To what extent could acute general psychiatric day care reduce inpatient admissions?

The multi-site research project (Acronym: EDEN-study) “Psychiatric day hospital treatment: An alternative to inpatient treatment, being cost-effective and minimizing post-treatment needs for care? An evaluative study in European countries with different care systems” was funded by the European Commission (Quality of Life and Management of Living, contract no. QLG4-CT-2000-01700). Additional national grants supporting the project were provided by Roland-Ernst-Stiftung für Gesundheitswesen and the Faculty of Medicine at the Dresden University of Technology, the National Health Service Executive Organization and Management Programme, the Polish National Committee of Scientific Affairs, and the Slovak Ministry of Education. Pfizer Pharmaceutical Company supported travel and accommodation for EDEN project meetings

Použití omezovacích opatření v psychiatrii

Psychiatrie má jedinečné postavení mezi ostatními lékařskými disciplínami vzhledem k tomu, že omezení autonomie pacientů používá v jejich nejlepším zájmu jak k jejich léčbě tak k jejich kontrole. Omezovací opatření, jako jsou umístění pacienta do izolace, omezení pacienta v pohybu, nebo užití neklidové medikace jsou široce užívané v klinické praxi jako metody zvládání akutních psychiatrických stavů či neklidných pacientů. Tato dizertační práce byla provedena v rámci mezinárodního projektu EUNOMIA (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice), který probíhal ve dvanácti Evropských státech. Byly stanoveny tyto výzkumné otázky: jaké jsou sociodemografické a klinické charakteristiky nedobrovolně hospitalizovaných pacientů u kterých jsou použita omezovací opatření; jaké typy omezovacích opatření jsou užívaná nejčastěji; jaké jsou interní a externí rizikové faktory související s jejích užitím; a konečně jaké jsou genderové rozdíly u pacientů se schizofrenií, u kterých bylo užito omezovacích opatření. Do studie bylo zařazeno 2,030 nedobrovolně hospitalizovaných pacientů, z nichž celkem u 770 (38%) bylo použito 1,462 omezovacích opatření. Procento pacientů, u kterých bylo použito omezovacích opatření, se ve sledovaných zemích nachází v rozmezí 21% až 59%, a do...Psychiatry has unique status among other medical disciplines where patients` autonomy might be restricted in the best interest of the patient in order to both cure and control the patient. Coercive measures such as seclusion, physical restraint or forced medication are widely used in clinical practice as methods for managing acute, disturbed or violent psychiatric patients. This thesis was carried out as a part of the EUNOMIA project (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice) in which centers from twelve European countries recruited involuntary admitted patients. The research questions of this thesis were the following: what are the socio-demographic and clinical characteristics of the patients who receive coercive measures; what types of coercive measures are used with involuntarily treated patients; what are the internal and external risk factors for their use; and finally what are the gender differences among involuntary admitted coerced patients with schizophrenia. All together we evaluated a group of 2,030 involuntarily admitted patients, in which 1,462 coercive measures were used with 770 patients (38%). The percentage of patients receiving coercive measures in each country varied between 21% and 59%. These twelve countries varied greatly in...Department of Psychiatry First Faculty of Medicine and General University Hospital in PraguePsychiatrická klinika 1. LF a VFN v PrazeFirst Faculty of Medicine1. lékařská fakult

Validation and Classification of the 9-Item Voice Handicap Index (VHI-9i)

The international nine-item Voice Handicap Index (VHI-9i) is a clinically established short-scale version of the original VHI, quantifying the patients’ self-assessed vocal handicap. However, the current vocal impairment classification is based on percentiles. The main goals of this study were to establish test–retest reliability and a sound statistical basis for VHI-9i severity levels. Between 2009 and 2021, 17,660 consecutive cases were documented. A total of 416 test–retest pairs and 3661 unique cases with complete multidimensional voice diagnostics were statistically analyzed. Classification candidates were the overall self-assessed vocal impairment (VHIs) on a four-point Likert scale, the dysphonia severity index (DSI), the vocal extent measure (VEM), and the auditory–perceptual evaluation (GRB scale). The test–retest correlation of VHI-9i total scores was very high (r = 0.919, p < 0.01). Reliability was excellent regardless of gender or professional voice use, with negligible dependency on age. The VHIs correlated best with the VHI-9i, whereas statistical calculations proved that DSI, VEM, and GRB are unsuitable classification criteria. Based on ROC analysis, we suggest modifying the former VHI-9i severity categories as follows: 0 (healthy): 0 ≤ 7; 1 (mild): 8 ≤ 16; 2 (moderate): 17 ≤ 26; and 3 (severe): 27 ≤ 36

Pathology-Related Influences on the VEM: Three Years’ Experience since Implementation of a New Parameter in Phoniatric Voice Diagnostics

The vocal extent measure (VEM) represents a new diagnostic tool to express vocal capacity by quantifying the dynamic performance and frequency range of voice range profiles (VRPs). For VEM calculation, the VRP area is multiplied by the quotient of the theoretical perimeter of a circle with equal VRP area and the actual VRP perimeter. Since different diseases affect voice function to varying degrees, pathology-related influences on the VEM should be investigated more detailed in this retrospective study, three years after VEM implementation. Data was obtained in a standardized voice assessment comprising videolaryngostroboscopy, voice handicap index (VHI-9i), and acoustic-aerodynamic analysis with automatic calculation of VEM and dysphonia severity index (DSI). The complete dataset comprised 1030 subjects, from which 994 adults (376 male, 618 female; 18-86 years) were analyzed more detailed. The VEM differed significantly between pathology subgroups (p<0.001) and correlated with the corresponding DSI values. Regarding VHI-9i, the VEM reflected the subjective impairment better than the DSI. We conclude that the VEM proved to be a comprehensible and easy-to-use interval-scaled parameter for objective VRP evaluation in all pathology subgroups. As expected, exclusive consideration of the measured pathology-related influences on the VEM does not allow conclusions regarding the specific underlying diagnosis

Coerced Hospital Admission and Symptom Change-A Prospective Observational Multi-Centre Study

PMCID: PMC3227658 Freely available online via CCplosone.org

THE PsyLOG MOBILE APPLICATION: DEVELOPMENT OF A TOOL FOR THE ASSESSMENT AND MONITORING OF SIDE EFFECTS OF PSYCHOTROPIC MEDICATION

Mobile health interventions are regarded as affordable and accessible tools that can enhance standard psychiatric care. As part of the mHealth Psycho-Educational Intervention Versus Antipsychotic-Induced Side Effects (mPIVAS) project (www.psylog.eu), we developed the mobile application "PsyLOG" based on mobile "smartphone" technology to monitor antipsychotic-induced side effects. The aim of this paper is to describe the rationale and development of the PsyLOG and its clinical use. The PsyLOG application runs on smartphones with Android operating system. The application is currently available in seven languages (Croatian, Czech, English, French, German, Japanese and Serbian). It consists of several categories: "My Drug Effects", "My Life Styles", "My Charts", "My Medication", "My Strategies", "My Supporters", "Settings" and "About". The main category "My Drug Effects" includes a list of 30 side effects with the possibility to add three additional side effects. Side effects are each accompanied by an appropriate description and the possibility to rate its severity on a visual analogue scale from 0-100%. The PsyLOG application is intended to enhance the link between patients and mental health professionals, serving as a tool that more objectively monitors side-effects over certain periods of time. To the best of our knowledge, no such applications have so far been developed for patients taking antipsychotic medication or for their therapists

Loss to follow-up in longitudinal psychiatric research

Publisher version: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8264315&fulltextType=RA&fileId=S1121189X0000283

Position Statement of the Union of European Phoniatricians (UEP) : Fees and Phoniatricians' Role in Multidisciplinary and Multiprofessional Dysphagia Management Team

The need for multidisciplinary and multiprofessional management of dysphagia is constantly increasing and creating a major challenge for healthcare professionals and society, especially in terms of professional expertise and human resources. The distribution of tasks among the dysphagia team members, which includes phoniatricians, otolaryngologists, and speech-language therapists, is flexible and overlapping. For assessing dysphagia, the (fibreoptic) flexible endoscopic evaluation of swallowing (FEES), with or without videofluoroscopy, is a pivotal diagnostic tool. This position paper aims to illustrate the phoniatrician's role in performing a FEES, which is an indispensable component of the diagnostic workup of patients suffering from oropharyngeal dysphagia. It is based on the current collaborative expert view of the Swallowing Committee of the Union of European Phoniatricians and a literature review. A FEES is one of the core competences of phoniatricians due to their endoscopic expertise and experience in the field of dysphagia and diseases of the upper aerodigestive tract. Therefore, the phoniatrician is an important member of the dysphagia team, for the medical diagnostics of the aerodigestive tract and dysphagia as well as for FEES. Phoniatric competence is especially important for head and neck cancer patients, infants, and complex cases.Peer reviewe