Involuntary Treatment Research Articles

A Systematic Review of the Legal Considerations Surrounding Medicines Management.

Background and Objectives: There is a paucity of integrated knowledge regarding legal considerations required to ensure patient safety through safe medicines management. This study explores the legal considerations surrounding medicines management, providing a synthesis of existing knowledge. An integrative systematic review of the current international knowledge was performed. Materials and Methods: The search encompassed the online databases of PubMed (including Medline), Scopus, CINAHL, and Web of Science using MeSH terms and relevant keywords relating to the legal considerations of medicines management in healthcare settings. Results: The search process led to the identification of 6051 studies published between 2010 and 2020, of which six articles were found to be appropriate for data analysis and synthesis based on inclusion criteria. Research methods were varied and included qualitative interviews, mixed-methods designs, retrospective case reports and cross-sectional interrupted time-series analysis. Their foci were on the delegation of medicines management, pharmacovigilance and reporting of adverse drug reactions (ADRs) before and after legislation by nurses, physicians and pharmacists, medico-legal litigation, use of forced medication and the prescription monitoring program. Given the heterogenicity of the studies in terms of aims and research methods, a meta-analysis could not be performed and, therefore, our review findings are presented narratively under the categories of ‘healthcare providers’ education and monitoring tasks’, ‘individual and shared responsibility’, and ‘patients’ rights’. Conclusion: This review identifies legal aspects surrounding medicines management, including supervision and monitoring of the effects of medicines; healthcare providers’ knowledge and attitudes; support and standardised tools for monitoring and reporting medicines’ adverse side effects/ADRs; electronic health record systems; individual and shared perceptions of responsibility; recognition of nurses’ roles; detection of sentinel medication errors; covert or non-voluntary administration of medication, and patient participation.

Outcomes of Victorian Prevention and Recovery Care Services: A matched pairs comparison.

In Victoria, Prevention and Recovery Care Services have been established to provide a partial alternative to inpatient admissions through short-term residential mental health care in the community. This study set out to determine whether Prevention and Recovery Care Services are achieving their objectives in relation to reducing service use and costs, fostering least restrictive care and leading to positive clinical outcomes. We matched 621 consumers whose index admission in 2014 was to a Prevention and Recovery Care ('PARCS consumers') with 621 similar consumers whose index admission in the same year was to an acute inpatient unit and who had no Prevention and Recovery Care stays for the study period ('inpatient-only consumers'). We used routinely collected data to compare them on a range of outcomes. Prevention and Recovery Care Services consumers made less subsequent use of acute inpatient services and, on balance, incurred costs that were similar to or lower than inpatient-only consumers. They were also less likely to spend time on an involuntary treatment order following their index admission. Prevention and Recovery Care Services consumers also experienced positive clinical outcomes over the course of their index admission, but the magnitude of this improvement was not as great as for inpatient-only consumers. This type of clinical improvement is important for Prevention and Recovery Care Services, but they may place greater emphasis on personal recovery as an outcome. Prevention and Recovery Care Services can provide an alternative, less restrictive care option for eligible consumers who might otherwise be admitted to an acute inpatient unit and do so at no greater cost.

Compulsory Treatment as Task of Public Governance or What Thyphoid Mary and Mad King Ludwig Had in Common (Abstract)

The article concerns involuntary treatment of infectious and mental diseases. Development of the legal regulation since the 19th century has been described here. Quality of the existing legal regulation has also been evaluated. Issues of involuntary psychiatric treatment have been analysed and demonstrated by the international case-law and state court practice. Significant differences between legislation in mental and infectious diseases has been detected, as well as differences have been traced between legal standards in the area of involuntary placement and involuntary treatment of mental disorders in Latvia and other countries. It has been concluded that involuntary psychiatric treatment, in line with epidemiological safety, is a task of public governance in the area of domestic security and safeguarding of human rights and it has to be reinforced by governmental authority. Thus, proposal of elaboration of the corresponding law has been made.

Anorexia Nervosa, Lack of "Coherence" with Deeply Held Beliefs and Values, and Involuntary Treatment

Anorexia Nervosa, Lack of "Coherence" with Deeply Held Beliefs and Values, and Involuntary Treatment

Clinical features and prognosis of primary myelofibrosis with hepatic vascular disease and/or portal hypertension

Objective To investigate the clinical features, liver histopathological features, treatment, and prognosis of primary myelofibrosis (PMF)-associated hepatic vascular disease and portal hypertension. Methods A retrospective analysis was performed for the clinical and pathological features of 68 patients who were diagnosed with PMF in 960 Hospital of the PLA Joint Logistics Support Force and Xijing Hospital of Digestive Diseases, Air Force Medical University, from July 2010 to December 2020, among whom 22 patients had hepatic vascular disease/portal hypertension as the main manifestation. The patients were divided into two groups according to the presence or absence of thrombosis, and treatment and prognosis were summarized. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used to compare long-term survival rate between the two groups. Results Among the 68 patients with PMF, 22 had hepatic vascular disease and/or portal hypertension, resulting in a prevalence rate of 32.35%, and among these 22 patients, 13 (59.1%) had extrahepatic portal vein occlusion, 1 (4.5%) had Budd-Chiari syndrome, and 8 (36.4%) had portal hypertension. Biopsy was performed for 7 patients, and pathological results showed extramedullary hematopoiesis in the liver and varying degrees of infiltration of lymphocytes, plasma cells, and eosinophils at the lobular and portal areas, but the lobular structure was normal. A total of 7 patients died during follow-up, among whom 5 died of complications associated with thrombosis or portal hypertension. The overall median survival time was 57.99 months for all patients; the median survival time was 45.33 months in patients with thrombosis and 64.00 months in patients without thrombosis, and although there was no significant difference between the two groups (χ2=3.035, P=0.081), the non-thrombosis group tended to have better survival and prognosis than the thrombosis group. Conclusion The possibility of PMF as the primary disease should be considered for patients with hepatic vascular disease and portal hypertension. Patients with PMF should be screened for hepatic vascular disease, and early intervention should be given. The patients without thrombosis tend to have better survival and prognosis than those with thrombosis.

Art of Paper Setting: The Blueprinting of MBBS Physiology Competency Based Curriculum

Introduction: Written examinations are integral component of students’ assessments at formative and summative level. There is no blueprint of question paper available for the new curriculum in Bachelor of Medicine and Bachelor of Surgery (MBBS) Physiology curriculum which may lead to variations in question paper setting. This lack of consistency in question papers affects the preparedness and performance of students. Aim: To prepare the blueprint of MBBS Physiology Competency Based Medical Education (CBME) curriculum and to do content validity by comparing with Preliminary Examination (PE) and University Examination (UE). Materials and Methods: This was a descriptive study conducted over a period of six months from July 2020 till December 2020. The study was conducted in Armed Forces Medical College, Pune. There are 15 topics and 140 outcomes for Physiology MBBS course as per new CBME curriculum is divided into paper I and II according to Maharashtra University of Health Sciences (MUHS) syllabus. The main topics in each paper were further subdivided into subtopics for preparing learning objectives. Marks were allotted to each system taking into consideration optimum marks 97 for subjective with included options and 20 marks Multiple Choice Questions (MCQs). The papers of UE and PE conducted with new format were analysed for content validity. Results: The blueprint of paper I (subjective) shows marks allotted for General Physiology 12, Haematology 13, Respiratory System (RS) 15, Cardiovascular (CVS) 17, Exercise 05, Renal system 15, Gastrointestinal System (GIT) 12, Lifestyle Aging and Meditation 03 and Attitude, Ethics and Communication. (AETCOM) 05 marks. The blueprint of paper II (subjective) shows marks for the Nerve-Muscle 16, Central Nervous System (CNS) 25, Special senses 14, endocrine system are 18, reproductive system 15, and temperature 09. MCQs were also allotted proportionate marks for each topic. Content analysis of papers showed exercise Physiology and body temperature regulation were not assessed in UE. Conclusion: There was disproportionate representation of topics in formative and summative examinations in absence of blueprint. The blueprint should be an integral part of assessments.

Special Forces Medical Sergeant/Special Operations Independent Duty Corpsman Candidates: Large Animal Module.

Medical care provided by Special Operations Forces (SOF) combat medics is vital for establishing communication with local populations. In many of these communities, livestock hold a valuable position within the social, political, and cultural structure. The West Virginia University (WVU) Special Forces Medical Sergeant/Special Operations Independent Duty Corpsman (SFMS/SOIDC) Large Animal Module is designed to provide a foundational experience in livestock husbandry and veterinary procedures to SOF combat medic candidates. This study was conducted to determine the participants' base knowledge of food animal production and to evaluate if the program content was sufficient for increasing their knowledge of the subject matter. A quasi-experimental design utilizing pre-test and post-test instruments was used. The validity of the testing instruments was established by a panel of subject matter experts and the instruments' reliability was determined by a split-half analysis using SPSS® statistical software. The difference between the pre-test and post-test examinations were compared for 66 candidates who were assigned to WVU Health Sciences Center for the applied medical experience program and 46 counterparts assigned to other institutions by a match pair analysis. Seventy-five percent of the subjects had no previous livestock exposure, and only 7% had previously participated in the 4-H program or Future Farmers of America (FFA). The average improvement in scores, pre-test versus post-test, was significantly greater for those that attended the module (18.5 versus 0.9). Few SFMS/SOIDC candidates have prior knowledge of livestock husbandry practices. The large animal module successfully provides education on livestock husbandry practice to participants. Knowledge of livestock production can assist SOF medics in establishing rapport with indigenous populations while on mission.

Agreement Between Ti-RADS Classification and Bethesda Cytopathological Findings from Thyroid Nodules in Young Adults.

Thyroid nodules are common in young adults. We sought to compare the sonographic characteristics (thyroid imaging reporting and data system [Ti-RADS] classification) with the reported cytological results (Bethesda categories) from thyroid nodules in young recruits and examine the efficiency of our unique multidisciplinary clinic. In this retrospective cohort, we identified young recruits (18-25years) who underwent needle biopsies for asymptomatic thyroid nodule(s), with cytology reports of Bethesda categories II-V, performed in our "Rapid Diagnostic Service" at a large Israeli Defense Forces Medical Corps healthcare facility, between 2013 and 2018. We studied the concordance rates between their Ti-RADS and Bethesda grades, and the preoperative Bethesda grades accuracy versus final pathology results, and the time period needed for their thyroid nodules workup. A total of 81 patients were included who contributed 91 nodules. A fair agreement was found between the Ti-RADS classifications and the Bethesda grades (Cohen's κ=0.238) that was more noticeable in males than in females. The agreement rate was 87.5% in males (21 of 24), but only 77.6% in females (59 of 67) [P=.029]. Of the 5 operated benign cases, all had low Ti-RADS, and 2 had low Bethesda. Of the 8 operated malignant cases, 6 had high Ti-RADS, and 5 had high Bethesda. On average, 37.64days elapsed between the first visit to the ultrasound study, and 24.2days elapsed until biopsy was performed. Despite an overall fair agreement between the sonographic features and cytological findings in young adults, we recommend a more aggressive approach and repeated biopsies despite reported benign pathology, because of a high false-negative rate.

The Development and Implementation of Specimens for Accident Forensic Toxicology Investigation Kit for Special Operations Forces.

After a vehicle rollover led to the death of a military member in Central Africa in 2018, it became apparent there was a significant gap in the capability to collect toxicology samples of Service Members involved in accidents and mishaps at remote Special Operations Forces locations in Africa. Multiple misconceptions surrounding sample collection, procedures for laboratory evaluation, and methods for shipment signaled the importance of establishing a procedure and a plan to provide the necessary medical inventory to properly collect and ship samples. The Special Operations Command Africa (SOCAFRICA) Surgeon's Office gathered the appropriate supplies for collection of forensic toxicology samples, and simultaneously developed a step-by-step checklist to safely and correctly perform urine and blood collection. The procedures were further improved after the completion of cognitive interviews with a Navy corpsman and Army Civil Affairs medic. Multiple shipping iterations occurred to ensure safe movement and arrival of samples at Armed Forces Medical Examiner System Dover AFB. Two Separate Specimens for Accident Forensic Toxicology Investigation Kits were generated to accommodate personnel typically associated with accidents involving vehicles and aircraft. SOCAFRICA's toxicology kit supports legal and medical chain of custody requirements for investigations, and provides deployed forces in Africa with a mechanism to collect and ship samples from Africa to Dover AFB. The kits are provided to ensure these samples are successfully analyzed, thereby removing any ambiguity surrounding an accident or mishap. SOCAFRICA established a prepared kit with all of the materials for sample collection, accompanied by step-by-step descriptions of the procedure, and clear guidance on the proper completion of the requisite paperwork that meets medico-legal requirements.

Avrupa Konseyi Biyoetik Komitesi'nin Psikiyatriye İlişkin Ek Protokol Çalışması Neler Söylüyor?

Psikiyatrik sorunlara ve psikiyatri pratiğine ilişkin etik duyarlılık örneklerini Dünya Psikiyatri Birliği’nin bildirgelerinde, ulusal hekim birliklerinin etik kodlarında ve uzmanlık derneklerinin konuya ilişkin metinlerinde görmek mümkündür. Bu bağlamda Türkiye Psikiyatri Derneği’nin ilke olarak benimsediği, “bilim, etik, dayanışma” söylemini ve 2002 yılında kapsamlı bir biçimde ortaya koyduğu “Ruh Hekimliği (Psikiyatri) Meslek Etiği Kuralları”nı görmek mümkündür. Bu çalışmada ülkemizin iç hukukunu biyoetik bağlamında “İnsan Hakları ve Biyotıp Sözleşmesi” ile etkilemiş olan Avrupa Konseyi’nin Biyoetik Komitesi’nin psikiyatriye ilişkin ek protokol çalışmalarının ortaya konulması ve tartışılması amaçlanmıştır. Protokol çalışmaları Biyoetik Komitesi tarafından yürütülmektedir. Süreç, hasta ve yakınlarının, hekimlerin ve ilgili diğer sağlık çalışanları ile insan hakları derneklerinin görüşlerinin alınarak ek protokol oluşturulması için organize edilmiştir. Ayrıca kamuoyu görüşlerinin alınması da önemsenmektedir. Protokolün üzerinde durduğu öncelikli konuların başında ülkelerin yasal düzenlemelerinde boşluklar olduğu görülen istem dışı yatış ve tedavi konusu yer almaktadır. Taslak protokolde istem dışı yatış ve tedavi kavramlarının, bunlara konu olan kişilerin durumunun, istem dışı yatış sürecinde değerlendirici olarak psikiyatristler ve yetkinlikleri konularının ayrıntılı şekilde ele alındığı görülmektedir. Ülkemizde henüz yasalaşmamış olsa da Türkiye Psikiyatri Derneği’nin önemli düzeyde katkı sunduğu “Ruh Sağlığı Yasası Taslağı” ile “Ruh Hekimliği (Psikiyatri) Meslek Etiği Kuralları” içerisinde konunun ayrıntılı biçimde yer almış olduğu dikkate değerdir.

Implementing Psychiatric Advance Directives: The Transmitter and Receiver Problem and the Neglected Right to Be Deemed Incapable.

Psychiatric advance directives (PADs) can help adults with serious mental illnesses preserve their autonomy and avoid involuntary interventions during an incapacitating mental health crisis. A PAD is a legal document prepared while mentally competent and states the person's treatment preferences to be implemented during a future crisis, ideally with the advocacy of an authorized proxy decision maker. PADs have been available in the United States for more than three decades but have yet to be robustly implemented in practice. This Open Forum describes PADs metaphorically as a device for remote communication among the person with mental illness, a proxy decision maker, and health care providers. Barriers to PAD usage occur on both "transmitter" and "receiver" sides and must be addressed to advance PAD implementation.

Efficacy of combined use of intravenous and intra-articular versus intra-articular tranexemic acid in blood loss in primary total knee arthroplasty: A randomized controlled study

Purpose/objectivesThis study was conducted to compare the efficacy of preoperative intravenous (IV) and intraoperative topical administration of tranexamic acid versus intraoperative topical administration of tranexamic acid along in reducing blood loss in primary total knee arthroplasty (TKA) subjects. The hypothesis of this study was the combined use of intravenous and Intra-articular injection of Tranexamic acid will be more efficacious than intra-articular administration alone in reducing blood loss in Primary Total Knee Arthroplasty. Materials and methodA total of 31 subjects were selected and randomized into intervention and control group. The intervention group received both intravenous and intra articular tranexamic acid i.e. Trenexamic acid 1 gm IV injection 15 min before skin incision and Trenexamic acid 1 gm intra articular application intraoperatively after joint capsule closure. Subjects in the control group received only intra articular tranexamic acid i.e. Trenexamic acid 1 gm in 20 ml normal saline using intra articular application after joint capsule closure. Outcome measurements included postoperative surgical site drain output, drop in haemoglobin levels and transfusion rate. Ethics approval was taken from the Medical Research Unit, Armed Forces Medical College, Pune. ResultsThe mean total blood (drain output) in the intervention group was 354.5 (±208.22) ml vs. 397.65 (±125.00) ml in the control group. T-test between the two groups on the volume drained post-operatively was not significant (p = 0.482). No subjects in the intervention group required post-operative blood transfusion but one subject from the control group required blood transfusion. ConclusionCombined use of intravenous and intraarticular injection tranexamic acid had lesser surgical site bleeding compared to only topical administration, however this was not statistically significant.

Involuntary Treatment in Dementia Care at Home: Results From the Netherlands and Belgium

Most PwD remain living at home. Due to complex care needs this can result in an increased risk for care provided against the wishes of the client and/or to which the client resists, referred to as involuntary treatment. This study explores the use and factors associated with involuntary treatment in PwD receiving home care in the Netherlands and Belgium. A secondary data analysis of two cross-sectional surveys (n=844 persons) showed that more than half of the PwD (51%) living at home received involuntary treatment (Belgium 68% and the Netherlands 45%). Non-consensual care (83%) was the most common, followed by psychotropic medication (41%) and physical restraints (18%). Involuntary treatment was associated with living alone, greater ADL dependency, lower cognitive ability, higher family caregiver burden and receiving home care in Belgium versus the Netherlands. In order to provide person-centered care, it is important to study ways to prevent involuntary treatment in PwD. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.

Prevention and Reduction of Care Against Someone’s Will in Cognitively Impaired People at Home: A Feasibility Study

Sometimes care is provided to a cognitively impaired person against the person’s will, referred to as involuntary treatment. An intervention (PRITAH) was developed to prevent and reduce involuntary treatment comprising 4 components: client-centered care policy, workshops, coaching on the job by a specialized nurse and the use of alternative interventions. A feasibility study was conducted including 30 professional caregivers. Feasibility was assessed by attendance lists (reach), a logbook (dose delivered and fidelity), evaluation questionnaires and focus group interviews (dose received, satisfaction & barriers). The workshops and coach were positively evaluated and the average attendance rate was 73%. Participants gained more awareness and knowledge and received practical tips and advice to prevent involuntary treatment. Implementation of the intervention was feasible with minor deviations from protocol. Recommendations for improvement included more emphasis on involvement of family caregivers and general practitioners and development of an extensive guideline to comply with the policy. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.

Advance Care Planning for Care-Dependent Older Persons Living at Home: A Cluster-Randomized Controlled Trial

Advance Care Planning (ACP) for care-dependent older persons living at home is an important part of care, but remains difficult to implement, mostly due to access barriers. The aim of this trial is to increase patient activation, family communication and surrogate designation through an ACP-intervention delivered by trained nurses to care-dependent clients in their homes. The intervention is evaluated in a cluster-randomised controlled trial in Germany (DRKS00016886). Primary outcome is patient activation (PAM-13); secondary outcomes cover institutionalisation, ACP-engagement and prevalence of ACP-documents. 28 home care services (HCS) with 20 trained nurses and about 340 participants have been included. First results show that patients and caregivers judged the topic and the discussion with trusted persons as important and seized the opportunity for communication. In conclusion, established relationships can be built upon to ensure access to ACP and thus to avoid involuntary treatment in situations of decisional incapacity. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.

The association between discontinuation of community treatment orders and outcomes in the 12-months following discharge from residential mental health rehabilitation

To compare the post-discharge outcomes of people admitted to community-based residential mental health rehabilitation facilities subject to a Community Treatment Order (CTO) who do and do not have this order discontinued prior to discharge.People subject to a CTO who were admitted across five Community Care Units (CCUs) in Queensland, Australia between 2005 and 2014 (N = 311), were grouped based on involuntary treatment status at the time of their discharge. Individuals whose status changed to voluntary (n = 63; CTO > VOL) were compared with those whose treatment remained involuntary (n = 248; CTO-CTO) on demographic, clinical and treatment-related characteristics. Group-level and individualised changes were assessed between the year pre-admission and the year post-discharge. The primary outcome measure was change in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes included disability (Life Skills Profile-16), service use, accommodation instability, and involuntary treatment. Logistic regression was completed to examine predictors of CTO discontinuation during CCU care. Potential predictors covered service-, consumer-, and treatment-related characteristics.Compared to the CTO-CTO group, the CTO > VOL group had significantly longer episodes of CCU care, more frequent primary diagnoses of schizophrenia spectrum disorders, and were more likely to be female. Following discharge, CTO > VOL subjects had more frequent reliable and clinically significant improvement in HoNOS scores, as well as more frequently demonstrated reliable improvement in hospital bed use and accommodation instability than the CTO-CTO subjects. CTO discontinuation was predicted by longer duration of CCU care, being a female, and having a smaller number of psychiatry-related bed use prior admission.Our findings suggest that CCU care of sufficient duration may lessen the need for subsequent compulsory treatment in the community.

Comparison of Air Force, Army, and Navy Emergency Medical Technician Candidates' Performance on the National Registry Cognitive Examination.

Military medics function similarly to civilian emergency medical technicians (EMTs); however, they perform their emergency medical care in combat zones and military treatment facilities. Both civilian and military EMTs must take and pass the National Registry of EMT's cognitive examination to be certified as a Nationally Registered EMT; however, there is a discrepancy in requirements for obtaining and maintaining National EMT Certification between the military branches of the DoD. In our study, we aimed to compare the performance of the U.S. Air Force (USAF), U.S. Army (USA), and U.S. Navy (USN) EMT candidates on the National EMT Certification cognitive examination from 2015 to 2017. We performed a cross-sectional analysis of the National Registry of EMT's database for the examination results of all military EMT candidates who attempted the National EMT Certification cognitive examination between January 1, 2015, and December 31, 2017. First and cumulative third attempt pass rates and cognitive performance from mean ability estimates (MAEs) on the examination were assessed. Descriptive statistics were calculated and comparisons between branches with regard to passing rates and MAEs were made using chi-square tests and ANOVA, respectively, at the alpha level of 0.05. During the 3-year study period, a total of 3,642 USAF, 14,050 USA, and 1,187 USN candidates attempted the cognitive examination one or more times. The USA candidates demonstrated the highest first attempt pass rates (2015: 78%; 2016: 78%; and 2017: 81%) followed by the USAF candidates (2015: 58%; 2016: 62%; and 2017: 64%) and the USN candidates (2015: 41%; 2016: 56%; and 2017: 62%). The cumulative third attempt pass rates followed a similar trend (e.g., USA: 2015: 94%; 2016: 95%; and 2017: 96%). These differences by branch were statistically significant for each year (P < .001). The overall test MAE scores also differed by branch, but only the USN candidates' MAE scores differed by year. The USA candidates demonstrated the highest MAE from 2015 to 2017 (523) followed by the USAF (489) and the USN (464) candidates. The overall test MAE scores for the USN candidates improved over the study period (2015: 449; 2016: 475; and 2017: 479, P < .001). Military EMT candidates had different performances on the EMT cognitive examination between branches. The USA candidates demonstrated higher pass rates and cognitive performance on the examination compared to their counterparts from the USAF and USN from 2015 to 2017. Further work should be directed at defining the cause of the differences in military EMT candidate performance and determining the characteristics that impact these differences.

Involuntary Care and Treatment in Psychiatric Settings – Manifestations of Power and Violence?

In this article I am trying to disengage from the common forms of discussion about violence related to mental health service users/survivors, such as, for example, biomedical ideologies and statistical assertion that imply that service users/survivors are more likely to enact violence. I want to explore how service users/survivors experience involuntary ‘care and treatment’ in psychiatric facilities in Sweden today, and how their experiences can possibly be understood by taking into consideration the context, or more precisely the dominant ideologies/discourses surrounding mental and emotional distress/’madness’ in Western countries, i. e. the biomedical model/bio medical models, and by drawing on alternative and counter discourses around ‘madness’. Coming from a Mad Studies perspective, I argue, that the experiences the ‘women’ spoke about should be seen as manifestations of power and violence, and as breaches of Human Rights.

Early prediction and identification for severe patients during the pandemic of COVID-19: A severe COVID-19 risk model constructed by multivariate logistic regression analysis.

BackgroundAs an emergent and fulminant infectious disease, Corona Virus Disease 2019 (COVID-19) has caused a worldwide pandemic. The early identification and timely treatment of severe patients are crucial to reducing the mortality of COVID-19. This study aimed to investigate the clinical characteristics and early predictors for severe COVID-19, and to establish a prediction model for the identification and triage of severe patients.MethodsAll confirmed patients with COVID-19 admitted by the Second Affiliated Hospital of Air Force Medical University were enrolled in this retrospective non-interventional study. The patients were divided into a mild group and a severe group, and the clinical data were compared between the two groups. Univariate and multivariate analysis were used to identify the independent early predictors for severe COVID-19, and the prediction model was constructed by multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the prediction model and each early predictor.ResultsA total of 40 patients were enrolled in this study, of whom 19 were mild and 21 were severe. The proportions of patients with venerable age (≥60 years old), comorbidities, and hypertension in severe patients were higher than that of the mild (P < 0.05). The duration of fever and respiratory symptoms, and the interval from illness onset to viral clearance were longer in severe patients (P < 0.05). Most patients received at least one form of oxygen treatments, while severe patients required more mechanical ventilation (P < 0.05). Univariate and multivariate analysis showed that venerable age, hypertension, lymphopenia, hypoalbuminemia and elevated neutrophil lymphocyte ratio (NLR) were the independent high-risk factors for severe COVID-19. ROC curves demonstrated significant predictive value of age, lymphocyte count, albumin and NLR for severe COVID-19. The sensitivity and specificity of the newly constructed prediction model for predicting severe COVID-19 was 90.5% and 84.2%, respectively, and whose positive predictive value, negative predictive value and crude agreement were all over 85%.ConclusionsThe severe COVID-19 risk model might help clinicians quickly identify severe patients at an early stage and timely take optimal therapeutic schedule for them.

Influence of comprehensive incubational measures on the perioperative treatment of extensively burned patients who underwent escharectomy and skin grafting

Objective: To explore the influence of standardized and comprehensive incubational measures on perioperative treatment of extensively burned patients who underwent escharectomy and skin grafting. Methods: From January 2017 to November 2018, 50 patients with extensive burn who underwent escharectomy and skin grafting in the First Affiliated Hospital of Air Force Medical University and met the inclusion criteria of this study, were recruited in this retrospective cohort study. According to the incubational measures at that time, 20 patients (14 males and 6 females, aged (33.5±5.2) years) who received routine incubation during the perioperative period from January to October 2017 were set as routine incubation group, and 30 patients (23 males and 7 females, aged (35.8±1.4) years) who received standardized comprehensive incubational measures during the perioperative period from November 2017 to November 2018 were set as comprehensive incubation group. Their body temperature was controlled mainly in 4 stages: preoperative preparation and transfer from intensive care unit (ICU) to operating room, preoperative preparation in operating room, intraoperative operating room management, as well as postoperative transfer from operating room to ICU. The initial body temperature in operating room and intraoperative hypothermia duration, intraoperative blood loss, postoperative recovery time, postoperative chill, blister, and ulcer, and wound healing rate on post operation day (POD) 10 were recorded and calculated. Data were statistically analyzed with two independent samples t test and chi-square test. Results: (1) The initial body temperature in operating room of patients in comprehensive incubation group was (36.3±0.4) ℃, which was significantly higher than (35.6±0.4)℃ in routine incubation group, t=6.658, P<0.01; the intraoperative duration of hypothermia was (205±38) min, which was significantly shorter than (234±42) min in routine incubation group, t=2.564, P<0.05. (2) The intraoperative blood loss of patients in comprehensive incubation group was (323±114) mL, which was significantly less than (490±162) mL in routine incubation group, t=4.272, P<0.01; the postoperative recovery time was (36±8) min, which was significantly shorter than (49±17) min in routine incubation group, t=3.229, P<0.01. (3) The incidence of postoperative chill of patients in comprehensive incubation group was significantly lower than that in routine incubation group (χ(2)=28.626, P<0.01). The incidences of postoperative blister and ulcer of patients between the 2 groups were close. (4) On POD 10, the wound healing rate of patients in comprehensive incubation group was (78.08±0.06)%, which was significantly higher than (71.03±0.08)% in routine incubation group, t=3.694, P<0.01. Conclusions: The standardized and comprehensive incubational measures can effectively improve the initial body temperature of patients entering the operating room, shorten the intraoperative duration of hypothermia, reduce the amount of blood loss and postoperative complications, as well as shorten the postoperative recovery time, thus improve the wound healing rate.