Least restrictive alternative - advance statements and the new mental health legislation

No abstract availabl

Models of advance directives in mental health care: stakeholder views

<i>Objective</i>: The aim of this study was to examine perceptions of the place of advance directives in mental health care. <i>Methods</i>: Postal survey of stakeholders was carried out to assess their views on different models of advance directives in mental health care. A total of 473 responded. <i>Results</i>: In all, 28% of psychiatrists thought advance directives were needed compared to 89% of voluntary organisations and above two–thirds of the other stakeholder groups. There were clear tensions between patient autonomy and right to treatment which underpin many of the concerns raised. Autonomy provided by advance directive can be contrasted with a co–operative partnership approach to advance planning. The legal status of advance directives is important for some people in relation to treatment refusal. There was general concern about the practical issues surrounding their implementation. <i>Conclusion</i>: There is a wide range of views in all stakeholder groups about the possible form advance directives should take. Although there is a widespread desire to increase patient involvement in treatment decisions, which advance directives could possibly help to realise, they may also have unwanted consequences for mental health services and individuals

The introduction and evaluation of Community Care Orders following the Mental Health (Patients in the Community) Act 1995

Community Care Orders (CCOs) were introduced in Scotland in the Mental Health (Patients in the Community) Act 1995, which also saw the reduction of leave of absence. The aim of the study was to evaluate the use of CCOs in the first 33 months of their availability and to assess psychiatrists' and patients' views on their usefulness. Three data sources were used: (1) Mental Welfare Commission; (2) a named patient survey to consultant psychiatrists; (3) interviews with patients. Forty-five CCOs were used between 1 April 1996 and 31 December 1998. Half of these were judged successful by consultants. Conditions were varied and the impact on patients' lives could be extensive. There is confusion over the ability of CCOs to enforce medication but 77% implicitly or explicitly mentioned medication. CCO use has been low but set against the negative expectations of psychiatrists might be judged more successful than expected

Changes to leave of absence in Scotland: the views of patients

Sixty-four patients were interviewed about changes to leave of absence brought about by the Mental Health (Patients in the Community) Act 1995 in the context of their views about services and medication. Few patients were clear about the change in the law,which suggests that more has to be done to inform patients of their rights and legal status. A number of patients reported difficulty in negotiating preferred medication with their psychiatrists and felt compelled to take medication that resulted in debilitating side-effects. A third of patients eligible to be interviewed agreed to an interview and ethical and practical difficulties in accessing patients for this type of research are discussed

The end of indefinitely renewable leave of absence in Scotland: the impact of the Mental Health (Patients in the Community) Act 1995

The Mental Health (Patients in the Community) Act 1995 restricted leave of absence (LOA) for detained patients in Scotland to 12 months. This study looked at the impact on patients who were affected by this restriction. A total of 266 patients were identified from Mental Welfare Commission records: 194 reached the new maximum, 47 were 'transitional', 16 were on improperly long LOA and 9 were on community care orders (CCOs) following LOA but not maximum LOA. Of this 194, 12 were transferred to guardianship and the remainder became voluntary patients. The responsible medical officers (RMOs) would have liked to renew LOA for 71% of patients. In 90% of cases RMOs renewed LOA to ensure compliance with medication. Patients were significantly more likely to be compliant with medication while on LOA than post-LOA. A minority (28%) were recorded as being involved in 'incidents' post-LOA. There were 37% who were known to have a substance use problem in their management. The results suggest that RMOs may have been conservative in using LOA

The Microhardness of Enamel and Dentin

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68055/2/10.1177_00220345580370041301.pd

Two nonmagnetic impurities in the DSC and DDW state of the cuprate superconductors as a probe for the pseudogap

The quantum interference between two nonmagnetic impurities is studied numerically in both the d-wave superconducting (DSC) and the d-density wave (DDW) state. In all calculations we include the tunnelling through excited states from the CuO$_2$ planes to the BiO layer probed by the STM tip. Compared to the single impurity case, a systematic study of the modulations in the two-impurity local density of states can distinguish between the DSC or DDW states. This is important if the origin of the pseudogap phase is caused by preformed pairs or DDW order. Furthermore, in the DSC state the study of the LDOS around two nonmagnetic impurities provide further tests for the potential scattering model versus more strongly correlated models.Comment: 6 pages, 6 figure

Comparative efficacy and tolerability of pharmacological interventions for attention-deficit/hyperactivity disorder in children, adolescents and adults: protocol for a systematic review and network meta-analysis

Introduction Attention-deficit/hyperactivity disorder (ADHD) is a major public health issue. Pharmacological treatments play an important role in the multimodal treatment of ADHD. Currently, there is a lack of up-to-date and comprehensive evidence on how available ADHD drugs compare and rank in terms of efficacy and tolerability, in children or adolescents as well as in adults. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs), to rank pharmacological treatments for ADHD according to their efficacy and tolerability profiles. Methods and analysis We will search a broad range of electronic databases, including PubMed, MEDLINE, EMBASE, PsycINFO, ERIC and Web of Science, with no date or language restrictions. We will also search for unpublished studies using international clinical trial registries and contacting relevant drug companies. We will identify and include available parallel-group, cross-over and cluster randomised trials that compare methylphenidate, dexmethylphenidate, amphetamine derivatives (including lisdexamfetamine), atomoxetine, clonidine, guanfacine, bupropion or modafinil (as oral therapy) either with each other or to placebo, in children, adolescents or adults with ADHD. Primary outcomes will be efficacy (indicated by reduction in severity of ADHD core symptoms measured on a standardised scale) and tolerability (the proportion of patients who left a study early due to side effects). Secondary outcomes will be global functioning, acceptability (proportion of patients who left the study early by any cause) and changes in blood pressure and body weight. NMA will be conducted in STATA within a frequentist framework. The quality of RCTs will be evaluated using the Cochrane risk of bias tool, and the quality of the evidence will be assessed using the GRADE approach. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings. Ethics and dissemination No ethical issues are foreseen. Results from this study will be published in a peer-reviewed journal and possibly presented at relevant national and international conferences

Comparative efficacy and tolerability of pharmacological interventions for attention-deficit/hyperactivity disorder in children, adolescents and adults: Protocol for a systematic review and network meta-analysis

Introduction Attention-deficit/hyperactivity disorder (ADHD) is a major public health issue. Pharmacological treatments play an important role in the multimodal treatment of ADHD. Currently, there is a lack of up-to-date and comprehensive evidence on how available ADHD drugs compare and rank in terms of efficacy and tolerability, in children or adolescents as well as in adults. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs), to rank pharmacological treatments for ADHD according to their efficacy and tolerability profiles. Methods and analysis We will search a broad range of electronic databases, including PubMed, MEDLINE, EMBASE, PsycINFO, ERIC and Web of Science, with no date or language restrictions. We will also search for unpublished studies using international clinical trial registries and contacting relevant drug companies. We will identify and include available parallel-group, cross-over and cluster randomised trials that compare methylphenidate, dexmethylphenidate, amphetamine derivatives (including lisdexamfetamine), atomoxetine, clonidine, guanfacine, bupropion or modafinil (as oral therapy) either with each other or to placebo, in children, adolescents or adults with ADHD. Primary outcomes will be efficacy (indicated by reduction in severity of ADHD core symptoms measured on a standardised scale) and tolerability (the proportion of patients who left a study early due to side effects). Secondary outcomes will be global functioning, acceptability (proportion of patients who left the study early by any cause) and changes in blood pressure and body weight. NMA will be conducted in STATA within a frequentist framework. The quality of RCTs will be evaluated using the Cochrane risk of bias tool, and the quality of the evidence will be assessed using the GRADE approach. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings. Ethics and dissemination No ethical issues are foreseen. Results from this study will be published in a peer-reviewed journal and possibly presented at relevant national and international conferences