Predictors of violent incidents amongst patients in psychiatric intensive care units: A review of global evidence

Aim: The objective is to identify key predictors of violent behaviour amongst patients admitted to PICUs. Methods: A literature search was carried out in five online databases using a predefined strategy with terms relevant to the setting and population. Articles were screened based on the inclusion criteria and quality assessed using the Hawker critical appraisal tool. A thematic matrix was prepared from the final articles to highlight the pivotal predictors for violent behaviour in PICUs. Results: Initial search without duplicates retrieved 152 articles, of which 120 were excluded after screening their title and abstract. The full-text of 32 articles was read of which a total of 10 studies with 4733 participants were included in the literature review. These studies had good designs and methodological quality. The key predictors of violent incidents were a longer duration of in-patient stay, higher readmission rate, non-voluntary admission to PICUs, previous history of violence and substance misuse, permanent staff absences, being a single young male, having low level of education and having schizophrenia. Conclusion: The findings suggest that a variety of different factors contribute to violent incidents in PICUs. Our results may assist in the development of community and hospital-based interventions including situation management regular staff training, promoting a friendly environment and post-incident debriefs that can prevent future violent incidents in PICU

COVID-19 Impact on Indian Economy and Health: The Emergence of Corona-Economics

The Novel Corona virus, popularly known as COVID-19, has crossed all borders in a very short period of time and has spared no continent except Antarctica. Some advanced countries are affected more severely than others; with United States of America, Spain, Italy, China, Germany, France and UK being the worst affected of all with a few more are joining them soon. Several countries has locked-down to prevent further spread of the virus. This resulted in severe economic and health impacts on the public at large

Efficacy and cost of atypical antipsychotics in treatment and management of dementia

There is a significant lack of pharmacoeconomic research on using atypical antipsychotics for the treatment of dementia. Further comprehensive research should be carried out into this field. We have found a good number of studies exploring the effectiveness and cost-effectiveness of atypical antipsychotics for schizophrenia using a decision-analytical model. However, there were only a couple of studies which have focused on the use of AAs for dementia and that too with several limitations. Therefore, it is pertinent to undertake further systematic and comprehensive research on the safety and efficacy of atypical antipsychotics for the management of BPSD. This is essential in improving clinical practice and suggesting better pathways for dementia treatment as well as in mitigating the adverse impacts on the quality of life of patients and their caregivers

Exploring the feasibility of an exercise programme including aerobic and resistance training in people with limited cutaneous systemic sclerosis.

OBJECTIVES: It is suggested that exercise can improve the vascular function and quality of life (QoL) in people with systemic sclerosis (SSc), potentially offering clinical benefits to this population. Yet the feasibility of such an intervention remains untested. Therefore, the purpose of this study is to examine the feasibility of a combined exercise protocol (aerobic and resistance training) in people with limited cutaneous SSc (lcSSc). METHODS: Thirty-two lcSSc patients (66.5 ± 12 years old) were randomly allocated in two groups (exercise and control group). The exercise group underwent a 12-week exercise programme, twice per week. All patients performed the baseline, three- and six-month follow-up measurements where functional ability, body composition and QoL were assessed. Participants' experiences were explored through interviews. RESULTS: Compliance was 92.6% with no dropouts. The individuals' confidence to participate in the study's exercise protocol for twice per week was 95%. The average value for the physical activity enjoyment scale was 103 ± 10 out of 119 (highest score). The mean values for the intention to engage in exercise twice per week were 6.4 ± 1 (likely) out of 7 (very likely). QoL for the exercise group showed to have a better life satisfaction, less anxiety and Raynaud's phenomenon-accompanied pain. CONCLUSIONS: Our results suggest that a combined exercise protocol was feasible for people with lcSSc, with no adverse events, resulting in high adherence and low attrition rates, high enjoyment levels and intentions for future engagement to this exercise. Thus, the specific protocol is a safe adjunct therapy for people with lcSSc. TRIAL REGISTRATION: ClinicalTrials.gov (NCT number): NCT03058887, February 23, 2017, https://clinicaltrials.gov/ct2/show/NCT03058887?term=NCT03058887&rank=1Key Points• High-intensity interval training in combination with resistance training constitutes a feasible exercise protocol for people with lcSSc.• Overall, the exercise programme demonstrated high adherence and enjoyment levels and low attrition rates.• The exercise protocol was proved to be safe with no adverse events for people with lcSSc

Perspective Chapter: Impact of COVID-19 on the Health of Ethnic Minorities in the UK – Salient Features and Recouping Strategies

COVID-19 has affected selected population groups, professions, and regions much more than others in terms of infection rate, hospital admission rate, and intensive care rate and then premature mortality rate. Globally, the seventh highest deaths due to COVID-19 (>155,000) have been experienced in the UK. The share of Black, Asia, and Ethnic Minorities (BAME) people in the UK is >20% with a high geographical concentration in major cities (London, Birmingham, and Manchester). Government statistics show that Black and Asian people represented disproportionately higher (>3 and 2 times, respectively) than white British in admission to Intensive & Emergency Care Units and resultant deaths due to Coronavirus. This chapter explores underlying reasons for differential impacts on BAME’s health and well-being including demographics, socioeconomic condition, health status/long-term conditions (LTCs), diet, and lifestyle. Compared with white British, the BAME people have higher prevalence of LTCs/obesity, lower health literacy, and living and working in most deprivation areas/occupations. These factors are important to plan for short- and long-term impact mitigation strategies to recoup BAME peoples’ health and well-being they enjoyed before the Pandemic. Two studies illustrate the Pandemic effect on: BAME access to organ transplants services, and racism experienced at workplace the National Health Services BAME staff

Equity in healthcare utilisation and cost of treatment in Western India

The paper compares the morbidity and healthcare utilisation scenario prevalent in Gujarat and Maharashtra as well as for all-India over the last 35 years by exploring the National Sample Surveys data for 1980-81, 1986-87, 1995-96, 2004 and 2014. The differentials and trends in morbidity rate, health seeking behaviour, use of public and private providers for inpatient and outpatient care and associated cost and burden of treatment are analysed by population groups. Changes in people’s demand for health services are correlated with the supply factors i.e. expansion of public and private health infrastructure. Rising cost and burden of treatment on the poor are examined through receipt of free inpatient and outpatient services as well as the extent of financial protection under the health insurance schemes. Overtime, morbidity rates have gone up, with several folds increase in select states; the reliance on public provision has gone down substantially despite being cheaper than the private sector; and cost of treatment at constant prices increased considerably even for the poor. Hospitalisation costs were higher among insured than the non-insured households in several states irrespective of whether resident in rural or urban areas (Haryana, Maharashtra, Himachal Pradesh, and Assam have reported that insured households ended-up paying almost double the hospitalisation expenses in 2014). Leaving aside Kerala (where insured households have paid just a half of the cost of the non-insured), this clearly reflects the widespread prevalence of moral hazard and insurance collusion in India