Medical psychiatry units: Improving their organization, focus, and value

Medical psychiatric units are hospital inpatient wards aimed at patients with physical and mental disorders, a combination that is common, especially in hospitals. For clinically admitted hospital patients, mental illness is associated with a longer length of hospital stay (LOS), higher medical costs and more readmissions. MPUs focus on the one hand on facilitating medical treatment, and on the other hand on restoration of functioning and quality of life. It is also often emphasized that they have the potential to reduce length of stay, costs and readmissions. Medical and psychiatric diagnoses of patients in these wards are wide and varying. Providing acute medical care creates a field of tension with more process-oriented treatment. There are approxim

Levensbeschouwing op school mist status

Volgens Expertisecentrum Lervo is er dringend behoefte aan een leerplan voor het vak levensbeschouwing en religie op middelbare scholen. ‘De school moet kinderen klaarmaken voor de superdiverse samenleving.’Religious Studie

Health-economic outcomes in hospital patients with medical-psychiatric comorbidity: A systematic review and meta-analysis

Background: Hospital inpatients often experience medical and psychiatric problems simultaneously. Although this implies a certain relationship between healthcare utilization and costs, this relationship has never been systematically reviewed. Objective: The objective is to examine the extent to which medical-psychiatric comorbidities relate to health-economic outcomes in general and in different subgroups. If the relationship is significant, this would give additional reasons to facilitate the search for targeted and effective treatments for this complex population. Method: A systematic review in Embase, Medline, Psycinfo, Cochrane, Web of Science and Google Scholar was performed up to August 2016 and included cross-references from included studies. Only peer-reviewed empirical studies examining the impact of inpatient medical-psychiatric comorbidities on three health-economic outcomes (length of stay (LOS), medical costs and rehospitalizations) were included. Study design was not an exclusion criterion, there were no restrictions on publication dates and patients included had to be over 18 years. The examined populations consisted of inpatients with medical-psychiatric comorbidities and controls. The controls were inpatients without a comorbid medical or psychiatric disorder. Non-English studies were excluded. Results: From electronic literature databases, 3165 extracted articles were scrutinized on the basis of title and abstract. This resulted in a full-text review of 86 articles: 52 unique studies were i

Implementation of a group-based physical activity programme for ageing adults with ID: A process evaluation

Rationale, aim and objectives This paper describes the results of the process evaluation of a physical activity programme for people with intellectual disabilities (ID), including information about the concepts 'fidelity', 'dose delivered', 'satisfaction' and 'context'. Methods Qualitative and quantitative methods among participants and programme leaders were used. Results The programme was well accepted, feasible and applicable to ageing people with ID. It was successfully implemented in terms of fidelity and dose delivered, although differences between day-activity centres were observed. Conclusions The hampering factors that are revealed in this study and the facilitating activities that were part of the implementation plan may be used by care provider services for (ageing) people with ID and other groups of people with cognitive and/or physical deficits, such as frail elderly people or people with dementia when developing and or preparing implementation of health promotion programmes

Factors influencing the admission decision for Medical Psychiatry Units: A concept mapping approach

Objective Medical Psychiatry Units (MPUs), also known as Complexity Intervention Units (CIUs), provide care for complex patients suffering from both psychiatric and physical disorders. Because there is no consensus on the indications for admission to an MPU, daily practice and effectiveness research are hampered. This study therefore used a concept mapping approach to investigate which organizational and medical factors determine the decision to admit a patient to an MPU. Methods The first step of the concept mapping approach was to create a list of factors determining MPU admission from literature. Secondly, clinical experts sorted and ranked these factors. The sorted and ranked data were then analyzed, and a draft conceptual framework was created. A final conceptual MPU admission framework was then drawn during an expert consensus meeting and recommendations for implementation were suggested. Results Thirteen clinical experts defined 90 factors from literature, which were sorted and ranked by 40 experts from 21 Dutch hospitals. This concept mapping approach resulted in a five-cluster solution for an MPU admission framework based on: 1. Staff competencies and organizational pre-requisites; 2. Patient context; 3. Patient characteristics; 4. Medical needs and capabilities; and 5. Psychiatric symptoms and behavioral problems. Furthermore, three inclusion and two exclusion criteria were formulated to help the clinicians decide whether or not to admit patients to an MPU. These criteria can be implemented in daily practice. Conclusion Implementing the five criteria derived from this conceptual framework will help make the admission decision for complex patients with psychiatric and physical disorders to an MPU more correct, consistent, and transparent

The state of psychiatry in the Netherlands: Strength by quality, influence by capabilities.

Item does not contain fulltextAbstract Psychiatry and mental healthcare in the Netherlands has a long history of institutional care, slowly more adapted to the community, but differentiated from mainstream healthcare in terms of organization and remuneration. It is in a crucial phase of reconsideration. Along with harsh cuts on the budgets in healthcare, the field is in transition where training is concerned. The good news is that in fruitful cooperation the government and all spcialist parties involved in mental healthcare are on the verge of reaching an important agreement that should make mental healthcare more patient centred, affordable and accessible for those who need it. The bad news that needs serious consideration and ongoing action is that mental health problems are still highly stigmatized and that as a result the government could impose an unjust and unfair own financial contribution for users in mental care as a means of lowering the costs in the field.1 augustus 201

Beloop van COVID-19-infecties en impact op mentale gezondheid; opzet van een landelijk casusregister [Course of COVID-19 infections and impact on mental health; setting up a national case register]

Achtergrond: De Nederlandse Vereniging voor Psychiatrie (NVvP) heeft een casusregister opgezet om de (neuro-)psychiatrische gevolgen van covid-19-besmetting in kaart te brengen. Doel: Inzicht krijgen in zowel kwetsbaarheden als beschermende factoren voor het krijgen van een covid-19-besmetting en het beloop hiervan in een (neuro)psychiatrische populatie. Methode: We verzamelen informatie van zo veel mogelijk patiënten met psychiatrische problematiek (zowel pre-existente psychiatrische problematiek als tijdens de infectie ontstane (neuro)psychiatrische klachten) en een covid-19-besmetting. De dataverzameling bestaat uit o.a. demografische gegevens, gegevens over de covid-19-besmetting en gegevens over de psychiatrische problematiek en de behandeling daarvan. Om een zo representatief mogelijk cohort te krijgen roepen wij alle ziekenhuizen, ggz-instellingen, verslavingszorg en andere zorginstellingen voor mensen met een psychiatrische aandoening in Nederland op om deel te nemen aan het CoviP-casusregister