scholarly journals A retrospective study comparing the length of admission of medium secure unit patients admitted in the three decades since 1985

2018 ◽  
Vol 43 (4) ◽  
pp. 154-157 ◽  
Author(s):  
Charles H. Earnshaw ◽  
Lucy Shaw ◽  
Deepu Thomas ◽  
Owen Haeney
Keyword(s):  
Clinical Implications ◽  
Discharge Destination ◽  
Median Length ◽  
Delivery Of Care ◽  
Factors Associated ◽  
Supported Accommodation ◽  
Admission Data ◽  
Time Period ◽  
Secure Unit ◽  
Single Medium

Aims and methodAdmissions of patients to secure forensic hospitals are often lengthy. Previous research has examined factors associated with prolonged admission, but studies analysing admission data at a single medium secure unit (MSU) over a prolonged time period are lacking. We compared admission data for all patients admitted to a MSU in England during the years 1985, 1995, 2005 and 2012.ResultsThe median length of admission increased from 167 days in 1985 to 580 days in 2012, though not in the intervening cohorts. There have been changes in the discharge destination of patients, away from independent accommodation in the community towards further care or supported accommodation.Clinical implicationsThe results suggest a change in the delivery of care. Further studies should be performed to assess whether the same trends exist at other sites. If these trends are also found elsewhere, this should trigger a specialty-wide discussion about admission length and its effects on bed availability.Declaration of interestNone.

FACTORS ASSOCIATED WITH PARTIAL REMISSION IN DEPRESSION

1999 ◽  
Vol 27 (3) ◽  
pp. 215-222 ◽  
Author(s):  
Peter L. Cornwall ◽  
Jan Scott
Keyword(s):  
Partial Remission ◽  
Self Esteem ◽  
Significant Loss ◽  
Clinical Implications ◽  
Major Depressive ◽  
Factors Associated ◽  
Full Remission ◽  
Loss Of Self ◽  
Observer Ratings

We report a subgroup analysis of 24 out of 42 subjects who were hospitalized for non-psychotic major depressive disorder and who agreed to participate in interviews at admission and 2 years afterwards (as reported previously by Domken, Scott, & Kelly, 1994; Bothwell & Scott, 1997). At 2 year follow-up, these 24 subjects were categorized according to established criteria into clients meeting criteria for full remission (FR; n=9) and those meeting criteria for partial remission (PR; n=15). The most striking findings were that, over time, PR subjects showed significant loss of self-esteem and showed greater divergence in self-ratings compared to observer ratings of their depressive symptoms, whilst the same ratings in the FR group changed in the opposite direction. We suggest that the persistence of depression in PR subjects may provide evidence to support Teasdale’s (1988) hypothesis that some individuals “get depressed about being depressed”. The research and clinical implications of the results are noted.

scholarly journals Police involvement, characteristics and outcomes of place of safety referrals in the Scottish Highlands

2020 ◽  
Vol 44 (6) ◽  
pp. 244-250
Author(s):  
Struan Simpson ◽  
Jude Eze
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
High Risk ◽  
Personality Disorder ◽  
Emergency Management ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Factors Associated ◽  
Scottish Highlands ◽  
Risk Areas

Aims and methodTo characterise police involvement with those detained under place of safety legislation and determine factors associated with admission to hospital. Place of safety referrals over a 1-year period were identified retrospectively and evaluated.ResultsPlace of safety legislation is generally used with regard to concerns about suicide. Individuals are often removed from high-risk areas and referrals to police are frequently initiated by individuals themselves. A diagnosis of mental illness or personality disorder predicted hospital admission. Presence of senior nursing staff at assessment, but not the seniority of the doctor, was associated with discharge.Clinical implicationsCloser multiagency working is required as police are currently being recruited to fill a void between mental health services and the population they serve. Junior doctors require more senior support in making complex, and often risky, emergency management decisions with this population.

scholarly journals Changes in diagnoses before admission to a specialist medium secure unit

2012 ◽  
Vol 36 (11) ◽  
pp. 404-408 ◽  
Author(s):  
Amrith Shetty ◽  
Dilum Jayawickrama ◽  
Pamela J. Taylor
Keyword(s):  
Substance Misuse ◽  
Service Providers ◽  
Psychiatric Services ◽  
Clinical Implications ◽  
Psychotic Illness ◽  
Violent Behaviour ◽  
Medium Security ◽  
History Of ◽  
Secure Unit ◽  
Study Participants

Aims and methodThere is evidence that changing diagnoses may be an important factor preceding homicide, but there is little literature on diagnostic antecedents to admission to specialist secure units after violent behaviour. Our aim was to establish the frequency of a history of changing diagnoses in patients in a UK specialist unit, and to explore the characteristics of these patients.ResultsIn total, 38 of 42 study participants had prior contact with psychiatric services. Just over 40% (16 of the 38) had had their diagnosis changed three or more times. All those who had major changes in their diagnosis had received a diagnosis of a psychotic illness at some point prior to the secure unit admission, but then had it withdrawn, only to be restored after prolonged assessment in the secure unit. Personality disorder and substance misuse comorbidity was common in this group; however, non-psychotic diagnoses were seen as more important than psychotic diagnoses by general services.Clinical implicationsChanges in diagnosis between first presentation to psychiatric services and admission to a medium-security unit were more common than would be expected from reports in the general literature. They are a testimony to the difficulties experienced by service providers in delivering a consistent service. This needs to be studied further.

Self-Care Behaviour and Factors Associated with Patient Outcomes Following Same-Day Discharge Percutaneous Coronary Intervention

2009 ◽  
Vol 8 (3) ◽  
pp. 190-199 ◽  
Author(s):  
Sandra Lauck ◽  
Joy L. Johnson ◽  
Pamela A. Ratner
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Disease ◽  
Health Care Systems ◽  
Self Care ◽  
Coronary Intervention ◽  
Cross Sectional ◽  
Delivery Of Care ◽  
Factors Associated ◽  
Percutaneous Coronary ◽  
Same Day Discharge

Background: The demand for percutaneous coronary intervention (PCI) exerts constant pressure on health care systems to meet the growing needs of patients. The practice of same-day discharge PCI has emerged as a medically safe option to optimize resource utilization and improve access to care. Aim: The purpose of this study was to describe elective same-day discharge PCI patients' self-care behaviour in the two to five days following their procedure, and the factors associated with cardiac self-efficacy (CSE) and self-care agency (SCA). Methods: Using a cross-sectional correlational design, 98 consecutive patients were contacted by telephone, following PCI, and asked about their CSE, SCA, and adherence to discharge recommendations. Associations between selected variables were explored through multiple regression analysis. Results: The findings revealed a high degree of adherence to discharge recommendations, although participants' appreciation of the long term management of their chronic disease was limited. Factors associated with lower levels of CSE and SCA included the burden of having additional chronic co-morbidities, living alone and lacking social support, and a positive screening for psychosocial distress. Conclusion: Same-day discharge PCI presents a sustainable option for delivery of care for most patients. Some clients may require additional support to manage the transition between acute intervention and chronic disease management.

State Development, Parity, and International Conflict

2017 ◽  
Vol 111 (1) ◽  
pp. 21-38 ◽  
Author(s):  
DOUGLAS M. GIBLER
Keyword(s):  
International Conflict ◽  
International System ◽  
State System ◽  
Statistical Relationship ◽  
System State ◽  
State Development ◽  
Factors Associated ◽  
Time Period ◽  
Over Time

This article explains the empirical connection between dyadic capability differences and international conflict as a consequence of how, when, and where states enter the international system. State capabilities are largely static, and, since states enter the system in geographic clusters, the processes of state maturation affect contiguous and regionally proximate states similarly. This makes dyadic capability differences static as well. The lack of change in capability differences over time suggests that the parity-conflict relationship is largely a product of the factors associated with state system entry. Indeed, as I demonstrate, several different proxies for the conditions of state system entry separately eliminate any statistical relationship between parity and militarized dispute onset, 1816–2001. I also find no relationship between parity and the wars that have occurred during that same time period. These results have a number of implications for the role of power and capabilities in explaining international conflict.

scholarly journals Police and sniffer dogs in psychiatric settings

2008 ◽  
Vol 32 (7) ◽  
pp. 253-256 ◽  
Author(s):  
Najat Khalifa ◽  
Simon Gibbon ◽  
Conor Duggan
Keyword(s):  
Illicit Drugs ◽  
Illicit Drug ◽  
Response Rate ◽  
The Other ◽  
Self Report ◽  
Clinical Implications ◽  
Patient Response ◽  
Secure Unit ◽  
The Individual ◽  
The Impact

Aims and MethodTo study the views of staff and patients on the use of sniffer dogs to detect illicit drugs and the prosecution of in-patients suspected of taking illicit drugs. A 15-item self-report questionnaire was given to all in-patients and staff who had any contact with patients in a medium-secure unit. Responses to the individual statements were measured on a five-point Likert scale and staff and patients' responses were compared.ResultsWe achieved a response rate of 63% (patient response rate, 71.6%; staff response rate, 60.7%). Overall there were fewer differences than anticipated, although, as expected, staff viewed the impact of illicit drugs more negatively than patients, and on the other hand, patients viewed the use of sniffer dogs and police involvement more negatively than the staff did.Clinical ImplicationsNotice ought to be taken of the discordance between staff and patients' views (particularly in relation to consent and confidentiality) when attempting to detect and manage illicit drug use among psychiatric in-patients.

Practice of Seclusion: A Five-Year Retrospective Review in North Cheshire

1998 ◽  
Vol 38 (4) ◽  
pp. 321-327 ◽  
Author(s):  
Emad Salib ◽  
A G Ahmed ◽  
Mike Cope
Keyword(s):  
Personality Disorder ◽  
Mental Disorder ◽  
Psychiatric Hospital ◽  
Clinical Diagnosis ◽  
Retrospective Review ◽  
Average Duration ◽  
Admission Rate ◽  
Factors Associated ◽  
Acceptable Method ◽  
Secure Unit

This study examines, retrospectively, the trends and factors associated with the use of seclusion over a five-year period in a regional secure unit located within a large psychiatric hospital that serves the population of North Cheshire. Ninety-four patients (15.3% of total admissions to the unit) spent some time in seclusion on 186 occasions. The average time spent in seclusion was 85 minutes (minimum 15 minutes and maximum 10 hours). Sixty-seven per cent of patients were secluded once, 20% secluded twice, and 13% more than three times. Patients with a clinical diagnosis of personality disorder (11.4%) accounted for 44.2% of seclusions whereas those with a defined mental disorder (55%) accounted for 35% of all seclusions. The rate of seclusion, characteristics of secluded patients, reasons, and average duration spent in seclusion, did not vary significantly over the study period, despite the significant reduction of the unit's admission rate from 150 to 63 per year. The consistent and regular occurrence of the practice over a five-year period may suggest that seclusion of some disturbed patients will inevitably continue to be used as an effective intervention and, probably at times, the only acceptable method that may ensure the safety of patients and staff.

scholarly journals The Effect of Denture Cleansers on Resiliency of Soft Lining Materials

2013 ◽  
Vol 14 (1) ◽  
pp. 65-70
Author(s):  
N Simhachalam Reddy ◽  
Nallala Amarendra Reddy ◽  
A Kaleswara Rao ◽  
Siddesh Kumar
Keyword(s):  
Elastic Recovery ◽  
Control Group ◽  
Clinical Implications ◽  
Time Interval ◽  
Partial Recovery ◽  
Time Period ◽  
Soft Liner ◽  
Silicon Based ◽  
Denture Cleansers

ABSTRACT Aim The present study was undertaken to determine the effect of denture cleansers on resiliency of soft liner. Materials and methods Two soft liners (Molloplast-B and Refit) and two denture cleansers (Clinsodent and Fittydent) were taken. Cylindrical aluminum dies were constructed of 12 mm length and 8 mm diameter at the ratio of 1.5:1. The samples are tested with Hounsfield tensometer. Observation and results Effect of both the denture cleansers on the lining materials was shown in the form of Graphs 1 and 2. The elastic recovery of Molloplast B in dry, Fittydent and Clinsodent is comparatively more than refit, but in control group the elastic recovery of both the material is almost equal. Conclusion Heat processed soft liners recover faster/better in a shorter time interval when compared to self-processed liners which takes longer time for the recovery. This time period is very important as the cushioning effect of the soft liner require an elastic recovery between the masticatory strokes. Clinical implications Greater the softness and better the elastic recovery of the denture soft liner, more effective would be its performance clinically. Silicon based material, such as Molloplast-B, rebounds quickly and would seem preferable to a material that is acrylic based. It is possible that, if the response is too slow or the elastic recovery is less, there may only be a partial recovery of the lining between the masticatory strokes. Progressive thinning of the lining materials might then occur resulting in a reduced cushioning effect.

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