No description available.

The purposes of this study were to identify and analyze characteristics of patients who fall, the types and circumstances of their falls, and analyze risk factors for fall-related injuries. In this retrospective study of 137 patients who fell between July 1, 2002 and December 31, 2005 at the neurological unit of a medical center located in the south of Taiwan. Data on patient characteristics, fall circumstances, and injuries were collected by reviewing of adverse event reports. Analyses were performed by use of SPSS statistical software. The result of this study found that the average age of patient who fell was 59.6 years. The majority of sex of the patient falls is male (61.3%). Many patients who fell had caregivers taking constant care (84%), and occurred in the patient room (68.6%). The most frequent diseases related to falls were cerebrovascular disease (47.5%). They usually falls happened during 12AM to 8AM (50.4%). Most falls (81%) did not result in severe injury, or disturbances of gait (78.8%). The most common activity performed at time of fall was during ambulation (39.4%), and getting out of bed (29.9%).The study found that significant risk factors for dizziness were correlated with fall injury (P<0.05); location and activity at time of fall were related to fall injury (P<0.05). The logistic regression model revealed that the significant risk factors for fall-related injuries were activity at time of fall sit and trying to pick up something (OR=18.15 with 95% CI of 1.15 to 285.92). The identified factors associated with injury may provide the information on reducing falling injuries for neurological patients, and development of fall intervention programs. The preventive strategies can ensure patient safety, improve health care quality and reduce resource utilization.

Thesis (M.S.)--University of Michigan, 1971.

Thesis (M.S.)--University of Michigan, 1971.

Introduction: Poor insight is included as a risk factor for violence in risk assessment tools such as the Historical Clinical Risk-Management-20 version 3 (HCR-20v3) yet there is a lack of consensus around the relationship between poor insight and violence in individuals with psychosis. A systematic literature review was therefore carried out to clarify this relationship. Relatedly, a research project aimed to outline the predictive validity of the HCR-20v3 total and sub-scale scores to violence in forensic inpatients. A secondary aim was to understand the predictive ability of 2 dynamic risk factors within the HCR-20v3 clinical sub-scale; insight and positive symptoms, alongside age and history of violence in relation to violence in psychosis. Method: A systematic search of studies investigating insight and violence in patients with psychosis, published between 1980 and 2016 was carried out on relevant databases.17 articles from combined search results of 5694, met the inclusion criteria. These were selected for full-text review and quality grading which was subject to inter-rater reliability. In the research project, the predictive validity of the HCR-20v3 to violence was assessed in N=167 forensic inpatients. A sub-sample of N=135 was then used to investigate insight, positive symptoms, age and history of violence in relation to violence. Data was extracted from case files, with the exception of violence data which was collected prospectively from date of HCR-20v3 publication via DATIX. Results: The systematic review found 8 studies in support of a positive relationship between poor insight and violence, whilst 9 studies did not support this relationship. The majority of better quality studies measured the clinical insight dimension which tended to demonstrate a positive relationship between poor insight and violence. Methodological limitations were apparent across studies. The research project found HCR-20v3 total and clinical and risk-management sub-scale scores to predict violence. The clinical sub-scale was the strongest predictor of violence and physical violence specifically. Sub-sample analysis found positive symptoms and history of violence to significantly predict violence generally whilst only positive symptoms demonstrated prediction of physical violence. Insight and age were not significantly associated with either violence type. Discussion: The systematic review found partial support for a positive relationship between poor insight and violence in psychosis. Future good quality research is required to develop a fuller understanding of this issue. Research project results support the use of the HCR-20v3 in the risk assessment and management of forensic inpatients. They reinforce the usefulness of dynamic risk factors within the clinical sub-scale in particular. In line with the majority of studies within the systematic review however, a relationship between insight and violence in a sub-sample of patients with psychosis was not found. Recommendations are made for the regular re-assessment of dynamic risk factors within the HCR-20v3 clinical sub-scale in order to support patients to reduce their level of risk, with the caveat that future research is still required to support a relationship between insight and violence in this patient group.

No description available.

Background: Response to treatment in anorexia nervosa entails various challenges, including an increased risk of relapse and re-admission in those treated as inpatients. A better understanding of patients’ experiences is paramount to improve treatment acceptability and outcome. This qualitative study aimed to explore the lived experiences of adult female inpatients undergoing a specialist inpatient treatment programme for anorexia nervosa. Methods: Semi-structured interviews were carried out with 21 female participants (aged 18-41 years) with a diagnosis of anorexia nervosa, undergoing treatment in a specialist inpatient eating disorder unit. Data were analysed using interpretative phenomenological analysis (IPA). Results: Qualitative analysis highlighted 5 master themes which underpinned treatment experiences: (1) Shifts in control, (2) Experience of transition, (3) The importance of supportive staff relationships, (4) Sharing with peers and (5) Process of recovery and self-discovery. Conclusions: Overall, findings suggest patients experience a process of change and adjustment during inpatient treatment in relation to their levels of perceived control, attachment to the treatment environment and a sense of self-identity. Treatment experiences appear to be influenced by the development of supportive relationships and the provision of individualised care.

O estudo é qualitativo e foi desenvolvido a partir da observação e interação direta com pacientes internados na Unidade de Queimados - Emergência do Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto (USP). Teve como objetivos conhecer os significados que os pacientes atribuíam à vivência da queimadura e detectar o processo de ajuda que o enfermeiro de saúde mental pode estabelecer. As bases teóricas que nortearam o estudo, centraram-se nos fundamentos de ROGERS(1966), de VINOGRADOV & YALOM(1992) e na teoria de CAPLAN(1950). A amostra foi constituída por 13 adultos de ambos os sexos, diferentes idades, ocupações e procedências. Os dados foram obtidos mediante a entrevista individual não diretiva e reuniões em grupo, que serviram, também, como veículo da assistência de enfermagem de saúde mental. O material foi submetido à análise temática conforme preconizado por BARDIN(1977). Daí emergiram temas comuns no discurso dos pacientes propiciando o conhecimento sobre a experiência vivida. Foram comuns as alusões referentes ao banho, curativo e a cirurgia, cujas percepções e significados compuseram o que se denominou de ciclo da dor. Esteve presente ainda, o tema solidão relacionado a vínculos familiares e pessoas significativas e por fim, as percepções dos pacientes a respeito da assistência recebida pela equipe de saúde. A partir da vivência da pesquisadora, enquanto profissional que estabeleceu um processo interativo durante 3 meses, foi possível relatar a experiência de ser uma enfermeira de saúde mental junto a essa população e ampliar o auto-conhecimento através da avaliação crítica de suas intervenções terapêuticas. Recomenda-se que o enfermeiro esteja igualmente atento a manifestações de dor externa (física) e interna (emocional) dos pacientes. / This is a qualitative study and was developed from the observation and direct interaction with inpatients at the Unidade de Queimados - Emergência do Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto (USP). Had as objectives to know the meaning that the patients ascribed to the burning experience and to detect the aid process that the mental health nursing can establish. The theoretical foundations that guided the study were centered on ROGERS(1966), VINOGRADOV & YALOM(1992) and CAPLAN\'s(1950) theories. The sample was constituted by 13 adults of both sexes, different ages, occupations and origins. The data were obtained from individual non directive interview and group meetings, which also served as a vehicle for mental health nursing assistance. The material was submitted to a theme analysis as indicated by BARDIN(1977). From that, common topics arised from the patients speeches, giving us a knowledge of the living experience. References to the baths, dressings and surgery were common, and the perceptions and significances formed what we call pain cicle. The theme loneliness was also present related to family ties and significant people and, at last, the patients perceptions about the assistance received from the health staff. From the researcher\'s experience as a professional who established an interactive process during 3 months, it was possible to report the experience of being a mental health nurse with this population, and to enlarge self knowledge by a critical evaluation of one\'s therapeutic interventions. It is recommend that the nurse has to be alert to manifestations of the patient\'s external (physical) and internal (emotional) pain.

Background: Acute inpatient stays are decreasing. Evidence for music therapy in mental healthcare exists but practice varies. Short admissions and therapy frequency (usually weekly), limit access, yet acceptability of increased frequency to patients is unknown. Research to model processes and outcomes of intensive provision may identify how best to provide for acute contexts informing clinical practice and future research. Methods: 114 patients admitted to hospital with acute mental health problems were recruited. Patients attended group music therapy 1-3 times per week during admission. Repeated measures assessing patient experiences, session appraisal, motivation and commitment were completed. Questionnaire thematic analysis identified important processes which were coded from session recordings. Multilevel modelling was used to examine associations between music therapy components, session appraisal, motivation, commitment and subsequent attendance. End of therapy interviews with 16 patients explored changes experienced and views on therapy frequency. Results: Attendance was 3 times greater for patients with 3 sessions per week. The majority found increased frequency acceptable and beneficial. Processes of engagement, emotional expression and social connection suggested active music-making, synchrony and singing to be important for group cohesion. Singing was significantly associated with appraisal and motivation. Musical initiation by group members was associated with motivation and commitment. All three outcomes were associated with each other, with session appraisal and increased frequency independently associated with subsequent attendance. Patient attributions for change included creativity, experiential learning and therapist directed reflective discussions. Conclusion: Intensive group music therapy is acceptable to the majority of patients, perceived as beneficial and increases access. Intensive provision is associated with greater engagement and positive experiences, which in turn, are associated with group commitment. Patient experiences can inform practice. Further research should examine effectiveness of intensive provision. Therapists should continue to prioritise engagement through active music-making and singing, and services consider implementation of intensive provision.

Introdução: Controle glicêmico estrito tem sido recomendado para pacientes gravemente enfermos. Entretanto, sua implementação pode ser difícil devido à sobrecarga da equipe de enfermagem, controle inadequado da glicemia e aumento do risco de hipoglicemia. Objetivos: Avaliar a eficácia e segurança de três protocolos de administração de insulina para controle glicêmico em pacientes clínicos admitidos em unidades de terapia intensiva (UTI). Métodos: Foram incluídos pacientes clínicos admitidos em UTI com ao menos uma glicemia maior ou igual a 150mg/dl e pelo menos uma das seguintes características: estar sob ventilação mecânica; politraumatismo; grande queimadura; apresentar ao menos 3 critérios de síndrome da resposta inflamatória sistêmica. Esses indivíduos foram alocados aleatoriamente para um dos seguintes tratamentos: protocolo A insulina regular endovenosa contínua (IREVC) visando manter glicemias entre 100mg/dL e 130mg/dL, com ajustes guiados por software para microcomputador ou handheld device; protocolo B - IREVC visando manter glicemias entre 80mg/dl e 110mg/dl; protocolo C insulina intermitente subcutânea, a partir de glicemias maiores do que 150mg/dl. Para cada paciente as medidas repetidas de glicemia foram sumarizadas como mediana. A avaliação de eficácia foi realizada comparando-se as médias de medianas de glicemia entre os grupos. A segurança foi avaliada comparando-se a incidência de hipoglicemia (40 mg/dl) entre os grupos. Resultados: Foram incluídos 167 pacientes. As médias e desvios-padrão calculados a partir das medianas de glicose foram de 125,0±17,7 mg/dl, 127,1±32,2mg/dl e 158,5±49,6 mg/dl para os pacientes alocados para os protocolos A, B e C, respectivamente (P<0,001 para comparação entre grupos A, B e C; P=0,34 para comparação entre grupo A e B). A incidência de hipoglicemia foi de 12 casos (21,4%) no protocolo A, 24 casos (41,4%) no protocolo B e 2 casos (3,8%) no grupo C (P<0,001 para comparação entre protocolos A, B e C; P=0,02 para comparação A versus B). Não houve diferenças de mortalidade ou quanto a outros desfechos clínicos entre os protocolos; exceto diferenças marginais na quantidade de dias sob noradrenalina (protocolo C<A<B). Conclusões: O protocolo de infusão de insulina com ajustes guiados por software para computador (protocolo A) permite controle tão eficaz da glicemia quanto o protocolo padrão de controle glicêmico estrito (protocolo B), mantendo a glicemia em níveis pós-prandiais normais (80-140 mg/dl), com menor risco de episódios de hipoglicemia. Hipoglicemia foi rara entre os pacientes do protocolo C, porém os níveis de glicemia foram maiores do que entre os pacientes tratados com o protocolo A ou B / Introduction: Strict glycemic control has been recommended for critically ill patients. However, its implementation may face difficulties with increased nursing workload, inadequate blood glucose control and higher risk of hypoglycemia. Objectives: To evaluate the efficacy and safety of three insulin protocols in medical ICU patients (MICU). Methods: MICU patients with at least one blood glucose of at least 150 mg/dL and one or more of the following characteristics were included: mechanical ventilation; at least three criteria for systemic inflammatory response syndrome; admitted because of trauma or burn. Patients were randomized to one of the following treatments: protocol A - continuous insulin infusion with adjustments guided by handheld device or desktop software targeting blood glucose levels between 100mg/dL-130mg/dL; protocol B continuous insulin aiming blood glucose levels between 80mg/dl-110mg/dl; protocol C conventional treatment intermittent subcutaneous administration of insulin if blood glucose levels exceeded 150mg/dL. Efficacy was measured by the mean of patients median blood glucose and safety was measured by the incidence of hypoglycemia (40 mg/dL). Results: 167 patients were included. Mean and standard deviation of patients median blood glucose was 125.0±17.7 mg/dl, 127.1±32.2mg/dl and 158.5±49.6 mg/dl for protocols A, B and C, respectively (P<0.001 for all protocol comparison; P=0.34 for protocol A versus B). 12 patients (21,4%) evolved with at least one episode of hypoglycemia in protocol A, 24 (41.4%) in protocol B, and 2(3.8%) in protocol C (P<0.001 for all protocol comparison; P=0.02 for protocol A versus B). There were no differences regarding mortality or other clinical outcome, except for a marginal difference on the number of days on norepinephrine (C < A < B). Conclusions: A computer guided insulin infusion protocol protocol A causes less episodes of hypoglycemia than and is as efficacious as the standard strict glycemic control protocol protocol B for controlling glucose at normal non-fasting levels (80 mg/dL 140mg/dL) in MICU patients. Hypoglycemia was rare under protocol C, however blood glucose levels were higher than protocol A or B