The impact of modified mania assessment scale (MAS-M) implementation on the use of mechanical restraint in psychiatric units

Abstract

Background and aim: During recent years, there has been an increased focus on reducing use of mechanical restraint in psychiatric care. Studies show that implementing an assessment tool could potentially prevent or decrease the number of episodes of mechanical restraint. This study aims to examine the association between use of the Danish assessment tool for psychiatric inpatients diagnosed with mania (MAS-M) and mechanical restraint to highlight if number, type, and duration of restraint could be prevented or reduced by this procedure.

Materials and method: This historical cohort study included psychiatric inpatients diagnosed with bipolar disorder and hospitalized with symptoms of mania at the departments of affective disorders during the years 2012–2015. Logistic regression was used in the statistical analyses.

Result: A total of 218 patients were included, 74 of whom were scored with MAS-M. Thirty-five episodes of mechanical restraint were recorded. A crude OR of 1.58 (95% CI: 0.75–3.30) of the association was estimated. The study showed a tendency toward patients scored with MAS-M being more frequently restrained with both belt and straps, however, in shorter duration, compared to the control group.

Conclusion: This study reported relevant clinical information concerning staff’s use of MAS-M, however, did not show a significant association between the use of MAS-M and mechanical restraint. Nevertheless, conflicting results about the impact of MAS-M on preventing and reducing these coercive measures have been highlighted, suggesting that more complex factors influence the use of mechanical restraint. No causal effect was examined thus further studies are needed.     

Sauve-Kapandji operation for disorders of the distal radioulnar joint after Colles' fracture: Good results in 12 patients followed for 1.5-4 years

Controversies continue concerning the treatment of the posttraumatic caput ulna syndrome. We have treated 12 patients, mean age 42 (23-77) years, with arthrodesis ad modum Sauve-Kapandji of the distal articulation between the radius and ulna, combined with resection of the ulnar neck. Before the operation, all patients had persistent ulnar wrist pain and restricted pronation-supination movement. At follow-up, after a mean of 2 (1.5-4) years, 8 patients had an excellent outcome, 3 a good, and 1 patient had a fair outcome. 10 patients had no wrist pain. The average grip-score improved from 53% preoper-atively to 76% at the follow-up.     

Vitamin D and calcium supplementation prevents severe falls in elderly community-dwelling women: a pragmatic population-based 3-year intervention study

BACKGROUND AND AIMS: We evaluated the effect of two programs for the prevention of falls leading to acute hospital admission in a population of elderly community-dwelling Danish residents. METHODS: This was a factorial, pragmatic, intervention study. We included 9605 community-dwelling city residents aged 66+ years. We offered a prevention program consisting of a daily supplement of 1000 mg of elemental calcium as calcium carbonate and 400 IU (10 microg) of vitamin-D3 to a total of 4957 participants. The remaining 5063 participants were offered home safety inspection with dietary and health advice, or no intervention. RESULTS: The Calcium and Vitamin D program was followed by 50.3% and the Environmental and Health Program by 46.4%. According to a multivariate analysis including age, marital status and intervention program, female residents who followed the Calcium and Vitamin D Program had a 12% risk reduction in severe falls (RR 0.88; 95% CI 0.79-0.98; p < 0.05; NNT 9). CONCLUSIONS: The present study supports the hypothesis that vitamin D and calcium supplementation prevent falls leading to acute hospitalization in community-dwelling elderly females in a northern European region known to be deficient in vitamin D.     

The Hamilton Depression Scale (HAM-D) and the Montgomery–Åsberg Depression Scale (MADRS). A psychometric re-analysis of the European Genome-Based Therapeutic Drugs for Depression Study using Rasch analysis

The objective of this re-analysis of the European Genome-Based Therapeutic Drugs for Depression Study (GENDEP) was to psychometrically test the unidimensionality of the full Montgomery Åsberg Depression Rating Scale (MADRS₁₀) and the Hamilton Depression Scale (HAM-D₁₇) versus their respective subscales (MADRS₅ and HAM-D₆) containing the core symptoms of depression severity. Rasch analysis was applied using RUMM 2030 software to assess the overall fit for unidimensionality. Neither the MADRS₁₀ nor the HAM-D₁₇ was found to fit the Rasch model for unidimensionality. The HAM-D₆ (containing the items of depressed mood, guilt, work and interests, psychomotor retardation, psychic anxiety, and somatic general) as well as the analogue MADRS₅ were tested for unidimensionality by use of the RUMM 2030 programme, and only the HAM-D₆ was accepted. When testing for invariance across rating weeks or centres, the RUMM 2030 had to be supplemented with the Friedman two-way analysis of variance by ranks. The HAM-D₆ but not the MADRS₅ was accepted. It was therefore concluded that the HAM-D₆ is a psychometrically valid outcome scale to measure change in clinical trials of antidepressants.     

As time goes by–developments in surgery for esophageal cancer in the new millennium

European Surgery - In the last two decades, both treatment options and epidemiological features of cancer have changed. We studied the influence of related parameters on the outcome of patients...     

Experiences of wake and light therapy in patients with depression: A qualitative study

Wake therapy can reduce depressive symptoms within days, and response rates are high. To sustain the effect, it is often combined with light therapy. Few studies have focussed on factors related to patients′ adherence to the regime, and none has used qualitative methods to examine their experience of these combined interventions. Therefore, the aim of the present study was to illuminate patients' experiences with wake and light therapy and factors related to adherence. Thirteen inpatients with depression were included. They participated in an intervention consisting of three wake therapies during the first week, 30 min of daily light treatment for the entire 9 weeks, and ongoing psychoeducation regarding good sleep hygiene. Patients kept a diary, and individual semistructured interviews were conducted. Data were analysed using qualitative content analysis. The participants' overall experience with the treatment was positive. Some experienced a remarkable and rapid antidepressant effect, whereas others described more long‐term benefits (e.g. improved sleep and diurnal rhythm). Yet recovery was fragile, and patients were only cautiously optimistic. Social support was important for maintaining the motivation to stay awake and receive daily light therapy. Overall, participants found the treatment worthwhile and would recommend it to others with depression. The study revealed a lack of knowledge among participants about the connection between regular sleep patterns and depression. In conclusion, this study provides insight into patients' experiences, and knowledge that can contribute to guidelines for future adherence‐promoting organization of wake and light therapy.     

Correlates of falling during 24 h among elderly Danish community residents

OBJECTIVES: To identify dietary, medical, and environmental correlates of falling during the last 24 h among elderly community residents. The limited accuracy of recall of falls in the elderly in previous studies was the reason for a 24-h time frame. METHODS: The study composes 4281 community residents aged 66+ years. The statistical analyses included Pearson's chi(2) test and multiple logistic regression. RESULTS: Mutually independent correlates of falls were a family history of fracture (OR, 3.0; 95% CI: 1.3-7.1); osteoarthrosis of the knee (OR, 2.9; 95% CI: 1.3-6.2); dizziness (OR, 4.1; 95% CI: 1.9-8.9); a diet not including sour dairy products (OR, 3.0; 95% CI: 1.4-6.3) or fish (OR, 3.4; 95% CI: 1.5-7.5); drinking tea (OR, 5.8; 95% CI 2.15-15.30); needing help for shopping (OR, 3.9; 95% CI: 1.6-9.3); and for administration of medicine (OR, 9.0; 95% CI: 2.0-40.6). Independent environmental correlates were vinyl on the floor in the bathroom (OR, 6.6; 95% CI: 2.1-20.9) and using indoor footwear without soles (OR, 5.5; 95% CI: 2.3-13.4). CONCLUSION: The present analyses suggest that several factors are associated to the risk of falling among elderly community residents. It appears relevant for further studies to test if modifications of the potential risk factors identified may reduce falls among community dwelling older persons.