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Sample records for inpatient treatment protocol

  1. Network coordination following discharge from psychiatric inpatient treatment: a study protocol

    PubMed Central

    2013-01-01

    Background Inadequate discharge planning following inpatient stays is a major issue in the provision of a high standard of care for patients who receive psychiatric treatment. Studies have shown that half of patients who had no pre-discharge contact with outpatient services do not keep their first outpatient appointment. Additionally, discharged patients who are not well linked to their outpatient care networks are at twice the risk of re-hospitalization. The aim of this study is to investigate if the Post-Discharge Network Coordination Program at ipw has a demonstrably significant impact on the frequency and duration of patient re-hospitalization. Subjects are randomly assigned to either the treatment group or to the control group. The treatment group participates in the Post-Discharge Network Coordination Program. The control group receives treatment as usual with no additional social support. Further outcome variables include: social support, change in psychiatric symptoms, quality of life, and independence in daily functioning. Methods/design The study is conducted as a randomized controlled trial. Subjects are randomly assigned to either the control group or to the treatment group. Computer generated block randomization is used to assure both groups have the same number of subjects. Stratified block randomization is used for the psychiatric diagnosis of ICD-10, F1. Approximately 160 patients are recruited in two care units at Psychiatrie-Zentrum Hard Embrach and two care units at Klinik Schlosstal Winterthur. Discussion The proposed post-discharge network coordination program intervenes during the critical post-discharge period. It focuses primarily on promoting the integration of the patients into their social networks, and additionally to coordinating outpatient care and addressing concerns of daily life. Trial registration ISRCTN: ISRCTN58280620 PMID:24007198

  2. Treatment histories of borderline inpatients.

    PubMed

    Zanarini, M C; Frankenburg, F R; Khera, G S; Bleichmar, J

    2001-01-01

    In this study, we describe the types and amounts of psychiatric treatment received by a well-defined sample of borderline personality disorder (BPD) inpatients, and compare these parameters with those of a group of carefully diagnosed personality-disordered controls. Finally, we assess the risk factors associated with a history of intensive, high-cost treatment, which we defined as having had two or more prior psychiatric hospitalizations. The treatment histories of 290 borderline inpatients and 72 axis II controls were assessed using a reliable semistructured interview. All nine forms of treatment studied except electroconvulsive therapy (ECT) were common among borderline patients (36% to 96%). In addition, a significantly higher percentage of borderline patients than axis II controls reported a history of individual and group therapy, day and residential treatment, psychiatric hospitalization, participating in self-help groups, and taking standing medications. They were also significantly younger when they first entered individual therapy and began to take standing medications. In addition, borderline patients spent more time than axis II controls in individual therapy and psychiatric hospitals, and were on standing medications for a significantly longer period of time. They also reported a significantly higher number of psychiatric hospitalizations, lifetime number of standing medications, and number of psychotropic medications taken at the same time. In addition, we found a highly significant multivariate predictive model for multiple prior hospitalizations. The six significant predictors were age 26 or older, a history of quasi psychotic thought, lifetime number of self-mutilative efforts and suicide attempts, a childhood history of reported sexual abuse, and an adult history of being physically and/or sexually assaulted. Taken together, these results confirm clinical impressions concerning the high rates of mental health services used by borderline patients

  3. A RFID grouping proof protocol for medication safety of inpatient.

    PubMed

    Huang, Hsieh-Hong; Ku, Cheng-Yuan

    2009-12-01

    In order to provide enhanced medication safety for inpatients, the medical mechanism which adopts the modified grouping proof protocol is proposed in this paper. By using the grouping proof protocol, the medical staffs could confirm the authentication and integrity of a group of Radio-Frequency Identification (RFID) tags which are embedded on inpatient bracelets and the containers of drugs. This mechanism is designed to be compatible with EPCglobal Class-1 Generation-2 standard which is the most popular specification of RFID tags. Due to the light-weight computational capacity of passive tags, only the pseudo-random number generator (PRNG) and cyclic redundancy code (CRC) are allowed to be used in the communication protocol. Furthermore, a practical scenario of using this proposed mechanism in hospital to examine the medication safety is also presented. PMID:20052898

  4. [Inpatient treatment in the addicted patient].

    PubMed

    Capece, José

    2010-01-01

    We review the patient hospitalization criteria for Substance Abuse Disorder, taking into account current controversies and the weight of the evidence in the investigation in relation to clinical efficacy and effectiveness. We raise the parameters that mark the 24.455 law on the basic treatment plan from the current data in Argentina, which are inpatient detoxification and residential rehabilitation. We identify the need for detoxification and comprehensive for dual patients rehabilitation centers as peremptory. Criteria are defined according to international validation. We discuss the advantages and disadvantages of hospitalization. Finally, we conclude in the need for a system where devices appropriate epidemiological needs, and that the clinical handle current information. PMID:20440409

  5. Inpatient management protocols to reduce health care costs.

    PubMed

    Wachtel, T; Moulton, A W; Pezzullo, J; Hamolsky, M

    1986-01-01

    A group of 12 internists, members of a university-affiliated hospital, designed and implemented protocols for the general inpatient management of four medical problems (chest pain, stroke, pneumonia, and upper gastrointestinal hemorrhage). Hospital charges for the 63 cases were compared with charges generated by 64 controls who had been patients admitted to the same physicians with the same diagnoses during the same period of the preceding year, before the project was begun. A group of nonparticipating internists was similarly evaluated during the two time periods to control for changes in practice patterns extraneous to the intervention. Adjustment was made for inflation (6%) and differences in case mix. The program resulted in a 15% reduction in total average charge generated by the cases. Sizeable reductions were achieved in utilization of EKGs (34.8%), x-rays (15.4%), laboratory testing (20.4%), and drugs (11.4%). Given the prevailing attitude that health care costs are too high and that many services are unnecessary, the benefit of altering physician behavior by using standards established by them for themselves could be substantial, especially with the threat of more restrictive and less sympathetic modes of controlling costs. PMID:3084902

  6. Therapeutic recreation treatment time during inpatient rehabilitation

    PubMed Central

    Gassaway, Julie; Dijkers, Marcel; Rider, Cecelia; Edens, Kelly; Cahow, Claire; Joyce, Joan

    2011-01-01

    Objective Following spinal cord injury (SCI), certified therapeutic recreation specialists (CTRSs) work with patients during rehabilitation to re-create leisure lifestyles. Although there is much literature available to describe the benefits of recreation, little has been written about the process of inpatient or outpatient rehabilitation therapeutic recreation (TR) programs or the effectiveness of such programs. To delineate how TR time is used during inpatient rehabilitation for SCI. Methods Six rehabilitation centers enrolled 600 patients with traumatic SCI for an observational study. CTRSs documented time spent on each of a set of specific TR activities during each patient encounter. Patterns of time use are described, for all patients and by neurologic category. Ordinary least-squares stepwise regression models are used to identify patient and injury characteristics predictive of total treatment time (overall and average per week) and time spent in TR activities. Results Ninety-four percent of patients enrolled in the SCIRehab study participated in TR. Patients received a mean total of 17.5 hours of TR; significant differences were seen in the amount of time spent in each activity among and within neurologic groups. The majority (76%) of patients participated in at least one structured therapeutic outing. Patient and injury characteristics explained little of the variation in time spent within activities. Conclusion The large amount of variability seen in TR treatment time within and among injury group categories, which is not explained well by patient and injury characteristics, sets the stage for future analyses to associate treatments with outcomes. PMID:21675356

  7. [Inpatient care in the treatment of alcohol use disorders].

    PubMed

    Balester Mouret, Sylvain

    2011-12-01

    Inpatient treatment has long been considered the reference in the treatment of alcoholism. It may indeed have many conceptual advantages, but practically it is a method of treatment with high costs and long waiting period. Moreover, reviews of studies evaluating effectiveness of treatment settings for alcohol dependence suggest that no significant differences exist between inpatient and outpatient programs. Therefore, it seems useful to determine indications of inpatient detoxification programs. As we may see, the choice of inpatient detox should be primarily guided by the contra-indications of outpatient detox. However, it also depends very much on patients' preference, essential to success, since they are the lead actors. Some other situations require urgent residential care, regardless of readiness to change or type of alcohol disorder underlying. PMID:22288351

  8. Minor burn injuries in children: inpatient versus outpatient treatment?

    PubMed Central

    La Ferla, G. A.; Fyfe, A. H.; Drainer, I. K.

    1983-01-01

    Seventy-two children with minor superficial burns presented at our casualty department over a 5-month period. Half were treated as inpatients and the other half as outpatients. The colonisation rates were similar in the two groups. Colonised and sterile burns treated as inpatients showed no significant difference in healing rates. The healing time, however, was prolonged in colonised outpatient treated burns. Cosmetic results were satisfactory overall. In the absence of a definite benefit from inpatient treatment, outpatient care of a child with a minor burn should therefore be used if circumstances allow. PMID:6357035

  9. Inpatient treatment of anorexia nervosa: review and recommendations.

    PubMed

    Bowers, W A; Andersen, A E

    1994-01-01

    Inpatient treatment of anorexia nervosa, difficult and at times complex, has been shown to promote enduring change. An integrated treatment approach that includes medical, psychological, nursing, and social interventions can restore patients to a healthy weight, improve abnormal eating behaviors, and ameliorate many of the central psychopathological attitudes and illness-driven behaviors characteristic of the disorder. This article reviews inpatient treatment of anorexia nervosa, evaluating empirical studies and providing a critique of their methodology and potential applicability, combining available published studies with clinical experience to suggest a comprehensive pragmatic treatment approach, and noting research needs for the future. More controlled double-blind studies are urgently needed to assess virtually every aspect of inpatient care, especially methods for promoting safe and rapid weight restoration. Comparative studies on the efficacy of behavioral, psychotherapeutic, and pharmacological approaches and determination of the optimum step-wise preparation for discharge into a weight-preoccupied society are also needed. PMID:9384902

  10. The Severely Disturbed Adolescent; Inpatient, Residential, and Hospital Treatment.

    ERIC Educational Resources Information Center

    Easson, William M.

    The text is an attempt to clarify specific indications for hospital treatment and to highlight the type of adolescent disturbance that might be helped in an inpatient therapeutic environment. Chapters discuss the prescription of residential treatment, the therapeutic facilities of a residential unit for disturbed adolescents, the continued…

  11. Treatment - mother-infant inpatient units.

    PubMed

    Glangeaud-Freudenthal, Nine M C; Howard, Louise M; Sutter-Dallay, Anne-Laure

    2014-01-01

    Infants of parents with psychiatric disorders may be particularly vulnerable and have a higher risk of developing psychiatric disorders in adulthood. Until the second half of the 20th century, women and infants were cared for separately. Today, hospitalisation of women with their babies in psychiatric mother-baby units enables psychiatric care of women and promotion of parent-infant interactions and child development. The distribution of psychiatric mother-baby units around the world, as well as within countries, varies strongly. Reasons for this may be related to the absence of national perinatal mental health policies related to psychiatric mother-baby unit location, differences in sources of referral for admission, and criteria for psychiatric mother-baby unit admission. Two principal national epidemiologic studies, in England and in France and Belgium, have described issues related to discharge from such care, as have smaller local studies, but no epidemiologic studies have yet demonstrated that joint inpatient psychiatric mother-baby unit care is cost-effective compared with separate care. PMID:24054169

  12. Outpatient versus inpatient uterine polyp treatment for abnormal uterine bleeding: randomised controlled non-inferiority study

    PubMed Central

    Cooper, Natalie A M; Middleton, Lee; Diwakar, Lavanya; Smith, Paul; Denny, Elaine; Roberts, Tracy; Stobert, Lynda; Jowett, Susan; Daniels, Jane

    2015-01-01

    Objective To compare the effectiveness and acceptability of outpatient polypectomy with inpatient polypectomy. Design Pragmatic multicentre randomised controlled non-inferiority study. Setting Outpatient hysteroscopy clinics in 31 UK National Health Service hospitals. Participants 507 women who attended as outpatients for diagnostic hysteroscopy because of abnormal uterine bleeding and were found to have uterine polyps. Interventions Participants were randomly assigned to either outpatient uterine polypectomy under local anaesthetic or inpatient uterine polypectomy under general anaesthesia. Data were collected on women’s self reported bleeding symptoms at baseline and at 6, 12, and 24 months. Data were also collected on pain and acceptability of the procedure at the time of polypectomy. Main outcome measures The primary outcome was successful treatment, determined by the women’s assessment of bleeding at six months, with a prespecified non-inferiority margin of 25%. Secondary outcomes included generic (EQ-5D) and disease specific (menorrhagia multi-attribute scale) quality of life, and feasibility and acceptability of the procedure. Results 73% (166/228) of women in the outpatient group and 80% (168/211) in the inpatient group reported successful treatment at six months (intention to treat relative risk 0.91, 95% confidence interval 0.82 to 1.02; per protocol relative risk 0.92, 0.82 to 1.02). Failure to remove polyps was higher (19% v 7%; relative risk 2.5, 1.5 to 4.1) and acceptability of the procedure was lower (83% v 92%; 0.90, 0.84 to 0.97) in the outpatient group Quality of life did not differ significantly between the groups. Four uterine perforations, one of which necessitated bowel resection, all occurred in the inpatient group. Conclusions Outpatient polypectomy was non-inferior to inpatient polypectomy. Failure to remove a uterine polyp was, however, more likely with outpatient polypectomy and acceptability of the procedure was slightly lower. Trial

  13. [Inpatient psychoanalytic treatment of patients with structural ego disorders].

    PubMed

    Ehl, M; Tress, W

    1988-01-01

    Psychoneurotic and psychosomatic patients with severe personality disorders suffer from structural defects of their ego-functions and are in need of specific treatment techniques which can be supplied by the differentiated strategies of inpatient psychoanalysis. The experiences of a specific inpatient ward of the Psychosomatic department at the Central Institute of Mental Health in Mannheim are summarized whereby the use of the inward setting to initiate long term psychotherapeutic processes is emphasized. According to an integrative treatment concept various verbal and non-verbal modalities of experience and working through represented by different members of the therapeutic team co-operate within their well defined functions. The main task of the team is to identify the various splitting mechanisms of the patients with personality disorders and to combine all the walled off ways of experiencing and social behavior into a complete picture of his person. To this end close attention is payed to the dynamics within the group of the patients as well as with the group of the therapists. As a precondition the setting of the ward and its rules of conduct for inpatient group life have closely to be watched and the respective behavior of the patients and the team has to be monitored. We describe our setting, the time phases of treatment, the tasks of the different therapists, and explicitely emphasize sociotherapeutic aspects for the final therapy phase. At last, we mention special emotional difficulties waiting for therapists who work in this setting. PMID:3239270

  14. Inpatient management of severe malnutrition: time for a change in protocol and practice.

    PubMed

    Brewster, D R

    2011-01-01

    This review focuses on how to reduce the high mortality of severe acute malnutrition (SAM) in African hospitals. The World Health Organization's 1999 manual for physicians (protocol) has not resulted in case-fatality rates of under 5%, even in published research studies from Africa, far less in district and central hospitals which do not record case-fatality rates. It is suggested that the following eight changes to the protocol need to be considered if we are serious about reducing case-fatality rates in African hospitals: (1) use of low lactose, low osmolality milk feeds during the early stage of treatment, especially for HIV-exposed infants and diarrhoeal cases; (2) more cautious use of high carbohydrate loads (ORS, ReSoMal, sucrose and 10% dextrose) during initial stabilisation; (3) more careful grading up and down of feed volumes according the child's responses during the early rehabilitation phase; (4) rapid rehydration of children in shock with Ringer's lactate, as for well-nourished children, with closer monitoring for heart failure; (5) greater use of 3rd-generation cephalosporin and fluoroquinolone antibiotics (e.g. ceftriaxone, ciprofloxacin) to treat sepsis owing to resistant organisms; (6) consider adding glutamine-arginine supplements as gut-protective agents in addition to zinc and vitamin A; (7) the addition of phosphate to existing potassium and magnesium supplements for those at risk of the refeeding syndrome; and (8) introduce better tools for diagnosis and clearer management of combined HIV and tuberculous infections in infants. Many will argue that these suggestions are unaffordable or impractical. On the contrary, cases of SAM requiring hospital admission need to be allocated more resources, including better nursing care, better diet and better medication. Resources made available for other childhood inpatient services such as ID and HIV dwarf those for severe malnutrition. Of course, prevention is always a better investment, including

  15. Cocaine dependence treatment on an inpatient detoxification unit.

    PubMed

    Wallace, B C

    1987-01-01

    A psychoanalytic-developmental treatment model includes individual and group psychotherapy which enables compulsive freebase cocaine smokers to articulate explanations for their drug dependence. Relapse prevention education includes recommendations for aftercare treatment. Psychosocial history and DSM-III diagnostic data (N = 31) reveals histories of dysfunctional family dynamics, high rates of depressive disorders, and personality disorders. A case history illustrates application of our treatment model and problems in currently available post-detox treatment. Residential therapeutic communities (TCs) need to offer variable program lengths and specialized crack residences in therapeutic milieus with trained clinical staff. TC programs should offer inpatient psychotherapy, family therapy, and provide direct entrance into program affiliated outpatient services. Recommendations for outpatient services include adjuncts to established anonymous self-help group networks in order to reduce changes of relapse. PMID:3041012

  16. The effects of cognitive-behavioral treatment for forensic inpatients.

    PubMed

    Timmerman, Irma G H; Emmelkamp, Paul M G

    2005-10-01

    The effects of an intramural cognitive-behavioral treatment for forensic inpatients with personality disorders in a high-security hospital were examined. Treatment was aimed at modifying maladaptive coping and social skills, at enhancing social awareness, at reducing egoistic and oppositional behaviors, and at reducing psychological complaints. The patients, who all had committed serious crimes (violence, arson, sexual offences), participated voluntarily in the study. A total of 39 patients started the study, but during the course of the study, several patients dropped out because of several reasons. Patients as a group showed significant improvements over time on psychopathological symptoms, personality traits, and coping. A significant decrease of oppositional behaviors was reported by the staff. Though the patients improved well at the group level, only a minority of patients showed reliable change over time at the individual level. The meaning of the results in relation to treatment are discussed. PMID:16260485

  17. Inpatient Treatment of Community-Acquired Pneumonias with Integrative Medicine

    PubMed Central

    Diederich, Klas; Kusserow, Maria; Laubersheimer, Andreas; Kramer, Klaus

    2013-01-01

    Introduction. The aim of the presented observational case series was to evaluate the experience in treating patients with community-acquired pneumonia (CAP) within integrative medicine, particularly anthroposophic medicine in a well-experienced and specialized unit. Patients and Methods. Patients with proven CAP were evaluated (CAP-study group) based on a retrospective chart review. To estimate the severity of pneumonia, the pneumonia severity index (PSI) was applied. Treatment efficacy was evaluated regarding body temperature, CRP level, leukocytes blood count, the need to be treated on ICU, and mortality. Results were compared with the inpatient data of the Pneumonia PORT Validation Cohort. Results. 15/18 patients of the CAP-study group belonged to risk class groups I–III (low and moderate risk), 2 patients to risk class IV, and one patient to risk class V (severe pneumonia). 16/18 patients were treated with anthroposophic medicine only and 2/18 got additionally antibiotic therapy (both of risk class IV). A significant reduction of body temperature, CRP level, and leukocytes blood count has been obtained by applying anthroposophic medicine, while neither complications nor pneumonia-related death occurred. Compared with the control group there was no significant difference in mortality rate, whereby no patient had to be treated on the ICU, but the duration of hospital stay was significantly longer in the presented series. Conclusion. Inpatient treatment of CAP with anthroposophic medicine without the use of antibiotics may achieve reasonable results in selected cases. Additional larger sized prospective controlled trials should further clarify the role of AM in the treatment of CAP. PMID:23762145

  18. Predicting Change in Emotional and Behavioural Problems during Inpatient Treatment in Clients with Mild Intellectual Disability

    ERIC Educational Resources Information Center

    Tenneij, Nienke; Didden, Robert; Koot, Hans M.

    2011-01-01

    Background: Little is known about client characteristics that are related to outcome during inpatient treatment of adults with mild intellectual disability (ID) and severe behavioural problems. Method: We explored variables that were related to a change in behavioural problems in 87 individuals with mild ID during inpatient treatment in facilities…

  19. Evaluation of a Salutogenetic Concept for Inpatient Psychosomatic Treatment

    PubMed Central

    Loew, Thomas

    2013-01-01

    The increase of psychosomatic disorders due to cultural changes requires enhanced therapeutic models. This study investigated a salutogenetic treatment concept for inpatient psychosomatic treatment, based on data from more than 11000 patients of a psychosomatic clinic in Germany. The clinic aims at supporting patients' health improvement by fostering values such as humanity, community, and mindfulness. Most of patients found these values realized in the clinical environment. Self-assessment questionnaires addressing physical and mental health as well as symptom ratings were available for analysis of pre-post-treatment effects and long-term stability using one-year follow-up data, as well as for a comparison with other clinics. With respect to different diagnoses, symptoms improved in self-ratings with average effect sizes between 0.60 and 0.98. About 80% of positive changes could be sustained as determined in a 1-year follow-up survey. Patients with a lower concordance with the values of the clinic showed less health improvement. Compared to 14 other German psychosomatic clinics, the investigated treatment concept resulted in slightly higher decrease in symptoms (e.g., depression scale) and a higher self-rated mental and physical improvement in health. The data suggest that a successfully implemented salutogenetic clinical treatment concept not only has positive influence on treatment effects but also provides long-term stability. PMID:24159352

  20. West meets east: cross-cultural issues in inpatient treatment.

    PubMed

    Sayed, M A; Collins, D T; Takahashi, T

    1998-01-01

    The authors analyze the role of culture and its influence on the inpatient psychiatric treatment setting through an examination of the contrasting beliefs and assumptions of the Euro-American and Arabic-Islamic traditions. Three case vignettes illustrate the form and impact of these contrasts on various aspects of the cross-cultural encounter when Arab patients are treated in a Western psychodynamically informed hospital setting. The impact of the culture of origin on both treaters and patients is examined. These observations can also be extrapolated to other significant cross-cultural encounters within the hospital setting. Cultural differences may contribute to either a mismatch of expectations or to a creative accommodation of them on the part of both patients and treaters. PMID:9810108

  1. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... adjustment for low-volume hospitals. 412.101 Section 412.101 Public Health CENTERS FOR MEDICARE & MEDICAID... Inpatient Operating Costs § 412.101 Special treatment: Inpatient hospital payment adjustment for low-volume... payment to a qualifying hospital for the higher incremental costs associated with a low volume...

  2. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... adjustment for low-volume hospitals. 412.101 Section 412.101 Public Health CENTERS FOR MEDICARE & MEDICAID... Inpatient Operating Costs § 412.101 Special treatment: Inpatient hospital payment adjustment for low-volume... payment to a qualifying hospital for the higher incremental costs associated with a low volume...

  3. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... adjustment for low-volume hospitals. 412.101 Section 412.101 Public Health CENTERS FOR MEDICARE & MEDICAID... Inpatient Operating Costs § 412.101 Special treatment: Inpatient hospital payment adjustment for low-volume... payment to a qualifying hospital for the higher incremental costs associated with a low volume...

  4. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... adjustment for low-volume hospitals. 412.101 Section 412.101 Public Health CENTERS FOR MEDICARE & MEDICAID... Inpatient Operating Costs § 412.101 Special treatment: Inpatient hospital payment adjustment for low-volume... payment to a qualifying hospital for the higher incremental costs associated with a low volume...

  5. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... adjustment for low-volume hospitals. 412.101 Section 412.101 Public Health CENTERS FOR MEDICARE & MEDICAID... Inpatient Operating Costs § 412.101 Special treatment: Inpatient hospital payment adjustment for low-volume... payment to a qualifying hospital for the higher incremental costs associated with a low volume...

  6. Markers for Aggression in Inpatient Treatment Facilities for Adults with Mild to Borderline Intellectual Disability

    ERIC Educational Resources Information Center

    Tenneij, Nienke H.; Didden, Robert; Stolker, Joost Jan; Koot, Hans M.

    2009-01-01

    In high care settings for persons with intellectual disability (ID) aggressive incidents often occur. Still little is known about factors that are associated with an increased risk for aggressive behavior in clients who are admitted to an inpatient treatment facility. In four inpatient facilities, 108 adults with mild and borderline ID and…

  7. Predictors of mental distress among substance abusers receiving inpatient treatment

    PubMed Central

    2010-01-01

    Background Mental distress measured by the HSCL-10 is used as an indicator of psychiatric disorders in population studies, where a higher level of mental distress has been shown to be related to demographic factors such as living conditions and level of education. The first aim of the study was to explore whether mental distress could be a valuable concept in substance use treatment. The second aim of the study was to explore to what degree mental distress among substance users at admission to treatment could be explained by the same demographic factors as in population studies, or whether treatment differences or differences in substance use would be better predictors of mental distress in this population. Methods Patients (N = 185) who received inpatient substance use treatment in five different settings in Northern Norway participated in the study. HSCL-10 was used as a measure for mental distress at admission to treatment. The self-report measures AUDIT, DUDIT and DUDIT-E were used for measuring substance use and readiness for treatment. The patients' clinicians reported demographic and treatment factors. A three-block hierarchical multiple regression analysis was conducted to determine potential predictors of mental distress. Block 1 included demographic variables, Block 2 included treatment variables, and Block 3 substance use variables. Results Patients generally reported a high level of mental distress at admission to treatment, and 83% reported mental distress higher than the established cut-off level. Being female, having previously received psychiatric treatment, having a higher score on DUDIT and AUDIT, and using a larger number of substances all predicted a higher level of mental distress. The model explained 32% of the variance in mental distress. Conclusions Mental distress measured by the HSCL-10 can be a valuable concept in substance use treatment. The HSCL-10 can be useful in screening for patients who are in need of further assessment for

  8. 21 CFR 312.83 - Treatment protocols.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 5 2012-04-01 2012-04-01 false Treatment protocols. 312.83 Section 312.83 Food...-debilitating Illnesses § 312.83 Treatment protocols. If the preliminary analysis of phase 2 test results appears promising, FDA may ask the sponsor to submit a treatment protocol to be reviewed under...

  9. 21 CFR 312.83 - Treatment protocols.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Treatment protocols. 312.83 Section 312.83 Food...-debilitating Illnesses § 312.83 Treatment protocols. If the preliminary analysis of phase 2 test results appears promising, FDA may ask the sponsor to submit a treatment protocol to be reviewed under...

  10. 21 CFR 312.83 - Treatment protocols.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 5 2014-04-01 2014-04-01 false Treatment protocols. 312.83 Section 312.83 Food...-debilitating Illnesses § 312.83 Treatment protocols. If the preliminary analysis of phase 2 test results appears promising, FDA may ask the sponsor to submit a treatment protocol to be reviewed under...

  11. 21 CFR 312.83 - Treatment protocols.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 5 2013-04-01 2013-04-01 false Treatment protocols. 312.83 Section 312.83 Food...-debilitating Illnesses § 312.83 Treatment protocols. If the preliminary analysis of phase 2 test results appears promising, FDA may ask the sponsor to submit a treatment protocol to be reviewed under...

  12. 21 CFR 312.83 - Treatment protocols.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Treatment protocols. 312.83 Section 312.83 Food...-debilitating Illnesses § 312.83 Treatment protocols. If the preliminary analysis of phase 2 test results appears promising, FDA may ask the sponsor to submit a treatment protocol to be reviewed under...

  13. The development of a mentalization-based outcomes and research protocol for an adolescent inpatient unit.

    PubMed

    Sharp, Carla; Williams, Laurel L; Ha, Carolyn; Baumgardner, Jenny; Michonski, Jared; Seals, Robert; Patel, Amee B; Bleiberg, Efrain; Fonagy, Peter

    2009-01-01

    The authors describe the development of a theory-driven assessment and research protocol at the Adolescent Treatment Program of The Menninger Clinic. First, the theoretical framework behind a mentalization-based model for assessment and treatment is described. Next, the process whereby measures were selected to operationalize key components of the mentalization-based model is discussed, including a brief discussion of each measure and assessment procedure. The next section describes the clinical and research use of the data collected. Here, the authors describe how outcomes assessment information is integrated into the clinical decision-making process, and they outline the research questions they aim to answer through the assessment protocol. The authors conclude with a section on the challenges, pitfalls, and future directions of the project. PMID:20025427

  14. The effect of childhood trauma on pharmacological treatment response in depressed inpatients.

    PubMed

    Douglas, Katie M; Porter, Richard J

    2012-12-30

    Childhood trauma and its association with pharmacological treatment response were examined in depressed inpatients. Treatment non-responders (n=31) reported significantly more severe trauma than treatment responders (n=25) and healthy controls (n=49), suggesting that the experience of childhood trauma in those hospitalised with depression can be detrimental to treatment success. PMID:22770764

  15. Outcome Evaluation of a High-Intensity Inpatient Sex Offender Treatment Program

    ERIC Educational Resources Information Center

    Olver, Mark E.; Wong, Stephen C. P.; Nicholaichuk, Terry P.

    2009-01-01

    The treatment outcome of a high-intensity inpatient sex offender treatment program was evaluated by comparing the sexual recidivism rates of 472 treated and 282 untreated sex offenders. The program is designed for moderate- to high-risk sex offenders and follows the principles of effective correctional treatment. The current investigation is an…

  16. Intravenous mirtazapine is safe and effective in the treatment of depressed inpatients.

    PubMed

    Mühlbacher, M; Konstantinidis, A; Kasper, S; Eichberger, G; Hinterhuber, H; Hofmann, P; Nimmerrichter, A; Schubert, H; Egger, C; Nickel, M; Stuppaeck, C

    2006-01-01

    Mirtazapine is a third-generation antidepressant with a dual mode of action. The oral administration has been shown to be effective and safe in the treatment of depressed patients. In this multicenter naturalistic study, we assessed the safety, tolerability, and therapeutic efficacy of intravenously administered mirtazapine in 80 moderately to severely depressed inpatients during a treatment period of 14 days. We found a significant decrease of the Hamilton Depression Rating Scale total score compared to baseline. Side effects were mild and transient. Our data indicate that intravenous mirtazapine is an effective, safe and well-tolerated treatment for depressed inpatients. PMID:16511339

  17. 21 CFR 312.320 - Treatment IND or treatment protocol.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 5 2012-04-01 2012-04-01 false Treatment IND or treatment protocol. 312.320... for Treatment Use § 312.320 Treatment IND or treatment protocol. Under this section, FDA may permit an investigational drug to be used for widespread treatment use. (a) Criteria. The criteria in § 312.305(a) must...

  18. 21 CFR 312.320 - Treatment IND or treatment protocol.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 5 2013-04-01 2013-04-01 false Treatment IND or treatment protocol. 312.320... for Treatment Use § 312.320 Treatment IND or treatment protocol. Under this section, FDA may permit an investigational drug to be used for widespread treatment use. (a) Criteria. The criteria in § 312.305(a) must...

  19. 21 CFR 312.320 - Treatment IND or treatment protocol.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 5 2014-04-01 2014-04-01 false Treatment IND or treatment protocol. 312.320... for Treatment Use § 312.320 Treatment IND or treatment protocol. Under this section, FDA may permit an investigational drug to be used for widespread treatment use. (a) Criteria. The criteria in § 312.305(a) must...

  20. 21 CFR 312.320 - Treatment IND or treatment protocol.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Treatment IND or treatment protocol. 312.320... for Treatment Use § 312.320 Treatment IND or treatment protocol. Under this section, FDA may permit an investigational drug to be used for widespread treatment use. (a) Criteria. The criteria in § 312.305(a) must...

  1. Guided self-help for binge eating/purging anorexia nervosa before inpatient treatment.

    PubMed

    Fichter, Manfred; Cebulla, Marian; Quadflieg, Nobert; Naab, Silke

    2008-09-01

    The goal of this study was to develop a cognitive-behavioral self-help manual for anorexia nervosa. Patients diagnosed with anorexia nervosa (N=102), binge eating/purging type (AN-B/P), were consecutively assigned to one of two conditions: 6-week manualized guided self-help or a wait-list control. All patients thereafter received inpatient treatment in a hospital for behavioral medicine. The primary outcome variable was the number of days in inpatient treatment. Secondary outcome variables were measures of psychopathology. Results showed that duration of inpatient treatment was significantly shorter (by 5.2 days) among participants receiving guided self-help. Body image, slimness ideal, general psychopathology, and some bulimic symptoms improved significantly during self-help. The authors conclude that, to increase effects of therapist-guided self-help in AN-B/P, additional variants of a self-help manual should be tried in different therapeutic settings. PMID:18816009

  2. The experience of specialist inpatient treatment for anorexia nervosa: A qualitative study from adult patients' perspectives.

    PubMed

    Smith, Vivien; Chouliara, Zoe; Morris, Paul G; Collin, Paula; Power, Kevin; Yellowlees, Alex; Grierson, David; Papageorgiou, Elena; Cook, Moira

    2016-01-01

    This qualitative study aimed to explore experiences of women currently undergoing specialist inpatient treatment for anorexia nervosa. Interviews were carried out with 21 women with a diagnosis of anorexia nervosa from a specialist adult inpatient eating disorder unit. Five master themes emerged using thematic analysis: (1) shifts in control, (2) experience of transition, (3) importance of supportive staff relationships, (4) sharing with peers and (5) process of recovery and self-discovery. Findings suggest that patients experience a process of change and adjustment in relation to levels of perceived personal control, attachment to the treatment environment and a sense of self-identity. PMID:24505059

  3. Inpatient Treatment for Adolescents with Anorexia Nervosa: Clinical Significance and Predictors of Treatment Outcome.

    PubMed

    Schlegl, Sandra; Diedrich, Alice; Neumayr, Christina; Fumi, Markus; Naab, Silke; Voderholzer, Ulrich

    2016-05-01

    This study evaluated the clinical significance as well as predictors of outcome for adolescents with severe anorexia nervosa (AN) treated in an inpatient setting. Body mass index (BMI), eating disorder (ED) symptoms [Eating Disorder Inventory-2 (EDI-2)], general psychopathology and depression were assessed in 238 patients at admission and discharge. BMI increased from 14.8 + 1.2 to 17.3 + 1.4 kg/m(2). Almost a fourth (23.6%) of the patients showed reliable changes, and 44.7% showed clinically significant changes (EDI-2). BMI change did not significantly differ between those with reliable or clinically significant change or no reliable change in EDI-2. Length of stay, depression and body dissatisfaction were negative predictors of a clinically significant change. Inpatient treatment is effective in about two thirds of adolescents with AN and should be considered when outpatient treatment fails. About one third of patients showed significant weight gain, but did not improve regarding overall ED symptomatology. Future studies should focus on treatment strategies for non-responders. PMID:26603278

  4. Perceived relapse risk and desire for medication assisted treatment among persons seeking inpatient opiate detoxification.

    PubMed

    Bailey, Genie L; Herman, Debra S; Stein, Michael D

    2013-09-01

    Most patients with opioid addiction do not receive medication at the time of discharge from brief inpatient detoxification programs despite the high risk of relapse and the availability of three FDA-approved medications. We surveyed 164 inpatient opioid detoxification patients to assess desire for pharmacotherapy following detoxification program discharge. Participants were predominantly male (71.3%) and 80% had detoxed in the past. Reporting on their most recent previous inpatient detoxification, 27% had relapsed the day they were discharged, 65% within a month of discharge, and 90% within a year of discharge. 63% reported they wanted medication-assisted treatment (MAT) after discharge from the current admission. The odds of desiring a treatment medication increased by a factor of 1.02 for every 1% increase in perceived relapse risk (p<.01). These data suggest patient preference discussions including relapse risk could increase post-detox abstinence. PMID:23786852

  5. Perceived Relapse Risk and Desire for Medication Assisted Treatment among Persons Seeking Inpatient Opiate Detoxification

    PubMed Central

    Bailey, Genie L; Herman, Debra S.; Stein, Michael D.

    2016-01-01

    Most patients with opioid addiction do not receive medication at the time of discharge from brief inpatient detoxification programs despite the high risk of relapse and the availability of three FDA-approved medications. We surveyed 164 inpatient opioid detoxification patients to assess desire for pharmacotherapy following detoxification program discharge. Participants were predominantly male (71.3%) and 80% had detoxed in the past. Reporting on their most recent previous inpatient detoxification, 27% had relapsed the day they were discharged, 65% within a month of discharge, and 90% within a year of discharge. 63% reported they wanted medication-assisted treatment (MAT) after discharge from the current admission. The odds of desiring a treatment medication increased by a factor of 1.02 for every 1% increase in perceived relapse risk (p < .01). These data suggest patient preference discussions including relapse risk could increase post-detox abstinence. PMID:23786852

  6. Group trauma-informed treatment for adolescent psychiatric inpatients: a preliminary uncontrolled trial.

    PubMed

    Gudiño, Omar G; Weis, J Rebecca; Havens, Jennifer F; Biggs, Emily A; Diamond, Ursula N; Marr, Mollie; Jackson, Christie; Cloitre, Marylene

    2014-08-01

    Despite high rates of trauma exposure (46%-96%) and significant posttraumatic stress disorder (PTSD; 21%-29%) symptoms in adolescent psychiatric inpatients, there is a dearth of research on effective interventions delivered in inpatient settings. The current report describes the development of Brief STAIR-A, a repeatable 3-module version of skills training in affective and interpersonal regulation (STAIR) developed for adolescents in inpatient care. An uncontrolled design was used to conduct a preliminary examination of the group intervention's effectiveness. Adolescent psychiatric inpatients (N = 38; ages 12 years-17 years) admitted to a public hospital participated in Brief STAIR-A and attended a median of 6 sessions (range 3-36). They completed measures of PTSD and depressive symptom severity, coping skill use, and coping efficacy upon admission and again prior to discharge. Participants reported significant reductions in symptom severity (d = 0.65-0.67), no change in the absolute level of coping skills used (d = 0.16), but greater coping efficacy when discharged from care (d = 0.75). Results from this pilot study suggest that this brief group treatment shows promise for treating adolescents' trauma-related difficulties in inpatient psychiatry settings, but additional research examining its effectiveness is essential. PMID:25070927

  7. Inpatient Treatment in Child and Adolescent Psychiatry--A Prospective Study of Health Gain and Costs

    ERIC Educational Resources Information Center

    Green, Jonathan; Jacobs, Brian; Beecham, Jennifer; Dunn, Graham; Kroll, Leo; Tobias, Catherine; Briskman, Jackie

    2007-01-01

    Background: Inpatient treatment is a complex intervention for the most serious mental health disorders in child and adolescent psychiatry. This is the first large-scale study into its effectiveness and costs. Previous studies have been criticised for methodological weaknesses. Methods: A prospective cohort study, including economic evaluation,…

  8. Summary of combined treatment under endoscope on 70 esophagus cancer inpatients

    NASA Astrophysics Data System (ADS)

    Wang, Cheng; Nong, Meilong; Li, Laisheng; Jia, Fang; Hao, Runchun

    1993-03-01

    We announce with satisfaction that combined treatment on 70 inpatients who suffered esophageal cancer in its middle or late course is perfectly successful. The combined methods include phototherapy, microwave therapy, and anticarcinogen local injection. The results are as follows: CR 3 cases, holds 4.3% of the total inpatients; PR 36 cases, 51.4%; MR 24 cases, 34.3%; NR 7 cases, 10%; the total effective rate 90%. Splendid results of treatment on enlarging the canal, improving dysphagia, and releasing obstruction have been obtained. The dysphagic grade increased from 66 to 148, the grade of esophagostenosis from 64 to 147, and the obstruction releasing rate is 69 out of 70 (that is 98.6%). The histological observation after treatment shows that 59/62 inpatients being reported as having cancer cells appear to have retrogression accompanied with a few or large quantities of necrotic cancer cells, and 3 inpatients were changed to negative reaction. No obvious poisoning or side effects arose. The combined treatment is more advantageous on those of old age or the physically weak and those who cannot stand for an operation, radiotherapy, or normal chemotherapy.

  9. Comparison of Results from Inpatient and Outpatient Treatment of Tuberculosis in Republic of Macedonia

    PubMed Central

    Simonovska, Ljiljana; Ilievska-Popovska, Biljana

    2015-01-01

    BACKGROUND: The successful treatment of patients with active tuberculosis is one of the priorities in the Tuberculosis Control Programs. AIM: The aim was to establish whether there was a statistically significant difference in the treatment outcome in patients with tuberculosis who began their initial treatment phase and/or pursued it as inpatient, as opposed to patients with tuberculosis who underwent their entire treatment regime as outpatient. Moreover, our goal was to determine whether there is a statistically significant difference in the outcome from the treatment between patients with tuberculosis who were hospitalized up to one month, two months, or more than two months. MATERIALS AND METHOD: The study includes 355 patients, divided into two groups. The first group, which consists of 219 patients, began their initial treatment phase as inpatient, and then they continued the treatment as outpatient. The second group, 136 patients, underwent their entire treatment as outpatient. The treatment outcome is determined with every patient (cured, treatment completed, treatment default, treatment failed, died, treatment in progress). For the statistical data analysis and for establishing the significance of the findings regarding the differences between the two groups we used the Pearson Chi-Square Test and the Yates Corrected Test. RESULTS: The statistical analysis with the Pearson Chi-Square Test showed that the treatment outcome does not significantly depend on the model of treatment (p = 0.31). The statistical data analysis showed that there is no statistically significant difference in the achievement of conversion of the bacterial result of the sputum at the end of the initial phase of treatment regarding the studied groups (p = 0.89). The statistical data analysis showed that the length of inpatient treatment affects the outcome of the treatment and that the difference is statistically highly significant (p < 0.00005). CONCLUSION: There are no statistically

  10. [Effectiveness of an inpatient multimodal psychiatric-psychotherapeutic program for the treatment of job burnout].

    PubMed

    Schwarzkopf, Kathleen; Conrad, Nathalie; Straus, Doris; Porschke, Hildburg; von Känel, Roland

    2016-03-16

    We studied the clinical course and long-term effects of inpatient treatment in 723 patients with job burnout referred with an ICD-10 F diagnosis and Z73.0 code («overwhelming exhaustion») to a Swiss hospital specialized in the treatment of job stress-related disorders. Patients were characterized in terms of age, gender, socioeconomic status. Self-rated psychological measures related to general and burnout-specific symptoms (i. e., emotional exhaustion, depersonalization, and diminished personal accomplishments) were applied before and after a six-week treatment program, as well as at 15 months after hospital discharge in 232 patients. The results show that the multimodal inpatient psychiatric-psychotherapeutic treatment was successful with a sustainable effect on psychological well-being (>90 %), including improvements regarding emotional exhaustion, depersonalization and personal accomplishments as well as professional reintegration in 71 % of cases. PMID:26980682

  11. A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding.

    PubMed Central

    Clark, T Justin; Middleton, Lee J; Cooper, Natalie Am; Diwakar, Lavanya; Denny, Elaine; Smith, Paul; Gennard, Laura; Stobert, Lynda; Roberts, Tracy E; Cheed, Versha; Bingham, Tracey; Jowett, Sue; Brettell, Elizabeth; Connor, Mary; Jones, Sian E; Daniels, Jane P

    2015-01-01

    BACKGROUND Uterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited. OBJECTIVES To test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined. DESIGN A multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study. SETTING Outpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals. PARTICIPANTS Women with AUB - defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding - and hysteroscopically diagnosed uterine polyps. INTERVENTIONS We randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia. MAIN OUTCOME MEASURES The primary outcome was successful treatment at 6 months, determined by the woman's assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained. RESULTS At 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative

  12. Predicting symptoms in major depression after inpatient treatment: the role of alexithymia.

    PubMed

    Günther, Vivien; Rufer, Michael; Kersting, Anette; Suslow, Thomas

    2016-07-01

    Alexithymia has been considered to have a negative influence on the course of symptoms in various psychiatric disorders. Only a few studies of depressed patients have examined whether alexithymia predicts the outcome of therapeutic interventions or the course of symptoms in naturalistic settings. This prospective study investigated whether alexithymia is associated with depressive symptoms after a multimodal inpatient treatment. Forty-five inpatients suffering from acute major depression were examined in the initial phase of treatment and then again after seven weeks. Patients took part in a multimodal treatment programme comprising psychodynamic-interactional oriented individual and group therapy. The majority of patients were taking antidepressants during study participation. To assess alexithymia and depressive symptoms, the 20-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory II (BDI-II) and the Hamilton Depression Scale (HAMD) were administered at baseline and follow-up. When controlling for baseline depressive symptoms along with trait anxiety, high scores in the externally oriented thinking (EOT) facet of alexithymia at baseline predicted high severity of depressive symptoms at follow-up (for self-reported as well as interviewer-based scores). Inpatients suffering from major depression with a more pronounced external cognitive style might benefit less from a routine multimodal treatment approach (including psychodynamic interactional therapy, antidepressant medication, and complementary therapies). Intervention programmes might modify or account for alexithymic characteristics to improve the course of depressive symptoms in these patients. PMID:26935972

  13. Inpatient Treatment of Vietnam Veterans with Post-Traumatic Stress Disorder: Treatment Issues and Strategies. Impediments in Institutional Implementation.

    ERIC Educational Resources Information Center

    Lips, Orville J.

    This paper describes the implementation of an inpatient treatment program for Vietnam combat veterans exhibiting symptoms related to Post-Traumatic Stress Disorder, at the North Chicago Veterans Administration Medical Center. Issues related to organizational and staff problems encountered during the program are outlined, and unique problems…

  14. A family member's legal experience with an insurer's refusal to recertify inpatient mental health treatment.

    PubMed

    Shyovitz, M

    2001-01-01

    My son Nathaniel has bipolar disorder and was hospitalized for 6 months, during which time our insurance company was prepared to refuse certification more than once despite a policy that included 365 days of inpatient mental health treatment. A break in coverage by the insurance company would have meant that Nathaniel, still suicidal, would not receive the life-saving care he needed. Fortunately, I am a lawyer, which enabled me to act as a legal advocate for my son when our insurer threatened not to recertify. Because my son's experience with the insurance company is not unusual--many patients with mental illness struggle with insurance companies who refuse to certify treatment--I believe that the family or support people of seriously ill psychiatric patients should be prepared to act in circumstances similar to mine. Psychiatric inpatient units should, as a matter of course, provide information on legal remedies that can be obtained before irreparable harm occurs. PMID:11765096

  15. Between difference and belonging: configuring self and others in inpatient treatment for eating disorders.

    PubMed

    Eli, Karin

    2014-01-01

    Dedicated inpatient care for eating disorders has profound impact on patients' embodied practices and lived realities. Analyses of inpatients' accounts have shown that participants endorse complex and conflicting attitudes toward their experiences in eating disorders wards, yet the apparent ambivalence that characterizes inpatient experiences has not been subject to critical examination. This paper examines the narrated experiences of 13 participants (12 women and one man; age 18-38 years at first interview) with past or present anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified, who had been hospitalized in an inpatient eating disorders ward for adults in central Israel. The interviews, which took place in 2005-2006, and again in 2011, were part of a larger longitudinal study exploring the subjective experiences of eating disorders and recovery among Israeli adults. Employing qualitative analysis, this study finds that the participants' accounts were concerned with dynamics of difference and belonging, as they played out in various aspects of inpatient care, including diagnosis, treatment, relationships with fellow patients and staff, and everyday life in hospital. Notably, participants simultaneously defined themselves as connected to, but also distinct from, the eating disordered others who formed their reference group at the ward. Through negotiating a protectively ambivalent positioning, participants recognized their eating disordered identities and connected with others on the ward, while also asserting their non-disordered individuality and distancing themselves from the potential dangers posed by 'excessive' belonging. The paper suggests that this ambivalent positioning can usefully be understood through the anthropological concept of liminality: being both a part of and apart from one's community. PMID:25210886

  16. Between Difference and Belonging: Configuring Self and Others in Inpatient Treatment for Eating Disorders

    PubMed Central

    Eli, Karin

    2014-01-01

    Dedicated inpatient care for eating disorders has profound impact on patients' embodied practices and lived realities. Analyses of inpatients' accounts have shown that participants endorse complex and conflicting attitudes toward their experiences in eating disorders wards, yet the apparent ambivalence that characterizes inpatient experiences has not been subject to critical examination. This paper examines the narrated experiences of 13 participants (12 women and one man; age 18–38 years at first interview) with past or present anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified, who had been hospitalized in an inpatient eating disorders ward for adults in central Israel. The interviews, which took place in 2005–2006, and again in 2011, were part of a larger longitudinal study exploring the subjective experiences of eating disorders and recovery among Israeli adults. Employing qualitative analysis, this study finds that the participants' accounts were concerned with dynamics of difference and belonging, as they played out in various aspects of inpatient care, including diagnosis, treatment, relationships with fellow patients and staff, and everyday life in hospital. Notably, participants simultaneously defined themselves as connected to, but also distinct from, the eating disordered others who formed their reference group at the ward. Through negotiating a protectively ambivalent positioning, participants recognized their eating disordered identities and connected with others on the ward, while also asserting their non-disordered individuality and distancing themselves from the potential dangers posed by ‘excessive’ belonging. The paper suggests that this ambivalent positioning can usefully be understood through the anthropological concept of liminality: being both a part of and apart from one's community. PMID:25210886

  17. The formal treatment contract in the inpatient management of borderline personality disorder.

    PubMed

    Miller, L J

    1990-09-01

    Formal, written contracts between the patient and the treatment team have been shown to be useful in the inpatient management of borderline personality disorder by fostering a therapeutic alliance, containing dangerous behavior, and protecting the integrity of the treatment. The author discusses the advantages and disadvantages of such contracts and points out several common contractual errors, including making a contract too restrictive, allowing the contract to substitute for psychotherapy, and using the contract as a means of defense or punishment. She provides 12 guidelines, for formulating successful contracts, beginning with the need to clearly state the purpose of the treatment plan mutually agreed on by patient and staff. PMID:2210708

  18. Inpatient treatment of the psychiatric patient with alcoholism.

    PubMed

    Bean-Bayog, M

    1987-05-01

    Patients with both alcoholism and mental illness, or the one masquerading as the other, are very common and often puzzling and discouraging to clinicians. This article reviews several aspects of these problems: epidemiologic studies show that substantial proportions of mentally ill people suffer from alcoholism, and these disorders interlock in complex ways, each exacerbating the other. Many physicians feel uncomfortable working with alcoholic people, mostly because of poor training, and this impinges on difficulties of giving excellent care to these taxing patients. Complexities and resistances to interviewing obstruct evaluation. Interviewing and history taking techniques and the reason for them are discussed. The decision whether a patient needs medical or psychiatric hospitalization, alcoholism rehabilitation, or outpatient psychiatric or alcoholism treatment is reviewed along with the management and sequencing of treatment for primary and secondary alcoholism with concomitant psychosis, mania, depression, panic disorder, and adult attention deficit disorder. Clinical intervention and referral for the patient on a medical or surgical floor who may have alcoholism is discussed. Two special clinical problems, the differential diagnosis of postdetoxification depression and the risks of using alcohol cross-tolerant drugs, are also reviewed. PMID:2884166

  19. A respiratory therapist-directed protocol for managing inpatients with asthma and COPD incorporating a long-acting bronchodilator.

    PubMed

    Colice, Gene L; Carnathan, Bettye; Sung, Jennifer; Paramore, L Clark

    2005-02-01

    This prospective study was designed to determine whether incorporating formoterol into a standardized respiratory therapist-directed protocol for administering bronchodilators to hospitalized patients with obstructive airway disease would reduce health care resource use and provide a safety advantage. All patients admitted to Washington Hospital Center with asthma and chronic obstructive pulmonary disease (CODP) are administered bronchodilators under a standardized respiratory therapist-directed protocol. Formoterol was the primary bronchodilator for the intervention period from January through March 2002, with levalbuterol, albuterol, and ipratropium available as needed. Results for the intervention period were compared against two historical control periods. From January through March 2000, the bronchodilators in the protocol were albuterol and ipratropium, and from January through March 2001 levalbuterol, albuterol, and ipratropium were available. Health care resource use was determined by the number of bronchodilator treatments administered per admission. Costs (adjusted to 2002 dollars) for supplies, therapist time, and drugs were calculated for the three time periods. Adverse events related to bronchodilator administration were recorded in a standardized manner for all three time periods. Bronchodilator treatments per admission, respiratory therapist visits per admission, and time spent per admission, and cost per bronchodilator treatment significantly decreased in 2002. Significantly fewer adverse events related to bronchodilator treatments were reported in 2002 than 2000. The addition of formoterol to a respiratory therapist-directed protocol for administering bronchodilators reduced health care resource use and adverse events for patients with asthma and COPD. PMID:15801325

  20. Critical Transitions: A Mixed Methods Examination of Sleep from Inpatient Alcohol Rehabilitation Treatment to the Community

    PubMed Central

    Brooks, Alyssa Todaro; Krumlauf, Michael; Fryer, Craig S.; Beck, Kenneth H.; Yang, Li; Ramchandani, Vijay A.; Wallen, Gwenyth R.

    2016-01-01

    Aims This prospective, repeated measures study utilized a convergent parallel mixed methods approach to assess sleep experiences among individuals who were alcohol-dependent undergoing inpatient detoxification and treatment at a clinical research facility across the transition periods associated with the rehabilitation process: the initial adjustment to becoming an inpatient and the transition from inpatient to outpatient status. Methods This study included individual semi-structured interviews and quantitative measures relating to psychological distress, sleep quality, daytime sleepiness, and sleep-related beliefs and behavior (n = 33; 66.7% male). Interviews were conducted and questionnaires were administered within one week of participants’ scheduled discharge date and again four to six weeks post-discharge when they returned for a follow-up visit (or via phone). Results Participants self-reported significant sleep disturbances at both study time points. Of those participants with valid data at both time points (n = 28), there were no significant changes in mean scores from pre- to post-discharge with the exception of self-efficacy for sleep (SE-S) being significantly higher post-discharge. Preliminary qualitative findings suggested differences between those with ongoing sleep disturbances, those whose sleep disturbances had resolved, and those with no sleep disturbances at either time point. Conclusions This analysis highlights individual variation in sleep throughout the process of inpatient treatment and transition to outpatient aftercare in individuals with alcohol dependence. Collecting quantitative and qualitative data concurrently and combining emerging themes from qualitative data with quantitative analyses allowed for a more thorough examination of this relatively novel area of research and provided information that can be utilized to inform future behavioral sleep interventions. PMID:27571353

  1. Characteristics of middle-aged women in inpatient treatment for eating disorders.

    PubMed

    Forman, Maryelizabeth; Davis, William N

    2005-01-01

    The current study examined descriptive characteristics of women 35 years and older seeking inpatient treatment for an eating disorder. A second purpose was to compare characteristics and treatment experiences of midlife patients to young adult patients. Participants were 193 women admitted for treatment to a residential eating disorders facility. All of the women received the standard inpatient treatment package offered by the treatment facility. Participants completed measures of eating attitudes, depression, anxiety, body image, and media influence at admission and discharge and a program assessment measure at discharge. Results revealed comparable scores on measures of eating attitudes, anxiety, and depression at admission, although younger patients scored significantly higher on measures of body image and media influence at admission. With regard to treatment experience, midlife patients experienced greater change with regard to depression and body image dissatisfaction and described family therapy and grief and loss group therapy as being significantly more helpful than young adult patients. There appears to be a number of similarities across age cohorts in terms of clinical presentation, but underlying causal factors may differ between age groups. In general, midlife patients and young patients describe the standard treatment package as equally helpful, although midlife patients might also benefit from groups addressing grief and loss. PMID:16864530

  2. Predictors of dropout from inpatient treatment for anorexia nervosa: data from a large French sample.

    PubMed

    Huas, Caroline; Godart, Nathalie; Foulon, Christine; Pham-Scottez, Alexandra; Divac, Snezana; Fedorowicz, Valérie; Peyracque, Emilie; Dardennes, Roland; Falissard, Bruno; Rouillon, Frédéric

    2011-02-28

    Dropout from anorexia nervosa inpatient treatment programs is frequent and is linked to a poorer outcome. This study aimed to identify predictive factors for dropout among anorexia nervosa inpatients. Between 1988 and 2004, 601 consecutive female inpatients with anorexia, restrictive (AN-R) or binge/purging (AN-B/P) subtype (Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)), were assessed at admission (clinical, socio-demographic, and psychological data). A stepwise logistic model was developed. Dropout rates were respectively 50.0% and 56.2% for AN-R and AN-B/P. Seven predictive factors were identified in multivariate analysis: having one or more children, low desired body mass index (BMI), a low minimum BMI, high scores on the SCL-90 paranoid ideation and the Morgan and Russell eating behavior subscales, and low educational status. Early dropouts had a particular profile: lower desired BMI, higher score on SCL90 paranoid subscale, and more impulsive behaviors (alcohol use, suicide attempts). Dropout appeared as a multifactorial event. In clinical practice, certain factors could serve as warning messages reflecting the severity of the illness (high EDI score and low minimum BMI); while others could be targeted before hospitalization (having at least one child and low desired BMI). PMID:20546922

  3. Factors related to compliance with oral analgesic treatment of inpatients with chronic pain.

    PubMed

    Zhu, Hong; Zheng, Yuzhu; Gao, Hui; Liu, Li; Yang, Lie

    2015-09-01

    This study aimed to determine the relationship between the different factors of analgesic therapy and the compliance of chronic pain inpatients. We prospectively investigated 100 consecutive inpatients with noncancer chronic pain who were hospitalized to receive oral analgesic treatment in the Pain Department of West China Hospital from May 2013 to October 2013. Patients who completed the treatment plan were recorded as good compliance, whereas patients who partly completed or even refused the treatment were recorded as moderate or non-compliance, respectively. A total of 73 (73.7%), 17 (17.1%), and 9 (9.2%) patients showed good, moderate, and non-compliance, respectively. Univariate analyses showed significantly better compliance among farmers, patients educated in college or above, with family income of < 3000 CNY, and with severe or moderate pain than those employed and unemployed (P = 0.02), patients educated below college (P = 0.013), with family income of ≥ 3000 CNY (P = 0.025), and with mild pain (P < 0.001), respectively. Logistic regression analysis showed that the family income of ≥ 3000 CNY (OR: 2.50, 95%CI: 1.65-4.51, P = 0.021) and mild pain (OR: 1.27, 95%CI: 1.03-3.31, P = 0.016) were associated with moderate or non-compliance with oral analgesic treatment. In conclusion, the low compliance with oral treatment of analgesics was found in Chinese inpatients with chronic pain and compliance was negatively associated with family income and degree of pain of patients. PMID:26290285

  4. An eclectic inpatient treatment model for Vietnam and Desert Storm veterans suffering from posttraumatic stress disorder.

    PubMed

    Viola, J M; McCarthy, D A

    1994-03-01

    This paper describes the therapeutic components of an eclectic, intensive inpatient treatment strategy for Vietnam and Desert Storm veterans with posttraumatic stress disorder. A specific treatment model was devised by this author. The procedure was a collaborative effort: the staff and the patients participated in this preparatory phase treatment program at the Tripler Posttraumatic Stress Unit, Tripler Army Medical Center, Honolulu, Hawaii. The basic treatment is based on group therapy, utilizing educational, cognitive-behavioral therapy, gestalt therapy, and individualized psychotherapy, and eye movement desensitization strategies. The timing and sequencing of these treatments are a critical part of the model, and we have come to refer to it as the layered model because the treatments are layered, much like the delicious parfait dessert. PMID:8041467

  5. Cost Analysis of Integrative Inpatient Treatment Based on DRG Data: The Example of Anthroposophic Medicine

    PubMed Central

    Heinz, Jürgen; Fiori, Wolfgang; Heusser, Peter

    2013-01-01

    Background. Much work has been done to evaluate the outcome of integrative inpatient treatment but scarcely the costs. This paper evaluates the costs for inpatient treatment in three anthroposophic hospitals (AHs). Material and Methods. Cost and performance data from a total of 23,180 cases were analyzed and compared to national reference data. Subgroup analysis was performed between the cases with and without anthroposophic medical complex (AMC) treatment. Results. Costs and length of stay in the cases without AMC displayed no relevant differences compared to the national reference data. In contrast the inlier cases with AMC caused an average of € 1,394 more costs. However costs per diem were not higher than those in the national reference data. Hence, the delivery of AMC was associated with a prolonged length of stay. 46.6% of the cases with AMC were high outliers. Only 10.6% of the inlier cases with AMC were discharged before reaching the mean length of stay of each DRG. Discussion. Treatment in an AH is not generally associated with an increased use of resources. However, the provision of AMC leads to a prolonged length of stay and cannot be adequately reimbursed by the current G-DRG system. Due to the heterogeneity of the patient population, an additional payment should be negotiated individually. PMID:23431346

  6. Universal parent training as a supplement to inpatient psychiatric treatment for children and adolescents.

    PubMed

    Schwenck, Christina; Schneider, Wolfgang; Reichert, Andreas

    2016-08-01

    Parent trainings constitute an effective method to target aspects of parenting in child and adolescent psychiatric and psychotherapeutic care. Past research has mainly been conducted in outpatient contexts, with parents of children with externalizing disorders and often included only small sample sizes. The aim of the current study was first to assess the effectiveness of a novel parent training which is characterized by a universal approach, an open group concept, and short duration, and second to identify variables that have an influence on the effectiveness. A sample of n = 151 parent-child dyads treated in an inpatient clinic was included in the study and randomly assigned to a treatment group and a waiting-list control group. As dependent measures served child behavior problems, dysfunctional parenting, parental mental health, and parental self-efficacy measured with parent-rated questionnaires prior to the training, post training and 3 months after discharge of the clinic. Additionally, a parent-child-interaction observation was conducted and rated by blind raters. Results indicated a general inpatient treatment effect on all dependent measures assessed with questionnaires. An additional effect of the parent training was only shown for parenting and parental mental health with the treatment group revealing better outcomes post training and at follow-up. No effects were found for the measures assessed by interaction observation. Out of a number of variables, only a low monthly income was associated with a higher reduction of dysfunctional parenting. Results indicate that parent training does not contribute additionally to standard inpatient care with respect to child behavior, but does have an influence on parental well-being, which might have a positive effect on the long run. PMID:26707493

  7. The INDDEP study: inpatient and day hospital treatment for depression – symptom course and predictors of change

    PubMed Central

    2013-01-01

    Background Depression can be treated in an outpatient, inpatient or day hospital setting. In the German health care system, episodes of inpatient or day hospital treatment are common, but there is a lack of studies evaluating effectiveness in routine care and subgroups of patients with a good or insufficient treatment response. Our study aims at identifying prognostic and prescriptive outcome predictors as well as comparative effectiveness in psychosomatic inpatient and day hospital treatment in depression. Methods/Design In a naturalistic study, 300 consecutive inpatient and 300 day hospital treatment episodes in seven psychosomatic hospitals in Germany will be included. Patients are assessed at four time points of measurement (admission, discharge, 3-months follow-up, 12-months follow-up) including a broad range of variables (self-report and expert ratings). First, the whole sample will be analysed to identify prognostic and prescriptive predictors of outcome (primary outcome criterion: Quick Inventory of Depressive Symptoms QIDS-total score, expert rating). Secondly, for a comparison of inpatient and day hospital treatment, samples will be matched according to known predictors of outcome. Discussion Naturalistic studies with good external validity are needed to assess treatment outcome in depression in routine care and to identify subgroups of patients with different therapeutic needs. Trial registration Current Controlled Trials ISRCTN20317064 PMID:23531019

  8. Evaluation of an internet-based aftercare program to improve vocational reintegration after inpatient medical rehabilitation: study protocol for a cluster-randomized controlled trial

    PubMed Central

    2013-01-01

    Background Mental disorders are the main reasons for rising proportions of premature pension in most high-income countries. Although inpatient medical rehabilitation has increasingly targeted work-related stress, there is still a lack of studies on the transfer of work-specific interventions into work contexts. Therefore, we plan to evaluate an online aftercare program aiming to improve vocational reintegration after medical rehabilitation. Methods Vocationally strained patients (n = 800) aged between 18 and 59 years with private internet access are recruited in psychosomatic, orthopedic and cardiovascular rehabilitation clinics in Germany. During inpatient rehabilitation, participants in stress management group training are cluster-randomized to the intervention or control group. The intervention group (n = 400) is offered an internet-based aftercare with weekly writing tasks and therapeutic feedback, a patient forum, a self-test and relaxation exercises. The control group (n = 400) obtains regular e-mail reminders with links to publicly accessible information about stress management and coping. Assessments are conducted at the beginning of inpatient rehabilitation, the end of inpatient rehabilitation, the end of aftercare, and 9 months later. The primary outcome is a risk score for premature pension, measured by a screening questionnaire at follow-up. Secondary outcome measures include level of vocational stress, physical and mental health, and work capacity at follow-up. Discussion We expect the intervention group to stabilize the improvements achieved during inpatient rehabilitation concerning stress management and coping, resulting in an improved vocational reintegration. The study protocol demonstrates the features of internet-based aftercare in rehabilitation. Trial registration International Standard Randomised Controlled Trial Number Register (ISRCTN:ISRCTN33957202) PMID:23351836

  9. Perception of Problem Severity, Treatment Motivations, Experiences, and Long-Term Plans among Pregnant Women in a Detoxification Inpatient Unit

    ERIC Educational Resources Information Center

    Jackson, Afton; Shannon, Lisa

    2013-01-01

    The purpose of this study was to examine pregnant women's substance use from initial use, to recognition of problem severity, motivations for treatment, and ultimately to treatment entry. The sample consisted of 114 pregnant women receiving inpatient detoxification treatment at the University of Kentucky Chandler Medical Center. Qualitative and…

  10. Outcome evaluation of a high-intensity inpatient sex offender treatment program.

    PubMed

    Olver, Mark E; Wong, Stephen C P; Nicholaichuk, Terry P

    2009-03-01

    The treatment outcome of a high-intensity inpatient sex offender treatment program was evaluated by comparing the sexual recidivism rates of 472 treated and 282 untreated sex offenders. The program is designed for moderate- to high-risk sex offenders and follows the principles of effective correctional treatment. The current investigation is an extension of an earlier study (Nicholaichuk et al., 2000) with the addition of 176 participants, an extra 4 years follow-up, and the use of Cox regression survival analysis to control for three potentially confounding variables: age of release, sexual offending history, and length of follow-up. Treated offenders sexually recidivated significantly less than the comparison group over nearly 20 years of follow-up, even after controlling for the aforementioned variables. The substantive findings suggest that treatment adhering to the what works principles can reduce long-term sexual recidivism for a moderate- to high-risk group of sex offenders. PMID:18458350

  11. Is There an Additional Value of Inpatient Treatment for Patients with Atopic Dermatitis?

    PubMed

    van der Schaft, Jorien; Keijzer, Welmoed W; Sanders, Koos J G; de Groot, Jette J C; van den Bersselaar, Donna L C M; van Os-Medendorp, Harmieke; van Doorn-Op den Akker, Margreet M; Bruijnzeel-Koomen, Carla A F M; de Bruin-Weller, Marjolein S

    2016-08-23

    An inpatient treatment and education programme has been developed for patients with difficult to control atopic dermatitis (AD), with the aim of achieving adequate self-management and long-term disease control. This observational study included adult patients diagnosed with difficult to control AD, admitted for a structured inpatient treatment and education programme. The primary outcome was the Six Area, Six Sign Atopic Dermatitis (SASSAD) score. In total, 79 patients (mean ± SD age 38.8 ± 17.1 years) were included. The median duration of hospitalization was 11 days (interquartile range 8-14). The mean percentage decrease in SASSAD score between admission and discharge was 60.7%, of which 64 (81.0%) patients achieved SASSAD50. The mean percentage decrease in SASSAD score was 69.0% during follow-up, of which 63 (79.7%) patients still had a SASSAD50. In the majority of these patients with difficult to control AD the admission resulted in sustained disease control. This could be achieved by optimization of treatment with topical corticosteroids. PMID:26983375

  12. The behavioral medicine unit: a community hospital model for inpatient treatment of adolescent depression.

    PubMed

    Greydanus, D E; Porter, J; Rypma, C B; Heuer, T; Granberg, A; Ruch, R

    1986-12-01

    This article describes one community hospital's response to the overwhelming needs of adolescents in central Iowa. It is based on the premise that many youths who have severe depression do not effectively respond to various outpatient counseling measures, and are in need of some type of inpatient treatment. Most such programs are locked psychiatric units run by child or adolescent psychiatrists. In our case, those wards already in existence are filled to capacity and cannot respond to outside needs. Placing these youth on traditional medical adolescent wards does not work, since medical staff are usually not geared to deal with the many, ever-changing mental health needs of these patients. Thus, we developed an unlocked adolescent inpatient unit with a pediatrician experienced in adolescent medicine as medical director; moreover, the program extensively utilizes psychologists, nurse-counselors, social worker-family therapists, recreation therapists, and other specialists. This program is a way for physicians trained in adolescent medicine and other appropriate persons to contribute to the complex health needs of youth; it is preferable to do this rather than send all depressed teenagers away by referrals, as seems to happen in some cases. It is also an important way for physicians and other specialists to demonstrate their expertise--both the Society for Adolescent Medicine and American Academy of Pediatrics have advocated such a demonstration--and to give physicians important training in the medical and mental health care needs of youth. Finally, the Spectrum Unit program provides a meaningful way for the primary care physician to be involved in the inpatient treatment of depressed adolescent patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3602650

  13. Psychotherapy of Borderline Personality Disorder: Can the Supply Meet the Demand? A German Nationwide Survey in DBT Inpatient and Day Clinic Treatment Facilities.

    PubMed

    Richter, Christoph; Steinacher, Bruno; zum Eschenhoff, Anna; Bermpohl, Felix

    2016-02-01

    The present study aimed to assess (1) the amount of inpatient and day clinic DBT treatment places for patients with borderline personality disorder and (2) the relationship between supply and demand in a given study region. Survey of inpatient and day clinic facilities in the German DBT network. 42 inpatient units and day clinics responded, representing 75 % of the DBT network members contacted. These institutions offer 527 DBT treatment places and treat about 2310 patients per year. The mean waiting period prior to treatment was 14.3 weeks. 700 DBT inpatient or day clinic places exist in Germany in 2011. 3000 patients receive DBT inpatient or day clinic treatment per year. This approximates a ratio of 820 borderline patients for one existing DBT inpatient or day clinic place in Germany. The long waiting time reflects the great demand for this treatment and could be interpreted as an imbalance between supply and demand. PMID:26323785

  14. Course of health care costs before and after psychiatric inpatient treatment: patient-reported vs. administrative records

    PubMed Central

    Zentner, Nadja; Baumgartner, Ildiko; Becker, Thomas; Puschner, Bernd

    2015-01-01

    Background: There is limited evidence on the course of health service costs before and after psychiatric inpatient treatment, which might also be affected by source of cost data. Thus, this study examines: i) differences in health care costs before and after psychiatric inpatient treatment, ii) whether these differences vary by source of cost-data (self-report vs. administrative), and iii) predictors of cost differences over time. Methods: Sixty-one psychiatric inpatients gave informed consent to their statutory health insurance company to provide insurance records and completed assessments at admission and 6-month follow-up. These were compared to the self‐reported treatment costs derived from the "Client Socio-demographic and Service Use Inventory" (CSSRI‐EU) for two 6‐month observation periods before and after admission to inpatient treatment to a large psychiatric hospital in rural Bavaria. Costs were divided into subtypes including costs for inpatient and outpatient treatment as well as for medication. Results: Sixty-one participants completed both assessments. Over one year, the average patient‐reported total monthly treatment costs increased from € 276.91 to € 517.88 (paired Wilcoxon Z = ‐2.27; P = 0.023). Also all subtypes of treatment costs increased according to both data sources. Predictors of changes in costs were duration of the index admission and marital status. Conclusion: Self-reported costs of people with severe mental illness adequately reflect actual service use as recorded in administrative data. The increase in health service use after inpatient treatment can be seen as positive, while the pre-inpatient level of care is a potential problem, raising the question whether more or better outpatient care might have prevented hospital admission. Findings may serve as a basis for future studies aiming at furthering the understanding of what to expect regarding appropriate levels of post-hospital care, and what factors may help or

  15. A Quasi-Experimental Evaluation of High-Intensity Inpatient Sex Offender Treatment in the Netherlands.

    PubMed

    Smid, Wineke J; Kamphuis, Jan H; Wever, Edwin C; Van Beek, Daan J

    2016-08-01

    The current study quasi-experimentally assessed the outcome of high-intensity inpatient sex offender treatment in the Netherlands in terms of sexual and violent (including sexual) recidivism. It was hypothesized that treated sex offenders would show lower recidivism rates than untreated sex offenders of the same risk level. In line with the risk principle of the Risk, Need, Responsivity (RNR) model, we predicted that this would especially hold true for offenders of higher risk levels. The study sample consisted of 25% of all convicted Dutch sex offenders not referred to any form of treatment and discharged from prison between 1996 and 2002, and all convicted Dutch sex offenders referred to inpatient treatment who were discharged between 1996 and 2002. Static-99R risk levels of these 266 offenders were retrospectively assessed and survival curves regarding sexual and violent (including sexual) recidivism were compared between treated and untreated offenders, controlling for level of risk. Mean follow-up was 148.0 months (SD = 29.6) and the base rate of sexual recidivism was 15.0% and 38.4% for violent (including sexual) recidivism. Cox regression survival analyses showed marginally significant lower failure rates regarding sexual recidivism for treated high-risk offenders only, and significantly lower failure rates regarding violent (including sexual recidivism) for treated sex offenders of moderate-high and high-risk levels. No treatment effects for low and low-moderate risk offenders were found. Results underscore the risk principle of the RNR model: Treatment is more effective when its dosage is attuned to risk level. PMID:24867416

  16. Early traumatized inpatients high in psychoform and somatoform dissociation: characteristics and treatment response.

    PubMed

    Jepsen, Ellen K K; Langeland, Willie; Heir, Trond

    2014-01-01

    This study examined the clinical relevance of differences in psychoform and somatoform dissociative symptoms in 55 early traumatized inpatients. The high psychoform and somatoform dissociative group (n = 18), somatoform dissociative group (n = 22), and nondissociative group (n = 15) did not differ on abuse severity, depressive symptoms, interpersonal problems, Axis I or II comorbidity, or deterioration rates. Compared to the other 2 groups, the highly dissociative group was characterized by younger age, living alone, higher levels of posttraumatic and general distress, more frequent reports of suicidality, self-mutilation, eating problems, and less favorable treatment response. The results highlight the clinical relevance of using dissociation measures for identifying subgroups of patients with severe psychopathology who may be more treatment resistant. PMID:24983399

  17. Cost analysis of inpatient treatment of anorexia nervosa in adolescents: hospital and caregiver perspectives

    PubMed Central

    Wong, Matthew; Katzman, Debra K.; Akseer, Nadia; Steinegger, Cathleen; Hancock-Howard, Rebecca L.; Coyte, Peter C.

    2015-01-01

    Background Admission to hospital is the treatment of choice for anorexia nervosa in adolescent patients who are medically unstable; however, stays are often prolonged and frequently disrupt normal adolescent development, family functioning, school and work productivity. We sought to determine the costs of inpatient treatment in this population from a hospital and caregiver perspective, and to identify determinants of such costs. Methods We used micro-costing methods for this cohort study involving all adolescent patients (age 12–18 yr) admitted for treatment of anorexia nervosa at a tertiary care child and adolescent eating disorder program in Toronto, between Sept. 1, 2011, and Mar. 31, 2013. We used hospital administrative data and Canadian census data to calculate hospital and caregiver costs. Results We included 73 adolescents in our cohort for cost-analysis. We determined a mean total hospital cost in 2013 Canadian dollars of $51 349 (standard deviation [SD] $26 598) and a mean total societal cost of $54 932 (SD $27 864) per admission, based on a mean length of stay of 37.9 days (SD 19.7 d). We found patient body mass index (BMI) to be the only significant negative predictor of hospital cost (p < 0.001). For every unit increase in BMI, we saw a 15.7% decrease in hospital cost. In addition, we found higher BMI (p < 0.001) and younger age (p < 0.05) to be significant negative predictors of caregiver costs. Interpretation The economic burden of inpatient treatment for adolescents with anorexia nervosa on hospitals and caregivers is substantial, especially among younger patients and those with lower BMI. Recognizing the symptoms of eating disorders early may preclude the need for admission to hospital altogether or result in admissions at higher BMIs, thereby potentially reducing these costs. PMID:26389097

  18. Treatment responses of inpatient eating disorder women with and without co-occurring obsessive-compulsive disorder.

    PubMed

    Cumella, Edward J; Kally, Zina; Wall, A David

    2007-01-01

    We analyzed the influence of co-occurring obsessive-compulsive disorder (OCD) on response to eating disorder (ED) treatment among 2,971 female inpatients. We assessed treatment response using Eating Disorder Inventory-2 and DSM-IV ED criteria. Multivariate analyses included sociodemographics, illness severity, and co-occurring Axis I/II diagnoses. ED inpatients with OCD had greater ED severity than those without OCD. However, no differences occurred in short- and intermediate-term ED outcomes. Patients with and without OCD evidenced the same degree of change in EDI-2 scores admission-to-discharge and discharge-to-one-year; and 93% of patients both with and without OCD no longer evidenced a DSM-IV ED diagnosis one-year post-discharge. Results suggest that with co-occurring OCD treated using evidence-based interventions ED inpatients with and without OCD may have similar prognoses. PMID:17454070

  19. Psychological factors and treatment effectiveness in resistant anxiety disorders in highly comorbid inpatients

    PubMed Central

    Ociskova, Marie; Prasko, Jan; Latalova, Klara; Kamaradova, Dana; Grambal, Ales

    2016-01-01

    Background Anxiety disorders are a group of various mental syndromes that have been related with generally poor treatment response. Several psychological factors may improve or hinder treatment effectiveness. Hope has a direct impact on the effectiveness of psychotherapy. Also, dissociation is a significant factor influencing treatment efficiency in this group of disorders. Development of self-stigma could decrease treatment effectiveness, as well as several temperamental and character traits. The aim of this study was to explore a relationship between selected psychological factors and treatment efficacy in anxiety disorders. Subjects and methods A total of 109 inpatients suffering from anxiety disorders with high frequency of comorbidity with depression and/or personality disorder were evaluated at the start of the treatment by the following scales: the Mini-International Neuropsychiatric Interview, the Internalized Stigma of Mental Illness scale, the Adult Dispositional Hope Scale, and the Temperament and Character Inventory – revised. The participants, who sought treatment for anxiety disorders, completed the following scales at the beginning and end of an inpatient-therapy program: Clinical Global Impression (objective and subjective) the Beck Depression Inventory – second edition, the Beck Anxiety Inventory, and the Dissociative Experiences Scale. The treatment consisted of 25 group sessions and five individual sessions of cognitive behavioral therapy or psychodynamic therapy in combination with pharmacotherapy. There was no randomization to the type of group-therapy program. Results Greater improvement in psychopathology, assessed by relative change in objective Clinical Global Impression score, was connected with low initial dissociation level, harm avoidance, and self-stigma, and higher amounts of hope and self-directedness. Also, individuals without a comorbid personality disorder improved considerably more than comorbid patients. According to

  20. Risky Decision-Making but Not Delay Discounting Improves during Inpatient Treatment of Polysubstance Dependent Alcoholics

    PubMed Central

    De Wilde, Bieke; Bechara, Antoine; Sabbe, Bernard; Hulstijn, Wouter; Dom, Geert

    2013-01-01

    Background: High levels of impulsivity, characteristics of addicted patients, are known to be important predictors of relapse. However, so far, little is known about the stability or variability of two main components of impulsivity (delay discounting and decision-making). The present study examined the changes in impulsivity during the first week of an abstinence based, behavioral orientated inpatient treatment program. Method: Thirty-seven polysubstance dependent alcoholics completed the Delay Discounting Task (DDT), and the Iowa Gambling Task (IGT) using the original version with decks A′B′C′D′, and an alternative version with decks K′L′M′N′, for measuring decision-making, after 2 and 6 weeks of active treatment. Results: It was found that performances on the IGT changed during treatment while performances on the DDT did not (test-retest period: 4 weeks). Conclusion: The results provide preliminary evidence that improvements in decision-making might be related to treatment effects. All patients followed a highly structured cognitive-behavioral treatment program, which might have enhanced their executive functioning (coping skills training). PMID:24027538

  1. Protocol development, treatment fidelity, adherence to treatment, and quality control.

    PubMed

    Persch, Andrew C; Page, Stephen J

    2013-01-01

    Occupational therapy leaders have emphasized the importance of intervention effectiveness research. The CONSORT and TREND checklists have been suggested as useful tools for reporting the results of randomized and nonrandomized studies, respectively. Despite such recommendations, research protocols and reports continue to underutilize the available tools, a situation reflecting limited resources for and experience with the conduct of effectiveness research. To address this issue, and using the CONSORT statement to structure the analysis, this article discusses strategies for optimization of protocol development, treatment fidelity, adherence to treatment, and quality control. We recommend several approaches to increase the quality of research throughout these various processes. Examples of implementation from our laboratory provide evidence of the utility of these strategies. PMID:23433268

  2. Protocol Development, Treatment Fidelity, Adherence to Treatment, and Quality Control

    PubMed Central

    Page, Stephen J.

    2013-01-01

    Occupational therapy leaders have emphasized the importance of intervention effectiveness research. The CONSORT and TREND checklists have been suggested as useful tools for reporting the results of randomized and nonrandomized studies, respectively. Despite such recommendations, research protocols and reports continue to underutilize the available tools, a situation reflecting limited resources for and experience with the conduct of effectiveness research. To address this issue, and using the CONSORT statement to structure the analysis, this article discusses strategies for optimization of protocol development, treatment fidelity, adherence to treatment, and quality control. We recommend several approaches to increase the quality of research throughout these various processes. Examples of implementation from our laboratory provide evidence of the utility of these strategies. PMID:23433268

  3. Motivational interviewing group at inpatient detoxification, its influence in maintaining abstinence and treatment retention after discharge.

    PubMed

    Bachiller, Diana; Grau-López, Lara; Barral, Carmen; Daigre, Constanza; Alberich, Cristina; Rodríguez-Cintas, Laia; Valero, Sergi; Casas, Miquel; Roncero, Carlos

    2015-01-01

    The relapse rate after discharge from inpatient detoxification is high. The objective of this pilot study is to assess the sociodemographic, clinical and therapeutic factors associated with maintaining abstinence in patients who participated in a brief motivational interviewing group during admission for detoxification. A total of 46 patients, diagnosed substance dependent according to DSM -IV, and admitted to the Hospital Detoxification Unit, participated in a brief motivational interviewing group. Sociodemographic, clinical, motivation to change (University of Rhode Island Change Assessment, URICA) and satisfaction with the treatment group (Treatment Perceptions Questionnaire, CPT) data were collected. Abstinence and treatment retention two months after discharge were assessed by weekly telephone calls. A survival analysis was performed. Being male, having more cognitions of the maintenance stage of change at discharge, being satisfied with group therapy and therapist during hospitalization are associated with longer abstinence after discharge. The brief motivational interviewing group approach with patients admitted for detoxification is related to greater likelihood of maintaining abstinence and subsequent treatment retention. PMID:26132300

  4. The effect of ethnicity on prescribing practice and treatment outcome in inpatients suffering from schizophrenia in Greece

    PubMed Central

    2011-01-01

    Background No studies have been conducted in Greece with the aim of investigating the influence of ethnicity on the prescribing and treatment outcome of voluntarily admitted inpatients. Most studies conducted in the UK and the US, both on inpatients and outpatients, focus on the dosage of antipsychotics for schizophrenic patients and many suffer from significant methodological limitations. Using a simple design, we aimed to assess negative ethnic bias in psychotropic medication prescribing by comparing discrepancies in use between native and non-native psychiatric inpatients. We also aimed to compare differences in treatment outcome between the two groups. Methods In this retrospective study, the prescribing of medication was compared between 90 Greek and 63 non-Greek inpatients which were consecutively admitted into the emergency department of a hospital covering Athens, the capital of Greece. Participants suferred from schizophrenia and other psychotic disorders. Overall, groups were compared with regard to 12 outcomes, six related to prescribing and six related to treatment outcome as assesed by standardised psychometric tools. Results No difference between the two ethnic groups was found in terms of improvement in treatment as measured by GAF and BPRS-E. Polypharmacy, use of first generation antipsychotics, second generation antipsychotics and use of mood stabilizers were not found to be associated with ethnicity. However, non-Greeks were less likely to receive SSRIs-SNRIs and more likely to receive benzodiazepines. Conclusions Our study found limited evidence for ethnic bias. The stronger indication for racial bias was found in benzodiazepine prescribing. We discuss alternative explanations and give arguments calling for future research that will focus on disorders other than schizophrenia and studying non-inpatient populations. PMID:21507225

  5. Handover of patient information from the crisis assessment and treatment team to the inpatient psychiatric unit.

    PubMed

    Waters, Amanda; Sands, Natisha; Keppich-Arnold, Sandra; Henderson, Kathryn

    2015-06-01

    Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20-item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery-oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm. PMID:25438620

  6. Treatment of severe perinatal mood disorders on a specialized perinatal psychiatry inpatient unit.

    PubMed

    Kimmel, Mary C; Lara-Cinisomo, S; Melvin, K; Di Florio, A; Brandon, A; Meltzer-Brody, S

    2016-08-01

    Perinatal patients with bipolar and psychotic mood disorder exacerbations are challenging to treat and often receive suboptimal care. We sought to examine the treatment patterns and outcomes on one of the only US-based Perinatal Psychiatry Inpatient Units (PPIU). Perinatal patients admitted to the PPIU completed self-report measures at admission and before discharge. Retrospective chart reviews extracted history, diagnoses (current and past), and medication treatment. Patients who had discharge diagnoses of bipolar disorder, major depression with psychotic features, or postpartum psychosis were included. Forty-seven met the diagnostic inclusion criteria. Over an average length of stay (ALOS) of 9.96 days, there was significant improvement in depressive and anxiety symptoms and daily functioning (Work and Social Adjustment Scale). Psychiatric comorbidity was common. Polypharmacy was utilized in 87 %. The most common medications prescribed at discharge were antipsychotics, alone or in combination with mood stabilizers or antidepressants. ECT was performed in 10 % of cases. The complexity of patients with severe mood disorders or psychosis admitted to the PPIU supports individualized treatment plans that address both primary diagnosis and psychiatric comorbidities. Our results provide important information that can be disseminated to others to improve clinical outcomes for severe perinatal mood disorders. PMID:26802019

  7. Evaluation of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation: study protocol of a cluster randomized controlled trial

    PubMed Central

    2013-01-01

    Background Chronic heart failure requires a complex treatment regimen on a life-long basis. Therefore, self-care/self-management is an essential part of successful treatment and comprehensive patient education is warranted. However, specific information on program features and educational strategies enhancing treatment success is lacking. This trial aims to evaluate a patient-oriented and theory-based self-management educational group program as compared to usual care education during inpatient cardiac rehabilitation in Germany. Methods/Design The study is a multicenter cluster randomized controlled trial in four cardiac rehabilitation clinics. Clusters are patient education groups that comprise HF patients recruited within 2 weeks after commencement of inpatient cardiac rehabilitation. Cluster randomization was chosen for pragmatic reasons, i.e. to ensure a sufficient number of eligible patients to build large-enough educational groups and to prevent contamination by interaction of patients from different treatment allocations during rehabilitation. Rehabilitants with chronic systolic heart failure (n = 540) will be consecutively recruited for the study at the beginning of inpatient rehabilitation. Data will be assessed at admission, at discharge and after 6 and 12 months using patient questionnaires. In the intervention condition, patients receive the new patient-oriented self-management educational program, whereas in the control condition, patients receive a short lecture-based educational program (usual care). The primary outcome is patients’ self-reported self-management competence. Secondary outcomes include behavioral determinants and self-management health behavior (symptom monitoring, physical activity, medication adherence), health-related quality of life, and treatment satisfaction. Treatment effects will be evaluated separately for each follow-up time point using multilevel regression analysis, and adjusting for baseline values. Discussion This

  8. Racial-ethnic differences in access, diagnosis, and outcomes in public-sector inpatient mental health treatment.

    PubMed

    Delphin-Rittmon, Miriam E; Flanagan, Elizabeth H; Andres-Hyman, Raquel; Ortiz, Jose; Amer, Mona M; Davidson, Larry

    2015-05-01

    This study investigated inequities in access, diagnosis, and treatment for African Americans and Hispanic Americans receiving treatment in northeast, public sector, inpatient mental health settings as part of a Department of Mental Health and Addiction Services Health Disparities Initiative. Data from 1,484 adults were obtained through a random extract of patients admitted to state inpatient facilities between 2002 and 2005. After controlling for demographic variables and symptom severity, logistic and linear regression showed that Hispanic Americans were significantly more likely to enter inpatient care through crisis/emergency sources and were significantly less likely to self-refer or come to inpatient care through other sources (e.g., family, outpatient). After admission, Hispanic Americans were more likely to be diagnosed with other psychotic disorders (e.g., schizoaffective disorder, delusional disorder), were less likely to receive an Axis II diagnosis at discharge, and had a shorter length of stay than non-Hispanic White Americans. African Americans were more likely than other groups to be diagnosed with schizophrenia, drug-related, and Cluster B diagnoses (discharge only), and they were less likely to be diagnosed with mood disorders and other nonpsychotic disorders. Although African Americans were more likely than other groups to come to inpatient units from numerous routes, including self-referral and referral from other sources (e.g., family, outpatient), they were more likely to terminate treatment against medical advice and displayed shorter length of stay despite receiving ratings of greater symptom severity at discharge. These findings highlight the need for policies, programs, and system interventions designed to eliminate disparities and improve the quality and cultural responsiveness of behavioral health services. PMID:25961650

  9. Socio-economic inequalities in the financing of cardiovascular & diabetes inpatient treatment in India

    PubMed Central

    Rao, Krishna D.; Bhatnagar, Aarushi; Murphy, Adrianna

    2011-01-01

    Background & objectives: Cardiovascular disease (CVD) and diabetes have become a leading threat to public health in India. This study examines socio-economic differences in self-reported morbidity due to CVD and diabetes, where people having these conditions seek care, how much households pay for and how they finance hospital treatment for these conditions. Methods: Data for this study are taken from the National Sample Survey Organization (NSSO) 60th round on ‘Morbidity and Health Care’ conducted between January and June 2004. Information from 2,129 and 438 individuals hospitalized for CVD and diabetes was analyzed. Results: The self-reported prevalence among adults was 12 per cent for CVD, 4 per cent (7% urban and 3% rural) for heart disease and 6 per cent (10% in urban and 4% in rural) for diabetes. Both self-reported CVD and diabetes appeared to afflict the wealthier more. The private sector was the main provider of outpatient and inpatient care for CVD and diabetes treatment, though the poor depended more on the public sector. Out-of-pocket payments (OOPS) for hospital treatment claimed a large share of annual household expenditures; 30 per cent for CVD and 17 per cent for diabetes. The OOPS share for diabetes treatment declined with increasing income. The majority of OOPS for hospital treatment paid by the poor was financed through borrowings. Interpretation & conclusions: The considerable financial strain which households, particularly the poor, face in treating CVD and diabetes is alarming. As the burden due to CVD and diabetes increases in India, more households will be subject to these financial strains and unfortunately, the economically vulnerable among them will be the worst affected. While primary prevention of these conditions need more emphasis, in addition, insurance schemes targeted at the poor like the RSBY have an important role to play in financially protecting vulnerable households. PMID:21321420

  10. Reinvigorating Inpatient Group Psychotherapy: Integrating Clients' Off-Unit Experiences in Treatment.

    ERIC Educational Resources Information Center

    Oxman, Elaine B.; Chambliss, Catherine

    Publicly funded psychiatric inpatient institutions focus increasingly on stabilization and relapse prevention, readying patients for rapid community reentry. Growing emphasis on consumer satisfaction and professionals' accountability for efficient outcomes has coincided with increasing cost concerns. Since staffing limitations mandate innovative…

  11. Occupational, Physical, and Speech Therapy Treatment Activities during Inpatient Rehabilitation for Traumatic Brain Injury

    PubMed Central

    Beaulieu, Cynthia L.; Dijkers, Marcel P.; Barrett, Ryan S.; Horn, Susan D.; Giuffrida, Clare G.; Timpson, Misti L.; Carroll, Deborah M.; Smout, Randy J.; Hammond, Flora M.

    2015-01-01

    Objective To describe use of Occupational Therapy (OT), Physical Therapy (PT) and Speech Therapy (ST) treatment activities throughout the acute rehabilitation stay of patients with traumatic brain injuries (TBI). Design Multi-site prospective observational cohort study. Setting 9 U.S. and 1 Canadian inpatient rehabilitation settings. Participants 2130 patients admitted for initial acute rehabilitation following TBI. Patients were categorized based on admission FIM cognitive scores, resulting in 5 fairly homogenous groups. Interventions Not applicable. Main Outcome Measures Percentage of patients engaged in specific activities and mean time patients engaged in the activities, per 10-hour block of time for OT, PT, and ST combined. Results Therapy activities in OT, PT, and ST across all 5 cognitive groups had a primary focus on basic activities. While advanced activities occurred in each discipline and within each cognitive group, these advanced activities occurred with fewer patients and usually only toward the end of the rehabilitation stay. Conclusions The pattern of activities engaged in was both similar to and different from patterns seen in previous PBE studies with different rehabilitation diagnostic groups. PMID:26212399

  12. Specialised teams or personal continuity across inpatient and outpatient mental healthcare? Study protocol for a natural experiment

    PubMed Central

    Giacco, Domenico; Bird, Victoria Jane; McCrone, Paul; Lorant, Vincent; Nicaise, Pablo; Pfennig, Andrea; Bauer, Michael; Ruggeri, Mirella; Lasalvia, Antonio; Moskalewicz, Jacek; Welbel, Marta; Priebe, Stefan

    2015-01-01

    Introduction Mental healthcare organisation can either pursue specialisation, that is, distinct clinicians and teams for inpatient and outpatient care or personal continuity of care, that is, the same primary clinician for a patient across the two settings. Little systematic research has compared these approaches. Existing studies subject have serious methodological shortcomings. Yet, costly reorganisations of services have been carried out in different European countries, inconsistently aiming to achieve specialisation or personal continuity of care. More reliable evidence is required on whether specialisation or continuity of care is more effective and cost-effective, and whether this varies for different patient groups and contexts. Design and methods In a natural experiment, we aim to recruit at least 6000 patients consecutively admitted to inpatient psychiatric care in Belgium, Germany, Italy, Poland, and the UK. In each country, care approaches supporting specialisation and personal continuity coexist. Patients will be followed up at 1 year to compare outcomes, costs and experiences. Inclusion criteria are: 18 years of age or older; clinical diagnosis of psychosis, affective disorder or anxiety/somatisation disorder; sufficient command of the language of the host country; absence of cognitive deterioration and/or organic brain disorders; and capacity to provide informed consent. Ethics and dissemination Ethical approval was obtained in all countries: (1) England: NRES Committee North East—Newcastle & North Tyneside (ref: 14/NE/1017); (2) Belgium: Comité d'Ethique hospitalo-facultaire des Cliniques St-Luc; (3) Germany: Ethical Board, Technische Universität Dresden; (4) Italy: Comitati Etici per la sperimentazione clinica (CESC) delle provincie di Verona, Rovigo, Vicenza, Treviso, Padova; (5) Poland: Komisja Bioetyczna przy Instytucie Psychiatrii i Neurologii w Warszawie. We will disseminate the findings through scientific publications and a study

  13. Extraction protocols for orthodontic treatment: A retrospective study

    PubMed Central

    Thirunavukkarasu, Vaishnevi N.; Ramachandra, Srinivas Sulugodu; Dicksit, Daniel D.; Gundavarapu, Kalyan C.

    2016-01-01

    Background and Objectives: Various extraction protocols have been followed for successful orthodontic treatment. The purpose of this study was to evaluate the extraction protocols in patients who had previously undergone orthodontic treatment and also who had reported for continuing orthodontic treatment from other clinics. Materials and Methods: One hundred thirty eight patients who registered for orthodontic treatment at the Faculty of Dentistry were divided into 10 extraction protocols based on the Orthodontic treatment protocol given by Janson et al. and were evaluated for statistical significance. Results: The descriptive statistics of the study revealed a total of 40 (29%) patients in protocol 1, 43 (31.2%) in protocol 2, 18 (13%) in protocol 3, 16 (11.6%) in protocol 5, and 12 (8.7%) in Type 3 category of protocol 9. The Type 3 category in protocol 9 was statistically significant compared to other studies. Midline shift and collapse of the arch form were noticed in these individuals. Conclusion: Extraction of permanent teeth such as canine and lateral incisors without rational reasons could have devastating consequences on the entire occlusion. The percentage of cases wherein extraction of permanent teeth in the crowded region was adopted as a treatment option instead of orthodontic treatment is still prevalent in dental practice. The shortage of orthodontists in Malaysia, the long waiting period, and lack of subjective need for orthodontic treatment at an earlier age group were the reasons for the patient's to choose extraction of the mal-aligned teeth such as the maxillary canine or maxillary lateral incisors. PMID:27041899

  14. Axis I comorbidity in adolescent inpatients referred for treatment of substance use disorders

    PubMed Central

    2010-01-01

    Background To assess comorbid DSM-IV-TR Axis I disorders in adolescent inpatients referred for treatment of substance use disorders. Methods 151 patients (mean age 16.95 years, SD = 1.76; range 13 - 22) were consecutively assessed with the Composite International Diagnostic Interview (CIDI) and standardized clinical questionnaires to assess mental disorders, symptom distress, psychosocial variables and detailed aspects of drug use. A consecutively referred subgroup of these 151 patients consisting of 65 underage patients (mean age 16.12, SD = 1.10; range 13 - 17) was additionally assessed with the modules for attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) using The Schedule for Affective Disorders and Schizophrenia for school-aged children (K-SADS-PL). Results 128 (84.8%) of the 151 patients were dependent on at least one substance, the remaining patients fulfilled diagnostic criteria for abuse only. 40.5% of the participants fulfilled criteria for at least one comorbid present Axis I disorder other than substance use disorders (67.7% in the subgroup additionally interviewed with the K-SADS-PL). High prevalences of present mood disorder (19.2%), somatoform disorders (9.3%), and anxiety disorders (22.5%) were found. The 37 female participants showed a significantly higher risk for lifetime comorbid disorders; the gender difference was significantly pronounced for anxiety and somatoform disorders. Data from the underage subgroup revealed a high prevalence for present CD (41.5%). 33% of the 106 patients (total group) who were within the mandatory school age had not attended school for at least a two-month period prior to admission. In addition, 51.4% had been temporarily expelled from school at least once. Conclusions The present data validates previous findings of high psychiatric comorbidity in adolescent patients with substance use disorders. The high rates of school refusal and conduct disorder indicate the severity of psychosocial

  15. Long Sick Leave after Orthopaedic Inpatient Rehabilitation: Treatment Failure or Relapse?

    ERIC Educational Resources Information Center

    Mangels, Marija; Schwarz, Susanne; Worringen, Ulrike; Holme, Martin; Rief, Winfried

    2011-01-01

    We investigated whether short-term versus long-term sick leave after orthopaedic inpatient rehabilitation can be predicted by initial assessment information, the clinical status at discharge, or whether the follow-up interval is crucial for later sick leave. We examined 214 patients from an orthopaedic rehabilitation hospital at admission,…

  16. Increased Physical Activity Not Decreased Energy Intake Is Associated with Inpatient Medical Treatment for Anorexia Nervosa in Adolescent Females

    PubMed Central

    Higgins, Janine; Hagman, Jennifer; Pan, Zhaoxing; MacLean, Paul

    2013-01-01

    There is a dearth of data regarding changes in dietary intake and physical activity over time that lead to inpatient medical treatment for anorexia nervosa (AN). Without such data, more effective nutritional therapies for patients cannot be devised. This study was undertaken to describe changes in diet and physical activity that precede inpatient medical hospitalization for AN in female adolescents. This data can be used to understand factors contributing to medical instability in AN, and may advance rodent models of AN to investigate novel weight restoration strategies. It was hypothesized that hospitalization for AN would be associated with progressive energy restriction and increased physical activity over time. 20 females, 11–19 years (14.3±1.8 years), with restricting type AN, completed retrospective, self-report questionnaires to assess dietary intake and physical activity over the 6 month period prior to inpatient admission (food frequency questionnaire, Pediatric physical activity recall) and 1 week prior (24 hour food recall, modifiable activity questionnaire). Physical activity increased acutely prior to inpatient admission without any change in energy or macronutrient intake. However, there were significant changes in reported micronutrient intake causing inadequate intake of Vitamin A, Vitamin D, and pantothenic acid at 1 week versus high, potentially harmful, intake of Vitamin A over 6 months prior to admission. Subject report of significantly increased physical activity, not decreased energy intake, were associated with medical hospitalization for AN. Physical activity and Vitamin A and D intake should be carefully monitored following initial AN diagnosis, as markers of disease progression as to potentially minimize the risk of medical instability. PMID:23637854

  17. A Retrospective Chart Review of Treatment Completers Versus Noncompleters Among In-patients at a Tertiary Care Drug Dependence Treatment Centre in India

    PubMed Central

    Sarkar, Siddharth; Balhara, Yatan Pal Singh; Gautam, Namita; Singh, Jawahar

    2016-01-01

    Background and Aims: Engagement into treatment is crucial for improving outcomes among patients with substance use disorders. This study aimed to find the rates and characteristics of treatment noncompletion in patients who were admitted to a drug dependence treatment center in north India. Methods: This retrospective record review analyzed data from consecutive patients admitted between January 1, 2014, and December 31, 2014, at the National Drug Dependence Treatment Centre, Ghaziabad, India. The type of discharge was discerned from the records, along with selected demographic and clinical characteristics of the patient. Results: A total of 942 in-patients were included in the analysis, 936 (99.4%) of whom were males. The mean duration of ward stay was 12.7 (±8.1) days. Of the 942 patients, 779 (82.7%) completed the inpatient treatment while 163 (17.3%) did not complete (n = 95, 10.1% were discharged against medical advice; n = 44, 4.7% were discharged on disciplinary grounds and n = 24, 2.5% absconded or left without intimation). The inpatient treatment noncompleters had a shorter duration of ward stay (8.3 ± 6.9 days vs. 13.6 ± 8.0 days, P < 0.001), were of a greater average age (33.1 ± 10.0 years vs. 30.5 ± 9.4 years, P = 0.002), were more likely to be dependent on opioids (71.2% vs. 59.1%, P = 0.004) and less likely to be dependent on alcohol (30.1% vs. 42.9%, P = 0.002) than treatment completers. Conclusion: Understanding the characteristics of patients with substance use disorders who do not complete inpatient treatment may help in identifying those at-risk of having poor outcomes. Efforts are required to address their concerns so that the overall patient outcomes can be improved. PMID:27570339

  18. [Changes in OPD-CA Axis Structure During Inpatient Psychodynamic Treatment of Adolescents Suffering from Comorbid Disorders of Conduct and Emotions].

    PubMed

    Cropp, Carola; Salzer, Simone; Streeck-Fischer, Annette

    2016-01-01

    In a randomized controlled clinical trial (RCT) we evaluated an inpatient psychodynamic treatment for adolescents suffering from mixed disorders of conduct and emotions. The sample consisted of severely impaired adolescents with remarkable deficits regarding psychic structure. The current study wanted to examine if the manualized treatment did not only reduce symptoms but also enhance the structural level of the patients. The axis structure of the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) was used to assess the structural level of N = 46 adolescent inpatients. To examine differences between the patients‘ structural level at the beginning and at the end of inpatient treatment we conducted a repeated measures ANOVA. The overall score as well as the three subscores of the axis structure improved significantly during inpatient treatment. The corresponding effect sizes were large (η(2) = .29 to .47). The inpatient psychodynamic treatment led to significant improvements regarding symptomatology as well as psychic structure. However, further studies with larger sample size and control group data should be conducted to confirm these results. PMID:27184789

  19. Protocol for the treatment of radiation injuries

    NASA Astrophysics Data System (ADS)

    Browne, D.; Weiss, J. F.; Macvittie, T. J.; Pillai, M. V.

    Despite adequate precautionary measures and high-quality safeguard devices, many accidental radiation exposures continue to occur and may pose greater risks in the future, including radiation exposure in the space environment. The medical management of radiation casualties is of major concern to health care providers. Such medical management was addressed at The First Consensus Development Conference on the Treatment of Radiation Injuries, Washington, DC, 1989. The conference addressed the most appropriate treatment for the hematopoietic and infectious complications that accompany radiation injuries and for combined radiation and traumatic/burn injuries. Based on the evidence presented at the conference, a consensus statement was formulated by expert physicians and scientists. The recommended therapies, including a suggested algorithm incorporating these recommendations for the treatment of radiation injuries, will be discussed.

  20. Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: Protocol Development and Initial Outcome Data

    ERIC Educational Resources Information Center

    Ellard, Kristen K.; Fairholme, Christopher P.; Boisseau, Christina L.; Farchione, Todd J.; Barlow, David H.

    2010-01-01

    The Unified Protocol (UP) is a transdiagnostic, emotion-focused cognitive-behavioral treatment developed to be applicable across the emotional disorders. The UP consists of 4 core modules: increasing emotional awareness, facilitating flexibility in appraisals, identifying and preventing behavioral and emotional avoidance, and situational and…

  1. Cellulitis: Home Or Inpatient in Children from the Emergency Department (CHOICE): protocol for a randomised controlled trial

    PubMed Central

    Ibrahim, Laila F; Babl, Franz E; Orsini, Francesca; Hopper, Sandy M; Bryant, Penelope A

    2016-01-01

    Introduction Children needing intravenous antibiotics for cellulitis are usually admitted to hospital, whereas adults commonly receive intravenous treatment at home. This is a randomised controlled trial (RCT) of intravenous antibiotic treatment of cellulitis in children comparing administration of ceftriaxone at home with standard care of flucloxacillin in hospital. The study aims to compare (1) the rate of treatment failure at home versus hospital (2) the safety of treatment at home versus hospital; and (3) the effect of exposure to short course ceftriaxone versus flucloxacillin on nasal and gut micro-organism resistance patterns and the clinical implications. Methods and analysis Inclusion criteria: children aged 6 months to <18 years with uncomplicated moderate/severe cellulitis, requiring intravenous antibiotics. Exclusions: complicated cellulitis (eg, orbital, foreign body) and immunosuppressed or toxic patients. The study is a single-centre, open-label, non-inferiority RCT. It is set in the emergency department (ED) at the Royal Children's Hospital (RCH) in Melbourne, Australia and the Hospital-in-the-Home (HITH) programme; a home-care programme, which provides outreach from RCH. Recruitment will occur in ED from January 2015 to December 2016. Participants will be randomised to either treatment in hospital, or transfer home under the HITH programme. The calculated sample size is 188 patients (94 per group) and data will be analysed by intention-to-treat. Primary outcome: treatment failure defined as a change in treatment due to lack of clinical improvement according to the treating physician or adverse events, within 48 h Secondary outcomes: readmission to hospital, representation, adverse events, length of stay, microbiological results, development of resistance, cost-effectiveness, patient/parent satisfaction. This study has started recruitment. Ethics and dissemination This study has been approved by the Human Research Ethics Committee of the RCH

  2. Fertility preservation with ovarian stimulation protocols prior to cancer treatment.

    PubMed

    Kasum, Miro; Šimunić, Velimir; Orešković, Slavko; Beketić-Orešković, Lidija

    2014-03-01

    An increasing trend towards later childbearing has been reported recently in many developed countries. Although the incidence of reproductive age in women who have delayed pregnancy with cancer is 10%, they may be concerned regarding the preservation of ovarian function due to advanced fertile age and with the impact of cancer treatment on later fertility. Among multiple strategies controlled, ovarian stimulation for embryo or oocyte cryopreservation is currently the most established method for fertility preservation. It is important to choose the appropriate ovulation induction protocol prior to oncologic treatment, because most of these patients have only the chance of a single cycle to conceive. Current treatment protocols offer a minimal time delay until oncologic treatment is commenced. In urgent settings, random-start ovarian stimulation represents a new technique which provides a significant advantage by decreasing the total time of the treatment, because it may be started irrespective of the phase of the cycle without compromising oocyte yield and maturity before cancer treatment. However, in patients with oestrogen-sensitive cancers stimulation, protocols using letrozole are currently preferred over tamoxifen regimens, and therefore, it may be highly advisable to use letrozole with gonadotrophins routinely as a safe, effective and novel protocol of ovulation induction. PMID:24256369

  3. [Outpatient orthopaedic rehabilitation: treatment, outcomes and costs as compared to inpatient rehabilitation].

    PubMed

    Bührlen, B; Jäckel, W H

    2002-01-01

    In a parallel design the study examined an outpatient rehabilitation model project for patients of the pension insurance scheme of Rhineland-Palatinate (LVA Rheinland-Pfalz). In 6 centers for the rehabilitation of musculoskeletal diseases patients were assessed at the beginning and at the end of rehabilitation as well as six and twelve months after discharge. In this article the final results concerning therapeutic measures as well as health-related and economic outcomes are presented. Not included are aspects of differential utilization and the perception of the rehabilitation by the clients, which will be published in a separate article. No large differences were found concerning participation in the various therapeutic measures. As measured by the main score and the sub-dimensions of the IRES patient questionnaire, effects of the same magnitude were found for the parallelized samples. Equally, no differences in outcome quality were found concerning the great majority of medical parameters documented in a doctors' questionnaire, the rate of applications for pension, occupational status twelve months after rehabilitation, as well as the reduction of sick-leave. The economic evaluation was carried out only from the perspective of the pension insurance agency. Considerable differences were found in the net costs of rehabilitation: although there are no user charges for patients in outpatient rehabilitation, mean expenditure was about 970 EURO lower than in inpatient rehabilitation. The study findings demonstrate that the concept of interdisciplinary rehabilitation has been realized in the outpatient centers as well and that the centers have reached an effectiveness comparable to that of inpatient rehabilitation. At least those patients who actively choose the outpatient setting gain as much as patients in inpatient rehabilitation. PMID:12007039

  4. Posthospitalization Outcomes for Psychiatric Sex Offenders: Comparing Two Treatment Protocols.

    PubMed

    Stinson, Jill D; McVay, Lee Ann; Becker, Judith V

    2016-05-01

    This study evaluates the effectiveness of safe offender strategies (SOS) in comparison with relapse prevention (RP) in a sample of 91 inpatient males in a secure psychiatric setting. All men evidenced a history of violent sexual offending and were diagnosed with serious psychiatric disorders and/or intellectual disabilities. Participants who received SOS (n= 58) and RP (n= 33) were followed from 6 to 36 months post release. SOS clients were significantly less likely to be arrested (0%) or rehospitalized (5.2%) than RP clients (9% arrested; 54.5% rehospitalized). In addition, SOS clients were more likely to transition continuously to less restrictive alternatives, with no returns to high security, in comparison with RP clients. The authors discuss implications for use of SOS, a treatment that facilitates skills development and affects global self-regulatory functioning, particularly in sex offenders with serious mental illness or intellectual impairment, in promoting community reintegration and limiting returns to psychiatric settings. PMID:26205684

  5. MCMI-III as a treatment outcome measure for psychiatric inpatients.

    PubMed

    Piersma, H L; Boes, J L

    1997-12-01

    The Million Clinical Multiaxial Inventory-III (MCMI-III) recently was introduced to replace and update the MCMI-II. A sample of 97 psychiatric inpatients were administered the MCMI-III shortly following admission, and again 7-10 days later. Changes in the personality and symptom scales generally paralleled those found in previous work with the MCMI-II, although the mean retest interval was considerably shorter than in the earlier study. However, some differences between the two instruments were observed, confirming the need for ongoing cross-validation work on the MCMI-III as an instrument that is distinct from the MCMI-II. PMID:9403384

  6. Mediation of symptom changes during inpatient treatment for eating disorders: the role of obsessive-compulsive features.

    PubMed

    Olatunji, Bunmi O; Tart, Candyce D; Shewmaker, Shona; Wall, David; Smits, Jasper A J

    2010-10-01

    The present study examined the relative contributions of changes in obsessive-compulsive symptoms among eating-disorder patients with (n = 254) and without (n = 254) obsessive-compulsive disorder (OCD) to eating-disorder symptom improvement observed with inpatient treatment. Consistent with hypothesis, multilevel mediation analyses revealed that improvements in OCD symptoms over time accounted for significant variance in the improvements in eating-disorder symptoms over time, with stronger mediation evident among eating-disorder patients with comorbid OCD (percent mediated; P(M) = 22.5%) compared to those without OCD (P(M) = 12.2%). However, decreases in eating-disorder symptoms over time fully mediated improvements in OCD symptoms over time, and this mediated pathway did not vary substantially as a function of comorbid OCD status. The theoretical and treatment implications of these findings for conceptualizing the relationship between eating disorders and OCD are discussed. PMID:20359715

  7. Adult Rhabdomyosarcoma Survival Improved With Treatment on Multimodality Protocols

    SciTech Connect

    Gerber, Naamit Kurshan; Wexler, Leonard H.; Singer, Samuel; Alektiar, Kaled M.; Keohan, Mary Louise; Shi, Weiji; Zhang, Zhigang; Wolden, Suzanne

    2013-05-01

    Purpose: Rhabdomyosarcoma (RMS) is a pediatric sarcoma rarely occurring in adults. For unknown reasons, adults with RMS have worse outcomes than do children. Methods and Materials: We analyzed data from all patients who presented to Memorial Sloan-Kettering Cancer Center between 1990 and 2011 with RMS diagnosed at age 16 or older. One hundred forty-eight patients met the study criteria. Ten were excluded for lack of adequate data. Results: The median age was 28 years. The histologic diagnoses were as follows: embryonal 54%, alveolar 33%, pleomorphic 12%, and not otherwise specified 2%. The tumor site was unfavorable in 67% of patients. Thirty-three patients (24%) were at low risk, 61 (44%) at intermediate risk, and 44 (32%) at high risk. Forty-six percent were treated on or according to a prospective RMS protocol. The 5-year rate of overall survival (OS) was 45% for patients with nonmetastatic disease. The failure rates at 5 years for patients with nonmetastatic disease were 34% for local failure and 42% for distant failure. Among patients with nonmetastatic disease (n=94), significant factors associated with OS were histologic diagnosis, site, risk group, age, and protocol treatment. On multivariate analysis, risk group and protocol treatment were significant after adjustment for age. The 5-year OS was 54% for protocol patients versus 36% for nonprotocol patients. Conclusions: Survival in adult patients with nonmetastatic disease was significantly improved for those treated on RMS protocols, most of which are now open to adults.

  8. Emotional Intolerance and Core Features of Anorexia Nervosa: A Dynamic Interaction during Inpatient Treatment? Results from a Longitudinal Diary Study

    PubMed Central

    Stroe-Kunold, Esther; Friederich, Hans-Christoph; Stadnitski, Tatjana; Wesche, Daniela; Herzog, Wolfgang; Schwab, Michael; Wild, Beate

    2016-01-01

    Objective The role of emotion dysregulation with regard to the psychopathology of anorexia nervosa (AN) is increasingly discussed. It is both assumed that AN symptoms have an impact on difficulties in tolerating aversive emotions and that—conversely—emotion dysregulation influences AN. To date, such conclusions are drawn on the basis of cross-sectional data not allowing for inferences on the temporal dynamics. The current study investigates the longitudinal interaction between emotional intolerance and core AN symptoms over the course of inpatient treatment by comparing patients with high (BMI<15 kg/m2) vs. low symptom severity (HSS vs. LSS). Method The study adopted a longitudinal, process-oriented design with N = 16 analysed electronic diaries. Throughout the course of their inpatient treatment, the patients answered questions daily about emotional intolerance and their AN-specific cognitions and behaviours. The temporal dynamics between emotional intolerance and these variables were analysed using a multivariate time series approach. Results The time series of the processes under investigation adequately reflected the individual treatment courses. The majority of significant linear time trends was found for HSS patients. Most importantly, analysis revealed significant temporal interactions between emotional intolerance and AN symptoms in almost 70% of HSS patients. Thereby, up to 37% of variance in eating restraint and up to 23% in weight concern could be attributed to changes in emotional intolerance. Conclusions The findings support the notion that intolerable unpleasant emotions in severely affected AN patients influence their psychopathology. Additionally, time series analysis outlined the inter-individual heterogeneity of psychosomatic treatment courses of AN patients. PMID:27191959

  9. Hospital and patient influencing factors of treatment schemes given to type 2 diabetes mellitus inpatients in Inner Mongolia, China

    PubMed Central

    Zhang, Nan; McNeil, Edward; Assanangkornchai, Sawitri; Fan, Yancun

    2016-01-01

    Background: In clinical practice, the physician’s treatment decision making is influenced by many factors besides the patient’s clinical conditions and is the fundamental cause of healthcare inequity and discrimination in healthcare settings. Type 2 diabetes mellitus (T2DM) is a chronic disease with high prevalence, long average length of stay and high hospitalization rate. Although the treatment of T2DM is well guideline driven, there is a large body of evidence showing the existence of treatment disparities. More empirical studies from the provider side are needed to determine if non-clinical factors influence physician’s treatment choices. Objective: To determine the hospital and patient influencing factors of treatment schemes given to T2DM inpatients in Inner Mongolia, China. Methods: A cross-sectional, hospital-based survey using a cluster sampling technique was conducted in three tertiary hospitals and three county hospitals in Inner Mongolia, China. Treatment schemes were categorized as lifestyle management, oral therapy or insulin therapy according to the national guideline. Socio-demographic characteristics and variables related to severity of disease at the individual level and hospital level were collected. Weighted multinomial logistic regression models were used to determine influencing factors of treatment schemes. Results: Regardless of patients’ clinical conditions and health insurance types, both hospital and patient level variables were associated with treatment schemes. Males were more likely to be given oral therapy (RRR=1.72, 95% CI=1.06-2.81) and insulin therapy (RRR=1.94, 95% CI=1.29-2.91) compared to females who were given lifestyle management more frequently. Compared to the western region, hospitals in the central regions of Inner Mongolia were less likely to prescribe T2DM patients oral therapy (RRR = 0.18, 95% CI=0.05-0.61) and insulin therapy (RRR = 0.20, 95% CI=0.06-0.67) than lifestyle management. Compared with non

  10. Predicting response to intensive multimodal inpatient treatment: a comparison of single- and multiple-class growth modeling approaches.

    PubMed

    Smith, Justin D; Van Ryzin, Mark J; Fowler, J Christopher; Handler, Leonard

    2014-01-01

    In a modest body of research, personality functioning assessed via performance-based instruments has been found to validly predict treatment outcome and, to some extent, differential response to treatment. However, state-of-the-science longitudinal and mixture modeling techniques, which are common in many areas of clinical psychology, have rarely been used. In this article, we compare multilevel growth curve modeling (MLM) and latent class growth modeling (LCGM) approaches with the same data set to illustrate the different research questions that can be addressed by each method. Global Assessment of Functioning (GAF) scores collected at 6 points during the course of a long-term multimodal inpatient treatment of 58 severely and persistently mentally ill adults were used to model the trajectory of treatment outcome. Pretreatment Rorschach-based markers of personality functioning and other markers of psychiatric severity were examined as covariates in each modeling approach. The results of both modeling approaches generally indicated that more psychologically impaired clients responded less favorably to treatment. The LCGM approach revealed 2 unique trajectories of improvement (a persistently low group and a higher starting, improving group). Personality functioning and baseline psychiatric variables significantly predicted group membership and the rate of change within the groups. A side-by-side examination of these 2 methods was found to be useful in predicting differential treatment response with personality functioning variables. PMID:24066712

  11. Decision-making capacity for treatment in psychiatric and medical in-patients: cross-sectional, comparative study†

    PubMed Central

    Owen, Gareth S.; Szmukler, George; Richardson, Genevra; David, Anthony S.; Raymont, Vanessa; Freyenhagen, Fabian; Martin, Wayne; Hotopf, Matthew

    2013-01-01

    Background Is the nature of decision-making capacity (DMC) for treatment significantly different in medical and psychiatric patients? Aims To compare the abilities relevant to DMC for treatment in medical and psychiatric patients who are able to communicate a treatment choice. Method A secondary analysis of two cross-sectional studies of consecutive admissions: 125 to a psychiatric hospital and 164 to a medical hospital. The MacArthur Competence Assessment Tool - Treatment and a clinical interview were used to assess decision-making abilities (understanding, appreciating and reasoning) and judgements of DMC. We limited analysis to patients able to express a choice about treatment and stratified the analysis by low and high understanding ability. Results Most people scoring low on understanding were judged to lack DMC and there was no difference by hospital (P = 0.14). In both hospitals there were patients who were able to understand yet lacked DMC (39% psychiatric v. 13% medical in-patients, P<0.001). Appreciation was a better ‘test’ of DMC in the psychiatric hospital (where psychotic and severe affective disorders predominated) (P<0.001), whereas reasoning was a better test of DMC in the medical hospital (where cognitive impairment was common) (P = 0.02). Conclusions Among those with good understanding, the appreciation ability had more salience to DMC for treatment in a psychiatric setting and the reasoning ability had more salience in a medical setting. PMID:23969482

  12. Eye movement desensitization and reprocessing (EMDR) therapy in the treatment of depression: a matched pairs study in an inpatient setting

    PubMed Central

    Hase, Michael; Balmaceda, Ute Mirian; Hase, Adrian; Lehnung, Maria; Tumani, Visal; Huchzermeier, Christian; Hofmann, Arne

    2015-01-01

    Background Depression is a severe mental disorder that challenges mental health systems worldwide as the success rates of all established treatments are limited. Eye Movement Desensitization and Reprocessing (EMDR) therapy is a scientifically acknowledged psychotherapeutic treatment for PTSD. Given the recent research indicating that trauma and other adverse life experiences can be the basis of depression, the aim of this study was to determine the effectiveness of EMDR therapy with this disorder. Method In this study, we recruited a group of 16 patients with depressive episodes in an inpatient setting. These 16 patients were treated with EMDR therapy by reprocessing of memories related to stressful life events in addition to treatment as usual (TAU). They were compared to a group of 16 controls matched regarding diagnosis, degree of depression, sex, age and time of admission to hospital, which were receiving TAU only. Results Sixty-eight percent of the patients in the EMDR group showed full remission at end of treatment. The EMDR group showed a greater reduction in depressive symptoms as measured by the SCL-90-R depression subscale. This difference was significant even when adjusted for duration of treatment. In a follow-up period of more than 1 year the EMDR group reported less problems related to depression and less relapses than the control group. Conclusions EMDR therapy shows promise as an effective treatment for depressive disorders. Larger controlled studies are necessary to replicate our findings. PMID:26085967

  13. "There's no such thing as a patient": reflections on the significance of the work of D. W. Winnicott for modern inpatient psychiatric treatment.

    PubMed

    Casher, Michael Ira

    2013-01-01

    The writings of D. W. Winnicott, British pediatrician and psychoanalyst, focus on the details of the early dyadic mother-child relationship and how impingements on the smooth unfolding of the developmental process can lead to psychopathology. Several of his concepts, such as holding environment and transitional object, have permeated into psychiatric theory and practice. The scope of his creative theoretical and clinical thinking goes far beyond these well-known terms and has particular relevance to the acute inpatient psychiatric setting. This article outlines the significance of Winnicott's major ideas and how they can be used to better understand the mutative factors of inpatient treatment, to illuminate complex clinical interactions, and to assist in guiding care of psychiatric inpatients. PMID:24651506

  14. Variations in Risk and Treatment Factors among Adolescents Engaging in Different Types of Deliberate Self-Harm in an Inpatient Sample

    ERIC Educational Resources Information Center

    Boxer, Paul

    2010-01-01

    This study employs a framework adopted in 2008 by Jacobson, Muehlenkamp, Miller, and Turner to explore differences in risk and treatment factors in a sample of 476 adolescent inpatients grouped with relation to their involvement in deliberately self-harmful (DSH) behavior. Participants were assigned to groups indicating no DSH, nonsuicidal…

  15. Substance Abuse Treatment: Group Therapy. Treatment Improvement Protocol (TIP) Series 41

    ERIC Educational Resources Information Center

    Gilbert, Jonathan Max; Hills, Susan; Rife, Mary Lou

    2005-01-01

    This Treatment Improvement Protocol (TIP) presents an overview of the role and efficacy of group therapy in substance abuse treatment. TIPs are best-practice guidelines for the treatment of substance use disorders that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel…

  16. Substance Abuse Treatment And Family Therapy. A Treatment Improvement Protocol (TIP) Series 39

    ERIC Educational Resources Information Center

    Gilbert, Jonathan Max; Oliff, Helen; Sutton, David; Bartlett, Catalina; Henderson, Randi

    2004-01-01

    This Treatment Improvement Protocol (TIP) addresses substance abuse treatment in the context of family therapy. TIPs are best-practice guidelines for the treatment of substance use disorders that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel of experts in the…

  17. Mandible condylar hyperplasia: a review of diagnosis and treatment protocol

    PubMed Central

    Olate, Sergio; Netto, Henrique Duque; Rodriguez-Chessa, Jaime; Alister, Juan Pablo; de Albergaria-Barbosa, Jose; de Moraes, Márcio

    2013-01-01

    Condylar hyperplasia (CH) is a bone disease characterized by the increased development of one mandibular condyle. It regularly presents as an active growth with facial asymmetry generally without pain. Statistically it affects more women in adolescence, although it does not discriminate by age or gender. Its best-known consequence is asymmetric facial deformity (AFD), which combined with alteration of the dental occlusion with unilateral crossbite or open bite. It is not known when CH begins and how long it lasts; diagnostic examinations are described and are efficient in some research about diagnosis. Protocol treatment is not well studie and depends on the criteria described in this paper. The aim of this research is to provide up-to-date information about the diagnosis of this disease and to analyze the treatment protocol, visualizing the CH and AFD presented. PMID:24179565

  18. Mandible condylar hyperplasia: a review of diagnosis and treatment protocol.

    PubMed

    Olate, Sergio; Netto, Henrique Duque; Rodriguez-Chessa, Jaime; Alister, Juan Pablo; de Albergaria-Barbosa, Jose; de Moraes, Márcio

    2013-01-01

    Condylar hyperplasia (CH) is a bone disease characterized by the increased development of one mandibular condyle. It regularly presents as an active growth with facial asymmetry generally without pain. Statistically it affects more women in adolescence, although it does not discriminate by age or gender. Its best-known consequence is asymmetric facial deformity (AFD), which combined with alteration of the dental occlusion with unilateral crossbite or open bite. It is not known when CH begins and how long it lasts; diagnostic examinations are described and are efficient in some research about diagnosis. Protocol treatment is not well studie and depends on the criteria described in this paper. The aim of this research is to provide up-to-date information about the diagnosis of this disease and to analyze the treatment protocol, visualizing the CH and AFD presented. PMID:24179565

  19. The significance of persistent fever in the treatment of suspected bacterial infections among inpatients: a prospective cohort study.

    PubMed

    Neuberger, A; Yahav, D; Daitch, V; Akayzen, Y; Farbman, L; Avni, T; Leibovici, L; Paul, M

    2015-04-01

    Antibiotic escalations are frequently guided by fever persistence. Unnecessary antibiotic escalation is associated with resistance induction. We examined whether fever persistence is associated with adverse outcomes among medical inpatients with sepsis. In a single-center prospective cohort study, we included consecutive medical inpatients with suspected or documented bacterial infections. Data were collected on days 0, 2, 4, and 30 days from episode onset. We examined the association between fever persistence at 4 days and 30-day mortality on univariate and multivariate analysis. Inappropriate empirical antibiotic treatment (IAET) was defined for patients with microbiologically documented infections (MDIs). Odds ratios (ORs) are presented with 95% confidence intervals (CIs). A total of 1,621 patients were included. Among patients with MDIs, 38/206 (18.4%) given appropriate empiric therapy had continued fever on day 4, compared to 64/231 (27.7%) of patients receiving IAET, OR 0.59, 95% CI 0.37-0.93. Fever persistence was not associated with mortality after adjustment for other risk factors. Among patients with presumed sepsis who did not have MDIs, persistent fever was significantly associated with 30-day mortality on a multivariate analysis, adjusted OR 2.77 (95% CI 1.78-4.31). Other risk factors for mortality included older age, nosocomial infections, malignancy, dyspnea, shock, decreased albumin, and elevated creatinine. For patients with MDIs, fever persistence for up to 4 days is a marker of IAET, but is not associated with mortality, and should not, in itself, trigger antibiotic escalation. For patients without MDIs, fever persistence should trigger careful re-evaluation, as it is associated with mortality. PMID:25502509

  20. The feasibility of a holistic wellness program for HIV/AIDS patients residing in a voluntary inpatient treatment program.

    PubMed

    Morgan, Vanessa

    2014-03-01

    The purpose of this project was to examine the feasibility of an ongoing holistic wellness program in a residential facility treating persons with HIV/AIDS. The goal was to create a voluntary, four week holistic wellness intensive within the established inpatient behavioral health treatment program. Participants were given practicable holistic self care tools to effectively manage HIV related symptoms, general medical issues, addiction, depression, stress and anxiety. The program incorporated evidence-based holistic activities including yoga, therapeutic dance, meditation, Reiki, and reflective journaling. Narrative survey results and post-program evaluation support that an ongoing holistic wellness program within the existing treatment model is feasible and could have numerous potential beneficial effects. This project clearly exemplified the ideal opportunity for holistic nurses to implement innovative holistic interventions within the current healthcare delivery system. It is the author's observation that future studies with a larger participant group to further examine measurable benefits can lend valuable information and insight into the future development of holistic wellness programs for residential treatment facilities. PMID:23686463

  1. VAC protocol for treatment of dogs with stage III hemangiosarcoma.

    PubMed

    Alvarez, Francisco J; Hosoya, Kenji; Lara-Garcia, Ana; Kisseberth, William; Couto, Guillermo

    2013-01-01

    Hemangiosarcomas (HSAs) are aggressive tumors with a high rate of metastasis. Clinical stage has been considered a negative prognostic factor for survival. The study authors hypothesized that the median survival time (MST) of dogs with metastatic (stage III) HSA treated with a vincristine, doxorubicin, and cyclophosphamide (VAC) chemotherapy protocol would not be different than those with stage I/II HSA. Sixty-seven dogs with HSA in different anatomic locations were evaluated retrospectively. All dogs received the VAC protocol as an adjuvant to surgery (n = 50), neoadjuvant (n = 3), or as the sole treatment modality (n = 14). There was no significant difference (P = 0.97) between the MST of dogs with stage III and stage I/II HSA. For dogs presenting with splenic HSA alone, there was no significant difference between the MST of dogs with stage III and stage I/II disease (P = 0.12). The overall response rate (complete response [CR] and partial response [PR]) was 86%). No unacceptable toxicities were observed. Dogs with stage III HSA treated with the VAC protocol have a similar prognosis to dogs with stage I/II HSA. Dogs with HSA and evidence of metastases at the time of diagnosis should not be denied treatment. PMID:24051260

  2. Single-Rooted Extraction Sockets: Classification and Treatment Protocol.

    PubMed

    El Chaar, Edgar; Oshman, Sarah; Fallah Abed, Pooria

    2016-09-01

    Clinicians have many treatment techniques from which to choose when extracting a failing tooth and replacing it with an implant-supported restoration and when successful management of an extraction socket during the course of tooth replacement is necessary to achieve predictable and esthetic outcomes. This article presents a straightforward, yet thorough, classification for extraction sockets of single-rooted teeth and provides guidance to clinicians in the selection of appropriate and predictable treatment. The presented classification of extraction sockets for single-rooted teeth focuses on the topography of the extraction socket, while the protocol for treatment of each socket type factors in the shape of the remaining bone, the biotype, and the location of the socket whether it be in the mandible or maxilla. This system is based on the biologic foundations of wound healing and can help guide clinicians to successful treatment outcomes. PMID:27608197

  3. Substance Abuse Treatment for Persons with Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series 42

    ERIC Educational Resources Information Center

    Substance Abuse and Mental Health Services Administration, 2005

    2005-01-01

    Treatment Improvement Protocols (TIPs), developed by the Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (DHHS), are best-practice guidelines for the treatment of substance use disorders. CSAT draws on the experience…

  4. A protocol for systematic reviews of Ayurveda treatments

    PubMed Central

    Narahari, Saravu R; Aggithaya, Madhur Guruprasad; Suraj, Kumbla R.

    2010-01-01

    This protocol is intended primarily for Ayurveda doctors who wish to take up systematic reviews along with an expert who has experience in doing such reviews. We have structured this protocol by incorporating the principles of patient treatment in Ayurveda, within the Cochrane framework, using Vitiligo as a model. The treatment section provides a comprehensive list of classical medicines used in the treatment of the disease. This will help in increasing the search terms. Such a list also helps to determine the needs of individualized treatment principles used in the trial and to assess the confounding factors. The search strategy includes an extensive listing of eastern data bases and hand searching. In Ayurveda, the titles of articles are not in the Population, Intervention, Control, and Outcome (PICO) pattern and sometimes the title and methodology do not tally. Therefore, a search of all types of studies is necessary to pool all the relevant publications. A data extraction form is proposed for use in assessing the quality of Ayurvedic studies. The form provides a template for performing evidence reviews of Ayurvedic interventions. PMID:21455455

  5. A protocol for systematic reviews of Ayurveda treatments.

    PubMed

    Narahari, Saravu R; Aggithaya, Madhur Guruprasad; Suraj, Kumbla R

    2010-10-01

    This protocol is intended primarily for Ayurveda doctors who wish to take up systematic reviews along with an expert who has experience in doing such reviews. We have structured this protocol by incorporating the principles of patient treatment in Ayurveda, within the Cochrane framework, using Vitiligo as a model. The treatment section provides a comprehensive list of classical medicines used in the treatment of the disease. This will help in increasing the search terms. Such a list also helps to determine the needs of individualized treatment principles used in the trial and to assess the confounding factors. The search strategy includes an extensive listing of eastern data bases and hand searching. In Ayurveda, the titles of articles are not in the Population, Intervention, Control, and Outcome (PICO) pattern and sometimes the title and methodology do not tally. Therefore, a search of all types of studies is necessary to pool all the relevant publications. A data extraction form is proposed for use in assessing the quality of Ayurvedic studies. The form provides a template for performing evidence reviews of Ayurvedic interventions. PMID:21455455

  6. Preventing Suicide Among Inpatients

    PubMed Central

    Sakinofsky, Isaac

    2014-01-01

    Objective Inpatient suicide comprises a proportionately small but clinically important fraction of suicide. This study is intended as a qualitative analysis of the comprehensive English literature, highlighting what is known and what can be done to prevent inpatient suicide. Method: A systematic search was conducted on the Cochrane Library, PubMed, Embase, Web of Knowledge, and a personal database for articles on cohort series, preferably controlled, of inpatient suicide (not deliberate self-harm or attempted suicide, unless they also dealt specifically with suicide data). Results: A qualitative discussion is presented, based on the findings of the literature searched. Conclusions: The bulk of inpatient suicides actually occur not on the ward but off premises, when the patient was on leave or had absconded. Peaks occur shortly after admission and discharge. It is possible to reduce suicide risk on the ward by having a safe environment, optimizing patient visibility, supervising patients appropriately, careful assessment, awareness of and respect for suicide risk, good teamwork and communication, and adequate clinical treatment. PMID:24881161

  7. Effects of long-term valproic acid treatment on hematological and biochemical parameters in adolescent psychiatric inpatients: a retrospective naturalistic study.

    PubMed

    Amitai, Maya; Sachs, Ephi; Zivony, Amir; Remez, Roei; Ben Baruch, Reut; Amit, Ben H; Kronenberg, Sefi; Apter, Alan; Shoval, Gal; Weizman, Abraham; Zalsman, Gil

    2015-09-01

    The objective of this study was to determine the long-term hematological and biochemical side effects of valproic acid (VPA) in psychiatric adolescent inpatients. A retrospective naturalistic study design was used. Participants were psychiatric inpatients treated with VPA, alone or in combination with other medications. Electronic medical files were reviewed for changes in hematological and biochemical parameters following a course of VPA treatment. One hundred and four adolescents aged 12-18 (mean 15.76±1.58) years fulfilled the study criteria. The mean blood level and duration of VPA treatment were 65.81±22.18 mcg/ml and 98.57±135.94 days, respectively. The mean levels of thyroid-stimulating hormones and triglyceride levels increased significantly from the first to the last measurement. Platelet count decreased significantly following VPA treatment. No correlation was observed between these parameters and age, duration of treatment, or VPA levels. No serious adverse events were reported. Long-term VPA treatment in adolescents with psychiatric disorders is associated with significant increases in triglyceride levels. Moreover, VPA-treated adolescent psychiatric inpatients may be at risk of developing pituitary-thyroid axis dysregulation and decreased platelet count. Therefore, baseline measurement of thyroid functions and metabolic and hematological parameters and monitoring throughout the treatment are recommended. PMID:26020713

  8. Coping strategies, hope, and treatment efficacy in pharmacoresistant inpatients with neurotic spectrum disorders

    PubMed Central

    Ociskova, Marie; Prasko, Jan; Kamaradova, Dana; Grambal, Ales; Kasalova, Petra; Sigmundova, Zuzana; Latalova, Klara; Vrbova, Kristyna

    2015-01-01

    Background Approximately 30%–60% of patients with neurotic spectrum disorders remain symptomatic despite treatment. Identifying the predictors of good response to psychiatric and psychotherapeutic treatment may be useful for increasing treatment efficacy in neurotic patients. The objective of this study was to investigate the influence of hope, coping strategies, and dissociation on the treatment response of this group of patients. Methods Pharmacoresistant patients, who underwent a 6-week psychotherapeutic program, were enrolled in the study. All patients completed the Clinical Global Impression (CGI) – both objective and subjective forms, Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI)-II at baseline and after 6 weeks. The COPE Inventory, the Adult Dispositional Hope Scale (ADHS), and the Dissociative Experiences Scale (DES) were completed at the start of the treatment. Results Seventy-six patients completed the study. The mean scores for all scales measuring the severity of the disorders (BAI, BDI-II, subjective and objective CGI) significantly decreased during the treatment. Several subscores of the COPE Inventory, the overall score of ADHS, and the overall score of DES significantly correlated with the treatment outcome. Multiple regression was used to find out which factors were the most significant predictors of the therapeutic outcomes. The most important predictors of the treatment response were the overall levels of hope and dissociation. Conclusion According to our results, a group of patients with a primary neurotic disorder, who prefer the use of maladaptive coping strategies, feel hopelessness, and have tendencies to dissociate, showed poor response to treatment. PMID:26028972

  9. Mandibular trauma treatment: A comparison of two protocols

    PubMed Central

    Kommers, Sofie C.; Roccia, Fabio; Forouzanfar, Tymour

    2015-01-01

    Objectives: The aim of this study was to evaluate the treatment of mandibular fractures treated in two European centre in 10 years. Study Design: This study is based on 2 systematic computer-assisted databases that have continuously recorded patients hospitalized with maxillofacial fractures in two centers in Turin, Italy and in Amsterdam, the Netherlands for ten years. Only patients who were admitted for mandibular fractures were considered for this study. Results: Between 2001 and 2010, a total of 752 patients were admitted at Turin hospital with a total of 1167 mandibular fractures not associated with further maxillofacial fractures, whereas 245 patients were admitted at Amsterdam hospital with a total of 434 mandibular fractures. At Amsterdam center, a total of 457 plates (1.5 - 2.7 mm) were used for the 434 mandibular fracture lines, whereas at Turin center 1232 plates (1.5 – 2.5 mm) were used for the management of the 1167 mandibular fracture lines. At Turin center, 190 patients were treated primarily with IMF, whereas 35 patients were treated with such treatment option at Amsterdam center. Conclusions: Current protocols for the management of mandibular fractures are quite efficient. It is difficult to obtain a uniform protocol, because of the difference of course of each occurring fracture and because of surgeons’ experiences and preferences. Several techniques can still be used for each peculiar fracture of the mandible. Key words:Mandibular fracture, facial trauma, maxillofacial, treatment, multicentre, database. PMID:25475782

  10. Adolescents in Residential and Inpatient Treatment: A Review of the Outcome Literature

    ERIC Educational Resources Information Center

    Bettmann, Joanna E.; Jasperson, Rachael A.

    2009-01-01

    Operationalizing treatment efficacy has become essential in the field of psychotherapy. Managed health care now requires psychotherapy to produce measurable outcomes and define success concretely. This requirement has resulted in research attempting to identify empirically supported and evidence-based treatments. This article presents a review of…

  11. Costs of HIV+/AIDS at CD4+ counts disease stages based on treatment protocols.

    PubMed

    Gable, C B; Tierce, J C; Simison, D; Ward, D; Motte, K

    1996-08-01

    We report treatment protocols for HIV+/AIDS patients by CD4+ counts (T-lymphocyte cells/mm3: > or = 500, 499-200, 199-50, and < 50) as a tool to provide better definition and to project annual costs (total charges for services) and lifetimes costs for HIV+/AIDS. The treatment protocols, derived from the literature and an HIV+/AIDS Physician Panel, defined the resource use associated with antiretroviral therapy and opportunistic disease prophylaxis and treatment. Resource use costs were derived from the published literature, insurance database, Medicare fee schedules, surveys, and the Physician Panel. At CD4+ counts, the rates of opportunistic diseases were derived from the Physician Panel experience; the mean occupancy times were derived from the literature. The sensitivity analysis indicated stability of the lifetime costs to variation in mean occupancy times, rates of opportunistic diseases, rates of adverse events (AE), and costs. The total annual costs (1995 dollars) of HIV+/AIDS patients ranged from $1,934 (> or = 500), $6,015 (200-499), and $9,031 (50-199), to $25,239 ( < 50). The annual costs of opportunistic diseases are esophageal candidiasis (EC) ($2,194), tuberculosis (TB) ($2,924), cryptococcal meningitis (CM) ($17,264), toxoplasmosis ($17,631), Mycobacterium avium complex (MAC) (+20,153), Non-Hodgkin's lymphoma (NHL) ($22,329), wasting syndrome ($26,676), central nervous system (CNS) lymphoma ($27,333), Pneumocystis carinii pneumonia (PCP) [mild ($3,545), moderate ($4,889), and severe ($32,609)], Kaposi' sarcoma (KS) [mild/moderate ($5,902), and severe ($10,744)], and cytomegalovirus (CMV) retinitis ($100,337). The projected lifetime costs of HIV+/AIDS are $94,726 (annual costs $7,645). Our lower lifetime costs as compared with recent estimates may be due to including resources only for HIV+/AIDS-related treatment and not for non-HIV+/AIDS conditions, as well as reduced resource use resulting from more efficient diagnostic and therapeutic techniques

  12. Oral health status and treatment needs among psychiatric inpatients in Rennes, France: a cross-sectional study

    PubMed Central

    2013-01-01

    Background Severe mental disorders have a chronic course associated with a high risk for co-morbid somatic illnesses and premature mortality and oral health is critical for overall systemic health. But general health care needs in this population are often neglected. Some studies have aimed at determining the oral health status of psychiatric in-patients but to date, no emphasis has been placed on oral health of psychiatric patients in France. The goal of this study was to assess the oral health and treatment needs of institutionalized patients in a large psychiatric hospital, where a dental service was available and free, to compare it with the average population, with psychiatric in-patients in other countries and to provide recommendations for psychiatrists and care-giving staff. Methods The dental status (DMFT), the oral hygiene (OHIS: Simplified Oral Hygiene Index), the saliva flow rate were recorded on a randomized patient sample. Demographic and medical data were retrieved from the institutional clinical files. Results Among the 161 examined patients, 95 (59.0%) were men and 66 (41.0%) were women. The mean age was 46.9 ± 17.5 years. The majority was diagnosed schizophrenia (36.6%) or mood disorders (21.1%). The mean OHIS was 1.7 ± 1.1. Among the 147 patients who agreed to carry out the salivary examination, the average saliva flow rate was 0.3 g ± 0.3 g/min. Saliva flow under the average rest saliva flow (0.52 mg/min) was found for 80.3% of the patient. The mean DMFT was 15.8 ± 8.8 (D = 3.7 ± 4.4, M = 7.3 ± 9.4, F = 4.7 ± 4.9) and significantly increased with age (p < 0.001) and degree of disability (p = 0.003) (stepwise linear regression). Eighteen patients (11.2%) were edentulous. Conclusions The DMFT was similar to low income French population but psychiatric patients had almost 4 times more decayed teeth, slightly less missing teeth and 1.5 times less filled teeth. Oral health appeared to be better than in most other countries. But compared to

  13. Three- and Five-Year Follow-Up of a Combined Inpatient-Outpatient Treatment of Obese Children and Adolescents

    PubMed Central

    Adam, Sibylle; Rudolphi, Birgit; Kraaibeek, Hanna-Kathrin

    2013-01-01

    Aim. “The combined DAK therapy for obesity in children and adolescents” combines a 6-week inpatient with a 10.5-month outpatient treatment. The aim of the study is to evaluate whether the therapeutic achievements are maintained two and four years after intervention. Method. All subjects who had participated in the 12-month program in 2004/2005 were included in the follow-up study. Body weight, height, and physical fitness were assessed through direct measurements, behaviour, and quality of life by self-report questionnaires. Statistical analysis is based on an intention-to-treat analysis. Results. The response rate after three years was 63.4% and 42.2% after five years. Within three years, participants reduced their BMI-SDS significantly by 0.20 (SD 0.49) and by 0.15 (SD 0.51) within five years. Significant positive changes could be observed with respect to the participants eating behaviour. Similarly, the food intake, particularly the consumption of calorie-reduced beverages, increased significantly while that of nonrecommended foods decreased. Improvement was also seen in the subjective quality of life as well as several aspects of self-perception. Conclusion. Compared to baseline data, significant reduction of BMI-SDS and positive changes of health-related behaviours could be observed even three and five years after the start of the initial program. PMID:23690795

  14. Treatment Integrity Assessment in the Schools: An Evaluation of the Treatment Integrity Planning Protocol

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; Kratochwill, Thomas R.

    2009-01-01

    The Treatment Integrity Planning Protocol (TIPP) provides a structured process for collaboratively creating a treatment integrity assessment within a consultation framework. The authors evaluated the effect of the TIPP on the implementation of an intervention designed to improve the consistency of students' mathematics performance. Treatment…

  15. Inpatient Applications of Cognitive-Behavioral Therapy

    PubMed Central

    STUART, SCOTT; THASE, MICHAEL E.

    1994-01-01

    The authors review empirical research of the past decade on cognitive-behavioral therapy (CBT) in the treatment of depressed inpatients and offer suggestions for future investigations. CBT appears to offer additive benefits in combination with pharmacotherapy, particularly after the transition from inpatient to outpatient treatment. CBT also holds promise as a primary treatment for inpatients but has not been clearly shown to be as effective as antidepressants. There is as yet no evidence that inpatient CBT is superior to other psychotherapies of comparable intensity or that short-term inpatient CBT has enduring value if not followed by outpatient therapy. Further research is needed to clarify the specific effects of CBT for inpatients and to establish its cost-effectiveness. PMID:22700196

  16. Nonsurgical Korean Integrative Treatments for Symptomatic Lumbar Spinal Stenosis: A Three-Armed Randomized Controlled Pilot Trial Protocol

    PubMed Central

    Kim, Kiok; Shin, Kyung-Min; Lee, Jun-Hwan; Seo, Bok-Nam; Jung, So-Young; Youn, Yousuk; Lee, Sang Ho; Kim, Jaehong; Qu, Wenchun

    2016-01-01

    This is a study protocol for a pilot three-armed randomized controlled trial on nonsurgical integrative Korean medicinal treatment for symptomatic lumbar spinal stenosis (LSS). Thirty-six participants who have been diagnosed with (LSS) and recommended for spinal surgery by neurosurgeons or orthopedics and have had spinal symptoms such as severe low back pain and neurological claudication regardless of at least three months of conservative treatments will be recruited. Participants will be randomly assigned to be one of the three intervention groups, including the Mokhuri treatment program group 1 or 2 or usual care group. All treatments will be administered in inpatient units over a period of 4 weeks. The primary outcomes are 0 to 100 Visual Analogue Scales for low back pain and leg pain and the secondary outcomes are Oswestry Disability Index; EQ-5D; Roland-Morris Disability Questionnaire; Oxford Claudication Score; physical function test, including treadmill test, walking duration, and distance assessment for free leg pain; radiologic testing; and adverse events which will be assessed during the 4-week treatment period as well as after 3 and 6 months of follow-up. Then, we will assess the feasibility of the clinical trial design as well as a nonsurgical integrative treatment program. This trial is registered with CRIS registration number: KCT0001218. PMID:26941823

  17. Nonsurgical Korean Integrative Treatments for Symptomatic Lumbar Spinal Stenosis: A Three-Armed Randomized Controlled Pilot Trial Protocol.

    PubMed

    Kim, Kiok; Shin, Kyung-Min; Lee, Jun-Hwan; Seo, Bok-Nam; Jung, So-Young; Youn, Yousuk; Lee, Sang Ho; Kim, Jaehong; Qu, Wenchun; Kim, Tae-Hun

    2016-01-01

    This is a study protocol for a pilot three-armed randomized controlled trial on nonsurgical integrative Korean medicinal treatment for symptomatic lumbar spinal stenosis (LSS). Thirty-six participants who have been diagnosed with (LSS) and recommended for spinal surgery by neurosurgeons or orthopedics and have had spinal symptoms such as severe low back pain and neurological claudication regardless of at least three months of conservative treatments will be recruited. Participants will be randomly assigned to be one of the three intervention groups, including the Mokhuri treatment program group 1 or 2 or usual care group. All treatments will be administered in inpatient units over a period of 4 weeks. The primary outcomes are 0 to 100 Visual Analogue Scales for low back pain and leg pain and the secondary outcomes are Oswestry Disability Index; EQ-5D; Roland-Morris Disability Questionnaire; Oxford Claudication Score; physical function test, including treadmill test, walking duration, and distance assessment for free leg pain; radiologic testing; and adverse events which will be assessed during the 4-week treatment period as well as after 3 and 6 months of follow-up. Then, we will assess the feasibility of the clinical trial design as well as a nonsurgical integrative treatment program. This trial is registered with CRIS registration number: KCT0001218. PMID:26941823

  18. Which values are important for patients during involuntary treatment? A qualitative study with psychiatric inpatients.

    PubMed

    Valenti, Emanuele; Giacco, Domenico; Katasakou, Christina; Priebe, Stefan

    2014-12-01

    Involuntary hospital treatment is practised throughout the world. Providing appropriate treatment in this context is particularly challenging for mental health professionals, who frequently face ethical issues as they have to administer treatments in the absence of patient consent. We have explored the views of 59 psychiatric patients who had been involuntarily admitted to hospital treatment across England. Moral deliberation theory, developed in the field of clinical bioethics, was used to assess ethical issues. Interviews were audio recorded and transcribed verbatim, and analysed through thematic content analysis. We have detected a number of circumstances in the hospital that were perceived as potentially conflictual by patients. We have established which patient values should be considered by staff when deliberating on ethically controversial issues in these circumstances. Patients regarded as important having freedom of choice and the feeling of being safe during their stay in the hospital. Patients also valued non-paternalistic and respectful behaviour from staff. Consideration of patient values in moral deliberation is important to manage ethical conflicts. Even in the ethically challenging context of involuntary treatment, there are possibilities to increase patient freedoms, enhance their sense of safety and convey respect. PMID:24129367

  19. How can we help masochistic inpatients not to sabotage psychiatric treatment before it even starts?

    PubMed

    Ness, David E; Groat, Michael

    2011-03-01

    Upon admission for psychiatric hospitalization, some patients present the treating staff with alienating or antagonistic behaviors that threaten to sabotage the treatment before it even begins. These may include passive-aggressive behavior, withdrawal and isolation, contention against unit rules, protestations about the futility of treatment efforts, or oppositional behavior. Diagnostically, many such patients fall into the category of narcissistic-masochistic personality disorder, and their alienating behavior contrasts with their underlying sense of neediness. An important element in treating these patients, in addition to processing countertransferences, is to reframe the behaviors early on as being a self-defeating defense. Reframing in this way can help to defuse the emotional intensity around alienating or antagonistic behavior, and to focus the treatment upon the issue that is most damaging to the patient, namely the tendency toward self-defeat. PMID:21430491

  20. The association between psychopathology and substance use: adolescent and young adult substance users in inpatient treatment in Cape Town, South Africa

    PubMed Central

    Saban, Amina; Flisher, Alan; Laubscher, Ria; London, Leslie; Morojele, Neo

    2014-01-01

    Introduction Evidence suggests that comorbid psychopathology can negatively affect treatment outcomes in substance users. In South Africa, limited information exists regarding the prevalence, nature and role of psychiatric comorbidity in substance users. This study examined psychiatric comorbidity and its association with specific substance use, and young adult substance users in treatment for substance use. Methods Male and female inpatient substance users (n=95; ages 17-30 years) were sampled consecutively in order of admission from three clinics in Cape Town. An interview schedule was administered to elicit patients’ sociodemographic and substance use history details. The computer-assisted Diagnostic Interview Schedule DSM IV (C-DIS IV) was administered to screen patients for current psychiatric disorders. Resuls The sample was largely male, Coloured, Muslim and single. Cannabis (51.6%) and crystal methamphetamine (17.9%) were the most common first substances of use. Heroin (53.7%) and crystal methamphetamine (33.7%) were the most common substances for which treatment was sought (primary substances). The most common comorbid psychopathologies were anti-social personality disorder (ASPD 87.4%) and conduct disorder (CD 67.4%). Regression analyses showed a marginally significant association between specific phobia and first use of cannabis, but indicated no statistically significant associations between psychopathology and substance use. Conclusion The results demonstrated a high proportion of previously unidentified comorbid psychopathology in inpatient substance users. Further research is needed to investigate psychiatric comorbidity in inpatient substance users. PMID:24643118

  1. Positive behavioral support planning in the inpatient treatment of severe disruptive behaviors: A description of service features.

    PubMed

    Hamlett, Nakia M; Carr, Erika R; Hillbrand, Marc

    2016-05-01

    Positive behavior support (PBS) plans are increasingly used on inpatient units to assess and treat serious and dangerous behaviors displayed by patients with serious psychiatric impairment. A contemporary extension of traditional applied behavior analytic procedures, PBS plans integrate theories from several domains with perspectives on community psychology, positive psychology, and recovery-oriented care. Because there is little evidence to suggest that more invasive, punitive disciplinary strategies lead to long-term positive behavioral change (Parkes, 1996), PBS plans have emerged as an alternative to the use of seclusion and restraint or other forms of restrictive measures typically used on inpatient psychiatric units (Hammer et al., 2011). Moreover, PBS plans are a preferred method of intervention because more invasive interventions often cause more harm than good to all involved (Elliott et al., 2005). This article seeks to provide an integrated framework for the development of positive behavior support plans in inpatient psychiatric settings. In addition to explicating the philosophy and core elements of PBS plans, this work includes discussion of the didactic and pragmatic aspects of training clinical staff in inpatient mental health settings. A case vignette is included for illustration and to highlight the use of PBS plans as a mechanism for helping patients transition to less restrictive settings. This work will add to the scant literature examining the use of positive behavioral support plans in inpatient psychiatric settings. (PsycINFO Database Record PMID:27148952

  2. Self-harm history predicts resistance to inpatient treatment of body shape aversion in women with eating disorders: The role of negative affect.

    PubMed

    Olatunji, Bunmi O; Cox, Rebecca; Ebesutani, Chad; Wall, David

    2015-06-01

    Although self-harm has been observed among patients with eating disorders, the effects of such tendencies on treatment outcomes are unclear. The current study employed structural equation modeling to (a) evaluate the relationship between self-harm and changes in body dissatisfaction and drive for thinness in a large sample of patients (n = 2061) who underwent inpatient treatment, and (b) to examine whether the relationship between self-harm and changes in body dissatisfaction and drive for thinness during inpatient treatment remains significant when controlling for change in negative affect during treatment. Results revealed that patients with a history of self-harm reported significantly less reduction in body dissatisfaction and drive for thinness following treatment. Patients experiencing less change in negative affect also reported significantly less reduction in body dissatisfaction and drive for thinness after discharge from treatment. However, the association between history of self-harm and reduction in body dissatisfaction and drive for thinness after treatment became non-significant when controlling for change in negative affect. This pattern of findings was also replicated among patients with a primary diagnosis of anorexia nervosa (n = 845), bulimia nervosa (n = 565), and eating disorder not otherwise specified (n = 651). The implications of these findings for delineating the specific role of self-harm in the nature and treatment of eating disorders are discussed. PMID:25868550

  3. Central retinal vein occlusion: modifying current treatment protocols.

    PubMed

    Ashraf, M; Souka, A A R; Singh, R P

    2016-04-01

    Central retinal vein occlusion (CRVO) is a common retinal vascular disorder that can result in severe visual acuity loss. The randomized control study, CRUISE, helped establish anti-VEGFs as the standard of care in cases with CRVO. The extension studies for CRUISE; HORIZON and RETAIN showed that not all visual gains are maintained beyond the first year. In addition, patients showed different behavior patterns; with some patients showing complete response with few recurrences, whereas others showed partial or even no response with multiple recurrences. Long-term follow-up demonstrated that patients responding poorly to anti-VEGFs tended to do so early in the course of treatment. It also demonstrated the effectiveness of a pro re nata (PRN) protocol for improving vision and maintaining these gains over long-term follow-ups. The SHORE study further illustrated this point by demonstrating that there were minimal differences in visual outcomes between patients receiving monthly injections and patients being treated PRN. In this review we analyzed the data from the major randomized clinical trials (RCT) that looked at anti-VEGFs as the primary treatment modality in patients with CRVO (CRUISE and the extension studies HORIZON and RETAIN for ranibizumab as well as GALILEO and COPERNICUS for aflibercept). In addition, we looked at SCORE and GENEVA to help determine whether there is a place for steroids as a first line therapy in current treatment practice. We then explored alternative treatment regimens such as laser therapy and switching between anti-VEGF agents and/or steroids for non or partially responding patients. Finally, we propose a simplified modified treatment algorithm for patients with CRVO for better long-term outcomes in all types of responders. PMID:26869163

  4. Establishing the effectiveness, cost-effectiveness and student experience of a Simulation-based education Training program On the Prevention of Falls (STOP-Falls) among hospitalised inpatients: a protocol for a randomised controlled trial

    PubMed Central

    Williams, Cylie; Kiegaldie, Debra; Kaplonyi, Jessica; Haines, Terry

    2016-01-01

    Introduction Simulation-based education (SBE) is now commonly used across health professional disciplines to teach a range of skills. The evidence base supporting the effectiveness of this approach for improving patient health outcomes is relatively narrow, focused mainly on the development of procedural skills. However, there are other simulation approaches used to support non-procedure specific skills that are in need of further investigation. This cluster, cross-over randomised controlled trial with a concurrent economic evaluation (cost per fall prevented) trial will evaluate the effectiveness, cost-effectiveness and student experience of health professional students undertaking simulation training for the prevention of falls among hospitalised inpatients. This research will target the students within the established undergraduate student placements of Monash University medicine, nursing and allied health across Peninsula Health acute and subacute inpatient wards. Methods and analysis The intervention will train the students in how to provide the Safe Recovery program, the only single intervention approach demonstrated to reduce falls in hospitals. This will involve redevelopment of the Safe Recovery program into a one-to-many participant SBE program, so that groups of students learn the communication skills and falls prevention knowledge necessary for delivery of the program. The primary outcome of this research will be patient falls across participating inpatient wards, with secondary outcomes including student satisfaction with the SBE and knowledge gain, ward-level practice change and cost of acute/rehabilitation care for each patient measured using clinical costing data. Ethics and dissemination The Human Research Ethics Committees of Peninsula Health (LRR/15/PH/11) and Monash University (CF15/3523-2015001384) have approved this research. The participant information and consent forms provide information on privacy, storage of results and dissemination

  5. Personality Disorders in Substance Abusers: A Comparison of Patients Treated in a Prison Unit and Patients Treated in Inpatient Treatment

    ERIC Educational Resources Information Center

    Stefansson, Ragnar; Hesse, Morten

    2008-01-01

    A large body of literature has shown a high prevalence of personality disorders in substance abusers. We compared a sample of substance abusers treated in a prison setting with substance abusers treated in a non-prison inpatient setting rated with the Millon Clinical Multiaxial Inventory-III. Base-rate scores indicated a prevalence of 95% of…

  6. A Novel Protocol for Model Calibration in Biological Wastewater Treatment

    PubMed Central

    Zhu, Ao; Guo, Jianhua; Ni, Bing-Jie; Wang, Shuying; Yang, Qing; Peng, Yongzhen

    2015-01-01

    Activated sludge models (ASMs) have been widely used for process design, operation and optimization in wastewater treatment plants. However, it is still a challenge to achieve an efficient calibration for reliable application by using the conventional approaches. Hereby, we propose a novel calibration protocol, i.e. Numerical Optimal Approaching Procedure (NOAP), for the systematic calibration of ASMs. The NOAP consists of three key steps in an iterative scheme flow: i) global factors sensitivity analysis for factors fixing; ii) pseudo-global parameter correlation analysis for non-identifiable factors detection; and iii) formation of a parameter subset through an estimation by using genetic algorithm. The validity and applicability are confirmed using experimental data obtained from two independent wastewater treatment systems, including a sequencing batch reactor and a continuous stirred-tank reactor. The results indicate that the NOAP can effectively determine the optimal parameter subset and successfully perform model calibration and validation for these two different systems. The proposed NOAP is expected to use for automatic calibration of ASMs and be applied potentially to other ordinary differential equations models. PMID:25682959

  7. A Novel Protocol for Model Calibration in Biological Wastewater Treatment

    NASA Astrophysics Data System (ADS)

    Zhu, Ao; Guo, Jianhua; Ni, Bing-Jie; Wang, Shuying; Yang, Qing; Peng, Yongzhen

    2015-02-01

    Activated sludge models (ASMs) have been widely used for process design, operation and optimization in wastewater treatment plants. However, it is still a challenge to achieve an efficient calibration for reliable application by using the conventional approaches. Hereby, we propose a novel calibration protocol, i.e. Numerical Optimal Approaching Procedure (NOAP), for the systematic calibration of ASMs. The NOAP consists of three key steps in an iterative scheme flow: i) global factors sensitivity analysis for factors fixing; ii) pseudo-global parameter correlation analysis for non-identifiable factors detection; and iii) formation of a parameter subset through an estimation by using genetic algorithm. The validity and applicability are confirmed using experimental data obtained from two independent wastewater treatment systems, including a sequencing batch reactor and a continuous stirred-tank reactor. The results indicate that the NOAP can effectively determine the optimal parameter subset and successfully perform model calibration and validation for these two different systems. The proposed NOAP is expected to use for automatic calibration of ASMs and be applied potentially to other ordinary differential equations models.

  8. A novel protocol for model calibration in biological wastewater treatment.

    PubMed

    Zhu, Ao; Guo, Jianhua; Ni, Bing-Jie; Wang, Shuying; Yang, Qing; Peng, Yongzhen

    2015-01-01

    Activated sludge models (ASMs) have been widely used for process design, operation and optimization in wastewater treatment plants. However, it is still a challenge to achieve an efficient calibration for reliable application by using the conventional approaches. Hereby, we propose a novel calibration protocol, i.e. Numerical Optimal Approaching Procedure (NOAP), for the systematic calibration of ASMs. The NOAP consists of three key steps in an iterative scheme flow: i) global factors sensitivity analysis for factors fixing; ii) pseudo-global parameter correlation analysis for non-identifiable factors detection; and iii) formation of a parameter subset through an estimation by using genetic algorithm. The validity and applicability are confirmed using experimental data obtained from two independent wastewater treatment systems, including a sequencing batch reactor and a continuous stirred-tank reactor. The results indicate that the NOAP can effectively determine the optimal parameter subset and successfully perform model calibration and validation for these two different systems. The proposed NOAP is expected to use for automatic calibration of ASMs and be applied potentially to other ordinary differential equations models. PMID:25682959

  9. Psychiatric disorders and associated factors in cancer: results of an interview study with patients in inpatient, rehabilitation and outpatient treatment.

    PubMed

    Härter, M; Reuter, K; Aschenbrenner, A; Schretzmann, B; Marschner, N; Hasenburg, A; Weis, J

    2001-07-01

    An association between mental disorders, especially affective and anxiety disorders, and cancer has been reported in many studies. The present study investigated current (4-weeks-, 12-months-, and lifetime-prevalence rates of comorbid mental disorders in cancer patients. Through a cross-sectional design, 517 patients (75% female patients) from two acute inpatient care clinics, two rehabilitation clinics and nine specialised practices for oncology were examined with standardised scales for psychological burden and quality of life. Somatic parameters were assessed through standardised medical records. In the second-stage-examination, a sample of 200 patients was interviewed with standardised clinical interview (CIDI) in order to obtain DSM-IV diagnoses of mental disorders. Differences in the type of mental disorders were examined for gender, treatment setting, severity of cancer and physical impairment. Prevalence rates of mental disorders were 23.5% for the 4-weeks, 40% for the 12-months, and 56.5% for the lifetime periods. The current and 12-months rates of affective and anxiety disorders were approximately 25-33% higher than prevalence rates found in recent epidemiological studies of the general population. These higher rates were, however, mainly due to the preponderance of female patients with a higher risk for mental disorders compared with males. The most prevalent current disorders were affective (9.5%), and anxiety disorders (13%). Female gender was associated with an approximately 2-fold risk of mental disorders during the patient's lifespan. Current diagnosis of affective disorders in women was highly related to the cancer. Physical impairment was also associated with the frequency of current psychiatric disorders, especially affective and anxiety disorders. The frequency of mental disorders in cancer patients does not differ from results of recent international epidemiological studies of the normal population. The slightly higher rates of anxiety

  10. Burden of blood transmitted infections in substance users admitted for inpatient treatment in Singapore and the associated factors

    PubMed Central

    Kinson, Rochelle Melina; Guo, Song; Wan, Yi Min; Manning, Victoria; Teoh, Hui Chin; Wong, Kim Eng

    2015-01-01

    INTRODUCTION There is a paucity of local data on the prevalence of blood transmitted infections (BTIs), such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV) infections, among illicit drug users. This study aimed to examine the prevalence of BTIs among substance-dependent inpatients and identify the factors associated with BTIs. METHODS We conducted a retrospective case note analysis of 170 inpatients who had a history of substance dependence and were seen at the National Addictions Management Service, Singapore, between 1 June 2009 and 31 May 2010. RESULTS The majority of the 170 inpatients were male (88.2%) and Chinese (58.2%). The mean age of the patients was 43.1 years, and the main drug of abuse was opioids (86.5%). BTIs were found in 70 (41.2%) inpatients; the prevalence of hepatitis B, hepatitis C and HIV infections was 3.7%, 39.6% and 0%, respectively. Lifetime intravenous drug use, but not needle-sharing, was more common among inpatients who were positive for BTIs (p < 0.01). Logistic regression analysis showed that lifetime intravenous drug use (OR 4.3, 95% CI 1.7–10.8, p < 0.01) was the only significant predictor of BTI. CONCLUSION 41.2% of the substance users seeking help were positive for at least one BTI. Lifetime intravenous drug users were found to be more than four times more likely to have a BTI. Early detection and prevention is essential to improve prognosis. PMID:25588571

  11. Profile of female patients seeking in-patient treatment for prescription opioid abuse from a tertiary care drug dependence treatment centre from India

    PubMed Central

    Dayal, Prabhoo; Balhara, Yatan Pal Singh

    2016-01-01

    Background & objectives: There has been a limited focus on prescription drug abuse among women in the country. Choice of psychoactive substance, reasons for initiation and co-occurring disorders have been found to be different among men and women. The current study was aimed at studying the profile of female patients seeking in-patient treatment for prescription drug use over a period of five years at a tertiary care drug dependence treatment centre in India. Methods: Case records of all female patients admitted with substance use disorder at a national level drug dependence treatment centre in north India across five years (between January 2008 and December 2012) were reviewed retrospectively to study their socio-demographic and clinical profile. The information was gathered using a semi-structured proforma and detailed case records. Abstinence, relapse and retention rates were calculated. Results: Over the five years, 31 female patients were admitted with prescription drug abuse. Of them, 12 (39%) used prescription opioids and 11 (36%) used prescription opioid along with benzodiazepines. Commonest prescription opioid was pentazocine used by 87 per cent of the women. Twenty two (71%) women were introduced to opioid by medical practitioners and commonest reason for introduction was pain (among 48%). Common co-occurring psychiatric diagnoses were depressive disorder (26%), cluster B traits/disorder (19%) and somatoform disorder (13%). Eight women did not complete treatment and left against medical advice. Thirteen women were advised maintenance treatment, and 70 per cent of them were retained for at least six months. Interpretation & conclusions: Our findings revealed a link between mental illness, pain and non-medical use of prescription opioids among women. Majority of these women received opioids as a legitimate prescription form physician. Therefore, these legitimate prescribers should be trained for pain management to facilitate proper treatment of pain and to

  12. A CBT Approach to Inpatient Psychiatric Hospitalization

    ERIC Educational Resources Information Center

    Masters, Kim J.

    2005-01-01

    During a psychiatric hospitalization of 5 to 10 days, cognitive-behavioral therapy (CBT) strategies can be used for the management of inpatients and to support the transition to outpatient treatment. This format was chosen after several years of frustration dealing with crisis inpatient care. The use of CBT is well known, and it seemed that an…

  13. Managing orthopedics and neurosciences costs through standard treatment protocols.

    PubMed

    McGinnity, E S; Pluth, T E

    1994-06-01

    High-cost, high-volume specialty programs such as orthopedics and neurosciences find themselves in a position of evaluating the costs and in some cases the appropriateness of medical practices in response to payer scrutiny and provider selection processes. Orthopedics and neurosciences programs are at a stage of development analogous to that of cardiovascular care several years ago. Many of the same trends have come into play, such as payer "carve-outs" for orthopedic services, payer selection of centers of excellence based on cost and quality, reduction of Medicare reimbursement, greater use of high-cost technology, the decline of profitability due to "older, sicker, and tougher" patients, and the recent emergence of national orthopedic specialty networks oriented to national contracts for care. In an era in which payers demand value on both sides of the cost-plus-quality equation, programs are challenged to maximize the return on a patient population rife with "no-win" situations. In the orthopedic service line these include a high proportion of Medicare patients and chronic conditions such as workers' compensation medical back cases or repetitive motion injuries, which can be elusive to diagnose and expensive to treat. Many hospitals continue to lose money on joint replacement surgeries, the largest-volume orthopedic inpatient service, primarily because of the high Medicare population and the cost of implants. Neuroservices, while still relatively well reimbursed, face a rising proportion of Medicare payments as patients live longer and develop chronic, degenerative conditions. Inpatient days are decreasing due to payer pressures to limit hospital stays and to shift inpatient care to outpatient services. Some hospitals "have lost interest in (the orthopedic) service line during the last five years because of recent trends in orthopedic-related inpatient volume and payment." But by managing costs strategically, both the neurosciences and orthopedics service lines

  14. Medium-term cost-effectiveness of an automated non-invasive ventilation outpatient set-up versus a standard fixed level non-invasive ventilation inpatient set-up in obese patients with chronic respiratory failure: a protocol description

    PubMed Central

    Mandal, S; Arbane, G; Murphy, P; Elliott, M W; Janssens, J P; Pepin, J L; Muir, J F; Cuvelier, A; Polkey, M; Parkin, D; Douiri, A; Hart, N

    2015-01-01

    Introduction Obesity is an escalating issue, with an accompanying increase in referrals of patients with obesity-related respiratory failure. Currently, these patients are electively admitted to hospital for initiation of non-invasive ventilation (NIV), but it is unknown whether outpatient initiation is as effective as inpatient set-up. We hypothesise that outpatient set-up using an autotitrating NIV device will be more cost-effective than a nurse-led inpatient titration and set-up. Methods and analysis We will undertake a multinational, multicentre randomised controlled trial. Participants will be randomised to receive the usual inpatient set-up, which will include nurse-led initiation of NIV or outpatient set-up with an automated NIV device. They will be stratified according to the trial site, gender and previous use of NIV or continuous positive airway pressure. Assuming a 10% dropout rate, a total sample of 82 patients will be required. Cost-effectiveness will be evaluated using standard treatment costs and health service utilisation as well as health-related quality of life measures (severe respiratory insufficiency (SRI) and EuroQol-5 dimensions (EQ-5D)). A change in the SRI questionnaire will be based on the analysis of covariance adjusting for the baseline measurements between the two arms of patients. Ethics and dissemination This study has been approved by the Westminster National Research Ethics Committee (11/LO/0414) and is the trial registered on the UKCRN portfolio. The trial is planned to start in January 2015 with publication of the trial results in 2017. Trial registration number ISRCTN 51420481. PMID:25908673

  15. For Whom Does It Work? Moderators of Outcome on the Effect of a Transdiagnostic Internet-Based Maintenance Treatment After Inpatient Psychotherapy: Randomized Controlled Trial

    PubMed Central

    Gollwitzer, Mario; Riper, Heleen; Cuijpers, Pim; Baumeister, Harald; Berking, Matthias

    2013-01-01

    Background Recent studies provide evidence for the effectiveness of Internet-based maintenance treatments for mental disorders. However, it is still unclear which participants might or might not profit from this particular kind of treatment delivery. Objective The study aimed to identify moderators of treatment outcome in a transdiagnostic Internet-based maintenance treatment (TIMT) offered to patients after inpatient psychotherapy for mental disorders in routine care. Methods Using data from a randomized controlled trial (N=400) designed to test the effectiveness of TIMT, we performed secondary analyses to identify factors moderating the effects of TIMT (intervention) when compared with those of a treatment-as-usual control condition. TIMT involved an online self-management module, asynchronous patient–therapist communication, a peer support group, and online-based progress monitoring. Participants in the control condition had unstructured access to outpatient psychotherapy, standardized outpatient face-to-face continuation treatment, and psychotropic management. Self-reports of psychopathological symptoms and potential moderators were assessed at the start of inpatient treatment (T1), at discharge from inpatient treatment/start of TIMT (T2), and at 3-month (T3) and 12-month follow-up (T4). Results Education level, positive outcome expectations, and diagnoses significantly moderated intervention versus control differences regarding changes in outcomes between T2 and T3. Only education level moderated change differences between T2 and T4. The effectiveness of the intervention (vs control) was more pronounced among participants with a low (vs high) education level (T2-T3: B=–0.32, SE 0.16, P=.049; T2-T4: B=–0.42, SE 0.21, P=.049), participants with high (vs low) positive outcome expectations (T2-T3: B=–0.12, SE 0.05, P=.02) and participants with anxiety disorder (vs mood disorder) (T2-T3: B=–0.43, SE 0.21, P=.04). Simple slope analyses revealed that

  16. Standardized hypnosis treatment for irritable bowel syndrome: the North Carolina protocol.

    PubMed

    Palsson, Olafur S

    2006-01-01

    The North Carolina protocol is a seven-session hypnosis-treatment approach for irritable bowel syndrome that is unique in that the entire course of treatment is designed for verbatim delivery. The protocol has been tested in two published research studies and found to benefit more than 80% of patients. This article describes the development, content, and testing of the protocol, and how it is used in clinical practice. PMID:16316883

  17. Involuntary treatment of psychiatric inpatients certified under the Saskatchewan Mental Health Services Act in a secure forensic psychiatric treatment center.

    PubMed

    Adelugba, Olajide; Mela, Mansfield; Haq, Inam

    2015-04-01

    A psychiatric patient prisoner is certified and treated involuntarily under the Saskatchewan Mental Health Services Act at the Regional Psychiatric Center if he/she is mentally ill, incapable of making treatment decision and is likely to cause harm to self or others. This retrospective study examined the treatment of certified patients during a 12-year period (1996 to 2007). A total of 112 patients were treated using 263 certifications during 163 separate hospital admissions. Fifty of all the certified patients (44.6%) required more than one certification, and out of these, 72% required another certification within three months of the first certification. Among those certified, schizophrenia and related psychosis (65.2%, n = 73), substance use disorder (50%, n = 56) and antisocial personality disorder (58%, n = 65) were the most common discharge diagnoses and antipsychotics, the most frequent discharge medications. Global Assessment of Functioning score of patients improved significantly (p < .05) from 43.6 at admission to 50.4 at discharge. This functional improvement may suggest a beneficial use of certification by keeping patients in treatment. This benefit may be enhanced if the statutory duration of certification can be increased to account for the length of time required for the adequate resolution of symptoms and to reduce the need for repeat certification. PMID:24644230

  18. Personality and symptom change in treatment-refractory inpatients: evaluation of the phase model of change using Rorschach,TAT, and DSM-IV Axis V.

    PubMed

    Fowler, J Christopher; Ackerman, Steven J; Speanburg, Stefanie; Bailey, Adrian; Blagys, Matthew; Conklin, Adam C

    2004-12-01

    In this study, we examined global treatment outcomes during 16 months of intensive, psychodynamic treatment for 77 inpatients suffering from treatment-refractory disorders. Hypotheses based on the phase model of treatment change (Howard, Lueger, Maling, & Martinovich, 1993; Howard, Moras, Brill, Martinovich, & Lutz, 1996) were supported in the study results. Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Axis V scales assessing behavioral functioning demonstrated large and medium effect size change, whereas stable, enduring personality functioning assessed by psychoanalytic Rorschach scales and the Social Cognition and Object Relations Scale (Westen, 1995) for the Thematic Apperception Test (Murray, 1943) demonstrated small and medium effect size change. We also report assessment of reliable change index and clinical significance. The ecological validity of Rorschach measures is supported by significant validity coefficients (in the hypothesized directions) between implicit measures of personality functioning and behavioral ratings. PMID:15548467

  19. An Inpatient Vocational Rehabilitation Unit.

    ERIC Educational Resources Information Center

    Bielefeld, Martin

    This paper describes the Cleveland Veterans Administration inpatient Vocational Rehabilitation Unit (VRU), an intensive vocational assessment and counseling program designed to maximize the self-reliance and productivity of patients. The VRU is presented as a minimal care, 3-month maximum treatment program in which patients work on incentive pay…

  20. Yoga protocol for treatment of breast cancer-related lymphedema

    PubMed Central

    Narahari, SR; Aggithaya, Madhur Guruprasad; Thernoe, Liselotte; Bose, Kuthaje S; Ryan, Terence J

    2016-01-01

    Introduction: Vaqas and Ryan (2003) advocated yoga and breathing exercises for lymphedema. Narahari et al. (2007) developed an integrative medicine protocol for lower-limb lymphedema using yoga. Studies have hypothesized that yoga plays a similar role as that of central manual lymph drainage of Foldi's technique. This study explains how we have used yoga and breathing as a self-care intervention for breast cancer-related lymphedema (BCRL). Methods: The study outcome was to create a yoga protocol for BCRL. Selection of yoga was based on the actions of muscles on joints, anatomical areas associated with different groups of lymph nodes, stretching of skin, and method of breathing in each yoga. The protocol was piloted in eight BCRL patients, observed its difficulties by interacting with patients. A literature search was conducted in PubMed and Cochrane library to identify the yoga protocols for BCRL. Results: Twenty yoga and 5 breathing exercises were adopted. They have slow, methodical joint movements which helped patients to tolerate pain. Breathing was long and diaphragmatic. Flexion of joints was coordinated with exhalation and extension with inhalation. Alternate yoga was introduced to facilitate patients to perform complex movements. Yoga's joint movements, initial positions, and mode of breathing were compared to two other protocols. The volume reduced from 2.4 to 1.2 L in eight patients after continuous practice of yoga and compression at home for 3 months. There was improvement in the range of movement and intensity of pain. Discussion: Yoga exercises were selected on the basis of their role in chest expansion, maximizing range of movements: flexion of large muscles, maximum stretch of skin, and thus part-by-part lymph drainage from center and periphery. This protocol addressed functional, volume, and movement issues of BCRL and was found to be superior to other BCRL yoga protocols. However, this protocol needs to be tested in centers routinely managing BCRL

  1. Inpatient hospital costs and length of stay for the treatment of affective and somatoform disorders – evidence from Germany

    PubMed Central

    Romeyke, Tobias; Scheuer, Hans Christoph; Stummer, Harald

    2014-01-01

    Introduction Diagnosis related costs analyses are the subject of science and research and are of great relevance and importance for decision makers in the hospital and for funding bodies, but also for international health policy. Up to now, standardized costs analyses with valid costs data have not been available for inpatient care of patients with affective and somatoform disorders. Background This clinical picture presents a major challenge for the provision of outpatient and inpatient care. An interdisciplinary approach in an inpatient setting can be beneficial for already “chronified” patients with severe forms of progression. Because of its structural and procedural demands, this type of care is associated with a greater expenditure of resources. Methods Costs data from the years 2008 to 2012 were analyzed for a total of 17,424 hospitalized patients in more than 200 different hospitals in Germany. The study compared the costs of treating patients with the main diagnosis affective and somatoform disorders using standardized interdisciplinary therapy, with the costs of conventional therapy. Results Interdisciplinary patient care is characterized by a high proportion of the costs derived from the structural and procedural implementation and the medical and nursing care. For interdisciplinary therapy with a mean period of hospitalization of 15.2 days, over 60% of the total costs were incurred by the personnel and material costs of the medical and non-medical infrastructure. The outlay is considerably greater than would be incurred by a conventional therapeutic approach without interdisciplinary therapy. Discussion and conclusion For the first time, detailed diagnosis-related costs data are published which were generated by consistent, standardized cost unit accounting. An interdisciplinary, holistic approach to the clinical picture results in a significant increase in costs for the hospitals. PMID:25506252

  2. Variations in Risk and Treatment Factors Among Adolescents Engaging in Different Types of Deliberate Self-Harm in an Inpatient Sample

    PubMed Central

    Boxer, Paul

    2010-01-01

    This study employs a framework adopted by Jacobson et al. (2008) to explore differences in risk and treatment factors in a sample of 476 adolescent inpatients grouped with relation to their involvement in deliberately self-harmful (DSH) behavior. Participants were assigned to groups indicating no DSH, non-suicidal self-injury (NSSI) only, suicide attempts (SA) only, and NSSI+SA. Groups were compared with respect to their status on a variety of background risk factors (e.g., maltreatment, presenting psychopathology, family history) and in-treatment behaviors (e.g., critical incidents resulting from self-injurious gestures) linked to DSH. Findings generally supported the conclusions drawn by Jacobson et al. (2008) in terms of the overall severity of youth exhibiting NSSI+SA, with some important similarities observed between the NSSI-only and NSSI+SA groups. PMID:20589559

  3. Brief Family Treatment Intervention to Promote Aftercare among Substance Abusing Patients in Inpatient Detoxification: Transferring A Research Intervention to Clinical Practice

    PubMed Central

    O’Farrell, Timothy J.; Murphy, Marie; Alter, Jane; Fals-Stewart, William

    2008-01-01

    Two earlier studies showed that a brief family treatment (BFT) intervention for substance abusing patients in inpatient detoxification increased aftercare treatment post-detox. BFT consisted of meeting with the patient and a family member with whom the patient lived to review aftercare plans for the patient. A phone conference was used when logistics prevented an in-person family meeting. Based on the earlier research results, we trained a newly hired staff person to continue providing BFT. We monitored key process benchmarks derived from the earlier research studies to ensure ongoing fidelity in delivering BFT. This method proved successful in transferring BFT from delivery in a research study to ongoing delivery in routine clinical practice after the research ended. It also ensured that a high proportion of patients had their families contacted and included in planning the patients’ aftercare. PMID:18063317

  4. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40

    ERIC Educational Resources Information Center

    Boone, Margaret; Brown, Nancy J.; Moon, Mary A.; Schuman, Deborah J.; Thomas, Josephine; Wright, Denise L.

    2004-01-01

    This Treatment Improvement Protocol (TIP) addresses the clinical use of buprenorphine in the treatment of opioid addiction. TIPs are best-practice guidelines for the treatment of substance use disorders that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel of experts…

  5. A pilot study of heart rate variability biofeedback therapy in the treatment of perinatal depression on a specialized perinatal psychiatry inpatient unit.

    PubMed

    Beckham, A Jenna; Greene, Tammy B; Meltzer-Brody, Samantha

    2013-02-01

    Heart rate variability biofeedback (HRVB) therapy may be useful in treating the prominent anxiety features of perinatal depression. We investigated the use of this non-pharmacologic therapy among women hospitalized with severe perinatal depression. Three questionnaires, the State Trait Anxiety Inventory (STAI), Warwick-Edinburgh Mental Well-Being Scale, and Linear Analog Self Assessment, were administered to 15 women in a specialized inpatient perinatal psychiatry unit. Participants were also contacted by telephone after discharge to assess continued use of HRVB techniques. The use of HRVB was associated with an improvement in all three scales. The greatest improvement (-13.867, p < 0.001 and -11.533, p < 0.001) was among STAI scores. A majority (81.9 %, n = 9) of women surveyed by telephone also reported continued frequent use at least once per week, and over half (54.6 %, n = 6) described the use of HRVB techniques as very or extremely beneficial. The use of HRVB was associated with statistically significant improvement on all instrument scores, the greatest of which was STAI scores, and most women reported frequent continued use of HRVB techniques after discharge. These results suggest that HRVB may be particularly beneficial in the treatment of the prominent anxiety features of perinatal depression, both in inpatient and outpatient settings. PMID:23179141

  6. Effectiveness of a modified administration protocol for the medical treatment of canine pyometra.

    PubMed

    Contri, Alberto; Gloria, Alessia; Carluccio, Augusto; Pantaleo, Stefania; Robbe, Domenico

    2015-03-01

    Pyometra is one of the most common diseases in intact bitches. The aim of this study was to evaluate the effectiveness of a modified aglepristone protocol for the medical treatment of pyometra in the bitch. Of these, 73 bitches affected by pyometra of different breeds and age (2-14 years old) were enrolled. They were randomly assigned to a control group (CTG - 26 bitches) treated with classical protocol (aglepristone at 0, 1 and 6 days - day 0 = day of the diagnosis) and a modified treated group (MTG - 47 bitches) treated with a different administration protocol (aglepristone at 0, 2, 5 and 8 days). The classical protocol with the anti-progestagen aglepristone was effective in 88.5 % (23/26) of CTG bitches while the modified protocol was effective in all (47/47) of MTG bitches. One of the 23 CTG bitches received a further administration on day 14, which resolved the pyometra, while in the three cases of CTG bitches, in which the treatment was ineffective, an ovariohysterectomy was carried out. The modified protocol showed a success rate of 100 %, compared with the classical protocol proposed in the literature, and no recurrence of the disease was recorded in the 24 months follow up. After treatment, the oestrus onset was earlier than expected (interoestrus of 128 ± 32 days). In this study, the modified treatment protocol showed high efficacy and lack of recurrence within 24 months, suggesting a complete recovery of reproductive function in the bitch, with a normal fertility. PMID:25323020

  7. [An update of the obstetrics hemorrhage treatment protocol].

    PubMed

    Morillas-Ramírez, F; Ortiz-Gómez, J R; Palacio-Abizanda, F J; Fornet-Ruiz, I; Pérez-Lucas, R; Bermejo-Albares, L

    2014-04-01

    Obstetric hemorrhage is still a major cause of maternal and fetal morbimortality in developed countries. This is an underestimated problem, which usually appears unpredictably. A high proportion of the morbidity of obstetric hemorrhage is considered to be preventable if adequately managed. The major international clinical guidelines recommend producing consensus management protocols, adapted to local characteristics and keep them updated in the light of experience and new scientific publications. We present a protocol updated, according to the latest recommendations, and our own experience, in order to be used as a basis for those anesthesiologists who wish to use and adapt it locally to their daily work. This last aspect is very important to be effective, and is a task to be performed at each center, according to the availability of resources, personnel and architectural features. PMID:24560060

  8. Orthodontic treatment outcomes obtained by application of a finishing protocol

    PubMed Central

    Carvajal-Flórez, Alvaro; Barbosa-Lis, Diana María; Zapata-Noreña, Oscar Arturo; Marín-Velásquez, Julissa Andrea; Afanador-Bayona, Sergio Andrés

    2016-01-01

    ABSTRACT Objective: To evaluate the results of a finishing protocol implemented in patients treated in the Orthodontics graduate program at Universidad de Antioquia. Evaluation was carried out by means of the criteria set by the Objective Grading System (OGS) of the American Board of Orthodontics (ABO). Methods: Cast models and panoramic radiographs of 34 patients were evaluated. The intervention group (IG) consisted of 17 patients (19.88 ± 4.4 years old) treated under a finishing protocol. This protocol included training in finishing, application of a finishing guide, brackets repositioning and patient's follow-up. Results of the IG were compared to a control group of 17 patients (21.88 ± 7.0 years old) selected by stratified randomization without finishing intervention (CG). Results: The scores for both CG and IG were 38.00 ± 9.0 and 31.41 ± 9.6 (p = 0.048), respectively. The score improved significantly in the IG group, mainly regarding marginal ridges (CG: 5.59 ± 2.2; IG: 3.65 ± 1.8) (p = 0.009) and root angulation (CG: 7.59 ± 2.8; IG: 4.88 ± 2.6) (p = 0.007). Criteria that did not improve, but had the highest scores were: alignment (CG: 6.35 ± 2.7; IG: 6.82 ± 2.8) (p = 0.62) and buccolingual inclination (CG: 3.6 ± 5.88; IG: 5.29 ± 3.9) (p = 0.65). Conclusions: Standardization and implementation of a finishing protocol contributed to improve clinical performance in the Orthodontics graduate program, as expressed by occlusal outcomes. Greater emphasis should be given on the finishing phase to achieve lower scores in the ABO grading system. PMID:27275620

  9. Psychopharmacological treatment of 2195 in-patients with borderline personality disorder: A comparison with other psychiatric disorders.

    PubMed

    Bridler, René; Häberle, Anne; Müller, Sabrina T; Cattapan, Katja; Grohmann, Renate; Toto, Sermin; Kasper, Siegfried; Greil, Waldemar

    2015-06-01

    Patients with borderline personality disorder (BPD) are usually prescribed a variety of psychotropic drugs; however, none is recommended in the guidelines nor has any been approved for this indication. As data on drug prescriptions for BPD are sparse, cross-sectional data from the European Drug Safety Project AMSP were used to analyse drug prescriptions of 2195 in-patients with BPD between 2001 and 2011, and the mean values, confidence intervals and regression analyses were calculated. 70% of all BPD patients were medicated with antipsychotics and/or antidepressants, 33% with anticonvulsants, 30% with benzodiazepines, and 4% with lithium; 90% received at least one, 80%≥2, and 54%≥3 psychotropic drugs concomitantly (mean: 2.8). Prescription rates for quetiapine, the single drug most often used in BPD (22%), increased significantly over time. In view of the high percentage of young females with BPD, 18-40 year-old female patients with BPD were compared with patients of the same age but with depression (unipolar and bipolar) and schizophrenia. Typical sedative antipsychotics and anticonvulsants were prescribed more often in BPD than in the other diagnostic groups, with the exception of bipolar depression; this was true for the single substances quetiapine, levomepromazine, chlorprothixene, carbamazepine, and valproate. A limitation of the study was the use of clinical data without verifying the diagnoses by structured interviews. Contrary to the guidelines, about 90% of in-patients with BPD received psychotropic drugs. Polypharmacy was common, and antipsychotics with sedative profiles such as quetiapine and mood-stabilizing anticonvulsants such as valproate appear to be preferred. PMID:25907249

  10. Brief inpatient psychotherapeutic technique.

    PubMed

    Stein, Michelle B; Jacobo, Michelle C

    2013-09-01

    Trainees rotate onto the medical psychiatric inpatient unit at Massachusetts General Hospital every 6 weeks to learn how to conduct brief inpatient psychotherapy from two staff psychologists and one staff psychiatrist. This article focuses on four key therapeutic principles/techniques used when teaching these trainees about brief inpatient psychotherapy. These include support, affective experience and expression, chain analysis, and identification of relational styles/maladaptive relational patterns. We also briefly discuss our approach to training. Theoretical rationale, numerous clinical examples, and empirical support (of inpatient psychotherapy) are provided. PMID:24000872

  11. A Pilot Study of Brief Heart Rate Variability Biofeedback to Reduce Craving in Young Adult Men Receiving Inpatient Treatment for Substance Use Disorders

    PubMed Central

    Eddie, D.; Kim, C.; Lehrer, P.; Deneke, E.; Bates, M.E.

    2014-01-01

    The present pilot study investigated the implementation feasibility, and efficacy for reducing alcohol and drug craving, of a brief, 3-session heart rate variability biofeedback (HRV BFB) intervention added to a traditional 28-day substance abuse disorder (SUD) inpatient treatment program. Forty-eight young adult men received either treatment as usual (TAU) plus three sessions of HRV BFB training over three weeks, or TAU only. Participants receiving HRV BFB training were instructed to practice daily using a handheld HRV BFB device. HRV BFB training was well tolerated by participants and supported by treatment staff. Men receiving TAU + HRV BFB demonstrated a greater, medium effect size reduction in alcohol and drug craving compared to those receiving TAU only, although this difference did not reach statistical significance. In addition, an interaction effect was observed in analyses that accounted for baseline craving levels, wherein heart rate variability (HRV) levels at treatment entry were predictive of changes in craving in the TAU group only. Low baseline levels of HRV were associated with increases in craving, whereas higher baseline HRV levels were associated with greater decreases in craving from start to end of treatment. In the TAU + HRV BFB group, however, there was no such association. That is, HRV BFB appeared to dissociate individual differences in baseline HRV levels from changes in craving. Given that alcohol and drug craving often precipitates relapse, HRV BFB merits further study as an adjunct treatment to ameliorate craving experienced by persons with substance use disorders. PMID:25179673

  12. [Poor knowledge of treatment protocols by members of an HIV association].

    PubMed

    Quatremère, Guillemette; Rojas Castro, Daniela; Liaud, Marie-Noëlle; Girardi, Patricia; Bouhier, Frédéric; Barbier, Franck

    2015-01-01

    The treatment protocol form defines all health care and treatments that are free of charge for patients living with a long-term disease in France. It is designed to facilitate the medical care of these patients. The way in which it is written impact on access and adequacy of health care. AIDES, a French HIV/AIDS/Hepatitis association, reported disparities and shortcomings in the use of this protocol. A survey was conducted among people attending this association in order to objectively demonstrate field observations. This article presents the results of this investigation designed to determine the level of knowledge of the people living with HIV and/or hepatitis in contact with the association regarding the use of this protocol. 224 people completed the questionnaire. The results confirm field observations: the appropriation of the treatment protocol by patients who participated in this survey remains limited, even within a study population in contact with a patient association. These findings raise the question of the effectiveness of the communication between health care practitioners/caregivers and patients concerning the use of this tool. More widely, the protocol drafting process needs to be reviewed: what are the respective places and roles for health stakeholders? What form of coordination between the patient, the general practitioner and the Health Insurance is required to establish an appropriate and appropriable treatment protocol? PMID:26916858

  13. [The effect of a treatment protocol on the prognosis of equine laminitis].

    PubMed

    Oosterlaan-Mayer, B; Back, W; Sloet van Oldruitenborgh-Oosterbaan, M M

    2002-11-01

    All horses and ponies with laminitis treated at the Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, between 1995 and 1998 were analysed retrospectively (n = 152). Based on the results of this study and on the world-wide knowledge on laminitis a standardised treatment protocol was adopted in 1999. Fifty-eight patients have been treated for laminitis between 1999 and 2001 following the treatment protocol. Compared to our hospital-population (orthopaedic patients), mares and ponies are at higher risk developing laminitis, but the prognosis does not differ between sexes as between breeds. Radiological evidence of rotation of the third phalanx seems to be of minor importance for the prognosis. Distal displacement of the third phalanx, however, seems to worsen the prognosis. The outcome of the acute cases is significantly better in the group treated following the protocol, than in the group without protocol. The outcome of the chronic cases is not influenced by the treatment protocol. Although the cases in both groups differ, as they are all clinical cases, our data suggest that the standardised treatment protocol results in a better outcome for cases of acute laminitis. PMID:12449656

  14. Thermal Treatment Protocol Development and Scale-up

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Development of thermal treatments requires a sequential approach consisting of laboratory tests to identify one or more heat treatment technologies that can be used for a specific commodity to control target quarantine pests without adversely affecting commodity quality or shelf life. Small scale t...

  15. Treatment protocol development for disinfesting legumes using radio frequency energy

    Technology Transfer Automated Retrieval System (TEKTRAN)

    There is an urgent need to develop technically effective and environmentally sound phytosanitary and quarantine treatments for the legume industry to replace chemical fumigation. The goal of this study was to develop practical non-chemical treatments for postharvest disinfestations of legumes using ...

  16. Leptin levels in patients with anorexia nervosa following day/inpatient treatment do not predict weight 1 year post-referral.

    PubMed

    Seitz, Jochen; Bühren, Katharina; Biemann, Ronald; Timmesfeld, Nina; Dempfle, Astrid; Winter, Sibylle Maria; Egberts, Karin; Fleischhaker, Christian; Wewetzer, Christoph; Herpertz-Dahlmann, Beate; Hebebrand, Johannes; Föcker, Manuel

    2016-09-01

    Elevated serum leptin levels following rapid therapeutically induced weight gain in anorexia nervosa (AN) patients are discussed as a potential biomarker for renewed weight loss as a result of leptin-related suppression of appetite and increased energy expenditure. This study aims to analyze the predictive value of leptin levels at discharge as well as the average rate of weight gain during inpatient or day patient treatment for body weight at 1-year follow-up. 121 patients were recruited from the longitudinal Anorexia Nervosa Day patient versus Inpatient (ANDI) trial. Serum leptin levels were analyzed at referral and discharge. A multiple linear regression analysis to predict age-adjusted body mass index (BMI-SDS) at 1-year follow-up was performed. Leptin levels, the average rate of weight gain, premorbid BMI-SDS, BMI-SDS at referral, age and illness duration were included as independent variables. Neither leptin levels at discharge nor rate of weight gain significantly predicted BMI-SDS at 1-year follow-up explaining only 1.8 and 0.4 % of the variance, respectively. According to our results, leptin levels at discharge and average rate of weight gain did not exhibit any value in predicting weight at 1-year follow-up in our longitudinal observation study of adolescent patients with AN. Thus, research should focus on other potential factors to predict weight at follow-up. As elevated leptin levels and average rate of weight gain did not pose a risk for reduced weight, we found no evidence for the beneficial effect of slow refeeding in patients with acute AN. PMID:26847072

  17. Motor-based intervention protocols in treatment of childhood apraxia of speech (CAS)

    PubMed Central

    Maas, Edwin; Gildersleeve-Neumann, Christina; Jakielski, Kathy J.; Stoeckel, Ruth

    2014-01-01

    This paper reviews current trends in treatment for childhood apraxia of speech (CAS), with a particular emphasis on motor-based intervention protocols. The paper first briefly discusses how CAS fits into the typology of speech sound disorders, followed by a discussion of the potential relevance of principles derived from the motor learning literature for CAS treatment. Next, different motor-based treatment protocols are reviewed, along with their evidence base. The paper concludes with a summary and discussion of future research needs. PMID:25313348

  18. Generic Protocol for the Verification of Ballast Water Treatment Technology

    EPA Science Inventory

    In anticipation of the need to address performance verification and subsequent approval of new and innovative ballast water treatment technologies for shipboard installation, the U.S Coast Guard and the Environmental Protection Agency‘s Environmental Technology Verification Progr...

  19. Addressing Viral Hepatitis in People with Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 53

    ERIC Educational Resources Information Center

    Substance Abuse and Mental Health Services Administration, 2011

    2011-01-01

    Treatment Improvement Protocols (TIPs) are developed by the Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (HHS). Each TIP involves the development of topic-specific best-practice guidelines for the prevention and…

  20. Development and Use of an Eating Disorder Assessment and Treatment Protocol

    ERIC Educational Resources Information Center

    Huebner, Lois A.; Weitzman, Lauren M.; Mountain, Lisa M.; Nelson, Kris L.; Oakley, Danielle R.; Smith, Michael L.

    2006-01-01

    Counseling centers have been challenged to effectively treat the growing number of college students who struggle with disordered eating. In response to this critical issue, an Eating Disorder Assessment and Treatment Protocol (EDATP) was developed to assist clinical disposition in the counseling center setting and identify treatment guidelines…

  1. A unified protocol for the transdiagnostic psychodynamic treatment of anxiety disorders: an evidence-based approach.

    PubMed

    Leichsenring, Falk; Salzer, Simone

    2014-06-01

    Although there is evidence for the efficacy of psychodynamic therapy (PDT) in anxiety disorders, results are not yet satisfactory, for example, if rates of remission and response are considered. To address this problem, a unified psychodynamic protocol for anxiety disorders (UPP-ANXIETY) is proposed that integrates the treatment principles of those methods of PDT that have proven to be efficacious in anxiety disorders. In addition, this protocol is transdiagnostic, implying that it is applicable to various forms of anxiety disorders and related disorders (generalized anxiety disorder, social phobia, panic disorders, avoidant personality disorder). Based on supportive-expressive therapy, the UPP-ANXIETY represents an integrated form of psychodynamic therapy that allows for a flexible use of empirically supported treatment principles. UPP-ANXIETY encompasses the following 9 treatment principles (modules): (1) socializing the patient for psychotherapy, (2) motivating and setting treatment goals, (3) establishing a secure helping alliance, (4) identifying the core conflict underlying anxiety, (5) focusing on the warded-off wish/affect, (6) modifying underlying internalized object relations, (7) changing underlying defenses and avoidance, (8) modifying underlying response of self, and (9) termination and relapse prevention. Some principles are regarded as core components to be used in every treatment (principles 3-8). A unified protocol for the psychodynamic treatment of anxiety disorders has several advantages, that is (1) integrating the most effective treatment principles of empirically supported psychodynamic treatments for anxiety disorders can be expected to further improve the efficacy of PDT; (2) using a unified protocol in efficacy studies has the potential to enhance the evidence-based status of PDT by aggregating the evidence; (3) a unified protocol will facilitate both training in PDT and transfer of research to clinical practice; and (4) thus, a unified

  2. Alcohol-Induced Impairment in Adolescents Admitted to Inpatient Treatment After Heavy Episodic Drinking: Effects of Age and Gender

    PubMed Central

    Mick, Inge; Gross, Cornelius; Lachnit, Andreas; Kalkbrenner, Manja; Hoppe, Linda; Reichert, Jörg; Zimmermann, Ulrich S.

    2015-01-01

    Objective: In Germany and many other countries, the number of adolescent heavy episodic drinking–induced hospital admissions (HEDHA) in pediatric units markedly increased during the past decade. A low level of response to alcohol in young adults is associated with high risk for later development of alcohol use disorders (AUDs). Method: We performed a retrospective chart review of all 1,123 HEDHA cases in adolescents aged 11–17 years who were admitted to one of the pediatric inpatient units covering the cities of Dresden, Pirna, and Rostock, Germany, between 2000 and 2008. Blood alcohol concentration (BAC) and Glasgow Coma Scale (GCS) measures on admission were documented in 846 cases. Results: The mean (SD) BAC was 155 (50) mg/100 ml full blood, and M (SD) GCS was 12.21 (3.02). These parameters were negatively correlated with each other (r = -.256, p < .001), indicating more impairment at higher BACs. To describe a numerical estimate of how severely a subject was compromised relative to his BAC, the GCS scores were inverted (making high scores indicate severe impairment) and divided by BAC. The resulting alcohol-induced impairment index (AIII) was significantly influenced by an interaction between age and gender, decreasing with age in boys but increasing in girls. Conclusions: During adolescence, alcohol-induced impairment develops differently in boys and girls, which may be because of the girls’ developmental edge. The high variability of observed AIII might help to predict the risk for later AUDs in the emergency department, simply by measuring BAC and GCS. PMID:25978837

  3. Development of a treatment protocol for Puerto Rican adolescents with suicidal behaviors.

    PubMed

    Duarté-Vélez, Yovanska; Torres-Dávila, Paloma; Spirito, Anthony; Polanco, Norka; Bernal, Guillermo

    2016-03-01

    Adolescents in Puerto Rico are at an increased risk for suicide attempts, though evidence-based treatments specifically for this group have not been tested. The current study was designed to develop and pilot test a culturally sensitive, manualized outpatient treatment for Puerto Rican adolescents who have experienced a suicidal crisis. The study was divided into phases. Phase 1 consisted of developing a socio-cognitive behavioral treatment for suicidal behavior. Phase 2 tested the treatment protocol in an open trial with 11 (6 male and 5 female) Puerto Rican adolescents. Active treatment had an approximate duration of 3-6 months. An initial assessment, process measures, and posttreatment assessment were completed with each participant to measure treatment feasibility as well as suicidality, symptoms, and risk factors. Participants were very satisfied with treatment and reported relevant clinical benefits. The retention rate was 73% (8 out of 11). For those who completed the treatment protocol, the goal of reducing further suicide risk was achieved; 2 showed reliable clinical changes in suicidal ideation, while 6 maintained low levels during treatment. All treatment completers had either a partial or total remission of their pretreatment diagnosis and half had reliable improvements in at least 1 risk factor. A theory-driven treatment protocol was developed according to patient's needs, but further research is needed to continue its development and to explore its efficacy. PMID:26928136

  4. Auricular point acupressure for chronic pain: a feasibility study of a 4-week treatment protocol.

    PubMed

    Yeh, Chao Hsing; Chien, Lung-Chang; Huang, Li Chun; Suen, Lorna Kwai-Ping

    2014-01-01

    This 1-group, 4-week observational study aimed to (1) assess the feasibility of recruiting, retention, and completion of a 4-week auricular point acupressure (APA) treatment protocol for chronic pain in adult patients and (2) assess the effects of APA in pain reduction (pain severity and pain interference) among these patients. The participants received a 4-week APA treatment protocol in weekly cycles. Each weekly cycle included 5 days with APA seeds taped onto the ear and 2 days without. Each participant was called every day to monitor adherence to the treatment protocol (the actual times the participant pressed the seeds each day and the duration of applied pressure), to answer analgesic use, and to answer the pain intensity questionnaire. Thirty participants were initially enrolled in this study, but 5 did not continue. The retention rate was 83% (n = 25). Approximately 60% of the participants (n = 15) adhered to the 4-week APA and completed all data assessments. At baseline assessment, only 40% of all participants (n = 12 of 30) were confident that APA would reduce and eliminate pain; nonetheless, all participants reported fewer episodes of pain occurrences and pain intensity with the APA treatment. For the participants who completed the 4-week APA protocol (n = 15), 96% (n = 14) decreased analgesic medication intake and 88% (n = 13) felt "much better" after the APA treatment. Participants reported an average reduction of 63% in the worst pain intensity at day 7. By the end of the 4-week APA protocol, an even greater reduction in pain intensity was reported (66%, n = 10, at day 28). The participants who did not complete the treatment protocol reported an average pain reduction of 29%, which fluctuated to 22% before they dropped out. Auricular point acupressure is feasible for patients with chronic pain. The preliminary findings of this feasibility study show a reduction in pain intensity and improvement in physical function, which demonstrate the potential for

  5. Provision of group psychoeducation for relatives of persons in inpatient depression treatment – a cross-sectional survey of acute care hospitals in Germany

    PubMed Central

    2014-01-01

    Background Depressive disorders are often recurrent and place a high burden on patients and their relatives. Psychoeducational groups for relatives may reduce relatives’ burden, help prevent relapses in patients, and are recommended by the German “National Disease Management Guideline Unipolar Depression”. Since there is limited knowledge on the provision of psychoeducational groups for relatives of persons in inpatient depression treatment, we conducted a survey among acute care hospitals in Germany. Methods We conducted a two-step cross-sectional survey. Step I consisted of a questionnaire asking the heads of all psychiatric/psychosomatic acute care hospitals in Germany (N = 512) whether psychoeducational groups for relatives were provided within depression treatment, and if not, the reasons for not implementing them. In group offering hospitals the person responsible for conducting psychoeducational groups received a detailed questionnaire on intervention characteristics (step II). We performed descriptive data analysis. Results The response rate was 50.2% (N = 257) in step I and 58.4% in step II (N = 45). 35.4% of the responding hospitals offered psychoeducational groups for relatives of patients with depressive disorders. According to the estimates of the respondents, relatives of about one in five patients took part in psychoeducational groups in 2011. Groups were mostly provided by two moderators (62.2%) as continuous groups (77.8%), without patients’ participation (77.8%), with up to ten participants (65.9%), consisting of four or fewer sessions (51.5%) which lasted between one and one and a half hours each (77.8%). The moderators in charge were mostly psychologists (43.9%) or physicians (26.8%). Approximately one third used published manuals. Reasons for not conducting such psychoeducational groups were lack of manpower (60.1%), time (44.9%) and financial constraints (24.1%). 25.3% mentioned adequate concepts of intervention as a

  6. A Protocol for the Assessment and Treatment of School Phobia.

    ERIC Educational Resources Information Center

    Doll, Beth

    This paper addresses the problem of school phobia, one of the most common childhood anxiety disorders. It presents four case studies of preadolescent school phobia involving two girls and two boys in grades four through seven. Several features of effective strategies for the assessment and treatment of school phobia which have emerged from the…

  7. Therapeutic Treatment Protocol for Enuresis Using an Enuresis Alarm

    ERIC Educational Resources Information Center

    Shapira, Bettina E.; Dahlen, Penny

    2010-01-01

    Enuresis, one of the most prevalent and chronic childhood disorders, imposes serious financial, physical, and emotional burdens on the child and the family affected by it. This article provides counselors with an overview of the complex etiologies, diagnostic criteria, and current treatment options for the disorder, as well as assessment tools and…

  8. Evaluation of image-guidance protocols in the treatment of head and neck cancers

    SciTech Connect

    Zeidan, Omar A. . E-mail: omar.zeidan@orhs.org; Langen, Katja M.; Meeks, Sanford L.; Manon, Rafael R.; Wagner, Thomas H.; Willoughby, Twyla R.; Jenkins, D. Wayne; Kupelian, Patrick A.

    2007-03-01

    Purpose: The aim of this study was to assess the residual setup error of different image-guidance (IG) protocols in the alignment of patients with head and neck cancer. The protocols differ in the percentage of treatment fractions that are associated with image guidance. Using data from patients who were treated with daily IG, the residual setup errors for several different protocols are retrospectively calculated. Methods and Materials: Alignment data from 24 patients (802 fractions) treated with daily IG on a helical tomotherapy unit were analyzed. The difference between the daily setup correction and the setup correction that would have been made according to a specific protocol was used to calculate the residual setup errors for each protocol. Results: The different protocols are generally effective in reducing systematic setup errors. Random setup errors are generally not reduced for fractions that are not image guided. As a consequence, if every other treatment is image guided, still about 11% of all treatments (IG and not IG) are subject to three-dimensional setup errors of at least 5 mm. This frequency increases to about 29% if setup errors >3 mm are scored. For various protocols that require 15% to 31% of the treatments to be image guided, from 50% to 60% and from 26% to 31% of all fractions are subject to setup errors >3 mm and >5 mm, respectively. Conclusion: Residual setup errors reduce with increasing frequency of IG during the course of external-beam radiotherapy for head-and-neck cancer patients. The inability to reduce random setup errors for fractions that are not image guided results in notable residual setup errors.

  9. The implementation of a new Malaria Treatment Protocol in Timor-Leste: challenges and constraints

    PubMed Central

    Martins, João Soares; Zwi, Anthony B; Hobday, Karen; Bonaparte, Fernando; Kelly, Paul M

    2012-01-01

    Background Timor-Leste changed its malaria treatment protocol in 2007, replacing the first-line for falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. This study explored the factors affecting the implementation of the revised treatment protocol, with an emphasis on identifying key constraints. Methods A mixed method approach drew on both qualitative and quantitative data. The study included data from District Health Services in seven districts, community health centres in 14 sub-districts, four hospitals, five private clinics, one private pharmacy and the country's autonomous medical store. In-depth interviews with 36 key informants, five group interviews and 15 focus group discussions were conducted. A survey was also undertaken at community health centres and hospitals to assess the availability of a physical copy of the Malaria Treatment Protocol, as well as the availability and utilization of artemether-lumefantrine and sulphadoxine-pyrimethamine. Results Many factors impeded the implementation of the new malaria protocol. These included: inadequate introduction and training around the revised treatment protocol; unclear phasing out of sulphadoxine-pyrimethamine and phasing in of the revised treatment, artemether-lumefantrine, and the rapid diagnostic test (RDT); lack of supervision; lack of adherence to the revised guidelines by foreign health workers; lack of access to the new drug by the private sector; obstacles in the procurement process; and the use of trade names rather than generic drug description. Insufficient understanding of the rapid diagnostic test and the untimely supply of drugs further hampered implementation. Conclusion To effectively implement a revised malaria treatment protocol, barriers should be identified during the policy formulation process and those emerging during implementation should be recognized promptly and addressed. PMID:22460007

  10. Managing symptoms during cancer treatments: evaluating the implementation of evidence-informed remote support protocols

    PubMed Central

    2012-01-01

    Background Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©). Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments. Methods A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a) establishing an advisory knowledge user team in each of three targeted settings; (b) assessing factors influencing nurses’ use of protocols using interviews/focus groups and a standardized survey instrument; (c) adapting protocols for local use, ensuring fidelity of the content; (d) selecting intervention strategies to overcome known barriers and implementing the protocols; (e) conducting think-aloud usability testing; (f) evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g) assessing satisfaction with remote support using symptom protocols and change in nurses’ barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing with comparisons across

  11. Coronal shear fractures of distal humerus: Diagnostic and treatment protocols

    PubMed Central

    Singh, Ajay Pal; Singh, Arun Pal

    2015-01-01

    Coronal shear fractures of distal humerus involving the capitellum and the trochlea are rare injuries with articular complexity, and are technically challenging for management. With better understanding of the anatomy and imaging advancements, the complex nature of these fractures is well appreciated now. These fractures involve metaphysealcomminution of lateral column and associated intraarticular injuries are common. Previously, closed reduction and excision were the accepted treatment but now preference is for open reduction and internal fixation with an aim to provide stable and congruent joint with early range of motion of joint. Various approaches including extensile lateral, anterolateral and posterior approaches have been described depending on the fracture pattern and complexity. Good to excellent outcome have been reported with internal fixations and poor results are noted in articular comminution with associated articular injuries. Various implants including headleass compression screws, minifragment screws, bioabsorbable implants and column plating are advocated for reconstruction of these complex fractures. Inspite of articular fragments being free of soft tissue attachments the rate of osteonecrosis and osteoarthritis is reported very less after internal fixation. This article summarizes the diagnostic and treatment strategies for these rare fractures and recommendations for management. PMID:26716083

  12. Successful withdrawal from antipsychotic treatment in elderly male inpatients with schizophrenia--description of four cases and review of the literature.

    PubMed

    Suzuki, Takefumi; Uchida, Hiroyuki

    2014-12-15

    We describe four elderly male inpatients with chronic schizophrenia successfully withdrawn from long-lasting antipsychotic treatment. Then we review studies in which antipsychotics were discontinued in patients 65 y.o. (or at least 50 on the average) or older using PubMed (last search; August 2014). The average (±S.D.) age, duration of illness and total duration of hospitalization of the patients were 77.0±8.6 y.o., 46.0±26.9 years, and 41.0±27.3 years, respectively. Illness severity as assessed with the Clinical Global Impression (CGI)-Severity was five for three patients and six for the other. After withdrawal from antipsychotic treatment for 28.3±11.4 weeks, none showed appreciable changes in psychopathology, functioning as well as adverse effects and the resultant CGI-Improvement was four for all patients. Compared with those who needed continuous antipsychotic treatment in the same unit (n=51; mean±S.D. age: 56.0±12.1 y.o.), they were significantly older and treated with a fewer number of total psychotropics at baseline (1.50±1.00 versus 4.94±1.93 agents). A literature search failed to find any studies in which antipsychotics were discontinued exclusively in patients with schizophrenia 65 years or older and underscored a clear paucity of data on this important topic. Cessation of chronic antipsychotic treatment could be a viable option at least in some patients with geriatric schizophrenia although more systematic studies are necessary. PMID:25200762

  13. Mental Health and Substance Use Characteristics of Flight Attendants Enrolled in an In-Patient Substance Abuse Treatment Program

    ERIC Educational Resources Information Center

    Horton, Gail; Diaz, Naelys; McIlveen, John; Weiner, Michael; Mullaney, Donald

    2011-01-01

    The purpose of this study was to explore the prevalence rates of co-occurring mental health problems among 70 flight attendants in substance abuse treatment. Results indicated that flight attendants in treatment were more likely to experience alcohol dependency than drug dependency. A high proportion of participants reported clinical levels of…

  14. [Normative definition of staff requirement for a guideline-adherent inpatient qualified detoxification treatment in alcohol dependence].

    PubMed

    Kiefer, F; Koopmann, A; Godemann, F; Wolff, J; Batra, A; Mann, K

    2016-03-01

    The central element of the "qualified withdrawal treatment" of alcohol dependence is - in addition to physical withdrawal treatment - psychotherapy. The treatment of the underlying addictive disorder that is displayed by intoxication, harmful behaviour and withdrawal symptoms is only possible with a combination of somatic and psychotherapeutic treatment elements. The successfully established multimodal therapy of the "qualified alcohol withdrawal treatment", postulated in the current S3-Treatment Guidelines, requires a multi-disciplinary treatment team with psychotherapeutic competence. The aim of the present work is to calculate the normative staff requirement of a guideline-based 21-day qualified withdrawal treatment and to compare the result with the staffing regulations of the German Institute for Hospital Reimbursement. The present data support the hypothesis that even in the case of a hundred per cent implementation of these data, adequate therapy of alcohol-related disorders, according to the guidelines, is not feasible. This has to be considered when further developing the finance compensation system based on the described superseded elements of the German Institute for Hospital Reimbursement. PMID:26842899

  15. Rules of engagement: qualitative experiences of therapeutic alliance when receiving in-patient treatment for anorexia nervosa.

    PubMed

    Sly, Richard; Morgan, John F; Mountford, Victoria A; Sawer, Francesca; Evans, Charlotte; Lacey, J Hubert

    2014-01-01

    Recent research has emphasised the importance of therapeutic alliance to treatment outcomes for anorexia nervosa. This study aimed to examine the experiences of service users in developing therapeutic alliance whilst in treatment for their eating disorders. This qualitative study, using purposive sampling, recruited a sample of service users receiving treatment at a national eating disorders service. In-depth interviews were audiotaped and transcribed, with transcriptions being subject to interpretative phenomenological analysis. Participants were eight adult women receiving tertiary level eating disorder treatment in a specialist setting. The text analysis produced four dominant categories: alliance as a key experience; being active, not passive; taboo talking; and first impressions count. The development of therapeutic alliance is a core component of treatment. This study identifies important areas that contribute to the successful cultivation of positive therapeutic alliance. PMID:24392991

  16. National Trends in the Surgical Treatment of Ovarian Torsion in Children: An Analysis of 2041 Pediatric Patients Utilizing the Nationwide Inpatient Sample.

    PubMed

    Sola, Richard; Wormer, Blair A; Walters, Amanada L; Heniford, B Todd; Schulman, Andrew M

    2015-09-01

    The aim of this study was to evaluate the national trends in surgical management of ovarian torsion (OT) in children. The Nationwide Inpatient Sample was queried from 1998 to 2011 for females less than 18 years of age with OT. Patients were stratified into three treatment groups: oophorectomy (OO), oophoropexy, or release of torsion (RT) alone. There were 2041 patients with OT, of which 1598 (78%) underwent OO, 126 (6%) oophoropexy, and 317 (15%) RT. RT significantly increased from 1998 to 2011 (9% vs 25%; P < 0.05). At nonteaching hospitals, there were higher rates of OO (89.3% vs 79.5%; P < 0.05) and lower rates of RT (10.7% vs 20.5%; P < 0.05) compared with teaching hospitals. RT was performed at a higher rate in Northeast United States compared with the South (22.7% vs 14.2%; P < 0.05). Girls presenting at nonteaching hospitals and the South had increased odds of undergoing OO compared with those presenting at teaching hospitals and the Northeast (P < 0.05). Although ovarian conservation for OT in children is more often performed in the Northeast United States and at teaching hospitals, this large population-based study demonstrates OO remains the most common surgical management for OT in the United States. PMID:26350658

  17. Can the Health of the Nation Outcome Scales for Children and Adolescents predict the necessity of inpatient stay during assertive community treatment?

    PubMed

    Urben, Sébastien; Mantzouranis, Gregory; Baier, Vanessa; Halfon, Olivier; Villard, Eva; Holzer, Laurent

    2016-08-30

    Understanding the trajectories of youths within Child and Adolescents Mental Health Service (CAMHS) is of primary importance. Our objective is to assess the usefulness of the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) to predict inpatient (IP) stay for youths followed by assertive community treatment (ACT) teams. 82 youths followed exclusively by ACT and 42 who needed IP were assessed with the HoNOSCA at admission to the program. The HoNOSCA allowed the computing of three scores: a total score, an externalizing symptoms (Ext) score and an emotional problems (Emo) score. Logistic regressions revealed that the three HoNOSCA scores at admission of ACT predicted later need for hospitalization. Using ROC curve analyses, we set up cut off scores with appropriate sensitivity and specificity for the HoNOSCA Total and Ext to optimally predict the need for hospitalization. This study revealed that the HoNOSCA may be a useful tool to predict the need for later IP during ACT. Such knowledge is important to set up the best therapeutic strategies. PMID:27341331

  18. Long-term patterns in interpersonal behaviour amongst psychopathic patients in secure inpatient treatment: A follow-up study.

    PubMed

    Draycott, Simon; Short, Roxanna; Kirkpatrick, Tim

    2015-05-01

    Psychopathy is a disorder that is partly defined by with maladaptive interpersonal behaviour and has significant effects on treatment outcomes. A previous study (Draycott et al., ) found that higher levels of psychopathy led to a specific interpersonal 'trajectory' amongst patients in a secure psychiatric treatment programme during the first 9 months of their admission. In that programme, more psychopathic patients became increasingly dominant over time, and less psychopathic patients became increasingly hostile. This study is a longer-term follow-up and extension of that study, extending the window of observation to 33 months of treatment. It was found that the more psychopathic patients' increased dominance returned to baseline levels by 33 months, as did the less psychopathic patients' increased hostility. This suggests that treatment for this group is not idiopathic but leaves unanswered the question as to what these divergent trajectories represent. PMID:25622564

  19. The Cost-Effectiveness of an Intensive Treatment Protocol for Severe Dyslexia in Children

    ERIC Educational Resources Information Center

    Hakkaart-van Roijen, Leona; Goettsch, Wim G.; Ekkebus, Michel; Gerretsen, Patty; Stolk, Elly A.

    2011-01-01

    Studies of interventions for dyslexia have focused entirely on outcomes related to literacy. In this study, we considered a broader picture assessing improved quality of life compared with costs. A model served as a tool to compare costs and effects of treatment according to a new protocol and care as usual. Quality of life was measured and valued…

  20. Psychological Symptoms Before and After a 14-Day Initial Inpatient Treatment in Tuberculosis Patients Compared with Their Primary Caregivers and Healthy Controls

    PubMed Central

    Emami, Habib; Modarressi, Taher; Najmi, Kosar; Radmand, Golnar; Tabarsi, Payam; Richter, Jörg

    2015-01-01

    Background: Tuberculosis (TB) is one of the most challenging public health burdens in the world. Recent research demonstrated high prevalence of mental disorders in TB patients and their caregivers. The purpose of this study was to assess mental health of TB patients and their caregivers in Iran before and after a two-week inpatient treatment and to determine the prevalence of psychological problems in these groups. Materials and Methods: A standardized questionnaire (SCL-90) was used to assess psychological symptoms in 146 hospitalized TB patients and their caregivers (n=89). Furthermore, the scores of both target groups were compared with those of a group of healthy individuals (n=85). Results: The mean scores before the start of the initial treatment of the patients were significantly lower for paranoid ideation (P=0.038) and hostility (P= 0.046), and the scores of depression (P=0.046) and somatization (P=0.001) were significantly higher than those of the healthy individuals. The patients scored significantly higher than the caregivers on depression (0.047) and somatization (P< 0.001), whereas the caregivers scored higher than the healthy individuals on paranoid ideation (P= 0.044) and hostility (P= 0.034). Multiple linear regression showed that age, educational level and marital status were factors affecting the mental health of TB patients and their caregivers. The variance in psychological symptoms of the patients was between 10% (paranoid ideation) and 27% (hostility) of the variance in the symptoms of their caregivers. Conclusion: Tuberculosis control and treatment programs should not only address issues like continued respiratory symptoms, but should also focus on mental health in TB patients and their caregivers. PMID:26858764

  1. An Evaluation of the Italian Version of the Yale Food Addiction Scale in Obese Adult Inpatients Engaged in a 1-Month-Weight-Loss Treatment.

    PubMed

    Ceccarini, Martina; Manzoni, Gian Mauro; Castelnuovo, Gianluca; Molinari, Enrico

    2015-11-01

    Addiction is a compulsive need for and use of a specific substance leading to a habit, tolerance, and psychophysiological symptoms. Excessive food consumption is similar to that of substance addiction. Some individuals who have trouble losing weight display addictive eating symptoms. To investigate food addiction in a sample of obese adults referred to hospital for a 1-month-weight-loss treatment. The Italian version of the Yale Food Addiction Scale (YFAS-16) was used as a screening tool in 88 obese inpatients. The construct validity of the YFAS-16 was assessed by testing its correlations with measures of binge eating (Binge Eating Scale), impulsiveness (Barratt Impulsiveness Scale), and emotional dysregulation (Difficulties in Emotion Regulation Scale). 34.1% of our sample was diagnosed with YFAS food addiction. Such diagnosis was also supported by strong associations between FA and psychological and behavioral features, typically descriptive of classic addiction. Patients who endorsed the YFAS-16 criteria for food addiction (FA) had significantly higher binge eating levels, greater emotional dysregulation, and nonacceptance of negative feelings; they lacked goal-oriented behavior, had little impulse control, had difficulty in emotion recognition, and attentional impulsivity; and they were unable to concentrate and lacked inhibitory control behavior, unlike participants who did not meet the FA criteria. Further research is needed to support the reliability of the YFAS-16. This measure has the potential to be applied in epidemiological research, estimating the prevalence of FA within the Italian population and to assess new treatments' efficacy for obese patients with food addiction symptoms seeking weight-loss treatments. PMID:26267366

  2. A Standardized Protocol for the Treatment of Early Postoperative Stiffness following Total Knee Arthroplasty.

    PubMed

    Werner, Steven; Jacofsky, Marc; Kocisky, Sarah; Jacofsky, David

    2015-10-01

    Manipulation under anesthesia (MUA) and continuous passive motion (CPM) are commonly used to optimize range of motion (ROM) for the treatment of early stiffness following total knee arthroplasty (TKA). The addition of systemic glucocorticoid as an adjunct to a standardized protocol of MUA and aggressive CPM treatment is outlined. Results demonstrate an average postoperative increase in knee ROM of 45 degrees in 78 TKAs at 10 weeks from MUA procedure with no complications reported. PMID:26030262

  3. The Development of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: A Case Study

    PubMed Central

    Boisseau, Christina L.; Farchione, Todd J.; Fairholme, Christopher P.; Ellard, Kristen K.; Barlow, David H.

    2013-01-01

    A detailed description of treatment utilizing the Unified Protocol (UP), a transdiagnostic emotion-focused cognitive-behavioral treatment, is presented using a clinical case example treated during the most current phase of an ongoing randomized controlled trial of the UP. The implementation of the UP in its current, modular version is illustrated. A working case conceptualization is presented from the perspective of the UP drawing from theory and research that underlies current transdiagnostic approaches to treatment and consistent with recent dimensional classification proposals (Brown & Barlow, in press). Treatment is illustrated module-by-module describing how the principles of the UP were applied in the presented case. PMID:23997572

  4. Confusion ahead as CMS changes inpatient criteria.

    PubMed

    2013-10-01

    In the Inpatient Prospective Payment System final rule for 2014, the Centers for Medicare & Medicaid Services established a benchmark of two midnights for an inpatient admission and issued robust requirements for documentation. Case managers must work closely with physicians to ensure that the documentation includes the expected length of stay, the rationale for hospital treatment, the treatment plan, and a written order for admission. Case managers must review every admission within 24 hours to make sure the hospital doesn't lose reimbursement. Auditors will be looking for incidents where hospitals keep patients over two midnights when it's not medically necessary in order to get inpatient reimbursement. CMS continues to emphasize quality in care. PMID:24195133

  5. Feasibility Testing of a Protocol to Stop Ineffective Drug and Nondrug Treatments.

    PubMed

    Kovach, Christine R; Hekel, Barb; Rababa, Mohammad

    2015-11-01

    Ineffective treatments continue to be given to nursing home residents with dementia, and many more treatments are started than stopped. The Track and Trigger Treatment (T(3)) Protocol assists nurses to track responses to new treatments and get ineffective treatments stopped or altered. This preliminary study determined feasibility for end users and examined differences between two randomized groups in assessments, treatment changes, nurse time, and drug costs over 8 weeks. Controlling for number of medical diagnoses, 41 residents in the T(3) group had significantly more treatments stopped than 37 residents in the usual care group. Treatments were most commonly stopped because of ineffectiveness (33%), followed by the problem being resolved (29%), side effects (18%), and a change in goals of care (20%). Assessment quality was a statistically significant mediator, and drug costs were significantly less for the T(3) group. The T(3) processes were rated as useful and easy, with one caveat. PMID:26250849

  6. Doses delivered to normal brain under different treatment protocols at Brookhaven National Laboratory

    SciTech Connect

    Capala, J.; Coderre, J.A.; Liu, H.B.

    1996-12-31

    As of October 31, 1996, 23 glioblastoma multiforme patients underwent BNCT under several treatment protocols at the Brookhaven Medical Research Reactor. For treatment planning and dosimetry purposes, these protocols may be divided into four groups. The first group comprises protocols that used an 8-cm collimator and allowed a peak normal brain dose of 10.5 Gy-Eq to avolume of 1 cm{sup 3} were the thermal neutron flux was maximal (even if it happened to be in the tumor volume). The second group differs from the first in that it allowed a peak normal brain dose of 12.6 Gy-Eq. The protocols of the third and fourth groups allowed the prescribed peak normal brain dose of 12.6 Gy-Eq to be outside of the tumor volume, used a 12-cm collimator and, respectively, uni- or bilateral irradiations. We describe the treatment planning procedures and report the doses delivered to various structures of the brain.

  7. Advantages of the Papillon protocol in the preoperative treatment of rectal carcinoma.

    PubMed

    Klimberg, V S; Langston, J D; Maners, A; Gocio, J C; Hutchins, L F; Lang, N P; Westbrook, K C; Broadwater, J R

    1992-11-01

    Standard treatment for advanced rectal carcinoma currently includes surgery, radiotherapy, and chemotherapy. Although there are theoretic advantages to preoperative irradiation, it is often not performed because of the prolonged delay of surgery and the purported increase in perioperative complications. A pilot study was undertaken at our institution to evaluate a treatment protocol advocated by Dr. Papillon that offers a shorter treatment time and less patient morbidity than conventional preoperative therapy for rectal carcinoma. Twenty patients with rectal cancer underwent the preoperative regimen that consisted of 3,000 cGy delivered in 10 fractions over 12 days with concomitant 5-fluorouracil and mitomycin-C. Complications were acceptable. Local recurrence was lower than in most reported trials, and survival rates were comparable. Additional benefits of the protocol include lower radiation morbidity to the patient and a decreased delay between diagnosis and surgery. PMID:1443366

  8. Development of a Unified Protocol for the Treatment of Emotional Disorders in Youth

    PubMed Central

    Ehrenreich, Jill T.; Goldstein, Clark M.; Wright, Lauren R.; Barlow, David H.

    2008-01-01

    This paper reviews the development and initial trial of a treatment for adolescents that targets negative emotionality and associated psychological difficulties, particularly anxiety and depressive disorders, as a more singular entity by utilizing an approach rooted in both emotion science and theory. The rationale for such an approach is based upon the perceived need for novel treatment approaches that target commonalities in emotional disorder symptom presentation and their intervention. Utilizing the Unified Protocol for the Treatment of Emotional Disorders originally developed for adults (Barlow, Allen & Choate, 2004), we conducted a multiple-baseline design study of a slightly modified version of this protocol with three adolescents presenting an array of anxiety and depression symptoms. Adolescent participants in this preliminary investigation evidenced symptom reductions across disorders at post-treatment, with greater improvements noted at a six-month follow-up. Based on these findings and research regarding the association between emotion science and developmental psychopathology, we detail a more extensive set of modifications to the protocol, undertaken in preparation for a subsequent open-trial investigation of the revised treatment. PMID:19617930

  9. Treatment Protocol for High Velocity/High Energy Gunshot Injuries to the Face

    PubMed Central

    Peled, Micha; Leiser, Yoav; Emodi, Omri; Krausz, Amir

    2011-01-01

    Major causes of facial combat injuries include blasts, high-velocity/high-energy missiles, and low-velocity missiles. High-velocity bullets fired from assault rifles encompass special ballistic properties, creating a transient cavitation space with a small entrance wound and a much larger exit wound. There is no dispute regarding the fact that primary emergency treatment of ballistic injuries to the face commences in accordance with the current advanced trauma life support (ATLS) recommendations; the main areas in which disputes do exist concern the question of the timing, sequence, and modes of surgical treatment. The aim of the present study is to present the treatment outcome of high-velocity/high-energy gunshot injuries to the face, using a protocol based on the experience of a single level I trauma center. A group of 23 injured combat soldiers who sustained bullet and shrapnel injuries to the maxillofacial region during a 3-week regional military conflict were evaluated in this study. Nine patients met the inclusion criteria (high-velocity/high-energy injuries) and were included in the study. According to our protocol, upon arrival patients underwent endotracheal intubation and were hemodynamically stabilized in the shock-trauma unit and underwent total-body computed tomography with 3-D reconstruction of the head and neck and computed tomography angiography. All patients underwent maxillofacial surgery upon the day of arrival according to the protocol we present. In view of our treatment outcomes, results, and low complication rates, we conclude that strict adherence to a well-founded and structured treatment protocol based on clinical experience is mandatory in providing efficient, appropriate, and successful treatment to a relatively large group of patients who sustain various degrees of maxillofacial injuries during a short period of time. PMID:23449809

  10. Treatment protocol for high velocity/high energy gunshot injuries to the face.

    PubMed

    Peled, Micha; Leiser, Yoav; Emodi, Omri; Krausz, Amir

    2012-03-01

    Major causes of facial combat injuries include blasts, high-velocity/high-energy missiles, and low-velocity missiles. High-velocity bullets fired from assault rifles encompass special ballistic properties, creating a transient cavitation space with a small entrance wound and a much larger exit wound. There is no dispute regarding the fact that primary emergency treatment of ballistic injuries to the face commences in accordance with the current advanced trauma life support (ATLS) recommendations; the main areas in which disputes do exist concern the question of the timing, sequence, and modes of surgical treatment. The aim of the present study is to present the treatment outcome of high-velocity/high-energy gunshot injuries to the face, using a protocol based on the experience of a single level I trauma center. A group of 23 injured combat soldiers who sustained bullet and shrapnel injuries to the maxillofacial region during a 3-week regional military conflict were evaluated in this study. Nine patients met the inclusion criteria (high-velocity/high-energy injuries) and were included in the study. According to our protocol, upon arrival patients underwent endotracheal intubation and were hemodynamically stabilized in the shock-trauma unit and underwent total-body computed tomography with 3-D reconstruction of the head and neck and computed tomography angiography. All patients underwent maxillofacial surgery upon the day of arrival according to the protocol we present. In view of our treatment outcomes, results, and low complication rates, we conclude that strict adherence to a well-founded and structured treatment protocol based on clinical experience is mandatory in providing efficient, appropriate, and successful treatment to a relatively large group of patients who sustain various degrees of maxillofacial injuries during a short period of time. PMID:23449809

  11. [Economic aspects of inpatient treatment for decompensated liver cirrhosis: a prospective study employing an evidence-based clinical pathway].

    PubMed

    Hahn, N; Bobrowski, C; Weber, E; Simon, P; Kraft, M; Aghdassi, A; Raetzell, M; Wilke, M; Lerch, M M; Mayerle, J

    2013-03-01

    The introduction of the G-DRG reimbursement system has greatly increased the pressure to provide cost effective treatment in German hospitals. Reimbursement based on diagnosis-related groups, which requires stratification of costs incurred is still not sufficiently discriminating the disease severity and severity in relation to the intensive costs in gastroenterology. In a combined retrospective and prospective study at a tertial referral centre we investigated whether this also applies for decompensated liver cirrhosis. In 2006, 64 retrospective cases (age 57 ± 12.9; ♂ 69.2 %, ♀ 29.8 %) with decompensated liver cirrhosis (ICD code K76.4) were evaluated for their length of hospitalisation, reimbursement as well as Child and MELD scores. In 2008, 74 cases with decompensated liver cirrhosis were treated in a prospective study according to a standardised and evidence-based clinical pathway (age 57 ± 12.2; 73 % ♂, ♀ 27 %). Besides a trend in the reduction of length of hospital stay (retrospective: 13.6 ± 8.6, prospective 13.0 ± 7.2, p = 0.85) overall revenues from patients treated according to a evidence-based clinical pathway were lower than the calculated costs from the InEK matrix. Costs of medication as a percentage of reimbursement amount increased with increasing severity. In both years we could demonstrate an inverse correlation between daily reimbursement and disease severity which precluded cost coverage. For the cost-covering hospital treatment of patients with decompensated liver cirrhosis an adjustment of the DRG based on clinical severity scores such as Child-Pugh or MELD is warranted, if evidence-based treatment standards are to be kept. PMID:23299901

  12. A comparison of treatment adherence in individuals with a first episode of psychosis and inpatients with psychosis.

    PubMed

    Spidel, Alicia; Greaves, Caroline; Yuille, John; Lecomte, Tania

    2015-01-01

    In predicting treatment compliance in individuals with severe mental illness, research has focused on variables such as substance abuse, personality, history of child abuse, and symptomatology, although these relationships have not been investigated in great detail in individuals at the onset of mental illness. To better understand these correlates of treatment compliance, two samples were examined: a sample of 117 individuals presenting with a first episode of psychosis and a more chronic forensic sample of 65 participants recruited from a psychiatric hospital. These samples were investigated for service engagement in terms of violence history, substance abuse, symptom severity, psychopathic traits and history of childhood abuse. Linear regressions performed for the first episode sample revealed that childhood physical abuse was the strongest predictor of poor service engagement, followed by problems with alcohol, a history of physical violence, any history of violence and higher psychopathic traits. Linear regression revealed for the forensic group that a lower level of service engagement was most strongly predicted by a history of childhood abuse and a higher score on the Brief Psychiatric Rating Scale (BPRS). Results are presented in light of the existing literature and clinical implications are discussed. PMID:25703818

  13. Methylphenidate in mania project (MEMAP): study protocol of an international randomised double-blind placebo-controlled study on the initial treatment of acute mania with methylphenidate

    PubMed Central

    2013-01-01

    Background Treatment of patients with acute mania remains a considerable medical challenge since onset of action of antimanic medication is delayed for several days. Psychostimulants could have an earlier onset of action. This assumption is based on the ‘vigilance regulation model of mania’ which postulates that vigilance is unstable in manic patients. Accordingly, vigilance-stabilising psychostimulants could be more useful than conventional treatment in acute mania. We present here the study protocol of a trial intended to study the efficacy and safety of methylphenidate in the initial treatment of acute mania. Methods/design A multi-centre, randomised, double-blind, placebo-controlled clinical trial will be conducted in 88 bipolar inpatients with acute mania. Male and female patients older than 18 years will be randomised to treatment with either methylphenidate (20 to 40 mg/day) or placebo for 2.5 days, given once or twice daily. The main outcome measure is the reduction in the Young Mania Rating Scale (YMRS) after 2.5 days of treatment. Other outcome measures include the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) the Clinical Global Impression–Bipolar Scale (CGI-BP), the Screen for Cognitive Impairment in Psychiatry (SCIP), actigraphy and the EEG-‘Vigilance Algorithm Leipzig’ (VIGALL). Discussion A positive study outcome of the proposed study could substantially impact our understanding of the etiopathogenesis of mania and open new treatment perspectives. Trial registration ClinicalTrials.gov: NCT 01541605 PMID:23446109

  14. Sensitivity Analysis of Per-Protocol Time-to-Event Treatment Efficacy in Randomized Clinical Trials

    PubMed Central

    Gilbert, Peter B.; Shepherd, Bryan E.; Hudgens, Michael G.

    2013-01-01

    Summary Assessing per-protocol treatment effcacy on a time-to-event endpoint is a common objective of randomized clinical trials. The typical analysis uses the same method employed for the intention-to-treat analysis (e.g., standard survival analysis) applied to the subgroup meeting protocol adherence criteria. However, due to potential post-randomization selection bias, this analysis may mislead about treatment efficacy. Moreover, while there is extensive literature on methods for assessing causal treatment effects in compliers, these methods do not apply to a common class of trials where a) the primary objective compares survival curves, b) it is inconceivable to assign participants to be adherent and event-free before adherence is measured, and c) the exclusion restriction assumption fails to hold. HIV vaccine efficacy trials including the recent RV144 trial exemplify this class, because many primary endpoints (e.g., HIV infections) occur before adherence is measured, and nonadherent subjects who receive some of the planned immunizations may be partially protected. Therefore, we develop methods for assessing per-protocol treatment efficacy for this problem class, considering three causal estimands of interest. Because these estimands are not identifiable from the observable data, we develop nonparametric bounds and semiparametric sensitivity analysis methods that yield estimated ignorance and uncertainty intervals. The methods are applied to RV144. PMID:24187408

  15. Conservative Treatment Protocol for Keratocystic Odontogenic Tumour: a Follow-up Study of 3 Cases

    PubMed Central

    Yildirim, Gülsün; Ataoglu, Hanife; Kalayci, Abdullah; Kucuk, Korhan; Esen, Alparslan

    2010-01-01

    ABSTRACT Background The keratocystic odontogenic tumour is classified as a developmental cyst derived from the enamel organ or from the dental lamina. The treatment of keratocystic odontogenic tumour of the jaw remains controversial. The aim of this study was to report the outcome of our conservative treatment protocol for keratocystic odontogenic tumour. Methods Three patients with different complaints referred to Oral and Maxillofacial Surgery Clinic, Faculty of Dentistry, Selçuk University. Initial biopsy was carried out in all patients and keratocystic odontogenic tumours was diagnosed subsequent to histopathological examination. The patients with keratocystic odontogenic tumours were treated by enucleation followed by open packing. This conservative treatment protocol was selected because of existing young aged patients. The average follow-up duration of the cases was 2 years. Results Out of 3 cases, 2 lesions were present in mandible and 1 lesion in maxilla. There was no evidence of recurrence during follow-up. All the cases were monitored continuously with panoramic radiographs, computed tomography and clinical evaluations. Conclusions This conservative treatment protocol for keratocystic odontogenic tumours, based on enucleation followed by open packing would be a possible choice with a view of offering low recurrence rate and low morbidity rate particularly in young patients. PMID:24421977

  16. Inpatient rehabilitation approach for a young woman with conversion hemiparesis and sensory deficits.

    PubMed

    Kanarek, Samantha L; Stevenson, Jennifer E; Wakefield, Holly; Reite, Elizabeth; Zumsteg, Jennifer M; Brockway, Jo Ann

    2013-01-01

    In the treatment of conversion disorder, the inpatient rehabilitation setting supports interdisciplinary functional goals and a structured approach consistent with encouraging psychological well-being. This case presentation illustrates 1 approach to the rehabilitation of hemiparesis secondary to conversion disorder that includes a behavioral management plan, as well as protocols for "learning to walk" and "learning to use your arm." We provide a practical starting point for advancing function in patients with conversion disorder when functional loss is present in both upper and lower extremities. PMID:23332911

  17. Effectiveness of psychiatric inpatient care.

    PubMed

    Sonesson, Ove; Arvidsson, Hans; Tjus, Tomas

    2013-06-01

    There is a growing demand for evaluating the process and outcome of mental health care. Most healthcare providers routinely collect and register data related to the process of treatment, and it is important to acquire more knowledge about how to make use of these databases. The aim of this study was to investigate the outcome of psychiatric inpatient care in relation to different clinical factors, using the Global Assessment of Functioning Scale (GAF) as a measure of outcome. Another objective was to explore the ability of routinely collected and registered data to provide valuable information about patients and their care. The studied psychiatric inpatient sample consisted of 816 care episodes with GAF ratings made both at admission and at discharge for 648 patients. Variables used in the study included GAF score at admission and at discharge, age, gender, diagnosis, length of stay and ward affiliation. The overall mean GAF change was 20.74, and the overall effect size Cohen's d 1.67, which corresponds to a large effect. The mean GAF change for women was 21.6, with an effect size of 1.80, and for men 19.4 with an effect size of 1.52. The effect size spectra including all groups of diagnoses ranged from 1.03 (substance-related disorders) to 2.33 (other mood disorders). Length of stay and ward affiliation also showed significant results concerning GAF change. Some limitations in this study could depend on the absence of randomization procedures and a control group. Another limitation concerns the insufficient control of the inpatient care interventions performed. The results support the capacity of the GAF to function as a measure of outcome in relation to different clinical factors, such as length of stay and diagnosis. Support was also found for the importance and usefulness of routinely collected and registered data. PMID:22775246

  18. Optimized Protocol To Analyze Changes in the Lipidome of Xenografts after Treatment with 2-Hydroxyoleic Acid.

    PubMed

    Fernández, Roberto; Garate, Jone; Lage, Sergio; Terés, Silvia; Higuera, Mónica; Bestard-Escalas, Joan; Martin, M Laura; López, Daniel H; Guardiola-Serrano, Francisca; Escribá, Pablo V; Barceló-Coblijn, Gwendolyn; Fernández, José A

    2016-01-01

    Xenografts are a popular model for the study of the action of new antitumor drugs. However, xenografts are highly heterogeneous structures, and therefore it is sometimes difficult to evaluate the effects of the compounds on tumor metabolism. In this context, imaging mass spectrometry (IMS) may yield the required information, due to its inherent characteristics of sensitivity and spatial resolution. To the best of our knowledge, there is still no clear analysis protocol to properly evaluate the changes between samples due to the treatment. Here we present a protocol for the evaluation of the effect of 2-hydroxyoleic acid (2-OHOA), an antitumor compound, on xenografts lipidome based on IMS. Direct treated/control comparison did not show conclusive results. As we will demonstrate, a more sophisticated protocol was required to evaluate these changes including the following: (1) identification of different areas in the xenograft, (2) classification of these areas (necrotic/viable) to compare similar types of tissues, (3) suppression of the effect of the variation of adduct formation between samples, and (4) normalization of the variables using the standard deviation to eliminate the excessive impact of the stronger peaks in the statistical analysis. In this way, the 36 lipid species that experienced the largest changes between treated and control were identified. Furthermore, incorporation of 2-hydroxyoleic acid to a sphinganine base was also confirmed by MS/MS. Comparison of the changes observed here with previous results obtained with different techniques demonstrates the validity of the protocol. PMID:26607740

  19. A protocol proposition of cell therapy for the treatment of chronic obstructive pulmonary disease.

    PubMed

    Ribeiro-Paes, J T; Stessuk, T; Marcelino, M; Faria, C; Marinelli, T; Ribeiro-Paes, M J

    2014-01-01

    The main feature of pulmonary emphysema is airflow obstruction resulting from the destruction of the alveolar walls distal to the terminal bronchioles. Existing clinical approaches have improved and extended the quality of life of emphysema patients. However, no treatment currently exists that can change the disease course and cure the patient. The different therapeutic approaches that are available aim to increase survival and/or enhance the quality of life of emphysema patients. In this context, cell therapy is a promising therapeutic approach with great potential for degenerative pulmonary diseases. In this protocol proposition, all patients will be submitted to laboratory tests, such as evaluation of heart and lung function and routine examinations. Stem cells will be harvested by means of 10 punctures on each anterior iliac crest, collecting a total volume of 200mL bone marrow. After preparation, separation, counting and labeling (optional) of the mononuclear cells, the patients will receive an intravenous infusion from the pool of Bone Marrow Mononuclear Cells (BMMC). This article proposes a rational and safe clinical cellular therapy protocol which has the potential for developing new projects and can serve as a methodological reference for formulating clinical application protocols related to the use of cellular therapy in COPD. This study protocol was submitted and approved by the Brazilian National Committee of Ethics in Research (CONEP - Brazil) registration number 14764. It is also registered in ClinicalTrials.gov (NCT01110252). PMID:24287082

  20. Treatment protocol to control Streptococcus mutans level in an orthodontic patient with high caries risk.

    PubMed

    Alves, Patrícia V M; Alviano, Wagner S; Bolognese, Ana M; Nojima, Lincoln Issamu

    2008-01-01

    The purpose of this article is to report a protocol for treating an orthodontic patient with a high risk of developing caries. The salivary level of Streptococcus mutans was evaluated during various stages of orthodontic treatment. It was significantly high before professional application of 1% chlorhexidine collagen gel, daily mouth rinsing with 0.05% sodium fluoride solution, and bonding of the bands and brackets. Although there were no other changes in hygiene habits, microbiologic tests showed that the microbiota was in balance during the follow-up periods. At the end of orthodontic treatment, periodontal health was observed, and enamel surfaces showed signs of remineralization. PMID:18174078

  1. Neglected dislocation in sub-axial cervical spine: Case series and a suggested treatment protocol

    PubMed Central

    Srivastava, Sudhir Kumar; Aggarwal, Rishi Anil; Bhosale, Sunil Krishna; Nemade, Pradip Sharad

    2016-01-01

    Context: Approaches suggested for treatment of neglected dislocations in the subaxial cervical spine (SACS) include only anterior approach (a), only posterior approach (b), posterior-anterior approach, posterior-anterior-posterior approach, and anterior-posterior-anterior-posterior approach. No protocol is suggested in literature to guide surgeons treating neglected dislocations. Aim: To describe a protocol for the treatment of neglected dislocation in the SACS. Settings and Designs: Retrospective case series and review of literature. Materials and Methods: Six consecutive patients of neglected dislocation (presenting to us more than 3 weeks following trauma) of the SACS were operated as per the protocol suggested in this paper. A retrospective review of the occupational therapy reports, patient records, and radiographs was performed. Only cases with time lapse of more than 3 weeks between the time of injury and initial management have been included in the review. Results: Closed reduction (CR) was achieved in three patients following cervical traction and these were managed by anterior cervical discectomy and fusion (ACDF). Open reduction via posterior approach and soft tissue release was required to achieve reduction in two patients. Following reduction posterior instrumented fusion was done in them. One patient with preoperative neurological deficit needed a facetectomy to achieve reduction. Following short-segment fixation, ACDF was also performed in this patient. None of the patients deteriorated neurologically following surgery. Fusion was achieved in all patients. Conclusions: Preoperative and intraoperative traction have a role in the management of neglected dislocations in the cervical spine. If CR is achieved the patient may be managed by ACDF. If CR is not achieved, posterior soft tissue release may be done to achieve reduction and partial facetectomy must be reserved for cases in which reduction is not achieved after soft tissue release. A treatment

  2. Pharmacokinetic-Pharmacodynamic Model To Evaluate Intramuscular Tetracycline Treatment Protocols To Prevent Antimicrobial Resistance in Pigs

    PubMed Central

    Ahmad, Amais; Græsbøll, Kaare; Christiansen, Lasse Engbo; Toft, Nils; Matthews, Louise

    2014-01-01

    High instances of antimicrobial resistance are linked to both routine and excessive antimicrobial use, but excessive or inappropriate use represents an unnecessary risk. The competitive growth advantages of resistant bacteria may be amplified by the strain dynamics; in particular, the extent to which resistant strains outcompete susceptible strains under antimicrobial pressure may depend not only on the antimicrobial treatment strategies but also on the epidemiological parameters, such as the composition of the bacterial strains in a pig. This study evaluated how variation in the dosing protocol for intramuscular administration of tetracycline and the composition of bacterial strains in a pig affect the level of resistance in the intestine of a pig. Predictions were generated by a mathematical model of competitive growth of Escherichia coli strains in pigs under specified plasma concentration profiles of tetracycline. All dosing regimens result in a clear growth advantage for resistant strains. Short treatment duration was found to be preferable, since it allowed less time for resistant strains to outcompete the susceptible ones. Dosing frequency appeared to be ineffective at reducing the resistance levels. The number of competing strains had no apparent effect on the resistance level during treatment, but possession of fewer strains reduced the time to reach equilibrium after the end of treatment. To sum up, epidemiological parameters may have more profound influence on growth dynamics than dosing regimens and should be considered when designing improved treatment protocols. PMID:25547361

  3. The cost-effectiveness of an intensive treatment protocol for severe dyslexia in children.

    PubMed

    Hakkaart-van Roijen, Leona; Goettsch, Wim G; Ekkebus, Michel; Gerretsen, Patty; Stolk, Elly A

    2011-08-01

    Studies of interventions for dyslexia have focused entirely on outcomes related to literacy. In this study, we considered a broader picture assessing improved quality of life compared with costs. A model served as a tool to compare costs and effects of treatment according to a new protocol and care as usual. Quality of life was measured and valued by proxies using a general quality-of-life instrument (EQ-5D). We considered medical cost and non-medical cost (e.g. remedial teaching). The model computed cost per successful treatment and cost per quality adjusted life year (QALY) in time. About 75% of the total costs was related to diagnostic tests to distinguish between children with severe dyslexia and children who have reading difficulties for other reasons. The costs per successful treatment of severe dyslexia were €36 366. Successful treatment showed a quality-of-life gain of about 11%. At primary school, the average cost per QALY for severe dyslexia amounted to €58 647. In the long term, the cost per QALY decreased to €26 386 at secondary school and €17 663 thereafter. The results of this study provide evidence that treatment of severe dyslexia is cost-effective when the investigated protocol is followed. PMID:21793122

  4. Pharmacokinetic-pharmacodynamic model to evaluate intramuscular tetracycline treatment protocols to prevent antimicrobial resistance in pigs.

    PubMed

    Ahmad, Amais; Græsbøll, Kaare; Christiansen, Lasse Engbo; Toft, Nils; Matthews, Louise; Nielsen, Søren Saxmose

    2015-03-01

    High instances of antimicrobial resistance are linked to both routine and excessive antimicrobial use, but excessive or inappropriate use represents an unnecessary risk. The competitive growth advantages of resistant bacteria may be amplified by the strain dynamics; in particular, the extent to which resistant strains outcompete susceptible strains under antimicrobial pressure may depend not only on the antimicrobial treatment strategies but also on the epidemiological parameters, such as the composition of the bacterial strains in a pig. This study evaluated how variation in the dosing protocol for intramuscular administration of tetracycline and the composition of bacterial strains in a pig affect the level of resistance in the intestine of a pig. Predictions were generated by a mathematical model of competitive growth of Escherichia coli strains in pigs under specified plasma concentration profiles of tetracycline. All dosing regimens result in a clear growth advantage for resistant strains. Short treatment duration was found to be preferable, since it allowed less time for resistant strains to outcompete the susceptible ones. Dosing frequency appeared to be ineffective at reducing the resistance levels. The number of competing strains had no apparent effect on the resistance level during treatment, but possession of fewer strains reduced the time to reach equilibrium after the end of treatment. To sum up, epidemiological parameters may have more profound influence on growth dynamics than dosing regimens and should be considered when designing improved treatment protocols. PMID:25547361

  5. Program of the University Clinic of Toxicology, Skopje, Republic of Macedonia in Treatment of Drug Addiction (Buprenorfin Treatment Protocol)

    PubMed Central

    Simonovska, Natasa; Chibishev, Andon; Babulovska, Aleksandra; Pereska, Zanina; Jurukov, Irena; Glasnovic, Marija

    2011-01-01

    The program of our Clinic includes, not only treatment of acute intoxication with opioids and other drugs, but also comprehends clinical investigations and treatment of the somatic complications of this population. For the first time in our country our Clinic offers to this population the alternative way of treatment with Buprenorfin. The Clinic started with this protocol on August 1, 2009. During a period of two years, the treatment with Buprenorfine has been initiated in 353 patients, of which 211 regularly attend the medical check ups. This model is used according to the national clinical guidelines and procedures for the use of buprenorfine in the treatment of opioid dependence The dose of this medicament depends on the evolution of the withdrawal symptoms. We have used the objective and subjective opioid withdrawal scale for the observation of these symptoms (OOWS ; SOWS – Handelsman et al 1987). This protocol starts with a complete clinical investigations, (i.e. where all patients undergo the inclusion and exclusion criteria with a written consent). Afterwards, the patients are hospitalized and start with a Buprenorfin teratment. After period of 7-10 days hospitalization they come to our Clinic, like outpatients for a regular controls. We have precise evidence for every patient who comes for control (e.g. medical record with all biochemical and toxicological screenings). All patients are recommended a tight cooperation with psychiatrists who are specialized to treat the problematic drug addictions. PMID:23678303

  6. Development of a geometrically accurate imaging protocol at 3 Tesla MRI for stereotactic radiosurgery treatment planning

    NASA Astrophysics Data System (ADS)

    Zhang, B.; MacFadden, D.; Damyanovich, A. Z.; Rieker, M.; Stainsby, J.; Bernstein, M.; Jaffray, D. A.; Mikulis, D.; Ménard, C.

    2010-11-01

    The purpose of this study is to develop a geometrically accurate imaging protocol at 3 T magnetic resonance imaging (MRI) for stereotactic radiosurgery (SRS) treatment planning. In order to achieve this purpose, a methodology is developed to investigate the geometric accuracy and stability of 3 T MRI for SRS in phantom and patient evaluations. Forty patients were enrolled on a prospective clinical trial. After frame placement prior to SRS, each patient underwent 3 T MRI after 1.5 T MRI and CT. MR imaging protocols included a T1-weighted gradient echo sequence and a T2-weighted spin echo sequence. Phantom imaging was performed on 3 T prior to patient imaging using the same set-up and imaging protocols. Geometric accuracy in patients and phantoms yielded comparable results for external fiducial reference deviations and internal landmarks between 3 T and 1.5 T MRI (mean <=0.6 mm; standard deviation <=0.3 mm). Mean stereotactic reference deviations between phantoms and patients correlated well (T1: R = 0.79; T2: R = 0.84). Statistical process control analysis on phantom QA data demonstrated the stability of our SRS imaging protocols, where the geometric accuracy of the 3 T SRS imaging protocol is operating within the appropriate tolerance. Our data provide evidence supporting the spatial validity of 3 T MRI for targeting SRS under imaging conditions investigated. We have developed a systematic approach to achieve confidence on the geometric integrity of a given imaging system/technique for clinical integration in SRS application.

  7. Protocol Directed Patient Care using a Computer

    PubMed Central

    Blum, B.; Lenhard, R.; McColligan, E.

    1980-01-01

    The Johns Hopkins Oncology Center has developed a clinical information system which assists in the care of the 2,000 patients currently under treatment at the Center. The system maintains a data base containing a summary diagnostic and treatment history plus complete tabulations of laboratory results, therapies, and other clinical findings. These data are organized and displayed in formats which aid decision-making. For the past year the Center has been working with an extension to the data system which produces daily care plans for each inpatient and outpatient treated at the Center. These plans are a function of the disease, treatment protocol, and current clinical status of each patient. This paper describes the objectives, organization, and experience to date with the use of computer generated plans for protocol directed patient care.

  8. Radioimmunotherapy: A Specific Treatment Protocol for Cancer by Cytotoxic Radioisotopes Conjugated to Antibodies

    PubMed Central

    Kawashima, Hidekazu

    2014-01-01

    Radioimmunotherapy (RIT) represents a selective internal radiation therapy, that is, the use of radionuclides conjugated to tumor-directed monoclonal antibodies (including those fragments) or peptides. In a clinical field, two successful examples of this treatment protocol are currently extended by 90Y-ibritumomab tiuxetan (Zevalin) and 131I-tositumomab (Bexxar), both of which are anti-CD20 monoclonal antibodies coupled to cytotoxic radioisotopes and are approved for the treatment of non-Hodgkin lymphoma patients. In addition, some beneficial observations are obtained in preclinical studies targeting solid tumors. To date, in order to reduce the unnecessary exposure and to enhance the therapeutic efficacy, various biological, chemical, and treatment procedural improvements have been investigated in RIT. This review outlines the fundamentals of RIT and current knowledge of the preclinical/clinical trials for cancer treatment. PMID:25379535

  9. Integrated surgical protocol for the treatment of the infected diabetic foot.

    PubMed

    Caravaggi, C

    2012-02-01

    Diabetes is a chronic disease with a worldwide increasing trend. Feet complication, closely related to neuropathy and obstructive peripheral vascular disease, are responsible for more than 1 million of leg amputations every year. Foot infection can dramatically improve the risk of amputation. Although many ulcer classification systems have been proposed to stratify the severity of infectious process the problem of the definition of a correct therapeutic approach to different clinical pictures still remains unresolved. A diabetic foot triage and an integrated surgical protocol are proposed to try identifying a diagnostic flowchart and a step-by-step surgical protocol that can be applied in the treatment of diabetic foot infection. Goals and technical aspects of emergent and elective surgical procedures in diabetic foot are analysed to evaluate critical aspects and to suggest proper surgical choices. PMID:22231526

  10. Steps Toward Creating A Therapeutic Community for Inpatients Suffering from Chronic Ulcers: Lessons from Allada Buruli Ulcer Treatment Hospital in Benin

    PubMed Central

    Amoussouhoui, Arnaud Setondji; Johnson, Roch Christian; Sopoh, Ghislain Emmanuel; Agbo, Ines Elvire; Aoulou, Paulin; Houezo, Jean-Gabin; Tingbe-Azalou, Albert; Boyer, Micah; Nichter, Mark

    2016-01-01

    Background Reducing social distance between hospital staff and patients and establishing clear lines of communication is a major challenge when providing in-patient care for people afflicted by Buruli ulcer (BU) and chronic ulcers. Research on hospitals as therapeutic communities is virtually non-existent in Africa and is currently being called for by medical anthropologists working in the field of health service and policy planning. This paper describes a pioneering attempt to establish a therapeutic community for patients suffering from BU and other chronic ulcers requiring long term hospital care in Benin. Methods A six-month pilot project was undertaken with the objectives of establishing a therapeutic community and evaluating its impact on practitioner and patient relations. The project was designed and implemented by a team of social scientists working in concert with the current and previous director of a hospital serving patients suffering from advanced stage BU and other chronic ulcers. Qualitative research initially investigated patients’ understanding of their illness and its treatment, identified questions patients had about their hospitalization, and ascertained their level of social support. Newly designed question–answer health education sessions were developed. Following these hospital wide education sessions, open forums were held each week to provide an opportunity for patients and hospital staff to express concerns and render sources of discontent transparent. Patient group representatives then met with hospital staff to problem solve issues in a non-confrontational manner. Psychosocial support for individual patients was provided in a second intervention which took the form of drop-in counseling sessions with social scientists trained to serve as therapy facilitators and culture brokers. Results Interviews with patients revealed that most patients had very little information about the identity of their illness and the duration of their

  11. Severe proliferative congenital temporomandibular joint ankylosis: a proposed treatment protocol utilizing distraction osteogenesis.

    PubMed

    Bartlett, Scott P; Reid, Russell R; Losee, Joseph E; Quinn, Peter D

    2006-05-01

    The classical treatment for temporomandibular joint (TMJ) ankylosis in children: 1) joint release; 2) arthroplasty; 3) reconstruction; and 4) postoperative physical therapy (PT), is often unsuccessful. Postoperative physical therapy is difficult in the young patient due to poor cooperation. Moreover, there is a subgroup of patients who have a refractory congenital proliferative bony process that is the cause of their disease. In these patients, a role for distraction osteogenesis (DO) has been defined. We present a series of young patients with congenital proliferative TMJ ankylosis. Some have failed classic treatment. In such cases, DO is used to expand the mandibular size and soft tissue matrix. This creates a static open bite, facilitates mid-facial growth, and avoids compromise of the airway, speech, nutrition, and oral hygiene. To maintain these objectives, mandibular DO may be repeated as the child matures. Once skeletal maturity is reached, DO is used to normalize occlusion and further expand the soft tissue envelope prior to definitive reconstruction and aggressive post-op PT. In seven patients, this protocol has been used. Five patients are currently in the active phase of growth and undergoing interim treatment with mandibular DO. Two patients have reached skeletal maturity and have completed the protocol of DO with definitive arthroplasty and reconstruction. DO is a valuable aid in the treatment of the problematic child with congenital proliferative TMJ ankylosis. Interim DO, prior to definitive arthroplasty and reconstruction, can provide a static open bite that prevents progressive deformity and its associated functional disturbances. PMID:16770209

  12. Patient directed self management of pain (PaDSMaP) compared to treatment as usual following total knee replacement: study protocol for a randomized controlled trial

    PubMed Central

    2012-01-01

    Background In 2009, 665 patients underwent total knee replacements (TKRs) at the Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH), representing nearly 1% of the national total. Pain control following the operation can be poor, and this can cause poor mobilization and potential long-term adverse events. Although high levels of pain are not associated with patient dissatisfaction, brief periods of pain may lead to neuronal remodeling and sensitization. Patient controlled oral analgesia (PCOA) may improve pain relief; however, the evidence to date has been inconclusive. Patient directed self management of pain (PaDSMaP) is a single center randomized controlled trial, which aims to establish if patient self-medication improves, or is equivalent to, treatment as usual and to create an educational package to allow implementation elsewhere. Methods/design Patients eligible for a TKR will be recruited and randomized in the outpatient clinic. All patients will undergo their operations according to normal clinical practice but will be randomized into two groups. Once oral medication has commenced, one group will have pain relief administered by nursing staff in the usual way (treatment as usual; TAU), whilst the second group will self manage their pain medication (patient directed self management of pain; PaDSMaP). Those recruited for self-medication will undergo a training program to teach the use of oral analgesics according to the World Health Organization (WHO) pain cascade and how to complete the study documentation. The primary endpoint of the trial is the visual analogue scale (VAS) pain score at 3 days or discharge, whichever is sooner. The follow-up time is 6 weeks with a planned trial period of 3 years. The secondary objectives are satisfaction with the management of patient pain post-operatively whilst an inpatient after primary TKR; overall pain levels and pain on mobilization; satisfaction with pain management information provided; global

  13. Does the use of health care and special school services, prior to admission for psychiatric inpatient treatment, differ between adolescents housed by child welfare services and those living with their biological parent(s)?

    PubMed

    Laukkanen, Matti; Hakko, Helinä; Räsänen, Pirkko; Riala, Kaisa

    2013-10-01

    We examined whether the use of health care and special school services, prior to admission for psychiatric inpatient treatment, differed between adolescents from child welfare units and those living at their parental home. 208 boys and 300 girls aged 12-17 years were admitted for psychiatric hospital between 2001 and 2006. Child welfare adolescents had used more health services/treatments prior to psychiatric hospital admission than adolescents living with their biological family. The best discriminating factors between study groups for both genders, were previous psychiatric hospitalizations, unemployed parents, use of special school services and self-perceived serious anxiety/tension or trouble controlling violent behavior. Repeated school grades and previous use of psychotropic medications were discriminating factors only in girls. Adolescents in child welfare deserve adequate mental health evaluations at an early stage, with referral to appropriate adolescent psychiatric services if required. Appropriate service provision and properly planned treatments may reduce the amount of intensive and sometimes unnecessary psychiatric inpatient treatments. PMID:23392732

  14. [Analysis on the requirements for clinical trial protocol writing of external treatment of TCM such as tuina].

    PubMed

    Gao, Shuang; Wang, Jingui; Wang, Hui

    2015-06-01

    According to Standard Protocol Items: Recommendations for Interventional Trials, Consolidated Standard of Reporting Trials 2010 Statement (CONSORT), CONSORT Extension for Non-Pharmacologic Treatment Interventions (CONSORT for NPT) and Good Clinical Practice, the detailed requirements for protocol writing, reporting, and practicing of clinical trial were classified and summarized in this article. By combining the practical situation of clinical trial of external treatment of TCM such as tuina, the requirernents for clinical trial protocol writing of external treatment of TCM were analyzed and acquired which could improve the quality of clinical trial protocol of external treatment of TCM, thus to provide references for standardized execution of TMC clinical trial and reports of research results. PMID:26480571

  15. 42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital... under the inpatient psychiatric facility prospective payment system. The prospective payment...

  16. [Betadine in the care of friction blisters. Treatment protocol in primary health care].

    PubMed

    Gonzalez de la Guerra, José Manuel; González Campo, Myrian

    2013-06-01

    First prize in the VII edition of the award winning work Betadine for nursing 2012. The dermatitis caused by repeated friction or trauma to the skin are very common in the population, mainly in athletes. The action of shear forces on the skin makes intradermal blisters very painful; being foot the areas more prone to its occurrence and local infection, one of the most common complications during its evolution. The proposed treatment protocol, presents a new technique of cost-effective cure for these injuries from the nursing consultation in Primary Health Care. Currently, there are many techniques in the treatment of these skin changes, but none has established itself as the "gold standard" in its approach. This technique of treatment accelerates regeneration of the injured area, reduces pain, prevents infection and epithelialization time is estimated between four and five days. PMID:23909219

  17. European protocols for the diagnosis and initial treatment of interstitial lung disease in children.

    PubMed

    Bush, Andrew; Cunningham, Steve; de Blic, Jacques; Barbato, Angelo; Clement, Annick; Epaud, Ralph; Hengst, Meike; Kiper, Nural; Nicholson, Andrew G; Wetzke, Martin; Snijders, Deborah; Schwerk, Nicolaus; Griese, Matthias

    2015-11-01

    Interstitial lung disease in children (chILD) is rare, and most centres will only see a few cases/year. There are numerous possible underlying diagnoses, with specific and non-specific treatment possibilities. The chILD-EU collaboration has brought together centres from across Europe to advance understanding of these considerations, and as part of this process, has created standard operating procedures and protocols for the investigation of chILD. Where established consensus documents exist already, for example, for the performance of bronchoalveolar lavage and processing of lung biopsies, these have been adopted. This manuscript reports our proposals for a staged investigation of chILD, starting from when the condition is suspected to defining the diagnosis, using pathways dependent on the clinical condition and the degree of illness of the child. These include the performance of genetic testing, echocardiography, high-resolution CT, bronchoscopy when appropriate and the definitive investigation of lung biopsy, in order to establish a precise diagnosis. Since no randomised controlled trials of treatment have ever been performed, we also report a Delphi consensus process to try to harmonise treatment protocols such as the use of intravenous and oral corticosteroids, and add-on therapies such as hydroxychloroquine and azithromycin. The aim is not to dictate to clinicians when a therapeutic trial should be performed, but to offer the possibility to collaborators of having a unified approach when a decision to treat has been made. PMID:26135832

  18. Treatment Protocols to Reduce Injury and Improve Stone Breakage in SWL

    NASA Astrophysics Data System (ADS)

    McAteer, James A.; Evan, Andrew P.; Connors, Bret A.; Pishchalnikov, Yuri A.; Williams, James C.; Lingeman, James E.

    2008-09-01

    Here we provide a capsule summary of key observations showing that adverse effects can be reduced and stone breakage outcomes can be improved by the choice of the treatment protocol used in SWL. The take home message is—technique in lithotripsy can be used to significant advantage. SW-rate is key, and so is the sequence of SW delivery. Patient studies have shown that stone breakage is significantly improved at 60SW/min compared to a rate of 120SW/min, and laboratory experiments with pigs show that acute SWL injury to the kidney can be reduced dramatically by further slowing the SW firing rate to 30SW/min. The sequence of SW administration has a profound effect on the kidney, and renal injury is significantly reduced when the treatment protocol incorporates a priming dose of SW's followed by a brief pause before treatment is resumed. Continued developments in lithotripsy technology are welcome and will hopefully lead to improved SWL systems. Current experience suggests, however, that technology is not a substitute for expert technique, and attention to the fundamentals of SW delivery is essential to achieve the best possible outcomes regardless of the lithotripter at hand.

  19. Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: A Randomized Controlled Trial

    PubMed Central

    Farchione, Todd J.; Fairholme, Christopher P.; Ellard, Kristen K.; Boisseau, Christina L.; Thompson-Hollands, Johanna; Carl, Jenna R.; Gallagher, Matthew W.; Barlow, David H.

    2012-01-01

    This study further evaluates the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). A diagnostically heterogeneous clinical sample of 37 patients with a principal anxiety disorder diagnosis was enrolled in a randomized controlled trial (RCT) involving up to 18 sessions of treatment and a 6-month follow-up period. Patients were randomly assigned to receive either immediate treatment with the UP (n=26) or delayed treatment, following a 16-week wait-list control period (WLC; n= 11). The UP resulted in significant improvement on measures of clinical severity, general symptoms of depression and anxiety, levels of negative and positive affect, and a measure of symptom interference in daily functioning across diagnoses. In comparison, participants in the WLC condition exhibited little to no change following the 16-week wait-list period. The effects of UP treatment were maintained over the 6-month follow-up period. Results from this RCT provide additional evidence for the efficacy of the UP in the treatment of anxiety and comorbid depressive disorders, and provide additional support for a transdiagnostic approach to the treatment of emotional disorders. PMID:22697453

  20. Treatment of Adolescents with Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 32.

    ERIC Educational Resources Information Center

    Substance Abuse and Mental Health Services Administration (DHHS/PHS), Rockville, MD. Center for Substance Abuse Treatment.

    This TIP on the best practice guidelines for treatment of substance abuse aims to help teach treatment providers about the latest information available to design and deliver better services to adolescent clients with substance use disorders. This publication represents advances in the understanding of the immediate and long-term physiologic,…

  1. Treatment for Stimulant Use Disorders. Treatment Improvement Protocol (TIP) Series 33.

    ERIC Educational Resources Information Center

    Substance Abuse and Mental Health Services Administration (DHHS/PHS), Rockville, MD. Center for Substance Abuse Treatment.

    This TIP on the best practice guidelines for treatment of substance abuse provides basic knowledge for practitioners, educators, and paraprofessionals about the nature and treatment of stimulant use disorders. More specifically, it reviews what is currently known about treating the medical, psychiatric, and substance abuse/dependence problems…

  2. Enhancing Motivation for Change in Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series 35.

    ERIC Educational Resources Information Center

    CDM Group, Inc.

    This TIP on the guidelines for treatment of substance use disorders is based on a fundamental rethinking of the concept of motivation. It suggests that the cognitive-behavioral approach to treatment requires a different perspective on the problem and on the prerequisites for change, while placing greater responsibility on the counselor whose job…

  3. Comprehensive Case Management for Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series 27.

    ERIC Educational Resources Information Center

    Cook, Paddy; Dogoloff, Mary Lou; Harteker, Linda; Nelson, Anne E.; Paul, Michelle M.; Shuman, Deborah J.; Mjoseth, Marcia; Vitzthum, Virginia; Hayes, Elizabeth; Gilbert, Max; Smith, Cara; Nguyen, Y-Lang

    This TIP contains information on the best practice guidelines on case management for substance abuse treatment providers. It serves to educate program coordinators and facilitators about the factors to consider as they decide to modify or implement case management activities. Many substance abuse clients arrive for treatment with a number of other…

  4. [Limiting factors in the class III camouflage treatment: a potential protocol].

    PubMed

    Chaques Asensi, José

    2016-06-01

    The Class III skeletal malocclusion has been traditionally treated with a combined approach of orthodontics and orthognathic surgery or with a strategy of orthodontic camouflage. Some severe cases can be identified as ideal candidates for a surgical treatment whereas some others can be handled with orthodontics alone, with a reasonable expectation of an acceptable result. However, the problem remains for the borderline patient. In fact, limited information is available in the literature regarding the identification of the factors that can help in establishing the limits for one treatment modality or the other. Furthermore, the quantification of some of these factors, for practical purposes, is practically missing or very seldom suggested. Therefore, the decision making process remains a subjective reflection based on the "good clinical sense" of the orthodontist or just reduced to an "educated guess". In order to add some information, hopefully useful in deciding the most suitable treatment option for the individual patient, we propose a clinical protocol based on four different factors. Namely: the skeletal discrepancy, the occlusal discrepancy, the periodontal condition and facial aesthetics. For each one of these factors several parameters will be evaluated and, for some of them, an attempt to provide some reference numerical values will be made. Finally, clinical examples will be presented to illustrate the concepts discussed and the treatment alternatives, final treatment plan and treatment outcome will be analyzed for each one of them. PMID:27358006

  5. Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol

    PubMed Central

    Hogue, Aaron; Bobek, Molly; Tau, Gregory Z.; Levin, Frances R.

    2014-01-01

    Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions. PMID:25505817

  6. Transdiagnostic Treatment of Bipolar Disorder and Comorbid Anxiety with the Unified Protocol: A Clinical Replication Series

    PubMed Central

    Ellard, Kristen K.; Deckersbach, Thilo; Sylvia, Louisa G.; Nierenberg, Andrew A.; Barlow, David H.

    2013-01-01

    Bipolar disorder (BD) is a chronic, debilitating disorder with recurrent manic and depressive episodes. Over 75% of bipolar patients have a current or lifetime diagnosis of a comorbid anxiety disorder. Comorbid anxiety in BD is associated with greater illness severity, greater functional impairment, and poorer illness-related outcomes. Effectively treating comorbid anxiety in individuals with BD has been recognized as one of the biggest unmet needs in the field of bipolar disorder. Recently, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was developed to be applicable to the full range of anxiety and mood disorders, based upon converging evidence from genetics, cognitive and affective neuroscience, and behavioral research suggesting common, core emotion-related pathology. Here, we present a preliminary evaluation of the efficacy of the UP for the treatment of BD with comorbid anxiety, in a clinical replication series consisting of three cases. PMID:22822175

  7. Economic comparison of common treatment protocols and J5 vaccination for clinical mastitis in dairy herds using optimized culling decisions.

    PubMed

    Kessels, J A; Cha, E; Johnson, S K; Welcome, F L; Kristensen, A R; Gröhn, Y T

    2016-05-01

    This study used an existing dynamic optimization model to compare costs of common treatment protocols and J5 vaccination for clinical mastitis in US dairy herds. Clinical mastitis is an infection of the mammary gland causing major economic losses in dairy herds due to reduced milk production, reduced conception, and increased risk of mortality and culling for infected cows. Treatment protocols were developed to reflect common practices in dairy herds. These included targeted therapy following pathogen identification, and therapy without pathogen identification using a broad-spectrum antimicrobial or treating with the cheapest treatment option. The cost-benefit of J5 vaccination was also estimated. Effects of treatment were accounted for as changes in treatment costs, milk loss due to mastitis, milk discarded due to treatment, and mortality. Following ineffective treatments, secondary decisions included extending the current treatment, alternative treatment, discontinuing treatment, and pathogen identification followed by recommended treatment. Average net returns for treatment protocols and vaccination were generated using an existing dynamic programming model. This model incorporates cow and pathogen characteristics to optimize management decisions to treat, inseminate, or cull cows. Of the treatment protocols where 100% of cows received recommended treatment, pathogen-specific identification followed by recommended therapy yielded the highest average net returns per cow per year. Out of all treatment scenarios, the highest net returns were achieved with selecting the cheapest treatment option and discontinuing treatment, or alternate treatment with a similar spectrum therapy; however, this may not account for the full consequences of giving nonrecommended therapies to cows with clinical mastitis. Vaccination increased average net returns in all scenarios. PMID:26947301

  8. Treatment goal setting for complex patients: protocol for a scoping review

    PubMed Central

    Grudniewicz, Agnes; Nelson, Michelle; Kuluski, Kerry; Lui, Vincci; Cunningham, Heather V; X Nie, Jason; Colquhoun, Heather; Wodchis, Walter P; Taylor, Susan; Loganathan, Mayura; Upshur, Ross E

    2016-01-01

    Introduction An increasing number of people are living longer with multiple health and social care needs, and may rely heavily on health system resources. When dealing with multiple conditions, patients, caregivers and healthcare providers (HCPs) often experience high treatment burden due to unclear care trajectories, a myriad of treatment decisions and few guidelines on how to manage care needs. By understanding patient and caregiver priorities, and setting treatment goals, HCPs may help improve patient outcomes and experiences. This study aims to examine the extent and nature of the literature on treatment goal setting in complex patients, identify gaps in evidence and areas for further inquiry and guide a research programme to develop definitions, measures and recommendations for treatment goal setting. Methods and analysis This study protocol outlines a scoping review of the peer reviewed and the grey literature, using established scoping review methodology. Literature will be identified using a multidatabase and grey literature search strategy developed by two librarians. Papers and reports on the topic of goal setting that address complexity or complex patients will be included. Results of the search will be screened independently by two reviewers and included studies will be abstracted and charted in duplicate. Ethics and dissemination Ethics approval is not required for this scoping review. Working with the knowledge users on the team, we will prepare educational materials and presentations to disseminate study findings to HCPs, caregivers and patients, and at relevant national and international conferences. Results will also be published in a peer-reviewed journal. PMID:27225653

  9. Catatonia in Resource Limited Settings: A Case Series and Treatment Protocol

    PubMed Central

    Smith, Stephanie L.; Grelotti, David J.; Fils-Aime, Reginald; Uwimana, Eugenie; Ndikubwimana, Jean-Sauveur; Therosme, Tatiana; Severe, Jennifer; Dushimiyimana, Dominique; Uwamariya, Clemence; Bienvenu, Robert; Alcindor, Yoldie; Eustache, Eddy; Raviola, Giuseppe J.; Fricchione, Gregory L.

    2014-01-01

    Objective The Catatonic Syndrome (“catatonia”) is characterized by motor and motivation dysregulation and is associated with a number of neuropsychiatric and medical disorders. It is recognizable in a variety of clinical settings. We present observations from the treatment of four individuals with catatonia in Haiti and Rwanda, and introduce a treatment protocol for use in resource limited settings Methods Four patients from rural Haiti and Rwanda with clinical signs of catatonia and a positive screen using the Bush-Francis-Catatonia Rating Scale were treated collaboratively by general physicians and mental health clinicians with either lorazepam or diazepam. Success in treatment was clinically assessed by complete remittance of catatonia symptoms. Results The four patients in this report exhibited a range of characteristic and recognizable signs of catatonia, including immobility/stupor, stereotypic movements, echophenomena, posturing, odd mannerisms, mutism, and refusal to eat or drink. All four cases presented initially to rural outpatient general health services in low resource settings. In some cases, diagnostic uncertainty initially led to treatment with typical antipsychotics. In each case, proper identification and treatment of catatonia with benzodiazepines led to significant clinical improvement. Conclusion Catatonia can be effectively and inexpensively treated in resource limited settings. Identification and management of catatonia is critical for the health and safety of patients with this syndrome. Familiarity with the clinical features of catatonia is essential for health professionals working in low resource settings. To facilitate early recognition of this treatable disorder, catatonia should feature more prominently in global mental health discourse. PMID:25467078

  10. Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study

    PubMed Central

    2014-01-01

    Background Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians. Methods/Design Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers’s diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods — pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance — with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation