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Berring LL, Holm T, Hansen JP, Delcomyn CL, Søndergaard R, Hvidhjelm J. Implementing Trauma-Informed Care-Settings, Definitions, Interventions, Measures, and Implementation across Settings: A Scoping Review. Healthcare (Basel) 2024; 12:908. [PMID: 38727465 PMCID: PMC11083630 DOI: 10.3390/healthcare12090908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/16/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Traumatic experiences can have long-lasting negative effects on individuals, organizations, and societies. If trauma is not addressed, it can create unsafe cultures with constant arousal, untrusting relationships, and the use of coercive measures. Trauma-informed care (TIC) can play a central role in mitigating these negative consequences, but it is unknown how and in which way(s) TIC should be implemented. Our objective was to conduct a scoping review that systematically explored and mapped research conducted in this area and to identify existing knowledge about the implementation of TIC. The search was conducted on the CINAHL, Cochrane, Embase, ERIC, Medline, PsycINFO, and Web of Science databases, and more than 3000 empirical papers, published between 2000 and 2022, were identified. Following further screening, we included 157 papers in our review, which were mainly from the USA, Australia, New Zealand, and Canada, focusing on study settings, methodologies, and definitions of TIC, as well as the types of interventions and measures used. This review shows that TIC is a complex and multifaceted framework, with no overarching structure or clear theoretical underpinnings that can guide practical implementations. TIC has been defined and adapted in varied ways across different settings and populations, making it difficult to synthesize knowledge. A higher level of agreement on how to operationalize and implement TIC in international research could be important in order to better examine its impact and broaden the approach.
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Affiliation(s)
- Lene Lauge Berring
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
| | - Tine Holm
- Psychosis Research Unit, Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark;
| | - Jens Peter Hansen
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
- Retspsykiatrisk Forskningsenhed, Østre Hougvej 70, 5500 Middelfart, Denmark
| | - Christian Lie Delcomyn
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
- Department for Forensic Psychiatry, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark
| | - Rikke Søndergaard
- Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, 4200 Slagelse, Denmark; (C.L.D.); (R.S.)
| | - Jacob Hvidhjelm
- Clinical Mental Health and Nursing Research Unit, Mental Health Center Sct Hans, Copenhagen University Hospital—Mental Health Services CPH, 2400 Copenhagen, Denmark;
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2
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Downe S, Nowland R, Clegg A, Akooji N, Harris C, Farrier A, Gondo LT, Finlayson K, Thomson G, Kingdon C, Mehrtash H, McCrimmon R, Tunçalp Ö. Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001594. [PMID: 37093790 PMCID: PMC10124898 DOI: 10.1371/journal.pgph.0001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Despite global attention, physical and verbal abuse remains prevalent in maternity and newborn healthcare. We aimed to establish theoretical principles for interventions to reduce such abuse. We undertook a mixed methods systematic review of health and social care literature (MEDLINE, SocINDEX, Global Index Medicus, CINAHL, Cochrane Library, Sept 29th 2020 and March 22nd 2022: no date or language restrictions). Papers that included theory were analysed narratively. Those with suitable outcome measures were meta-analysed. We used convergence results synthesis to integrate findings. In September 2020, 193 papers were retained (17,628 hits). 154 provided theoretical explanations; 38 were controlled studies. The update generated 39 studies (2695 hits), plus five from reference lists (12 controlled studies). A wide range of explicit and implicit theories were proposed. Eleven non-maternity controlled studies could be meta-analysed, but only for physical restraint, showing little intervention effect. Most interventions were multi-component. Synthesis suggests that a combination of systems level and behavioural change models might be effective. The maternity intervention studies could all be mapped to this approach. Two particular adverse contexts emerged; social normalisation of violence across the socio-ecological system, especially for 'othered' groups; and the belief that mistreatment is necessary to minimise clinical harm. The ethos and therefore the expression of mistreatment at each level of the system is moderated by the individuals who enact the system, through what they feel they can control, what is socially normal, and what benefits them in that context. Interventions to reduce verbal and physical abuse in maternity care should be locally tailored, and informed by theories encompassing all socio-ecological levels, and the psychological and emotional responses of individuals working within them. Attention should be paid to social normalisation of violence against 'othered' groups, and to the belief that intrapartum maternal mistreatment can optimise safe outcomes.
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Affiliation(s)
- Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Rebecca Nowland
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Andrew Clegg
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Naseerah Akooji
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom
| | - Cath Harris
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Alan Farrier
- Healthy and Sustainable Settings Unit, University of Central Lancashire, Preston, United Kingdom
| | | | - Kenny Finlayson
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Carol Kingdon
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rebekah McCrimmon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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3
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Nagayama Y, Tanaka K, Oe M. Strengths Model-Based Nursing Interventions for Inpatients in Psychiatric Inpatient Settings Using a Seclusion Room: A Case Series Study. NURSING REPORTS 2023; 13:644-658. [PMID: 37092485 PMCID: PMC10123628 DOI: 10.3390/nursrep13020057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/25/2023] Open
Abstract
The use of coercive measures in psychiatric inpatient settings has been an important issue for many years. Nursing interventions based on a strengths model could enable a reduction in the use of these measures. This study aimed to describe the practice of nursing interventions using a strengths model for psychiatric inpatients who have been in seclusion for a long time. We also constructed a nursing model to minimize coercive measures. The participants were eight inpatients who had been in seclusion for a long time. Nursing interventions based on a strengths model were implemented in collaboration with nurses from six long-term care units in three psychiatric hospitals in Japan. For 4 of the 8 participants, the seclusion time decreased by 20-45%. However, for another 2, it increased by about 23-34%. An average decrease of 9.6% was observed, and the open observation time increased by 1.4 h per day on the seclusion days. When using this model, the nurses considered the effects of stimulating strengths. We believe this approach may promote inpatients' self-insight. Considering the perspective of stimulus adjustment might be useful for maximizing the positive effects of working on strengths.
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Affiliation(s)
- Yutaka Nagayama
- School of Nursing, Kanazawa Medical University, 1-1 Uchinada, Kahoku 920-0265, Japan
| | - Koji Tanaka
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa 920-0942, Japan
| | - Masato Oe
- School of Nursing, Kanazawa Medical University, 1-1 Uchinada, Kahoku 920-0265, Japan
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4
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Baker J, Kendal S, Berzins K, Canvin K, Branthonne‐Foster S, McDougall T, Goldson B, Kellar I, Wright J, Duxbury J. Mapping review of interventions to reduce the use of restrictive practices in children and young people's institutional settings: The CONTRAST study. CHILDREN & SOCIETY 2022; 36:1351-1401. [PMID: 36588794 PMCID: PMC9790399 DOI: 10.1111/chso.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/14/2022] [Accepted: 04/27/2022] [Indexed: 06/17/2023]
Abstract
Restrictive practices are often used harmfully with children in institutional settings. Interventions to reduce their use do not appear to have been mapped systematically. Using environmental scanning, we conducted a broad-scope mapping review of English language academic databases, websites and social media, using systematic methods. Included records (N = 121) were mostly from the United States and contained details of 82 different interventions. Children's participation was limited. Reporting quality was inconsistent, which undermined claims of effectiveness. Overall, despite a multitude of interventions, evidence is limited. Leaders should consider the evidence, including children's perspectives, before introducing poorly understood interventions into children's settings.
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Affiliation(s)
| | | | | | | | | | - Tim McDougall
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | | | | | | | - Joy Duxbury
- Manchester Metropolitan UniversityManchesterUK
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5
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Perers C, Bäckström B, Johansson BA, Rask O. Methods and Strategies for Reducing Seclusion and Restraint in Child and Adolescent Psychiatric Inpatient Care. Psychiatr Q 2022; 93:107-136. [PMID: 33629229 PMCID: PMC8993718 DOI: 10.1007/s11126-021-09887-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 11/26/2022]
Abstract
Restraints and seclusions are restrictive interventions used in psychiatric inpatient units when there is an imminent risk of harm to the patient or others. Coercive measures are controversial and can lead to negative consequences, including negative emotions, re-traumatization, injuries, or death. The article summarizes the last 10 years of literature regarding methods and strategies used for reducing seclusions and restraints in child and adolescent psychiatric inpatient units, and reports on their outcomes. The literature was reviewed by searching PubMed and PsycInfo for English-language articles published between May 2010 and May 2020. Eighteen articles were found that described methods or strategies aimed at reducing restraint or seclusion utilization in child and adolescent psychiatric inpatient units. The following interventions were evaluated: Trauma-Informed Care (TIC), Six Core Strategies, Child and Family Centered Care (CFCC), Collaborative & Proactive Solutions (CPS), Strength-Based Care, Modified Positive Behavioral Interventions and Supports (M-PBIS), Behavioral Modification Program (BMP), Autism Spectrum Disorder Care Pathway (ASD-CP), Dialectical Behavior Therapy (DBT), sensory rooms, Mindfulness-Based Stress Reduction Training (MBSR) of staff, and Milieu Nurse-Client Shift Assignments. Most of the interventions reduced the use of seclusions and/or restraints. Two child-centered and trauma-informed initiatives eliminated the use of mechanical restraints. This review shows that the use of coercive measures can be reduced and should be prioritized. Successful implementation requires ongoing commitment on all levels of an organization and a willingness to learn. To facilitate comparisons, future models should evaluate different standardized parameters.
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Affiliation(s)
| | - Beata Bäckström
- Skåne Child & Adolescent Psychiatry, Unit for Pediatric Bipolar & Psychotic Disorders, Lund, Sweden
| | - Björn Axel Johansson
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, Lund, Sweden
- Skåne Child & Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Malmö, Sweden
| | - Olof Rask
- Skåne Child & Adolescent Psychiatry, Unit for Pediatric Bipolar & Psychotic Disorders, Lund, Sweden
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, Lund, Sweden
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6
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Sorter M, Chua J, Lamy M, Barzman D, Ryes L, Shekhtman JA. Management of Emotion Dysregulation and Outbursts in Children and Adolescents. Curr Psychiatry Rep 2022; 24:213-226. [PMID: 35316849 DOI: 10.1007/s11920-022-01325-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Emotion dysregulation and outbursts are very common reasons for referral to child and adolescent mental health services and a frequent cause of admission to hospitals and residential programs. Symptoms of emotion dysregulation and outburst are transdiagnostic, associated with many disorders, have the potential to cause severe impairment and their management presents a major challenge in clinical practice. RECENT FINDINGS There are an increasing number of psychosocial interventions that demonstrate promise in improving emotion dysregulation and outbursts. Acute care systems to manage the most severely ill patients have limited best practice guidelines but program advancements indicate opportunities to improve care models. Pharmacotherapy may be of assistance to psychosocial interventions but must be used with caution due to potential adverse effects. Much remains to be discovered however evidence informed, targeted treatments for specific populations show potential for future improvements in outcomes.
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Affiliation(s)
- Michael Sorter
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. .,University of Cincinnati College of Medicine, Cincinnati, USA.
| | - Jaclyn Chua
- Children's Hospital of Philadelphia, Philadelphia, USA
| | - Martine Lamy
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
| | - Drew Barzman
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
| | - Louis Ryes
- Xavier University, Cincinnati, USA.,University of Kentucky College of Medicine, Lexington, USA
| | - Joshua Abraham Shekhtman
- The Ohio State University, Columbus, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
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7
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Goulet MH, Lessard-Deschênes C. Le Modèle de prévention de l’utilisation des mesures de contrôle en santé mentale : une revue intégrative. SANTÉ MENTALE AU QUÉBEC 2022. [DOI: 10.7202/1094149ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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8
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Pérez-Revuelta JI, Torrecilla-Olavarrieta R, García-Spínola E, López-Martín Á, Guerrero-Vida R, Mongil-San Juan JM, Rodríguez-Gómez C, Pascual-Paño JM, González-Sáiz F, Villagrán-Moreno JM. Factors associated with the use of mechanical restraint in a mental health hospitalization unit: 8-year retrospective analysis. J Psychiatr Ment Health Nurs 2021; 28:1052-1064. [PMID: 33657672 DOI: 10.1111/jpm.12749] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 02/07/2021] [Accepted: 02/23/2021] [Indexed: 12/20/2022]
Abstract
WHAT IS ALREADY KNOWN ABOUT THE TOPIC?: Our present understanding of mechanical restraint is heterogenous, largely due to the important differences between countries/regions. In Spain, the use of this restrictive practice is not regulated, nor is its use protocolized. Previous studies that have investigated the impact of organizational factors and changes in these protocols are often short and not conducted within a framework designed to establish a long-term plan for reducing the use of mechanical restraint. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: We demonstrate that the implementation of administrative and protocol changes in our psychiatric unit significantly reduced the use of mechanical restraint, thus laying the foundations for a regulatory framework. Our analysis shows that the profile of patients who require mechanical restraint is highly variable, but that certain clinical and institutional aspects within the framework of a long-term plan for the reduction in mechanical restraint can be targeted with long-lasting positive effects. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Organizational changes focussed on training staff, promoting family support and requiring the registration and close monitoring of episodes empower the role of the nursing staff in the prevention, monitoring and regulation of mechanical restraint. ABSTRACT: Introduction Mechanical restraint is a controversial restrictive practice to manage agitation or violent behaviour. Numerous studies have evaluated the factors and organizational changes that influence on mechanical restraint, but only for short time periods. None of those studies have assessed the effects of measures applied within the framework of a long-term plan to reduce the use of mechanical restraint. Given the lack of specific legislation in Spain, more data are required for its proper regulation. Aim/Question To evaluate the risk factors associated and the impact of specific measures designed to minimize the application of mechanical restraint in an acute mental health unit over an 8-year period and previous observation of 5 years. Methods Cross-sectional study based on a retrospective analysis of mechanical restraint records. We compared admissions requiring ≥one episode of restraint versus admissions not requiring this coercive measure. Results Between 2007 and 2014, 412 admissions (12%) required mechanical restraint. The data show that the measures applied in the previous five years had significantly reduced the total hours of restraint per semester. The factors associated with admissions requiring mechanical restraint were involuntary, unscheduled and longer admissions. The best predictor of restraint was involuntary admission (OR = 6.37), followed by the diagnosis of personality disorder (OR = 5.01). Discussion Identification of the factors associated with mechanical restraint would allow for early detection strategies. Our results provide additional evidence on the usefulness of organizational changes to reduce coercive measures, even in a country without specific legislation. Implications for Practice Organizational changes, such as staff training and increased family support during admission of episodes of mechanical restraint, can reduce the use of this measure. These measures also give the nursing staff greater responsibility in terms of their role in registering and monitoring the restrictive practice, thus helping to prevent or minimize the use of mechanical restraint.
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Affiliation(s)
- Jose I Pérez-Revuelta
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA) Unidad Investigación Hospital Universitario de Puerta del Mar Universidad de Cádiz, España Hospital Universitario Puerta del Mar, Cádiz, Spain.,UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez. Servicio Andaluz de Salud, Jerez de la Frontera, Cádiz, 11407, Spain
| | - Rocío Torrecilla-Olavarrieta
- UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez. Servicio Andaluz de Salud, Jerez de la Frontera, Cádiz, 11407, Spain
| | - Edgar García-Spínola
- Departamento Neurociencias, Área Psiquiatría, Universidad de Cádiz, Cádiz, Spain
| | - Ángela López-Martín
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA) Unidad Investigación Hospital Universitario de Puerta del Mar Universidad de Cádiz, España Hospital Universitario Puerta del Mar, Cádiz, Spain.,Departamento Neurociencias, Área Psiquiatría, Universidad de Cádiz, Cádiz, Spain
| | - Rafael Guerrero-Vida
- UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez. Servicio Andaluz de Salud, Jerez de la Frontera, Cádiz, 11407, Spain
| | - Jose M Mongil-San Juan
- UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez. Servicio Andaluz de Salud, Jerez de la Frontera, Cádiz, 11407, Spain
| | - Carmen Rodríguez-Gómez
- UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez. Servicio Andaluz de Salud, Jerez de la Frontera, Cádiz, 11407, Spain
| | - Juan M Pascual-Paño
- UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez. Servicio Andaluz de Salud, Jerez de la Frontera, Cádiz, 11407, Spain
| | - Francisco González-Sáiz
- UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez. Servicio Andaluz de Salud, Jerez de la Frontera, Cádiz, 11407, Spain.,Departamento Neurociencias, Área Psiquiatría, Universidad de Cádiz, Cádiz, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Madrid, Spain
| | - Jose M Villagrán-Moreno
- UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez. Servicio Andaluz de Salud, Jerez de la Frontera, Cádiz, 11407, Spain.,Departamento Neurociencias, Área Psiquiatría, Universidad de Cádiz, Cádiz, Spain
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9
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Chua JD, Bellonci C, Sorter MT. Treatment of Childhood Emotion Dysregulation in Inpatient and Residential Settings. Child Adolesc Psychiatr Clin N Am 2021; 30:505-525. [PMID: 34053683 DOI: 10.1016/j.chc.2021.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Children hospitalized in inpatient and residential treatment facilities often present with severe emotion dysregulation, which is the result of a wide range of psychiatric diagnoses. Emotion dysregulation is not a diagnosis but is a common but inconsistently described set of symptoms and behaviors. With no agreed upon way of measuring emotion dysregulation, the authors summarize the existing contemporary treatment focusing on proxy measures of emotion dysregulation in inpatient and residential settings. Interventions are summarized and categorized into individual- and systems-level interventions in addressing aggressive behaviors. Going forward, dysregulation will need to be operationalized in a standard way.
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Affiliation(s)
- Jaclyn Datar Chua
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, 3440 Market Street, Suite 200, Philadelphia, PA 19104, USA.
| | | | - Michael T Sorter
- Cincinnati Children's Hospital and the University of Cincinnati, Cincinnati Children's 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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10
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Roy C, Castonguay A, Fortin M, Drolet C, Franche-Choquette G, Dumais A, Lafortune D, Bernard P, Geoffrion S. The Use of Restraint and Seclusion in Residential Treatment Care for Youth: A Systematic Review of Related Factors and Interventions. TRAUMA, VIOLENCE & ABUSE 2021; 22:318-338. [PMID: 31122160 DOI: 10.1177/1524838019843196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Children placed in residential treatment centers (RTCs) typically present challenging behavior including aggression. In this context, restraint and seclusion (R&S) are seen as "last resort" strategies for educators to manage youth aggression. The use of R&S is controversial, as they can lead to psychological and physical consequences for both the client and the care provider and have yet to be empirically validated as therapeutic. The objectives of this systematic review are to identify the factors related to R&S use in RTCs for youth and to review the interventions aiming to reduce the use of R&S. The identification of these factors is the first step to gaining a better understanding of the decision-making process leading to the use of R&S and ultimately to reducing the use of these strategies to a minimum. Thus, the present systematic review was conducted by searching PubMed, CINAHL, ERIC, and PsycNET for articles published between 2002 and 2017. Key words used were synonyms of R&S, youth, and RTCs. Thirty-one studies met the inclusion criteria: must report on factors affecting the use of R&S in RTCs, must be conducted in RTCs for youth under the age of 21, and must report on original and empirical data. Factors related to the characteristics of the client, the care provider, and the environment, as well as to the implementation of programs for the reduction of R&S, were found to influence the use of R&S in RTCs. A conceptual model is presented. The implementation of programs to reduce R&S use is discussed.
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Affiliation(s)
- Camille Roy
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
| | - Ariane Castonguay
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
| | - Maxime Fortin
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Christine Drolet
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
| | - Geneviève Franche-Choquette
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
| | - Alexandre Dumais
- Research Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry and Addictology, 5622University of Montreal, Montreal, Quebec, Canada
- Philippe Pinel Institute of Montreal, Montreal, Quebec, Canada
| | - Denis Lafortune
- University Institute for Troubled Youth, Montreal, Quebec, Canada
- School of Criminology, 5622University of Montreal, Montreal, Quebec, Canada
| | - Paquito Bernard
- Research Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- Department of Physical Activity Sciences, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Steve Geoffrion
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
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11
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Guzman-Parra J, Aguilera-Serrano C, Huizing E, Bono Del Trigo A, Villagrán JM, García-Sánchez JA, Mayoral-Cleries F. A regional multicomponent intervention for mechanical restraint reduction in acute psychiatric wards. J Psychiatr Ment Health Nurs 2021; 28:197-207. [PMID: 32667113 DOI: 10.1111/jpm.12669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: A relevant number of restraint prevention programmes have been developed internationally. In Spain, there is no harmonized policy to prevent the use of restraint. More studies are necessary to establish which programmes and components are necessary to prevent restraint. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: There was a significant decreasing trend in the total number of mechanical restraint hours during the implementation of the intervention. There was no significant decreasing trend in the number of mechanical restraint episodes. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Interventions at a regional level aimed at preventing mechanical restraint are feasible in the Spanish context. All components of the Six Core Strategies could be necessary to prevent episodes of mechanical restraint. ABSTRACT: Introduction Mechanical restraint (MR) is used in many countries, including Spain, where non-harmonized policies between autonomous communities exist. There is a lack of research about interventions at regional levels to reduce their use. Aim To analyse data on key outcomes during the implementation of a multicomponent intervention in Andalusia (Spain) to reduce the use of MR. Method Episodes in a period of 30 months in all wards (N = 20) were analysed. The intervention consisted of five strategies: (a) leadership, (b) analysis of the situation, (c) awareness training for the heads of the wards, (d) unified record of MR and (e) staff training. We analysed the monthly trend of restraint hours and restraint episodes/1,000 bed days using segmented regression. Results There were 206.32 restraint hours and 12.96 restraint episodes/1,000 bed days during the study period. A significant decreasing trend was observed in restraint hours (-1.79%, p < .001), but not in the number of restraint episodes (-0.45%; p = .149). Discussion The results coincide with other international studies; however, studies with better designs are required to evaluate the effectiveness of the intervention. Implications for Practice Interventions at a regional level aimed at preventing MR are feasible in the Spanish context.
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Affiliation(s)
- Jose Guzman-Parra
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Carlos Aguilera-Serrano
- Community Mental Health Unit of Motril, South Health Management Area of Granada, Motril, Spain
| | | | | | - José María Villagrán
- Mental Health Hospitalization Unit, Jerez de la Frontera Hospital, Jerez de la Frontera, Spain
| | - Juan Antonio García-Sánchez
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Fermín Mayoral-Cleries
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
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Carlson GA, Chua J, Pan K, Hasan T, Bied A, Martin A, Klein DN. Behavior Modification Is Associated With Reduced Psychotropic Medication Use in Children With Aggression in Inpatient Treatment: A Retrospective Cohort Study. J Am Acad Child Adolesc Psychiatry 2020; 59:632-641.e4. [PMID: 31381991 DOI: 10.1016/j.jaac.2019.07.940] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE There are few data to guide management of agitated and aggressive psychiatrically hospitalized children. Available studies do not account for setting, age, sex, diagnosis, admission reason, or clinical intervention. Seclusion, restraint, and physical holds (S/R/H) are usually the only outcome measure. In this study, we examine changes in PRN (pro re nata, or "as needed") psychotropic medication use to manage severe aggression on a children's psychiatric inpatient unit, comparing rates before and after a behavior modification program (BMP) was discontinued. METHOD We compare 661 children (aged 5-12 years) in 5 cohorts over 10 years, 510 (77%) of whom were admitted for aggressive behavior. PRN use per 1,000 patient-days was the primary outcome measure, but S/R/H was also examined. We use the following as predictors: BMP status, full- or half-time child and adolescent psychiatrist (CAP) oversight, diagnosis, age, length of stay, and neuroleptic use. RESULTS Children admitted for aggression had high rates of externalizing disorders (79%), low rates of mood (27%) and anxiety (21%) disorders, and significantly higher rates of PRN and S/R/H (p < .001) use. Rate of PRN use was significantly lower (p < .001) when the BMP was present (mean [SD], 163 [319] per 1,000 patient-days) than when it was absent (483 [569]; p < .001). Higher PRN use was predicted by BMP absence, neuroleptic treatment, and young patient age (p < .001), and by half-time CAP oversight (p = .002). CONCLUSION In this sample of young children with primarily externalizing disorders, data support the effectiveness of a BMP in lowering rates of PRN and S/R/H use.
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Affiliation(s)
| | - Jaclyn Chua
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Katherine Pan
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Tahsin Hasan
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Adam Bied
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT
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Abstract
Psychiatrists have been involved in seclusion and restraint (S-R) management and mitigating its abuses for 200 years. The emphasis on finding alternatives to S-R has produced much of the recent success in decreasing its use. Nonetheless, patients continue to suffer from abuse and to die in S-R events, so a need for more assessments and interventions seems like a productive avenue to pursue. One approach is to involve psychiatrists more intensively in all S-R activities as is part of the widely used, rationale-based practice, Six Core Strategies to Prevent Conflict, Trauma, and Violence. These opportunities are reviewed.
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Affiliation(s)
- Kim J Masters
- Three Rivers Residential Treatment Center, Midlands Campus, West Columbia, Columbia, South Carolina (Masters); Department of Physician Assistant Studies, College of Health Professions, Medical University of South Carolina, Charleston (Masters); and Evidence-Based Practices and Programs, Wellpath Recovery Solutions, Nashville, Tennessee (Huckshorn)
| | - Kevin Ann Huckshorn
- Three Rivers Residential Treatment Center, Midlands Campus, West Columbia, Columbia, South Carolina (Masters); Department of Physician Assistant Studies, College of Health Professions, Medical University of South Carolina, Charleston (Masters); and Evidence-Based Practices and Programs, Wellpath Recovery Solutions, Nashville, Tennessee (Huckshorn)
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Aremu B, Hill PD, McNeal JM, Petersen MA, Swanberg D, Delaney KR. Implementation of Trauma-Informed Care and Brief Solution-Focused Therapy: A Quality Improvement Project Aimed at Increasing Engagement on an Inpatient Psychiatric Unit. J Psychosoc Nurs Ment Health Serv 2018. [DOI: 10.3928/02793695-20180305-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Geoffrion S, Goncalves J, Giguère CÉ, Guay S. Impact of a Program for the Management of Aggressive Behaviors on Seclusion and Restraint Use in Two High-Risk Units of a Mental Health Institute. Psychiatr Q 2018; 89:95-102. [PMID: 28500477 DOI: 10.1007/s11126-017-9519-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Omega Program for the Management of Aggressive Behaviors aims to reduce patients' dangerous behaviors, towards themselves or others, and to reduce the use of seclusion and restraint (S/R). A previous study in a Mental Health Institute (Montreal, Canada) showed that implementing this program allowed employees of the intensive care and emergency units to gain confidence in coping with patients' aggressions and to reduce their psychological distress. The present study, conducted in the same high-risk units, assesses the effect of the program on S/R use. We hypothesize that the incidence and duration of S/R should diminish significantly following the implementation of the program in both units. This naturalistic, prospective study covered archival data between April 2010 and July 2014. Pre-training data (April 2010-December 2011) were compared to data during training (January 2012-October 2012) and to post-training data (November 2012-July 2014) for both units. In the intensive care unit, we confirmed an increase of both mean daily number and duration of S/R by admissions in pre-training, followed by a decrease during the training and post-training. In the emergency unit, a decreasing trend is seen during the entire period thus suggesting that the decrease in S/R may be independent of the training. These findings suggest that Omega is a promising intervention program to use in an intensive care unit. However, a more global approach, including institutional changes in culture and attitude, can be important factors to develop to increase the positive outcomes.
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Affiliation(s)
- Steve Geoffrion
- Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, Quebec, H1N 3V2, Canada.,University of Montreal, Pavillon Lionel-Groulx, 3150 Jean-Brillant, Montreal, Quebec, H3T 1N8, Canada
| | - Jane Goncalves
- Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, Quebec, H1N 3V2, Canada
| | - Charles-Édouard Giguère
- Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, Quebec, H1N 3V2, Canada
| | - Stéphane Guay
- Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, Quebec, H1N 3V2, Canada. .,University of Montreal, Pavillon Lionel-Groulx, 3150 Jean-Brillant, Montreal, Quebec, H3T 1N8, Canada.
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Aguilera-Serrano C, Guzman-Parra J, Garcia-Sanchez JA, Moreno-Küstner B, Mayoral-Cleries F. Variables Associated With the Subjective Experience of Coercive Measures in Psychiatric Inpatients: A Systematic Review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:129-144. [PMID: 29069981 PMCID: PMC5788134 DOI: 10.1177/0706743717738491] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This systematic review presents evidence regarding factors that may influence the patient's subjective experience of an episode of mechanical restraint, seclusion, or forced administration of medication. METHOD Two authors searched CINAHL, PubMed, SCOPUS, Web of Science, and Psych-Info, considering published studies between 1 January 1992 and 1 February 2016. Based on the inclusion criteria and methodological quality, 34 studies were selected, reporting a total sample of 1,869 participants. RESULTS The results showed that the provision of information, contact and interaction with staff, and adequate communication with professionals are factors that influence the subjective experience of these measures. Humane treatment, respect, and staff support are also associated with a better experience, and debriefing is an important procedure/technique to reduce the emotional impact of these measures. Likewise, the quality of the working and physical environment and some individual and treatment variables were related to the experience of these measures. There are different results in relation to the most frequently associated experiences and, despite some data that indicate positive experiences, the evidence shows such experiences to be predominantly negative and frequently with adverse consequences. It seems that patients find forced medication and seclusion to be more tolerable than mechanical restraint and combined measures. CONCLUSIONS It appears that the role of the staff and the environmental conditions, which are potentially modifiable, affect the subjective experience of these measures. There was considerable heterogeneity among studies in terms of coercive measures experienced by participants and study designs.
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Affiliation(s)
- Carlos Aguilera-Serrano
- 1 Department of Mental Health, University General Hospital of Malaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain.,2 University of Málaga, Andalucía Tech, Faculty of Psychology, Málaga, Spain
| | - Jose Guzman-Parra
- 1 Department of Mental Health, University General Hospital of Malaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain.,3 Departamento Personalidad, Evaluación y Tratamiento Psicológico, Grupo GAP, Facultad de Psicología, Universidad de Málaga, Spain
| | - Juan A Garcia-Sanchez
- 1 Department of Mental Health, University General Hospital of Malaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | | | - Fermin Mayoral-Cleries
- 1 Department of Mental Health, University General Hospital of Malaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
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Guzman-Parra J, Aguilera Serrano C, García-Sánchez JA, Pino-Benítez I, Alba-Vallejo M, Moreno-Küstner B, Mayoral-Cleries F. Effectiveness of a Multimodal Intervention Program for Restraint Prevention in an Acute Spanish Psychiatric Ward. J Am Psychiatr Nurses Assoc 2016; 22:233-41. [PMID: 27122483 DOI: 10.1177/1078390316644767] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND International recommendations have called to implement strategies to reduce the use of coercion in psychiatric settings. However, in Spain there is a lack of research about intervention programs to reduce mechanical restraint in acute psychiatric units. OBJECTIVE The aim of this study was to evaluate the effectiveness of a multimodal intervention program based on the principles of six core strategies to reduce the frequency of use of mechanical restraint in an acute psychiatric ward. DESIGN The design was a retrospective analysis of the frequency and duration of episodes of mechanical restraint prior to the intervention program (2012) and during the intervention program (2013) in one acute psychiatric ward. The intervention was governed by four strategies: (1) leadership and organizational changes, (2) registration and monitoring of risk patients, (3) staff training, and (4) involving patients in the treatment program. RESULTS There was a significant difference between the mean number of monthly episodes of mechanical restraint per 1,000 patient days, pre-intervention (18.54 ± 8.78) compared with postintervention (8.53 ± 7.00; p = .005). We found the probability that mechanical restraint would occur in a hospital admission decreased after performing the intervention (odds ratio = .587; confidence interval = 0.411-0.838; p = .003) after adjusting for confounding variables. The total percentage of restrained patients fell from 15.07% to 9.74%. CONCLUSIONS The main implication of the study is to support the effectiveness of specific intervention programs based on different measures to reduce mechanical restraint and without contemplating all the strategies that are considered effective.
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Affiliation(s)
- Jose Guzman-Parra
- Jose Guzman-Parra, PsyD, University Regional Hospital of Malaga, Biomedical Research Institute (IBIMA), Malaga, Spain
| | | | - Juan A García-Sánchez
- Juan A. García-Sánchez, RN, University Regional Hospital of Malaga, Biomedical Research Institute (IBIMA), Malaga, Spain
| | - Isabel Pino-Benítez
- Isabel Pino-Benítez, RN, University Regional Hospital of Malaga, Biomedical Research Institute (IBIMA), Malaga, Spain
| | - Mercedes Alba-Vallejo
- Mercedes Alba-Vallejo, MD, University Regional Hospital of Malaga, Biomedical Research Institute (IBIMA), Malaga, Spain
| | | | - Fermin Mayoral-Cleries
- Fermin Mayoral-Cleries, PhD, University Regional Hospital of Malaga, Biomedical Research Institute (IBIMA), Malaga, Spain
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