Srp Ark Celok Lek
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The general aims of this article are: a) to cover the current status of research on the important clinical and human rights issue of involuntary psychiatric hospitalization, and b) to discuss some factors which might influence future developments in this area of mental health care provision. Firstly, the article will outline main results from two literature reviews on outcomes of involuntary hospital admission. ⋯ Thirdly and finally, the article will shed some light on future prospects of this topic. Thus, some recommendations for best clinical practice in the use of involuntary hospital admission will be discussed, and arguments for two future scenarios, increase vs. decrease of involuntary psychiatric hospitalizations, will be contrasted and analyzed.
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The nature of some mental illness is such that persons affected by their conduct endangering life, health and safety, as well as life, health and safety of others from their surroundings. These persons, because of their mental condition, are often unable to properly assess their own interest. Because of the above it is permitted for these persons, under certain circumstances, to be forcibly hospitalized against their will. ⋯ The main reason is the fact that involuntary hospitalization is an act of deprivation of liberty and intervention into the personal integrity, which at that the measure is taken against the individual who has not committed any crime. In order to provide restricted approach to the application of compulsory hospitalization, it is necessary to pass a legislation on the protection of persons with mental disorders that would more closely define the undertaken proceedings, reasons and conditions for involuntary detention and involuntary hospitalization in a psychiatric institution, forced detention of voluntarily hospitalized persons and penal policy violation of this law. It is necessary to initiate the procedure for amending the Law on Contested Procedure, which would reform the procedure for compulsory hospitalization, as an important segment of mentally disordered persons' rights, in order to be in accordance with international and European standards within this field.
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Some research results point to significant benefit in the use of methadone substitution treatment in reduction of criminogenic activities in opiate addicts, as in positive affect on their somatic and mental state. ⋯ Future research at our centre should show the efficiency of methadone program in a decrease of risky behaviour, degree of criminogenic activity and judicial problems, improvement of life quality, as well as show the ways for preventive acting.
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Hetero-aggressive behaviour in patients with mental disorders is frequent and requires special skills of doctors and other medical staff in order to urgently protect the patient and indicate hospitalization. ⋯ The most common diagnostic categories to which the patients with hetero-aggressive behavioural outbursts belonged were from the schizophrenic circuit, followed by substance abuse, personality disorders, etc. Involuntary hospitalization was the most common form of hospitalization in patients with violent behaviour. Socio-demographic characteristics of examinees revealed this profile as the most common: male gender, younger age, secondary education, unmarried and unemployed, repeatedly hospitalized.
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Randomized Controlled Trial
Procalcitonin-based therapeutic strategy to reduce antibiotic use in patients after cardiac surgery: a randomized controlled trial.
Procalcitonin (PCT) is a thyroid gland prohormone, and its serum concentration is elevated in systemic bacterial infections. The diagnostic cut-off value of PCT in patients early after cardiac surgery remains unclear. ⋯ Procalcitonin-guided antibiotic treatment is safe and can significantly reduce the cost of postoperative care. Additionally, the antibiotic use during immediate postoperative course should be timely controlled and limited to documented bacterial infections.