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      Preventing and reducing ‘coercion’ in mental health services: an international scoping review of English‐language studies

      review-article
      1 , , 1 , 1
      Acta Psychiatrica Scandinavica
      John Wiley and Sons Inc.
      coercion, human rights, reducing coercion

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          Abstract

          This article discusses initiatives aimed at preventing and reducing ‘coercive practices’ in mental health and community settings worldwide, including in hospitals in high‐income countries, and in family homes and rural communities in low‐ and middle‐income countries. The article provides a scoping review of the current state of English‐language empirical research. It identifies several promising opportunities for improving responses that promote support based on individuals’ rights, will and preferences. It also points out several gaps in research and practice (including, importantly, a gap in reviews of non‐English‐language studies). Overall, many studies suggest that efforts to prevent and reduce coercion appear to be effective. However, no jurisdiction appears to have combined the full suite of laws, policies and practices which are available, and which taken together might further the goal of eliminating coercion.

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          Guidance for conducting systematic scoping reviews.

          Reviews of primary research are becoming more common as evidence-based practice gains recognition as the benchmark for care, and the number of, and access to, primary research sources has grown. One of the newer review types is the 'scoping review'. In general, scoping reviews are commonly used for 'reconnaissance' - to clarify working definitions and conceptual boundaries of a topic or field. Scoping reviews are therefore particularly useful when a body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature not amenable to a more precise systematic review of the evidence. While scoping reviews may be conducted to determine the value and probable scope of a full systematic review, they may also be undertaken as exercises in and of themselves to summarize and disseminate research findings, to identify research gaps, and to make recommendations for the future research. This article briefly introduces the reader to scoping reviews, how they are different to systematic reviews, and why they might be conducted. The methodology and guidance for the conduct of systematic scoping reviews outlined below was developed by members of the Joanna Briggs Institute and members of five Joanna Briggs Collaborating Centres.
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            Unwanted incidents during transition of geriatric patients from hospital to home: a prospective observational study

            Background Geriatric patients recently discharged from hospital experience increased chance of unplanned readmissions and admission to nursing homes. Several studies have shown that medication-related discrepancies are common. Few studies report unwanted incidents by other factors than medications. In 2002 an ambulatory team (AT) was established within the Department of Geriatrics, St. Olavs University Hospital HF, Trondheim, Norway. The AT monitored the transition of the patients from hospital to home and four weeks after discharge in order to reveal unwanted incidents. The aim of the present study was to describe unwanted incidents registered by the AT among patients discharged from a geriatric evaluation and management unit (GEMU) by character, frequency and stage in the transitional process. Only unwanted incidents with a severity making contact with the primary health care (PHC) necessary were registered. Methods A prospective observational study with patients treated in the GEMU and followed by the AT was performed. Current practice included comprehensive geriatric assessment and management including discharge planning in the GEMU and collaboration with the primary health care on appointments on assistance to be provided after discharge from hospital. Unwanted incidents severe enough to induce contact with the primary health care were registered during the transitional phase and after discharge. Results 118 patients (65% female), with mean age 83.2 ± 6.4 years participated. Median Barthel Index at discharge was 18 (interquartile range 16-19) and median Mini Mental Status Examination 24 (interquartile range 21-26). A total of 146 unwanted incidents were registered in 70 (59%) of the patients. Most frequent were unwanted incidents related to drug prescription regime (32%), exchange of information in and between the GEMU and the primary health care (25%) and service or help provided from the PHC (17%). Conclusions Despite a seemingly well-organised system for transition of patients from the GEMU to their homes, one or more unwanted incidents occurred in most patients during discharge or four weeks post discharge. The study has revealed areas of importance for improving transitional care of geriatric patients.
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              Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department

              Background Among injury victims relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. PTSD is associated with functional impairments and decreased health-related quality of life (HRQoL). Previous studies that addressed the latter were restricted to injuries at the higher end of the severity spectrum. This study examined the association between PTSD symptoms and health-related quality of life (HRQoL) in a comprehensive population of injury patients of all severity levels and external causes. Methods We conducted a self-assessment survey which included items regarding demographics of the patient, accident type, sustained injuries, EuroQol health classification system (EQ-5D) and Health Utilities Index (HUI) to measure functional outcome and HRQoL, and the Impact of Event Scale (IES) to measure PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of PTSD. The survey was completed by 1,781 injury patients two years after they were treated at the Emergency Department (ED), followed by either hospital admission or direct discharge to the home environment. Results Symptoms indicative of PTSD were associated with more problems on all EQ-5D and HUI3 domains of functional outcome and a considerable utility loss in both hospitalized (0.23-0.24) and non-hospitalized (0.32-0.33) patients. Differences in reported problems between patients with IES scores higher or lower than 35 were largest for EQ-5D health domains pain/discomfort (82% versus 28%) and anxiety/depression (53% versus 11%) and HUI domains emotion (92% versus 33%) and pain (84% versus 38%). After adjusting for potential confounders, PTSD remained strongly associated with adverse HRQoL. Conclusions Among patients treated at an ED posttraumatic stress symptoms indicative of PTSD were associated with a considerable decrease in HRQoL in both hospitalized and non-hospitalized patients. PTSD symptoms may therefore raise a major barrier for full recovery of injury patients of even minor levels of severity.
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                Author and article information

                Contributors
                p.gooding@unimelb.edu.au
                Journal
                Acta Psychiatr Scand
                Acta Psychiatr Scand
                10.1111/(ISSN)1600-0447
                ACPS
                Acta Psychiatrica Scandinavica
                John Wiley and Sons Inc. (Hoboken )
                0001-690X
                1600-0447
                09 February 2020
                July 2020
                : 142
                : 1 ( doiID: 10.1111/acps.v142.1 )
                : 27-39
                Affiliations
                [ 1 ] University of Melbourne Parkville Vic Australia
                Author notes
                [*] [* ] Piers Gooding, University of Melbourne, Parkville, Vic. 3010, Australia.

                E‐mail: p.gooding@ 123456unimelb.edu.au

                Author information
                https://orcid.org/0000-0001-5743-5708
                Article
                ACPS13152
                10.1111/acps.13152
                7496148
                31953847
                f6c2c2d0-daa3-43f4-a00c-c891f9f59a10
                © 2020 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 12 January 2020
                Page count
                Figures: 1, Tables: 1, Pages: 13, Words: 9315
                Funding
                Funded by: United Nations Office for the High Commission for Human Rights
                Categories
                Systematic Review or Meta‐Analysis
                Systematic Review Or Meta‐Analysis
                Custom metadata
                2.0
                July 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.0 mode:remove_FC converted:11.09.2020

                Clinical Psychology & Psychiatry
                coercion,human rights,reducing coercion
                Clinical Psychology & Psychiatry
                coercion, human rights, reducing coercion

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