Reintegration Of Patients Research Articles

Reintegration after severe brain injury: A retrospective study

Primary objective: The evaluation of school and work reintegration of patients following severe brain injury and of the relationship between the most common (early and late) prognostic indicators and reintegration itself.Research design: A retrospective study on a population of 353 patients consecutively admitted to an intensive rehabilitation unit (S. Cuore Hospital, Negrar, Italy) from 1991–1999.Methods and procedures: Evaluation of school and work outcome in this population up to December 2001 (follow-up from 2–10 years post-trauma). Data collection was made using the EBIS (European Brain Injury Society) protocol.Results: In December 2001, 53% of those previously working had returned to competitive work; 76.5% of students were continuing with their studies or had progressed into work. There was a significant difference between employed and non-employed groups in terms of GCS, post-traumatic amnesia (PTA), in-patient rehabilitation length of stay (LOS) and GOS at 6 and at 12 months post-injury.Conclusions: The data confirm the predictive value of the indices used regarding work reintegration in TBI patients. Nevertheless, prolonged and intensive rehabilitation programmes can lead to high re-employment rates in patients whose initial prognosis seemed very poor.

Cardiac risk of coronary patients after reintegration into occupations with heavy physical exertion

The job related reintegration of patients with coronary artery disease (CAD) is a central part of cardiac rehabilitation. However, specific occupational demands like jobs with heavy physical exertion (> 6 METs) could increase the cardiovascular risk because the relative risk for acute myocardial infarction (MI) and cardiac death is temporarily elevated after vigorous exertion ("hazard period"). Thus, in 2001 any male patient with proven CAD who performed a job with heavy exertion until the occurrence of an index event (MI/ACS, any interventional or surgical revascularization measure) received a questionnaire after an average of 20 months. Complete data were available in 108 from 119 included patients (90.8%), aged 51.8+/-7.8 years. Ejection fraction was 61.5+/-13.1% and the functional capacity at the time of hospital discharge averaged 130.1+/-31.2 W. 75% of the patients had a previous MI and 59.3% underwent bypass surgery. During follow-up the previous job with heavy exertion was performed over a cumulated time of 74 years. The aim of the study was to compare the observed and the expected incidence of MI and cardiac death with and without job performance. The expected ("basal") risk for MI and cardiac death without heavy physical exertion was determined from pooled study results and assumed to be 5.2% per year. The combined risk due to performing an occupation with strenuous exertion can be calculated from time periods with and without working hours and amounts to 11.9%. There could be expected 0.119 . 74=8.8 cardiac events related to the job. In contrast, 5 MIs (4 NSTEMI, 1 STEMI) were observed (6.8%). The relative risk for an expected event compared to the basal risk without heavy exertion was 2.3 (95% CI: 0.7-7.4). The relative risk for the observed cardiac events amounts to 1.3 (95% CI: 0.4-4.8). The lower observed risk is probably due to the high grade of physical fitness in this patient group. In spite of several limitations, our study showed no convincing evidence for increasing the cardiac risk of patients with CAD performing occupations with heavy physical exertion. Because of the importance of this prognostic finding, a representative and prospective study is strongly required.

Book Review: History of Psychiatry: The Confinement of the Insane: International Perspectives, 1800–1965

History of Psychiatry The Confinement of Insane: International Perspectives, 1800-1965. Roy Porter, David Wright, editors. Cambridge (UK): Cambridge University Press; 2003. 371 p. US$70.00. Reviewer rating: Good This scholarly work exemplifies best traditions of history of medicine research. It gives reader a global perspective on asylum's evolution from 1800s to end of 20th century, incorporating 14 essays that cover its history in various locations throughout world. Included are essays from Europe, US, Canada, Argentina, Mexico, India, and Nigeria. This book analyzes in depth demographic, social, and political factors that shaped evolution of asylum in different societies; it is a data-rich formulation from a psychosocial and political perspective. What is missing for practising psychiatrists, however, is a review of changing psychopathology and diagnostic formulation. While there are numerous case studies, emphasis is on large psychosocial and political engines that shaped asylum's development. Only 1 of 17 contributors has formal psychiatric training: rest are social historians, some of whom (such as David Wright) have a special interest in historical epidemiology of mental illness. The opening chapter on history of South African asylum at Robin Island is illustrative of later chapters. In it, author emphasizes that initial function of this asylum was to house an overflow of black prison inmates. Over time, the proportion of white patients rose as asylum underwent reforms along moral management lines. By early 20th century, original forensic black population was restored as white middle-class inmates were channelled to new asylums. The remaining black inmates, who represented the most dangerous and threatening members of society, were both excluded from society and contained. The Canadian audience will be interested in chapter on Toronto, Hamilton, and London asylums. The inmate population reflects a more democratic selection of patients admitted across adult age spectrum and representing general population. The population also reflects wider sociopolitical issues of employment patterns, kinship networks, immigration, and socioeconomic growth in Victorian Ontario. This readable chapter, by David Wright and his colleagues, explodes myth that women were overrepresented within these institutions. The close proximity and reintegration of patients into their local family environment wherever possible portrays a kinder, more informed aspect of early Canadian asylum. Reference is made to book's on-going theme-the still-pressing need to place those who suffer from mental illness more appropriately in institutions other than jails. In Victorian Ontario, this issue was politicized, and development of asylums was fuelled in part by political orientation of local judiciary. As noted earlier, detailed analysis of psychiatric symptomotology has yet to be undertaken: for all work that has been conducted around world on socio-demographic characteristics of patients, there has been little attention paid to symptom profile of these patients (p 127) Later chapters on records from asylums in Berlin and South Carolina emphasize impact of war and local political climates on patient population and negative impact of a deteriorating socioeconomic climate on smooth running of institutions: deteriorating financial circumstances, overcrowding, and marginalization of basic custodial care. …

Rehabilitation after replantation

Limb replantation represents a particular surgical challenge. Rehabilitation and functional integration of the patient into everyday life has proven to be as equally important as the operation itself. This requires intensive and long-term cooperation between surgeon, therapist, and patient since replanted limbs without restoration of function are of no use. Besides physiotherapy, ergotherapy is highly important for this since it helps to reactivate daily activities.Also, tactile gnosis and protecting nervous sensibility and motor function can be improved by ergotherapy. With the help of special devices, adjustments,and psychological care, ergotherapy also supports the patient's reintegration into his former social environment.

Xenotransplantation: the challenge to current psychosocial attitudes

Because of the limited availability of transplantable human organs, xenotransplantation, the use of animal organs as an alternative source, has received considerable attention in recent years. Xenotransplantation would provide an unlimited supply of organs, and these organs would be available whenever required. Although the pig is considered the best source for organs, significant immunologic barriers currently prohibit the implementation of a clinical trial of organ transplantation. However, as medical research gains more insight into the mechanisms underlying rejection of pig organs in primates, therapeutic xenotransplantation is becoming more feasible. Clinical trials of porcine cell transplants are currently underway. Although xenotransplantation will minimize the waiting period for an organ and obviate the feelings of guilt or indebtedness commonly experienced by recipients of human organs, several psychosocial issues may hinder the reintegration of patients into society. For example, concerns that infectious pathogens could be transferred to recipients of pig organs will necessitate life-long monitoring and perhaps even temporary isolation of patients. The possible risk of the spread of a xenozoonosis from the patient to other members of the community may inspire public controversy and even fear, which may have an adverse impact on the patient's emotional state. Additionally, some patients may be psychologically disturbed by the need to incorporate pig organs into their body. This article addresses these and other psychosocial issues that may be associated with clinical xenotransplantation.

Hungry earth and vengeful stars: soul loss and identity in the Peruvian Andes

This article contributes to the cross-cultural literature on fright sickness and soul loss with an analysis of cases among Quechua indians ( runa) in a rural community in the southern Peruvian Andes. One of the aims of this article is to incorporate an emic understanding of the intersection of the cosmological and social landscapes into discussions of Quechua conceptions of health and illness. It outlines Quechua constructions of body, self, and cosmos that are relevant to explaining the concepts of soul/spirit, interior/exterior, and runa/non runa that are related to soul loss. The illness suffered by victims of fright sickness embodies the Quechua construction of self and is linked not only to broader sociopolitical realities of Peru but also to cosmological beliefs. The diagnosis of spirit loss and fright in this cultural context reveals a crisis of identity: sufferers represent non runa, or nonhumans. They succumb to fright or soul loss because of an emic concept of vulnerability that transcends the characteristics of gender and age usually associated with soul loss cross-culturally. Treatments, therefore, involve a reaffirmation of ethnic identity and a reintegration of patients into their families in terms of a culturally specific understanding of identity, community, and cosmos.

Rehabilitation of patients with acetabular fractures.

In the rehabilitation of patients with acetabular fractures, we try to achieve anatomical reconstruction of the joint as well as unlimited mobility. This is important for the patient's reintegration at work and in social life.These aims can only be reached with joint effort of the patient him/herself and all the different specialists concerned with the treatment. Functional physiotherapy should start as early as possible after trauma. Prophylaxis of joint stiffness, thrombosis, pneumonia and soft-tissue ulcers due to immobilization are not only important in the beginning. The restoration of circulation and resorption in the affected tissues, in addition to creation of global sensomotoric motion patterns, are the main aspects of this therapy. Definite long-term success should be ensured by concomitant ergotherapy and well-timed measures for the patient to regain his/her occupational abilities.

Rehabilitation following hip fractures

In the rehabilitation of patients with acetabular fractures, we try to achieve anatomical reconstruction of the joint as well as unlimited mobility. This is important for the patient's reintegration at work and in social life. These aims can only be reached with joint effort of the patient him/herself and all the different specialists concerned with the treatment. Functional physiotherapy should start as early as possible after trauma. Prophylaxis of joint stiffness, thrombosis, pneumonia and soft-tissue ulcers due to immobilization are not only important in the beginning. The restoration of circulation and resorption in the affected tissues, in addition to creation of global sensorimotor motion patterns, are the main aspects of this therapy. Definite long-term success should be ensured by concomitant ergotherapy and well-timed measures for the patient to regain his/her occupational abilities.

The Day Center in the Service Network of the Department of Mental Health

The day center (DC) is one of the oldest outpatient facilities; the first was opened in Moscow [1]. However, it was not until the 1960s that it began to spread at all systematically, when it became part of public outpatient services complementary to the psychiatric hospital (PH). The services included a dispensary, a day center, home visits, a sheltered workshop, and protected housing. Indeed, these years saw the progressive maturation of the conviction that the PH had to be internally changed and have access to outside, complementary services for rehabilitation and reintegration of patients [2]. In the '70s, the idea of a community service network became increasingly radicalized until, finally, it became an alternative , no longer complementary, to the hospital. In particular, I might mention that in 1977, in the USA, because of the shortcomings of the aid given to the disabled discharged from mental hospitals, the General Accounting Office [3] arranged to have federal financing allotted only to community mental health centers (CMHCs), which, in addition to the above-mentioned services, specified by law (under the Community Mental Health Centers Act of 1963), had day programs of rehabilitation and residential programs for the seriously and chronically mentally ill and disabled. In accordance with this initiative, in 1978 the U.S. National Institute of Mental Health worked out a general model for community services defined as the community support system [4]. In 1978 in Italy, the health reform prescribed discontinuing psychiatric hospitals and establishing community departmental services whose structures and resources were not well defined. The experience gained has made

Sudden deaths of patients in a mental handicap hospital

AbstractOne Hundred and two sudden or traumatic deaths of mental handicap inpatients were examined retrospectively over a 28 year period. Data was obtained on each case from medical and nursing case notes and death certificates. Post-mortem results were available for half of the deaths. Cardio-vascular causes accounted for 50% of the total. Sudden deaths of profoundly handicapped patients occurred at a significantly younger age than severely, moderately or mildly handicapped patients. In the latter half of the 28 year period there was an increased incidence of traumatic deaths and sudden deaths due to asphyxia. There was also a significant increase in the mean age of sudden deaths due to epilepsy. Probable explanations for these findings are discussed. In particular, recent accidental traumatic deaths may be related to the process of increased reintegration of patients into the community; a relationship between neuroleptic and anticholingeric medication and asphyxial deaths is proposed.

Psychiatric day treatment as alternative to and transition from full-time hospitalization.

A review of the comparative studies on day treatment as an alternative modality to traditional full-time hospitalization reveals impressive evidence of its superior effectiveness in facilitating the adjustment and re-integration of patients into the community. On other measures, such as cost effectiveness, family stress, symptom alleviation and relapse rate, day treatment proves to be on par with full-time hospitalization. The data base pertaining to the efficacy of day treatment as a transitional facility from hospital to community is promising, but much too incomplete to permit conclusive statements. Methodological and conceptual issues in the current research are discussed and recommendations for future studies are offered.

Team tension as a vital sign

Current efforts to provide comprehensive health care have accentuated the need for new models that integrate the biological, psychological, and social fields. One approach to meeting this need has been the development of health care teams. However, the multidisciplinary perspectives of such teams often result in tension and discord. While this tension may be partly attributable to institutional or professional biases or lack of adequate decision-making techniques, it may also be an essential diagnostic tool for exploring and integrating the paradoxes of the patient's homeostatic system. This approach captures and bridges some of the inadequacies of our prevailing knowledge base. The team's tension can be experienced as an essential empathic connectedness to the patient's life situation. Resolution of the team's internalized conflict becomes a paradigm for the patient's reintegration of his or her own paradoxical or contradictory needs.

Psychiatric emergency room service patterns

This paper reports on patterns of service in the Emergency Room of a Comprehensive Community Mental Health Center. The interdisciplinary approach has provided optimum handling of different psychiatric and social problems. Mental patients suffering functional psychoses or disorders accompanied by chronically impaired social adaptation present themselves to the E.R. at times of stress. The success of the E.R., according to our experience, is based on precision in diagnostic formulations, an early intervention in situations of stress and utilization of community resources. Social workers and visiting nurses are essential in promoting and maintaining changes necessary to the patient's re-integration into the community.

Young schizophrenic mothers' initial posthospital adjustment at home. Special reference to the motherchild interaction.

Problems of rehabilitation and reintegration of the hospitalized psychotic patient into family and community have been a focus of growing interest and study in recent years. In a previous paper I described the usefulness of joint patient-family-doctor interviews in preparing the schizophrenic patient’s return to the community. The present paper is intended as a further contribution to the general problems of reintegration of patients into the community, with special reference to the crucial area of mother-child interaction. Indeed, for a patient who has been hospitalized for schizophrenic illness, the initial phase of his posthospital adjustment is a critical moment in his life, because his success or failure in making this transition may determine his future status at home and in the community. If he succeeds, he may gain the confidence he needs to meet the challenge of the complicated, demanding role of an adult