Characteristics of Patients With Constant Observers.

BACKGROUND: The use of constant observers ("sitters") has been common practice in many medical centers to maintain patient safety. RESULTS: A retrospective chart review of patients who required sitters from October 1, 2007 to September 31, 2013 at a large, private hospital serving a multiethnic community showed that the top reasons for sitters include suicide risk, agitation, fall risk, interfering with medical devices, and confusion/disorientation. Sitters were used for a mean of 3.4 days ranging from 1 to 287 days, with a mean hospital length of stay of 18.9 days. Although 42.4% of all cases with sitters had a psychiatric consultation, psychiatry was consulted on only 8.5% of those with agitation, 6.3% of those who were disoriented, and 12.7% of those with decisional capacity concerns. Psychiatry was consulted on 87.4% of patients with a constant observer for suicide risks. Sitters were most often discontinued when behaviors improved or when patients were discharged. CONCLUSION: This information will be useful for understanding the optimal way to implement a program that will increase patient safety and decrease cost.

Predator odor fear conditioning: current perspectives and new directions.

Predator odor fear conditioning involves the use of a natural unconditioned stimulus, as opposed to aversive electric foot-shock, to obtain novel information on the neural circuitry associated with emotional learning and memory. Researchers are beginning to identify brain sites associated with conditioned contextual fear such as the ventral anterior olfactory nucleus, dorsal premammillary nucleus, ventrolateral periaqueductal gray, cuneiform nucleus, and locus coeruleus. In addition, a few studies have reported an involvement of the basolateral and medial nucleus of the amygdala and hippocampus in fear conditioning. However, several important issues concerning the effectiveness of different predator odor unconditioned stimuli to produce fear conditioning, the precise role of brain nuclei in fear conditioning, and the general relation between the current predator odor and the traditional electric foot-shock fear conditioning procedures remain to be satisfactorily addressed. This review discusses the major behavioral results in the current predator odor fear conditioning literature and introduces two novel contextual and auditory fear conditioning models using cat odor. The new models provide critical information on the acquisition of conditioned fear behavior during training and the expression of conditioned responses in the retention test. Future studies adopting fear conditioning procedures that incorporate measures of both unconditioned and conditioned responses during training may lead to broad insights into predator odor fear conditioning and identify specific brain nuclei mediating conditioned stimulus-predator odor unconditioned stimulus associations.