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Coercive or restrictive practices such as compulsory admission, involuntary medication, seclusion and restraint impinge on individual autonomy. International consensus mandates reduction or elimination of restrictive practices in mental healthcare. To achieve this requires knowledge of the extent of these practices.
Aims
We determined rates of coercive practices and compared them across countries.
Method
We identified nine country- or region-wide data-sets of rates and durations of restrictive practices in Australia, England, Germany, Ireland, Japan, New Zealand, The Netherlands, the USA and Wales. We compared the data-sets with each other and with mental healthcare indicators in World Health Organization and Organisation for Economic Cooperation and Development reports.
Results
The types and definitions of reported coercive practices varied considerably. Reported rates were highly variable, poorly reported and tracked using a diverse array of measures. However, we were able to combine duration measures to examine numbers of restrictive practices per year per 100 000 population for each country. The rates and durations of seclusion and restraint differed by factors of more than 100 between countries, with Japan showing a particularly high number of restraints.
Conclusions
We recommend a common set of international measures, so that finer comparisons within and between countries can be made, and monitoring of trends to see whether alternatives to restraint are successful. These measurements should include information about the total numbers, durations and rates of coercive measures. We urge the World Health Organization to include these measures in their Mental Health Atlas.
Compulsory Community Treatment Orders (CTOs) enable psychiatric medication without the need for consent. Careful scrutiny of outcomes including mortality is required to ensure compulsory treatment is evidence-based and ethical.
Aims
To report mortality for patients placed on CTOs and analyse data according to CTO status, mortality cause and diagnosis.
Method
Data for all patients placed under CTOs between 1 January 2009 and 31 December 2018 was provided by the Ministry of Health, New Zealand. Data included diagnostic and demographic information, dates of CTOs, and any dates and causes of death. Deaths were categorised into suicides, accidents and assaults, and medical causes. Mortality data are reported according to CTO status and diagnosis.
Results
A total of 14 726 patients were placed on CTOs over the study period, during which there were 1328 deaths. The mortality rate was 2.97 on and 2.31 off CTOs (rate ratio 1.29, 95% CI 1.14–1.45; P < 0.01). The mortality rate for accidents and assaults was 0.44 on and 0.25 off CTOs (rate ratio 1.73, 95% CI 1.23–2.42; P < 0.01). The mortality rate for medical causes was 2.33 on and 1.90 off CTOs (rate ratio 1.22, 95% CI 1.07–1.40; P < 0.01). The suicide rate was 0.20 on and 0.15 off of CTOs (rate ratio 1.33, 95% CI 0.81–2.12; P = 0.22).
Conclusions
Increased care and medication provided during compulsory treatment does not the modify the course of illness sufficiently to reduce mortality during CTOs. Higher mortality rates during CTO periods compared with non-CTO periods may reflect greater unwellness during CTOs.
Compulsory community treatment orders (CTOs) are controversial because they enforce psychiatric treatment of patients in the community. It is important to know which patients benefit from compulsory treatment to better inform CTO use.
Aims
To examine the effect of a range of diagnoses on outcomes associated with CTOs to determine whether there are specific outcome signatures for CTOs according to diagnosis.
Method
New Zealand's Ministry of Health databases provided demographic, service use and medication-dispensing data for all individuals placed on a CTO between 2009 and 2018. We used a hierarchical approach to categorise individuals according to diagnosis. Admission rates, admission days per year, community care and medication dispensing were analysed according to diagnosis and CTO status.
Results
In total, 14 726 patients were placed on a CTO over the 10-year period between 1 January 2009 and 31 December 2018. For psychotic disorders, CTOs were associated with reduced admission frequency and duration. However, the opposite occurred for dementia disorders, bipolar disorders, major depressive disorder and personality disorders. Higher rates of medications, including depot antipsychotic medications, were dispensed on CTOs for all diagnostic groups.
Conclusions
CTOs were associated with reduced admission frequency and admission days per year for patients with psychotic disorders, whereas the opposite occurred for other diagnostic groups. Rather than seeking to establish whether CTOs are effective, we suggest that there are specific outcome signatures associated with CTOs for different disorders and knowledge of these can improve understanding and clinical practice in this area.
There appears to be no research to date investigating patients’ preferences for sociocultural characteristics or behavioural qualities of psychiatrists. We aimed to assess which are most important to patients. Patients (132) in community mental health teams across two sites (East Cornwall, East London) completed a questionnaire ranking the importance of different sociocultural characteristics and behaviours of psychiatrists.
Results
Patients cared more about age and gender than other characteristics. Four preferences (from a choice of ten) regarding behavioural qualities were clearly identified as important: explaining things clearly, dedication to personal treatment, being friendly and polite, and being up to date with medical knowledge.
Clinical implications
Patients are fairly unconcerned about the age, gender, religion and social background of psychiatrists. Characteristics they care about most include communication skills, competence, dedication to personal treatment and friendliness. Explaining things clearly is particularly important. This indicates specific areas of improvement for training and further research.
In this article we re-examine the conclusions of our article on advance statements in adult mental healthcare that was published in 2010 in the light of new literature published in the intervening decade. We explore the results of studies on the implementation and effectiveness of advance statements in adult mental health services, and then summarise recommendations for legislative changes from the Independent Review of the Mental Health Act 1983 that are relevant for England and Wales.
Multispectral images of leaf reflectance in the visible and near infrared region from 384 to 810 nm were used to establish the feasibility of developing a site-specific classifier to distinguish lettuce plants from weeds in California direct-seeded lettuce fields. An average crop vs. weed classification accuracy of 90.3% was obtained in a study of over 7,000 individual spectra representing 150 plants. The classifier utilized reflectance values from a small spatial area (3 mm diameter) of the leaf in order to allow the method to be robust to occlusion and to eliminate the need to identify leaf boundaries for shape-based machine vision recognition. Reflectance spectra were collected in the field using equipment suitable for real-time operation as a weed sensor in an autonomous system for automated weed control.
A series of laser pump, x-ray probe experiments show that above band gap photoexcitation can generate a large out-of-plane strain in multiferroic BiFeO3 thin films. The strain decays in a time scale that is the same as the photo-induced carriers measured in an optical transient absorption spectroscopy experiment. We attribute the strain to the piezoelectric effect due to screening of the depolarization field by laser induced carriers. A strong film thickness dependence of strain and carrier relaxation is also observed, revealing the role of the carrier transport in determining the structural and carrier dynamics in complex oxide thin films.
Edited by
Michael L. Power, American College of Obstetricians and Gynecologists, Washington DC,Jay Schulkin, American College of Obstetricians and Gynecologists, Washington DC
Preterm birth accounts for 70% of neonatal mortality and is a common cause for intellectual handicap among survivors. Approximately 50% of cases of cerebral palsy are associated with preterm birth, in turn preterm birth increases the risk of cerebral palsy by 40 times! (Goldenberg, 2002). Preterm labor thus afflicts individuals at the very beginning of their lives, depriving them of opportunities and increasing health and educational costs for families and society in general. Unfortunately the rates of preterm birth have not changed for over 30 years due to an inability to predict the event and lack of effective therapies.
This clinical problem has driven research into the mechanisms that regulate the timing of human birth and the disorders which cause preterm birth.
For reasons of ethics most research in the past has focused on animal work, especially in the sheep. Unfortunately studies have revealed substantial differences between parturition in humans and that in other animals. Thus animal studies provide us with clues as to how systems operate to regulate delivery in mammals but frustrate us with uncertainty as to whether particular mechanisms operate in the human. Experimental in vivo studies provide the strongest evidence for cause and effect, yet the closer we come to the human state in our near relatives the apes, the larger the ethical constraints on experimental studies become.
A case is reported in which a Nucleus 22 channel cochlear implant was inserted into the basal turn of the cochlea of a patient with advanced otosclerosis. It then passed out of the anterior end of the basal turn into an otospongiotic cavity related to the cochlea. Seven electrodes were located in the basal turn and it was possible to map them sufficiently well for the patient to derive considerable benefit from the implant. The problem of implant induced facial nerve stimulation in otospongiosis is also discussed.
This paper is an interim report of our inferences about the hydrostatic structure of the Sun, following the first report of the GONG team in Science (Gough et al., 1996). That work confirms that the spherically averaged structure of the Sun is more or less in agreement with current standard solar models. However, there remain some significant deviations which we regard as important clues to the existence of dynamical phenomena which are not taken into account in standard solar modelling.
Nucleation and growth of GaN under Ga-rich conditions by molecular beam epitaxy using a nitrogen rf plasma source is shown to result in both a smoother GaN surface and a reduced inversion domain content. In addition, preliminary results of the dramatic effect of atomic hydrogen on growth kinetics for Ga-rich growth are presented.
The Cochlear Implant Programme at Manchester Royal Infirmary was established in 1988 and so far (January,1992) 38 patients have been implanted with the Nucleus 22 channel intracochlear device and one with the Ineraid device. All patients who are referred for consideration for an implant are initially seen at a preliminary cochlear implant assessment clinic conducted by an ENT surgeon. One hundred and seventy three patients attended the initial outpatient screening clinic between 1987 and January 1992. Of these 112 patients (67.6 percent) went on for further investigation regarding suitability for implantation. This paper details the aetiology and severity of deafness in these patients and explains how suitability for admission to the next stage of assessment was decided.
The study was designed to investigate the process of speech accommodation between bilinguals from two ethnolinguistic groups. It was hypothesized that the greater the amount of effort in accommodation that a bilingual speaker of one group was perceived to put into his message, the more favourably he would be perceived by listeners from another ethnic group, and also the more effort they in turn would put into accommodating back to him. Eighty bilingual English-Canadians were divided into four groups and individually tested. Ss heard on tape a French-Canadian describe a picture and they were required to sketch this while listening. Ss were made fully aware that their speaker had a choice of language for his description. The four groups heard the same male speaker describe the drawing but each in a different guise: (1) French, (2) Mix-mix, (3) Fluent English and (4) Nonfluent English. Ss were then requested to rate their speaker and his performance, and to record a description of another picture themselves for that same French-Canadian to draw later. From analyses of the ratings and the Ss' tapes, the hypotheses were confirmed and different types of accommodation noted. A theoretical framework for these results and other forms of interpersonal accommodation was suggested. (Bilingualism; social interaction; accommodation theory; Canadian French, Canadian English.)
There has recently been a growing concern within political science with the public's support for governmental institutions. To date, the research in the judicial realm — focusing extensively on the United States Supreme Court — has measured support primarily in terms of the public's evaluation of court outputs and has attempted to explain support through variables believed to function as important bases or references for these evaluations, e.g., policy orientations, political party identification, and race (Murphy and Tanenhaus, 1968a and 1968b; Dolbeare and Hammond, 1968; Dolbeare, 1967; Hirsh and Donohew, 1968). Yet the public is not especially cognizant of court decisions and the low “visibility” of judicial bodies (Dolbeare, 1967; 198-201; Barth, 1968; Jacob, 1966) would suggest that the basis of support might well be more diffuse than specific. An analysis of diffuse support might be concerned primarily with the public's general willingness to comply with judicial decrees or with its willingness to maintain judicial institutions as bodies appropriate for resolving conflicts, and only secondarily with outputs.
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