Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu?

Specific efforts by hospital accreditation organizations encourage renovation of nursing stations, so nurses can better see, attend, and care for their patients. The purpose of this study was to examine the effect of nursing station design on the therapeutic milieu in an adult acute care psychiatric unit. A repeated cross-sectional, pretest-posttest design was used. Data were collected from a convenience sample of 81 patients and 25 nursing staff members who completed the Ward Atmosphere Scale. Pretest data were collected when the unit had an enclosed nursing station, and posttest data were collected after renovations to the unit created an open nursing station. No statistically significant differences were found in patient or staff perceptions of the therapeutic milieu. No increase in aggression toward staff was found, given patients' ease of access to the nursing station. More research is needed about the impact of unit design in acute care psychiatric settings.     

Nationwide Newspaper Coverage of Posttraumatic Stress: A Community Structure Approach

This study utilized the community structure approach to analyze newspaper coverage of posttraumatic stress (PTS) in veterans in 26 U.S. cities. The study examined whether media placed responsibility for PTS treatment on government or society through a review of 353 articles from March 20, 2003, to March 20, 2013. Researchers coded articles for “prominence” and “direction” to produce a “Media Vector” for each paper, ranging from 0.8403 to ?0.3592. Results showed that 25 of 26 Media Vectors (96%) supported government responsibility. Pearson correlations yielded nine significant findings. Results disconfirmed buffer hypotheses linking privilege with support for government responsibility (privilege defined by percentage of college educated, percentage of family income $100,000 or more, and percentage of professional/technical occupational status; r = ?.486, ?.524, ?.553, respectively, significant at the .006 level). Stakeholder hypotheses were also disconfirmed; greater percentages of age 65 and older correlated with more emphasis on government responsibility (r = .340, p = .048), whereas greater percentages of age 25 to 44 correlated with less emphasis (r = ?.342, p = .047). The only confirmed hypothesis linked percentage of age 45 to 64 with less emphasis on government responsibility (r = ?.559, p = .002). A regional finding was noteworthy: Media in the Midwest supported government responsibility more than other regions. Regression analysis revealed three variables influencing coverage most significantly: Family Income $100K+ (26% of variance), Percentage of Hispanic (8%), and Professional/Technical Occupational status (5%). It must be noted that nearly all newspapers yielded positive Media Vectors. This indicates that coverage in major cities generally favors government responsibility for veterans' PTS treatment, and Pearson correlation results may represent differences in the degree of support and demographic characteristics influencing this support.     

Family structure and the gender gap in ADHD

Review of Economics of the Household - We document the large, excess male-female gap in ADHD diagnosis and treatment rates for non-traditional families. Pre-teen boys in traditional families are...     

Reactive and proactive aggression in children with and without ADHD and negative emotional lability

Children with attention‐deficit/hyperactivity disorder (ADHD) exhibit marked difficulty with frequent and intense shifts in negative or positive emotions, referred to as emotional lability. This study examines the relationships between negative emotional lability (NEL), ADHD, and reactive and proactive aggression. A community sample of 96 children (53 with ADHD, 43 control) ages 8–12 and their parents completed a baseline session include a diagnostic structured interview and the Reactive–Proactive Aggression Questionnaire (RPAQ). Parents then rated their child's NEL using the Positive and Negative Affect Scale as part of an Ecological Momentary Assessment protocol 3 times a day for 28 days. Seventy‐three participants (37 with ADHD, 36 control) completed the RPAQ at follow‐up. Hierarchical regression analyses indicated that NEL significantly and independently estimates reactive aggression at baseline and follow‐up, regardless of ADHD status. NEL and ADHD status significantly estimates concurrent proactive aggression, but not at follow‐up. Results of this study suggest that NEL accounts for a significant amount of the variability in reactive aggression, a common difficulty in children with ADHD. Further, individuals that are reportedly emotionally labile become more reactively aggressive over time. Both ADHD diagnostic and NEL are predictors of proactive aggression at baseline, although no interaction occurred.     

A new industrial order for physicians: a talk with Jeff C. Goldsmith, PhD. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Jeff C. Goldsmith, PhD, President of Health Futures, Inc. on October 12, 1999 to discuss how the Internet will affect health care delivery in the millennium. One of the most profound changes that he sees is how the relationship between physicians and patients will be altered. Empowered consumers are where the real revolution is happening--a trend sometimes overlooked by physicians. Goldsmith says, "The key thing physicians have missed is that the patient is in charge of the process.... The Internet has enabled patients to aggregate their collective experience across disease entities." But there is too much information. "It is almost universally acknowledged by patients and physicians that there is a terrible quality problem. Getting from information to knowledge is a huge commercial opportunity for somebody." He doesn't think that people have put enough emphasis on the collective learning part of this new technology.