Use Of Control Interventions Research Articles

Determinants of Non-emergency Use of Control Interventions in Older Canadian Psychiatric Inpatients: Analysizing the InterRAI Mental Health Electronic Health Records.

Background: The use of control interventions (CIs; acute control medications, physical/mechanical restraint) is associated with negative physical and psychological outcomes, particularly in older adults who are physically vulnerable. The aims of this study were to: (i) report the rates of CI use in older psychiatric inpatients (age 65 – 84 and age 85+), and compare them with younger age groups (18 – 44, age 45 – 64); and (ii) identify the factors associated with non-emergency CI use in older psychiatric inpatients.Methods: Routinely collected interRAI Mental Health assessments from 2005 – 2018 in Ontario, Canada, were analyzed to determine the rates of CI use. Logistic regression models were used to examine the sociodemographic and clinical determinants of non-emergency and any CI use.Results: There were 226,119 (female: 48.6%) interRAI assessments, and 85% of those assessed were under 65 years of age. The rates of non-emergency CI use in the four age groups were: 18 – 44 = 9.4%, 45 – 64 = 8.3%, 65 – 84 = 9.9%, 85+ = 13.2%. The most significant determinants of non-emergency CI use in older adults were highest impairments in activities of daily living (ADL Short Form score 8–16: OR = 2.72, 95% CI = 2.42 – 3.06), highest levels of aggression (Aggressive Behavior Scale score 4 – 6: OR = 1.76, 95% CI = 1.57 – 1.98), and highest levels of positive psychotic symptoms (Positive Symptoms Scale score 9+: OR = 1.65, 95% CI = 1.43 – 1.90). Delirium, cognitive disorder diagnosis, cognitive impairment, and falls were also associated with increased CI use odds, as were having the reasons for admission be danger to self, danger to others or inability to care for self. Females were less likely to have non-emergency CI use (OR = 0.84, 95% CI = 0.73 – 0.95). Patients admitted from long-term care homes had significantly greater odds of non-emergency CI use compared with community admissions (OR = 1.18; 95% CI = 1.07 – 1.29).Conclusion: The higher rates of non-emergency CI use in older psychiatric inpatients is concerning. Alternative non-pharmacological and person-centered management strategies should be considered to support older psychiatric inpatients with functional impairment, positive symptoms, aggressive behavior, cognitive impairment and delirium. The use of CIs could be incorporated as a quality improvement activity to monitor changes at various service provision levels.

Moving Forward.

Moving Forward.

Optimal control of infectious disease: Information-induced vaccination and limited treatment

In this study, a nonlinear compartmental model for an infectious disease is proposed. The spread of information is considered due to spread of disease in the population. The dynamics of the information is modeled by a separate rate equation and it is assumed that the growth of the information depends on the density of the infective population. The model accounts for the effect of information on vaccination coverage during the epidemic outbreak when medical resources for treatment are limited. Further, considering information-induced vaccination and treatment as controls, an optimal control problem is proposed which minimizes costs incurred due to the disease burden and applied controls. The total incurred cost is determined by taking a weighted sum of cost of productivity loss due to disease and costs incurred in applying control interventions. A higher nonlinearity in cost is considered for information induced vaccination efforts. With the help of Pontryagin’s Maximum Principle, the control system is analyzed and optimal control profiles for the applied controls are obtained. We further numerically explore the optimal control problem. A comparative study is made by choosing following control strategies: (A) execution of only information-induced vaccination, (B) implementation of only treatment and (C) execution of both the policies simultaneously. We observe that the comprehensive use of control interventions reduces the severity of the disease burden and also minimizes the economic burden incurred due to these interventions. Further, the effect of the basic reproduction number on the proposed control strategies as well as on the dynamics of infectious diseases is investigated. The numerical results infer that the treatment is more effective and economically feasible for a mild epidemic, while the information induced vaccination is more efficient for a serious epidemic.

Use of control interventions in adult in-patient mental health services.

This study examined the prevalence of Control Intervention (CI) use in adult in-patient psychiatric units/hospitals in Ontario and developed a profile of those patients who had CI use during their admission between April 2006 and March 2010. Control intervention types included mechanical/physical, chair prevents rising, acute control medications, and seclusion. The profiles of patients with control intervention use included an examination of sociodemographic, mental health service use, and mental health clinical characteristics.