Physical and Pharmacologic Restraint in Hospitalized Children With Autism Spectrum Disorder.

OBJECTIVES: Children with autism spectrum disorder (ASD) have high rates of cooccurring conditions and are hospitalized longer and more frequently than children without ASD. Little is known about use of involuntary physical or pharmacologic restraint in hospitalized children with ASD. This study compares use of restraint because of violent or self-injurious behavior during inpatient pediatric hospitalization in children with ASD compared with typical peers. METHODS: This retrospective cohort study examines electronic health records of all children aged 5 to 21 years admitted to a pediatric medical unit at a large urban hospital between October 2016 and October 2021. Billing diagnoses from inpatient encounters identified ASD and cooccurring diagnoses. Clinical orders identified physical and pharmacologic restraint. Propensity score matching ensured equivalency between ASD and matched non-ASD groups on demographic factors. Logistic regression determined the odds of restraint in children with ASD compared with children without ASD, controlling for hospitalization factors and cooccurring diagnoses. RESULTS: Of 21 275 hospitalized children, 367 (1.7%) experienced restraint and 1187 (5.6%) had ASD. After adjusting for reason for admission, length of stay, and cooccurring mental health, developmental, and behavioral disorders, children with ASD were significantly more likely to be restrained than children without ASD (odds ratio 2.3, 95% confidence interval 1.6-3.4; P < .001). CONCLUSIONS: Hospitalized children with ASD have significantly higher odds of restraint for violent or self-injurious behavior compared with children without ASD after accounting for reason for admission, length of hospitalization and cooccurring diagnoses. Work is needed to modify the hospital environment for children with ASD to reduce behavioral dysregulation and restraint.

Pilot assessment of an on-demand telehealth 'left without being seen' follow-up programme.

INTRODUCTION: On-demand telehealth can have a high rate of patients requesting visits and dropping off without being seen by a provider, especially during the COVID-19 pandemic. METHODS: On-demand telehealth requests made to a large healthcare system in the USA between 15 March 2020 and 31 May 2020 were included for analysis with a focus on patients who were defined as left without being seen (LWBS). As part of a pilot program a registered nurse attempted to call LWBS patients within 24 hours of their telehealth request and asked if they were ok, if they sought care for their original visit reason, what that care was, or if they still needed guidance. This information and patient demographics were analyzed. RESULTS: During the study period there were 21,610 completed on-demand telehealth visits and 1852 patients for whom there were LWBS attempted follow-ups. Most patients LWBS for a reason that originated from the patient and not associated with the provider or telehealth platform. The mean wait time for LWBS patients was 12.4 min compared to patients waiting 15.1 min before engaging with a provider to complete a visit. Of the 1852 total LWBS patients in the follow-up programme, 819 (44.2%) were successfully contacted with a follow-up phone call. Most of these patients (63.2%) already completed or planned to complete a telehealth visit, 13.6% indicated they no longer needed to see a provider, and 12.8% planned or already completed an in-person visit. Only 2.2% went to an emergency department. DISCUSSION: Results suggest patients can effectively self-manage their care needs.

A descriptive analysis of an on-demand telehealth approach for remote COVID-19 patient screening.

INTRODUCTION: COVID-19 requires methods for screening patients that adhere to physical distancing and other Centers for Disease Control and Prevention guidelines. There is little data on the use of on-demand telehealth to meet this need. METHODS: The functional performance of on-demand telehealth as a COVID-19 remote patient screening approach was conducted by analysing 9270 patient requests. RESULTS: Most on-demand telehealth requests (5712 of 9270 total requests; 61.6%) had a visit reason that was likely COVID-19 related. Of these, 79.1% (4518 of 5712) resulted in a completed encounter and 20.9% (1194 of 5712) resulted in left without being seen. Of the 4518 completed encounters, 19.1% were referred to an urgent care centre, emergency department or COVID-19 testing centre. The average completed encounter wait time was 26.5 min and the mean visit length was 8.8 min. For patients that completed an encounter 42.8% (1935 of 4518) stated they would have sought in-person care and 9.1% stated they would have done nothing if on-demand telehealth was unavailable. DISCUSSION: On-demand telehealth can serve as a low-barrier approach to screen patients for COVID-19. This approach can prevent patients from visiting healthcare facilities, which reduces physical contact and reduces healthcare worker use of personal protective equipment.

Monitoring intrathoracic impedance in heart failure patients: implications for inpatient use.

Monitoring of intrathoracic impedance to evaluate heart failure status has been used for some years in the outpatient setting. Recent technological advances in pacemaker and internal cardioverter-defibrillator design allow for easier access to that same information in the inpatient setting. This has implications for earlier and more precise recognition and treatment of heart failure in the hospitalized patient and for reducing hospital length of stay.

The relationship of adult attachment constructs to object relational patterns of representing self and others.

This study examined the relation between attachment constructs assessed by self-report and object relations constructs assessed from narratives. Young adult participants (N = 65; median age 28) completed the Reciprocal Attachment Questionnaire (West, Sheldon, &Reiffer, 1987), provided a set of interpersonal narratives rated using the Social Cognition and Object Relations Scale (SCORS; Westen, Barends, Leigh, Mendel, &Silbert, 1994), and completed other relationship-related measures. Results suggest some conceptual convergence between internal working models and representations of self, others, and relationships; for example, individuals who perceive significant others as offering a secure base for emotional connection tend to have complex, well-differentiated representations of self and others. In addition, multiple dimensions of object relationships were found to be significantly associated with participants' relationship status (current involvement in a significant relationship) and their parents' marital status.