Following the Report

This chapter discusses what happens after a report to Child Protection Services (CPS), including foundations of CPS authority, contact with the reporting source, interviews with children, parental consent, physical examinations, interviewer skills, service to Indigenous children, and practice models. This content is embedded in a demonstration of the child protection services path. By clarifying the processes and potential outcomes of a child protection investigation, this chapter aims to increase mandatory reporters’ comfort level and knowledge base when contacting CPS. The information provided herein about child protection investigations aims to increase reporters’ sense of confidence and credibility when reporting, which may subsequently enhance their feeling of efficacy when advocating for the family.

Cardiovascular causes of sudden death in athletes

Sudden cardiac death (SCD) is usually the result of an interaction between transient acute events (’triggers’) and either structural or non-structural cardiovascular substrates. The structural culprit resides in any of the cardiovascular components, i.e. aorta, coronary arteries, myocardium, valves, conduction system, or ion channels. Epidemiological studies have demonstrated that the occurrence of SCD in athletes is nearly three times than that in non-athletes, so that sport activity adds a significant risk if the athletes are affected by concealed cardiac diseases. Triggers of SCD in young competitive athletes include exercise-related sympathetic stimulation, abrupt haemodynamic changes, and myocardial ischaemia. In this chapter, we will review the various structural diseases, either congenital or acquired, which pose a risk of SCD in athletes. Disparities among published studies emphasizes the need for uniform reporting (source of data, retrospective versus prospective, autopsy versus no autopsy, etc). Identifying causes of SCD in the athletic population is important for guiding preventive measures.

Self-Report Versus Informant Responses: Exploring the Relationship between Excessive Reassurance Seeking and Depression

Introduction: This study expanded on prior research exploring the relationship between excessive reassurance seeking (ERS) and depression by conducting a longitudinal study evaluating two reporting sources (participants and informants). The current research was also the first to examine a sequential mediation model, with interpersonal competence as an antecedent in this relationship. Method: One hundred and ten participants completed measures at two time-points separated by five weeks. Corresponding informants completed comparable measures at participants' Time 2. Results: Results revealed differences based on reporting source, with more significant correlations found among participant- as compared to informant-reported variables. Moreover, findings supported interpersonal competence as an antecedent to the ERS-depression relationship. Finally, this research highlighted the role of brooding, in addition to ERS, in the development of depressive symptoms. Discussion: This study offers support for further consideration of methodology on outcomes, underlines the role of interpersonal competence as a precursor to depression, and encourages clinicians to target both brooding and ERS behavior in the treatment and prevention of depression.

Sluggish Cognitive Tempo in Adults Referred for an ADHD Evaluation: A Psychometric Analysis of Self- and Collateral Report

Objective: Sluggish cognitive tempo (SCT) symptoms uniquely contribute to psychiatric and functional outcomes in child samples; however, the psychometric properties of SCT measures among adult outpatients are unknown. Method: Adults ( n = 124) presenting for an ADHD evaluation provided self- and collateral report of SCT symptoms. Results: The SCT scale had good internal consistency and yielded three factors across raters: Slow/Daydreamy, Sleepy/Sluggish, and Low Initiation/Persistence. SCT scores exhibited convergent validity with ADHD symptoms across raters. Individuals with ADHD received higher SCT ratings than those without ADHD via collateral report, a pattern that was similar when comorbidity was considered. SCT was associated with poorer functioning after accounting for ADHD symptoms with some differential effects based on reporting source. Conclusion: Findings support the internal consistency and validity of a three-factor SCT scale among adult outpatients. Differential results between self- and collateral report demonstrate the importance of multiple reporters of SCT in clinical settings.

Locoregional Prostate Cancer Treatment Pattern Variation in Independent Cancer Centers: Policy Effect, Patient Preference, or Physician Incentive?

Surveillance, Epidemiologic, and End Results (SEER) registry data abstracted from a priority 2 or higher reporting source from 2006 to 2008 were used to compare treatment patterns in 45–64-year old men diagnosed with locoregional prostate cancer (LRPC) across states with or without radiation therapy-directed certificate of need (CON) laws and across independent cancer centers (ICCs) compared to large multi-specialty groups (LMSGs). Adjusted treatment percentages for the five most common LRPC treatments (surgery, external beam radiation therapy (EBRT), combination brachytherapy with EBRT, brachytherapy, and observation) were compared using cross-sectional logistic regression between CON-unregulated and -regulated states and between LMSGs and ICCs. LRPC EBRT rates were no different across CON regions, but are increased in ICCs compared to LMSGs (37.00% vs. 13.23%, P < 0.001). Variation in LRPC treatment patterns by reporting source merits further scrutiny under the Affordable Care Act of 2010, considering the intent of incentivized accountable care organizations (ACOs) established by the Patient Protection and Affordable Care Act of 2010 (PPACA) and the implications of early descriptions of these new healthcare provider organizations on prostate cancer treatment patterns.

ASSESSING SEARCHES IN NICE SINGLE TECHNOLOGY APPRAISALS: PRACTICE AND CHECKLIST

Objectives: No guidelines exist in the approach that Evidence Review Groups (ERGs) should take to appraise search methodologies in the manufacturer's submission (MS) in Single Technology Appraisals (STA). As a result, ERGs are left to appraise searches using their own approach. This study investigates the limitations of manufacturers' search methodologies as critiqued by ERGs in published STA reports and to provide a recommended checklist.Methods: Limitations from search critiques in 83 ERG reports published in the NIHR Web site between 2006 and May 2011 were extracted. The limitations were grouped into themes. Comparisons were made between limitations reported in the clinical effectiveness versus cost-effectiveness searches.Results: Twelve themes were identified, six relating to the search strategy, source, limits, filters, translation, reporting, and missing studies. The search strategy theme contained the most limitations. Missing studies were frequently found by the ERG group in the clinical effectiveness searches. The omission of searches by manufacturers for unpublished and ongoing trials was frequently reported by the ERG. By contrast, failure of the manufacturer to report strategies was the most common limitation in the cost-effectiveness searches. Themes with the most frequent limitations in both types of searches are search strategy, reporting and source.Conclusions: It is recommended that a checklist that has reporting, source and search strategy elements be used in the appraisal of manufacturer's searches during the STA process.