***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Psychiatric advance directives are intended to enable self-determined treatment for patients who lose decisional capacity , and thus reduce the need for coercive interventions such as police transport , involuntary commitment , seclusion and restraints , and involuntary medications during mental health crises ; whether PADs can help prevent the use of these interventions in practice is unknown . Aims : This study examined whether completion of a Facilitated Psychiatric Advance Directive ( F-PAD ) was associated with reduced frequency of coercive crisis interventions . Method : The study prospect ively compared a sample of PAD completers ( n = 147 ) to non-completers ( n = 92 ) on the frequency of any coercive interventions , with follow-up assessment s at 6 , 12 , and 24 months . Repeated- measures multiple regression analysis was used to estimate the effect of PADs . Models controlled for relevant covariates including a propensity score for initial selection to PADs , baseline history of coercive interventions , concurrent global functioning and crisis episodes with decisional incapacity . Results : F-PAD completion was associated with lower odds of coercive interventions ( adjusted OR = 0.50 ; 95 % CI = 0.26–0.96 ; p < 0.05 ) . Conclusions : PADs may be an effective tool for reducing coercive interventions around incapacitating mental health crises . Less coercion should lead to greater autonomy and self-determination for people with severe mental illness Background Crises and ( involuntary ) admissions have a strong impact on patients and their caregivers . In some countries , including the Netherl and s , the number of crises and ( involuntary ) admissions have increased in the last years . There is also a lack of effective interventions to prevent their occurrence . Previous research has shown that a form of psychiatric advance statement – joint crisis plan – may prevent involuntary admissions , but another study showed no significant results for another form . The question remains which form of psychiatric advance statement may help to prevent crisis situations . This study examines the effects of two other psychiatric advance statements . The first is created by the patient with help from a  patient 's advocate ( Patient Advocate Crisis Plan : PACP ) and the second with the help of a clinician only ( Clinician facilitated Crisis Plan : CCP ) . We investigate whether patients with a PACP or CCP  show fewer emergency visits and ( involuntary ) admissions as compared to patients without a psychiatric advance statement . Furthermore , this study seeks to identify possible mechanisms responsible for the effects of a PACP or a CCP . Methods / Design This study is a r and omised controlled trial with two intervention groups and one control condition . Both interventions consist of a crisis plan , facilitated through the patient 's advocate or the clinician respectively .  Out patients with psychotic or bipolar disorders , who experienced at least one psychiatric crisis during the previous two years , are r and omly allocated to one of the three groups . Primary outcomes are the number of emergency ( after hour ) visits , ( involuntary ) admissions and the length of stay in hospital . Secondary outcomes include psychosocial functioning and treatment satisfaction . The possible mediator variables of the effects of the crisis plans are investigated by assessing the patient 's involvement in the creation of the crisis plan , working alliance , insight into illness , recovery style , social support , locus of control , service engagement and coping with crises situations . The interviews take place before r and omisation , nine month later and finally eighteen months after r and omisation . Discussion This study examines the effects of two types of crisis plans . In addition , the results offer an underst and ing of the way these advance statements work and whether it is more effective to include a patients ' advocate in the process of creating a psychiatric advance statement . These statements may be an intervention to prevent crises and the use of compulsion in mental health care . The strength and limitations of this study are discussed . Trial registration Current Controlled Trails NTR1166 At an antenatal clinic in St. Thomas 's Hospital , London , 246 expectant mothers were r and omly allocated to hold either their own maternity case notes or the st and ard co-operation card . Information was collected on three occasions during their care on attitudes and health behaviour . Clinical outcomes were recorded and the effects of the two systems on clinic administration were observed . More of the notes group expressed satisfaction with most aspects of their care and delivery and significantly more of the notes group felt well informed and satisfied with their companion during labour . There were no differences in clinical outcomes between the two groups except that , for no identifiable systematic reason , there were more assisted deliveries among the notes group . A number of administrative advantages result ed from mothers holding their own notes and although initial reservations were found amongst professional staff interviewed at the start of the study , the results proved persuasive and the practice of giving mothers their own notes is now to be extended throughout the department BACKGROUND An advance directive is a statement of a person 's preferences for treatment , should he or she lose capacity to make treatment decisions in the future . AIMS To evaluate whether use of advance directives by patients with mental illness leads to lower rates of compulsory readmission to hospital . METHOD In a r and omised controlled trial in two psychiatric services in inner London , 156 in- patients about to be discharged from compulsory treatment under the Mental Health Act were recruited . The trial compared usual psychiatric care with usual care plus the completion of an advance directive . The primary outcome was the rate of compulsory readmission . RESULTS Fifteen patients ( 19 % ) in the intervention group and 16 ( 21 % ) in the control group were readmitted compulsorily within 1 year of discharge . There was no difference in the numbers of compulsory readmissions , numbers of patients readmitted voluntarily , days spent in hospital or satisfaction with psychiatric services . CONCLUSIONS Users ' advance instruction directives had little observable impact on the outcome of care at 12 months BACKGROUND Patients and doctors often have divergent views on care needs . AIMS To examine whether providing patients with an opportunity to identify and discuss their needs would improve communication and induce changes in care . METHOD Patients with schizophrenia ( n=134 ) were r and omly allocated to either st and ard care or use of the Two-Way Communication Checklist ( 2-COM ) . Before seeing their clinician for a routine follow-up , participants in the active intervention group were given 2-COM , a list of 20 common needs , and told to indicate those areas they wanted to discuss with their doctor . Outcomes were assessed immediately and again after 6 weeks . RESULTS Using 2-COM induced a stable improvement of patient-reported quality of patient-doctor communication ( B=0.33 , P=0.031 ) , and induced changes in management immediately after the intervention ( OR=3.7 , P=0.009 ; number needed to treat , 6 ) . Treatment change was more likely in patients with more reported needs , and needs most likely to induce treatment change displayed stronger associations with non-medication than with medication changes . CONCLUSIONS A simple intervention to aid people in discussion of their needs results in improved communication and changes in management The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas Abstract Objective To investigate whether a form of advance agreement for people with severe mental illness can reduce the use of inpatient services and compulsory admission or treatment . Design Single blind r and omised controlled trial , with r and omisation of individual patients . The investigator was blind to allocation . Setting Eight community mental health teams in southern Engl and . Participants 160 people with an operational diagnosis of psychotic illness or non-psychotic bipolar disorder who had experienced a hospital admission within the previous two years . Intervention The joint crisis plan was formulated by the patient , care coordinator , psychiatrist , and project worker and contained contact information , details of mental and physical illnesses , treatments , indicators for relapse , and advance statements of preferences for care in the event of future relapse . Main outcome measures Admission to hospital , bed days , and use of the Mental Health Act over 15 month follow up . Results Use of the Mental Health Act was significantly reduced for the intervention group , 13 % ( 10/80 ) of whom experienced compulsory admission or treatment compared with 27 % ( 21/80 ) of the control group ( risk ratio 0.48 , 95 % confidence interval 0.24 to 0.95 , P = 0.028 ) . As a consequence , the mean number of days of detention ( days spent as an inpatient while under a section of the Mental Health Act ) for the whole intervention group was 14 compared with 31 for the control group ( difference 16 , 0 to 36 , P = 0.04 ) . For those admitted under a section of the Mental Health Act , the number of days of detention was similar in the two groups ( means 114 and 117 , difference 3 , −61 to 67 , P = 0.98 ) . The intervention group had fewer admissions ( risk ratio 0.69 , 0.45 to 1.04 , P = 0.07 ) . There was no evidence for differences in bed days ( total number of days spent as an inpatient ) ( means 32 and 36 , difference 4 , −18 to 26 , P = 0.15 for the whole sample ; means 107 and 83 , difference −24 , −72 to 24 , P = 0.39 for those admitted ) . Conclusions Use of joint crisis plans reduced compulsory admissions and treatment in patients with severe mental illness . The reduction in overall admission was less . This is the first structured clinical intervention that seems to reduce compulsory admission and treatment in mental health services Psychiatric advance directives ( PADs ) statutes presume competence to complete these documents , but the range and dimensions of decisional competence among people who actually complete PADs is unknown . This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity . N=469 adults with psychotic disorders were interviewed at baseline and then r and omly assigned to either a control group in which they received written material s about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD . At baseline , domains on the Decisional Competence Assessment Tool for PADs ( DCAT-PAD ) were most strongly associated with IQ , verbal memory , abstract thinking , and psychiatric symptoms . At one-month follow-up , participants in the intervention group showed more improvement on the DCAT-PAD than controls , particularly among participants with pre-morbid IQ estimates below the median of 100 . The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs , thereby maximizing the chances their advance directives will be valid Background The use of compulsory treatment under the Mental Health Act ( MHA ) has continued to rise in the UK and in other countries . The Joint Crisis Plan ( JCP ) is a statement of service users ' wishes for treatment in the event of a future mental health crisis . It is developed with the clinical team and an independent facilitator . A recent pilot RCT showed a reduction in the use of the MHA amongst service users with a JCP . The JCP is the only intervention that has been shown to reduce compulsory treatment in this way . The CRIMSON trial aims to determine if JCPs , compared with treatment as usual , are effective in reducing the use of the MHA in a range of treatment setting s across the UK . Methods / Design This is a 3 centre , individual-level , single-blind , r and omised controlled trial of the JCP compared with treatment as usual for people with a history of relapsing psychotic illness in Birmingham , London and Lancashire/Manchester . 540 service users will be recruited across the three sites . Eligible service users will be adults with a diagnosis of a psychotic disorder ( including bipolar disorder ) , treated in the community under the Care Programme Approach with at least one admission to a psychiatric inpatient ward in the previous two years . Current in patients and those subject to a community treatment order will be excluded to avoid any potential perceived pressure to participate . Research assessment s will be conducted at baseline and 18 months . Following the baseline assessment , eligible service users will be r and omly allocated to either develop a Joint Crisis Plan or continue with treatment as usual . Outcome will be assessed at 18 months with assessors blind to treatment allocation . The primary outcome is the proportion of service users treated or otherwise detained under an order of the Mental Health Act ( MHA ) during the follow-up period , compared across r and omisation groups . Secondary outcomes include overall costs , service user engagement , perceived coercion and therapeutic relationships . Sub-analyses will explore the effectiveness of the JCP in reducing use of the MHA specifically for Black Caribbean and Black African service users ( combined ) . Qualitative investigations with staff and service users will explore the acceptability of the JCPs . Discussion JCPs offer a potential solution to the rise of compulsory treatment for 
    Output:
    
The evidence gap remains regarding user-held , personalised , accessible clinical information for people with psychotic illnesses for many of the outcomes of interest .
However , based on moderate quality evidence , this review suggests that there is no effect of the intervention on hospital or outpatient appointment use for individuals with psychotic disorders .