Coercion in Psychiatry: Exploring the Subjective Experience of Coercion Among Patients in Five Portuguese Psychiatric Departments.

The subjective experience of coercion may have a more significant impact on clinical outcomes than formal coercive measures. This study aimed to investigate the subjective experience of coercion among patients on admission in Portuguese psychiatric departments by assessing their perceived coercion, procedural justice, and negative pressures during admission. The study also investigated whether this subjective experience of coercion changed with time during admission, and the predictors of this change. Validated instruments, including the McArthur Admission Experience Survey (AES) and the Client Assessment of Treatment Scale, were used to collect information from 208 adults admitted to five public psychiatric inpatient departments in rural and urban regions of Portugal. About a third (32.24%, n = 49) of the sample had a legal involuntary admission status, while more than a third of them perceived their admission to be involuntary (40.13%, n = 61). The subjective experience of coercion was significantly higher among people who perceived their admission to be involuntary compared to people who perceived their admission to be voluntary (Median = 10, IQR = 5.5 vs. Median = 3, IQR = 6; p < 0.001). Satisfaction with their care was significantly inversely correlated with the subjective experience of coercion (p < 0.01). The changes in the subjective experience of coercion at the second assessment were predicted by the perceived admission status rather than the legal admission status, and the initial procedural justice (p < 0.05). The study findings highlight the importance of improving procedural justice in psychiatric admissions, regardless of the legal status of admission.

Tratamiento de la no unión ósea con clavo colchero / Treatment with Colchero's nail for bone nonunion

Se presentan 722 casos de no unión ósea (en tibia 344, en fémur 292 y en húmero 86) tratados por medio del clavo Colchero intramedular con pernos. En 382 pacientes el padecimiento fue aséptico y en 340 infectados por lo cual hubo que retirar la sepsis por el método de escarificación, para convertir la falta de unión en aséptica y dejarla preparada para la osteosíntesis. En las no uniones atróficas se utilizó hueso esponjoso autólogo y en las hipertróficas no hubo que recurrir a este procedimiento. La unión se logró con una cirugía en 720 casos, existiendo 2 no uniones que se volvieron a operar por el mismo método y se resolvieron. La marcha con apoyo total se inició a los tres días de la cirugía; con ello, la consolidación fue rápida, el enfermo pudo volver al trabajo pronto y a una vida social activa