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“The prevalence of mental health problems among children and adolescents in Western countries is high. Belgium, like many other
Western countries, struggles with the set-up of a coherent and effective strategy for dealing with this complex societal problem. This paper describes the development of a policy scenario for the organization of child and adolescent mental health care services (CAMHS) in Belgium. The development CP-456773 price process relied on Soft Systems Methodology including a participatory process with 66 stakeholders and a review of the existing (inter-)national evidence. A diagnostic analysis illustrated that the Belgian CAMHS is a system in serious trouble characterized by fragmentation and compartmentalization. A set of 10 strategic recommendations was formulated
to lay down the contours of a future, more effective CAMHS system. They focus on mastering the demands made on scarce and expensive specialized mental health services; strengthening the range of services – in particular for those with serious, complex and multiple mental health problems – and strengthening the adaptive capacity of and the ethical guidance within the future CAMHS system. (C) 2013 Elsevier Ireland Ltd. All rights reserved.”
“Purpose and background: Emergency medical services (EMSs) vary considerably. While some are physician staffed, most systems are run by paramedics. The objective of this randomized, controlled simulation study was to compare the emergency care between physician YH25448 mw staffed EMS teams (control group) and paramedic teams that were supported telemedically by an EMS physician (telemedicine Selleck Trichostatin A group).
Methods: Overall 16 teams (1 EMS physician, 2 paramedics) were randomized to the control group or the telemedicine group. Telemedical functionalities included two-way audio communication, transmission of vital data (numerical values and curves) and video streaming from the scenario room to the remotely located EMS physician. After a run-in scenario all teams completed four standardized scenarios, in which no highly invasive procedures (e. g. thoracic drain) were required, two using high-fidelity simulation (burn trauma, intoxication) and two using standardized
patients (renal colic, barotrauma). All scenarios were videotaped and analyzed by two investigators using predefined scoring items.
Results: Non case-specific items (31 vs. 31 scenarios): obtaining of ‘symptoms’, ‘past medical history’ and ‘events’ were carried out comparably, but in the telemedicine group ‘allergies’ (17 vs. 28, OR 7.69, CI 2.1-27.9, p = 0.002) and ‘medications’ (17 vs. 27, OR 5.55, CI 1.7-18.0, p = 0.004) were inquired more frequently. No significant differences were found regarding the case-specific items and in both groups no potentially dangerous mistreatments were observed.
Conclusion: Telemedically assisted paramedic care was feasible and at least not inferior compared to standard EMS teams with a physician on-scene in these scenarios.