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Background: Primary care is the main point-of-entry for identifying and treating mental health problems. This research examines the effect of a new model of supporting primary care providers (PCPs) treating mental health disorders, the electronic consultation (eConsults), a standard process for communication between PCPs and psychiatrists through an electronic health records system., Methods: A cluster-randomized evaluation of the psychiatric eConsults model, as implemented in a large integrated delivery system. Web survey data before and after the implementation of psychiatric eConsults were collected on PCPs' perceptions of their capability and skill to deliver mental health services, and analyzed with linear regression models., Results: At baseline PCPs had mixed assessments of perceived support for delivering mental health services and of the availability of specialist consultations, but had relatively high perceived self-efficacy and skill for identifying, diagnosing and treating depression. PCPs in the Treatment group had statistically significant 18%, 13%, and 16% improvements in perceived support for diagnosing mental health problems, making treatment decisions, and changing treatment regimens, respectively; and 24% improved perceived ease of access to consultations for mental health, compared to the Control group. Evidence of effects on self-efficacy and perceived skill around depression was more limited., Conclusions: The psychiatric eConsults model improved PCPs' perceptions of support for delivering mental health care and perceptions of access to specialist consultations., Implications: Electronic consultations may be a promising approach to support the delivery of mental health services in primary care settings., Level of Evidence: Pre- and post-intervention web surveys from a cluster-randomized trial., (Copyright © 2017. Published by Elsevier Inc.)

Objective: To assess the effectiveness of Augmentative and Alternative Communication (AAC) strategies to enable people who are temporarily voiceless due to medical intervention, to communicate., Methods: A systematic review informed by a protocol published on an international register. Ten databases were searched from January 2004 to January 2017. Included studies assessed the effect of using AAC strategies on patient related outcomes and barriers to their use. All included studies were quality appraised. Due to the heterogeneity of interventions and outcome measures findings were narratively reviewed., Results: Twelve studies met the inclusion criteria and were included in the review reporting outcomes from 1981 patient and 454 health professional participants. The quality of included studies were moderate to weak. AAC communication strategies increased the number of communication interactions, improved patient satisfaction with communication and reduced communication difficulties. Barriers to usage were device characteristics, the clinical condition of the patient, lack of timeliness in communication and staff constraints., Conclusions: There is preliminary, but inconsistent evidence that AAC strategies are effective in improving patient satisfaction with communication and reducing difficulties in communication. A lack of comparable studies precluded the identification of the most effective AAC strategy., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

An algorithm of fluid resuscitation for cutaneous burns is presented. The management of these cases entails an initial process of evaluation followed, when appropriate, by the administration of intravenous fluids. The fluid requirements are prospectively calculated and subsequently modified by using closed loop feedback with monitoring of urine output, plasma deficit, osmolality and vital signs. Three 'problem boxes' have been incorporated into the algorithm to outline the management of: 1. fluid deficit and excess; 2. acute renal failure; 3. the critically ill patient. An algorithm such as this can never be complete, but in its present form it provides both a teaching tool for junior staff as well as a valuable clinical aid for those involved in the acute management of burns patients.