Coercion, Perceived Care and Quality of Life Among Patients in Psychiatric Hospitals

The goals of the study were to describe patients’ perceptions of care after experiencing seclusion/restraint and their quality of life. The goal was moreover to identify methodological challenges related to studies from the perspective of coerced patients. The study was conducted in three phases between September 2008 and April 2012. In the first phase, the instrument Secluded/ Restrained Patients’ Perception of their Treatment (SR-PPT) was developed and validated in Japan in cooperation with a Finnish research group (n = 56). Additional data were collected over one year from secluded/restrained patients using the instrument (n = 90). In the second phase, data were collected during the discharge process (n = 264). In the third phase, data were collected from electronic databases. Methodological and ethical issues were reviewed (n = 32) using systematic review method. Patients perceived that co-operation with the staff was poor; patients’ opinions were not taken into account, treatment targets collated and treatment methods were seen in different ways. Patients also felt that their concerns were not well enough understood. However, patients received getting nurses’ time. In particular, seclusion/restraint was considered unnecessary. The patients felt that they benefited from the isolation in treating their problems more than they needed it, even if the benefit was seen to be minor. Patients treated on forensic wards rated their treatment and care significantly lower than in general units. During hospitalization secluded/restrained patients evaluated their quality of life, however, better than did non-secluded/restrained patients. However, no conclusion is drawn to the effect that the better quality of life assessment is attributable to the seclusion/restraint because patients’ treatment period after the isolation was long and because of many other factors, as rehabilitation, medication, diagnostic differences, and adaptation. According to the systematic mixed studies review variation between study designs was found to be a methodological challenge. This makes comparison of the results more difficult. A research ethical weakness is conceded as regards descriptions of the ethical review process (44 %) and informed consent (32 %). It can be concluded that patients in psychiatric hospital care and having a voice as an equal expert require special attention to clinical nursing, decision-making and service planning. Patients and their family members will be consulted in plans of preventive and alternative methods for seclusion and restraint. The study supports the theory that in ethical decision-making situations account should be taken of medical indications, in addition to the patients’ preferences, the effect of treatment on quality of life, and this depends on other factors. The connection between treatment decisions and a patient’s quality of life should be evaluated more structurally in practice. Changing treatment culture towards patients’ involvement will support daily life in nursing and service planning taking into account improvements in patients’ quality of life.Pakko, potilaiden kokema hoito ja elämänlaatu psykiatrisessa sairaalassa Tutkimuksen tavoitteena oli kuvata pakkoa kokeneiden potilaiden näkemystä hoidostaan sekä heidän elämänlaatuaan. Lisäksi tavoitteena oli tunnistaa metodologisia haasteita tutkimuksissa koskien potilaiden näkemystä pakosta psykiatriassa. Tutkimus tuotettiin kolmessa vaiheessa syyskuun 2008 ja huhtikuun 2012 välisenä aikana. Ensimmäisessä vaiheessa instrumentti Secluded/Restrained Patients’ Perception of Their Treatment (SR-PPT) kehitettiin ja validoitiin Japanissa yhteistyössä suomalaisen tutkimusryhmän kanssa (n = 56). Lisäksi tutkimusaineisto kerättiin edellä mainitulla mittarilla vuoden aikana eristetyiltä/sidotuilta potilailta (n = 90). Toisessa vaiheessa aineisto kerättiin kotiutusvaiheessa olevilta potilaita (n = 264). Kolmannessa vaiheessa tutkimusaineisto kerättiin sähköisistä tietokannoista. Metodologiset ja eettiset aiheet tarkasteltiin systemaattisen kirjallisuuskatsauksen menetelmällä (n = 32). Potilaat kokivat yhteistyön henkilöstön kanssa heikkona; potilaiden mielipiteitä ei otettu huomioon, hoidon tavoitteita ei asetettu yhdessä ja hoitokeinot nähtiin eri tavoin. Potilaiden mielestä heidän huoliaan ei ymmärretty riittävästi. Kuitenkin potilaat saivat hoitajien aikaa. Erityisesti eristäminen/ sitominen koettiin tarpeettomina. Potilaat kokivat hyötyvänsä eristämisestä ongelmiensa hoidossa enemmän kuin tarvitsevansa sitä, vaikka myös hyöty siitä nähtiin vähäisenä. Oikeuspsykiatrisilla osastoilla hoidetut potilaat arvioivat hoitonsa selkeästi alhaisemmaksi kuin muut. Sairaalahoidon aikana eristetyt/sidotut potilaat arvioivat elämänlaatunsa kuitenkin paremmaksi kuin ei-eristetyt/sidotut potilaat. Kuitenkaan johtopäätöksenä ei voida todeta, että parempi elämänlaadun arvio olisi seurausta eristämisestä, koska potilaiden hoitoaika eristämiskokemuksen jälkeen oli pitkä ja koska muut tekijät, kuten kuntoutus, lääkitys, diagnostiikka, sopeutuminen, mahdollisesti vaikuttivat tuloksiin. Kirjallisuuskatsauksen pohjalta metodologisena haasteena havaittiin tutkimusasetelmien erilaisuus, mikä vaikeuttaa tutkimusten tulosten vertailua. Tutkimuseettisenä heikkoutena ilmeni puutteellinen kuvaus eettisestä ennakkoarvioinnista (44 %) ja informoidun suostumuksen käsittelystä (32 %). Voidaan todeta, että psykiatrista sairaalahoitoa vaativan potilaan kohtaaminen ja kuuleminen tasa-arvoisena oman hoitonsa asiantuntijana vaatii erityistä huomiota niin kliinisessä hoitotyössä, päätöksenteossa kuin palveluiden suunnittelussa. Potilaiden ja omaisten tahtoa tulee kuulla kehitettäessä ennaltaehkäiseviä ja vaihtoehtoisia menetelmiä eristämiselle ja sitomiselle. Tutkimus tukee näkökulmaa, että eettisissä päätöksentekotilanteissa tulee tapauskohtaisesti huomioida lääketieteellisten indikaatioiden lisäksi potilaan näkemys, hoidon vaikutus elämänlaatuun ja tilanteeseen vaikuttavat muut tekijät. Hoitopäätösten yhteyttä potilaan elämänlaatuun tulee arvioida strukturoidummin käytännössä. Hoitokulttuurin muutosta kohti potilaan osallisuutta tulee tukea hoitotyön arjessa ja palveluiden suunnittelussa huomioiden yhteys elämänlaadun paranemiseen.Siirretty Doriast

Offense-Related Issues in Forensic Psychiatric Treatment : A Thematic Analysis

Publisher Copyright: © Copyright © 2020 Askola, Soininen and Seppänen.Characteristics unique to forensic psychiatric treatment include coming to terms with the offenses committed, the long duration of treatment and the assessment of the risk of repeat offending. This study describes the views of both patients and staff on the significance of the patient’s offense as a part of forensic psychiatric rehabilitation. Eight forensic psychiatric patients and eight forensic psychiatric nurses from two forensic psychiatric hospitals in Finland participated in this study. Data were gathered by means of thematic interview and analyzed by means of thematic analysis. The findings suggest that patients and professionals alike concur that ascertaining the factors with a bearing on the offense, and working through the offense and the factors leading up to it, constitute an essential aspect of forensic treatment. This, in turn, has a bearing on the planning and administration of a treatment plan consisting of both medical and psychosocial support and interventions intended to enable patients to live independent, fulfilling lives, thus reducing the likelihood of reoffending. The findings of this study can be used as part of the development of international, standardized treatment models for clinical forensic psychiatric practices.Peer reviewe

Safety hazards in patient seclusion events in psychiatric care: A video observation study

Introduction: Seclusion is used to maintain safety in psychiatric care. There is still a lack of knowledge on potential safety hazards related to seclusion practices.Aim: To identify safety hazards that might jeopardize the safety of patients and staff in seclusion events in psychiatric hospital care.Method: A descriptive design with non-participant video observation was used. The data consisted of 36 video recordings, analysed with inductive thematic analysis.Results: Safety hazards were related to patient and staff actions. Patient actions included aggressive behaviour, precarious movements, escaping, falling, contamination and preventing visibility. Staff actions included leaving hazardous items in a seclusion room, unsafe administration of medication, unsecured use of restraints and precarious movements and postures.Discussion: This is the first observational study to identify safety hazards in seclusion, which may jeopardize the safety of patients and staff. These hazards were related to the actions of patients and staff. Implications for Practice Being better aware of possible safety hazards could help prevent adverse events during patient seclusion events. It is therefore necessary that nursing staff are aware of how their actions might impact their safety and the safety of the patients. Video observation is a useful method for identifying safety hazards. However, its use requires effort to safeguard the privacy and confidentiality of those included in the videos.</p

Dominant Distal Myopathy 3 (MPD3) Caused by a Deletion in the HNRNPA1 Gene

Background and Objectives To determine the genetic cause of the disease in the previously reported family with adult-onset autosomal dominant distal myopathy (myopathy, distal, 3; MPD3). Methods Continued clinical evaluation including muscle MRI and muscle pathology. A linkage analysis with single nucleotide polymorphism arrays and genome sequencing were used to identify the genetic defect, which was verified by Sanger sequencing. RNA sequencing was used to investigate the transcriptional effects of the identified genetic defect. Results Small hand muscles (intrinsic, thenar, and hypothenar) were first involved with spread to the lower legs and later proximal muscles. Dystrophic changes with rimmed vacuoles and cytoplasmic inclusions were observed in muscle biopsies at advanced stage. A single nucleotide polymorphism array confirmed the previous microsatellite-based linkage to 8p22-q11 and 12q13-q22. Genome sequencing of three affected family members combined with structural variant calling revealed a small heterozygous deletion of 160 base pairs spanning the second last exon 10 of the heterogeneous nuclear ribonucleoprotein A1 (HNRNPA1) gene, which is in the linked region on chromosome 12. Segregation of the mutation with the disease was confirmed by Sanger sequencing. RNA sequencing showed that the mutant allele produces a shorter mutant mRNA transcript compared with the wild-type allele Immunofluorescence studies on muscle biopsies revealed small p62 and larger TDP-43 inclusions. Discussion A small exon 10 deletion in the gene HNRNPA1 was identified as the cause of MPD3 in this family. The new HNRNPA1-related phenotype, upper limb presenting distal myopathy, was thus confirmed, and the family displays the complexities of gene identification.Peer reviewe

A comparison of anthropometric, metabolic, and reproductive characteristics of young adult women from opposite-sex and same-sex twin pairs

Background: Prenatal exposure to androgens has been linked to masculinization of several traits. We aimed to determine whether putative female intra-uterine exposure to androgens influences anthropometric, metabolic, and reproductive parameters using a twin design. Methods: Two cohorts of Finnish twins born in 1975-1979 and 1983-1987 formed the basis for the longitudinal FinnTwin16 (FT16) and FinnTwin12 (FT12) studies. Self-reported anthropometric characteristics, disease status, and reproductive history were compared between 679 same-sex (SS) and 789 opposite-sex (OS) female twins (mean age ± SD: 34 ± 1.1) from the wave 5 of data collection in FT16. Serum lipid and lipoprotein subclass concentrations measured by nuclear magnetic resonance spectroscopy were compared in 226 SS and 169 OS female twins (mean age ± SD: 24 ± 2.1) from the wave 4 of data collection in FT12 and FT16. Results: Anthropometric measures, the prevalence of hypertension and diabetes mellitus type 2 did not differ significantly between females from SS and OS twin pairs at age 34. Similarly, the prevalence of infertility, age at first pregnancy and number of induced and spontaneous abortions did not differ significantly between these two groups of women. The serum lipid and lipoprotein profile did not differ between females from SS and OS twins at age 24. Conclusion: We found no evidence that androgen overexposure of the female fetus affects obesity, metabolic profile, or reproductive health in young adult females. However, these results do not exclude the possibility that prenatal androgen exposure in females could be adversely associated with these phenotypes later in life.Peer reviewe

A comparison of anthropometric, metabolic, and reproductive characteristics of young adult women from opposite-sex and same-sex twin pairs

Background: Prenatal exposure to androgens has been linked to masculinization of several traits. We aimed to determine whether putative female intra-uterine exposure to androgens influences anthropometric, metabolic, and reproductive parameters using a twin design. Methods: Two cohorts of Finnish twins born in 1975&ndash;1979 and 1983&ndash;1987 formed the basis for the longitudinal FinnTwin16 (FT16) and FinnTwin12 (FT12) studies. Self-reported anthropometric characteristics, disease status, and reproductive history were compared between 679 same-sex (SS) and 789 opposite-sex (OS) female twins (mean age &plusmn; SD: 34 &plusmn; 1.1) from the wave 5 of data collection in FT16. Serum lipid and lipoprotein subclass concentrations measured by nuclear magnetic resonance spectroscopy were compared in 226 SS and 169 OS female twins (mean age &plusmn; SD: 24 &plusmn; 2.1) from the wave 4 of data collection in FT12 and FT16. Results: Anthropometric measures, the prevalence of hypertension and diabetes mellitus type 2 did not differ significantly between females from SS and OS twin pairs at age 34. Similarly, the prevalence of infertility, age at first pregnancy and number of induced and spontaneous abortions did not differ significantly between these two groups of women. The serum lipid and lipoprotein profile did not differ between females from SS and OS twins at age 24. Conclusion: We found no evidence that androgen overexposure of the female fetus affects obesity, metabolic profile, or reproductive health in young adult females. However, these results do not exclude the possibility that prenatal androgen exposure in females could be adversely associated with these phenotypes later in life.</p

Automatic MRI Quantifying Methods in Behavioral-Variant Frontotemporal Dementia Diagnosis

Aims: We assessed the value of automated MRI quantification methods in the differential diagnosis of behavioral-variant frontotemporal dementia (bvFTD) from Alzheimer disease (AD), Lewy body dementia (LBD), and subjective memory complaints (SMC). We also examined the role of the C9ORF72-related genetic status in the differentiation sensitivity. Methods: The MRI scans of 50 patients with bvFTD (17 C9ORF72 expansion carriers) were analyzed using 6 quantification methods as follows: voxel-based morphometry (VBM), tensor-based morphometry, volumetry (VOL), manifold learning, grading, and white-matter hyperintensities. Each patient was then individually compared to an independent reference group in order to attain diagnostic suggestions. Results: Only VBM and VOL showed utility in correctly identifying bvFTD from our set of data. The overall classification sensitivity of bvFTD with VOL + VBM achieved a total sensitivity of 60%. Using VOL + VBM, 32% were misclassified as having LBD. There was a trend of higher values for classification sensitivity of the C9ORF72 expansion carriers than noncarriers. Conclusion: VOL, VBM, and their combination are effective in differential diagnostics between bvFTD and AD or SMC. However, MRI atrophy profiles for bvFTD and LBD are too similar for a reliable differentiation with the quantification methods tested in this study

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms