Relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units, and alternative residential options: a cross sectional survey, one day census data, and staff interviews

Abstract

Objective: To determine whether treatment with low dose aspirin and heparin leads to a higher rate of live births than that achieved with low dose aspirin alone in women with a history of recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies), lupus anticoagulant, and cardiolipin antibodies (or anticardiolipin antibodies). Design: Randomised controlled trial. Setting: Specialist clinic for recurrent miscarriages. Subjects: 90 women (median age 33 (range 22-43)) with a history of recurrent miscarriage (median number 4 (range 3-15)) and persistently positive results for phospholipid antibodies. Intervention: Either low dose aspirin (75 mg daily) or low dose aspirin and 5000 U of unfractionated heparin subcutaneously 12 hourly. All women started treatment with low dose aspirin when they had a positive urine pregnancy test. Women were randomly allocated an intervention when fetal heart activity was seen on ultrasonography. Treatment was stopped at the time of miscarriage or at 34 weeks' gestation. Main outcome measures: Rate of live births with the two treatments. Results: There was no significant difference in the two groups in age or the number and gestation of previous miscarriages. The rate of live births with low dose aspirin and heparin was 71% (32/45 pregnancies) and 42% (19/45 pregnancies) with low dose aspirin alone (odds ratio 3.37 (95% confidence interval 1.40 to 8.10)). More than 90% of miscarriages occurred in the first trimester. There was no difference in outcome between the two treatments in pregnancies that advanced beyond 13 weeks' gestation. Twelve of the 51 successful pregnancies (24%) were delivered before 37 weeks' gestation. Women randomly allocated aspirin and heparin had a median decrease in lumbar spine bone density of 5.4% (range − 8.6% to 1.7%). Conclusion: Treatment with aspirin and heparin leads to a significantly higher rate of live births in women with a history of recurrent miscarriage associated with phospholipid antibodies than that achieved with aspirin alone.

Doctor to Patient Ratio and Infrastructure Gap in a Psychiatric Hospital in Oil Rich Eket, Nigeria

“…The pressure on beds appears to reflect a wider mismatch of provision and need [28]. This is in consonance with the fact that shortage of beds in acute psychiatric units is related to both social deprivation and the overall availability of acute beds [41,42]. It is reported that South Africa, Egypt, Ethiopia and Kenya have higher proportions of psychiatric beds, with the neuropsychiatric hospital, Aro Hospital having over 500 beds [24,39].…”

“…This decay has been going on for over a decade without adequate representation in learned journals, media houses and policy statements. In the study center, patients do not have privacy and there is concern that patients often do not have privacy, nor are they guaranteed the therapeutic and recreational facilities that are a necessary part of good care [41,42]. Women are not spared, as the situation depicted in this report that, there is clear evidence that women are particularly disadvantaged with regard to both privacy and safety [42].…”

“…In the study center, patients do not have privacy and there is concern that patients often do not have privacy, nor are they guaranteed the therapeutic and recreational facilities that are a necessary part of good care [41,42]. Women are not spared, as the situation depicted in this report that, there is clear evidence that women are particularly disadvantaged with regard to both privacy and safety [42]. There is also frequent violation of the basic human rights of patients, such as the right to confidentiality, to privacy and to communication, with women undergoing constant violence [17,22].…”

Survey of long-stay patients on acute psychiatric wards

“…Their progress may also be hindered by the lack of opportunity to rehearse appropriate social roles and practical skills (Lelliottt & Quirk, 2004). The unacceptably high number of long-stay patients stuck on acute wards has been consistently reported and the associated shortcomings in community and longer stay in-patient provision have been highlighted (Kurian et al, 1994;Shepherd et al, 1997;Rowlands et al, 1998). The role of rehabilitation, whether in the hospital or in another placement, has largely been neglected (Holloway, 2005) during a decade that has seen national policy initiatives focus chiefly on the development of non-residential community services, notably assertive outreach and home treatment teams (Department of Health, 1999).…”

Acute hospital care: the beauty and the beast of psychiatry

“…Moreover, admissions are often required to offer patients and others, particularly their carers, protection and respite. Frequently, hospital care may also prove the only alternative available when the prospect of living in the community is shattered by homelessness (Commander et al, 1997) and social deprivation (Shepherd et al, 1997).…”