[Effects of a training of power and balance on the use of mechanical restraint among in-patients with dementia]. / Effekte eines Kraft- und Bewegungstrainings auf die Fixierungshäufigkeit bei Demenzpatienten in der stationären gerontopsychiatrischen Versorgung.

BACKGROUND: Patients with dementia are most frequently affected by mechanical restraint in psychiatric hospitals, most frequently due to falls. There is evidence for beneficial effects of a training of power and balance on the frequency of falls in residential homes. METHODS: An adapted training of power and balance was developed by specialists of training in sports. In 2007, 159 patients with dementia were trained. The frequency and duration of mechanical restraint was compared with a control group of a different hospital (n = 217) and the patients treated in the year before (n = 164). RESULTS: The percentage of patients with mechanical restraint and the mean duration of restraint per admission were significantly lower than in the control group. However, only a non-significant reduction could be achieved in comparison with the patients treated in the year before without an increase of falls. CONCLUSIONS: A considerable reduction of the use of mechanical restraint in patients with dementia is feasible. An unequivocal association with the training could not be confirmed due to other influencing factors.

[Incidence of coercive measures as an indicator of quality in psychiatric hospitals. Problems of data recording and processing, preliminary results of a benchmarking study]. / Die Inzidenz von Zwangsmassnahmen als Qualitätsindikator in psychiatrischen Kliniken. Probleme der Datenerfassung und -verarbeitung und erste Ergebnisse.

OBJECTIVE: The clinical practice concerning the use of coercive measures in psychiatry should be compared. METHOD: A common documentation of physical restraint, seclusion, and medication by coercion was introduced among 10 hospitals. RESULTS: 8.4 % of cases treated within the first 6 months of 2004 were exposed to coercive measures with the highest percentage among patients with psychoorganic disorders (32.1 %). The incidence of coercive measures varied highly between different diagnostic groups and hospitals. DISCUSSION: The processing of the large multi-site data sets yields considerable technical problems. Data interpretation should consider confounding factors such as case mix and hospital structure characteristics.

Diagnosis-related frequency of compulsory measures in 10 German psychiatric hospitals and correlates with hospital characteristics.

OBJECTIVE: To investigate the incidence of coercive measures in standard psychiatric care in different psychiatric hospitals. METHODS: We developed a common documentation of mechanical restraint, seclusion, and medication by coercion, and introduced it in 10 participating hospitals. We developed software able to process the data and to calculate four key indicators for routine clinical use. RESULTS: 9.5% of 36,690 cases treated in 2004 were exposed to coercive measures with the highest percentage among patients with organic psychiatric disorders (ICD-10 F0) (28.0%). Coercive measures were applied a mean 5.4 times per case and lasted a mean 9.7 h each. The incidence and duration of coercive measures varied highly between different diagnostic groups and different hospitals. Use of detailed guidelines for seclusion and restraint was associated with a lower incidence of coercive measures. DISCUSSION: Data interpretation should consider numerous confounding factors such as case mix and hospital characteristics. Suggestions on how to cope with ethical and technical problems in the processing of large multi-site data sets in routine clinical use are made.

Inmunosupresión de las emulsiones lipídicas parenterales en un modelo de inmunoestimulación definida / Immunosuppresion by parenteral lipid emulsions in a model of defined immunostimulation

En el modelo del alotransplante de corazón en ratas se investigó el efecto inmunosupresivo de emulsiones grasas i.v. con una combinación diferente de ácidos grasos n-3 y n-6. Emulsiones de un 20 por ciento de aceite de cardo (n-3/n-6=1/370), de pescado (7,6/1), de soja (1/6,5), y una mezcla 1:1 de aceite de cardo y de pescado (1/2,1; como grupo control de aceite) fueron infundidos continuamente después del trasplante hasta el rechazo (9g de grasa/Kg peso corporal diario, n=10 por grupo). Fueron analizados el tiempo de supervivencia del trasplante, las subpoblaciones del infiltrado de células inmunocompetentes o circulantes y la secreción de interleuquina-6 de células mononucleares circulantes. En el grupo de aceite de cardo, de pescado y de soja, el tiempo de supervivencia del trasplante fue alargado hasta 13,3; 12,3 y 10,4 días en comparación a los 6,7 días en el grupo de aceite respectivamente y de 7,8 días en el grupo control de NaCL (p<0,01). En los dos grupos con la prolongación de supervivencia más alta se redujo el número de células en el infiltrado hasta un 50 por ciento y la producción de interleuquina-6 de células monocelulares hasta un 45 por ciento. Además se observó una disminución de las células-T circulantes en el grupo aceite de pescado. Las emulciones grasas i.v provocan, dependiendo de la relación de ácidos grasos de n-3/n-6, diferentes reacciones inmunomodulantes. Tanto los ácidos grasos de n-6 como los n-3 causan su efecto inmunosupresor mediante la reducción de la infiltración, la movilización y la producción de citocinas de células inmunocompetentes. El aceite de soja, con la relación de ácidos grasos n-3/n-6 más ponderada que el aceite de cardo, es significativamente menos inmunosupresivo, y las emulsiones grasas con una relación n-3/n-6 1.2 son inmunológicamente neutrales