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Psychiatric comorbidities are frequent in patients admitted in general hospital and are associated with greater lengths of stay (LOS). Early consultation-liaison psychiatry (CLP) interventions may reduce the LOS but previous studies were underpowered to allow subgroup analyses and have generally not considered the severity of the condition for which patients were admitted ('disease severity'). To investigate the association between the timing of CLP interventions and LOS in a general hospital. We retrospectively included 4500 consecutive patients admitted in non-psychiatric wards of a university hospital between 2008 and 2016 who had a first CLP intervention. We used general linear models to examine the association between the referral time, defined as log(days before the consultation)/log(LOS), and log(LOS), adjusting for age, gender, year of admission, place of residence, main psychiatric diagnosis, admission to the intensive care unit (ICU), main physical condition and disease severity. Referral time was associated with log(LOS) (β = 0.31; <0.001), notably for older patients (β = 0.43; <0.001) and those admitted to the ICU (β = 0.50; <0.001), but not for those with psychotic disorders (β = -0.20; = 0.10). The association was confirmed when considering the expected LOS for each patient. For instance, for an expected LOS of 10 days, a CLP intervention on day 3 compared with day 6 was associated with a reduction of the actual LOS of 2.4 days. Earlier CLP interventions were associated with a clinically significant shorter LOS in a large population even after adjusting for disease severity. Early CLP interventions may have benefits for both patients and health-related costs.

Most of the world's population in developed regions lives in urban areas, with this proportion growing annually. A key question regarding this trend is the effects that reduced contact with nature may have on human well-being and functioning. In this paper, we propose to evaluate, using the empirical literature, the hypothesis that human beings have a basic psychological need for nature relatedness. This proposition could have positive benefits for human well-being, the way we design human environments and communities, and the natural environment itself if properly evidenced; however, to date, no article has evaluated the extant literature for such a purpose. The objective of this paper is to use previous conceptualisations of basic psychological needs, and the criteria proposed by Baumeister and Leary (1995) and Sheldon (2011) to critically examine whether enough evidence exists to support this proposition. Research from diverse research areas are reviewed, with conclusions drawn for each criterion as well as for the overall literature. In general, research supports the proposition for a basic psychological need for nature relatedness, with stronger evidence pointing to the idea of this as a need-as-requirement than a need-as-motive, though both are well-evidenced. La population mondiale des régions développées vit majoritairement en zone urbaine, et cette proportion croît d'année en année. La principale question concernant cette tendance a trait aux effets éventuels du contact réduit avec la nature sur le mieux-être et le fonctionnement humain. Dans le présent article, nous proposons d'évaluer, au regard des écrits empiriques, l'hypothèse voulant que les êtres humains aient un besoin psychologique fondamental de liaison avec la nature. Cette proposition, si elle est dûment étayée, pourrait avoir des effets positifs sur le mieux-être humain, sur la façon dont nous concevons les collectivités et les milieux humains, ainsi que sur l'environnement naturel. Or, à ce jour, aucun article n'a évalué les publications existantes dans un tel objectif. Le présent article vise à utiliser les conceptualisations établies des besoins psychologiques de base ainsi que les critères proposés par Baumeister et Leary (1995) ainsi que Sheldon (2011) pour examiner de manière critique s'il existe suffisamment de preuves pour étayer cette proposition. La recherche effectuée dans divers domaines sera examinée, et des conclusions seront tirées pour chaque critère, ainsi que pour la documentation dans son ensemble. De manière générale, la recherche confirme la proposition voulant que l'humain ait un besoin psychologique fondamental de liaison avec la nature. Des preuves mieux étayées semblent indiquer qu'il s'agit d'un besoin motivé par la nécessité plutôt que par la volonté, même si ces deux possibilités sont bien démontrées.

Scales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking. To evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS scale, Modified SAD PERSONS scale, Barratt Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 months. A multisite prospective cohort study was conducted of adults aged 18 years and over referred to liaison psychiatry services following self-harm. Scale cut-offs were evaluated using diagnostic accuracy statistics. The area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy. In total, 483 episodes of self-harm were included in the study. The episode-based 6-month repetition rate was 30% ( = 145). Sensitivity ranged from 1% (95% CI 0-5) for the SAD PERSONS scale, to 97% (95% CI 93-99) for the Manchester Self-Harm Rule. Positive predictive values ranged from 13% (95% CI 2-47) for the Modified SAD PERSONS Scale to 47% (95% CI 41-53) for the clinician assessment of risk. The AUC ranged from 0.55 (95% CI 0.50-0.61) for the SAD PERSONS scale to 0.74 (95% CI 0.69-0.79) for the clinician global scale. The remaining scales performed significantly worse than clinician and patient estimates of risk ( <0.001). Risk scales following self-harm have limited clinical utility and may waste valuable resources. Most scales performed no better than clinician or patient ratings of risk. Some performed considerably worse. Positive predictive values were modest. In line with national guidelines, risk scales should not be used to determine patient management or predict self-harm.

SummaryThis systematic review and meta-analysis suggests that fracture liaison service (FLS) is associated with a significantly lower probability of subsequent fractures and mortality although the latter was only found in studies comparing outcomes before and after the introduction of an FLS.IntroductionTo systematically review and evaluate the impact of fracture liaison services (FLSs) on subsequent fractures and mortality using meta-analysis.MethodsA literature search was performed within PubMed and Embase to identify original articles published between January 1, 2010, and April 30, 2020, reporting the effect of FLSs on subsequent fractures and/or mortality. Only studies comparing FLS to no-FLS were included. A meta-analysis using random-effects models was conducted. The quality of studies was appraised after combining and modifying criteria of existing quality assessment tools.ResultsThe search retrieved 955 published studies, of which 16 studies fulfilled the inclusion criteria. Twelve studies compared outcomes before (pre-FLS) and after (post-FLS) FLS implementation, two studies compared outcomes between hospitals with and without FLS, and two other studies performed both comparisons. In total, 18 comparisons of FLS and no-FLS care were reported. Follow-up time varied from 6 months to 4 years. Sixteen comparisons reported on subsequent fractures and 12 on mortality. The quality assessment revealed methodological issues in several criteria. Excluding studies with very high selection bias, the meta-analysis of nine comparisons (in eight papers) revealed that the FLS care was associated with a significantly lower probability of subsequent fractures (odds ratio: 0.70, 95% CI: 0.52–0.93, P=0.01). In studies with a follow-up > 2 years, a significantly lower probability of subsequent fractures was captured for FLS care (odds ratio: 0.57, 95% CI: 0.34–0.94, P=0.03), while in studies ≤ 2 years, there was no difference in the odds of subsequent fractures. No significant difference in the odds of mortality was observed (odds ratio: 0.73, 95% CI: 0.49–1.09, P=0.12) in the meta-analysis of eight comparisons (in seven papers). However, a significantly lower probability of mortality was identified in the six pre-post FLS comparisons (odds ratio: 0.65, 95% CI: 0.44–0.95, P=0.03), but not in studies comparing hospitals with and without FLS. No difference was observed in mortality stratified by follow-up time.ConclusionThis systematic review and meta-analysis suggests that FLS care is associated with a significantly lower probability of subsequent fractures and mortality although the latter was only found in studies comparing outcomes before and after the introduction of an FLS. The quality assessment revealed that some important methodological issues were unmet in the currently available studies. Recommendations to guide researchers to design high-quality studies for evaluation of FLS outcomes in the future were provided.

PurposeThis article describes an onboarding program created for liaison librarians at an academic library and details a replicable framework for effective implementation at other institutions.Design/methodology/approachThis article outlines a month-long onboarding program that provides new-to-the-field and experienced librarians with support and structure as they learn the core competencies of liaison work, adjust to a new professional setting and grow in their practice as liaison librarians.FindingsInformation about onboarding practices across academic libraries, liaison librarianship within the library and information science (LIS) curriculum and the need for onboarding programs that provide a comprehensive overview of core liaison librarianship competencies is provided.Originality/valueOnboarding programs specific to liaison librarians is an underexplored topic. This article emphasizes fostering community and skill development throughout the onboarding process to bolster confidence, engagement and retention.

Academic liaison librarians have traditionally supported reference, instruction, and research support. Many aspects of these activities are demand driven and hence, easily capture the attention and priorities for the busy academic liaison librarian with multiple subject assignments. Pro-actively supporting faculty's and students' research needs can vary widely by subject area/discipline, departmental culture, and even individual professors' and researchers' practices, and requires creativity and experimentation to develop and sustain successfully. This presentation will detail activities and strategies that librarians can use to better assess needs, gain skills, identify unmet challenges, and better equip themselves for strategic interventions throughout the research cycle. Audience participation, discussion, and suggestions will be integrated throughout this presentation.

Disputes over the costs and benefits of intelligence liaisons between the US and its African allies are routine. The contentious and largely overlooked bargaining processes that stem from these disputes call into question prominent depictions of US-African security partnerships as rigidly hierarchical alliances. Through an assessment of compliance bargaining between Ethiopia and the US over the terms of their intelligence liaison, this article posits that, despite the vast power asymmetry between these allies, Ethiopia routinely dictated and policed the terms of this liaison, while consistently leveraging it as means to acquire political concessions from the US.

BackgroundEach year, 220 000 episodes of self-harm are managed by emergency departments in England, providing support to people at risk of suicide.AimsTo explore treatment of self-harm in emergency departments, comparing perspectives of patients, carers and practitioners.MethodFocus groups and semi-structured interviews with 79 people explored experiences of receiving/delivering care. Participants were patients (7 young people, 12 adults), 8 carers, 15 generalist emergency department practitioners and 37 liaison psychiatry practitioners. Data were analysed using framework analysis.ResultsWe identified four themes. One was common across stakeholder groups: (a) the wider system is failing people who self-harm: they often only access crisis support as they are frequently excluded from services, leading to unhelpful cycles of attending the emergency department. Carers felt over-relied upon and ill-equipped to keep the person safe. Three themes reflected different perspectives across stakeholders: (b) practitioners feel powerless and become hardened towards patients, with patients feeling judged for seeking help which exacerbates their distress; (c) patients need a human connection to offer hope when life feels hopeless, yet practitioners underestimate the therapeutic potential of interactions; and (d) practitioners are fearful of blame if someone takes their life: formulaic question-and-answer risk assessments help make staff feel safer but patients feel this is not a valid way of assessing risk or addressing their needs.ConclusionsEmergency department practitioners should seek to build a human connection and validate patients’ distress, which offers hope when life feels hopeless. Patients consider this a therapeutic intervention in its own right. Investment in self-harm treatment is indicated.

Background Liaison psychiatry services provide mental health care for patients in physical healthcare (usually acute hospital) settings including emergency departments. Liaison work involves close collaboration with acute hospital staff so that high quality care can be provided. Services however are patchy, relatively underfunded, heterogeneous and poorly integrated into acute hospital care pathways. Methods We carried out in-depth semi-structured interviews with 73 liaison psychiatry and acute hospital staff from 11 different acute hospitals in England. The 11 hospitals were purposively sample to represent hospitals in which four different types of liaison services operated. Staff were identified to ensure diversity according to professional background, sub-specialism within the team, and whether they had a clinical or managerial focus. All interviews were audio-recorded and transcribed. The data were analysed using a best-fit framework analysis. Results Several key themes emerged in relation to facilitators and barriers to the effective delivery of integrated services. There were problems with continuity of care across the secondary-primary interface; a lack of mental health resources in primary care to support discharge; a lack of shared information systems; a disproportionate length of time spent recording information as opposed to face to face patient contact; and a lack of a shared vision of care. Relatively few facilitators were identified although interviewees reported a focus on patient care. Similar problems were identified across different liaison service types. Conclusions The problems that we have identified need to be addressed by both liaison and acute hospital teams, managers and funders, if high quality integrated physical and mental health care is to be provided in the acute hospital setting.

The Coronavirus Disease 2019 (COVID-19) can affect mental health in different ways. There is little research about psychiatric complications in hospitalized patients with COVID-19. The aim of the study was to describe the psychiatric clinical profile and pharmacological interactions in COVID-19 inpatients referred to a Consultation-Liaison Psychiatry (CLP) unit. This is a cross-sectional study, carried out at a tertiary hospital in Spain, in inpatients admitted because of COVID-19 and referred to our CLP Unit from March 17,2020 to April 28,2020. Clinical data were extracted from electronic medical records. The patients were divided in three groups depending on psychiatric diagnosis: delirium, severe mental illness (SMI) and non-severe mental illness (NSMI). Of 71 patients included (median [ICR] age 64 [54–73] years; 70.4% male), 35.2% had a delirium, 18.3% had a SMI, and 46.5% had a NSMI. Compared to patients with delirium and NSMI, patients with SMI were younger, more likely to be institutionalized and were administered less anti-COVID19 drugs. Mortality was higher among patients with delirium (21.7%) than those with SMI (0%) or NSMI (9.45%). The rate of side effects due to interactions between anti-COVID19 and psychiatric drugs was low, mainly drowsiness (4.3%) and borderline QTc prolongation (1.5%). Patients affected by SMI were more often undertreated for COVID-19. However, the rate of interactions was very low, and avoidable with a proper evaluation and drug-dose adjustment. Half of the patients with SMI were institutionalized, suggesting that living conditions in residential facilities could make them more vulnerable to infection.