Twenty-two patients in moderate and late stages of dementia were observed for 8 weeks by caregiving staff of a special care unit. Results indicated that bathing in a typical institutional tub is both a source of apprehension and obstreperous behavior and a considerable departure from prior lifelong bathing experiences. Given information about the habits and idiosyncrasies of patients, staff can play an important role in minimizing obstreperous behaviors. Staff training and awareness of the physical environment, which included attention to the interrelationship between environment and behavior, were found to be instrumental in successful bathing.

Aged↗

PubMedDate not supplied

Dynamic Recovery: comparative study of therapeutic communities in homeless shelters for men.

The Dynamic Recovery Project examined relationships between homelessness, substance abuse, and recovery, and investigated the effectiveness of the therapeutic community (TC) treatment model in helping homeless drug users move toward stable, drug-free living. This project compared two short-term TCs that were situated within pre-existing homeless shelters with a clean and sober dormitory. In a separate condition, peer counselors and staff were provided additional training in TC philosophy and practice to reduce program dropout. Dramatic decreases in drug and alcohol use at follow-up were verified by urinalysis. Length of time in treatment rather than specific program accounted for decreased alcohol and drug use. Important decreases in posttreatment criminality for both treatment programs were documented. The comparison group, starting with low criminality, experienced smaller, nonsignificant decreases unrelated to type of program or time in treatment. Major declines in Beck Depression Scores were evident, but were unrelated to groups or time in treatment. Training had no measurable impact on client retention or outcomes and there were no significant differences between TCs and the comparison group on posttreatment drug use, criminality, or depression. This report documents that short-term therapeutic communities can be successfully implemented in public shelters for homeless men.

Adolescent↗

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Women and the drugs-crime connection: crime rates among drug abusing women at Rikers Island.

Explore the source record for details and available documents.

Adolescent↗

PubMedDate not supplied

The setting for the crack era: macro forces, micro consequences (1960-1992).

This article provides an overview of the social history leading up to the crack era, especially 1960 to the present. The central theme holds that several major macro social forces (e.g., economic decline, job loss, ghettoization, housing abandonment, homelessness) have disproportionately impacted on the inner-city economy. These forces have created micro consequences that have impacted directly on many inner-city residents and have increased levels of distress experienced by households, families, and individuals. Economic marginality has generated high levels of alcohol and other drug abuse as well as criminality, which are exemplified in this article by one inner-city household having an extensive family history exhibiting the chronic impacts of these macro forces and their micro consequences.

Crack Cocaine↗

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Studying crack abusers: strategies for recruiting the right tail of an ill-defined population.

This study attempts to better understand a limited segment of the drug-abusing population, especially individuals who repeatedly use crack and other drugs. This article addresses the methodological strategies and underlying paradigms informing the recruitment of hard-to-reach and ill-defined subpopulations of crack abusers and noncrack drug abusers. Subjects were recruited from diverse social contexts: streets or communities where most drug users do their business, arrested persons who were released, jail inmates, probationers and parolees, prison inmates, and treatment settings. A systematic comparison of subject attributes across recruitment locales and with other, similar target groups is presented. The utility and external comparability of the recruitment techniques are supported by the findings.

Adolescent↗

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Children's preoperative coping and its effects on postoperative anxiety and return to normal activity.

A model was tested to assess children's preoperative coping with major orthopedic surgery and how coping is related to two different postoperative outcomes, anxiety and return to normal activities. Ninety children, ages 8 to 17, participated. Data were collected the day before surgery, the second postoperative day, and at 3-, 6-, and 9-month recovery periods. A respecified model was not significantly different from the data (p = .90), indicating a good fit. Children who were older, more anxious, and more internal in locus of control exhibited more vigilant coping. Avoidant coping was associated with less anxiety 2 days postoperatively, and vigilant coping was associated with return to normal activities over the course of recovery.

Activities of Daily Living↗

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Non-physician supervision of cardiopulmonary exercise testing in chronic heart failure: safety and results of a preliminary investigation.

PURPOSE: In the current era of efficient use of personnel and cost containment, the use of non-physicians in selected roles previously occupied exclusively by physicians has become increasingly prevalent. Traditionally, physicians have directly supervised graded exercise testing of patients with chronic heart failure. The purpose of this prospective pilot investigation was to determine the safety and results of non-physician supervised exercise testing of these high-risk patients. METHODS: Two hundred eighty-nine consecutive outpatients (211 men, 78 women) with left ventricular ejection fractions of < or = 35% were referred for cardiopulmonary exercise testing. Symptom-limited treadmill graded exercise tests were supervised by paramedical personnel with a physician immediately available, but not present in the lab. RESULTS: Nonsustained ventricular tachycardia was present during exercise in approximately 20% of patients. Test-limiting hypotension was documented in 5% of subjects. Only one serious event occurred during the 289 exercise tests, an episode of ventricular fibrillation with a successful resuscitation outcome. Peak exercise respiratory exchange ratio averaged 1.10 +/- 0.14, consistent with a near-maximal patient effort. Peak oxygen uptake was 18 +/- 5 ml/kg/min. CONCLUSIONS: Supervision of cardiopulmonary graded exercise testing in properly screened patients with severe systolic left ventricular dysfunction by experienced non-physicians appears to be reasonably safe and the results are suitable for clinical decision making. Such a practice is an attractive cost-containment strategy and deserves further investigation.

Adult↗

PubMedDate not supplied

Children's ratings of postoperative pain compared to ratings by nurses and physicians.

Children's ratings of their postoperative pain were compared to nurses' and physicians' ratings of the children's postoperative pain. Children and adolescents were able to rate their pain using a visual analogue scale (VAS). Although there were differences between groups on their mean pain ratings, the ratings of the nurses and physicians correlated significantly with the children's pain ratings. Also, the correlation between nurses and physicians was highly significant, indicating that the use of a VAS may help nurses and physicians explore the cues used to estimate children's pain. This dialogue may enhance communication and collaboration between professionals about pain management strategies specific to each child's pain experience.

Adolescent↗