Seclusion and Psychiatric Intensive Care Evaluation Study (SPICES) : Combined qualitative and quantitative approaches to the uses and outcomes of coercive practices in mental health services

BackgroundSeclusion (the isolation of a patient in a locked room) and transfer to a psychiatric intensive care unit (PICU; a specialised higher-security ward with higher staffing levels) are two common methods for the management of disturbed patient behaviour within acute psychiatric hospitals. Some hospitals do not have seclusion rooms or easy access to an on-site PICU. It is not known how these differences affect patient management and outcomes.ObjectivesTo (1) assess the factors associated with the use of seclusion and PICU care, (2) estimate the consequences of the use of these on subsequent violence and costs (study 1) and (3) describe differences in the management of disturbed patient behaviour related to differential availability (study 2).DesignThe electronic patient record system at one trust was used to compare outcomes for patients who were and were not subject to seclusion or a PICU, controlling for variables, including recent behaviours. A cost-effectiveness analysis was performed (study 1). Nursing staff at eight hospitals with differing access to seclusion and a PICU completed attitudinal measures, a video test on restraint-use timing and an interview about the escalation pathway for the management of disturbed behaviour at their hospital. Analyses examined how results differed by access to PICU and seclusion (study 2).ParticipantsPatients on acute wards or PICUs in one NHS trust during the period 2008–13 (study 1) and nursing staff at eight randomly selected hospitals in England, with varying access to seclusion and to a PICU (study 2).Main outcome measuresAggression, violence and cost (study 1), and utilisation, speed of use and attitudes to the full range of containment methods (study 2).ResultsPatients subject to seclusion or held in a PICU were more likely than those who were not to be aggressive afterwards, and costs of care were higher, but this was probably because of selection bias. We could not derive satisfactory estimates of the causal effect of either intervention, but it appeared that it would be feasible to do so for seclusion based on an enriched sample of untreated controls (study 1). Hospitals without seclusion rooms used more rapid tranquillisation, nursing of the patient in a side room accompanied by staff and seclusion using an ordinary room (study 2). Staff at hospitals without seclusion rated it as less acceptable and were slower to initiate manual restraint. Hospitals without an on-site PICU used more seclusion, de-escalation and within-eyesight observation.LimitationsOfficial record systems may be subject to recording biases and crucial variables may not be recorded (study 1). Interviews were complex, difficult, constrained by the need for standardisation and collected in small numbers at each hospital (study 2).ConclusionsClosing seclusion rooms and/or restricting PICU access does not appear to reduce the overall levels of containment, as substitution of other methods occurs. Services considering expanding access to seclusion or to a PICU should do so with caution. More evaluative research using stronger designs is required.FundingThe National Institute for Health Research Health Services and Delivery Research programme

Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for pediatric life support is based on the most extensive evidence evaluation ever performed by the Pediatric Life Support Task Force. Three types of evidence evaluation were used in this review: systematic reviews, scoping reviews, and evidence updates. Per agreement with the evidence evaluation recommendations of the International Liaison Committee on Resuscitation, only systematic reviews could result in a new or revised treatment recommendation. Systematic reviews performed for this 2020 CoSTR for pediatric life support included the topics of sequencing of airway-breaths-compressions versus compressions-airway-breaths in the delivery of pediatric basic life support, the initial timing and dose intervals for epinephrine administration during resuscitation, and the targets for oxygen and carbon dioxide levels in pediatric patients after return of spontaneous circulation. The most controversial topics included the initial timing and dose intervals of epinephrine administration (new treatment recommendations were made) and the administration of fluid for infants and children with septic shock (this latter topic was evaluated by evidence update). All evidence reviews identified the paucity of pediatric data and the need for more research involving resuscitation of infants and children

Democracy, the Rule of Law and Transnational Pressures: Comparing RECONNECT Findings in Global and European Trends

This report is aimed at comparing some of the key findings that have been highlighted in the research carried out thus far regarding the global context of democracy and the rule of law, with the research which is primarily focused on unravelling trends within the European Union (EU or Union) and its Member States. In doing so, it will seek to compare developments observed within the EU, with global trajectories of democracy and rule of law, as part of the aims of Work Package 3 in the RECONNECT project, which is specifically devoted to analysing and explaining the interactions between the crisis of European governance and the broader regional and global context. It will also bring into focus the challenges of measuring and comparing such trends through the aggregation of relevant indexes, showing how conceptual, historical and qualitative forms of research bring a level of nuance to this bird’s eye view, which is essential. It shall focus in a first instance, on the area of democracy, which includes the more formal dimension of institutional and procedural features, as well as the more substantive dimension of fundamental rights. It will reconsider the evidence presented in the analysis conducted by Asif Efrat, Sivan Hirsch-Hoefler and Amichai Magen on ‘Global Democracy & Rule of Law Conditions and Trajectories’ (Deliverable 3.1) which brings together and compares indices on democracy and the rule of law, both globally and in the EU. It will compare findings at a conceptual level, as well as look at empirical findings from RECONNECT research, also exploring avenues for deeper research into comparing trends at an EU and global level. A similar exercise will be carried out for research relating specifically to the rule of law. Secondly, it will re-examine the impact of global pressures on the EU, from deliberate disruptors to transnational crises, relating them for instance to shifts in voter expectations or changing conceptions of legitimacy. In doing so, it will reassess the RECONNECT research conducted by Asif Efrat, Sivan Hirsch, Amichai Magen and Moran Stav in their working paper on ‘Structural Factors, Actors, and Dynamics Strengthening or Undermining intra-EU Commitment to Democratic Governance’ (Deliverable 3.2). In that context, some reflections will be devoted to the COVID-19 pandemic, which was still unfolding at the time of writing.status: Published onlin

Justice reinvestment, human rights, interagency partnership, and decarceration : the future of corrections?

Indigenous overrepresentation in Australia is a pervasive social injustice problem, which sees this once proud group of people fail to meet minimum standards across education, employment, health, criminal justice, and socioeconomic status. Currently, Indigenous people account for 3.3 percent of the Australian population but account for 28 percent of the national imprisonment rate and, at any given time, Indigenous youth account for 53 percent of the overnight prison population. To address this systemic social injustice issue, an investigation into how penal policy, criminal justice and human rights coincide with decision-making processes was undertaken. Within this chapter, the authors propose that the way forward is through an interagency partnership with a strong obligation to upholding human rights for all. To operationalize human rights obligations for Aboriginal and Torres Strait Islanders in Australia, a case study based on the existing micro-level project called the Maranguka Justice Reinvestment project was used. The authors adopted a human rights framework which has six fundamental principles which found that when both formal institutions and individuals’ who are impacted by decision-making policies work in partnership, meaningful change occurs. While prisons neither deter nor rehabilitate offenders, working together with all marginalized voices represented is the way forward

Reconnecting European Political Parties with European Union Citizens

Democracy involves popular control over decision-making, and political equality among those exercising that control. In parliamentary democracies, day-to-day control is delegated to elected politicians, who organize themselves in political parties. Globally, political parties have become an important interface between government and the people. Since their establishment, European political parties have enhanced their role(s) within the polity of the European Union. Within the context of multiple challenges to democracy worldwide, and in view of the 2019 European Parliament elections, European political parties are increasingly called upon to represent EU citizens in their work, and ensure an effective connection with people. This Discussion Paper takes a comprehensive approach to understanding the role(s) of European political parties within the polity of the EU. It focuses on how European political parties can (re)connect with EU citizens, and emphasizes the regulatory framework in which European political parties operate. It also provides insights into European political parties’ linkage with national political parties, and outreach in relation to EU political actors and citizens. It includes a set of recommendations to advance the broadening, deepening and diversification of avenues and tools for European political parties to connect with citizens

Reconnecting European Political Parties with European Union Citizens

Democracy involves popular control over decision-making, and political equality among those exercising that control. In parliamentary democracies, day-to-day control is delegated to elected politicians, who organize themselves in political parties. Globally, political parties have become an important interface between government and the people. Since their establishment, European political parties have enhanced their role(s) within the polity of the European Union. Within the context of multiple challenges to democracy worldwide, and in view of the 2019 European Parliament elections, European political parties are increasingly called upon to represent EU citizens in their work, and ensure an effective connection with people. This Discussion Paper takes a comprehensive approach to understanding the role(s) of European political parties within the polity of the EU. It focuses on how European political parties can (re)connect with EU citizens, and emphasizes the regulatory framework in which European political parties operate. It also provides insights into European political parties’ linkage with national political parties, and outreach in relation to EU political actors and citizens. It includes a set of recommendations to advance the broadening, deepening and diversification of avenues and tools for European political parties to connect with citizens.status: Published onlin

Forum : Vol. 36, No. 02 (Summer : 2012)

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