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The use of coercive measures is an increasingly debated aspect of psychiatric treatment. Considering the multitude of negative effects, patients, clinicians, and ethicists alike have called for a more cautious application of coercion. It therefore remains important to investigate which organizational characteristics have the potential to facilitate efficient coercion reduction. The same holds true for the efficient reduction of symptom severity during inpatient treatment.
Methods
The current study compared 22 Swiss psychiatric clinics treating 45,095 cases regarding their relative efficiency in treating cases without coercion given their staff resources. To this end, we applied a Data Envelopment Analysis to clinical routine data. We focused specifically on inefficiencies attributable to management factors independent of the clinics’ total staff numbers. We further compared the clinics’ relative efficiencies regarding changes of self-reports and third-person reports of symptom severity during inpatient stays.
Results
Efficiency scores suggest that on average, the clinics could improve the percentage of cases treated without coercion by 9% and the changes of symptom severity by 34% (for third-person ratings) or 18% (for self-reports) while keeping staff numbers constant. An analysis of specific coercion types revealed that the potential for efficiency improvements via management was highest for movement restrictions. We found no effect of clinic size on efficiency scores regarding any of the outcome measures.
Conclusions
Our results underline the importance of management factors beyond staff resources (e.g., staff trainings or changes in ward structure and treatment concepts) for the efficient reduction of coercion and psychiatric symptoms during inpatient stays.
Employment and relationship are crucial for social integration. However, individuals with major psychiatric disorders often face challenges in these domains.
Aims
We investigated employment and relationship status changes among patients across the affective and psychotic spectrum – in comparison with healthy controls, examining whether diagnostic groups or functional levels influence these transitions.
Method
The sample from the longitudinal multicentric PsyCourse Study comprised 1260 patients with affective and psychotic spectrum disorders and 441 controls (mean age ± s.d., 39.91 ± 12.65 years; 48.9% female). Multistate models (Markov) were used to analyse transitions in employment and relationship status, focusing on transition intensities. Analyses contained multiple multistate models adjusted for age, gender, job or partner, diagnostic group and Global Assessment of Functioning (GAF) in different combinations to analyse the impact of the covariates on the hazard ratio of changing employment or relationship status.
Results
The clinical group had a higher hazard ratio of losing partner (hazard ratio 1.46, P < 0.001) and job (hazard ratio 4.18, P < 0.001) than the control group (corrected for age/gender). Compared with controls, clinical groups had a higher hazard of losing partner (affective group, hazard ratio 2.69, P = 0.003; psychotic group, hazard ratio 3.06, P = 0.001) and job (affective group, hazard ratio 3.43, P < 0.001; psychotic group, hazard ratio 4.11, P < 0.001). Adjusting for GAF, the hazard ratio of losing partner and job decreased in both clinical groups compared with controls.
Conclusion
Patients face an increased hazard of job loss and relationship dissolution compared with healthy controls, and this is partially conditioned by the diagnosis and functional level. These findings underscore a high demand for destigmatisation and support for individuals in managing their functional limitations.
Immediately before working for Enrico Scrovegni in Padua, Giotto served Boniface VIII as painter to the papal court in Rome and was in Rome for the Jubilee in 1300 before moving to the Veneto.1 Without any extensive written documents on the chapel’s gestation or preparatory drawings, modern scholarship mostly takes the precise correspondence between illusionistic frescoes and architecture in the chapel as testimony of Giotto’s direct involvement with its design, planning, and construction.
Highlighting its prominent location on the site of the ancient Roman arena in Padua, the oratory of Santa Maria della Carità has traditionally been called the Cappella dell’Arena or Arena Chapel (Figs. 1.1–1.2). Part of a new family palace commissioned by Enrico Scrovegni, the chapel was built and decorated by Giotto in the years following the Roman Jubilee of 1300, after the Tuscan painter had worked for Pope Boniface VIII as his papal court artist in Rome. The construction of Santa Maria della Carità, so closely connected to Giotto’s murals, was most likely masterminded and supervised by Giotto himself. The building can be dated between 1300 and 1303, and the parameters for the frescoes have been set between 1303 and 1307.2 The overall structure and proportions of the Arena Chapel?s nave are akin to two triumphal arches placed in succession.3 The barrel-vaulted core interior is divided into two precincts – public and private – with two respective entrances. Formerly adjoining Palazzo Scrovegni, the chapel stands projecting out from the elliptical plan of the ruins of the ancient Roman arena.4 The chapel’s building history, based upon some documented and some obvious physical alterations undertaken during construction, has been profoundly debated.5 Walter Euler describes the effect of the interior as surprisingly grand for its height, which is only about one-and-a-half times its width. In this simple geometry of the classical barrel vault, the cross section equals a square with a semicircle on top of it.6
This book on Giotto’s Arena Chapel in Padua – the Cappella degli Scrovegni, circa 1300–1307 – takes its cues not so much from the familiar aspects of a celebrated and intensely studied monument as from its inbuilt surprises. Some of these are visual puzzles; some depend on mostly forgotten circumstances of the chapel’s creation and reception; still others challenge academic boundaries and conventional assumptions about its place in the history of Western art. These lines of inquiry, taken sequentially and together, enable a decoding – and, I shall argue, a recoding – of the structure, visual appeal, and significance of the chapel. As an investigation of the different zones and historical styles represented in the chapel, this book constitutes an exercise in escaping from the quicksand of history that so quickly swallows important local and temporal context for art and architecture.
In Padua, we have seen a painter who leaves nothing to chance – someone who perspectivally adjusts each single tiny consoled dentil on the faux architectural cornice over the Virtues and Vices; someone who leaves traces of blonde polychromy on a fictive statue’s undercut areas and not on her head; someone who gives the head fragment of a fictive Bacchus a 180-degree rotation to show the force of a heavy triumphal cross falling like a hammer across his shoulders; someone who lets ancient garlands blossom around the Kiss at the Golden Gate even when those are barely visible from the ground. The details are as well-considered as the system in which they appear.
This chapter takes an in-depth tour through the chapel, scrutinizing first the painted relief system of the entire space, the doorways, the west wall’s Last Judgment, and the Virtues and Vices with their washed-off polychromy. A detailed discussion of the stories of the Lives of Mary and Jesus will then be followed by an analysis of the chancel arch, the coretti, and, finally, the fictive broken double vault with its starry sky. The focus is upon specific classicizing or Romanizing elements on the one hand, and the significance of optical relief on the other. This shifting of gears, precipitated by an integrated analysis of different parts of the system, is a process of calibration – adjusting a system’s range and aspects according to their own standards.
In the late Duecento Veneto and Lazio, a faint memory of two other families weaves itself into the long history of the Scrovegni Chapel: the Dalesmanini, a Paduan banking family and the former owners of the arena, and the Frangipani, an old noble Roman family whose name is connected with papal history. In the north of Italy, the Dalesmanini family palace was situated in Padua’s ancient Roman arena until Enrico Scrovegni financially ruined his rivals and eventually acquired the arena, complete with their residence. Down in Rome, several branches of the Frangipani resided in their prestigious urban estate over the Velia in at least three family towers. Positioned between the Colosseum and the Frangipani family church, Santa Maria Nova, their palace’s walls incorporated the Arch of Titus. This architectural ensemble would provide a model that Scrovegni could simulate in Padua for himself, both materially-visually – when he merged Scrovegni Palace with his chapel in the ruins of the Paduan arena – and verbally – when the extensive text of the inscription celebrated his act of triumphing over ancient heathen forces as well as his local predecessors.