Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.

The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.

We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.

We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.

Alzheimer s disease (AD) is a progressive neurodegenerative disease leading to cognitive decline and eventually death. Degradation of cortical neuroplasticity is thought to be a major catalyst of AD-related cognitive decline. Repetitive transcranial magnetic stimulation (rTMS), which uses pulsed magnetism to stimulate neurons, increases cortical plasticity and induces long-lasting neuroplastic changes. Patients have benefited from rTMS to treat AD, especially when done in conjunction with cognitive training exercises. This case report presents a 31-year-old male who tested positive for an autosomal dominant mutation implicated in early-onset AD. rTMS and cognitive training were employed to assist in the delay of early-onset AD manifestation in two cycles.

Prior to each treatment cycle, the patient completed questionnaires and interviews designed to test his cognitive functioning; his spouse was interviewed to provide a third-party assessment of his functioning. Following pre-treatment data collection, 30 daily rTMS/cognitive training sessions were completed in the first cycle and 35 daily rTMS/cognitive training sessions were completed in the second cycle. The bilateral dorsolateral prefrontal cortices each received 1,000 pulses (10 Hz, 110% SMT). Tolerability and side effect data were collected after each treatment. Immediately following rTMS, the patient played cognitive training games at our Brain Fitness Center. All pre-treatment assessments were repeated after completion of the 30 sessions in the first cycle and the 35 sessions in the second cycle for comparison of pre- to post-treatment cognitive functionality.

Pre-treatment testing indicated the patient was asymptomatic before each cycle. The patient completed 30 daily rTMS sessions in the first cycle and 35 daily rTMS sessions in the second cycle. Tolerability/side effect data showed he tolerated treatment well and experienced only minor pain. The patient also completed 30 cognitive training sessions in the first cycle and 35 cognitive training sessions in the second cycle and showed moderate improvement across all cognitive domains. Post-treatment assessments indicated no change in functioning except to note the patient s improved sleep. A third treatment cycle is scheduled to begin in February 2020.

This case report supports rTMS paired with cognitive training to be a safe and tolerable treatment for early-onset AD. However, more treatment cycles must be completed before conclusions about its efficacy can be determined.

Multimorbidity is common but little is known about its relationship with obstructive sleep apnea (OSA).

Men Androgen Inflammation Lifestyle Environment and Stress Study participants underwent polysomnography. Chronic diseases (CDs) were determined by biomedical measurement (diabetes, dyslipidaemia, hypertension, obesity), or self-report (depression, asthma, cardiovascular disease, arthritis). Associations between CD count, multimorbidity, apnea-hyponea index (AHI) and OSA severity and quality-of-life (QoL; mental & physical component scores), were determined using multinomial regression analyses, after adjustment for age.

Of the 743 men participating in the study, overall 58% had multimorbidity (2+ CDs), and 52% had OSA (11% severe). About 70% of those with multimorbidity had undiagnosed OSA. Multimorbidity was associated with AHI and undiagnosed OSA. Elevated CD count was associated with higher AHI value and increased OSA severity.

We demonstrate an independent association between the presence of OSA and multimorbidity in this representative sample of community-based men. This effect was strongest in men with moderate to severe OSA and three or more CDs, and appeared to produce a greater reduction in QoL when both conditions were present together.

Surgical site infection (SSI) after total hip and knee arthroplasty is a common postoperative complication. We sought to determine readmission rates and costs for total hip and knee arthroplasty complicated by SSI.

The Thomson Reuters MarketScan database was searched for patients who underwent knee or hip arthroplasty in 2007. From these data, patients who received a diagnosis of SSI and were readmitted after diagnosis were identified.

A population of 31 to 45 million individuals receiving insurance coverage. Patients who underwent knee or hip arthroplasty who experienced a hospitalization for SSI in the year after surgery were analyzed.

Total readmission rates and costs per readmission at 30, 60, and 90 days and 1 year after diagnosis of SSI.

Of the 76,289 case patients with hip or knee replacement in 2007, 1,026 (1.3%) had a hospitalization for SSI within the year after surgery. Among these patients, 310 (30.2%) were subsequently rehospitalized in the year after initial hospitalization specifically due to SSI-related issues. These rehospitalizations were associated with a mean hospital stay of 7.4 ± 11.4 days and a median cost of $20,001 (interquartile range [IQR], $14,057-$30,551). A total of 517 subjects had a subsequent “all-cause” hospitalization during the year after SSI. These rehospitalizations were associated with a mean hospital stay of 6.4 ± 10.4 days and a median cost of $19,870 (IQR, $13,913-$29,728).

Readmissions during the year after SSI diagnosis accounted for 1,072 hospital admissions and cost over $25.5 million. These readmissions are costly and might be a future target for decreased reimbursement.