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2 results

  • Constructing a hospital post-stroke depression management protocol by studying the management of post-stroke depression in a hospital setting

  • N. Ghoshal, A. Sett
  • Journal:
    European Psychiatry / Volume 64 / Issue S1 / April 2021
    Published online by Cambridge University Press:
    13 August 2021, p. S689
    • Article
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  • Introduction

    A stroke is a potentially debilitating event which can render the victim unable to perform many tasks and functions, significantly decreasing their quality of life. This, in addition to emotional/mental changes post-stroke, can lead to a phenomenon known as “post stroke depression” (PSD), characterised by persistent low mood following a stroke.

    Objectives

    This study aims to amalgamate recommendations based on national guidelines and previous literature, in addition to an original inpatient study of stroke patients within a hospital, to construct a standardised protocol of the management of PSD in the hospital setting.

    Methods

    248 patients who had been treated for stroke within a hospital were analysed using hospital notes to assess for incidence of PSD, in-hospital management, and outpatient follow-up. In addition a literature search was conducted and national guidelines were consulted to develop a PSD management protocol.

    Figure 1: Post stroke depression management protocol.

    Results

    While 8% (20/248) of stroke patients experienced low mood immediately post stroke, 45% (9/20) of these patients did not receive any therapy or drug treatment, 80% (16/20) did not receive any outpatient monitoring of their mood and 100% of patients received no outpatient monitoring of newly commenced antidepressants.

    Conclusions

    Using the results and literature search, a PSD management protocol, encompassing both appropriate in-hospital therapy and robust outpatient monitoring, was developed (Figure 1). We hope that through this, hospital care of PSD can be improved and optimised, in order for victims of PSD to receive the best possible, evidence-based care available to treat this potentially devastating condition.

    Disclosure

    No significant relationships.

  • MP54: Management algorithm for the treatment of intoxications with calcium channel blockers: a simulation trial (MATRICS)

  • V. Gauvin, É. Raymond-Dufresne, M. St-Onge
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
    Published online by Cambridge University Press:
    13 May 2020, p. S62
    Print publication:
    May 2020
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  • Introduction: Cardiotoxicants poisonings are rare but have the potential to be highly lethal. Given the precarious nature of these poisonings, the Quebec Poison Control Center (CAPQ) has established a management protocol for optimal treatment. This study seeks to evaluate whether CAPQ's Calcium Channel Blocker (CCB) poisoning management protocol improves treatment delivery by physicians using simulation. The primary outcome is whether the management protocol decreases time to delivery of calcium and insulin. The secondary outcome is whether use of the management protocol increases appropriate dosing. Methods: For this randomized AB / BA crossover trial, Emergency Medicine and Internal Medicine residents were randomly assigned to one of two groups; one group received the management protocol during the simulation and the other did not. The crossover occurred 3-months later whereby the groups were reversed. Inverse probability weighting was used to compensate for losses at follow-up. Differences in baseline characteristics, as well as carry-over effect, were evaluated. The outcomes were analyzed with a two-level hierarchical model. Results: Twenty-three residents were included in the study. No significant differences in baseline characteristics were noted between the AB / BA groups, and no carry-over effect was identified on statistical analysis for all variables. As for the primary outcomes, time to administration of IV calcium decreased by 87 seconds (CI -266 to 92), time to insulin bolus decreased by 52 seconds (-217 to 114), and time to insulin infusion decreased by 115 seconds (-213 to -18) when the protocol was used. As for the secondary outcomes, there were no statistically significant differences for the percentage of adequate doses of IV calcium (RR: 1.27; 95% CI: 0.80–2.02), insulin bolus (RR: 1.30; 95% CI: 0.80–2.12) and insulin infusion (RR: 1.37; 95% CI: 0.99–1.91). Conclusion: This randomized cross-over study, which uses simulation to evaluate the performance of CAPQ's CCB poisoning management protocol, does not statistically demonstrate decreased time to administration or increased accuracy of dosing, due to the large confidence intervals. Unfortunately, we were not able to obtain the planned sample size due to limited participation. However, our results trend towards more optimal dosing and rapid dosing of treatments, and from a qualitative standpoint, the protocol appeared to increase the structure of patient care.