Until recent years there has been no evidence from randomized controlled trials (RCTs) on the efficacy of deep brain stimulation (DBS) for Parkinson's disease (PD). This review and meta-analysis of RCTs describes the efficacy of DBS in improving motor signs, functionality and quality of life of PD patients. Several electronic databases were consulted up to April 2013. RCTs that compared DBS plus medication versus medication (alone or plus sham DBS) in PD patients were included. Outcome measures were motor function, waking time on good functioning without troublesome dyskinesias, levodopa-equivalent dose reduction, medication-induced complications, activities of daily living, health-related quality of life, and neurocognitive and psychiatric effects. Six RCTs (n = 1,184) that compared DBS plus medication versus medication alone were included. The results show that DBS significantly improves patients' symptoms, functionality and quality of life. Effects sizes are intense for the reduction of motor signs and improvement of functionality in the off-medication phase, in addition to the reduction of the required medication dose and its associated complications. Moderate effects were observed in the case of motor signs and time in good functionality in the on-medication phase, in addition to the quality of life. Although the number of RCTs obtained is small, the total sample size is relatively large, confirming the efficacy of DBS in the control of motor signs and improvement of patients' functionality and quality of life. More controlled research is required on the neurocognitive and psychiatric effects of DBS.
With the converging forces of strong local leadership, rapid economic changes, and slow cultural shifts, IPS may soon become a priority intervention in Europe for ensuring that people living with serious mental illnesses are able to obtain competitive employment.
Objective: This article describes the adoption of Individual Placement and Support (IPS) supported employment between 2013 and 2017 in Catalonia (Spain) in the context of high unemployment and a predominance of traditional preemployment training approaches. It reports the experience of implementing IPS to promote competitive job placement of people with mental disorders. Method: The Avedis Donabedian Research Institute (FAD) designed, trained, implemented, and evaluated the project. We used a longitudinal, mixedmethods approach. Results: The demonstration project comprised 7 employment services and 12 ambulatory mental health centers. It followed up programs and participants from October 2013 to December 2017. The project added 1,188 new competitive jobs, increased the rate of competitive employment from 16% to 43%, and improved the fidelity of IPS by 44% on the organizational dimension and by 34% on services dimension. The quality of employment was similar to the overall employment market, with 94% of temporary jobs. The qualitative analysis confirmed several areas of improvement, including the vision of recovery, collaborations between vocational and mental health services, work patterns of practitioners, and views of work as an This article was published Online First January 13, 2020.
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