The significance of therapy in a private room to patientsin acute psychiatric wards

本研究は,全個室病棟で療養する精神疾患患者を対象に,患者自身が考える個室環境の意味を明らかにすることを目的とした｡個室に2週間以上療養し,インタビューの協力が得られた患者は7名であった｡患者にとっての個室環境の肯定的意味は,自分だけの空間を確保できることから,他者との距離の調節の場,プライバシーが保護される場,自由裁量が拡大される場であると捉えていた｡また,休養や睡眠が確保できる場,症状をコントロールできる場であるという治療的意味や,個室を自己洞察の場ととらえ,他者の影響を受けずに自分らしさを再獲得するためという意味が示された｡一方,個室環境の否定的意 味として,寂しさや不安が挙げられ,話しかけられる存在を身近に見出しにくい個室においては,わからないことや不安なことを尋ねにくく,人間関係を築くきっかけがつかみにくいことが示された｡This study sought to clarify the significance of therapy provided in a private room to hospitalized mentally ill patients, by determining through interview and observation their thoughts and feelings about such an experience. Subjects were 7 mentally ill patients resident in a ward of private rooms. Few patients requested a private room on admission and their reasons for this were considered to include admissions on an involuntary basis, for medical treatment or for custodial care, or because psychiatric status did not enable them to state an intention to have a private room. The results showed that most patients hoped for treatment in a private room regardless of whether or not they had requested it, and that the offer of using such a facility was important to them because most patients who experienced such a therapeutic environment requested it thereafter. Thus, once a patient recognized the availability of therapy in a private room and its benefits, they wanted to use it or to use it more. Patients were found to request use of a private room to preserve privacy, rest in a therapeutic environment promote circumspection, and see themselves as independent of others around, with the affirmative meaning of using a private room as "a place to preserve my privacy ", "a place to take a rest", "a place to gain insight into myself", and "a place to control my condition". Patients reported a negative meaning of "a place to feel loneliness and anxiety"

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era