Pro re nata (PRN), a Latin phrase meaning 'as needed', is used to describe medications that might be used in specific situations, in addition to regularly-scheduled medications, such as when a patient is particularly anxious, experiencing insomnia, or suffering pain. While helpful in some circumstances, PRN are associated with an increased risk of morbidity, overuse, dependence, and polypharmacy. There is also a dearth of medical literature describing current practices and trends of PRN administration in mental health facilities, especially in Canada, and the literature that does exist is limited by poor documentation practices. Therefore, the primary objective of the current study was to understand the reason (purpose), frequency, use, documentation practices, and outcome (i.e. effectiveness, side-effects) of PRN medication use on inpatient units. Data were pulled to capture a snapshot of PRN administrations over a 3-month period, and included information related to the administration of the PRN medication, such as time of administration, type and dose of PRN medication, and prescribed indication, as well as patient-specific information. Results indicated that approximately 8200 psychotropic PRN medications were administered during the designated 3-month time period, and over 90% of patients received at least one PRN. Most of these were benzodiazepines, followed by antipsychotics. Further analyses were conducted to determine other characteristics of PRN use patterns and to provide a baseline of understanding that will inform future research to investigate the practice of PRN administration to psychiatric inpatients.

The aim of the present study was to elucidate what non-pharmacological interventions are applied by nursing staff prior to the administration of psychotropic pro re nata (PRN) medication. Best practices would instruct clinical staff to provide non-pharmacological strategies, such as de-escalation and skills coaching, as the first response to patient distress, anxiety, or agitation. Non-pharmacological strategies might be safer for patients, promote more collaborative relationships, and facilitate greater skills development for managing symptoms. The literature has highlighted that poor documentation of pre-PRN administration interventions has limited our understanding of this practice, but evidence suggests that when this information is available, non-pharmaceutical approaches are not being attempted in the majority of cases. This is troubling given that, while clinically appropriate in some instances, PRN have been subject to criticism and lack critical evidence to support their use. The current study is a continuation of our previous work, which examined the reason, frequency, documentation, and outcome (e.g. effectiveness, side-effects) of PRN medication use at our facility. A chart review was conducted to understand what happens prior to the administration of PRN medication at our facility across all inpatient units over the course of 3 months. Results support previous findings that nonpharmacological interventions are poorly documented by front-line staff and are seemingly used infrequently. The use of these interventions differs by patient presentation (e.g. agitation, insomnia), and most often include supportive measures. The findings suggest that both documentation and intervention practices of nursing staff require further investigation and adjustment to align with best practices.

No abstract

T he word dyslexia is derived from two Greek words: dys (inadequate or lack of ) and lexicon (word and/or verbal language).1 Dyslexia thus means problems learning how to read words and deal with language in print. Historically, dyslexia has been used to describe difficulty in reading as a result of brain damage. 2There are two models used in defining dyslexia: the Orthodox Model and the Davis Model.2 The Orthodox Model describes dyslexia as developed rather than innate, with difficulty in reading as a result of cerebral disease rather than brain injury. The Davis Model describes dyslexia as difficulty in reading or language processing as a result of intermittent disorientation. This disorientation comes from conflicting messages to the brain, for example, when the eyes are telling the brain one thing but senses of balance and movement are saying something different. Another way of understanding dyslexia is the dual-route model. 3,4,5 This model explains two pathways from print to speech.3 One pathway operates via the use of grapheme-phoneme correspondence rules which are termed the nonlexical route for reading aloud. The other pathway operates via access to a semantic system, the lexical route for reading aloud.3 The non-lexical route successfully allows an individual to read non-words, abstract: Dyslexia is a specific learning disability that is neurological in origin, with an estimated overall worldwide prevalence of 5-10% of the population. It is characterised by difficulties in reading, accuracy, fluency, spelling and decoding abilities. The majority of publications reviewed indicated that screening is performed at the preschool level. Screening can also be conducted at birth or the first year of life. Understanding human development theory, for example, Piaget's human development theory, may help determine at which stage of childhood development dyslexia is more detectable, and therefore guide the management of this disability. The objective of this review is to provide a brief and updated overview of dyslexia and its management in children through human development issues.