The authors describe an external crisis intervention service in a general hospital. This service is intended for a clientele presenting acute mental health problems, referred, in the majority of cases, from the emergency department. They present demographic data, diagnostic data, data on the factors precipitating the crises and data which can be used to qualify and quantify the clientele. In addition, they describe the therapeutic approach and the treatment philosophy, the number of follow-up sessions, and the guidance provided to the clientele after follow-up. Finally, the authors suggest prerequisites considered essential to the effective operation of a crisis intervention module in an external psychiatric clinic.
This study provides a geographic analysis of variation in temporal accessibility to emergency services by accident victims within regional municipalities in Quebec. The model employed takes account of various post-accident variables (supply and demand; the service organization) which existed in Quebec in 1987. The study population consisted of 8,989 accident victims who required ambulance service between June 1 and August 31, 1987. The study concludes that the time between the accident and the arrival of the victim at the hospital was longer than one hour (the "Golden Hour") in 25% of the regional municipalities in distant regions and in the areas close to Ontario and the United States. Emergency interventions took less than 40 minutes in suburbs to the North and South of Montreal Island. Forty-eight percent of the variance is linked to the presence and the type of emergency services with an ATLS professional available and 20% is linked with the variables of distance and time.
Three cases of abdominal catheter migration through the anus following ventriculo-peritoneal shunt are described. Two cases involved hydrocephalus secondary to tuberculous meningitis and the third myelomeningocele. Among the reasons for migration, the length of the abdominal catheter, trauma during the operation and infection must be taken into consideration. One patient was suffering from meningitis at the time of admission, while the two others were asymptomatic. Treatment involved removing the peritoneal catheter in 2 cases and the entire shunt system in the patient with meningitis. The shunt was replaced one to two weeks later. The outcome was favourable in all three cases.