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Sample records for acute psychiatric unit

  1. Mobile Mindfulness Intervention on an Acute Psychiatric Unit: Feasibility and Acceptability Study.

    Science.gov (United States)

    Mistler, Lisa A; Ben-Zeev, Dror; Carpenter-Song, Elizabeth; Brunette, Mary F; Friedman, Matthew J

    2017-08-21

    Aggression and violence on acute psychiatric inpatient units is extensive and leads to negative sequelae for staff and patients. With increasingly acute inpatient milieus due to shorter lengths of stay, inpatient staff is limited in training and time to be able to provide treatments. Mobile technology provides a new platform for offering treatment on such units, but it has not been tested for feasibility or usability in this particular setting. The aim of this study was to examine the feasibility, usability, and acceptability of a brief mindfulness meditation mobile phone app intended to reduce anger and aggression in acute psychiatric inpatients with schizophrenia, schizoaffective disorder, or bipolar disorder, and a history of violence. Participants were recruited between November 1, 2015 and June 1, 2016. A total of 13 inpatients at an acute care state hospital carried mobile phones for 1 week and were asked to try a commercially available mindfulness app called Headspace. The participants completed a usability questionnaire and engaged in a qualitative interview upon completion of the 7 days. In addition, measures of mindfulness, state and trait anger, and cognitive ability were administered before and after the intervention. Of the 13 enrolled participants, 10 used the app for the 7 days of the study and completed all measures. Two additional participants used the app for fewer than 7 days and completed all measures. All participants found the app to be engaging and easy to use. Most (10/12, 83%) felt comfortable using Headspace and 83% (10/12) would recommend it to others. All participants made some effort to try the app, with 6 participants (6/12, 50%) completing the first 10 10-minute "foundation" guided meditations. This is the first known study of the use of a commercially available app as an intervention on acute psychiatric inpatient units. Acutely ill psychiatric inpatients at a state hospital found the Headspace app easy to use, were able to complete

  2. READMIT: a clinical risk index to predict 30-day readmission after discharge from acute psychiatric units.

    Science.gov (United States)

    Vigod, Simone N; Kurdyak, Paul A; Seitz, Dallas; Herrmann, Nathan; Fung, Kinwah; Lin, Elizabeth; Perlman, Christopher; Taylor, Valerie H; Rochon, Paula A; Gruneir, Andrea

    2015-02-01

    Our aim was to create a clinically useful risk index, administered prior to discharge, for determining the probability of psychiatric readmission within 30 days of hospital discharge for general psychiatric inpatients. We used population-level sociodemographic and health administrative data to develop a predictive model for 30-day readmission among adults discharged from an acute psychiatric unit in Ontario, Canada (2008-2011), and converted the final model into a risk index system. We derived the predictive model in one-half of the sample (n = 32,749) and validated it in the other half of the sample (n = 32,750). Variables independently associated with 30-day readmission (forming the mnemonic READMIT) were: (R) Repeat admissions; (E) Emergent admissions (i.e. harm to self/others); (D) Diagnoses (psychosis, bipolar and/or personality disorder), and unplanned Discharge; (M) Medical comorbidity; (I) prior service use Intensity; and (T) Time in hospital. Each 1-point increase in READMIT score (range 0-41) increased the odds of 30-day readmission by 11% (odds ratio 1.11, 95% CI 1.10-1.12). The index had moderate discriminative capacity in both derivation (C-statistic = 0.631) and validation (C-statistic = 0.630) datasets. Determining risk of psychiatric readmission for individual patients is a critical step in efforts to address the potentially avoidable high rate of this negative outcome. The READMIT index provides a framework for identifying patients at high risk of 30-day readmission prior to discharge, and for the development, evaluation and delivery of interventions that can assist with optimizing the transition to community care for patients following psychiatric discharge.

  3. Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome

    Directory of Open Access Journals (Sweden)

    Jensen Gunnar

    2011-01-01

    Full Text Available Abstract Background Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units. Methods We used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA, which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA total score were analysed with a regression model. Results The sample comprised 192 adolescents admitted during one year (response rate 87%. Mean age was 15.7 years (range 10-18 and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean intake HoNOSCA total score was 18.5 (SD 6.4. The largest groups of main diagnostic conditions were affective (28% and externalizing (26% disorders. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement in the HoNOSCA total score was 5.1 (SD 6.2, with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and self-injury and emotional symptoms were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA total score at intake, or involvement of the Child Protection Service predicted improvement during admission

  4. Registered nurses' experiences of patient violence on acute care psychiatric inpatient units: an interpretive descriptive study.

    Science.gov (United States)

    Stevenson, Kelly N; Jack, Susan M; O'Mara, Linda; LeGris, Jeannette

    2015-01-01

    Nurses working in acute care psychiatry settings experience high rates of patient violence which influences outcomes for nurses and the organization. This qualitative study explored psychiatric nurses' experiences of patient violence in acute care inpatient psychiatric settings. An interpretive descriptive design guided this study that included 17 semi-structured interviews with a purposeful sample of 12 Canadian registered nurses who self-reported experiencing patient violence within acute care inpatient psychiatry. Thematic analysis and constant comparison techniques were used for analysis. A problem, needs and practice analysis was also used to structure overall data interpretation. Thirty three unique exposures to patient violence among the sample of nurses were analysed. Nurses reported experiencing physical, emotional and verbal violence. For many, patient violence was considered "part of the job." Nurses often struggled with role conflict between one's duty to care and one's duty to self when providing care following a critical incident involving violence. Issues of power, control and stigma also influenced nurse participant perceptions and their responses to patient violence. Nurses used a variety of strategies to maintain their personal safety and to prevent, and manage patient violence. Nurses endorsed the need for improved education, debriefing following an incident, and a supportive work environment to further prevent patient violence. Present findings have implications for reducing the barriers to reporting violent experiences and the creation of best practice guidelines to reduce patient violence in the workplace. Understanding the perspectives and experiences of nurses in acute inpatient psychiatry leads to greater understanding of the phenomenon of patient violence and may inform the development of interventions to prevent and to respond to patient violence, as well as support nurses working within the acute care setting.

  5. The Amsterdam Studies of Acute Psychiatry –II (ASAP-II): a comparative study of psychiatric intensive care units in the Netherlands.

    NARCIS (Netherlands)

    Koppelmans, V.; Schoevers, R.A.; Wijk, van C.G.; Mulder, W.; Hornbach, A.; Barkhof, E.; Klaasen, A.; Egmond, van M.; Verlooij, van J.; Bijpost, Y.; Nusselder, H.; Herrewaarden, van M.; Maksimovic, I.; Achilles, A.; Dekker, J.J.M.

    2009-01-01

    Background The number of patients in whom mental illness progresses to stages in which acute, and often forced treatment is warranted, is on the increase across Europe. As a consequence, more patients are involuntarily admitted to Psychiatric Intensive Care Units (PICU). From several studies and

  6. The Amsterdam Studies of Acute Psychiatry - II (ASAP-II): a comparative study of psychiatric intensive care units in the Netherlands

    NARCIS (Netherlands)

    Koppelmans, V.; Schoevers, R.; van Wijk, C.G.; Mulder, W.; Hornbach, A.; Barkhof, E.; Klaassen, A.; van Egmond, M.; van Venrooij, J.; Bijpost, Y.; Nusselder, H.; van Herrewaarden, M.; Maksimovic, I.; Achilles, A.; Dekker, J.

    2009-01-01

    Background: The number of patients in whom mental illness progresses to stages in which acute, and often forced treatment is warranted, is on the increase across Europe. As a consequence, more patients are involuntarily admitted to Psychiatric Intensive Care Units (PICU). From several studies and

  7. Training needs and role constraints of nurses and assistant nurses working in acute inpatients units of psychiatric hospitals

    Directory of Open Access Journals (Sweden)

    Nikolaos Gonis

    2010-07-01

    Full Text Available Aim: The aim of the research was to record the main clinical problems that mental health nurses and assistant nurses encounter in everyday practice.Material-Method: Data collection based on semi-structured interviews and nurses’ quotes who work in psychiatric acute inpatient wards. Content analysis was carried out and data was categorized into main themes. The total sample consisted of 82 mental health nurses and assistant nurses.Results: Analysis of data revealed that: The constraints of nursing role include the lack of autonomy, the accountability, the medication administration and nursing interventions. Training and clinical needs concern the managing of crisis, the collaboration inside the therapeutic team, the lack of nursing staff that means less time spent with the patient, the security in the work place and the psychological support for nurses.Conclusions: The findings indicated that mental health nurses are called to undertake a demanding role in every day clinical practice with inadequate preparation and training.

  8. The Amsterdam Studies of Acute Psychiatry - II (ASAP-II: a comparative study of psychiatric intensive care units in the Netherlands

    Directory of Open Access Journals (Sweden)

    van Venrooij Janine

    2009-09-01

    Full Text Available Abstract Background The number of patients in whom mental illness progresses to stages in which acute, and often forced treatment is warranted, is on the increase across Europe. As a consequence, more patients are involuntarily admitted to Psychiatric Intensive Care Units (PICU. From several studies and reports it has become evident that important dissimilarities exist between PICU's. The current study seeks to describe organisational as well as clinical and patient related factors across ten PICU's in and outside the Amsterdam region, adjusted for or stratified by level of urbanization. Method/Design This paper describes the design of the Amsterdam Studies of Acute Psychiatry II (ASAP-II. This study is a prospective observational cohort study comparing PICU's in and outside the Amsterdam region on various patient characteristics, treatment aspects and recovery related variables. Dissimilarities were measured by means of collecting standardized forms which were filled out in the framework of care as usual, by means of questionnaires filled out by mental health care professionals and by means of extracting data from patient files for every consecutive patient admitted at participating PICU's during a specific time period. Urbanization levels for every PICU were calculated conform procedures as proposed by the Dutch Central Bureau for Statistics (CBS. Discussion The current study may provide a deeper understanding of the differences between psychiatric intensive care units that can be used to promote best practice and benchmarking procedures, and thus improve the standard of care.

  9. Effects of music therapy on self- and experienced stigma in patients on an acute care psychiatric unit: a randomized three group effectiveness study.

    Science.gov (United States)

    Silverman, Michael J

    2013-10-01

    Stigma is a major social barrier that can restrict access to and willingness to seek psychiatric care. Psychiatric consumers may use secrecy and withdrawal in an attempt to cope with stigma. The purpose of this study was to determine the effects of music therapy on self- and experienced stigma in acute care psychiatric inpatients using a randomized design with wait-list control. Participants (N=83) were randomly assigned by cluster to one of three single-session group-based conditions: music therapy, education, or wait-list control. Participants in the music therapy and education conditions completed only posttests while participants in the wait-list control condition completed only pretests. The music therapy condition was a group songwriting intervention wherein participants composed lyrics for "the stigma blues." Results indicated significant differences in measures of discrimination (experienced stigma), disclosure (self-stigma), and total stigma between participants in the music therapy condition and participants in the wait-list control condition. From the results of this randomized controlled investigation, music therapy may be an engaging and effective psychosocial technique to treat stigma. Limitations, suggestions for future research, and implications for clinical practice and psychiatric music therapy research are provided.

  10. Acute psychiatric beds: distribution and staffing in NSW and ACT.

    Science.gov (United States)

    Rosenman, S

    1995-06-01

    This study examined the availability and staffing of acute psychiatry beds in NSW and ACT. "Gazetted" acute psychiatry hospitals (which take compulsory admissions under mental health law) were polled directly for bed numbers, occupancy and staffing for the year 1990-1991. The NSW Department of Health provided beds numbers for non-gazetted and private hospitals. Four analyses sequentially reallocated beds according to the origin of patients to estimate acute bed availability and use by regional populations. Socio-demographic determinants of acute admission rates were measured. Acute "gazetted" beds averaged 13.2 per 100,000 population but ranged from 6.9 to 49.1 per 100,000 when cross-regional flows were considered. "Non-gazetted" beds raised the provision to 15.5 per 100,000 and private beds raised provision further to 24.5 per 100,000. Inner metropolitan provision was higher than rural or provincial provision. The only determinant of the admission rate to gazetted beds was the number of available beds. Bed availability did not affect either bed occupancy or referral of patients to remote hospitals. Nursing staffing of gazetted units was reasonably uniform, although smaller units had significantly more nurses per bed. Medical staffing was highly variable and appears determined by staff availability. The average provision of acute psychiatric beds approximates lowest levels seen in international models for psychiatric services. Average occupancy rates suggest that there is not an overall shortfall of acute psychiatric beds, but uneven bed distribution creates barriers to access. Referral of patients to remote hospitals is not related to actual bed provision in the regions, but appears to reflect attitudes to ensuring local care. Recommendations about current de facto standards are made. Current average nursing and medical staffing standards are reported.

  11. Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial

    National Research Council Canada - National Science Library

    Abderhalden, Christoph; Needham, Ian; Dassen, Theo; Halfens, Ruud; Haug, Hans-Joachim; Fischer, Joachim E

    2008-01-01

    .... To assess whether such risk assessments decrease the incidence of violence and coercion. A cluster randomised controlled trial was conducted with 14 acute psychiatric admission wards as the units of randomisation, including a preference arm...

  12. Hostility and violence of acute psychiatric inpatients

    Directory of Open Access Journals (Sweden)

    Azzoni Antonella

    2005-07-01

    Full Text Available Abstract Objective The aim of the present study was to find out the extent of hostility and violence and the factors that are associated with such hostility and violence in a psychiatric intensive care unit. Methods Retrospective analysis of data prospectively collected in a 6-year period. Results No hostility was observed in 56.1%, hostility in 40.9%, and violence in 3.0% of the admitted cases. Seclusion was never used. Six cases (2,5‰ required physical restraint. Risk factors associated with violence were younger age, suicidal risk, and diagnosis of schizophrenia. Risk factors associated with hostile and violent behavior were younger age at the onset of the disorder, being single, having no children, lower GAF scores, higher BPRS hostility, SAPS, and CGI scores, lower BPRS anxiety-depression score, higher doses of psychoactive drugs, more frequent use of neuroleptics, diagnosis of mania, personality disorder, substance and alcohol related disorders, no diagnosis of depression. Conclusion The study confirms the low rate of violence among Italian psychiatric in-patients, the major relevance of clinical rather than socio-demographic factors in respect of aggressive behavior, the possibility of a no seclusion-no physical restraint policy, not associated either with higher rates of hostility or violence or with more severe drug side effects.

  13. Pregnant crack addicts in a psychiatric unit

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    Gabriela de Moraes Costa

    2012-01-01

    Full Text Available OBJECTIVE: In this study we aim to characterize a sample of 85 pregnant crack addicts admitted for detoxification in a psychiatric inpatient unit. METHOD: Cross-sectional study. Sociodemographic, clinical, obstetric and lifestyle information were evaluated. RESULTS: Age of onset for crack use varied from 11 to 35 years (median = 21. Approximately 25% of the patients smoked more than 20 crack rocks in a typical day of use (median = 10; min-max = 1-100. Tobacco (89.4%, alcohol (63.5% and marijuana (51.8% were the drugs other than crack most currently used. Robbery was reported by 32 patients (41.2%, imprisonment experience by 21 (24.7%, trade of sex for money/drugs by 38 (44.7%, home desertion by 33 (38.8%; 15.3% were positive for HIV, 5.9% for HCV, 1.2% for HBV and 8.2% for syphilis. After discharge from the psychiatric unit, only 25% of the sample followed the proposed treatment in the chemical dependency outpatient service. CONCLUSION: Greater risky behaviors for STD, as well as high rates of maternal HIV and Syphilis were found. Moreover, the high rates of concurrent use of other drugs and involvement in illegal activities contribute to show their chaotic lifestyles. Prevention and intervention programs need to be developed to address the multifactorial nature of this problem.

  14. Implementing a Music Therapy Program at a New 72-Hour Acute Psychiatric Admissions Unit: A Case Study of a Patient Who Was Malingering

    Science.gov (United States)

    Silverman, Michael J.

    2009-01-01

    Because of the relatively poor treatment available, the high financial costs of hospitalization, multiple and complex issues of persons with severe mental illnesses, and advancements in pharmacotherapy, psychiatric patients are often only hospitalized for a few days before they are discharged. Thus, brief psychosocial interventions for persons who…

  15. Implementing a Music Therapy Program at a New 72-Hour Acute Psychiatric Admissions Unit: A Case Study of a Patient Who Was Malingering

    Science.gov (United States)

    Silverman, Michael J.

    2009-01-01

    Because of the relatively poor treatment available, the high financial costs of hospitalization, multiple and complex issues of persons with severe mental illnesses, and advancements in pharmacotherapy, psychiatric patients are often only hospitalized for a few days before they are discharged. Thus, brief psychosocial interventions for persons who…

  16. Incidence of violent behavior among patients in Psychiatric Intensive Care Units

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    Valentina C. Iversen

    2016-03-01

    Full Text Available Background and Objectives: Both psychiatric acute units and psychiatric intensive care units (PICUs focus on acute treatment of behavioral disturbances such as violence and aggressive threats and acts. The aim of the present study is to describe the frequency of violent behavior; such as verbal or physical threats and physical attacks, among patients admitted to psychiatric intensive care unit (PICU. In addition the relationship between the episodes of threats and/or attacks in relation to time of the day, days of the week, and their seasonal variations was explored. Methods: All violent behavior was continuously assessed at the psychiatric emergency department. Data were collected during the period from May 2010 to May 2012. Results: Patients with only one hospitalization were less violent than those who have had two hospitalizations. There was a statistically significant difference in violence among patients without formal secondary education and those who have not formal education. Violent behavior showed two peaks during the day; the first occurring at 1 pm and the second at 8 pm. In regard to seasonality, summer had a higher incidence of violence. The most peaceful seasons of the year were spring and autumn. Conclusions: Violent behavior shows variation in daytime, days of the week and season in acute psychiatric intensive care. Daytime variation shows two peaks of violence at 1 pm and 8 pm, Sundays and Wednesdays being the quietest days regarding violence both in winter and summer. Patient's level of education and hospitalization status partially explain the variation.

  17. Risk factors leading to increased rehospitalization rates among adolescents admitted to an acute care child and adolescent psychiatric hospital.

    Science.gov (United States)

    McCarthy, Logan; Pullen, Lisa M; Savage, Jennifer; Cayce, Jonathan

    2017-09-18

    Suicide is the third leading cause of death in adolescents in the United States, with suicidal behavior peaking in adolescence. Suicidal and self-harming behavior is often chronic, with an estimated 15-30% of adolescents who attempt suicide having a second suicide attempt within a year. The focus of acute psychiatric hospitalization is on stabilization of these psychiatric symptoms resulting at times in premature discharge. Finding from studies based on high rehospitalization rates among adolescents admitted to an acute psychiatric hospital indicates that adolescents continue to experience crisis upon discharge from an acute psychiatric hospital, leading to the question of whether or not these adolescents are being discharged prematurely. A chart review was performed on 98 adolescent clients admitted to an acute psychiatric hospital to identify risk factors that may increase rehospitalization among adolescents admitted to an acute psychiatric hospital. Clients admitted to the hospital within a 12-month time frame were compared to clients who were not readmitted during that 12-month period. History of self-harming behavior and length of stay greater than 5 days were found to be risk factors for rehospitalization. Adolescent clients who are admitted to an acute psychiatric hospital with a history of self-harming behavior and extended length of stay need to be identified and individualized treatment plans implemented for preventing repeat hospitalizations. © 2017 Wiley Periodicals, Inc.

  18. The inpatient psychiatric unit as both a safe and unsafe place: implications for absconding.

    Science.gov (United States)

    Muir-Cochrane, Eimear; Oster, Candice; Grotto, Jessica; Gerace, Adam; Jones, Julia

    2013-08-01

    Absconding from acute psychiatric inpatient units is a significant issue with serious social, economic, and emotional costs. A qualitative study was undertaken to explore the experiences of people (n = 12) who had been held involuntarily under the local mental health act in an Australian inpatient psychiatric unit, and who had absconded (or attempted to abscond) during this time. The aim of the study was to explore why people abscond from psychiatric inpatient units, drawing on published work from health geography on the significance of the person-place encounter, and in particular the concept of 'therapeutic landscapes'. The findings show that the inpatient unit is perceived as a safe or unsafe place, dependent on the dialectical relationship between the physical, individual, social, and symbolic aspects of the unit. Consumers absconded when the unit was perceived as unsafe. Forming a therapeutic relationship with staff, familiarity with the unit, a comfortable environment, and positive experiences with other consumers all supported perceptions that the unit was safe, decreasing the likelihood of absconding. Findings extend existing work on the person-place encounter within psychiatric inpatient units, and bring new knowledge about the reasons why consumers abscond. Implications for practice are discussed.

  19. Improving the smoking patterns in a general hospital psychiatric unit

    Directory of Open Access Journals (Sweden)

    Celso Iglesias García

    2009-01-01

    Full Text Available Objectives: The purpose of the present paper is to evaluate the effects of a smoking ban in a general hospital psychiatric unit. Methods: We study the effects of smoking ban in 40 consecutive psychiatric inpatients. The staff registered socio-demographic and tobacco-related variables. We also registered any kind of behavioral effects of smoking ban.Results: The patients were willing to stop smoking during their hospital stay (with or without nicotine replacement with two mild behavioural incidences registered throughout the study. Conclusions: The benefits of non-smoking policy in a psychiatric unit can be significant. The introduction of smoking bans in psychiatric inpatients settings is possible and safe.

  20. Improving the smoking patterns in a general hospital psychiatric unit

    OpenAIRE

    Celso Iglesias García; María José Alonso Villa; Juan Carlos Bernaldo de Quirós; Elena Bocanegra Suárez; Julia Cueta Gonzalo; Rosario García del Valle; José Manuel González González; Álvaro Miranda García; Ana Belén Palacio Bande

    2009-01-01

    Objectives: The purpose of the present paper is to evaluate the effects of a smoking ban in a general hospital psychiatric unit. Methods: We study the effects of smoking ban in 40 consecutive psychiatric inpatients. The staff registered socio-demographic and tobacco-related variables. We also registered any kind of behavioral effects of smoking ban.Results: The patients were willing to stop smoking during their hospital stay (with or without nicotine replacement) with two mild behavioural inc...

  1. Prevalence and Risk Factors of Violence by Psychiatric Acute Inpatients: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Iozzino, Laura; Ferrari, Clarissa; Large, Matthew; Nielssen, Olav; de Girolamo, Giovanni

    2015-01-01

    Violence in acute psychiatric wards affects the safety of other patients and the effectiveness of treatment. However, there is a wide variation in reported rates of violence in acute psychiatric wards. To use meta-analysis to estimate the pooled rate of violence in published studies, and examine the characteristics of the participants, and aspects of the studies themselves that might explain the variation in the reported rates of violence (moderators). Systematic meta-analysis of studies published between January 1995 and December 2014, which reported rates of violence in acute psychiatric wards of general or psychiatric hospitals in high-income countries. Of the 23,972 inpatients described in 35 studies, the pooled proportion of patients who committed at least one act of violence was 17% (95% confidence interval (CI) 14-20%). Studies with higher proportions of male patients, involuntary patients, patients with schizophrenia and patients with alcohol use disorder reported higher rates of inpatient violence. The findings of this study suggest that almost 1 in 5 patients admitted to acute psychiatric units may commit an act of violence. Factors associated with levels of violence in psychiatric units are similar to factors that are associated with violence among individual patients (male gender, diagnosis of schizophrenia, substance use and lifetime history of violence).

  2. Prevention and management of aggression training and violent incidents on U.K. Acute psychiatric wards.

    Science.gov (United States)

    Bowers, Len; Nijman, Henk; Allan, Teresa; Simpson, Alan; Warren, Jonathan; Turner, Lynny

    2006-07-01

    Reports of violence and injuries to staff and patients in acute psychiatric inpatient settings have led to the development and implementation of training courses in the Prevention and Management of Violence and Aggression (PMVA). The purpose of this study was to explore the relationship between PMVA training of acute psychiatric ward nursing staff and officially reported violent incident rates. A retrospective analysis was conducted of training records (312 course attendances) and violent incident rates (684 incidents) over two-and-a-half years on 14 acute admission psychiatric wards (5,384 admissions) at three inner-city hospitals in the United Kingdom as part of the Tompkins Acute Ward Study. A positive association was found between training and rates of violent incidents. There was weak evidence that increased rates of aggressive incidents prompted course attendance, no evidence that course attendance reduced violence, and some evidence that attendance of briefer update courses triggered small short-term rises in rates of physical aggression. Course attendance was associated with a rise in physical and verbal aggression while staff were away from the ward. The failure to find a drop in incident rates after training, coupled with the small increases in incidents detected, raises concerns about the training course's efficacy as a preventive strategy. Alternatively, the results are consistent with a threshold effect, indicating that once adequate numbers of staff have been trained, further training keeps incidents at a low rate.

  3. A sociological study of bed blocking in psychiatric rehabilitation units.

    Science.gov (United States)

    Leighton, Kevin

    2002-08-01

    This study focuses on the reported problem of psychiatric patients who are 'bed-blocking' mental health rehabilitation units. It explores the concept of individualized care within psychiatric nursing and argues that this 'received view' is counterproductive for some client groups. Individualized care assumes a number of mainstream social values and beliefs that may conflict radically with the attitudes to life (ideologies) of some service users. These clients may resist normalisation, independence and individualism, preferring instead a more collective, pastoral and spiritual lifestyle. Clients and nurses may reject culture-biased care policy, using various strategies to neutralize individualized care in practice. In the absence of a coherent alternative, such action may lead to frustration, alienation and bed blocking. The study uses structured and unstructured interviews in two psychiatric units to examine this hypothesis.

  4. Warning signs prior to aggressive behavior in child psychiatric units

    NARCIS (Netherlands)

    Faay, M.D.M.; Valenkamp, M.W.; Nijman, H.L.I.

    2017-01-01

    This study aims at detecting and categorizing early warning signs of aggressive behavior in child psychiatric units. We analyzed 575 violent incident report forms and developed a coding scheme consisting of 16 warning signs. From the 575 incident report forms, a total of 1087 signs were coded. Most

  5. Outbreak of Streptococcus pneumoniae in a Psychiatric Unit

    Centers for Disease Control (CDC) Podcasts

    2012-11-02

    Dr. Katherine Fleming-Dutra, an epidemiologist at CDC, discusses her investigation of a Streptococcus pneumoniae outbreak in a pediatric psychiatric unit.  Created: 11/2/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID); National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 11/5/2012.

  6. The Jerusalem psychiatric mother-baby unit.

    Science.gov (United States)

    Maizel, S; Kandel Katzenelson, S; Fainstein, V

    2005-09-01

    The Jerusalem mother and baby unit (MBU) is influenced by the psychoanalytical orientation of the staff, and the historical and cultural conditions surrounding the unit. Forty-three patients with 44 babies (one set of twins) were admitted in 13 years, a rate of admission far from the theoretical demand. Schizophrenia, schizoaffective disorder and mood disorders have been the major diagnoses in more than 50% of the patients. Mothers with schizophrenia were significantly more likely to be admitted sooner after the birth than mothers without schizophrenia (p = 0.025). One infant was separated from the mother on discharge and four recommendations for adoption were given.

  7. An observational study in psychiatric acute patients admitted to General Hospital Psychiatric Wards in Italy

    Directory of Open Access Journals (Sweden)

    Margari Francesco

    2007-01-01

    Full Text Available Abstract Objectives this Italian observational study was aimed at collecting data of psychiatric patients with acute episodes entering General Hospital Psychiatric Wards (GHPWs. Information was focused on diagnosis (DSM-IV, reasons of hospitalisation, prescribed treatment, outcome of aggressive episodes, evolution of the acute episode. Methods assessments were performed at admission and discharge. Used psychometric scales were the Brief Psychiatric Rating Scale (BPRS, the Modified Overt Aggression Scale (MOAS and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30. Results 864 adult patients were enrolled in 15 GHPWs: 728 (320 M; mean age 43.6 yrs completed both admission and discharge visits. A severe psychotic episode with (19.1% or without (47.7% aggressive behaviour was the main reason of admission. Schizophrenia (42.8% at admission and 40.1% at discharge and depression (12.9% at admission and 14.7% at discharge were the predominant diagnoses. The mean hospital stay was 12 days. The mean (± SD total score of MOAS at admission, day 7 and discharge was, respectively, 2.53 ± 5.1, 0.38 ± 2.2, and 0.21 ± 1.5. Forty-four (6.0% patients had episodes of aggressiveness at admission and 8 (1.7% at day 7. A progressive improvement in each domain/item vs. admission was observed for MOAS and BPRS, while NOSIE-30 did not change from day 4 onwards. The number of patients with al least one psychotic drug taken at admission, in the first 7 days of hospitalisation, and prescribed at discharge, was, respectively: 472 (64.8%, 686 (94.2% and 676 (92.9%. The respective most frequently psychotic drugs were: BDZs (60.6%, 85.7%, 69.5%, typical anti-psychotics (48.3%, 57.0%, 49.6%, atypical anti-psychotics (35.6%, 41.8%, 39.8% and antidepressants (40.9%, 48.8%, 43.2%. Rates of patients with one, two or > 2 psychotic drugs taken at admission and day 7, and prescribed at discharge, were, respectively: 24.8%, 8.2% and 13.5% in mono-therapy; 22.0%, 20

  8. Dissociative disorders in acute psychiatric inpatients in Taiwan.

    Science.gov (United States)

    Chiu, Chui-De; Meg Tseng, Mei-Chih; Chien, Yi-Ling; Liao, Shih-Cheng; Liu, Chih-Min; Yeh, Yei-Yu; Hwu, Hai-Gwo; Ross, Colin A

    2017-04-01

    Dissociative disorders have been documented to be common psychiatric disorders which can be detected reliably with standardized diagnostic instruments in North American and European psychiatric inpatients and outpatients (20.6% and 18.4%, respectively). However, there are concerns about their cross-cultural manifestations as an apparently low prevalence rate has been reported in East Asian inpatients and outpatients (1.7% and 4.9%, respectively). It is unknown whether the clinical profile of dissociative disorders in terms of their core symptomatic clusters, associated comorbid disorders, and environmental risk factors that has emerged in western clinical populations can also be found in non-western clinical populations. A standardized structured interview for DSM-IV dissociative disorders, post-traumatic stress disorder, and a history of interpersonal victimization was administered in a sample of Taiwanese acute psychiatric inpatients. Our results showed that 19.5% of our participants met criteria for a DSM-IV dissociative disorder, mostly dissociative disorder not otherwise specified. More importantly, the western clinical profile of dissociative disorders also characterized our patients, including a poly-symptomatic presentation and a history of interpersonal trauma in both childhood and adulthood. Our results lend support to the conclusion that cross-cultural manifestations of dissociative pathology in East Asia are similar to those in North America and Europe. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  9. Acute psychiatric inpatient care: A cross-cultural comparison between two hospitals in Germany and Japan

    OpenAIRE

    2012-01-01

    Background: Intercultural differences influence acute inpatient psychiatric care systems. Aims: To evaluate characteristics of acute inpatient care in a German and a Japanese hospital. Method: Based on a sample of 465 admissions to the Psychiatric State Hospital Regensburg (BKR) and 91 admissions to the Hirakawa Hospital (HH) over a six-month period in 2008, data from the psychiatric basic documentation system (BADO) were analysed with regard to socio-demographic characteristics, treatm...

  10. Effectiveness of a Multimodal Intervention Program for Restraint Prevention in an Acute Spanish Psychiatric Ward.

    Science.gov (United States)

    Guzman-Parra, Jose; Aguilera Serrano, Carlos; García-Sánchez, Juan A; Pino-Benítez, Isabel; Alba-Vallejo, Mercedes; Moreno-Küstner, Berta; Mayoral-Cleries, Fermin

    2016-05-01

    International recommendations have called to implement strategies to reduce the use of coercion in psychiatric settings. However, in Spain there is a lack of research about intervention programs to reduce mechanical restraint in acute psychiatric units. The aim of this study was to evaluate the effectiveness of a multimodal intervention program based on the principles of six core strategies to reduce the frequency of use of mechanical restraint in an acute psychiatric ward. The design was a retrospective analysis of the frequency and duration of episodes of mechanical restraint prior to the intervention program (2012) and during the intervention program (2013) in one acute psychiatric ward. The intervention was governed by four strategies: (1) leadership and organizational changes, (2) registration and monitoring of risk patients, (3) staff training, and (4) involving patients in the treatment program. There was a significant difference between the mean number of monthly episodes of mechanical restraint per 1,000 patient days, pre-intervention (18.54 ± 8.78) compared with postintervention (8.53 ± 7.00; p = .005). We found the probability that mechanical restraint would occur in a hospital admission decreased after performing the intervention (odds ratio = .587; confidence interval = 0.411-0.838; p = .003) after adjusting for confounding variables. The total percentage of restrained patients fell from 15.07% to 9.74%. The main implication of the study is to support the effectiveness of specific intervention programs based on different measures to reduce mechanical restraint and without contemplating all the strategies that are considered effective. © The Author(s) 2016.

  11. Risk Factors of Acute Behavioral Regression in Psychiatrically Hospitalized Adolescents with Autism

    Science.gov (United States)

    Périsse, Didier; Amiet, Claire; Consoli, Angèle; Thorel, Marie-Vincente; Gourfinkel-An, Isabelle; Bodeau, Nicolas; Guinchat, Vincent; Barthélémy, Catherine; Cohen, David

    2010-01-01

    Aim: During adolescence, some individuals with autism engage in severe disruptive behaviors, such as violence, agitation, tantrums, or self-injurious behaviors. We aimed to assess risk factors associated with very acute states and regression in adolescents with autism in an inpatient population. Method: Between 2001 and 2005, we reviewed the charts of all adolescents with autism (N=29, mean age=14.8 years, 79% male) hospitalized for severe disruptive behaviors in a psychiatric intensive care unit. We systematically collected data describing socio-demographic characteristics, clinical variables (severity, presence of language, cognitive level), associated organic conditions, etiologic diagnosis of the episode, and treatments. Results: All patients exhibited severe autistic symptoms and intellectual disability, and two-thirds had no functional verbal language. Fifteen subjects exhibited epilepsy, including three cases in which epilepsy was unknown before the acute episode. For six (21%) of the subjects, uncontrolled seizures were considered the main cause of the disruptive behaviors. Other suspected risk factors associated with disruptive behavior disorders included adjustment disorder (N=7), lack of adequate therapeutic or educational management (N=6), depression (N=2), catatonia (N=2), and painful comorbid organic conditions (N=3). Conclusion: Disruptive behaviors among adolescents with autism may stem from diverse risk factors, including environmental problems, comorbid acute psychiatric conditions, or somatic diseases such as epilepsy. The management of these behavioral changes requires a multidisciplinary functional approach. PMID:20467546

  12. Patient access to medical records on a psychiatric inpatient unit.

    Science.gov (United States)

    Stein, E J; Furedy, R L; Simonton, M J; Neuffer, C H

    1979-03-01

    The authors studied the effects of patient access to medical records during hospitalization in a psychiatric unit of a community general hospital. Questionnaires were completed by about 20 staff and 88 patients, and records were compared with those from an earlier period to note any changes in the written record. Patients reported feeling better informed and more involved in their treatment, and staff said that they became more thoughtful about their notes in the chart. The availability of staff seems crucial to this process and facilitates the working alliance.

  13. Human Bite of a Staff Nurse on a Psychiatric Unit.

    Science.gov (United States)

    Suguna, Anbazhagan; Joseph, Bobby

    2016-04-01

    Occupational violence among health care professionals is a cause for concern, although often neglected especially in developing countries like India. Violence undermines the healing mission of the health care organization and interferes with the ability of the health care team to optimally contribute to positive patient outcomes. The authors discuss a case of a human bite of a staff nurse on a psychiatric unit in a tertiary care Indian hospital. The reported violence against this staff nurse lead to her admission for emergency care followed by emotional stress. Issues related to prevention of occupational violence are also discussed. © 2015 The Author(s).

  14. What happens when 55% of acute psychiatric beds are closed in six days: an unexpected naturalistic observational study

    Science.gov (United States)

    Branch, Matt; Mitchell, Anji; Parkin, Lindsay; Confue, Phil; Shankar, Rohit; Wilson-James, Diane; Marshall, Mike; Edgecombe, Maria; Keaney, Bernie; Gill, Kiran; Harrison, Juliet

    2016-01-01

    Objective The sudden closure of 30 out of 54 acute psychiatric beds in Cornwall presented a stressful challenge to staff but also a natural experiment on how a service dealt with this situation. We aimed to evaluate the outcomes of patients needing to leave the closed ward, how bed occupancy rates were affected and the impact on admission rates. Design A service evaluation of the impact of the ward closure. Setting A comprehensive secondary NHS mental health service in Cornwall serving 550,000 population. Main outcome measures The destination of the patients needing to leave the acute unit, the effect of the closure on bed occupancy, admission rates and serious untoward incidents. Results Of 26 patients needing to be moved from the acute ward, only 10 needed an acute psychiatric bed. None of the seven patients who had been on the ward longer than nine weeks needed an acute unit. Admission rates fell over the subsequent three months. There was no increase in serious incidents due to the closure. Conclusions This naturalistic event suggests that many patients on acute units could be cared for elsewhere, especially recovery/rehabilitation care environments, if political and financial urgency is present. Admission rates are responsive to the pressure on beds. PMID:27757241

  15. Switch Function and Pathological Dissociation in Acute Psychiatric Inpatients.

    Directory of Open Access Journals (Sweden)

    Chui-De Chiu

    Full Text Available Swift switching, along with atypical ability on updating and inhibition, has been found in non-clinical dissociators. However, whether swift switching is a cognitive endophenotype that intertwines with traumatisation and pathological dissociation remains unknown. Unspecified acute psychiatric patients were recruited to verify a hypothesis that pathological dissociation is associated with swift switching and traumatisation may explain this relationship. Behavioural measures of intellectual function and three executive functions including updating, switching and inhibition were administered, together with standardised scales to evaluate pathological dissociation and traumatisation. Our results showed superior control ability on switching and updating in inpatients who displayed more symptoms of pathological dissociation. When all three executive functions were entered as predictors, in addition to intellectual quotient and demographic variables to regress upon pathological dissociation, switching rather than updating remained the significant predictor. Importantly, the relationship between pathological dissociation and switching became non-significant when the effect of childhood trauma were controlled. The results support a trauma-related switching hypothesis which postulates swift switching as a cognitive endophenotype of pathological dissociation; traumatisation in childhood may explain the importance of swift switching.

  16. Quantitative EEG findings in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department

    Directory of Open Access Journals (Sweden)

    Linaker Olav M

    2008-11-01

    Full Text Available Abstract Background Patients with brief depressive episodes and concurrent rapidly fluctuating psychiatric symptoms do not fit current diagnostic criteria and they can be difficult to diagnose and treat in an acute psychiatric setting. We wanted to study whether these patients had signs of more epileptic or organic brain dysfunction than patients with depression without additional symptomatology. Methods Sixteen acutely admitted patients diagnosed with a brief depressive episode as well as another concurrent psychiatric diagnosis were included. Sixteen patients with major depression served as controls. Three electroencephalographic studies (EEG were visually interpreted and the background activity was also analysed with quantitative electroencephalography (QEEG. Results The group with brief depression and concurrent symptoms had multiple abnormal features in their standard EEG compared to patients with major depression, but they did not show significantly more epileptiform activity. They also had significantly higher temporal QEEG delta amplitude and interhemispheric temporal delta asymmetry. Conclusion Organic brain dysfunction may be involved in the pathogenesis of patients with brief depressive episodes mixed with rapidly fluctuating psychiatric symptoms. This subgroup of depressed patients should be investigated further in order to clarify the pathophysiology and to establish the optimal evaluation scheme and treatment in an acute psychiatric setting.

  17. Acute and long-term psychiatric side effects of mefloquine

    DEFF Research Database (Denmark)

    Ringqvist, Asa; Bech, Per; Glenthøj, Birte

    2014-01-01

    psychiatric side effects were retrospectively assessed using the SCL-90-R and questions based on Present State Examination (PSE). Subjects reporting suspected psychotic states were contacted for a personal PSE interview. Electronic records of psychiatric hospitalizations and diagnoses were cross-checked. Long...

  18. Symptoms of epilepsy and organic brain dysfunctions in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department

    Directory of Open Access Journals (Sweden)

    Linaker Olav M

    2009-09-01

    Full Text Available Abstract Background In psychiatric acute departments some patients present with brief depressive periods accompanied with fluctuating arrays of other psychiatric symptoms like psychosis, panic or mania. For the purpose of the present study we call this condition Acute Unstable Depressive Syndrome (AUDS. The aims of the present study were to compare clinical signs of organic brain dysfunctions and epilepsy in patients with AUDS and Major Depressive Episode (MDE. Methods Out of 1038 consecutive patients admitted to a psychiatric acute ward, 16 patients with AUDS and 16 age- and gender-matched MDE patients were included in the study. Using standardized instruments and methods we recorded clinical data, EEG and MRI. Results A history of epileptic seizures and pathologic EEG activity was more common in the AUDS group than in the MDE group (seizures, n = 6 vs. 0, p = 0.018; pathologic EEG activity, n = 8 vs. 1, p = 0.015. Five patients in the AUDS group were diagnosed as having epilepsy, whereas none of those with MDE had epilepsy (p = 0.043. There were no differences between the groups regarding pathological findings in neurological bedside examination and cerebral MRI investigation. Conclusion Compared to patients admitted with mood symptoms fulfilling DSM 4 criteria of a major depressive disorder, short-lasting atypical depressive symptoms seem to be associated with a high frequency of epileptic and pathologic EEG activity in patients admitted to psychiatric acute departments. Trial registration NCT00201474

  19. Psychiatric emergency services in Amsterdam: Experiences with acute admissions in a metropolitan area

    NARCIS (Netherlands)

    Mulder, W.; Dekker, J.J.M.; Gijsbers van WIjk, C.

    2005-01-01

    Problems in the acute sector of psychiatric care are not unique to the Netherlands and at an international level appear to be linked to problems that are significant for big cities. The search for an “acute bed” had become more difficult and patients were being placed and transported through the who

  20. Psychiatric emergency services in Amsterdam: Experiences with acute admissions in a metropolitan area

    NARCIS (Netherlands)

    Mulder, W.; Dekker, J.J.M.; Gijsbers van WIjk, C.

    2005-01-01

    Problems in the acute sector of psychiatric care are not unique to the Netherlands and at an international level appear to be linked to problems that are significant for big cities. The search for an “acute bed” had become more difficult and patients were being placed and transported through the

  1. Psychiatric context of acute/early HIV infection. The NIMH Multisite Acute HIV Infection Study: IV.

    Science.gov (United States)

    Atkinson, J Hampton; Higgins, Jenny A; Vigil, Ofilio; Dubrow, Robert; Remien, Robert H; Steward, Wayne T; Casey, Corinna Young; Sikkema, Kathleen J; Correale, Jackie; Ake, Chris; McCutchan, J Allen; Kerndt, Peter R; Morin, Stephen F; Grant, Igor

    2009-12-01

    Acute/early HIV infection is a period of high risk for HIV transmission. Better understanding of behavioral aspects during this period could improve interventions to limit further transmission. Thirty-four participants with acute/early HIV infection from six US cities were assessed with the Mini International Diagnostic Interview, Beck Depression Inventory II, State-Trait Anxiety Inventory, Brief COPE, and an in-depth interview. Most had a pre-HIV history of alcohol or substance use disorder (85%); a majority (53%) had a history of major depressive or bipolar disorder. However, post-diagnosis coping was predominantly adaptive, with only mild to moderate elevations of anxious or depressive mood. Respondents described challenges managing HIV in tandem with pre-existing substance abuse problems, depression, and anxiety. Integration into medical and community services was associated with adaptive coping. The psychiatric context of acute/early HIV infection may be a precursor to infection, but not necessarily a barrier to intervention to reduce forward transmission of HIV among persons newly infected.

  2. Sleep in acute care units.

    Science.gov (United States)

    BaHammam, Ahmed

    2006-03-01

    Patients in the acute care units (ACU) are usually critically ill, making them more susceptible to the unfavorable atmosphere in the hospital. One of these unfavorable factors is sleep disruption and deprivation. Many factors may affect sleep in the ACU, including therapeutic interventions, diagnostic procedures, medications, the underlying disease process, and noise generated in the ACU environment. Many detrimental physiological effects can occur secondary to noise and sleep deprivation, including cardiovascular stimulation, increased gastric secretion, pituitary and adrenal stimulation, suppression of the immune system and wound healing, and possible contribution to delirium. Over the past few years, many studies have endeavored to objectively assess sleep in the ACUs, as well as the effect of mechanical ventilation and circadian rhythm changes critically ill patients. At this time, therefore, it is important to review published data regarding sleep in ACUs, in order to improve the knowledge and recognition of this problem by health care professionals. We have therefore reviewed the methods used to assess sleep in ACUs, factors that may affect sleep in the ACU environment, and the clinical implications of sleep disruption in the ACU.

  3. Adverse incidents, patient flow and nursing workforce variables on acute psychiatric wards: the Tompkins Acute Ward Study

    OpenAIRE

    Bowers, L.; Allan, T.; Simpson, A.; Nijman, H; Warren, J.

    2007-01-01

    Background: Adverse incidents (violence, self-harm and absconding) can cause significant harm to patients and staff, are difficult to predict, and are driving an increase in security measures and defensive practice.\\ud \\ud Aims: To explore the relationship between adverse incidents on acute psychiatric wards, admissions and nursing workforce variables.\\ud \\ud Methods: A retrospective analysis of officially collected data covering a period of 30 months on 14 acute wards at three hospitals. Thi...

  4. Nurse-police coalition: improves safety in acute psychiatric hospital.

    Science.gov (United States)

    Allen, Diane E; Harris, Frank N; de Nesnera, Alexander

    2014-09-01

    Although police officers protect and secure the safety of citizens everywhere, nurses are the primary guardians of patient safety within the treatment milieu. At New Hampshire Hospital, both nurses and police officers share ownership of this responsibility, depending on the needs that arise specific to each profession. Psychiatric nurses take pride in their ability to de-escalate agitated and potentially aggressive patients; however, times arise when the best efforts of nurses fail, or when a situation requires intervention from police officers. Nurses and police officers at New Hampshire Hospital have worked together for many years to develop a trusting, respectful alliance. This coalition has resulted in a safe, clear, orderly process for transfer of authority from nurses to police during violent, clinically unmanageable psychiatric emergencies. Nurses and police officers work collaboratively toward the common goal of ensuring safety for patients and staff, while also acknowledging the unique strengths of each profession.

  5. Depression in patients with schizophrenia admitted to the acute services of the Psychiatric Hospital of Havana

    OpenAIRE

    Llanes Basulto, Yasmani; Barrios Hernández, Yanquiel; Oliva Hernández, Ignacio; Pimentel Noda, Susel de la Caridad; Calvo Guerra, Esvieta

    2014-01-01

    The presence of depression in the acute phase of schizophrenia is evaluated, and the clinical and psychosocial characteristics that can be associated with depression are identified. Participants included 73 patients that were admitted to the acute services of the Psychiatric Hospital of Havana, given that depression is a symptom in a significant amount of the patients with schizophrenia, 35.6% of the patients presented clinically significant symp- toms, and these were related significantly wi...

  6. Investigation into the acceptability of door locking to staff, patients, and visitors on acute psychiatric wards.

    Science.gov (United States)

    Muir-Cochrane, Eimear; van der Merwe, Marie; Nijman, Henk; Haglund, Kristina; Simpson, Alan; Bowers, Len

    2012-02-01

    There is disagreement among psychiatric professionals about whether the doors of acute psychiatric wards should be kept locked to prevent patients from leaving and harming themselves or others. This study explored patient, staff, and visitor perceptions about the acceptability of locking the ward door on acute psychiatric inpatient wards. Interviews were conducted with 14 registered nurses, 15 patients, and six visitors from three different acute wards. Findings revealed commonalities across all groups, with general agreement that locking the door reduced absconding. Staff expressed feelings of guilt, embarrassment, and fear of being blamed when a patient absconded. Staff also reported that open wards created anxious vigilance to prevent an abscond and increased workload in allocating staff to watch the door, whereas staff on partially-locked doors also perceived an increased workload in letting people in and out of the ward. Patients had mixed feelings about the status of the door, expressing depression, a sense of stigma, and low self-esteem when the door was locked. The issue of balancing safety and security on acute psychiatric wards against the autonomy of patients is not easily resolved, and requires focused research to develop innovative nursing practices. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

  7. Nurses' experiences of patient suicide and suicide attempts in an acute unit

    OpenAIRE

    DOYLE, LOUISE

    2008-01-01

    PUBLISHED Suicide and suicide attempts in Ireland have increased dramatically in the last twenty years. Many of the presentations of suicide attempts to Emergency Departments are recommended an admission to an acute mental health unit. A psychiatric staff nurse working in an acute mental health setting has a high chance of experiencing a patient suicide or suicide attempt during their career. The occurrence of an inpatient suicide or suicide attempt is unquestionably an overwhelmingly stre...

  8. A Comparative Study of Pituitary Volume Variations in MRI in Acute Onset of Psychiatric Conditions.

    Science.gov (United States)

    Soni, Brijesh Kumar; Joish, Upendra Kumar; Sahni, Hirdesh; George, Raju A; Sivasankar, Rajeev; Aggarwal, Rohit

    2017-02-01

    The growing belief that endocrine abnormalities may underlie many mental conditions has led to increased use of imaging and hormonal assays in patients attending to psychiatric OPDs. People who are in an acute phase of a psychiatric disorder show Hypothalamic Pituitary Adrenal (HPA) axis hyperactivity, but the precise underlying central mechanisms are unclear. To assess the pituitary gland volume variations in patients presenting with new onset acute psychiatric illness in comparison with age and gender matched controls by using MRI. The study included 50 patients, with symptoms of acute psychiatric illness presenting within one month of onset of illness and 50 age and gender matched healthy controls. Both patients and controls were made to undergo MRI of the Brain. A 0.9 mm slices of entire brain were obtained by 3 dimensional T1 weighted sequence. Pituitary gland was traced in all sagittal slices. Anterior pituitary and posterior pituitary bright spot were measured separately in each slice. Volume of the pituitary (in cubic centimetre- cm(3)) was calculated by summing areas. Significance of variations in pituitary gland volumes was compared between the cases and controls using Analysis of Covariance (ANOVA). There were significantly larger pituitary gland volumes in the cases than the controls, irrespective of psychiatric diagnosis (ANOVA, f=15.56; p=0.0002). Pituitary volumes in cases were 15.36% (0.73 cm(3)) higher than in controls. There is a strong likelihood of HPA axis overactivity during initial phase of all mental disorders along with increased pituitary gland volumes. Further studies including hormonal assays and correlation with imaging are likely to provide further insight into neuroanatomical and pathological basis of psychiatric disorders.

  9. Acute infantile motor unit disorder. Infantile botulism?

    Science.gov (United States)

    Clay, S A; Ramseyer, J C; Fishman, L S; Sedgwick, R P

    1977-04-01

    Eight infants with an acute reversible motor unit disorder are described, including two infants from whom Clostridum botulinum type A was isolated from stool specimens. The clinical spectrum includes constipation, cranial nerve deficits, pupillary involvement, and generalized hypotonic weakness. There were no deaths, and all infants have had complete clinical recovery. A characteristic electromyographic (EMG) pattern was present in part until clinical recovery. This distinctive pattern consisted of brief, small, abundant for power exerted motor unit potentials. This EMG pattern in the context of the clinical syndrome may well be diagnostic for acute infantile motor unit disorder.

  10. Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology.

    Science.gov (United States)

    Svindseth, Marit F; Nøttestad, Jim Aage; Wallin, Juliska; Roaldset, John Olav; Dahl, Alv A

    2008-02-27

    The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM). This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21), The Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM). Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations >/=0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales. Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination.

  11. Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology

    Science.gov (United States)

    Svindseth, Marit F; Nøttestad, Jim Aage; Wallin, Juliska; Roaldset, John Olav; Dahl, Alv A

    2008-01-01

    Background The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM). Methods This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21), The Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM). Results Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales. Conclusion Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination. PMID:18304339

  12. Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology

    Directory of Open Access Journals (Sweden)

    Wallin Juliska

    2008-02-01

    Full Text Available Abstract Background The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM. Methods This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS and the Global Assessment of Functioning (GAF. The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21, The Hospital Anxiety and Depression Scale (HADS and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM. Results Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales. Conclusion Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination.

  13. Effects of suicidal behavior on a psychiatric unit nursing team.

    Science.gov (United States)

    Joyce, Beverley; Wallbridge, Hal

    2003-03-01

    1. Suicide of a psychiatric inpatient can have significant, although diverse, effects on the emotions and behavior of both individual nurses and team functioning. 2. The majority of participants in this study felt there was a need for formal debriefing or counseling for themselves and their colleagues after a critical incident, although there was less consensus about the timing and structure of such an intervention. 3. This research highlights the need for advanced training of critical incident stress management team members and for flexibility in the application of critical incident stress management techniques.

  14. Experiences by student nurses during clinical placement in psychiatric units in a hospital

    Directory of Open Access Journals (Sweden)

    W.J.C. Van Rhyn

    2004-09-01

    Full Text Available An exploratory study was conducted with the aim of discovering and describing experiences of psychiatric nursing students during clinical placement in a psychiatric unit. For the purpose of the study an unstructured interview was conducted with each participant during their first placement in a psychiatric unit to identify the factors experienced as stressful. The results indicated that all eight participants experienced average to high stress. Sources of stress identified included, among others, ineffective teaching and learning programmes, poor managerial governance of the service, detachment of professional nurses from their teaching role, poor relationships among staff, overreliance on the medical model of care and patient neglect. Psychiatric nursing students sampled indicated universal support for in-service education and training for professional nurses, attitude change of professional nurses towards students, support for student initiatives, student involvement in patient care and adequate allocation of resources for patient care and nurse training. The exploration and description of experiences of the psychiatric nursing students will help nurse educators plan clinical learning opportunities in such a way that they are less stressful, thus ensuring that psychiatric nursing students are equipped to utilise themselves as therapeutic instruments.

  15. Psychiatric disorders in children attending a Nigerian primary care unit: functional impairment and risk factors

    Directory of Open Access Journals (Sweden)

    Tunde-Ayinmode Mosunmola

    2012-07-01

    Full Text Available Abstract Background There is dearth of data on the level of functional impairment and risk factors for psychiatric morbidity in children attending primary care services in developing countries like Nigeria. The risk factors for psychiatric morbidity and functional impairment in children attending the primary care unit of a teaching hospital in Ilorin, Nigeria was therefore investigated to obtain data that could be used in improving service provision by primary care physicians. Methods A cross-sectional two-stage design was employed for the study. The first stage involved administration of the Child Behavior Questionnaire (CBQ to 350 children while the children’s version of the schedule for affective disorders and schizophrenia was used for the second stage involving 157 children, all high scorers on CBQ (score of ≥ 7 and 30% of low scorers (score  In addition, the Children Global Assessment Scale was used to assess the functional status of the children (score of ≤ 70 indicates functional impairment while the mothers’ mental health status was assessed with the 12-item version of the General Health Questionnaire, a score of 3 or more on this instrument indicate presence of mental morbidity. Results It was observed that 11.4% of the children had diagnosable psychiatric disorders and 7.1% were functionally impaired; and those with psychiatric disorders were more functionally impaired than those without. Thus, significant negative correlation was noted between CBQ scores and CGAS (r = 0.53; p  Conclusions Child psychiatric disorders are prevalent in the primary care unit studied. Many of the risk factors identified in the study population are modifiable. Collaborative efforts between psychiatrists and primary care physicians could therefore help to reduce level of risk and functional impairment and psychiatric morbidity among children attending the primary care unit studied. It could also help improve referral rates of

  16. Identifying Patients in the Acute Psychiatric Hospital Who May Benefit From a Palliative Care Approach.

    Science.gov (United States)

    Burton, M Caroline; Warren, Mark; Cha, Stephen S; Stevens, Maria; Blommer, Megan; Kung, Simon; Lapid, Maria I

    2016-04-01

    Identifying patients who will benefit from a palliative care approach is the first critical step in integrating palliative with curative therapy. Criteria are established that identify hospitalized medical patients who are near end of life, yet there are no criteria with respect to hospitalized patients with psychiatric disorders. The records of 276 consecutive patients admitted to a dedicated inpatient psychiatric unit were reviewed to identify prognostic criteria predictive of mortality. Mortality predictors were 2 or more admissions in the past year (P = .0114) and older age (P = .0006). Twenty-two percent of patients met National Hospice and Palliative Care Organization noncancer criteria for dementia. Palliative care intervention should be considered when treating inpatients with psychiatric disorders, especially older patients who have a previous hospitalization or history of dementia.

  17. A systematic review of music therapy practice and outcomes with acute adult psychiatric in-patients.

    Directory of Open Access Journals (Sweden)

    Catherine Carr

    Full Text Available There is an emerging evidence base for the use of music therapy in the treatment of severe mental illness. Whilst different models of music therapy have been developed in mental health care, none have specifically accounted for the features and context of acute in-patient settings. This review aimed to identify how music therapy is provided for acute adult psychiatric in-patients and what outcomes have been reported.A systematic review using medical, psychological and music therapy databases. Papers describing music therapy with acute adult psychiatric in-patients were included. Analysis utilised narrative synthesis.98 papers were identified, of which 35 reported research findings. Open group work and active music making for nonverbal expression alongside verbal reflection was emphasised. Aims were engagement, communication and interpersonal relationships focusing upon immediate areas of need rather than longer term insight. The short stay, patient diversity and institutional structure influenced delivery and resulted in a focus on single sessions, high session frequency, more therapist direction, flexible use of musical activities, predictable musical structures, and clear realistic goals. Outcome studies suggested effectiveness in addressing a range of symptoms, but were limited by methodological shortcomings and small sample sizes. Studies with significant positive effects all used active musical participation with a degree of structure and were delivered in four or more sessions.No single clearly defined model exists for music therapy with adults in acute psychiatric in-patient settings, and described models are not conclusive. Greater frequency of therapy, active structured music making with verbal discussion, consistency of contact and boundaries, an emphasis on building a therapeutic relationship and building patient resources may be of particular importance. Further research is required to develop specific music therapy models for this

  18. Implementing Best Practice Guidelines in Pain Assessment and Management on a Women's Psychiatric Inpatient Unit: Exploring Patients' Perceptions.

    Science.gov (United States)

    Rolin-Gilman, Cheryl; Fournier, Bonnie; Cleverley, Kristin

    2017-06-01

    Assessing and managing chronic pain in women with histories of interpersonal trauma, mood disorders and co-morbid addiction is complex. The aim of this paper is to report on the findings from a quality improvement project exploring women's experiences who have co-occurring mental health issues, addiction and chronic pain. Exploring perceptions was an initial step in implementing the Registered Nurses' Association of Ontario (RNAO) Best Practice Guideline (BPG) on the Assessment and Management of Pain. Focus group discussions were conducted using an exploratory design with 10 women who were hospitalized in an acute psychiatric unit. Our findings suggest that these women view their pain as complex and often feel powerless within an acute psychiatric setting resorting to coping through self management. The women expressed the importance of therapeutic relationships with clinicians in assessing and managing their pain. The implications of this study suggest that patients have a key role in informing the implementation and applicability of best practice guidelines. Validating the patient's personal pain management experience and particular psychological and physical therapies were suggested as strategies to enhance the patient's quality of life. Many clinicians working in mental health are knowledgeable about these therapies, but may not be aware of the application to managing physical pain. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  19. Acute atropine intoxication with psychiatric symptoms by herbal infusion of Pulmonaria officinalis (Lungwort

    Directory of Open Access Journals (Sweden)

    Enrique Baca-García

    2007-06-01

    Full Text Available Background and objectives: Lungwort infusion is a preparation extracted from Pulmonaria officinalis which is occasionally used as a folk remedy for the common cold. The current report aims to describe acute atropine intoxications with delirium caused by Lungwort infusion in several members of the same family. Methods: Description of three case reports. Search of literature through Medline. Results: Three generations of a same family presented acute and moderately severe atropine intoxications after drinking an infusion prepared with Pulmonaria officinalis. Conclusions: Despite the lack of scientific evidence for its clinical use, medicinal plants continue being widely used. In spite of severe adverse effects reported, the general thought is that herbal remedies are harmless. To our knowledge, this is the first report of acute atropine intoxications with psychiatric symptoms secondary to Pulmonaria officinalis in several members of a family. We suspect that the lungwort infusion may have been contaminated with some other substance with atropinic properties.

  20. Specific psychiatric correlates of acute care utilization among unstably housed HIV-positive adults.

    Science.gov (United States)

    Chartier, Maggie; Carrico, Adam W; Weiser, Sheri D; Kushel, Margot B; Riley, Elise D

    2012-01-01

    The role of specific psychiatric diagnoses in emergency department use and/or inpatient hospitalizations (acute care) has not been extensively examined among HIV-infected, unstably housed persons. A community-recruited sample of 284 HIV-infected, unstably housed adults completed the Diagnostic Interview Schedule for DSM-IV. One-third of participants screened positive for major depression and stimulant use disorders. Sleeping on the street [adjusted odds ratio (AOR) = 4.21], major depression (AOR = 2.88) and stimulant use disorders (AOR = 4.45) were associated with greater odds of acute care use. Housing and effective treatment of depression and stimulant use disorders may decrease use of acute care services in this population.

  1. 42 CFR 485.647 - Condition of participation: psychiatric and rehabilitation distinct part units.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: psychiatric and rehabilitation distinct part units. 485.647 Section 485.647 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS...

  2. 42 CFR 412.27 - Excluded psychiatric units: Additional requirements.

    Science.gov (United States)

    2010-10-01

    ... medicine or osteopathy responsible for the care of the inpatient, a nurse, social worker and, when... nurses, licensed practical nurses, and mental health workers to provide nursing care necessary under each... active treatment measures and engage in discharge planning, as follows: (1) Personnel. The unit must...

  3. Adverse incidents, patient flow and nursing workforce variables on acute psychiatric wards: the Tompkins Acute Ward Study.

    Science.gov (United States)

    Bowers, Len; Allan, Teresa; Simpson, Alan; Nijman, Henk; Warren, Jonathan

    2007-01-01

    Adverse incidents (violence, self-harm and absconding) can cause significant harm to patients and staff, are difficult to predict, and are driving an increase in security measures and defensive practice. To explore the relationship between adverse incidents on acute psychiatric wards, admissions and nursing workforce variables. A retrospective analysis of officially collected data covering a period of 30 months on 14 acute wards at three hospitals. This data included 69 serious untoward incidents. Adverse incidents were more likely during and after weeks of high numbers of male admissions, during weeks when other incidents also occurred, and during weeks of high regular staff absence through leave and vacancy. It may be possible to predict adverse incidents. Careful staff management and deployment may reduce the risks.

  4. A pilot randomized control trial: testing a transitional care model for acute psychiatric conditions.

    Science.gov (United States)

    Hanrahan, Nancy P; Solomon, Phyllis; Hurford, Matthew O

    2014-01-01

    People with multiple and persistent mental and physical health problems have high rates of transition failures when transferring from a hospital level of care to home. The transitional care model (TCM) is evidence-based and demonstrated to improve posthospital outcomes for elderly with physical health conditions, but it has not been studied in the population with serious mental illness. Using a randomized controlled design, 40 inpatients from two general hospital psychiatric units were recruited and randomly assigned to an intervention group (n = 20) that received the TCM intervention that was delivered by a psychiatric nurse practitioner for 90 days posthospitalization, or a control group (n = 20) that received usual care. Outcomes were as follows: service utilization, health-related quality of life, and continuity of care. The intervention group showed higher medical and psychiatric rehospitalization than the control group (p = .054). Emergency room use was lower for intervention group but not statistically significant. Continuity of care with primary care appointments were significantly higher for the intervention group (p = .023). The intervention group's general health improved but was not statistically significant compared with controls. A transitional care intervention is recommended; however, the model needs to be modified from a single nurse to a multidisciplinary team with expertise from a psychiatric nurse practitioner, a social worker, and a peer support specialist. A team approach can best manage the complex physical/mental health conditions and complicated social needs of the population with serious mental illness. © The Author(s) 2014.

  5. Hospital Related Stress Among Patients Admitted to a Psychiatric In-patient Unit in India

    Directory of Open Access Journals (Sweden)

    Latha KS

    2011-04-01

    Full Text Available The psychiatric patient’s attitudes towards hospitalization have found an association between patient perceptions of the ward atmosphere and dissatisfaction. The aim of the study was to determine the aspects of stress related to hospitalization in inpatients admitted to a psychiatric facility. Fifty in-patients of both sexes admitted consecutively to a psychiatric unit in a General Hospital were asked to rate the importance of, and their satisfaction with, 38 different aspects of in-patient care and treatment. Results showed that the major sources of stress were related to having a violent patient near to his/her bed; being away from family; having to stay in closed wards; having to eat cold and tasteless food; losing income or job due to illness, being hospitalized away from home; not able to understand the jargons used by the clinical staff and not getting medication for sleep. A well-differentiated assessment of stress and satisfaction has implications for the evaluation of the quality of psychiatric care and for the improvement of in-patient psychiatric care.

  6. Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland

    Directory of Open Access Journals (Sweden)

    Fischer Joachim E

    2007-12-01

    Full Text Available Abstract Background Aggression and violence and negative consequences thereof are a major concern in acute psychiatric inpatient care globally. Variations in study designs, settings, populations, and data collection methods render comparisons of the incidence of aggressive behaviour in high risk settings difficult. Objective To describe the frequency and severity of aggressive incidents in acute psychiatric wards in the German speaking part of Switzerland. Methods We conducted a prospective multicentre study on 24 acute admission wards in 12 psychiatric hospitals in the German speaking part of Switzerland. Aggressive incidents were recorded by the revised Staff Observation Aggression Scale (SOAS-R and we checked the data collection for underreporting. Our sample comprised 2344 treatment episodes of 2017 patients and a total of 41'560 treatment days. Results A total of 760 aggressive incidents were registered. We found incidence rates per 100 treatment days between 0.60 (95% CI 0.10–1.78 for physical attacks and 1.83 (1.70–1.97 for all aggressive incidents (including purely verbal aggression. The mean severity was 8.80 ± 4.88 points on the 22-point SOAS-R-severity measure; 46% of the purely verbally aggression was classified as severe (≥ 9 pts.. 53% of the aggressive incidents were followed by a coercive measure, mostly seclusion or seclusion accompanied by medication. In 13% of the patients, one ore more incidents were registered, and 6.9% of the patients were involved in one ore more physical attack. Involuntary admission (OR 2.2; 1.6–2.9, longer length of stay (OR 2.7; 2.0–3.8, and a diagnosis of schizophrenia (ICH-10 F2 (OR 2.1; 1.5–2.9 was associated with a higher risk for aggressive incidents, but no such association was found for age and gender. 38% of the incidents were registered within the first 7 days after admission. Conclusion Aggressive incidents in acute admission wards are a frequent and serious problem. Due to the

  7. An audit of patient aggression in an adult psychiatric unit: 2013-2014.

    Science.gov (United States)

    Ewing, Claire; Phillipou, Andrea; Castle, David

    2017-08-01

    The aim of this study was to determine the rates of patient aggression in a psychiatric unit over 12 months and to determine underlying causes, notably the role of substances. A retrospective file audit was undertaken of all patients admitted to St Vincent's psychiatric unit (Melbourne, Australia) in the first half of 2013 and 2014 involved in an aggressive incident. Patient information included demographics, psychiatric, substance and aggression history. The setting and context of aggression and associated mental state findings were also reviewed. There were 26 aggressive incidents in 2013 and 63 in 2014, perpetrated by 11 and 34 patients respectively. No significant differences were found between the groups' baseline demographics. The 2014 cohort was significantly more likely to have substance use history (odds ratio (OR) 4.83) and have made threats to staff (OR 4.07) but significantly less likely to be distracted by internal stimuli (OR 0.05). There were also (not statistically significant) trends for the 2014 cohort; they were more likely to report a history of alcohol use (OR 3.9); be accompanied to emergency department by police (OR 2.95) and have leave prior to aggression ( χ(2) = 7.37). Aggressive incidents more than doubled over 12 months. Substance use appeared to be a major factor associated with aggression. These findings have implications for service provision and training. Further research is needed to better understand and manage substances in psychiatric settings.

  8. The effect of a change of director in a psychiatric inpatient unit.

    Science.gov (United States)

    Nathan, R J; Slovak, J P

    1976-02-01

    Suicide, aggressive acting out, and increased numbers of AWOL patients are distinct possibilities if internal structures of psychiatric impatient units are altered-especially in units that offer intensive therapeutic experience on a short term basis to severely ill patients. One such time is when the directorship changes in this kind of unit. A sucessful unit is frequently thought to be the result of the charismatic leadership of its chief. With his departure, the unit loses its elan and becomes an uninspired pedestrian operation. Hence, such a unit loses personnel and even its program when the chief changes. In this paper, the authors give data to support the hypothesis that a unit with a specific philosophical treatment orientation will continue to function at a relatively high level of effectiveness and efficiency regardless of the difference between chiefs.

  9. Team climate and attitudes toward information and communication technology among nurses on acute psychiatric wards.

    Science.gov (United States)

    Koivunen, Marita; Anttila, Minna; Kuosmanen, Lauri; Katajisto, Jouko; Välimäki, Maritta

    2015-01-01

    Objectives: To describe the association of team climate with attitudes toward information and communication technology among nursing staff working on acute psychiatric wards. Background: Implementation of ICT applications in nursing practice brings new operating models to work environments, which may affect experienced team climate on hospital wards. Method: Descriptive survey was used as a study design. Team climate was measured by the Finnish modification of the Team Climate Inventory, and attitudes toward ICT by Burkes' questionnaire. The nursing staff (N = 181, n = 146) on nine acute psychiatric wards participated in the study. Results: It is not self-evident that experienced team climate associates with attitudes toward ICT, but there are some positive relationships between perceived team climate and ICT attitudes. The study showed that nurses' motivation to use ICT had statistically significant connections with experienced team climate, participative safety (p = 0.021), support for innovation (p = 0.042) and task orientation (p = 0.042). Conclusion: The results suggest that asserting team climate and supporting innovative operations may lead to more positive attitudes toward ICT. It is, in particular, possible to influence nurses' motivation to use ICT. More attention should be paid to psychosocial factors such as group education and co-operation at work when ICT applications are implemented in nursing.

  10. Analysis of referrals received by a psychiatric unit in a general hospital Part 2

    Directory of Open Access Journals (Sweden)

    VJ Ehlers

    2002-01-01

    Full Text Available The study sought to analyse the referrals received by a psychiatric unit in a general hospital in the Western Cape by studying the referral letters and the referral responses.

    Opsomming
    Hierdie navorsing het gepoog om verwysings te ontleed wat deur 'n psigiatriese eenheid in 'n algemene hospitaal in die Wes Kaap ontvang is. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

  11. [Schizophrenia diagnostic announcement in a French psychiatric unit].

    Science.gov (United States)

    Rocamora, J F; Benadhira, R; Saba, G; Stamatadis, L; Kalalaou, K; Dumortier, G; Plaze, M; Aubriot-Delmas, B; Glikman, J; Januel, D

    2005-01-01

    Announcement of schizophrenia diagnostic to the patients is a topical issue in France. The evolution in clinical practices, a better efficiency in therapeutic procedures and the fundamental right of the patient to obtain information have initialised the discussion of its interest. Spontaneous claim for information from the patient is rarely observed although awareness troubles might be reported at the instauration of the mental disorder or during its evolution. Methodological studies concerning the diagnostic announcement are limited. Except the Bayle studies recently published, only a few publications are available in France about the knowledge of their pathology and their need to be clearly informed. French scientific literature deals generally about medico-legal aspects of this information and consisted of survey about diagnostic announcement. International literature is more abundant and presents positive and negative aspects of the announcement. An information procedure of schizophrenia announcement to the patient has been developed in our hospitalisation unit of psychiatry. This procedure has taken place on the basis of the literature data, our specificity and our clinical experiences. For some Anglo-American psychiatrists who have proceeded to semi-structured interview in order to announce the diagnostic, information to the patients might improve the clinical relationship. Thus, compliance to the treatment is significantly increased. The ability of the patient to recognise the symptoms of the disease and to accept their consequences and the treatments is associated to a better social prognosis, daily activities and response to the treatment. The announcement impact justifies the prescription of neuroleptics, treatment that is notoriously perceived as prejudicial by the patients themselves or more commonly in the basic population. To obtain compliance to the treatment, a satisfactory acceptance of the mental disorder is required. Compliance is based on

  12. Mother-Baby psychiatric units (MBUs): national data collection in France and in Belgium (1999-2000).

    Science.gov (United States)

    Glangeaud-Freudenthal, N M-C

    2004-02-01

    The French version of the Marcé checklist was used to collect data for 176 joint admissions to 11 psychiatric mother-baby units in 1999 and 2000. Mean age of the babies at admission ranged from 4 to 16 weeks. Two units also admitted older children. Mothers admitted were diagnosed with schizophrenia or chronic delusional disorders (n = 44), acute transitory psychosis "Bouffée délirante" (n = 20), bipolar disorders (n = 20), depressive illness (n = 38), personality disorders or intellectual disability (n = 39), and other disorders (n = 15). The mean duration of hospitalisation was 11 weeks. Units that also offered day-care admission in the same or a near-by unit had shorter mean admissions. More than half the women's partners (or babies' fathers) had mental health problems. Women with schizophrenia or chronic delusional disorders and personality disorders or intellectual disability remained hospitalised longer, improved less, and were more often separated from their babies, or discharged with supervision, than women admitted with other diagnoses.

  13. Associations of homelessness and residential mobility with length of stay after acute psychiatric admission

    Directory of Open Access Journals (Sweden)

    Tulloch Alex D

    2012-08-01

    Full Text Available Abstract Background A small number of patient-level variables have replicated associations with the length of stay (LOS of psychiatric inpatients. Although need for housing has often been identified as a cause of delayed discharge, there has been little research into the associations between LOS and homelessness and residential mobility (moving to a new home, or the magnitude of these associations compared to other exposures. Methods Cross-sectional study of 4885 acute psychiatric admissions to a mental health NHS Trust serving four South London boroughs. Data were taken from a comprehensive repository of anonymised electronic patient records. Analysis was performed using log-linear regression. Results Residential mobility was associated with a 99% increase in LOS and homelessness with a 45% increase. Schizophrenia, other psychosis, the longest recent admission, residential mobility, and some items on the Health of the Nation Outcome Scales (HoNOS, especially ADL impairment, were also associated with increased LOS. Informal admission, drug and alcohol or other non-psychotic diagnosis and a high HoNOS self-harm score reduced LOS. Including residential mobility in the regression model produced the same increase in the variance explained as including diagnosis; only legal status was a stronger predictor. Conclusions Homelessness and, especially, residential mobility account for a significant part of variation in LOS despite affecting a minority of psychiatric inpatients; for these people, the effect on LOS is marked. Appropriate policy responses may include attempts to avert the loss of housing in association with admission, efforts to increase housing supply and the speed at which it is made available, and reforms of payment systems to encourage this.

  14. [Psychosocial functioning in non-psychiatric acute and chronic inpatients: depression, alexithymia and lack of assertiveness].

    Science.gov (United States)

    Arancibia, Marcelo; Behar, Rosa; Marín, Sofía; Inzunza, Nicolás; Madrid, Eva

    2016-11-01

    Depression, alexithymia, and lack of assertiveness interfere with individual psychosocial functioning and may result in longer hospitalization stay and poorer therapeutic results. To analyze the psychosocial functioning in acute and chronic patients and its association with psychological, clinical and sociodemographic variables. We performed a cross-sectional study that included 80 inpatients of both sexes with organic pathology, aged between 18 to 70 years old, without any current psychiatric disorder. Clinical and sociodemographic data were collected from a semi-structured interview and hospital records. Beck Depression Inventory-IA, Toronto Alexithymia Scale-20 and Rathus Assertiveness Scale were administered. Fifty five percent of patients had some degree of depression, 33% alexithymia and 34% lack of assertiveness. The levels of depression, alexithymia and lack of assertiveness in chronic patients were significantly higher than those observed in acute patients. Women and participants older than 60 years exhibited the highest degrees of depression. Alexithymia and lack of assertiveness were associated with a lower educational level. A negative significant correlation between alexithymia and assertiveness scores was observed among acute patients. Participants with chronic diseases had a lower psychosocial functioning. Less educated patients showed more alexithymic and less assertive features. We emphasized the need of a better management of these aspects by the health team, since social functioning might interfere with the outcome of physical illnesses.

  15. 'Shared-rhythm cooperation' in cooperative team meetings in acute psychiatric inpatient care.

    Science.gov (United States)

    Vuokila-Oikkonen, P; Janhonen, S; Vaisanen, L

    2004-04-01

    The cooperative team meeting is one of the most important interventions in psychiatric care. The purpose of this study was to describe the participation of patients and significant others in cooperative team meetings in terms of unspoken stories. The narrative approach focused on storytelling. The data consisted of videotaped cooperative team meetings (n = 11) in two acute closed psychiatric wards. The QRS NVivo computer program and the Holistic Content Reading method were used. During the process of analysis, the spoken and unspoken stories were analysed at the same time. According to the results, while there was some evident shared-rhythm cooperation (the topics of discussion were shared and the participants had eye contact), there were many instances where the interaction was controlled and defined by health care professionals. This lack of shared rhythm in cooperation, as defined in terms of storytelling, was manifested as monologue and the following practices: the health care professionals controlled the storytelling by sticking to their opinions, by giving the floor or by pointing with a finger and visually scanning the participants, by interrupting the speaker or by allowing the other experts to sit passively. Implications for mental health nursing practice are discussed.

  16. [Triage in acute medical admission units.

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Folkestad, Lars; Hallas, Peter

    2010-01-01

    . At 87% of the MAUs, a doctor was contacted by the admitting physician, while the contact was the responsibility of a nurse in 13% of MAUs. None of the contacted MAUs used a validated triage tool and 95% answered that they triaged on the basis of individual clinical assessment of patients. However, 22......INTRODUCTION: Many emergency departments use validated triage tools. It is currently undocumented if such a practice is common in Danish medical admission units (MAU). The current study was conducted in order to clarify this. MATERIAL AND METHODS: Questionnaire survey with data collected from......% answered that selected groups of patients were routinely assessed by a senior physician. CONCLUSION: None of the Danish MAUs uses a validated triage tool to prioritize acutely admitted medical patients. Udgivelsesdato: 2010-May-31...

  17. A preliminary study of Patient Dignity Inventory validation among patients hospitalized in an acute psychiatric ward

    Directory of Open Access Journals (Sweden)

    Di Lorenzo R

    2017-01-01

    Full Text Available Rosaria Di Lorenzo,1 Giulio Cabri,2 Eleonora Carretti,3 Giacomo Galli,4 Nina Giambalvo,4 Giulia Rioli,4 Serena Saraceni,4 Giulia Spiga,4 Cinzia Del Giovane,5 Paola Ferri6 1Mental Health Department, Service of Psychiatric Diagnosis and Treatment in NOCSAE General Hospital, 2Private Accredited Psychiatric Hospital villa Igea, Modena, 3Nursing Home of Rubiera, Reggio Emilia, 4Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, 5PhD Statistics Unit, Department of Diagnostic, Clinical and Public Health Medicine, 6Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy Purpose: To investigate the perception of dignity among patients hospitalized in a psychiatric setting using the Patient Dignity Inventory (PDI, which had been first validated in oncologic field among terminally ill patients. Patients and methods: After having modified two items, we administered the Italian version of PDI to all patients hospitalized in a public psychiatric ward (Service of Psychiatric Diagnosis and Treatment of a northern Italian town, who provided their consent and completed it at discharge, from October 21, 2015 to May 31, 2016. We excluded minors and patients with moderate/severe dementia, with poor knowledge of Italian language, who completed PDI in previous hospitalizations and/or were hospitalized for <72 hours. We collected the demographic and clinical variables of our sample (n=135. We statistically analyzed PDI scores, performing Cronbach’s alpha coefficient and principal factor analysis, followed by orthogonal and oblique rotation. We concomitantly administered to our sample other scales (Hamilton Rating Scales for Depression and Anxiety, Global Assessment of Functioning and Health of the Nation Outcome Scales to analyze the PDI concurrent validity. Results: With a response rate of 93%, we obtained a mean PDI score of 48.27 (±19.59 SD with

  18. Twenty years of electroconvulsive therapy in a psychiatric unit at a university general hospital

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    Amilton dos Santos Jr.

    2013-01-01

    Full Text Available Objective: To describe the sociodemographic and clinical profile of patients who underwent electroconvulsive therapy (ECT at a university general hospital. Method: In this retrospective study, records from all patients undergoing ECT between January 1988 and January 2008 at the psychiatric unit of the general hospital of Universidade Estadual de Campinas (UNICAMP were reviewed. Telephone contact was made with patients/relatives to collect follow-up data. Results: A total of 200 charts were reviewed. The majority of patients were women, with a mean age of 39 years, and history of psychiatric hospitalization. The main indications for ECT were depression and catatonia. Complications were observed in less than half of the cases, and most were temporary and not severe. There was a good psychiatric outcome for 89.7% of the patients, especially for catatonic patients (100%, p = 0.02. Thirty-four percent of the cases were later contacted by telephone calls, at a mean of 8.5 years between the procedure and the contact. Among these, three (1.5% reported persistent memory disorders and 73% considered ECT a good treatment. Conclusion: ECT has been performed according to international guidelines. In the vast majority of cases, undesirable effects were temporary and not severe. Response to ECT was positive in most cases, particularly in catatonic patients.

  19. Psychiatric Comorbidity in Patients from the Addictive Disorders Assistance Units of Galicia: The COPSIAD Study.

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    César Pereiro

    Full Text Available The objective of this study is to assess the prevalence of psychiatric comorbidity in patients under treatment within the addictive disorders assistance units of Galicia (Spain.A total of 64 healthcare professionals performed clinical diagnosis of mental disorders (on DSM IV-TR criteria in 2300 patients treated throughout March 2010 in 21 addictive disorders assistance units.56.3% of patients with substance abuse/dependency also showed some other mental disorder, 42.2% of patients suffering from at least an Axis I condition and 20.2% from some Axis II condition. Mood and anxiety disorders and borderline and antisocial personality disorders were the most frequent disorders in both axes.A high comorbidity was found between mental and substance use disorders (SUD in patients seen at the addictive disorders assistance units of Galicia.

  20. Failures of foreseeability: Risk management considerations in reducing allegations of sexual violence in psychiatric units.

    Science.gov (United States)

    Banja, John D

    2017-01-01

    This article begins with a brief discussion of findings on causal factors leading to allegations of sexual violence in health care facilities and then offers the author's account of 4 such cases that he reviewed, 3 of which occurred in psychiatric units. These cases show remarkably similar variables, especially involving decisions to allow male and female patients to commingle, the inadequate physical layout of the units, poor or absent video surveillance, and staff unacquainted with institutional policies on patient safety or refusing to enforce relevant rules. These variables arguably amount to "failures of foreseeability" that reasonably cautious health care personnel should recognize as facilitating or enabling sexual violence. As such, the proactive message of this article for health care risk management urges critical and robust attention paid to a unit's environmental/physical design as well as to performance factors among personnel so as to prevent sexual attacks and diminish the probability of malpractice actions.

  1. Mechanical and pharmacological restraints in acute psychiatric wards--why and how are they used?

    Science.gov (United States)

    Knutzen, Maria; Bjørkly, Stål; Eidhammer, Gunnar; Lorentzen, Steinar; Helen Mjøsund, Nina; Opjordsmoen, Stein; Sandvik, Leiv; Friis, Svein

    2013-08-30

    Restraint use has been reported to be common in acute psychiatry, but empirical research is scarce concerning why and how restraints are used. This study analysed data from patients' first episodes of restraint in three acute psychiatric wards during a 2-year study period. Logistic regression analyses were used to identify predictors for type and duration of restraint. The distribution of restraint categories for the 371 restrained patients was as follows: mechanical restraint, 47.2%; mechanical and pharmacological restraint together, 35.3%; and pharmacological restraint, 17.5%. The most commonly reported reason for restraint was assault (occurred or imminent). It increased the likelihood of resulting in concomitant pharmacological restraint. Female patients had shorter duration of mechanical restraint than men. Age above 49 and female gender increased the likelihood of pharmacological versus mechanical restraint, whereas being restrained due to assault weakened this association. Episodes with mechanical restraint and coinciding pharmacological restraint lasted longer than mechanical restraint used separately, and were less common among patients with a personality disorder. Diagnoses, age and reason for restraint independently increased the likelihood for being subjected to specific types of restraint. Female gender predicted type of restraint and duration of episodes.

  2. Acute surgical unit: The consultant experience

    Directory of Open Access Journals (Sweden)

    Patrick J Stokes

    2016-07-01

    Full Text Available Background Establishment of the Acute Surgical Unit (ASU has redefined the approach to emergency surgery in Australia with quantitative data showing improvement in patient outcomes. However, as qualitative data regarding the ASU remains scarce, we sought to determine the impact of the ASU on overall surgeon job satisfaction. Aims The aim of this paper was to specifically address the impact of the ASU on consultant surgeons overall job satisfaction. Methods We designed a 34 – item questionnaire with consultant general surgeons addressing important aspects of the ASU. Themes included on – call rostering and workload, academic pursuits, surgical training, work – life balance and overall job satisfaction. Results We received responses from 88 surgeons currently working on ASU units, responding correctly and in full to the survey. Overall, our surveyed cohort reported better on – call rostering, improved surgical training and higher levels of job satisfaction and overall work – life balance with ASU implementation. Conclusion Preliminary qualitative results indicate that the ASU may improve on – call rostering, work – life balance and overall job satisfaction.

  3. Psychiatric nurse practitioners’ experiences of working with mental health care users presenting with acute symptoms

    Directory of Open Access Journals (Sweden)

    Kgalabi J. Ngako

    2012-05-01

    Full Text Available Psychiatric nurse practitioners (PNPs working with mental health care users presenting with acute symptoms work in a complex environment. This environment is characterised by mental health care users who may present with a history of violence, sexual assault and substance misuse.The objectives of this study were twofold: firstly, to explore and describe the experiences of PNPs working with mental health care users (MHCUs presenting with acute symptoms; and secondly, to make recommendations for the advanced PNPs to facilitate promotion of the mental health of PNPs with reference to nursing practice, research and education.A qualitative, explorative, descriptive and contextual design was used. The target population was PNPs working with MHCUs presenting with acute symptoms in a public mental health care institution in Gauteng. Data were collected by means of four focus group interviews involving 21 PNPs. The researcher made use of drawings, naïve sketches and field notes for the purpose of data triangulation. Data were analysed in accordance with Tesch’s method of open coding.The three themes that emerged were: PNPs experienced working with these MHCUs as entering an unsafe world where care became a burden; they experienced negative emotional reactions and attitudes towards these MHCUs that compromised quality nursing care; and they made a plea for a nurturing environment that would enhance quality nursing care.The PNPs suggest skills and competency development, organisational support, and a need for external resources. Creation of a positive environment and mobilisation of resources as well as the identification and bridging of obstacles are essential in the promotion of the overall wellbeing and mental health of PNPs. 

  4. Relationship between psychiatric nurse work environments and nurse burnout in acute care general hospitals.

    Science.gov (United States)

    Hanrahan, Nancy P; Aiken, Linda H; McClaine, Lakeetra; Hanlon, Alexandra L

    2010-03-01

    Following deinstitutionalization, inpatient psychiatric services moved from state institutions to general hospitals. Despite the magnitude of these changes, evaluations of the quality of inpatient care environments in general hospitals are limited. This study examined the extent to which organizational factors of the inpatient psychiatric environments are associated with psychiatric nurse burnout. Organizational factors were measured by an instrument endorsed by the National Quality Forum. Robust clustered regression analysis was used to examine the relationship between organizational factors in 67 hospitals and levels of burnout for 353 psychiatric nurses. Lower levels of psychiatric nurse burnout was significantly associated with inpatient environments that had better overall quality work environments, more effective managers, strong nurse-physician relationships, and higher psychiatric nurse-to-patient staffing ratios. These results suggest that adjustments in organizational management of inpatient psychiatric environments could have a positive effect on psychiatric nurses' capacity to sustain safe and effective patient care environments.

  5. Acute effects of electroconvulsive therapy on regional cerebral blood flow (rCBF) in psychiatric disorders

    Energy Technology Data Exchange (ETDEWEB)

    Prohovnik, I.; Alderson, P.O.; Sackheim, H.A.; Decina, P.; Kahn, D.

    1984-01-01

    Electroconvulsive therapy (ECT) is frequently used in the treatment of major depression and other psychiatric disorders; its mechanism of action is not established, but previous evidence suggests that it is associated with postictal metabolic suppression. The authors have used measurements of rCBF as an index of cortical metabolic activity to study the acute effects of ECT. Measurements of rCBF were made in 32 cortical regions in 10 patients (pts) following one minute breathing of Xe-133 (5mCi/L); the measurements were performed 30min before and 50min after ECT. Bilateral ECT was administered to six pts (five diagnosed as major depressives and one schizophrenic) and unilateral ECT to four (all diagnosed as unipolar or bipolar affective disorder). The total rCBF material consists of 52 measurements in these pts, made before and after 16 bilateral and 10 unilateral treatments. ECT was found to cause significant reduction of rCBF. Mean hemispheric flows (using the Initial Slope Index to measure grey-matter flow) were reduced by about 5% in both hemispheres following bilateral treatment. Unilateral treatment caused a 9% reduction of flow in the treated hemisphere, but only 2% contralaterally. Regional patterns of flow decreases also differed between the two treatment modes: bilateral frontal reductions were found after bilateral treatment, whereas unilateral ECT caused a widespread flow reduction in the treated hemisphere, and almost no effect contralaterally. These results suggest that rCBF studies are useful for assessing ECT, and indicate that the acute cerebral effects of ECT vary with the mode of treatment.

  6. ACUTE UNDIFFERENTIATED FEVER IN INTENSIVE CARE UNITS

    Directory of Open Access Journals (Sweden)

    Srikanth Ram Mohan

    2014-03-01

    Full Text Available Acute undifferentiated fever (AUF is common in tropical regions of the developing world, its specific etiology is often unknown. It’s common causes include malaria, dengue fever, enteric fever, leptospirosis, rickettsial infection. AUF is defined as fever without any localised source of infection, of 14 days or less in duration. The objective of the study was to focus on identifying the causes of AUF in patients admitted to Intensive care units & to determine importance of clinical examination in identifying the cause. It was a prospective study done in our Medical college Hospital at Kolar, Karnataka between 1-11-2010 to 30-11-2011. Cases presenting to hospital aged >18 years with complaints of Fever & admitted in Intensive care units were included in study. A total of 558 cases were enrolled. The clinical findings were noted and subsequent Investigations required were asked for. The study compromised of approximately equal number of Male & Female patients & age varied from 18 – 100 years. There was a clear seasonal variation – More no of cases were admitted between April & November. Majority presented with Fever of Short duration (1-3 days. Certain well defined syndromes were identified like:  Fever with Thrombocytopenia – the most common of all the syndromes.  Fever with Myalgia & Arthralgia,  Fever with Hepatorenal dysfunction,  Fever with Encephalopathy,  Fever with Pulmonary - Renal dysfunction and  Fever with Multiorgan dysfunction (MODS. Out of 558 cases AUF was noted in 339 cases (60.86%. An etiological diagnosis could be made for 218 cases (39.06%. Leptospirosis was the commonest cause with 72 cases (12.9%. The no of cases with Dengue were 48(8.6%, Malaria –25 (4.4%, Viral fever –35 (6.2%, Mixed infections – 12 (2.1%, Pulmonary Tuberculosis -25 ( 4.4% and one case of Rickettsial Infection. MODS was the most common presentation in AUF patients, seen in 108 cases (31.8% and 40 cases expired. A study of AUF

  7. Care of Acute Gastrointestinal Conditions in the Observation Unit.

    Science.gov (United States)

    Ham, Jason J; Ordonez, Edgar; Wilkerson, R Gentry

    2017-08-01

    The Emergency Department Observation Unit (EDOU) provides a viable alternative to inpatient admission for the management of many acute gastrointestinal conditions with additional opportunities of reducing resource utilization and reducing radiation exposure. Using available evidence-based criteria to determine appropriate patient selection, evaluation, and treatment provides higher-quality medical care and improved patient satisfaction. Discussions of factors involved in creating an EDOU capable of caring for acute gastrointestinal conditions and clinical protocol examples of acute appendicitis, gastrointestinal hemorrhage, and acute pancreatitis provide a framework from which a successful EDOU can be built. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. The relationship between leadership, teamworking, structure, burnout and attitude to patients on acute psychiatric wards

    NARCIS (Netherlands)

    Bowers, L.; Nijman, H.L.I.; Simpson, A.; Jones, J.

    2011-01-01

    Background: Conflict (aggression, substance use, absconding, etc.) and containment (coerced medication, manual restraint, etc.) threaten the safety of patients and staff on psychiatric wards. Previous work has suggested that staff variables may be significant in explaining differences between wards

  9. Factors related to positive and negative outcomes in psychiatric inpatients in a General Hospital Psychiatric Unit: a proposal for an outcomes index

    Directory of Open Access Journals (Sweden)

    HUGO KARLING MORESCHI

    2015-02-01

    Full Text Available Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS, Global Assessment of Functioning (variation and at discharge and Clinical Global Impression (severity and improvement were used to build a ten-point improvement index (I-Index. Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint “behavioral change/aggressiveness” and psychotic features. Multivariate analysis found a higher OR for diagnoses of “psychotic disorders” and “personality disorders” and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.

  10. Short-term diagnostic stability of acute psychosis: Data from a tertiary care psychiatric center in South India

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    Janardhanan C Narayanaswamy

    2012-01-01

    Full Text Available Context: Studies on acute psychosis in patients from India report good outcome. A small proportion of these patients may suffer relapses or other develop major psychiatric disorders later. Aim: The aim of this study was to examine the diagnostic stability of acute psychosis in patients from India. Materials and Methods: The records of patients who presented with the first episode of acute and transient psychotic disorder (n=57 over 1 year (2004 were analyzed, and the follow-up data at the end of 1 and 2 years were recorded. Results: The mean age of the sample was 30.72 years. The mean duration of illness episode was 18.15±17.10 days. The follow-up data were available for 77.2% (n=44 and 75.4% (n=43 of the sample at the end of first and second years. Relapse was recorded in 47.4 and 54.4% at the end of first and second years, respectively. Conclusion: The diagnosis changed into other disorders such as bipolar disorder, schizophrenia, and unspecified psychosis, while a majority retained the initial diagnosis of acute psychosis. The findings suggest that acute psychosis is a relatively stable condition. A small percentage of these patients may go on to develop schizophrenia or bipolar disorder.

  11. The Norwegian version of Mini-International Neuropsychiatric Interview (M.I.N.I.): Feasibility, patient acceptability and test-retest reliability in an acute psychiatric ward.

    OpenAIRE

    Gundersen, Øystein

    2007-01-01

    ABSTRACT Background: Mini-International Neuropsychiatric Interview (MINI) is a structured psychiatric diagnostic interview. Feasibility, patient acceptability, reliability and validity of MINI have been tested in other countries, but not yet in Norway. Objective: The aim of the present study was to test the feasibility, patient acceptability and test-retest reliability of the Norwegian MINI version in an acute psychiatric ward. Methods: From August 2006 to February 2007 3...

  12. Treatments for common psychiatric conditions among adults during acute, rehabilitation, and reintegration phases.

    Science.gov (United States)

    Difede, Joann; Cukor, Judith; Lee, Francis; Yurt, Roger

    2009-12-01

    Common and pernicious adult psychiatric disorders consequent to burn injury include post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and new-onset substance abuse disorder. Diagnosing and treating these disorders is complicated by the complex psychosocial issues associated with burns including grief, pain, role impairment, disfigurement, dysfunction, stigma, as well as financial and legal issues. Additionally, pre-morbid psychiatric and neurological illnesses are risk factors for burns, adding to the challenge of diagnosis and treatment. This article will focus on the diagnosis and treatment of PTSD and MDD consequent to burn trauma, as these are the major psychiatric outcomes, addressing the attendant psychosocial problems as threads in this post-trauma tapestry.

  13. Characteristics of Adolescent Suicide Attempters Admitted to an Acute Psychiatric Ward in Taiwan

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    Pei-Ning Chiou

    2006-09-01

    Conclusion: Our study confirms some previous Western reports that adolescents with depressive disorders commonly manifest suicide attempts. There are, however, some cultural differences in risk factors. School-related problems play an important role in Taiwan among the adolescent suicides, and prior suicide attempts predict future suicidal behavior. Enhancing school-based screening for adolescents with suicide risk and transferring them to psychiatric professionals for intervention is important. We should focus suicide prevention resources mainly on the adolescent population with psychiatric illness, prior suicide attempts, and with high risk factors.

  14. Accountable Care Units: A Disruptive Innovation in Acute Care Delivery.

    Science.gov (United States)

    Castle, Bryan W; Shapiro, Susan E

    2016-01-01

    Accountable Care Units are a disruptive innovation that has moved care on acute care units from a traditional silo model, in which each discipline works separately from all others, to one in which multiple disciplines work together with patients and their families to move patients safely through their hospital stay. This article describes the "what," "how," and "why" of the Accountable Care Units model as it has evolved in different locations across a single health system and includes the lessons learned as different units and hospitals continue working to implement the model in their complex care environments.

  15. Assessment of the Acute Psychiatric Patient in the Emergency Department: Legal Cases and Caveats

    Science.gov (United States)

    2014-05-01

    1994; 24(4):672–677. 7. Dubin WR, Weiss KJ, Zeccardi JA. Organic brain syndrome: The psychiatric imposter. JAMA. 1993;249(1):60–62. 8. Tintinalli JE...16. Dubin WR, Weiss KJ. Emergency psychiatry. In: Michels R, Cavenar JD, Cooper AM, et al, ed: Psychiatry. Philadelphia: Lippincott-Raven; 1997:1–15

  16. Door locking and exit security measures on acute psychiatric admission wards

    NARCIS (Netherlands)

    Nijman, H.L.I.; Bowers, L.; Haglund, K.; Muir-Cochrane, E.; Simpson, A.; Merwe, M. van der

    2011-01-01

    Locking the exit doors of psychiatric wards is believed to reduce the risk of patients absconding. The aims of the study were to investigate both the prevalence of door locking and other exit security measures on UK admission wards, as well as whether door locking appears to be effective in keeping

  17. A preliminary study of Patient Dignity Inventory validation among patients hospitalized in an acute psychiatric ward

    Science.gov (United States)

    Di Lorenzo, Rosaria; Cabri, Giulio; Carretti, Eleonora; Galli, Giacomo; Giambalvo, Nina; Rioli, Giulia; Saraceni, Serena; Spiga, Giulia; Del Giovane, Cinzia; Ferri, Paola

    2017-01-01

    Purpose To investigate the perception of dignity among patients hospitalized in a psychiatric setting using the Patient Dignity Inventory (PDI), which had been first validated in oncologic field among terminally ill patients. Patients and methods After having modified two items, we administered the Italian version of PDI to all patients hospitalized in a public psychiatric ward (Service of Psychiatric Diagnosis and Treatment of a northern Italian town), who provided their consent and completed it at discharge, from October 21, 2015 to May 31, 2016. We excluded minors and patients with moderate/severe dementia, with poor knowledge of Italian language, who completed PDI in previous hospitalizations and/or were hospitalized for Depression and Anxiety, Global Assessment of Functioning and Health of the Nation Outcome Scales) to analyze the PDI concurrent validity. Results With a response rate of 93%, we obtained a mean PDI score of 48.27 (±19.59 SD) with excellent internal consistency (Cronbach’s alpha coefficient =0.93). The factorial analysis showed the following three factors with eigenvalue >1 (Kaiser’s criterion), which explained >80% of total variance with good internal consistency: 1) “Loss of self-identity and social role”, 2) “Anxiety and uncertainty for future” and 3) “Loss of personal autonomy”. The PDI and the three-factor scores were statistically significantly positively correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Conclusion Our preliminary research suggests that PDI can be a reliable tool to assess patients’ dignity perception in a psychiatric setting, until now little investigated, helping professionals to improve quality of care and patients to accept treatments. PMID:28182110

  18. The permeable institution: an ethnographic study of three acute psychiatric wards in London.

    Science.gov (United States)

    Quirk, Alan; Lelliott, Paul; Seale, Clive

    2006-10-01

    In Asylums, Goffman [1961. Asylums. London: Penguin] identified some permeable features of the old mental hospitals but presented them as exceptions to the rule and focused on their impermeable aspects. We argue that this emphasis is no longer valid and offer an alternative ideal type that better represents the reality of everyday life in contemporary 'bricks and mortar' psychiatric institutions. We call this the "permeable institution". The research involved participant observation of between 3 and 4 months and interviews with patients, patient advocates and staff on 3 psychiatric wards. Evidence for permeability includes that ward membership is temporary and changes rapidly (patients tend to have very short stays and staff turnover is high); patients maintain contact with the outside world during their stay; and institutional identities are blurred to the point where visitors or new patients can easily mistake staff and patients for one another. Permeability has both positive consequences (e.g., reduced risk of institutionalism), and negative consequences (e.g., unwanted people coming into hospital to cause trouble, and illicit drug use among patients). Staff employ various methods to regulate their ward's permeability, within certain parameters. The metaphor of the total/closed institution remains valuable, but it fails to capture the highly permeable nature of the psychiatric institutions we studied. Analysts may therefore find the permeable institution a more helpful reference point or ideal type against which to examine and compare empirical cases. Perhaps most helpful is to conceptualise a continuum of institutional permeability with total and permeable institutions at each extreme.

  19. The Revolving Door Phenomenon in an Italian Acute Psychiatric Ward: A 5-Year Retrospective Analysis of the Potential Risk Factors.

    Science.gov (United States)

    Di Lorenzo, Rosaria; Sagona, Marco; Landi, Giulia; Martire, Lisa; Piemonte, Chiara; Del Giovane, Cinzia

    2016-09-01

    To highlight the revolving door (RD) phenomenon in an acute psychiatric ward, we retrospectively identified the patients hospitalized three or more times in a calendar year from 1/1/2009 to 31/12/2013 as RD patients (RDP). We collected sociodemographic and clinical variables of RDP and statistically analyzed the potential RD risk factors. We divided RDP into "high" and "extremely high" utilizers and evaluated the variables related to more frequent readmissions. RDP represented 5.68% of all patients and their hospitalizations (RDH) 25% of all admissions. The statistically significant risk factors for all RDH were "disability pension," "substance abuse/dependence," "mild/severe aggressiveness," and "psychiatric and social rehabilitative programs". The comparison between "high" and "extremely high" utilizers showed that "manic episodes" and "personality disorders," among the diagnoses, "familial relational conflicts" and "violence/suicidality", among the hospitalization reasons, were statistically significant risk factors for more frequent readmissions. RD phenomenon was greatly affected by severe clinical conditions with social disability.

  20. Length of stay of general psychiatric inpatients in the United States: systematic review.

    LENUS (Irish Health Repository)

    Tulloch, Alex D

    2011-05-01

    Psychiatric length of stay (LOS) has reduced but is still longer than for physical disorders. Inpatient costs are 16% of total mental health spending. Regression analyses of the determinants of LOS for US adult psychiatric inpatients were systematically reviewed. Most studies predated recent LOS reductions. Psychosis, female gender and larger hospital size were associated with longer LOS, while discharge against medical advice, prospective payment, being married, being detained and either younger or middle age were associated with shorter LOS. Associations appeared consistent, especially where sample size was above 3,000. Updated studies should be adequately powered and include the variables above.

  1. Effects of psychiatric disorders on Type A acute aortic dissection pathogenesis and analysis of follow-up results

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    Paolo Nardi

    2015-12-01

    Full Text Available Aims: A connection between psychiatric disorders (PDs and Type A acute aortic dissection (AAD has not been shown. The aim of this study was to define the psychological profile of patients treated for AAD, and to analyze the prevalence of PDs in their medical histories, in the immediate postoperative period, and at a mid-term follow-up. Patients and Methods: From March 2005 to October 2014, 240 consecutive patients underwent surgery for AAD. 60 patients (mean age 60+/-13 years; 43 males underwent psychiatric consultation postoperatively, and they represent the subjects of our retrospective study. Ascending aorta +/- arch replacement was performed in 43 patients, whereas the Bentall procedure +/- arch replacement was performed in 17. Data were retrospectively analyzed. Follow-ups were completed in 59 patients (mean duration 35+/-23 months. Results: PDs were present in the medical histories of 34 patients. Postoperatively, in 28 cases, a definitive diagnosis of PD (group PD was made in agreement with the diagnostic and statistical manual of mental disorders-IV criteria, including: Major depression (n=13, anxious-depressive syndrome (n=6, bipolar disorder Type 2 (n=4, panic attacks (n=2, paranoid schizophrenia (n=1, and anxiety (n=2. 32 patients without a definitive psychiatric diagnosis were classified as Group non-PD. In the postoperative period, clinical manifestations of PDs, including delirium, persistent spatio-temporal disorientation, and psychomotor agitation were evident in 22 patients (78% in group PD versus 8 patients (25% in group non-PD (P<0.0001. During follow-up, only one death for non-cardiac reasons occurred in group PD. There were no suicides; only 10 patients of group PD required PD treatment (P<0.0001 vs. early postoperative findings; 4 patients in group non-PD required PD treatment. Conclusion: Our findings suggest a strong relationship between PD and AAD. Because the psychiatric conditions appeared to be largely stable after

  2. Non-Psychiatric Services Provided in a Mental Health Unit in a County Jail.

    Science.gov (United States)

    Young, Diane S.

    2002-01-01

    Examines mental health service provision by social workers in a county jail through a retrospective review of 359 mentally ill jail inmates' health and mental health records. Of the non-psychiatric, mental health services provided beyond initial assessment, housing placement evaluations and follow-up sessions were the most frequent. Suggestions…

  3. Pharmacist-led medication review in an acute admissions unit

    DEFF Research Database (Denmark)

    Hansen, Trine Graabæk; Bonnerup, Dorthe Krogsgaard; Kjeldsen, Lene Juel

    2015-01-01

    Objectives Over the last decades, several papers have evaluated clinical pharmacy interventions in hospital settings with conflicting findings as results. Medication reviews are frequently a central component of these interventions. However, the term ‘medication review’ covers a plethora.......Methods A procedure was developed based on clinical experience and inspiration from previous studies and literature on medication review models. The procedure was developed to fit the busy workflow in acute admissions units.Results The procedure consists of five steps: (1) collection of clinical patient data, (2...... of principles and methodologies, and the practical procedure is seldom described in detail, which makes reproducing study findings difficult. The objective of this paper is to provide a detailed description of a procedure developed and used for pharmacist-led medication review in acute admissions units...

  4. Focused Acute Medicine Ultrasound (FAMUS) - point of care ultrasound for the Acute Medical Unit.

    Science.gov (United States)

    Smallwood, Nicholas; Dachsel, Martin; Matsa, Ramprasad; Tabiowo, Eugene; Walden, Andrew

    2016-01-01

    Point of care ultrasound (POCU) is becoming increasingly popular as an extension to clinical examination techniques. Specific POCU training pathways have been developed in specialties such as Emergency and Intensive Care Medicine (CORE Emergency Ultrasound and Core UltraSound Intensive Care, for example), but until this time there has not been a curriculum for the acutely unwell medical patient outside of Critical Care. We describe the development of Focused Acute Medicine Ultrasound (FAMUS), a curriculum designed specifically for the Acute Physician to learn ultrasound techniques to aid in the management of the unwell adult patient. We detail both the outline of the curriculum and the process involved for a candidate to achieve FAMUS accreditation. It is anticipated this will appeal to both Acute Medical Unit (AMU) clinicians and general physicians who deal with the unwell or deteriorating medical or surgical patient. In time, the aspiration is for FAMUS to become a core part of the AIM curriculum.

  5. Acute manic and psychotic symptoms following subcutaneous leuprolide acetate in a male patient without prior psychiatric history: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Yuan-Hung Pong

    2014-03-01

    Full Text Available Leuprolide acetate is usually used in the treatment of advanced prostate cancer. The adverse events associated with administration of leuprolide acetate include fatigue, hot flashes, loss of libido, impotence, and depression. These side effects can be treated conservatively. Acute manic and psychiatric symptoms following leuprolide acetate injection are very rare. Few case reports have been published documenting these symptoms. Here, we describe the case of a 62-year-old male with metastatic prostate cancer, who developed acute manic and psychiatric symptoms 2 months after subcutaneous leuprolide acetate injection. These symptoms were relieved after administration of neuroleptic drugs, such as risperidone. Administration of leuprolide acetate was eventually stopped. The exact mechanism causing the manic and psychiatric adverse events is unclear. Some experts have theorized that estrogen withdrawal following leuprolide acetate therapy may induce psychiatric symptoms. Manic episodes may arise from a deficit in central serotonergic neurotransmission. Based on these hypotheses, risperidone, lithium, and some anticonvulsants, such as divalproex sodium and carbamazepine, have been used effectively in the treatment and prophylaxis of manic episodes. Although psychiatric adverse events are rare following administration of leuprolide acetate, clinicians should be aware of the possibility.

  6. Impact of Experiencing Acute Coronary Syndrome Prior to Open Heart Surgery on Psychiatric Status

    Directory of Open Access Journals (Sweden)

    Volkan Yüksel

    Full Text Available Abstract Objective: The incidence of depression and anxiety is higher in patients with acute coronary syndrome. The aim of this study is to determine whether experiencing acute coronary syndrome prior to open heart surgery affects patients in terms of depression, hopelessness, anxiety, fear of death and quality of life. Methods: The study included 63 patients who underwent coronary bypass surgery between January 2015 and January 2016. The patients were divided into two groups: those diagnosed after acute coronary syndrome (Group 1 and those diagnosed without acute coronary syndrome (Group 2. Beck depression scale, Beck hopelessness scale, Templer death anxiety scale and death depression scale, State-Trait anxiety inventory and WHOQOL-Bref quality of life scale were applied. Results: There was no significant difference between the two groups in terms of the total score obtained from Beck depression scale, Beck hopelessness scale - future-related emotions, loss of motivation, future-related expectations subgroups, death anxiety scale, the death depression scale, State-Trait Anxiety Inventory - social and environmental subgroups. The mental quality of life sub-scores of group 2 were significantly higher. The patients in both groups were found to be depressed and hopeless about the future. Anxiety levels were found to be significantly higher in all of the patients in both groups. Conclusion: Acute coronary syndrome before coronary artery bypass surgery impairs more the quality of life in mental terms. But unexpectedly there are no differences in terms of depression, hopelessness, anxiety and fear of death.

  7. Music listening preferences and preadmission dysfunctional psychosocial behaviors of adolescents hospitalized on an in-patient psychiatric unit.

    Science.gov (United States)

    Weidinger, C K; Demi, A S

    1991-01-01

    This study investigated the relationship between music listening preferences and preadmission, dysfunctional psychosocial behaviors (PDPB) of 60 adolescents who were hospitalized on an in-patient psychiatric unit. Findings were that hospitalized adolescents who primarily listened to music with negative lyrics/themes had a history of more PDPB than hospitalized adolescents who primarily listened to music that did not contain negative lyrics/themes; and hospitalized adolescents who primarily listened to heavy metal music had a history of more PDPB than hospitalized adolescents who primarily listened to other types of music.

  8. Comparing the Obvious: Interactional characteristics of staff in acute mental health nursing and forensic psychiatric nursing

    DEFF Research Database (Denmark)

    Gildberg, Frederik Alkier; Bradley, Stephen K.; Hounsgaard, Lise

    2013-01-01

    This article reports on and compares two separate studies of the interactional characteristics of forensic mental health staff and acute mental health staff as they interact with inpatients, respectively. Both studies were conducted using participant observation, along with informal and formal...... interviews. Findings show that both acute and forensic mental health nursing practice is characterized by two overriding themes; ‘trust and relationship-enabling care’ and ‘behavior and perception-corrective care.’ The comparison of the two studies shows no major differences in the characteristics of staff...

  9. Acute psychiatric treatment and the use of physical restraint in first-generation immigrants in Italy: a prospective concurrent study.

    Science.gov (United States)

    Tarsitani, Lorenzo; Pasquini, Massimo; Maraone, Annalisa; Zerella, Maria Paola; Berardelli, Isabella; Giordani, Roberta; Polselli, Gian Marco; Biondi, Massimo

    2013-09-01

    and Immigrants in Europe appear at higher risk of psychiatric coercive interventions. No studies have investigated this issue in Italy. The aim of this study is to investigate whether the use of physical restraint, compulsory admission and other treatment characteristics differ in immigrated and Italian-born patients admitted to a psychiatric intensive care unit. One hundred first-generation immigrant patients were compared to 100 age-, gender- and diagnosis-matched Italian-born patients. Subjects were diagnosed according to DSM-IV-TR and rated on the Clinical Global Impression - Severity Scale and the Global Assessment of Functioning. Clinical data and treatment characteristics were collected. Immigrant patients were more likely to be physically restrained as compared to Italian-born patients (11% vs 3%; χ (2) = 4.92; p = 0.027; RR = 3.67; 95% CI = 1.05-12.7). No differences in the proportion of involuntary treatment were found. Immigrant patients did not receive higher doses of antipsychotics or benzodiazepines, but they had a longer stay in the hospital. The higher rate of physical restraint among migrants may reflect cultural, ethnic and language differences leading to communication problems between immigrant patients and mental health professionals. Since coercive interventions can be harmful, specific strategies to prevent this phenomenon in immigrants are needed.

  10. Comparing the Obvious: Interactional characteristics of staff in acute mental health nursing and forensic psychiatric nursing

    DEFF Research Database (Denmark)

    Gildberg, Frederik Alkier; Bradley, Stephen K.; Hounsgaard, Lise

    2013-01-01

    interviews. Findings show that both acute and forensic mental health nursing practice is characterized by two overriding themes; ‘trust and relationship-enabling care’ and ‘behavior and perception-corrective care.’ The comparison of the two studies shows no major differences in the characteristics of staff...

  11. Acute Gastroenteritis on Cruise Ships - United States, 2008-2014.

    Science.gov (United States)

    Freeland, Amy L; Vaughan, George H; Banerjee, Shailendra N

    2016-01-15

    From 1990 to 2004, the reported rates of diarrheal disease (three or more loose stools or a greater than normal frequency in a 24-hour period) on cruise ships decreased 2.4%, from 29.2 cases per 100,000 travel days to 28.5 cases (1,2). Increased rates of acute gastroenteritis illness (diarrhea or vomiting that is associated with loose stools, bloody stools, abdominal cramps, headache, muscle aches, or fever) occurred in years that novel strains of norovirus, the most common etiologic agent in cruise ship outbreaks, emerged (3). To determine recent rates of acute gastroenteritis on cruise ships, CDC analyzed combined data for the period 2008-2014 that were submitted by cruise ships sailing in U.S. jurisdiction (defined as passenger vessels carrying ≥13 passengers and within 15 days of arriving in the United States) (4). CDC also reviewed laboratory data to ascertain the causes of acute gastroenteritis outbreaks and examined trends over time. During the study period, the rates of acute gastroenteritis per 100,000 travel days decreased among passengers from 27.2 cases in 2008 to 22.3 in 2014. Rates for crew members remained essentially unchanged (21.3 cases in 2008 and 21.6 in 2014). However, the rate of acute gastroenteritis was significantly higher in 2012 than in 2011 or 2013 for both passengers and crew members, likely related to the emergence of a novel strain of norovirus, GII.4 Sydney (5). During 2008-2014, a total of 133 cruise ship acute gastroenteritis outbreaks were reported, 95 (71%) of which had specimens available for testing. Among these, 92 (97%) were caused by norovirus, and among 80 norovirus specimens for which a genotype was identified, 59 (73.8%) were GII.4 strains. Cruise ship travelers experiencing diarrhea or vomiting should report to the ship medical center promptly so that symptoms can be assessed, proper treatment provided, and control measures implemented.

  12. Substance abuse in patients admitted voluntarily and involuntarily to acute psychiatric wards: a national cross-sectional study

    Directory of Open Access Journals (Sweden)

    Anne Opsal

    2011-12-01

    Full Text Available Background: Substance abuse and mental disorder comorbidity is high among patients admitted to acute psychiatric wards. The aim of the study was to identify this co-occurrence as a reason for involuntary admission and if specific substance use-related diagnoses were associated with such admissions.Methods: The study was a part of a multicentre, cross-sectional national study carried out during 2005-2006 within a research network of acute mental health services. Seventy-five percent of Norwegian hospitals providing acute in-patient treatment participated. Substance use was measured using the Clinician Rating Scale and the ICD-10 diagnoses F10-19. Diagnostic assessments were performed by the clinicians during hospital stay.Results: Overall, 33.2% (n=1,187 of the total patient population (3,506 were abusing alcohol or drugs prior to admission according to the Clinician Rating Scale. No difference in the overall prevalence of substance abuserelated diagnoses between the two groups was found. Overall, 310 (26% of the admissions, 216 voluntarily and 94 involuntarily admitted patients received a double diagnosis. Frequent comorbid combinations among voluntarily admitted patients were; a combination of alcohol and either mood disorder (40% or multiple mental disorders (29%. Among involuntarily admitted patients, a combination of poly drug use and schizophrenia was most frequent (47%. Substance abusing patients diagnosed with mental and behavioral disorders due to the use of psychoactive stimulant substances had a significantly higher risk of involuntary hospitalization (OR 2.3.Conclusion: Nearly one third of substance abusing patients are involuntarily admitted to mental hospitals, in particular stimulant drug use was associated with involuntarily admissions.

  13. The Role of Inhaled Loxapine in the Treatment of Acute Agitation in Patients with Psychiatric Disorders: A Clinical Review

    Directory of Open Access Journals (Sweden)

    Domenico de Berardis

    2017-02-01

    Full Text Available Loxapine is a first generation antipsychotic, belonging to the dibenzoxazepine class. Recently, loxapine has been reformulated at a lower dose, producing an inhaled powder that can be directly administered to the lungs to treat the agitation associated with psychiatric disorders, such as schizophrenia and bipolar disorder. Thus, the aim of this narrative and clinical mini-review was to evaluate the efficacy and tolerability of inhaled loxapine in the treatment of acute agitation in patients with psychiatric disorders. The efficacy of inhaled loxapine has been evaluated in one Phase II trial on patients with schizophrenia, and in two Phase III trials in patients with schizophrenia and bipolar disorder. Moreover, there are two published case series on patients with borderline personality disorder and dual diagnosis patients. Inhaled loxapine has proven to be effective and generally well tolerated when administered to agitated patients with schizophrenia and bipolar disorder. Two case series have suggested that inhaled loxapine may also be useful to treat agitation in patients with borderline personality disorder and with dual diagnosis, but further studies are needed to clarify this point. However, the administration of inhaled loxapine requires at least some kind of patient collaboration, and is not recommended in the treatment of severe agitation in totally uncooperative patients. Moreover, the drug-related risk of bronchospasm must always be kept in mind when planning to use inhaled loxapine, leading to a careful patient assessment prior to, and after, administration. Also, the higher costs of inhaled loxapine, when compared to oral and intramuscular medications, should be taken into account when selecting it for the treatment of agitation.

  14. Motor unit involvement in human acute Chagas' disease

    Directory of Open Access Journals (Sweden)

    O. R. Benavente

    1989-09-01

    Full Text Available Thirty five patients with acute Chagas' disease who demonstrated parasitaemia at the time of the investigation were submitted to a detailed electromyographical study. With their muscles at rest, 12 patients showed fibrillation potentials and/or positive sharp waves. On volitional contraction, 7 had short duration motor unit potentials (MUPs and low polyphasic MUPs. On motor and sensory nerve fibers conduction studies, 20 disclosed values below the lower control limit within one or more nerves. Finally, 12 patients produced a muscle, decremental response on nerve supramaximal repetitive stimulation. The findings signal that primary muscle involvement, neuropathy and impairement of the neuromuscular transmission, either isolated or combined, may be found in the acute stage of human Chagas' disease.

  15. Affective Spectrum Disorders in an Urban Swedish Adult Psychiatric Unit: A Descriptive Study

    Directory of Open Access Journals (Sweden)

    M. Scharin

    2012-01-01

    Full Text Available Background. Several studies have found that patients with affective-/anxiety-/stress-related syndromes present overlapping features such as cooccurrence within families and individuals and response to the same type of pharmacological treatment, suggesting that these syndromes share pathogenetic mechanisms. The term affective spectrum disorder (AfSD has been suggested, emphasizing these commonalities. The expectancy rate, sociodemographic characteristics, and global level of functioning in AfSD has hitherto not been studied neglected. Material and Method. Out of 180 consecutive patients 94 were included after clinical investigations and ICD-10 diagnostics. Further investigations included well-known self-evaluation instruments assessing psychiatric symptoms, personality disorders, psychosocial stress, adaptation, quality of life, and global level of functioning. A neuropsychological screening was also included. Results. The patients were young, had many young children, were well educated, and had about expected (normal distribution of intelligence. Sixty-one percent were identified as belonging to the group of AfSD. Conclusion. The study identifies a large group of patients that presents much suffering and failure of functioning. This group is shared between the levels of medical care, between primary care and psychiatry. The term AfSD facilitates identification of patient groups that share common traits and identifies individuals clinically, besides the referred patients, in need of psychiatric interventions.

  16. Affective spectrum disorders in an urban Swedish adult psychiatric unit: a descriptive study.

    Science.gov (United States)

    Scharin, M; Archer, T; Hellström, P

    2012-01-01

    Background. Several studies have found that patients with affective-/anxiety-/stress-related syndromes present overlapping features such as cooccurrence within families and individuals and response to the same type of pharmacological treatment, suggesting that these syndromes share pathogenetic mechanisms. The term affective spectrum disorder (AfSD) has been suggested, emphasizing these commonalities. The expectancy rate, sociodemographic characteristics, and global level of functioning in AfSD has hitherto not been studied neglected. Material and Method. Out of 180 consecutive patients 94 were included after clinical investigations and ICD-10 diagnostics. Further investigations included well-known self-evaluation instruments assessing psychiatric symptoms, personality disorders, psychosocial stress, adaptation, quality of life, and global level of functioning. A neuropsychological screening was also included. Results. The patients were young, had many young children, were well educated, and had about expected (normal distribution of) intelligence. Sixty-one percent were identified as belonging to the group of AfSD. Conclusion. The study identifies a large group of patients that presents much suffering and failure of functioning. This group is shared between the levels of medical care, between primary care and psychiatry. The term AfSD facilitates identification of patient groups that share common traits and identifies individuals clinically, besides the referred patients, in need of psychiatric interventions.

  17. Reflections from Dutch advanced nursing practice students on psychiatric mental healthcare in the United States.

    Science.gov (United States)

    Maas, Lillian Garcia; Ezeobele, Ifeoma Ezebuiro

    2014-12-01

    An international clinical learning experience is a unique opportunity to witness another nursing and healthcare system. The Master of Advanced Nursing Practice (MANP) program at Rotterdam University of Applied Sciences in the Netherlands, mandates an international experience. Semi-structured qualitative interviews, a focus group session and written reflections were used for data collection with 6 Dutch MANP nursing students who specialized in psychiatric mental healthcare. Five major themes were revealed from the data. The themes identified were as follows: (1) pride and passion for mental health profession (2) role diversity within psychiatric mental health nursing (3) nursing leadership at the organization level (4) comparable Westernized approaches to mental healthcare and (5) differences in access to care. Incorporating a mandatory international clinical experience is a beneficial tool to promote a global understanding of the unique advanced practice nursing student's academic and professional development. The international clinical learning experience is considered a highlight of the 2-year MANP program. The students are able to gain a new and broader vision of the APN role and a greater appreciation for the Dutch healthcare system. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Talking therapy groups on acute psychiatric wards: patients' experience of two structured group formats

    Science.gov (United States)

    Radcliffe, Jonathan; Bird, Laura

    2016-01-01

    Aims and method We report the results of a clinical audit of patients' reactions to two types of talking therapy groups facilitated by assistant psychologists and psychology graduates on three acute wards. Patients' experiences of problem-solving and interpersonal group formats were explored via focus groups and structured interviews with 29 group participants. Results Both group formats generated high satisfaction ratings, with benefits related mostly to generic factors. Clinical implications Adequately trained and supported assistant psychologists and psychology graduates can provide supportive talking groups that patients find helpful. PMID:27512586

  19. Characteristics of patients frequently subjected to pharmacological and mechanical restraint--a register study in three Norwegian acute psychiatric wards.

    Science.gov (United States)

    Knutzen, Maria; Bjørkly, Stål; Eidhammer, Gunnar; Lorentzen, Steinar; Mjøsund, Nina Helen; Opjordsmoen, Stein; Sandvik, Leiv; Friis, Svein

    2014-01-30

    This retrospective study from three catchment-area-based acute psychiatric wards showed that of all the pharmacologically and mechanically restrained patients (n=373) 34 (9.1%) had been frequently restrained (6 or more times). These patients accounted for 39.2% of all restraint episodes during the two-year study period. Adjusted binary logistic regression analyses showed that the odds for being frequently restrained were 91% lower among patients above 50 years compared to those aged 18-29 years; a threefold increase (OR=3.1) for those admitted 3 times or more compared to patients with only one stay; and, finally, a threefold increase (OR=3.1) if the length of stay was 16 days or more compared to those admitted for 0-4 days. Among frequently restrained patients, males (n=15) had significantly longer stays than women (n=19), and 8 of the females had a diagnosis of personality disorder, compared to none among males. Our study showed that being frequently restrained was associated with long inpatient stay, many admissions and young age. Teasing out patient characteristics associated with the risk of being frequently restraint may contribute to reduce use of restraint by developing alternative interventions for these patients.

  20. A cross-sectional descriptive study of prevalence and nature of psychiatric referrals from intensive care units in a multispecialty hospital

    Directory of Open Access Journals (Sweden)

    Govind S Bhogale

    2011-01-01

    Full Text Available Context: The prevalence of psychiatric comorbidity in general hospital range from 20% to 60%. Presence of psychiatric morbidity compounds the disability and suffering in medical patients. There is a limited literature on the prevalence of psychiatric morbidity in patients admitted in the intensive care units (ICUs. Aims: The aim of the study was to estimate the prevalence and nature of comorbid psychiatric illness in the cases referred from ICUs. Settings and Design: Cross-sectional observational study. Materials and Methods: This study included all the consecutive patients referred from different ICUs to psychiatry department for consultation during the four-year period from January 1, 2000 to December 31, 2003, assessment was done by psychiatrist and diagnosis was made using ICD-10. Statistical Analysis: Descriptive statistics. Results: There were 309 (1.97% referrals from ICUs to psychiatry department during the period of study. Among the referred patients, diagnosis of organic mental disorders was the commonest psychiatric diagnosis present in 104 (33.65% patients followed by suicidal attempt in 101 (32.69%; anxiety disorders in 40 (12.94%; depressive disorders in 21 (6.8%; Psychotic illness in 10 (3.24%; other psychiatric illnesses in 28 (9.06%; and nil psychiatric illness in 5 (1.62% patients. Conclusion: Prevalence of psychiatric referrals from ICUs was low. This could be due to stigma and lack of awareness among physicians. There is increased need for recognition and treatment of comorbid psychiatric illness by the treating physicians which may help to decrease morbidity and overall cost of the treatment.

  1. [Tertiary syphilis diagnosed in a psychiatric unit in Buenos Aires, XXI century].

    Science.gov (United States)

    Cestaro, Omar A; Calicchio, Ada D; Loidl, Fabián; Presas, Lina

    2012-01-01

    It is a common belief that syphilis, since its effective treatment, is eradicated. However, because of failure prevention and control it is still present. Therefore, we describe what happened in our service with a young patient who was admitted with a presumptive diagnosis of delusional syndrome with a history of multiple symptoms and signs that led him to wander around different specialties in many hospitals. Semiology led us to think of neurosyphilis which was confirmed by laboratory tests on blood and cerebrospinal fluid. Due was then applied in addition to psychiatric treatment for syphilis, but despite this, the patient had a torpid evolution given the lateness of his picture. In this paper we wish to make a warning to doctors about the need to consider when framing neurosyphilis differential diagnosis and thus avoid the progression of the disease.

  2. Dissociative identity disorder among adolescents: prevalence in a university psychiatric outpatient unit.

    Science.gov (United States)

    Sar, Vedat; Onder, Canan; Kilincaslan, Ayse; Zoroglu, Süleyman S; Alyanak, Behiye

    2014-01-01

    The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients. A total of 116 consecutive outpatients between 11 and 17 years of age who were admitted to the child and adolescent psychiatry clinic of a university hospital for the 1st time were evaluated using the Adolescent Dissociative Experiences Scale, adolescent version of the Child Symptom Inventory-4, Childhood Trauma Questionnaire, and McMaster Family Assessment Device. All patients were invited for an interview with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) administered by 2 senior psychiatrists in a blind fashion. There was excellent interrater reliability between the 2 clinicians on SCID-D diagnoses and scores. Among 73 participants, 33 (45.2%) had a dissociative disorder: 12 (16.4%) had DID, and 21 (28.8%) had dissociative disorder not otherwise specified. There was no difference in gender distribution, childhood trauma, or family dysfunction scores between the dissociative and nondissociative groups. Childhood emotional abuse and family dysfunction correlated with self-reported dissociation. Of the dissociative adolescents, 93.9% had an additional psychiatric disorder. Among them, only separation anxiety disorder was significantly more prevalent than in controls. Although originally designed for adults, the SCID-D is promising for diagnosing dissociative disorders in adolescents, its modest congruence with self-rated dissociation and lack of relationship between diagnosis and childhood trauma and family dysfunction suggest that the prevalence rates obtained with this instrument originally designed for adults must be replicated. The introduction of diagnostic criteria for adolescent DID in revised versions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, would refine the assessment of dissociative disorders in this age group.

  3. Special acute care unit for older adults with Alzheimer's disease.

    Science.gov (United States)

    Soto, Maria E; Nourhashemi, Fati; Arbus, Christophe; Villars, Hélène; Balardy, Laurent; Andrieu, Sandrine; Vellas, Bruno

    2008-02-01

    To describe the cognitive, functional, and nutritional features of patients admitted to a Special Acute Care Unit (SACU) for elderly patients with Alzheimer's disease (AD). One-year observational study of patients with AD and other related disorders hospitalized in the SACU, Department of Geriatrics, Toulouse university Hospital during 2005. A comprehensive neurocognitive and non-cognitive geriatric assessment was performed. Data on full clinical evaluation, nutritional status, activities of daily living (ADL), gait and balance disturbance, behavioural and psychological symptoms (BPSD), and sociodemographics were recorded. Four-hundred and ninety-two patients were assessed. Their mean age was 81.1+/-7.7, the mean length of stay was 10.7+/-6.3 days, 62% were female, 63.9% were admitted from their own home and 30.4% from a nursing home. Eighty percent of patients had probable Alzheimer's disease or mixed dementia, less than 20% had other causes of dementia. Results of their comprehensive assessment showed a mean mini-mental state examination of 14.5+/-7.4; a mean total ADL score of 3.7+/-1.7. Seventy-seven percent had gait or balance disturbances; 90% of patients presented an unsatisfactory nutritional status. The most common reason for admission was BPSD. AD complications are responsible for many acute admissions. Elderly patients suffering from dementia represent a population with unique clinical characteristics. Further randomised clinical trials are needed to evaluate the effectiveness of Special Acute Care Units for patients with AD and other related disorders. Copyright (c) 2007 John Wiley & Sons, Ltd.

  4. Psychiatric emergency services in Copenhagen 2012

    DEFF Research Database (Denmark)

    Moltke, Katinka; Høegh, Erica B; Sæbye, Ditte;

    2015-01-01

    BACKGROUND: Since the first publication of the psychiatric emergency units (PEUs) in Copenhagen 1985, outpatient facilities have undergone considerable changes. Our aim is to examine how these changes have influenced the activities in the PEUs in the same catchment area. METHODS: We conducted...... reduced the number of visits in the PEUs considerably. The results have shown a change of diagnostic distribution and more severe conditions requiring acute admissions for emergency treatment. Close collaboration with the patients' families, GPs, social authorities and specialized psychiatric outpatient...

  5. Comparing the effect of non-medical mechanical restraint preventive factors between psychiatric units in Denmark and Norway

    DEFF Research Database (Denmark)

    Bak, Jesper; Zoffmann, V.; Sestoft, D.M.;

    2015-01-01

    -medical origin may explain the differing number of MR episodes between Denmark and Norway. METHODS: This study is a cross-sectional survey of psychiatric units. Linear regression was used to assess the confounding effects of the MR preventive factors, i.e. whether a difference in the impact of these factors......BACKGROUND: The use of mechanical restraint (MR) is controversial, and large differences regarding the use of MR are often found among countries. In an earlier study, we observed that MR was used twice as frequently in Denmark than Norway. AIMS: To examine how presumed MR preventive factors of non......-staff ratio (- 11%), and the identification of the patient's crisis triggers (- 10%). CONCLUSIONS: These six MR preventive factors might partially explain the difference in the frequency of MR episodes observed in the two countries, i.e. higher numbers in Denmark than Norway. One MR preventive factor...

  6. Acute renal failure in the intensive care unit.

    Science.gov (United States)

    Weisbord, Steven D; Palevsky, Paul M

    2006-06-01

    Acute renal failure (ARF) is a common complication in critically ill patients, with ARF requiring renal replacement therapy (RRT) developing in approximately 5 to 10% of intensive care unit (ICU) patients. Epidemiological studies have demonstrated that ARF is an independent risk factor for mortality. Interventions to prevent the development of ARF are currently limited to a small number of settings, primarily radiocontrast nephropathy and rhabdomyolysis. There are no effective pharmacological agents for the treatment of established ARF. Renal replacement therapy remains the primary treatment for patients with severe ARF; however, the data guiding selection of modality of RRT and the optimal timing of initiation and dose of therapy are inconclusive. This review focuses on the epidemiology and diagnostic approach to ARF in the ICU and summarizes our current understanding of therapeutic approaches including RRT.

  7. Epidemiology of Acute Kidney Injury in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    James Case

    2013-01-01

    Full Text Available The incidence of acute kidney injury (AKI in the intensive care unit (ICU has increased during the past decade due to increased acuity as well as increased recognition. Early epidemiology studies were confounded by erratic definitions of AKI until recent consensus guidelines (RIFLE and AKIN standardized its definition. This paper discusses the incidence of AKI in the ICU with focuses on specific patient populations. The overall incidence of AKI in ICU patients ranges from 20% to 50% with lower incidence seen in elective surgical patients and higher incidence in sepsis patients. The incidence of contrast-induced AKI is less (11.5%–19% of all admissions than seen in the ICU population at large. AKI represents a significant risk factor for mortality and can be associated with mortality greater than 50%.

  8. 'Welcoming the Other': psychodrama in an acute inpatient unit.

    Science.gov (United States)

    Michael, Lorraine

    2016-02-01

    In this article, the author uses the leitmotifs inherent in a critically acclaimed film and in the philosophy of Emmanuel Levinas as a backdrop for discussion around how we encounter the humanity in the Other and its particular relevance for psychiatry. She proceeds to describe the existential underpinnings of psychodrama and demonstrates how she has been directing a psychodrama group, 'Theatre of Life', which has been operating for well over a decade within a public mental health system, acute inpatient unit. Through the ensuing discussion, she illustrates how the humanistic ethic of 'welcoming the Other' is actualised in the 'here-and now' of the psychodrama group psychotherapy process. A thematic analysis derived from group-members' evaluation of each session illuminates their felt sense depicting the ethic in action. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  9. Observed-predicted length of stay for an acute psychiatric department, as an indicator of inpatient care inefficiencies. Retrospective case-series study.

    Directory of Open Access Journals (Sweden)

    Marot Milagros

    2004-02-01

    Full Text Available Abstract Background Length of stay (LOS is an important indicator of efficiency for inpatient care but it does not achieve an adequate performance if it is not adjusted for the case mix of the patients hospitalized during the period considered. After two similar studies for Internal Medicine and Surgery respectively, the aims of the present study were to search for Length of Stay (LOS predictors in an acute psychiatric department and to assess the performance of the difference: observed-predicted length of stay, as an indicator of inpatient care inefficiencies. Methods Retrospective case-series of patients discharged during 1999 from the Psychiatric Department from General Hospital "Hermanos Ameijeiras" in Havana, Cuba. The 374 eligible medical records were randomly split into two groups of 187 each. We derived the function for estimating the predicted LOS within the first group. Possible predictors were: age; sex; place of residence; diagnosis, use of electroconvulsive therapy; co morbidities; symptoms at admission, medications, marital status, and response to treatment. LOS was the dependent variable. A thorough exam of the patients' records was the basis to assess the capacity of the function for detecting inefficiency problems, within the second group. Results The function explained 37% of LOS variation. The strongest influence on LOS came from: age (p = 0.002, response to treatment (p Conclusions This study demonstrates the importance of possible predictors of LOS, in an acute care Psychiatric department. The proposed indicator can be readily used to detect inefficiencies.

  10. Acute medical assessment units: an efficient alternative to in-hospital acute medical care.

    LENUS (Irish Health Repository)

    Watts, M

    2011-02-01

    Acute Medical Assessment Units (AMAUs) are being proposed as an alternative to congested Emergency Departments (EDs for the assessment of patients with a range of acute medical problems. We retrospectively reviewed the discharge destination of patients referred to a newly established AMAU during a six-month period. During the same period we contrasted activity in the ED for a similar group of patients. 1,562 patients were assessed in the AMAU. 196 (12.5%) were admitted to an in-patient bed and 1,148 (73.5%) were entered into specific diagnosis-driven out-patient pathways. 1,465 patients attended the ED and 635 (43.3%) were admitted. Out-patient alternatives to expensive in-patient care need to be provided at the \\'coal face" of acute referral. The AMAU provides this, and as a consequence admission rates are relatively low. This is achieved by directly communicating with GPs, accessing senior clinical decision makers, and providing immediate access to diagnostically driven outpatient pathways.

  11. Proactive and Reactive Aggression in a Child Psychiatric Inpatient Population

    Science.gov (United States)

    Fite, Paula J.; Stoppelbein, Laura; Greening, Leilani

    2009-01-01

    This study examined relations between proactive and reactive aggression and indicators of antisocial behavior (callous/unemotional traits and behavioral consequences) and negative affect (depression and suicidal behavior) in a sample of 105 children admitted to an acute child psychiatric inpatient unit. The majority of the children were male (69%)…

  12. Improving acute psychiatric hospital services according to inpatient experiences. A user-led piece of research as a means to empowerment.

    Science.gov (United States)

    Walsh, Jim; Boyle, Joan

    2009-01-01

    This paper has been undertaken by people with experience with mental health issues and mental health care systems. The aim of the research was to explore psychiatric inpatients' strategies for coping with mental ill health and in what ways acute inpatient psychiatric hospital services are facilitative to the individual attempting recovery. Ten focus groups were facilitated and data were analysed through systematic content analysis. Findings revealed that the main areas of concern for inpatients were: information, communication, relationships, activities, self-help, patient involvement in care treatment plans, and the physical environment. The authors also make a case to improve the status of user-led research as a means to understand the needs of mental health service users.

  13. An analysis of acute admissions to a general hospital psychiatric unit

    African Journals Online (AJOL)

    QuickSilver

    Statistics for 1999 showed that Helen Joseph Hospital admits on the average 53 new .... Lund C & Flisher AJ. South African Mental Health Process Indicators. .... paper) will fall well on the ears of general hospital management. Moosa and ...

  14. Causes of Death in an Acute Psychiatric Inpatient Unit of a Portuguese General Hospital.

    Science.gov (United States)

    Barbosa, Sofia; Sequeira, Márcia; Castro, Sara; Manso, Rita; Klut Câmara, Catarina; Trancas, Bruno; Borja-Santos, Nuno; Maia, Teresa

    2016-08-01

    Introdução: Os doentes afectos de patologia psiquiátrica apresentam maior risco de morte, tanto por causas naturais como não naturais. Este estudo avalia as causas de morte de todos os doentes de uma unidade de internamento de agudos de Psiquiatria num hospital geral em Portugal, ao longo de dezasseis anos (de 1998 a 2013). Material e Métodos: Vinte e um doentes morreram na unidade de internamento de doentes agudos entre 1998 e 2013 (média 1,3 por ano). As características demográficas, os diagnósticos médicos e psiquiátricos foram recolhidos através de um estudo retrospectivo que consistiu na análise dos processos clínicos da amostra selecionada. Os doentes transferidos para outras enfermarias durante o internamento não foram incluídos no estudo. Resultados: As doenças do sistema circulatório foram as causas de morte mais prevalentes, ocorrendo em 2/3 dos doentes, incluindo embolismo pulmonar (n = 6), acidente vascular cerebral (n = 3), arritmia cardíaca (n = 2), enfarte agudo do miocárdio (n = 1), rutura de aneurisma da aorta abdominal (n = 1) e insuficiência cardíaca (n = 1). Dois doentes morreram de pneumonia e em quatro casos a causa de morte foi indeterminada. Apenas um caso de suicídio foi registado. Discussão: As doenças do aparelho circulatório foram as causas de morte mais frequentes nesta unidade de agudos. O suicídio em doentes internados, apesar de constituir um evento raro, é uma realidade que comporta consequências complexas para os profissionais de saúde, familiares e restantes doentes, devendo permanecer como foco de prevenção continuada. Conclusão: Os estudos de mortalidade são importantes para determinar a qualidade dos cuidados de saúde e criar recomendações para medidas preventivas.

  15. Admitting acute ischemic stroke patients to a stroke care monitoring unit versus a conventional stroke unit : a randomized pilot study

    NARCIS (Netherlands)

    Sulter, Geert; Elting, Jan Willem; Langedijk, Marc; Maurits, Natasha M; De Keyser, Jacques

    2003-01-01

    BACKGROUND AND PURPOSE: Pathophysiological considerations and observational studies indicate that elevated body temperature, hypoxia, hypotension, and cardiac arrhythmias in the acute phase of ischemic stroke may aggravate brain damage and worsen outcome. METHODS: Both units were organized with the

  16. Admitting acute ischemic stroke patients to a stroke care monitoring unit versus a conventional stroke unit : a randomized pilot study

    NARCIS (Netherlands)

    Sulter, Geert; Elting, Jan Willem; Langedijk, Marc; Maurits, Natasha M; De Keyser, Jacques

    2003-01-01

    BACKGROUND AND PURPOSE: Pathophysiological considerations and observational studies indicate that elevated body temperature, hypoxia, hypotension, and cardiac arrhythmias in the acute phase of ischemic stroke may aggravate brain damage and worsen outcome. METHODS: Both units were organized with the

  17. Methodological advances in unit cost calculation of psychiatric residential care in Spain.

    Science.gov (United States)

    Moreno, Karen; Sanchez, Eduardo; Salvador-Carulla, Luis

    2008-06-01

    The care of the severe mentally ill who need intensive support for their daily living (dependent persons), accounts for an increasingly large proportion of public expenditure in many European countries. The main aim of this study was the design and implementation of solid methodology to calculate unit costs of different types of care. To date, methodologies used in Spain have produced inaccurate figures, suggesting few variations in patient consumption of the same service. An adaptation of the Activity-Based-Costing methodology was applied in Navarre, a region in the North of Spain, as a pilot project for the public mental health services. A unit cost per care process was obtained for all levels of care considered in each service during 2005. The European Service Mapping Schedule (ESMS) codes were used to classify the services for later comparisons. Finally, in order to avoid problems of asymmetric cost distribution, a simple Bayesian model was used. As an illustration, we report the results obtained for long-term residential care and note that there are important variations between unit costs when considering different levels of care. Considering three levels of care (Level 1-low, Level 2-medium and Level 3-intensive), the cost per bed in Level 3 was 10% higher than that of Level 2. The results obtained using the cost methodology described provide more useful information than those using conventional methods, although its implementation requires much time to compile the necessary information during the initial stages and the collaboration of staff and managers working in the services. However, in some services, if no important variations exist in patient care, another method would be advisable, although our system provides very useful information about patterns of care from a clinical point of view. Detailed work is required at the beginning of the implementation in order to avoid the calculation of distorted figures and to improve the levels of decision making

  18. Clay and Anxiety Reduction: A One-Group, Pretest/Posttest Design with Patients on a Psychiatric Unit

    Science.gov (United States)

    Kimport, Elizabeth R.; Hartzell, Elizabeth

    2015-01-01

    Little research exists on using clay as an anxiety-reducing intervention with patients in psychiatric hospitals. This article reports on a study that used a one-group, pretest/posttest design with 49 adults in a psychiatric facility who created a clay pinch pot. The State-Trait Anxiety Inventory (STAI) was used as a pre- and posttest measure.…

  19. Clay and Anxiety Reduction: A One-Group, Pretest/Posttest Design with Patients on a Psychiatric Unit

    Science.gov (United States)

    Kimport, Elizabeth R.; Hartzell, Elizabeth

    2015-01-01

    Little research exists on using clay as an anxiety-reducing intervention with patients in psychiatric hospitals. This article reports on a study that used a one-group, pretest/posttest design with 49 adults in a psychiatric facility who created a clay pinch pot. The State-Trait Anxiety Inventory (STAI) was used as a pre- and posttest measure.…

  20. Improving access to competitive employment for service users in forensic psychiatric units.

    Science.gov (United States)

    Beck, Charlotte; Wernham, Connie

    2014-01-01

    Employment has been proven to be an effective recovery tool and therapeutic intervention for those with severe and enduring mental health conditions. Aside from monetary reward, employment is a means of structuring time and provides a sense of worth and achievement, which enhances self-esteem and confidence. A social identity is developed through employment, encouraging social support and increasing social networks. Securing employment can bring about improved quality of life and positive change in one's social circumstances; therefore it can reduce symptoms associated with mental illness and potentially prevent re-offending, as the individual develops a sense of independence, self-efficacy, and value. Barriers to employment exist for forensic mental health service users and therefore it is imperative that employment needs are addressed at the earliest possible stage in recovery. An evaluation of employment activities across two forensic mental health units revealed a lack of appropriate employment opportunities for service users, and those roles available were not implemented in line with recommended best practice. In response to this issue several enterprises were established to offer opportunities for service users to engage in meaningful employment and develop skills that a future employer would value. Each enterprise responds to a business need within the units to ensure sustainability of services. The enterprises are essentially micro-businesses with social objectives whose surpluses are reinvested for the purpose of increasing opportunities for service users. The enterprises are underpinned by the philosophy of the Individual Placement and Support (IPS) model; empirical evidence suggests that the IPS model is the most effective intervention, based on the 'place then train' philosophy. The model recommends a focus upon rapid job search to achieve competitive employment for those who want to work; opportunities sourced should be consistent with individual

  1. Psychiatric disorders after radiation exposure

    Energy Technology Data Exchange (ETDEWEB)

    Kokai, Masahiro [Hyogo Coll. of Medicine, Nishinomiya (Japan); Soejima, Toshinori; Wang, Shangdong; Shinfuku, Naotaka

    2001-04-01

    This review focuses on the mental and psychological effects of medical radiation exposure, the nuclear accident at Three Mile Island, the Chernobyl disaster, atomic bomb explosions at Nagasaki and Hiroshima, and accidents at nuclear power plants and nuclear waste plants. Studies have shown that anxiety about the adverse effects of radiation in medicine (such as infertility, carcinogenicity, and genotoxicity) and fear for exposure has caused psychiatric disorders. Several studies on the mental health effects of the nuclear accident at Three Mile Island were conducted, and the results indicated that psychiatric distress persisted for a certain period of time, particularly in pregnant women and women who have children, even when no evidence of substantial of radiation exposure is seen clinically. The psychological consequences of the Chernobyl disaster have been investigated continuously, and various problems, e.g., acute stress reaction, neurosis, and psychosis, have been identified, although no physical damage due to the radiation or PTSD have been reported. By contrast, PTSD has been seen in survivors of the Nagasaki and Hiroshima nuclear explosions. A study in Ohio, (United States), which has a nuclear waste plant, investigated PTSD in people living near the plant and found that the symptom level was mild. In general, the most common symptoms among people with mental and psychological disorders due to radiation exposure are depression and anxiety, with many people having associated somatoform disorders, and some people complain of PTSD. Vague anxiety and fear of sequelae, regardless of the exposure dose, appears to cause such psychiatric disorders. Although it is rare for psychiatrists to see such cases of psychiatric disorders due to radiation exposure, their number may increase as psychiatric services become more widely available. (K.H.)

  2. High Rates of Psychiatric Comorbidity in Narcolepsy: Findings From the Burden of Narcolepsy Disease (BOND) Study of 9,312 Patients in the United States.

    Science.gov (United States)

    Ruoff, Chad M; Reaven, Nancy L; Funk, Susan E; McGaughey, Karen J; Ohayon, Maurice M; Guilleminault, Christian; Black, Jed

    2017-02-01

    To evaluate psychiatric comorbidity patterns in patients with a narcolepsy diagnosis in the United States. Truven Health Analytics MarketScan Research Databases were accessed to identify individuals ≥ 18 years of age with ≥ 1 ICD-9 diagnosis code(s) for narcolepsy continuously insured between 2006 and 2010 and non-narcolepsy controls matched 5:1 (age, gender, region, payer). Extensive subanalyses were conducted to confirm the validity of narcolepsy definitions. Narcolepsy subjects and controls were compared for frequency of psychiatric comorbid conditions (based on ICD-9 codes/Clinical Classification Software [CCS] level 2 categories) and psychiatric medication use. The final population included 9,312 narcolepsy subjects and 46,559 controls (each group, mean age = 46.1 years; 59% female). All categories of mental illness were significantly more prevalent in patients with narcolepsy versus controls, with the highest excess prevalence noted for CCS 5.8 Mood disorders (37.9% vs 13.8%; odds ratio [OR] = 4.0; 95% CI, 3.8-4.2), CCS 5.8.2 Depressive disorders (35.8% vs 13.0%; OR = 3.9; 95% CI, 3.7-4.1), and CCS 5.2 Anxiety disorders (25.1% vs 11.9%; OR = 2.5; 95% CI, 2.4-2.7). Excess prevalence of anxiety and mood disorders (narcolepsy vs controls) was higher in younger age groups versus older age groups. Psychiatric medication usage was higher in the narcolepsy group versus controls in the following categories: selective serotonin reuptake inhibitors (36% vs 17%), anxiolytic benzodiazepines (34% vs 19%), hypnotics (29% vs 13%), serotonin-norepinephrine reuptake inhibitors (21% vs 6%), and tricyclic antidepressants (13% vs 4%) (all P values Narcolepsy is associated with significant comorbid psychiatric illness burden and higher psychiatric medication usage compared with the non-narcolepsy population.

  3. Effectiveness of a Mobile Outreach and Crisis Services unit in reducing psychiatric symptoms in a population of homeless persons with severe mental illness.

    Science.gov (United States)

    Morris, D W; Warnock, J K

    2001-08-01

    The purpose of this study was to use a time-lag design to evaluate the effectiveness of a Mobile Outreach and Crisis Services unit in remitting psychiatric symptomatology, improving global functioning, and decreasing homelessness in a population of homeless, severely mentally ill residing in a mid-sized urban center. Using a time-lag study design, two groups of subjects--25 individuals before receiving services (control group) and 25 individuals after receiving services (experimental group)--were contrasted across outcome measures. The results indicate that a MOCS unit utilizing a Program for Assertive Community Treatment mode was effective in significantly decreasing psychiatric symptomatology, reducing homelessness, and increasing global functioning. If carefully implemented and interpreted, a time-lag design may be a means of providing valuable feedback and information in a timely manner.

  4. Barriers and challenges in seeking psychiatric intervention in a General Hospital, by the collaborative child response unit, (A multidisciplinary team approach to handling child abuse A qualitative analysis

    Directory of Open Access Journals (Sweden)

    Vyjayanthi Kanugodu Srinivasa Subramaniyan

    2017-01-01

    Full Text Available Child abuse is a serious criminal act against children in our country and punishable according to protection of children from sexual offenses act 2012. No one agency has the ability to respond completely to the abuse. Hence a multidisciplinary team approach was developed in India. Aim is to narrate the collaborative effort among the multiple disciplines in a general hospital to deliver child protection services and explore the barriers to integrate psychiatric services. Methodology: Members of the team were recruited from different disciplines and trained by experts. A mission statement, protocol to assess the victims and provide treatment was formulated as an algorithm. The barriers to psychiatric treatment among the stakeholders were analyzed using framework method of qualitative analysis. Results (After 20 months the unit received 27 referrals in 20 months, 24 females, and 3 males. Age of the victims was between 8 months and 17 years. Two cases found to be physically abused. Penetrative sexual abuse was found in 23 cases, pregnant victims were 4. Most referrals were by police, trafficking found in 6 cases. Discussion: It was possible to provide multidisciplinary care to the victims and families. Recurrent themes of barriers to psychiatric treatment were stigma, victim blaming; focus on termination of pregnancy, minimization of abuse in males by stakeholders. Conclusion is collaboration needs more effort to integrate psychiatric services but can minimize the reduplication of services.

  5. Barriers and Challenges in Seeking Psychiatric Intervention in a General Hospital, by the Collaborative Child Response Unit, (A Multidisciplinary Team Approach to Handling Child Abuse) A Qualitative Analysis

    Science.gov (United States)

    Subramaniyan, Vyjayanthi Kanugodu Srinivasa; Mital, Anukant; Rao, Chandrika; Chandra, Girish

    2017-01-01

    Child abuse is a serious criminal act against children in our country and punishable according to protection of children from sexual offenses act 2012. No one agency has the ability to respond completely to the abuse. Hence a multidisciplinary team approach was developed in India. Aim is to narrate the collaborative effort among the multiple disciplines in a general hospital to deliver child protection services and explore the barriers to integrate psychiatric services. Methodology: Members of the team were recruited from different disciplines and trained by experts. A mission statement, protocol to assess the victims and provide treatment was formulated as an algorithm. The barriers to psychiatric treatment among the stakeholders were analyzed using framework method of qualitative analysis. Results (After 20 months) the unit received 27 referrals in 20 months, 24 females, and 3 males. Age of the victims was between 8 months and 17 years. Two cases found to be physically abused. Penetrative sexual abuse was found in 23 cases, pregnant victims were 4. Most referrals were by police, trafficking found in 6 cases. Discussion: It was possible to provide multidisciplinary care to the victims and families. Recurrent themes of barriers to psychiatric treatment were stigma, victim blaming; focus on termination of pregnancy, minimization of abuse in males by stakeholders. Conclusion is collaboration needs more effort to integrate psychiatric services but can minimize the reduplication of services.

  6. The periodicities in and biometeorological relationships with bed occupancy of an acute psychiatric ward in Antwerp, Belgium

    Science.gov (United States)

    Maes, M.; de Meyer, F.; Peeters, D.; Meltzer, H.; Schotte, C.; Scharpe, S.; Cosyns, P.

    1993-06-01

    Recently, some investigators have established a seasonal pattern in normal human psychology, physiology and behaviour, and in the incidence of psychiatric psychopathology. In an attempt to elucidate the chronopsy and meteotropism in the latter, we have examined the chronograms of, and the biometeorological relationships to bed occupancy of the psychiatric ward of the Antwerp University Hospital during three consecutive calendar years (1987 1989). Weather data for the vicinity were provided by a local meteorological station and comprise mean atmospheric pressure, air temperature, relative humidity, wind speed and minutes of sunlight and precipitation/day. The number of psychiatric beds occupied during the study period exhibited a significant seasonal variation. Peaks in bed occupancy were observed in March and November, with lows in August. An important part of the variability in the number of beds occupied could be explained by the composite effects of weather variables of the preceding weeks. Our results suggest that short-term fluctuations in atmospheric activity may dictate some of the periodicities in psychiatric psychopathology.

  7. Managing acute medical admissions: a survey of acute medical services and medical assessment and planning units in New Zealand.

    Science.gov (United States)

    Providence, C; Gommans, J; Burns, A

    2012-01-01

    To determine the current provision of acute medical services, including the development of medical assessment and planning units (MAPUs), by district health boards (DHBs) throughout New Zealand (NZ). A questionnaire-based survey about organisation of acute medical services and establishment of MAPUs was sent to all 21 DHBs in NZ. All 21 DHBs responded. Seven DHBs serving 42% of the population have established MAPUs since 2003 and a further six have plans to do so over the next 3 years, potentially expanding service to 73% of the NZ population. All seven current MAPUs are in close proximity to and accept patients directly from emergency departments. Each MAPU has a documented target length of stay, four units have referral protocols, five provide guidelines for management of common medical emergencies and five routinely audit unit performance. Five MAPUs have cardiac monitored beds and isolation rooms. Rapid access is available to computed tomography scanning (six units), ultrasound (five) and echocardiography (four). Two units have no nominated physician leadership and two lack dedicated therapy resources. General physicians are involved in provision of acute medical services in 20 of 21 DHBs. Medical assessment and planning units have become an important component of acute medical service provision in NZ. The established units largely comply with Australasian recommendations, although important deficiencies exist. Training of physicians must combine the needs of acute medical patients and clinical roles of physicians within MAPUs with local DHB requirements for services to be most effective. © 2010 The Authors. Internal Medicine Journal © 2010 Royal Australasian College of Physicians.

  8. Prevention of acute kidney injury and protection of renal function in the intensive care unit

    NARCIS (Netherlands)

    Joannidis, Michael; Druml, Wilfred; Forni, Lui G.; Groeneveld, A. B. Johan; Honore, Patrick; Oudemans-van Straaten, Heleen M.; Ronco, Claudio; Schetz, Marie R. C.; Woittiez, Arend Jan

    2010-01-01

    Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasop

  9. Prevalence and illness beliefs of sleep paralysis among Chinese psychiatric patients in China and the United States.

    Science.gov (United States)

    Yeung, Albert; Xu, Yong; Chang, Doris F

    2005-03-01

    To investigate the prevalence and illness beliefs of sleep paralysis (SP) among Chinese patients in a psychiatric out-patient clinic, consecutive Chinese/Chinese-American patients who attended psychiatric out-patient clinics in Boston and Shanghai were asked about their lifetime prevalence, personal experience and perceptions regarding the causes, precipitating factors, consequences, and help-seeking of SP. During the 4-month study period, 42 non-psychotic psychiatric out-patients from the Boston site and 150 patients from the Shanghai site were interviewed. The prevalence of SP was found to be 26.2% in Boston and 23.3% in Shanghai. Patients with post-traumatic stress disorder (PTSD) or panic disorder reported a higher prevalence of SP than did patients without these disorders. Patients attributed SP to fatigue, stress, and other psychosocial factors. Although the experience has traditionally been labeled 'ghost oppression' among the Chinese, only two patients, one from each site, endorsed supernatural causes of their SP. Sleep paralysis is common among Chinese psychiatric out-patients. The endorsement of supernatural explanations for SP is rare among contemporary Chinese patients.

  10. Perspectives of patients with acute abdominal pain in an emergency department observation unit and a surgical assessment unit

    DEFF Research Database (Denmark)

    Schultz, Helen; Qvist, Niels; Mogensen, Christian B;

    2014-01-01

    AIMS AND OBJECTIVES: To investigate the patient perspective when admitted with acute abdominal pain to an emergency department observation unit compared with the perspective when admitted to a surgical assessment unit. BACKGROUND: An increase in emergency department observation units has led...... to more short-term admissions and has changed the patient journey from admission to specialised wards staffed by specialist nurses to stays in units staffed by emergency nurses. DESIGN: A comparative field study. METHODS: The study included 21 patients. Participant observation and qualitative interviews...... were performed, and the analyses were phenomenological-hermeneutic. RESULTS: Emergency department observation unit patients had extensive interaction with health professionals, which could create distrust. Surgical assessment unit patients experienced lack of interaction with nurses, also creating...

  11. Management of Acute Pancreatitis in Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Güniz Meyancı Köksal

    2010-12-01

    Full Text Available Pancreatitis is characterized by an inflammation occuring due to digestion of pancreatic self tissues and other organs after activation of digestive enzymes which are stable under normal conditions . For all the pancreatitis cases, the mortality rate is <%15. In the acute pancreatitis cases, the monitorization of the inspiration system, cardiovascular system and the metabolic status are needed. There is no primary therapy for the pancreatitis. All the therapy protocols are support therapy. The basic support therapy methods are: Liquid replacement, respiration support, pain management, pancreas secretion inhibition, metabolic support, intra-abdominal monitoring and decompression, nutrition, antibiotherapy, immunomodulation, coagulation mechanism monitoring. In the acute pancreatitis, the causes of early deaths are pancreatic shock and acute pulmonary thrombohemorrhage, within the first 7 days the causes of the 75% deaths are pulmonary shock and congestion and after 7 days the causes of the 77% are pancreas abscess, MOF (multiple organ failure, purulent peritonitis and erosive hemorrhage. (Journal of the Turkish Society of Intensive Care 2010; 8: 85-9

  12. Reflective Prompts to Guide Termination of the Psychiatric Clinical Student Nursing Experience.

    Science.gov (United States)

    Hubbard, Grace B

    2016-04-01

    The average length of stay on psychiatric inpatient units has decreased in the past 40 years from 24.9 to 7.2 days. Inpatient psychiatric nurses are challenged to meet the standards and scope of practice despite the changing circumstances of their work environment. The amount of time student nurses spend with a given patient has been affected by changes in acute psychiatric inpatient care and decreased length of stay; however, opportunities exist for effective termination of the nurse-client relationship. Facilitation of students' awareness and understanding of the dynamics inherent in the termination process is an important teaching task for psychiatric nursing clinical instructors. In the current article, a clinically focused learning activity using structured prompts to guide and promote psychiatric nursing students' experiences with the process of termination is described and teaching strategies are discussed.

  13. Psychiatric assessment of suicide attempters in Japan: a pilot study at a critical emergency unit in an urban area

    Directory of Open Access Journals (Sweden)

    Kishida Ikuko

    2007-11-01

    Full Text Available Abstract Background The incidence of suicide has increased markedly in Japan since 1998. As psychological autopsy is not generally accepted in Japan, surveys of suicide attempts, an established risk factor of suicide, are highly regarded. We have carried out this study to gain insight into the psychiatric aspects of those attempting suicide in Japan. Methods Three hundred and twenty consecutive cases of attempted suicide who were admitted to an urban emergency department were interviewed, with the focus on psychosocial background and DSM-IV diagnosis. Moreover, they were divided into two groups according to the method of attempted suicide in terms of lethality, and the two groups were compared. Results Ninety-five percent of patients received a psychiatric diagnosis: 81% of subjects met the criteria for an axis I disorder. The most frequent diagnosis was mood disorder. The mean age was higher and living alone more common in the high-lethality group. Middle-aged men tended to have a higher prevalence of mood disorders. Conclusion This is the first large-scale study of cases of attempted suicide since the dramatic increase in suicides began in Japan. The identification and introduction of treatments for psychiatric disorders at emergency departments has been indicated to be important in suicide prevention.

  14. Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

    Science.gov (United States)

    Ekerstad, Niklas; Karlson, Björn W; Dahlin Ivanoff, Synneve; Landahl, Sten; Andersson, David; Heintz, Emelie; Husberg, Magnus; Alwin, Jenny

    2017-01-01

    Objective The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting This study was conducted in a large county hospital in western Sweden. Participants The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14–0.79), ambulation (OR =0.19, 95% CI =0.1–0.37), dexterity (OR =0.38, 95% CI =0.19–0.75), emotion (OR =0.43, 95% CI =0.22–0.84), cognition (OR = 0.076, 95% CI =0.033–0.18) and pain (OR =0.28, 95% CI =0.15–0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32–0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). Conclusion Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality

  15. An effective system to measure and report quality indicators in acute medical units.

    Science.gov (United States)

    Atkinson, J; Barton, L; Harrison, A; Roper, N

    2012-01-01

    The Society for Acute Medicine has developed a number of clinical quality indicators by which all UK Acute Medicine Units can bench mark their activity. These will help to ensure high quality care for patients, inform the continuing development of acute medical services and demonstrate the positive impact of this new specialty. Prospective collection of these data may be a challenge for many busy units. This paper describes a local solution developed in house in a North East hospital. It demonstrates how the data collected can be analysed to assess the effect of changes in consultant presence on the unit and also time taken for patients to be seen by a doctor. The limitations of the system and potential for future development are considered.

  16. [Application of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction].

    Science.gov (United States)

    Wang, Zhi-min; Wang, Peng; Chen, Jie; Luo, Dan-hong; Shen, Wang-ming

    2008-07-01

    To evaluate the efficacy of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction. 77 acute cerebral infarction patients were randomly assigned to stroke rehabilitation unit group and 73 to ordinary group. The NIH stroke scale (NIHSS), activities of daily living (ADL) Barthel index and average hospitalized time were compared in two groups before and after the treatment. The average NIHSS in two groups before treatment were 9.26 and 9.12 respectively (P > 0.05) but became 2.62 and 7.64 after treatment (P 0.05) but 87.26 and 64.20 after the treatment (P stroke rehabilitation unit being applied in the acute phase of cerebral infarction, it showed positive results in the following aspects as: improving the neurological function, capabilities of managing daily life, and also shortening the days of hospitalization.

  17. A Typology of Interprofessional Teamwork in Acute Geriatric Care: A Study in 55 units in Belgium.

    Science.gov (United States)

    Piers, Ruth D; Versluys, Karen J J; Devoghel, Johan; Lambrecht, Sophie; Vyt, André; Van Den Noortgate, Nele J

    2017-09-01

    To explore the quality of interprofessional teamwork in acute geriatric care and to build a model of team types. Cross-sectional multicenter study. Acute geriatric units in Belgium. Team members of different professional backgrounds. Perceptions of interprofessional teamwork among team members of 55 acute geriatric units in Belgium were measured using a survey covering collaborative practice and experience, managerial coaching and open team culture, shared reflection and decision-making, patient files facilitating teamwork, members' belief in the power of teamwork, and members' comfort in reporting incidents. Cluster analysis was used to determine types of interprofessional teamwork. Professions and clusters were compared using analysis of variance. The overall response rate was 60%. Of the 890 respondents, 71% were nursing professionals, 20% other allied health professionals, 5% physicians, and 4% logistic and administrative staff. More than 70% of respondents scored highly on interprofessional teamwork competencies, consultation, experiences, meetings, management, and results. Fewer than 55% scored highly on items about shared reflection and decision-making, reporting incidents from a colleague, and patient files facilitating interprofessional teamwork. Nurses in this study rated shared reflection and decision-making lower than physicians on the same acute geriatric units (P teamwork in acute geriatric units is satisfactory, but shared reflection and decision-making needs improvement. Four types of interprofessional teamwork are identified and can be used to benchmark the teamwork of individual teams. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  18. PSYCHIATRIC DISORDER

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    2004536 Association study of clinical presentation in first-episode schizophrenia and possible candidate genes in chromosome 22. MA Xiaohong (马小红), et al. Dept Psychiatr, West China Hosp, Sichuan U-niv, Chengdu 610041. Chin J Psychiatr 2004;37(3): 145-148.

  19. Introduction of an acute surgical unit: comparison of performance indicators and outcomes for operative management of acute appendicitis.

    Science.gov (United States)

    Lancashire, John F; Steele, M; Parker, D; Puhalla, H

    2014-08-01

    The Acute Surgical Unit (ASU) is a recent change in management of acute general surgical patients in hospitals worldwide. In contrast to traditional management of acute surgical presentations by a rotating on-call system, ASUs are shown to deliver improved efficiency and patient outcomes. This study investigated the impact of an ASU on operative management of appendicitis, the most common acute surgical presentation, by comparing performance indicators and patient outcomes prior to and after introduction of an ASU at the Gold Coast Hospital, Queensland, Australia. A retrospective study of patients admitted from the Emergency Department (ED) and who underwent emergency appendectomy from February 2010 to January 2011 (pre-ASU) and after introduction of the ASU from February 2011 to January 2012 (post-ASU). A total of 548 patients underwent appendectomy between February 2010 and January 2012, comprising 247 pre-ASU and 301 post-ASU patients. Significant improvements were demonstrated: reduced time to surgical review, fewer complications arising from operations commencing during ASU in-hours, and more appendectomies performed during the daytime attended by the consultant. There was no significant difference in total cost of admission or total admission length of stay. This study demonstrated that ASUs have potential to significantly improve the outcomes for operative management of acute appendicitis compared to the traditional on-call model. The impact of the ASU was limited by access to theaters and restricted ASU operation hours. Further investigation of site-specific determinants could be beneficial to optimize this new model of acute surgical care.

  20. Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units

    Science.gov (United States)

    2014-01-01

    Background In psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings. Methods A convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings. Results Eighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued. Conclusions Aggression in acute old age psychiatry inpatient units occurs

  1. Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units.

    Science.gov (United States)

    McCann, Terence V; Baird, John; Muir-Cochrane, Eimear

    2014-03-19

    In psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings. A convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings. Eighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued. Aggression in acute old age psychiatry inpatient units occurs occasionally and is problematic. A range of causative

  2. Unit-Specific Rates of Hand Hygiene Opportunities in an Acute-Care Hospital.

    Science.gov (United States)

    Han, Angela; Conway, Laurie J; Moore, Christine; McCreight, Liz; Ragan, Kelsey; So, Jannice; Borgundvaag, Emily; Larocque, Mike; Coleman, Brenda L; McGeer, Allison

    2017-04-01

    OBJECTIVE To explore the frequency of hand hygiene opportunities (HHOs) in multiple units of an acute-care hospital. DESIGN Prospective observational study. SETTING The adult intensive care unit (ICU), medical and surgical step-down units, medical and surgical units, and the postpartum mother-baby unit (MBU) of an academic acute-care hospital during May-August 2013, May-July 2014, and June-August 2015. PARTICIPANTS Healthcare workers (HCWs). METHODS HHOs were recorded using direct observation in 1-hour intervals following Public Health Ontario guidelines. The frequency and distribution of HHOs per patient hour were determined for each unit according to time of day, indication, and profession. RESULTS In total, 3,422 HHOs were identified during 586 hours of observation. The mean numbers of HHOs per patient hour in the ICU were similar to those in the medical and surgical step-down units during the day and night, which were higher than the rates observed in medical and surgical units and the MBU. The rate of HHOs during the night significantly decreased compared with day (P92% of HHOs on medical and surgical units, compared to 67% of HHOs on the MBU. CONCLUSIONS Assessment of hand hygiene compliance using product utilization data requires knowledge of the appropriate opportunities for hand hygiene. We have provided a detailed characterization of these estimates across a wide range of inpatient settings as well as an examination of temporal variations in HHOs. Infect Control Hosp Epidemiol 2017;38:411-416.

  3. Acute hepatitis E by a new isolate acquired in the United States.

    Science.gov (United States)

    Kwo, P Y; Schlauder, G G; Carpenter, H A; Murphy, P J; Rosenblatt, J E; Dawson, G J; Mast, E E; Krawczynski, K; Balan, V

    1997-12-01

    To report the first case of acute hepatitis E by a novel isolate acquired in the United States and confirmed by nucleotide sequencing. We describe the clinical manifestations and the results of associated laboratory studies in a man who was found to have acute hepatitis E infection. A 62-year-old man was hospitalized because of fever, abdominal pain, and jaundice. After an initial evaluation did not provide a cause, his serum was found to be positive for IgG anti-hepatitis E virus (HEV) by three antibody assays. Serum was also positive for HEV RNA by reverse transcriptase polymerase chain reaction (PCR). Sequencing results from the PCR products demonstrated substantial differences at the nucleotide level between this strain and the known Mexican and Burmese strains. On the basis of this initial report, HEV should be considered an etiologic agent in patients with acute non-ABC hepatitis in the United States.

  4. Patterns of admissions in an acute medical unit: priorities for service development and education.

    Science.gov (United States)

    James, Natalie J; Hussain, Rumana; Moonie, Alasdair; Richardson, Donald; Waring, W Stephen

    2012-01-01

    An Acute Medical Unit has recently been established at York Hospital. The present study sought to characterise the case mix of acutely unwell medical patients to allow identification of priorities for ongoing service development and to assess educational opportunities for trainees in the region. Data were collected for 16001 admission episodes between January 2010 and April 2011 inclusive. These allowed characterisation of the case mix, and identified key priorities where clinical pathway do not yet exist, namely heart failure, urinary tract infection, and acute diarrhoea. Good educational opportunities exist for most aspects of the Acute Medicine curriculum; several weaknesses were identified, and trainees might address these by undertaking a specific period of specialty training in endocrinology and neurology.

  5. Unit-Based Acute Confusion Resource Nurse: An Educational Program To Train Staff Nurses.

    Science.gov (United States)

    Rapp, Carla Gene; Onega, Lisa L.; Tripp-Reimer, Toni; Mobily, Paula; Wakefield, Bonnie; Kundrat, Mary; Akins, Jackie; Wadle, Karen; Mentes, Jan; Culp, Ken; Meyer, Jean; Waterman, James

    1998-01-01

    Describes the development and evaluation of an eight-hour educational program designed to prepare staff nurses to perform in a new role, the unit-based acute confusion Resource Nurse (ACRN). Tests showed that knowledge and confidence significantly increased for participants as a result of their participation in the educational program. (Author/GCP)

  6. Genetic analysis of Israel Acute Paralysis Virus: distinct clusters are circulating into the United States.

    Science.gov (United States)

    Israel acute paralysis virus (IAPV) is associated with colony collapse disorder of honey bees. Nonetheless, its role in the pathogenesis of the disorder and its geographic distribution are unclear. Here, we report phylogenetic analysis of IAPV obtained from bees in the United States, Canada, Austral...

  7. How Patients and Nurses Experience an Open Versus an Enclosed Nursing Station on an Inpatient Psychiatric Unit.

    Science.gov (United States)

    Shattell, Mona; Bartlett, Robin; Beres, Kyle; Southard, Kelly; Bell, Claire; Judge, Christine A; Duke, Patricia

    2015-01-01

    The inpatient environment is a critical space for nurses and patients in psychiatric settings. In this article, we describe nurses' and patients' perceptions of the inpatient environment both before the removal of a Plexiglas enclosure around a nurses' station and after its removal. Nurses had mixed feelings about the enclosure, reporting that it provided for confidentiality and a concentrated work space but also acknowledged the challenge of the barrier for communication with their patients. Patients unanimously preferred the nurses' station without the barrier, reporting increased feelings of freedom, safety, and connection with the nurses after its removal. It is important to consider the implications of environmental decisions in inpatient settings in order to promote a healthy workplace and healing environment for all community members.

  8. Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

    Directory of Open Access Journals (Sweden)

    Ekerstad N

    2016-12-01

    Full Text Available Niklas Ekerstad,1,2 Björn W Karlson,3 Synneve Dahlin Ivanoff,4 Sten Landahl,5 David Andersson,6 Emelie Heintz,7 Magnus Husberg,2 Jenny Alwin2 1Department of Cardiology, NU (NÄL-Uddevalla Hospital Group, Trollhattan, 2Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, 3Department of Molecular and Clinical Medicine, Institute of Medicine, 4Centre for Ageing and Health, AGECAP, Department of Health and Rehabilitation, 5Department of Geriatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 6Division of Economics, Department of Management and Engineering, Linköping University, Linköping, 7Health Outcomes and Economic Evaluation Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206 or control group (n=202. Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3. Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by

  9. Finding solutions through empowerment: a preliminary study of a solution-orientated approach to nursing in acute psychiatric settings.

    Science.gov (United States)

    Stevenson, C; Jackson, S; Barker, P

    2003-12-01

    Acute inpatient care is not a therapeutic milieu, perhaps owing to the lack of nursing skills. Solution-focused therapy (SFT) has been successful in US inpatient facilities in relation to both objective and subjective 'measures'. This paper reports a study of SFT in a UK context, with the aim of developing a user-friendly SFT training course and assessing its impact on both nurses and clients, via a multifaceted, triangulated data collection design. Nurses' knowledge and clinical performance were assessed, as was the client's perspective. There was a significant difference in nurses' SFT knowledge after training and strong evidence of the model being used in practice during the course of training, although nursing documentation was not fully completed. Eighty-three per cent of nurses said that they would continue using the model, and clients found the SFT approach helpful. The findings match the US experience of using SFT.

  10. Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit

    Directory of Open Access Journals (Sweden)

    Tanya West

    2013-01-01

    Full Text Available Background. Comprehensive stroke unit care, incorporating acute care and rehabilitation, may promote early physical activity after stroke. However, previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit. This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit. Methods. This study was a prospective observational study. Behavioural mapping was used to determine the proportion of the day spent in different activities. Therapist reports were used to determine the amount of formal therapy received on the day of observation. The timing of commencement of activity out of bed was obtained from the medical records. Results. On average, patients spent 45% (SD 25 of the day in some form of physical activity and received 58 (SD 34 minutes per day of physiotherapy and occupational therapy combined. Mean time to first mobilisation out of bed was 46 (SD 32 hours post-stroke. Conclusions. This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit, when compared to studies of other acute stroke models of care.

  11. Knowledge translation: An interprofessional approach to integrating a pain consult team within an acute care unit.

    Science.gov (United States)

    Feldman, Kira; Berall, Anna; Karuza, Jurgis; Senderovich, Helen; Perri, Giulia-Anna; Grossman, Daphna

    2016-11-01

    Management of pain in the frail elderly presents many challenges in both assessment and treatment, due to the presence of multiple co-morbidities, polypharmacy, and cognitive impairment. At Baycrest Health Sciences, a geriatric care centre, pain in its acute care unit had been managed through consultations with the pain team on a case-by-case basis. In an intervention informed by knowledge translation (KT), the pain specialists integrated within the social network of the acute care team for 6 months to disseminate their expertise. A survey was administered to staff on the unit before and after the intervention of the pain team to understand staff perceptions of pain management. Pre- and post-comparisons of the survey responses were analysed by using t-tests. This study provided some evidence for the success of this interprofessional education initiative through changes in staff confidence with respect to pain management. It also showed that embedding the pain team into the acute care team supported the KT process as an effective method of interprofessional team building. Incorporating the pain team into the acute care unit to provide training and ongoing decision support was a feasible strategy for KT and could be replicated in other clinical settings.

  12. An interdisciplinary visual team in an acute and sub-acute stroke unit

    DEFF Research Database (Denmark)

    Norup, Anne; Guldberg, Anne-Mette; Friis, Claus Radmer;

    2016-01-01

    OBJECTIVE: To describe the work of an interdisciplinary visual team in a stroke unit providing early identification and assessment of patients with visual symptoms, and secondly to investigate frequency, type of visual deficits after stroke and self-evaluated impact on everyday life after stroke...

  13. Acute two-photon imaging of the neurovascular unit in the cortex of active mice

    Science.gov (United States)

    Tran, Cam Ha T.; Gordon, Grant R.

    2015-01-01

    In vivo two-photon scanning fluorescence imaging is a powerful technique to observe physiological processes from the millimeter to the micron scale in the intact animal. In neuroscience research, a common approach is to install an acute cranial window and head bar to explore neocortical function under anesthesia before inflammation peaks from the surgery. However, there are few detailed acute protocols for head-restrained and fully awake animal imaging of the neurovascular unit during activity. This is because acutely performed awake experiments are typically untenable when the animal is naïve to the imaging apparatus. Here we detail a method that achieves acute, deep-tissue two-photon imaging of neocortical astrocytes and microvasculature in behaving mice. A week prior to experimentation, implantation of the head bar alone allows mice to train for head-immobilization on an easy-to-learn air-supported ball treadmill. Following just two brief familiarization sessions to the treadmill on separate days, an acute cranial window can subsequently be installed for immediate imaging. We demonstrate how running and whisking data can be captured simultaneously with two-photon fluorescence signals with acceptable movement artifacts during active motion. We also show possible applications of this technique by (1) monitoring dynamic changes to microvascular diameter and red blood cells in response to vibrissa sensory stimulation, (2) examining responses of the cerebral microcirculation to the systemic delivery of pharmacological agents using a tail artery cannula during awake imaging, and (3) measuring Ca2+ signals from synthetic and genetically encoded Ca2+ indicators in astrocytes. This method will facilitate acute two-photon fluorescence imaging in awake, active mice and help link cellular events within the neurovascular unit to behavior. PMID:25698926

  14. Acute two-photon imaging of the neurovascular unit in the cortex of active mice

    Directory of Open Access Journals (Sweden)

    Cam Ha Thai Tran

    2015-02-01

    Full Text Available In vivo two-photon scanning fluorescence imaging is a powerful technique to observe physiological processes from the millimeter to the micron scale in the intact animal. In neuroscience research, a common approach is to install an acute cranial window and head bar to explore neocortical function under anesthesia before inflammation peaks from the surgery. However, there are few detailed acute protocols for head-restrained and fully awake animal imaging of the neurovascular unit during activity. This is because acutely performed awake experiments are typically untenable when the animal is naïve to the imaging apparatus. Here we detail a protocol that achieves acute, deep-tissue two-photon imaging of neocortical astrocytes and microvasculature in behaving mice. A week prior to experimentation, implantation of the head bar alone allows mice to train for head-immobilization on an easy-to-learn air-supported ball treadmill. Following just two brief familiarization sessions to the treadmill on separate days, an acute cranial window can subsequently be installed for immediate imaging. We demonstrate how running and whisking data can be captured simultaneously with two-photon fluorescence signals with acceptable movement artifacts during active motion. We also show possible applications of this technique by 1 monitoring dynamic changes to microvascular diameter and red blood cells movements in response to vibrissa sensory stimulation, 2 examining responses of the cerebral microcirculation to the systemic delivery of pharmacological agents using a tail artery cannula during awake imaging, and 3 measuring Ca2+ signals from synthetic and genetically encoded Ca2+ indicators in astrocytes. This method will facilitate acute two-photon fluorescence imaging in awake, active mice and help link cellular events within the neurovascular unit to behaviour.

  15. Viral etiology of acute respiratory infections (ari) in old adults from ageriatric care unit

    OpenAIRE

    Beltrán, Karent Julieth; Grupo de Enfermedades Infecciosas, Línea de investigación Microbiología Molecular y Aplicada de las enfermedades Infecciosas, Pontificia Universidad Javeriana, Bogotá-Colombia.; Segura, Juan Camilo; Pontificia Universidad Javeriana, Bogotá-Colombia; Bettin, Laura; Pontificia Universidad Javeriana, Bogotá-Colombia; Coriat, Jeanette; Programa de Medicina, Pontificia Universidad Javeriana, Bogotá-Colombia; Mercado, Marcela; Instituto Nacional de Salud, Bogotá-Colombia.; Hidalgo, Marylin; Grupo de Enfermedades Infecciosas, Departamento de Microbiología. Facultad de Ciencias. Pontificia Universidad Javeriana. Bogotá, D.C. Colombia.; Díez, Hugo; Grupo de Enfermedades Infecciosas, Pontificia Universidad Javeriana, Bogotá-Colombia.

    2015-01-01

    Objective: To determine viral etiology of acute respiratory infections in older-than-60 adults, living at 4 geriatric care units in Bogota.Methods: The study was performed in two phases: Phase 1: Descriptive prospective study to evaluate incidence of viral respiratory infection during 1 year in old adults. 71 patients, suffering respiratory diseases, were selected, and evaluated, including physical exploration, thorax X-ray, and collection of respiratory samples for analysis. In order to dete...

  16. Short admission in an emergency psychiatry unit can prevent prolonged lengths of stay in a psychiatric institution Internação breve em unidade de emergência psiquiátrica pode prevenir permanência prolongada em instituições psiquiátricas

    Directory of Open Access Journals (Sweden)

    Régis Eric Maia Barros

    2010-06-01

    Full Text Available OBJECTIVE: Characterize and compare acute psychiatric admissions to the psychiatric wards of a general hospital (22 beds, a psychiatric hospital (80 and of an emergency psychiatry unit (6. METHOD: Survey of the ratios and shares of the demographic, diagnostic and hospitalization variables involved in all acute admissions registered in a catchment area in Brazil between 1998 and 2004. RESULTS: From the 11,208 admissions, 47.8% of the patients were admitted to a psychiatric hospital and 14.1% to a general hospital. The emergency psychiatry unit accounted for 38.1% of all admissions during the period, with a higher variability in occupancy rate and bed turnover during the years. Around 80% of the hospital stays lasted less than 20 days and in almost half of these cases, patients were discharged in 2 days. Although the total number of admissions remained stable during the years, in 2004, a 30% increase was seen compared to 2003. In 2004, bed turnover and occupancy rate at the emergency psychiatry unit increased. CONCLUSION: The increase in the number of psychiatric admissions in 2004 could be attributed to a lack of new community-based services available in the area beginning in 1998. Changes in the health care network did affect the emergency psychiatric service and the limitations of the community-based network could influence the rate of psychiatric admissions.OBJETIVO: Caracterizar e comparar internações psiquiátricas agudas em alas psiquiátricas no hospital geral (22 leitos, hospital psiquiátrico (80 e emergência psiquiátrica (6. MÉTODO: Foram analisadas todas as internações agudas entre 1998 e 2004 na região do estudo, com razões e proporções de variáveis demográficas, diagnósticas e das hospitalizações. RESULTADOS: Das 11.208 internações, 47,8% foram no hospital psiquiátrico e 14,1% no hospital geral. A emergência psiquiátrica realizou 38,1% das internações no período, com grande variabilidade da taxa de ocupa

  17. An end to psychiatric detention? Implications of the United Nations Convention on the Rights of Persons with Disabilities.

    Science.gov (United States)

    Kelly, Brendan D

    2014-03-01

    The United Nations Convention on the Rights of Persons with Disabilities is a welcome articulation of the rights of the disabled. However, as its definition of disability appears to include mental illness, the UK appears to violate it by linking mental illness with detention. Clarity and, possibly, change are needed.

  18. [Detection of palliative care needs in an acute care hospital unit. Pilot study].

    Science.gov (United States)

    Rodríguez-Calero, Miguel Ángel; Julià-Mora, Joana María; Prieto-Alomar, Araceli

    2016-01-01

    Previous to wider prevalence studies, we designed the present pilot study to assess concordance and time invested in patient evaluations using a palliative care needs assessment tool. We also sought to estimate the prevalence of palliative care needs in an acute care hospital unit. A cross-sectional study was carried out, 4 researchers (2 doctors and 2 nurses) independently assessed all inpatients in an acute care hospital unit in Manacor Hospital, Mallorca (Spain), using the validated tool NECPAL CCOMS-ICO©, measuring time invested in every case. Another researcher revised clinical recordings to analise the sample profile. Every researcher assessed 29 patients, 15 men and 14 women, mean age 74,03 ± 10.25 years. 4-observer concordance was moderate (Kappa 0,5043), tuning out to be higher between nurses. Mean time per patient evaluation was 1.9 to 7.72 minutes, depending on researcher. Prevalence of palliative care needs was 23,28%. Moderate concordance lean us towards multidisciplinary shared assessments as a method for future research. Avarage of time invested in evaluations was less than 8 minutes, no previous publications were identified regarding this variable. More than 20% of inpatients of the acute care unit were in need of palliative care. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  19. Training in Psychiatric Genomics during Residency: A New Challenge

    Science.gov (United States)

    Winner, Joel G.; Goebert, Deborah; Matsu, Courtenay; Mrazek, David A.

    2010-01-01

    Objective: The authors ascertained the amount of training in psychiatric genomics that is provided in North American psychiatric residency programs. Methods: A sample of 217 chief residents in psychiatric residency programs in the United States and Canada were identified by e-mail and surveyed to assess their training in psychiatric genetics and…

  20. Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function.

    Science.gov (United States)

    Bonnefoy-Cudraz, Eric; Bueno, Hector; Casella, Gianni; De Maria, Elia; Fitzsimons, Donna; Halvorsen, Sigrun; Hassager, Christian; Iakobishvili, Zaza; Magdy, Ahmed; Marandi, Toomas; Mimoso, Jorge; Parkhomenko, Alexander; Price, Susana; Rokyta, Richard; Roubille, Francois; Serpytis, Pranas; Shimony, Avi; Stepinska, Janina; Tint, Diana; Trendafilova, Elina; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zima, Endre; Zukermann, Robert; Lettino, Maddalena

    2017-08-01

    Acute cardiovascular care has progressed considerably since the last position paper was published 10 years ago. It is now a well-defined, complex field with demanding multidisciplinary teamworking. The Acute Cardiovascular Care Association has provided this update of the 2005 position paper on acute cardiovascular care organisation, using a multinational working group. The patient population has changed, and intensive cardiovascular care units now manage a large range of conditions from those simply requiring specialised monitoring, to critical cardiovascular diseases with associated multi-organ failure. To describe better intensive cardiovascular care units case mix, acuity of care has been divided into three levels, and then defining intensive cardiovascular care unit functional organisation. For each level of intensive cardiovascular care unit, this document presents the aims of the units, the recommended management structure, the optimal number of staff, the need for specially trained cardiologists and cardiovascular nurses, the desired equipment and architecture, and the interaction with other departments in the hospital and other intensive cardiovascular care units in the region/area. This update emphasises cardiologist training, referring to the recently updated Acute Cardiovascular Care Association core curriculum on acute cardiovascular care. The training of nurses in acute cardiovascular care is additionally addressed. Intensive cardiovascular care unit expertise is not limited to within the unit's geographical boundaries, extending to different specialties and subspecialties of cardiology and other specialties in order to optimally manage the wide scope of acute cardiovascular conditions in frequently highly complex patients. This position paper therefore addresses the need for the inclusion of acute cardiac care and intensive cardiovascular care units within a hospital network, linking university medical centres, large community hospitals, and smaller

  1. Acute kidney injury biomarkers for patients in a coronary care unit: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Tien-Hsing Chen

    Full Text Available BACKGROUND: Renal dysfunction is an established predictor of all-cause mortality in intensive care units. This study analyzed the outcomes of coronary care unit (CCU patients and evaluated several biomarkers of acute kidney injury (AKI, including neutrophil gelatinase-associated lipocalin (NGAL, interleukin-18 (IL-18 and cystatin C (CysC on the first day of CCU admission. METHODOLOGY/PRINCIPAL FINDINGS: Serum and urinary samples collected from 150 patients in the coronary care unit of a tertiary care university hospital between September 2009 and August 2010 were tested for NGAL, IL-18 and CysC. Prospective demographic, clinical and laboratory data were evaluated as predictors of survival in this patient group. The most common cause of CCU admission was acute myocardial infarction (80%. According to Acute Kidney Injury Network criteria, 28.7% (43/150 of CCU patients had AKI of varying severity. Cumulative survival rates at 6-month follow-up following hospital discharge differed significantly (p<0.05 between patients with AKI versus those without AKI. For predicting AKI, serum CysC displayed an excellent areas under the receiver operating characteristic curve (AUROC (0.895 ± 0.031, p < 0.001. The overall 180-day survival rate was 88.7% (133/150. Multiple Cox logistic regression hazard analysis revealed that urinary NGAL, serum IL-18, Acute Physiology, Age and Chronic Health Evaluation II (APACHE II and sodium on CCU admission day one were independent risk factors for 6-month mortality. In terms of 6-month mortality, urinary NGAL had the best discriminatory power, the best Youden index, and the highest overall correctness of prediction. CONCLUSIONS: Our data showed that serum CysC has the best discriminative power for predicting AKI in CCU patients. However, urinary NGAL and serum IL-18 are associated with short-term mortality in these critically ill patients.

  2. Leadership-organizational culture relationship in nursing units of acute care hospitals.

    Science.gov (United States)

    Casida, Jesus; Pinto-Zipp, Genevieve

    2008-01-01

    The phenomena of leadership and organizational culture (OC) has been defined as the driving forces in the success or failure of an organization. Today, nurse managers must demonstrate leadership behaviors or styles that are appropriate for the constantly changing, complex, and turbulent health care delivery system. In this study, researchers explored the relationship between nurse managers' leadership styles and OC of nursing units within an acute care hospital that had achieved excellent organizational performance as demonstrated by a consistent increase in patient satisfaction ratings. The data from this study support that transformational and transactional contingent reward leaderships as nurse manager leadership styles that are associated with nursing unit OC that have the ability to balance the dynamics of flexibility and stability within their nursing units and are essential for maintaining organizational effectiveness. It is essential for first-line nursing leaders to acquire knowledge and skills on organizational cultural competence.

  3. Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study

    Directory of Open Access Journals (Sweden)

    T B Singh

    2013-01-01

    Full Text Available Acute kidney injury (AKI is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years of either gender who developed AKI based on RIFLE criteria (using serum creatinine, 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively ( P < 0.0001. There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward ( P = 0.001. RIFLE-R was the most common AKI in medical (39.2% and ICU (50% wards but in the surgical ward, it was RIFLE-F that was most common (52.6%. Acute tubular necrosis was more common in ICU ( P = 0.043. Most common etiology of HAAKI in medical unit was drug induced (39.2%, whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively. Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively ( P = 0.003. Length of hospital stay in surgical, ICU and medical units were different ( P = 0.007. This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.

  4. Healthcare costs of acute and chronic tonsillar conditions in the pediatric population in the United States.

    Science.gov (United States)

    Duarte, Victor M; McGrath, Caitlin L; Shapiro, Nina L; Bhattacharrya, Neil

    2015-06-01

    To determine the prevalence and healthcare costs associated with the diagnosis and treatment of acute and chronic tonsillar conditions (ACT) in children. Cross-sectional analysis of the 2006, 2008, and 2010 Medical Expenditure Panel Surveys. Pediatric patients (age children with and without a diagnosis of ACT and acute versus chronic tonsillitis, with multivariate adjustment for age, sex, ethnicity, region, insurance coverage and comorbid conditions (e.g., asthma and otitis media). A total of 74.3 million children (mean age 8.55 years, 51% male) were sampled (raw N = 28,873). Of these, 804,229 children (1.1 ± 0.1%) were diagnosed with ACT annually (mean age 7.24 years, 49.1% male); 64.6 ± 2.0% had acute tonsillitis diagnoses and 35.4 ± 2.0% suffered from chronic tonsillitis. Children with ACT incurred an additional 2.3 office visits and 2.1 prescription fills (both p Children with acute tonsillar diagnoses carried total healthcare expenditures of $1303 ± 390 annually versus $2401 ± 618 for those with chronic tonsillitis (p = 0.193). ACT was associated with an incremental increase in total healthcare expense of $1685 per child, annually (p children, parents and the healthcare system. With its prevalence in the United States, pediatric tonsillitis accounts for approximately $1.355 billion in incremental healthcare expense and is a significant healthcare utilization concern. 2C. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Psychiatric rehabilitation

    OpenAIRE

    2010-01-01

    Psychiatric rehabilitation is an important component in the management of the mentally ill. This article presents a selective review of the publications in this journal. Questions addressed in this review range from assessment of rehabilitation needs to different rehabilitative approaches. Although the number of publications providing the answers is meager, there are innovative initiatives. There is a need for mental health professionals to publish the models they follow across the country.

  6. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis

    OpenAIRE

    Guo, Lei; Wang, Weiwei; Zhao, Nana; Guo, Libo; Chi, Chunjie; Hou, Wei; Wu, Anqi; Tong, Hongshuang; Wang, Yue; Wang, Changsong; Li, Enyou

    2016-01-01

    Background It has been shown that the application of a lung-protective mechanical ventilation strategy can improve the prognosis of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). However, the optimal mechanical ventilation strategy for intensive care unit (ICU) patients without ALI or ARDS is uncertain. Therefore, we performed a network meta-analysis to identify the optimal mechanical ventilation strategy for these patients. Methods We searched the Cochra...

  7. Is treatment in groups a useful alternative for psychiatry in low-income countries? An evaluation of a psychiatric outpatient unit in Nicaragua.

    Science.gov (United States)

    Caldera, T; Kullgren, G; Penayo, U; Jacobsson, L

    1995-11-01

    Centro de Atención Psicosocial in León, Nicaragua is a psychiatric outpatient unit that has developed a group-oriented model of working, in which 80% of all visits are in groups: first-admission groups, insight-oriented group psychotherapy, psycho-educative, family groups and relatives groups. The aim of the present study was to analyze patient characteristics and make a preliminary study of improvement, compliance and patient satisfaction in a 1-year perspective. One hundred consecutive visits were assessed, 44 of them first admissions. They were assessed according to all axes of DSM-III-R plus the Structural Clinical Interview for DSM-III Disorders. A 1-year follow up was conducted on 39 of 41 selected patients within the major diagnostic groups. One of 4 patients had a psychotic disorder where schizophrenia dominated. Among nonpsychotics major depression, anxiety and adjustment disorders were most frequent. Personality disorders were common (80%) among nonpsychotic patients, paranoid, obsessive-compulsive, passive-aggressive and masochistic personality disorders dominating. The illiteracy rate was 10%, but 50% had high school or university background. Severity of mental disorders and functional level did not differ between educational levels. There was a strong male dominance in all diagnostic, socioeconomic and educational level strata and few old patients. Improvement in functional level was clinically and statistically significant in all groups, and more than two thirds were very satisfied with the group treatment offered.

  8. External validation of Acute Physiology and Chronic Health Evaluation IV in Dutch intensive care units and comparison with Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II

    NARCIS (Netherlands)

    S. Brinkman; F. Bakhshi-Raiez; A. Abu-Hanna; E. de Jonge; R.J. Bosman; L. Peelen; N.F. de Keizer

    2011-01-01

    Purpose: The aim of this study was to validate and compare the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) IV in the Dutch intensive care unit (ICU) population to the APACHE II and Simplified Acute Physiology Score (SAPS) II. Materials and Methods: This is a prospectiv

  9. A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

    Directory of Open Access Journals (Sweden)

    Chong Mei

    2011-08-01

    Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care

  10. Psychiatric wards: places of safety?

    Science.gov (United States)

    Jones, J; Nolan, P; Bowers, L; Simpson, A; Whittington, R; Hackney, D; Bhui, K

    2010-03-01

    In recent years, the purpose and quality of provision delivered in acute inpatient psychiatric settings have been increasingly questioned. Studies from a service user perspective have reported that while some psychiatric inpatients feel safe and cared for, others feel their time in hospital is neither safe nor therapeutic. This paper explores the experiences of service users on acute inpatient psychiatric wards in England, with a particular focus on their feelings of safety and security. Interviews were conducted with 60 psychiatric inpatients in England. The majority of service users felt safe in hospital and felt supported by staff and other service users. However, anything that threatened their sense of security such as aggression, bullying, theft, racism and the use of alcohol and drugs on the ward, made some respondents feel insecure and unsafe. Psychiatric wards are still perceived by many as volatile environments, where service users feel forced to devise personal security strategies in order to protect themselves and their property. It would appear that there remains much to do before research findings and policies are implemented in ways that facilitate all service users to derive the maximum benefit from their inpatient experience.

  11. Sociodemographic characteristics and frequency of psychiatric disorders in Turkish pilgrims attended to psychiatry outpatient clinics during Hajj

    Directory of Open Access Journals (Sweden)

    Şakir Özen

    2010-03-01

    Full Text Available Objectives: The psychiatric problems of pilgrims fromnon-Arabic speaking countries have not been investigatedsufficiently. The aim of this study was to investigate thefrequency of psychiatric disorders and socio-demographiccharacteristics of Turkish pilgrims in psychiatry departmentof Turkish Mecca Hospital.Methods: A detailed psychiatric interview was performedon 294 Turkish Pilgrims who attended the outpatient clinicof the psychiatric unit at the Turkish hospital in Mecca,Saudi Arabia, during 2008 Hajj period. Information wascollected by using a semi-structured form and the patients’diagnoses were done according to the DSM-IV-TRcriteria.Results: The study group consisted of 175 women (59.5% and 119 men (40.5 % with the mean age of 53.0±13years. A total of 71 % patients had not traveled abroadpreviously, and 60% had received a former psychiatrictreatment. The commonest disorders were found asdepression (26.5%, adjustment disorder with anxiety(16.3% and panic disorder (14% in the patients. Anxietydisorders alone or co-morbid with any other psychiatricdisorder were found in 49% of the patients. Nine percentof the patients had symptoms of acute psychosis, schizophrenia,dementia or mania which could prevent pilgrimsfrom performing Hajj rituals. Suicide attempt, alcohol andillicit drug use were not detected.Conclusions: Previous psychiatric admission and absenceof any foreign travel experience were commonamong Turkish pilgrims who had sought psychiatric helpduring the Hajj. Psychiatric disorders seems to be relatedwith older age, low educational level, and having previousmedical and psychiatric problems.

  12. Environmental design in acute care settings: a case study of a neurological rehabilitation unit.

    Science.gov (United States)

    McCunn, Lindsay J; Gifford, Robert

    2013-01-01

    The purpose of this case study was to examine environmental variables that lead to staff error in acute care settings: noise; lighting; ergonomics, furniture, and equipment; and patient room design and unit layout. Chaudhury, Mahmood, & Valente (2009) reviewed a number of design considerations related to reducing errors by nursing staff in acute care settings. The Neurological Rehabilitation Unit (NRU) at one hospital served to further examine the design recommendations outlined by Chaudhury et al. (2009). Based on photographs, a site tour, interviews with the NRU manager and with the son of a patient of 5 months, comparisons were made between the NRU and the acute care setting design considerations reviewed by Chaudhury et al. (2009). The NRU appeared to comply with many recommendations: enforced noise reduction was facilitated through limiting both the number of patients per room and the number of patients admitted to the unit. Distinct rooms were used for various tasks that helped to contain activity-based noise. A combination of daylighting and artificial lighting was in place, but efforts to control glare and thermal comfort were not integrated into the design. The ergonomic needs of employees were incorporated in the design of the NRU, and the layouts of patient rooms and the layout of the NRU in general also were compatible with the design recommendations reviewed by Chaudhury et al. (2009). Many of the design attributes advocated by Chaudhury et al. (2009) were included in the NRU. Supplemental research should be undertaken, however, to objectively measure nursing error, efficiency, and staff satisfaction with respect to the comparisons and assumptions presented in this study. Case study, design, hospital, satisfaction, staff.

  13. Prolonged stays in hospital acute geriatric care units: identification and analysis of causes.

    Science.gov (United States)

    Parent, Vivien; Ludwig-Béal, Stéphanie; Sordet-Guépet, Hélène; Popitéan, Laura; Camus, Agnès; Da Silva, Sofia; Lubrano, Anne; Laissus, Frederick; Vaillard, Laurence; Manckoundia, Patrick

    2016-06-01

    In France, the population of very old frail patients, who require appropriate high-quality care, is increasing. Given the current economic climate, the mean duration of hospitalization (MDH) needs to be optimized. This prospective study analyzed the causes of prolonged hospitalization in an acute geriatric care unit. Over 6 months, all patients admitted to the target acute geriatric care unit were included and distributed into two groups according to a threshold stay of 14 days: long MDH group (LMDHG) and short MDH group (SMDHG). These two groups were compared. 757 patients were included. The LMDHG comprised 442 with a mean age of 86.7 years, of whom 67.65% were women and the SMDHG comprised 315 with a mean age of 86.6 years, of whom 63.2% were women. The two groups were statistically similar for age, sex, living conditions at home (alone or not, help), medical history and number of drugs. Patients in the LMDHG were more dependent (p=0.005), and were more likely to be hospitalized for social reasons (p=0.024) and to have come from their homes (p=0.011) than those in the SMDHG. The reasons for the prolonged stay, more frequent in the LMDHG than the SMDHG (p<0.05), were principally: waiting for imaging examinations, medical complications, and waiting for discharge solutions, assistance from social workers and/or specialist consultations. In order to reduce the MDH in acute geriatric care unit, it is necessary to consider the particularities of the patients who are admitted, their medico-socio-psychological management, access to technical facilities/consultations and post-discharge accommodation.

  14. Acute kidney injury on admission to the intensive care unit: where to go from here?

    Science.gov (United States)

    Ostermann, Marlies

    2008-01-01

    Acute kidney injury (AKI) is a common problem, especially in critically ill patients. In Critical Care, Kolhe and colleagues report that 6.3% of 276,731 patients in 170 intensive care units (ICUs) in the UK had evidence of severe AKI within the first 24 hours of admission to ICU. ICU and hospital mortality as well as length of stay in hospital were significantly increased. In light of this serious burden on individuals and the health system in general, the following commentary discusses the current state of knowledge of AKI in ICU and calls for more attention to preventive strategies.

  15. Psychiatric Treatment

    Science.gov (United States)

    Rudin, Edward; Zimmerman, Rick

    1978-01-01

    The California legislature enacted tight constraints on the use of psychosurgery and electroconvulsive therapy in 1974. In April 1976 a State Court of Appeals declared part of the law to be unconstitutional. In doing so, the court enunciated several principles for regulating medical procedures. It affirmed the inherent police powers which permit the state to safeguard the public, especially incompetent, involuntary or confined persons, with respect to intrusive and hazardous medical procedures and to procedures which affect thought or feeling. Although limited to legislation concerning two psychiatric procedures, the court's decision, and subsequently enacted legislation governing these procedures, has implications for other medical procedures and for other parts of the nation. PMID:664647

  16. PSYCHIATRIC DISORDER

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    14.1 Schizophrenia2007133 A comparative study of intramuscular ziprasidone and haloperidol in treating acute agitation in schizophrenia. LI Lehua(李乐华), et al. Mental Health Insit, 2nd Xiangya Hosp, Centr South Univ, Changsha 410011. Chin J Psychiat 2006;39(4):216-219. Objective To evaluate the efficacy and safety of injection ziprasidone in the treatment of acute agitation behavior in schizophrenia.

  17. Cost differences in VHA acute and subacute rehabilitation units: implications for VHA resource planning.

    Science.gov (United States)

    Vogel, W Bruce; Barnett, Tracey E; Reker, Dean

    2010-01-01

    Within the Veterans Health Administration (VHA), the top tier of postacute rehabilitation care is provided in acute rehabilitation bedservice units (ARBUs). The next level of care is provided in subacute rehabilitation bedservice units (SRBUs). We fitted reduced-form and structural models to explain VHA cost differences between ARBUs and SRBUs across time and for the individual cost components. We included sociodemographic variables, time since stroke onset, care facility, and the Functional Independence Measure at admission as explanatory variables. The multivariable results indicate that total index stay costs are lower in ARBUs by almost $6,000 (or approximately 25%) compared with SRBUs. Moreover, the lower costs observed in ARBUs in this study combined with the higher rates of guideline compliance and improved outcomes in ARBUs found in previous work suggest that stroke rehabilitation in an ARBU may be more cost-effective than stroke rehabilitation in an SRBU.

  18. Psychiatric aspects of induced abortion.

    Science.gov (United States)

    Stotland, Nada L

    2011-08-01

    Approximately one third of the women in the United States have an abortion during their lives. In the year 2008, 1.21 million abortions were performed in the United States (Jones and Koolstra, Perspect Sex Reprod Health 43:41-50, 2011). The psychiatric outcomes of abortion are scientifically well established (Adler et al., Science 248:41-43, 1990). Despite assertions to the contrary, there is no evidence that abortion causes psychiatric problems (Dagg, Am J Psychiatry 148:578-585, 1991). Those studies that report psychiatric sequelae suffer from severe methodological defects (Lagakos, N Engl J Med 354:1667-1669, 2006). Methodologically sound studies have demonstrated that there is a very low incidence of frank psychiatric illness after an abortion; women experience a wide variety of feelings over time, including, for some, transient sadness and grieving. However, the circumstances that lead a woman to terminate a pregnancy, including previous and/or ongoing psychiatric illness, are independently stressful and increase the likelihood of psychiatric illness over the already high baseline incidence and prevalence of mood and anxiety disorders among women of childbearing age. For optimal psychological outcomes, women, including adolescents, need to make autonomous and supported decisions about problem pregnancies. Clinicians can help patients facing these decisions and those who are working through feelings about having had abortions in the past.

  19. Improved Outcome of Severe Acute Pancreatitis in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Polychronis Pavlidis

    2013-01-01

    Full Text Available Background. Severe acute pancreatitis (SAP is associated with serious morbidity and mortality. Our objective was to describe the case mix, management, and outcome of patients with SAP receiving modern critical care in the Intensive Care Unit (ICU. Methods. Retrospective analysis of patients with SAP admitted to the ICU in a single tertiary care centre in the UK between January 2005 and December 2010. Results. Fifty SAP patients were admitted to ICU (62% male, mean age 51.7 (SD 14.8. The most common aetiologies were alcohol (40% and gallstones (30%. On admission to ICU, the median Acute Physiology and Chronic Health Evaluation (APACHE II score was 17, the pancreatitis outcome prediction score was 8, and the median Computed Tomography Severity Index (CTSI was 4. Forty patients (80% tolerated enteral nutrition, and 46% received antibiotics for non-SAP reasons. Acute kidney injury was significantly more common among hospital nonsurvivors compared to survivors (100% versus 42%, . ICU mortality and hospital mortality were 16% and 20%, respectively, and median lengths of stay in ICU and hospital were 13.5 and 30 days, respectively. Among hospital survivors, 27.5% developed diabetes mellitus and 5% needed long-term renal replacement therapy. Conclusions. The outcome of patients with SAP in ICU was better than previously reported but associated with a resource demanding hospital stay and long-term morbidity.

  20. Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia

    Science.gov (United States)

    Kepplinger, Jessica; Barlinn, Kristian; Albright, Karen C.; Schrempf, Wiebke; Boehme, Amelia K.; Pallesen, Lars-Peder; Schwanebeck, Uta; Graehlert, Xina; Storch, Alexander; Reichmann, Heinz; Alexandrov, Andrei V.; Bodechtel, Ulf

    2017-01-01

    Early screening for sleep apnea (SA) is rarely considered in patients with acute cerebral ischemia. We aimed to evaluate the feasibility of early SA screening on a stroke unit, its impact on post-discharge SA care and the relation of SA to clinical features. Patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) prospectively underwent overnight cardiorespiratory polygraphy within 3 ± 2 days of symptom-onset. Feasibility was defined as analyzable polygraphy in 90 % of studied patients. We enrolled 61 patients (84 % AIS, 16 % TIA): mean age 66 ± 8 years, 44 % men, median NIHSS 1 (0–15), median ESS 5 (0–13). Analyzability was given in 56/61 (91.8 %; one-sided 95 % CI, lower-bound 86.0 %) patients indicating excellent feasibility of early SA screening with no significant differences in stroke severity (100 % in TIA, 91 % minor stroke, 83 % major stroke, p = 0.474). Ninety-one percent (51/56) had an apnea–hypopnea index ≥5/h (median: 20/h [0–79]); 32 % (18/ 56) mild, 30 % (17/56) moderate, and 29 % (16/56) severe SA. When comparing sleep-related ischemic stroke (SIS) and non-SIS patients, no differences were found regarding the presence (95 vs. 89 %, p = 0.49) or severity (e.g., severe SA: 32 vs. 27 %, p = 0.69) of SA. After 12 months, 27/38 (71 %) patients given specific recommendations completed in-laboratory sleep work-up and 7/27 (25 %) were prescribed for non-invasive ventilatory correction. In conclusion, early SA screening is feasible in patients with acute cerebral ischemia and may have a positive impact on post-discharge SA care. Given the high frequency and atypical presentation of SA, early screening for SA should be considered in all acute cerebral ischemia patients. PMID:23263538

  1. Mechanical ventilation in pediatric intensive care units during the season for acute lower respiratory infection: a multicenter study.

    Science.gov (United States)

    Farias, Julio A; Fernández, Analía; Monteverde, Ezequiel; Flores, Juan C; Baltodano, Arístides; Menchaca, Amanda; Poterala, Rossana; Pánico, Flavia; Johnson, María; von Dessauer, Bettina; Donoso, Alejandro; Zavala, Inés; Zavala, Cesar; Troster, Eduardo; Peña, Yolanda; Flamenco, Carlos; Almeida, Helena; Nilda, Vidal; Esteban, Andrés

    2012-03-01

    To describe the characteristics and outcomes of mechanical ventilation in pediatric intensive care units during the season of acute lower respiratory infections. Prospective cohort of infants and children receiving mechanical ventilation for at least 12 hrs. Sixty medical-surgical pediatric intensive care units. All consecutive patients admitted to participating pediatric intensive care units during a 28-day period. Of 2,156 patients admitted to pediatric intensive care units, 1185 (55%) received mechanical ventilation for a median of 5 days (interquartile range 2-8). Median age was 7 months (interquartile range 2-25). Main indications for mechanical ventilation were acute respiratory failure in 78% of the patients, altered mental status in 15%, and acute on chronic pulmonary disease in 6%. Median length of stay in the pediatric intensive care units was 10 days (interquartile range 6-18). Overall mortality rate in pediatric intensive care units was 13% (95% confidence interval: 11-15) for the entire population, and 39% (95% confidence interval: 23 - 58) in patients with acute respiratory distress syndrome. Of 1150 attempts at liberation from mechanical ventilation, 62% (95% confidence interval: 60-65) used the spontaneous breathing trial, and 37% (95% confidence interval: 35-40) used gradual reduction of ventilatory support. Noninvasive mechanical ventilation was used initially in 173 patients (15%, 95% confidence interval: 13-17). In the season of acute lower respiratory infections, one of every two children admitted to pediatric intensive care units requires mechanical ventilation. Acute respiratory failure was the most common reason for mechanical ventilation. The spontaneous breathing trial was the most commonly used method for liberation from mechanical ventilation.

  2. Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit

    DEFF Research Database (Denmark)

    Matzen, Lars E; Jepsen, Ditte B; Ryg, Jesper

    2012-01-01

    ABSTRACT: BACKGROUND: Functional decline is associated with increased risk of mortality in geriatric patients.Assessment of activities of daily living (ADL) with the Barthel Index (BI) at admission wasstudied as a predictor of survival in older patients admitted to an acute geriatric unit. METHODS...... to an acute geriatricunit. These data suggest that assessment of ADL may have a potential role in decisionmaking for the clinical management of frail geriatric inpatients....

  3. Discharge destination from an acute care for the elderly (ACE unit

    Directory of Open Access Journals (Sweden)

    Luis F Amador

    2007-10-01

    Full Text Available Luis F Amador1,2, Carlos A Reyes-Ortiz1,2, Diana Reed 3, Cheryl Lehman2,41Department of Internal Medicine, 2Sealy Center on Aging, 3Department Care Management, 4Department of Nursing, University of Texas Medical Branch at Galveston, TX, USA Abstract: Older adults age 65 and over account for a disproportional number of hospital stays and discharges compared to other age groups. The objective of this paper is to describe placement and characteristics of older patients discharged from an acute care for the elderly (ACE unit. The study sample consists of 1,351 men and women aged 65 years or older that were discharged from the ACE Unit during a 12-month period. The mean number of discharges per month was 109.2 ± 28.4. Most of the subjects were discharged home or home with home health 841, 62.3%. The oldest elderly and patients who had been admitted from long term care institutions or from skilled nursing facilities to the ACE unit were less likely to return to home.Keywords: hospitalization, geriatric, discharge disposition

  4. Clinical analysis of seven cases with acute myocardial infarction complicated psychiatric symptoms%急性心肌梗死患者并发精神症状临床分析(附7例报告)

    Institute of Scientific and Technical Information of China (English)

    任澎; 王勇; 古孜丽; 李国庆; 涂良珍

    2012-01-01

    目的:探讨急性心肌梗死(AMI)并发精神症状的原因和治疗方法.方法:回顾分析7例AMI并发精神症状患者的临床资料、诊断和治疗方法.结果:所有患者均给以规范的冠心病二级预防治疗.病例1、3给以心境稳定剂,心理疏导、亲人安慰关怀,症状很快缓解;病例4转脑外科治疗;病例5予以小剂量镇静剂联合心理辅导;病例2、6、7给以小剂量抗精神病药物治疗.所有患者出院前均恢复正常.出院后1,3,6月随访患者无精神症状发生.结论:急性心肌梗死并发精神症状在常规冠心病治疗基础上给予心理治疗及抗精神病药物治疗预后良好.%Objective: To study causes and therapeutic methods of acute myocardial infarction (AMI) complicated psychiatric symptoms. Methods: Clinical data, diagnosis and therapeutic methods of seven AMI patients complicated psychiatric symptoms were retrospectively analyzed. Results: All patients received uniform secondary prevention and therapy for coronary heart disease. First case and third case received mood stabilizers, psychological counseling and comforts from family, and symptoms relieved soon; fourth case was transferred to brain surgery; fifth case received amall dose of sedative combined psycholgical counseling; second, sixth and seventh cases received small dose of antipsychotics. All patients recovered before discharge. No psychiatric symptoms occurred on first, third and sixth month after discharge. Conclusion: Psychological therapy and antipsychotic drug treatment based on routine treatment of coronary heart disease can achieve good prognosis in patients with acute myocardial infarction complicated psychiatric symptoms.

  5. Adolescents and young adults on the acute medical unit: how might we do it better?

    Science.gov (United States)

    Albon, Lorraine; Vaughan, Louella

    2014-12-01

    It is a common perception that young people do not become ill and do not pose a challenge in the unscheduled healthcare setting. The research, however, increasingly suggests that young adults and adolescents (YAAs) are a highly vulnerable group, with poorer outcomes than either older adults or children, and distinct healthcare needs. The acute medical unit (AMU) setting poses particular challenges to the care of this patient group. To improve care and patient experience, adult clinicians need to look critically at their services and seek to adapt them to meet the needs of YAAs. This requires cooperation and linkage with local paediatric and emergency services, as well as the input of other relevant stakeholder groups. Staff on AMUs also need to develop the knowledge, skills and attitudes to communicate effectively and address the developmental and health needs of YAAs and their parents/carers at times of high risk and stress.

  6. Children’s experiences of acute hospitalisation to a paediatric emergency and assessment unit

    DEFF Research Database (Denmark)

    Jensen, Claus Sixtus; Jackson, Karen; Kolbæk, Raymond;

    2012-01-01

    Short-stay treatment has become a popular form of care as a strategy to cope with increased demands on health care. There is little research that considers children’s experiences of acute hospitalisation to a short-stay care facility such as a Paediatric Emergency and Assessment Unit (PEAU......). This study explored the experiences of eight children aged 8–10 years. Semi-structured interviews were carried out to investigate the children’s own experiences of being hospitalised in a PEAU. Thematic content analyses were used. Three major themes were identified: the children’s understanding of disease......, treatment and procedures; the children’s experiences of health-care personnel and the PEAU and transformation of everyday life into the settings of the hospital. The children identified the hospital stay as an overall positive experience. The children took part in leisure activities as they would at home...

  7. Noninvasive ventilation for acute hypercapnic respiratory failure: intubation rate in an experienced unit.

    Science.gov (United States)

    Contou, Damien; Fragnoli, Chiara; Córdoba-Izquierdo, Ana; Boissier, Florence; Brun-Buisson, Christian; Thille, Arnaud W

    2013-12-01

    Failure of noninvasive ventilation (NIV) is common in patients with COPD admitted to the ICU for acute hypercapnic respiratory failure (AHRF). We aimed to assess the rate of NIV failure and to identify early predictors of intubation under NIV in patients admitted for AHRF of all origins in an experienced unit. This was an observational cohort study using data prospectively collected over a 3-year period after the implementation of a nurse-driven NIV protocol in a 24-bed medical ICU of a French university hospital. Among 242 subjects receiving NIV for AHRF (P(aCO2) > 45 mm Hg), 67 had cardiogenic pulmonary edema (CPE), 146 had acute-on-chronic respiratory failure (AOCRF) (including 99 subjects with COPD and 47 with other chronic respiratory diseases), and 29 had non-AOCRF (mostly pneumonia). Overall, the rates of intubation and ICU mortality were respectively 15% and 5%. The intubation rates were 4% in CPE, 15% in AOCRF, and 38% in non-AOCRF (P intubation rate was reduced to 15% in patients receiving NIV for AHRF, with a mortality rate of only 5%. Whereas the risk of NIV failure is associated with hypoxemia and acidosis after initiation of NIV, it is also markedly influenced by the presence or absence of an underlying chronic respiratory disease.

  8. Children's experiences of acute hospitalisation to a paediatric emergency and assessment unit--a qualitative study.

    Science.gov (United States)

    Jensen, Claus Sixtus; Jackson, Karen; Kolbæk, Raymond; Glasdam, Stinne

    2012-09-01

    Short-stay treatment has become a popular form of care as a strategy to cope with increased demands on health care. There is little research that considers children's experiences of acute hospitalisation to a short-stay care facility such as a Paediatric Emergency and Assessment Unit (PEAU). This study explored the experiences of eight children aged 8-10 years. Semi-structured interviews were carried out to investigate the children's own experiences of being hospitalised in a PEAU. Thematic content analyses were used. Three major themes were identified: the children's understanding of disease, treatment and procedures; the children's experiences of health-care personnel and the PEAU and transformation of everyday life into the settings of the hospital. The children identified the hospital stay as an overall positive experience. The children took part in leisure activities as they would at home and enjoyed time together with their parents while in hospital. In their conversations with staff they adapted to professional terms that they did not necessarily understand. They did not differentiate between professionals. Further work should be considered to clarify the consequences of this. This study has provided some limited insight into the child's experiences of acute hospitalisation, which should inform nursing care.

  9. Acute gastrointestinal injury in the intensive care unit: a retrospective study

    Directory of Open Access Journals (Sweden)

    Chen HS

    2015-10-01

    Full Text Available HuaiSheng Chen,1,* HuaDong Zhang,1,* Wei Li,1 ShengNan Wu,1 Wei Wang2 1Intensive Care Unit, 2Endocrinology Department, Second Affiliated Hospital of Jinan University, Shenzhen People’s Hospital, Shenzhen, People’s Republic of China *These authors contributed equally to this work Background: Acute gastrointestinal injury (AGI is a common problem in the intensive care unit (ICU. This study is a review of the gastrointestinal function of patients in critical care, with the aim to assess the feasibility and effectiveness of grading criteria developed by the European Society of Intensive Care Medicine (ESICM Working Group on Abdominal Problems (WGAP. Methods: Data of patients who were admitted to the ICU of Shenzhen People’s Hospital, Shenzhen, People’s Republic of China, from January 2010 to December 2011 were reviewed. A total of 874 patients were included into the current study. Their sex, age, ICU admissive causes, complication of diabetes, AGI grade, primary or secondary AGI, mechanical ventilation (MV, and length of ICU stay (days were recorded as risk factors of death. These risk factors were studied by unconditioned logistic regression analysis. Results: All the risk factors affected mortality rate. Unconditional logistic regression analysis revealed that the mortality rate of secondary AGI was 71 times higher than primary AGI (odds ratio [OR] 4.335, 95% CI [1.652, 11.375]. When the age increased by one year, the mortality probability would increase fourfold. Mortality in patients with MV was 63-fold higher than for patients with non-MV. Mortality rate increased 0.978 times with each additional day of ICU stay. Conclusion: Secondary AGI caused by severe systemic conditions can result in worsened clinical outcomes. The 2012 ESICM WGAP AGI recommendations were to some extent feasible and effective in guiding clinical practices, but the grading system lacked the support of objective laboratory outcomes. Keywords: critical care, acute

  10. Acute care clinical pharmacy practice: unit- versus service-based models.

    Science.gov (United States)

    Haas, Curtis E; Eckel, Stephen; Arif, Sally; Beringer, Paul M; Blake, Elizabeth W; Lardieri, Allison B; Lobo, Bob L; Mercer, Jessica M; Moye, Pamela; Orlando, Patricia L; Wargo, Kurt

    2012-02-01

    This commentary from the 2010 Task Force on Acute Care Practice Model of the American College of Clinical Pharmacy was developed to compare and contrast the "unit-based" and "service-based" orientation of the clinical pharmacist within an acute care pharmacy practice model and to offer an informed opinion concerning which should be preferred. The clinical pharmacy practice model must facilitate patient-centered care and therefore must position the pharmacist to be an active member of the interprofessional team focused on providing high-quality pharmaceutical care to the patient. Although both models may have advantages and disadvantages, the most important distinction pertains to the patient care role of the clinical pharmacist. The unit-based pharmacist is often in a position of reacting to an established order or decision and frequently is focused on task-oriented clinical services. By definition, the service-based clinical pharmacist functions as a member of the interprofessional team. As a team member, the pharmacist proactively contributes to the decision-making process and the development of patient-centered care plans. The service-based orientation of the pharmacist is consistent with both the practice vision embraced by ACCP and its definition of clinical pharmacy. The task force strongly recommends that institutions pursue a service-based pharmacy practice model to optimally deploy their clinical pharmacists. Those who elect to adopt this recommendation will face challenges in overcoming several resource, technologic, regulatory, and accreditation barriers. However, such challenges must be confronted if clinical pharmacists are to contribute fully to achieving optimal patient outcomes.

  11. Acute stroke unit improves stroke management-four years on from INASC.

    LENUS (Irish Health Repository)

    Shanahan, E

    2015-02-01

    The Irish Heart Foundation carried out the Irish National Audit of Stroke Care (INASC) in 2008. Management practices were significantly poorer than those in the UK Sentinel audits. Since then an acute stroke unit has been established in University Hospital Limerick. A stroke database was established. 12 key indicators of stroke management audited by INASC were identified. Results were compared to those in INASC. 89 stroke patients were admitted. 8 of the 12 key indicators scored significantly better than in INASC. 92.5% had a brain scan within 24hrs (INASC-40%, p = < 0.001). 100% of ischaemic strokes received anti-thrombotics (INASC-85%, p = 0.001). 94% had rehab goals agreed by MDT (22% in INASC p = 0.0000). 55% were treated in stroke unit (2% in INASC, p = 0.0000). MDT input improved with regard to physiotherapy (87% vs 43% in INASC, p = < 0.02) and SALT (74% vs 26%, p = < 0.02). Stroke management has significantly improved from 2008, however some deficiencies remain.

  12. Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

    Science.gov (United States)

    Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

    2012-01-01

    The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

  13. Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

    Science.gov (United States)

    Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

    2012-01-01

    The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

  14. Multi-unit Providers Survey. For-profits report decline in acute-care hospitals ... newcomers to top 10.

    Science.gov (United States)

    Bellandi, D; Kirchheimer, B

    1999-05-24

    For-profit hospital systems cleaned house last year. After years of adding hospitals, investor-owned operators shed facilities in 1998, recording the first decline in the number of acute-care hospitals they've owned or managed since 1991, according to our 23rd annual Multi-unit Providers Survey.

  15. Occurrence of post traumatic stress symptoms and their relationship to professional quality of life (ProQoL in nursing staff at a forensic psychiatric security unit: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Nonstad Kåre

    2009-04-01

    Full Text Available Abstract Background Violence is frequent towards nurses in forensic mental health hospitals. Implications of this high risk environment have not been systematically explored. This paper explores occurrence of symptoms on post traumatic stress and their relationship to professional quality of life. Methods Self report questionnaires assessing symptoms of post traumatic stress and professional quality of life were distributed among psychiatric nurses in a high security forensic psychiatric unit with high frequency of violent behaviour. Relationships between post traumatic stress symptoms, forensic nursing experience, type of ward and compassion satisfaction, burnout and compassion fatigue were explored. Results The prevalence of post traumatic stress symptoms was low. Low scores were found on compassion satisfaction. Length of psychiatric nursing experience and low scores on compassion satisfaction were correlated to increased post traumatic stress symptoms. Conclusion Although high violence frequency, low rate of post traumatic stress symptoms and low compassion satisfaction scores was found. High staff/patient ratio and emotional distance between staff and patients are discussed as protective factors.

  16. Investigation of the degree of organisational influence on patient experience scores in acute medical admission units in all acute hospitals in England using multilevel hierarchical regression modelling

    Science.gov (United States)

    Sullivan, Paul

    2017-01-01

    Objectives Previous studies found that hospital and specialty have limited influence on patient experience scores, and patient level factors are more important. This could be due to heterogeneity of experience delivery across subunits within organisations. We aimed to determine whether organisation level factors have greater impact if scores for the same subspecialty microsystem are analysed in each hospital. Setting Acute medical admission units in all NHS Acute Trusts in England. Participants We analysed patient experience data from the English Adult Inpatient Survey which is administered to 850 patients annually in each acute NHS Trusts in England. We selected all 8753 patients who returned the survey and who were emergency medical admissions and stayed in their admission unit for 1–2 nights, so as to isolate the experience delivered during the acute admission process. Primary and secondary outcome measures We used multilevel logistic regression to determine the apportioned influence of host organisation and of organisation level factors (size and teaching status), and patient level factors (demographics, presence of long-term conditions and disabilities). We selected ‘being treated with respect and dignity’ and ‘pain control’ as primary outcome parameters. Other Picker Domain question scores were analysed as secondary parameters. Results The proportion of overall variance attributable at organisational level was small; 0.5% (NS) for respect and dignity, 0.4% (NS) for pain control. Long-standing conditions and consequent disabilities were associated with low scores. Other item scores also showed that most influence was from patient level factors. Conclusions When a single microsystem, the acute medical admission process, is isolated, variance in experience scores is mainly explainable by patient level factors with limited organisational level influence. This has implications for the use of generic patient experience surveys for comparison between

  17. The geriatric patient: use of acute geriatrics units in the emergency care of elderly patients in France.

    Science.gov (United States)

    Somme, D; Lazarovici, C; Dramé, M; Blanc, P; Lang, P O; Gauvain, J B; Voisin, T; Gonthier, R; De Wazières, B; Jeandel, C; Couturier, P; Blanchard, F; Saint-Jean, O

    2011-01-01

    We studied the factors influencing the choice of admission to Geriatrics units, instead of other acute hospital units after an emergency visit. We report the results from a cohort of 1283 randomly selected patients aged >75 years hospitalized in emergency and representative of the French University hospital system. All patients underwent geriatric assessment. Baseline characteristics of patients admitted to Geriatrics and other units were compared. A center effect influencing the use of Geriatrics units during emergencies was also investigated. Admission to a Geriatrics unit during the acute care episode occurred in 499 cases (40.3%). By multivariate analysis, 4 factors were related to admission to a Geriatrics unit: cognitive disorder: odds ratio (OR)=1.79 (1.38-2.32) (95% confidence interval=95% CI); "failure to thrive" syndrome OR=1.54 (1.01-2.35), depression: OR=1.42 (1.12-1.83) or loss of Activities of Daily Living (ADL): OR=1.35 (1.04-1.75). The emergency volume of the hospital was inversely related to the use of Geriatrics units, with high variation that could be explained by other unstudied factors. In the French University Emergency Healthcare system, the "geriatrics patient" is defined by the existence of cognitive disorder, psychological symptoms or installed loss of autonomy. Nevertheless, considerable nation-wide variation was observed underlining the need to clarify and reinforce this discipline in the emergency healthcare system. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  18. Barriers and Challenges in Seeking Psychiatric Intervention in a General Hospital, by the Collaborative Child Response Unit, (A Multidisciplinary Team Approach to Handling Child Abuse) A Qualitative Analysis.

    Science.gov (United States)

    Subramaniyan, Vyjayanthi Kanugodu Srinivasa; Mital, Anukant; Rao, Chandrika; Chandra, Girish

    2017-01-01

    Child abuse is a serious criminal act against children in our country and punishable according to protection of children from sexual offenses act 2012. No one agency has the ability to respond completely to the abuse. Hence a multidisciplinary team approach was developed in India. Aim is to narrate the collaborative effort among the multiple disciplines in a general hospital to deliver child protection services and explore the barriers to integrate psychiatric services.

  19. Pressure ulcers and prevention among acute care hospitals in the United States.

    Science.gov (United States)

    Bergquist-Beringer, Sandra; Dong, Lei; He, Jianghua; Dunton, Nancy

    2013-09-01

    Most pressure ulcers can be prevented with evidence-based practice. Many studies describe the implementation of a pressure ulcer prevention program but few report the effect on outcomes across acute care facilities. Data on hospital-acquired pressure ulcers and prevention from the National Database of Nursing Quality Indicators 2010 Pressure Ulcer Surveys were linked to hospital characteristics and nurse staffing measures within the data set. The sample consisted of 1,419 hospitals from across the United States and 710,626 patients who had been surveyed for pressure ulcers in adult critical care, step-down, medical, surgical, and medical/surgical units. Hierarchical logistic regression analysis was performed to identify study variables associated with hospital-acquired pressure ulcers among patients at risk for these ulcers. The rate of hospital-acquired pressure ulcers was 3.6% across all surveyed patients and 7.9% among those at risk. Patients who received a skin and pressure ulcer risk assessment on admission were less likely to develop a pressure ulcer. Additional study variables associated with lower hospital-acquired pressure ulcer rates included a recent reassessment of pressure ulcer risk, higher Braden Scale scores, a recent skin assessment, routine repositioning, and Magnet or Magnet-applicant designation. Variables associated with a higher likelihood of hospital-acquired pressure ulcers included nutritional support, moisture management, larger hospital size, and academic medical center status. Results provide empirical support for pressure ulcer prevention guideline recommendations on skin assessment, pressure ulcer risk assessment, and routine repositioning, but the 7.9% rate of hospital-acquired pressure ulcers among at-risk patients suggests room for improvement in pressure ulcer prevention practice.

  20. Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction.

    Science.gov (United States)

    Musiienko, Anton M; Shakerian, Rose; Gorelik, Alexandra; Thomson, Benjamin N J; Skandarajah, Anita R

    2016-10-01

    The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes. A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality. Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02). The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change. © 2015 Royal Australasian College of Surgeons.

  1. The accessibility of research-based knowledge for nurses in United Kingdom acute care settings.

    Science.gov (United States)

    Thompson, C; McCaughan, D; Cullum, N; Sheldon, T A; Mulhall, A; Thompson, D R

    2001-10-01

    The successful dissemination of the results of the National Health Service (NHS) research and development strategy and the development of evidence based approaches to health care rely on clinicians having access to the best available evidence; evidence fit for the purpose of reducing the uncertainties associated with clinical decisions. To reveal the accessibility of those sources of information actually used by nurses, as well as those which they say they use. Mixed method case site, using interview, observational, Q sort and documentary audit data in medical, surgical and coronary care units (CCUs) in three acute hospitals. Three perspectives on accessibility were identified: (a) the humanist--in which human sources of information were the most accessible; (b) local information for local needs--in which locally produced resources were seen as the most accessible and (c) moving towards technology--in which information technology begins to be seen as accessible. Nurses' experience in a clinical specialty is positively associated with a perception that human sources such as clinical nurse specialists, link nurses, doctors and experienced clinical colleagues are more accessible than text based sources. Clinical specialization is associated with different approaches to accessing research knowledge. Coronary care unit nurses were more likely to perceive local guidelines, protocols and on-line databases as more accessible than their counterparts in general medical and surgical wards. Only a third of text-based resources available to nurses on the wards had any explicit research base. These, and the remainder were out of date (mean age of textbooks 11 years), and authorship hard to ascertain. A strategy to increase the use of research evidence by nurses should harness the influence of clinical nurse specialists, link nurses and those engaged in practice development. These roles could act as 'conduits' through which research-based messages for practice, and information

  2. Relationship between aggression, interpersonal style, and therapeutic alliance during short-term psychiatric hospitalization.

    Science.gov (United States)

    Cookson, Amy; Daffern, Michael; Foley, Fiona

    2012-02-01

    Aggression during psychiatric hospitalization is frequent, problematic, and a major challenge for nurses and mental health services more generally. The strength of the therapeutic alliance between nursing staff and patients has been posited as an important protective factor that can limit the likelihood of aggression. This study examined the relationship between interpersonal style, perceived coercion, and psychiatric symptoms on the therapeutic alliance between patients and staff, and how each, in turn, is related to aggression. Participants in this study were 79 patients admitted to an acute psychiatric hospital. Each participant was interviewed to determine perceived coercion, symptoms of psychiatric illness, interpersonal style, and therapeutic alliance. Incidents of aggression were recorded at discharge through a review of incident forms, file review, and interviews with unit nursing staff. The results showed that a hostile-dominant interpersonal style and symptoms of paranoia predicted poor therapeutic alliance, contributing 14% of the variance in therapeutic alliance scores. A dominant interpersonal style predicted aggression towards staff. Therapeutic alliance, perceived coercion, and symptoms of psychiatric illness did not predict aggression. Implications for engagement in treatment and the prevention of aggression are discussed.

  3. [Hyponatremia in elderly patients admitted in an acute geriatric care unit. prevalence and prognosis].

    Science.gov (United States)

    Rubio-Rivas, Manuel; Formiga, Francesc; Cuerpo, Sandra; Franco, Jonathan; di Yacovo, Silvana; Martínez, Concepción; Pujol, Ramón

    2012-06-30

    In order to analyze the prevalence of hyponatremia in in-hospital elderly patients and its prognosis factor value, we performed a transversal prospective study in an Acute Geriatric Unit (AGU). Two hundred and sixty in-hospital patients were collected prospectively in an AGU. Sociodemographic and lab data were collected as well as the Barthel, Pfeiffer and Charlson tests. A questionnaire was performed in hospital. Hyponatremia was considered when the plasmatic sodium was ≤134 mmol/l. The sample consisted of 137 women (52.7%) and 123 men (47.3%). Mean age was 83.6 years (SD 7.9). Mean plasmatic sodium values were 137.3 mmol/l (range 112-168). Emergency lab tests showed 60 patients with hyponatremia (23.7%), 35 (13.6%) in the AGU. Cardiopulmonary were the most related diseases. Mean hospital length of stay was 12.8 days (SD 12.8). In-hospital mortality was 12.9%. We observed a statistic relationship between the presence of hyponatremia and a greater mean length of stay (15.53 vs 11.99 days, P=.003). No relationship was found between hyponatremia and mortality (15 vs 12.7%, P=.588). Hyponatremia in patients admitted in an AGU is a prevalent disorder related with a greater hospital length of stay, but not with mortality. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  4. Psychiatric Disorder

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    15.1 Schizophrenia2007274 Effect and safety of combination therapy of valproate with lithium on recurrent mania. XU Wenwei(徐文炜), et al. Dept Psychiat, Wuxi Ment Health Center, Wuxi 214151. Chin J Psychiat 2007;40(2):86-89. Objective The study was to explore the effectiveness and safety of chronic combination reatment of valproate with lithium on recurrent mania. Method All 105 patients with mania-onset were andomly assigned to receive sodium valproate plus lithium (n=35), and monotherapy with lithium n=35) or sodium valproate (n=35), and were followed up for 5 years. At baseline, the symptom was valuated with the Bech-Rafaelsen Mania Rating Scale (BRMS). The drug dosage, times of relapse, effects nd safcty was compared among the three groups. Results After the acute therapy, the reductions in BRMS core were(43±29)% in lithium group, (42±27)% in valproate group, and (58±25)% in combination roup, respectively, with significant differences between the three groups (F=3.579, P=0.031). At ollowed-up, tile relapse times was significantly less in combination group than that in lithium and valproate roup(mean times of 2.0±1.5, 3.5±1.8, and 3.5±2.2, P=0.001). The combination therapy had etter effectiveness especially in patients with rapid cycling bipolar disorder(F=4.120, P=0.033) than the ther two monotherapy group. The mean dosage of single drug in combination group was significantly lower han that in lithium and valproate group (P<0.01; P<0.001). There were no significantly statistic differences on side-effects among three groups. Conclusion The efficacy of combination therapy of valproate with lithium on mania is better than the monotherapy of lithium or valproate in the light of safety and reduced occurrence.

  5. Psychiatric home care: a new tool for crisis intervention.

    Science.gov (United States)

    Spiro, A H

    1994-03-01

    The cost of psychiatric care has been rapidly increasing in recent years. Between 1984 and 1987, there was a 46 percent increase in psychiatric hospitals beds and a 60 percent increase in psychiatric units in general hospitals. This reflected a recognition by many health care systems that psychiatric patients were a good source of revenue. With this push toward more and more inpatient programs, crucial aspects of psychiatric care were left behind. Specifically, the limitations of inpatient therapy have not been recognized. Within the past five years, a new program has been developed and pioneered to use home care to prevent psychiatric hospitalizations and to also prevent the difficult transitions for psychiatric patients. Over a two-year period, this program was studied for its impact on the quality and cost of psychiatric care.

  6. Elements of Successful School Reentry after Psychiatric Hospitalization

    Science.gov (United States)

    Clemens, Elysia V.; Welfare, Laura E.; Williams, Amy M.

    2011-01-01

    Psychiatric hospitalization is an intensive intervention designed to stabilize adolescents who are experiencing an acute mental health crisis. Reintegrating to school after discharge from psychiatric hospitalization can be overwhelming for many adolescents (E. V. Clemens, L. E. Welfare, & A. M. Williams, 2010). The authors used a consensual…

  7. Incidence and Clinical Features of Peptic Ulcer Disease In Acute Upper Gastrointestinal Bleeding: -Experience of Moroccan University Hospital Unit-

    Directory of Open Access Journals (Sweden)

    Y. Cherradi

    2015-12-01

    Full Text Available Introduction: Peptic ulcer disease (PUD has been recognized as the leading cause of acute upper gastrointestinal bleeding (AUGIB. This study aims to report general features of bleeding peptic ulcers in patients who benefit of urgent endoscopy in our department after an acute upper gastrointestinal hemorrhage. Results: A total of 1809 patients were explored for acute upper gastrointestinal bleeding in our unit since 2003 to 2008. Gastroduodenal peptic ulcers were the most frequent diagnosed etiology. They present 38% of all reported causes of bleeding (n=527 (table I. 25% were located at duodenal mucosa (n= 347 and 13% were gastric ulcers (n=180. No esophageal ulcers were reported. Incidence of both duodenal and gastric ulcers decreases during the last years. Conclusion: In our department, incidence of bleeding peptic ulcer disease is decreasing but they continue to be the first cause of AUGIB.

  8. HYPERTENSION IN PSYCHIATRIC PATIENTS

    OpenAIRE

    Chaturvedi, Santosh K.; Michael, Albert

    1986-01-01

    SUMMARY Known cases of hypertension and those fulfilling WHO criteria for diagnosis of hypertension were identified in psychiatric patients and compared with non - hypertensive psychiatric patients. Hypertension was detected in 141 (9.98%) cases, and was significantly more associated with elder age, married status, urban background and neurotic illness. The implications are in early detection and effective management of hypertension in psychiatric patients.

  9. Nurse-patient interaction in acute adult inpatient mental health units: a review and synthesis of qualitative studies.

    Science.gov (United States)

    Cleary, Michelle; Hunt, Glenn E; Horsfall, Jan; Deacon, Maureen

    2012-02-01

    Mental health nurses work with acutely unwell patients, and the busy setting is characterised by unpredictable events. This paper is a report of a review conducted to identify, analyse and synthesize research in adult acute inpatient mental health units, which focused on nurse-patient interaction. Several electronic databases were searched using relevant keywords to identify studies published from 1999-present. Qualitative studies published in English were included if they specifically investigated nurse-patient interaction in acute inpatient care in adult settings. Eighteen studies were included (23 papers). Findings were grouped into the following six categories: 1) sophisticated communication; 2) subtle discriminations; 3) managing security parameters; 4) ordinary communication; 5) reliance on colleagues; and 6) personal characteristics. These studies of acute inpatient mental health units reveal that nurse communication involves interpersonal approaches and modalities that exemplify highly developed communication and personal skills designed specifically for this challenging setting. Further quality research should focus on the conditions that enable the development of therapeutic interactional skills and the relationship of these skills to the nuanced context in which they are practiced.

  10. Malnutrition in acutely ill children at the paediatric emergency unit in a tertiary hospital in Nigeria

    Directory of Open Access Journals (Sweden)

    Isaac E Ocheke

    2015-01-01

    Full Text Available Background: In many developing countries, malnutrition remains an important cause of morbidity and mortality particularly in under-five children. The factors responsible for malnutrition could be immediate, underlying or basic, acting either alone or together. It has been shown that children who are malnourished have poorer outcomes from other illnesses than well-nourished children. It is important therefore to periodically describe the extent and pattern of childhood malnutrition so that effective preventive measures can be put in place. Objective: To describe the prevalence and pattern of malnutrition in children presenting with acute illnesses at the Jos University Teaching Hospital. Patients and Methods: A cross-sectional descriptive study in children aged 6 to 59 months seen at the paediatric emergency unit from April to October 2012. The subjects were recruited consecutively. Each child had both clinical assessment and appropriate laboratory evaluations done alongside anthropometric measurements. The nutritional/dietary and socio-demographic histories were also obtained. Results: Of the 379 children, 224 (59.1% were males and 155 (40.9% females. The median age was 17 months, range (6-57. Wasting (WFH z-scores ≤−3 to <−1SD was evident in one hundred children, giving an overall prevalence of 26.9%. Severe wasting (WFH z-score <−3, was present in 22 (5.9% children indicating the prevalence of marasmus, whereas only two children (0.53% had oedematous malnutrition (kwashiorkor. Stunting or chronic malnutrition, (HFA z-scores ≤−3 to <−1SD was present in 67 children (18.0%. Seventeen (4.6% were severely stunted (HFA z-score <−3. Conclusions: Wasting was the most common form of malnutrition in the study.

  11. Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study

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    Bencsik Gabor

    2011-09-01

    Full Text Available Abstract Background Despite the substantial progress in the quality of critical care, the incidence and mortality of acute kidney injury (AKI continues to rise during hospital admissions. We conducted a national, multicenter, prospective, epidemiological survey to evaluate the importance of AKI in intensive care units (ICUs in Hungary. The objectives of this study were to determine the incidence of AKI in ICU patients; to characterize the differences in aetiology, illness severity and clinical practice; and to determine the influencing factors of the development of AKI and the patients' outcomes. Methods We analysed the demographic, morbidity, treatment modality and outcome data of patients (n = 459 admitted to ICUs between October 1st, 2009 and November 30th, 2009 using a prospectively filled in electronic survey form in 7 representative ICUs. Results The major reason for ICU admission was surgical in 64.3% of patients and medical in the remaining 35.7%. One-hundred-twelve patients (24.4% had AKI. By AKIN criteria 11.5% had Stage 1, 5.4% had Stage 2 and 7.4% had Stage 3. In 44.0% of patients, AKI was associated with septic shock. Vasopressor treatment, SAPS II score, serum creatinine on ICU admission and sepsis were the independent risk factors for development of any stage of AKI. Among the Stage 3 patients (34 50% received renal replacement therapy. The overall utilization of intermittent renal replacement therapy was high (64.8%. The overall in-hospital mortality rate of AKI was 49% (55/112. The ICU mortality rate was 39.3% (44/112. The independent risk factors for ICU mortality were age, mechanical ventilation, SOFA score and AKI Stage 3. Conclusions For the first time we have established the incidence of AKI using the AKIN criteria in Hungarian ICUs. Results of the present study confirm that AKI has a high incidence and is associated with high ICU and in-hospital mortality.

  12. Patient characteristics and comorbidities associated with cerebrovascular accident following acute myocardial infarction in the United States.

    Science.gov (United States)

    Naderi, Nassim; Masoomi, Hossein; Mozaffar, Tahseen; Malik, Shaista

    2014-08-01

    Although cerebrovascular accident (CVA) is a relatively infrequent complication of acute myocardial infarction (AMI), the occurrence of CVA in patients with AMI is associated with increased morbidity and mortality. We wanted to assess post-AMI CVA rate in the United States and identify the associated patient characteristics, comorbidities, type of AMI, and utilization of invasive procedures. This is an observational study from the Nationwide Inpatient Sample, 2006-2008. Using multivariate regression models, we assessed predictive risk factors for post-AMI CVA among patients admitted for AMI. Among the 1,924,413 patients admitted for AMI, the overall rate of CVA was 2% (ischemic stroke: 1.47%, transient ischemic attack [TIA]: 0.35% and hemorrhagic stroke: 0.21%). In this sample of AMI patient, higher incidence of CVA was associated with: CHF (adjusted odds ratio [AOR] 1.71; 95% confidence interval [CI], 1.58-1.84,), age over 65 AOR, 1.65; 95% CI, 1.60-1.70, alcohol abuse AOR, 1.60; 95% CI, 1.49-1.73, cocaine use AOR, 1.48; 95% CI, 1.29-1.70, atrial fibrillation AOR, 1.43; 95% CI, 1.39-1.46, Black race AOR, 1.35; 95% CI, 1.30-1.40, female gender AOR, 1.32; 95% CI, 1.29-1.35, peripheral vascular disease [PVD] AOR, 1.26; 95% CI, 1.22-1.30, coronary artery bypass graft (CABG) AOR, 1.22; 95% CI, 1.17-1.27, PCVA post-AMI. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. RIFLE classification in geriatric patients with acute kidney injury in the intensive care unit.

    Science.gov (United States)

    Shin, Min Ji; Rhee, Harin; Kim, Il Young; Song, Sang Heon; Lee, Dong Won; Lee, Soo Bong; Kwak, Ihm Soo; Seong, Eun Young

    2016-06-01

    The RIFLE classification is widely used to assess the severity of acute kidney injury (AKI), but its application to geriatric AKI patients complicated by medical problems has not been reported. We investigated 256 geriatric patients (≥65 years old; mean age, 74.4 ± 6.3 years) who developed AKI in the intensive care unit (ICU) according to the RIFLE classification. Etiologic, clinical, and prognostic variables were analyzed. They were categorized into RIFLE-R (n = 53), RIFLE-I (n = 102), and RIFLE-F (n = 101) groups. The overall in-hospital mortality was 39.8 %. There were no significant differences in RIFLE category between survivors and non-survivors. Survivors had significantly less needs for a ventilator and vasopressor, and lower number of failing organs. Survivors had higher systolic blood pressure, hemoglobin level, and serum albumin levels. We performed a logistic regression analysis to identify the independent predictors of in-hospital mortality. In a univariate analysis, hypertension, chronic kidney disease, RIFLE classification, number of failing organs, need for a ventilator and vasopressor, systolic blood pressure, hemoglobin level, and serum albumin levels were identified as prognostic factors of in-hospital mortality. However, in a multivariate analysis, hypertension, chronic kidney disease, number of failing organs, and serum albumin levels were independent risk factors, with no significant difference for in-hospital mortality with the RIFLE classification. The RIFLE classification might not be associated with mortality in geriatric AKI patients in the ICU. In geriatric patients with AKI, various factors besides severity of AKI should be considered to predict mortality.

  14. Incidence of acute kidney injury in the neonatal intensive care unit.

    Science.gov (United States)

    Youssef, Doaa; Abd-Elrahman, Hadeel; Shehab, Mohamed M; Abd-Elrheem, Mohamed

    2015-01-01

    The aim of this work is to study the incidence of acute kidney injury (AKI) in neonates admitted to the neonatal intensive care unit (NICU) over a six-month period from September 2011 to March 2012. This prospective study was performed on 250 neonates admitted to the NICU at the Children's Hospital, Faculty of Medicine, Zagazig University. All neonates were subjected to detailed history taking, including pre-natal, natal and post-natal history, with stress on symptoms suggestive of AKI. All neonates were examined thoroughly and the following investigations were performed: Blood urea nitrogen (BUN), serum creatinine, sodium, potassium, calcium, complete blood count, C-reactive protein, arterial blood gases, urine sodium and urine creatinine. AKI was diagnosed in 27 cases (10.8%), including 12 females and 15 males. 40.7% of the AKI cases were born after full-term pregnancy while 59.3% were pre-term babies. 29.6% of the AKI cases had oliguria, and there was male sex predominance, with a male-female ratio of 1.3:1. The cause of AKI was pre-renal in 96.3% and intrinsic renal in 3.7% of the cases. The predisposing factors for AKI were sepsis in 63% of the cases, respiratory distress syndrome in 55.6%, mechanical ventilation in 51.9%, peri-natal asphyxia in 18.5%, dehydration in 14.8%, surgical operation in 11.1%, congenital heart disease in 7.4%, sub-galeal hematoma in 3.7%, polycythemia in 3.7% and intra-ventricular hemorrhage in 3.7% of the cases. Our data suggest that pre-renal failure was the most common form of AKI in our patients. Early recognition of risk factors such as sepsis, peri-natal asphyxia or peri-operative problems and rapid effective treatment of contributing conditions will reduce the incidence of AKI in the neonatal period.

  15. Psychiatrists and psychiatric rehabilitation.

    Science.gov (United States)

    Torrey, William C; Green, Ronald L; Drake, Robert E

    2005-05-01

    Interventions that focus directly on functional impairments related to mental illnesses are termed psychiatric rehabilitation. Research demonstrates that rehabilitation services are increasingly able to help adults with psychiatric disabilities achieve the functional outcomes they desire, particularly in the areas of housing and employment. To support the community lives of adults with severe mental illnesses, psychiatrists must stay current with advances in this field and know how to integrate psychiatric rehabilitation with other interventions. This article reviews the concept of psychiatric rehabilitation, current approaches in the field, the psychiatrist's role in these services, and implications for psychiatric training and continuing education.

  16. Time-To-Treatment of Acute Coronary Syndrome and Unit of First Contact in the ERICO Study

    Science.gov (United States)

    dos Santos, Rafael Caire de Oliveira; Goulart, Alessandra Carvalho; Kisukuri, Alan Loureiro Xavier; Brandão, Rodrigo Martins; Sitnik, Debora; Staniak, Henrique Lane; Bittencourt, Marcio Sommer; Lotufo, Paulo Andrade; Bensenor, Isabela Martins; Santos, Itamar de Souza

    2016-01-01

    Background To the best of our knowledge, there are no studies evaluating the influence of the unit of the first contact on the frequency and time of pharmacological treatment during an acute coronary syndrome (ACS) event. Objectives The main objective was to investigate if the unit of first contact influenced the frequency and time of aspirin treatment in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. Methods We analyzed the pharmacological treatment time in 830 ERICO participants - 700 individuals for whom the hospital was the unit of first contact and 130 who initially sought primary care units. We built logistic regression models to study whether the unit of first contact was associated with a treatment time of less than three hours. Results Individuals who went to primary care units received the first aspirin dose in those units in 75.6% of the cases. The remaining 24.4% received aspirin at the hospital. Despite this finding, individuals from primary care still had aspirin administered within three hours more frequently than those who went to the hospital (76.8% vs 52.6%; p<0.001 and 100% vs. 70.7%; p=0.001 for non ST-elevation ACS and ST-elevation myocardial infarction, respectively). In adjusted models, individuals coming from primary care were more likely to receive aspirin more quickly (odds ratio: 3.66; 95% confidence interval: 2.06-6.51). Conclusions In our setting, individuals from primary care were more likely to receive aspirin earlier. Enhancing the ability of primary care units to provide early treatment and safe transportation may be beneficial in similar settings. PMID:27849262

  17. [Recurrent psychiatric manifestations during malaria prevention with mefloquine. A case report].

    Science.gov (United States)

    Rodor, F; Bianchi, G; Grignon, S; Samuelian, J C; Jouglard, J

    1990-01-01

    The authors report the case of a 22 years old woman without psychiatric antecedent who started a prophylaxis with mefloquine for a journey in a chloroquino resistant area. The first tablet induced an acute psychiatric syndrome which lasted five days; the second tablet induced the recidive of the psychiatric data and a suicide attempt by drowning.

  18. Comprehensive geriatric assessment on an acute medical unit: a qualitative study of older people's and informal carer's perspectives of the care and treatment received.

    Science.gov (United States)

    Darby, Janet; Williamson, Tracey; Logan, Pip; Gladman, John

    2017-01-01

    This qualitative study was imbedded in a randomized controlled trial evaluating the addition of geriatricians to usual care to enable the comprehensive geriatric assessment process with older patients on acute medical units. The qualitative study explored the perspectives of intervention participants on their care and treatment. A constructivist study incorporating semi-structured interviews that were conducted in patients' homes within six weeks of discharge from the acute medical unit. These interviews were recorded, transcribed, and analysed using thematic analysis. An acute medical unit in the United Kingdom. Older patients ( n = 18) and their informal carers ( n = 6) discharged directly home from an acute medical unit, who had been in the intervention group of the randomized controlled trial. Three core themes were constructed: (1) perceived lack of treatment on the acute medical unit; (2) nebulous grasp of the role of the geriatrician; and (3) on-going health and activities of daily living needs postdischarge. These needs impacted upon the informal carers, who either took over, or helped the patients to complete their activities of daily living. Despite the help received with activities of daily living, a lot of the patients voiced a desire to complete these activities themselves. The participants perceived they were just monitored and observed on the acute medical unit, rather than receiving active treatment, and spoke of on-going unresolved health and activity of daily living needs following discharge, despite receiving the additional intervention of a geriatrician.

  19. [The architectural design of psychiatric care buildings].

    Science.gov (United States)

    Dunet, Lionel

    2012-01-01

    The architectural design of psychiatric care buildings. In addition to certain "classic" creations, the Dunet architectural office has designed several units for difficult patients as well as a specially adapted hospitalisation unit. These creations which are demanding in terms of the organisation of care require close consultation with the nursing teams. Testimony of an architect who is particularly engaged in the universe of psychiatry.

  20. Physical therapists' guideline adherence on early mobilization and intensity of practice at dutch acute stroke units: a country-wide survey

    NARCIS (Netherlands)

    Otterman, N.M.; Wees, P.J. van der; Bernhardt, J.; Kwakkel, G.

    2012-01-01

    BACKGROUND AND PURPOSE: Clinical practice guidelines for patients with stroke recommend early stroke rehabilitation at acute hospital stroke units. The present study aimed to (1) explore the organization of early stroke rehabilitation; (2) investigate current practice with respect to early

  1. Incidence of acute kidney injury in the neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Doaa Youssef

    2015-01-01

    Full Text Available The aim of this work is to study the incidence of acute kidney injury (AKI in neonates admitted to the neonatal intensive care unit (NICU over a six-month period from September 2011 to March 2012. This prospective study was performed on 250 neonates admitted to the NICU at the Children′s Hospital, Faculty of Medicine, Zagazig University. All neonates were subjected to detailed history taking, including pre-natal, natal and post-natal history, with stress on symptoms suggestive of AKI. All neonates were examined thoroughly and the following investigations were performed: Blood urea nitrogen (BUN, serum creatinine, sodium, potassium, calcium, complete blood count, C-reactive protein, arterial blood gases, urine sodium and urine creatinine. AKI was diagnosed in 27 cases (10.8%, including 12 females and 15 males. 40.7% of the AKI cases were born after full-term pregnancy while 59.3% were pre-term babies. 29.6% of the AKI cases had oliguria, and there was male sex predominance, with a male-female ratio of 1.3:1. The cause of AKI was pre-renal in 96.3% and intrinsic renal in 3.7% of the cases. The predisposing factors for AKI were sepsis in 63% of the cases, respiratory distress syndrome in 55.6%, mechanical ventilation in 51.9%, peri-natal asphyxia in 18.5%, dehydration in 14.8%, surgical operation in 11.1%, congenital heart disease in 7.4%, sub-galeal hematoma in 3.7%, polycythemia in 3.7% and intra-ventricular hemorrhage in 3.7% of the cases. Our data suggest that pre-renal failure was the most common form of AKI in our patients. Early recognition of risk factors such as sepsis, peri-natal asphyxia or peri-operative problems and rapid effective treatment of contributing conditions will reduce the incidence of AKI in the neonatal period.

  2. [DRGs in psychiatric hospital financing exemplified by Hungary. A model for Germany?].

    Science.gov (United States)

    Maylath, E

    2000-12-01

    One of the most important provisions incorporated in the reform of the German health sector has been the introduction of a per case prospective payment system for hospitals with the exception of admissions to psychiatric care. The reasons for the exclusion of psychiatric care are unclear, but it is as a result all the more interesting to look at the experience of Hungary, where in-patient psychiatric care has been financed on the basis of diagnosis-related groups (DRGs) for the past seven years. The article describes how in the early 1990's the funding of the Hungarian health service was reorganized from being a state-financed system with a set budget to a system financed by contributions. Parallel to this development, service-related financing was introduced. In the hospital sector this involved DRGs. At the beginning of 1993 the Hungarian DRGs comprised only 437 categories, but this has since increased to 758. Furthermore, other characteristics are listed which, apart from the number of groups, differentiate the Hungarian DRGs from the AP-DRGs. Among other things, service-related financing includes non-typical areas such as psychiatry. In this case, it covers in-patient psychiatric care in an unusual combination of DRGs in the acute case category (50% of all beds in psychiatric units in Hungary are for acute cases) with daily nursing charges in the chronic case category. An analysis is given in the article of 16 homogeneous diagnostic categories in psychiatric care, followed by experiences gathered in conjunction with the application of this approach in this particular sphere, with special reference to three problem areas. These are as follows: the trend towards diagnoses with a relatively high weighting; the practice of charging for psychiatric DRGs in somatic wards; and, finally, the perpetuation of poor service structures and practices through DRGs. In general, evidently the introduction of psychiatric DRGs may also be recommended in Germany because of the

  3. Psychiatric nursing: an unpopular choice.

    Science.gov (United States)

    Jansen, R; Venter I

    2015-03-01

    Research studies in the United States, the United Kingdom, New Zealand and Australia suggest that students do not consider psychiatric nursing as a popular career option. According to this research, there is a widespread concern about the nursing shortages in psychiatry. The demand for mental health services continues to grow and there is a need for strategies to recruit nurses for this specialized field. The purpose of this study was to identify the factors preventing undergraduate nursing students in South Africa (SA) from choosing psychiatric nursing as a career. A qualitative research design that aimed to explore and describe was used. Data were collected through the Nominal Group Technique. A sample of convenience of 27 final year nursing students from the School of Nursing at the University of the Free State as well as the Free State School of Nursing, situated in Bloemfontein (SA), voluntarily participated in this research. The following categories emerged from the content analysis of the data: personal factors, working environment, unprofessional behaviour, learning environment and the unclassified category. Psychiatric nursing as a career choice is in a predicament and nursing schools need to implement practical strategies to recruit future nurses for this field.

  4. [History of psychiatric legislation in Italy].

    Science.gov (United States)

    Stocco, Ester; Dario, Claudia; Piazzi, Gioia; Fiori Nastro, Paolo

    2009-01-01

    The different models of mental illness which have followed one another in Italian psychiatry have been linked to the history of psychiatric legislation and its various attempts at reform. The first law of the newly United State which unified legislations and former procedures, whose prevalent psychiatric theories were those that referred to degeneration, was the law 36/1904 that set up the asylums. Accordingly psychiatric praxis was focused on social protection and custody, given that the mentally ill was seen as incurable; Fascism added the inmate's obligation to be enrolled in the judicial register. Afterwards numerous attempts to reform the psychiatric legislation were made that eventually gave rise to law 431/1968 which paved the way to territorial psychiatry. Law 180/1978 changed the organization of Italian psychiatry abolishing asylums and the concept of dangerousness, including psychiatry in the National Health Service but adopting an idea of mental illness as simply social unease.

  5. Train-the-trainer intervention to increase nursing teamwork and decrease missed nursing care in acute care patient units.

    Science.gov (United States)

    Kalisch, Beatrice J; Xie, Boqin; Ronis, David L

    2013-01-01

    Teamwork is essential for patient safety and results in less missed nursing care. The aim of this study was to test the impact of a train-the-trainer intervention on the level of satisfaction with nursing teamwork and the amount of missed nursing care. This study used a quasiexperimental design with repeated measures taken at pretest, posttest, and 2 months after completion of the intervention. The sample for this study was the nursing staff on three medical-surgical units in three separate acute care hospitals (one unit in each hospital). Three nurses from each unit underwent a training program and then taught the skills and knowledge they acquired to the staff members on their units in three-hour-long sessions. The training involved staff role-playing scenarios based on teamwork problems that occur regularly on inpatient units in acute care hospitals followed by debriefing, which focused on teamwork behaviors (e.g., leadership, team orientation, backup, performance monitoring) and missed nursing care. Four measures were used to test the efficacy of this intervention: The Nursing Teamwork Survey, the MISSCARE Survey, and questions about the knowledge of and satisfaction with teamwork. Return rates for the surveys ranged from 73% to 84%. Follow-up tests individually comparing pretest, posttest, and delayed posttest were conducted within the mixed model and used the Bonferroni correction for multiple comparisons. Teamwork increased (F = 6.91, df = 259.01, p = .001) and missed care decreased (F = 3.59, df = 251.29, p = .03) over time. Nursing staff also reported a higher level of satisfaction with teamwork and an increase of teamwork knowledge after the intervention. The intervention tested in this study shows promise of being an effective and efficient approach to increase nursing teamwork and decrease missed nursing care.

  6. Acute pain from the perspective of minor trauma patients treated at the emergency unit

    Directory of Open Access Journals (Sweden)

    Andrea Regina Martin

    Full Text Available OBJECTIVE: To study the factors that influence the perception of acute pain and the consequences of this experience in patients suffering from mild trauma. METHOD: Descriptive qualitative study conducted in an emergency service in southern Brazil. Data was collected in October 2013, through semi-structured interviews with 29 individuals who reported pain after physical trauma, regardless of the triggering factor. To process the data, we used a Content Analysis technique, subject modality. RESULTS: Two categories emerged: Factors that influence the perception of pain resulting from trauma and, Consequences of acute pain due to trauma. The acute pain sensation was influenced by biological, emotional, spiritual and socio-cultural factors and induced biological and emotional consequences for individuals. CONCLUSION: The health professionals need to consider the factors that influence soreness and its consequences for the proper assessment and management of pain resulting from trauma.

  7. Children’s experiences of acute hospitalisation to a paediatric emergency and assessment unit – A qualitative study

    DEFF Research Database (Denmark)

    Jensen, Claus Sixtus; Jackson, Karen; Kolbæk, Raymond

    2012-01-01

    Short-stay treatment has become a popular form of care as a strategy to cope with increased demands on health care. There is little research that considers children’s experiences of acute hospitalisation to a short-stay care facility such as a Paediatric Emergency and Assessment Unit (PEAU......, treatment and procedures; the children’s experiences of health-care personnel and the PEAU and transformation of everyday life into the settings of the hospital. The children identified the hospital stay as an overall positive experience. The children took part in leisure activities as they would at home...

  8. Psychopathy in women: Prediction of criminality and violence in UK and USA psychiatric patients resident in the community.

    Science.gov (United States)

    Gray, Nicola S; Snowden, Robert J

    2016-03-30

    Psychopathy is an important clinical construct often used in the assessment and management of psychiatric patients and offenders. This, in part, is due to the strong association between psychopathy, crime, and particularly violent crime. However, there are few studies of these associations in women. These relationships were examined using information from two large databases. The Partnerships in Care database contains data from a sample of forensic psychiatric patients (154 women and 777 men) in the UK that were discharged from secure psychiatric units. Follow-up was via official conviction data within the next 2 years. The MacArthur study examined violence and aggression in a sample of civil psychiatric patients (367 women and 496 men) in the USA following discharge from an acute psychiatric hospital. Follow-up was via a mixture of self-report, informant report and official records. Psychopathy in both samples was measured via the PCL:SV prior to discharge. Psychopathy was a good predictor of target events for the women in both samples and for all time intervals used. No significant gender differences in the PCL:SV's predictive efficacy were found. The results provide a strong evidence-base for the use of psychopathy in women when considering future community behaviour and reoffending.

  9. Neurobiology of psychiatric disorders

    Directory of Open Access Journals (Sweden)

    Đokić Gorica

    2015-01-01

    Full Text Available Neurobiologically spoken, the supstrate of the mind is formed by neuronal networks, and dysregulated neurocircuitry can cause psychiatric disorders. Psychiatric disorders are diagnosed by symptom clusters that are the result of abnormal brain tissue, and/or activity in specialized areas of the brain. Dysregulated circuitry results from abnormal neural function, or abnormal neural connections from one brain area to another, which leads to neurotransmitter imbalances. Each psychiatric disorder has uniquely dysregulated circuitry and thereby unique neurotransmitter imbalance, such as: prefrontal cortical-limbic pathways in depression or prefrontal cortical-striatal pathways in schizophrenia ie. serotonin-norepinephrin-dopamin imbalance in depression, or dopamine hyperactivity in schizophrenia. Biological psychiatry has completely changed the farmacological treatment of psychiatric disorders, and new foundings in that field are supportive to futher more neuropsychopharmacological and nonpharmacological therapy studies, whish has as a result more safe and effective therapy for psychiatric disorders.

  10. Five Years of Acute Stroke Unit Care: Comparing ASU and Non-ASU Admissions and Allied Health Involvement

    Directory of Open Access Journals (Sweden)

    Isobel J. Hubbard

    2014-01-01

    Full Text Available Background. Evidence indicates that Stroke Units decrease mortality and morbidity. An Acute Stroke Unit (ASU provides specialised, hyperacute care and thrombolysis. John Hunter Hospital, Australia, admits 500 stroke patients each year and has a 4-bed ASU. Aims. This study investigated hospital admissions over a 5-year period of all strokes patients and of all patients admitted to the 4-bed ASU and the involvement of allied health professionals. Methods. The study retrospectively audited 5-year data from all stroke patients admitted to John Hunter Hospital (n=2525 and from nonstroke patients admitted to the ASU (n=826. The study’s primary outcomes were admission rates, length of stay (days, and allied health involvement. Results. Over 5 years, 47% of stroke patients were admitted to the ASU. More male stroke patients were admitted to the ASU (chi2=5.81; P=0.016. There was a trend over time towards parity between the number of stroke and nonstroke patients admitted to the ASU. When compared to those admitted elsewhere, ASU stroke patients had a longer length of stay (z=−8.233; P=0.0000 and were more likely to receive allied healthcare. Conclusion. This is the first study to report 5 years of ASU admissions. Acute Stroke Units may benefit from a review of the healthcare provided to all stroke patients. The trends over time with respect to the utilisation of the John Hunter Hospitall’s ASU have resulted in a review of the hospitall’s Stroke Unit and allied healthcare.

  11. Psychiatric Advance Directives: Getting Started

    Science.gov (United States)

    ... More... Home Getting Started National Resource Center on Psychiatric Advance Directives - Getting Started Getting Started Psychiatric advance directives (PADs) are relatively new legal instruments ...

  12. Long term prognosis of acute coronary syndrome with chronic renal dysfunction treated in different therapy units at department of cardiology: a retrospective cohort study.

    Science.gov (United States)

    Fu, Cong; Sheng, Zulong; Yao, Yuyu; Wang, Xin; Yu, Chaojun; Ma, Genshan

    2015-01-01

    Coronary care unit is common in hospitals and clinical centers which offer intensive care and therapy for severe coronary artery disease patients. However, if coronary care unit could improve the long term prognosis of acute coronary syndrome patients with renal dysfunction remain unknown. Accordingly, we designed this study to evaluate the differences of incidence of major adverse cardiovascular events for acute coronary syndromes patients with renal dysfunction who treated in coronary care unit or normal unit. The primary end point was all cause mortality. A total of 414 acute coronary syndromes patients with renal dysfunction involved in the study. The results showed that during 12-48 months follow-up, death of any cause occurred in 1.8% patients (4 of 247) in coronary care unit group, as compared with 1.8% in the normal group (3 of 167) (hazard ratio, 1.098; 95% confidence interval, 0.246 to 4.904; P=0.903). Kaplan-Meier survival analysis showed that there were no significant differences between the two groups with respect to the risk of death (P=0.903), revascularization (P=0.948), stroke (P=0.542), heart failure (P=0.198). This trial firstly revealed that acute coronary syndromes patients with renal dysfunction treated in coronary care unit and normal units. Our study showed that acute coronary syndromes patients with renal dysfunction treated in coronary care unit obtained no significant benefits compared with patients in normal units, although there was a declining tendency of the risk of major adverse cardiovascular effectswith patients in coronary care unit.

  13. Long term prognosis of acute coronary syndrome with chronic renal dysfunction treated in different therapy units at department of cardiology: a retrospective cohort study

    Science.gov (United States)

    Fu, Cong; Sheng, Zulong; Yao, Yuyu; Wang, Xin; Yu, Chaojun; Ma, Genshan

    2015-01-01

    Coronary care unit is common in hospitals and clinical centers which offer intensive care and therapy for severe coronary artery disease patients. However, if coronary care unit could improve the long term prognosis of acute coronary syndrome patients with renal dysfunction remain unknown. Accordingly, we designed this study to evaluate the differences of incidence of major adverse cardiovascular events for acute coronary syndromes patients with renal dysfunction who treated in coronary care unit or normal unit. The primary end point was all cause mortality. A total of 414 acute coronary syndromes patients with renal dysfunction involved in the study. The results showed that during 12-48 months follow-up, death of any cause occurred in 1.8% patients (4 of 247) in coronary care unit group, as compared with 1.8% in the normal group (3 of 167) (hazard ratio, 1.098; 95% confidence interval, 0.246 to 4.904; P=0.903). Kaplan-Meier survival analysis showed that there were no significant differences between the two groups with respect to the risk of death (P=0.903), revascularization (P=0.948), stroke (P=0.542), heart failure (P=0.198). This trial firstly revealed that acute coronary syndromes patients with renal dysfunction treated in coronary care unit and normal units. Our study showed that acute coronary syndromes patients with renal dysfunction treated in coronary care unit obtained no significant benefits compared with patients in normal units, although there was a declining tendency of the risk of major adverse cardiovascular effectswith patients in coronary care unit. PMID:26770436

  14. Epidemiology of Acute Hepatitis B in the United States From Population-Based Surveillance, 2006-2011.

    Science.gov (United States)

    Iqbal, Kashif; Klevens, R Monina; Kainer, Marion A; Baumgartner, Jennifer; Gerard, Kristin; Poissant, Tasha; Sweet, Kristin; Vonderwahl, Candace; Knickerbocker, Tracey; Khudyakov, Yury; Xia, Guo-Liang; Roberts, Henry; Teshale, Eyasu

    2015-08-15

    An estimated 20 000 new hepatitis B virus (HBV) infections occur each year in the United States. We describe the results of enhanced surveillance for acute hepatitis B at 7 federally funded sites over a 6-year period. Health departments in Colorado, Connecticut, Minnesota, Oregon, Tennessee, 34 counties in New York state, and New York City were supported to conduct enhanced, population-based surveillance for acute HBV from 2006 through 2011. Demographic and risk factor data were collected on symptomatic cases using a standardized form. Serum samples from a subset of cases were also obtained for molecular analysis. In the 6-year period, 2220 acute hepatitis B cases were reported from the 7 sites. For all sites combined, the incidence rate of HBV infection declined by 19%, but in Tennessee incidence increased by 90%, mainly among persons of white race/ethnicity and those aged 40-49 years. Of all reported cases, 66.1% were male, 57.1% were white, 58.4% were aged 30-49 years, and 60.1% were born in the United States. The most common risk factor identified was any drug use, notably in Tennessee; healthcare exposure was also frequently reported. The most common genotype for all reported cases was HBV genotype A (82%). Despite an overall decline in HBV infection, attributable to successful vaccination programs, a rise in incident HBV infection related to drug use is an increasing concern in some localities. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  15. How to reduce avoidable admissions due to acute diabetes complications?: Interrelation between primary and specialized attention in a diabetes unit

    Directory of Open Access Journals (Sweden)

    N. V. García-Talavera Espín

    2012-12-01

    Full Text Available Introduction: Type 2 Diabetes Mellitus is a serious health problem. In the year 2030 it will affect 366 million people around the world. Objective: Evaluate the effectiveness of a mixed intervention and reducing the amount and seriousness of acute complications in diabetics from our Health Area. Materials and method: Protocols of action as well as information documents were produced. Diabetes Unit coordinated educational activities in the different support levels of the Area VII of Murcia. Information talks were provided for the people in charge of the Diabetes Unit in every Care Center and Service of the Health Area. Personalized training was provided for patients treated in the differet Care levels. The study comprised three stages. Information leaflets were spread and talks offered to the patient regarding in house handling of hypo and hyper glycemia. Results: A reduction of 39% of the emergencies due to acute non complicated diabetes was achieved, as well as a reduction of 47.6% of hospital admissions. There was a reduction of 67.8% of the amount of total hospital stays for the group of patients under 35 years who were admitted into the hospital due to type 1 or 2 diabetes mellitus that didn't show any complications (GRD295. Conclusions: There was a reduction of more than thirty percent in the emergencies due to acute decompensations in the disease and a significant reduction in the avoidable hospital stays in the young adult, thus improving the patients' life quality and reducing the social cost of the diabetic patient.

  16. Predicting Length of Psychiatric Hospital Stay in Children and Adolescents.

    Science.gov (United States)

    Leininger, Michele; Stephenson, Laura A.

    Length of stay in psychiatric inpatient units has received increasing attention with the external pressures for treatment cost-effectiveness and evidence that longer hospital stays do not appear to have significant advantages over shorter hospital stays. This study examined the relationship between length of psychiatric hospital stay and…

  17. SAPS 3, APACHE IV or GRACE: which score to choose for acute coronary syndrome patients in intensive care units?

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    Antonio Paulo Nassar Junior

    Full Text Available CONTEXT AND OBJECTIVE Acute coronary syndromes (ACS are a common cause of intensive care unit (ICU admission. Specific prognostic scores have been developed and validated for ACS patients and, among them, GRACE (Global Registry of Acute Coronary Events has had the best performance. However, intensive care clinicians generally use prognostic scores developed from heterogeneous populations of critically ill patients, such as APACHE IV (Acute Physiologic and Chronic Health Evaluation IV and SAPS 3 (Simplified Acute Physiology Score 3. The aim of this study was to evaluate and compare the performance of these three scores in a non-selected population of ACS cases. DESIGN AND SETTING Retrospective observational study to evaluate three prognostic scores in a population of ACS patients admitted to three general ICUs in private hospitals in São Paulo. METHODS All patients with ACS admitted from July 2008 to December 2009 were considered for inclusion in the study. Score calibration and discrimination were evaluated in relation to predicting hospital mortality. RESULTS A total of 1065 patients were included. The calibration was appropriate for APACHE IV and GRACE but not for SAPS 3. The discrimination was very good for all scores (area under curve of 0.862 for GRACE, 0.860 for APACHE IV and 0.804 for SAPS 3. CONCLUSIONS In this population of ACS patients admitted to ICUs, GRACE and APACHE IV were adequately calibrated, but SAPS 3 was not. All three scores had very good discrimination. GRACE and APACHE IV may be used for predicting mortality risk among ACS patients.

  18. SAPS 3, APACHE IV or GRACE: which score to choose for acute coronary syndrome patients in intensive care units?

    Science.gov (United States)

    Nassar Junior, Antonio Paulo; Mocelin, Amilcar Oshiro; Andrade, Fabio Moreira; Brauer, Leonardo; Giannini, Fabio Poianas; Nunes, Andre Luiz Baptiston; Dias, Carlos Augusto

    2013-01-01

    CONTEXT AND OBJECTIVE Acute coronary syndromes (ACS) are a common cause of intensive care unit (ICU) admission. Specific prognostic scores have been developed and validated for ACS patients and, among them, GRACE (Global Registry of Acute Coronary Events) has had the best performance. However, intensive care clinicians generally use prognostic scores developed from heterogeneous populations of critically ill patients, such as APACHE IV (Acute Physiologic and Chronic Health Evaluation IV) and SAPS 3 (Simplified Acute Physiology Score 3). The aim of this study was to evaluate and compare the performance of these three scores in a non-selected population of ACS cases. DESIGN AND SETTING Retrospective observational study to evaluate three prognostic scores in a population of ACS patients admitted to three general ICUs in private hospitals in São Paulo. METHODS All patients with ACS admitted from July 2008 to December 2009 were considered for inclusion in the study. Score calibration and discrimination were evaluated in relation to predicting hospital mortality. RESULTS A total of 1065 patients were included. The calibration was appropriate for APACHE IV and GRACE but not for SAPS 3. The discrimination was very good for all scores (area under curve of 0.862 for GRACE, 0.860 for APACHE IV and 0.804 for SAPS 3). CONCLUSIONS In this population of ACS patients admitted to ICUs, GRACE and APACHE IV were adequately calibrated, but SAPS 3 was not. All three scores had very good discrimination. GRACE and APACHE IV may be used for predicting mortality risk among ACS patients.

  19. Liver cirrhosis is a risk factor of repeat acute hemorrhagic rectal ulcer in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Pi-Kai Chang

    2014-01-01

    Full Text Available Background: Acute hemorrhagic rectal ulcer (AHRU can be found in patients with severe comorbid illness, who are bedridden for a long time. Per anal suturing is a quick and feasible treatment. However, recurrent bleeding occurs frequently after suture ligation of a bleeder and can be life-threatening. However, the risk factor for recurrent bleeding is not well known. Our study tries to clarify the risk factor of repeat AHRU in Intensive Care Unit (ICU patients. Materials and Methods: From January 2004 to December 2009, the medical records of 32 patients, who were admitted to the ICU of the Tri-Service General Hospital, a tertiary referral center in Taiwan, and who underwent per anal suturing of acute hemorrhagic rectal ulcer were retrospectively reviewed. Results: Of the 96 patients who received emergency treatment for acute massive hematochezia, 32 patients were diagnosed with AHRU. Eight (25% patients had recurrent bleeding following suture ligation of AHRU and underwent a reoperation; no patient had recurrent bleeding after the second operation. The duration from the first hematochezia attack to surgery (P = 0.04, liver cirrhosis (P = 0.002, and coagulopathy (P = 0.01 were the risk factors of recurrent bleeding after suture ligation of a bleeder. Multivariate logistic regression analysis indicated that liver cirrhosis (OR = 37.77, P = 0.014 was an independent risk factor for recurrent bleeding. Conclusion: AHRU could be a major cause of acute massive hematochezia in patients with severe illness. Our data showed that per anal suturing could quickly and effectively control bleeding. We found that liver cirrhosis was an independent risk factor for recurrent bleeding. Therefore, treatment of a liver cirrhosis patient with AHUR should be more aggressive, such as, early detection and proper suture ligation.

  20. [The link between aggressive behavior and depression in adolescence. A cross-sectional study conducted in the psychiatric emergency unit at the Sainte-Anne hospital].

    Science.gov (United States)

    Benarous, X; Guedj, M J; Braitman, A; Gallois, E; Lana, P

    2014-12-01

    The link between depression and aggressive behavior in adults has been found in many studies. In adolescents, this relationship is still controversial. Several studies point out that irritability is a key symptom in adolescent depressed. Few studies have analyzed precisely the kind of aggressive behavior. This study sets out to assess the relationship between aggressive behavior and depressive affects in adolescents. We also pay attention in this population to hopelessness feelings, anxiety, global functioning and the type of aggressive behavior. This is a descriptive and observational cross-sectional study. Data was collected from 49 successive adolescents admitted for a 24-hour evaluation in the emergency department of the Sainte-Anne psychiatric hospital. The inclusion period was from February to April 2012, with age limits between 15 and 18. For each patient, the clinician completed with the parents or other caregivers the Modified Overt Aggressive Scale (MOAS) searching for existence of aggressive behavior in the week prior to the consultation. The population was divided into two groups: P- group when the MOAS score was Adolescent Depression Rating Scale for clinicians (ADRSc) were also completed. Each patient completed the self-report Buss-Perry Aggression Questionnaire (QA), the Beck Hopelessness scale and the Adolescent Depression Rating Scale for patients (ADRSp). Forty-nine adolescents with a median age of 16 years and 4 months participated. The first reason for consultation was depressive symptoms, followed by disruptive behavior. The analysis was conducted on 39 questionnaires. The demographic profile of the two groups was similar. We did not find any significant difference between the groups P+ and P- on ADRSc scores and secondary criteria. However, we found higher scores in the QA in the more depressed patient, especially a higher hostility score in this sample. In the subgroup analysis: as expected self-aggressive behavior was associated with a

  1. Postgraduate psychiatric training in Thailand.

    Science.gov (United States)

    Ratta-Apha, Woraphat; Sitdhiraksa, Nantawat; Saisavoey, Nattha; Lortrakul, Manote; Udomratn, Pichet

    2009-01-01

    In Thailand, after medical students graduated from medical schools, the general practitioners have to work for the government for at least three years. Then, they can enroll in postgraduate training program. Postgraduate training usually takes three to four years. All of the psychiatric training programs are supervised and monitored by the board of education of the Royal College of Psychiatrists of Thailand (RCPsychT). One of the missions of all training institutes is to prepare residents to be the high qualified psychiatrists to serve the mental well-being of Thai people. Additionally, they should teach the learners to be the leaders in academic and research fields in psychiatry. Currently, there are nine psychiatric training institutions in Thailand, most of which are running by university programs. The training program core curriculum composes of the compulsory rotations such as general psychiatry, child and adolescent psychiatry, neurology, consultation-liaison psychiatry, mental hospital psychiatry and addiction psychiatry. Moreover, the residents also have three months for elective in each program. The learning process includes practicing in an out-patient and in-patient unit under psychiatric staff supervision, individual and group supervision, case conference, journal club, book club and grand round etc. Research in field of psychiatry and social sciences is also compulsory for board examination. The RCPsychT approved two Certificate Diplomas including Diploma of Thai Board of Psychiatry, and Diploma of Thai Board of Child and Adolescent Psychiatry. There are only nine psychiatric training institutes and only thirty to forty residents enrolled in these programs in each year. The compact and collaboration of all training institutes bring about the benefits in efficiency programs management by regular meeting of representatives from each institute. They keep the standard of training program to progress in the same vision and direction. Furthermore, residents

  2. Social climate of acute old age psychiatry inpatient units: staff perceptions within the context of patient aggression.

    Science.gov (United States)

    McCann, T; Baird, J; Muir-Cochrane, E C

    2015-03-01

    Patient aggression occurs in old age psychiatry and is contrary to their recovery and to the well-being of staff. A favourable social climate can contribute to a reduction in aggression. The aim of this study was to examine the perceptions of clinical staff about the social climate of acute old age psychiatry inpatient units. Eighty-five clinicians were recruited from these facilities. They completed a survey questionnaire about the social climate or ward atmosphere of inpatient units. The findings showed that, to some extent, respondents' perceived patient cohesion and mutual support were evident, units were perceived somewhat positively as safe environments for patients and staff, and the ward climate helped meet patients' therapeutic needs. Overall, clinicians were somewhat positive about the social climate of the units, and this has implications for the perception of aggression in old age psychiatry inpatient settings. As there is a direct relationship between social climate and aggression, clinicians should consider adopting a broad-based, person-centred approach to the promotion of a favourable social climate in old age psychiatry inpatient settings.

  3. Internet and technology transfer in acute care hospitals in the United States: survey-2000.

    Science.gov (United States)

    Hatcher, M

    2001-12-01

    This paper provides the results of the survey-2000 measuring technology transfer and, specifically, Internet usage. The purpose of the survey was to measure the levels of Internet and Intranet existence and usage in acute care hospitals. The depth of the survey includes e-commerce for both business-to-business and customers. These results are compared with responses to the same questions in survey-1997. Changes in response are noted and discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the third of three articles based upon the results of the survey-2000. Readers are referred to prior articles by the author, which discuss the survey design and provide a tutorial on technology transfer in acute care hospitals. (1) Thefirst article based upon the survey results discusses technology transfer, system design approaches, user involvement, and decision-making purposes. (2)

  4. Oxytocin and Psychiatric Disorders

    Directory of Open Access Journals (Sweden)

    Gokce Nur Say

    2016-06-01

    Full Text Available Oxytocin is a neuropeptide that plays critical role in mother-infant bonding, pair bonding and prosocial behaviors. Several neuropsychiatric disorders such as autism, schizophrenia, affective disorders, anxiety disorders, attention deficit/hyperactivity disorder, alcohol/substance addiction, aggression, suicide, eating disorders and personality disorders show abnormalities of oxytocin system. These findings have given rise to the studies searching therapeutic use of oxytocin for psychi-atric disorders. The studies of oxytocin interventions in psychiatric disorders yielded potentially promising findings. This paper reviews the role of oxytocin in emotions, behavior and its effects in psychiatric disorders. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(2: 102-113

  5. Effects of nursing care and staff skill mix on patient outcomes within acute care nursing units.

    Science.gov (United States)

    Hart, Patricia; Davis, Nancy

    2011-01-01

    This article presents the findings from a study that evaluates the relationships between staffing indicators and patient outcomes at the hospital unit level. Nursing administrators should not only evaluate the impact staffing decisions have on patient outcomes at the hospital level but also examine these relationships at the unit level. The findings from this study have implications for nursing practice in the areas of staff orientation, education, and patient outcome monitoring.

  6. Barriers to discharge in an acute care medical teaching unit: a qualitative analysis of health providers' perceptions.

    Science.gov (United States)

    Okoniewska, Barbara; Santana, Maria Jose; Groshaus, Horacio; Stajkovic, Svetlana; Cowles, Jennifer; Chakrovorty, David; Ghali, William A

    2015-01-01

    The complex process of discharging patients from acute care to community care requires a multifaceted interaction between all health care providers and patients. Poor communication in a patient's discharge can result in post hospital adverse events, readmission, and mortality. Because of the gravity of these problems, discharge planning has been emphasized as a potential solution. The purpose of this paper is to identify communication barriers to effective discharge planning in an acute care unit of a tertiary care center and to suggest solutions to these barriers. Health care providers provided comments to a single open-ended question: "What are the communication barriers between the different health care providers that limit an effective discharge of patients from Unit 36?" We conducted qualitative thematic analysis by identifying themes related to communication barriers affecting a successful discharge process. Three broad themes related to barriers to the discharge process were identified: communication, lack of role clarity and lack of resources. We also identified two themes for opportunities for improvement, ie, structure and function of the medical team and need for leadership. While it was evident that poor communication was an overarching barrier identified by health care providers, other themes emerged. In an effort to increase inter-team communication, "bullet rounds", a condensed form of discharge rounds, were introduced to the medical teaching unit and occurred on a daily basis between the multidisciplinary team. To help facilitate provider-patient communication, electronic transfer of care summaries were suggested as a potential solution. To help role clarity, a discharge coordinator and/or liaison was suggested. Communication can be enhanced through use of electronic discharge summaries, bullet rounds, and implementation of a discharge coordinator(s). The findings from this study can be used to aid future researchers in devising appropriate

  7. Shrinking inpatient psychiatric capacity: cause for celebration or concern?

    Science.gov (United States)

    Salinsky, Eileen; Loftis, Christopher

    2007-08-01

    This issue brief examines reported capacity constraints in inpatient psychiatric services and describes how these services fit within the continuum of care for mental health treatment. The paper summarizes the type and range of acute care services used to intervene in mental health crises, including both traditional hospital-based services and alternative crisis interventions, such as mobile response teams. It reviews historical trends in the supply of inpatient psychiatric beds and explores the anticipated influence of prospective payment for inpatient psychiatric services under Medicare. The paper also considers other forces that may affect the need for and supply of acute mental health services, including key factors that could improve the quality and efficiency of inpatient psychiatric care.

  8. Undiagnosed chronic obstructive pulmonary diseases in patients admittet to an acute assessment unit

    DEFF Research Database (Denmark)

    Eikhof, Karin Dam; Olsen, Kristine R; Wrengler, NCH

    2017-01-01

    % were offered follow-up visit after 6 weeks. Results: Of the 1145 admitted patients, 46% were eligible: 28% of those had an abnormal spirometry. The offered follow-up visit was attended by 51% and in this group 17% were diagnosed with lung disease. COPD was the most prevalent diagnosis (73%), and 2......Introduction: Chronic obstructive pulmonary disease (COPD) is very prevalent worldwide, yet underdiagnosed. Aim: This study investigates feasibility of performing spirometry in patients in need of acute hospital admission as well as the prevalence of undiagnosed COPD in the same cohort. Methods...

  9. Psychiatric impairment and

    African Journals Online (AJOL)

    2002-12-03

    Dec 3, 2002 ... preventing psychiatric disability in the workplace'). An area of .... The employer should create a culture/climate where the affect- ed employee is able to ... (ii) offer praise and positive reinforcement appropriately. 2. Supervisors ...

  10. American Psychiatric Association

    Science.gov (United States)

    ... Psychiatry? Become an APA Member Learn More Explore APA Psychiatrists Residents & Medical Students Patients & Families About APA ... Psychiatric News Message from President APA Blogs Join APA General Members Residents and Fellows Medical Students International ...

  11. Mathari psychiatric hospital

    African Journals Online (AJOL)

    2007-11-26

    Nov 26, 2007 ... burnout among the staff at the Mathari Psychiatric Hospital. Method: This was .... poor relationship with the management staff were quoted as some of the .... Emotional exhaustion and depersonalization as indicators of burnout ...

  12. Hyperthyroidism and psychiatric morbidity

    DEFF Research Database (Denmark)

    Brandt, Frans; Thvilum, Marianne; Pedersen, Dorthe Almind

    2014-01-01

    Thyroid hormones are essential for the normal development of the fetal brain, while hyperthyroidism in adults is associated with mood symptoms and reduced quality of life. We aimed to investigate the association and temporal relation between hyperthyroidism and psychiatric morbidity....

  13. Cancer and Psychiatric Disorders

    Directory of Open Access Journals (Sweden)

    Gulcan Gulec

    2011-06-01

    Full Text Available Cancer diagnosis which is used as synonym of “death”, “pain” and “sorrow” leads to a hard-coping period in these patients which requires a rapid intervention. Studies conducted in cancer patients regarding prevalance of psychiatric illnesses reported rates ranging from 9 % to 60%. In many cancer patients, psychiatric disorders can be seen as a reaction to disease or cancer tratment, while in ten precent of cases it can be seen as an aggrevation of premorbid personality disorders or anxiety disorders. Although psychiatric disorders in cancer patients can be treated and by this way, morbidity and mortality of these disorders can be prevented, these disorders are underdiagnosed and not properly treated in many patients. In this article, we briefly reviewed literature about psychiatric disorders and symptoms in cancer patients, their diagnosis and treatment suggestions.

  14. Molecular Diagnosis of Chagas Disease in Colombia: Parasitic Loads and Discrete Typing Units in Patients from Acute and Chronic Phases

    Science.gov (United States)

    Hernández, Carolina; Cucunubá, Zulma; Flórez, Carolina; Olivera, Mario; Valencia, Carlos; Zambrano, Pilar; León, Cielo; Ramírez, Juan David

    2016-01-01

    Background The diagnosis of Chagas disease is complex due to the dynamics of parasitemia in the clinical phases of the disease. The molecular tests have been considered promissory because they detect the parasite in all clinical phases. Trypanosoma cruzi presents significant genetic variability and is classified into six Discrete Typing Units TcI-TcVI (DTUs) with the emergence of foreseen genotypes within TcI as TcIDom and TcI Sylvatic. The objective of this study was to determine the operating characteristics of molecular tests (conventional and Real Time PCR) for the detection of T. cruzi DNA, parasitic loads and DTUs in a large cohort of Colombian patients from acute and chronic phases. Methodology/Principal Findings Samples were obtained from 708 patients in all clinical phases. Standard diagnosis (direct and serological tests) and molecular tests (conventional PCR and quantitative PCR) targeting the nuclear satellite DNA region. The genotyping was performed by PCR using the intergenic region of the mini-exon gene, the 24Sa, 18S and A10 regions. The operating capabilities showed that performance of qPCR was higher compared to cPCR. Likewise, the performance of qPCR was significantly higher in acute phase compared with chronic phase. The median parasitic loads detected were 4.69 and 1.33 parasite equivalents/mL for acute and chronic phases. The main DTU identified was TcI (74.2%). TcIDom genotype was significantly more frequent in chronic phase compared to acute phase (82.1% vs 16.6%). The median parasitic load for TcIDom was significantly higher compared with TcI Sylvatic in chronic phase (2.58 vs.0.75 parasite equivalents/ml). Conclusions/Significance The molecular tests are a precise tool to complement the standard diagnosis of Chagas disease, specifically in acute phase showing high discriminative power. However, it is necessary to improve the sensitivity of molecular tests in chronic phase. The frequency and parasitemia of TcIDom genotype in chronic

  15. Barriers to discharge in an acute care medical teaching unit: a qualitative analysis of health providers’ perceptions

    Directory of Open Access Journals (Sweden)

    Okoniewska B

    2015-02-01

    Full Text Available Barbara Okoniewska,1 Maria Jose Santana,1 Horacio Groshaus,2 Svetlana Stajkovic,3 Jennifer Cowles,4 David Chakrovorty,5 William A Ghali1 1Department of Community Health Sciences, W21C Research and Innovation Centre, Institute of Public Health, 2Department of Internal Medicine, University of Calgary, 3Community Based Practice, 4Foothills Medical Centre, 5Department of Quality and Healthcare Improvement, Alberta Health Services, Calgary, AB, Canada Background: The complex process of discharging patients from acute care to community care requires a multifaceted interaction between all health care providers and patients. Poor communication in a patient’s discharge can result in post hospital adverse events, readmission, and mortality. Because of the gravity of these problems, discharge planning has been emphasized as a potential solution. The purpose of this paper is to identify communication barriers to effective discharge planning in an acute care unit of a tertiary care center and to suggest solutions to these barriers. Methods: Health care providers provided comments to a single open-ended question: “What are the communication barriers between the different health care providers that limit an effective discharge of patients from Unit 36?” We conducted qualitative thematic analysis by identifying themes related to communication barriers affecting a successful discharge process. Results: Three broad themes related to barriers to the discharge process were identified: communication, lack of role clarity and lack of resources. We also identified two themes for opportunities for improvement, ie, structure and function of the medical team and need for leadership. Conclusion: While it was evident that poor communication was an overarching barrier identified by health care providers, other themes emerged. In an effort to increase inter-team communication, “bullet rounds”, a condensed form of discharge rounds, were introduced to the medical

  16. Predictors of pneumonia in acute stroke in patients in an emergency unit

    Directory of Open Access Journals (Sweden)

    Sara R. M. Almeida

    2015-05-01

    Full Text Available Objective To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. Method Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. Results 159 patients (18-90 years were admitted. Prevalence of pneumonia was 32%. Pneumonia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001, higher National Institute of Health Stroke Scale (NIHSS (p = 0.047 and, lower Glasgow Coma Score (GCS (p < 0.0001. Patients with pneumonia had longer hospitalization (p < 0.0001. Multivariable logistic regression analysis identified NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002. Conclusion Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

  17. [Use of enoximone in patients with acute and subacute heart failure in the intensive care unit].

    Science.gov (United States)

    Holubarsch, C; Pieske, B; Hasenfuss, G; Just, H

    1994-01-01

    The phosphodiesterase inhibitor enoximone has both vasodilating and positive inotropic pharmacological properties. The balance between vasodilation and positive inotropism may be different between the various types of heart failure as well as the various stages of heart failure. Therefore, we investigated the effect of intravenous application of enoximone (1 mg/kg body weight) in a cohort of patients (n = 10) suffering from acute or subacute heart failure mainly due to ischemia or hypoxia. All patients had high left ventricular filling pressure, low cardiac output and were pretreated with intravenous dobutamine. Enoximone increased cardiac output from 3.2 +/- 1.2 to 5.5 +/- 2.2 l/min, increased heart rate from 94 +/- 20 to 100 +/- 18 beats/min, decreased systemic peripheral resistance from 1770 +/- 861 to 931 +/- 340 dyn.sec.cm-5 and decreased pulmonary wedge pressure from 24 +/- 5 to 20 +/- 6 mmHg, significantly. However, systolic aortic pressure, systolic pulmonary pressure and right atrial pressure were not significantly altered. We conclude that in a selected group of patients enoximone-given intravenously and acutely in the intensive care unity-can induce beneficial effects on central hemodynamics without critical falls in perfusion pressure.

  18. [Psychiatric examination of accused for the "United Nations International Tribunal for the prosecution of persons responsible for serious violations of International Humanitarian Law committed in the territory of the former Yugoslavia" (ICTY)].

    Science.gov (United States)

    Soyka, M

    2002-02-01

    Psychiatric examination of accused for the International Tribunal is a new and challenging task for expert medical witness and forensic psychiatry. After a brief description of a case report relevant aspects of psychiatric evaluation of persons responsible for war crimes are outlined and possible implications for forensic research are discussed.

  19. Remifentanil in the intensive care unit: tolerance and acute withdrawal syndrome after prolonged

    NARCIS (Netherlands)

    Delvaux, B.; Ryckwaert, Y.; Boven, van R.M.; Kock, M.; Capdevila, X.

    2005-01-01

    SEDATION in the intensive care unit should be minimized to reduce the duration of mechanical ventilation and its related complications.1 The drug regimen would ideally allow rapid awakening, to perform neurologic and respiratory evaluation on a daily basis.2,3 In this context, remifentanil, with its

  20. A UK wide survey on attitudes to point of care ultrasound training amongst clinicians working on the Acute Medical Unit.

    Science.gov (United States)

    Smallwood, Nicholas; Matsa, Ramprasad; Lawrenson, Philip; Messenger, Jenny; Walden, Andrew

    2015-01-01

    The use of point of care ultrasound (POCU) is increasing across a number of specialties, becoming mandatory within some specialist training programmes (for example respiratory and emergency medicine). Despite this, there are few data looking at the prevalence of use or the training clinicians have undertaken; this survey sought to address this. It shows that the majority of POCU undertaken on the Acute Medical Unit (AMU) is without formal accreditation, with significant arriers to training highlighted including a lack of supervision, time and equipment. For those who undertook POCU, it was shown to regularly speed up clinical decision making, while 76.3% respondents believed a lack of access to POCU out of hours may affect patient safety. The data provide support to the concept of developing AMU specific POCU accreditation, to ensure robust and safe use of this modality on the AMU.

  1. Children’s experiences of acute hospitalisation to a paediatric emergency and assessment unit – A qualitative study

    DEFF Research Database (Denmark)

    Jensen, Claus Sixtus; Jackson, Karen; Kolbæk, Raymond;

    2012-01-01

    Short-stay treatment has become a popular form of care as a strategy to cope with increased demands on health care. There is little research that considers children’s experiences of acute hospitalisation to a short-stay care facility such as a Paediatric Emergency and Assessment Unit (PEAU......). This study explored the experiences of eight children aged 8–10 years. Semi-structured interviews were carried out to investigate the children’s own experiences of being hospitalised in a PEAU. Thematic content analyses were used. Three major themes were identified: the children’s understanding of disease......, treatment and procedures; the children’s experiences of health-care personnel and the PEAU and transformation of everyday life into the settings of the hospital. The children identified the hospital stay as an overall positive experience. The children took part in leisure activities as they would at home...

  2. Secondary analysis of data can inform care delivery for Indigenous women in an acute mental health inpatient unit.

    Science.gov (United States)

    Bradley, Pat; Cunningham, Teresa; Lowell, Anne; Nagel, Tricia; Dunn, Sandra

    2017-02-01

    There is a paucity of research exploring Indigenous women's experiences in acute mental health inpatient services in Australia. Even less is known of Indigenous women's experience of seclusion events, as published data are rarely disaggregated by both indigeneity and gender. This research used secondary analysis of pre-existing datasets to identify any quantifiable difference in recorded experience between Indigenous and non-Indigenous women, and between Indigenous women and Indigenous men in an acute mental health inpatient unit. Standard separation data of age, length of stay, legal status, and discharge diagnosis were analysed, as were seclusion register data of age, seclusion grounds, and number of seclusion events. Descriptive statistics were used to summarize the data, and where warranted, inferential statistical methods used SPSS software to apply analysis of variance/multivariate analysis of variance testing. The results showed evidence that secondary analysis of existing datasets can provide a rich source of information to describe the experience of target groups, and to guide service planning and delivery of individualized, culturally-secure mental health care at a local level. The results are discussed, service and policy development implications are explored, and suggestions for further research are offered. © 2016 Australian College of Mental Health Nurses Inc.

  3. Viabilidade de unidades psiquiátricas em hospitais gerais no Brasil Viabilidad de unidades psiquiátricas en hospitales generales en Brasil Feasibility of general hospitals psychiatric units in Brazil

    Directory of Open Access Journals (Sweden)

    Maurício Lucchesi

    2009-02-01

    Taubate (Sureste de Brasil, 2005-2006. Las evidencias fueron obtenidas por medio de entrevistas, observación participante y palestras sobre el proyecto de la unidad psiquiátrica para el cuerpo clínico del hospital. RESULTADOS: La inversión del órgano gestor posibilitó que las concepciones estigmatizantes presentes en la cultura del hospital estudiado (violencia, debilidad moral e intratabilidad fueran resignificadas por medio de discusiones clínicas y sanitarias, viabilizando la implantación de la unidad psiquiátrica. El análisis mostró que esas concepciones eran reactualizadas por el contexto asistencial, en el cual el acceso de los portadores de trastornos mentales era restringido. CONCLUSIONES: La postura asumida por el órgano gestor, que decidió por el financiamiento adecuado de la unidad psiquiátrica y ejerció su ascendencia sobre el hospital prestador, fue decisiva para el desenlace del caso. La principal dificultad para la implantación de las unidades psiquiátricas no es el estigma presente en la cultura de los hospitales generales, pero una limitación de orden estratégica: la falta de una política afirmativa para esas unidades.OBJECTIVE: To comprehend the stigma against people with mental disorders still persists in the culture of general hospitals and acts as a limiting factor in the implementation of psychiatric units in general hospitals in Brazil. METHODOLOGICAL PROCEDURES: A qualitative social survey was outlined based on action research strategy as of the agreement to adopt a psychiatric unit in a general hospital in Taubaté, Southeastern Brazil. Data was obtained through interviews, participant observation and talks on the psychiatric unit project given to the hospital's clinical staff. RESULTS: The investment made by the healthcare authority enabled the stigmatizing conceptions (violence, moral weakness and untreatability present in the hospital culture in question to be resignified by means of clinical and sanitary discussions, which

  4. Single- vs double-unit cord blood transplantation for children and young adults with acute leukemia or myelodysplastic syndrome.

    Science.gov (United States)

    Michel, Gérard; Galambrun, Claire; Sirvent, Anne; Pochon, Cecile; Bruno, Benedicte; Jubert, Charlotte; Loundou, Anderson; Yakoub-Agha, Ibrahim; Milpied, Noel; Lutz, Patrick; Marie-Cardine, Aude; Gandemer, Virginie; Blaise, Didier; Michallet, Mauricette; Rialland, Fanny; Renard, Cecile; Oudin, Claire; Esmiol, Sophie; Seux, Mylene; Baumstarck, Karine; Mohty, Mohamad; Rocha, Vanderson; Dalle, Jean-Hugues

    2016-06-30

    Transplantation of 2 unrelated cord blood (UCB) units instead of 1 has been proposed to increase the cell dose. We report a prospective randomized study, designed to compare single- vs double-UCB transplantation in children and young adults with acute leukemia in remission or myelodysplasia. Eligible patients had at least two 4-6 HLA-identical UCBs with >3 × 10(7) nucleated cells/kg for the first and >1.5 × 10(7) for the second. The primary end point was the 2-year cumulative incidence of transplantation strategy failure, a composite end point including transplant-related mortality (TRM), engraftment failure, and autologous recovery. Randomized patients who did not proceed to transplantation due to refractory disease were considered transplantation failures. A total of 151 patients were randomized and included in the intent-to-treat analysis; 137 were transplanted. Double-UCB transplantation did not decrease transplantation strategy failure (23.4% ± 4.9% vs 14.9% ± 4.2%). Two-year posttransplant survival, disease-free survival, and TRM were 68.8% ± 6.0%, 67.6% ± 6.0%, and 5.9% ± 2.9% after single-unit transplantation compared with 74.8% ± 5.5%, 68.1% ± 6.0%, and 11.6% ± 3.9% after double-unit transplantation. The final relapse risk did not significantly differ, but relapses were delayed after double-unit transplantation. Overall incidences of graft-versus-host disease (GVHD) were similar, but chronic GVHD was more frequently extensive after double-UCB transplantation (31.9% ± 5.7% vs 14.7% ± 4.3%, P = .02). In an exploratory subgroup analysis, we found a significantly lower relapse risk after double-unit transplantation in patients receiving total body irradiation without antithymocyte globulin (ATG), whereas the relapse risk was similar in the group treated with busulfan, cyclophosphamide, and ATG. Single-UCB transplantation with adequate cell dose remains the standard of care and leads to low TRM. Double-unit transplantation should be reserved for

  5. Incidence, risk factors and prognostic factors of acute renal failure in patients admitted to an intensive care unit

    Directory of Open Access Journals (Sweden)

    S.E. Mataloun

    2006-10-01

    Full Text Available The objective of the present study was to assess the incidence, risk factors and outcome of patients who develop acute renal failure (ARF in intensive care units. In this prospective observational study, 221 patients with a 48-h minimum stay, 18-year-old minimum age and absence of overt acute or chronic renal failure were included. Exclusion criteria were organ donors and renal transplantation patients. ARF was defined as a creatinine level above 1.5 mg/dL. Statistics were performed using Pearsons' chi2 test, Student t-test, and Wilcoxon test. Multivariate analysis was run using all variables with P < 0.1 in the univariate analysis. ARF developed in 19.0% of the patients, with 76.19% resulting in death. Main risk factors (univariate analysis were: higher intra-operative hydration and bleeding, higher death risk by APACHE II score, logist organ dysfunction system on the first day, mechanical ventilation, shock due to systemic inflammatory response syndrome (SIRS/sepsis, noradrenaline use, and plasma creatinine and urea levels on admission. Heart rate on admission (OR = 1.023 (1.002-1.044, male gender (OR = 4.275 (1.340-13642, shock due to SIRS/sepsis (OR = 8.590 (2.710-27.229, higher intra-operative hydration (OR = 1.002 (1.000-1004, and plasma urea on admission (OR = 1.012 (0.980-1044 remained significant (multivariate analysis. The mortality risk factors (univariate analysis were shock due to SIRS/sepsis, mechanical ventilation, blood stream infection, potassium and bicarbonate levels. Only potassium levels remained significant (P = 0.037. In conclusion, ARF has a high incidence, morbidity and mortality when it occurs in intensive care unit. There is a very close association with hemodynamic status and multiple organ dysfunction.

  6. Variability in the treatment of acute spinal cord injury in the United Kingdom: results of a national survey.

    Science.gov (United States)

    Werndle, Melissa C; Zoumprouli, Argyro; Sedgwick, Philip; Papadopoulos, Marios C

    2012-03-20

    The aim of this study was to examine how traumatic spinal cord injury is managed in the United Kingdom via a questionnaire survey of all neurosurgical units. We contacted consultant neurosurgeons and neuroanesthetists in all neurosurgical centers that manage patients with acute spinal cord injury. Two clinical scenarios-of complete and incomplete cervical spinal cord injuries-were given to determine local treatment policies. There were 175 responders from the 33 centers (36% response rate). We ascertained neurosurgical views on urgency of transfer, timing of surgery, nature and aim of surgery, as well as neuroanesthetic views on type of anesthetic, essential intraoperative monitoring, drug treatment, and intensive care management. Approximately 70% of neurosurgeons will admit patients with incomplete spinal cord injury immediately, but only 40% will admit patients with complete spinal cord injury immediately. There is no consensus on the timing or even the role of surgery for incomplete or complete injuries. Most (96%) neuroanesthetists avoid anesthetics known to elevate intracranial pressure. What was deemed essential intraoperative monitoring, however, varied widely. Many (22%) neuroanesthetists do not routinely measure arterial blood pressure invasively, central venous pressure (85%), or cardiac output (94%) during surgery. There is no consensus among neuroanesthetists on the optimal levels of arterial blood pressure, or oxygen and carbon dioxide partial arterial pressure. We report wide variability among U.K. neurosurgeons and neuroanesthetists in their treatment of acute traumatic spinal cord injury. Our findings reflect the lack of Class 1 evidence that early surgical decompression and intensive medical management of patients with spinal cord injury improves neurological outcome.

  7. Cholera gravis associated with acute renal failure in a traveler from Haiti to the United States.

    Science.gov (United States)

    Reyes-Corcho, Andrés; Pinsker, Richard W; Sarkar, Samir; Bagheri, Farshad; Patel, Mahendra C; Lam, Pablo; González, Argentina

    2012-09-01

    Cholera is a gastroenteric disease caused by epidemic or pandemic Vibrio cholerae which still is responsible for over 100,000 annual deaths worldwide. Since October 2010, Haiti experienced a cholera outbreak affecting more than 300,000 persons. Few imported cases related to the Haitian epidemic have been reported so far in the United States and Canada. We presented a patient who developed cholera gravis soon after arrival at New York City from Haiti. The patient needed admission to an Intensive Care Unit, for vigorous intravenous hydration, antibiotic therapy, and hemodialysis due to refractory oliguric renal failure. The patient was discharged the day 6 after admission and V. cholerae O1 was isolated from the stool culture. Cholera can be a life-threatening disease; early recognition based on travel history and clinical features is the corner stone for successful management. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Results of a Prospective Multicentre Myeloablative Double-Unit Cord Blood Transplantation Trial in Adult Patients with Acute Leukaemia and Myelodysplasia

    Science.gov (United States)

    Barker, Juliet N.; Fei, Mingwei; Karanes, Chatchada; Horwitz, Mitchell; Devine, Steven; Kindwall-Keller, Tamila L.; Holter, Jennifer; Adams, Alexia; Logan, Brent; Navarro, Willis H.; Riches, Marcie

    2017-01-01

    Summary Double-unit cord blood (CB) grafts may improve engraftment and relapse risk in adults with haematological malignancies. We performed a prospective high-dose myeloablative double-unit CB transplantation (CBT) trial in adults with high-risk acute leukaemia or myelodysplasia (MDS) between 2007 and 2011. The primary aim was to establish the one-year overall survival in a multi-centre setting. Fifty-six patients (31 acute myeloid leukaemia, 19 acute lymphoblastic leukaemia, 4 other acute leukaemias, 2 myelodysplastic syndrome [MDS]) were transplanted at 10 centres. The median infused total nucleated cell doses were 2.62 (larger unit) and 2.02 (smaller unit) × 107/kg. The cumulative incidence of day 100 neutrophil engraftment was 89% (95% confidence interval [CI]: 80–96). Day 180 grade II-IV acute graft-versus-host disease (GVHD) incidence was 64% (95%CI: 51–76) and 36% (95%CI: 24–49) of patients had chronic GVHD by 3-years. At 3-years post-transplant, the transplant-related mortality (TRM) was 39% (95%CI: 26–52), and the 3-year relapse incidence was 11% (95%CI: 4–21). With a median 37-month (range 23–71) follow-up of survivors, the 3-year disease-free survival was 50% (95%CI: 37–63). Double-unit CBT is a viable alternative therapy for high-risk acute leukaemia/MDS in patients lacking a matched unrelated donor. This is especially important for minority patients. The relapse incidence was low but strategies to ameliorate TRM are needed. PMID:25272241

  9. Psychiatric Aspects of Infertility

    Directory of Open Access Journals (Sweden)

    Hacer Sezgin

    2014-06-01

    Full Text Available Infertility can be defined as a crisis with cultural, religious, and class related aspects, which coexists with medical, psychiatric, psychological, and social problems. Relation between psychiatric and psychological factors stem from a mutual interaction of both. Family is an important institution in maintaining human existence and raising individuals in line with society's expectations. Fertility and reproduction are seen as universal functions unique to women with raising children as the expected result of the family institution. Incidence of infertility has increased recently and can become a life crisis for a couple. Even though not being able to have a child affects both sexes emotionally, women feel greater amounts of stress, pressure, anxiety, and depression.Consequences of infertility arise from short and long-term devastating effects on both individual's physical and mental health, and marital system. Many studies focus on infertility related psychological and psychiatric disorders (depression, anxiety, grief, marital conflict, gender differences, relation between the causes of infertility and psychopathology, the effects of psychiatric evaluation and intervention -when necessaryon the course of infertility treatment, pregnancy rates, and childbirth. The most important underlying causes of high levels of stress and anxiety that infertile women experience are the loss of maternity, reproduction, sense of self, and genetic continuity. In this review article is to investigate the relationship between medically unexplained symptoms and psychiatric symptoms. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 165-185

  10. Effects of a Dedicated Regional Psychiatric Emergency Service on Boarding of Psychiatric Patients in Area Emergency Departments

    Directory of Open Access Journals (Sweden)

    Scott Zeller

    2014-02-01

    Full Text Available Introduction: Mental health patients boarding for long hours, even days, in United States emergency departments (EDs awaiting transfer for psychiatric services has become a considerable and widespread problem. Past studies have shown average boarding times ranging from 6.8 hours to 34 hours. Most proposed solutions to this issue have focused solely on increasing available inpatient psychiatric hospital beds, rather than considering alternative emergency care designs that could provide prompt access to treatment and might reduce the need for many hospitalizations. One suggested option has been the “regional dedicated emergency psychiatric facility,” which serves to evaluate and treat all mental health patients for a given area, and can accept direct transfers from other EDs. This study sought to assess the effects of a regional dedicated emergency psychiatric facility design known at the “Alameda Model” on boarding times and hospitalization rates for psychiatric patients in area EDs. Methods: Over a 30-day period beginning in January 2013, 5 community hospitals in Alameda County, California, tracked all ED patients on involuntary mental health holds to determine boarding time, defined as the difference between when they were deemed stable for psychiatric disposition and the time they were discharged from the ED for transfer to the regional psychiatric emergency service. Patients were also followed to determine the percentage admitted to inpatient psychiatric units after evaluation and treatment in the psychiatric emergency service.Results: In a total sample of 144 patients, the average boarding time was approximately 1 hour and 48 minutes. Only 24.8% were admitted for inpatient psychiatric hospitalization from the psychiatric emergency service. Conclusion: The results of this study indicate that the Alameda Model of transferring patients from general hospital EDs to a regional psychiatric emergency service reduced the length of boarding

  11. Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units

    Science.gov (United States)

    Lu, Zhiwei; Cheng, Yusheng; Tu, Xiongwen; Chen, Liang; Chen, Hu; Yang, Jian; Wang, Jinyan; Zhang, Liqin

    2016-01-01

    Purpose The aim of this study was to appraise the effect of community-acquired pneumonia (CAP) on inhospital mortality in critically ill acute exacerbation of COPD (AECOPD) patients admitted to a respiratory intensive care unit. Patients and methods A retrospective observational study was performed. Consecutive critically ill AECOPD patients receiving treatment in a respiratory intensive care unit were reviewed from September 1, 2012, to August 31, 2015. Categorical variables were analyzed using chi-square tests, and continuous variables were analyzed by Mann–Whitney U-test. Kaplan–Meier analysis was used to assess the association of CAP with survival of critically ill AECOPD patients for univariate analysis. Cox’s proportional hazards regression model was performed to identify risk factors for multivariate analysis. Results A total of 80 consecutive eligible individuals were reviewed. These included 38 patients with CAP and 42 patients without CAP. Patients with CAP had a higher inhospital rate of mortality than patients without CAP (42% vs 33.3%, Pcritically ill AECOPD patients (CAP: hazard ratio, 5.29; 95% CI, 1.50–18.47, Pcritically ill AECOPD patients. PMID:27563239

  12. A guest in the house: nursing instructors' experiences of the moral distress felt by students during inpatient psychiatric clinical rotations.

    Science.gov (United States)

    Wojtowicz, Bernadine; Hagen, Brad

    2014-01-01

    Significant research has been done on the impact of moral distress among nurses, particularly in acute and intensive care settings. However, little research to date has investigated the experiences that nursing students have with moral distress. Additionally, there is a dearth of research on the role of nursing instructors' perceptions of their responsibilities to their students when encountering morally distressing situations. This manuscript describes a qualitative study conducted with eight mental health nursing instructors who acknowledged a responsibility for helping students deal with moral distress and ethical issues, but who also struggled with ways to do so. Additionally, instructors expressed frustration with their "guest" status on inpatient psychiatric units and their powerlessness to effect moral change in a medical model of psychiatric care.

  13. Serum 1H-NMR metabolomic fingerprints of acute-on-chronic liver failure in intensive care unit patients with alcoholic cirrhosis.

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    Roland Amathieu

    Full Text Available INTRODUCTION: Acute-on-chronic liver failure is characterized by acute deterioration of liver function in patients with compensated or decompensated, but stable, cirrhosis. However, there is no accurate definition of acute-on-chronic liver failure and physicians often use this term to describe different clinical entities. Metabolomics investigates metabolic changes in biological systems and identifies the biomarkers or metabolic profiles. Our study assessed the metabolomic profile of serum using proton nuclear magnetic resonance ((1H-NMR spectroscopy to identify metabolic changes related to acute-on-chronic liver failure. PATIENTS: Ninety-three patients with compensated or decompensated cirrhosis (CLF group but stable liver function and 30 patients with cirrhosis and hospitalized for the management of an acute event who may be responsible of acute-on-chronic liver failure (ACLF group, were fully analyzed. Blood samples were drawn at admission, and sera were separated and stored at -80°C until (1H-NMR spectral analysis. Using orthogonal projection to latent-structure discriminant analyses, various metabolites contribute to the complete separation between these both groups. RESULTS: The predictability of the model was 0.73 (Q(2 Y and the explained variance was 0.63 (R(2 Y. The main metabolites that had increased signals related to acute-on-chronic liver failure were lactate, pyruvate, ketone bodies, glutamine, phenylalanine, tyrosine, and creatinine. High-density lipids were lower in the ALCF group than in CLF group. CONCLUSION: A serum metabolite fingerprint for acute-on-chronic liver failure, obtained with (1H-NMR, was identified. Metabolomic profiling may aid clinical evaluation of patients with cirrhosis admitted into intensive care units with acute-on-chronic liver failure, and provide new insights into the metabolic processes involved in acute impairment of hepatic function.

  14. The business of palliative medicine--part 4: Potential impact of an acute-care palliative medicine inpatient unit in a tertiary care cancer center.

    Science.gov (United States)

    Walsh, Declan

    2004-01-01

    In this study, a hematology/oncology computerized discharge database was qualitatively and quantitatively reviewed using an empirical methodology. The goal was to identify potential patients for admission to a planned acute-care, palliative medicine inpatient unit. Patients were identified by the International Classifications of Disease (ICD-9) codes. A large heterogenous population, comprising up to 40 percent of annual discharges from the Hematology/Oncology service, was identified. If management decided to add an acute-care, palliative medicine unit to the hospital, these are the patients who would benefit. The study predicted a significant change in patient profile, acuity, complexity, and resource utilization in current palliative care services. This study technique predicted the actual clinical load of the acute-care unit when it opened and was very helpful in program development. Our model predicted that 695 patients would be admitted to the acute-care palliative medicine unit in the first year of operation; 655 patients were actually admitted during this time.

  15. Effect of intensive care unit organizational model and structure on outcomes in patients with acute lung injury.

    Science.gov (United States)

    Treggiari, Miriam M; Martin, Diane P; Yanez, N David; Caldwell, Ellen; Hudson, Leonard D; Rubenfeld, Gordon D

    2007-10-01

    Prior studies supported an association between intensive care unit (ICU) organizational model or staffing patterns and outcome in critically ill patients. To examine the association of closed versus open models with patient mortality across adult ICUs in King County (WA). Cohort study of patients with acute lung injury (ALI). ICU structure, organization, and patient care practices were assessed using self-administered mail questionnaires completed by the medical director and nurse manager. We defined closed ICUs as units that required patient transfer to or mandatory patient comanagement by an intensivist and open ICUs as those relying on other organizational models. Outcomes were obtained from the King County Lung Injury Project, a population-based cohort of patients with ALI. The main endpoint was hospital mortality. Of 24 eligible ICUs, 13 ICUs were designated closed and 11 open. Complete survey data were available for 23 (96%) ICUs. Higher physician and nurse availability was reported in closed versus open ICUs. A total of 684 of 1,075 (63%) of patients with ALI were cared for in closed ICUs. After adjusting for potential confounders, patients with ALI cared for in closed ICUs had reduced hospital mortality (adjusted odds ratio, 0.68; 95% confidence interval, 0.53, 0.89; P = 0.004). Consultation by a pulmonologist in open ICUs was not associated with improved mortality (adjusted odds ratio, 0.94; 95% confidence interval, 0.74, 1.20; P = 0.62). These findings were robust for varying assumptions about the study population definition. Patients with ALI cared for in a closed-model ICU have reduced mortality. These data support recommendations to implement structured intensive care in the United States.

  16. Prospective survey of acute osteoarticular infections in a French paediatric orthopedic surgery unit.

    Science.gov (United States)

    Ferroni, A; Al Khoury, H; Dana, C; Quesne, G; Berche, P; Glorion, C; Péjin, Z

    2013-09-01

    The epidemiology of acute paediatric osteoarticular infections (OAI) has recently evolved, mainly due to the improvement of microbiological diagnosis. We conducted a prospective study to analyse the recent epidemiology and the clinical evolution of paediatric OAI in order to validate the adequacy of our probabilistic first-line antibiotic treatment (intraveinous cefamandole + gentamicin). All children suspected of community acquired OAI were included and followed-up for 3 years. The etiologic diagnosis was based on blood cultures, joint aspirations and bone punctures. All osteoarticular (OA) samples were systematically inoculated into blood culture bottles. Real-time universal 16S rRNA and PCR targeted on Staphylococcus aureus, Kingella kingae, Streptococcus pneumoniae and Streptococcus pyogenes were performed twice a week. From 17 March 2007 to 26 February 2009, 98 septic arthritis, 70 osteomyelitis, 23 osteoarthritis and six spondylodiscitis were analysed. A portal of entry was suspected in 44% of cases, including 55% of otorhinolaryngological infections. C reactive protein was the most sensitive inflammatory marker. PCR increased by 54% the performance of bacteriological diagnosis. Among the patients completely investigated (blood culture and OAI samples), there were 63% documented OAI. The main pathogens found were K. kingae (52%), S. aureus (28%), S. pyogenes (7%), S. pneumoniae (3%) and Streptococcus agalactiae (2%). All isolated bacteria were sensitive to the probabilist treatment and outcome was favorable. PCR has significantly improved the performance and the delay of IOA diagnosis in children, for which K. kingae turned out to be the first causative agent. The probabilistic treatment was active against the main bacteria responsible for paediatric OAI.

  17. Perinatal psychiatric episodes

    DEFF Research Database (Denmark)

    Munk-Olsen, Trine; Maegbaek, M L; Johannsen, B M

    2016-01-01

    ). This was done for all women who had records of one or more singleton births from 1998 until 2012. In total, we had information on 822 439 children born to 491 242 unique mothers. Results showed first-time psychiatric episodes treated at inpatient facilities were rare during pregnancy, but increased...... significantly shortly following childbirth (0.02 vs 0.25 per 1000 births). In comparison, first-time psychiatric episodes treated at outpatient facilities were more common, and showed little variation across pregnancy and postpartum. For every single birth resulting in postpartum episodes treated at inpatient...

  18. Implicaciones criminológicas de los casos legales recibidos en una unidad de Psiquiatría: Resultados preliminares/ Legal cases received in a Psychiatric unit and it’s criminological implications: Preliminary results

    Directory of Open Access Journals (Sweden)

    Odalis Tibisay Parra Izarra (Venezuela

    2014-01-01

    ,1 % of legal references of the institutions of social formal control. Concluding that there criminological relevance in the "legal cases" referred to the Psychiatry Unit of the IAHULA and, it is suggested, that a professional like the clinical criminologist, of being considered in both instances, could serve of bridge between the Psychiatric Unit and the institutions of social formal control.

  19. Adolescents and Dual Diagnosis in a Psychiatric Emergency Service.

    Science.gov (United States)

    Matali, José Luis; Andión, Oscar; Pardo, Marta; Iniesta, Raquel; Serrano, Eduard; San, Luis

    2016-03-02

    In recent years, both the prevalence of drug use and related child and adolescent psychiatric emergencies have risen sharply. There are few studies about the impact on child and adolescent emergency services. This study has a twofold aim. The first is to describe the prevalence of substance use disorders, mental disorders and dual diagnosis (substance use problems plus mental disorder) in adolescents in psychiatric emergency service. The second is to analyze clinical and healthcare differences between patients with dual diagnosis and patients with a mental disorder without substance use disorder.We retrospectively reviewed 4012 discharge forms for emergencies treated at the psychiatric emergency department during the period 2007-2009. We obtained a sample of 1795 visits. This sample was divided into two groups: the dual diagnosis group (n = 477) and the psychiatric disorder group (n = 1318).The dual diagnosis group accounted for 26.5% of psychiatric emergencies analyzed. Compared to the psychiatric disorder group,the dual diagnosis group had significantly more conduct disorders, social problems, involuntariness in the visit, less hospital admissions and less connection with the healthcare network.Adolescents with a dual diagnosis account for a high percentage of visits at child and adolescent psychiatric emergency services. This patient group requires specialized care both at emergency services and in specific units. Accordingly, these units should play a triple role when handling dual diagnosis: detection, brief treatment and referral to a specialised unit.

  20. Organization of acute stroke services in Poland - Polish Stroke Unit Network development.

    Science.gov (United States)

    Sarzyńska-Długosz, Iwona; Skowrońska, Marta; Członkowska, Anna

    2013-01-01

    According to the recommendations of stroke organizations, every stroke patient should be treated in a specialized stroke unit (SU). We aimed to evaluate the development of the SU network in Poland during the past decade. In Poland, stroke is treated mainly by neurologists. A questionnaire evaluating structure and staff of neurological departments was sent to all neurological departments in 2003, 2005 and 2007. In 2010, we collected data based on information from the National Health Fund. We divided departments into categories: with a comprehensive SU, with a primary SU unit, and departments without an SU. Primary SUs were further divided into class A SUs (fulfilling criteria of the National Programme of Prevention and Treatment of Stroke Experts - eligible for thrombolysis), class B (conditionally fulfilling criteria), and class C (not fulfilling criteria). Final analyses included 87.4% of departments (194/222) in 2003, 85.5% of departments (188/220) in 2005, and 83.1% of departments (182/219) in 2007. According to the above-mentioned classification there were 20 class A SUs in 2003, 58 in 2005 and 5 comprehensive and 51 class A SUs in 2007. In 2012, based on information from the National Health Fund there were 150 SUs, all fulfilling criteria for thrombolysis, 9 of them comprehensive SUs. The SU network in Poland is developing dynamically but thrombolysis and endovascular procedures are done too rarely. Now it is necessary to improve quality of stroke services and to make organizational changes in the in-hospital stroke pathways as well as to organize continuous education of medical staff.

  1. Time Perception and Psychiatric Disorders

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    Hatice Ceviz

    2013-09-01

    Full Text Available Time perception is an ability which we use in every moment of daily life, that guides the formation and continuation of our behaviors and from an evolutionary perspective ensures survival. Internal clock models help us to understand time perception. Time perception is known to vary between individuals and particular situations. This variability is explained with the mechanisms which is associated with the processes related to attention, the speed of the internal clock and the memory unit. It is suggested that time perception is mainly associated with the activities of dopamine and acetylcholine. Some dopaminergic psychoactive substances like cocaine and amphetamine have all been shown to change time perception by increasing the speed of internal clock while on the other hand some antipsychotic drugs make an opposite change in time perception by descreasing the speed of the clock. Similarly, time perception is affected in some psychiatric disorders and an ethiopathological relationship between time perception disturbances and psychiatric disorders is suggested. In this article time perception changes in schizophrenia, attention deficit/hyperactivity syndrome, depression, anxiety disorders and personality disorders are briefly reviewed.

  2. Development and Pilot of a Checklist for Management of Acute Liver Failure in the Intensive Care Unit.

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    Oren K Fix

    Full Text Available Acute liver failure (ALF is an ideal condition for use of a checklist. Our aims were to develop a checklist for the management of ALF in the intensive care unit (ICU and assess the usability of the checklist among multiple providers.The initial checklist was developed from published guidelines and expert opinion. The checklist underwent pilot testing at 11 academic liver transplant centers in the US and Canada. An anonymous, written survey was used to assess the usability and quality of the checklist. Written comments were used to improve the checklist following the pilot testing period.We received 81 surveys involving the management of 116 patients during the pilot testing period. The overall quality of the checklist was judged to be above average to excellent by 94% of users. On a 5-point Likert scale, the majority of survey respondents agreed or agreed strongly with the following checklist characteristics: the checklist was easy to read (99% agreed/agreed strongly, easy to use (97%, items are categorized logically (98%, time to complete the checklist did not interfere with delivery of appropriate and safe patient care (94% and was not excessively burdensome (92%, the checklist allowed the user the freedom to use his or her clinical judgment (80%, it is a useful tool in the management of acute liver failure (98%. Web-based and mobile apps were developed for use of the checklist at the point of care.The checklist for the management of ALF in the ICU was shown in this pilot study to be easy to use, helpful and accepted by a wide variety of practitioners at multiple sites in the US and Canada.

  3. Acute kidney injury in a tropical country: a cohort study of 253 patients in an infectious diseases intensive care unit

    Directory of Open Access Journals (Sweden)

    Elizabeth De Fransceco Daher

    2014-01-01

    Full Text Available Introduction: Acute kidney injury (AKI is a frequent and potentially fatal complication in infectious diseases. The aim of this study was to investigate the clinical aspects of AKI associated with infectious diseases and the factors associated with mortality. Methods: This retrospective study was conducted in patients with AKI who were admitted to the intensive care unit (ICU of a tertiary infectious diseases hospital from January 2003 to January 2012. The major underlying diseases and clinical and laboratory findings were evaluated. Results: A total of 253 cases were included. The mean age was 46±16 years, and 72% of the patients were male. The main diseases were human immunodeficiency virus (HIV infection, HIV/acquired immunodeficiency syndrome (AIDS (30%, tuberculosis (12%, leptospirosis (11% and dengue (4%. Dialysis was performed in 70 cases (27.6%. The patients were classified as risk (4.4%, injury (63.6% or failure (32%. The time between AKI diagnosis and dialysis was 3.6±4.7 days. Oliguria was observed in 112 cases (45.7%. The Acute Physiology and Chronic Health Evaluation (APACHE II scores were higher in patients with HIV/AIDS (57±20, p-value=0.01 and dengue (68±11, p-value=0.01. Death occurred in 159 cases (62.8%. Mortality was higher in patients with HIV/AIDS (76.6%, p-value=0.02. A multivariate analysis identified the following independent risk factors for death: oliguria, metabolic acidosis, sepsis, hypovolemia, the need for vasoactive drugs, the need for mechanical ventilation and the APACHE II score. Conclusions: AKI is a common complication in infectious diseases, with high mortality. Mortality was higher in patients with HIV/AIDS, most likely due to the severity of immunosuppression and opportunistic diseases.

  4. [Crisis interventions: a psychotherapeutical challenge for psychiatric emergencies?].

    Science.gov (United States)

    Bressi, Cinizia; Damsa, Cristian; Pirrotta, Roberto; Lazignac, Coralie; Invernizzi, Giordano

    2005-01-01

    Taking care of patients consulting the emergency psychiatric unit, raises nosological, legal, ethical and even logistic questions for the emergency departments. The need for emergency psychiatric interventions has grown constantly during the last twenty years and clinicians were challenged to find a new psychotherapeutic approach, more focused on the actual symptoms presented by the patients than the 'classic' psychiatric interventions. The goal of this article is to discuss the possibility of a psychotherapeutic approach in an emergency department, departing from a treatment model that has been developed at the psychiatric emergency of the University of Milan. In this approach, the psychotherapeutic treatment is divided in four different stages: preparation, incubation, transformation and verification. The "psychiatric crisis" becomes an opportunity to change for the patient, being a passage rite towards a new and better psychological functioning.

  5. Diagnostic accuracy on the management of acute paediatric urinary tract infection in a general paediatric unit

    Institute of Scientific and Technical Information of China (English)

    Fahisham Taib; Bakht Jamal

    2015-01-01

    Objective: To ascertain diagnostic accuracy of paediatric urinary tract infection (UTI) in a general paediatric unit of a district hospital. Methods: Retrospective case note review and comparing to the final computerised database of Human in-Patient Enquiry (HIPE) at Portiuncula Hospital, Galway, Ireland. All children from 0-16 years of age with the diagnosis of UTI were enrolled within the 3 year study period. The information was first retrieved from HIPE system to capture list of patients. Case notes revision was followed to extract data under standardized pro-forma for demography, accuracy of diagnosis, treatment instituted and investigation ordered. Patients’ data was reviewed according to updated definition. Results: There were 85 cases treated for UTI during the 3 year period, and only 45 cases were considered as genuine UTI according to diagnostic criteria. Out of 45 cases, 16 cases were considered as suspected UTI cases. Escherichia coli was noted to be the commonest organism. Cephradine has been used as the first line treatment as per local guideline;however, different antibiotic regimes were based on physician’s preferences. The sensitivity of the current method of UTI diagnosis remained at 64%when comparing final diagnosis in the HIPE system. Conclusions: UTI can be difficult to accurately diagnosis in certain clinical cases. Decisions made should be individualized and tailored according to clinical suspicion and presentation of the patients. Improvement to ensure accurate diagnosis is vital to ensure correct data capture in the HIPE system thus giving valuable information and resource for future care.

  6. Acute Bronchiolitis. Which Patients Should Be Admitted to Intensive Care Units?

    Directory of Open Access Journals (Sweden)

    Ariel Efrén Uriarte Méndez

    2014-12-01

    Full Text Available Bronchiolitis is the most common viral infection of the lower respiratory tract in childhood; it is considered the most severe respiratory condition that affects children under 2 years of age. In general, mortality from bronchiolitis is low, but it can reach up to 30% in patients at risk. Twenty children have died from this condition in the pediatric hospital of Cienfuegos in the last 30 years. Bronchiolitis-related deaths account for approximately 4 % of all deaths from 2010 to date. This fact has led to the implementation of administrative measures to reduce deaths from this cause, which have not solved the problem. The aim of this paper is to present a set of criteria for admission of bronchiolitis patients to intensive care units in order to be considered by the administrators of the institution. These criteria based on the authors’ experience and scientific evidence reflected in the literature focus on preventing overcrowding of this service with patients not showing signs of serious condition, and on the contrary, timely identifying those likely to have an unfavourable outcome.

  7. [Psychiatric treatment sentences.

    DEFF Research Database (Denmark)

    Stevens, Hanne; Nordentoft, Merete; Agerbo, Esben

    2010-01-01

    INTRODUCTION: Previous Danish studies of the increasing number of sentences to psychiatric treatment (SPT) have compared prevalent populations of persons undergoing treatment with incident measures of reported crimes. Examining the period 1990-2006, we studied incident sentences, taking the type...

  8. Aggression in Psychiatric Wards

    DEFF Research Database (Denmark)

    Hvidhjelm, Jacob; Sestoft, Dorte; Skovgaard, Lene Theil

    2016-01-01

    Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated...

  9. Pathological Gambling: Psychiatric Models

    Science.gov (United States)

    Westphal, James R.

    2008-01-01

    Three psychiatric conceptual models: addictive, obsessive-compulsive spectrum and mood spectrum disorder have been proposed for pathological gambling. The objectives of this paper are to (1) evaluate the evidence base from the most recent reviews of each model, (2) update the evidence through 2007 and (3) summarize the status of the evidence for…

  10. Cerebellum and psychiatric disorders

    OpenAIRE

    Baldaçara,Leonardo; Borgio,João Guilherme Fiorani; Lacerda, Acioly Luiz Tavares de [UNIFESP; Jackowski, Andrea Parolin [UNIFESP

    2008-01-01

    OBJECTIVE: The objective of this update article is to report structural and functional neuroimaging studies exploring the potential role of cerebellum in the pathophysiology of psychiatric disorders. METHOD: A non-systematic literature review was conducted by means of Medline using the following terms as a parameter: "cerebellum", "cerebellar vermis", "schizophrenia", "bipolar disorder", "depression", "anxiety disorders", "dementia" and "attention deficit hyperactivity disorder". The electron...

  11. Cannabis and psychiatric disorders.

    Science.gov (United States)

    Loga, Slobodan; Loga-Zec, Svjetlana; Spremo, Mira

    2010-06-01

    There are connection between use of cannabis and many psychiatric disturbances in adolescents, especially "cannabis psychosis", depression, panic attacks and suicide. Negative effects could occur either as a result of a specific pharmacological effect of cannabis, or as the result of stressful experiences during the intoxication of cannabis in young people. Potentially is very dangerous high frequency suicidal ideation among cannabis users.

  12. Children and adolescents in the Psychiatric Emergency Department: a 10-year survey in Copenhagen County

    DEFF Research Database (Denmark)

    Taastrøm, Annette; Klahn, Julie; Staal, Nina;

    2014-01-01

    Background: Knowledge on psychiatric emergencies in children and adolescents is limited. The Psychiatric Emergency Departments (PED) in Copenhagen enable the acute examination of children and adolescents 24 h a day, 7 days a week. However, very little is known about who presents to the PED...

  13. Psychiatric personnel, risk management and the new institutionalism.

    Science.gov (United States)

    Hazelton, M

    1999-12-01

    This article reports the findings of a series of ethnographic research interviews conducted with psychiatric personnel in one region of Tasmania between 1995 and 1997. These interviews formed part of a more wide-ranging project examining changes in the regulatory practices of psychiatric personnel in the light of the professional, media and policy discourses that inform them, especially in relation to the impact of social justice reforms spelt out in recent Australian mental health policy. In discussing the nature of psychiatric work the personnel interviewed returned repeatedly to the themes of safety and risk management. The study presents an analysis of discourses deployed around these themes and argues that concerns over safety and risk are central to the emergence of a new institutionalism in acute in-patient psychiatric services.

  14. Sodium modelling to reduce intradialytic hypotension during haemodialysis for acute kidney injury in the intensive care unit.

    Science.gov (United States)

    Lynch, Katherine E; Ghassemi, Fatimah; Flythe, Jennifer E; Feng, Mengling; Ghassemi, Marzyeh; Celi, Leo Anthony; Brunelli, Steven M

    2016-10-01

    Intradialytic hypotension often complicates haemodialysis for patients with acute kidney injury (AKI) and may impact renal recovery. Sodium modelling is sometimes used as prophylaxis against intradialytic hypotension in the chronic haemodialysis population, but there is little evidence for its use among critically ill patients with AKI. A retrospective cohort with AKI requiring intermittent haemodialysis in the intensive care unit from 2001 to 2008 was used to study the association of prophylactic sodium modelling and multiple outcomes. Outcomes included a composite of in-hospital death or dialysis dependence at hospital discharge, as well as intradialytic hypotension, ultrafiltration goal achievement and net ultrafiltration volume. Associations were estimated using logistic regression, mixed linear models and generalized estimating equations adjusting for demographic and clinical characteristics. One hundred and ninety-one individuals who underwent 892 sessions were identified; sodium modelling was prescribed in 27.1% of the sessions. In adjusted analyses, sodium modelling was not significantly associated with intradialytic hypotension (P = 0.67) or with the ultrafiltration goal achievement (P = 0.06). Sodium modelling during the first dialysis session was numerically associated with lower risk for the composite of in-hospital death or dialysis dependence: adjusted odds ratio (95% confidence interval) 0.39 (0.15-1.02; P = 0.06); however, this association did not reach statistical significance. We did not observe statistically significant associations between sodium modelling and improved outcomes among AKI patients receiving intermittent dialysis in the intensive care unit. However, suggestive findings warrant further study. © 2015 Asian Pacific Society of Nephrology.

  15. Comparison of management and outcomes of ED patients with acute decompensated heart failure between the Canadian and United States' settings.

    Science.gov (United States)

    Lai, Anita; Tenpenny, Elliott; Nestler, David; Hess, Erik; Stiell, Ian G

    2016-03-01

    Introduction The objective of this study was to compare the emergency department (ED) management and rate of admission of acute decompensated heart failure (ADHF) between two hospitals in Canada and the United States and to compare the outcomes of these patients. This was a health records review of adults presenting with ADHF to two EDs in Canada and the United States between January 1 and April 30, 2010. Outcome measures were admission to the hospital, myocardial infarction (MI), and death or relapse rates to the ED. Data were analysed using descriptive, univariate and multivariate analyses. In total, 394 cases were reviewed and 73 were excluded. Comparing 156 Canadian to 165 U.S. patients, respectively, mean age was 76.0 and 75.8 years; male sex was 54.5% and 52.1%. Canadian and U.S. ED treatments were noninvasive ventilation 7.7% v. 12.8% (p=0.13); IV diuretics 77.6% v. 36.0% (p<0.001); IV nitrates 4.5% v. 6.7% (p=0.39). There were significant differences in rate of admission (50.6% v. 95.2%, p<0.001) and length of stay in ED (6.7 v. 3.0 hours, p<0.001). Proportion of Canadian and U.S. patients who died within 30 days of the ED visit was 5.1% v. 9.7% (p=0.12); relapsed to the ED within 30 days was 20.8% v. 17.5% (p=0.5); and had MI within 30 days was 2.0% v. 1.9% (p=1.0). The U.S. and Canadian centres saw ADHF patients with similar characteristics. Although the U.S. site had almost double the admission rate, the outcomes were similar between the sites, which question the necessity of routine admission for patients with ADHF.

  16. Usage of psychiatric emergency services by asylum seekers

    DEFF Research Database (Denmark)

    Reko, Amra; Bech, Per; Wohlert, Cathrine

    2015-01-01

    BACKGROUND: Asylum seekers are found to be at high risk of mental health problems. Little is known about the use of acute psychiatric emergency services by asylum seekers. AIM: To describe the usage of an inpatient/outpatient psychiatric emergency service in Denmark by adult asylum seekers......, and discuss clinical implications. METHOD: This descriptive study is based on retrospective data collected from patient charts during a 3-month period. RESULTS: A total of 31 evaluations were made (3.3% of all evaluations), based on 23 asylum seekers. Patients originated from 16 different countries, were...... predominantly male and married. The group consisted primarily (61%) of failed asylum seekers. Most patients (81%) presented with relevant mental health problems. The main reasons for presenting to the acute psychiatric emergency service were suicidal ideation and/or behaviour (60%). The most frequent diagnosis...

  17. Physiotherapists' perceptions of and experiences with the discharge planning process in acute-care general internal medicine units in ontario.

    Science.gov (United States)

    Matmari, Lakshmi; Uyeno, Jennifer; Heck, Carol S

    2014-01-01

    To examine discharge planning of patients in general internal medicine units in Ontario acute-care hospitals from the perspective of physiotherapists. A cross-sectional study using an online questionnaire was sent to participants in November 2011. Respondents' demographic characteristics and ranking of factors were analyzed using descriptive statistics; t-tests were performed to determine between-group differences (based on demographic characteristics). Responses to open-ended questions were coded to identify themes. Mobility status was identified as the key factor in determining discharge readiness; other factors included the availability of social support and community resources. While inter-professional communication was identified as important, processes were often informal. Discharge policies, timely availability of other discharge options, and pressure for early discharge were identified as affecting discharge planning. Respondents also noted a lack of training in discharge planning; accounts of ethical dilemmas experienced by respondents supported these themes. Physiotherapists consider many factors beyond the patient's physical function during the discharge planning process. The improvement of team communication and resource allocation should be considered to deal with the realities of discharge planning.

  18. Does breastfeeding reduce acute procedural pain in preterm infants in the neonatal intensive care unit? A randomized clinical trial.

    Science.gov (United States)

    Holsti, Liisa; Oberlander, Timothy F; Brant, Rollin

    2011-11-01

    Managing acute procedural pain effectively in preterm infants in the neonatal intensive care unit remains a significant problem. The objectives of this study were to evaluate the efficacy of breastfeeding for reducing pain and to determine if breastfeeding skills were altered after this treatment. Fifty-seven infants born at 30-36 weeks gestational age were randomized to be breastfed (BF) or to be given a soother during blood collection. Changes in the Behavioral Indicators of Infant Pain (BIIP) and in mean heart rate (HR) across 3 phases of blood collection were measured. In the BF group, the Premature Infant Breastfeeding Behaviors (PIBBS) scale was scored before and 24 hours after blood collection. Longitudinal regression analysis was used to compare changes in Lance/squeeze and Recovery phases of blood collection between groups, with gestational age at birth, baseline BIIP scores, and mean HR included as covariates. Differences in PIBBS scores were assessed using a paired t-test. Relationships between PIBBS scores, BIIP scores, and HR were evaluated with Pearson correlations. No differences between treatment groups were found: BIIP (P=0.44, confidence interval [CI] -1.60-0.69); HR (P=0.73, CI -7.0-10.0). Infants in the BF group showed improved PIBBS scores after the treatment (Ppain indices or interfere with the acquisition of breastfeeding skills. Exploratory analyses indicate there may be benefit for infants with mature breastfeeding abilities.

  19. The Inter-Rater Reliability of Simplified Acute Physiology Score 3 (SAPS3 among Intensive Care Unit Nurses

    Directory of Open Access Journals (Sweden)

    Jun Hyun Kim

    Full Text Available Background: Simplified acute physiology score 3 (SAPS3 was developed in 2005 to evaluate intensive care unit (ICU performance and to predict patient mortality or disease severity. The score is usually calculated by doctors, but it requires substantial human resources. And many nurse-lead studies use this scoring system. In the present study, we examined the inter-rater reliability of SAPS3 among nurses in an ICU. Methods: Five ICU nurses who worked in an ICU for a mean length of 7.8 years were educated for 2 hours about SAPS3 score and its components. Each nurse scored 26 patients, and the intraclass correlation coefficient (ICC of the total scores and each subset were evaluated. Results: The ICC (95% confidence interval of SAPS3 score was 0.89 (0.82-0.95, that of subset I was 0.90 (0.82-0.95, subset II was 0.54 (0.35-0.73, and subset III was 0.95 (0.91-0.97. The ICC of predicted mortality was 0.91 (0.85-0.96. Conclusions: The ICC of SAPS3 score and predicted mortality among ICU nurses were reliable. According to these ICC values, SAPS3 score is a reliable scale to be used by nurses. The ICC of subset II was lower than those of the other subsets, suggesting that education of SAPS3 should focus on the definition of each subset II component.

  20. Mechanism of Mitochondrial Connexin43′s Protection of the Neurovascular Unit under Acute Cerebral Ischemia-Reperfusion Injury

    Directory of Open Access Journals (Sweden)

    Shuai Hou

    2016-05-01

    Full Text Available We observed mitochondrial connexin43 (mtCx43 expression under cerebral ischemia-reperfusion (I/R injury, analyzed its regulation, and explored its protective mechanisms. Wistar rats were divided into groups based on injections received before middle cerebral artery occlusion (MCAO. Cerebral infarction volume was detected by 2,3,5-triphenyltetrazolim chloride staining, and cell apoptosis was observed by transferase dUTP nick end labeling. We used transmission electron microscopy to observe mitochondrial morphology and determined superoxide dismutase (SOD activity and malondialdehyde (MDA content. MtCx43, p-mtCx43, protein kinase C (PKC, and p-PKC expression were detected by Western blot. Compared with those in the IR group, cerebral infarction volumes in the carbenoxolone (CBX and diazoxide (DZX groups were obviously smaller, and the apoptosis indices were down-regulated. Mitochondrial morphology was damaged after I/R, especially in the IR and 5-hydroxydecanoic acid (5-HD groups. Similarly, decreased SOD activity and increased MDA were observed after MCAO; CBX, DZX, and phorbol-12-myristate-13-acetate (PMA reduced mitochondrial functional injury. Expression of mtCx43 and p-mtCx43 and the p-Cx43/Cx43 ratio were significantly lower in the IR group than in the sham group. These abnormalities were ameliorated by CBX, DZX, and PMA. MtCx43 may protect the neurovascular unit from acute cerebral IR injury via PKC activation induced by mitoKATP channel agonists.

  1. Clinical Characteristics and 30-Day Outcomes of Intermittent Hemodialysis for Acute Kidney Injury in an African Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Arthur Kwizera

    2016-01-01

    Full Text Available Introduction. Acute kidney injury (AKI is a common occurrence in the intensive care unit (ICU. Studies have looked at outcomes of renal replacement therapy using intermittent haemodialysis (IHD in ICUs with varying results. Little is known about the outcomes of using IHD in resource-limited settings where continuous renal replacement therapy (CRRT is limited. We sought to determine outcomes of IHD among critically ill patients admitted to a low-income country ICU. Methods. A retrospective review of patient records was conducted. Patients admitted to the ICU who underwent IHD for AKI were included in the study. Patients’ demographic and clinical characteristics, cause of AKI, laboratory parameters, haemodialysis characteristics, and survival were interpreted and analyzed. Primary outcome was mortality. Results. Of 62 patients, 40 had complete records. Median age of patients was 38.5 years. Etiologic diagnoses associated with AKI included sepsis, malaria, and ARDS. Mortality was 52.5%. APACHE II (OR 4.550; 95% CI 1.2–17.5, p=0.028, mechanical ventilation (OR 13.063; 95% CI 2.3–72, p=0.003, and need for vasopressors (OR 16.8; 95% CI 3.4–82.6, p=0.001 had statistically significant association with mortality. Conclusion. IHD may be a feasible alternative for RRT in critically ill haemodynamically stable patients in low resource settings where CRRT may not be available.

  2. Evaluation of a flexible acute admission unit: effects on transfers to other hospitals and patient throughput times.

    Science.gov (United States)

    van der Linden, Christien; Lucas, Cees; van der Linden, Naomi; Lindeboom, Robert

    2013-07-01

    To prevent overcrowding of the emergency department, a flexible acute admission unit (FAAU) was created, consisting of 15 inpatient regular beds located in different departments. We expected the FAAU to result in fewer transfers to other hospitals and in a lower length of stay (LOS) of patients needing hospital admission. A before-and-after interventional study was performed in a level 1 trauma center in the Netherlands. Number of transfers and LOS of admitted ED patients in a 4-month period in 2008 (control period) and a 4-month period in 2009 (intervention period) were analyzed. Of 1,619 regular admission patients, 768 were admitted in the control period and 851 in the intervention period. The number of transfers decreased from 80 (10.42%) to 54 (6.35%) (P = .0037). The mean ED LOS of both the non-admitted patients and the admitted patients needing special care significantly increased (105 minutes vs 117 minutes [P = .022] and 176 minutes vs 191 minutes [P transfers of admitted patients to other hospitals. The increase in LOS for special care patients and non-admitted patients was not observed for regular, FAAU-admissible patients. Flexible bed management might be useful in preventing overcrowding. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

  3. Psychiatric specialty training in Greece.

    Science.gov (United States)

    Margariti, M; Kontaxakis, V; Ploumpidis, D

    2017-01-01

    specialty, the European Board of Psychiatry. In the US, the supervising bodies are the Accreditation Council on Graduate Medical Education (ACGME) and the American Board of Psychiatry and Neurology, in the United Kingdom the Royal College of Psychiatrists, in Canada the Royal College of Physicians and Surgeons, etc. In our country, the debate on the need to reform the institutional framework for Psychiatric training has been underway since the mid-90s, with initiatives especially by the Hellenic Psychiatric Association, aiming to raise awareness and concern among psychiatrists while responding to requests from competent central bodies of the state, as well as establishing Panhellenic training programs for psychiatric trainees and continuing education programs. But what is the situation of the educational map in the country today, what would be the objectives, and how might we proceed? These questions we will try to answer in an effort initiated by Hellenic Psychiatric Association (HPA) and the journal "Psychiatriki" with the publication of thematic articles starting by presenting in the next issue of "Psychiatriki"a comparative study of the training in the specialty of psychiatry at two distinct periods of time (2000 and 2014). These time-frames are of great importance, since the first is a period that in retrospect can be considered as wealthier yet missing robust priorities, while the second, at the peak of the economic crisis, constitutes a difficult environment with limited resources. Already in the year 2000, psychiatric residency training in our country had major difficulties due to its outdated framework and its fragmentation. All areas in which training is assessed (clinical experience, theoretical training and training in psychotherapy exhibited inadequacies and limited convergence with European golden standards, in the absence of a plan and the implementation of a national education curriculum. Certain university clinics constituted an important exception, though

  4. Medicare Program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system changes and FY2011 rates; provider agreements and supplier approvals; and hospital conditions of participation for rehabilitation and respiratory care services; Medicaid program: accreditation for providers of inpatient psychiatric services. Final rules and interim final rule with comment period.

    Science.gov (United States)

    2010-08-16

    : We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain provisions of the Affordable Care Act and other legislation. In addition, we describe the changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capital-related costs. We also are setting forth the update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. We are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and setting forth the changes to the payment rates, factors, and other payment rate policies under the LTCH PPS. In addition, we are finalizing the provisions of the August 27, 2009 interim final rule that implemented statutory provisions relating to payments to LTCHs and LTCH satellite facilities and increases in beds in existing LTCHs and LTCH satellite facilities under the LTCH PPS. We are making changes affecting the: Medicare conditions of participation for hospitals relating to the types of practitioners who may provide rehabilitation services and respiratory care services; and determination of the effective date of provider agreements and supplier approvals under Medicare. We are also setting forth provisions that offer psychiatric hospitals and hospitals with inpatient psychiatric programs increased flexibility in obtaining accreditation to participate in the Medicaid program. Psychiatric hospitals and hospitals with inpatient psychiatric programs will have the choice of undergoing a State survey or of obtaining accreditation from a national accrediting organization whose hospital accreditation

  5. Psychiatric adverse effects of pediatric corticosteroid use.

    Science.gov (United States)

    Drozdowicz, Linda B; Bostwick, J Michael

    2014-06-01

    Corticosteroids, highly effective drugs for myriad disease states, have considerable neuropsychiatric adverse effects that can manifest in cognitive disorders, behavioral changes, and frank psychiatric disease. Recent reviews have summarized these effects in adults, but a comprehensive review on corticosteroid effects in children has not been published since 2005. Here, we systematically review articles published since then that, we find, naturally divide into 3 main areas: (1) chronic effects of acute prenatal and neonatal exposure associated with prematurity and congenital conditions; (2) immediate behavioral effects of acute exposure via oncological protocols; and (3) acute behavioral effects of sporadic use in children and adolescents with other conditions. PsycInfo, MEDLINE, Embase, and Scopus were queried to identify articles reporting psychiatric adverse effects of corticosteroids in pediatric patients. Search terms included corticosteroids, adrenal cortex hormones, steroid psychosis, substance-induced psychoses, glucocorticoids, dexamethasone, hydrocortisone, prednisone, adverse effects, mood disorders, mental disorders, psychosis, psychotic, psychoses, side effect, chemically induced, emotions, affective symptoms, toxicity, behavior, behavioral symptoms, infant, child, adolescent, pediatric, paediatric, neonatal, children, teen, and teenager. Following guidelines for systematic reviews from the Potsdam Consultation on Meta-Analysis, we have found it difficult to draw specific conclusions that are more than general impressions owing to the quality of the available studies. We find a mixed picture with neonates exposed to dexamethasone, with some articles reporting eventual deficits in neuropsychiatric functioning and others reporting no effect. In pediatric patients with acute lymphoblastic leukemia, corticosteroid use appears to correlate with negative psychiatric and behavioral effects. In children treated with corticosteroids for noncancer conditions

  6. Culture and psychiatric diagnosis.

    Science.gov (United States)

    Lewis-Fernández, Roberto; Aggarwal, Neil Krishan

    2013-01-01

    Since the publication of DSM-IV in 1994, neurobiologists and anthropologists have criticized the rigidity of its diagnostic criteria that appear to exclude whole classes of alternate illness presentations, as well as the lack of attention in contemporary psychiatric nosology to the role of contextual factors in the emergence and characteristics of psychopathology. Experts in culture and mental health have responded to these criticisms by revising the very process of diagnosis for DSM-5. Specifically, the DSM-5 Cultural Issues Subgroup has recommended that concepts of culture be included more prominently in several areas: an introductory chapter on Cultural Aspects of Psychiatric Diagnosis - composed of a conceptual introduction, a revised Outline for Cultural Formulation, a Cultural Formulation Interview that operationalizes this Outline, and a glossary on cultural concepts of distress - as well as material directly related to culture that is incorporated into the description of each disorder. This chapter surveys these recommendations to demonstrate how culture and context interact with psychiatric diagnosis at multiple levels. A greater appreciation of the interplay between culture, context, and biology can help clinicians improve diagnostic and treatment planning. Copyright © 2013 APA*

  7. Automated telehealth for managing psychiatric instability in people with serious mental illness.

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    Pratt, Sarah I; Naslund, John A; Wolfe, Rosemarie S; Santos, Meghan; Bartels, Stephen J

    2015-01-01

    Serious mental illness (SMI) with psychiatric instability accounts for disproportionately high use of emergency room visits and hospitalizations. To evaluate the effectiveness of an automated telehealth intervention supported by nurse health care management for improving psychiatric illness management and reducing acute service use among individuals with SMI and psychiatric instability. Thirty-eight individuals with SMI received the automated telehealth intervention for 6 months. Psychiatric symptoms, illness self-management, and self-reported service use (emergency room visits and hospital admissions) were collected at baseline, 3- and 6-months. Measures of quality of life, health indicators, and subjective health status were also collected. Participants demonstrated improvements in self-reported psychiatric symptoms and illness self-management skills, an 82% decrease in hospital admissions (from 76 to 14 hospitalizations, p manager for people with SMI, and highlight the potential for cost savings through reductions in acute health care utilization.

  8. Trends in the age adjusted mortality from acute ST segment elevation myocardial infarction in the United States (1988-2004) based on race, gender, infarct location and comorbidities.

    Science.gov (United States)

    Movahed, Mohammed-Reza; John, Jooby; Hashemzadeh, Mehrnoosh; Jamal, M Mazen; Hashemzadeh, Mehrtash

    2009-10-15

    Treatment of acute ST-segment elevation myocardial infarction (STEMI) has dramatically changed over the past 2 decades. The goal of this study was to determine trends in the mortality of patients with acute STEMIs in the United States over a 16-year period (1988 to 2004) on the basis of gender, race, infarct location, and co-morbidities. The Nationwide Inpatient Sample database was used to analyze the age-adjusted mortality rates for STEMI from 1988 to 2004 for inpatients age >40. International Classification of Diseases, Ninth Revision, Clinical Modification codes consistent with acute STEMI were used. The Nationwide Inpatient Sample database contained a total of 1,316,216 patients who had diagnoses of acute STEMIs from 1988 to 2004. The mean age of these patients was 66.92 +/- 12.82 years. A total of 163,915 hospital deaths occurred during the study period. From 1988, the age-adjusted mortality rate decreased gradually for all acute STEMIs for the entire study period (in 1988, 406.86 per 100,000, 95% confidence interval 110.25 to 703.49; in 2004, 286.02 per 100,000, 95% confidence interval 45.21 to 526.84). Furthermore, unadjusted mortality decreased from 15% in 1988 to 10% in 2004 (p <0.01). This decrease was similar between the genders, among most ethnicities, and in patients with diabetes and those with congestive heart failure. However, women and African Americans had higher rates of acute STEMI-related mortality compared to men and Caucasians over the years studied. In conclusion, age-adjusted mortality from acute STEMIs has significantly decreased over the past 16 years, with persistent higher mortality rates in women and African Americans the study period.

  9. [APACHE II and ATN-ISS in acute renal failure (ARF) in intensive care unit (ICU) and non-ICU].

    Science.gov (United States)

    Fernandes, Natáia Maria da Silva; Pinto, Patrícia dos Santos; Lacet, Thiago Bento de Paiva; Rodrigues, Dominique Fonseca; Bastos, Marcus Gomes; Stella, Sérgio Reinaldo; Cendoroglo Neto, Miguel

    2009-01-01

    Acute renal failure (ARF) remains highly prevalent with a high rate of morbidity and mortality. of this study was to compare use of the APACHE II scoring prognosis with that of the ATN-ISS to determine whether the APACHE II could be used for patients with ARF outside the ICU. For this purpose, 205 patients with ARF were accompanied in a prospective cohort. Demographic data, preexisting conditions, organ failure and characteristics of ARF were analyzed. The prognostic scores were performed with the assessment of a nephrologist. The mean age was 52 +/- 18 years, 50% were male, 69% were white, 45% were treated in ICU and 55% in other units. Mortality in the ICU group was 85% and in the non-ICU group 18%. Factors that correlated with higher mortality were more prevalent in the ICU group: age, male, hospitalization with ARF, organ failure, sepsis, septic IRA, oliguria and need of dialysis. Overall, the prognostic markers were the same for both the ICU and non-ICU groups. The discrimination with the APACHE II was similar in both, ICU and non-ICU groups and calibration was better in the non-ICU group. The ATN-ISS achieved good discrimination in both the ICU and non-ICU groups, but, regarding calibration, there was a discreet over estimating of mortality in the non-ICU group. The ATN-ISS showed a greater capacity for discrimination than the APACHE II in both the ICU and non-ICU groups. It was concluded that the APACHE II and ATN-ISS scores could be used for stratification of risk in patients with ARF treated outside of the ICU in Brazil.

  10. Contribution of cholescintigraphy to the early diagnosis of acute acalculous cholecystitis in intensive-care-unit patients

    Energy Technology Data Exchange (ETDEWEB)

    Prevot, N.; Granjon, D.; Dubois, F. [Dept. of Nuclear Medicine, Service de Medecine Nucleaire, Hopital Nord, CHRU Saint-Etienne (France); Mariat, G.; Mahul, P.; Jospe, R.; Auboyer, C. [Department of Intensive Care, Hospital Nord, CHRU Saint-Etienne (France); Cuilleron, M. [Department of Radiology, Hospital Nord, CHRU Saint-Etienne (France); Tiffet, O. [Department of Surgery, Hospital Nord, CHRU Saint-Etienne (France); De Filipis, J.-P. [Department of Nephrology, Hospital Nord, CHRU Saint-Etienne (France)

    1999-10-01

    Thirty-two intensive care unit patients (78% on long-term total parenteral nutrition) suspected of having acute acalculous cholecystitis (AAC) were studied prospectively. All of these patients underwent abdominal ultrasonography and cholescintigraphy with technetium-99m mebrofenin. Morphine sulphate (0.04 mg/kg) was administered only if the gallbladder was not visualised after 1 h (16 patients). The final diagnosis was reached after clinical improvement, or upon the discovery of another aetiology for the symptoms presented, or on the basis of histopathology following cholecystectomy (when this was performed). We analysed the contribution of individual cholescintigraphic findings (I: non-visualisation of the gallbladder during the first 60 min of the examination; II: persistent non-visualisation of the gallbladder 30 min following morphine administration; III: non-visualisation of the small bowel for at least 90 min) and their various combinations. We obtained a sensitivity of 79% and a specificity rate 100% using the interpretative criteria ''I and II or III''. Excluding obstructive syndrome (''I and II''), the sensitivity and specificity figures were 70% and 100% respectively (28 patients). We had no false-positive results in our patient population. Cholescintigraphy was found to complement ultrasonography, which had either good sensitivity (93%) and poor specificity (17%), when at least two of the three major signs were present (sludge, thickened wall, gallbladder distension), or poor sensitivity (36%) and good specificity (89%) when all three signs were present. We conclude that cholescintigraphy is a useful tool for early diagnosis of AAC in critically ill patients, in whom ultrasonography alone does not provide enough information to permit a sufficiently early decision regarding the use of surgery. (orig.)

  11. Acute kidney injury in patients with systemic sclerosis participating in hematopoietic cell transplantation trials in the United States.

    Science.gov (United States)

    Hosing, Chitra; Nash, Richard; McSweeney, Peter; Mineishi, Shin; Seibold, James; Griffith, Linda M; Shulman, Howard; Goldmuntz, Ellen; Mayes, Maureen; Parikh, Chirag R; Crofford, Leslie; Keyes-Elstein, Lynette; Furst, Daniel; Steen, Virginia; Sullivan, Keith M

    2011-05-01

    Recipients of hematopoietic cell transplantation may be at risk for developing acute kidney injury (AKI), and this risk may be increased in patients who undergo transplantation for severe systemic sclerosis (SSc) due to underlying scleroderma renal disease. AKI after transplantation can increase treatment-related mortality. To better define these risks, we analyzed 91 patients with SSc who were enrolled in 3 clinical trials in the United States of autologous or allogeneic hematopoietic cell transplantation (HCT). Eleven (12%) of the 91 patients with SSc in these studies (8 undergoing autologous HCT, 1 undergoing allogeneic HCT, 1 pretransplantation, 1 given i.v. cyclophosphamide on a transplantation trial) experienced AKI, of whom 8 required dialysis and/or therapeutic plasma exchange. AKI injury in the 9 HCT recipients developed a median of 35 days (range, 0-90 days) after transplantation. Ten of 11 patients with AKI received angiotensin-converting enzyme inhibitor (ACE-I) therapy. The etiology of AKI was attributed to scleroderma renal crisis in 6 patients (including 2 with normotensive renal crisis), to AKI of uncertain etiology in 2 patients, and to AKI superimposed on scleroderma kidney disease in 3 patients. Eight of the 11 patients died, one each because of progression of SSc, multiorgan failure, gastrointestinal and pulmonary bleeding, pericardial tamponade and pulmonary complications, diffuse alveolar hemorrhage, pulmonary embolism, graft-versus-host disease, and malignancy. Limiting nephrotoxins, cautious use of corticosteroids, renal shielding during total body irradiation, strict control of blood pressure, and aggressive use of ACE-Is may be of importance in preventing renal complications after HCT for SSc.

  12. Rifampin use in acute community-acquired meningitis in intensive care units: the French retrospective cohort ACAM-ICU study.

    Science.gov (United States)

    Bretonnière, Cédric; Jozwiak, Mathieu; Girault, Christophe; Beuret, Pascal; Trouillet, Jean-Louis; Anguel, Nadia; Caillon, Jocelyne; Potel, Gilles; Villers, Daniel; Boutoille, David; Guitton, Christophe

    2015-08-26

    Bacterial meningitis among critically ill adult patients remains associated with both high mortality and frequent, persistent disability. Vancomycin was added to treatment with a third-generation cephalosporin as recommended by French national guidelines. Because animal model studies had suggested interest in the use of rifampin for treatment of bacterial meningitis, and after the introduction of early corticosteroid therapy (in 2002), there was a trend toward increasing rifampin use for intensive care unit (ICU) patients. The aim of this article is to report on this practice. Five ICUs participated in the study. Baseline characteristics and treatment data were retrospectively collected from charts of patients admitted with a diagnosis of acute bacterial meningitis during a 5-year period (2004-2008). The ICU mortality was the main outcome measure; Glasgow Outcome Scale and 3-month mortality were also assessed. One hundred fifty-seven patients were included. Streptococcus pneumoniae and Neisseria meningitidis were the most prevalent causative microorganisms. The ICU mortality rate was 15%. High doses of a cephalosporin were the most prevalent initial antimicrobial treatment. The delay between admission and administration of the first antibiotic dose was correlated with ICU mortality. Rifampin was used with a cephalosporin for 32 patients (ranging from 8% of the cohort for 2004 to 30% in 2008). Administration of rifampin within the first 24 h of hospitalization could be associated with a lower ICU survival. Statistical association between such an early rifampin treatment and ICU mortality reached significance only for patients with pneumococcal meningitis (p=0.031) in univariate analysis, but not in the logistic model. We report on the role of rifampin use for patients with community-acquired meningitis, and the results of this study suggest that this practice may be associated with lower mortality in the ICU. Nevertheless, the only independent predictors of ICU

  13. Revenue, relationships and routines: the social organization of acute myocardial infarction patient transfers in the United States.

    Science.gov (United States)

    Veinot, Tiffany C; Bosk, Emily A; Unnikrishnan, K P; Iwashyna, Theodore J

    2012-11-01

    Heart attack, or acute myocardial infarction (AMI), is a leading cause of death in the United States (U.S.). The most effective therapy for AMI is rapid revascularization: the mechanical opening of the clogged artery in the heart. Forty-four percent of patients with AMI who are admitted to a non-revascularization hospital in the U.S. are transferred to a hospital with that capacity. Yet, we know little about the process by which community hospitals complete these transfers, and why publicly available hospital quality data plays a small role in community hospitals' choice of transfer destinations. Therefore, we investigated how community hospital staff implement patient transfers and select destinations. We conducted a mixed methods study involving: interviews with staff at three community hospitals (n = 25) in a Midwestern state and analysis of U.S. national Medicare records for 1996-2006. Community hospitals in the U.S., including our field sites, typically had longstanding relationships with one key receiving hospital. Community hospitals addressed the need for rapid AMI patient transfers by routinizing the collective, interhospital work process. Routinization reduced staff uncertainty, coordinated their efforts and conserved their cognitive resources for patient care. While destination selection was nominally a physician role, the decision was routinized, such that staff immediately contacted a "usual" transfer destination upon AMI diagnosis. Transfer destination selection was primarily driven at an institutional level by organizational concerns and bed supply, rather than physician choice or patient preference. Transfer routinization emerged as a form of social order that invoked tradeoffs between process speed and efficiency and patient-centered, quality-driven decision making. We consider the implications of routinization and institutional imperatives for health policy, quality improvement and health informatics interventions. Copyright © 2012 Elsevier Ltd

  14. Feigning Acute Intermittent Porphyria

    Directory of Open Access Journals (Sweden)

    Rania Elkhatib

    2014-01-01

    Full Text Available Acute intermittent porphyria (AIP is an autosomal dominant genetic defect in heme synthesis. Patients with this illness can have episodic life-threatening attacks characterized by abdominal pain, neurological deficits, and psychiatric symptoms. Feigning this illness has not been reported in the English language literature to date. Here, we report on a patient who presented to the hospital with an acute attack of porphyria requesting opiates. Diligent assessment of extensive prior treatment records revealed thirteen negative tests for AIP.

  15. Rifampin use in acute community-acquired meningitis in intensive care units: the French retrospective cohort ACAM-ICU study

    National Research Council Canada - National Science Library

    Bretonnière, Cédric; Jozwiak, Mathieu; Girault, Christophe; Beuret, Pascal; Trouillet, Jean-Louis; Anguel, Nadia; Caillon, Jocelyne; Potel, Gilles; Villers, Daniel; Boutoille, David; Guitton, Christophe

    2015-01-01

    .... Five ICUs participated in the study. Baseline characteristics and treatment data were retrospectively collected from charts of patients admitted with a diagnosis of acute bacterial meningitis during a 5-year period (2004-2008...

  16. DIAGNOSTIC EFFICACY OF CARDIAC TROPONIN-T IN ACUTE MYOCARDIAL INFARCTION PATIENTS ADMITTED IN INTENSIVE CARDIAC CARE UNIT

    Directory of Open Access Journals (Sweden)

    Tapan

    2016-03-01

    Full Text Available INTRODUCTION Myocardial infarction is a common and severe manifestation of ischaemic heart disease (IHD. Acute myocardial infarction (AMI is the result of death of heart muscle cells following either from a prolonged or severe ischaemia. The World Health Organisation emphasises IHD as our "Modern Epidemic" and AMI as common cause of sudden death. AIM The present study has been undertaken with the aim to assess the role of cardiac Troponin-T in early diagnosis of AMI and to evaluate its positive roles over CK-MB and LDH enzyme assays. The study also aims to find out the role of cardiac Troponin-T test, where ECG changes are nondiagnostic and inconclusive for AMI. MATERIAL & METHOD One hundred cases of provisionally diagnosed AMI, who were admitted during June 2012 to July 2015 in ICC Unit of TMC & Dr. BRAM Teaching Hospital, formed the subjects for the study. Those patients reported 2 to 10 hours after onset of chest pain were included in this study. Patients reported beyond 10 hours after onset of chest pain of AMI cases and patients having chest pain of non-AMI causes are excluded from the study. The provisional diagnosis of AMI was done on the basis of the history, chest pain, clinical findings and ECG changes. Trop-T test (Troponin-T sensitive rapid test by Muller Bardoff, et al, 1991 as well as CK-MB (creatine kinase-MB isoenzymeassays were performed immediately for each and every patient. Trop-T test was repeated in some selective cases where the early changes were insignificant and the results were compared with those of CK-MB, at different period of the disease onset. RESULTS The rapid cardiac Troponin-T test (CTn-T has 100% specificity for AMI whereas CK-MB and LDH have specificities of 80% and 60% respectively. The CTn-T has diagnostic efficiency of 92% for AMI but ECG has only 69% sensitivity and 80% specificity. The overall diagnostic efficacy of cardiac Troponin-T is higher than that of CK-MB, LDH and ECG (94% versus 92%, 91 % and 72

  17. The Psychiatric Consequences of Child and Adolescent Sexual Abuse

    Science.gov (United States)

    YÜCE, Murat; KARABEKİROĞLU, Koray; YILDIRIM, Zeynep; ŞAHİN, Serkan; SAPMAZ, Dicle; BABADAĞI, Zehra; TURLA, Ahmet; AYDIN, Berna

    2015-01-01

    Introduction The purpose of this study was to investigate the psychiatric consequences of sexual abuse and its associated factors in children and adolescents referred to our child and adolescent psychiatry clinic from official medico–legal units. Methods All victims of sexual abuse (n=590) aged 1–18 (mean: 13.56±3.38) referred from forensic units to Ondokuz Mayis University Child and Adolescent Psychiatry Clinic over a period of 2 years [boys: 83 (14.1%); girls: 507 (85.9%)] were included. Child and adolescent psychiatry and forensic medicine specialists evaluated all the cases. The Wechsler Intelligence Scale for Children-Revised Form (WISC-R) and the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version-Turkish Version (K-SADS-PL-T) were applied. Results Abuse-related psychiatric diagnoses (of which 45.9% were major depressive disorder and 31.7% were post-traumatic stress disorder cases) were made in 75.2% of the cases. In 80.3% of the cases, the perpetrators were known to their victims [incest, n=91 (15.1%)], and intercourse took place in 48.8%. Although gender and age were not significantly associated with the appearance of any psychiatric disorders, severity of abuse (e.g., intercourse; p=.006), additional physical assault (pabuse severity, incest, involvement of any other victim, additional physical assault, and length of time from first abuse to first psychiatric evaluation. This combination of variables (occurrence of incest, additional physical assault, and a long duration from first abuse to first psychiatric evaluation) significantly predicted the appearance of a psychiatric disorder of any kind (χ2=55.42; df=7; n=522; pabuse to first psychiatric evaluation predict higher rates of sexual abuse-related psychiatric disorders.

  18. [Dual diagnosis in psychiatric inpatients: prevalence and general characteristics].

    Science.gov (United States)

    Rodríguez-Jiménez, Roberto; Aragüés, María; Jiménez-Arriero, Miguel Angel; Ponce, Guillermo; Muñoz, Antonio; Bagney, Alexandra; Hoenicka, Janet; Palomo, Tomás

    2008-06-01

    Comorbidity between a substance use disorder (SUD) and another psychiatric disorder is known as dual diagnosis. It is of great relevance due to its important clinical consequences and costs of care. There are practically no published studies on dual diagnosis prevalence in patients admitted to psychiatric hospitalization units in general hospitals (PHUGH) in our country. The objectives were to estimate the prevalence of dual diagnosis in psychiatric inpatients admitted consecutively to a Psychiatric Hospitalization Unit (Hospital Universitario 12 de Octubre, Madrid, Spain) in one year, to compare clinical and sociodemographic variables between the dual diagnosis group (DD group) and the group with a psychiatric disorder but no SUD (PD group), and to study the types of substances used. This is a retrospective study, based on the review of the clinical charts of the 257 patients admitted to this PHUGH in one year. The results showed that, excluding nicotine dependence, 24.9% of our inpatients had a SUD as well as another psychiatric disorder. A statistically significant predominance of men was found in the DD group, as well as a younger age at the time of the study, at the beginning of their psychiatric attention and on their first psychiatric admission, and they had received diagnoses of schizophrenia or related psychoses more often than the PD group, who had mostly affective disorders. The substances most frequently used in the DD group were alcohol (78.1%), cannabis (62.5%), and cocaine (51.6%). Due to the high prevalence and repercussions of dual diagnosis, it would be advisable to have specialized therapeutic programs for its treatment.

  19. Results of the 2008-2009 International Pressure Ulcer Prevalence Survey and a 3-year, acute care, unit-specific analysis.

    Science.gov (United States)

    VanGilder, Catherine; Amlung, Stephanie; Harrison, Patrick; Meyer, Stephanie

    2009-11-01

    The National Quality Forum has identified a pressure ulcer as a hospital-acquired condition (HAC) that is high-cost and high-volume and may be preventable with implementation of evidence-based guidelines. The Center for Medicare and Medicaid Services no longer reimburses acute care facilities for the ancillary cost of facility-acquired (FA) ulcers. Benchmarking patient safety indicators, such as FA, may help facilities reduce pressure ulcer rates. The purpose of this observational, cross-sectional cohort study was to report the International Pressure Ulcer Prevalence Survey (IPUP) in the United States in 2008 and 2009. In addition, previously collected data (2006/2007) were used to evaluate and report general and unit-specific prevalence rates in acute care facilities. The overall prevalence and FA pressure ulcer rates were 13.5% and 6% (2008, N = 90,398) and 12.3 and 5% (2009, N = 92,408), respectively. In 2008 and 2009, overall prevalence rates were highest in long-term acute care (22%). FA rates were highest in adult intensive care units (ICUs) and ranged from 9.2% (general cardiac care unit [CCU]) to 12.1% (medical ICU) in 2008 and from 8.8% (general CCU) to 10.3% (surgical ICU) in 2009. In 2009, 3.3% of ICU patients developed severe FA ulcers (Stage III, Stage IV, eschar/unable to stage, or deep tissue injury). In 2009, approximately 10% (n = 1,631) of all ulcers were described as device-related. The most common anatomic locations for device-related ulcers were the ear (20%) and sacral/coccyx region (17%). Both the overall and FA pressure ulcer prevalence rates were lower in 2008 and 2009 than in 2006 and 2007. Results indicate that, although overall prevalence trends are encouraging, there is a stark contrast from the desired state, especially in adult ICUs.

  20. Psychiatric comorbidity : fact or artifact?

    NARCIS (Netherlands)

    van Loo, Hanna; Romeijn, Jan-Willem

    2015-01-01

    The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus eit

  1. Treating the disconfirmed psychiatric client.

    Science.gov (United States)

    Heineken, J

    1983-01-01

    Frequent disconfirmation behaviors have been documented in psychiatric clients. Individuals who demonstrate maladaptive patterns of disconfirmation can learn to understand and modify this dysfunctional sequence. Through one to one interactions and group discussions, psychiatric nurses can help clients learn more positive communication behaviors. This accomplishment will positively affect the client's interpersonal responsiveness and self-esteem.

  2. College Students with Psychiatric Disabilities

    Science.gov (United States)

    Singh, Delar K.

    2011-01-01

    This paper focuses on college students with psychiatric disabilities. It defines and discusses various psychiatric conditions such as mood disorders, anxiety disorders, eating disorders, and personality disorders. It concludes with accommodations that a college professor can make to help these students succeed in higher education. (Contains 1…

  3. Psychiatric aspects of burn

    Directory of Open Access Journals (Sweden)

    Dalal P

    2010-10-01

    Full Text Available Burn injuries and their subsequent treatment cause one of the most excruciating forms of pain imaginable. The psychological aspects of burn injury have been researched in different parts of the world, producing different outcomes. Studies have shown that greater levels of acute pain are associated with negative long-term psychological effects such as acute stress disorder, depression, suicidal ideation, and post-traumatic stress disorder for as long as 2 years after the initial burn injury. The concept of allostatic load is presented as a potential explanation for the relationship between acute pain and subsequent psychological outcomes. A biopsychosocial model is also presented as a means of obtaining better inpatient pain management and helping to mediate this relationship.

  4. Lowering bronchoaspiration rate in an acute stroke unit by means of a 2 volume/3 texture dysphagia screening test with pulsioximetry.

    Science.gov (United States)

    Cocho, D; Sagales, M; Cobo, M; Homs, I; Serra, J; Pou, M; Perez, G; Pujol, G; Tantinya, S; Bao, P; Aloy, A; Sabater, R; Gendre, J; Otermin, P

    During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the Stroke Unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. We examined 418 patients with acute stroke (G0=275, G1=143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs. 29% in G1, P=.005) and median NIHSS score (4 points in G0 vs. 7 points in G1, P=.003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs. 25% in G1, P=.4), lower mortality (1.7% in G0 vs. 0.7% in G1, P=.3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs. 2.1% in G1, P=.05). Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. [Psychiatric treatment sentences.

    DEFF Research Database (Denmark)

    Stevens, Hanne; Nordentoft, Merete; Agerbo, Esben

    2010-01-01

    INTRODUCTION: Previous Danish studies of the increasing number of sentences to psychiatric treatment (SPT) have compared prevalent populations of persons undergoing treatment with incident measures of reported crimes. Examining the period 1990-2006, we studied incident sentences, taking the type...... and severity of crime into account. MATERIAL AND METHODS: Using data from Statistics Denmark's national crime statistics, we have compared time-trends of SPT with time-trends of suspended and custodial sentences stratified by type of crime. RESULTS: We found that the rise in SPT is primarily attributable...... to violent offending, and that particularly assaults against public servants have contributed to the development. CONCLUSION: Regarding violent offences against private persons, the time-trends for SPT are parallel to the time-trends for suspended and custodial sentences, which may indicate that the same...

  6. Homocysteine and Psychiatric Disorders

    Directory of Open Access Journals (Sweden)

    Vanessa Cavalcante da Silva PhD

    2017-03-01

    Full Text Available Psychiatric disorders are highly prevalent all over the world with a great impact on public health. Altered homocysteine metabolism is implicated in the pathogenesis of many of these disorders, as it can interfere in normal methylation of subcellular components, promote neuroexcitotoxicity, and induce oxidative stress and inflammation. There are cumulative data implicating these mechanisms in the development of autism, schizophrenia, depression, bipolar disorder, and Alzheimer disease. Altered homocysteine metabolism is multifactorial in its origin. On one hand, genetic factors act as predisposing factors through brain development and function, and on the other hand, environmental factors give the opportunity for nutritional interventions improving metabolic status and possibly also clinical parameters. This article provides a review on the association of 1-carbon metabolism and autism, schizophrenia, depression, bipolar disorder, and dementia and goes through studies on the role of different cofactors and metabolites involved in this pathway.

  7. Psychiatric patients' perception of physical restraint.

    Science.gov (United States)

    Fugger, G; Gleiss, A; Baldinger, P; Strnad, A; Kasper, S; Frey, R

    2016-03-01

    To investigate psychiatric patients' subjective perception during and after belt fixation. All patients who were involuntarily admitted and physically restrained at a psychiatric intensive care unit within an 18-month study period were analysed. Ratings were obtained at four visits when questioning was possible. Within a heterogeneous diagnostic sample of 47 patients, only 12 patients were eligible to participate during belt fixation. After cessation of fixation, eight patients lacked any memory of restraint, while 36 could be questioned. Visual analogue scale median scores indicated powerlessness and depressiveness rather than anxiety and aggression. Patients' acceptance of the coercive measure was significantly higher (P = 0.003), while patients' memory was significantly lower than expected (P < 0.001). About 50% of the patients documented high perceived coercion, and post-traumatic stress disorder (PTSD) could be supposed in a quarter of the restrained individuals. Subjective perceptions concerning fixation showed no significant changes over time. Results showed high interindividual variability. Visual analogue scale revealed that belt fixation seemed to be forgotten or accepted in the majority of patients, probably due to psychiatric intensive care, psychopharmacological treatment and clinical improvements. The responses of a quarter of the patients assessed before discharge may be in accordance with symptoms of PTSD. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. [Family and psychiatric hospitalization in a general hospital].

    Science.gov (United States)

    de Mello, Rita Mello; Schneider, Jacó Fernando

    2011-06-01

    This study aims to identify the reasons that lead relatives to hospitalize patients in a psychiatric unit of a general hospital. It is a qualitative study based on Alfred Schutz' phenomenological sociology. Fourteen relatives, each with one family member hospitalized, were interviewed from August to October 2009. The guiding question of the phenomenological interview was "What do you expect from psychiatric hospitalization in a general hospital?". Phenomenological sociology was used to understand and interpret the interviews. Statements showed three concrete categories, that lead to the reasons for: treatment guidelines and continuity; prospects for improvement; ideas about normality. This research shows the experiences of relatives, contributing with mental health professionals' reflection about their actions and about the involvement of families in a general hospital's psychiatric unit.

  9. Demographics, Psychiatric Diagnoses, and Other Characteristics of North American Deaf and Hard-of-Hearing Inpatients

    Science.gov (United States)

    Black, Patricia A.; Glickman, Neil S.

    2006-01-01

    This study examined demographic and clinical data from a specialty deaf inpatient unit so as to better understand characteristics of severely and chronically mentally ill deaf people. The study compares deaf and hearing psychiatric inpatients on demographic variables, psychiatric discharge diagnoses, a language assessment measure, a cognitive…

  10. Characterizing Aggressive and Noncompliant Behaviors in a Children's Psychiatric Inpatient Setting

    Science.gov (United States)

    Sukhodolsky, Denis G.; Cardona, Laurie; Martin, Andres

    2005-01-01

    This study was conducted to evaluate aggression and noncompliance among child psychiatric inpatients in relation to demographic, clinical, and hospitalization characteristics, including the use of restraints and seclusion. Eighty six children (10.8 plus or minus 2.4 years old, 67% male) consecutively admitted to an inpatient psychiatric unit were…

  11. Chemical restraint in routine clinical practice: a report from a general hospital psychiatric ward in Greece

    Directory of Open Access Journals (Sweden)

    Papamichael Georgios

    2011-02-01

    Full Text Available Abstract Background There is a dearth of studies regarding chemical restraint in routine clinical psychiatric practice. There may be wide variations between different settings and countries. Methods A retrospective study on chemical restraint was performed in the 11-bed psychiatric ward of the General Hospital of Arta, in northwestern Greece. All admissions over a 2-year-period (from March 2008 to March 2010 were examined. Results Chemical restraint was applied in 33 cases (10.5% of total admissions. From a total of 82 injections, 22 involved a benzodiazepine and/or levomepromazine, whereas 60 injections involved an antipsychotic agent, almost exclusively haloperidol (96.7% of cases, usually in combination with a benzodiazepine (61.7% of cases. In 36.4% of cases the patient was further subjected to restraint or seclusion. Conclusions In our unit, clinicians prefer the combined antipsychotic/benzodiazepine regimen for the management of patients' acute agitation and violent behaviour. Conventional antipsychotics are administrated almost exclusively and in a significant proportion of cases further coercive measures are applied. Studies on the practice of chemical restraint should be regularly performed in clinical settings.

  12. Psychiatric manifestations of treatable hereditary metabolic disorders in adults.

    Science.gov (United States)

    Demily, Caroline; Sedel, Frédéric

    2014-01-01

    Detecting psychiatric disorders of secondary origin is a crucial concern for the psychiatrist. But how can this reliably be done among a large number of conditions, most of which have a very low prevalence? Metabolic screening undertaken in a population of subjects with psychosis demonstrated the presence of treatable metabolic disorders in a significant number of cases. The nature of the symptoms that should alert the clinician is also a fundamental issue and is not limited to psychosis. Hereditary metabolic disorders (HMD) are a rare but important cause of psychiatric disorders in adolescents and adults, the signs of which may remain isolated for years before other more specific organic signs appear. HMDs that present purely with psychiatric symptoms are very difficult to diagnose due to low awareness of these rare diseases among psychiatrists. However, it is important to identify HMDs in order to refer patients to specialist centres for appropriate management, disease-specific treatment and possible prevention of irreversible physical and neurological complications. Genetic counselling can also be provided. This review focuses on three HMD categories: acute, treatable HMDs (urea cycle abnormalities, remethylation disorders, acute intermittent porphyria); chronic, treatable HMDs (Wilson's disease, Niemann-Pick disease type C, homocystinuria due to cystathionine beta-synthase deficiency, cerebrotendinous xanthomatosis); and chronic HMDs that are difficult to treat (lysosomal storage diseases, X-linked adrenoleukodystrophy, creatine deficiency syndrome). We also propose an algorithm for the diagnosis of HMDs in patients with psychiatric symptoms.

  13. Police and pastoral power: governmentality and correctional forensic psychiatric nursing.

    Science.gov (United States)

    Holmes, Dave

    2002-06-01

    Police and pastoral power: governmentality and correctional forensic psychiatric nursing Since 1978, the federal inmates of Canada have had access to a full range of psychiatric care within the penitentiary system. Several psychiatric units are now integrated into the correctional services of Canada. This paper presents the results of a grounded theory doctoral study undertaken in a multilevel secured psychiatric ward within the Canadian federal penitentiary system. The author describes and discusses the results of qualitative data that emerged from his fieldwork. The concept of governmentality, as defined by the late French philosopher Michel Foucault, constitutes one of the major theoretical tools that were helpful in analyzing these data. Police and pastoral power, two dimensions of the security apparatus of governmentality, were found to be useful in understanding and characterizing nursing practice caught between the penal and the psychiatric dispositifs. A Foucauldian perspective allows one to understand the manner in which forensic psychiatric nursing is involved in the governance of mentally ill inmates through three forms of power - sovereign, disciplinary and pastoral - which have posited nursing practice as a strategic tool of the correctional services. This research consists of a study of nursing practice in an extreme setting that deserves a radical analysis.

  14. Psychiatric Symptoms in Childhood Wilson’s Disease: Case Reports

    Directory of Open Access Journals (Sweden)

    Sevcan Karakoç Demirkaya

    2016-12-01

    Full Text Available Various psychiatric symptoms/signs have been identified since the identification of Wilson’s disease (WD. Every patient with WD suffers from one or more psychiatric problems (organic dementia, psychosis, and impulsivity across the disease course. Sometimes, insidious symptoms, such as behavioral changes, failure in school performance, and disturbances in hand-eye coordination may be seen before the onset of neurologic presentation. In this report, five patients, who were diagnosed with WD and followed up in the Child Neurology Unit, were assessed by a Diagnostic and Statistical Manual of Mental Disorders-4-based semistructured psychiatric interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children. All patients had psychiatric symptoms. One patient had a history of a manic episode and the other had a history of a psychotic disorder at the initial stage of WD. Psychiatric symptoms coexist mostly with neurologic signs in patients with WD. In this sense, pediatric neurological consultation and copper screening are lifesaving in excluding organic etiology. However, WD is a lifelong treatment-requiring disease and psychiatric evaluation of the patients is essential.

  15. How common are errors in the medication process in a psychiatric hospital?

    DEFF Research Database (Denmark)

    Sørensen, Ann Lykkegaard; Mainz, Jan; Lisby, Marianne

    2012-01-01

    How common are errors in the medication process in a psychiatric hospital? Background and purpose: Medication errors in psychiatric care is a problem in need of attention in Denmark. Studies are sparse and does not investigate all stages of the medication process. There is an urgent need for clar...... education in guidelines related to the medication process. Errors directly related to ward staff constituted 37% of all errors detected and consequently the nurses’ role in improving psychiatric medication safety should be further explored.......How common are errors in the medication process in a psychiatric hospital? Background and purpose: Medication errors in psychiatric care is a problem in need of attention in Denmark. Studies are sparse and does not investigate all stages of the medication process. There is an urgent need...... frequency, type and potential clinical consequences of errors in all stages of the medication process in an inpatient psychiatric setting. Methods and materials: A cross-sectional study in two general psychiatric wards and one acute psychiatric ward. Participants were eligible psychiatric in...

  16. The impact of psychiatric comorbidity on Medicare reimbursement for inpatient medical care.

    Science.gov (United States)

    Goldberg, R J; Daly, J; Golinger, R C

    1994-01-01

    Funding for psychiatric consultation-liaison (C-L) services has been a difficult problem. It has been suggested that the identification of psychiatric co-morbidities in Medicare patients on medical services could generate incremental hospital revenue by moving patients from a lower to a higher paying Diagnostic Related Group (DRG). This increased revenue could be used as a means of supporting the psychiatric C-L service. This study documents the financial impact of screening for and documenting psychiatric co-morbidities on a general acute medical service. We clinically assessed 100 consecutive Medicare admissions and found 25 psychiatric co-morbidities in 20 patients. In only one case did the psychiatric diagnosis result in moving the case to a higher DRG. However, the need for psychiatric consultation remains evident as there was significant lack of recognition and documentation of the psychiatric diagnoses by the medical team. The authors discuss both the financial and clinical implications of screening medical inpatients for psychiatric co-morbidities and propose directions for further studies in this area.

  17. Improvement of psychiatric symptoms in youth following resolution of sinusitis.

    Science.gov (United States)

    Mahony, Talia; Sidell, Douglas; Gans, Hayley; Brown, Kayla; Farhadian, Bahare; Gustafson, Melissa; Sherr, Janell; Thienemann, Margo; Frankovich, Jennifer

    2017-01-01

    Accumulating evidence supports a role for inflammation in psychiatric illness, and the onset or exacerbation of psychiatric symptoms may follow non-CNS infections. Here, we provide the first detailed description of obsessive-compulsive and related psychiatric symptoms arising concurrently with sinusitis. We reviewed the charts of 150 consecutive patients evaluated in our Pediatric Acute-onset Neuropsychiatric Syndromes clinic for documented sinusitis as defined by the American Academy of Pediatrics guidelines. Sinusitis treatments, sinonasal imaging, and neuropsychiatric symptoms before, during, and after sinusitis onset were noted. Patients were included in the final review if they had a clear diagnosis of isolated sinusitis (without concurrent illness and/or immunodeficiency), and were evaluated during an episode of sinusitis. 10/150 (6.6%) patients had isolated sinusitis at the time of their neuropsychiatric deterioration. Eight patients received antibiotics to treat sinusitis, three of whom also received sinus surgery. Neuropsychiatric symptoms improved in all eight patients concurrent with resolution of sinusitis per parent report and clinician assessment. One patient did not follow through with recommended sinus surgery or antibiotics and her psychiatric symptoms persisted. One patient was lost to follow-up. Improvement of psychiatric symptoms correlated with resolution of sinus disease in this retrospective study. Identification, treatment, and resolution of underlying infections, including sinusitis, may have the potential to change the trajectory of some neuropsychiatric illnesses. Randomized clinical trials are needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Psychiatric morbidity and pattern of dysfunctions in patients with leprosy

    Directory of Open Access Journals (Sweden)

    Bhatia M

    2006-01-01

    Full Text Available BACKGROUND: Leprosy, being a chronic infectious disease with profound social stigma, remains associated with high psychological mortidity. PURPOSES: To find out the pattern of psychiatric morbidity in leprosy patients and the relationship of various factors with the morbidity. METHODS: Ninty patients attending leprosy clinic were randomly chosen for the study group alongwith 40 patients suffering from acute skin problem other than leprosy as control group. The socio-demographic data were recorded in semi-structural proforma; all patients were given Goldbery Health Questioneaire (GHQ. Patients having GHQ score> 2 was assessed by Disability Assessent Questionaire (DAQ. The psychiatric diagnoses was made according to ICD-10 by W ho0 and physical deformity by W ho 0 Disability Scale. FINDINGS: The mean GHQ score of the study grant was 3.44 and that of control group was 1.62. The mean DAQ score was 45.13. Psychiatric disorder was seen in 44.4% and 7.5% of study group and control group respectively. The psychiatric illness was generalised anoxidy disorder (GAD (27.8%. CONCLUSIONS: Leprosis highly associated with psychiatric mobidity. LIMITATIONS: The findings can not be generalised due to small sample size and clinic-based data.

  19. Monitoring for pests and diseases in native oak woodlands: the case of acute oak decline in the United Kingdom

    Science.gov (United States)

    Nathan Brown; Stephen Parnell; Frank van den Bosch; Mike Jeger; Sandra Denman

    2017-01-01

    In recent years, a novel form of decline has been observed in southern and central England. This syndrome has been termed acute oak decline (AOD) and affects native oak, Quercus petraea and Q. robur. Typical symptoms include bark cracks that weep dark exudates, which are caused by necrotic patches in the...

  20. Cytogenetics of childhood acute myeloid leukemia: United Kingdom Medical Research Council Treatment trials AML 10 and 12.

    NARCIS (Netherlands)

    Harrison, C.J.; Hills, R.K.; Moorman, A.V.; Grimwade, D.J.; Hann, I.; Webb, D.K.; Wheatley, K.; Graaf, S.S.N. de; Berg, E. van den; Burnett, A.K.; Gibson, B.E.

    2010-01-01

    PURPOSE: Karyotype is an independent indicator of prognosis in acute myeloid leukemia (AML) that is widely applied to risk-adapted therapy. Because AML is rare in children, the true prognostic significance of individual chromosomal abnormalities in this age group remains unclear. PATIENTS AND METHOD

  1. Trends in broad-spectrum antibiotic prescribing for children with acute otitis media in the United States, 1998–2004

    Directory of Open Access Journals (Sweden)

    Gambler Angela S

    2009-06-01

    Full Text Available Abstract Background Overuse of broad-spectrum antibiotics is associated with antibiotic resistance. Acute otitis media (AOM is responsible for a large proportion of antibiotics prescribed for US children. Rates of broad-spectrum antibiotic prescribing for AOM are unknown. Methods Analysis of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1998 to 2004 (N = 6,878. Setting is office-based physicians, hospital outpatient departments, and emergency departments. Patients are children aged 12 years and younger prescribed antibiotics for acute otitis media. Main outcome measure is percentage of broad-spectrum antibiotics, defined as amoxicillin/clavulanate, macrolides, cephalosporins and quinolones. Results Broad-spectrum prescribing for acute otitis media increased from 34% of visits in 1998 to 45% of visits in 2004 (P Conclusion Prescribing of broad-spectrum antibiotics for acute otitis media has steadily increased from 1998 to 2004. Associations with non-clinical factors suggest potential for improvement in prescribing practice.

  2. [Psychiatric comorbidity in pathological gambling].

    Science.gov (United States)

    Skokauskas, Norbertas; Satkeviciūte, Regina; Burba, Benjaminas

    2003-01-01

    In this article the peculiarities of psychiatric comorbidity in pathological gambling were investigated. The authors were based both on the data of many foreign scientists and on their own one. Our data on 77 cases of pathological gambling were collected based on interviews of Lithuanian psychiatrists and psychotherapists about their patients with gambling addiction in period from 1991 to 2001. The data that we publish and analyze allows us to make conclusions that pathological gambling can reveal together with very wide spectrum of psychiatric disorders, but more often with alcoholism and depression. The mechanism of psychiatric comorbidity in pathological gambling is very complex.

  3. [Qualitative methods in psychiatric research].

    Science.gov (United States)

    Sikorski, Claudia; Glaesmer, Heide

    2011-01-01

    This article addresses the usage of qualitative methods in psychiatric research and presents the qualitative approach in more detail. Recent original empirical work of a German psychiatric journal was systematically reviewed. Methods used to collect and analyse the information are detailed. One third of the articles used a solely qualitative research design. One further article applied a combination of quantitative and qualitative approaches. Three kinds of the qualitative interviews were used (in depth, narrative and problem-focussed interview). Additionally, focus groups (group discussions) and qualitative content analysis were applied by studies. Qualitative approaches are an integral part of psychiatric research. Further work should assure to use adequate sampling strategies.

  4. Psychiatric disorders in myasthenia gravis

    Directory of Open Access Journals (Sweden)

    Mariana Inés Ybarra

    2011-04-01

    Full Text Available OBJECTIVE: To investigate the prevalence of psychiatric disorders in patients with myasthenia gravis (MG. METHOD: Forty-one patients with MG answered to a structured psychiatric interview (MINI-Plus. RESULTS: Eleven (26.1% patients were diagnosed with a depressive disorder and 19 (46.3% were diagnosed with an anxiety disorder. Patients with dysthymia were older (p=0.029 and had longer disease duration (p=0.006. Patients with social phobia also had longer disease duration (p=0.039. CONCLUSION: Psychiatric disorders in MG are common, especially depressive and anxiety disorders.

  5. The cerebellum and psychiatric disorders

    Directory of Open Access Journals (Sweden)

    Joseph ePhillips

    2015-05-01

    Full Text Available The cerebellum has been considered for a long time to play a role solely in motor coordination. However, studies over the past two decades have shown that the cerebellum also plays a key role in many motor, cognitive, and emotional processes. In addition, studies have also shown that the cerebellum is implicated in many psychiatric disorders including attention deficit hyperactivity disorder, autism spectrum disorders, schizophrenia, bipolar disorder, major depressive disorder and anxiety disorders. In this review, we discuss existing studies reporting cerebellar dysfunction in various psychiatric disorders. We will also discuss future directions for studies linking the cerebellum to psychiatric disorders.

  6. Impact of psychiatric disorders on the quality of life of brazilian HCV-infected patients

    Directory of Open Access Journals (Sweden)

    Susana Batista-Neves

    2009-02-01

    Full Text Available The aim of our study was to determine the impact of psychiatric comorbidities on the health-related quality of life of HCV-infected patients. Assessment of clinical, socio-demographic and quality of life data of the patients followed up at a Hepatology unit was performed by using a standard questionnaire and the SF-36 instrument. Psychiatric diagnoses were confirmed by using the Mini International Neuropsychiatric Interview, Brazilian version 5.0.0 (MINI Plus. Evaluation using the MINI plus demonstrated that 46 (51% patients did not have any psychiatric diagnosis, while 44 (49% had at least one psychiatric diagnosis. Among patients with a psychiatric comorbidity, 26 (59.1% had a current mental disorder, out of which 22 (84.6% had not been previously diagnosed. Patients with psychiatric disorders had lower scores in all dimensions of the SF-36 when compared to those who had no psychiatric diagnosis. Scores of physical functioning and bodily pain domains were lower for those suffering from a current psychiatric disorder when compared to those who had had a psychiatric disorder in the past. Females had lower scores of bodily pain and mental health dimensions when compared to males. Scores for mental health dimension were also lower for patients with advanced fibrosis. The presence of a psychiatric comorbidity was the variable that was most associated with the different scores in the SF-36, compared to other variables such as age, gender, aminotransferase levels, and degree of fibrosis.

  7. Predictors of mortality of patients with acute respiratory failure secondary to chronic obstructive pulmonary disease admitted to an intensive care unit: A one year study

    Directory of Open Access Journals (Sweden)

    Banga Amit

    2004-11-01

    Full Text Available Abstract Background Patients with acute exacerbation of chronic obstructive pulmonary disease (COPD commonly require hospitalization and admission to intensive care unit (ICU. It is useful to identify patients at the time of admission who are likely to have poor outcome. This study was carried out to define the predictors of mortality in patients with acute exacerbation of COPD and to device a scoring system using the baseline physiological variables for prognosticating these patients. Methods Eighty-two patients with acute respiratory failure secondary to COPD admitted to medical ICU over a one-year period were included. Clinical and demographic profile at the time of admission to ICU including APACHE II score and Glasgow coma scale were recorded at the time of admission to ICU. In addition, acid base disorders, renal functions, liver functions and serum albumin, were recorded at the time of presentation. Primary outcome measure was hospital mortality. Results Invasive ventilation was required in 69 patients (84.1%. Fifty-two patients survived to hospital discharge (63.4%. APACHE II score at the time of admission to ICU {odds ratio (95 % CI: 1.32 (1.138–1.532; p Conclusion APACHE II score at admission and SA levels with in 24 hrs after admission are independent predictors of mortality for patients with COPD admitted to ICU. The equation derived from these two parameters is useful for predicting outcome of these patients.

  8. Care systematization in psychiatric nursing within the psychiatric reform context.

    Science.gov (United States)

    Hirdes, A; Kantorski, L P

    2002-02-01

    The aim of this study was to approach care systematization in psychiatric nursing in two psychiatric disorder patients who attended 'Nossa Casa', São Lourenço do Sul, RS, Brazil. Nossa Casa services psychiatric patients in the community, focussing on: (i) permanence in their environment, allowing patients to remain close to their families and social spheres; (ii) integral attendance to meet individual needs; (iii) respecting individual differences; (iv) rehabilitation practices; and (v) social reinsertion. Concepts and assumptions of the psychiatric reform and the Irving's nursing process were used as theoretical-methodological references to elaborate this systematization. A therapeutic project for the psychiatric patient was elaborated, in accordance with the interdisciplinary proposal accepted by Nossa Casa. Interdisciplinary team intervention, guided by a previously discussed common orientation and defined through an individualized therapeutic project, allowed for an effective process of psychosocial rehabilitation. The authors concluded that a therapeutic project based on the mentioned premises leads to consistent, comprehensive, dialectical and ethical assistance in mental health, thereby reinstating the citizenship of psychiatric patients.

  9. Psychiatric Comorbidities among Female Adolescents with Anorexia Nervosa

    Science.gov (United States)

    Salbach-Andrae, Harriet; Lenz, Klaus; Simmendinger, Nicole; Klinkowski, Nora; Lehmkuhl, Ulrike; Pfeiffer, Ernst

    2008-01-01

    This study investigated current comorbid Axis I diagnoses associated with Anorexia Nervosa (AN) in adolescents. The sample included 101 female adolescents treated at a psychiatric unit for primary DSM-IV diagnoses of AN. 73.3% of the AN patients were diagnosed as having a current comorbidity of at least one comorbid Axis I diagnosis, with no…

  10. Psychiatric Comorbidities among Female Adolescents with Anorexia Nervosa

    Science.gov (United States)

    Salbach-Andrae, Harriet; Lenz, Klaus; Simmendinger, Nicole; Klinkowski, Nora; Lehmkuhl, Ulrike; Pfeiffer, Ernst

    2008-01-01

    This study investigated current comorbid Axis I diagnoses associated with Anorexia Nervosa (AN) in adolescents. The sample included 101 female adolescents treated at a psychiatric unit for primary DSM-IV diagnoses of AN. 73.3% of the AN patients were diagnosed as having a current comorbidity of at least one comorbid Axis I diagnosis, with no…

  11. Patient aggression in psychiatric services: the experience of a ...

    African Journals Online (AJOL)

    the affective and behavioural components and these ... Objective: Aggression is a common feature in psychiatric in-patient units in Africa. ... Training programmes are required to change staff attitudes as well as research on the cultural factors ... Section A: A Socio-demographic Questionnaire: designed ... Data analysis.

  12. Profiles of Personal Resiliency in Child and Adolescent Psychiatric Inpatients

    Science.gov (United States)

    Kumar, Geetha; Steer, Robert A.; Gulab, Nazli A.

    2010-01-01

    To ascertain whether children and adolescents whose ages ranged from 9 to 17 years described distinct profiles of personal resiliency, the Resiliency Scales for Children and Adolescents (RSCA) were administered to 100 youth who were admitted to an inpatient psychiatric unit and were diagnosed with various "DSM-IV-TR" disorders along with the Beck…

  13. Some Determinants of Employee Turnover in a Psychiatric Facility.

    Science.gov (United States)

    Zautra, Alex J.; And Others

    1987-01-01

    Used research from illness-prevention and job-enrichment approaches to enhancing quality of work environments to create instruments assessing number of job stressors and level of task interest on psychiatric hospital units. Instruments successfully predicted employee turnover during one year. Job stress and interaction between job stress and task…

  14. Psychiatric Inpatient Admissions of Adults with Intellectual Disabilities: Predictive Factors

    Science.gov (United States)

    Cowley, Amy; Newton, Jonathan; Sturmey, Peter; Bouras, Nick; Holt, Geraldine

    2005-01-01

    Information on admission to psychiatric inpatient units is lacking from the literature on contemporary services for people with intellectual disability and mental health needs. Here we report on predictors of admission for a cohort of 752 adults from this population living in community settings; 83 were admitted. We also report on two subsamples…

  15. Surgery for psychiatric disorders.

    Science.gov (United States)

    Luigjes, Judy; de Kwaasteniet, Bart P; de Koning, Pelle P; Oudijn, Marloes S; van den Munckhof, Pepijn; Schuurman, P Richard; Denys, Damiaan

    2013-01-01

    Surgery in psychiatric disorders has a long history and has regained momentum in the past few decades with deep brain stimulation (DBS). DBS is an adjustable and reversible neurosurgical intervention using implanted electrodes to deliver controlled electrical pulses to targeted areas of the brain. It holds great promise for therapy-refractory obsessive-compulsive disorder. Several double-blind controlled and open trials have been conducted and the response rate is estimated around 54%. Open trials have shown encouraging results with DBS for therapy-refractory depression and case reports have shown potential effects of DBS on addiction. Another promising indication is Tourette syndrome, where potential efficacy of DBS is shown by several case series and a few controlled trials. Further research should focus on optimizing DBS with respect to target location and increasing the number of controlled double-blinded trials. In addition, new indications for DBS and new target options should be explored in preclinical research. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Acute appendicitis: should the laparoscopic approach be proposed as the gold standard? Six-year experience in an Emergency Surgery Unit

    Science.gov (United States)

    GUERCIO, G.; AUGELLO, G.; LICARI, L.; DAFNOMILI, A.; RASPANTI, C.; BAGARELLA, N.; FALCO, N.; ROTOLO, G.; FONTANA, T.; PORRELLO, C.; GULOTTA, G.

    2016-01-01

    Acute appendicitis is common in an Emergency Surgery Unit. Although the laparoscopic approach is a method accepted for its treatment, no strong data are available for determining how many procedures must an experienced surgeon carry out for obtaining all the advantages of this technique and if this approach can become the gold standard in the activity of a general emergency unit with senior surgeons variously skilled on the basic laparoscopy. 142 patients that underwent appendectomy (90 laparoscopic, 52 conventional) for acute appendicitis were enrolled in this institutional retrospective cohort study. The surgeons were classified with a descriptor-based grading and divided in two groups regarding the skill. The only relevant result of our study was the significant reduction of conversion rate in case of laparoscopic approach. No strong differences were found concerning the duration of the procedure and the hospital stay between the two groups. The rate of complications were very low in both groups. In conclusion, the experienced surgeons can easily perform a laparoscopic approach independently from the specific skill in this approach. PMID:27938536

  17. Community acquired pneumonia in the elderly: the Pneumonia in Italian Acute Care for Elderly units (PIACE study protocol by the Italian Society of Hospital and Community Geriatrics (SIGOT

    Directory of Open Access Journals (Sweden)

    Filippo Luca Fimognari

    2017-01-01

    Full Text Available Pneumonia is a frequent cause of hospital admission in elderly patients. Diagnosis of pneumonia in elderly persons with comorbidity may be challenging, due to atypical presentation and complex clinical scenarios. Community-acquired pneumonia (CAP arises out-of-hospital in subjects without previous contact with the healthcare system. Healthcare associated pneumonia (HCAP occurs in patients who have frequent contacts with the healthcare system and should be treated with empiric broad spectrum antibiotic therapy also covering multi-drug resistant (MDR pathogens. Recent findings, however, have questioned this approach, because the worse prognosis of HCAP compared to CAP may better reflect increased level of comorbidity and frailty (poor functional status, older age of HCAP patients, as well as poorer quality of hospital care provided to such patients, rather than pneumonia etiology by MDR pathogens. The Pneumonia in Italian Acute Care for Elderly units (PIACE Study, promoted by the Società Italiana di Geriatria Ospedale e Territorio (SIGOT, is an observational prospective cohort study of patients consecutively admitted because of pneumonia to hospital acute care units of Geriatrics throughout Italy. Detailed information regarding clinical presentation, diagnosis, etiology, comprehensive geriatric assessment, antibiotic therapy, possible complications and comorbidities was recorded to identify factors potentially predicting in-hospital mortality (primary endpoint, 3-month mortality, length of hospital stay, postdischarge rate of institutionalization and other secondary endpoints. This paper describes the rationale and method of PIACE Study and reviews the main evidence on pneumonia in the elderly.

  18. Psychiatric disorders in the elderly.

    Science.gov (United States)

    Skoog, Ingmar

    2011-07-01

    Recent research has shown that depression, anxiety disorders, and psychosis are more common than previously supposed in elderly populations without dementia. It is unclear whether the frequency of these disorders increases or decreases with age. Clinical expression of psychiatric disorders in old age may be different from that seen in younger age groups, with less and often milder symptoms. Concurrently, comorbidity between different psychiatric disorders is immense, as well as comorbidity with somatic disorders. Cognitive function is often decreased in people with depression, anxiety disorders, and psychosis, but whether these disorders are risk factors for dementia is unclear. Psychiatric disorders in the elderly are often related to cerebral neurodegeneration and cerebrovascular disease, although psychosocial risk factors are also important. Psychiatric disorders, common among the elderly, have consequences that include social deprivation, poor quality of life, cognitive decline, disability, increased risk for somatic disorders, suicide, and increased nonsuicidal mortality.

  19. Modeling psychiatric disorders through reprogramming

    Directory of Open Access Journals (Sweden)

    Kristen J. Brennand

    2012-01-01

    Full Text Available Psychiatric disorders, including autism spectrum disorders and schizophrenia, are extremely heritable complex genetic neurodevelopmental disorders. It is now possible to directly reprogram fibroblasts from psychiatric patients into human induced pluripotent stem cells (hiPSCs and subsequently differentiate these disorder-specific hiPSCs into neurons. This means that researchers can generate nearly limitless quantities of live human neurons with genetic backgrounds that are known to result in psychiatric disorders, without knowing which genes are interacting to produce the disease state in each patient. With these new human-cell-based models, scientists can investigate the precise cell types that are affected in these disorders and elucidate the cellular and molecular defects that contribute to disease initiation and progression. Here, we present a short review of experiments using hiPSCs and other sophisticated in vitro approaches to study the pathways underlying psychiatric disorders.

  20. Suicide among older psychiatric inpatients

    DEFF Research Database (Denmark)

    Erlangsen, Annette; Zarit, Steven H; Tu, Xin;

    2006-01-01

    OBJECTIVE: Older adults have elevated suicide rates, especially in the presence of a psychiatric disorder, yet not much is known about predictors for suicide within this high-risk group. The current study examines the characteristics associated with suicide among older adults who are admitted...... to a psychiatric hospital. METHOD: All persons aged 60 and older living in Denmark who were hospitalized with psychiatric disorders during 1990-2000 were included in the study. Using a case-control design and logistic regression analysis, the authors calculated the suicide risk associated with specific patient...... characteristics. RESULTS: Affective disorders were found to be associated with an almost twofold higher risk of suicide among psychiatric inpatients than other types of disorders (95% confidence interval [CI]: 1.5-2.6). Patients with dementia had a significantly lower risk ratio of 0.2 (95% CI: 0...

  1. Psychiatric genetics in South Africa

    African Journals Online (AJOL)

    Pippa

    . Psychiatric genetic studies in South Africa seem to involve relatively low-cost methodologies and only a ... Xhosa population shows a significant genetic contribution from ...... Venter M, Warnich L. A pharmacogenetic study of CD4 recovery in.

  2. [Acute ethylene glycol poisoning among patients of Nofer Institute of Occupational Medicine in Łódź, Toxicology Unit, hospitalized in the years 2000-2009].

    Science.gov (United States)

    Czyewska, Sylwia; Winnicka, Renata; Rzepecki, Jacek; Kołaciński, Zbigniew; Politański, Piotr; Sawicka, Joanna; Krakowiak, Anna

    2013-01-01

    Acute poisonings with ethylene glycol pose real challenge in the clinical toxicology. The main objective of this study is an analysis of clinical features and identification of prognostic factors in poisoning with ethylene glycol of patients hospitalized in the Toxicology Unit in the years 2000-2009. The medical records of the patients were identified and separated. In the years 2000-2009, 102 patients were hospitalized due to ethylene glycol poisoning, what accounted for 0.38% of total admissions to the unit (26.801 hospitalized people). The mean age of patients amounted 48.05 +/- 12.55 years, the history positive for chronic alcohol abuse was present in 63 (61.76%) cases. Mean values of ethylene glycol concentration were as: in serum 173.14 mg/dl, in urine 6576.46 mg/l. Patients condition on admission varied, with 63 (61.76%) cases described as the severe state. The most frequently noted pathologies were consciousness disturbances and tachycardia. 14 patients died within the analysed group and 63 (61.76%) developed single or multiorgan complications in the course of disease. The most commonly encountered complication were: acute renal failure, anaemia, pneumonia and central nervous system damage. Such parameters as: BE and HCO3 measured on admission should be considered as the prognostic factors, determining the course of the disease and the outcomes of treatment. Poor prognosis may be associated with such clinical features on admission, as: respiratory and circulatory disturbances and cerebral sequelae. The importance of acute poisoning of ethylene glycol is determined both by high frequency of immediate life threatening conditions and by the risk of complications leading to permanent organs damage.

  3. Burden of acute gastroenteritis among children younger than 5 years of age – a survey among parents in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Howidi Mohammad

    2012-06-01

    Full Text Available Abstract Background Despite its high incidence among children under the age of five, little is known about the burden of pediatric gastroenteritis outside the medical setting. The objective of this study was to describe the burden of acute gastroenteritis among children residing in the United Arab Emirates, including those not receiving medical care. Methods A quantitative cross-sectional survey of 500 parents of children under 5 years of age who had suffered from acute gastroenteritis the preceding three months was conducted in the cities of Abu Dhabi and Al Ain. Data collected included respondent characteristics, disease symptoms, medical care sought, and parental expenditures and work loss. Data were analyzed using parametric and non-parametric statistical methods. Results Vomiting and diarrhea episodes lasted on average between 3 and 4 days. Overall, 87% of parents sought medical care for their children; 10% of these cases required hospitalization with an average length of stay of 2.6 days. When medical care was sought, the average parental cost per gastroenteritis episode was US$64, 4.5 times higher than with home care only (US$14. Nearly 60% of this difference was attributable to co-payments and medication use: 69% of children used oral rehydration solution, 68% antiemetics, 65% antibiotics and 64% antidiarrheals. Overall, 38 parents missed work per 100 gastroenteritis episodes for an average of 1.4 days. Conclusions Given its high incidence, pediatric gastroenteritis has an important financial and productivity impact on parents in the United Arab Emirates. To reduce this impact, efforts should be made both to prevent acute gastroenteritis and to optimize its treatment.

  4. Psychiatric sequelae of induced abortion.

    Science.gov (United States)

    Gibbons, M

    1984-03-01

    An attempt is made to identify and document the problems of comparative evaluation of the more recent studies of psychiatric morbidity after abortion and to determine the current consensus so that when the results of the joint RCGP/RCOG study of the sequelae of induced abortion become available they can be viewed in a more informed context. The legalization of abortion has provided more opportunities for studies of subsequent morbidity. New laws have contributed to the changing attitudes of society, and the increasing acceptability of the operation has probably influenced the occurrence of psychiatric sequelae. The complexity of measuring psychiatric sequelae is evident from the many terms used to describe symptomatology and behavioral patterns and from the number of assessment techniques involved. Numerous techniques have been used to quantify psychiatric sequelae. Several authors conclude that few psychiatric problems follow an induced abortion, but many studies were deficient in methodology, material, or length of follow-up. A British study in 1975 reported a favorable outcome for a "representative sample" of 50 National Health Service patients: 68% of these patients had an absence of or only mild feelings of guilt, loss, or self reproach and considered abortion as the best solution to their problem. The 32% who had an adverse outcome reported moderate to severe feelings of guilt, regret, loss, and self reproach, and there was evidence of mental illness. In most of these cases the adverse outcome was related to the patient's environment since the abortion. A follow-up study of 126 women, which compared the overall reaction to therapeutic abortion between women with a history of previous mild psychiatric illness and those without reported that a significantly different emotional reaction could not be demonstrated between the 2 groups. In a survey among women seeking an abortion 271 who were referred for a psychiatric opinion regarding terminations of pregnancy

  5. Early re-presentation to hospital after discharge from an acute medical unit: perspectives of older patients, their family caregivers and health professionals.

    Science.gov (United States)

    Slatyer, Susan; Toye, Christine; Popescu, Aurora; Young, Jeanne; Matthews, Anne; Hill, Andrew; Williamson, D James

    2013-02-01

    To explore the perceptions of older patients who re-presented to hospital within 28 days of discharge from an acute medical unit (AMU), their family caregivers and appropriately experienced health professionals. Hospitals are increasingly using AMUs to provide rapid assessment and treatment for medical patients. Evidence of efficacy is building, however in-depth exploration of the experiences of older patients who re-present to hospital soon after discharge from an AMU, and those who care for them, appears to be lacking. A qualitative, descriptive design was used. In 2007, our team purposively sampled older patients who re-presented to hospital within 28 days of discharge from an AMU (n = 12), family caregivers (n = 15), and health professionals (n = 35). Data were collected using semi-structured interviews and subjected to thematic content analysis. Four themes emerged: the health trajectory, communication challenges, discharge readiness and the decision to return. Re-presentation to hospital was seen as part of a declining health trajectory. The AMU was viewed as treating acute illness well, however patients and family caregivers left hospital with limited understanding of underlying health problems and, therefore, ill-prepared for future health crises. There are clear benefits for older patients from AMUs, which expedite treatment for acute health crises. However, AMU discharge planning needs to consider patients' overall health status and likely future needs to optimise outcomes. Such a requirement is problematic in the context of acute time pressures. To ensure prompt and expert attention to key aspects of discharge planning for older people leaving AMUs, there is a role for in-depth clinical expertise in the care of older people facing deteriorating life-limiting conditions. Therefore, a leadership role for nurses with geriatric and palliative care expertise, alongside medical and allied health professionals, merits attention in this context. © 2013

  6. Early treatment with intravenous metoprolol for suspected acute myocardial infarction: a phase IV United States trial. Phase IV Metoprolol in Myocardial Infarction Study Group.

    Science.gov (United States)

    Antman, E M; Dupont, W D; Bonalsky, J; Califf, R M; Corwin, S; Fink, L; Hansen, D E; Kawanishi, D T; Kronenberg, M W; McKay, C R

    1989-05-01

    Recent randomized clinical trials have shown that total mortality and cardiovascular mortality are reduced by the early intravenous administration of beta-blockers to patients suspected of suffering from acute myocardial infarction. These trials were conducted on patients meeting strict entry criteria. In order to assess this therapy when applied to a broader range of myocardial infarction patients, we performed a Phase IV study of metoprolol in acute myocardial infarction. The study was designed to test whether early (less than 8 hours from onset of chest pain) intervention by practicing physicians with open label intravenous metoprolol for cases of suspected acute myocardial infarction achieved mortality results similar to those obtained in large randomized clinical trials. We studied 3824 patients treated by 741 physicians representing a broad spectrum of clinical practice in the United States. Seventy-two percent of the patients entered into the study had confirmed myocardial infarction (39% anterior, 39% inferior, 22% other locations) and 85% of all individuals treated tolerated the full intravenous dose of 15 mg of metoprolol. The 15 day total mortality and cardiovascular mortality rates were 4.9% and 4.5%; 90 day mortality rates were 6.9 and 5.9%. Patients with anterior infarctions had a significantly greater cumulative mortality rate than patients with other types of infarctions. Marked bradycardia (heart rate less than 45 beats per minute) in the first 8 hours post treatment occurred in 4.7% cases and hypotension (systolic blood pressure less than 90 mm Hg) occurred in 9.8% of cases. When compared with the results of the Göteborg and MIAMI trials of metoprolol, it appears that there is no appreciable increase in mortality or morbidity when metoprolol is used in the community practice of acute coronary care.

  7. Technology transfer with system analysis, design, decision making, and impact (Survey-2000) in acute care hospitals in the United States.

    Science.gov (United States)

    Hatcher, M

    2001-10-01

    This paper provides the results of the Survey-2000 measuring technology transfer for management information systems in health care. The relationships with systems approaches, user involvement, usersatisfaction, and decision-making were measured and are presented. The survey also measured the levels Internet and Intranet presents in acute care hospitals, which will be discussed in future articles. The depth of the survey includes e-commerce for both business to business and customers. These results are compared, where appropriate, with results from survey 1997 and changes are discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the first of three articles based upon the results of the Srvey-2000. Readers are referred to a prior article by the author that discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.

  8. Engram Formation in Psychiatric Disorders

    Directory of Open Access Journals (Sweden)

    Peter J. Gebicke-Haerter

    2014-05-01

    Full Text Available Environmental factors substantially influence beginning and progression of mental illness, reinforcing or reducing the consequences of genetic vulnerability. Often initiated by early traumatic events, engrams or memories are formed that may give rise to a slow and subtle progression of psychiatric disorders. The large delay between beginning and time of onset (diagnosis may be explained by efficient compensatory mechanisms observed in brain metabolism that use optional pathways in highly redundant molecular interactions.To this end, research has to deal with mechanisms of learning and long-term memory formation, which involves a epigenetic changes, b altered neuronal activities and c changes in neuron-glia communication. On the epigenetic level, apparently DNA-methylations are more stable than histone modifications, although both closely interact. Neuronal activities basically deliver digital information, which clearly can serve as basis for memory formation (LTP. However, research in this respect has long time neglected the importance of glia. They are more actively involved in the control of neuronal activities than thought before. They can both reinforce and inhibit neuronal activities by transducing neuronal information from frequency-encoded to amplitude and frequency-modulated calcium wave patterns spreading in the glial syncytium by use of gap junctions. In this way, they serve integrative functions. In conclusion, we are dealing with two concepts of encoding information that mutually control each other and synergize: a digital (neuronal and a wave-like (glial computing, forming neuron-glia functional units with inbuilt feedback loops to maintain balance of excitation and inhibition. To better understand mental illness, we have to gain more insight into the dynamics of adverse environmental impact on those cellular and molecular systems. This report summarizes existing knowledge and draws some outline about further research in molecular

  9. The incidence and risk factors of associated acute myocardial infarction (AMI in acute cerebral ischemic (ACI events in the United States.

    Directory of Open Access Journals (Sweden)

    Ali Seifi

    Full Text Available OBJECTIVES: To determine the association between myocardial infarction (AMI and clinical outcome in patients with primary admissions diagnosis of acute cerebral ischemia (ACI in the US. METHODS: Data from Nationwide Inpatient Sample (NIS was queried from 2002-2011 for inpatient admissions of patients with a primary diagnosis of ACI with and without AMI using International Classification of Diseases, Ninth Revision, Clinical Modification coding (ICD-9. A multivariate stepwise regression analysis was performed to assess the correlation between identifiable risk factors and clinical outcomes. RESULTS: During 10 years the NIS recorded 886,094 ACI admissions with 17,526 diagnoses of AMI (1.98%. The overall cumulative mortality of cohort was 5.65%. In-hospital mortality was associated with AMI (aOR 3.68; 95% CI 3.49-3.88, p≤0.0001, rTPA administration (aOR 2.39 CI, 2.11-2.71, p<0.0001, older age (aOR 1.03, 95% CI, 1.03-1.03, P<0.0001 and women (aOR 1.06, 95% CI 1.03-1.08, P<0.0001. Overall, mortality risk declined over the course of study; from 20.46% in 2002 to 11.8% in 2011 (OR 0.96, 95% CI 0.95-0.96, P<0.0001. Survival analysis demonstrated divergence between the AMI and non-AMI sub-groups over the course of study (log-rank p<0.0001. CONCLUSION: Our study demonstrates that although the prevalence of AMI in patients hospitalized with primary diagnosis of ACI is low, it negatively impacts survival. Considering the high clinical burden of AMI on mortality of ACI patients, a high quality monitoring in the event of cardiac events should be maintained in this patient cohort. Whether prompt diagnosis and treatment of associated cardiovascular diseases may improve outcome, deserves further study.

  10. Dissociative disorders in the psychiatric emergency ward.

    Science.gov (United States)

    Sar, Vedat; Koyuncu, Ahmet; Ozturk, Erdinc; Yargic, L Ilhan; Kundakci, Turgut; Yazici, Ahmet; Kuskonmaz, Ekrem; Aksüt, Didem

    2007-01-01

    The aim of this study was to determine the prevalence of dissociative disorders among emergency psychiatric admissions. Forty-three of the 97 consecutive outpatients admitted to the psychiatric emergency unit of a university hospital were screened using the Dissociative Experiences Scale (DES). Seventeen (39.5% of the 43 evaluated) patients with a DES score above 25.0 were then interviewed with the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for Dissociative Disorders. Fifteen emergency unit patients (34.9% of the 43 evaluated participants) were diagnosed as having a dissociative disorder. Six (14.0%) patients had dissociative identity disorder, 6 (14.0%) had dissociative disorder not otherwise specified, and 3 (7.0%) had dissociative amnesia. The average DES score of dissociative patients was 43.7. A majority of them had comorbid major depression, somatization disorder, and borderline personality disorder. Most of the patients with dissociative disorder reported auditory hallucinations, symptoms associated with psychogenic amnesia, flashback experiences, and childhood abuse and/or neglect. Dissociative disorders constitute one of the diagnostic groups with high relevance in emergency psychiatry.

  11. Coral reef health response to chronic and acute changes in water quality in St. Thomas, United States Virgin Islands.

    Science.gov (United States)

    Ennis, Rosmin S; Brandt, Marilyn E; Wilson Grimes, Kristin R; Smith, Tyler B

    2016-10-15

    It is suspected that land cover alteration on the southern coast of St. Thomas, USVI has increased runoff, degrading nearshore water quality and coral reef health. Chronic and acute changes in water quality, sediment deposition, and coral health metrics were assessed in three zones based upon perceived degree of human influence. Chlorophyll (pCoral bleaching in all zones peaked in November with a regional thermal stress event (pbleaching prevalence was significantly greater in the most impacted zone compared to the offshore zone (p=0.0396), suggesting a link between declining water quality and bleaching severity. Published by Elsevier Ltd.

  12. A pressure ulcer and fall rate quality composite index for acute care units: A measure development study.

    Science.gov (United States)

    Boyle, Diane K; Jayawardhana, Ananda; Burman, Mary E; Dunton, Nancy E; Staggs, Vincent S; Bergquist-Beringer, Sandra; Gajewski, Byron J

    2016-11-01

    Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement. The study objective was to develop a unit-level inpatient composite nursing care quality performance index-the Pressure Ulcer and Fall Rate Quality Composite Index. Two-phase measure development study. 5144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors(®) during the year 2013. The Pressure Ulcer and Fall Rate Quality Composite Index was developed in two phases. In Phase 1 the formula was generated using a utility function and generalized penalty analysis. Experts with experience in healthcare quality measurement provided the point of indicator equivalence. In Phase 2 initial validity evidence was gathered based on hypothesized relationships between the Pressure Ulcer and Fall Rate Quality Composite Index and other variables using two-level (unit, hospital) hierarchical linear mixed modeling. The Pressure Ulcer and Fall Rate Quality Composite Index=100-PUR-FR, where PUR is pressure ulcer rate and FR is total fall rate. Higher scores indicate better quality. Bland-Altman plots demonstrated agreement between pairs of experts and provided evidence for inter-rater reliability of the formula. The validation process demonstrated that higher registered nurse skill mix, higher percent of registered nurses with a baccalaureate in nursing or higher degree, higher percent of registered nurses with national specialty certification, and lower percent of hours supplied by agency staff were significantly associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Higher percentages of unit patients at risk for a hospital-acquired pressure ulcer and higher unit rates of physical restraint use were not associated with higher Pressure

  13. Addressing psychiatric comorbidity.

    Science.gov (United States)

    Woody, G E; McLellan, A T; O'Brien, C P; Luborsky, L

    1991-01-01

    Research studies indicate that addressing psychiatric comorbidity can improve treatment for selected groups of substance-abusing patients. However, the chances for implementing the necessary techniques on a large scale are compromised by the absence of professional input and guidance within programs. This is especially true in public programs, which treat some of the most disadvantaged, disturbed, and socially destructive individuals in the entire mental health system. One starting point for upgrading the level of knowledge and training of staff members who work in this large treatment system could be to develop a better and more authoritative information dissemination network. Such a system exists in medicine; physicians are expected to read appropriate journals and to guide their treatment decisions using the data contained in the journals. Standards of practice and methods for modifying current practice are within the tradition of reading new facts, studying old ones, and comparing treatment outcome under different conditions with what is actually being done. No such general system of information-gathering or -sharing exists, particularly in public treatment programs. One of the most flagrant examples of this "educational shortfall" can be found among those methadone programs that adamantly insist on prescribing no more than 30 to 35 mg/day for all patients, in spite of the overwhelming evidence that these dose levels generally are inadequate. In some cases, program directors are unaware of studies that have shown the relationship between dose and outcome. In other cases, they are aware of the studies but do not modify their practices accordingly. This example of inadequate dosing is offered as an example of one situation that could be improved by adherence to a system of authoritative and systematic information dissemination. Many issues in substance abuse treatment do not lend themselves to information dissemination as readily as that of methadone dosing

  14. Hyperbaric programs in the United States: Locations and capabilities of treating decompression sickness, arterial gas embolisms, and acute carbon monoxide poisoning: survey results.

    Science.gov (United States)

    Chin, Walter; Jacoby, Laura; Simon, Olivia; Talati, Nisha; Wegrzyn, Gracelene; Jacoby, Rachelle; Proano, Jacob; Sprau, Susan E; Markovitz, Gerald; Hsu, Rita; Joo, Ellie

    2016-01-01

    Hyperbaric oxygen therapy is the primary treatment for arterial gas embolism, decompression sickness and acute carbon monoxide poisoning. Though there has been a proliferation of hyperbaric centers throughout the United States, a scarcity of centers equipped to treat emergency indications makes transport of patients necessary. To locate and characterize hyperbaric chambers capable of treating emergency cases, a survey of centers throughout the entire United States was conducted. Using Google, Yahoo, HyperbaricLink and the UHMS directory, a database for United States chambers was created. Four researchers called clinicians from the database to administer the survey. All centers were contacted for response until four calls went unreturned or a center declined to be included. The survey assessed chamber readiness to respond to high-acuity patients, including staff availability, use of medical equipment such as ventilators and intravenous infusion devices, and responding yes to treating hyperbaric emergencies within a 12-month period. Only 43 (11.9%, N = 361) centers had equipment, intravenous infusion pumps and ventilators, and staff necessary to treat high-acuity patients. Considering that a primary purpose of hyperbaric oxygen therapy is the treatment of arterial gas embolism and decompression sickness, more hyperbaric centers nationwide should be able to accommodate these emergency cases quickly and safely.

  15. The duration of hypotension determines the evolution of bacteremia-induced acute kidney injury in the intensive care unit.

    Directory of Open Access Journals (Sweden)

    Karin Janssen van Doorn

    Full Text Available BACKGROUND: Exploration of the impact of severe hypotension on the evolution of acute kidney injury in septic patients. METHODS AND RESULTS: We reviewed the hemodynamic parameters of 137 adults with septic shock and proven blood stream infection in the ICU. Severe hypotension was defined as a mean arterial blood pressure (MAP ≤65 mmHg. The influence of the duration of severe hypotension on the evolution of acute kidney injury was evaluated according to the RIFLE classification, with day 0 defined as the day of a positive blood stream infection. After bloodstream infection, the probability for a patient to be in Failure was significantly higher than before blood stream infection (OR = 1.94, p = 0.0276. Patients have a significantly higher risk of evolving to Failure if the duration of severe hypotension is longer (OR = 1.02 for each 10 minutes increase in duration of a MAP <65 mmHg, p = 0.0472. A cut-off of at least 51 minutes of severe hypotension (<65 mmHg or at least 5.5 periods of severe hypotension within 1 day identified patients with increased risk to evolve to Failure. CONCLUSIONS: There is a significant influence of both the duration and the number of periods of severe hypotension on the evolution to Failure. Blood stream infection has a significantly negative effect on the relationship between severe hypotension and Failure.

  16. Headache attributed to psychiatric disorders.

    Science.gov (United States)

    Guidetti, Vincenzo; Galli, Federica; Sheftell, Fred

    2010-01-01

    The association between psychiatric illness and headache is widely recognized. "Headache attributed to psychiatric disorder" is a new category of secondary headache introduced in the 2004 revision of the International Classification of Headache Disorders (ICHD-II) (Headache Classification Subcommittee of the International Headache Society, 2004). It represents a new, but not conclusive, step toward a better systematization of the topic "headache and psychological factors." From the early 1990s the involvement of psychological factors in headache disorders has been clearly identified as "psychiatric comorbidity." The current conceptualization of the term implies an association, more than casual, but likely not causal, between an index disease or disorder and one or more coexisting physical or psychological pathologies. Additionally, clarifying the direction, meaning, and weight of comorbidities has pathophysiological, nosological, course, and treatment implications. However, the study of comorbidity may present a series of difficulties related to the current understanding of the etiology and pathophysiology of diseases at the center of our attention. Sometimes, as happens in the subject of headache, we proceed against a background where many issues need to be clarified. In this chapter, we analyze the past and current literature, tracing the line from "migraine personality" to "psychiatric comorbidity" to "headache attributed to psychiatric disorders." Questions related to etiology, pathophysiology, and treatment options are discussed for different headache subtypes.

  17. Visceral Pain and Psychiatric Disorders.

    Science.gov (United States)

    Felice, Valeria D; Moloney, Rachel D; Cryan, John F; Dinan, Timothy G; O'Mahony, Siobhain M

    2015-01-01

    The high comorbidity existing between visceral pain and psychiatric disorders such as depression and anxiety is well documented and it is gaining increasing interest among scientists. When visceral pain and psychiatric disorders are comorbid, they present a more debilitating condition than each disorder alone, impacting significantly on the quality of life of these patients. Despite several groups having shown that an overlapping pathophysiology exists between visceral pain and stress-related disorders the link between them is not clear yet. Moreover, it still remains to be elucidated if psychiatric conditions predispose the individual to develop visceral hypersensitivity or vice versa. The brain-gut-microbiome axis is the bidirectional communication between the CNS and the gastrointestinal tract. Alterations at different levels of this axis have been implicated in both visceral hypersensitivity and psychiatric disorders. Here we give an overview of what it is known about comorbid visceral pain and psychiatric disorders and provide evidence of potential overlapping pathophysiological mechanisms involved. Preclinical models of comorbid visceral pain and stress-related disorders are also discussed. © 2015 S. Karger AG, Basel.

  18. Acute psychological stress reduces working memory-related activity in the dorsolateral prefrontal cortex.

    NARCIS (Netherlands)

    Qin, S.; Hermans, E.J.; Marle, H.J.F. van; Luo, J.; Fernandez, G.S.E.

    2009-01-01

    BACKGROUND: Acute psychological stress impairs higher-order cognitive function such as working memory (WM). Similar impairments are seen in various psychiatric disorders that are associated with higher susceptibility to stress and with prefrontal cortical dysfunctions, suggesting that acute stress

  19. A cluster of salivirus A1 (Picornaviridae) infections in newborn babies with acute gastroenteritis in a neonatal hospital unit in Hungary.

    Science.gov (United States)

    Boros, Ákos; Raáb, Margit; Károly, Éva; Karai, Adrienn; Kátai, Andrea; Bolba, Nóra; Pankovics, Péter; Reuter, Gábor

    2016-06-01

    Salivirus (family Picornaviridae) may be associated with acute gastroenteritis in humans, but there have been no reports of salivirus outbreaks. Salivirus A1 infection with faecal virus concentrations of 2.1-2.6 × 10(9)/g were identified retrospectively in newborn babies, between the ages of 1.5 and 5 days, with apparent clinical symptoms of diarrhea (100 %), fever (40 %), vomiting (40 %), and loss of appetite (40 %) in a neonatal hospital unit in Hungary in July 2013. The complete genome sequence of the salivirus (including the 5'-terminal end) was determined. Salivirus mono-infection may be associated with gastroenteritis in babies who are a few days old. Salivirus testing should be done in public health laboratories in gastroenteritis outbreaks with unknown etiology.

  20. Patient need at the heart of workforce planning: the use of supply and demand analysis in a large teaching hospital's acute medical unit.

    Science.gov (United States)

    Le Jeune, I R; Simmonds, M J R; Poole, L

    2012-08-01

    Timely medical assessment is integral to the safety and quality of healthcare delivery in acute medicine. Medical staff are an expensive resource. This study aimed to develop a modelling system that facilitated efficient workforce planning according to patient need on the acute medical unit. A realistic 24-hour 'supply' of junior doctors was calculated by adjusting the theoretical numbers on the rota for leave allowances, natural breaks and other ward duties by a combination of direct observation of working practice and junior doctor interviews. 'Demand' was analysed using detailed admission data. Supply and demand were then integrated with data from a survey of the time spent on the process of clerking and assessment of medical admissions. A robust modelling system that predicted the number of unclerked patients was developed. The utility of the model was assessed by demonstrating the impact of a regulation-compliant redesign of the rota using existing staff and by predicting the most efficient use of an additional shift. This simple modelling system has the potential to enhance quality of care and efficiency by linking workforce planning to patient need.

  1. Recovery rate and associated factors of children age 6 to 59 months admitted with severe acute malnutrition at inpatient unit of Bahir Dar Felege Hiwot Referral hospital therapeutic feeding unite, northwest Ethiopia

    Science.gov (United States)

    Desyibelew, Hanna Demelash; Fekadu, Abel; Woldie, Haile

    2017-01-01

    Background Despite numerous advances made in improving child health and the clinical management protocols for treating severe acute malnutrition at treatment centers, evidences concerning the treatment outcomes are scarce. Therefore, this study was conducted to assess the recovery rate and associated factors of severely acute malnourished children of age 6 to 59 months admitted to inpatient therapeutic feeding unit at Felege Hiwot Referral Hospital. Methods We conducted a hospital-based cross-sectional study including 401 severely malnourished children who were admitted from September 2012 to January 2016. Bivariable and a Multivariable logistic regression model were fitted to identify factors associated with recovery rate. Adjusted Odds ratio with its 95% CI was reported and P-value less than 0.05 was considered as significant. Results Fifty eight percent (58.4%) (95%CI: 53.1–64.1) of admitted children were recovered with a mean recovery time of 18 (±6.3) days. Being female, children who were fully and partially vaccinated, who had better MUAC measurement, who stayed longer in the hospital, and children who took routine vitamin-A supplementation had better recovery rate. However, children who had co-morbidity at admission, had human immune virus (HIV) and Tuberculosis (TB) infection, and who had edema were less likely to recover. Interpretation Recovery rate was low as compared to international SPHERE cutoff points (> 75% recovery rate). Interventions that could address the outlined factors would be helpful to improve treatment recovery rate of admitted children. PMID:28166247

  2. Excited delirium: Consideration of selected medical and psychiatric issues

    Directory of Open Access Journals (Sweden)

    Edith Samuel

    2009-01-01

    Full Text Available Edith Samuel1, Robert B Williams1, Richard B Ferrell21Department of Psychology, Atlantic Baptist University, Moncton, New Brunswick Canada; 2Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire, USAAbstract: Excited delirium, sometimes referred to as agitated or excited delirium, is the label assigned to the state of acute behavioral disinhibition manifested in a cluster of behaviors that may include bizarreness, aggressiveness, agitation, ranting, hyperactivity, paranoia, panic, violence, public disturbance, surprising physical strength, profuse sweating due to hyperthermia, respiratory arrest, and death. Excited delirium is reported to result from substance intoxication, psychiatric illness, alcohol withdrawal, head trauma, or a combination of these. This communication reviews the history of the origins of excited delirium, selected research related to its causes, symptoms, management, and the links noted between it and selected medical and psychiatric conditions. Excited delirium involves behavioral and physical symptoms that are also observed in medical and psychiatric conditions such as rhabdomyolysis, neuroleptic malignant syndrome, and catatonia. A useful contribution of this communication is that it links the state of excited delirium to conditions for which there are known and effective medical and psychiatric interventions.Keywords: excited delirium, excited states, cocaine misuse, restraint or in custody deaths

  3. Family violence and psychiatric disorder.

    Science.gov (United States)

    Bland, R; Orn, H

    1986-03-01

    The relationship between family violence and psychiatric disorders was examined using standardized diagnostic interviews of 1200 randomly selected residents of a large Canadian city. The results showed that higher than expected proportions of those exhibiting violent behavior had a psychiatric diagnosis and the rate of violent behaviors in those with diagnoses (54.4%) significantly (p less than .0001) exceeds the rate in the remainder of the sample (15.5%). Particularly high rates of violence are found in those where alcoholism is combined with antisocial personality disorder and/or recurrent depression (80-93%). Also at high risk for violence are those who have made suicide attempts (over 50%) and those who have been arrested for non-traffic offences (two-thirds). These data suggest that psychiatric disorders have a strong relationship to violent behavior, and are not in agreement with the predominantly sociological explanations of family violence.

  4. [Movement disorders is psychiatric diseases].

    Science.gov (United States)

    Hidasi, Zoltan; Salacz, Pal; Csibri, Eva

    2014-12-01

    Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it, or can be the consequence of psychopharmacological therapy. Most common features include tic, stereotypy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia, catatonia, Tourette-disorder and psychogenic movement disorder, leading to differential-diagnostic and therapeutical difficulties in everyday practice. Movement disorders due to psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent psychiatric comorbidity is found in primary movement disorders, such as Parkinson's disease, Wilson's disease, Huntington's disease, diffuse Lewy-body disorder. Complex neuropsychiatric approach is effective concerning overlapping clinical features and spectrums of disorders in terms of movement disorders and psychiatric diseases.

  5. Psychiatric Adverse Effects of Dermatological Drugs

    Directory of Open Access Journals (Sweden)

    Mine Özmen

    2010-07-01

    Full Text Available Dermatological drugs, mostly corticosteroids and isotretinoin, cause different psychiatric adverse effects. During steroid therapy, a wide range of psychiatric conditions, from minor clinical symptoms like insomnia and anxiety to serious psychiatric syndromes like psychosis and delirium might be seen. In medical literature, a causal connection is usually suggested between “isotretinoin”, which is used for treatment of acne vulgaris and depression and suicide attempts. However, there are no statistically significant double-blind randomized studies that support this connection. Clinicians must know patient’s psychiatric history before using any dermatological treatment known as causing psychiatric adverse effects, and psychiatric consultation should be established whenever necessary.

  6. Acute kidney injury patterns and outcomes in low-risk versus high-risk critically ill patients admitted to the medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Cyriacus Anaele

    2017-01-01

    Full Text Available Background: Acute kidney injury (AKI is often one component of multiple organ failure (MOF in the intensive care unit (ICU. However, not all patients with MOF develop AKI, and AKI may develop in the absence of MOF. We compared the impact of AKI alone and in combination with MOF on the survival of patients admitted to a large tertiary care medical intensive care unit (MICU.  Methods: We abstracted data from the electronic medical records of patients admitted to the MICU from April 2012 through June 2013 and categorized patients as either high-risk or low- risk status based on use of vasopressor support or mechanical ventilation during the ICU stay. The outcomes we considered were in-hospital, 30-day, 90-day, 180-day, and 1-year mortality. Results: Of the 834 critically ill patients, 743 (89% developed some degree of AKI. Ninety-one percent of the high-risk cohort developed AKI and 87% of the low-risk cohort developed AKI. Patients with AKI had higher mortality at 1-year than patients without AKI (adjusted odds ratio [OR], 2.5; 95% confidence interval [CI], 1.38 to 4.53; P interaction 0.0026.  Hospital mortality was greater for high-risk patients without AKI than for low-risk patients with AKI. Conclusion: Acute kidney injury occurs at similar frequency in high and low-risk ICU patients and has significant impact on survival in both groups.  Cardiovascular collapse or respiratory failure has greater impact on short term mortality than AKI, but this effect diminishes over time. Conversely, the impact of AKI on mortality increased over time and remained an independent risk factor for mortality.

  7. Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: a multi-centric study from intermediate care geriatric rehabilitation units of Catalonia.

    Science.gov (United States)

    Pérez, Laura Mónica; Inzitari, Marco; Roqué, Marta; Duarte, Esther; Vallés, Elisabeth; Rodó, Montserrat; Gallofré, Miquel

    2015-10-01

    Recovery after a stroke is determined by a broad range of neurological, functional and psychosocial factors. Evidence regarding these factors is not well established, in particular influence of cognition changes during rehabilitation. We aimed to investigate whether selective characteristics, including cognitive performance and its change over time, modulate functional recovery with home discharge in stroke survivors admitted to post-acute rehabilitation units. We undertook a multicenter cohort study, including all patients discharged from acute wards to any geriatric rehabilitation unit in Catalonia-Spain during 2008. Patients were assessed for demographics, clinical and functional variables using Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris (CMBD-RSS), which adapts the Minimum Data Set tool used in America's nursing homes. Baseline-to-discharge change in cognition was calculated on repeated assessments using the Cognitive Performance Scale (CPS, range 0-6, best-worst cognition). The multivariable effect of these factors was analyzed in relation to the outcome. 879 post-stroke patients were included (mean age 77.48 ± 10.18 years, 52.6% women). A worse initial CPS [OR (95% CI) = 0.851 (0.774-0.935)] and prevalent fecal incontinence [OR (95% CI) = 0.560 (0.454-0.691)] reduced the likelihood of returning home with functional improvement; whereas improvement of CPS, baseline to discharge, [OR (95% CI) = 1.348 (1.144-1.588)], more rehabilitation days within the first 2 weeks [OR (95% CI) = 1.011 (1.006-1.015)] and a longer hospital stay [OR (95% CI) = 1.011 (1.006-1.015)] were associated with the outcome. In our sample, different clinical characteristics, including cognitive function and its improvement over time, are associated with functional improvement in stroke patients undergoing rehabilitation. Our results might provide information to further studies aimed at exploring the influence of cognition changes during rehabilitation.

  8. Introduction of an NT-proBNP assay to an acute admission unit--a 2-year audit.

    LENUS (Irish Health Repository)

    Murtagh, Gillian

    2012-02-01

    BACKGROUND: The differential diagnosis of dyspnoea is difficult due to the low predictive value of clinical and laboratory parameters. The elevated levels of NT-proBNP in congestive heart failure may improve diagnostic accuracy. We have evaluated the effect of the introduction of an NT-proBNP assay on hospital length of stay (LOS) and mortality. METHODS: There were 11,853 AMAU patient episodes in the 22 months study period (March 2005-Dec 2006). An NT-proBNP assay was requested in 657 (5.5%) of these. Comparison between categorical variables such as diagnosis, NT-proBNP testing, LOS, and in-hospital mortality was made using Chi-square tests. Literature review suggested that an NT-proBNP cut-off >or=5000 ng\\/L should predict acute in-patient mortality. Logistic regression analysis was used to examine the association between such an elevated NT-proBNP level and outcomes. RESULTS: Of the 396 patients with NT-proBNP <5000 ng\\/L, 8.1% died compared with 22.5% of the 178 patients dying with values >or=5000 ng\\/L (p<0.0001). An NT-proBNP >or=5000 ng\\/L was predictive of both LOS >or=9 days (odds ratios (OR) 1.54 (95% CI 1.06, 2.24: p=0.02) and LOS >or=14 days (OR=1.87 (95% CI 1.29, 2.71: p=0.0009). NT-proBNP requests increased over time, from 2.6% to 8.2% of all patients; the result fell in the diagnostic range for CHF in 60% of requests. CONCLUSION: The introduction of an NT-proBNP was reflected in an appropriate but rapidly increasing pattern of requests from clinicians. High NT-proBNP levels predicted in-hospital mortality and longer LOS in an acute medical population.

  9. Blood tests: One too many? Evaluating blood requesting guidance developed for acute patients admitted to trauma and orthopaedic units.

    Science.gov (United States)

    Faulkner, Alastair; Reidy, Mike; Scicluna, Gabrielle; Love, Gavin J; Joss, Judith

    2016-03-01

    In a recently published report from the Academy of Medical Royal Colleges, around 20% of clinical practice which encompasses blood science investigations is considered wasteful. Blood tests including liver function tests (LFTs), C-reactive protein (CRP), coagulation screens, and international normalising ratios (INR) are frequently requested for patients who undergo emergency hospital admission. The paucity of guidance available for blood requesting in acute trauma and orthopaedic admissions can lead to inappropriate requesting practices and over investigation. Acute admissions over a period of one month were audited retrospectively for the frequency and clinical indications of requests for LFTs, coagulation screens/INR, and CRP. The total number of blood tests requested for the duration of the patient's admission was recorded. Initial auditing of 216 admissions in January 2014 demonstrated a striking amount of over-investigation. Clinical guidelines were developed with multidisciplinary expert input and implemented within the department. Re-audit of 233 admissions was carried out in September 2014. Total no. of LFTs requested: January 895, September 336 (-62.5%); coagulation screens/INR requested: January 307, September 210 (-31.6%); CRPs requested: January 894, September 317 (-64.5%). No. of blood requests per patient: January (M=4.81, SD 4.75), September (M=3.60, SD=4.70). Approximate combined total cost of LFT, coagulation/INR, CRP in January £2674.14 and September £1236.19 (-£1437.95, -53.77%). A large decrease was observed in admission requesting and subsequent monitoring (p<0.01) following the implementation. This both significantly reduced cost and venepuncture rates.

  10. Acute Myopericarditis Mimicking Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Seval İzdeş

    2011-08-01

    Full Text Available Acute coronary syndromes among young adults are relatively low when compared with older population in the intensive care unit. Electrocardiographic abnormalities mimicking acute coronary syndromes may be caused by non-coronary syndromes and the differential diagnosis requires a detailed evaluation. We are reporting a case of myopericarditis presenting with acute ST elevation and elevated cardiac enzymes simulating acute coronary syndrome. In this case report, the literature is reviewed to discuss the approach to distinguish an acute coronary syndrome from myopericarditis. (Journal of the Turkish Society Intensive Care 2011; 9:68-70

  11. The nature of psychiatric disorders.

    Science.gov (United States)

    Kendler, Kenneth S

    2016-02-01

    A foundational question for the discipline of psychiatry is the nature of psychiatric disorders. What kinds of things are they? In this paper, I review and critique three major relevant theories: realism, pragmatism and constructivism. Realism assumes that the content of science is real and independent of human activities. I distinguish two "flavors" of realism: chemistry-based, for which the paradigmatic example is elements of the periodic table, and biology-based, for which the paradigm is species. The latter is a much better fit for psychiatry. Pragmatism articulates a sensible approach to psychiatric disorders just seeking categories that perform well in the world. But it makes no claim about the reality of those disorders. This is problematic, because we have a duty to advocate for our profession and our patients against other physicians who never doubt the reality of the disorders they treat. Constructivism has been associated with anti-psychiatry activists, but we should admit that social forces play a role in the creation of our diagnoses, as they do in many sciences. However, truly socially constructed psychiatric disorders are rare. I then describe powerful arguments against a realist theory of psychiatric disorders. Because so many prior psychiatric diagnoses have been proposed and then abandoned, can we really claim that our current nosologies have it right? Much of our current nosology arose from a series of historical figures and events which could have gone differently. If we re-run the tape of history over and over again, the DSM and ICD would not likely have the same categories on every iteration. Therefore, we should argue more confidently for the reality of broader constructs of psychiatric illness rather than our current diagnostic categories, which remain tentative. Finally, instead of thinking that our disorders are true because they correspond to clear entities in the world, we should consider a coherence theory of truth by which disorders

  12. Optogenetics in psychiatric animal models.

    Science.gov (United States)

    Wentz, Christian T; Oettl, Lars-Lennart; Kelsch, Wolfgang

    2013-10-01

    Optogenetics is the optical control of neuronal excitability by genetically delivered light-activated channels and pumps and represents a promising tool to fuel the study of circuit function in psychiatric animal models. This review highlights three developments. First, we examine the application of optogenetics in one of the neuromodulators central to the pathophysiology of many psychiatric disorders, the dopaminergic system. We then discuss recent work in translating functional magnetic resonance imaging in small animals (in which optogenetics can be employed to reveal physiological mechanisms underlying disease-related alterations in brain circuits) to patients. Finally, we describe emerging technological developments for circuit manipulation in freely behaving animals.

  13. Quinolones: review of psychiatric and neurological adverse reactions.

    Science.gov (United States)

    Tomé, Ana M; Filipe, Augusto

    2011-06-01

    of reports, while for ofloxacin and pefloxacin, the number of reports may be over-representative. A total of 232 ADRs were identified from the selected articles, with 206 of these related to psychiatric and/or neurological ADRs. The other 26 were related to other body systems but were reported together with the reactions of interest. Mania, insomnia, acute psychosis and delirium were the most frequently reported psychiatric adverse events; grand mal convulsion, confusional state, convulsions and myoclonus were the most frequently reported neurological adverse events. Several aspects should be taken into account in the development of CNS adverse effects, such as the pharmacokinetics of quinolones, chemical structure and quinolone uptake in the brain. These events may affect not only susceptible patients but also 'healthy' patients.

  14. The medication process in a psychiatric hospital

    DEFF Research Database (Denmark)

    Soerensen, Ann Lykkegaard; Lisby, Marianne; Nielsen, Lars Peter

    2013-01-01

    Purpose: To investigate the frequency, type, and potential severity of errors in several stages of the medication process in an inpatient psychiatric setting. Methods: A cross-sectional study using three methods for detecting errors: (1) direct observation; (2) unannounced control visits in the w......Purpose: To investigate the frequency, type, and potential severity of errors in several stages of the medication process in an inpatient psychiatric setting. Methods: A cross-sectional study using three methods for detecting errors: (1) direct observation; (2) unannounced control visits....... The observational unit: The individual handling of medication (prescribing, dispensing, and administering). Results: In total, 189 errors were detected in 1,082 opportunities for error (17%) of which 84/998 (8%) were assessed as potentially harmful. The frequency of errors was: prescribing, 10/189 (5%); dispensing......, 18/189 (10%); administration, 142/189 (75%); and discharge summaries, 19/189 (10%). The most common errors were omission of pro re nata dosing regime in computerized physician order entry, omission of dose, lack of identity control, and omission of drug. Conclusion: Errors throughout the medication...

  15. Do locked doors in psychiatric hospitals prevent patients from absconding?

    Directory of Open Access Journals (Sweden)

    Undine E. Lang

    Full Text Available Background and Objectives: In the acute treatment of acute psychiatric patients coercive measures are often required and therapeutic relationships can be affected by such measures. In this study we assessed whether opening the entrance door of an acute psychiatric ward influences absconding behaviour. Methods: An acute psychiatric ward was primarily closed (91.4% for six months and primarily open (75.6% for six months over the time period of one year. In this one year period, 337 patients were treated (206 male, age: 40 ± 16 years: 60.2% of the patients had schizophrenia, 13.6% had affective disorders, 11.6% suffered from addiction and 14.5% displayed other diagnoses. Results: In terms of age (t = 0.026, df = 335, p = 0.979, gender (chi² = 1.6, df = 1, p = 0.13, diagnoses (chi² = 7.337, df = 1, p = 0.062 and duration of stay (t = -0.90, df = 335, p = 0.928, we found no significant differences between the patients admitted in the closed and those admitted in the open ward period. Absconding (df = 1, chi² = 5.107, p = 0.029, aggressive incidents (chi² = 4.46, df = 1, p = 0.050 and coercive medications (chi² = 4.646, df = 1, p = 0.037 were observed significantly more often in the closed door period. Moreover, the duration up to readmission was reduced in the closed time period (t = 2.314, df = 54, p = 0.025. Conclusions: We hypothesize that open doors reduce patient's discomfort, improve ward atmosphere and aggressive acts and do not appear to increase the risk of absconding.

  16. Biofeedback for psychiatric disorders: a systematic review

    NARCIS (Netherlands)

    Schoenberg, P.L.; David, A.S.

    2014-01-01

    Biofeedback potentially provides non-invasive, effective psychophysiological interventions for psychiatric disorders. The encompassing purpose of this review was to establish how biofeedback interventions have been used to treat select psychiatric disorders [anxiety, autistic spectrum disorders, dep

  17. Biofeedback for psychiatric disorders: a systematic review

    NARCIS (Netherlands)

    Schoenberg, P.L.; David, A.S.

    2014-01-01

    Biofeedback potentially provides non-invasive, effective psychophysiological interventions for psychiatric disorders. The encompassing purpose of this review was to establish how biofeedback interventions have been used to treat select psychiatric disorders [anxiety, autistic spectrum disorders,

  18. Skin disorders in chronic psychiatric illness

    NARCIS (Netherlands)

    Mookhoek, E. J.; van de Kerkhof, P. C. M.; Hovens, J. E. J. M.; Brouwers, J. R. B. J.; Loonen, A. J. M.

    2010-01-01

    Background Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce. Objective To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients. Methods Ninety-one randomly chosen patients of the

  19. An observational study on rhabdomyolysis in the intensive care unit. Exploring its risk factors and main complication: acute kidney injury.

    Science.gov (United States)

    El-Abdellati, Esmael; Eyselbergs, Michiel; Sirimsi, Halil; Hoof, Viviane Van; Wouters, Kristien; Verbrugghe, Walter; Jorens, Philippe G

    2013-03-14

    Because neither the incidence and risk factors for rhabdomyolysis in the ICU nor the dynamics of its main complication, i.e., rhabdomyolysis-induced acute kidney injury (AKI) are well known, we retrospectively studied a large population of adult ICU patients (n = 1,769). CK and sMb (serum myoglobin) and uMb (urinary myoglobin) were studied as markers of rhabdomyolysis and AKI (RIFLE criteria). Hemodialysis and mortality were used as outcome variables. Prolonged surgery, trauma, and vascular occlusions are associated with increasing CK values. CK correlates with sMb (p sMb or uMb.The logistic regression showed a positive correlation between CK and the development of AKI, with an OR of 2.21. Univariate logistic regression suggests that elevations of sMb and uMb are associated with the development of AKI, with odds ratios of 7.87 and 1.61 respectively. The ROC curve showed that for all three markers a significant correlation with AKI, for sMb with the greatest area under the curve. The best cutoff values for prediction of AKI were CK > 773 U/l; sMb > 368 μg/l and uMb > 38 μg/l respectively. Because it also has extrarenal elimination kinetics, our data suggest that measuring myoglobin in patients at risk for rhabdomyolysis in the ICU may be useful.

  20. Evaluation of risk factors in acute myocardial infarction patients admitted to the coronary care unit, Tripoli Medical Centre, Libya.

    Science.gov (United States)

    Abduelkarem, A R; El-Shareif, H J; Sharif, S I

    2012-04-01

    The aim of this study was to provide an overview of the risk factors for acute myocardial infarction in patients attending Tripoli Medical Centre, Libya. Records were reviewed for 622 patients with a mean age of 58.3 (SD 12.9) years. Diabetes mellitus (48.2%), hypertension (35.7%) and smoking (50.6%) were among the risk factors reported. There were 110 patients (17.7%) who died during hospitalization, mainly suffering cardiogenic shock (48.0%). The rate of use of thrombolytic therapy was low in patients who were female (40.4% versus 58.4% for males), older age (31.6% for those > 85 years versus 63.3% for patients < 55 years), diabetics (45.3% versus 62.0% for non-diabetic patients) and hypertensives (47.3% versus 57.8% for non-hypertensive patients). Prevention strategies should be implemented in order to improve the long-term prognosis and decrease overall morbidity and mortality from coronary artery disease in Libyan patients.

  1. Pregnancy-related acute kidney injury: experience of the nephrology unit at the university hospital of fez, morocco.

    Science.gov (United States)

    Arrayhani, Mohamed; El Youbi, Randa; Sqalli, Tarik

    2013-01-01

    Introduction. Acute kidney injury (PRAKI) continues to be common in developing countries. The aim of this paper is to study AKI characteristics in pregnancy and identify the factors related to the unfavorable evolution. Methods. This prospective study was conducted in the University Hospital Hassan II of Fez, Morocco, from February 01, 2011 to January 31, 2012. All patients presenting PRAKI were included. Results. 37 cases of PRAKI were listed. Their ages varied from 20 to 41 years old, with an average of 29.03 ± 6.3 years and an average parity of 1.83. High blood pressure was the most common symptom (55.6%). Thirty-nine percent were oliguric. PRAKI occurred during the 3rd trimester in 66.6% of the cases and 25% of the cases in the postpartum. Hemodialysis was necessary in 16.2% of cases. The main causes were preeclampsia, hemorrhagic shocks, and functional, respectively, in 66.6%, 25%, and 8.3% of the cases. The outcome was favorable, with a complete renal function recovery for 28 patients. Poor prognosis was related to two factors: age over 38 years and advanced stage of AKI according to RIFLE classification. Conclusion. Prevention of PRAKI requires an improvement of the sanitary infrastructures with the implementation of an obligatory prenatal consultation.

  2. United States stock market performance and acute myocardial infarction rates in 2008-2009 (from the Duke Databank for Cardiovascular Disease).

    Science.gov (United States)

    Fiuzat, Mona; Shaw, Linda K; Thomas, Laine; Felker, G Michael; O'Connor, Christopher M

    2010-12-01

    We sought to examine the relation between the United States economic decrease in 2008 and cardiovascular events as measured by local acute myocardial infarction (AMI) rates. Mental stress and traumatic events have been shown to be associated with increased risk of MI in patients with ischemic heart disease. This was an observational study of data from the Duke Databank for Cardiovascular Disease and includes patients undergoing angiography for evaluation of ischemic heart disease from January 2006 to July 2009. Patients with AMI occurring within 3 days before catheterization were used to calculate AMI rates. Stock market values were examined to determine the period of severe economic decrease, and time trends in AMI rates were examined over the same period. Time series models were used to assess the relation between United States stock market National Association of Securities Dealers Automated Quotation (NASDAQ) and rates of AMI. Of 11,590 patients included in the study cohort, 2,465 patients had an AMI during this period. Time series analysis showed a significant increase in AMI rates during a period of stock market decrease from October 2008 to April 2009 (p = 0.003), which remained statistically significant when adjusted for seasons (p = 0.02). In conclusion, unadjusted and adjusted analyses of patients in the Duke Databank for Cardiovascular Disease indicated a significant correlation between a period of stock market decrease and increased AMI rates in our local cohort.

  3. Community Psychiatric Rehabilitation in Israel.

    Science.gov (United States)

    Levy, Amihay; Neumann, Micha

    1988-01-01

    This paper describes the development of community-based rehabilitation services for persons with mental illness in Israel. It focuses on occupational, social, and residential community psychiatric rehabilitation services. The paper argues that service development has been slow and out of step with the philosophy and objectives of community…

  4. Paraphilias in adult psychiatric inpatients.

    Science.gov (United States)

    Marsh, Patrick J; Odlaug, Brian L; Thomarios, Nick; Davis, Andrew A; Buchanan, Stephanie N; Meyer, Craig S; Grant, Jon E

    2010-05-01

    The goal of the present study was to examine the prevalence of paraphilias in an adult inpatient psychiatric population. One hundred twelve consecutive, voluntarily admitted, adult male psychiatric inpatients were administered the Structured Clinical Interview for DSM-IV, Sexual Disorders Module, Male Version, to assess the rates of DSM-IV paraphilias. Fifteen patients (13.4%) reported symptoms consistent with at least one lifetime DSM-IV paraphilia. The most common paraphilias were voyeurism (n = 9 [8.0%]), exhibitionism (n = 6 [5.4%]), and sexual masochism (n = 3 [2.7%]). Patients who screened positive for a paraphilia had significantly more psychiatric hospitalizations (P = .006) and, on a trend level, were more likely to have attempted suicide. In addition, patients with paraphilias were significantly more likely to report having been sexually abused than patients without a paraphilia (P = paraphilia. Paraphilias appear to be more common in adult male psychiatric inpatients than previously estimated. The study also demonstrated that these disorders were not screened for by the treating physician and thus may go untreated. Further, larger-scale studies are necessary in order to further examine the rates of these disorders in the general population.

  5. Dyspepsia in chronic psychiatric patients

    NARCIS (Netherlands)

    Mookhoek, E.J.; Meijs, V.M.M.; Loonen, A.J.M.; Leufkens, H.G.M.

    2005-01-01

    Introduction: We report on dyspeptic complaints among patients hospitalized in the long-stay ward of a general psychiatric hospital. Methods: A representative sample of the patients was interviewed using a structured questionnaire. Results: Eighty percent of the patients reported one or more symptom

  6. Job satisfaction in psychiatric nursing.

    Science.gov (United States)

    Ward, M; Cowman, S

    2007-08-01

    In recent years, mental health services across Europe have undergone major organizational change with a move from institutional to community care. In such a context, the impact of change on the job satisfaction of psychiatric nurses has received little attention in the literature. This paper reports on the job satisfaction of psychiatric nurses and data were collected in 2003. The population of qualified psychiatric nurses (n = 800) working in a defined geographical health board area was surveyed. Methodological triangulation with a between-methods approach was used in the study. Data were collected on job satisfaction using a questionnaire adopted from the Occupational Stress Indicator. A response rate of 346 (43%) was obtained. Focus groups were used to collect qualitative data. Factors influencing levels of job satisfaction predominantly related to the nurses work location. Other factors influencing job satisfaction included choice of work location, work routine, off duty/staff allocation arrangements, teamwork and working environment. The results of the study highlight to employers of psychiatric nurses the importance of work location, including the value of facilitating staff with choices in their working environment, which may influence the recruitment and retention of nurses in mental health services.

  7. Restless Legs Syndrome and Psychiatric Disorders.

    Science.gov (United States)

    Mackie, Susan; Winkelman, John W

    2015-09-01

    There are strong epidemiologic ties between restless legs syndrome (RLS) and a wide array of psychiatric conditions. Although the mechanism of this association is not fully understood, there are likely bidirectional cause-and-effect relationships. Appreciation of psychiatric comorbidity is an essential component of the treatment of RLS. Clinicians should be prepared to facilitate appropriate psychiatric treatment and consider the complex interactions between psychiatric medications, RLS medications, and the clinical course of both illnesses.

  8. Descripción de la consulta psiquiátrica en centros penitenciarios de la Comunidad Valenciana Description of the psychiatric unit in prisons in the Autonomous Community of Valencia

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    F. Arnau-Peiró

    2012-10-01

    Full Text Available Introducción: Existen pocos trabajos sobre el contenido de las consultas psiquiátricas en las prisiones. Objetivos: Explorar el perfil sociodemográfico, clínico y de tratamiento de los pacientes valorados en la consulta psiquiátrica de tres centros penitenciarios. Métodos: Estudio epidemiológico multicéntrico, descriptivo, longitudinal, y prospectivo de los pacientes valorados en la consulta psiquiátrica de tres prisiones de la Comunidad Valenciana durante 2009, 2010 y 2011. Se obtuvieron variables clínicas, sociodemográficas y penitenciarias de cada paciente. Las frecuencias se compararon mediante la Ji² de Pearson y las medias por el test de ANOVA o el método de Kruskall-Wallis. Se calculó la probabilidad de mantenerse en agenda psiquiátrica mediante curvas de Kaplan-Meier, estableciéndose las diferencias con el método de Mantel-Haenzsel (Logrank. Se diseñó un modelo de regresión logística para determinar las variables asociadas a hiperfrecuentación. Resultados: Se valoraron 786 pacientes en 2.006 consultas (2,5 visitas/paciente. El 90% eran varones y el 88,2% españoles, con una edad media de 36,0 años. El 29,9% tenían patología infecciosa crónica asociada. El 69,5% consume algún tipo de sustancia. El 59,2% sufría un trastorno de personalidad y el 11,6% del espectro de la esquizofrenia. Los cuadros clínicos más frecuentes fueron; 49,1% cuadros ansiosos, 20,8% depresivos y 11,7% síntomas psicóticos. Los trastornos psicóticos supusieron 1,5 veces más probabilidad (IC 95%; 1,1-1,9 de mantenerse más tiempo en agenda. Los fármacos más prescritos fueron quetiapina, mirtazapina, pregabalina y diacepam. Conclusiones: Los trastornos mentales en prisión son muy prevalentes. Es necesario potenciar los recursos disponibles para una adecuada atención de estas patologías.Introduction: Little work has been done on the contents of psychiatric consultancies in prisons. Aims: To explore the sociodemographic, clinical and

  9. Cutaneous factitia in elderly patients: alarm signal for psychiatric disorders

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    Chiriac A

    2014-03-01

    Full Text Available Anca Chiriac,1 Liliana Foia,2 Cristina Birsan,1 Ancuta Goriuc,2 Caius Solovan3 1Department of Dermatology, Nicolina Medical Center, Iaşi, Romania; 2Surgical Department, Grigore T Popa University of Medicine and Pharmacy, Iaşi, Romania; 3Department of Dermatology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania Background: The factitious disorders, more commonly known in daily practice as pathomimia, are expressed in dermatology units by skin lesions induced voluntarily by the patient, in order to draw attention of the medical staff and/or the family members. The disorder is often challenging to diagnose and even more difficult to document in front of the patient or relatives. It represents a challenge for the physician, and any attempt at treatment may be followed by recurrence of the self-mutilation. This paper describes two cases of pathomimia diagnosed by dermatologists and treated in a psychiatry unit, highlighting the importance of collaboration in these situations. Patients and methods: Two case reports, describing old female patients with pathomimia, hospitalized in a department of dermatology for bizarre skin lesions. Results: The first case was a 77-year-old female with unknown psychiatric problems and atrophic skin lesions on the face, self-induced for many months, with multiple hospitalizations in dermatology units, with no response to different therapeutic patterns, and full recovery after psychiatric treatment for a major depressive syndrome. The second case was a 61-year-old female patient with disseminated atrophic scars on the face, trunk, and limbs. She raised our interest because of possible psychiatric issues, as she had attempted to commit suicide. The prescription of antidepressants led to a significant clinical improvement. Conclusion: These cases indicate that a real psychiatric disease may be recorded in patients suffering from pathomimia. Therefore, complete psychiatric evaluation in order to

  10. Dilemmas in private psychiatric practice

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    Nanasaheb M Patil

    2011-01-01

    Full Text Available Background: A practicing psychiatrist faces dilemmas on a number of occasions, in deciding the best course of action he/she needs to undertake while treating a patient. At times, this choice may not be in accordance with the ethical and moral principles and may in fact appear to violate patient′s autonomy and rights. Aim: To study the nature of psychiatric practice by the practicing psychiatrist in the areas of admission, discharge, consent, physical restraint, electroconvulsive therapy (ECT, certification, treatment, suicide and psychotherapy. Settings and Design: Cross-sectional observational study. Materials and Methods: Forty-eight psychiatrists gave consent to participate in the study. A special proforma was prepared, which addresses the common dilemmas in the clinical psychiatric practice. All the psychiatrists were given specially designed profoma and were requested to fill the proforma with appropriate answers. Statistical analysis was done using SPSS software. Results: There were 42 male and 6 female psychiatrists. The age of the psychiatrists ranged from 28 to 65 years with a mean of 43.08 years. The mean duration of practice of these psychiatrists was 14.81΁11.07 years. Question and answers related to admission, discharge, consent, physical restraint, ECT, certification, treatment, suicide and psychotherapy are discussed. Conclusions: The present standard and practice especially in private psychiatric set-up does not confirm to the rules, recommendations, and regulations suggested by Mental Health Act 1987, Mental Health Authorities and various guidelines of practice. Indian Psychiatric Society and other professional bodies need to take steps to prepare guidelines for a good psychiatric practice.

  11. [THE CLINICAL ORGANIZATIONAL SUBSTANTIATION OF NEW TECHNOLOGY OF HOSPITAL PSYCHIATRIC CARE].

    Science.gov (United States)

    Podsevatkin, V G; Blinov, D S; Podsevatkin, D V; Podsevatkina, S V; Smirnova, O A

    2015-01-01

    The new technology of hospital psychiatric care, developed and implemented in the Mordovia republican clinical hospital, permits resolving problems of hospitalism, lethality, pharmaceutical resistance and others. The essence of this technology is in staging of hospital care under condition of intensification and standardization of curative diagnostic process, implementation of complex approach to treatment of psychiatric disorders. The patient sequentially passes through three stages: intensive diagnostics and intensive treatment (intensive care department, intensive therapy department), supportive therapy (general psychiatric department); rehabilitation measures (curative rehabilitative department). The concentration of resources at the first stage, application of intensive therapy techniques permit in the shortest period to arrest acute psychotic symptomatic. The described new technology of hospital psychiatric care permits enhancing effectiveness of treatment, significantly shorten period of hospitalization (37.5 days), to obtain lasting and qualitative remission, to rehabilitate most fully social working status of patient and to significantly decrease lethality.

  12. Knowledge of nurses at a psychiatric hospitalization unit of a teaching hospital Saberes de los enfermeros en una unidad de internación psiquiátrica en un hospital universitario Saberes dos enfermeiros em uma unidade de internação psiquiátrica de um hospital universitário

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    Agnes Olschowsky

    2007-08-01

    Full Text Available This study aims to identify the knowledge of the nurses in a psychiatric hospitalization unit at a university hospital. It is an exploratory, descriptive research with a qualitative approach, utilizing semistructured interviews. The nurses refer to a change in the assisting care, starting from their experience in the asylum mode and making references to the concepts of the psychosocial mode: integrality, welcoming, interdisciplinarity and interpersonal relationship. Integral and individual care, knowledge of the psychiatric syndromes and their treatment as well as the consideration of the subjectivity of the subject under psychiatric suffering are part of the knowledge that guides nursing actions in mental health.Este estudio tiene por objetivo identificar los saberes de los enfermeros en una unidad de internación psiquiátrica en un hospital universitario. Se trata de una investigación exploratoria, descriptiva, con aproximación cualitativa, utilizando la entrevista semi-estructurada. Los enfermeros refieren una transformación en el cuidado asistencial a partir de su experiencia en el modo asilar, haciendo referencias a las concepciones del modo psicosocial: integralidad, acogida, interdisciplinaridad y relación interpersonal. El cuidado integral e individual, el conocimiento de los síndromes psiquiátricos y su tratamiento y la consideración de la subjetividad del individuo bajo sufrimiento psíquico son formas del saber que orientan las acciones de la enfermería en salud mental.Este estudo tem o objetivo de identificar os saberes dos enfermeiros em uma unidade de internação psiquiátrica em um hospital universitário. Trata-se de pesquisa exploratório-descritiva, com abordagem qualitativa, utilizando a entrevista semi-estruturada. Os enfermeiros relatam transformação no cuidado assistencial a partir de sua experiência no modo asilar, fazendo referências às concepções do modo psicossocial: integralidade, acolhimento

  13. Predicting psychiatric symptoms among homeless people.

    Science.gov (United States)

    Calsyn, R J; Morse, G A

    1992-10-01

    Multiple regression was used to predict psychiatric symptoms among homeless people. The following variables were significant predictors of psychiatric symptoms: current life satisfaction, previous psychiatric hospitalization, the number of stressful life events, social support, problem drinking, and childhood unhappiness. The results are discussed in terms of their policy and practice implications, particularly the need for crisis intervention services and for dual-diagnosed clients.

  14. The psychoactive effects of psychiatric medication: the elephant in the room.

    Science.gov (United States)

    Moncrieff, Joanna; Cohen, David; Porter, Sally

    2013-01-01

    The psychoactive effects of psychiatric medications have been obscured by the presumption that these medications have disease-specific actions. Exploiting the parallels with the psychoactive effects and uses of recreational substances helps to highlight the psychoactive properties of psychiatric medications and their impact on people with psychiatric problems. We discuss how psychoactive effects produced by different drugs prescribed in psychiatric practice might modify various disturbing and distressing symptoms, and we also consider the costs of these psychoactive effects on the mental well-being of the user. We examine the issue of dependence, and the need for support for people wishing to withdraw from psychiatric medication. We consider how the reality of psychoactive effects undermines the idea that psychiatric drugs work by targeting underlying disease processes, since psychoactive effects can themselves directly modify mental and behavioral symptoms and thus affect the results of placebo-controlled trials. These effects and their impact also raise questions about the validity and importance of modern diagnosis systems. Extensive research is needed to clarify the range of acute and longer-term mental, behavioral, and physical effects induced by psychiatric drugs, both during and after consumption and withdrawal, to enable users and prescribers to exploit their psychoactive effects judiciously in a safe and more informed manner.

  15. Prevalence, management, and outcomes of patients with coagulopathy after acute nonvariceal upper gastrointestinal bleeding in the United Kingdom.

    Science.gov (United States)

    Jairath, Vipul; Kahan, Brennan C; Stanworth, Simon J; Logan, Richard F A; Hearnshaw, Sarah A; Travis, Simon P L; Palmer, Kelvin R; Murphy, Michael F

    2013-05-01

    Coagulopathy after major hemorrhage has been found to be an independent risk factor for mortality after traumatic bleeding. It is unclear whether similar associations are present in other causes of major hemorrhage. We describe the prevalence, use of plasma, and outcomes of patients with coagulopathy after acute nonvariceal upper gastrointestinal bleeding (NVUGIB). This study was a multicenter UK national audit. Data were collected prospectively on consecutive admissions with upper gastrointestinal bleeding over a 2-month period to 212 UK hospitals. Coagulopathy was defined as an international normalized ratio (INR) of at least 1.5. Logistic regression was used to examine the relationship between coagulopathy and patient-related outcome measures of mortality, rebleeding, and need for surgery and/or radiologic intervention. A total of 4478 patients were included in the study. Coagulopathy was present in 16.4% (444/2709) of patients in whom an INR was recorded. Patients with coagulopathy were more likely to present with hemodynamic shock (45% vs. 36%), have a higher clinical Rockall score (4 vs. 2), receive red blood cell transfusion (79% vs. 48%) and have high-risk stigmata of hemorrhage at endoscopy (34% vs. 25%). After adjustment for confounders the presence of a coagulopathy was associated with a fivefold increased in the odds of mortality (odds ratio, 5.63; 95% confidence interval, 3.09-10.27; p < 0.001). Only 35% of patients with coagulopathy received fresh-frozen plasma transfusion. Coagulopathy was prevalent in 16% of patients after NVUGIB and independently associated with more than a fivefold increase in the odds of in-hospital mortality. Wide variation in plasma use exists indicates clinical uncertainty regarding optimal practice. © 2012 American Association of Blood Banks.

  16. A clinical training unit for diarrhoea and acute respiratory infections: an intervention for primary health care physicians in Mexico.

    Science.gov (United States)

    Bojalil, R; Guiscafré, H; Espinosa, P; Viniegra, L; Martínez, H; Palafox, M; Gutiérrez, G

    1999-01-01

    In Tlaxcala State, Mexico, we determined that 80% of children who died from diarrhoea or acute respiratory infections (ARI) received medical care before death; in more than 70% of the cases this care was provided by a private physician. Several strategies have been developed to improve physicians' primary health care practices but private practitioners have only rarely been included. The objective of the present study was to evaluate the impact of in-service training on the case management of diarrhoea and ARI among under-5-year-olds provided by private and public primary physicians. The training consisted of a five-day course of in-service practice during which physicians diagnosed and treated sick children attending a centre and conducted clinical discussions of cases under guidance. Each training course was limited to six physicians. Clinical performance was evaluated by observation before and after the courses. The evaluation of diarrhoea case management covered assessment of dehydration, hydration therapy, prescription of antimicrobial and other drugs, advice on diet, and counselling for mothers; that of ARI case management covered diagnosis, decisions on antimicrobial therapy, use of symptomatic drugs, and counselling for mothers. In general the performance of public physicians both before and after the intervention was better than that of private doctors. Most aspects of the case management of children with diarrhoea improved among both groups of physicians after the course; the proportion of private physicians who had five or six correct elements out of six increased from 14% to 37%: for public physicians the corresponding increase was from 53% to 73%. In ARI case management, decisions taken on antimicrobial therapy and symptomatic drug use improved in both groups; the proportion of private physicians with at least three correct elements out of four increased from 13% to 42%, while among public doctors the corresponding increase was from 43% to 78%. Hands

  17. ELECTROCONVULSIVE THERAPY AMONG ADOLESCENT PSYCHIATRIC PATIENTS- A RETROSPECTIVE STUDY

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    Lakshimi Borgohain

    2017-05-01

    Full Text Available BACKGROUND Electroconvulsive Therapy (ECT among adolescent psychiatric patient is rarely used and studies in this regard are also rare, while its need is of great importance. Aim of this study was to study the prevalence of ECT in common psychiatric illnesses among adolescent age group, where it is indicated and outcome of ECT in those psychiatric patients. MATERIALS AND METHODS All data were collected retrospectively from the chart review for those adolescents aged between 12 to 18 years who received ECT during the period of 2008 - 2012. During the study period a total of 554 patients received ECT, among whom 104 were adolescents. RESULTS Adolescent patients were 18.77% in the whole ECT sample; the average age of the adolescents was 16.33 years and number of patients were more with older age. Among all the patients, 48.08% had positive family history of mental illness and 81.73% were from lower Socioeconomic Class. The use of ECT was more with schizophrenia (n= 63, 60.57% and acute and transient psychotic disorder (n= 30, 28.85%. The most common indication was agitation and aggression (n= 29, 27.88% followed by poor medication response (n= 19, 18.27%. Good response is found in most of the cases (n= 88, 84.62%, only a few percentage of cases showed minor and transient adverse event. CONCLUSION The result of our study suggests that prevalence of ECT among adolescent psychiatric patients is quite high and ECT is a safe and effective method of treatment in the adolescent psychiatric patients, especially those patients who are severely ill and poorly responding to medication.

  18. Psychiatric morbidity in dermatology patients: Frequency and results of consultations

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    Seyhan Muammer

    2006-01-01

    Full Text Available BACKGROUND: Dermatological patients quite commonly depict psychiatric morbidity. PURPOSES: To study the psychiatric morbidity among skin patients of our clinic. METHODS: In the present study, the patients who were treated in the Dermatology Clinic of Inonu University Medical Faculty were evaluated retrospectively. The age, gender, marital status, habits, dermatological and systemic diseases, previously used drugs, current therapy and psychiatric diagnosis of each patient were recorded. FINDINGS: Of 636 patients involved in the study, 15.3% had psychopathological problems, which were depression (32.0%, adjustment difficulty (15.5%, anxiety (13.4%, psychosomatic disorders (10.3%, obsessive-compulsive disorder and conversion (5.1%, dysthymic disorder (4.1%, attention deficit and hyperactivity disorder (2.1%, panic attack (1.0%, premenstrual syndrome, schizophrenia, somatization disorder, insomnia, alcohol dependency, bipolar affective disorder, mental retardation, agoraphobia, social phobia and dementia. The dermatological diseases defined for the patients with psychopathology diagnosis were chronic urticaria (25.8%; psoriasis (15.5%; alopecia areata, totalis and iniversalis (11.3%; acute urticaria, neurodermatitis and Behcet′s disease (5.1%; atopic dermatitis and drug eruptions (4.1%; pemphigus (3.1%; angioedema, contact dermatitis and generalized pruritus (2.1%; folliculitis and the others (1.0%. CONCLUSIONS: Psychiatric morbidity has an affect on the course of dermatological diseases. When required, psychiatric consultation should be sought by dermatology clinics and patients should be followed with the cooperation of dermatologists and psychiatrists. LIMITATION: The indoor-based study had not included any control group and any domicillary patient.

  19. The Effect of an Electronic SBAR Communication Tool on Documentation of Acute Events in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Panesar, Rahul S; Albert, Ben; Messina, Catherine; Parker, Margaret

    2016-01-01

    The Situation, Background, Assessment, Recommendation (SBAR) handoff tool is designed to improve communication. The effects of integrating an electronic medical record (EMR) with a SBAR template are unclear. The research team hypothesizes that an electronic SBAR template improves documentation and communication between nurses and physicians. In all, 84 patient events were recorded from 542 admissions to the pediatric intensive care unit. Three time periods were studied: (a) paper documentation only, (b) electronic documentation, and (c) electronic documentation with an SBAR template. Documentation quality was assessed using a 4-point scoring system. The frequency of event notes increased progressively during the 3 study periods. Mean quality scores improved significantly from paper documentation to EMR free-text notes and to electronic SBAR-template notes, as did nurse and attending physician notification. The implementation of an electronic SBAR note is associated with more complete documentation and increased frequency of documentation of communication among nurses and physicians.

  20. Rising United States Hospital Admissions for Acute Bacterial Skin and Skin Structure Infections: Recent Trends and Economic Impact.

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    Keith S Kaye

    Full Text Available The number of ambulatory patients seeking treatment for skin and skin structure infections (SSSI are increasing. The objective of this study is to determine recent trends in hospital admissions and healthcare resource utilization and identify covariates associated with hospital costs and mortality for hospitalized adult patients with a primary SSSI diagnosis in the United States.We performed a retrospective cross-sectional analysis (years 2005-2011 of data from the US Healthcare Cost and Utilization Project National Inpatient Sample. Recent trends, patient characteristics, and healthcare resource utilization for patients hospitalized with a primary SSSI diagnosis were evaluated. Descriptive and bivariate analyses were conducted to assess patient and hospital characteristics.A total of 1.8% of hospital admissions for the years 2005 through 2011 were for adult patients with a SSSI primary diagnosis. SSSI-related hospital admissions significantly changed during the study period (P < .001 for trend ranging from 1.6% (in 2005 to 2.0% (in 2011. Mean hospital length of stay (LOS decreased from 5.4 days in the year 2005 to 5.0 days in the year 2011 (overall change, P < .001 with no change in hospital costs. Patients with postoperative wound infections had the longest hospital stays (adjusted mean, 5.81 days; 95% confidence interval (CI, 5.80-5.83 and highest total costs (adjusted mean, $9388; 95% CI, $9366-$9410. Year of hospital admission was strongly associated with mortality; infection type, all patient refined diagnosis related group severity of illness level, and LOS were strongly associated with hospital costs.Hospital admissions for adult patients in the United States with a SSSI primary diagnosis continue to increase. Decreasing hospital inpatient LOS and mortality rate may be due to improved early treatment. Future research should focus on identifying alternative treatment processes for patients with SSSI that could shift management from

  1. Profile and outcome of patients with acute toxicity admitted in intensive care unit: Experiences from a major corporate hospital in urban India

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    Omender Singh

    2011-01-01

    Full Text Available Background and Aim: There is scarcity of data from the Indian subcontinent regarding the profile and outcome of patients presenting with acute poisoning admitted to intensive care units (ICU. We undertook this retrospective analysis to assess the course and outcome of such patients admitted in an ICU of a tertiary care private hospital. Methods: We analyzed data from 138 patients admitted to ICU with acute poisoning between July 2006 and March 2009. Data regarding type of poisoning, time of presentation, reason for ICU admission, ICU course and outcome were obtained. Results: Seventy (50.7% patients were males and majority (47.8% of admissions were from age group 21 to 30 years. The most common agents were benzodiazepines, 41/138 (29.7%, followed by alcohol, 34/138 (24.63% and opioids, 10/138 (7.2%. Thirty-two (23% consumed two or more agents. Commonest mode of toxicity was suicidal (78.3% and the route of exposure was mainly oral (97.8%. The highest incidence of toxicity was due to drugs (46.3% followed by household agents (13%. Organ failure was present in 67 patients (48.5%. During their ICU course, dialysis was required in four, inotropic support in 14 and ventilator support in 13 patients. ICU mortality was 3/138 (2.8%. All deaths were due to aluminium phosphide poisoning. Conclusions: The present data give an insight into epidemiology of poisoning and represents a trend in urban India. The spectrum differs as we cater to urban middle and upper class. There is an increasing variety and complexity of toxins, with substance abuse attributing to significant number of cases.

  2. Management of acute ST-elevation myocardial infarction in the coronary care units of Piedmont in 2005: results from the PRIMA regionwide survey.

    Science.gov (United States)

    Steffenino, Giuseppe; Chinaglia, Alessandra; Millesimo, Giorgio; Gnavi, Roberto; Picariello, Roberta; Orlando, Anna

    2008-02-01

    In Piedmont (north-western Italy) a network for emergency treatment of acute ST-elevation myocardial infarction is being implemented. To provide a baseline for care assessment and quality improvement, a regionwide survey was conducted. We describe the clinical characteristics, treatment and outcomes of patients admitted to the coronary care units (CCUs) of the Regional Health System. All patients with acute ST-elevation myocardial infarction study. Of 818 patients (28.1% female, mean age 66 +/- 12 years), 14.3% had diabetes mellitus and 39.7% anterior myocardial infarction; 77% had their first medical contact within 3 h of symptom onset, and 53% reached full-time interventional CCUs. The 118 emergency medical system was used by 50% of patients. Median door-to-electrocardiogram time was 9 min (case for the absence of reperfusion treatment (odds ratio 2.16; 95% confidence interval 1.17-4.02), TIMI risk index >33 (odds ratio 6.78; 95% confidence interval 3.70-12.40), and chronic renal failure (odds ratio 4.96; 95% confidence interval 1.82-13.55). In Piedmont, candidates for myocardial reperfusion treatment admitted to the CCUs of the Regional Health System are about 600 per million inhabitants/year. The 118 emergency medical system is used by about half of them, and medical contact occurs within 3 h of symptom onset in most cases. Use of reperfusion treatment is frequent, the choice is related to on-site availability rather than to risk profile, and door-to-treatment times can be improved. Use of emergency transfer is limited, poorly selected, and slow.

  3. Intermittent versus continuous renal replacement therapy for acute kidney injury patients admitted to the intensive care unit: results of a randomized clinical trial.

    Science.gov (United States)

    Lins, Robert L; Elseviers, Monique M; Van der Niepen, Patricia; Hoste, Eric; Malbrain, Manu L; Damas, Pierre; Devriendt, Jacques

    2009-02-01

    There is uncertainty on the effect of different dialysis modalities for the treatment of patients with acute kidney injury (AKI), admitted to the intensive care unit (ICU). This controlled clinical trial performed in the framework of the multicentre SHARF 4 study (Stuivenberg Hospital Acute Renal Failure) aimed to investigate the outcome in patients with AKI, stratified according to severity of disease and randomized to different treatment options. This was a multicentre prospective randomized controlled trial with stratification according to severity of disease expressed by the SHARF score. ICU patients were eligible for inclusion when serum creatinine was >2 mg/dL, and RRT was initiated. The selected patients were randomized to intermittent (IRRT) or continuous renal replacement therapy (CRRT). A total of 316 AKI patients were randomly assigned to IRRT (n = 144) or CRRT (n = 172). The mean age was 66 (range 18-96); 59% were male. Intention-to-treat analysis revealed a mortality of 62.5% in IRRT compared to 58.1% in CRRT (P = 0.430). No difference between IRRT and CRRT could be observed in the duration of ICU stay or hospital stay. In survivors, renal recovery at hospital discharge was comparable between both groups. Multivariate analysis, including the SHARF score, APACHE II and SOFA scores for correction of disease severity, showed no difference in mortality between both treatment modalities. This result was confirmed in pre-specified subgroup analysis (elderly, patients with sepsis, heart failure, ventilation) and after exclusion of possible confounders (early mortality, delayed ICU admission). Modality of RRT, either CRRT or IRRT, had no impact on the outcome in ICU patients with AKI. Both modalities need to be considered as complementary in the treatment of AKI (Clinical Trial: SHARF 4, NCT00322933, http://ClinicalTrials.gov).

  4. Prevalence, risk factors, clinical course, and outcome of acute kidney injury in Chinese intensive care units: a prospective cohort study

    Institute of Scientific and Technical Information of China (English)

    WEN Ying; JIANG Li; XU Yuan; QIAN Chuan-yun; LI Shu-sheng; QIN Tie-he; CHEN Er-zhen

    2013-01-01

    Background Acute kidney injury (AKI) has been recognized as a major healthcare problem affecting millions of patients worldwide.However,epidemiologic data concerning AKI in China are still lacking.The objectives of this study were to characterize AKI defined by RIFLE criteria,assess the association with hospital mortality,and evaluate the impact of AKI in the context of other risk factors.Methods This prospective multicenter observational study enrolled 3,063 consecutive patients from 1 July 2009 to 31 August 2009 in 22 ICUs across mainland China.We excluded patients who were admitted for less than 24 hours (n=1623),younger than 18 years (n=127),receiving chronic hemodialysis (n=29),receiving renal transplantation (n=1) and unknown reasons (n=28).There were 1255 patients in the final analysis.AKI was diagnosed and classified according to RIFLE criteria.Results There were 396 patients (31.6%) who had AKI,with RIFLE maximum class R,I,and F in 126 (10.0%),91 (7.3%),and 179 (14.3%) patients,respectively.Renal function deteriorated in 206 patients (16.4%).In comparison with non AKI patients,patients in the risk class on ICU admission were more likely to progress to the injury class (odds ratio (OR) 3.564,95% confidence interval (CI) 1.706-7.443,P =0.001],while patients in the risk class (OR 5.215,95% CI 2.798-9.719,P <0.001) and injury class (OR 13.316,95% CI 7.507-23.622,P <0.001) had a significantly higher probability of deteriorating into failure class.The adjusted hazard ratios for 90-day mortality were 1.884 for the risk group,3.401 for the injury group,and 5.306 for the failure group.Conclusions The prevalence of AKI was high among critically ill patients in Chinese ICUs.In comparison with non-AKI patients,patients with RIFLE class R or class I on ICU admission were more susceptibility to progression to class I or class F.The RIFLE criteria were robust and correlated well with clinical deterioration and mortality.

  5. A Q fever outbreak in a psychiatric care institution in The Netherlands

    NARCIS (Netherlands)

    Koene, R.P.M.; Schimmer, B.; Rensen, H.; Biesheuvel, M.; Bruin, A. de; Lohuis, A.; Horrevorts, A.; Lunel, F.V.; Delsing, C.E.; Hautvast, J.L.A.

    2011-01-01

    In May 2008 the Nijmegen Municipal Health Service (MHS) was informed about an outbreak of atypical pneumonia in three in-patients of a long-term psychiatric institution. The patients had been hospitalized and had laboratory confirmation of acute Q fever infection. The MHS started active case finding

  6. The relationship between substance use and exit security on psychiatric wards

    NARCIS (Netherlands)

    Simpson, A.; Bowers, L.; Allan, T.; Haglund, K.; Muir-Cochrane, E.; Nijman, H.L.I.; Merwe, M. van der

    2011-01-01

    Aim. In this paper we report on the rates of drug/alcohol use on acute psychiatric wards in relation to levels and intensity of exit security measures. Background. Many inpatient wards have become permanently locked, with staff concerned about the risk of patients leaving the ward and harming

  7. Psychiatric diseases: Need for an increased awareness among the anesthesiologists

    OpenAIRE

    Sukhminder Jit Singh Bajwa; Ravi Jindal; Jasbir Kaur; Amarjit Singh

    2011-01-01

    Psychological disorders and psychiatric diseases have been on the rise since the last three decades. An increasing number of such patients are encountered nowadays for elective or emergency surgery. A multi-array of challenges are faced while anesthetizing these patients or treating them in an intensive care unit. The problems include the deteriorated mental physiology, altered cognition and the possible drug interactions with psychotropic medications. The challenge starts from the preoperati...

  8. Occurrence of comorbid substance use disorders among acute ...

    African Journals Online (AJOL)

    some patients, the mental disorder and substance use might ... Therefore, this study was conducted to examine the prevalence of SUD among acute adult psychiatric inpatients at Stikland Hospital .... Substance induced anxiety disorders. 0.

  9. Recollected experiences of first hospitalisation for acute psychosis ...

    African Journals Online (AJOL)

    psychiatric hospital admission for acute psychosis of people diagnosed with schizophrenia. ..... having his basic needs met by others. Note that .... participants have strong emotional requirements of the nursing staff. The nurse-patient ...

  10. Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit.

    Science.gov (United States)

    Harwood, Rowan H; Goldberg, Sarah E; Whittamore, Kathy H; Russell, Catherine; Gladman, John Rf; Jones, Rob G; Porock, Davina; Lewis, Sarah A; Bradshaw, Lucy E; Elliot, Rachel A

    2011-05-13

    Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function, disability, behavioural and

  11. Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit

    Directory of Open Access Journals (Sweden)

    Gladman John RF

    2011-05-01

    Full Text Available Abstract Background Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. Methods/design We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home, or days spent in the same care home (if admitted from a care home. Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of

  12. Bilateral thalamic infarction with psychiatric symptoms: case report

    Directory of Open Access Journals (Sweden)

    Betül Tekin Güveli

    2016-04-01

    Full Text Available Introduction: Thalamus is a mass of gray matter, which plays a role in the transmission of sensory and motor information to the primary sensory and motor centers of the cerebral cortex, cerebellum and basal ganglia. Vascular lesions of thalamus may occur in different syndromes depending on the affected nuclei. In this report, a case with acute evolving personality and behavior changes and detected bilateral thalamic infarction will be presented. Case: A 40-year-old male patient was brought to the psychiatric ER with complaints of acute excessive sleep and behavioral changing. His neurological examination was normal except for limited cooperation and dysarthria. There was hyperintensity in bilateral paramedian thalamic regions in diffusion MRI and hypointensity in the right side in the ADC. During clinical observation the patient occasionally had visual hallucinations and attempted suicide. The psychiatrist diagnosed the patient with psychotic disorder due to his general medical condition and olanzapine 10 mg / day was prescribed. Etiological tests were normal. The patient was discharged after clinical improvement on the tenth day of hospitalization. Conclusion: Bilateral thalamic infarcts are very rare in all ischemic cerebrovascular diseases and typically result in changing of consciousness, gaze palsy and memory. The most common etiological cause of bilateral thalamic infarct is cardioembolism and the prognosis is generally good. Thalamic infarcts have a clinical spectrum varying according to the location of the lesion and may even just be present with psychiatric symptoms. In acute or subacute personality and behavior changes in a patient with no history of psychiatric disorders, thalamic lesions should be considered.

  13. Early Mobilization Reduces Duration of Mechanical Ventilation and Intensive Care Unit Stay in Patients With Acute Respiratory Failure.

    Science.gov (United States)

    Lai, Chih-Cheng; Chou, Willy; Chan, Khee-Siang; Cheng, Kuo-Chen; Yuan, Kuo-Shu; Chao, Chien-Ming; Chen, Chin-Ming

    2017-05-01

    To evaluate the effects of a quality improvement program to introduce early mobilization on the outcomes of patients with mechanical ventilation (MV) in the intensive care unit (ICU). A retrospective observational study. Nineteen-bed ICU at a medical center. Adults patients with MV (N=153) admitted to a medical ICU. A multidisciplinary team (critical care nurse, nursing assistant, respiratory therapist, physical therapist, patient's family) initiated the protocol within 72 hours of MV when patients become hemodynamically stable. We did early mobilization twice daily, 5d/wk during family visits (30min each time), and cooperated with family, if possible. MV duration, rate of successful weaning, and length of ICU and hospital stay. We enrolled 63 patients in the before protocol group and 90 in the after protocol group. The 2 groups were well matched in age, sex, body height, body weight, body mass index, disease severity, cause of intubation, number of comorbidities, and most underlying diseases. After protocol group patients had shorter MV durations (4.7d vs 7.5d; PICU stays (6.9d vs 9.9d; P=.001) than did before protocol group patients. Early mobilization was negatively associated with the duration of MV (β=-.269; PICU shortened MV durations and ICU stays. A multidisciplinary team that includes the patient's family can work together to improve the patient's clinical outcomes. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  14. Involuntary First Admissions to a Tertiary Psychiatric Hospital in Cape Town: A Five Year Review of Family Referrals to Psychology

    Directory of Open Access Journals (Sweden)

    Thornton HB

    2015-10-01

    Full Text Available Background: Valkenberg Hospital is one of three tertiary psychiatric hospitals in Cape Town – and has a catchment area population of over one million. It is an acute admissions hospital for adults (18-59 years. Objectives: This article aimed to determine the psychosocial history of male patients involuntarily admitted to a high care psychiatric unit for the first time, and the needs and concerns of their families, to allow for the development of more appropriate services. Method: The psychology family clerking interviews (June 2007 – June 2012 of the Male High Care Unit (MHCU of Valkenberg Psychiatric Hospital’s first admission families (FAF were reviewed. All of the patients in the chart review were severely psychotic and had not been able to be managed at a secondary hospital level, which had necessitated their referral to Valkenberg. Each clerking interview with the family lasted 1.5 to 2 hours, and was conducted by the Intern Clinical Psychologist placed at Male Admissions. All 225 available folders were reviewed and coded. Results: The majority of the patients were young (mode = 21, still living at home (80%, single (90% and unemployed (65%.More than 80% of the men were given a working diagnosis of either Substance Induced Psychotic Disorder (SIPD: 46%, Schizophrenia (27% or Bipolar (11%. There was a strong family history of severe mental illness (SMI: 49 %, psychiatric admissions (30%, depression (26%, suicide (18%, substance use (SUD in parent/s: 45%, siblings: 36% and domestic violence (30%. Most families suspected that the patient had used drugs and police had had to be involved in at least 40% of the admissions. Despite nearly half of the patients expressing regret at their substance use, more than half the families reported that the patient had become aggressive and that at some stage they had feared them. The families most identified the patients’ admission as their greatest stressor. The second most identified greatest

  15. La vivencia de la sujeción mecánica experimentada por el personal de enfermería de una unidad de psiquiatria infanto-juvenil Mechanical restraints as experienced by nursing staff at a child and adolescent psychiatric unit

    Directory of Open Access Journals (Sweden)

    Susana Marqués Andrés

    2007-11-01

    Full Text Available Introducción: La sujeción mecánica es una técnica ampliamente utilizada por las enfermeras en los hospitales bajo indicación médica. Su utilización en las unidades de adolescentes provoca situaciones de conflicto emocional e inconvenientes viviéndolo las enfermeras en primera persona. Hablar de sujeción es poco concreto; para entenderla es necesario explicar motivos, situaciones, expectativas profesionales, tipo de enfermos y problemáticas. Los menores que ingresan en una unidad psiquiátrica sienten gran frustración, manifestándola habitualmente a través de agresividad al darse cuenta que pasarán algunos días ingresados. Objetivo: Conocer la vivencia del equipo de enfermería de la unidad de psiquiatría infanto juvenil del Hospital de Basurto (Bilbao, respecto al fenómeno de la sujeción mecánica de adolescentes. Método: El enfoque teórico es la fenomenología. El diseño, descriptivo interpretativo, basado en metodología cualitativa. Resultados: Las categorías emergidas durante el estudio se agrupan en tres, cada una con varias subcategorías: (a La intervención: la sujeción mecánica = las sensaciones corporales, los pensamientos y las actuaciones. (b El cuestionamiento = la evaluación individual, la percepción del equipo, la autocrítica de la utilización, el uso de los criterios. (c La utilidad de la técnica = la provocación del entorno, el refuerzo negativo, última alternativa. Existe un malestar generalizado como consecuencia de la utilización de la sujeción. Conclusiones: Unificar criterios es necesario para trabajar de manera cohesionada, tranquila y autocontrolada siendo la autocrítica una necesidad útil para emplear una técnica tan conflictiva y compleja de usar como real en su aplicación.Introduction: The restraint is a technique widely used by nurses in hospitals under medical supervision. Its use in psychiatric units adolescent patients can result in emotionally conflictive. When referring to the

  16. [Ketamine: psychiatric indications and misuses].

    Science.gov (United States)

    Delimbeuf, N; Petit, A; Karila, L; Lejoyeux, M

    2014-01-01

    Ketamine or -ketamine hydrochloride- is used as an anesthesic and a painkiller. It may also, in some indications, be prescribed in psychiatry and addictology. A literature review was conducted from 2003 to 2013, in PubMed, Google Scholar, Embase, and Psyclnfo, using the following key words (alone or combined): "ketamine", "abuse", "addiction", "dependence" and "misuse". Various studies have shown the benefit of kétamine in some psychiatric conditions such as major depressive episodes and electroconvulsive therapy. Others have demonstrated beneficial effects in alcohol or opiate abstinence maintenance. Ketamine seems to be a promising molecule in psychiatry and in the treatment of addictions, despite the absence of marketing approval for those specific uses. Being a strong psycho-stimulant, ketamine can be the source of abuse and dependence with somatic, psychiatric and cognitive complications.

  17. Perinatal psychiatric disorders: an overview.

    Science.gov (United States)

    Paschetta, Elena; Berrisford, Giles; Coccia, Floriana; Whitmore, Jennifer; Wood, Amanda G; Pretlove, Sam; Ismail, Khaled M K

    2014-06-01

    Perinatal mental illness has a significant implication on maternal health, birth outcomes, and the offspring's development. Prevalence estimates of perinatal psychiatric illnesses range widely, with substantial heterogeneity in different population studies, with a lower prevalence rate in high- rather than low- or middle-income countries. Because of the potential negative impact on maternal and child outcomes and the potential lability of these disorders, the perinatal period is a critical time to identify psychiatric illnesses. Thus, obstetricians and midwives play a crucial role in assessing women's mental health needs and to refer identified women promptly for multidisciplinary specialist assessment. However, there is still limited evidence on best practice assessment and management policies during pregnancy and postpartum. This review focuses on the prevalence of common perinatal mental disorders and antenatal screening policies to identify women at risk. The effect of these conditions and their management on pregnancy, fetal outcomes, and child development are discussed. Copyright © 2014 Mosby, Inc. All rights reserved.

  18. Imaging genetics and psychiatric disorders.

    Science.gov (United States)

    Hashimoto, R; Ohi, K; Yamamori, H; Yasuda, Y; Fujimoto, M; Umeda-Yano, S; Watanabe, Y; Fukunaga, M; Takeda, M

    2015-01-01

    Imaging genetics is an integrated research method that uses neuroimaging and genetics to assess the impact of genetic variation on brain function and structure. Imaging genetics is both a tool for the discovery of risk genes for psychiatric disorders and a strategy for characterizing the neural systems affected by risk gene variants to elucidate quantitative and mechanistic aspects of brain function implicated in psychiatric disease. Early studies of imaging genetics included association analyses between brain morphology and single nucleotide polymorphisms whose function is well known, such as catechol-Omethyltransferase (COMT) and brain-derived neurotrophic factor (BDNF). GWAS of psychiatric disorders have identified genes with unknown functions, such as ZNF804A, and imaging genetics has been used to investigate clues of the biological function of these genes. The difficulty in replicating the findings of studies with small sample sizes has motivated the creation of largescale collaborative consortiums, such as ENIGMA, CHARGE and IMAGEN, to collect thousands of images. In a genome-wide association study, the ENIGMA consortium successfully identified common variants in the genome associated with hippocampal volume at 12q24, and the CHARGE consortium replicated this finding. The new era of imaging genetics has just begun, and the next challenge we face is the discovery of small effect size signals from large data sets obtained from genetics and neuroimaging. New methods and technologies for data reduction with appropriate statistical thresholds, such as polygenic analysis and parallel independent component analysis (ICA), are warranted. Future advances in imaging genetics will aid in the discovery of genes and provide mechanistic insight into psychiatric disorders.

  19. Dissociative Experiences in Psychiatric Inpatients

    OpenAIRE

    Ali Firoozabadi; Nooshin Reza Alizadeh

    2016-01-01

    Dissociative disorders are conditions that involve disruptions of memory, awareness, identity, or perception. Data collected in diverse geographic locations underline the consistency in clinical symptoms of dissociative disorders. In this cross-sectional descriptive study, prevalence of dissociative experiences has been screened in hospitalized patients in psychiatric wards of Shiraz University of Medical Sciences in Iran. One hundred and sixty patients in two hospitals entered the study. Our...

  20. Imaging Genetics and Psychiatric Disorders

    Science.gov (United States)

    Hashimoto, R; Ohi, K; Yamamori, H; Yasuda, Y; Fujimoto, M; Umeda-Yano, S; Watanabe, Y; Fukunaga, M; Takeda, M

    2015-01-01

    Imaging genetics is an integrated research method that uses neuroimaging and genetics to assess the impact of genetic variation on brain function and structure. Imaging genetics is both a tool for the discovery of risk genes for psychiatric disorders and a strategy for characterizing the neural systems affected by risk gene variants to elucidate quantitative and mechanistic aspects of brain function implicated in psychiatric disease. Early studies of imaging genetics included association analyses between brain morphology and single nucleotide polymorphisms whose function is well known, such as catechol-O-methyltransferase (COMT) and brain-derived neurotrophic factor (BDNF). GWAS of psychiatric disorders have identified genes with unknown functions, such as ZNF804A, and imaging genetics has been used to investigate clues of the biological function of these genes. The difficulty in replicating the findings of studies with small sample sizes has motivated the creation of large-scale collaborative consortiums, such as ENIGMA, CHARGE and IMAGEN, to collect thousands of images. In a genome-wide association study, the ENIGMA consortium successfully identified common variants in the genome associated with hippocampal volume at 12q24, and the CHARGE consortium replicated this finding. The new era of imaging genetics has just begun, and the next challenge we face is the discovery of small effect size signals from large data sets obtained from genetics and neuroimaging. New methods and technologies for data reduction with appropriate statistical thresholds, such as polygenic analysis and parallel independent component analysis (ICA), are warranted. Future advances in imaging genetics will aid in the discovery of genes and provide mechanistic insight into psychiatric disorders. PMID:25732148

  1. Psychiatric Thoughts in Ancient India

    Directory of Open Access Journals (Sweden)

    Ravi Abhyankar

    2015-01-01

    Full Text Available A review of the literature regarding psychiatric thoughts in ancient India is attempted. Besides interesting reading, many of the concepts are still relevant and can be used in day-to-day practice especially towards healthy and happy living. Certain concepts are surprisingly contemporary and valid today. They can be used in psychotherapy and counselling and for promoting mental health. However, the description and classification of mental illness is not in tune with modern psychiatry.

  2. Dissociative Experiences in Psychiatric Inpatients

    Directory of Open Access Journals (Sweden)

    Ali Firoozabadi

    2016-11-01

    Full Text Available Dissociative disorders are conditions that involve disruptions of memory, awareness, identity, or perception. Data collected in diverse geographic locations underline the consistency in clinical symptoms of dissociative disorders. In this cross-sectional descriptive study, prevalence of dissociative experiences has been screened in hospitalized patients in psychiatric wards of Shiraz University of Medical Sciences in Iran. One hundred and sixty patients in two hospitals entered the study. Our tool to screen the prevalence of dissociative experiences was Dissociative Experience Scale (DES. Linear regression analysis shows that gender and age are predictors of high DES scores to some extent while psychiatric disorders are not good predictors. Age, gender and psychiatric disorders are poor predictors (almost 7% of high DES scores in this study (R square=0.69. In this study, patients with Borderline Personality Disorder had higher dissociative experiences based on DES score (Mean: 56.44, followed by Schizophrenic patients (Mean: 28.22 and patients with Bipolar Personality Disorder (Mean: 25.18. This study showed that we might be able to create a new category in psychological disorders based on dissociative experiences. As age, gender and psychological disorders were poor predictors of dissociative experiences, stronger predictors such as positive childhood psychological traumas could be responsible for dissociative disorders.

  3. TRP channels and psychiatric disorders.

    Science.gov (United States)

    Chahl, Loris A

    2011-01-01

    Depression and schizophrenia are major psychiatric disorders that cause much human suffering. Current treatments have major limitations and new drug targets are eagerly sought. Study of transient receptor potential (TRP) channels in these disorders is at an early stage and the potential of agents that activate or inhibit these channels remains speculative. The findings that TRPC6 channels promote dendritic growth and are selectively activated by hyperforin, the key constitutent of St John's wort, suggest that TRPC6 channels might prove to be a new target for antidepressant drug development. There is now considerable evidence that TRPV1 antagonists have anxiolytic activity but there is no direct evidence that they have antidepressant activity. There is also no direct evidence that TRP channels play a role in schizophrenia. However, the findings that TRPC channels are involved in neuronal development and fundamental synaptic mechanisms, and that TRPV1 channels play a role in central dopaminergic and cannabinoid mechanisms is suggestive of potential roles of these channels in schizophrenia. Investigation of TRP channels in psychiatric disorders holds the promise of yielding further understanding of the aetiology of psychiatric disorders and the development of new drug treatments.

  4. Psychiatric aspects of air pollution.

    Science.gov (United States)

    Lundberg, A

    1996-02-01

    Psychological and toxic effects of air pollution can lead to psychiatric symptoms, including anxiety and changes in mood, cognition, and behavior. Increased levels of some air pollutants are accompanied by an increase in psychiatric admissions and emergency calls and, in some studies, by changes in behavior and a reduction in psychological well-being. Numerous toxic pollutants interfere with the development and adult functioning of the nervous system. Manifestations are often insidious or delayed, but they can provide a more sensitive indicator of toxic effects than cancer rates or mortality data. Other medical effects of air pollution, such as asthma, can indirectly affect psychological health. The sick building syndrome and multiple chemical sensitivity are conditions with toxicologic and psychiatric aspects. Psychosocial stress can cause symptoms similar to those of organic mental disorders. Reactions to stress depend on cultural, individual, and situational variables. We must understand these factors to be able to alleviate and prevent the consequences of environmental trauma. Expanded research is recommended in three main areas: (1) how people perceive and cope with environmental health risks, (2) the effects of air pollution on behavior and neuropsychological functioning, and (3) neurotoxicologic evaluation of air pollutants with both behavioral and in vitro studies.

  5. RIFLE classification and mortality in obstetric patients admitted to the intensive care unit with acute kidney injury: a 3-year prospective study.

    Science.gov (United States)

    Kamal, Ebtesam M; Behery, Manal M El; Sayed, Gamal Abbas El; Abdulatif, Howaida K

    2014-10-01

    This study is to assess the correlation of risk, injury, failure, loss, and end-stage renal failure (RIFLE) classification with hospital mortality in intensive care unit (ICU) obstetric patients and to evaluate the relation of acute kidney injury (AKI) to other risk factors. The 4 stages of RIFLE (nonacute renal failure, risk, injury, and failure) were scored from 0 to 3 points, respectively. The prognostic performance of the RIFLE score was compared to the general ICU models. AKI occurred in 30 (5.88%) of patients admitted to ICU. The main causes of AKI were hemolysis, elevated liver enzymes, and low platelet syndrome 13 (43%), pregnancy-related hypertension 9 (30%), puerperal sepsis 3 (10%), abruption placentae 2 (6.6%), disseminated intravascular coagulopathy 2 (6.6%), and anesthetic complications 1 (3.3%). According to the RIFLE criteria, patients were classified into Risk (3.3%), Injury (16.6%), Failure (33.3%), and Loss (46.6%). Maternal mortality from total ICU admission occurred in 51 (10%) cases, of these 16 (31.3%) cases were due to AKI. Independent risk factors associated with mortality were hyperbilirubinemia, low levels of HCO3, and RIFLE. Receiver-operator characteristic curves for ICU patients according to RIFLE score showed area under the curve = 0.824. The RIFLE classification system could predict the risk of mortality from AKI in obstetric ICU patients and mortality was positively associated with high RIFLE classes. © The Author(s) 2014.

  6. [The psychiatric illness of Vincent van Gogh].

    Science.gov (United States)

    Strik, W K

    1997-05-01

    Vincent van Gogh's illness has been the object of much speculation. Explanations as disparate as acute intermittent porphyria, epilepsy and schizophrenia have been proposed. Many of the diagnostic hypotheses, however, are based on partial or incomplete consideration of the biography and of the reports of his subjective experience in his letters to his brother. Karl Leonhard showed, in a detailed analysis of Vincent's biography, that both the course and symptoms of the disorder were consistent with the diagnosis of a cycloid psychosis (anxiety-elation psychosis). In the present paper, the diagnostic judgement of Leonhard is described and discussed in the light of independent research on van Gogh's letters, his works and biography. The bibliographical sources were investigated for information consistent with a cycloid psychosis, but also for information that might contradict this hypothesis. The course and symptoms of the disorder are presented as comprehensively and systematically as possible and are documented with the respective citations. Furthermore, the most important diagnoses proposed in the literature are critically discussed. Based on this investigation, it was possible to show that only the diagnosis of a cycloid psychosis allowed us to connect all the available information to a typical psychiatric syndrome.

  7. Genetic influences on the neural and physiological bases of acute threat: A research domain criteria (RDoC) perspective.

    Science.gov (United States)

    Sumner, Jennifer A; Powers, Abigail; Jovanovic, Tanja; Koenen, Karestan C

    2016-01-01

    The NIMH Research Domain Criteria (RDoC) initiative aims to describe key dimensional constructs underlying mental function across multiple units of analysis-from genes to observable behaviors-in order to better understand psychopathology. The acute threat ("fear") construct of the RDoC Negative Valence System has been studied extensively from a translational perspective, and is highly pertinent to numerous psychiatric conditions, including anxiety and trauma-related disorders. We examined genetic contributions to the construct of acute threat at two units of analysis within the RDoC framework: (1) neural circuits and (2) physiology. Specifically, we focused on genetic influences on activation patterns of frontolimbic neural circuitry and on startle, skin conductance, and heart rate responses. Research on the heritability of activation in threat-related frontolimbic neural circuitry is lacking, but physiological indicators of acute threat have been found to be moderately heritable (35-50%). Genetic studies of the neural circuitry and physiology of acute threat have almost exclusively relied on the candidate gene method and, as in the broader psychiatric genetics literature, most findings have failed to replicate. The most robust support has been demonstrated for associations between variation in the serotonin transporter (SLC6A4) and catechol-O-methyltransferase (COMT) genes with threat-related neural activation and physiological responses. However, unbiased genome-wide approaches using very large samples are needed for gene discovery, and these can be accomplished with collaborative consortium-based research efforts, such as those of the Psychiatric Genomics Consortium (PGC) and Enhancing Neuro Imaging Genetics through Meta-Analysis (ENIGMA) Consortium.

  8. Prediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation II and III prognostic systems in a United Kingdom intensive care unit.

    Science.gov (United States)

    Beck, D H; Taylor, B L; Millar, B; Smith, G B

    1997-01-01

    To evaluate the ability of two prognostic systems to predict hospital mortality in adult intensive care patients. Prospective cohort study. A mixed medical and surgical intensive care unit (ICU) in the United Kingdom. A total of 1,144 patients consecutively admitted to the study. None. Acute Physiology and Chronic Health Evaluation (APACHE) II and III prognostic systems were applied to assess probabilities of hospital mortality, which were compared with the actual outcome. The overall goodness-of-fit of both models was assessed. Hospital death rates were higher than those predicted by each system. Risk estimates showed a strong positive correlation between both systems (nonsurvivors r2 = 0.756, p best overall total correct classification rate was 80.6% for APACHE III and 77.9% for APACHE II (both for a decision criterion of 40%). The areas under the receiver operating characteristic curves were 0.806 and 0.847 for APACHE II and III, respectively, confirming the better discrimination of APACHE III. When patients were classified by diagnostic categories, risk predictions did not fit uniformly across the spectrum of disease groups. For both models, mortality ratios were highest for trauma patients and lowest for the group with respiratory disease. APACHE II predictions for patients with gastrointestinal disease were significantly better. Risk estimates for surgical admissions were superior with APACHE II (MR = 1.27) compared with APACHE III (MR = 1.56), but were similar for medical patients (1.22 vs. 1.28 for APACHE II and III, respectively). Bias induced by factors reflecting the clinical practice in an individual ICU (e.g., admission criteria, treatment before admission) may have considerable impact on risk estimates. The identification of such factors appears to be a prerequisite for the meaningful interpretation of observed and predicted death rates on the individual ICU level. Both predictive models demonstrated a similar degree of overall goodness-of-fit. APACHE

  9. Antipsychotic polypharmacy in children and adolescents at discharge from psychiatric hospitalization.

    Science.gov (United States)

    Saldaña, Shannon N; Keeshin, Brooks R; Wehry, Anna M; Blom, Thomas J; Sorter, Michael T; DelBello, Melissa P; Strawn, Jeffrey R

    2014-08-01

    Antipsychotic polypharmacy-the use of more than one antipsychotic concomitantly-has increased in children and adolescents and may be associated with increased adverse effects, nonadherence, and greater costs. Thus, we sought to examine the demographic and clinical characteristics of psychiatrically hospitalized children and adolescents who were prescribed antipsychotic polypharmacy and to identify predictors of this prescribing pattern. Retrospective medical record review. The inpatient psychiatric unit of a large, acute care, urban children's hospital. One thousand four hundred twenty-seven children and adolescents who were consecutively admitted and discharged between September 2010 and May 2011. At discharge, 840 (58.9%) of the 1427 patients were prescribed one or more antipsychotics, and 99.3% of these received second-generation antipsychotics. Of these 840 patients, 724 (86.2%) were treated with antipsychotic monotherapy, and 116 (13.8%) were treated with antipsychotic polypharmacy. Positive correlations with antipsychotic polypharmacy were observed for placement or custody outside the biological family; a greater number of previous psychiatric admissions; longer hospitalizations; admission for violence/aggression or psychosis; and intellectual disability, psychotic, disruptive behavior, or developmental disorder diagnoses. Negative correlations with antipsychotic polypharmacy included admission for suicidal ideation/attempt or depression, and mood disorder diagnoses. Significant predictors of antipsychotic polypharmacy included admission for violence or aggression (odds ratio [OR] 2.76 [95% confidence interval (CI) 1.36-5.61]), greater number of previous admissions (OR 1.21 [95% CI 1.10-1.33]), and longer hospitalizations (OR 1.08 [95% CI 1.04-1.12]). In addition, diagnoses of intellectual disability (OR 2.62 [95% CI 1.52-4.52]), psychotic disorders (OR 5.60 [95% CI 2.29-13.68]), and developmental disorders (OR 3.18 [95% CI 1.78-5.65]) were predictors of

  10. Liaison psychiatry on a burn unit.

    Science.gov (United States)

    Billowitz, A; Friedson, W; Schubert, D S

    1980-12-01

    Psychiatric liaison activities and intervention on a burn unit are described. The authors review the psychiatrist's interventions with regard to unhealthy staff denial; educating staff about psychiatric issues; facilitating improved staff-patient communication; and helping nurses manage patients' inappropriate sexual behavior.

  11. Psychiatric and Medical Management of Marijuana Intoxication in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Bui, Quan M.

    2015-05-01

    Full Text Available We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient’s psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care. [West J Emerg Med. 2015;16(3:414–417.

  12. Usage of psychiatric emergency services by asylum seekers: Clinical implications based on a descriptive study in Denmark.

    Science.gov (United States)

    Reko, Amra; Bech, Per; Wohlert, Cathrine; Noerregaard, Christian; Csillag, Claudio

    2015-01-01

    Asylum seekers are found to be at high risk of mental health problems. Little is known about the use of acute psychiatric emergency services by asylum seekers. To describe the usage of an inpatient/outpatient psychiatric emergency service in Denmark by adult asylum seekers, and discuss clinical implications. This descriptive study is based on retrospective data collected from patient charts during a 3-month period. A total of 31 evaluations were made (3.3% of all evaluations), based on 23 asylum seekers. Patients originated from 16 different countries, were predominantly male and married. The group consisted primarily (61%) of failed asylum seekers. Most patients (81%) presented with relevant mental health problems. The main reasons for presenting to the acute psychiatric emergency service were suicidal ideation and/or behaviour (60%). The most frequent diagnosis given at the initial evaluation was ICD-10 F43.9 "reaction to severe stress, unspecified" (50%). Evaluations were made primarily by non-psychiatrists. No standardized screening or diagnostic instrument was used. This first description of the use of an acute psychiatric emergency service by asylum seekers in Denmark shows some of the acute mental health needs asylum seekers present with. The findings of high levels of suicidal ideation and possible diagnostic difficulties are discussed, as well as possible improvements of the referral and psychiatric evaluation processes.

  13. Dysrhythmias Induced by Streptokinase Infusion in Patients with Acute Myocardial Infarction Admitted to Cardiac Care Units in the Northwest of Iran

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    Parizad Razieh

    2014-01-01

    Full Text Available Objective: Currently, the most common cause of death in the world is cardiovascular disease, particularly myocardial infarction. Myocardial infarction is caused by reducing or cutting off the blood supply to the heart muscle due to obstruction caused by the presence of plaque or thrombus. The first step for the treatment of acute myocardial infarction is using thrombolytic drugs. By the analysis of plaque and removing the blockage, the blood flows to the affected area again. The most important thrombolytic agent is streptokinase; however, in addition to its therapeutic effect it also has some complications and by identifying them mortality and disability can be prevented. The present study aimed to investigate the most common arrhythmia after infusion of streptokinase in patients with acute myocardial infarction (AMI. Materials and Methods: This research was a descriptive study. The study population included patients admitted to the cardiac care unit of Shahid Madani Hospital, Tabriz, Iran, with a diagnosis of AMI from September 2012 until March 2014. Data were collected by using a checklist and the findings of the study were analyzed by SPSS software. Results: Of the 116 hospitalized patients, 78 (67.5% were male and 37 (32.5% were female, and the largest percentage of infected patients was in the age group of 60-70 years [n = 38 (33%]. Regarding cardiac risk factors, 57 (49% of patients were hyperlipidemic, 36 (31% were diabetic, 34 (30% had high blood pressure, 25 (21% were smokers, and 21 (18% had a positive family history of cardiac problems. Patients who were admitted with a diagnosis of AMI, in 53 (46% cases had streptokinase injection, and in 86 (74% complications had occurred during drug injection; 87 (75% patients had dysrhythmia and 29 (25% had bleeding. Common dysrhythmia was premature ventricular contraction (PVC with 90 (78.2% cases. Moreover, 53 (46% patients had slow ventricular tachycardia (VT, 18 (16% had premature atrial

  14. The Competencies, Roles and Scope of Practice of Advanced Psychiatric Nursing in Indonesia

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    Yulia Wardani

    2014-01-01

    Full Text Available The graduate advanced psychiatric nursing (psychiatric nursing specialist from master degree in Indonesia are about 70 nurses, 67 nurses were graduated from University of Indonesia. They are working at mental health services and educational setting around Indonesia and yet seem not ready to perform some specific advanced competencies in clinical area. The mastery on mental health assessment, neurochemical perspectives, medical management and psychotherapy have not yet performed by the psychiatric nurse specialist in the clinical area or community.To have those competencies and its performances, therefore the curriculum in a psychiatric nursing graduate program must include advanced courses in physiopsychology, psychopathology, advanced psychopharmacology, neurobehavioral science, advanced mental health assessment, and advanced treatment interventions such as psychotherapy and prescription and management of psychotropic medications as their core and major courses in the curriculum. Those courses should be performed in their clinical practice courses or other related learning experiences. When those qualifications are met, then they are competent to be called advanced psychiatric nurse.As advanced practice registered nurses, the advanced psychiatric nurses should be able to demonstrate their direct expertise and roles in advanced mental health assessment, diagnostic evaluation, psychopharmacology management, psychotherapy with individuals, group and families, case management, millieu management, liason and counselling from prevention, promotion until psychiatric rehabilitation. Meanwhile the skill such as psycho-education, teaching, unit management, research and staff development can be added as their indirect roles.

  15. Career Choice and Longevity in U.S. Psychiatric-Mental Health Nurses.

    Science.gov (United States)

    Alexander, Robbi K; Diefenbeck, Cynthia A; Brown, Carlton G

    2015-06-01

    The demand for mental health services in the United States taxes the existing care continuum and is projected to increase as federal initiatives such as the Affordable Care Act and mental health parity improve access to, and coverage for, mental health services. Quality health care providers, such as psychiatric-mental health nurses, are needed to bolster the mental health system. Prior research has focused on the unpopularity of psychiatric nursing as a career choice for nursing students. The purpose of this study is to understand how seasoned psychiatric nurses came to choose and remain in the specialty; descriptive phenomenology is used. In a face-to-face interview, eight registered nurses described their experiences with psychiatric nursing as a student, their entry into psychiatric nursing, and factors related to their longevity in the specialty. Giorgi's Existential Phenomenological Research Method was employed to analyze the interview data. Three themes emerged related to career choice: Interest Developed Prior to or While in Nursing School, Personal Relevance, and Validation of Potential. Three themes emerged related to retention: Overcoming Stereotypes to Develop Career Pride, Positive Team Dynamics, and Remaining Hopeful. Nurse educators play an important role in identifying talent, validating capability, enhancing interest, and increasing students' confidence to pursue a psychiatric nursing career, while nursing administrators and clinical specialists play a key role in retention. Findings also stimulate pertinent questions surrounding the long-term viability of the psychiatric-mental health nursing specialty.

  16. Curriculum development: Preparing trainees to care for children and adolescents with psychiatric disorders.

    Science.gov (United States)

    Foley, Kimberly P; Haggerty, Treah S; Harrison, Natasha

    2015-01-01

    Family physicians provide care for about one-third of the children and adolescents in the United States, many of whom present with psychological concerns. Family physicians often do not recognize these psychological disorders and therefore do not diagnose or treat them. This report describes the implementation of a curriculum designed to increase family medicine trainees' level of awareness that children/adolescents experience psychiatric conditions. This goal is achieved through the addition of a clinical child/adolescent psychologist faculty member, resident self-assessment of training needs and subsequent development of didactic presentations to address these needs. The curriculum relies on the acquisition of child/adolescent psychiatric screeners, development of child/adolescent-focused bibliotherapy materials, and the development of a longitudinal behavioral sciences curriculum. To facilitate the screening of child/adolescent psychiatric disorders, a comprehensive collection of age-appropriate psychiatric screeners were compiled and made readily available in all precepting areas. To assist with the identification of specific child/adolescent psychiatric deficit areas, family medicine resident physicians were presented with an inventory of child/adolescent psychiatric, psychosocial, and behavioral topics, based upon American Academy of Family Practice guidelines and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition psychiatric disorders, and self-selected training deficiencies.

  17. The structure of psychiatric science.

    Science.gov (United States)

    Kendler, Kenneth S

    2014-09-01

    This essay addresses two interrelated questions: What is the structure of current psychiatric science and what should its goals be? The author analyzed all studies addressing the etiology of psychiatric disorders in the first four 2013 issues of 12 psychiatry and psychology journals. He classified the resulting 197 articles by the risk factors examined using five biological, four psychological, and three environmental levels. The risk factors were widely dispersed across levels, suggesting that our field is inherently multilevel and already practicing empirically based pluralism. However, over two-thirds of the studies had a within-level focus. Two cross-level patterns emerged between 1) systems neuroscience and neuropsychology and 2) molecular or latent genetic factors and environmental risks. The author suggests three fundamental goals for etiological psychiatric research. The first is an eclectic effort to clarify risk factors regardless of level, including those assessed using imaginative understanding, with careful attention to causal inference. An interventionist framework focusing on isolating causal effects is recommended for this effort. The second goal is to clarify mechanisms of illness that will require tracing causal pathways across levels downward to biological neuroscience and upward to social factors, thereby elucidating the important cross-level interactions. Here the philosophy of biology literature on mechanisms can be a useful guide. Third, we have to trace the effects of these causal pathways back up into the mental realm, moving from the Jasperian level of explanation to that of understanding. This final effort will help us expand our empathic abilities to better understand how symptoms are experienced in the minds of our patients.

  18. Martyrs of the psychiatric hospitals

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    Serra Paolo

    2013-01-01

    Full Text Available This article is based on the history of an Italian psychiatric hospital (Arezzo that closed in 1989 and was turned into a university. The illegal and inhumane treatment in asylum-type institutions is condemned. In particular the treatment of those patients who, according to the analysis, hospital directors referred to as “social cases.” These individuals did not stay in hospital because of health problems but only due to the lack of social care by the state. AS a consequence they are condemned to be “prisoners” without committing any crimes.

  19. Psychiatric Emergencies in the Elderly.

    Science.gov (United States)

    Sikka, Veronica; Kalra, S; Galwankar, Sagar; Sagar, Galwankar

    2015-11-01

    With the increasing life expectancy, the geriatric population has been increasing over the past few decades. By the year 2050, it is projected to compose more than a fifth of the entire population, representing a 147% increase in this age group. There has been a steady increase in the number of medical and psychiatric disorders, and a large percentage of geriatric patients are now presenting to the emergency department with such disorders. The management of our progressively complex geriatric patient population will require an integrative team approach involving emergency medicine, psychiatry, and hospitalist medicine.

  20. Volatile substance abuse: a review of possible long-term neurological, intellectual and psychiatric sequelae.

    Science.gov (United States)

    Ron, M A

    1986-03-01

    The possibility that chronic abuse of volatile substances can cause permanent neurological, psychiatric, and intellectual sequelae is critically reviewed. Toluene, present in the commonly used adhesives, is most often implicated in 'glue sniffing'; this review focuses on its potential long-term effects. Many criticisms--particularly poor matching of control samples and inability to distinguish between acute and chronic effects--can be levelled at the available studies, while no adequate follow-up studies have been performed. In the light of present knowledge, the possibility that permanent structural brain damage, with accompanying psychiatric manifestations, results from solvent abuse remains inconclusive.

  1. Alternative comorbidity adjustors for the Medicare inpatient psychiatric facility PPS.

    Science.gov (United States)

    Drozd, Edward M; Maier, Jan; Hales, Jan F; Thomas, Frederick G

    2008-01-01

    The inpatient psychiatric facility prospective payment system (IPF-PPS), provides per diem payments for psychiatric hospitals and units, including 17 comorbid condition payment adjustors that cover 11 percent of patients. This study identifies an alternative set of 16 adjustors identifying three times as many high-cost patients and evaluates the improved predictive power in log per diem cost regression models. A model using the IPF-PPS adjustors achieved 8.8 percent of the feasible improvement from a no-adjustor baseline, while the alternative adjustors achieved 22.1 percent of the feasible improvement. The current adjustors may therefore be too restrictive, resulting in systematic over- or underpayment for many patients.

  2. Psychiatric sequelae of traumatic brain injury

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    Suprakash Chaudhury

    2013-01-01

    Full Text Available Almost half of the people suffering traumatic brain injury (TBI may later be diagnosed with psychiatric disorders. The literature (PubMed, IndMed of past 30 years on psychiatric disturbances associated with TBI is reviewed. The authors highlight the close link between head injury and psychiatry and provide an overview of the epidemiology, risk-factors, and mechanisms of psychiatric sequelae including, cognitive deficits, substance abuse, psychoses, mood disorders, suicide, anxiety disorders, dissociative disorders, post-concussion syndrome, and personality changes following head injury. The various psychiatric sequelae are briefly discussed.

  3. Caracterização das internações de dependentes químicos em Unidade de Internação Psiquiátrica do Hospital Geral Characterization of admission of chemical-dependents in a Psychiatric Admission Unit of the General Hospital

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    Fernando Sérgio Pereira de Sousa

    2010-05-01

    Full Text Available A Unidade de Internação Psiquiátrica do Hospital Geral (UIPHG é uma proposta articulada ao movimento da reforma psiquiátrica. O objetivo deste estudo foi avaliar os determinantes das internações de dependentes químicos na UIPHG Dr. Estevam, em Sobral (CE. Este estudo foi do tipo documental com abordagem quantitativa, envolvendo 203 clientes que foram internados na UIPHG no período de outubro de 2005 a abril de 2006. Os dados foram coletados por meio de um roteiro adaptado a partir do documento usado no momento da internação. Observou-se predomínio de pacientes do sexo masculino (95,1%, com idade entre 30 e 40 anos (62,5% e solteiros (59,1%. Em 76,3% dos casos, o diagnóstico da internação foi síndrome de abstinência do álcool. Após alta hospitalar, 70% desses clientes foram encaminhados ao CAPS-AD. Esses resultados demonstram quão imprescindíveis são os serviços de saúde mental que enfoquem a problemática do alcoolismo.The Psychiatric Admission Unit of the General Hospital (UIPHG is integrated to the psychiatric reform movement. The aim of this study was to evaluate chemical-dependent's admission causes at the UIPHG Dr. Estevam in the city of Sobral, Ceará State. It was a documental study with a quantitative approach involving 203 patients who were admitted at the UIPGH Dr. Estevam from October 2005 to April 2006. Data were collected from a document filled during admission process in the hospital. 95.1% of the sample was represented by men, age range of 30-40 years (62.5% and single (59.1%. The alcohol withdrawal syndrome was the main admission cause (76.3%. After leaving the hospital, 70% of the sample was conducted to aftercare at CAPS-AD. These results provide preliminary evidence for the need of mental health services emphasizing alcohol dependence problem.

  4. Metereological conditions and Psychiatric Emergency Visits in Messina, Italy

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    Salvatore Settiner

    2016-01-01

    Full Text Available Objective: The aim of this study is to examine the association between psychiatric disease, climatic and seasonal factors in patients recorded to the Emergency Unit, in Messina Hospital (Italy. Method: A total of 6565 psychiatric patients were recorded to the Emergency Unit in Messina from January 2005 and December 2010. Each psychiatric visit in emergency, was categorized by date of appearance and admitting diagnosis according to diagnostic categories: Anxiety, Mood Disorders and Psychosis. Local weather data were obtained from the Metereological Instituted “Aereonautica Militare” station in Messina, Sicily, In addition, to gathering data on the state of the sky, temperature, atmosphericpressure with the normalized value at sea level, relative humidity, rainfall, wind direction and speed, the station is connected to a buoy located on the eastern sector of Tyrrhenian Sea. Results: In anxiety disorders we have found relevant results comparison between winter and spring (p=.007 and spring and fall (p=.001. In affective disorders the differences occur in relation to winter and fall (p=.002, spring and fall (p=001, spring and summer (p=002. The psychotic disorder presents significant differences between summer and fall (p=.001 and spring and fall (p=.002. Conclusions: We can observe a similarity of affective disorders, i.e. anxiety and mood disorders compared to psychosis, which have different influences and probably according to dissimilar etiopathogenetic ways. In our research, the distribution of anxiety disorders is higher than depressive disorders in terms of delivering emergency room visits. The major differences occur comparing spring and fall, the seasons when all pathological classes have significant differences. It follows that the most abrupt climate change, typical of these seasons, as a whole, cause psychopathological emergencies. The study is important for planning a more effective assistance for patients needing psychiatric

  5. The professionalization of psychiatric nursing. From doctors' handmaidens to empowered professionals.

    Science.gov (United States)

    Boling, Anita

    2003-10-01

    The professionalization of psychiatric nursing in the United States has been subject to political, economic, and theoretical influences, and prominent individuals such as Florence Nightingale and Hildegard Peplau have caused changes over time. Throughout history, professional and societal beliefs about mental illness have affected the nature of psychiatric nursing. In colonial times, people with mental illnesses were considered to be either possessed by demons or inferior and treated as animals. Today, psychobiological causes of mental illness are better understood, and treatment is aimed at adjusting disordered physiology and implementing psychosocial interventions. Care of people with mental illnesses has echoed this shift with increasing professionalization of psychiatric nurses. Attention to the lessons of history can help psychiatric nurses identify current societal influences, act on them according to their own vision, and further increase their professionalism.

  6. Psychiatric diagnoses and psychoactive medication use among nonsurgical critically ill patients receiving mechanical ventilation

    DEFF Research Database (Denmark)

    Wunsch, Hannah; Christiansen, Christian Fynbo; Johansen, Martin B

    2014-01-01

    in 2006-2008 with follow-up through 2009, and 2 matched comparison cohorts from hospitalized patients and from the general population. EXPOSURES: Critical illness defined as intensive care unit admission with mechanical ventilation. MAIN OUTCOMES AND MEASURES: Adjusted prevalence ratios (PRs......IMPORTANCE: The relationship between critical illness and psychiatric illness is unclear. OBJECTIVE: To assess psychiatric diagnoses and medication prescriptions before and after critical illness. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study in Denmark of critically ill patients......) of psychiatrist-diagnosed psychiatric illnesses and prescriptions for psychoactive medications in the 5 years before critical illness. For patients with no psychiatric history, quarterly cumulative incidence (risk) and adjusted hazard ratios (HRs) for diagnoses and medications in the following year, using Cox...

  7. Non-invasive positive pressure ventilation in acute hypercapnic respiratory failure: ten-year’s clinical experience of a Respiratory Semi-Intensive Care Unit (VERSIONE IN ITALIANO

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    Mario Naldi

    2007-12-01

    Full Text Available BackgroundAlthough several prospective controlled randomizedtrials demonstrated the success of non-invasive positive pressure ventilation (NIV in selected cases of acute hypercapnic respiratory failure (IRA in setting with different care levels, clinical practice data about the use of NIV in the “real world” are limited.AimTo report the results of our clinical experience in NIV applied for IRA in the Respiratory Semi-Intensive Care Unit (UTSIR allocated within the Respiratory Division of Arezzo in the years 1996-2006 in terms of: tolerance, effects upon arterial blood gases, success rate and predictors of failure.MethodsThree hundred filthy of the 1484 patients (23.6% consecutively admitted for IRA to our RespiratoryDivision during the study period received NIV in addition to standard therapy, according to the pre-defined routinely used criteria.ResultsEight patients (2.3% did not tolerated NIV becauseof mask discomfort, while the remaining 342 (M: 240, F: 102; median (interquartiles age: 74.0 (68.0-79.3 yrs; COPD: 69.3% were ventilatedfor >1 hour. Arterial blood gases significantlyimproved after two hours of NIV (mean (standard deviation pH: 7.33 (0.07 versus 7.28 (7.25-7.31, p 48 hrs of ventilation after an initial positive response.ConclusionsAs results of our ten-year’s clinical experience performed in a UTSIR, NIV is confirmed to be well tolerated, effective in improving arterial blood gases and useful in avoiding intubation in most IRA episodes non-responder to standard therapy.

  8. Non-Invasive Positive Pressure Ventilation in Acute Hypercapnic Respiratory Failure: Ten-Year’s Clinical Experience of a Respiratory Semi-Intensive Care Unit

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    Raffaele Scala, M.D., esp.

    2007-12-01

    Full Text Available BackgroundAlthough several prospective controlled randomizedtrials demonstrated the success of non-invasive positive pressure ventilation (NIPPV in selected cases of acute hypercapnic respiratory failure (ARF in setting with different care levels, clinical practice data about the use of VNI in the “real world” are limited.AimTo report the results of our clinical experiencein NIPPV applied for ARF in the Respiratory Semi-Intensive Care Unit (UTSIR allocated within the Respiratory Division of Arezzo betweenthe years 1996-2006 in terms of: patient tolerance, effects upon arterial blood gases, successrate and predictors of failure. Methods: Three hundred and filthy out of the 1484 patients (23.6% consecutively admittedfor ARF to our Respiratory Division during the study period received NIPPV in addition to standard therapy, according to the predeterminedroutinely used criteria. Results: Eight patients (2.3% did not tolerateNIPPV because of mask discomfort, while the remaining 342 (M: 240, F: 102; median (interquartilesage: 74.0 (68.0-79.3 yrs; COPD: 69.3% were ventilated for >1 hour. Arterial blood gases significantly improved after two hours of NIPPV (mean (standard deviation pH: 7.33 (0.07 versus 7.28 (7.25-7.31, p 48 hrs of ventilation after an initial positive response. Conclusions: As results of ten years of clinicalexperience at our UTSIR, NIPPV was shown to be well tolerated, effective in improving arterialblood gases and useful in avoiding intubationin most ARF episodes non-responsive to standard therapy.

  9. Effect of diabetes and acute rejection on liver transplant outcomes: An analysis of the organ procurement and transplantation network/united network for organ sharing database.

    Science.gov (United States)

    Kuo, Hung-Tien; Lum, Erik; Martin, Paul; Bunnapradist, Suphamai

    2016-06-01

    The effects of diabetic status and acute rejection (AR) on liver transplant outcomes are largely unknown. We studied 13,736 liver recipients from the United Network for Organ Sharing/Organ Procurement Transplant Network database who underwent transplantation between 2004 and 2007 with a functioning graft for greater than 1 year. The association of pretransplant diabetes mellitus (PDM), new-onset diabetes after transplant (NODAT), and AR rates on allograft failure, all-cause mortality, and cardiovascular mortality were determined. To determine the differential and joint effects of diabetic status and AR on transplant outcomes, recipients were further stratified into 6 groups: neither (reference, n = 6600); NODAT alone (n = 2054); PDM alone (n = 2414); AR alone (n = 1448); NODAT and AR (n = 707); and PDM and AR (n = 513). An analysis with hepatitis C virus (HCV) serostatus was also performed (HCV recipients, n = 6384; and non-HCV recipient, n = 5934). The median follow-up was 2537 days. The prevalence of PDM was 21.3%. At 1 year after transplant, the rates of NODAT and AR were 25.5% and 19.4%, respectively. Overall, PDM, NODAT, and AR were associated with increased risks for graft failure (PDM, hazard ratio [HR] = 1.31, P < 0.01; NODAT, HR = 1.11, P = 0.02; AR, HR = 1.28, P < 0.01). A multivariate Cox regression analysis of the 6 recipient groups demonstrated that NODAT alone was not significantly associated with any study outcomes. The presence of PDM, AR, NODAT and AR, and PDM and AR were associated with higher overall graft failure risk and mortality risk. The presence of PDM was associated with higher cardiovascular mortality risk. The analyses in both HCV-positive and HCV-negative cohorts showed a similar trend as in the overall cohort. In conclusion, PDM and AR, but not NODAT, is associated with increased mortality and liver allograft failure. Liver Transplantation 22 796-804 2016 AASLD.

  10. Effect of acupressure with valerian oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome in a cardiac intensive care unit.

    Science.gov (United States)

    Bagheri-Nesami, Masoumeh; Gorji, Mohammad Ali Heidari; Rezaie, Somayeh; Pouresmail, Zahra; Cherati, Jamshid Yazdani

    2015-10-01

    The purpose of this three-group double-blind clinical trial study was to investigate the effect of acupressure ( zhǐ yā) with valerian ( xié cǎo) oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome (ACS) in a coronary intensive care unit (CCU). This study was conducted on 90 patients with ACS in Mazandaran Heart Center (Sari, Iran) during 2013. The patients were randomly assigned to one of three groups. Patients in the acupressure with valerian oil 2.5% group (i.e., valerian acupressure group) received bilateral acupoint ( xué wèi) massage with two drops of valerian oil for 2 minutes for three nights; including every point this treatment lasted in total 18 minutes. Patients in the acupressure group received massage at the same points with the same technique but without valerian oil. Patients in the control group received massage at points that were 1-1.5 cm from the main points using the same technique and for the same length of time. The quality and quantity of the patients' sleep was measured by the St. Mary's Hospital Sleep Questionnaire (SMHSQ). After the intervention, there was a significant difference between sleep quality and sleep quantity in the patients in the valerian acupressure group and the acupressure group, compared to the control group (p Gushing Spring ( yǒng quán) acupoints can have therapeutic effects and may improve the quality and quantity of sleep in patients with ACS. Using these techniques in combination with herbal medicines such valerian oil can have a greater impact on improving sleep and reducing waking during the night.

  11. Topographic Locomotive Analysis of {sup 99m}Tc-HDP Uptake of Acute Rhabdomyolysis and Musculotendinous Unit Injury due to Excessive Swimming Exercise in Novice: A Case Report

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    Bahk, Yong Whee; Jeon, Ho Seung [SungAe General Hospital, Seoul (Korea, Republic of)

    2008-12-15

    Rhabdomyolysis (RM), also referred to as myonecrosis, is not an uncommon disorder of skeletal muscle, the incidence of which is on the increase as endurance tests, sports and body build have become popular. RM is divided into diffuse muscle fiber damage and musculotendinous unit (MTU) injury. A recent study by Crenshaw et al. revealed that muscular fiber damage caused by racing was associated with elevated intra-muscular pressure, capillary damage, and ischchemia. It is to be remembered that myocytes are mainly destroyed in RM whereas perimysial connective is predominantly damaged in myositis ossificans. When muscle fibers disrupt myoglobin escapes into extracellular fluid and plasma resulting in myoglobinemia and often acute renal failure. Plasma creatine phosphokinase level becomes elevated. We report a case of strenuous swimming-related RM that occurred in the muscles of the shoulder girdles and chest wall analyzed using magnified {sup 9}:9{sup m}Tc-HDP bone scan. Of interest magnified bone scan of RM in the present case showed not only ordinary muscular injury but also MTU injury. MRI is useful in the study of soft tissue injury and in recent years sonography has also become increasingly used. As mentioned {sup 99m}Tc-HDP bone scan, especially magnification scan, sensitively depicts metabolic change that occurred in injured muscles and tendons. Unless injury is trivial the bone scan nearly always reveals pathological uptake in a damaged muscle, MTU, and/or tendinous insertion permitting the topographic distinction of injury. Thus, the diagnosis of myolysis, MTU injury, and enthesitis can specifically be made when one uses magnification technique.

  12. Chest pain unit (CPU) in the management of low to intermediate risk acute coronary syndrome: a tertiary hospital experience from New Zealand.

    Science.gov (United States)

    Mazhar, J; Killion, B; Liang, M; Lee, M; Devlin, G

    2013-02-01

    A chest pain unit (CPU) for management of patients with chest pain at low to intermediate risk for acute coronary syndrome (ACS) appears safe and cost-effective. We report our experience with a CPU from March 2005 to July 2009. Prospective audit of patients presenting with chest pain suggestive of ACS but no high risk features and managed using a CPU, which included; serial cardiac troponins and electrocardiography and exercise tolerance test (ETT) if indicated. Outcomes assessed included three-month readmission rate and one year mortality. 2358 patients were managed according to the CPU. Mean age 56 years (17-96 years), 59% men and median stay of 22h (IQR 17-26h). 1933 (82%) were diagnosed as non-cardiac chest pain. 1741 (74%) patients had an ETT. Median time from triage to ETT was 21h (IQR 16-24h). 64 (2.7%) were readmitted within three months. The majority of readmissions, 39 (61%) were for a non-cardiac cause. Twenty patients (1%) were readmitted with ACS. There was no cardiac death after one year of being discharged as non-cardiac chest pain. This study confirms that a CPU with high usage of predischarge ETT is a safe and effective way of excluding ACS in patients without high risk features in a New Zealand setting. Copyright © 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  13. Delirium in patients with acute ischemic stroke admitted to the non-intensive stroke unit: Incidence and association between clinical features and inflammatory markers.

    Science.gov (United States)

    Kozak, Hasan Hüseyin; Uğuz, Faruk; Kılınç, İbrahim; Uca, Ali Ulvi; Serhat Tokgöz, Osman; Akpınar, Zehra; Özer, Nejla

    Stroke patients with development of delirium have unfavorable outcomes, higher mortality, longer hospitalizations, and a greater degree of dependence after discharge. Studies suggest that delirium is associated with abnormal immunological responses and a resultant increase in inflammatory markers. Our aim was to determine whether there is an entity relationship between delirium, inflammation and acute ischemic stroke (AIS). Sixty AIS patients admitted to the hospital were consecutively recruited. Delirium was diagnosed with the clinical assessment according to the Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of Interleukin-1 beta (IL-1 beta), Interleukin 18 (IL-18), Tumor Necrosis Factor-alpha (TNF-alpha), Brain-Derived Neurotrophic Factor (BDNF), and Neuron Specific Enolase (NSE) at admission. Eleven (18.3%) of 60 patients were diagnosed with delirium, and the majority (n=8, 72.7%) was the hypoactive type. Delirious and non-delirious patients had similar demographic and clinical features. Delirious patients had significantly higher lengths of hospital stay, National Institutes of Health Stroke Scale (NIHSS) at admission and discharge compared to non-delirious patients. In addition, there was no significant statistical difference between delirious and non-delirious patients with AIS in respect of levels of TNF-alpha, IL-1 beta, IL-18, BDNF and NSE. This study suggests that delirium is not scarce in patients with AIS admitted to the non-intensive stroke unit, and that delirium developing after AIS seems not to be associated with serum TNF-alpha, IL-1 beta, IL-18, BDNF and NSE but is associated with length of hospital stay and stroke severity. Copyright © 2016. Published by Elsevier Urban & Partner Sp. z o.o.

  14. Diagnostic work-up for detection of paroxysmal atrial fibrillation after acute ischemic stroke: cross-sec