Notes

Bivariate pseudo-observations regarding frequent function examination together with critical events.
Community psychiatrists and mental health professionals of the future will need to be well trained in the nano to macroskills required to take responsibility for the mental health and wellbeing of their catchment communities and to provide leadership in service-planning, management, and continuing revision on the basis of rigorous evaluation. These approaches should be the core of all training in psychiatry and all mental health professions prior to any subspecialization.Purpose of review To inform readers about the increasingly popular Western dietary supplement, kratom (Mitragyna speciosa) and how the products are available in the Western world compared with traditional Southeast Asian use. Kratom has been traditionally used for increasing stamina of outdoor laborers (farmers), mood enhancement, pain, and opium addiction. Interestingly, kratom has been reported to have a paradoxical effect in that stimulant feelings, and sedative feelings can be obtained depending on the amount utilized. There are several biologically active alkaloids present in kratom. Recent findings Recent studies have been focused on the interactions of mitragynine, the most abundant alkaloid, and opioid-like effects. This has been driven by the harm that kratom products have produced in the Western world, in stark contrast to the lack of harm in Southeast Asian traditional use over centuries. Many users in the Western world ingest kratom for mood enhancement and/or to ween themselves from prescription or illicit opioids. Highly concentrated products and recreational use and misuse have resulted in individuals pushing doses to levels that have not been imagined or ever studied in animal, let alone humans. Summary Kratom, as a preparation and how it is utilized is different around the world.Purpose of review Assertive Community Treatment is an established evidenced based practice that provides intensive community treatment for individuals with severe mental illness with recurrent hospitalizations and/or homelessness. Emerging evidence indicates limitations in its implementation in terms of to the original ACT model and its current relevance. Recent findings Findings from recent studies (2018-2020) reveals challenges with implementation centered around basic implementation activities, such as changes in the psychosocial context of individuals with SMI, clinicians' abilities to demonstrate competencies with new practices, and ongoing evolution of mental health systems of care worldwide. Intermediary and purveyor organizations (IPO) can provide the infrastructure to support the spread of EBPs while addressing challenges and opportunities. Thus, implementation of ACT can be accomplished when employing a rigorous framework and infrastructure that can synthesize and translate science relevant for practice. Summary The relevance of ACT depends on its implementation that is responsive to change. An implementation science-informed approach is key to providing ACT to individuals in the critical space between the hospital and community. With this approach, we can optimize ACT as a service delivery vehicle by careful analysis of how best to furnish and evaluate the latest, most effective and efficient treatments, rehabilitation and support services.Objectives This is the first of a 2-part article that discusses essential case management practices and strategies amidst the novel coronavirus disease 2019 (COVID-19). The series showcases the potential professional case managers have in support of managing during a crisis such as this global pandemic. Part I discusses reenvisioned roles and responsibilities of case managers and leaders known to address patients' needs during a crisis, with a special focus on telehealth, tele-case management, surge capacity, redeployment, discharge planning, and transitions of care. Primary practice settings Applicable to the various case management practice settings across the continuum of health and human services, especially acute care. Findings conclusions The COVID-19 global pandemic crisis has brought an unprecedented challenge to professional case managers and health care professionals. It also has provided opportunities for innovation and partnerships within and across health care organizations and the various care sse management professionals. It has raised awareness to sites of care never were as popular before, resulting in an increased need and recognition for tele-case management practice and virtual case managers. It has also forced partnerships and collaborations among the diverse contexts of health care organizations (public, private, or both) and other industries, regardless of whether directly involved in the delivery of care or having a support service role. These new and innovative approaches in the provision of care and case management services will without a doubt become routine expectations beyond the current pandemic period. Of special note are the enhanced roles of case managers in discharge planning and transitions of care.Objectives This is the second of a 2-part article that discusses essential case management practices and strategies amidst the novel coronavirus disease 2019 (COVID-19). The series showcases the potential professional case managers have in support of managing during a crisis such as a global pandemic. Part II continues to describe reenvisioned roles and responsibilities of case managers and their leaders to meet the needs of patients/support systems during the crisis. It focuses on the increased need for end-of-life care, impact on workers' compensation case management practice, and the self-care needs of the professional case manager. Primary practice settings Applicable to the various case management practice settings across the continuum of health and human services, with special focus on acute care. Findings/conclusions The COVID-19 global pandemic has resulted in a crisis case managers and other health care professionals never faced something like it before. At the same time, it has provided opportunitieo far, the experience of this crisis has resulted in a deliberate need to ensure the safety of both, those who are the recipients of health care services and those who are responsible for the provision of care. Self-care and resilience of health care professionals and case managers, especially due to the complex dynamics of the COVID-19 pandemic, have advanced a desirable and necessary view of remote/virtual practice and as a strategy for enhancing the person's health and well-being. This pandemic has forced the development of impactful partnerships and collaborations among the diverse contexts of health care organizations and support service providers. These contexts of care delivery have also emphasized the necessary legal and ethical practice of case managers and the other involved parties. Experts agree that the innovative care delivery methods practiced during the pandemic will undoubtedly remain as desirable beyond the current crisis period.Succession planning appears to be a logical and essential component of human resources and leadership planning. However, the complexities and requirements of a successful succession planning process are significant and generally not well understood. Perhaps for this reason, succession planning often yields disappointing results. It is inherently an imperfect management process-as seen, for example, when an identified internal successor leaves an organization for a more immediate opportunity elsewhere. My experiences as CEO of Henry Ford Health System for 14 years and as chair of three compensation committees (for two public companies and one foundation) have given me a unique understanding of the challenges and opportunities of succession planning. This article highlights the myths, realities, and building blocks of effective succession planning in healthcare organizations.Healthcare is uniquely destined for growth, largely because of the increasing demands of an aging population. In this field bursting with highly trained professionals driven by a passion for serving others, we as healthcare leaders are well positioned to cultivate an environment where high-performing employees can achieve their potential.Unfortunately, we are not well positioned to face the risk of losing continuity. Most healthcare C-suites are occupied by baby boomers who will soon exit the workforce. The impending transitions, adding to the effects of system consolidations and market demands for leadership talent, call for a concerted effort to prepare the next generation of leaders. There are significant benefits to promoting from within, yet formal succession plans are hard to build and even harder to embed in an organization's culture.The planning and attention required to develop the next generation is not a static process. The work is hard and ongoing. However, the return on the human investment in succession planning can be substantial for an organization, its senior executives, and its emerging leaders. click here Preparing the next generation should be an imperative for all senior leaders. An effective approach involves a defined plan, development tools, alignment with a leadership competency framework, and attention to diversity and inclusion. Handled effectively, early careerists who are taught the skills needed to succeed as leaders will be able to help guide their organizations and healthcare in general when called on to make a difference. There is great potential to be realized in developing future leaders internally, and we as today's leaders must start that work now.Leadership succession does not need to be extremely difficult. However, it does require time, a carefully planned process, well-defined roles, and the intent of all parties to achieve a successful transition-along with the trust to make these various aspects come together. In a CEO succession, the work does not begin at the time of an announced retirement or departure but rather well in advance. The outgoing CEO must want to make the upcoming transition as smooth as possible for everyone involved. The organization must already be committed to the ongoing education of its board, medical staff, and administrators so that all stakeholders are well prepared to execute the transition. Candidates for the CEO role in transition also must be confident in the knowledge of their own needs as well as the needs of the organization. When everyone's best interests come together to create a good fit, the succession can be successful.In this article, the leadership transition at one healthcare system is recounted from the perspectives of three principal players the outgoing president and CEO, the chair of the board of trustees search committee, and the incoming president and CEO.Background The Bernese periacetabular osteotomy (PAO) is one of the most-used surgical techniques to treat symptomatic acetabular dysplasia. Although good functional and radiographic short-term and long-term outcomes have been reported, several complications after PAO have been described. One complication that may compromise clinical results is nonunion of an osteotomy. However, the exact prevalence and risk factors associated with nonunion are poorly elucidated. Questions/purposes (1) What proportion of patients have complete bony healing versus nonunion during the first year after PAO? (2) What is the clinical and functional impact of nonunion at a minimum of 1 year after PAO, as assessed by the modified Harris hip score (mHHS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS)? (3) What patient-specific or surgery-specific factors are associated with nonunion at 6 months and at a minimum of 1 year postoperatively? Methods Between January 2012 and December 2015, we retrospectively identified 314 patients who underwent PAO at our institution.
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