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Tri-State Bird Rescue and Research was contracted to manage the wildlife response following a discharge of 340,000 gallons of No. 2 diesel fuel into Sugarland Creek in Fairfax County, Virginia, on March 28, 1993. A wildlife stabilization team was sent to Virginia to establish an on-site medical stabilization facility for affected animals, which were then transferred to Tri-State's oil spill rehabilitation facility in Delaware. Treating some of the less-frequently (nonavian) oiled wild animals, including turtles and beavers, presented challenges. Colleague participation and interagency coordination were both important.

Objective: To analyze the number and severity of falls in a subacute rehabilitation facility before and after the implementation of the “no-restraint policy” of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Design: Retrospective study. Setting: Subacute rehabilitation facility. Participants: All residents at the facility between January 1, 1996, and July 1, 1999. Interventions: Not applicable. Main Outcome Measure: The number of falls were quantified. Severity of injuries was qualified: level 0 is no injury, level 1 is a minor injury, level 2 is a major injury, and level 3 is death. Results: There was a significant increase in falls (207 before, 227 after) when the no-restraint policy started ( P =.0005), with a relative risk (RR) of 1.4 (restraints were defined as bedrails). There was no significant difference in the severity of injuries between the groups. In the bedrail group, significantly more injuries were found in those who were confused ( P =.0595). In oriented patients, a significant decrease in the number of falls ( P =.0624) and risk of injuries were found with bedrail use (RR=.54). Conclusions: After the implementation of the JCAHO no-restraint policy, a significant increase in the number of falls was found in our long-term care facility. There was an observable tendency of a subgroup of patients to benefit from bedrails (oriented patients).

(2001) Int J Geriatr Psychiatr 16, 321. Pomeroy IM, Clark CR, Philp I. . The effectiveness of very short scales for depression screening in elderly medical patients. . Mar; . : . –6 . [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] QUESTION: In older patients, are short scales as effective as long scales in screening for depression? Blinded comparison of 3 Geriatric Depression Scales (GDS-4, GDS-15, and GDS-30) and the Mental Health Inventory-1 (MHI-1) scale with diagnostic criteria of research of International Classification of Diseases—10th edition (DCR-10). A teaching hospital in the UK 87 patients (mean age 79 y, 60% women) who were > 60 years of age and attended the day rehabilitation facility or were admitted to the medical rehabilitation wards. Patients were excluded if they had an illness, communication problems, or a score of < 6 on the 10-item Abbreviated Mental Test (AMT). The GDS-30, GDS-4, 10-item AMT, and … [1]: {openurl}?query=rft.jtitle%253DInternational%2Bjournal%2Bof%2Bgeriatric%2Bpsychiatry%26rft.stitle%253DInt%2BJ%2BGeriatr%2BPsychiatry%26rft.aulast%253DPomeroy%26rft.auinit1%253DI.%2BM.%26rft.volume%253D16%26rft.issue%253D3%26rft.spage%253D321%26rft.epage%253D326%26rft.atitle%253DThe%2Beffectiveness%2Bof%2Bvery%2Bshort%2Bscales%2Bfor%2Bdepression%2Bscreening%2Bin%2Belderly%2Bmedical%2Bpatients.%26rft_id%253Dinfo%253Adoi%252F10.1002%252Fgps.344%26rft_id%253Dinfo%253Apmid%252F11288167%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1002/gps.344&link_type=DOI [3]: /lookup/external-ref?access_num=11288167&link_type=MED&atom=%2Febmed%2F6%2F6%2F187.atom [4]: /lookup/external-ref?access_num=000167917300011&link_type=ISI

Twenty eight days is apparently how long you normally stay if-after getting disgustingly drunk and wrecking your sister's wedding, not to mention the nuptial limousine-you reluctantly enter an American “rehabilitation” clinic. Rehabilitation is big business in the United States, and remarkably monolithic. 28 Days gives a reasonably accurate impression of life in a typical private rehabilitation facility and of some of its highs and lows. The highs include heart warming insights of the “I guess I never saw it that way” variety and the support and …

LEARNING OUTCOME: To examine an alternative multidisciplinary procedure for nutrition risk screening to achieve more efficiency of registered dietitian time and to expedite medical nutrition therapy to patients at risk. Departmental quality assurance monitoring indicated gradual deviation in the dietitian's ability to perform the nutrition screen within established timeframes. Contributing variables were: compression of staffing; reduced length of stay; higher turnover, increased admissions. As nursing completed initial patient interviews within 24 hours, some information collected by the dietitian was duplicated. Given the association's definitions for screening and assessment, and JCAHO's efforts to effect multidisciplinary patient care, a proposal was accepted by nursing administration to consider transferring nutrition screening to the nursing staff— thereby prompting a referral to the R.D. to assess and intervene with patients at risk more promptly. Criteria were established and a screening tool for nursing was developed for a six-week trial period on one unit Concurrent screening was performed by the R.D. The trial validated the tool to identify patients at nutrition risk; 88 percent accuracy was achieved. Over 30 percent of the trial population did not need R.D. contact. Subsequently, the tool was piloted with the remaining population, confirming the validity of the tool and the hypothesis for the project. The degree of accuracy for risk identification was 81 percent. The final stage of the project involves incorporating the nutrition screening criteria into the nursing interview form, with quality assurance monitoring by nutrition services for compliance and appropriateness of referrals.

The objectives of this study were to (1) identify and characterize hospitalized patients with an organic-related psychiatric diagnosis who had received buspirone therapy and (2) assess the effect of buspirone on aggressive behaviors. A retrospective medical records review was conducted on all patients who were admitted to our psychiatric/rehabilitation facility over a 36-month period and who had received buspirone therapy. Monthly behavioral therapy records were used to determine the quality and quantity of aggressive-related behaviors. Study endpoint was reached in each subject when buspirone was discontinued or when records were unavailable. Twenty subjects, ranging in age from 15 to 55 years old (mu = 26.1 +/- 9.8), were identified for study. Nine (90%) of 10 subjects for whom data were available for at least 3 months showed an improvement in behavior by study endpoint, and 6 (60%) showed at least a 50% reduction in behavioral symptoms by study endpoint. Results from this study suggest that buspirone is well tolerated and may be effective in the treatment of aggressive and other maladaptive behaviors in individuals with an organic component to their psychiatric illness, particularly traumatic brain injury. Prospective, controlled trials are needed to validate these findings.

A retrospective chart review was conducted to determine the frequency, progression, and outcome of neurogenic dysphagia in head-injured adults admitted to a rehabilitation facility. Approximately 25 percent of the sample demonstrated swallowing or oral motor problems on admission. Ninety-four percent of this group ultimately became successful oral feeders. The majority of these patients participated in a feeding program planned and implemented by the physical therapist. The average time from injury for the nonoral feeders to successful completion of their first oral meal was about three months. A concomitant resolution of cognitive problems, primitive oral motor reflexes, and neurogenic dysphagia occurred.

A psychologist's role in a specific rehabilitation facility for older visually impaired people is described. The uses of the assessment process for this population and the participation in the process by the student (client, patient), his family, other staff members, as well as the psychologist, are detailed. Specific tests that have been used with this population effectively are mentioned.

The effects of alcohol intoxication on serum amylase levels were tested in both normal subjects and chronic alcoholics. Paired samples of ethanol levels and isoamylase levels in the normal subjects (n = 11) showed a rise in both total serum amylase (P less than 0.01) and nonpancreatic isoamylase (P less than 0.05) after drinking. Unpaired cohort groups of sober chronic alcoholics at a rehabilitation facility (n = 46) and intoxicated chronic alcoholics in an emergency room (n = 58) were also compared. Average blood alcohol levels in the intoxicated controls were 93 mg% compared to a level of 301 mg% in the intoxicated chronic alcoholic. Intoxication superimposed on chronic alcoholism caused a moderate rise in the total serum amylase (NS) and a significant elevation of the nonpancreatic isoamylase (P less than 0.01). Sober chronic alcoholics had a significantly greater average total serum amylase (P less than 0.001) and nonpancreatic isoamylase (P less than 0.01) than the normal controls. No difference in the average pancreatic isoamylase levels was seen in any group. These data suggest a biphasic response to alcohol on the serum amylase level. Acute and chronic changes appear to operate independently. The cause for these effects is speculative. Isoamylase analysis is needed in the alcoholic population to sort out the meaning of hyperamylasemia.

Human Factors Environmental Design suggestions were made for a proposed experimental commuting/residential educational drug rehabilitation facility being developed for the State of New Jersey. Within the constraints imposed by the necessity to use an existing structure and having only limited modification opportunities imposed by financial, architectural and community circumstances, it was concluded that the methodologies used in the aerospace industry and in architectural psychological studies were applicable to the planning and design study described in this paper. Additionally, many of the postulates developed and used in the design of environments for confined or restricted individuals are also applicable to such a specialized facility.

Summary The purpose of this paper is to attempt to show that present day paraprofessional drug milieu treatment facilities are extended drug subcultures and are not fully rehabilitating addicts. Research tends to indicate that Synanon House of California may offer its residents a protective society and a program which is not conducive to complete rehabilitation. It was also noted that ex-addicts may become part of Synanon's ex-addict social system and that the ex-addict may become emotionally dependent upon Synanon. Also, numerous clinical impressions and observations made by the writer during a graduate field work placement were noted. It was suggested that professional ex-addicts may be part of an extended drug subculture. Maintenance of the extended subculture and some of the inter- and inter personal dynamics which appear to be operating at a para-professional drug rehabilitation facility were discussed. Lastly, modifications of present day drug programs were suggested to facilitate rehabilitation. Generally, the recommendations centred around getting community people into the facility and getting residents out of the facility.

Links between hospital and community may be affected by such physical characteristics as size, location, and architecture; by policy characteristics, such as state versus local initiative and policy concerning trustees; and by the nature of hospital-based rehabilitation facilities, such as day care. Since rehabilitation has the objective of maintaining the patient in the community, and since this requires a fertile soil of community acceptance, it is important to identify and strengthen those forces which tend to link together the community and the hospital.

Case histories of 47 children with strict criteria for Landry-Guillain-Barre-Strohl polyneuritis admitted to a rehabilitation facility from late 1959 through 1972 were analyzed retrospectively. The children were followed to full recovery (good to normal strength in all muscle groups) or for three years without full recovery. The data were then compared statistically for possible predictive indicators of recovery or lack of recovery within three years. The most significant early predictor of incomplete recovery was the time interval between the greatest weakness and beginning improvement; a period longer than 18 days of plateau before gains are evident is indicative of incomplete recovery within limits of 99% confidence.

I am honored to be chosen from among the many professionals in the insurance industry of the United States of America to clarify why we are involved in the whole process of “rehabilitation of brain damaged people.”

Quality assurance (QA) in rehabilitation facilities and units must be tailored to rehabilitation activities, that is, those activities that enable patients to manage conditions and disabilities caused by their injuries or illnesses. Good Samaritan Medical and Rehabilitation Center in Zanesville, Ohio, has developed a system for QA in which managers of departments and services are responsible for QA in their own areas, thereby enabling them to monitor and evaluate the important aspects of care provided by their department or service. This article outlines the steps by which appropriate QA activities are determined and implemented in a rehabilitation facility using this decentralized approach.

Nursing has a professional responsibility to ensure the provision of quality health care to the patient/consumer. One method to fulfill this responsibility is using a quality assurance process. A successful program must have involvement and commitment from all staff members. The essence of this commitment comes through unit-level quality assurance committees. This article describes one such program being implemented in a 78-bed rehabilitation facility.

The authors agree with the principle, widely accepted, that spinal cord injured (SCI) individuals should receive all their acute, rehabilitative and follow-up care in a spinal cord injury centre. The evolution of rehabilitation medicine and services in the United States, however, has favoured the separation of acute and rehabilitation care for spinal cord injured patients, as well as other disabilities. This has resulted partly from specialisation of medical and allied health personnel, physical separation of acute and rehabilitation facilities, and reluctance of some funders of health care to see rehabilitation as a natural extension of medical care in these patients. In Houston the proximity of a rehabilitation facility to three acute care university hospitals, representing three medical schools, provided an opportunity to improve communication among the medical personnel. These individuals have recognised the value of early rehabilitation even while the patient is acutely ill; they agreed to institute a system of care wherein the rehabilitation physician partakes in the early management in a designated area of the acute hospitals for spinal cord injured patients and works toward early transfer to the rehabilitation hospital in as ideal a condition as possible. Surgeons, who have initial primary responsibility, also visit the rehabilitation hospital, following their patient's progress at selected conferences and at the bedside. This paper describes how, a spinal cord injury service was established, how the major barriers to early transfer were confronted, and the results of the first 6 months of operation.

A trial of psychiatric nursing was made with a group of 21 female patients drawn from the wards of a 2000-bed chronic disease and rehabilitation facility. At the end of the two-month period, the study patients were greatly improved in behavioral and intellectual functioning compared to the control group. The chief factor was the establishment of trust in the psychiatric nurse. This was enhanced by the nurse conveying feelings of interest and affection by occasionally touching the patients for this purpose. No threatening demands were made of the patients in the one-to-one and group meetings. Plans were made through mutual cooperation, and resulted in a re-awakening of the patients' desires to be responsible, productive and useful.

Since 1972 a hospital based specialty home health team consisting of a Registered Nurse, a Registered Physical Therapist, and a Vocational Rehabilitation Counselor has been serving spinal cord injury patients hospitalized previously in a University affiliated Rehabilitation Center. This paper presents the preliminary findings resulting from a study examining the appropriateness, cost-effectiveness, and efficiency of this unique rehabilitation facility service component.