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Summary: Objective: To investigate the health care utilization cost of patients presenting with psychogenic nonepileptic seizures (PNES) to a tertiary hospital in Australia. Methods: This is a retrospective analysis of adult patients with PNES based on video‐electroencephalographic confirmation over a 5‐year period. We used an itemized list to collect detailed health care utilization data. The items included emergency room visits, hospital ward admissions, intensive care unit (ICU) admissions, outpatient neurology clinic visits, medical interventions, Code Blue and Medical Emergency Team calls for seizures, medications, and investigations. We calculated the cost of each individual item separately for each individual presentation. To investigate the proportional contribution of each covariate toward the total health care utilization cost, an analysis of the relative importance in the linear regression was performed. Results: There were 39 patients, of whom seven (18%) were admitted to the ICU with suspected status epilepticus. The median total health care utilization cost per person until the diagnosis of PNES was established as 26 468 Australian dollars (AUD; 19 207 US dollars [USD]). In the item breakdown, the highest median cost was incurred by investigations (13 119 AUD = 9520 USD), followed by hospital ward management (8890 AUD = 6451 USD), ICU stay (3764 AUD = 2731 USD), outpatient neurology clinics (2200 AUD = 1596 USD), and emergency room visits (570 AUD = 413 USD). Nonepileptic psychogenic status (23%) and the duration of PNES disorder (10%) were the most significant variables contributing to the variance (R2) of the model. Significance: A considerable burden of health care utilization cost is caused by PNES. The presence of nonepileptic psychogenic status and a longer duration of the condition predict a higher cost. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the impact of implementing a smoke-free policy in an Australian high-security forensic psychiatry in-patient hospital. Methods. Focus groups (n = 21) and surveys with both patients (n = 45) and staff (n = 111, 53.2% nurses) elicited participants' experience of and attitudes towards an introduced smoke-free policy. A follow-up survey elicited the impact of the policy on 15 patients' smoking practice after discharge. Results. Eighty-five per cent of patients stated it was easier to quit smoking when no one else smoked. Over half the discharged patients surveyed (58%) continued to not smoke after discharge, despite almost half the staff (41%) perceiving that patients were unlikely to quit long-term. Smoking staff were significantly more pessimistic than non-smoking staff. Many patients (69%) perceived that their health had improved as a result of not smoking. Most staff (80%) viewed nicotine dependence treatment as important, but fewer (66%) felt confident to support patients to stop smoking. Increased patient violence and management difficulties expected by staff were not realised. Conclusions. A smoke-free policy can be successfully implemented in forensic psychiatry in-patient units. Nursing staff are a large and important group who need particular support to implement a smoke-free policy into practice effectively, particularly those who are smokers. Continuity of care as part of a coordinated policy and service response is needed. [ABSTRACT FROM AUTHOR]

Australia needs to align with other nations and implement sex and gender analysis in health and medical research In response, the Institute of Medicine established the Understanding the Biology of Sex and Gender Differences committee, which produced the landmark report I Exploring the biological contributions to human health: does sex matter? Key informants from journals shared that despite no publicly available policies on sex and gender health data, there were internal rules that the editors, reviewers and authors followed. [Extracted from the article]