Risk factors for coercion length at psychiatric hospitals in Israel: Relationship with staff.

Background: Coercive interventions continue to be applied frequently in psychiatric care when patients are at imminent risk of harming themselves and/or others. Aim: The purpose of this study was to demonstrate the relationship between the length of coercion and a variety of factors, including the sociodemographic background of patients, their diagnoses and the characteristics of hospital staff. Methods: This is a one-year cross-sectional retrospective study, including records of 298 patients who underwent restraint and/or seclusion interventions in male acute, closed wards in two psychiatric hospitals in Israel. Results: A higher proportion of academic nurses to nonacademic nurses on duty leads to a shorter coercion time (P < 0.000). The number of male staff on duty, without any relation to their level of education, also leads to the shortening of the coercion time. Conclusion: The presence of registered, academic female nurses, male staff on duty and the administration of medication before coercive measures can reduce the length of restriction.

Impact of an Antibiotic Stewardship Program on the Incidence of Resistant Escherichia coli: A Quasi-Experimental Study.

Infections caused by multidrug-resistant Gram-negative bacteria increase hospitalizations and mortality rates; antibiotic pressure increases resistance rates. We evaluated the impact of the antibiotics stewardship program (ASP) on Escherichia coli resistance rates, evaluating all antibiotic use and patients with positive cultures hospitalized between 2011 and 2018. Data on antibiotics were collected quarterly as the defined daily dose (DDD)/100 days hospitalization. In 2014, an intervention was introduced, targeting the reduction of overall antibiotic use as well as specifically targeting quinolones and other broad-spectrum antibiotics. Using interrupted time series analysis (ITS), we compared the rates and trends of antibiotic use and resistant E. coli. We included 6001 patients, 3182 pre-ASP and 2819 post-ASP. We observed significant changes in absolute numbers as well as in trends for use of DDD/100 days of all antibiotics by 31% from 76 to 52, and by 52% from 10.4 to 4.9 for quinolones. ITS demonstrated that before the ASP intervention, there was a slope pattern for increased E. coli resistance to antibiotics. This slope was reversed following the intervention for quinolones -1.52, aminoglycosides -2.04, and amoxicillin clavulanate (amox/clav) -1.76; the effect of the intervention was observed as early as three months after the intervention and continued to decrease over time until the end of the study, at 48 months. We conclude that the ASP can positively impact the resistance rate of Gram-negative infections over time, regardless of the targeted combination of antibiotics, if the overall use is reduced.

Clinical and demographic characteristics of secluded and mechanically restrained mentally ill patients: a retrospective study.

BACKGROUND: Restraint or seclusion measures in acute psychiatric care are used as a last resort when all other methods for removal of physical threat have failed. The purpose of this study is to find a correlation between coercive measures, demographic characteristics within this patient group, and factors associated with shortened periods of restriction. METHODS: This is a one-year retrospective study conducted in a male acute closed ward of a psychiatric hospital in Israel. The data from January 1, 2014 to December 31, 2014 were retrieved from the records of patients who underwent restraint and/or seclusion interventions during this period. The analyzed data included age, psychiatric diagnosis, marital status, education, race, ethnicity, length of hospital stay, legal status during admission, type of coercive measure (mechanical restraint, seclusion), number and duration of coercive episodes, reasons for coercion, time of event, number of previous hospitalizations, aggression in past and present treatment, and treatment during events. RESULTS: During this time period, there were 563 admissions in the study ward. Over this period, 176 subjects (31.3%) underwent 488 restraints and/or seclusions. 98% were aggressive in the past. (Although some results reached statistical significance, we prefer to emphasize here only the most important results, while the others will be presented in the text.) Patients with personality disorders were physically limited for the longest time, while schizophrenia patients were restricted for the shortest time compared with other diagnoses (p = 0.007). A negative correlation was found between the length of coercion and the number of academic female nurses on duty (p = 0.005), as well as the administration of sedative medications during the restricting procedure. CONCLUSIONS: We believe that the presence of registered, academic female nurses on duty and medication administration during coercive measures can reduce the length of restriction.

Postoperative Atrial Fibrillation Following Coronary Artery Bypass Graft Surgery Predicts Long-Term Atrial Fibrillation and Stroke.

BACKGROUND: Atrial fibrillation (AF) is a common complication of coronary artery bypass graft (CABG) surgery, occurring in 20%-40% of patients, mostly during the first week after surgery. It is associated with increased morbidity and mortality, but data are limited. OBJECTIVES: To assess the correlation between new-onset in-hospital AF following CABG and long-term AF, cerebrovascular accident (CVA), or death. METHODS: We conducted an analysis of 161 consecutive patients who underwent isolated CABG surgery in a tertiary center during the period 2002-2003. RESULTS: Patients' mean age was 72 years, and the majority were males (77%). Approximately half of the patients experienced prior myocardial infarction, and 14% had left ventricular ejection fraction < 40%. Postoperative AF (POAF) occurred in 27% of the patients. Patients were older and had larger left atrium diameter. POAF was strongly correlated with late AF (OR 4.34, 95%CI 1.44-13.1, P = 0.01) during a mean follow-up of 8.5 years. It was also correlated with long-term stroke but was not associated with long-term mortality. CONCLUSIONS: POAF is a common complication of CABG surgery, which is correlated with late AF and stroke. Patients with POAF should be closely monitored to facilitate early administration of anticoagulant therapy in a high risk population upon recurrence of AF.

Contribution of dust storms to PM10 levels in an urban arid environment.

UNLABELLED: Quantitative information on the contribution of dust storms to atmospheric PM10 (particulate matter with an aerodynamic diameter < or = 10 microm) levels is still lacking, especially in urban environments with close proximity to dust sources. The main objective of this study was to quantify the contribution of dust storms to PM10 concentrations in a desert urban center, the city of Beer-Sheva, Negev, Israel, during the period of 2001-2012. Toward this end, a background value based on the "dust-free" season was used as a threshold value to identify potentially "dust days." Subsequently, the net contribution of dust storms to PM10 was assessed. During the study period, daily PM10 concentrations ranged from 6 to over 2000 microg/m3. In each year, over 10% of the daily concentrations exceeded the calculated threshold (BVt) of 71 microg/m3. An average daily net contribution of dust to PM10 of 122 microg/m3 was calculated for the entire study period based on this background value. Furthermore, a dust storm intensity parameter (Ai) was used to analyze several storms with very high PM10 contributions (hourly averages of 1000-5197 microg/m3). This analysis revealed that the strongest storms occurred mainly in the last 3 yr of the study. Finally, these findings indicate that this arid urban environment experiences high PM10 levels whose origin lies in both local and regional dust events. IMPLICATIONS: The findings indicate that over time, the urban arid environment experiences high PM10 levels whose origin lies in local and regional dust events. It was noticed that the strongest storms have occurred mainly in the last 3 yr. It is believed that environmental changes such as global warming and desertification may lead to an increased air pollution and risk exposure to human health.

Oral squamous cell carcinoma in patients twenty years of age or younger--review and analysis of 186 reported cases.

To review the literature on reported cases of squamous cell carcinoma (SCC) of the oral cavity in patients twenty-years-of-age or younger. All well-documented cases of oral SCC in patients twenty-years-of-age or less, published between 1936 and 2012, were collected and the clinicopathologic features were evaluated. Primary cases of oral SCC were selected. Age, gender, intra-oral subsite were recorded. A total of 88 articles describing 186 cases were included. The group of otherwise healthy patients had a mean age of 14.08years (range newborn-20years), the m:f ratio was 1.36; the oral subsites were the tongue, gingiva, and lower lip. A second group of patients who have disorders that predispose to cancer development, such as xeroderma pigmentosum, Fanconi's anemia, and a history of bone marrow transplant, had a mean age of 13.17years (range 5-20years); the m:f ratio was 1.23; the oral subsite was mainly the tongue. There was a slight difference between otherwise healthy patients and patients with predisposing systemic factors, but this difference was not statistically significant. It contrast to adults, there is only a weak predilection for males (m:f ratio of 1.23-1.36). In the young population SCC occurs most frequently in the tongue, followed by gingiva and lips. Unlike in adults, SCC is very uncommon in the floor of mouth. Oral SCC may, indeed, occur in patients younger than 20years and clinicians should take cognizance of this. Periodical examination of the oral cavity of young patients is recommended in cases of systemic diseases that predispose to cancer development such as xeroderma pigmentosum, Fanconi's anemia, and a history of bone marrow transplant.

Predictive value of amplitude-integrated electroencephalography pattern and voltage in asphyxiated term infants.

The aim of this study was to correlate amplitude-integrated electroencephalography soon after birth with neurodevelopmental outcome in children who suffered from hypoxic-ischemic encephalopathy. Near term infants with hypoxic-ischemic encephalopathy and amplitude-integrated electroencephalography recording before 6 hours of age were included. Neurologic and cognitive outcome were assessed at 30 months of age and over. Outcome was correlated with either the pattern or voltage of the tracing. Thirty-nine infants were included. Eight died in the immediate neonatal period. At the age of 3 and 6 hours, sensitivity of low voltage to poor outcome was 33% and 42% respectively and of burst suppression pattern to poor outcome was 83% and 75% respectively. Association of voltage to outcome was significant only at 6 hours of age (P = 0.025). Association of pattern to outcome was significant both at 3 and 6 hours of age (P = 0.003, 0.008). These data on amplitude-integrated electroencephalography predictive value early in life were similar to previous studies. Burst suppression pattern, as early as 3 hours of age, is associated with poor outcome. At the age of 6 hours, both low voltage and burst suppression are associated with poor outcome. Pattern seems more sensitive than voltage.