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PubMed1997

The relationship of vocally disruptive behavior and previous personality in severely demented institutionalized patients.

The aim of this study was to explore the previous personalities of patients, their behavior during the course of the disease, and the relationship between the previous personality and vocally disruptive behavior of severely demented patients. Twenty-one severely demented patients identified as vocally disruptive and 19 severely demented control subjects who were matched for gender and ward were studied. A family member or close relative who knew the patient very well described the patient's personal characteristics from what they judged to be the "best" period in the patient's life and responded, on behalf of the patient, to the 57 items in a modified version of the Eysenck Personality Inventory. The results of this study can be interpreted to indicate that a previous personality described as introverted, rigid, and with a tendency to control emotions, as remembered retrospectively by a close family member, may correlate to current disruptive behavior. Despite the limitations of this study, the findings indicated that a patient's previous personality characteristics need to be taken into consideration because they may partially explain vocal activity and are therefore important for the provision of nursing care. Further research has to be performed to highlight the impact of previous personality characteristics on various kinds of behavior during the course of the disease.

Aged↗
PubMed1999

Comparison between premortem and postmortem serum concentrations of phenobarbital, phenytoin, carbamazepine and its 10,11-epoxide metabolite in institutionalized patients with epilepsy.

The last premortem serum concentrations of phenobarbital (PB), phenytoin (PHT), carbamazepine (CBZ) and its CBZ-10,11-epoxide metabolite (CE) were compared with the corresponding postmortem serum concentrations in 16 adult patients of an epilepsy centre. Based on complete postmortem examinations, 12 individuals showed a known cause of death (KCD) and four patients succumbed from sudden unexplained death (SUD). The last premortem and the postmortem serum levels of PB (r = 0.991), PHT (r = 0.986), CBZ (r = 0.985) and CE (r = 0.936) were highly correlated. However, the regression analysis indicated that, except for CE, the premortem concentrations were significantly higher than the postmortem concentrations, i.e. 65% for PB, 34% for PHT, and 16% for CBZ. Varying time lapses (4-62 h) between death and serum sampling during autopsy did not significantly influence the ratio of premortem to postmortem serum levels for PB, PHT, CBZ, and CE (p > 0.1). Furthermore we found no significant differences between the premortem and the postmortem serum concentration ratios CE/CBZ. Considering the above variables, the data of SUD and KCD patients were comparable. Postmortem decrease in anticonvulsant serum concentrations, especially for PB and PHT, should be considered in order to avoid misinterpretation in respect to so-called 'subtherapeutic' serum levels and noncompliance in context with SUD or fatal intoxication.

Adult↗
PubMed1999

Nasopharyngeal carriage of multidrug-resistant Streptococcus pneumoniae in institutionalized HIV-infected and HIV-negative children in northeastern Romania.

OBJECTIVES: The study compared nasopharyngeal carriage of resistant pneumoniae in human immunodeficiency virus (HIV)-seropositive and -seronegative children. METHODS: Nasopharyngeal colonization with Streptococcus pneumoniae was investigated during May 1996 in 162 HIV-negative infants and children (age range, 1-38 mo) and 40 HIV-infected children (age range, 39-106 mo) living in an orphanage in Iasi, northeastern Romania. The HIV-infected children lived separated from the other children and were cared for by a different staff. Streptococcus pneumoniae was isolated from 12 of 40 (30%) HIV-infected and from 81 of 160 (50%) HIV-negative children. Antimicrobial susceptibility to penicillin and ceftriaxone was determined by E-test, and to another five antibiotics by disk diffusion. Serotyping was performed by the Quellung method on 81 of 93 (87%) isolates. RESULTS: Serotypes 6A, 6B, 19A, and 23F together represented 98% of all isolates. Ninety-nine percent of S. pneumoniae isolates were resistant to penicillin, and 74% were highly resistant to penicillin (minimum inhibitory concentration [MIC] > 1 mg/mL); MIC50 and MIC90 to penicillin of the isolates were 2 mg/mL and 8 mg/mL, respectively. Eighty-nine of ninety-one isolates were susceptible to ceftriaxone; 99%, 87%, 87%, 48%, and 21% of the isolates were resistant to trimethoprim-sulphamethoxazole, erythromycin, clindamycin, tetracycline, and chloramphenicol, respectively. Eighty-two (89%) isolates were multidrug resistant (resistant to =/>3 antibiotic classes); 37 of 92 (40%) isolates were resistant to 5 or more antibiotic classes, and 16 of these 37 (43%) belonged to serotype 19A. All serotype 19 isolates were highly resistant to penicillin. CONCLUSIONS: No significant differences were observed in the resistance rates of S. pneumoniae in HIV-infected children compared to HIV-negative children. Multidrug-resistant pneumococci were highly prevalent in this Romanian orphanage in both HIV-negative and older HIV-infected children. The observed high prevalence of multidrug-resistant pneumococci (coupled with high penicillin resistance) with a limited number of circulating serotypes emphasizes the need to further evaluate the conjugate vaccines in children at risk for invasive pneumococcal infection.

Anti-Bacterial Agents↗
PubMed2003

Institutionalizing pain management: the Post-Operative Pain Management Quality Improvement Project.

Clinical practice and quality improvement (QI) guidelines for acute postoperative pain management have been developed to address the well-documented problem of undertreatment of postoperative pain. The Post-Operative Pain Management Quality Improvement Project (the POP Project) was initiated to determine whether an intervention designed to support hospitals in the development of QI efforts would lead to improvements in structures, processes, and outcomes consistent with recommended guidelines. A nationwide sample of 233 hospitals joined the project. The intervention consisted of written resource materials accompanied by support services that included an e-mail list server, a resource Web page, and assistance from POP Project staff via telephone. Data regarding critical structures, processes (practice patterns), and patient outcomes were collected at baseline before the intervention began and at follow-up 12 to 18 months later. Results showed a statistically significant increase from baseline (45%) to follow-up (72%) in the presence of structural elements that are critical to improving pain management. There were statistically significant improvements in practices including documented use of pain rating scales, decreased use of intramuscular opioids, and increased use of nonpharmacologic strategies. Patient survey data showed no change in pain outcomes. Evaluation data showed that 70% of hospitals were very or extremely satisfied with their participation in the POP Project and 90% of them planned to continue efforts to improve pain management after the POP Project ended. Further research is needed to determine how to translate the excellent results obtained for structure and process into meaningful outcomes for patients.

Data Collection↗
PubMed1999

Some methodological issues in using aggression rating scales in intervention studies among institutionalized elderly.

BACKGROUND: Aggressive behavior among geriatric psychiatry inpatients spontaneously declines during serial measurements over time with rating scales. METHOD: Evidence for decline in aggressive behavior, over a 6-week period, on a continuing-care geriatric psychiatry ward was examined with the Staff Observation Aggression Scale (SOAS) and the Rating Scale for Aggressive Behavior in the Elderly (RAGE). RESULTS: The RAGE and all its subitems did not spontaneously decline. The total number of aggressive incidents on the SOAS, the SOAS total score, and the subitem scores, except for the SOAS results subitem, spontaneously declined after Week 4 and became established by Week 5. CONCLUSION: A "run in" period of at least 4 weeks may be needed in intervention studies using the SOAS to reduce contamination by spontaneous decline.

Aged↗
PubMed1999

Institutionalization, behavior, and international adoption.

International adoption represents about 10% of all adoptions in the United States annually. With the fall of communism, increased numbers of children have been adopted from former communist countries. These children bring to their families unique risks and difficulties. This article presents behavioral data on one group of international adoptees from Romania (n = 216), comparing their behavior to normative behavior data and to a sample of domestically adopted children (n = 61). Results suggest that Romanian adoptees have more behavior problems than typical children, although not as severe as children getting mental health services. At the same time, their behavior is similar to domestically adopted children. Implications for policy and practice are reviewed.

Journal Article↗