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Mikusek-Pham Van M. Deep Vein Thrombosis in a 15-Year-Old Previously Restrained Psychiatric Patient: A Case Report. Cureus 2024; 16:e62261. [PMID: 39006701 PMCID: PMC11244944 DOI: 10.7759/cureus.62261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/16/2024] Open
Abstract
Deep vein thrombosis is a condition in which a thrombus forms in one of the deep veins of the body, most often in the legs. It may manifest with pain, swelling, redness, or increased temperature of the limb, potentially leading to fatal complications such as pulmonary embolism. This is a case of a 15-year-old psychiatric patient diagnosed with deep vein thrombosis of the left lower limb of uncertain etiology. The patient presented few risk factors associated with venous thromboembolism disorder such as immobilization, antipsychotic treatment, and obesity. Even though psychiatry deals primarily with the mind of a patient, somatic complications occur very often and should not be underestimated. One of those complications is deep vein thrombosis, which is worth remembering, especially when applying procedures during which patients are immobilized for a long period.
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2
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Manderius C, Clintståhl K, Sjöström K, Örmon K. The psychiatric mental health nurse's ethical considerations regarding the use of coercive measures - a qualitative interview study. BMC Nurs 2023; 22:23. [PMID: 36698105 PMCID: PMC9875520 DOI: 10.1186/s12912-023-01186-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In psychiatric inpatient care, situations arise where it may be necessary to use coercive measures and thereby restrict individual autonomy. The ethical principles of healthcare, i.e., respect for autonomy, beneficence, nonmaleficence, and justice, are recognized as central aspects in healthcare practice, and nurses must be clear about which ethical theories and principles to prioritize and what values are needed for a thorough ethical consideration. The aim of this study is to shed light on psychiatric mental health nurses' ethical considerations and on the factors influencing them when performing coercive measures. METHODS This qualitative interview study included twelve psychiatric mental health nurses with experience from psychiatric inpatient care. A content analysis was made. The interviews were audio recorded and transcribed verbatim, and categories were formulated. RESULTS The study revealed a duality that created two categories: Ethical considerations that promote the patient's autonomy and health and Obstacles to ethical considerations. Based on this duality, ethical considerations were made when performing coercive measures to alleviate suffering and promote health. The result shows a high level of ethical awareness in clinical work. However, a request emerged for more theoretical knowledge about ethical concepts that could be implemented among the staff. CONCLUSION The psychiatric mental health nurses in this study strive to do what is best for the patient, to respect the patient's autonomy as a guiding principle in all ethical considerations, and to avoid coercive measures. An organizational ethical awareness could increase the understanding of the difficult ethical considerations that nurses face with regard to minimizing the use of coercive measures in the long run.
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Affiliation(s)
- Charlotta Manderius
- Psychiatric assessment unit, adult psychiatry, Region Skane, Helsingborg, Sweden
| | | | - Karin Sjöström
- grid.32995.340000 0000 9961 9487Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Karin Örmon
- grid.32995.340000 0000 9961 9487Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden ,Regionhälsan, The Västra Götaland Competence Centre on Intimate Partner Violence, Gothenburg, Sweden
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Varpula J, Välimäki M, Lantta T, Berg J, Soininen P, Lahti M. Safety hazards in patient seclusion events in psychiatric care: A video observation study. J Psychiatr Ment Health Nurs 2022; 29:359-373. [PMID: 34536315 DOI: 10.1111/jpm.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Coercive measures such as seclusion are used to maintain the safety of patients and others in psychiatric care. The use of coercive measures can lead to harm among patients and staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first of its kind to rely on video observation to expose safety hazards in seclusion events that have not been reported previously in the literature. The actions that both patients and staff take during seclusion events can result in various safety hazards. IMPLICATIONS FOR PRACTICE?: Constant monitoring of patients during seclusion is important for identifying safety hazards and intervening to prevent harm. Nursing staff who use seclusion need to be aware of how their actions can contribute to safety hazards and how they can minimize their potential for harm ABSTRACT: Introduction Seclusion is used to maintain safety in psychiatric care. There is still a lack of knowledge on potential safety hazards related to seclusion practices. Aim To identify safety hazards that might jeopardize the safety of patients and staff in seclusion events in psychiatric hospital care. Method A descriptive design with non-participant video observation was used. The data consisted of 36 video recordings, analysed with inductive thematic analysis. Results Safety hazards were related to patient and staff actions. Patient actions included aggressive behaviour, precarious movements, escaping, falling, contamination and preventing visibility. Staff actions included leaving hazardous items in a seclusion room, unsafe administration of medication, unsecured use of restraints and precarious movements and postures. Discussion This is the first observational study to identify safety hazards in seclusion, which may jeopardize the safety of patients and staff. These hazards were related to the actions of patients and staff. Implications for Practice Being better aware of possible safety hazards could help prevent adverse events during patient seclusion events. It is therefore necessary that nursing staff are aware of how their actions might impact their safety and the safety of the patients. Video observation is a useful method for identifying safety hazards. However, its use requires effort to safeguard the privacy and confidentiality of those included in the videos.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya School of Nursing, Central South University, Hunan, China
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Johanna Berg
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| | | | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
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Hirose N, Morita K, Nakamura M, Fushimi K, Yasunaga H. Association between the duration of physical restraint and pulmonary embolism in psychiatric patients: A nested case-control study using a Japanese nationwide database. Arch Psychiatr Nurs 2021; 35:534-540. [PMID: 34561070 DOI: 10.1016/j.apnu.2021.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/01/2021] [Accepted: 07/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pulmonary embolism is the most life-threatening adverse event following physical restraint. However, little is known about the associaton between the duration of physical restraint and pulmonary embolism in psychiatric patients. OBJECTIVE The purpose of this study is to evaluate whether more total days of physical restraint is associated with a higher risk of pulmonary embolism. METHOD This is a retrospective nested case-control study using a Japanese nationwide administrative inpatient database. We identified patients who were admitted to psychiatric departments from July 2010 to March 2017. One-to-four case-control matching was performed with patients with and without pulmonary embolism. We performed multivariable conditional logistic regression analyses to assess the odds ratios of total days of physical restraint regarding pulmonary embolism. RESULTS We identified 223,285 eligible psychiatric patients; 132 (0.059%) patients developed pulmonary embolism during hospitalization. Overall, 13.2% of the psychiatric patients experienced physical restraint for at least 1 day. More total days of physical restraint was significantly associated with a higher risk of pulmonary embolism. CONCLUSIONS Longer exposure to physical restraint may increase the risk of pulmonary embolism in psychiatric patients.
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Affiliation(s)
- Naoki Hirose
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan; Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima 7348551, Japan.
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
| | - Mitsuhiro Nakamura
- Department of Psychiatry, Yokohama Camellia Hospital, 920 Shirane-Cho, Asahi-Ku, Yokohama, Kanagawa 2410003, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 1138510, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
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Guzman-Parra J, Aguilera-Serrano C, Huizing E, Bono Del Trigo A, Villagrán JM, García-Sánchez JA, Mayoral-Cleries F. A regional multicomponent intervention for mechanical restraint reduction in acute psychiatric wards. J Psychiatr Ment Health Nurs 2021; 28:197-207. [PMID: 32667113 DOI: 10.1111/jpm.12669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: A relevant number of restraint prevention programmes have been developed internationally. In Spain, there is no harmonized policy to prevent the use of restraint. More studies are necessary to establish which programmes and components are necessary to prevent restraint. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: There was a significant decreasing trend in the total number of mechanical restraint hours during the implementation of the intervention. There was no significant decreasing trend in the number of mechanical restraint episodes. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Interventions at a regional level aimed at preventing mechanical restraint are feasible in the Spanish context. All components of the Six Core Strategies could be necessary to prevent episodes of mechanical restraint. ABSTRACT: Introduction Mechanical restraint (MR) is used in many countries, including Spain, where non-harmonized policies between autonomous communities exist. There is a lack of research about interventions at regional levels to reduce their use. Aim To analyse data on key outcomes during the implementation of a multicomponent intervention in Andalusia (Spain) to reduce the use of MR. Method Episodes in a period of 30 months in all wards (N = 20) were analysed. The intervention consisted of five strategies: (a) leadership, (b) analysis of the situation, (c) awareness training for the heads of the wards, (d) unified record of MR and (e) staff training. We analysed the monthly trend of restraint hours and restraint episodes/1,000 bed days using segmented regression. Results There were 206.32 restraint hours and 12.96 restraint episodes/1,000 bed days during the study period. A significant decreasing trend was observed in restraint hours (-1.79%, p < .001), but not in the number of restraint episodes (-0.45%; p = .149). Discussion The results coincide with other international studies; however, studies with better designs are required to evaluate the effectiveness of the intervention. Implications for Practice Interventions at a regional level aimed at preventing MR are feasible in the Spanish context.
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Affiliation(s)
- Jose Guzman-Parra
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Carlos Aguilera-Serrano
- Community Mental Health Unit of Motril, South Health Management Area of Granada, Motril, Spain
| | | | | | - José María Villagrán
- Mental Health Hospitalization Unit, Jerez de la Frontera Hospital, Jerez de la Frontera, Spain
| | - Juan Antonio García-Sánchez
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Fermín Mayoral-Cleries
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
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Hirsch S, Steinert T. Measures to Avoid Coercion in Psychiatry and Their Efficacy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:336-343. [PMID: 31288909 PMCID: PMC6630163 DOI: 10.3238/arztebl.2019.0336] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 08/20/2018] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Coercive measures such as seclusion and restraint encroach on the patient's human rights and can have serious adverse effects ranging from emotional trauma to physical injury and even death. At the same time, they may be the only way to avert acute danger for the patient and/or the hospital staff. In this article, we provide an overview of the efficacy of the measures that have been studied to date for the avoidance of coercion in psychiatry. METHODS This review is based on publications retrieved by a systematic search in the Medline and Cinahl databases, supplemented by a search in the reference lists of these publications. We provide a narrative synthesis in which we categorize the interventions by content. RESULTS Of the 84 studies included in this review, 16 had a control group; 6 of these 16 were randomized controlled trials (RCTs). The interventions were categorized by seven different types of content: organization, staff training, risk assessment, environment, psychotherapy, debriefings, and advance directives. Most interventions in each category were found to be effective in the respective studies. 38 studies investigated complex treatment programs that incorporated elements from more than one category; 37 of these (including one RCT) revealed effective reduction of the frequency of coercion. Two RCTs on the use of rating instruments to assess the risk of aggressive behavior revealed a relative reduction of the number of seclusion measures by 27% and a reduction of the cumulative duration of seclusion by 45%. CONCLUSION Complex intervention programs to avoid coercive measures, incorporating elements of more than one of the above categories, seem to be particularly effective. In future, cluster-randomized trials to investigate the individual categories of intervention would be desirable.
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Affiliation(s)
- Sophie Hirsch
- ZfP Südwürttemberg, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weissenau
| | - Tilman Steinert
- ZfP Südwürttemberg, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weissenau
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7
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Ellis N, Grubb CM, Mustoe S, Watkins E, Codling D, Fitch S, Stirland L, Quraishy M, Jenkinson J, Harrison J. Venous thromboembolism risk in psychiatric in-patients: a multicentre cross-sectional study. BJPsych Bull 2019; 43:255-259. [PMID: 31030692 DOI: 10.1192/bjb.2019.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and methodWe assessed venous thromboembolism (VTE) risk, barriers to prescribing VTE prophylaxis and completion of VTE risk assessment in psychiatric in-patients. This was a cross-sectional study conducted across three centres. We used the UK Department of Health VTE risk assessment tool which had been adapted for psychiatric patients. RESULTS: Of the 470 patients assessed, 144 (30.6%) were at increased risk of VTE. Patients on old age wards were more likely to be at increased risk than those on general adult wards (odds ratio = 2.26, 95% CI 1.51-3.37). Of those at higher risk of VTE, auditors recorded concerns about prescribing prophylaxis in 70 patients (14.9%). Only 20 (4.3%) patients had a completed risk assessment.Clinical implicationsMental health in-patients are likely to be at increased risk of VTE. VTE risk assessment is not currently embedded in psychiatric in-patient care. There is a need for guidance specific to this population.Declaration of interestNone.
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Kersting XAK, Hirsch S, Steinert T. Physical Harm and Death in the Context of Coercive Measures in Psychiatric Patients: A Systematic Review. Front Psychiatry 2019; 10:400. [PMID: 31244695 PMCID: PMC6580992 DOI: 10.3389/fpsyt.2019.00400] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/21/2019] [Indexed: 11/13/2022] Open
Abstract
Background: For centuries coercive measures in psychiatry have been means of averting acute danger. It has been known for almost as long that these measures can lead to harm or even death to those affected. Over the past two decades the topic has increasingly been the subject of scientific discussion and research. While the legal and ethical preconditions for coercive measures in psychiatry as well as epidemiological studies on their incidence and patients' subjective experiences have increasingly come into focus, research on possible adverse events has lagged behind. To our knowledge there is no systematic review on the harmful or even fatal physical adverse effects of coercive interventions in psychiatry. Methods: We searched the databases PubMed and CINAHL for primary literature with a search string based on the PICO framework including key words describing different psychiatric diagnoses, coercive measures, and harms. Results: In total, 67 eligible studies (mainly case reports and case series) of very heterogeneous quality were included. Two RCTs were found reporting position-dependent cardiac deterioration, but were, however, carried out with healthy people and were characterized by a small number of cases. Death was the most frequently reported harm: cardiac arrest by chest compression in 14 studies, cardiac arrest by strangulation in 9, and pulmonary embolism in 8 studies. Further harms were, among others, venous thromboembolism and injuries. Injuries during physical restraint were reported in 0.8-4% of cases. For other kinds of coercive interventions, there are no sufficient data. Venous thromboembolism occurred in a considerable percentage of cases during mechanical restraint, also under prophylaxis. The most commonly reported coercive measure was restraint, distinguishing in mechanical restraint (43 studies), physical restraint (22 studies), bedrails (eight studies), vest restraint (7 studies), and chair restraint (6 studies). Forced medication was explicitly mentioned only in two, but seems to have occurred in nine studies. Six studies included seclusion. Conclusion: Coercive measures can lead to physical harm or even death. However, there is a significant lack of data on the incidence of such adverse events related to coercive interventions. Though reported anecdotally, physical adverse events during seclusion appear to be highly underresearched.
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Affiliation(s)
- Xenia A K Kersting
- Clinic for Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.,MVZ Venusberg of the University Hospital Bonn, Bonn, Germany
| | - Sophie Hirsch
- Clinic for Psychiatry and Psychotherapy I, Ulm University (Weissenau), Ulm, Germany
| | - Tilman Steinert
- Clinic for Psychiatry and Psychotherapy I, Ulm University (Weissenau), Ulm, Germany.,Zentrum für Psychiatrie Suedwuerttemberg, Weissenau, Germany
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Ziaei M, Massoudifar A, Rajabpour-Sanati A, Pourbagher-Shahri AM, Abdolrazaghnejad A. Management of Violence and Aggression in Emergency Environment; a Narrative Review of 200 Related Articles. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 3:e7. [PMID: 31172118 PMCID: PMC6548084 DOI: 10.22114/ajem.v0i0.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
CONTEXT The aim of this study is to reviewing various approaches for dealing with agitated patients in emergency department (ED) including of chemical and physical restraint methods. EVIDENCE ACQUISITION This review was conducted by searching "Violence," "Aggression," and "workplace violence" keywords in these databases: PubMed, Scopus, EmBase, ScienceDirect, Cochrane Database, and Google Scholar. In addition to using keywords for finding the papers, the related article capability was used to find more papers. From the found papers, published papers from 2005 to 2018 were chosen to enter the paper pool for further review. RESULTS Ultimately, 200 papers were used in this paper to conduct a comprehensive review regarding violence management in ED. The results were categorized as prevention, verbal methods, pharmacological interventions and physical restraint. CONCLUSION In this study various methods of chemical and physical restraint methods were reviewed so an emergency medicine physician be aware of various available choices in different clinical situations for agitated patients.
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Affiliation(s)
- Maryam Ziaei
- Department of Emergency Medicine, Khatam-Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Massoudifar
- Department of Psychiatry, School of Medicine, Hormozgan University of Medical Sciences, Bandarabbas, Iran
| | | | | | - Ali Abdolrazaghnejad
- Department of Emergency Medicine, Khatam-Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
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Tezenas du Montcel C, Kowal C, Leherle A, Kabbaj S, Frajerman A, Le Guen E, Hamdani N, Schürhoff F, Leboyer M, Pelissolo A, Pignon B. Isolement et contention mécanique dans les soins psychiatriques : modalités de prescription, prise en charge et surveillance. Presse Med 2018; 47:349-362. [DOI: 10.1016/j.lpm.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/22/2018] [Accepted: 03/06/2018] [Indexed: 12/19/2022] Open
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Gaertner S, Piémont A, Faller A, Bertschy G, Hallouche N, Mirea C, Le Ray I, Cordeanu EM, Stephan D. Incidence and risk factors of venous thromboembolism: Peculiarities in psychiatric institutions. Int J Cardiol 2017; 248:336-341. [DOI: 10.1016/j.ijcard.2017.07.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/23/2017] [Accepted: 07/26/2017] [Indexed: 01/26/2023]
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12
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Lee JS. Restraint in the Intensive Care Unit. JOURNAL OF NEUROCRITICAL CARE 2015. [DOI: 10.18700/jnc.2015.8.2.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Lorenzo RD, Miani F, Formicola V, Ferri P. Clinical and organizational factors related to the reduction of mechanical restraint application in an acute ward: an 8-year retrospective analysis. Clin Pract Epidemiol Ment Health 2014; 10:94-102. [PMID: 25320635 PMCID: PMC4196251 DOI: 10.2174/1745017901410010094] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 07/11/2014] [Accepted: 07/13/2014] [Indexed: 01/09/2023]
Abstract
Background: The purpose of this study was to describe the frequency of mechanical restraint use in an acute psychiatric ward and to analyze which variables may have significantly influenced the use of this procedure. Methods: This retrospective study was conducted in the Servizio Psichiatrico di Diagnosi e Cura (SPDC) of Modena Centro. The following variables of our sample, represented by all restrained patients admitted from 1-1-2005 to 31-12-2012, were analyzed: age, gender, nationality, psychiatric diagnoses, organic comorbidity, state and duration of admission, motivation and duration of restraints, nursing shift and hospitalization day of restraint, number of patients admitted at the time of restraint and institutional changes during the observation period. The above variables were statistically compared with those of all other non-restrained patients admitted to our ward in the same period. Results: Mechanical restraints were primarily used as a safety procedure to manage aggressive behavior of male patients, during the first days of hospitalization and night shifts. Neurocognitive disorders, organic comorbidity, compulsory state and long duration of admission were statistically significantly related to the increase of restraint use (p<.001, multivariate logistic regression). Institutional changes, especially more restricted guidelines concerning restraint application, were statistically significantly related to restraint use reduction (p<.001, chi2 test, multivariate logistic regression). Conclusion: The data obtained highlight that mechanical restraint use was influenced not only by clinical factors, but mainly by staff and policy factors, which have permitted a gradual but significant reduction in the use of this procedure through a multidimensional approach.
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Affiliation(s)
- Rosaria Di Lorenzo
- Psychiatrist of Mental Health Department, SPDC-Modena Centro, NOCSAE, via Giardini 1355, 41126 Baggiovara(MO), Italy
| | - Fiorenza Miani
- Psychiatrist of Mental Health Department, SPDC-Modena Centro, NOCSAE, via Giardini 1355, 41126 Baggiovara(MO), Italy
| | - Vitantonio Formicola
- Psychiatrist of Mental Health Department, SPDC-Modena Centro, NOCSAE, via Giardini 1355, 41126 Baggiovara(MO), Italy
| | - Paola Ferri
- Psychiatrist of Mental Health Department, SPDC-Modena Centro, NOCSAE, via Giardini 1355, 41126 Baggiovara(MO), Italy
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Ishida T, Katagiri T, Uchida H, Takeuchi H, Sakurai H, Watanabe K, Mimura M. Incidence of Deep Vein Thrombosis in Restrained Psychiatric Patients. PSYCHOSOMATICS 2014; 55:69-75. [DOI: 10.1016/j.psym.2013.04.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 03/03/2013] [Accepted: 04/01/2013] [Indexed: 01/01/2023]
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15
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Batalis NI, Harley RA. Pulmonary Embolic Disorders. Acad Forensic Pathol 2013. [DOI: 10.23907/2013.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Deaths due to pulmonary thromboemboli are frequently encountered by the forensic pathologist and account for a significant percentage of sudden, unexpected deaths. Diagnosing these straightforward cases is often not a challenge, but unfortunately some cases in which a thromboembolism is expected can become complicated. Occasionally, a postmortem clot may mimic a thromboembolism and lead to a mistaken diagnosis, and in other situations it may become paramount to attempt to age a thrombus as part of a medicolegal lawsuit. Additionally, many individuals use the less specific term, “pulmonary emboli”, when referring to these cases in which a portion of a thrombus, usually originating in the deep veins of the lower extremities, breaks off and travels to the pulmonary vasculature bed where it occludes vessels and leads to a rapid demise. One must remember, though, that several other materials and tissues including fat, amniotic fluid, air, tumors, solid organs, synthetic materials, and parasites may be displaced and embolize to the lungs and cause significant disease. In the following pages we will provide a thorough review of pulmonary embolic disorders, focusing on those diseases most likely to be encountered by the forensic pathologist. The aim of this review is to aid the pathologist in using proper terminology, diagnosing various types of embolic disorders, and recognizing potential mimics.
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Affiliation(s)
- Nicholas I. Batalis
- Medical University of South Carolina
- Medical University of South Carolina - Department of Pathology and Lab Medicine, Charleston, SC, and The Joint Pathology Center - Pulmonary Pathology, Silver Spring, MD (RH)
| | - Russell A. Harley
- Medical University of South Carolina - Department of Pathology and Lab Medicine, Charleston, SC, and The Joint Pathology Center - Pulmonary Pathology, Silver Spring, MD (RH)
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Rakhmatullina M, Taub A, Jacob T. Morbidity and mortality associated with the utilization of restraints : a review of literature. Psychiatr Q 2013; 84:499-512. [PMID: 23649219 DOI: 10.1007/s11126-013-9262-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Use of physical restraints remains a highly controversial topic. Even with proven efficacy in restraint usage across multiple settings, for years, investigators have debated whether or not the risks outweigh the benefits. There is a growing concern regarding restraints-related negative consequences. Although over the past two decades, with new regulations, education and training, there has been a reduction in the prevalence of restraint episodes, morbidity and mortality are still disconcerting. Given this subject remains an issue today, a more up-to-date review of available literature is warranted. This article reviews the current literature surrounding the utilization of restraints that has been published over last 10 years with particular emphasis on restraints-related adverse outcomes. The vast amount of literature during the past decade demonstrates an increased awareness in potential dangers, as well as highlights new areas of research in restraint utilization. Despite the proliferation of studies, there continues to remain a lack of evidence from prospective studies that would elucidate the dangers from theory to practice.
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Affiliation(s)
- Maryam Rakhmatullina
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA,
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Di Lorenzo R, Baraldi S, Ferrara M, Mimmi S, Rigatelli M. Physical restraints in an Italian psychiatric ward: clinical reasons and staff organization problems. Perspect Psychiatr Care 2012; 48:95-107. [PMID: 22458723 DOI: 10.1111/j.1744-6163.2011.00308.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To analyze physical restraint use in an Italian acute psychiatric ward, where mechanical restraint by belt is highly discouraged but allowed. DESIGN AND METHODS Data were retrospectively collected from medical and nursing charts, from January 1, 2005, to December 31, 2008. Physical restraint rate and relationships between restraints and selected variables were statistically analyzed. FINDINGS Restraints were statistically significantly more frequent in compulsory or voluntary admissions of patients with an altered state of consciousness, at night, to control aggressive behavior, and in patients with "Schizophrenia and other Psychotic Disorders" during the first 72 hr of hospitalization. PRACTICAL IMPLICATIONS Analysis of clinical and organizational factors conditioning restraints may limit its use.
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Affiliation(s)
- Rosaria Di Lorenzo
- Department of Mental Health, Az-USL Modena, Servizio Psichiatrico di Diagnosi e Cura 1, NOCSAE, Baggiovara (Modena), Italy.
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Cecchi R, Lazzaro A, Catanese M, Mandarelli G, Ferracuti S. Fatal thromboembolism following physical restraint in a patient with schizophrenia. Int J Legal Med 2012; 126:477-82. [DOI: 10.1007/s00414-012-0670-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 01/06/2012] [Indexed: 11/27/2022]
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Stansby G, Noble S, Howes O. The importance of venous thromboembolism - a physical consequence of psychiatric treatments. Int J Clin Pract 2010; 64:1005-6. [PMID: 20642699 DOI: 10.1111/j.1742-1241.2010.02435.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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