A shifting paradigm?:A scoping review of the factors influencing recovery and rehabilitation forensic research

Forensic research and practice have historically focused on risk assessment and prevention. This risk-oriented paradigm is shifting towards a more recovery-oriented perspective. The aim of this scoping review is to provide an overview of research on the factors influencing rehabilitation and recovery and discuss the recovery paradigm in a forensic setting. We performed a systematic search of the literature from the past 10 years, in Pubmed, Cinahl and PsycInfo, on recovery and rehabilitation. All types of study designs were included. Data was analysed and charted using an Excel template with various data items of interest. Clinical, personal, social, functional and forensic factors were found to be of influence on recovery and rehabilitation. A number of these overlapped with factors of influence on recidivism and desistance, others did not. Most studies on recovery and rehabilitation focused on a clinical forensic setting. This study provides an overview of the current body of knowledge on the factors influencing recovery and rehabilitation in forensic clients, and encourages researchers and practitioners in their focus on the recovery paradigm in forensic care. The body of evidence on rehabilitation and recovery is not yet as profound as that on recidivism and desistance. More knowledge on recovery trajectories for offenders in prison or ambulatory care, for example, is required

Assertive Community Treatment in the Netherlands

__Introduction: __ Assertive Community Treatment is a model for care and treatment of patients with the most severe mental illness in the community. Key principles of Assertive Community Treatment (ACT) are: integration of services, low patient–staff ratio, locus of contact in the community, medication management, focus on everyday problems in living, assertive outreach, and time unlimited services. ACT is the most extensively studied care delivery model for people with severe mental illness (SMI) and widely implemented in- and outside the US. Despite the extensive number of studies, there are still some research questions remained. As studies examining the association between the degree to which the ACT model is implemented and effect on patient outcomes are rare, the role of model fidelity is unclear. Also, it is unknown whether some ingredients of the model are more important than others, or whether certain ingredients are associated with specific patients outcomes. From 2005 on, another care delivery model for SMI patients was developed. Flexible Assertive Community Treatment, Flexible ACT, was inspired by and based on the ACT model, but with its adaptions more suitable in rural areas and able to serve a broader range of patients with severe mental illness. The Flexible ACT team is a case management team with partly an individual approach and partly a team approach; the approach varies from patient to patient, depending on the patient’s needs. For more stable long-term patients, Flexible ACT provides coordinated multidisciplinary treatment and care by individual case management. Unstable patients at risk of relapse, neglect and readmission are provided with intensive assertive outreach care by the same team, working with a shared caseload for this subgroup. __Aims of the thesis:__ This thesis addresses two principal aims: - To study the association between (ingredients of) the ACT model fidelity and patient outcomes; - To describe the development of the Flexible ACT scale. Chapters 2 to 6 of the thesis use data of our prospective longitudinal study, conducted from 2005 – 2008, in which twenty outpatient teams for SMI patients located in different regions of the Netherlands participated. 530 patients with severe mental illness participated in the study. ACT model fidelity and patient outcomes were assessed during a 2-year follow-up period. As ACT teams were slowly replaced by Flexible ACT teams in the Netherlands, we conclude in chapter 7 with the subsequent evolution of the Flexible ACT model fidelity scale. __Results: __ This thesis shows that high fidelity is associated with improved functioning and decreased homelessness. In particular, team structure, the subscale of the ACT fidelity scale including ingredients such as shared caseload, daily team meetings, and a team leader who participates in patient care, was associated with lower HoNOS total scores over time, reflecting better functioning. Team approach and team responsibility are characteristics that distinguish ACT from (individual) case management. Our study suggests that these distinguishing characteristics could make a difference in patient outcomes

Initial results of secukinumab drug survival in patients with psoriasis: A multicentre daily practice cohort study

Interleukin 17-antagonist secukinumab demonstrated high efficacy for treatment of psoriasis in randomized controlled trials. However, performance in daily practice may differ from trials. Drug survival is a comprehensive outcome covering effectiveness and safety, suitable for analyses of daily practice. The aim of this study was to evaluate drug survival of secukinumab in a daily practice psoriasis cohort. Data were collected from 13 hospitals. Drug survival was analysed using Kaplan–Meier survival curves, split for reason of discontinuation. In total, 196 patients were included (83% biologic experienced). Overall, 12 and 18 months drug survival of secukinumab was 76% and 67%, respectively, and was mostly determined by ineffectiveness. There was a trend towards shorter drug survival in women and in biologic experienced patients. Thirteen percent of patients experienced at least one episode of fungal infection. This is one of the first studies of drug survival of secukinumab in patients with psoriasis treated in daily practice

Autoantibodies against type I IFNs in patients with life-threatening COVID-19

Interindividual clinical variability in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is vast. We report that at least 101 of 987 patients with life-threatening coronavirus disease 2019 (COVID-19) pneumonia had neutralizing immunoglobulin G (IgG) autoantibodies (auto-Abs) against interferon-w (IFN-w) (13 patients), against the 13 types of IFN-a (36), or against both (52) at the onset of critical disease; a few also had auto-Abs against the other three type I IFNs. The auto-Abs neutralize the ability of the corresponding type I IFNs to block SARS-CoV-2 infection in vitro. These auto-Abs were not found in 663 individuals with asymptomatic or mild SARS-CoV-2 infection and were present in only 4 of 1227 healthy individuals. Patients with auto-Abs were aged 25 to 87 years and 95 of the 101 were men. A B cell autoimmune phenocopy of inborn errors of type I IFN immunity accounts for life-threatening COVID-19 pneumonia in at least 2.6% of women and 12.5% of men

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

A shifting paradigm?: A scoping review of the factors influencing recovery and rehabilitation forensic research

Forensic research and practice have historically focused on risk assessment and prevention. This risk-oriented paradigm is shifting towards a more recovery-oriented perspective. The aim of this scoping review is to provide an overview of research on the factors influencing rehabilitation and recovery and discuss the recovery paradigm in a forensic setting. We performed a systematic search of the literature from the past 10 years, in Pubmed, Cinahl and PsycInfo, on recovery and rehabilitation. All types of study designs were included. Data was analysed and charted using an Excel template with various data items of interest. Clinical, personal, social, functional and forensic factors were found to be of influence on recovery and rehabilitation. A number of these overlapped with factors of influence on recidivism and desistance, others did not. Most studies on recovery and rehabilitation focused on a clinical forensic setting. This study provides an overview of the current body of knowledge on the factors influencing recovery and rehabilitation in forensic clients, and encourages researchers and practitioners in their focus on the recovery paradigm in forensic care. The body of evidence on rehabilitation and recovery is not yet as profound as that on recidivism and desistance. More knowledge on recovery trajectories for offenders in prison or ambulatory care, for example, is required

Forensische (flexibele) assertive community treatment ((F)ACT): Cliëntkenmerken en behandelresultaten

Item does not contain fulltextAchtergrond: Steeds vaker wordt (flexibele) assertive community treatment ((f)act) ingezet bij forensisch psychiatrische cliënten. Over de effectiviteit van forensische (f)act is echter nog weinig bekend. Doel: Nagaan in hoeverre (subgroepen van) cliënten die in behandeling zijn bij een forensisch (f)act-team na een jaar veranderingen laten zien in sociaal-maatschappelijk en psychisch functioneren en op justitiële uitkomstmaten. Methode: Acht forensische (f)act-teams leverden tussen 2009 en 2011 op twee meetmomenten (met een tussenpoos van gemiddeld een jaar) gegevens aan over kenmerken van cliënten en uitkomsten van zorg. Er werden 202 cliënten in het onderzoek betrokken. Resultaten: Cliënten bleken na een jaar significant beter psychisch en sociaal te functioneren, hadden minder politie- en justitiecontacten, werden minder vaak en korter gedetineerd en werden als minder delictgevaarlijk getaxeerd. Het aantal opnames in de ggz, verslavingszorg en forensische zorg bleef gelijk. Conclusie: Cliënten met een psychiatrische aandoening en delictgevaarlijk gedrag laten verbetering zien tijdens de behandeling door forensische (f)act-teams. Nader onderzoek moet uitwijzen of forensische (f)act ook op langere termijn de gewenste effecten sorteert en de status verdient van evidence based practice

De ontwikkeling van de vernieuwde Flexible ACT-schaal:F-ACT-s 2017

Achtergrond: Een belangrijk model voor de organisatie van zorg voor mensen met een ernstige psychische aandoening (epa) is flexible assertive community treatment (f-act). f-act combineert casemanagement met assertieve crisisinterventie. Kwaliteitsbewaking gebeurt sinds 2008 door middel van een modelgetrouwheidsschaal. Uit onderzoek bleek dat de gehanteerde normering niet meer strookte met moderne normen rond herstelgerichte en evidence-based zorg, zoals vastgesteld in behandelrichtlijnen. Doel: Ontwikkelen van een nieuwe modelgetrouwheidsschaal voor f-act-teams. Methode: Door empirisch onderzoek,raadpleging van experts en feedback van professionals, onderzoekers, belangenverenigingen en naasten werd een nieuwe modelgetrouwheidsschaal ontwikkeld (f-acts 2017).De proefschaal werd uitgeprobeerd met getrainde auditors bij 21 f-act-teams en aangepast in twee pilotrondes. Resultaten: In 2017 werd de definitieve versie voorgelegd aan de betrokkenen en vastgesteld door het bestuur van het Centrum Certificering act en fact (ccaf). Ze wordt nu in de praktijk gebruikt. Conclusies: Het (onderzoeks)veld heeft met de f-acts 2017 een nieuw state-of-the-art instrument om de kwaliteit van de zorg voor patiënten met epa te monitoren. Het gebruikt veldnormen om het modelgetrouw werken van teams die zich richten op patiënten met epa te beoordelen in een snel veranderende context