Traumatic visual loss of inpatients in Yazd, Iran from 2005 to 2006

AIM: To investigate the conditions of traumatic visual loss of inpatients in Yazd, Iran from 2005 to 2006, and to explore the possible causes and preventive methods. METHODS: We retrospectively analyzed data on all patients with eye injuries (70 cases) hospitalized at Shahid Sadoughi Hospital between August 2005 and August 2006, including age, gender, causes, type of injury, time of initial treatment, visual acuity during admission and discharge, surgical procedures, and final outcome. Furthermore, standardized international classification of ocular trauma (Birmingham Eye Trauma Terminology) was used for eye injury categorization. · RESULTS: A total of 70 inpatients with ocular injuries were selected by simple approach. The male/female ratio was 2.8 to 1. The most frequent causes of eye injury were metallic objects (34.3%) especially in age group of ≤10 and ≥30 years old, accidents (22.8%) and assaults (17.2%). Waiting time to initial treatment was 6-24 hours in most cases (51.4%). Trauma was blunt in 38.6% and penetrating in 61.4%. The most and the least final visual acuity in blunt and penetrating trauma was LP (51.8%, 41.8%) and HM (7.5%, 4.7%) respectively. Surgery outcome was globe saving with acceptable visual acuity in 72.9% and enucleation in 24.2%. CONCLUSION: With regard to the high incidence of ocular trauma and consequent severe visual loss, parents' attention, eye safety protection and early treatment should be considered as final preserving globe in most accidents.     

老年住院病人健康知识掌握程度与生活质量的相关性

目的了解内科老年住院病人健康知识掌握程度对生活质量的影响,为做好内科老年住院病人的护理工作和提高他们的生活质量,提供科学合理的指导方法。方法青州市人民医院2008年1月—2009年3月期间因心血管疾病住院的、意识清晰、具有良好口头表达能力、且愿意接受问卷调查的156位老年人为研究对象,用健康知识掌握程度问卷和李凌江与杨德森[1]编制的生活质量综合评定问卷对本组病人进行问卷调查,采集数据,进行统计学处理。结果健康知识掌握程度与性别、年龄、婚姻状况无关,与受教育程度高低呈正相关(r=0.206,P0.05);健康知识掌握程度与生活质量呈显著正相关(r=0.215,P0.05)。结论健康知识的掌握程度影响老年内科住院病人的生活质量。根据现有的护理现状,应采用多种方式相结合的健康指导形式,提高病人对健康知识的掌握程度,提高老人的生活质量。     

Effects of cognitive remediation therapy versus other interventions on cognitive functioning in schizophrenia inpatients

Computerised cognitive remediation therapy (CCRT) has been shown to improve cognitive function in individuals with schizophrenia beyond effects of other forms of therapy. However, results vary between studies, and most are aimed at individuals who are living in the community. Very few studies have investigated its efficacy in psychiatric wards in order to assess whether or not this is a suitable site to start the therapy. This study evaluated CCRT efficacy among schizophrenia inpatients who received a broad range of therapeutic interventions in a psychiatric ward. A randomised controlled trial of CCRT versus an active control in 66 young inpatients with a diagnosis of schizophrenia was conducted. The intervention lasted for 6 weeks and its efficacy was assessed with the composite score of the MATRICS Consensus Cognitive Battery. Both groups improved similarly in cognitive function and psychopathological symptoms. However, the CCRT group improved more than the controls in negative symptoms. This result shows that providing a drill and practice cognitive remediation to inpatients does not produce benefits for cognitive functioning substantially greater than other forms of therapy provided in a ward, but it is more efficient in reduction of negative symptoms. Our results suggest that CRT might be considered as a promising intervention for reducing negative symptoms in schizophrenia individuals.     

Prevalence of substance use in a Swiss psychiatric hospital: interview reports and urine screening

BACKGROUND: Co-morbid substance misuse is common in psychiatric disorders, has potentially severe adverse consequences and may be frequently undetected. AIMS: To measure the prevalence of substance use among patients admitted to a Swiss psychiatric hospital and to examine the potential utility of routine urine drug screening in this setting. METHOD: 266 inpatients were included. 238 patients completed the interview and 240 underwent a urine drug screening. RESULTS: Lifetime prevalence of substance use among psychiatric patients was very high for alcohol (98%; 95% CI: 96-100), benzodiazepines (86%; 95% CI: 82-91) and cannabis (53%; 95% CI: 47-60), but also for "hard drugs" like cocaine (25% ; 95% CI: 19-30) or opiates (20%; 95% CI: 15-25). Regular current use of alcohol (32%; 95% CI: 26-38) or cannabis (17%; 95% CI: 12-22) was the most frequent. Substance use was associated with male sex, younger age, unmarried status and nicotine smoking. Urine screening confirms reports from patients on recent use, and remained positive for cannabis during hospitalisation, but not for cocaine nor for opiates. CONCLUSION: Substance use is frequent among psychiatric patients. Systematic interviewing of patients about their substance use remains essential, and is usually confirmed by urine screening. Urine screening can be useful to provide specific answers about recent use.     

Seasonal variation in undiagnosed HIV infection on the general medicine and trauma services of two urban hospitals

OBJECTIVE: To examine the seroprevalence of undiagnosed HIV and variation by season among patients admitted to the general internal medicine (GIM) and trauma services of two urban hospitals. DESIGN: A cross-sectional blinded HIV-1 seroprevalence survey. SETTING: A 725-bed academic medical center's hospital and an affiliated 324-bed tertiary care hospital. PARTICIPANTS: Residual serological specimens were obtained for unique patients aged 17 to 65 to study services in summer (June 16 to September 4, 2001) and fall to winter (November 1, 2001 to January 8, 2002). METHODS: Hospital files provided data on demographics, service type, and discharge clinical categories (fall-winter group only). HIV ELISA (enzyme-linked immunosorbent assay) tests with confirmatory Western blot were linked to subjects' de-identified files. We excluded 34 subjects with known HIV. Of the remaining unique admissions in summer (n=604) and fall-winter (n=978), 60% and 55% were tested, respectively. Predictors of undiagnosed HIV infection were examined using multivariate analysis. RESULTS: The summer cohort (n=362) had significantly lower unadjusted seroprevalence of undiagnosed HIV infection (1.4%; 95% confidence interval [CI], 0.4% to 3.2%) than the fall-winter cohort (n=539; 3.7%; 95% CI, 2.3% to 5.7%; P=.04). Overall, undiagnosed HIV was somewhat less likely in women (adjusted odds ratio [AOR], 0.45; 95% CI, 0.19 to 1.07) but more likely in black patients (AOR, 3.46; 95% CI, 0.70 to 17.06). In the fall-winter cohort, undiagnosed HIV was more likely for discharges with the following clinical categories versus those with a cardiac condition: dermatologic/breast (AOR, 14.90; 95% CI, 1.20 to 184.77), renal/urological (AOR, 22.43; 95% CI, 2.12 to 236.75), or infectious (AOR, 31.08; 95% CI, 2.40 to 402.98). CONCLUSIONS: The higher seroprevalence of undiagnosed HIV in the fall-winter admissions to GIM and trauma services supports especially targeting HIV testing in these months.     

Differences in the progress of discharged and undischarged patients in a medium secure unit: a pilot study

This study compared 15 patients ('undischarged' group) who were showing little sign of progress in a medium secure unit (MSU) after 2 years with 15 who had been discharged from the same unit 1-2 years following admission. The two groups were compared across a number of broadly defined behavioural indices during their first 6 months and first 12 months following admission. The measures used were indices of progress to wards of lower security (highest ward status and transfers to wards of higher security) and progress in terms of leave (highest leave status and reductions in leave status). In addition, the two groups were compared on number of recorded incidents attributable to them. Discharged patients were significantly older at the time of their admission than the undischarged patients (median ages 33 and 26 years, respectively). They made more progress in their first year in terms of ward security and leave status and were responsible for fewer recorded incidents. These results were also obtained at 6 months following admission with the exception that the difference for highest ward status was not statistically significant. The findings of this small-scale study suggest that within the first 6 months of admission, it may be possible to distinguish patients who will probably make good progress in a MSU from those whose progress is likely to be very slow. Implications of the study are discussed.     

Behavior change and achieving hospital discharge in persons with severe,chronic psychiatric disabilities

Economic and political pressures have led state governments to shrink and close long-term psychiatric inpatient units in favor of community-based treatment. These pressures present inpatient clinicians with an opportunity to examine their clinical practices and question whether the focus of treatment addresses the behaviors most relevant to helping patients achieve discharge and maintain community tenure. The social learning approach of Gordon Paul is the empirically validated treatment of choice for long-term psychiatric inpatients. In this study, we compared changes in daily functioning of sixty-four chronic psychiatric inpatients treated in two rehabilitation programs based extensively on Gordon Paul's social learning approach. Half of the participants were successfully discharged from the hospital. Analysis found both similarities and differences in behavioral improvements between the groups. These results provide some clarity to the relationship between selfcare skills, participation in programs, maladaptive behaviors, and achieving hospital discharge for chronically hospitalized individuals.     

Dysphagia in psychiatric patients: Clinical and videofluoroscopic study

Deaths due to airway obstruction are more common in psychiatric inpatients than in the normal population. A dysphagia program was started in a 400 bed Massachusetts psychiatric hospital after 4 patients in 1 year died from asphyxia. In the year after the program was started, there were no deaths; however, 28 patients experienced 32 choking incidents. The 28 patients received clinical evaluations by speech pathologists, neurologists, psychiatrists, and internists. Of the incidents, 55% required use of the Heimlich maneuver to open the airway. Choking incidents could be classified into five types based on results of clinical examination: bradykinetic, dyskinetic, fast eating syndrome, paralytic, and medical. Twenty-one of the 28 patients were studied by videofluoroscopy and 86% of the videos were abnormal, showing aspiration in eight, webs in five, and delay in the oral phase in five. Patients with bradykinetic dysphagia (secondary to neuroleptic-induced extra-pyramidal syndrome [EPS]) and paralytic dysphagia appeared to experience a more severe from of choking.     

An Epidemiological Study on Hyponatremia in Psychiatric Patients in Mental Hospitals in Nara Prefecture

Abstract: Hyponatremia occurs often in mental illness. The frequency was not noticed because of the uncharacteristic symptoms of mild hyponatremia. Of the 1,114 psychiatric inpatients retrospectively surveyed, 10.5% had hyponatremia. Not only patients with schizophrenia, but also patients with other mental illness, especially with epilepsy, having hyponatremia were confirmed. An early onset, a long duration of psychiatric disorder and a prolonged admission were statistically significant factors. Nicotine abuse was not a significant factor. It was suggested that the pathogenesis of hyponatremia in psychiatric patients might be involved in a chronic course of psychiatric disorders and poor response to psychopharmacotherapy.     

IDENTIFICATION OF AT-RISK DRINKERS IN AN ORTHOPAEDIC INPATIENT POPULATION

The prevalence of hazardous drinking of alcohol in orthopaedic inpatients and its impact on patient management was determined. A prospective survey was performed on acute and arranged admissions in the orthopaedic wards at St Vincent's Hospital, Melbourne, over a 3 month period. At-risk drinking was measured by the AUDIT questionnaire, a score of eight or more suggesting hazardous drinking and a score of 20 or more suggesting dependence. A separate questionnaire recorded relevant details of the admission, complications during hospital stay, degree of difficulty nursing the patient and any past history of alcohol problems. Thirty-four (36%) of 94 patients were drinking at hazardous levels. Of these, 62% gave no prior history of problems with alcohol. Thirty-four per cent of 53 acute admissions and 39% of 41 arranged admissions were harmful drinkers suggesting that trauma may not be the only contribution to problem drinking in the orthopaedic setting. Hazardous drinking occurred in both male and female groups aged less than 55 years and in males greater than 55 years. Hazardous drinking was associated with more inpatient complications (χ²= 6.6, d.f. = 1, P= 0.01) and greater nursing difficulty (χ²= 5.5, d.f. = 1, P= 0.02). A third of the patients in the orthopaedic wards drink alcohol at hazardous levels, whether they are acute or arranged admissions. Hazardous drinking is associated with more complications and greater difficulty in nursing patients.