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This study aimed to show simulation improves confidence and competence in caregivers of children with a tracheostomy and examined the impact on patient emergency department visits and mortality. All participants received standard classroom training. One group also received training using simulation. Confidence at post-test was significantly greater in the simulation group. Correlation between post-test confidence and competency measures was not statistically significant. Mortality in family homes was almost five times higher for children whose caregivers did not participate in simulation. Simulation should be considered an important adjunct when preparing caregivers to respond to tracheostomy emergencies at home. • Parents who received simulation training on emergency tracheostomy care showed a significantly greater level of confidence at post-test when compared with those who did not. • The correlation between post-test confidence and competency measures was not statistically significant. • Emergency department visits increased in the simulation group. These results suggest simulation may make caregivers more sensitive to their child's distress and more likely to use the emergency department than expected. • Mortality related to tracheostomy emergencies in family homes was nearly 5 times higher for children whose caregivers did not participate in simulation. [ABSTRACT FROM AUTHOR]

Abstract: Symptoms of internalizing disorders (depression, anxiety, somatic, trauma) are the major risk factors for suicide. Atypical suicide risk is characterized by people with few or no symptoms of internalizing disorders. Objective: In persons screened at intake to alcohol or other drug (AOD) treatment, this research examined whether person fit statistics would support an atypical subtype at high risk for suicide that did not present with typical depression and other internalizing disorders. Methods: Symptom profiles of the prototypical, typical, and atypical persons, as defined using fit statistics, were tested on 7408 persons entering AOD treatment using the Global Appraisal of Individual Needs (GAIN; ). Results: Of those with suicide symptoms, the findings were as expected with the atypical group being higher on suicide and lower on symptoms of internalizing disorders. In addition, the atypical group was similar or lower on substance problems, symptoms of externalizing disorders, and crime and violence. Conclusions: Person fit statistics were useful in identifying persons with atypical suicide profiles and in enlightening aspects of existing theory concerning atypical suicidal ideation. [Copyright &y& Elsevier]