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Issue 5 – 2018


This is the fifth issue of the International Journal of Clinical Neurosciences and Mental Health. The journal aims to provide high-quality publications in the areas of Psychiatry and Mental Health, Neurology, Neurosurgery, and Medical Psychology. This publication is intended to provide a forum for experts from all around the world to share their knowledge, expertise, and research efforts. The journal operates under an Open Access model, and therefore everyone is invited to join this initiative.

Issue Nr:

5

|    Issue date: 2018-02-13

Editorial


Persisting use of physical restraint: Knowledge Translation vs. Attitudes - read full article

By: Nicole Walker, Theresa Scott, Nadeeka N. Dissanayaka, Fiona Kate Barlow, and Nancy A. Pachana

Physical restraint in residential aged care (RAC) 
The use of physical restraint in residential aged care (RAC) is relatively common [1]. Existing research suggests that the proportion of residents physically restrained in RAC facilities ranges from 12% to 47% [2]. The last two decades have seen much research discussing both the potential benefits and adverse consequences of physical restraint [3]. While at a global level, there are distinctive factors that determine both the prevalence and justification for employing physical restraint on a case by case basis rather than an umbrella explanation [4], the prevalence of physical restraint use in RAC is concerning. If knowledge about the negative impact on quality of care and quality of life could be presumed to decrease the use of physical restraint in RAC, then additional factors could also be presumed to be simultaneously (and strongly) promoting the use of physical restraint. In this paper, in the moment affective processes (e.g., emotions, negative attitudes) are suggested as one such likely factor, potentially overriding knowledge-based interventions and thus maintaining the use of physical restraint. Specifically, negative attitudes towards residents residing in RAC may exist in many populations, and these, in addition to the unique environment associated with working in RAC (including high levels of one on one care, frailty and decrease mobility), perhaps promotes behaviour that is driven by affect, rather than knowledge. Multiple studies reveal that physical restraint harms residents [2]. In particular, serious injury and mortality are often directly related to both proper and improper use (selection and application) of physical restraint on residents [1], and physical restraint is likewise associated with reduced psychological well-being, and mobility [2]. Further, residents who are managed via physical restraint exhibit rapid cognitive decline compared to those who are not restrained [2, 5]. Despite this evidence, physical restraint is frequently referenced as a protective measure [6]. For example, it is argued that physical restraint reduces the risk of personal injury to residents and employees [2], controls wandering, and facilitates medical treatment [7, 8]. However, the literature suggests that such justifications are not evidence-based and in fact are not supported by the data [8, 9]. (Continues)

International Journal of Clinical Neurosciences and Mental Health 2018; 5:1
DOI: https://doi.org/10.21035/ijcnmh.2018.5.1

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Original Article


Hit or Miss? Diagnostic contributions of neuropsychological assessment in patients with suspected dementia - read full article

By: Donna Pinsker, Ada H. Y. Lo, Catherine Haslam, Nancy A. Pachana, and Hayden Pinsker

Objectives: Accurate early diagnosis of dementia has important implications for prognosis, treatment, and management. In hospital settings, neuropsychological assessment is frequently included in the diagnostic work-up for dementia, particularly in clinically ambiguous cases. However, the diagnostic contributions of neuropsychological testing in this population are not well established. This paper reports the findings from a preliminary study examining the diagnostic utility of such assessment in patients with suspected dementia. 
Methods: A retrospective review of hospital medical records was performed for 84 patients who underwent neuropsychological assessment for diagnostic purposes within a five-year time frame. A proxy measure of diagnostic accuracy was obtained using the level of agreement between the neuropsychologist’s opinion and the most recent working diagnosis of the medical treatment provider, allowing a minimum follow-up period of twelve months.
Results: Using defined clinical coding criteria to account for differences between clinical conditions (e.g., mild neurocognitive disorder) and underlying pathology (e.g., Alzheimer’s disease), the baseline diagnosis of the neuropsychologist concurred with the most recent diagnosis of the treatment provider in 88% of cases with an exact match in 77% of cases. Follow-up neuropsychological assessments over time did not lead to a significant improvement in diagnostic accuracy.
Conclusion: A high level of diagnostic agreement emerged between neuropsychology and treating medical consultant opinions, independent of available neuroimaging evidence. The findings highlight the contribution of neuropsychological testing in the diagnosis of dementia in hospital settings. Replication of these results is required using prospective designs, larger samples, multiple sites, and autopsy confirmed diagnoses.

Keywords: Alzheimer’s disease, Dementia, Diagnostic accuracy, Neuropsychological assessment.

International Journal of Clinical Neurosciences and Mental Health 2018; 5:2
DOI: https://doi.org/10.21035/ijcnmh.2018.5.2

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