Security Hospital Research Articles

Coping, Mindfulness, Stress, and Burnout among Forensic Health Care Professionals

ABSTRACTAlthough working within forensic services can often prove emotionally challenging and stressful, there has been a surprising lack of research into potential interventions aimed at addressing stress and burnout experienced by forensic health care professionals (FHCPs). This study investigated the role of coping and dispositional mindfulness on stress and burnout among FHCPs employed within secure hospitals. One hundred and fifty-one FHCPs were recruited from five different low and medium secure hospitals (secure psychiatric units) in Wales. A postal research pack was used to collect background information and measures of coping, dispositional mindfulness, stress, and burnout. The study found that FHCPs reported elevated levels of stress and moderate levels of emotional exhaustion and depersonalization but retained a positive sense of personal accomplishment. Higher mindfulness skills were found to be significantly associated with lower levels of maladaptive coping, stress, and burnout. Higher levels of maladaptive coping significantly predicted elevated levels of stress and emotional exhaustion and lower levels of personal accomplishment. In relation to mindfulness, higher levels of acting with awareness significantly predicted lower levels of emotional exhaustion and depersonalization. The results appeared to support the commonly held assertion that forensic services can be stressful and emotionally challenging working environments, which can cause FHCPs to experience elevated levels of burnout and stress. Higher levels of dispositional mindfulness were significantly associated with lower maladaptive coping, stress, and burnout levels, therefore mindfulness based interventions could prove to be viable strategies to help support FHCPs. The results also suggested that higher levels of acting with awareness may help prevent FHCPs from experiencing emotional exhaustion and depersonalization.

HYPERTENSION;

Background and Objectives:Asymptomatic nature of hypertension (HTN) has made it a silent killer. The better understanding of the underlying causes or factors can be beneficial in reducing the mortality and morbidity rate. Thus, the present study aims to determine the risk factors associated with HTN among adults and elderly patients visiting outpatient departments (OPDs) and the knowledge of patients about their health status. Study Design: Cross-sectional study. Setting: Outpatient departments (OPDs) of four tertiary care hospitals (Nishtar hospital, Khawaja Farid Social Security hospital, Railway hospital and Bakhtawar Amin Memorial hospital) of Multan, Pakistan. Period:1st May 2017 and 31st October 2017. Patients and Methods:364 patients (≥18 years−≥60 years of age) in OPDs of four tertiary care hospitals of Multan, Pakistan. Data regarding demographic details, medical history and blood pressure measurements were collected on a structured questionnaire. Data were analyzed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) and Microsoft Excel (MS Office 2010).Result: Overall 38.7% of the participants were suffering from HTN. Most of them were 40-59 years of age and had body mass index (BMI) >23 kg/m2. Bivariate analysis (p-value <0.005) showed a significant association of age, marital status, gender, weight, and physical activity with HTN. Conclusion: The major determinants of HTN include increase in age, obesity, sedentary lifestyle, genetics, diabetes mellitus (DM) and lack of health concerns. Although patients are knowledgeable of their poor health status but make little or no efforts in controlling and preventing HTN.

Forensic Mental Health Nursing in Secure Hospitals and the Criminal Justice System

Forensic Mental Health Nursing in Secure Hospitals and the Criminal Justice System

An Enhanced Electrocardiogram Biometric Authentication System Using Machine Learning

Traditional authentication systems use alphanumeric or graphical passwords, or token-based techniques that require "something you know and something you have". The disadvantages of these systems include the risks of forgetfulness, loss, and theft. To address these shortcomings, biometric authentication is rapidly replacing traditional authentication methods and is becoming a part of everyday life. The electrocardiogram (ECG) is one of the most recent traits considered for biometric purposes. In this work we describe an ECG-based authentication system suitable for security checks and hospital environments. The proposed system will help investigators studying ECG-based biometric authentication techniques to define dataset boundaries and to acquire high-quality training data. We evaluated the performance of the proposed system and found that it could achieve up to the 92 percent identification accuracy. In addition, by applying the Amang ECG (amgecg) toolbox within MATLAB, we investigated the two parameters that directly affect the accuracy of authentication: the ECG slicing time (sliding window) and the sampling time period, and found their optimal values.

Temporal Fascia Versus Tragal Perichondrial Graft in Myringoplasty and Tympanoplasty

The objective of this study is to compare the results of tympanoplastywith underlay technique with respect to graft uptake, hearing improvement and complications. Thestudy was conducted between January 2006 & January 2018 at Haider clinic, Kulsum international Hospital Islamabad, MaroofInternational Hospital, Social security Hospital Islamabad and PAF hospital Islamabad. Sampling was done by non-probability convenient sampling type by random selection. Total of 1677 patients were selected had Tympanoplasty type 1. All had dry central perforations of different sizes for more than 3 months and conductive hearing loss of less than 40dB with patent Eustachian tube. Informed consent was taken from patients andethical committee. Patients with sensorineural hearing loss and with severe nasal pathology were excluded. Patients were divided into 2 groups, A and B, were subjected totympanoplasty by underlay technique by the same group of surgeons. In group A, temporalis fascia graft and in group B tragalperichondrial graft was used. Postoperative audiometry was done after 3 months in each case to calculate air bone gap. In our study there were 62% males and 38% females, mean age was 32.5. In Group A, 689 patients hadtympanoplasty with temporalis fascia and in group B 988 patients with chondro-perichondrial graft. Medialization was seen in 30(4.3%) patients in Group A and in 10(1%) in group B. Persistent Perforations happened in 32(4.6%) patients in group A and in 8(0.8%) patients group B. Graft uptake success rate using temporalis fascia was 85.9% and was 97.4% with Chondro-perichondrial graft. Hearing improvement was seen in 627(91%) patients in group A and 970(98%) patients in group B. Statistical analysis of the data was done using SPSS 16. Temporalis fascia and tragal perichondrium both are excellent material to repair tympanic membrane. Graft uptake rate and hearing improvement are better in perichondrial graft.

Efecto del entrenamiento cognitivo-emocional en la satisfacción laboral y el desgaste ocupacional del personal de enfermería: un estudio piloto

ObjectiveThe purpose of the research was to evaluate the effect of cognitive-emotional training in the improvement of job satisfaction and reduction of burnout, of the nursing staff of a social security hospital in the state of Jalisco, Mexico. MethodThe design of the study was quasi-experimental, pre and post-test. The diagnosis of job satisfaction and occupational burnout was obtained from one hundred participants, which was made up of the total number of nursing staff workers on the morning shift. The assessment instruments used were the MSL35 questionnaire on Motivation and Work Satisfaction (MSL-35, García, Pacas y Ramírez, 2006) and the Occupational Burnout Scale (EDO, Uribe-Prado, 2010). Subsequently, seven workers were randomly selected to form each of the groups (experimental and control). The intervention was with a cognitive-emotional technique in eight sessions of two hours each, where the reactions to work stress and coping skills were analyzed. Finally, the participants of both groups were re-assessed; the one-factor ANOVA statistic and the Cohen index were used to determine the effect of the intervention. ResultsSignificant differences were found between the experimental and control group in job satisfaction and burnout after the intervention. The effect size was (d=.68) in the 32% of motivation; and in 59%, of job satisfaction (d=1.46); in 25% the level of emotional exhaustion was decreased (d=.52) and in 33%, depersonalization (d=.70). ConclusionsEmotional cognitive training had a positive effect on motivation and job satisfaction and reduced the level of emotional exhaustion and depersonalization in the study group.

Quality of service at the geriatric outpatient department of a social security hospital: a qualitative study

Objetivo: Determinar la calidad de servicio a pacientes adultos mayores en niveles asistenciales ambulatorios de geriatria. Materiales y metodos: Estudio cualitativo con un grupo de 45 participantes mayores de 60 anos que acudieron para atencion medica al servicio de Geriatria del Hospital Guillermo Almenara Irigoyen entre enero y junio de 2005. Resultados: Se determino que el 77 % de los participantes se mostraron satisfechos con la calidad de atencion, ademas las categorias que presentaron mayores quejas fueron la falta de interaccion medico paciente, falta de empatia y seguridad durante su atencion del servicio. Los aspectos que destacaron fueron la confiabilidad y la entrega de informacion. Conclusiones: La falta de interaccion medico paciente y la falta de empatia son los problemas mas destacables.

The Relationship Between Ward Social Climate, Ward Sense of Community, and Incidents of Disruptive Behavior: A Study of a High Secure Psychiatric Sample

Assaults and seclusions within the UK obstruct patient recovery, and carry a combined UK cost of £106 million a year. Research has identified low ward social climate and lack of sense of community as potential factors that contributes to disruptive behavior. The current study investigates the relationship between self-reported sense of community and social climate scores with incidents of disruptive behavior (i.e., assaults and seclusions) within a UK high security psychiatric hospital. Findings reveal that both social climate and sense of community predict incidents of disruptive behaviour. This study suggests that both factors should be monitored in high security hospitals.

Investigación reciente sobre la cesárea y sobre el problema de la incidencia del cáncer

La cesárea es el procedimiento quirúrgico que se realiza con más frecuencia en los Estados Unidos, con casi 1.3 millones de casos realizados cada año. Después de aumentar durante varias décadas, la tasa de cesárea se ha estancado en aproximadamente el 32% de todas las entregas (1). En Perú, la tasa ha seguido aumentando de 22.9% en 2011 a 34.8% en 2017 (2). La tasa es más alta en los hospitales de seguridad social y mucho más en los hospitales privados.

Group cognitive analytic music therapy: a quasi-experimental feasibility study conducted in a high secure hospital

ABSTRACTThis study conducted a feasibility patient preference quasi-experimental study of group cognitive analytic music therapy (G-CAMT) for mentally disordered offenders. Participants either chose or were randomised to 16 sessions of manualised G-CAMT (N = 10) plus treatment as usual (TAU) or TAU alone (N = 10). Self-rated and staff-rated outcomes were assessed at baseline, post-intervention and 8-weeks post-intervention. Residency was assessed at 2-year follow-up. Results indicate that G-CAMT was easily implemented; 9/10 participants completed G-CAMT and attendees had high satisfaction with the approach. Session attendance was high; 4/10 participants attended all sessions. At the 8-week follow-up, 3/9 G-CAMT participants had reliable reductions (i.e. statistically reliable pre to 8-week follow-up change results) in intrusive/possessive behaviours and fear of separation/abandonment. On the staff-rated outcome measure G-CAMT participants as a group were statistically significantly friendlier compared to TAU at 8-week follow-up (U = 0.50, p = 0.009, d = 1.92, CI 0.44 to 3.11). There were no differences between the arms in terms of residency outcomes at 2-year follow-up. The study is discussed in terms of G-CAMT’s theoretical grounding and high acceptability. The study is limited by its small sample size, but indicates the possibility of progressing onto a full trial.

UHSI in the somatic care system for prisoners

Inter-regional secure hospital units have noted an increase in the complex pathologies and care load of detained patients they receive for somatic care in a short-stay scheduled hospitalisation. Communication between health care providers and prison staff is essential for the proper functioning of these closed units. Transmissions with level 1 health units are essential to ensure continuity of care upon the patient's return to custody.

The role of marketing mix (the 7 Ps) in patients’ attitudes to Iranian hospitals based on their kind of ownership (case study in Iran)

ABSTRACT Introduction: Disregard of marketing approaches, mutual profits of service providers and service users in the health-care section causes patients' dissatisfaction. This study aimed to investigate the role of the components of the marketing mix (7 Ps) in patients' tendency towards hospitals based on the kind of ownership. Method: This applied study was a descriptive-analytical research conducted in 2016 in two hospitals of Mazandaran Province, Iran. The research sample included 400 personnel (200 therapeutic and 200 non-therapeutic) selected by applying a stratified random sampling. They completed a valid and reliable standard questionnaire on marketing mix with seven components (7ps). Data were analyzed in SPSS 22. Findings: The highest mean belonged to the component price in both the teaching hospital (3.78 ± .58) and the social security one (4.03 ± .72). In the teaching hospital, the components product (p = .024), price and place (p < .001) and promotion (p = .015) had significant relationship with patients' tendency and in the social security hospital, the components price, place and personnel (p <. 001) showed such a relationship. Conclusion: Price, place, and personnel in the social security hospital and price, place, promotion and product in the teaching hospital were the main factors at work in marketing mix in patients' tendency to select health services.

684. Risk Stacking for Pneumococcal Disease in Costa Rica

BackgroundThe value of nontraditional high-risk factor stacking is not known in the Costa Rican population. We aim to describe risk factor stacking for pneumococcal disease (PD) in patients seeking care at Social Security Hospitals in Costa RicaMethodsDescriptive study of adult patients with microbiological culture-positive Streptococcus pneumoniae disease seeking care at two tertiary hospitals in Costa Rica between years 2014 and 2016. Information on underlying comorbidities (nontraditional) and other risk factors for PD was analyzed and stalked for each age group (G1: <50, G2: 50–64, and G3: ≥65 y/o).ResultsWe included 181 culture-positive patients. We found that patients in G1 predominantly stacked ≥2 risk factors (63%), the proportion of patients with ≥2 risk factor was similar to high-risk patients in G2 (33% vs. 38%). In G3, 18% didn’t stacked any other risk factor and 46% was on high-risk. Most frequent risk factors in G1/G2 were smoking and alcoholism, and in G3 chronic pulmonary and heart diseases.ConclusionWe conclude that risk factor stacking is more relevant than high-risk conditions and PD also occurs in persons <50 y/o. We recommend that risk factor stacking should be considered in prevention strategies for PD. Disclosures All authors: No reported disclosures.

Agents and spectres: Life-space on a medium secure forensic psychiatric unit

Medium secure forensic psychiatric units are unique environments within the broader ‘post asylum’ landscape of mental health services. Length of stay is much greater, a recovery-focused care system is much more difficult to implement, and there is a paucity of suitable “step-down” services. The aim of this study was to examine how forensic psychiatric environments contribute to the shaping of recovery, by examining key features such as social interactions and agency. Here, we report on the findings from patients participating in a qualitative-visual study. This analysis forms part of larger study on staff and patient experiences of secure hospital space. In this paper, the analytical focus is directed towards two key elements of recovery - agency and relationality, using the concept of ‘topology’ and ‘life-space’, developed by the social psychologist Kurt Lewin. First, we explore how patients have relative freedom to move within institutional spaces, yet lack relational space. Secondly, we explore how life-space is expanded or compressed by the manner in which the patient's present life in hospital is connected or disconnected from their past or pending future. Finally, we discuss the implications of these findings for a recovery model within secure forensic settings, focused on personalisation and expanded life-space.

Night-time confinement is an unacceptable hospital practice.

SummaryNight-time confinement, currently imposed as a blanket restriction on all patients on wards in UK high secure hospitals, constitutes an arbitrary restriction of liberty, not being based on any therapeutic purpose for those so restricted, nor serving a need for the protection of others. Its imposition constitutes a form of 'degrading' treatment as well as an unjustified restriction of 'residual' liberty. Persons who are vulnerable, especially those who are involuntarily detained as in this case, are particularly at risk of suffering human rights abuses. A compelling case can be made, based on ethics, law and accepted practice standards, for ruling out night-time confinement as an acceptable measure.Declaration of interestNone.

Évaluation du sadisme sexuel sévère dans un population médico-légale. Validation francophone de la Sexual Sadism Scale (SESAS)

ObjectivesSexual sadism is associated with a high risk of sexual violence and general recidivism in sex offenders. However, its evaluation encounters vague diagnostic criteria and uses idiosyncratic methods that require evaluators to infer the individual's motivations and sadistic fantasies. The Sexual Sadism Scale (SESAS) is a cumulative scale that is based exclusively on elements of the crime scene. Both inter-rater agreement and scale reliability of this one-dimensional scale comprising 11 items is high. The items are coded dichotomously based on offenders's files. An individual would be classified as likely meeting the diagnostic criteria if at least 4 of the criteria are present. The objective of our study was the French validation of the SESAS. MethodsFrom the sex offenders’ population in our High Security Hospital “Les Marronniers”, 62 participants were randomly selected. Participants signed a consent form. Inter-rater agreements were analyzed from two evaluators. Offender's files contained data concerning the offense(s), psychiatric expertises carried out for the courts in charge of the follow-up of the participants, and the psychiatric and social reports concerning the evolution of the patients. Results have been anonymized. Statistical analyzes were performed using the Statistical Package for Social Science (SPSS) software. In relation to the hypotheses of our study, the following analyzes were performed: Pearson's correlation coefficient (inter-rater agreement), Kappa coefficient (inter-rater agreement on items and inter-rater agreement on the established diagnosis), Alpha of Cronbach (Internal Consistency) and Principal Component Analysis (PCA) ResultsOf the 62 participants included, three met the diagnostic criteria for sexual sadism (4 or more criteria, 4.84%). The distribution of scores indicates that the 95% of the sample had 2 items or less, and the remaining 5% had 6 or more items. Of the 11 items in SESAS, the Pearson's correlation coefficient (r) is significant (r=0.76, p<0.001) and indicates a satisfactory positive association. Alpha of Cronbach is very satisfactory (α=0.86). The items in the scale tend to represent a good internal consistency, meaning that the scale is in adequacy with the object of its measurement: the latent profile of sexual sadism. From the Principal Component Analysis, A two-factor structure can not be retained. ConclusionsFrom this study, we were able to propose the French version of the SESAS as a useful scale in the evaluation of sexual sadism in a forensic population. We confirm the dimensional aspect of sexual sadism, as it tends to be described in the DSM-5 which distinguishes paraphilia from paraphilic disorder. Moreover, we show here, following the original studies, that an evaluation of sexual sadism based on the crime scene behavioral indicators allows to limit the bias of the idiosyncratic approaches, marked by the inference of individual's sadistic motivations and fantasies.

A comparison of the Levels of Organizational Learning in Hospitals, Based on Ownership Types: A Case Study in Iran

Objective: Learning new skills tremendously increases the self-confidence of employees and helps them attain their organizational targets. This study was done to compare the levels of organizational learning in hospitals with regard to ownership type. Methods: This cross-sectional study was conducted using an analytical-descriptive approach in 2016. The research community members included 2,162 employees of the nominated hospitals in Lorestan province. The sample consisted of 339 people, who were selected using Cochran’s formula with 95% reliability factor. The data collection tools used were the Persian edition of Watkins and Marsick’s standard questionnaire (2003). The collected data was analyzed by SPSS 20 software using statistical tests (i.e. Kolmogorov–Smirnov test, t-test, and ANOVA), and p ≤ 0.05 was considered significant. Results: The average score of learning variable was 2.77±0.64 for teaching hospitals, 2.57±0.77 for Social Security hospitals, and 3.21±0.94 for private hospitals. Learning variables variances were different in these three types of ownership (p < 0.001). Moreover, significant differences were found between learning aspects of individual learning (p < 0.001), group learning (p = 0.007), and organizational learning (p = 0.002). The study was based on the type of hospital ownership. Conclusion: The level of organizational learning in hospitals has a significant difference with regard to their type of ownership. The level of learning can be improved with the help of staff empowerment initiatives taken toward attaining common goals, creating equal opportunities for continuous learning for all personnel, and an appropriate relationship of the organization with the surrounding environment.

Relationship between Moral Intelligence and Anger in Social Security Hospital nurses

Relationship between Moral Intelligence and Anger in Social Security Hospital nurses

Uropathogens and their antibiotic sensitivity pattern among poorly controlled diabetic Pakistani patients with Asymptomatic Bacteriuria

Background: Urinary tract infections (UTIs) are common among diabetic patients, 60% of the patients with diabetes mellitus (DM) have risk of UTI and two third of them develop symptomatic or asymptomatic UTIs. The uropathogens may vary in their susceptibility to antimicrobials from place to place and time to time, therefore susceptibility pattern of predominant organisms against antimicrobials is essential. The aim of the study was to investigate the incidence of asymptomatic bacteriuria (ASB) and UTIs in clinically diagnosed diabetic patients and to determine the uropathogens responsible for ASB and UTIs as well as their antimicrobial susceptibility pattern.&#x0D; Methodology: An observational, prospective study was conducted at the Islamabad Social Security Hospital, Pakistan. Total 269 patients were recruited as per the study inclusion/exclusion criteria. Fasting blood glucose (FBG), blood sedimentation rate (BSR), urine routine examination (RE), abdominal ultrasound and hemoglobin-A1c (HbA1c) were examined in all patients to exclude other causes of urosepsis.&#x0D; Results: According to the study results 106 urine cultures were positive in the absence of urinary symptoms. Majority of the study subjects were around 50 years of age with an average glycosylated hemoglobin level of 8.98 g/dl. Urine culture and sensitivity test showed that E coli - Extended-spectrum beta-lactamases (ESBL) isolated in 39.63% was the most common organism sensitive to Tazobactam and Tiegecycline. E coli isolated in 32% was observed sensitive to levofloxacin, cefotaxime and tazobactam. Klebsiella (ESBL) isolated in 5.6% and found sensitive to tazobactum and amikacin. Klebsiella saprophyticus isolated in 3.77% with greater sensitivity to Tazobactum and cefixime while Enterococcus isolated in 5.6% mainly sensitive to minocycline and vancomycin. Majority of the isolated organisms were poorly sensitive or resistant to cefixime, quinolones and amoxiclav.&#x0D; Conclusion: Asymptomatic bactriuria is common in type 2 diabetic patients. The growth and sensitivity of microorganism reveal resistance and poor sensitivity to commonly used oral antibiotics therefore it is mandatory to treat UTI only after isolation of microorganisms according to culture and sensitivity to prevent resistant strains.&#x0D;

Dilema ético en la evacuación de un hospital ante un movimiento telúrico

&lt;p class="p1"&gt;&lt;strong&gt;&lt;em&gt;Introducción. &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;México está expuesto a una gran variedad de fenómenos geológicos, considerado como uno de los países con mayor actividad sísmica en el mundo por experimentar anualmente más de 90 sismos de una magnitud 4 o más en la escala de Richter, según datos del Fondo de Desastres Naturales.&lt;/em&gt;&lt;span class="s1"&gt;&lt;em&gt;1 &lt;/em&gt;&lt;/span&gt;&lt;em&gt;La OMS&lt;/em&gt;&lt;span class="s1"&gt;&lt;em&gt;2 &lt;/em&gt;&lt;/span&gt;&lt;em&gt;creó las Estrategias para la Reducción de Desastres, en las que integró en 2004 el término “Hospitales Seguros” con la finalidad de lograr que las personas tuvieran acceso a establecimientos de salud en correcto funcionamiento durante y después de un desastre natural. &lt;/em&gt;&lt;strong&gt;&lt;em&gt;Desarrollo. &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;En los hospitales conviven personas con afecciones en su salud, las cuales las limitan en movilidad y/o en sus funciones y merman su capacidad de toma de decisiones. De ellas, los pacientes en áreas críticas (quirófanos, cuidados intensivos) y pediátricas son los más vulnerables ante una contingencia. Por lo que es responsabilidad del personal de salud y brigadistas el prudente seguimiento de los protocolos de Protección Civil para su evacuación. &lt;/em&gt;&lt;strong&gt;&lt;em&gt;Conclusiones. &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;En el presente ensayo se exponen los principios éticos que el personal de salud enfrenta al momento de una emergencia de desastre natural, así como se contextualiza, en un marco normativo y también moral, las respuestas que permitan la ágil y oportuna acción ante estas situaciones, donde no existan juicios sobre la decisión tomada en el instante de la contingencia, pues es preciso definir con bases legales y éticas las responsabilidades a las que está comprometido para actuar durante y después de un siniestro.&lt;span class="Apple-converted-space"&gt; &lt;/span&gt;&lt;/em&gt;&lt;/p&gt;