Biometric palm vein authentication of psychiatric patients for reducing in-hospital medication errors: a pre-post observational study.

OBJECTIVES: This study aimed to evaluate a biometric palm vein authentication system to prevent medication administration errors in psychiatric hospitals. DESIGN: This is a pre-post observational study. SETTING: Conventionally, the medication was distributed after a double check. We developed and introduced a new medication administration cart in two psychiatric hospitals in Japan, in which each patient-specific drug box had to be electronically opened only by palm vein authentication. PARTICIPANTS: A total of 3444 and 3523 patients were present 18 months before and after introducing the cart, respectively. Of the 212 nurses recruited, 28 were excluded due to a lack of experience with the conventional medication administration system and incomplete questionnaires. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the efficacy of this system by comparing the incidence of medication administration errors before and after introducing the cart. The secondary outcome was a survey regarding nurses' attitudes toward this system. RESULTS: After introduction of the new system, the number of medication errors due to misidentification of persons relative to the total number of admitted patients was significantly reduced from 6/3444 to 2/3523 (p<0.0001). Among 184 nurses, 182 responded that anxiety regarding administration errors was either reduced or unchanged using this system. Male nurses reported a greater increase in work burden than female nurses (OR=3.11, 95% CI=1.44 to 6.72). Nurses working in chronic care wards reported greater time pressure than nurses working in emergency wards (OR=3.33, 95% CI=1.16 to 9.57). Nurses working in dementia care wards reported a greater patient care burden than nurses working in emergency wards (OR=5.67, 95% CI=1.22 to 26.27). CONCLUSIONS: This new system might have potential for reducing the patient misidentification risk during medication without increasing the anxiety experienced by nurses concerning administration errors. However, system usability and efficiency must be improved to reduce additional work burden, time pressure and patient care burden.

[Psychiatric Experts' Opinion on the Diagnosis and Treatment for Behavioral and Psychological Symptoms of Dementia].

Besides data cited from several articles about behavioral and psychological symptoms of dementia (BPSD), including diagnosis and treatment guidelines of dementia published by Japanese Society of Neurology in 2017, how BPSD are elucidated in three dimensions, bio-psycho-social, in the clinical practice are defined by four specialists at dementia centers. In fact, understanding the following two aspects is highly emphasized. The first aspect relates to the symptoms directly elicited by the pathological process of the cause disease of dementia; another aspect is how a person with dementia recognizes the outside world and attempts to adapt to the surroundings inapproately.

Risk Factors of a Suicide Reattempt by Seasonality and the Method of a Previous Suicide Attempt: A Cohort Study in a Japanese Primary Care Hospital.

Suicide has a great impact on the individual whose life is lost and the bereaved family members. The risk of a suicide reattempt is particularly high during the first 12 months after a suicide attempt. In this cohort study, risk factors for a suicide reattempt were explored among 291 patients at suicide risk. Clinical and demographic data were collected from a Japanese primary care hospital. Past psychiatric history and multiple diagnoses were associated with suicide reattempts in both genders. Drug overdose, past psychiatric history, and the summer season were linked to suicide reattempts among males. Past psychiatric history and multiple diagnoses were linked to suicide reattempts among females. Appropriate assessment of past psychiatric history, season and method of suicide attempt, gender, and diagnosis may play a role in preventing suicide.

A case-control study regarding relative factors for behavioural and psychological symptoms of dementia at a Canadian regional long-term extended care facility: a preliminary report.

BACKGROUND: Behavioural and psychological symptoms of dementia (BPSD) are prevalent and have an impact on the care of persons with dementia. Previous studies regarding predisposing factors have included pharmacotherapy, but other factors may not have been sufficiently studied. We hypothesized that psychotropic medications, past history, comorbid psychiatric disorders and other factors may be relevant factors related to BPSD. METHODS: Data were collected from patients' medical charts at an extended care facility over a 2-year period from 1 May 2008 to 30 April 2010. Information obtained included the presence of BPSD, gender, age, marital status, past history, comorbid psychiatric disorder and medication use. Patients were divided into two groups: a group with BPSD (n = 29) and a group without BPSD (n = 10). A binomial logistic regression analysis was performed for the above factors. RESULTS: Comorbid major depression was linked to BPSD (odds ratio = 12.57, 95% confidence interval: 1.31-120.74) as well as to the use of antidepressants (odds ratio = 6.49, 95% confidence interval: 1.02-41.25). There was a trend towards statistical significance in the relationship between greater use of antidepressants for the patients with comorbid major depression and the presence of BPSD. Past history of depression (Fisher's exact test; P = 0.03) and cerebral vascular accident (degrees of freedom = 1, χ(2) = 4.44, P = 0.04) were linked to the presence of BPSD and comorbid major depression. CONCLUSION: Accurate evaluation and treatment of comorbid major depression may affect BPSD. In order to reduce the burden of BPSD on patients and caregivers, there should be a careful and thoughtful diagnosis of comorbid major depression in patients with dementia.

Impact of the great East Japan earthquake on caregiver burden: a cross-sectional study.

OBJECTIVE: After the great East Japan earthquake of 2011, residents with intellectual disabilities and their caregivers in Fukushima were evacuated to the prefecture of Chiba. We investigated the impact of the earthquake on the caregivers' burden. METHODS: Between August 2011 and January 2012, 46 caregivers evacuated from Fukushima and 46 caregivers at similar facilities in Chiba who were not forced to evacuate completed a survey including the 12-item General Health Questionnaire (GHQ-12) and additional questions. A logistic regression analysis and median tests were performed. RESULTS: The evacuation was linked to GHQ-12 global scores ≥3, indicating psychiatric morbidity (relative risk [RR]=2.81), as well as to scores ≥8, indicating a more severe condition (RR=3.57). There was a trend for evacuated caregivers to have more social dysfunction than psychological distress. CONCLUSIONS: A statistically significant difference in emotional stress was observed among caregivers who were forced to evacuate after the earthquake.

Delayed recovery of caregivers from social dysfunction and psychological distress after the Great East Japan Earthquake.

BACKGROUND: In April 2011, two hundred and eighty residents who were suffering from intellectual disabilities and their eighty caregivers at nine facilities in Fukushima were evacuated and moved to Chiba, Japan after the Great East Japan Earthquake. We investigated the impact of the evacuation after the earthquake on the caregiver burden. METHOD: There were 41 participants from Chiba as a reference group and 32 participants from Fukushima as a case group included. Data were collected regarding their demographics and the General Health Questionnaires 12 (GHQ-12) score for both groups in two different points. RESULTS: The evacuation was linked to a follow-up GHQ-12 global score ≥ 3 (RR=4.52, 95%CI; 1.32-15.47). There was no significant improvement of the GHQ-12 global score in the case group from Fukushima for the follow-up data compared to the baseline data. Social dysfunction had continued in the case group from the baseline data (p<0.01) during the follow-up period (p<0.001). A statistically significant difference was noted for the case group from Fukushima regarding psychological distress in the follow-up data (p<0.01), which was not found in the baseline data (p=0.07). LIMITATIONS: The sample size was limited to a non-randomized and unmasked sample of 73 patients. No causal relationship could be determined due to the cross-sectional nature of the study. CONCLUSIONS: The caregivers from Fukushima exhibited more psychiatric morbidity, which persisted for the duration of their evacuation after the earthquake. It is important to provide long-term support for such caregivers who have been evacuated after a major disaster.