Background Strains on the mental health system and inaccessible services for individuals with intellectual disabilities (ID) often force caregivers to bring individuals with ID to the emergency department (ED) when in psychiatric crisis. The purpose of this study was to understand the experience of caregivers and adults with ID and mental health issues, according to caregivers' perspectives. Method Focus groups were conducted with one group of unpaid caregivers (i.e. family members) and two groups of paid caregivers (i.e. staff from community agencies) from Ontario, Canada. Results Caregivers identified a number of issues centering on a lack of services, on respect, on knowledge and on expertise. Diagnostic overshadowing and overmedication were also prevalent concerns. Conclusions Input from caregivers points to deficiencies in the system that lead them to use the ED when other options have been exhausted. A number of recommendations can be implemented to improve the emergency psychiatric care of adults with ID in the ED.

We report previously undocumented evidence of genetic discrimination by Australian insurance companies, obtained through direct consumer reports. We surveyed 174 consumers with cancer-predisposing variants, recruited by cancer organisations Lynch Syndrome Australia and Pink Hope. Questions related to experiences accessing risk-rated insurance after genetic testing. Results indicate that both legal (permitted under current regulation) and illegal discrimination is occurring. Although some respondents had not applied for risk-rated insurance, or had insurance in place before genetic testing (n = 100), those seeking new policies (n = 74) commonly experienced difficulties obtaining insurance (86%, 64/74). Of those experiencing difficulties, 50% (32/64) had no prior history or symptoms of cancer, and had undertaken risk reduction through surveillance and/or preventative surgery. Seventy-seven percent (49/64) reported difficulties related to life insurance. Follow-up telephone interviews with four respondents further described cases of apparent illegal breaches. All reports of discrimination identified were, to our knowledge, previously unreported in the literature. The number of cases suggests a systemic problem with the Australian life insurance industry. We support calls for government oversight of the inherently conflicted model of industry self-regulation in Australia, and an immediate ban on the use of genetic test results in insurance underwriting.

No abstract

No abstract

LEARNING OBJECTIVES1. Describe the IOM competencies practitioners need in order to deliver quality healthcare. 2. Identify methods to integrate evidence-based medicine for improving healthcare safety into the MLS curricula. 3. Describe exercises to employ in MLS curricula to develop problem-solving skills required for participation in quality improvement projects. 4. Identify key aspects of delivering patient-centered care to include in MLS curricula. ABSTRACTHealthcare quality has yet to meet the aims of the Institute of Medicine (IOM) with respect to safety, effectiveness, patient-centeredness, efficiency, timeliness and equity. No professional curricula adequately prepare future healthcare practitioners-including medical laboratory science professionals-with all competencies necessary to deliver quality healthcare. Practicing evidence-based medicine, focusing on quality improvement, using information technology, delivering patient-centered care and working as part of interdisciplinary teams are identified by the IOM as the five core competencies that every healthcare practitioner needs to effectively provide healthcare. Medical laboratory science educators need to incorporate patient safety concepts into the curricula and include assignments to develop the IOM competencies in order to adequately prepare future practitioners to effectively practice medical laboratory science in the healthcare system of the 21 st century. ABBREVIATIONS: