Psychiatric nursing emergency: a simulated experience of a wrist-cutting suicide attempt.

A simulated wrist-cutting suicide attempt scenario was developed and implemented, with the goal of integrating the concepts of psychiatric emergency care, contraband, environmental assessment, and personal safety. Faculty also wanted to convey and provide care and support for participants through-out the visually and emotionally stimulating activity. The under-lying premise was that providing readings and lecture material on these topics was insufficient to the level of learning and performance needed by nursing students and novice nurses. How-ever, actual student clinical episodes integrating these concepts were also infrequent, unpredictable, and often not conducive to student learning. Therefore, faculty implemented a simulation teaching modality to deliver the concepts in a vivid and memorable format. A standardized rating scale on perceived learning and care from faculty during the course of the simulation was administered immediately following participation in the activity. Participants were overwhelmingly positive in their assessment of the activity, reporting an enhanced appreciation for safety in the conduct of inpatient psychiatric nursing care.Further, the faculty member's observation and post-simulation processing of the activity noted cognitive, behavioral, and emotional responses at the individual and group levels related to communication, observation and assessment, decision making,and interpersonal support

Rivastigmine: an open-label, observational study of safety and effectiveness in treating patients with Alzheimer's disease for up to 5 years.

BACKGROUND: Rivastigmine, a butyl- and acetylcholinesterase inhibitor, is approved for symptomatic treatment of Alzheimer's disease (AD). Data supporting the safety and efficacy of second-generation cholinesterase inhibitors, such as rivastigmine, are available for treatment up to 1 year, with limited data up to 2 1/2 years. The purpose of this report is to present safety and effectiveness data for rivastigmine therapy in patients with mild to moderately severe AD receiving treatment for up to 5 years. METHODS: An observational approach was used to study 37 patients with originally mild to moderate AD receiving rivastigmine as a therapy for AD in an open-label extension (ENA713, B352 Study Group, 1998). RESULTS: The initial trial demonstrated rivastigmine was well-tolerated and effective in terms of cognition, global functioning and activities of daily living. In this open label extension, high-dose rivastigmine therapy was safe and well tolerated over a 5-year period. Two thirds of the participants still enrolled at week 234 were in the original high-dose rivastigmine group during the double-blind phase, suggesting that early therapy may confer some benefit in delaying long-term progression of symptoms. CONCLUSIONS: Long-term cholinesterase inhibition therapy with rivastigmine was well tolerated, with no dropouts due to adverse effects past the initial titration period. Early initiation of treatment, with titration to high-dose therapy, may have an advantage in delaying progression of the illness.