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Objective: Assertive community treatment (ACT) teams provide outreach services to individuals coping with severe mental illness. Because such individuals are at increased risk for involvement with law enforcement, a model that integrates police officers into ACT teams (ACT-PI) was developed for ACT teams serving clients with or without forensic involvement. The goal of this study, conducted in British Columbia, was to evaluate the benefits and drawbacks of the ACT-PI model.Methods: Qualitative semistructured interviews were conducted with 21 ACT-PI clients (in 2017) and 22 ACT-PI staff (in 2018). Thematic analyses identified key themes related to the benefits and drawbacks of officer integration into the ACT-PI model.Results: Perceived benefits of police integration were opportunities for relationship building between officers and clients, improved safety, more holistic care due to embeddedness (i.e., effective interagency collaboration between police and health care providers), the prevention of future problems, and police officers' authority enhancing compliance. Perceived drawbacks included risk for legal consequences, stigma from police interaction, escalating distress of clients, low officer availability, and the risk for changing the nature of ACT teams.Conclusions: Participants reported that the model of officer integration into ACT-PI teams may improve both client and staff well-being. In some communities, and with certain precautions, ACT-PI may be a viable model for ACT teams serving clients with and clients without a history of forensic involvement. [ABSTRACT FROM AUTHOR]

Abstract: We conducted a randomized controlled trial of a public health and education screening program aimed at a]l 4.797 four to five year old children registering for kindergarten in three school districts of southern Ontario, Canada. Children received either the Denver Developmental Screening Test (DDST) with a community health intervention program for positive screenees: the DDST with no intervention for positive screenees: or no screening test. The intervention program consisted of referral to the child's physician for assessment: a review conference between the child's teacher and the school health nurse: parent counseling and monitoring of the child in school by the school health nurse. At the end of the third school year. no differences were found between positive screenees in the community health intervention group and the "no intervention" groups using individual academic achievement, cognitive, and developmental tests. Parents' reports revealed no differences between groups in children's mental, social. and behavioral well-being. However, parents of intervention program children had more worry about their child's school progress suggesting a potentially harmful labeling effect. In comparison to a random sample of children with normal DDST results, or a random sample of children who had randomly, not been screened. The children with positive preschool DDSTs had substantially more school problems three years after screening. [ABSTRACT FROM AUTHOR]

Abstract: The Denver Developmental Screening Test (DDST) was administered to 2,569 children live to seven months prior to starting kindergarten in September 1980 in a geographically well-defined community. The test was administered by trained public health nurses, At the end of the 1980-1981 school year. all 163 kindergarten teachers in the area completed a rating form for each child in their class. The rating form determined global ratings of: 1) learning abilities: 2) classroom behavior; 3) amount of special attention required: and 4) referrals to special education services outside the classroom. The specificity of the DDST in predicting kindergarten teacher ratings wan 99 per ¢ for all areas. Test sensitivity varied from 5 per ¢ to 10 per ¢ in detecting problems in the four areas. The predictive values or an positive test varied from 31 per ¢ for behavior problems to 62 per ¢ for extra attention required in the classroom. Negative test predictive values varied from 79 per ¢ to 93 per ¢. These results based on kindergarten teacher ratings suggest that, because of the low sensitivity and modest predictive value, the DDST may be relatively inefficient to use in a school entry screening program in a general community population of children. [ABSTRACT FROM AUTHOR]

Aim: To assess the prescribing practice of enoxaparin in comparison to dosing guidelines., Method: A prospective observational chart review of patients who received enoxaparin for the treatment of thrombosis at Dunedin Public Hospital between August 2007 and January 2008. Deviations in dose from guidelines were defined and recorded along with various clinical and demographic data of participants., Results: Fifty-nine patients (62 admissions) were recruited. Dose deviations occurred on 19 (30.7%) occasions. More dose deviations occurred at or close to guideline transition points (total body weight over 90 kg and/or creatinine clearance between 20-40 mL/min)., Conclusion: Current enoxaparin dosing guidelines are too simplistic and result in discord between dosing in practice and that approved by Medsafe.

Aim: To determine the incidence of bleeding associated with the use of enoxaparin in NSTEACS at Dunedin Public Hospital (DPH) and to identify bleeding risk factors in this patient group., Methods: A case-control retrospective review of clinical notes was undertaken. NSTEACS admissions in 2005 where a bleeding event occurred were identified and matched with controls (matched for age and sex). The incidence of Thrombolysis in Myocardial Infarction (TIMI) minor and major bleeding, not related to cardiac surgery, was determined. Univariate and multivariate analyses were used to identify risk factors for all bleeding events., Results: There were 446 eligible NSTEACS admissions (409 patients), of which 47 bleeding events (10.5%) were reported. Eight events (1.8%) were major according to the TIMI bleeding classification. Three risk factors were identified: renal function, the duration of enoxaparin therapy, and medical conditions involving haemostasis. Renal impairment and the duration of enoxaparin therapy were found to be significant predictors of bleeding (p=0.036 and p=0.008, respectively)., Conclusions: The incidence of bleeding in NSTEACS patients treated with enoxaparin at DPH is comparable to that reported in the literature. Renal impairment and prolonged treatment with enoxaparin were significantly associated with an increase in bleeding risk.