[The family transition experience: family-centered hospitalization care of bipolar disorder patients].

BACKGROUND: Differences in cognition and attitudes between bipolar disorder patients and their families frequently result in differences between the two in terms of opinions and perceptions on appropriate medical treatments and prognoses. Transforming patient-centered-care psychotherapy into an intervention that provides family-focused nursing, promotes interaction among family members, and changes communication styles may assist families to adapt and focus on pursuing the soundest medical treatment. PURPOSE: This qualitative study explores the healing process of family transition in terms of family-centered care for bipolar disorder patients and nursing strategy intervention. METHODS: A psychiatric nurse with clinical experience used four 60-90 minute semi-structured, in-depth interviews to collect data from 8 families. The process was recorded and transcribed verbatim. Content analysis was used to analyze and categorize the major themes. RESULTS: Results were generalized into three themes that addressed the interaction-in-transition between patients and their families. These themes were: "All of the blame comes from the disease", "There is love in the family", and "Agreement to start over". Nurses increased their positive interaction with the family by facilitating cognitive, emotional, and behavioral change in the family. The 3 nursing strategy interventions used in this study to promote family adaptation in this study were: (1) guiding family experiences of the disease situation; (2) inspiring the potential strength in the families; (3) mobilizing the internal and external resources of families. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Nurses may help family healing by identifying family strengths and resources, looking for solutions to problems, transforming effective communicating style, and making family contracts.

Does non-implanted electrical stimulation reduce post-stroke urinary or fecal incontinence? A systematic review with meta-analysis.

BACKGROUND: Urinary and fecal incontinence are disabling impairments after stroke that can be clinically managed with electrical stimulation. AIM: The purpose of this systematic review was to determine the effectiveness of non-implanted electrical stimulation to reduce the severity of post-stroke incontinence. SUMMARY OF REVIEW: Clinical trials of non-implanted electrical stimulation applied for the purposes of treating post-stroke incontinence were searched in MEDLINE, EMBASE, CINAHL, PEDro, and CENTRAL. From a total of 5043 manuscripts, 10 trials met the eligibility criteria (n = 894 subjects). Nine trials reported urinary incontinence severity outcomes enabling meta-analysis of transcutaneous electrical nerve stimulation (TENS; five trials) and electroacupuncture (four trials). Studies provide good-to-fair quality evidence that TENS commenced <3 months post-stroke has a large effect on urinary continence (SMD = -3.40, 95% CI -4.46 to -2.34) and a medium effect when commenced >3 months after stroke (SMD = -0.67, 95% CI -1.09 to -0.26). Electroacupuncture has a large effect when administered >5 times a week (SMD = -2.32, 95% CI -2.96 to -1.68) and a small effect when administered five times a week (SMD = -0.44, 95% CI -0.69 to -0.18). Only one trial reported the effect of non-implanted electrical stimulation on post-stroke fecal incontinence. CONCLUSIONS: Published trials evaluating the effect of non-implanted electrical stimulation on post-stroke incontinence are few and heterogenous. Synthesized trials suggest that early and frequent treatment using electrical stimulation is probably more effective than sham or no treatment. Further trials measuring incontinence in an objective manner are required.

Randomized, controlled trial of a brief family-centred care programme for hospitalized patients with bipolar disorder and their family caregivers.

Family interventions have been emphasized in the treatment of bipolar disorder (BPD) due to the bidirectional and entangled relationships between patients and the family system, and have benefits for patients' symptoms and health; however, the effects of family interventions on family function and caregivers' health-related outcomes have not been well investigated. This randomized, controlled trial with 47 hospitalized patients with BPD/family caregiver dyads at a medical centre in northern Taiwan compared the effects of a brief family-centred care (BFCC) programme with treatment as usual (TAU). All of the family caregivers in two groups were invited to attend a routine 60-min family discussion group about violence and suicide prevention. The TAU group without specific family interview for patient and family caregiver dyad. In the BFCC group, four 90-min BFCC programme sessions were additionally provided twice a week for each hospitalized family dyad. We hypothesized that, first, family caregivers in the BFCC group could increase their family function, and second, improve perceived health status and reduce caregiver's burdens compared to the TAU. The results showed that family caregivers in the BFCC group significant interaction effects in overall family function (P = 0.03) and subscale conflict (P = 0.04), communication (P = 0.01), and problem-solving (P = 0.04), but there were no significant interaction effects on the caregivers' perceived health status and caregivers' burdens. Our findings support both the feasibility of using the BFCC programme for inpatients and its specific benefits for family function. An intensive family intervention during hospitalization has been suggested in psychiatric practice to support patients with BPD and family caregivers.