured children. (PsycInfo Database Record (c) 2024 APA, all rights reserved).