Patients’ Preference and Experiences of Forced Medication and Seclusion

This study examined patients’ preferences for coercive methods and the extent to which patients’ choices were determined by previous experience, demographic, clinical and intervention-setting variables. Before discharge from closed psychiatric units, 161 adult patients completed a questionnaire. The association between patients’ preferences and the underlying variables was analyzed using logistic regression. We found that patients’ preferences were mainly defined by earlier experiences: patients without coercive experiences or who had had experienced seclusion and forced medication, favoured forced medication. Those who had been secluded preferred seclusion in future emergencies, but only if they approved its duration. This suggests that seclusion, if it does not last too long, does not have to be abandoned from psychiatric practices. In an emergency, however, most patients prefer to be medicated. Our findings show that patients’ preferences cannot guide the establishment of international uniform methods for managing violent behaviour. Therefore patients’ individual choices should be considered

Thoracic costotransverse joint pain patterns: a study in normal volunteers

<p>Abstract</p> <p>Background</p> <p>Pain referral patterns of asymptomatic costotransverse joints have not been established. The objective of this study was to determine the pain referral patterns of asymptomatic costotransverse joints via provocative intra-articular injection.</p> <p>Methods</p> <p>Eight asymptomatic male volunteers received a combined total of 21 intra-articular costotransverse joint injections. Fluoroscopic imaging was used to identify and isolate each costotransverse joint and guide placement of a 25 gauge, 2.5 inch spinal needle into the costotransverse joint. Following contrast medium injection, the quality, intensity, and distribution of the resultant pain produced were recorded.</p> <p>Results</p> <p>Of the 21 costotransverse joint injections, 16 (76%) were classified as being intra-articular via arthrograms taken at the time of injection, and 14 of these injections produced a pain sensation distinctly different from that of needle placement. Average pain produced was 3.3/10 on a 0–10 verbal pain scale. Pain was described generally as a deep, dull ache, and pressure sensation. Pain patterns were located superficial to the injected joint, with only the right T2 injections showing referred pain 2 segments cranially and caudally. No chest wall, upper extremity or pseudovisceral pains were reported.</p> <p>Conclusion</p> <p>This study provides preliminary data of the pain referral patterns of costotransverse joints. Further research is needed to compare these findings with those elicited from symptomatic subjects.</p

Direct discovery of the inner exoplanet in the HD 206893 system : Evidence for deuterium burning in a planetary-mass companion

Aims. HD 206893 is a nearby debris disk star that hosts a previously identified brown dwarf companion with an orbital separation of ∼10 au. Long-term precise radial velocity (RV) monitoring, as well as anomalies in the system proper motion, has suggested the presence of an additional, inner companion in the system. Methods. Using information from ongoing precision RV measurements with the HARPS spectrograph, as well as Gaia host star astrometry, we have undertaken a multi-epoch search for the purported additional planet using the VLTI/GRAVITY instrument. Results. We report a high-significance detection over three epochs of the companion HD 206893c, which shows clear evidence for Keplerian orbital motion. Our astrometry with ∼50−100 μarcsec precision afforded by GRAVITY allows us to derive a dynamical mass of 12.7MJup and an orbital separation of 3.53 au for HD 206893c. Our fits to the orbits of both companions in the system use both Gaia astrometry and RVs to also provide a precise dynamical estimate of the previously uncertain mass of the B component, and therefore allow us to derive an age of 155 ± 15 Myr for the system. We find that theoretical atmospheric and evolutionary models that incorporate deuterium burning for HD 206893c, parameterized by cloudy atmosphere models as well as a “hybrid sequence” (encompassing a transition from cloudy to cloud-free), provide a good simultaneous fit to the luminosity of both HD 206893B and c. Thus, accounting for both deuterium burning and clouds is crucial to understanding the luminosity evolution of HD 206893c. Conclusions. In addition to using long-term RV information, this effort is an early example of a direct imaging discovery of a bona fide exoplanet that was guided in part by Gaia astrometry. Utilizing Gaia astrometry is expected to be one of the primary techniques going forward for identifying and characterizing additional directly imaged planets. In addition, HD 206893c is an example of an object narrowly straddling the deuterium-burning limit but unambiguously undergoing deuterium burning. Additional discoveries like this may therefore help clarify the discrimination between a brown dwarf and an extrasolar planet. Lastly, this discovery is another example of the power of optical interferometry to directly detect and characterize extrasolar planets where they form, at ice-line orbital separations of 2−4 au

Fifteen years of research with the Staff Observation Aggression Scale; A review

Contains fulltext : 56855.pdf (publisher's version ) (Closed access

Differences in seclusion rates between admission wards: Does patient compilation explain?

Contains fulltext : 116451.pdf (Publisher’s version ) (Closed access)Comparison of seclusion figures between wards in Dutch psychiatric hospitals showed substantial differences in number and duration of seclusions. In the opinion of nurses and ward managers, these differences may predominantly be explained by differences in patient characteristics, as these are expected to have a large impact on these seclusion rates. Nurses assume more admissions of severely ill patients are related to higher seclusion rates. In order to test this hypothesis, we investigated differences in patient and background characteristics of 718 secluded patients over 5,097 admissions on 29 different admission wards over seven Dutch psychiatric hospitals. We performed an extreme group analysis to explore the relationship between patient and ward characteristics and the wards' number of seclusion hours per 1,000 admission hours. In a multivariate and a multilevel analysis, various characteristics turned out to be related to the number of seclusion hours per 1,000 admission hours as well as to the likelihood of a patient being secluded, confirming the nurses assumptions. The extreme group analysis showed that seclusion rates depended on both patient and ward characteristics. A multivariate and multilevel analyses revealed that differences in seclusion hours between wards could partially be explained by ward size next to patient characteristics. However, the largest deal of the difference between wards in seclusion rates could not be explained by characteristics measured in this study. We concluded ward policy and adequate staffing may, in particular on smaller wards, be key issues in reduction of seclusion.14 p