29 research outputs found
Il performance management nei Dipartimenti di salute mentale (DSM) : proposta di un cruscotto multidimensionale e prospettive di implementazione
No full textIl tema della misurazione e della valutazione delle performance delle attività sanitarie è oggi centrale non solo a livello aziendale ma anche a livello di singole partizioni organizzative. Dipartimenti, distretti, unità operative sono chiamate a sviluppare sistemi e strumenti di performance management basati sulle proprie esigenze informative, allo scopo di supportare il middle management a migliorarne la gestione e orientare i comportamenti dei clinici.
Questo lavoro di ricerca propone un cruscotto di valutazione delle performance costruito per i Dipartimenti di Salute Mentale, che mira a superare i gap riscontrati in letteratura e nell’applicazione pratica di sistemi di performance management destinati a tale tipologia di dipartimenti. La definizione e la validazione del cruscotto ha, inoltre, coinvolto esperti del settore tramite focus group. Nelle conclusioni sono discussi le prospettive e i limiti dell’applicazione del cruscotto multidimensionale.Performance management in Mental Health Departments: a proposal for a multidimensional dashboard and considerations for implementation. Performance management is a central topic for health care sector, not just at corporate level but also for each organizational unit. Clinical directorates, healthcare districts, and clinical units must develop performance management systems and tools based on their peculiar needs of data and information in order to support middle managers' decisions, and orient clinicians' behaviors. This research proposes a multidimensional dashboard for Mental Health Departments. The proposal aims to overcome literature gaps and failures in implementation of performance management tools in this sector. The definition and validation of the multidimensional dashboard have involved several experts through a series of focus group. In conclusion, the authors discuss prospects and limits for implementation of this multidimensional dashboard
Psychosocial Rehabilitation in Italy Today
No full textThe continuity of care in the usual context of subject’s life and the multiprofessional care is the approach to psychiatric care of severe mental disorders prototypically implemented in Italy after the Psychiatric Reform of 1978. In this framework, the practice of psychiatric rehabilitation has been gradually refining and consolidating its paradigms, offering procedures and interventions with selective and targeted objectives. In this position paper, promoted by the Italian Society for Psychosocial Rehabilitation, some relevant statements are presented about the definition of psychosocial rehabilitation, the facilities where it is done and the interventions and activities implemented, the professionals involved and their education and training, and issues of management and organization. Limits and perspectives of this area are also discussed
Evaluating the Acceptance of Cinematic Virtual Reality-Based Applications for Rehabilitative Interventions in Schizophrenia
No full textObjectives: This study aims to evaluate the acceptability of Cinematic VR technology as a novel therapeutic approach supporting Social Skills Training (SST) rehabilitation interventions among patients with schizophrenia.Materials and Methods: We developed an innovative cinematic VR-based platform as a support system for SST rehabilitation of independent living skills and evaluated its acceptance among psychiatric patients in terms of usability, user experience, and use performance. Ten voluntary participants were enrolled in the study. The study inclusion criteria consisted of age 18-65 years, lack of moderate and severe intellectual disability, no substance use disorder, and schizophrenia spectrum disorder pathology according to DSM V. We administered post treatment questionnaires and developed the platform to capture relevant data automatically.Results: Patients rated usability and user experience from good to excellent. We also observed an improvement in the use performance.Conclusions: Cinematic Virtual Reality based applications showed good acceptability among patients with schizophrenia. This result supports further efforts in evaluating its effectiveness as a novel therapeutic approach supporting SST rehabilitation interventions
Quality of life evaluation in residential facilities for the mentally ill in Puglia (Italy). Phase 2: evaluation of quality of care
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Improving the “real life” management of schizophrenia spectrum disorders by LAI antipsychotics: A one-year mirror-image retrospective study in community mental health services
No full textSchizophrenia poses a significant economic burden on the healthcare system as well as it has a significant impact on society at large. Reasons for such a high economic burden of schizophrenia include the frequent relapses and hospitalizations occurring in this disorder. We analyze the effectiveness of long-acting injectable antipsychotics (LAIs) compared to oral medications, in terms of “clinical process management” in a sample of patients with a diagnosis of schizophrenia spectrum disorder treated in community mental health centers. An observational, retrospective, mirror-image study was carried out to evaluate the effectiveness of LAIs compared to oral medications in terms of number of hospitalizations, emergency visits and planned visits on a 10-year period (from July 2007 to June 2017). Differences between first and second generation LAIs were also explored. Our findings show that hospitalization and emergency visits are significantly decreased with the use of LAIs, while planned visits are increased in patients treated with LAIs. Our results suggest that LAIs, in particular, second generation ones, reduce hospitalization rates and emergency visits, improving the economic burden of schizophrenia. Therefore, LAIs should be considered a cost-effective treatment in the management of schizophrenia under routine conditions.</div
Similarities and differences between multivariate patterns of cognitive and socio-cognitive deficits in schizophrenia, bipolar disorder and related risk
No full textCognition and social cognition anomalies in patients with bipolar disorder (BD) and schizophrenia (SCZ) have been largely documented, but the degree of overlap between the two disorders remains unclear in this regard. We used machine learning to generate and combine two classifiers based on cognitive and socio-cognitive variables, thus delivering unimodal and multimodal signatures aimed at discriminating BD and SCZ from two independent groups of Healthy Controls (HC1 and HC2 respectively). Multimodal signatures discriminated well between patients and controls in both the HC1-BD and HC2-SCZ cohorts. Although specific disease-related deficits were characterized, the HC1 vs. BD signature successfully discriminated HC2 from SCZ, and vice-versa. Such combined signatures allowed to identify also individuals at First Episode of Psychosis (FEP), but not subjects at Clinical High Risk (CHR), which were classified neither as patients nor as HC. These findings suggest that both trans-diagnostic and disease-specific cognitive and socio-cognitive deficits characterize SCZ and BD. Anomalous patterns in these domains are also relevant to early stages of disease and offer novel insights for personalized rehabilitative programs
Abnormal inter-hemispheric effective connectivity from left to right auditory regions during Mismatch Negativity (MMN) tasks in psychosis
No full textAnomalous Mismatch Negativity (MMN) in psychosis could be a consequence of disturbed neural oscillatory activity at sensory/perceptual stages of stimulus processing. This study investigated effective connectivity within and between the auditory regions during auditory odd-ball deviance tasks. The analyses were performed on two magnetoencephalography (MEG) datasets: one on duration MMN in a cohort with various diagnoses within the psychosis spectrum and neurotypical controls and one on duration and pitch MMN in first-episode psychosis patients and matched neurotypical controls. We applied spectral Granger causality to MEG source-reconstructed signals to compute effective connectivity within and between the left and right auditory regions. Both experiments showed that duration-deviance detection was associated with early increases of effective connectivity in the beta band followed by increases in the alpha and theta bands, with the connectivity strength linked to the laterality of the MMN amplitude. Compared to controls, people with psychosis had overall smaller effective connectivity, particularly from left to right auditory regions, in the pathway where bilateral information converges toward lateralized processing, often rightward. Blunted MMN in psychosis might reflect a deficit in inter-hemispheric communication between auditory regions, highlighting a “dysconnection” already at preattentive stages of stimulus processing as a model system of widespread pathophysiology
Improving the mental health care process in response to Covid-19 pandemic: The case of a penitentiary mental health division.
No full textCovid-19 outbreak led all organizations to reorganize their processes to prevent infection and contagion risk. All healthcare facilities, included penitentiary mental health services, had to redesign their processes to safely deliver care services. In this paper, the case of a Penitentiary Mental Health Division located in southern Italy is presented. Soft System Methodology and Business process management principles and techniques are adopted to analyse and redesign the detainees' mental health care process. The process, characterized by direct, close and prolonged contact with patients, exposes detainees and healthcare staff to a high Covid-19 infection risk. Through document analysis, interviews with the actors involved in the process and direct observation, the process's inefficiencies and criticalities are identified. The process is redesigned to make it compliant with Covid-19 prevention provisions and national penitentiary regulations and address the other criticalities. The proposed methodological approach-which innovatively combines Soft System Methodology and Business Process Management-constitutes a human-centered process-based redesign approach that can be used both in healthcare and other organizational settings
Management of violent behaviour and rapid tranquillisation during acute psychotic episode: discrepancy between routine practice and evidence. The SIEP-DIRECT'S Project
No full textAIMS: To evaluate the quality of acute psychiatric care concerning the management of violent behaviour and rapid tranquilization. METHODS: Data concerning 13 indicators, drawn from NICE recommendations, were collected in 19 Departments of Mental Health, in the frame of the SIEP-DIRECT'S Project, to evaluate the implementation of NICE recommendations in Italian Mental Health Services. RESULTS: In about two thirds of Departments of Mental Health (DMHs) professionals were trained in the management of violent behaviour, while written procedures existed only in one fourth of DMHs. About a half of the professionals working in Psychiatric Wards in General Hospital were trained in rapid tranquilization, while procedures on this topic are practically absent and specific care for monitoring intensively the heavily sedated patient was not frequent. CONCLUSIONS: Management of violent behaviour and rapid tranquilization are two critical areas in the care performed by Psychiatric Wards in General Hospital. Training on these topics is more frequent than implementation of procedures. NICE recommendations and SIEP indicators are useful tools for improving the quality of acute psychiatric care
