scholarly journals Expert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data

2021 ◽  
Vol 12 ◽  
Author(s):  
Adrian P. Mundt ◽  
Sabine Delhey Langerfeldt ◽  
Enzo Rozas Serri ◽  
Mathias Siebenförcher ◽  
Stefan Priebe
Keyword(s):  
Systematic Review ◽  
Community Care ◽  
Integration Of Care ◽  
Admission Rates ◽  
Expert Opinions ◽  
Psychiatric Beds ◽  
Occupancy Rates ◽  
Mental Health Policies ◽  
Bed Numbers

Introduction: Mental health policies have encouraged removals of psychiatric beds in many countries. It is under debate whether to continue those trends. We conducted a systematic review of expert arguments for trends of psychiatric bed numbers.Methods: We searched seven electronic databases and screened 15,479 papers to identify expert opinions, arguments and recommendations for trends of psychiatric bed numbers, published until December 2020. Data were synthesized using thematic analysis and classified into arguments to maintain or increase numbers and to reduce numbers.Results: One hundred six publications from 25 countries were included. The most common themes arguing for reductions of psychiatric bed numbers were inadequate use of inpatient care, better integration of care and better use of community care. Arguments to maintain or increase bed numbers included high demand of psychiatric beds, high occupancy rates, increasing admission rates, criminalization of mentally ill, lack of community care and inadequately short length of stay. Cost effectiveness and quality of care were used as arguments for increase or decrease.Conclusions: The expert arguments presented here may guide and focus future debate on the required psychiatric bed numbers. The recommendations may help policymakers to define targets for psychiatric bed numbers. Arguments need careful local evaluation, especially when supporting opposite directions of trends in different contexts.

Acute Psychiatric Beds: Distribution and Staffing in NSW and ACT

1995 ◽  
Vol 29 (2) ◽  
pp. 238-247 ◽  
Author(s):  
Stephen Rosenman
Keyword(s):  
Admission Rate ◽  
Private Hospitals ◽  
Admission Rates ◽  
Acute Psychiatry ◽  
Department Of Health ◽  
Barriers To Access ◽  
Nursing Staffing ◽  
Psychiatric Beds ◽  
Occupancy Rates ◽  
Average Occupancy

This study examined the availability and staffing of acute psychiatry beds in NSW and ACT. “Gazetted” acute psychiatry hospitals (which take compulsory admissions under mental health law) were polled directly for bed numbers, occupancy and staffing for the year 1990–1991. The NSW Department of Health provided beds numbers for non-gazetted and private hospitals. Four analyses sequentially reallocated beds according to the origin of patients to estimate acute bed availability and use by regional populations. Socio-demographic determinants of acute admission rates were measured. Acute “gazetted” beds averaged 13.2 per 100,000 population but ranged from 6.9 to 49.1 per 100,000 when cross-regional flows were considered. “Non-gazetted” beds raised the provision to 15.5 per 100,000 and private beds raised provision further to 24.5 per 100,000. Inner metropolitan provision was higher than rural or provincial provision. The only determinant of the admission rate to gazetted beds was the number of available beds. Bed availability did not affect either bed occupancy or referral of patients to remote hospitals. Nursing staffing of gazetted units was reasonably uniform, although smaller units had significantly more nurses per bed. Medical staffing was highly variable and appears determined by staff availability. The average provision of acute psychiatric beds approximates lowest levels seen in international models for psychiatric services. Average occupancy rates suggest that there is not an overall shortfall of acute psychiatric beds, but uneven bed distribution creates barriers to access. Referral of patients to remote hospitals is not related to actual bed provision in the regions, but appears to reflect attitudes to ensuring local care. Recommendations about current de facto standards are made. Current average nursing and medical staffing standards are reported.

scholarly journals Interventions to address health outcomes among autistic adults: A systematic review

Autism ◽  
2020 ◽  
Vol 24 (6) ◽  
pp. 1345-1359 ◽  
Author(s):  
Teal W Benevides ◽  
Stephen M Shore ◽  
May-Lynn Andresen ◽  
Reid Caplan ◽  
Barb Cook ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Systematic Review ◽  
Health Outcome ◽  
Health Outcomes ◽  
Intervention Studies ◽  
Expert Opinions ◽  
Primary Health ◽  
Autistic Adults

Research has shown that autistic adults have poor health outcomes. We conducted a systematic review to identify existing interventions to address health outcomes for autistic adults and to determine whether these interventions address the priorities of the autistic community. We searched PubMed for articles that included an intervention, a primary health outcome measured at the individual (not system) level, and a sample population of at least 50% autistic adults. Studies were excluded if they were not peer-reviewed, had a focus on caregivers, were expert opinions on specific interventions, untested protocols, or interventions without a primary health outcome. Out of the 778 articles reviewed, 19 were found to meet the stated criteria. Based on the evidence gathered, two were considered emerging evidence-based approaches: cognitive behavioral approaches and mindfulness. The remaining interventions included in the review did not have sufficient evidence to support current use with this population. The majority of the studies included samples of young autistic adults, primarily male, without an intellectual disability. Anxiety, quality of life, depression, and behavioral issues were among the health outcomes measured in the final included articles. More research on preferred interventions with prioritized health outcomes of the autistic adult population is needed. Lay abstract Autistic adults have more health problems then their same-aged peers. Yet little research has been conducted that focuses on addressing these health problems. In order to guide future research, it is important to know what intervention studies have been done to improve health outcomes among autistic adults. The project team and student assistants read studies that were published between 2007 and 2018 in the online research database, PubMed. We looked for studies published in English, which were peer-reviewed and included (1) an intervention, (2) an outcome that was related to health, and (3) a study group that included autistic adults. We did not include studies that had outcomes about employment (unless there was a health outcome), studies about caregivers or caregiving, or expert opinions about interventions. Of 778 reviewed articles, 19 studies met all of the criteria above. Within these studies, two approaches were found to have emerging evidence for their use in autistic adults: cognitive behavioral interventions and mindfulness-based approaches for improved mental health outcomes. The remaining intervention approaches did not have enough articles to support their use. Many of the outcomes were about reduced symptoms of co-occurring mental health diagnoses (e.g. reduced anxiety, depression). Most of the participants in these studies were male and did not have intellectual disability. Most study participants were adults younger than 40. There are not many intervention studies that address health outcomes among autistic adults. More research is needed on interventions which are desired by the adult autism community and address preferred health outcomes such as increased quality of life or well-being.

scholarly journals Developing case management for the long-term mentally ill

1993 ◽  
Vol 17 (7) ◽  
pp. 409-411 ◽  
Author(s):  
Richard Ford ◽  
Alan Beadsmoore ◽  
Paul Norton ◽  
Anna Cooke ◽  
Julie Repper
Keyword(s):  
Mental Health ◽  
Mentally Ill ◽  
Community Care ◽  
Chronically Ill ◽  
Integrated Services ◽  
Psychiatric Services ◽  
Health Policies ◽  
Mental Health Policies ◽  
Bed Numbers

Mental health policies and the focus of psychiatric services have shifted over the last three decades from hospital to community care. Greater care in the community and reduced psychiatric bed numbers have contributed to the discharge or non-admission of many patients with severe and persistent disorders who formerly would have been cared for in hospital. Increasing numbers of the chronically ill in the community will necessitate the development of systems to provide continuous and integrated services for such people.

scholarly journals Acute inpatient psychiatry in England: an old problem and a new priority

2006 ◽  
Vol 15 (2) ◽  
pp. 91-94 ◽  
Author(s):  
Paul Lelliott
Keyword(s):  
Community Care ◽  
Leisure Activities ◽  
International Standards ◽  
Psychiatric Admission ◽  
Admission Ward ◽  
Acute Psychiatric Wards ◽  
Underlying Causes ◽  
The Uk ◽  
Psychiatric Beds ◽  
Bed Numbers

AbstractWith the development of community care, the number of National Health Service psychiatric beds in England has been reduced to between one-fifth and one-quarter of those provided in the mid-1950s. Psychiatric bed numbers are close to the irreducible minimum if they have not already reached it. The problems facing today's acute psychiatric admission wards include: poor design, maintenance and ambience; a lack of therapeutic and leisure activities for patients leading to inactivity and boredom; frequent incidents of aggression and low-level violence and problems with staffing. It is suggested that there are a number of underlying causes: First, there has been failure to plan inpatient services, or to define their role, as attention has focused on new developments in community care. Second, the reduction in bed numbers has led to a change in the casemix of inpatients with a concentration on admission wards of a more challenging group of patients. Third, admission ward environments are permeable to the adverse effects of local street life, including drug taking. After years of neglect, acute inpatient psychiatric services in England are now high on the UK Government agenda. The paper lists a number of national initiatives designed to improve their quality and safety. A recent review of qualitative research suggests that acute psychiatric wards in other countries face similar problems to those reported in England. It is suggested that there might be a need for joint action which might take the form either of international research about acute inpatient care or the development of international standards and a common quality improvement system.

Characteristics of the Frequency-Following Response to Speech in Neonates and Potential Applicability in Clinical Practice: A Systematic Review

2020 ◽  
Vol 63 (5) ◽  
pp. 1618-1635
Author(s):  
Céline Richard ◽  
Mary Lauren Neel ◽  
Arnaud Jeanvoine ◽  
Sharon Mc Connell ◽  
Alison Gehred ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cochrane Library ◽  
Neurodevelopmental Outcomes ◽  
Frequency Following Response ◽  
Ovid Medline ◽  
Published Evidence ◽  
Mesh Terms ◽  
Potential Applicability ◽  
Clinical Potential

Purpose We sought to critically analyze and evaluate published evidence regarding feasibility and clinical potential for predicting neurodevelopmental outcomes of the frequency-following responses (FFRs) to speech recordings in neonates (birth to 28 days). Method A systematic search of MeSH terms in the Cumulative Index to Nursing and Allied HealthLiterature, Embase, Google Scholar, Ovid Medline (R) and E-Pub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Web of Science, SCOPUS, COCHRANE Library, and ClinicalTrials.gov was performed. Manual review of all items identified in the search was performed by two independent reviewers. Articles were evaluated based on the level of methodological quality and evidence according to the RTI item bank. Results Seven articles met inclusion criteria. None of the included studies reported neurodevelopmental outcomes past 3 months of age. Quality of the evidence ranged from moderate to high. Protocol variations were frequent. Conclusions Based on this systematic review, the FFR to speech can capture both temporal and spectral acoustic features in neonates. It can accurately be recorded in a fast and easy manner at the infant's bedside. However, at this time, further studies are needed to identify and validate which FFR features could be incorporated as an addition to standard evaluation of infant sound processing evaluation in subcortico-cortical networks. This review identifies the need for further research focused on identifying specific features of the neonatal FFRs, those with predictive value for early childhood outcomes to help guide targeted early speech and hearing interventions.

Psychological and Cognitive Aspects of Borderline Intellectual Functioning

2017 ◽  
Vol 22 (3) ◽  
pp. 159-166 ◽  
Author(s):  
Bastianina Contena ◽  
Stefano Taddei
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Intellectual Functioning ◽  
Clinical Impact ◽  
Review Of The Literature ◽  
Borderline Intellectual Functioning ◽  
General Quality ◽  
Meta Analyses ◽  
Over Time

Abstract. Borderline Intellectual Functioning (BIF) refers to a global IQ ranging from 71 to 84, and it represents a condition of clinical attention for its association with other disorders and its influence on the outcomes of treatments and, in general, quality of life and adaptation. Furthermore, its definition has changed over time causing a relevant clinical impact. For this reason, a systematic review of the literature on this topic can promote an understanding of what has been studied, and can differentiate what is currently attributable to BIF from that which cannot be associated with this kind of intellectual functioning. Using Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria, we have conducted a review of the literature about BIF. The results suggest that this condition is still associated with mental retardation, and only a few studies have focused specifically on this condition.

Проблемы оценки качества при проектировании транспортных услуг

2020 ◽  
pp. 30-40
Author(s):  
S.U. Lyapina ◽  
◽  
V.N. Tarasova ◽  
V.B. Ruchkin ◽  
E.O. Koscheeva ◽  
...  
Keyword(s):  
Life Cycle ◽  
Business Processes ◽  
Service Industries ◽  
Service Organizations ◽  
Quality Of Services ◽  
Market Failures ◽  
Expert Opinions ◽  
Service Life Cycle ◽  
Quantitative Indicators

The quality issues of new services directly affect the competitiveness of service organizations. However, the introduction of new services to the market is often limited only to the construction of the logistics of business processes, and the design applies only to technological equipment and infrastructure, the quality of which ultimately does not always ensure the quality of the services provided. At the same time, quality management affects mainly operational aspects, that is, it covers the later stages of the service life cycle. In resource-intensive service industries (for example, transport, communications, etc.), the high cost of equipment and infrastructure reduces the possibility of changes in service delivery technologies to improve their quality, which leads to inefficiency and market failures due to the fact that the new service does not match the real needs of customers. Despite this, forecasting and planning the quality of a service at the stage «making a decision» to launch a new service on the market remains largely without sufficient attention. The authors prove the need to design the quality of services at the stage «making a decision» to bring new services to the market. The purpose of the article is to describe the approach developed by the authors to assessing the quality of projected services at the early stages of their life cycle, which makes it possible to integrate qualitative and quantitative indicators of the future service and take into account the forecast requests of customers. The proposed approach has two features: (1) forecasting customer requirements for the quality of services is based on the results of machine learning based on data on existing and potential customers, as well as on the basis of the accumulated knowledge base of customer experience and expert opinions; (2) multi-criteria optimization is used, while some of the optimized parameters are discrete and high-quality. In conclusion, the authors demonstrated the advantages of the developed model on the examples of transport and logistics business in the field of passenger and freight transportation in Russia.

How Does Mindfulness Affect Cognition? A Reflection on Confounding Issues Surrounding Mindfulness-based Intervention Research Targeting Cognitive Outcomes

2018 ◽  
Author(s):  
David R Vago ◽  
Resh Gupta ◽  
Sara Lazar
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Cognitive Functioning ◽  
Cognitive Processes ◽  
Methodological Quality ◽  
Cognitive Outcomes ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Existing Data

One potential pathway by which mindfulness-based meditation improves health outcomes is through changes in cognitive functioning. A systematic review of randomized controlled trials of mindfulness-based interventions (MBIs) was conducted with a focus on assessing the state of the evidence for effects on cognitive processes and associated assays. Here, we comment on confounding issues surrounding the reporting of these and related findings, including 1) criteria that appropriately define an MBI; 2) limitations of assays used to measure cognition; and 3) methodological quality of MBI trials and reporting of findings. Because these issues contribute to potentially distorted interpretations of existing data, we offer constructive means for interpretation and recommendations for moving the field of mindfulness research forward regarding the effects on cognition.

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