Patients In Health Care Settings Research Articles

“Let me through—I'm an arts practitioner!”

The Manchester Metropolitan University, UK, recently hosted a 4-day symposium on Culture, Health, and the Arts, attended by 450 delegates from 27 countries. The symposium addressed three broad areas of use for the visual and performing arts in health care; humanising the education of health-care professionals; improving the quality of care provided to patients in health-care settings; and developing healthier communities.

CONTROL OF ANTIMICROBIAL RESISTANCE IN THE HEALTH CARE SYSTEM

Resistance continues to spread in nosocomial pathogens in acute care hospitals and other key settings of managed health care systems. Appropriate control measures for such resistant organisms depend, in part, on the pathways by which resistance has arisen. Unfortunately, these pathways differ greatly from organism to organism and setting to setting. Although the epidemiology of resistant organisms sometimes is similar to that of susceptible organisms of the same kind, in some situations it may be quite different. This article highlights some of the pathways leading to the development of resistance in bacteria and the relevance of these mechanisms to measures for the control of resistant bacteria in hospital and community settings.

Health Care Workers with HIV and a Patient's Right to Know

Accidental human immunodeficiency virus (HIV) infection of patients in health care settings raises the question about whether patients have a right to expect disclosure of HIV/AIDS diagnoses by their health workers. Although such a right-and the correlative duty to disclose-might appear justified by reason of standards of informed consent, I argue that such standards should only apply to questions of risks of and barriers to HIV infection involved in a particular medical treatment, not to disclosure of personal diagnoses. Because the degree of risk of HIV infection is low and disclosure would also have damaging consequences for health workers, and because patient protection is available in other ways, it is argued that no such generalized right should be recognized.

The structure and correlates of alcohol dependence: WHO collaborative project on the early detection of persons with harmful alcohol consumption—III

The cross-cultural validity of the Alcohol Dependence Syndrome was tested on 13 symptoms of alcohol dependence which were assessed as part of a WHO collaborative study of the early detection of harmful drinking. The subjects were drinking patients in health care settings in Australia, Bulgaria, Kenya, Mexico, Norway, and the US. Principal Components Analyses were performed on the symptoms in each centre, and the degree of agreement between the results was assessed by calculating coefficients of congruence between the item loadings on the first principal component. In all six centres the first Principal Component accounted for at least half of the total variance and all symptoms had positive loadings greater than 0.40 on the first Principal Component. The coefficients of congruence were all 0.98 or more, and the 13 symptoms had internal consistency coefficients of 0.94 or more. An alcohol dependence score defined by the sum of positive responses to the 13 alcohol dependence symptoms was positively correlated with self-reported alcohol consumption, alcohol-related problems, serum gamma glutamyltransferase and a clinical examination assessment of alcoholism in all six samples.

PREVENTION AND CONTROL OF TUBERCULOSIS IN THE 1990s

Beginning in 1984, the long-term decline in tuberculosis (TB) cases stopped, and since 1985 the number of cases has actually increased by 18%, from 22,201 new cases in 1985 to 26,283 in 1991. The change in the morbidity trend appears to be primarily due to three factors: HIV coinfection, TB occurring in persons from countries where this disease is prevalent, and deterioration of the health care infrastructure with resultant outbreaks of TB. This article presents six interventions that address major areas where action is needed. These efforts will require coordinated action by health care providers, public health departments, and other public and private organizations. Protection of all workers and patients in health care settings is one important goal of these efforts.

Violent patients

The medical community is becoming increasingly concerned about violent patients in healthcare settings. Healthcare professionals should be trained to deal with aggressive patients, and they should have access to a room free of dangerous objects for evaluation and examination. Having security personnel stand by may be appropriate in some cases. Verbal intervention is the key to dealing with violent patients. The safest and most effective pharmacologic intervention is use of benzodiazepines, either alone or in conjunction with antipsychotic agents when indicated. Seclusion or restraint may be needed for some violent patients; in such situations, close patient monitoring and explicit documentation are essential. Physicians can be held liable for injuries patients sustain while being restrained, so staff members should receive instruction in safe physical intervention techniques.

Respect: Response to shame in health care

Shame is a not uncommon experience of patients in health care settings. Religious assessments often confuse shame with guilt, and therefore respond in ways that may not be appropriate. Illustrated by a case study, this article distinguishes shame from guilt and examines systemic considerations. Then shame is explored in relation to traditional, negotiating, and individualistic belief paradigms, looking at epistemology, causality, response to shame, healing models, and tasks. It concludes with a discussion of the idea of "respect" as foundational for responding to people experiencing shame in health care.