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PubMed2006

Assessment of risk and special observations in mental health practice: a comparison of forensic and non-forensic settings.

The use of special observations in psychiatric practice may be employed as an alternative to more restrictive methods such as the use of seclusion and restraint. From the literature, special observations are used for a complex array of signs and symptoms (and risk behaviours) which include suicidal intent, self-injurious behaviour, hallucinatory experiences, and absconding. This paper reports on research into the use of special observations in both forensic and non-forensic psychiatric settings. A comparative approach was adopted to establish if the perceived risk factors leading to the adoption of special observations were similar in both settings. Three groups of nursing staff were requested to assess 30 patients who were placed on special observations. Before this, nurses were requested to rate the risk factors in terms of their severity on a 7-point Likert scale. The rank-ordering analysis revealed a similarity of identified risk factors and anova (one-way, unrelated) and the Jonckheere Trend Test revealed that there were significant differences between the scores in the forensic and the non-forensic settings. The statistical differences existed for risk factors relating to harm to self and others but not for psychiatric symptomatology.

Analysis of Variance↗

PubMed1984

Epilepsy rehabilitation: evaluating specialized versus general agency outcome.

This 1982 study was a retrospective comparison of vocational outcome between eight state rehabilitation agencies and the University of Washington Epilepsy Center's Vocational Unit for the years 1977-1978. Hypotheses included: (a) A significantly higher portion of those with epilepsy will find employment through a specialized (i.e., Epilepsy Center) versus a general rehabilitation program. (b) A specialized program will have a significantly lower proportion of program dropouts. (c) Those finding jobs through a specialized program will earn higher salaries and have better job retention than those employing a general agency program. On several comparisons the specialized program outperformed the general agencies--higher proportion of successful job placements and lower proportions of dropouts and those remaining in process (all chi2 tests significant at the p less than 0.001 level). Placement rates for specialized programs have traditionally approximated 50%, whereas these state agencies placed from 9 to 21%. Salary level and job retention differences were inconclusive. Data implications are discussed.

Employment↗

PubMed1998

Utility of deeper sections and special stains for dermatopathology specimens.

Special (non-hematoxylin and eosin) stains and deeper sections are routinely used in dermathopathology, although their utility has not been well established. All cases requiring special stains or deeper sections over a three-month period were reviewed to see how often these additional studies contributed to accurate diagnosis. In our series, deeper sections provided diagnostic information to the pathologist in 37.3% [95% confidence interval (CI) 28-46%] of the cases in which they were performed. Deeper sections are more likely to provide a more accurate diagnosis (23.6%, 95% CI 16-32%) rather than establish a new diagnosis not seen on the original sections (13.6%, 95% CI 7-20%). Their use is especially helpful in assessing the presence or absence of cutaneous malignancy rather than in diagnosing inflammatory skin processes. Special stains contributed to the diagnosis in 21.1% (95% CI 11-32%) of cases. When special stains were performed to diagnose an infection they were effective in 14.7% (95% CI 6-24%) of the cases. When special stains were performed to diagnose any other pathologic processes (neoplasm, inflammation, collagen vascular disease, and amyloid) they were effective in 31.8% (95% CI 24-44%) of the cases.

Coloring Agents↗

PubMed1988

Special antigens on sperm from autoimmune infertile men.

Sera from three fertile men and four infertile men without sperm antibodies, 17 infertile men with sperm antibodies in serum and seminal plasma (S.P.), and 25 infertile men with sperm antibodies in S.P. were tested by Western Blot analysis against sperm membrane extracts and S.P. from fertile nonautoimmune men and infertile autoimmune men. Sera from fertile men reacted against common antigens with molecular weights (MW) of 28, 38, 48, 60, and 68 kD present on sperm from autoimmune and nonautoimmune men and special antigen of MW 76 kD on the sperm of fertile men. Sera from 15 of 17 (88%) autoimmune infertile men with sperm antibodies in serum and S.P. detected special antigens with MW of 58 kD (sera reactivity in 47% of these men), 43kD (in 29%), 30 kD (in 24%), 35 kD (in 18%), 52 kD (in 12%), 41 kD (in 6%), and 71 kD (in 6%) on the sperm of autoimmune men in addition to the common antigens. Sera from 15 of 25 (60%) men with sperm antibodies in their S.P. showed reactivity to special antigens with MW 52 kD (in 20%), 35 kD (in 16%), 41 kD (in 16%), 58 kD (in 8%), 70/71 kD (in 8%), 30 kD (in 8%), and 56 kD (in 4%). Sera from 18 of 42 (43%) infertile men with sperm antibodies also detected special antigens of MW 26, 46, and 76 kD present only in fertile men's sperm. Sera from only 15 of 42 (36%) autoimmune infertile men reacted against special antigens with MW 17, 20, 23, 30, 43, and 58 kD in the seminal plasma of autoimmune infertile men.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens↗

PubMed2000

What happens to special hospital patients admitted to medium security?

This article describes the outcome of all the Special Hospital patients admitted to and discharged from the Norvic Clinic over a period of ten years since its opening in 1984. This study identified 23 patients. Of those transferred, 56% had a legal classification of mental illness. A much higher percentage (91%) were restricted under the powers of s.41 of the Mental Health Act 1983, compared to 69% in the West Midlands study (Cope and Ward, 1993). There appears to be a significant difference between the mental disorder groups for age on admission to Special Hospital when considering all patients (males and females). This difference is not maintained when males and females are looked at separately, although the result for males is nearly significant (p = 0.0606). The number of female patients is small (five) and so the tests will hardly be reliable for the female sample. No significant differences were demonstrated for any of the other variables considered. Like the West Midlands study, minor reconvictions were completely absent. This was an unusual finding within the West Midlands study and not replicated from any of the previous Special Hospital studies. In this study, failure constituted an unsuccessful transfer with return to Special Hospital and reconviction. The percentage of those returned to Special Hospital without reaching the community was slightly lower than the West Midlands study, for both the mentally ill and those classified as suffering from psychopathic disorder.

Adolescent↗

PubMed2001

The use of electroconvulsive therapy in special patient populations.

BACKGROUND: Despite its well-established efficacy and its increasing use, electroconvulsive therapy (ECT) remains a controversial treatment. Lack of clarity in the issues related to its use in special patient populations (for example, in children, in adolescents, in pregnant women, in the elderly, and in the medically ill) often contributes to the debate about the use of ECT. METHOD: The literature on ECT use in special patient populations is reviewed, together with the commonly associated high-risk medical conditions in clinical practice. Specific reference is made in each case to the safety, tolerability, and efficacy of the procedure. RESULTS: Much of the literature surveyed consists of case studies, although a few controlled trials are available. In general, ECT use in special populations is relatively safe and extremely effective. In small case series, ECT use in children and adolescents is effective but requires further systematic study. In pregnant women, ECT is very effective, and with proper medical care, it is relatively safe in all trimesters of pregnancy, as well as in the postpartum period. The frail elderly are particularly good candidates for ECT because they are often unresponsive to or intolerant of psychotropic medication. Medical conditions that should receive particular attention during a course of ECT are disorders of the central nervous system (CNS), cardiovascular, and respiratory system. With modern anesthesia techniques and careful medical management of each high-risk patient, most can successfully complete a course of ECT. The process of obtaining informed consent also requires special consideration in this group of patients because their capacity to consent to treatment may be compromised. CONCLUSIONS: With careful attention to each patient's medical and anesthesia needs, ECT is an effective and relatively safe procedure in high-risk special patient populations.

Adolescent↗

PubMed2001

Use of specialized coagulation testing in the evaluation of patients with acute ischemic stroke.

OBJECTIVE: To investigate the use and appropriateness of specialized coagulation tests in the evaluation of patients with acute ischemic stroke and identify factors that influence test ordering. BACKGROUND: Coagulation abnormalities are a rare but recognized cause of ischemic stroke. METHODS: Patient demographics, stroke risk factors, history of venous thrombosis or miscarriage, family history of stroke, and the results of specialized tests for coagulation disorders were recorded for a consecutive series of ischemic stroke patients over age 18 admitted to an academic medical center over 3 years (n = 674). Factors associated with testing were identified with univariate analyses in a random sample of two-thirds of the patients (n = 450). Multivariate logistic regression modeling was then used to identify variables independently associated with testing and then validated in the remaining patients (n = 224). RESULTS: Of the 31% of patients (n = 208) tested for coagulopathies, 29% (n = 60) were tested when the result was unlikely to influence therapeutic decisions. Historical factors associated with an increased incidence of a coagulopathy, such as history of venous thrombosis or miscarriage, were not commonly documented. The absence of small-artery atherosclerosis (OR 0.36, 95% CI 0.17 to 0.76) and younger age (OR 0.89 per year, 95% CI 0.87 to 0.92) were independently related to the frequency of specialized coagulation testing. CONCLUSIONS: One-third of specialized coagulation tests were ordered when the test results were unlikely to affect therapeutic decisions. Age was the only clinical factor increasing the likelihood of a coagulopathy that appeared to influence ordering of specialized coagulation tests.

Adult↗

PubMed1996

Identification and characterization of espin, an actin-binding protein localized to the F-actin-rich junctional plaques of Sertoli cell ectoplasmic specializations.

Ectoplasmic specializations are membrane-cytoskeletal assemblages found in Sertoli cells at sites of attachment to elongate spermatids or neighboring Sertoli cells. They are characterized in part by the presence of a unique junctional plaque which contains a narrow layer of parallel actin bundles sandwiched between the Sertoli cell plasma membrane and an affiliated cistern of endoplasmic reticulum. Using a monoclonal antibody, we have identified 'espin,' a novel actin-binding protein localized to ectoplasmic specializations. By immunogold electron microscopy, espin was localized to the parallel actin bundles of ectoplasmic specializations at sites where Sertoli cells contacted the heads of elongate spermatids. The protein was also detected at the sites of ectoplasmic specializations between neighboring Sertoli cells. Espin exhibits an apparent molecular mass of approximately 110 kDa in SDS gels. It is encoded by an approximately 2.9 kb mRNA, which was found to be specific to testis among the 11 rat organs and tissues examined. On the basis of cDNA sequence, espin is predicted to be an 836 amino acid protein which contains 8 ankyrin-like repeats in its N-terminal third, a potential P-loop, two proline-rich peptides and two peptides which contain clusters of multiple glutamates bracketed by arginines, lysines and glutamines in a pattern reminiscent of the repetitive motif found in the protein trichohyalin. The ankyrin-like repeats and a 66 amino acid peptide in the C terminus show significant sequence similarity to proteins encoded by the forked gene of Drosophila. A fusion protein containing the C-terminal 378 amino acids of espin was found to bind with high affinity (Kd = approximately 10 nM) to F-actin in vitro with a stoichiometry of approximately 1 espin per 6 actin monomers. When expressed by transfected NRK fibroblasts, the same C-terminal fragment of espin was observed to decorate actin fibers or cables. On the basis of its structure, localization and properties, we hypothesize that espin is involved in linking actin filaments to each other or to membranes, thereby potentially playing a key role in the organization and function of the ectoplasmic specialization.

Actins↗

PubMed2002

Providing dental care for special patients: tips for the general dentist.

BACKGROUND: Nearly 20 percent of the U.S. population has some type of disability, with approximately 12 percent of the population considered to have severe disabilities. The provision of dental care to such patients requires consideration beyond routine approaches. OVERVIEW: This article discusses techniques, such as establishing a relaxing treatment environment, that can be used to accommodate special-needs patients in the general dental practice. It provides background information on the current special-needs population in the United States, and it describes the oral care approaches used in a residential care facility vs. a general dental practice. The article concludes with tips for integrating this special patient population into a general dental practice. CONCLUSIONS AND PRACTICE IMPLICATIONS: As the U.S. population with special needs increases, more general dentists are likely to find that such patients require their services. While the prospect of accommodating the needs of patients with disabilities may seem daunting initially, such treatment actually can be incorporated into a general dental practice easily. The practitioner treating patients with disabilities likely will find that he or she needs special equipment less than compassion and tolerance.

Anesthesia, Dental↗

PubMed2004

Access to dental care in Alabama for children with special needs: parents' perspectives.

BACKGROUND: Access to dental care and delivery of quality dental health services are important for children with special needs. The authors surveyed parents of children with special needs in Alabama to determine their perceptions of access and barriers to dental care for their children. METHODS: The authors sent a questionnaire to 2,057 parents of children aged 3 to 13 years with special needs--cleft lip and/or palate; cerebral palsy, or CP; spina bifida; or epilepsy/seizure disorders--who were listed in a database provided by Children Rehabilitation Services of Alabama. The authors conducted univariate and multivariate analyses to calculate odds ratios and 95 percent confidence intervals. RESULTS: The overall response rate was 38 percent (N = 714). Eighty-five percent of respondents reported that their children had received some form of routine dental care. However, 35 percent of respondents reported they had had problems finding dentists willing to treat their children. Among those with problems, significant barriers to dental care included their children's having Medicaid insurance, poor oral health or CP, as well as a shortage of dentists with training in the care of children with special needs. CONCLUSIONS AND PRACTICE IMPLICATIONS: While the majority of respondents said their children had access to dental care, one-third said their children had problems receiving this care. Many of these problems can be ameliorated. Increasing providers' participation in the Medicaid program and improving their knowledge about, empathy for and training in the care of children with special needs is essential in improving access to dental care for this population.

Adolescent↗

PubMed2007

Underinsurance and key health outcomes for children with special health care needs.

OBJECTIVE: The objective was to examine the relationship between underinsurance and other core outcomes for children with special health care needs. METHODS: This study analyzed data from the National Survey of Children With Special Health Care Needs. Two alternative definitions of underinsurance, designated attitudinal and economic, were investigated. Logistic regression models in which the response variables were the child's status for each of the target core outcomes and underinsurance status was a dichotomous predictor variable were created. In addition to underinsurance status, 10 other predictor variables were included in the model. RESULTS: Underinsurance is associated with the Maternal and Child Health Bureau core outcomes for children with special health care needs related to satisfaction with care and partnering with families in decision-making, access to a medical home, community-based service delivery that is easy to use, and access to services to make transitions to adulthood. In each case, children with special health care needs who were underinsured had significantly poorer outcomes than did children who were adequately insured. CONCLUSIONS: Although these results cannot clarify the cause of poorer outcomes, there are clear negative effects associated with the problem of underinsurance. Inadequate health care coverage for children with special health care needs may save dollars in the short-term but, if other outcomes are compromised, then children, their families, and society at large may pay a price in the longer term.

Adolescent↗

PubMed2006

Density-dependent topographical specialization in Gyrodactylus anisopharynx (Monogenoidea, Gyrodactylidae): boosting transmission or evading competition?

Viviparous gyrodactylids are remarkable monogenoid ectoparasites, not only because of their speciousness, but also due to their unusually wide range of hosts. Although many factors have been proposed to determine the location where gyrodactylids attach to their hosts, little is known about how their preference for specific host body regions changes over the course of infection. In this study, we investigate the dynamics of topographical specialization of the parasite Gyrodactylus anisopharynx on 2 of its natural freshwater fish hosts (Corydoras paleatus and C. ehrhardti), as well as a naïve host (C. schwartzi). We recorded the spatial location of this parasite from the foundation of the infrapopulation to its extinction to assess how topographical specialization is affected by host species, the size and the age of the infrapopulation, and the possibility of transmission among hosts. Our results indicate that topographical specialization is negatively correlated with infrapopulation size and only marginally affected by infrapopulation age. Also, the degree of specialization was different among host species, but seemed unaffected by the possibility of transmission among hosts. Therefore, observed changes in spatial specialization of G. anisopharynx do not appear to represent adaptive responses to maximize their transmission. Rather, mechanisms such as increased competition and/ or local immune responses might cause parasites to occupy less favorable regions of the body of their hosts with increasing density.

Animals↗

PubMed1976

Current regulatory status of foods for special dietary uses.

The Food and Drug Administration has redefined foods for "special dietary use". Such foods must now: (1) Supply a special dietary need that exists by reason of a physical or physiological condition, such as convalescence, a pregnancy, lactation, or by reason of a specific disease or disorder; (2) Supply a vitamin, mineral, or other dietary property to supplement diet by increasing total dietary intake; (3) Meet a special nutritional need as the sole item of the diet. The stricter definition of this category of food means that the conventional foods with added nutrients or food for which nutritional claims are made or nutritional information provided will no longer be considered as foods for special dietary uses, although they must conform to standard nutritional labeling requirements. The new regulation establishes a clearly delineated position within which the consumer, industry, and FDA can deal with special dietary foods without the past confusion as to what belonged in this category.

Diet Therapy↗

PubMed2006

Effects of a therapeutic riding program on at-risk and special education children.

OBJECTIVE: To determine the effects of a therapeutic riding program on psychosocial measurements among children considered at risk for poor performance or failure in school or life and among children in special education programs. DESIGN: Observational study. POPULATION: 17 at-risk children (6 boys and 11 girls) and 14 special education children (7 boys and 7 girls). PROCEDURE: For the at-risk children, anger, anxiety, perceived self-competence, and physical coordination were assessed. For the special education children, anger and cheerfulness were measured, and the children's and their mothers' perceptions of the children's behavior were assessed. Measurements were made before and after an 8-session therapeutic riding program. RESULTS: For boys enrolled in the special education program, anger was significantly decreased after completion of the riding program. The boys' mothers also perceived significant improvements in their children's behavior after completion of the program. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that an 8-session therapeutic riding program can significantly decrease anger in adolescent boys in a special education program and positively affect their mothers' perception of the boys' behavior.

Adolescent↗

PubMed1995

Education of nursing students with special needs.

Recent legislation such as the Americans with Disabilities Act will have a significant impact on higher education in nursing. A survey was conducted to describe the extent to which BSN and ADN nursing programs in the United States admit and graduate special needs and chronically ill students, and to identify the accommodations which have been successful in providing nursing education to these students. Responses received from 86 schools of nursing in 44 states indicated that most schools have had contact with students with special needs such as visual, hearing, or mobility impairments, learning disabilities, and mental or chronic illnesses. Learning disabilities and mental impairment were cited most frequently as having been present among the student population. Few programs have had experience with students with vision problems. While most programs responding had little experience with providing special accommodations to special needs students, most were aware of accessibility on their campuses. Recent legislation aimed at creating opportunities for disabled individuals to successfully enter the work force creates challenges for schools of nursing in education of students with special needs. Issues are raised that must be addressed to meet this important challenge.

Persons with Disabilities↗

PubMed1999

Variation in referring newborns to special care in Finland.

We studied the frequency of referring newborns to special care in Finland and its variation between hospitals. Data was obtained from the nationwide Finnish Birth Register for 1991 and 1994. Newborns who during their first week of life had been in special care, in another hospital, in a respirator, or who had received a blood exchange were defined as having been in special care. This applied to 7% of newborns in 1991 and to 8% in 1994. The proportions of newborns in special care varied notably between hospitals of the same level. The differences could be explained by varying patient mixtures and different thresholds for referral to care. The indications for referring newborns into special care, especially in hospitals with high rates of referral, requires scrutiny.

Catchment Area, Health↗

PubMed1999

[Prospective study of the long-term effectiveness of inpatient rehabilitation of patients with chronic cervicobrachial syndromes and the effect of prescribing special functional pillows].

In order to investigate the long-term effect of clinical rehabilitation measures as well as the additional effect of prescription of a special pillow in patients suffering from chronic cervicobrachialgia a total of 149 patients was investigated. All patients suffered from chronic cervicobrachialgia and were admitted for rehabilitative treatment in the orthopaedic Elfenmaar-Klinik of Bad Bertrich. For a four-week period the patients were treated with physical therapy including gymnastics, electrotherapy, thermotherapy, and massage. Additionally they underwent a health-promoting programme specially designed for patients with spondylopathia. The patients were randomly divided into two groups, one receiving a special pillow (Curavario, Pala-Medic-Company) for the use during and after the rehabilitative treatment (n = 76 or n = 73, respectively). For two weeks before the treatment, during the four-week treatment period and for two weeks after the treatment the patients had to fill in a questionnaire, comprising among others six questions on the intensity of their cervicobrachialgic symptoms (pain-intensity [local pain, radiation of pain], muscular tenseness, paraesthesia and sleep disorders [caused by pain or paraesthesia]). Three, six, and nine month after the treatment period the patients received a similar questionnaire. Immediately after the treatment period a significant reduction of mean pain intensity and muscle tenseness (p < 0.001; Rep.-Mes.-ANOVA) was found. At the same time significantly lower frequencies of pain radiation and sleep disorders caused by pain or paraesthesia (p < 0.001; chi-square-test) were found. During the following nine months the intensity of the symptoms slightly re-increased, however, all parameters were still reduced nine months after treatment compared to the values before treatment (p < 0.01). Before and during the treatment no difference between the two groups could be detected, however, the follow-up showed significantly lower scores of pain intensity (p < 0.05; Student-t-test) and sleep disorders (p < 0.01; chi-square test) in the patients who had received the special pillow. It is concluded that the rehabilitative treatment is effective in patients suffering from chronic cervicobrachialgia and that the complaints in the post-treatment period can be reduced by prescription of special pillows.

Adult↗

PubMed1975

Dental care of the special patient in the hospital environment.

In this new era, where the emphasis in dental care is gradually moving in the direction of the patient, as differentiated from the former emphasis on the teeth and the mouth, the 'special patient' can and should receive the type of total dental care he or she deserves. The environment of the hospital, and all that the hospital brings with it to the patient care environment, makes the facilities for special patient care better and allows patients who were formerly seriously neglected to receive much the same attention as so-called normal patients. The group of special patients considered includes the physically handicapped, institutionalized or home-bound chronically ill, those with psychiatric disturbances and the mentally retarded as well as the hospitalized patient. One example of a hospital dental service conducted as a group practice is described in some detail. Advantages of this pattern of practice to the participants include the availability of conferences and clinics, access to a broad range of patient experience and the possibility of further study in specialized hospital activities. For the patient, total dental care is available throughout the 24 hours. Each patient is normally assigned to his or her own dentist, but is referred to another member of the group when special skills are needed.

Dental Service, Hospital↗