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Buss A, Areia C, Biggs C, Edmundson H, Young L, Roman C, Santos M, Tarassenko L, Watkinson P, Vollam S. Using a novel ambulatory monitoring system to support patient safety on an acute infectious disease ward during an unfolding pandemic. J Adv Nurs 2024; 80:2452-2461. [PMID: 38054397 DOI: 10.1111/jan.15977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/16/2023] [Accepted: 11/09/2023] [Indexed: 12/07/2023]
Abstract
AIM To gain staff feedback on the implementation and impact of a novel ambulatory monitoring system to support coronavirus patient management on an isolation ward. DESIGN Qualitative service evaluation. METHODS Semi-structured interviews were conducted with 15 multidisciplinary isolation ward staff in the United Kingdom between July 2020 and May 2021. Interviews were audio-recorded, transcribed and analysed using thematic analysis. FINDINGS Adopting Innovation to Assist Patient Safety was identified as the overriding theme. Three interlinked sub-themes represent facets of how the system supported patient safety. Patient Selection was developed throughout the pandemic, as clinical staff became more confident in choosing which patients would benefit most. Trust In the System described how nurses coped with discrepancies between the ambulatory system and ward observation machines. Finally, Resource Management examined how, once trust was built, staff perceived the ambulatory system assisted with caseload management. This supported efficient personal protective equipment resource use by reducing the number of isolation room entries. Despite these reported benefits, face-to-face contact was still highly valued, despite the risk of coronavirus exposure. CONCLUSION Hospital wards should consider using ambulatory monitoring systems to support caseload management and patient safety. Patients in isolation rooms or at high risk of deterioration may particularly benefit from this additional monitoring. However, these systems should be seen as an adjunct to nursing care, not a replacement. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses valued ambulatory monitoring as a means of ensuring the safety of patients at risk of deterioration and prioritizing their workload. IMPACT The findings of this research will be useful to all those developing or considering implementation of ambulatory monitoring systems in hospital wards. REPORTING METHOD This manuscript follows the Consolidated criteria for Reporting Qualitative Research (COREQ) guidelines with inclusion of relevant SQUIRE guidelines for reporting quality improvement. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Annika Buss
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Allied Health Professions Research & Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carlos Areia
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Christopher Biggs
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Holly Edmundson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Louise Young
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Cristian Roman
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Mauro Santos
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Peter Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah Vollam
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- OXinAHR, Oxford Brookes University, Oxford, UK
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Park S, Bae S, Kim EO, Chang E, Kim MJ, Chong YP, Choi SH, Lee SO, Kim YS, Jung J, Kim SH. The impact of discontinuing single-room isolation of patients with vancomycin-resistant enterococci: a quasi-experimental single-centre study in South Korea. J Hosp Infect 2024; 147:77-82. [PMID: 38492645 DOI: 10.1016/j.jhin.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES There is limited data on the effects of discontinuing single-room isolation while maintaining contact precautions, such as the use of gowns and gloves. In April 2021, our hospital ceased single-room isolation for patients with vancomycin-resistant enterococci (VRE) because of single-room unavailability. This study assessed the impact of this policy by examining the incidence of hospital-acquired VRE bloodstream infections (HA-VRE BSI). METHODS This retrospective quasi-experimental study was conducted at a tertiary-care hospital in Seoul, South Korea. Time-series analysis was used to evaluate HA-VRE BSI incidence at the hospital level and in the haematology unit before (phase 1) and after (phase 2) the policy change. RESULTS At the hospital level, HA-VRE BSI incidence level (VRE BSI per 1000 patient-days per month) and trend did not change significantly between phase 1 and phase 2 (coefficient -0.015, 95% confidence interval (CI): -0.053 to 0.023, P=0.45 and 0.000, 95% CI: -0.002 to 0.002, P=0.84, respectively). Similarly, HA-VRE BSI incidence level and trend in the haematology unit (-0.285, 95% CI: -0.618 to 0.048, P=0.09 and -0.018, 95% CI: -0.036 to 0.000, P = 0.054, respectively) did not change significantly across the two phases. CONCLUSIONS Discontinuing single-room isolation of VRE-colonized or infected patients was not associated with an increase in the incidence of VRE BSI at the hospital level or among high-risk patients in the haematology unit. Horizontal intervention for multi-drug-resistant organisms, including measures such as enhanced hand hygiene and environmental cleaning, may be more effective at preventing VRE transmission.
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Affiliation(s)
- S Park
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - S Bae
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - E O Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - E Chang
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - M J Kim
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y P Chong
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-H Choi
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-O Lee
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y S Kim
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J Jung
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea; Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - S-H Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea; Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Lee JH, Shim JW, Lim MH, Baek C, Jeon B, Cho M, Park S, Choi DH, Kim BS, Yoon D, Kim YG, Cho SY, Lee KM, Yeo MS, Zo H, Shin SD, Kim S. Towards optimal design of patient isolation units in emergency rooms to prevent airborne virus transmission: From computational fluid dynamics to data-driven modeling. Comput Biol Med 2024; 173:108309. [PMID: 38520923 DOI: 10.1016/j.compbiomed.2024.108309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/26/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Patient isolation units (PIUs) can be an effective method for effective infection control. Computational fluid dynamics (CFD) is commonly used for PIU design; however, optimizing this design requires extensive computational resources. Our study aims to provide data-driven models to determine the PIU settings, thereby promoting a more rapid design process. METHOD Using CFD simulations, we evaluated various PIU parameters and room conditions to assess the impact of PIU installation on ventilation and isolation. We investigated particle dispersion from coughing subjects and airflow patterns. Machine-learning models were trained using CFD simulation data to estimate the performance and identify significant parameters. RESULTS Physical isolation alone was insufficient to prevent the dispersion of smaller particles. However, a properly installed fan filter unit (FFU) generally enhanced the effectiveness of physical isolation. Ventilation and isolation performance under various conditions were predicted with a mean absolute percentage error of within 13%. The position of the FFU was found to be the most important factor affecting the PIU performance. CONCLUSION Data-driven modeling based on CFD simulations can expedite the PIU design process by offering predictive capabilities and clarifying important performance factors. Reducing the time required to design a PIU is critical when a rapid response is required.
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Affiliation(s)
- Jong Hyeon Lee
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Jae Woo Shim
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Min Hyuk Lim
- Graduate School of Health Science and Technology, Ulsan National Institute of Science and Technology (UNIST), 50 UNIST-gil, Eonyang-eup, Ulju-gun, Ulsan, Republic of Korea; Department of Biomedical Engineering, Ulsan National Institute of Science and Technology (UNIST), 50 UNIST-gil, Eonyang-eup, Ulju-gun, Ulsan, Republic of Korea; Department of Transdisciplinary Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Changhoon Baek
- Department of Transdisciplinary Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea; Innovative Medical Technology Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea; Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Byoungjun Jeon
- Innovative Medical Technology Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea; Office of Hospital Information, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Minwoo Cho
- Department of Transdisciplinary Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea; Innovative Medical Technology Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea; Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Sungwoo Park
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea; Innovative Medical Technology Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Dong Hyun Choi
- Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Byeong Soo Kim
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Dan Yoon
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Young Gyun Kim
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Seung Yeon Cho
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Kyung-Min Lee
- International Vaccine Institute, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Myoung-Souk Yeo
- Department of Architecture and Architectural Engineering, Seoul National University College of Engineering, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Hangman Zo
- Department of Architecture and Architectural Engineering, Seoul National University College of Engineering, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea; Institute of Bioengineering, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea; Artificial Intelligence Institute, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea.
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Russo S, Telfer J, Silva C, Daly E, Browning S. Haemodialysis machine designation for patients with chronic Hepatitis B virus: A practice and attitudes survey of Australian renal healthcare workers. Infect Dis Health 2024; 29:107-111. [PMID: 38485528 DOI: 10.1016/j.idh.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/02/2024] [Accepted: 02/25/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND To reduce the risk of viral transmission, guidelines recommend the use of designated haemodialysis machines and patient isolation for patients with chronic hepatitis B virus (HBV). These practices are without a strong evidence base, and may no longer be necessary in the setting of heat disinfection programs and standard precautions. METHODS An online cross-sectional survey was developed for renal clinicians across Australia and New Zealand to explore infection prevention policy concerning patients with chronic HBV in haemodialysis units. We sought to determine whether psychosocial and cultural impacts might result from the mandatory use of machine designation and patient isolation practices, as perceived by multidisciplinary healthcare workers with experience working with this patient population. RESULTS Sixty-seven responses from 27 health districts across all states of Australia and one New Zealand district were received. Most respondents were from urban areas (65%), and were nurses (87%). 50% of health districts reported using designated machines, while 32% isolate patients. Lack of necessary resources limited the use of designated machines (57%), and patient isolation (78%). Respondents not routinely using these precautions were more likely to express concerns regarding patient psychosocial wellbeing and cultural appropriateness. Overall, 30% of respondents expressed concerns regarding the cultural appropriateness of these recommendations. CONCLUSION We demonstrate wide variation in haemodialysis infection prevention and control policy and practice with regards to managing patients with chronic HBV. While use of standard precautions and machine disinfection are consistently applied, resource availability and concerns for patient psychosocial wellbeing limit adherence to international guidelines.
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Affiliation(s)
- Sarah Russo
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New South Wales, Australia. https://twitter.com/renalrusso
| | - Jill Telfer
- Dialysis Services, Peel, Mehi and Tablelands Sectors, Hunter New England Local Health District, New South Wales, Australia
| | - Carla Silva
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New South Wales, Australia
| | - Eliza Daly
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New South Wales, Australia
| | - Sarah Browning
- Infection Prevention Service, Hunter New England Local Health District, New South Wales, Australia; University of Newcastle, School of Medicine and Public Health, Callaghan, New South Wales, Australia; Infection Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
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Anderer S. CDC Eases Isolation Guidance for Respiratory Viruses. JAMA 2024; 331:1081. [PMID: 38477941 DOI: 10.1001/jama.2024.2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
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Wright D, Christie J, Lawrence J, Vaughn KL, Walsh TF. Effectiveness of dry hydrogen peroxide in reducing air and surface bioburden in a multicenter clinical setting. Infect Control Hosp Epidemiol 2024; 45:501-508. [PMID: 38017626 PMCID: PMC11007363 DOI: 10.1017/ice.2023.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/04/2023] [Accepted: 06/09/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To determine the effectiveness of dry hydrogen peroxide (DHP) in reducing environmental bioburden in occupied areas. DESIGN Prospective environmental cohort study. SETTING The study was conducted in 2 tertiary-care hospitals and 1 free-standing emergency department. INTERVENTION Environmental air and surface sites were cultured before and after continuous deployment of DHP systems in targeted hospital areas. METHODS In total, 1,554 surface and 1,036 air samples were collected from 74 patient areas among the 3 facilities on 3 consecutive days before DHP deployment and on days 14, 30, 60, and 90 after deployment. At each sampling time, 2 air samples were collected at each facility from 1 room without DHP, along with 2 outdoor samples from each facility. The impact of negative-pressure usage on the efficacy of DHP was also evaluated, with 1 hospital continuously using negative pressure, another utilizing it only in patient isolation scenarios, and another without negative pressure. RESULTS In the 2 facilities without continuous negative pressure, exposure to DHP was associated with a significant reduction in surface bioburden, characterized as total colony-forming units (P = .019; P = .002). Significant associations between DHP exposure and reductions in airborne bacterial load at the 2 hospitals were observed (P ≤ .001; P = .041), and the free-standing emergency department experienced a reduction that did not achieve statistical significance (P = .073). CONCLUSIONS Our findings confirm that DHP has the potential to reduce microbial air and surface bioburden in occupied patient rooms with standard ventilation parameters.
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Affiliation(s)
- Don Wright
- Universal Health Services, King of Prussia, Pennsylvania
| | | | - Jordan Lawrence
- Department of Infection Prevention and Control, Aiken Regional Medical Centers, Aiken, South Carolina
| | - Kimberly L. Vaughn
- Department of Infection Prevention and Control, Henderson Hospital, Henderson, Nevada
| | - Timothy F. Walsh
- Department of Infection Prevention and Control, Valley Hospital Medical Center, Las Vegas, Nevada
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Furlow B. US CDC plans to relax COVID-19 isolation guidelines. Lancet Respir Med 2024; 12:272. [PMID: 38432243 DOI: 10.1016/s2213-2600(24)00075-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
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Havilla S, Alanazi FK, Boon B, Patton D, Ho YC, Molloy L. Exploring the impact of a multilevel intervention focused on reducing the practices of seclusion and restraint in acute mental health units in an Australian mental health service. Int J Ment Health Nurs 2024; 33:442-451. [PMID: 37964469 DOI: 10.1111/inm.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
Reducing and eliminating seclusion and restraint in inpatient settings has been a key area of focus in mental health policy and research for many years. To address this issue, numerous programmes aimed at minimising the use of these practices have been developed over the past two decades, with varying degrees of success. This article reports on research focused on the implementation of a localised, multilevel complex intervention that targeted both organisational and individual factors related to the use of seclusion and restraint. The researchers followed the impact of the intervention by interviewing medical, nursing and allied health staff who worked within the service (N = 12) and analysing the rates of seclusion and restraint over an 18-month period. Post-adoption, participants identified that there were clear changes in practice culture. Seclusion clearly became a practice of last resort and other options became prominent in staff's practice. Participants identified that there was a sense of shared purpose across the multidisciplinary team. The clinical environment was viewed as being more therapeutic for service users and less frightening for staff. There was a significant difference in the total number of seclusion events between pre- (Mean = 6.22, SD = 5.82) and post-implementation (Mean = 2.55, SD = 2.44, p = 0.002, d = 0.94), demonstrating a significantly lower number of seclusions was observed after the intervention. Similarly, a significant difference in restraint events between pre- (Mean = 5.50, SD = 3.77) and post-implementations (Mean = 3.38, SD = 3.21, p = 0.037, d = 0.62) was observed.
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Affiliation(s)
- Sizwile Havilla
- Illawarra Shoalhaven Local Health District Mental Health Service, Shellharbour, New South Wales, Australia
| | | | - Brad Boon
- Illawarra Shoalhaven Local Health District Mental Health Service, Shellharbour, New South Wales, Australia
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Yen-Chung Ho
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan ROC
| | - Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
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Askola R, Lantta T. Factors that enable or hinder the rebuilding of the therapeutic relationship following an episode of physical restraint in acute forensic services. Evid Based Nurs 2024; 27:70. [PMID: 37640424 DOI: 10.1136/ebnurs-2023-103798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Riitta Askola
- Department of Nursing, University of Turku, Turku, Finland
| | - Tella Lantta
- Department of Nursing, University of Turku, Turku, Finland
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Sila T, Suriyaamorn W, Toh C, Rajborirug S, Surasombatpattana S, Thongsuksai P, Kongkamol C, Chusri S, Sornsenee P, Wuthisuthimethawee P, Chaowanawong R, Sangkhathat S, Ingviya T. Factors associated with the worsening of COVID-19 symptoms among cohorts in community- or home-isolation care in southern Thailand. Front Public Health 2024; 12:1350304. [PMID: 38572011 PMCID: PMC10987961 DOI: 10.3389/fpubh.2024.1350304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/09/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction This study aimed to investigate factors associated with time-to-referral due to worsening symptoms in patients with laboratory-confirmed COVID-19 in southern Thailand. While underlying diseases have been evaluated to assess COVID-19 severity, the influence of vaccinations and treatments is also crucial. Methods A cohort of 8,638 patients quarantined in home or community isolation with laboratory-confirmed COVID-19 was analyzed. Survival analysis and the Cox proportional hazard ratio were employed to assess factors influencing time-toreferral. Results Age ≥ 60 years, neurologic disorders, cardiovascular disease, and human immunodeficiency virus infection were identified as significant risk factors for severe COVID-19 referral. Patients who received full- or booster-dose vaccinations had a lower risk of experiencing severe symptoms compared to unvaccinated patients. Notably, individuals vaccinated during the Omicron-dominant period had a substantially lower time-to-referral than those unvaccinated during the Delta-dominant period. Moreover, patients vaccinated between 1 and 6 months prior to infection had a significantly lower risk of time-to-referral than the reference group. Discussion These findings demonstrate early intervention in high-risk COVID-19 patients and the importance of vaccination efficacy to reduce symptom severity. The study provides valuable insights for guiding future epidemic management strategies and optimising patient care during infectious disease outbreaks.
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Affiliation(s)
- Thanit Sila
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Department of Health Science and Clinical Research, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Wisanuwee Suriyaamorn
- Division of Digital Innovation and Data Analytics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chanavee Toh
- Department of Health Science and Clinical Research, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Songyos Rajborirug
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Paramee Thongsuksai
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Department of Health Science and Clinical Research, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chanon Kongkamol
- Division of Digital Innovation and Data Analytics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sarunyou Chusri
- Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Phoomjai Sornsenee
- Faculty of Medicine, Department of Family Medicine and Preventive Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Prasit Wuthisuthimethawee
- Department of Emergency Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Raya Chaowanawong
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Surasak Sangkhathat
- Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Faculty of Medicine, Translational Medicine Research Center, Prince of Songkla University, Songkhla, Thailand
| | - Thammasin Ingviya
- Division of Digital Innovation and Data Analytics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Piamjinda P, Boonnag C, Ittichaiwong P, Rattanasonrerk S, Veerakanjana K, Duangchaemkarn K, Limpornchitwilai W, Thanontip K, Asawalertsak N, Kaewlee T, Wilaiprasitporn T. CHIVID: A Rapid Deployment of Community and Home Isolation During COVID-19 Pandemics. IEEE J Transl Eng Health Med 2024; 12:390-400. [PMID: 38606388 PMCID: PMC11008800 DOI: 10.1109/jtehm.2024.3377258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 02/10/2024] [Accepted: 03/05/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND CHIVID is a telemedicine solution developed under tight time constraints that assists Thai healthcare practitioners in monitoring non-severe COVID-19 patients in isolation programs during crises. It assesses patient health and notifies healthcare practitioners of high-risk scenarios through a chatbot. The system was designed to integrate with the famous Thai messaging app LINE, reducing development time and enhancing user-friendliness, and the system allowed patients to upload a pulse oximeter image automatically processed by the PACMAN function to extract oxygen saturation and heart rate values to reduce patient input errors. METHODS This article describes the proposed system and presents a mixed-methods study that evaluated the system's performance by collecting survey responses from 70 healthcare practitioners and analyzing 14,817 patient records. RESULTS Approximately 71.4% of healthcare practitioners use the system more than twice daily, with the majority managing 1-10 patients, while 11.4% handle over 101 patients. The progress note is a function that healthcare practitioners most frequently use and are satisfied with. Regarding patient data, 58.9%(8,724/14,817) are male, and 49.7%(7,367/14,817) within the 18 to 34 age range. The average length of isolation was 7.6 days, and patients submitted progress notes twice daily on average. Notably, individuals aged 18 to 34 demonstrated the highest utilization rates for the PACMAN function. Furthermore, most patients, totaling over 95.52%(14,153/14,817), were discharged normally. CONCLUSION The findings indicate that CHIVID could be one of the telemedicine solutions for hospitals with patient overflow and healthcare practitioners unfamiliar with telemedicine technology to improve patient care during a critical crisis. Clinical and Translational Impact Statement- CHIVID's success arises from seamlessly integrating telemedicine into third-party application within a limited timeframe and effectively using clinical decision support systems to address challenges during the COVID-19 crisis.
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Affiliation(s)
- Parpada Piamjinda
- Sense AI Company Ltd.Rayong21210Thailand
- Bio-Inspired Robotics and Neural Engineering (BRAIN) Laboratory, School of Information Science and Technology (IST)Vidyasirimedhi Institute of Science and Technology (VISTEC)Rayong21210Thailand
| | - Chiraphat Boonnag
- Bio-Inspired Robotics and Neural Engineering (BRAIN) Laboratory, School of Information Science and Technology (IST)Vidyasirimedhi Institute of Science and Technology (VISTEC)Rayong21210Thailand
| | - Piyalitt Ittichaiwong
- Sense AI Company Ltd.Rayong21210Thailand
- Siriraj Informatics and Data Innovation Center, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkok10700Thailand
| | | | - Kanyakorn Veerakanjana
- Siriraj Informatics and Data Innovation Center, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkok10700Thailand
| | - Khanita Duangchaemkarn
- Department of Pharmacy PracticeSchool of Pharmaceutical SciencesUniversity of Phayao, Mae KaMuangPhayao56000Thailand
| | - Warissara Limpornchitwilai
- Bio-Inspired Robotics and Neural Engineering (BRAIN) Laboratory, School of Information Science and Technology (IST)Vidyasirimedhi Institute of Science and Technology (VISTEC)Rayong21210Thailand
| | - Kamonwan Thanontip
- Bio-Inspired Robotics and Neural Engineering (BRAIN) Laboratory, School of Information Science and Technology (IST)Vidyasirimedhi Institute of Science and Technology (VISTEC)Rayong21210Thailand
| | - Napasara Asawalertsak
- Department of Biomedical EngineeringFaculty of EngineeringMahidol UniversityNakhon Pathom73170Thailand
| | - Thitikorn Kaewlee
- Sense AI Company Ltd.Rayong21210Thailand
- Bio-Inspired Robotics and Neural Engineering (BRAIN) Laboratory, School of Information Science and Technology (IST)Vidyasirimedhi Institute of Science and Technology (VISTEC)Rayong21210Thailand
| | - Theerawit Wilaiprasitporn
- Sense AI Company Ltd.Rayong21210Thailand
- Bio-Inspired Robotics and Neural Engineering (BRAIN) Laboratory, School of Information Science and Technology (IST)Vidyasirimedhi Institute of Science and Technology (VISTEC)Rayong21210Thailand
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12
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Sun JJ, Hsiao CT, Liu TY. Caregiving experiences of primary family caregivers caring for family members affected by COVID-19 during home isolation: A phenomenology study. Nurs Health Sci 2024; 26:e13091. [PMID: 38356113 DOI: 10.1111/nhs.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/16/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024]
Abstract
During home isolation due to the coronavirus disease, family caregivers assumed the responsibility of caring for infected family members; however, the full extent of the difficulties and challenges they encountered remains unclear. This study applied a descriptive phenomenology approach, using semi-structured, one-on-one, in-depth interviews to explore the experiences of 16 primary family caregivers during home isolation amid the coronavirus disease. The key themes identified were as follows: (1) protecting family, comprising anxiety over preventing infection and bearing the responsibility of caregiving and a concern about the diagnosis; (2) seeking stability, encompassing the impact of epidemic control policies on daily routines, strategies to overcome obstacles caused by quarantine measures, and gathering resources and receiving support; and (3) reflections on life, including favoring love over discrimination, rediscovering oneself, cherishing family, and acknowledging personal growth and dedication. This study highlights that family members who took on caregiving roles due to obstacles or health risks faced significant pressure to protect their family members during isolation and actively sought professional consultation and acquired caregiving skills to enhance their confidence and adaptability.
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Affiliation(s)
- Jia-Jing Sun
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Nursing, Taipei City Hospital, Taipei, Taiwan
| | | | - Tsui-Yao Liu
- Department of Nursing, Taipei City Hospital, Taipei, Taiwan
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13
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Rowsell KA, Akinbola A, Hancock M, Nyambayo T, Jackson Z, Hunt DF. Reducing use of seclusion on a male medium secure forensic ward. BMJ Open Qual 2024; 13:e002576. [PMID: 38365432 PMCID: PMC10875490 DOI: 10.1136/bmjoq-2023-002576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024] Open
Abstract
The reduction of restrictive practices is a priority for mental health inpatient services. Often such practices are considered to increase patients' feelings of anger, loneliness, hopelessness and vulnerability. Moreover, such approaches are counterintuitive to both recovery-orientated and trauma-informed practice.Our project, based in a male 15-bed secure forensic ward, aimed to reduce the duration (outcome measure) and frequency (balancing measure) of the use of seclusion by 10% over 6 months. Following the analysis of our local data systems and feedback from both patients and staff, we identified the high levels of use of seclusion, and reluctance to terminate it. These included a lack of awareness of the effective and appropriate use of such a facility, a hesitancy to use de-escalation techniques and an over-reliance on multidisciplinary team and consultant decision making.We subsequently designed and implemented three tests of change which reviewed seclusion processes, enhanced de-escalation skills and improved decision making. Our tests of change were applied over a 6-month period. During this period, we surpassed our original target of a reduction of frequency and duration by 10% and achieved a 33% reduction overall. Patients reported feeling safer on the ward, and the team reported improvements in relationships with patients.Our project highlights the importance of relational security within the secure setting and provides a template for other wards wishing to reduce the frequency and duration of seclusions.
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Affiliation(s)
- Kathryn Amy Rowsell
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ayodele Akinbola
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Mark Hancock
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Tsitsi Nyambayo
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Zoe Jackson
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - David Francis Hunt
- School of Psychology, University of Exeter Faculty of Health and Life Sciences, Exeter, UK
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14
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Shi H. The effect of social support on home isolation anxiety and depression among college students in the post-pandemic era: the mediating effect of perceived loss of control and the moderating role of family socioeconomic status. Front Public Health 2024; 12:1288848. [PMID: 38406501 PMCID: PMC10884108 DOI: 10.3389/fpubh.2024.1288848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/30/2024] [Indexed: 02/27/2024] Open
Abstract
Background There is an escalating concern about the rising levels of anxiety and depression among college students, especially during the post-pandemic era. A thorough examination of the various dimensions of social support and their impact on these negative emotions in college students is imperative. Aim This study aimed to determine if a perceived loss of control mediates the relationship between social support and levels of anxiety and depression among college students during the post-pandemic era. Additionally, it examined whether family socioeconomic status moderates this mediated relationship. Methods We administered an online cross-sectional survey in China, securing responses from 502 participants. The sample comprised home-isolated college students impacted by COVID-19. Established scales were employed to assess social support, anxiety, depression, perceived loss of control, and family socioeconomic status. Analytical techniques included descriptive statistics, correlation analysis, and a bootstrap method to investigate mediating and moderating effects. Results Social support was found to negatively affect anxiety and depression in college students, with perceived loss of control partially mediating this relationship. In addition, family socio-economic status was shown to moderate this moderating process. Furthermore, family socioeconomic status influenced this mediation, with higher socioeconomic families exhibiting a stronger moderating effect on perceived loss of control across different dimensions of social support. Conclusion This study may help to develop strategies to mitigate the impact of anxiety and depression in the lives and studies of university students during unexpected public health crises, and to promote better mental health among college students.
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Affiliation(s)
- Hui Shi
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
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15
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Phattharapornjaroen P, Carlström E, Sivarak O, Tansuwannarat P, Chalermdamrichai P, Sittichanbuncha Y, Kongtoranin L, Phattranonuthai R, Marlow P, Winyuchonjaroen W, Pongpasupa N, Khorram-Manesh A. Community-Based Response to Pandemic: Case Study of Home Isolation Center using Flexible Surge Capacity - CORRIGENDUM. Prehosp Disaster Med 2024; 39:118. [PMID: 38108206 DOI: 10.1017/s1049023x23006714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
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16
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Yin Z, Wang X, Lu X, Fu H. Hospital pharmacists' mental health during home isolation in the post-pandemic era of COVID-19: influencing factors, coping strategies, and the mediating effect of resilience. Front Public Health 2024; 12:1268638. [PMID: 38356948 PMCID: PMC10864583 DOI: 10.3389/fpubh.2024.1268638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Objective There is a notable research gap on the mental health challenges faced by hospital pharmacists in the post-pandemic era. Therefore, the present study aims to explore mental health status, influencing factors, coping strategies, and the mediating effect of resilience of home quarantine hospital pharmacists (HQHPs). Methods An embedded mixed-method study was conducted in Zhengzhou, a megalopolis in central China, from 20 October to 3 November 2022. For the qualitative study, semi-structured interviews and focus group discussions were conducted among HQHPs to understand their mental health state,the factors that affect their mental health, and the alleviating strategies they used. For the quantitative study, the Generalized Anxiety Disorder Scale (GAD-7) and the Chinese version of the Connor-Davidson Resilience Scale (CD-RISC-25) were used to explore the mental health level of HQHPs. Meanwhile, the mediating effect of resilience was explored and verified with the bootstrap method or the structural equation model. Results 20 HQHPs participated in the qualitative study. Two themes were identified in terms of the factors that influenced the HQHPs' mental health levels. The positive factors include optimism, family company, and connection with friends, while the negative factors include inadequate supplies, inadequate information, and other emergencies. 210 HQHPs participated in the quantitative study, with a median resilience score of 66 [55.75, 74] in the lowest score range and an anxiety score of 5 [2, 7] in the mild anxiety range. The correlation analysis showed that nine of the 10 influencing factors identified in qualitative research were positively correlated with CD-RISC-25 scores and negatively correlated with the GAD-7 score. The mediating effect of resilience on anxiety was significant (95% bootstrap CI [-1.818, -0.384], p<0.001; or 95% bootstrap CI [-1.174, -0.430], p<0.001). Conclusion Even in the post-epidemic era, hospital pharmacists face psychological challenges. They actively address these issues based on accumulated experience and a stabilized mindset. In this process, resilience plays a significant mediating role.
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Affiliation(s)
- Zhao Yin
- Institute for Hospital Management of Henan Province, Zhengzhou, China
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - XiangYu Wang
- Beijing Chaoyang Hospital, Party Committee Office, Beijing, China
| | - Xiaojing Lu
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Drug Clinical Comprehensive Evaluation Center, Zhengzhou, China
| | - Hang Fu
- Institute for Hospital Management of Henan Province, Zhengzhou, China
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17
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Picquet G. [Addressing the issue of seclusion and restraint in psychiatry]. Soins Psychiatr 2024; 45:33-37. [PMID: 38218621 DOI: 10.1016/j.spsy.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
In an ever-changing environment, the question of the meaning of care within a caring, ethical framework is of paramount importance. The development of a patient-centred approach relies on an understanding of the Other. Caring and empathy are the essential foundations of this approach. An attempt to analyze practices through a few notions of ethics can be proposed.
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Affiliation(s)
- Grégory Picquet
- EPSM de l'agglomération lilloise, 1 rue de Lommelet, 59871 Saint-André-lez-Lille cedex, France.
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18
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Matte-Landry A, Collin-Vézina D. Patterns of change in restrictive measures in residential care: Trauma-informed staff training benefits children and youth who need it the Most. Child Abuse Negl 2024; 147:106576. [PMID: 38043458 DOI: 10.1016/j.chiabu.2023.106576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/08/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Implementation of trauma-informed staff training is promising to reduce restrictive measures (restraints, seclusions, and time-outs) used to address problem behaviors in youth in residential care. Previous mixed results may be explained in part by the heterogeneity in the use of restrictive measures among youth. OBJECTIVE The objective was twofold: (1) to examine whether heterogeneity in the initial number of restrictive measures experienced by youth, before implementing trauma-informed staff training, moderates the effect of the training and (2) to explore whether children and youth's characteristics are associated with the number of restrictive measures. PARTICIPANTS AND SETTING A trauma-informed staff training was implemented in 44 residential care units in Quebec, Canada. METHODS This study used administrative data. The sample (n = 297 youth) was divided into three subgroups based on the number of restrictive measures experienced in the six-month period prior to the training: 1) absence or low (52 % of the sample); 2) moderate (23 %); 3) high (25 %). RESULTS The use of restrictive measures was compared between the subgroups. Main and interaction effects were all significant. None of the slopes for groups 1 and 2 were significant. In contrast, significant decreases from T1 were observed at T2 (-0.18 (0.02), p < .000) and T3 (-0.22 (0.02), p < .000) in group 3. Several children and youth's characteristics distinguished groups. CONCLUSIONS Implementation was more beneficial to youth who experienced a high number of restrictive measures. Training opportunities can lead to positive changes in measures used to address problem behaviors in youth.
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Affiliation(s)
- Alexandra Matte-Landry
- School of Social Work and Criminology, Université Laval, Quebec City, Canada; Centre de recherche universitaire sur les jeunes et les familles, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada; Centre de recherche Jeunes, familles et réponses sociales, Quebec City, Canada.
| | - Delphine Collin-Vézina
- Centre de recherche universitaire sur les jeunes et les familles, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada; Centre for Research on Children and Families, School of Social Work, McGill University, Montreal, Canada
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Atdjian S, Huckshorn KA. Toward the Cessation of Seclusion and Mechanical Restraint Use in Psychiatric Hospitals: A Call for Regulatory Action. Psychiatr Serv 2024; 75:64-71. [PMID: 37461820 DOI: 10.1176/appi.ps.202100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
The use of seclusion and mechanical restraints (S-R) in psychiatric hospitals remains widespread despite the traumatizing effects and risk for lethality associated with these practices. Neither the Centers for Medicare and Medicaid Services (CMS) nor The Joint Commission (TJC) have updated their guidelines on the use of S-R since 2005. Their regulations do not include current best practices, such as the evidence-based six core strategies (6CS) or other trauma-informed approaches, despite robust data on their effectiveness in preventing violence and S-R use. The authors describe Pennsylvania State hospitals' nearly 10-year cessation of S-R use via their continuous adherence to 6CS. In contrast, the authors describe the significant decrease in S-R use during the implementation of 6CS at a public psychiatric hospital while under U.S. Department of Justice (DOJ) monitoring and the resumption of high S-R use after DOJ monitoring and adherence to 6CS ended. The authors emphasize the importance of external regulatory oversight and mandates to safely achieve and sustain the cessation of S-R use in psychiatric hospitals. Urging CMS and TJC to update their regulations, the authors offer a roadmap to more effectively mandate the reduction and eventual cessation of S-R use in psychiatric hospitals.
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Affiliation(s)
- S Atdjian
- Johns Hopkins University, Baltimore (Atdjian); Kevin Huckshorn & Associates Inc., Chapel Hill, North Carolina (Huckshorn)
| | - K A Huckshorn
- Johns Hopkins University, Baltimore (Atdjian); Kevin Huckshorn & Associates Inc., Chapel Hill, North Carolina (Huckshorn)
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20
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Wasser T, Strockbine B, Uyanwune Y, Kapoor R. Restraint and Seclusion Practices and Policies in U.S. Forensic Psychiatric Hospitals. J Am Acad Psychiatry Law 2023; 51:566-574. [PMID: 38065618 DOI: 10.29158/jaapl.230099-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Over the last 30 years, there have been significant efforts to reduce the use of restraint and seclusion in psychiatric hospitals. Although authors have previously described restraint policies and practices in general psychiatry settings across the United States, this study is the first to attempt to describe policies regarding those practices in forensic hospital settings. We review the history of restraint and seclusion use in the United States, placing it within an international context. We then describe the results of a national survey of state forensic services directors regarding restraint modalities and policies in forensic hospital facilities. Twenty-nine respondents representing 25 states completed the survey. The results indicate that physical holds are the most frequently available method of restraint and that restraint chairs are the least frequently available. Most respondents reported having a policy regulating the use of restraint in their facilities, most commonly at the institutional level.
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Affiliation(s)
- Tobias Wasser
- Dr. Wasser is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT. Dr. Strockbine is the Chief Medical Officer, Whiting Forensic Hospital, Middletown, CT. Dr. Uyanwune is a Psychiatry Resident, Yale School of Medicine, New Haven, CT. Dr. Kapoor is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT.
| | - Bentley Strockbine
- Dr. Wasser is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT. Dr. Strockbine is the Chief Medical Officer, Whiting Forensic Hospital, Middletown, CT. Dr. Uyanwune is a Psychiatry Resident, Yale School of Medicine, New Haven, CT. Dr. Kapoor is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Yvonne Uyanwune
- Dr. Wasser is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT. Dr. Strockbine is the Chief Medical Officer, Whiting Forensic Hospital, Middletown, CT. Dr. Uyanwune is a Psychiatry Resident, Yale School of Medicine, New Haven, CT. Dr. Kapoor is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Reena Kapoor
- Dr. Wasser is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT. Dr. Strockbine is the Chief Medical Officer, Whiting Forensic Hospital, Middletown, CT. Dr. Uyanwune is a Psychiatry Resident, Yale School of Medicine, New Haven, CT. Dr. Kapoor is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT
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Bensemann C, Maxwell D, O'Keeffe K, Tresize L, Wairama K, Keelan W. Closing the equity gap as we move to the elimination of seclusion: Early results from a national quality improvement project. Australas Psychiatry 2023; 31:786-790. [PMID: 37772406 DOI: 10.1177/10398562231202125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
OBJECTIVE Use of seclusion within mental health inpatient facilities is harmful for consumers and staff, but it is still used in many Aotearoa New Zealand and Australian facilities, at higher, inequitable rates for the indigenous populations of both countries. We report early results from a national programme to eliminate seclusion in mental health services in Aotearoa New Zealand, using a bicultural approach to reduce inequity for Māori. METHOD The 'Zero Seclusion: Safety and dignity for all' programme, with programme teams nationwide, developed a co-designed bicultural change package combining Māori cultural and Western clinical interventions, incorporating quality improvement methodologies. Outcome measures included seclusion rates, duration, and average number of episodes per person admitted, by ethnicity, with a focus on equity. RESULTS Nationally, rates of seclusion for Māori reduced from the 12-month (to August 2019) baseline mean monthly rate of 7.5% to 6.8%, sustained from late 2020 to September 2022. The duration of seclusion for Māori reduced by 33% (4.5 h at baseline to 3.0). CONCLUSION A focus on inequity for Māori in use of seclusion, and a bicultural approach with cultural and clinical interventions, has been associated with a national reduction in rates and duration of seclusion for Māori.
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Affiliation(s)
- Clive Bensemann
- Mental Health and Addiction Quality Improvement Programme, New Zealand Health Quality and Safety Commission, Wellington, New Zealand
| | - Deirdre Maxwell
- Mental Health and Addiction Quality Improvement Programme, New Zealand Health Quality and Safety Commission, Wellington, New Zealand
| | - Karen O'Keeffe
- Mental Health and Addiction Quality Improvement Programme, New Zealand Health Quality and Safety Commission, Wellington, New Zealand
| | - Lee Tresize
- Health Quality Intelligence, New Zealand Health Quality and Safety Commission, Wellington, New Zealand
| | - Karl Wairama
- Mental Health and Addiction Quality Improvement Programme, New Zealand Health Quality and Safety Commission, Wellington, New Zealand
| | - Wikepa Keelan
- Mental Health and Addiction Quality Improvement Programme, New Zealand Health Quality and Safety Commission, Wellington, New Zealand
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22
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Kilinc-Balci FS. Investigation of the barrier performance of disposable isolation gowns. Am J Infect Control 2023; 51:1401-1405. [PMID: 37690482 DOI: 10.1016/j.ajic.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Recent epidemics and pandemics highlighted the need for effective personal protective equipment, including isolation gowns. The most critical property of an isolation gown is its ability to keep liquids and viruses from passing through the gown. Liquid and viral barrier penetration can be measured using laboratory test methods. Association for the Advancement of Medical Instrumentation (AAMI) PB70 standard defines isolation gown barrier performance levels and requirements. In this study, 22 disposable isolation gown models from 6 manufacturers were tested for liquid and viral penetration resistance. METHODS Standard test methods were used to evaluate water and viral penetration. Test results were evaluated using AAMI PB70 barrier performance criteria for 4 protection levels. RESULTS Seven of the 22 tested gown models did not pass liquid and viral penetration testing based on AAMI PB70 at the level claimed by the manufacturer. The majority of these failures occurred at the seam and/or tie attachment areas. CONCLUSIONS The study findings underscore the need for improved processes surrounding activities such as premarket testing and postmarket evaluation of gowns according to standardized test methods by third-party laboratories. This study also supports the recent Food and Drug Administration guidance document that clarified the characteristics of isolation gowns considered to be class II and subject to Food and Drug Administration premarket review. Infection preventionists, hospital purchasers, and safety professionals should seek isolation gowns demonstrating conformance to industry standards from manufacturers.
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Affiliation(s)
- F Selcen Kilinc-Balci
- US Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA.
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23
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Jie C, Xugui S, Min Z, Ergang Z, Hongwu W, Jun S. The influence of home isolation during COVID-19 on the physical fitness development of college students: a study utilizing repeated measures analysis of variance. BMC Public Health 2023; 23:2186. [PMID: 37936096 PMCID: PMC10631170 DOI: 10.1186/s12889-023-16772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/16/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Research on the impact of COVID-19-induced home isolation on the physical fitness of college students is limited. This study aims to compare and analyze the physical fitness test scores of college students in two groups: those who experienced home isolation and those who did not, over three consecutive years after enrolment, to investigate the effects of home isolation on the physical fitness development of Chinese college students. METHODS This comparative study included two longitudinal surveys conducted among medical college students. The participants were divided into an experimental group and a control group. The physical fitness indicators measured included body mass index (BMI), vital capacity (VC), 50-metre run, sit-and-reach, standing long jump, 1000/800-metre runs (males/females), pull-ups (males) and sit-ups (females). Repeated measures analysis of variance (ANOVA) was employed, and the Greenhouse-Geisser correction was applied when Mauchly's assumption of sphericity was violated. Pairwise comparisons were conducted using the Bonferroni method. RESULTS A total of 6580 students participated in the study, with 3360 students (1490 males, 1870 females) enrolled in 2019 as the experimental group and 3220 students (1326 males, 1894 females) enrolled in 2017 as the control group. All participants completed the physical fitness tests for three consecutive years. The results showed that the experimental group exhibited decreased performance in the 1000-metre and 800-metre runs, and improved performance in the sit-and-reach test. After the end of home isolation, there was an improvement in the performance of the 1000-metre run and 800-metre run, while no significant differences were observed in the trends of the other tested indicators. CONCLUSION The findings of this study indicate that the home isolation environment during COVID-19 had a significant impact on the physical fitness of college students, specifically in terms of endurance and flexibility qualities, as well as male BMI. To better prepare for future public health emergencies and mitigate the effects of isolation, teaching students endurance exercises that can be performed at home should be prioritized. Furthermore, physical education programs should be improved to enhance student flexibility.
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Affiliation(s)
- Chang Jie
- Department of Medical Information, Wannan Medical College, Wuhu, China
| | - Sun Xugui
- Department of Public Foundation, Wannan Medical College, Wuhu, China
| | - Zhang Min
- Physical Education Institute, Chizhou University, Chizhou, China
| | - Zhu Ergang
- Department of Public Foundation, Wannan Medical College, Wuhu, China
| | - Wang Hongwu
- Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | - Sun Jun
- Department of Public Foundation, Wannan Medical College, Wuhu, China.
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Ruch TQ, Hoops C, El-Mallakh RS, Terrell C. Protest behaviors among patients placed in seclusion in a psychiatric emergency service. Ann Clin Psychiatry 2023; 35:234-237. [PMID: 37850998 DOI: 10.12788/acp.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Patients placed in seclusion for behavioral dyscontrol often perceive that the health care team is treating them inappropriately. These patients may express their indignation in many ways. To better characterize these behaviors, we conducted a study of protest behaviors in a psychiatric emergency service. METHODS Video surveillance of seclusion room occupants is routinely reviewed as part of our safety protocol. For 1 month in 2022, we noted the frequency and timing of potential protest behaviors such as disrobing and evacuation. Descriptive statistics were applied. RESULTS A total of 41 seclusion events (8.1%) occurred over the surveillance period, which included 504 initial emergency psychiatric evaluations. Six patients (14.6%) engaged in protest behaviors (all within 5 minutes of being placed in seclusion), including 3 (7.3%) who urinated and 3 (7.3%) who disrobed. One patient urinated almost immediately (2.4%), and another urinated 25 minutes after entering seclusion; the latter was not interpreted as a protest behavior. CONCLUSIONS Immediate behaviors in seclusion that are different from behaviors that led to seclusion can be interpreted as protest behaviors. The 2 most often observed protest behaviors were urination and disrobing.
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Affiliation(s)
- Tyler Q Ruch
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Chelsea Hoops
- University of Louisville Hospital, Louisville, Kentucky, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Christina Terrell
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Kim S, Chang H, Kim T, Cha WC. Patient Anxiety and Communication Experience in the Emergency Department: A Mobile, Web-Based, Mixed-Methods Study on Patient Isolation During the COVID-19 Pandemic. J Korean Med Sci 2023; 38:e303. [PMID: 37821083 PMCID: PMC10562183 DOI: 10.3346/jkms.2023.38.e303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Anxiety and communication difficulties in the emergency department (ED) may increase for various reasons, including isolation due to coronavirus disease 2019 (COVID-19). However, little research on anxiety and communication in EDs exists. This study explored the isolation-related anxiety and communication experiences of ED patients during the COVID-19 pandemic. METHODS A prospective mixed-methods study was conducted from May to August 2021 at the Samsung Medical Center ED, Seoul. There were two patient groups: isolation and control. Patients measured their anxiety using the State-Trait Anxiety Inventory (STAI X1) at two time points, and we surveyed patients at two time points about factors contributing to their anxiety and communication experiences. These were measured through a mobile web-based survey. Researchers interviewed patients after their discharge. RESULTS ED patients were not anxious regardless of isolation, and there was no statistical significance between each group at the two time points. STAI X1 was 48.4 (standard deviation [SD], 8.0) and 47.3 (SD, 10.9) for early follow-up and 46.3 (SD, 13.0) and 46.2 (SD, 13.6) for late follow-up for the isolation and control groups, respectively. The clinical process was the greatest factor contributing to anxiety as opposed to the physical environment or communication. Communication was satisfactory in 71.4% of the isolation group and 66.7% of the control group. The most important aspects of communication were information about the clinical process and patient status. CONCLUSION ED patients were not anxious and were generally satisfied with medical providers' communication regardless of their isolation status. However, patients need clinical process information for anxiety reduction and better communication.
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Affiliation(s)
- Sumin Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Hansol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taerim Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Digital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Wu D, Chen J, Fu X, Li Z, Tan F, Lin H. Study on the migration characteristics of bioaerosols and optimization of ventilation patterns in a negative pressure isolation ward considering different patient postures. PLoS One 2023; 18:e0290288. [PMID: 37590299 PMCID: PMC10434850 DOI: 10.1371/journal.pone.0290288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023] Open
Abstract
Due to the serious global harm caused by the outbreak of various viral infectious diseases, how to improve indoor air quality and contain the spread of infectious bioaerosols has become a popular research subject. Negative pressure isolation ward is a key place to prevent the spread of aerosol particles. However, there is still limited knowledge available regarding airflow patterns and bioaerosol diffusion behavior in the ward, which is not conducive to reducing the risk of cross-infection between health care workers (HCWs) and patients. In addition, ventilation layout and patient posture have important effects on aerosol distribution. In this study, the spatial and temporal characteristics as well as dispersion patterns of bioaerosols under different ventilation patterns in the ward were investigated using the computational fluid dynamics (CFD) technique. It is concluded that changes in the location of droplet release source due to different body positions of the patient have a significant effect on the bioaerosol distribution. After optimizing the layout arrangements of exhaust air, the aerosol concentration in the ward with the patient in both supine and sitting positions is significantly reduced with particle removal efficiencies exceeding 95%, that is, the ventilation performance is improved. Meanwhile, the proportion of aerosol deposition on all surfaces of the ward is decreased, especially the deposition on both the patient's body and the bed is less than 1%, implying that the risk of HCWs being infected through direct contact is reduced.
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Affiliation(s)
- Dieen Wu
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Jianji Chen
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Xihua Fu
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Zongkun Li
- School of Electric Power, South China University of Technology, Guangzhou, China
- Guangdong Province Key Laboratory of Efficient and Clean Energy Utilization, Guangzhou, China
| | - Futai Tan
- Guangzhou Huijin Energy Efficiency Technology Co. Ltd, Guangzhou, China
| | - Hai Lin
- Guangzhou Huijin Energy Efficiency Technology Co. Ltd, Guangzhou, China
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Hanna M, Shah R, Marquez L, Barzegar R, Gordon A, Pammi M. Infant isolation and cohorting for preventing or reducing transmission of healthcare-associated infections in neonatal units. Cochrane Database Syst Rev 2023; 6:CD012458. [PMID: 37368649 PMCID: PMC10297826 DOI: 10.1002/14651858.cd012458.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Neonatal healthcare-associated infections (HAIs) result in increased morbidity and mortality, as well as increased healthcare costs. Patient isolation measures, i.e. single-room isolation or the cohorting of patients with similar infections, remain a recommended and commonly used practice for preventing horizontal spread of infections in the neonatal intensive care unit (NICU). OBJECTIVES: Our primary objective was to assess the effect of single-room isolation or cohorting, or both for preventing transmission of HAIs or colonization with HAI-causing pathogens in newborn infants less than six months of age admitted to the neonatal intensive care unit (NICU). Our secondary objective was to assess the effect of single-room isolation or cohorting, or both on neonatal mortality and perceived or documented adverse effects in newborn infants admitted to the NICU. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, the WHO ICTRP and ClinicalTrials.gov trials registries. There were no restrictions to date, language or publication type. We also checked the reference lists of studies identified for full-text review. SELECTION CRITERIA: Types of studies: cluster-randomized or quasi-randomized trials at the level of the cluster (where clusters may be defined by NICU, hospital, ward, or other subunits of the hospital). We also included cross-over trials with a washout period of more than four months (arbitrarily defined). TYPES OF PARTICIPANTS newborn infants less than six months of age in neonatal units that implemented patient isolation or cohorting as infection control measures to prevent HAIs. Types of interventions: patient isolation measures (single-room isolation or cohorting, or both of infants with similar colonization or infections) compared to routine isolation measures. TYPES OF OUTCOME MEASURES the primary outcome was the rate of transmission of HAIs as estimated by the infection and colonization rates in the NICU. Secondary outcomes included all-cause mortality during hospital stay at 28 days of age, length of hospital stay, as well as potential adverse effects of isolation or cohorting measures, or both. DATA COLLECTION AND ANALYSIS The standard methods of Cochrane Neonatal were used to identify studies and assess the methodological quality of eligible cluster-randomized trials. The certainty of the evidence was to be assessed by the GRADE method as evidence of high, moderate, low, or very low certainty. Infection and colonization rates were to be expressed as rate ratios for each trial and if appropriate for meta-analysis, the generic inverse variance method in RevMan was to be used. MAIN RESULTS We did not identify any published or ongoing trials to include in the review. AUTHORS' CONCLUSIONS The review found no evidence from randomized trials to either support or refute the use of patient isolation measures (single-room isolation or cohorting) in neonates with HAIs. Risks secondary to infection control measures need to be balanced against the benefits of decreasing horizontal transmission in the neonatal unit for optimal neonatal outcomes. There is an urgent need to research the effectiveness of patient isolation measures for preventing the transmission of HAIs in neonatal units. Well-designed trials randomizing clusters of units or hospitals to a type of patient isolation method intervention are warranted.
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Affiliation(s)
- Morcos Hanna
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
| | - Rita Shah
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
| | - Lucila Marquez
- Department of Pediatric Infectious Diseases, Baylor College of Medicine, Houston, USA
| | - Rebecca Barzegar
- RPA Newborn Care, Sydney Local Health District, Sydney, Australia
| | - Adrienne Gordon
- RPA Newborn Care, Sydney Local Health District, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Mohan Pammi
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
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Varpula J, Välimäki M, Pulkkinen J, Lantta T. Patient Falls in Seclusion Rooms in Psychiatric Inpatient Care: A Sociotechnical Probabilistic Risk Modeling Study. J Nurs Care Qual 2023; 38:190-197. [PMID: 36476941 PMCID: PMC9944373 DOI: 10.1097/ncq.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient falls are a major adverse event in psychiatric inpatient care. PURPOSE To model the risk for patient falls in seclusion rooms in psychiatric inpatient care. METHODS Sociotechnical probabilistic risk assessment (ST-PRA) was used to model the risk for falls. Data sources were the research team, literature review, and exploration groups of psychiatric nurses. Data were analyzed with fault tree analysis. RESULTS The risk for a patient fall in a seclusion room was 1.8%. Critical paths included diagnosis of a psychiatric disorder, the mechanism of falls, failure to assess and prevent falls, and psychological or physical reason. The most significant individual risk factor for falls was diagnosis of schizophrenia. CONCLUSIONS Falls that occur in seclusion events are associated with physical and psychological risk factors. Therefore, risk assessment methods and fall prevention interventions considering patient behavioral disturbance and physiological risk factors in seclusion are warranted.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
| | - Johanna Pulkkinen
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
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Parisi S, Lehner N, Schrader H, Kierer L, Fleischer A, Miljukov O, Borgulya G, Rüter G, Viniol A, Gágyor I. Experiencing COVID-19, home isolation and primary health care: A mixed-methods study. Front Public Health 2023; 10:1023431. [PMID: 36703817 PMCID: PMC9872200 DOI: 10.3389/fpubh.2022.1023431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Objectives Although the vast majority of COVID-19 cases are treated in primary care, patients' experiences during home isolation have been little studied. This study aimed to explore the experiences of patients with acute COVID-19 and to identify challenges after the initial adaptation of the German health system to the pandemic (after first infection wave from February to June 2020). Methods A mixed-method convergent design was used to gain a holistic insight into patients experience. The study consisted of a cross-sectional survey, open survey answers and semi-structured telephone interviews. Descriptive analysis was performed on quantitative survey answers. Between group differences were calculated to explore changes after the first infection wave. Qualitative thematic analysis was conducted on open survey answers and interviews. The results were then compared within a triangulation protocol. Results A total of 1100 participants from all German states were recruited by 145 general practitioners from August 2020 to April 2021, 42 additionally took part in qualitative interviews. Disease onset varied from February 2020 to April 2021. After the first infection wave, more participants were tested positive during the acute disease (88.8%; 95.2%; P < 0.001). Waiting times for tests (mean 4.5 days, SD 4.1; 2.7days, SD 2.6, P < 0.001) and test results (mean 2.4 days, SD 1.9; 1.8 days, SD 1.3, P < 0.001) decreased. Qualitative results indicated that the availability of repeated testing and antigen tests reduced insecurities, transmission and related guilt. Although personal consultations at general practices increased (6.8%; 15.5%, P < 0.001), telephone consultation remained the main mode of consultation (78.5%) and video remained insignificant (1.9%). The course of disease, the living situation and social surroundings during isolation, access to health care, personal resilience, spirituality and feelings of guilt and worries emerged as themes influencing the illness experience. Challenges were contact management and adequate provision of care during home isolation. A constant contact person within the health system helped against feelings of care deprivation, uncertainty and fear. Conclusions Our study highlights that home isolation of individuals with COVID-19 requires a holistic approach that considers all aspects of patient care and effective coordination between different care providers.
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Affiliation(s)
- Sandra Parisi
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Nina Lehner
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Hanna Schrader
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Leonard Kierer
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Anna Fleischer
- Division of Medical Psychosomatics, University Hospital Würzburg, Würzburg, Germany
| | - Olga Miljukov
- Institute of Clinical Epidemiology and Biometry, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Gabor Borgulya
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Gernot Rüter
- Academic Teaching Practice, Mentoring Team of the Competence-Based Continuing Education Baden-Württemberg Kompetenzzentrum Weiterbildung Baden-Württemberg (KWBW), University of Tübingen, Tübingen, Germany
| | - Annika Viniol
- Department of General Practice, University of Marburg, Marburg, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
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Al-Yahyai M, Al-Musalhi F, Elmojtaba I, Al-Salti N. Mathematical analysis of a COVID-19 model with different types of quarantine and isolation. Math Biosci Eng 2023; 20:1344-1375. [PMID: 36650814 DOI: 10.3934/mbe.2023061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
A COVID-19 deterministic compartmental mathematical model with different types of quarantine and isolation is proposed to investigate their role in the disease transmission dynamics. The quarantine compartment is subdivided into short and long quarantine classes, and the isolation compartment is subdivided into tested and non-tested home-isolated individuals and institutionally isolated individuals. The proposed model has been fully analyzed. The analysis includes the positivity and boundedness of solutions, calculation of the control reproduction number and its relation to all transmission routes, existence and stability analysis of disease-free and endemic equilibrium points and bifurcation analysis. The model parameters have been estimated using a dataset for Oman. Using the fitted parameters, the estimated values of the control reproduction number and the contribution of all transmission routes to the reproduction number have been calculated. Sensitivity analysis of the control reproduction number to model parameters has also been performed. Finally, numerical simulations to demonstrate the effect of some model parameters related to the different types of quarantine and isolation on the disease transmission dynamics have been carried out, and the results have been demonstrated graphically.
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Affiliation(s)
- Maryam Al-Yahyai
- Department of Mathematics, Sultan Qaboos University, Muscat, Oman
| | - Fatma Al-Musalhi
- Centre of Preparatory Studies, Sultan Qaboos University, Muscat, Oman
| | | | - Nasser Al-Salti
- Department of Applied Mathematics and Science, National University of Science and Technology, Muscat, Oman
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Furuya H. Risk of Airborne Transmission During Home Isolation: A Modeling Study. Tokai J Exp Clin Med 2022; 47:139-142. [PMID: 36073286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The worldwide pandemic of SARS-CoV-2 and its B.1.1.529 variant, Omicron, remain a threat to health. In Japan, self-isolation in a room at home has been recommended in some prefectures to reduce the burden on hospitals. With the aim of preventing the infection of family members in other rooms, this study quantified the risk of infection by airborne transmission to mask-wearing, non-infected members of the household. METHODS A mathematical modeling approach was used to estimate the risk of airborne infection. RESULTS For pre-SARS-CoV-2 variants of concern (VOC), the risk of infection of non-mask-wearing family members had an LN distribution with GM of 0.11, GD of 5.38, and median of 0.11; whereas that of mask-wearing members had an LN distribution with GM of 0.05, GD of 5.46, and median of 0.05. For Delta variant, the risk of infection of non-mask-wearing family members had an LN distribution with GM of 0.39, GD of 76.30, and median of 0.40, and that of mask-wearing members had an LN distribution with GM of 0.18, GD of 76.30, and median of 0.18. The difference of these medians was 0.22, which suggests that family members wearing masks is effective for preventing infection, even for highly infectious variants.
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Affiliation(s)
- Hiroyuki Furuya
- Basic Clinical Science and Public health, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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Flammer E, Eisele F, Hirsch S, Steinert T. Increase in coercive measures in psychiatric hospitals in Germany during the COVID-19 pandemic. PLoS One 2022; 17:e0264046. [PMID: 36044407 PMCID: PMC9432719 DOI: 10.1371/journal.pone.0264046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To examine whether the pandemic in 2020 caused changes in psychiatric hospital cases, the percentage of patients exposed to coercive interventions, and aggressive incidents. Methods We used the case registry for coercive measures of the State of Baden-Wuerttemberg, comprising case-related data on mechanical restraint, seclusion, physical restraint, and forced medication in each of the State’s 31 licensed hospitals treating adults, to compare data from 2019 and 2020. Results The number of cases in adult psychiatry decreased by 7.6% from 105,782 to 97,761. The percentage of involuntary cases increased from 12.3 to 14.1%, and the absolute number of coercive measures increased by 4.7% from 26,269 to 27,514. The percentage of cases exposed to any kind of coercive measure increased by 24.6% from 6.5 to 8.1%, and the median cumulative duration per affected case increased by 13.1% from 12.2 to 13.8 hrs, where seclusion increased more than mechanical restraint. The percentage of patients with aggressive incidents, collected in 10 hospitals, remained unchanged. Conclusions While voluntary cases decreased considerably during the pandemic, involuntary cases increased slightly. However, the increased percentage of patients exposed to coercion is not only due to a decreased percentage of voluntary patients, as the duration of coercive measures per case also increased. The changes that indicate deterioration in treatment quality were probably caused by the multitude of measures to manage the pandemic. The focus of attention and internal rules as well have shifted from prevention of coercion to prevention of infection.
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Affiliation(s)
- Erich Flammer
- Clinic for Psychiatry and Psychotherapy I, Ulm University, Ulm, Germany
- Centers for Psychiatry Suedwuerttemberg, Ravensburg, Germany
| | - Frank Eisele
- Centers for Psychiatry Suedwuerttemberg, Ravensburg, Germany
| | - Sophie Hirsch
- Clinic for Psychiatry and Psychotherapy I, Ulm University, Ulm, Germany
- Centers for Psychiatry Suedwuerttemberg, Biberach, Germany
| | - Tilman Steinert
- Clinic for Psychiatry and Psychotherapy I, Ulm University, Ulm, Germany
- Centers for Psychiatry Suedwuerttemberg, Ravensburg, Germany
- Department Psychiatry, Tuebingen University, Tuebingen, Germany
- * E-mail:
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Coronado-Vázquez V, Benito-Alonso E, Holgado-Juan M, Dorado-Rabaneda MS, Bronchalo-González C, Gómez-Salgado J. Telephone Monitoring of Isolated Patients With Suspected COVID-19 Disease in Primary Care: Prospective Cohort Study. Int J Public Health 2022; 67:1604747. [PMID: 36111198 PMCID: PMC9468220 DOI: 10.3389/ijph.2022.1604747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 08/04/2022] [Indexed: 01/08/2023] Open
Abstract
Objective: Isolation of suspected cases of COVID-19 has been shown effective in reducing disease transmission and monitoring these patients from primary care allows to detect complications. The objective of this study is to determine the evolution of a cohort of patients with suspected COVID-19, and to analyse the factors associated with hospital admissions due to their unfavourable evolution.Methods: Prospective cohort study. A cohort of 166 patients with COVID-19 symptoms was selected and was followed-up by telephone calls during 14 days of home isolation.Results: By the end of the follow-up, a hospital admission had taken place in 14.7% of patients. The mean survival time until admission among diabetics was 12.6, 10.9 days for chronic kidney diseases, and 9.3 days in immunocompromised patients. Immunosuppression was a risk factor for admission over 50 years of age.Conclusion: Hospital admissions for suspected cases of COVID-19 are associated with diabetes, chronic kidney disease, and immunosuppression. Telephone monitoring of these patients from primary care allows for home isolation and early detection of disease complications.
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Affiliation(s)
- Valle Coronado-Vázquez
- B21-20R Group, Instituto Aragonés de Investigaciones Sanitarias, Universidad de Zaragoza, Zaragoza, Spain
- Las Cortes Health Centre, Madrid Health Service, Madrid, Spain
- Universidad Francisco de Vitoria, Madrid, España
| | - Elena Benito-Alonso
- El Viso de San Juan Health Centre, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | | | | | | | - Juan Gómez-Salgado
- Sociology, Social Work and Public Health, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Escuela de Posgrado, Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
- *Correspondence: Juan Gómez-Salgado,
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Wang Y, Tian J, Qu H, Yu L, Zhang X, Huang L, Zhou J, Lian W, Wang R, Wang L, Li G, Tang L. Changes in blood pressure and related risk factors among nurses working in a negative pressure isolation ward. Front Public Health 2022; 10:942904. [PMID: 35937224 PMCID: PMC9353044 DOI: 10.3389/fpubh.2022.942904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo observe changes in blood pressure (ΔBP) and explore potential risk factors for high ΔBP among nurses working in a negative pressure isolation ward (NPIW).MethodsData from the single-center prospective observational study were used. Based on a routine practice plan, female nurses working in NPIW were scheduled to work for 4 days/week in different shifts, with each day working continuously for either 5 or 6 h. BP was measured when they entered and left NPIW. Multivariable logistic regression was used to assess potential risk factors in relation to ΔBP ≥ 5 mm Hg.ResultsA total of 84 nurses were included in the analysis. The ΔBP was found to fluctuate on different working days; no significant difference in ΔBP was observed between the schedules of 5 and 6 h/day. The standardized score from the self-rating anxiety scale (SAS) was significantly associated with an increased risk of ΔBP ≥ 5 mm Hg (odds ratio [OR] = 1.12, 95% CI: 1.00–1.24). Working 6 h/day (vs. 5 h/day) in NPIW was non-significantly related to decreased risk of ΔBP (OR = 0.70), while ≥ 2 consecutive working days (vs. 1 working day) was non-significantly associated with increased risk of ΔBP (OR = 1.50).ConclusionThis study revealed no significant trend for ΔBP by working days or working time. Anxiety was found to be significantly associated with increased ΔBP, while no <2 consecutive working days were non-significantly related to ΔBP. These findings may provide some preliminary evidence for BP control in nurses who are working in NPIW for Coronavirus Disease 2019 (COVID-19).
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Affiliation(s)
- Yaoyao Wang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Junzhang Tian
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Hongying Qu
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Lingna Yu
- Nursing Department, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xiaoqin Zhang
- Nursing Department, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Lishan Huang
- Infectious Diseases Ward, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jianqun Zhou
- Infectious Diseases Ward, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wanmin Lian
- Center for Information, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Ruoting Wang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Lijun Wang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Li Tang
| | - Li Tang
- Nursing Department, Guangdong Second Provincial General Hospital, Guangzhou, China
- *Correspondence: Guowei Li
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Opgenhaffen T, Put J. Means of restraint in residential care when there is no acute danger. Time for the European committee on the prevention of torture to set the standard. Int J Law Psychiatry 2022; 83:101807. [PMID: 35687972 DOI: 10.1016/j.ijlp.2022.101807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
This contribution analyses the approach of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) to means of restraint in residential psychiatric and disability care. Generally, the CPT states that means of restraint can only be applied in cases of acute danger, and if all alternatives have failed. Detailed and strict conditions apply, including for the duration (usually minutes rather than hours). However, an analysis of the CPT's country reports shows that sometimes longer-term use is implicitly accepted, first to preventively maintain order and safety in a care facility and second, to protectively safeguard the interests of the patient. Based on country reports and general human rights principles, this contribution tries to provide the clearest possible picture of the conditions for applying means of restraint and the required legal guarantees in these cases. Nevertheless, many loose ends remain. To safeguard the rights of patients, it is desirable that the CPT is more explicit concerning means of restraint when there is no acute danger.
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Affiliation(s)
- Tim Opgenhaffen
- Institute for Social Law, University of Leuven (KU Leuven), Belgium; CORe, Hasselt University, Hasselt, Belgium.
| | - Johan Put
- Institute for Social Law, University of Leuven (KU Leuven), Belgium; Institute for Social Law and Leuven Institute of Criminology, University of Leuven (KU Leuven), Belgium
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Bindella G, Caruzzo D, Sbrugnera S, Danielis M, Mansutti I. [ Patient isolation during Sars-CoV-2 pandemic: the caregivers' experience in a neuro-rehabilitation unit]. Assist Inferm Ric 2022; 41:105-113. [PMID: 36503948 DOI: 10.1702/3920.39045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
. Patient isolation during Sars-CoV-2 pandemic: the caregivers' experience in a neuro-rehabilitation unit. INTRODUCTION During the Covid-19 pandemic, caregiver visits were suspended in many health care facilities and, even today, limitations remain. These restrictions have impacted not only the patients but also caregivers. AIM To explore the life experience of caregivers of hospitalized patients, during the pandemic and the impact of visit limitations in a rehabilitation unit. METHOD An exploratory qualitative study was conducted, following the COREQ guidelines. Caregivers of inpatients were purposefully sampled and interviewed, until data saturation. A qualitative thematic analysis with an inductive approach was performed. RESULTS Fifteen caregivers were interviewed. The themes emerged were: 1. perception of the illness as a sudden change; 2. concerns for their loved one (i.e. the loneliness or the suffering); 3. critical (difficult to organize and perceived too short) and positive aspects of the visits; 4. barriers to communication (for example, masks when in presence; or the difficult use of technologies by elders); 5. patient's protection and support (thinking that the relative's presence may improve the rehabilitation); 6. emotions (from discouragement when visits were not allowed, to joy when meeting their loved one). CONCLUSIONS Caregivers experienced uncertainty, worry, anxiety, fear, and lack of understanding of their loved one's clinical situation. Alternatives to the visits or the visits with physical barriers were helpful but not always effective.
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Mangiarotti GG, Arias CM, Zak E, Castro Pérez GA. Seguimiento de pacientes con psoriasis en contexto de políticas de aislamiento domiciliario por COVID-19: Encuesta realizada a pacientes en hospital de Argentina. Actas Dermo-Sifiliográficas 2022; 113:745-747. [PMID: 35221339 PMCID: PMC8856961 DOI: 10.1016/j.ad.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Cintia Marisol Arias
- Servicio de Dermatología, Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
| | - Elizabeth Zak
- Servicio de Dermatología, Hospital Interzonal General de Agudos Eva Perón, Buenos Aires, Argentina
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Gavrilovic Haustein N, Freudiger M, Hunziker A, Hepp U, Jellestad L, von Känel R, Stulz N. Seclusion as a coercive measure in suicidality - daily routine or exception? BMC Psychiatry 2022; 22:431. [PMID: 35752775 PMCID: PMC9233814 DOI: 10.1186/s12888-022-04076-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Coercive measures continue to be an important topic in psychiatry. However, there is no proof of the effectiveness of the use of coercive measures, especially with suicidal people. For many years, attempts have been made to replace such measures with alternative noncoercive intervention options. This paper aims to clarify the situation of coercive measures, more precisely seclusions, in a general psychiatric hospital in Switzerland. It focuses on compulsory measures in patients with suicidal tendencies. METHOD In this single-centre retrospective cohort study, we used routinely collected medical data and performed qualitative analyses of medical histories to examine whether alternative measures to seclusion had been offered and/or provided to patients who had been secluded solely because of suicidality. Patients were aged 18-65 years and had received inpatient treatment at one of five adult acute care units at a general psychiatric hospital in Switzerland between September 2016 and December 2019. RESULTS There were 5,935 inpatient treatment cases during the study period. Suicidality was rated as "acute" or "very high" at least once during the hospitalization in 219 (3.7%) cases. Of these, 60 were excluded from further analyses as they involved seclusion, but suicidality was not the exclusive indication for this measure. Coercive seclusion was imposed exclusively due to suicidality in 53 (33.3%) of the remaining 159 cases, whereas 106 (66.7%) cases were not secluded. The rates of seclusion among suicidal patients varied considerably between the hospital wards (13.0% to 55.3%). Suicidal patients with non-Swiss residence status and/or lacking language skills were particularly prone to be secluded. Additionally, alternative interventions were offered and provided significantly more frequently in the nonsecluded patients. CONCLUSIONS To avoid seclusion due to suicidal tendencies, it is necessary to have a general attitude of avoiding coercive measures at all costs. It is also important for qualified staff to be able to deal with challenging sociodemographic characteristics of patients such as foreign-language, which may require translators and intercultural interpreters.
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Affiliation(s)
| | - Maurice Freudiger
- Integrated Psychiatric Services Winterthur – Zurcher Unterland, P.O. Box 144, CH-8408 Winterthur, Switzerland
| | - Anna Hunziker
- Integrated Psychiatric Services Winterthur – Zurcher Unterland, P.O. Box 144, CH-8408 Winterthur, Switzerland
| | - Urs Hepp
- Meilener Institute Zurich, Stockerstrasse 45, Zurich, CH-8002 Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lena Jellestad
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niklaus Stulz
- Integrated Psychiatric Services Winterthur – Zurcher Unterland, P.O. Box 144, CH-8408 Winterthur, Switzerland
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Boulton KA, Raghupathy V, Guastella AJ, Bowden MR. Reducing seclusion use in an Australian child and adolescent psychiatric inpatient unit. J Affect Disord 2022; 305:1-7. [PMID: 35227762 DOI: 10.1016/j.jad.2022.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND In inpatient psychiatric units, seclusion (isolation in a locked room) is recommended only as a last resort for serious aggression or agitation. In response to an increase in seclusion during 2015, an 8-bed child and adolescent inpatient unit implemented a suite of multidisciplinary interventions. This study examines changes in seclusion rates following intervention implementation and assesses whether specific patient factors were associated with seclusion rates before and after interventions. METHOD Multi-modal interventions, comprised of patient treatment plans, intake and handover meetings, staff supervision and debriefing sessions, were implemented from January 2016. We compared quarterly seclusion rates (episodes per 1000 patient days) across a thirteen-year period, from July 2008 to June 2021. Change in seclusion rates following intervention was evaluated using a segmented regression analysis. We examined whether patient factors were associated with seclusion rates, and whether the duration of seclusion episodes differed before and after interventions. RESULTS There was a 100% reduction in seclusion rates in the 6 months following intervention implementation, from 28.4 episodes per 1000 patient days in July-September 2015, to 4.7 episodes in January-March 2016, reaching 0.0 episodes by April-June 2016. This reduction was maintained until April-June 2021. Most patients with seclusion events before and after intervention implementation had a neurodevelopmental disorder diagnosis and a minority of patients accounted for most seclusion events. There was a 65% reduction in the average duration of seclusion episodes following interventions, however this was not statistically significant. LIMITATIONS Due to a crisis in staff morale, interventions were implemented simultaneously, preventing an understanding of whether a single intervention accounted for change. While not addressed in the current study, assessing perceptions of staff, children and parents following intervention implementation may have elucidated barriers and facilitators to change. CONCLUSIONS Multidisciplinary, patient-centered interventions may be effective for long-term reduction of seclusion rates in inpatient psychiatric units. These findings highlight patient factors associated with seclusion reduction which should be considered when implementing interventions.
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Affiliation(s)
- Kelsie A Boulton
- Autism Clinic for Translational Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Veena Raghupathy
- Psychological Medicine, Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney, Australia
| | - Adam J Guastella
- Autism Clinic for Translational Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Michael R Bowden
- Psychological Medicine, Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney, Australia; Mental Health - Children and Young People, Mental Health Branch, NSW Health, Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, Australia
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van Heesch B, Boucké J, De Somer J, Dekkers I, Jacob E, Jeandarme I. The use of coercive measures in a high security setting in Belgium: Prevalence and risk factors. Int J Law Psychiatry 2022; 82:101792. [PMID: 35439661 DOI: 10.1016/j.ijlp.2022.101792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
Coercive measures are often used in forensic psychiatric settings as a strategy to manage violent and other problematic behavior. Few studies have been published regarding the use of coercive measures in high security populations. This is the first empirical study on this subject in Belgium. The aim of the present study was to examine the prevalence rates of coercive measures in Flanders' two high security settings and to identify individual patient risk factors for being subjected to a coercive measure. The study included all patients (N = 654) who were admitted in the Forensic Psychiatric Centres of Antwerp or Ghent over a six-year period. Data on the use of coercive measures (seclusion, mechanical restraint, and chemical restraint) were registered prospectively. Several regression analyses were conducted with multiple independent variables. The results show that half of the population (50.3%) was subjected to at least one coercive measure during admission in one of the high security settings. A small subgroup of patients (6.4%) was the subject of half of all coercive measures (50,4%). Seclusion was the most frequently used coercive measure (48.3%), followed by chemical restraint (20.2%). The prevalence rate of mechanical restraint was very low (0.8%) compared to previous research in similar populations. Various individual risk factors were significantly associated with a higher use of coercive measures. Clinical implications are discussed and the importance of developing international standards on recording and reporting on coercive measures is highlighted.
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Affiliation(s)
- Ben van Heesch
- Forensic Psychiatric Center Ghent, Hurstweg 9, 9000 Ghent, Belgium
| | - Jan Boucké
- Forensic Psychiatric Center, Beatrijslaan 96, 2050 Antwerp, Belgium.
| | - Johanna De Somer
- Forensic Psychiatric Center Ghent, Hurstweg 9, 9000 Ghent, Belgium.
| | - Ingrid Dekkers
- Forensic Psychiatric Center, Beatrijslaan 96, 2050 Antwerp, Belgium.
| | - Elise Jacob
- Forensic Psychiatric Center Ghent, Hurstweg 9, 9000 Ghent, Belgium.
| | - Inge Jeandarme
- Forensic Psychiatric Center, Beatrijslaan 96, 2050 Antwerp, Belgium; KU Leuven, Belgium.
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Steinert T, Hirsch S, Flammer E. [Effects of the Decision of the German Constitutional Court on mechanical restraint in 2018 : Coercive measures in the psychiatric hospitals in Baden-Wuerttemberg in 2019 compared to the years 2015-2017]. Nervenarzt 2022; 93:706-712. [PMID: 35303128 DOI: 10.1007/s00115-022-01267-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/29/2022]
Abstract
On 23 July 2018 the German Constitutional Court decided that mechanical restraint in psychiatric patients with 5 or 7‑point mechanical restraint lasting longer than 30 min requires a judicial authorization. On the same day, the German Association for Psychiatry and Psychotherapy (DGPPN) published guidelines on the prevention of coercion and violence. Together, this can be considered as the strongest intervention to reduce coercion on a national level worldwide. The registry for coercive measures in the Federal State of Baden-Wuerttemberg, available since 2015 and comprising all 32 hospitals licensed to admit involuntary patients, has made it possible to evaluate the effect of the legal change. We analyzed the mean percentage of patients subjected to coercive measures and the mean cumulative duration of these interventions in ICD-10 diagnostic groups in psychiatric hospitals from 2015 to 2017 compared to 2019 among a total of 438,003 admissions. The percentage of patients subjected to any kind of freedom-restricting coercion (restraint or seclusion) decreased from 6.7% (average 2015-2017) to 5.8% in 2019 (p < 0.001). Effects were strongest in patients with organic (F0) and schizophrenic disorders (F2). The percentage of patients subjected to mechanical restraint decreased from 4.8% to 3.6% in 2019, and the percentage of mechanical restraints less than 30 min increased from 1.8% to 10.5%. Vice versa, the percentage of patients subjected to seclusion increased from 2.9% to 3.3%. The median cumulated duration of restraint and seclusion per affected case decreased from 12.7h to 10.9 h (median). The intervention was probably responsible for a reduction of the percentage of cases subjected to coercive measures by about 13% and a reduction of the duration of these measures per affected case by about 14%.
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Affiliation(s)
- Tilman Steinert
- Klinik für Psychiatrie und Psychotherapie I, Universität Ulm (Weissenau), Ravensburg, Deutschland.
- Zentren für Psychiatrie Südwürttemberg, Ravensburg, Deutschland.
- Klinik für Psychiatrie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland.
- , Weingartshofer Str. 2, 88214, Ravensburg, Deutschland.
| | - Sophie Hirsch
- Klinik für Psychiatrie und Psychotherapie I, Universität Ulm (Weissenau), Ravensburg, Deutschland
- Zentren für Psychiatrie Südwürttemberg, Ravensburg, Deutschland
- Zentren für Psychiatrie Südwürttemberg, Biberach, Deutschland
| | - Erich Flammer
- Klinik für Psychiatrie und Psychotherapie I, Universität Ulm (Weissenau), Ravensburg, Deutschland
- Zentren für Psychiatrie Südwürttemberg, Ravensburg, Deutschland
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Abstract
Restraints and seclusions are restrictive interventions used in psychiatric inpatient units when there is an imminent risk of harm to the patient or others. Coercive measures are controversial and can lead to negative consequences, including negative emotions, re-traumatization, injuries, or death. The article summarizes the last 10 years of literature regarding methods and strategies used for reducing seclusions and restraints in child and adolescent psychiatric inpatient units, and reports on their outcomes. The literature was reviewed by searching PubMed and PsycInfo for English-language articles published between May 2010 and May 2020. Eighteen articles were found that described methods or strategies aimed at reducing restraint or seclusion utilization in child and adolescent psychiatric inpatient units. The following interventions were evaluated: Trauma-Informed Care (TIC), Six Core Strategies, Child and Family Centered Care (CFCC), Collaborative & Proactive Solutions (CPS), Strength-Based Care, Modified Positive Behavioral Interventions and Supports (M-PBIS), Behavioral Modification Program (BMP), Autism Spectrum Disorder Care Pathway (ASD-CP), Dialectical Behavior Therapy (DBT), sensory rooms, Mindfulness-Based Stress Reduction Training (MBSR) of staff, and Milieu Nurse-Client Shift Assignments. Most of the interventions reduced the use of seclusions and/or restraints. Two child-centered and trauma-informed initiatives eliminated the use of mechanical restraints. This review shows that the use of coercive measures can be reduced and should be prioritized. Successful implementation requires ongoing commitment on all levels of an organization and a willingness to learn. To facilitate comparisons, future models should evaluate different standardized parameters.
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Affiliation(s)
| | - Beata Bäckström
- Skåne Child & Adolescent Psychiatry, Unit for Pediatric Bipolar & Psychotic Disorders, Lund, Sweden
| | - Björn Axel Johansson
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, Lund, Sweden
- Skåne Child & Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Malmö, Sweden
| | - Olof Rask
- Skåne Child & Adolescent Psychiatry, Unit for Pediatric Bipolar & Psychotic Disorders, Lund, Sweden
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, Lund, Sweden
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Gallucci F, Vadakkan C, Kompella S, James T, Kamboj S, Parker J, Coffey BJ. Seclusion-Induced Psychosis in an Adolescent Boy. J Child Adolesc Psychopharmacol 2022; 32:127-130. [PMID: 35294265 DOI: 10.1089/cap.2022.29217.bjc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Felicia Gallucci
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
- Jackson Behavioral Health Hospital, Miami, Florida, USA
| | - Christy Vadakkan
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
- Jackson Behavioral Health Hospital, Miami, Florida, USA
| | - Sindhura Kompella
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
- Jackson Behavioral Health Hospital, Miami, Florida, USA
| | - Taylor James
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
- Jackson Behavioral Health Hospital, Miami, Florida, USA
| | - Shivam Kamboj
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
- Jackson Behavioral Health Hospital, Miami, Florida, USA
| | - Jonathan Parker
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
- Jackson Behavioral Health Hospital, Miami, Florida, USA
| | - Barbara J Coffey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
- Jackson Behavioral Health Hospital, Miami, Florida, USA
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Dixon M, Long EM. An Educational Intervention to Decrease the Number of Emergency Incidents of Restraint and Seclusion on a Behavioral Health Unit. J Contin Educ Nurs 2022; 53:70-76. [PMID: 35103503 DOI: 10.3928/00220124-20220104-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The objective of this study was to implement an educational intervention on an inpatient, behavioral health care unit with the goal of reducing the number of crisis interventions of seclusion or restraint. METHOD A quasi-experimental pretest and posttest design using De-escalate Anyone, Anywhere, Anytime training was employed with a focus of an increased understanding of a range of de-escalation techniques to use instead of restraint and seclusion. RESULTS A convenience sample of 21 mental health employees participated in the training. The rates of restraint declined from a mean of 6 preintervention to 2 postintervention. The number of seclusions on the designated unit declined from a mean of 4.33 preintervention to a mean of 1.667 postintervention. CONCLUSION These data suggest that an educational intervention to increase the knowledge of direct care staff in a broad range of de-escalation techniques resulted in a reduction in the use of restraint and seclusion. Ongoing training for nursing staff may reassure them of the efficacy of alternative methods for dealing with aggressive patients. [J Contin Educ Nurs. 2022;53(2):70-76.].
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Hoteit M, Mortada H, Al-Jawaldeh A, Ibrahim C, Mansour R. COVID-19 home isolation and food consumption patterns: Investigating the correlates of poor dietary diversity in Lebanon: a cross-sectional study. F1000Res 2022; 11:110. [PMID: 35251599 PMCID: PMC8864186 DOI: 10.12688/f1000research.75761.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 12/15/2022] Open
Abstract
Background: The unfurling COVID-19 pandemic has uncovered the defenselessness of the Lebanese food system leading to serious implication in maintaining a healthy sustainable lifestyle. Aim: The main purpose of this study is to examine the impact of the COVID-19 pandemic on food consumption patterns and dietary diversity of the Lebanese people. Methods: The online survey, completed between April and June 2020, consisted of a cross-sectional study on 2282 Lebanese participants (mean age: 29.36±12.221, 80.9% women) that was part of a survey across 38 different countries conducted by De Backer, C.
et al. A food frequency questionnaire was used to investigate the consumption patterns along with the calculation of the Food Consumption Score (FCS), a proxy indicator of dietary diversity. Data collected on cooking attitudes, shopping, and food stock identify the community mitigation measures. Results: Home isolation due to COVID-19 induced an increase in the consumption of legumes and pulses (3.2%, p-value=0.001) and whole wheat groups (2.8%, p-value=0.03). In contrast, a decrease of 5.4%, 6.9%, 5.8%, 5.1%, 3.1%, 3.4% and 2.8% was observed in the consumption of fruits (p-value=0), vegetables (p-value=0), processed meats, poultry, and fish (p-value=0), other dairy products (p-value=0), sweet snacks (p-value=0.001), sugared beverages (p-value=0), fats and oils (p-value=0.001), respectively. The FCS decreased by 4.6%. As food-related behaviors, most cooking attitudes, and practices (10 out of 13) showed an amelioration during the lockdown and the proportions of food stocked have been changing since the start of the pandemic seeing higher amounts of pasta, rice or other grains, flour, and legumes/pulses stocked. Conclusion: To conclude, the hostile home isolation strategy followed to prevent the COVID-19 spread in Lebanon, came at a high nutritional cost, driving poor dietary diversity.
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Affiliation(s)
- Maha Hoteit
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
- PHENOL research group (Public HEalth Nutrition prOgram-Lebanon), Faculty of Public Health, Lebanese University, Beirut, Lebanon
- Lebanese University Nutrition Surveillance Center, Lebanese University, Beirut, Lebanon
| | - Hussein Mortada
- PHENOL research group (Public HEalth Nutrition prOgram-Lebanon), Faculty of Public Health, Lebanese University, Beirut, Lebanon
- Faculty of Science IV, Lebanese University, Beirut, Lebanon
| | - Ayoub Al-Jawaldeh
- World Health Organization Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Carla Ibrahim
- PHENOL research group (Public HEalth Nutrition prOgram-Lebanon), Faculty of Public Health, Lebanese University, Beirut, Lebanon
- Department of Nutrition and food sciences, faculty of arts and sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Rania Mansour
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
- Social Work Program, The Doha Institute for Graduate Studies, Doha, Qatar
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Luning-Koster MN, Alma MA, van den Boogaard J, Verheij NP, van der Mei SF, Landsman JA, Reijneveld SAM. [Experience of first COVID-19 patients in Northern part of the Netherlands: Information provision, source investigation, contact tracing and home isolation]. Ned Tijdschr Geneeskd 2022; 166:D6469. [PMID: 35138745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this study was to investigate how patients experience the information, the source investigation and contact tracing and the measures in isolation at the start of a pandemic. DESIGN Secondary analysis of semi-structured interviews was conducted as part of a larger exploratory mixed-methods study on COVID-19 patient experiences. METHODS Semi-structured interviews were conducted with 29 people from Friesland and Groningen who tested positive for SARS-CoV-2 between 9 March and 3 April 2020, recruited via maximum variation sampling. Thematic analysis was used. RESULTS The following themes emerged from the analysis: 1) Information: Conflicting information by different advisors led to a lack of clarity. Patients admitted to hospital usually felt uninformed about the rules of home isolation after discharge. 2) Investigation into the source of infection: For most it was unclear whether and how this investigation took place. Some expected feedback on their suggestions. 3) Informing contacts: Not everyone felt able to inform the right contacts. Some felt stigmatized. 4) Living with the measures in home isolation: The recommended living rules were often not fully applied. Some patients felt insufficiently supported. CONCLUSION Our study shows that not all COVID-19 patients felt well cared for at the start of the outbreak. Scaling down monitoring by the public health service can mean that questions about source and contact investigation and isolation remain unanswered or are answered by others. This leads to conflicting information and non-compliance with measures. The supervision of patients in isolation should be better guarded.
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Makhlouf MD. Stemming the Shadow Pandemic: Integrating Sociolegal Services in Contact Tracing and Beyond. J Law Med Ethics 2022; 50:719-725. [PMID: 36883384 PMCID: PMC10009374 DOI: 10.1017/jme.2023.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has shed light on the challenges of complying with public health guidance to isolate or quarantine without access to adequate income, housing, food, and other resources. When people cannot safely isolate or quarantine during an outbreak of infectious disease, a critical public health strategy fails. This article proposes integrating sociolegal needs screening and services into contact tracing as a way to mitigate public health harms and pandemic-related health inequities.
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Affiliation(s)
- Medha D Makhlouf
- PENNSYLVANIA STATE UNIVERSITY, DICKINSON SCHOOL OF LAW, CARLISLE, PA, USA
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Leitão IDC, Calil PT, Galliez RM, Moreira FRR, Mariani D, Castiñeiras ACP, da Silva GPD, Maia RA, Corrêa IA, Monteiro FLL, de Souza MRM, Gonçalves CCA, Higa LM, de Jesus Ribeiro L, Fonseca VWP, Bastos VC, Voloch CM, Faffe DS, da Costa Ferreira O, Tanuri A, Castiñeiras TMPP, da Costa LJ. Prolonged SARS-CoV-2 Positivity in Immunocompetent Patients: Virus Isolation, Genomic Integrity, and Transmission Risk. Microbiol Spectr 2021; 9:e0085521. [PMID: 34787498 PMCID: PMC8597635 DOI: 10.1128/spectrum.00855-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022] Open
Abstract
Current guidelines for patient isolation in COVID-19 cases recommend a symptom-based approach, averting the use of control real-time reverse transcription PCR (rRT-PCR) testing. However, we hypothesized that patients with persistently positive results by RT-PCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could be potentially infectious for a prolonged time, even if immunocompetent and asymptomatic, which would demand a longer social isolation period than presently recommended. To test this hypothesis, 72 samples from 51 mildly symptomatic immunocompetent patients with long-lasting positive rRT-PCR results for SARS-CoV-2 were tested for their infectiousness in cell culture. The serological response of samples from those patients and virus genomic integrity were also analyzed. Infectious viruses were successfully isolated from 34.38% (22/64) of nasopharynx samples obtained 14 days or longer after symptom onset. Indeed, we observed successful virus isolation up to 128 days. Complete SARS-COV-2 genome integrity was demonstrated, suggesting the presence of replication-competent viruses. No correlation was found between the isolation of infectious viruses and rRT-PCR cycle threshold values or the humoral immune response. These findings call attention to the need to review current isolation guidelines, particularly in scenarios involving high-risk individuals. IMPORTANCE In this study, we evaluated mildly symptomatic immunocompetent patients with long-lasting positive rRT-PCR results for SARS-CoV-2. Infectious viruses were successfully isolated in cell cultures from nasopharynx samples obtained 14 days or longer after symptom onset. Indeed, we observed successful virus isolation for up to 128 days. Moreover, SARS-CoV-2 genome integrity was demonstrated by sequencing, suggesting the presence of replication-competent viruses. These data point out the risk of continuous SARS-CoV-2 transmission from patients with prolonged detection of SARS-CoV-2 in the upper respiratory tract, which has important implications for current precaution guidelines, particularly in settings where vulnerable individuals may be exposed (e.g., nursing homes and hospitals).
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Affiliation(s)
- Isabela de Carvalho Leitão
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Pedro Telles Calil
- Laboratório de Genética e Imunologia das Infecções Virais, Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Rafael Mello Galliez
- Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Filipe Romero Rebello Moreira
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Diana Mariani
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Gustavo Peixoto Duarte da Silva
- Laboratório de Genética e Imunologia das Infecções Virais, Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Richard Araújo Maia
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Isadora Alonso Corrêa
- Laboratório de Genética e Imunologia das Infecções Virais, Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Fábio Luís Lima Monteiro
- Laboratório de Genética e Imunologia das Infecções Virais, Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Marcos Romário Matos de Souza
- Laboratório de Genética e Imunologia das Infecções Virais, Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Luiza Mendonça Higa
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Liane de Jesus Ribeiro
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Victoria Cortes Bastos
- Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Carolina Moreira Voloch
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Débora Souza Faffe
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Orlando da Costa Ferreira
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Amilcar Tanuri
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Luciana Jesus da Costa
- Laboratório de Genética e Imunologia das Infecções Virais, Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Abstract
OBJECTIVES The aim of this study was to describe use of seclusion and restraint after injurious assaults by psychiatric inpatients in U.S. hospitals, including examination of hospital, unit, assaultive patient, and assault characteristics as predictors of seclusion/restraint use. METHODS Data from 2004 to 2017 on 23,630 injurious assaults reported by 747 psychiatric units in 482 general hospitals were analyzed. Odds of seclusion, odds of three restraint types (device, hold, pharmacological), and duration of seclusion and device restraint were modeled as functions of hospital, unit, assaultive patient, and assault characteristics. RESULTS Compared with teaching hospitals, nonteaching hospitals had lower rates of seclusion but higher rates of all three types of restraint. Seclusion and restraint rates were lower in government hospitals and hospitals in metropolitan settings. Pharmacological restraint was most common in for-profit hospitals; seclusion was most common in nonprofit hospitals. Episodes of seclusion and device restraint were approximately 20% shorter in teaching hospitals than in nonteaching hospitals and lasted markedly longer in federal government hospitals. Hospitals in metropolitan settings reported 30% longer time spent in seclusion, on average. Involuntary admission was associated with higher odds of seclusion, device restraint, and hold. Female patients were less likely than males to be restrained with a device, and their seclusion and device restraint episodes tended to be shorter. The number of persons injured in an assault predicted odds of seclusion and all three types of restraint. The maximum level of injury sustained predicted odds of seclusion, device restraint, and hold, as well as duration of both seclusion and device restraint. Odds of seclusion/restraint were lower when the most severely injured person was a patient rather than a clinical health care worker. CONCLUSIONS Inconsistencies were observed in seclusion and restraint use, which varied by hospital type, patient sex and admission status, maximum level of injury sustained, and type of person most severely injured. Thus, there may be room for improvement in hospital and unit policies and practices. More comprehensive data are needed for further research on use of seclusion and restraint in response to incidents other than injurious assault.
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Affiliation(s)
- Vincent S Staggs
- From the School of Medicine, University of Missouri-Kansas City, and Biostatistics & Epidemiology, Health Services & Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri
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Richterman A, Richard-Greenblatt M, Whitaker K. Back Pain, Fever, and Cough in a 46-Year-Old Man. JAMA 2021; 326:2070-2071. [PMID: 34812888 DOI: 10.1001/jama.2021.17584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Aaron Richterman
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia
| | | | - Kathryn Whitaker
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia
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