scholarly journals Community treatment orders: Are they useful?

2017 ◽  
Vol 23 (4) ◽  
pp. 222-230 ◽  
Author(s):  
Jorun Rugkåsa ◽  
Tom Burns
Keyword(s):  
Hospital Admissions ◽  
Evidence Base ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Ongoing Debate ◽  
Current Controversy ◽  
Treatment Plans ◽  
The Uk ◽  
Different Levels

SummaryIn the wake of the deinstitutionalisation of mental health services, community treatment orders (CTOs) have been introduced in around 75 jurisdictions worldwide. They make it a legal requirement for patients to adhere to treatment plans outside of hospital. To date, about 60 CTO outcome studies have been conducted. All studies with a methodology strong enough to infer causality conclude that CTOs do not have the intended effect of preventing relapse and reducing hospital admissions. Despite this, CTOs are still debated, possibly reflecting different attitudes to the role of evidence-based practice in community psychiatry. There are clinical, ethical, legal, economic and professional reasons why the current use of CTOs should be reconsidered.Learning Objectives• Gain an overview of the development and use of CTOs in the UK and internationally• Get up-to-date information about the evidence base for CTO effectiveness and the relative contributions of different levels of evidence• Appreciate the nature of the current controversy around the use of CTOs and become familiar with the factors in the ongoing debate about their future

Community treatment order legislation in the Commonwealth

2016 ◽  
Author(s):  
John Dawson
Keyword(s):  
Outpatient Treatment ◽  
Community Care ◽  
Common Law ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Treatment Plans ◽  
The Uk ◽  
Treatment Order ◽  
Community Treatment Order

This chapter provides an overview of legislation governing the use of community treatment orders (CTOs)—that authorize compulsory outpatient treatment—in the UK, Canada, Australia, and New Zealand. It focuses particularly on the cluster of powers that CTOs confer on community mental health teams, permitting them to continue supervising a person’s outpatient care. It covers the criteria, procedures, and structure of authority for a CTO, the conditions such an order can impose on a person’s community care, the role of statutory treatment plans, and the powers available to enforce the outpatient treatment regime, especially the power of recall to hospital—analysing and comparing the subtly different regimes enacted in these Commonwealth nations that share a common law tradition.

scholarly journals The Role of Figurative Complexity in the Comprehension and Appreciation of Advertisements

2018 ◽  
Vol 40 (6) ◽  
pp. 957-991 ◽  
Author(s):  
Paula Pérez-Sobrino ◽  
Jeannette Littlemore ◽  
David Houghton
Keyword(s):  
Significant Variation ◽  
Processing Time ◽  
Consumer Response ◽  
Cross Cultural ◽  
Cultural Variation ◽  
Perceived Effectiveness ◽  
The Uk ◽  
Linguistic Backgrounds ◽  
Different Levels

Abstract To date, research in advertising has focussed almost exclusively on metaphor, with linguists and marketing scholars paying very little attention to alternative types of figurative expression. Beyond the finding that metaphor leads to an increased appreciation of advertisements, there has been surprisingly little research into how consumer response is affected by metonymy, or by metaphor–metonymy interactions. In this article, we present findings from a study that investigated the depth to which participants (n = 90) from a range of cultural and linguistic backgrounds (the UK, Spain, and China) were found to process 30 real-world adverts featuring creative metaphor and metonymy in multimodal format. We focus on the cross-cultural variation in terms of time taken to process, appreciation and perceived effectiveness of adverts, and on individual differences explained by different levels of need for cognition. We found significant variation in the understanding of advertisements containing metaphor, metonymy, and combinations of the two, between subjects and across nationalities in terms of (i) processing time, (ii) overall appeal, and (iii) the way in which participants interpreted the advertisements.

scholarly journals Community treatment orders and mental health social work: Issues for policy and practice in the UK and Ireland

2019 ◽  
Vol 64 ◽  
pp. 230-237 ◽  
Author(s):  
Jim Campbell ◽  
Gavin Davidson ◽  
Pearse McCusker ◽  
Hannah Jobling ◽  
Tom Slater
Keyword(s):  
Mental Health ◽  
Social Work ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Policy And Practice ◽  
The Uk

scholarly journals Areas of agreement in the management of childhood non-infectious chronic anterior uveitis in the UK

2019 ◽  
Vol 104 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Ameenat Lola Solebo ◽  
Jugnoo S Rahi ◽  
Andrew D Dick ◽  
Athimalaipet V Ramanan ◽  
Jane Ashworth ◽  
...  
Keyword(s):  
Anterior Uveitis ◽  
Severe Disease ◽  
Evidence Base ◽  
Future Research ◽  
Multiple Sources ◽  
Delphi Consensus ◽  
Modified Delphi ◽  
The Uk ◽  
High Level

Background/aimsThere is a paucity of high-level evidence to support the management of childhood uveitis, particularly for those children without juvenile idiopathic arthritis uveitis (JIA). We undertook a modified Delphi consensus exercise to identify agreement in the management of chronic anterior uveitis (CAU), the most common manifestation of childhood disease.MethodsA four-round, two-panel process was undertaken between June and December 2017. Paediatric uveitis specialists identified through multiple sources, including a multicentre network (the Paediatric Ocular Inflammation Group), were invited to participate. They were asked whether they agreed with items derived from existing guidelines on the management of JIA-U when extrapolated to the population of all children with CAU. Consensus was defined as agreement greater than or equal to 75% of respondents.Results26 of the 38 (68%) invited specialists participated with the exercise, and response rates were 100% for rounds one to three, and 92% for round four. Consensus was reached on 23 of the 44 items. Items for which consensus was not reached included management at presentation, use of systemic and periocular steroids for children with severe disease and the role of conventional steroid sparing immunosuppressants beyond methotrexate.ConclusionThe areas of management uncertainty at the level of the group, as indicated by absence of consensus, reflect the areas where the evidence base is particularly poor. Our findings identify the key areas for the future research needed to ensure better outcomes for this blinding childhood ocular inflammatory disorders.

scholarly journals Community treatment orders and their use in the UK

2010 ◽  
Vol 16 (4) ◽  
pp. 260-262 ◽  
Author(s):  
Mark Taylor
Keyword(s):  
Treatment Adherence ◽  
Scientific Evidence ◽  
Health Needs ◽  
Community Treatment ◽  
Compulsory Treatment ◽  
Ethical Considerations ◽  
Community Treatment Orders ◽  
England And Wales ◽  
The Uk

SummaryDespite the lack of supportive scientific evidence, the uptake of community treatment orders (CTOs) in England and Wales since their introduction in late 2008 has been higher than expected, although there has been a relative dearth of second opinion appointed doctors. In Scotland, CTOs now constitute about 30% of all long-term civil detentions, with lack of insight and lack of treatment adherence given as the major reasons for CTO use. Ethical considerations such as balancing autonomy against health needs will continue to be weighed by clinicians considering compulsory treatment in the community.

scholarly journals Simulation past, present and future—a decade of progress in simulation-based education in the UK

2020 ◽  
pp. bmjstel-2020-000601
Author(s):  
Helen Higham
Keyword(s):  
Evidence Base ◽  
Healthcare Systems ◽  
National Society ◽  
Interprofessional Team ◽  
The Past ◽  
Cognitive Aids ◽  
Simulation Based ◽  
The Uk ◽  
Simulation Practice

This review will present developments in simulation-based education (SBE) over the past decade with a focus on activity in the UK’s National Health Service and the role of the national society (the Association for Simulation Practice in Healthcare). The article covers the evolution of strategic changes for the use of SBE in the UK and the operational challenges faced by clinicians and other faculty in SBE. The expansion of the evidence base to support SBE in healthcare both in technical skills and, more broadly, in interprofessional team training is explored. Finally, the wider role of simulation in patient safety and healthcare systems, including testing pathways and the development of cognitive aids and involvement of patients in SBE is considered.

scholarly journals Evidence ν. rights-based decision making for nutrition

2003 ◽  
Vol 62 (2) ◽  
pp. 553-562 ◽  
Author(s):  
Roger Shrimpton
Keyword(s):  
Human Rights ◽  
Large Body ◽  
Well Being ◽  
Evidence Base ◽  
Wide Distribution ◽  
Role Of The State ◽  
Food And Nutrition ◽  
The Uk ◽  
The Right

The need for an evidence base for human nutrition action is analysed in the context of human rights. Over the last 50 years the twin tracks of development, economical needs based and normative rights based, have come progressively closer in terms of goals and objectives, even if they do maintain different orientations and origins. The international human rights machinery is described, together with those parts that are of relevance to the right to food and nutrition. The role of the State in respecting, protecting and facilitating these rights is further described. The evidence base for the benefit of nutrition interventions during the fetal and infant period to the health and well-being of populations throughout life's course is briefly reviewed, and reasons why such a large body of evidence has not been acted upon are discussed. The power of nutrition is in prevention more than cure, and the prevention of nutritional deficiency is best suited to radical population-wide strategies rather than high-risk strategies targeted at individuals. The population-wide distribution of benefits of nutrition is in congruence with universality of human rights. In the UK much remains to be done to ensure that food and nutrition rights are realised, especially during the critical period of fetal and infant growth. What role the Nutrition Society might play in the realisation of these rights, including the creation of a robust evidence base for nutrition action, is further discussed.

Dementia and frailty

2019 ◽  
pp. 579-618
Keyword(s):  
Palliative Care ◽  
Hospital Admissions ◽  
Advanced Disease ◽  
Psychological Symptoms ◽  
Management Strategies ◽  
People With Dementia ◽  
Diagnosis Of Dementia ◽  
The Uk ◽  
End Stage

This chapter outlines the symptoms, epidemiology, aetiology, and differential diagnosis of dementia, with emphasis on advanced disease. It discusses the role of dementia treatments, the challenges faced with advanced disease, and guides to recognition and treatment of common symptoms, including behavioural and psychological symptoms of dementia and pain. The chapter also discusses pharmacological and non-pharmacological approaches to management of dementia symptoms, highlighting the role of palliative care, when it is appropriate to refer, and terminal care. The chapter illustrates some of the controversial aspects of care. At the current rate there will be 850,000 people with dementia in the UK by 2015, and this number is forecast to increase to over 1 million by 2025 and over 2 million by 2051.This is contributing to one in four hospital admissions, with the health and social costs of dementia estimated to be more than stroke, heart disease, and cancer combined. Along with these worrying progressive epidemiological figures, we need to take into account the immense caring burden for families, carers, and society. End-stage dementia often falls between the cracks of specialization, with professionals feeling under-prepared for the intricacies of end-stage dementia management strategies. Palliative care has been slow in its involvement for multiple reasons, but primarily because dementia has a much slower disease trajectory than cancer, with an unclear prognosis.

scholarly journals Community treatment orders: background and implications of the OCTET trial

2014 ◽  
Vol 38 (1) ◽  
pp. 3-5 ◽  
Author(s):  
Tom Burns ◽  
Andrew Molodynski
Keyword(s):  
Controlled Trial ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
International Evidence ◽  
Obvious Benefit ◽  
Evaluation Trial ◽  
Randomised Controlled ◽  
The Uk ◽  
Treatment Order ◽  
Community Treatment Order

SummaryCommunity treatment orders (CTOs) were introduced into the UK despite unconvincing international evidence for their effectiveness. The Oxford Community Treatment Order Evaluation Trial (OCTET) is a multisite randomised controlled trial of 333 patients with psychosis conducted in the UK. It confirms an absence of any obvious benefit in reducing relapse despite significant curtailment of liberty. Community mental health teams need to seriously consider whether they should continue using CTOs or shift their clinical focus to strengthening the working alliance.

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