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Microsoft powerpoint - clinical audit

Physical disability, complex communication Hagiliassis, N., Gulbenkoglu, H., DiMarco, M., Larkin, H., Watson, J., Iacono, T., & Young, S.
„ A project being undertaken by Scope Specialist Services in collaboration with the Centre for Developmental Disability Health Victoria, Monash University.
„ The Bridging Project has as its mission to progress the knowledge and resource base to ensure that individuals with complex communication and mental health needs „ To examine the prevalence and nature of mental health problems for people with physical disabilities „ To examine the kinds of specialist and generic mental health services being accessed by people with complex communication and mental health needs.
Background – Mental Health in Australia „ Mental health is one of the leading causes of burden of disease and injury in Australia, and is associated with higher rates of health risk factors, poorer physical health, and higher rates of deaths from many causes including „ The 1997 National Survey of Mental Health and Wellbeing reported that 18% of adults had a mental disorder in the 12 months preceding the survey (ABS, 1997).
Background – Intellectual Disability and Growing interest in the mental health needs of people with Reported prevalence of mental health problems among adults with ID varies widely between 10 and 39% (Deb et al., 2001).
Prevailing view is that people with ID experience a higher rate of mental health problems than people without ID.
„ The extent and nature of psychosocial stressors experienced „ Heightened ‘vulnerability’ to psychosocial stress (Deb et al., 2001).
Research is “all but silent” (DiMarco, 2001).
Reason to suspect a higher rate of mental health problems among people with physical disabilities and complex communication needs.
Mental Health
„ Child population; generalisablility of these data to adult „ Jenkins & Gulbenkoglu (1998).
„ 11% of people with physical and multiple disabilities identified as experiencing a mental health condition, with depression (38%) and anxiety (17%) occurring most common.
„ People with physical disabilities may experience a quantitatively and qualitatively distinct cohort of „ Complex communication needs associated with physical disability can be a substantial hurdle to the accurate identification and treatment of mental health issues.
„ The range of assessment approaches and tools, that are used as a standard part of a psychiatric evaluation are not easily accessed by people with complex 390 client ‘central files’ audited to determine: whether the person had a psychiatric diagnosis in the last 12 months the kinds of services that were being accessed in support of any Of the 390 files, 55 files were audited to determine the extent and nature of prescription of psychotropic medications.
Audit information augmented by information provided by Specialist Ethics approval obtained from the Scope Ethics Advisory Committee; all data collected in a de-identified way.
Total number of people included in sample Number of people with diagnosed mental health condition Percentage of people with disabilities with diagnosed mental Percentage of people from general community with diagnosed mental health condition (Source: ABS, 1998) How does this compare with the general population? 1- Australian Bureau of Statistics 2- National Institute of Mental Health
3- American Psychiatric Association 4 - de Girolamo & Dotto (2000)
Generalised anxiety disorder
Personality disorder
Social Phobia
Bipolar disorder
What kinds of services are being accessed? Private Service Provider e.g., Psychiatrist 1 Australian Bureau of Statistics
What is the extent of psychotropic medication use? Number of people without formal diagnosis Number of people on psychotropic medication 17 (31%) Present study suggests the overall prevalence of mental health c for people with physical disabilities is 11%, in contrast to the rate of mental health conditions for the general community of 18%, as reported onal Survey of Mental Health and Wellbeing Lower rate of mental health issues for people with physical disabilities and Methodological limitations of the present study.
Consistent with traditional belief that that people with disabilities may be ‘sheltered’ from everyday psychosocial stressors.
More likely that actual rate is closer to, or higher than, general population, but there is an ‘under-identification’ phenomenon.
Review of medications also suggests under-identification of mental health issues: of 55 people, 1 person with formal diagnosis, but 10 people on antidepressant or antipsychotic medications.
Possible reasons for under-identification phenomenon: Misperception that people with disabilities somehow do not posses the intellectual or personal capacity to be affected by everyday psychosocial stressors and, therefore, are not vulnerable to psychiatric illness.
Diagnosis of psychiatric illness in people with disabilities is fraught with difficulties, compounded by complex communication needs.
Phenomenon of symptom masking, that is, when a symptom that is normally ascribed to a psychiatric illness is attributed as a behavioural Poor early detection of psychiatric illness, with mild to moderate cases People with disabilities less likely to be seen by generic mental health services (22%) as compared with the general population (38%; ABS, People with disabilities likely to use specialist services for a mental Likelihood of using generic or specialist health services for a mental health problem may be related to type and nature of mental health disorder, client characteristics, perceived service role and capacity, service accessibility, client preferences.
Addressing the under-identification phenomenon through attitudinal change, d training, improved screening and identification processes, early detection and intervention, and greater focus on identification of mild- Further research into the types of psychosocial stressors experienced by people with physical disabilities and complex communication needs, and the impact of these stressors on mental health outcomes.
Development of assessment tools that are accessible to people with complex communication needs and that reflect the range of needs of Bridging the divide between generic and specialist health services, while acknowledging value and contribution from each.


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Veterinary Microbiology 95 (2003) 75–89Interleukin 6, serum amyloid A and haptoglobinexperimentally infected with Actinobacillus C. Hultén , E. Johansson , C. Fossum , P. Wallgren a Department of Clinical Chemistry, P.O. Box 7038, Uppsala, Sweden b Division of Immunology, Department of Veterinary Microbiology, BMC, c Department of Large Animal Clinical Sciences, Faculty of Veter

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