Entre sangradores e doutores: práticas e formação médica na primeira metade do século XIX

Durante a primeira metade do século XIX, a atividade do sangrador (fundamental na terapêutica do período) passou por mudanças relacionadas à progressiva organização dos médicos - sobretudo por meio da institucionalização de sua educação com a criação de faculdades. Estes lutavam pelo monopólio das atividades terapêuticas, buscando desautorizar e desqualificar a prática da sangria por aqueles que não fossem médicos e/ou cirurgiões formados na academia. O artigo pretende analisar tais mudanças, focando a atenção na relação entre os sangradores e os médicos acadêmicos e a crescente preocupação destes com a higienização

Joint crisis plans in mental health hospitals-Real practice in an association of psychiatric hospitals

Background: Joint crisis plans (JCPs) are offered in many psychiatric hospitals, but patients only rarely make use of them. Objective: To assess the rates of JCPs among inpatients of mental health hospitals and to analyze the clinical characteristics of patients who make use of a JCP. Material and methods: We carried out a retrospective analysis of routine data from the statistical database/basis documentation of the LVR hospital association, which consists of nine psychiatric hospitals. The basis documentation is consistent in the nine hospitals. All admissions between 2016 and 2020 were considered. We recorded the existence of a JCP, age, gender and main diagnosis at release, as well as previous hospital stays, detention under the Mental Health Act of the Federal State of NRW and experiences with compulsory measures (seclusion/restraint) in the previous 24 months before index admission. Results: Out of a total of 117,662 inpatients 467 (0.4%) had completed a JCP. Patients with JCP were more likely to be diagnosed with schizophrenia, bipolar disorder, or emotionally unstable personality disorder. Patients with a JCP had more previous inpatient stays and they had more frequently experienced detentions and compulsory measures. However, 50% of the patients with a JCP had other diagnoses and the vast majority of them had experienced no detention or compulsory measure in the 24 months preceding the first documentation of a JCP. Conclusions: Overall, the use of JCPs is limited. The targeted group of patients with severe mental illness and previous experience with involuntary placements and compulsory measures make use of the offer of a JCP but so do other patients as well. Additional qualitative analyses are required in order to analyze the content and objectives of JCPs in more detail