Restraint In Health Care Research Articles

Impact of COVID19 pandemic on the hospitalization burden of cancer patients: Results of a quasi-experimental study.

e13527 Background: The SARS-CoV-2 (COVID19) pandemic has had a huge impact on health care, leading to the declaration of a “state of alarm” in many countries. This situation has possibly conditioned the care of cancer patients, compromising hospitalization resources due to healthcare restraints. We aim to analyze the impact of the COVID19 pandemic on the hospitalization of cancer patients during the “state of alarm” in an Academic Hospital in Madrid, considered one of the most affected regions in the World during the first wave of the pandemic in Europe. Methods: Quasi-experimental study with similar controls collected in the same period of the previous year from cancer patients admitted to the Medical Oncology (MO) department of the Puerta de Hierro University Hospital in Madrid. Patients were selected from diagnoses coded by the ICD-10 obtained from discharge reports in the Admission Department. Cancer and viral pneumonia codes (excluding influenza) were analyzed. Admission to Internal Medicine (IM) department was also explored to describe hospitalization due to COVID19 pneumonia. We defined two groups: pandemic (03/14/20 - 06/20/20) and control (pre-pandemic) (03/14/19 - 06/20/19). Results: 74 cancer patients were admitted to MO department in 2020, while 162 admissions were recorded for the equivalent period in 2019 (- 54%). No differences were observed related to sex and age. In 2020, emergency and programmed admissions decreased by the same proportion, and no difference in mortality was observed. Admissions for all neoplasms decreased, but with higher magnitude in breast cancer. Viral pneumonia (no influenza) in cancer patients were mostly admitted to IM (96%) rather than MO department. 79 cases were identified in 2020, 22 in 2019 (p < 0.001), with a non-significant increase in mortality in patients with pneumonia: 25,3% in 2020 and 13,6% in 2019. Conclusions: The COVID 19 pandemic seriously impacted cancer hospitalization care, decreasing admissions to the MO department in half compared to the equivalent period. We observed a reduction in admissions through all neoplasias. Admissions due to viral pneumonia in cancer patients increased 3.5 times, mostly admitted to IM changing the dynamics of cancer hospitalization burden and compromising resources. A non-significant increase in mortality from viral pneumonia was observed. The analysis of hospitalizations through administrative data can allow better management of resources and facilitate rapid decision-making in a pandemic situation yet to be resolved.[Table: see text]

La restricción y el aislamiento mostrados a través de imágenes publicadas en Twitter: ¿Cuáles son las implicaciones para los profesionales de la salud?

Healthcare professionals who work with patients with cognitive impairments face a complex and challenging work situation. The purpose of the present study was to map areas of discussion about use of seclusion and restraint in healthcare, as expressed in motifs posted on Twitter. 188 images from Twitter postings were analyzed. Five categories were identified: Informative and educational messages; Equipment as artifacts; Spatiality; The restrained subjects; Sociopolitical connotations of restraint. We discuss that posters intended to educate others on how to use restraint properly, thus connoting an ethical dimension to a subject associated with measures used to exert power over others.

Restraint in paediatrics: A delicate balance.

Patient restraint in health care is currently under intense review. There are two disparate groups that should be considered. First, infants and young children are commonly restrained while undergoing simple medical procedures such as venepuncture or immunisation, and this practice may be better framed as 'hugging' not 'holding'. Second, there is a distinct but significant group of children and adolescents with serious psychiatric or organic illness with behavioural disturbances necessitating restraint, who are the primary focus of this paper. Nevertheless, the balance between restraining any young person in health care and causing preventable harm is delicate: any form of child restraint, whether physical, chemical or seclusion, merits ethical reflection and should be undertaken judiciously. All clinicians should prioritise the dignity and privacy of the young person while weighing the vulnerability of this cohort of patients.

Police involvement in restraint in healthcare.

Essential facts In January, new guidance was drawn up for police and healthcare professionals, outlining for the first time how and when police officers should be involved in physically restraining people in healthcare settings in England and Wales.

Police involvement in restraint in healthcare

Essential facts In January, new guidance was drawn up for police and healthcare professionals, outlining for the first time how and when police officers should be involved in physically restraining people in healthcare settings in England and Wales.

P01-154 - Are acute involuntary hospitalization related to anxiety disorders?

IntroductionAcute involuntary hospitalization is perceived as a threatening event for most of patients. Acute involuntary hospitalization of psychiatric patients is probably a major source of anxiety and may be related to anxiety disorders. Further knowledge on the anxiety disorders secondary to involuntary hospitalization may limit traumatic experience and is, indeed, of considerable importance.MethodsBibliographic review of the existing literature was conducted using MEDLINE/PubMed (1969-2010). The following key words were used “involuntary hospitalization”; “coercion”; “patient admission”; “stress disorder” “anxiety” and “posttraumatic stress disorder”. All papers in English and French were considered in this review.ResultsAlthough the impact of diverse stressful or traumatic events has been the subject of numerous publications, we found only one study in the literature dealing with PTSD symptoms related to acute involuntary hospitalization. In this article involuntarily admitted patients were not more traumatized than voluntarily admitted ones. Although coercive measures can be traumatizing, but forced medication, seclusion, or application of any coercive measure were not significantly associated with traumatizing. Reviews on involuntary hospital admission’ demonstrated negative and positive consequences on various outcome domains. Findings highlight the predominantly negative impact of physical restraint on the person restrained and their family. These findings support minimal use of restraint in health care to a relatively vulnerable group of people. But coercion can also lead to positive outcomes.ConclusionsSpecific studies concerning the impact of involuntary hospitalization, coercitive measures and forced treatment causing anxiety disorders are still needed. Discussion about its methodology and ethical aspects remains necessary.

The experience of physical restraint: A systematic review of qualitative research

The objective of this review was to summarise the experience of physical restraint from the perspectives of the person subject to restraint and of their family. A review of interpretive and descriptive research was undertaken that entailed a comprehensive literature search. Studies were included in the review if they provided qualitative data on this experience. An interpretive data synthesis was undertaken to generate a composite description of the experience of restraint. Findings highlight the predominantly negative impact of physical restraint on the person restrained and their family. These findings support the most minimal use of restraint in health care and give voice to a relatively powerless and vulnerable group of people.