Dataset Information

Compulsory Psychiatric Admissions in an Italian Urban Setting: Are They Actually Compliant to the Need for Treatment Criteria or Arranged for Dangerous Not Clinical Condition?

ABSTRACT: Background: Italy was one of the first European countries adopting the need for treatment criteria for compulsory admission (CA). The aim of the present study was to confirm whether CA in an urban setting in Italy was compliant with the requested clinical criteria. Methods: In this retrospective observational study, we retrieved all collected information regarding CA in Turin (Italy) from January 2006 to December 2013. All content and data reported in the CA forms, including diagnosis and clinical details, were gathered and analyzed. Comparisons between CA with and without a diagnosis of DSM-IV psychiatric disorders and between different diagnoses were performed using either parametric or non-parametric tests, depending on variable distribution. Results: Three hundred and two (10.5%) of 2,870 consecutive CAs made in Turin during a lag time of 8 years were due to unknown psychiatric diagnoses (113; 3.9%) or to psychomotor agitation (189; 6.6%). The most prevalent psychiatric disorders leading to CA were schizophrenia (729; 25.4%), brief psychotic disorder (627; 21.8%), bipolar disorder episode (396; 13.8%), delusional disorder (292; 10.2%), and personality disorder (237; 8.3%). The CAs due to psychiatric disorder were longer (U = 328,875.0; p < 0.001) and involved patients who were more likely to be compulsorily admitted during the study period (U = 357,012.5; p = 0.003), to have had prior contact with a psychiatrist [ ? ( 2 ) 2 = 28.34; p < 0.001], to have had previous admissions to a psychiatric ward [ ? ( 2 ) 2 = 33.06; p < 0.001], to be under the care of psychiatric services [ ? ( 3 ) 2 = 87.01; p < 0.001], and not to have concurrent alcohol [ ? ( 1 ) 2 = 23.06; p < 0.001] and/or drug use [ ? ( 1 ) 2 = 12.97; p < 0.001] than those due to psychomotor agitation/unspecified diagnoses. Conclusion: Despite a history of 35 years of CA made according to a strict need for treatment criteria, the evaluation of CA records shows that a certain proportion of CAs appears to have been due to brief, not psychiatric, alcohol/drug related behavioral conditions. Further studies should confirm the need for law reform leading to the integration between the need for treatment and the danger criteria for CAs.

SUBMITTER: Oliva F

PROVIDER: S-EPMC6331583 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Compulsory Psychiatric Admissions in an Italian Urban Setting: Are They Actually Compliant to the Need for Treatment Criteria or Arranged for Dangerous Not Clinical Condition?

Oliva Francesco F Ostacoli Luca L Versino Elisabetta E Portigliatti Pomeri Alberto A Furlan Pier Maria PM Carletto Sara S Picci Rocco Luigi RL

Frontiers in psychiatry 20190108

<b>Background:</b> Italy was one of the first European countries adopting the need for treatment criteria for compulsory admission (CA). The aim of the present study was to confirm whether CA in an urban setting in Italy was compliant with the requested clinical criteria. <b>Methods:</b> In this retrospective observational study, we retrieved all collected information regarding CA in Turin (Italy) from January 2006 to December 2013. All content and data reported in the CA forms, including diagno ...[more]

PMID: 30670991

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Project description:IntroductionIn the United States there is debate regarding the appropriate first test for new-onset renal colic, with non-contrast helical computed tomography (CT) receiving the highest ratings from both Agency for Healthcare Research and Quality and the American Urological Association. This is based not only on its accuracy for the diagnosis of renal colic, but also its ability to diagnose other surgical emergencies, which have been thought to occur in 10-15% of patients with suspected renal colic, based on previous studies. In younger patients, it may be reasonable to attempt to avoid immediate CT if concern for dangerous alternative diagnosis is low, based on the risks of radiation from CTs, and particularly in light of evidence that patients with renal colic have a very high likelihood of having multiple CTs in their lifetimes. The objective is to determine the proportion of patients with a dangerous alternative diagnosis in adult patients age 50 and under presenting with uncomplicated (non-infected) suspected renal colic, and also to determine what proportion of these patients undergo emergent urologic intervention.MethodsRetrospective chart review of 12 months of patients age 18-50 presenting with "flank pain," excluding patients with end stage renal disease, urinary tract infection, pregnancy and trauma. Dangerous alternative diagnosis was determined by CT.ResultsTwo hundred and ninety-one patients met inclusion criteria. One hundred and fifteen patients had renal protocol CTs, and zero alternative emergent or urgent diagnoses were identified (one-sided 95% CI [0-2.7%]). Of the 291 encounters, there were 7 urologic procedures performed upon first admission (2.4%, 95% CI [1.0-4.9%]). The prevalence of kidney stone by final diagnosis was 58.8%.ConclusionThis small sample suggests that in younger patients with uncomplicated renal colic, the benefit of immediate CT for suspected renal colic should be questioned. Further studies are needed to determine which patients benefit from immediate CT for suspected renal colic, and which patients could undergo alternate imaging such as ultrasound.

Project description:BackgroundCurrently, there is a lack of clear definition for neonatal sepsis. The Pediatric Committee of the European Medicines Agency (EMA) developed consensus criteria to ensure a standardization for neonatal sepsis definition. However, there is no evidence supporting the accuracy of the EMA sepsis criteria in neonatal sepsis diagnosis. The main objective of this study was to evaluate the diagnostic accuracy of EMA sepsis criteria for proven neonatal sepsis.MethodsA multicenter prospective cohort study was conducted from October 2015 to November 2018. Infants with a gestational age over 34th weeks, diagnosed with clinical sepsis and received antibiotics according to the EMA criteria or experienced neonatologists' opinion were included. Blood culture or multiplex real time-PCR or 16S-rRNA positive infants were accepted as "proven sepsis". The predictive performance of EMA criteria for proven sepsis was evaluated by sensitivity, specificity, accuracy, and area under the curve measures of receiver operator characteristic curves. Data-mining methods were used for further analysis.ResultsAmong the 245 included infants, the EMA criteria were positive in 97 infants (39.6%), while proven sepsis was diagnosed in 113 infants (46.1%). The sensitivity, specificity, and accuracy of the EMA criteria for proven sepsis were 44.2% (95%CI: 34.9-53.9), 64.4% (95%CI: 55.6-72.5), 55.1% (95%CI: 46.6-59.4) respectively. None of the clinical and laboratory parameters had sufficient performance individually in terms of sensitivity, specificity and accuracy measures. The diagnostic performance was similar when different clinical findings were added to the EMA sepsis criteria or assessment of the score was interpreted in different ways.ConclusionsResults highlighted that clinician opinion and standard laboratory tests are limited in the neonatal sepsis diagnosis. The EMA criteria also did not efficiently meet the diagnostic accuracy measures for neonatal sepsis. A predictive sepsis definition and rapid bedside point-of care tests are urgently needed.

Dataset Information

Compulsory Psychiatric Admissions in an Italian Urban Setting: Are They Actually Compliant to the Need for Treatment Criteria or Arranged for Dangerous Not Clinical Condition?

Publications

Compulsory Psychiatric Admissions in an Italian Urban Setting: Are They Actually Compliant to the Need for Treatment Criteria or Arranged for Dangerous Not Clinical Condition?

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