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1

Evidence-based approach to an inpatient tobacco cessation protocol.  

PubMed

Tobacco use contributes to USD53 to USD73 billion per year in healthcare expenditures and causes nearly 440,000 deaths per year. Given the strong cause-effect relationship between smoking and poor health outcomes, it is critical that smokers are identified early and advised about smoking cessation. Furthermore, the Joint Commission now mandates that tobacco cessation advice be given to patients admitted with heart failure, pneumonia, and acute myocardial infarction. As such, an interdisciplinary group at an urban academic medical center developed and implemented a tobacco cessation protocol with the goal of identifying and targeting inpatient smokers through evidence-based education and counseling. The protocol focused on admission assessment, education, and provision of standing orders for medication treatment for nicotine withdrawal and/or tobacco cessation therapy during the inpatient encounter and referral for outpatient counseling at discharge. PMID:18670201

Ginn, Mary Beth; Cox, Geoff; Heath, Janie

2

Treatment histories of borderline inpatients  

Microsoft Academic Search

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

Mary C. Zanarini; Frances R. Frankenburg; Gagan S. Khera; Julieta Bleichmar

2001-01-01

3

Inpatient treatment of alcoholism: a behavioral approach.  

PubMed

After detoxification has been completed (if needed), a comprehensive assessment of the individual patient's drinking and other problems is the first step in inpatient behavioral treatment of alcoholism. On the basis of the assessment results, treatment is planned and delivered in an individualized manner to achieve three major goals. The first goal of treatment is to facilitate and consolidate the patient's commitment to change by carefully reviewing the evidence from the assessment of negative consequences of the patient's drinking. Alcohol education about the long-term negative consequences of drinking and the use of a decision matrix to clarify the patient's reasons for not drinking also are useful in this regard. The second goal is to stabilize the change in the drinking that occurred when the patient decided to enter the inpatient treatment program. Aversion therapy to decrease desire for alcohol, teaching alternative skills to deal with likely precipitants of renewed alcohol use, and strengthening behaviors incompatible with alcohol abuse all can be used to help maintain abstinence. Antabuse (including behavioral contracting procedures to increase compliance with this drug), along with psychotropic medication for additional psychopathology, are pharmacological interventions that often can be used to stabilize change. A final very important goal is the careful planning of aftercare and post-discharge life to help maintain the changes started during inpatient treatment. A case is presented to illustrate the above notions. PMID:3437486

O'Farrell, T J; Langenbucher, J

1987-01-01

4

Involuntary medication in psychiatric inpatient treatment  

Microsoft Academic Search

The aim of this study was to examine involuntary medication in psychiatric inpatient treatment. A retrospective chart review of 1543 consecutive admissions of working aged civil patients from well-defined catchment areas to three psychiatric centres were evaluated regarding events of involuntary medication. 8.2% of the admissions included involuntary medication episode(s). Involuntary medication was associated with a diagnosis of schizophrenia, involuntary legal

R. Kaltiala-Heino; M. Välimäki; J. Korkeila; C. Tuohimäki; V. Lehtinen

2003-01-01

5

Goals of inpatient treatment for psychiatric disorders.  

PubMed

The purpose of the psychiatric hospital changed dramatically during the twentieth century. Formerly the primary location for psychiatric treatment, the hospital now plays a more circumscribed role within a community-based system of care. Crisis stabilization, safety, and a focus on rapid discharge are the critical components of the acute inpatient stay. Subspecialized units focus on geriatrics, children, adolescents, dual diagnosis (substance abuse and mental illness), trauma disorders, eating disorders, and forensics. When integrated with the general medical system and a comprehensive base of community-delivered day treatment, residential services, and outpatient services, psychiatric hospitalization is a humane alternative to long-term institutional care. PMID:18729730

Sharfstein, Steven S

2009-01-01

6

Inpatient vs outpatient treatment for substance dependence revisited  

Microsoft Academic Search

Miller and Hester's 1986 review of inpatient versus outpatient alcohol treatment studies concluded with no “justification” for inpatient treatment. Further examination of these studies revealed shortcomings such as the use of random assignment designs which excluded psychiatrically-complicated patients. Carrier Foundation's inpatient\\/outpatient study of private psychiatric patients with alcohol and\\/or cocaine dependence includes a patient-treatment matching design to address weaknesses in

Helen M. Pettinati; Kathleen Meyers; Jacqueline M. Jensen; Frances Kaplan; Bradley D. Evans

1993-01-01

7

Treatment and Changes in Aggressive Behavior Following Adolescents' Inpatient Hospitalization  

Microsoft Academic Search

The purpose of the study was to describe aggressive behavior in inpatient adolescents and to identify individual characteristics and aspects of mental health treatment that are associated with changes in aggression over time. Type of treatment and treatment satisfaction were examined in relation to changes in aggressive behavior in an inpatient setting and 1 year later. High levels of aggressive

Michele S. Knox; Michael P. Carey; Wun Jung Kim; Tiffany Marciniak

2004-01-01

8

Randomised controlled trial of day patient versus inpatient psychiatric treatment.  

PubMed Central

OBJECTIVE--To assess the proportion of acutely ill psychiatric patients who can be treated in a day hospital and compare the outcome of day patient and inpatient treatment. DESIGN--Prospective randomised controlled trial of day patient versus inpatient treatment after exclusion of patients precluded by severity of illness or other factors from being treated as day patients. All three groups assessed at three and 12 months. SETTING--Teaching hospital serving small socially deprived inner city area. Day hospital designed to take acute admissions because of few beds. PATIENTS--175 Patients were considered, of whom 73 could not be allocated. Of the remaining 102 patients, 51 were allocated to each treatment setting but only 89 became established in treatment--namely, 41 day patients and 48 inpatients. 73 Of these 89 patients were reassessed at three months and 70 at one year. INTERVENTIONS--Standard day patient and inpatient treatment. MAIN OUTCOME MEASURES--Discharge from hospital and return to previous level of social functioning; reduction of psychiatric symptoms, abnormal behaviour, and burden on relatives. RESULTS--33 Of 48 inpatients were discharged at three months compared with 17 of 41 day patients. But at one year 9 of 48 inpatients and three of 41 day patients were in hospital. 18 Of 35 day patients and 16 of 39 inpatients were at their previous level of social functioning at one year. The only significant difference at three months was a greater improvement in social role performance in the inpatients. At one year there was no significant difference between day patients and inpatients in present state examination summary scores and social role performance, burden, or behaviour. CONCLUSIONS--Roughly 40% of all acutely ill patients presenting for admission to a psychiatric unit may be treated satisfactorily in a well staffed day hospital. The outcome of treatment is similar to that of inpatient care but might possibly reduce readmissions. The hospital costs seem to be similar but further research is required to assess the costs in terms of extra demands on relatives, general practitioners, and other community resources.

Creed, F; Black, D; Anthony, P; Osborn, M; Thomas, P; Tomenson, B

1990-01-01

9

A randomised controlled trial linking mental health inpatients to community smoking cessation supports: A study protocol  

Microsoft Academic Search

Background  Mental health inpatients smoke at higher rates than the general population and are disproportionately affected by tobacco\\u000a dependence. Despite the advent of smoke free policies within mental health hospitals, limited systems are in place to support\\u000a a cessation attempt post hospitalisation, and international evidence suggests that most smokers return to pre-admission smoking\\u000a levels following discharge. This protocol describes a randomised

Emily AL Stockings; Jennifer A Bowman; John Wiggers; Amanda L Baker; Margarett Terry; Richard Clancy; Paula M Wye; Jenny Knight; Lyndell H Moore

2011-01-01

10

Indirect Costs of Specialized VA Inpatient Mental Health Treatment.  

National Technical Information Service (NTIS)

This technical report describes the indirect cost of specialized inpatient mental health treatment programs of the U.S. Department of Veterans Affairs (VA). We defined the direct costs of treatment programs as the cost of the staff and supplies used by th...

P. G. Barnett M. Berger

2003-01-01

11

Correlates of Burnout in Inpatient Substance Abuse Treatment Therapists.  

ERIC Educational Resources Information Center

|Identifies the occupational and personal characteristics and stressors that might be correlated with burnout among inpatient therapists (N=79) in substance abuse treatment facilities. Results show that recovering therapists had a higher sense of personal accomplishment than nonrecovering therapists. Therapists with more social support also…

Elman, Barnett D.; Dowd, Edmund Thomas

1997-01-01

12

Audit of start of anticoagulation treatment in inpatients  

Microsoft Academic Search

AIMS: To develop a method for evaluating the start of anticoagulation treatment in inpatients. METHODS: One hundred case notes were audited using a proforma based on local guidelines in accordance with British Society for Haematology recommendations. RESULTS: Confirmatory investigations were done in 93% and 79% of patients with symptomatic deep venous thrombosis and pulmonary embolism, respectively. Identification of patients' risk

G Tan; H Cohen; F Taylor; J Gabbay

1993-01-01

13

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

PubMed

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 improving breastfeeding rates, improving complementary feeding practices and using ready-to-use therapeutic foods (RUTF) or similar supplements for those failing to thrive in the community, but SAM is unlikely to disappear from our hospitals, and these children need to be better managed if we are serious about reducing mortality. PMID:21575313

Brewster, D R

2011-01-01

14

[Forced medical intervention in psychiatric inpatient treatment].  

PubMed

In anticipation of ratification of the Convention on the Rights of Persons with Disabilities, the Japanese Government made a Cabinet decision to promote institutional reforms concerning disabled persons, in which involuntary hospitalization and medical intervention for persons with mental disabilities would be reviewed. In response to the decision, the Cabinet launched the Council to Promote Reform for "Promotion Council reform Persons with Disabilities" in the Cabinet Office, and the Ministry of Health, Labour and Welfare set up a task force aimed to build systems of community mental health care. Although the activities have been progressing, according to published documents, the effectiveness and efficacy of the countermeasures presented in the documents seem insufficient. Fundamental reforms of systems for the treatment and support of persons with mental disabilities are needed. PMID:24050017

Oshita, Akira

2013-01-01

15

Predictive factors of length of inpatient treatment in anorexia nervosa  

Microsoft Academic Search

Objective  To identify clinical variables influencing the length of stay (LOS) of inpatient treatment for anorexia nervosa (AN).\\u000a \\u000a \\u000a \\u000a Method  We analyzed structured clinical charts of 300 consecutive hospitalizations for AN in a specialized eating disorder unit. The\\u000a sample included patients from 12 to 22 years old. Factors related to the patient and events occurring during the stay were\\u000a investigated as possible predictors of

Luisa Strik Lievers; Florence Curt; Jenny Wallier; Fabienne Perdereau; Zoé Rein; Philippe Jeammet; Nathalie Godart

2009-01-01

16

Characteristics of Middle-Aged Women in Inpatient Treatment for Eating Disorders  

Microsoft Academic Search

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

Maryelizabeth forman; William N. Davis

2005-01-01

17

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

ERIC Educational Resources Information Center

|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…

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

2011-01-01

18

MIXED ANACLITIC–INTROJECTIVE PSYCHOPATHOLOGY IN TREATMENT-RESISTANT INPATIENTS UNDERGOING PSYCHOANALYTIC PSYCHOTHERAPY  

Microsoft Academic Search

Utilizing data from the Riggs-Yale Project, 45 male and 45 female 18–29-year-old treatment-resistant inpatients undergoing intensive psychoanalytically oriented treatment were studied. Twenty-seven mixed-type anaclitic–introjective inpatients were compared with 29 \\

Golan Shahar; Sidney J. Blatt; Richard Q. Ford

2003-01-01

19

Evaluation of a Salutogenetic Concept for Inpatient Psychosomatic Treatment  

PubMed Central

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.

Loew, Thomas

2013-01-01

20

The detection and treatment of posttraumatic distress and substance intoxication in the acute care inpatient setting  

Microsoft Academic Search

Each year, approximately 2.5 million Americans require inpatient admissions after sustaining traumatic physical injuries. Few investigations have assessed the routine detection and treatment of acute care inpatients with high levels of posttraumatic distress. A representative sample of 101 hospitalized patients with acute injuries was screened for posttraumatic stress disorder (PTSD) and depressive symptoms, as well as substance intoxication. Patients' medical

Douglas Zatzick; Joan Russo; Frederick Rivara; Peter Roy-Byrne; Gregory Jurkovich; Wayne Katon

2005-01-01

21

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

ERIC Educational Resources Information Center

|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…

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

2009-01-01

22

Short-term outcome of anorexia nervosa in adolescents after inpatient treatment: a prospective study  

Microsoft Academic Search

The current study describes the short-term outcome of adolescent inpatient population suffering from anorexia nervosa (AN)\\u000a and analyzes the clinical predictors of poor outcome in these patients. Fifty-seven female AN patients (mean = 15.8, SD = 1.3)\\u000a admitted for inpatient treatment to a specialized eating disorder unit at a university medical center were reassessed 1 year\\u000a after being discharged. Assessments were made at the beginning

Harriet Salbach-Andrae; Nora Schneider; Katja Seifert; Ernst Pfeiffer; Klaus Lenz; Ulrike Lehmkuhl; Alexander Korte

2009-01-01

23

The psychiatric inpatient treatment of children and youth in general hospitals  

Microsoft Academic Search

National attention has recently focused on the mental health needs and services of children and youth. The lack of outpatient services and their coordination has been noted, as well as the consequent press towards inpatient care. We describe the inpatient treatment of children and adolescents (ages 0-18) irk short-term, non-Federal general hospitals in 1980. Nationally, 128,300 children were treated for

Charles A. Kiesler; Celeste Simpkins; Teru Morton

1989-01-01

24

Inpatient treatment for eating disorders: Outcome at discharge and 3-month follow-up  

Microsoft Academic Search

There have been few studies of inpatient treatment for eating disorders. Existing studies have mostly examined small samples of either anorexic or bulimic patients. The current study evaluated large samples of anorexic and bulimic inpatients at intake, discharge, and a 3-month follow-up. At discharge, patients in both groups showed substantial and statistically significant improvements on self-report measures of depression and

Michael R. Lowe; William N. Davis; Rachel A. Annunziato; Dara L. Lucks

2003-01-01

25

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

PubMed Central

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

2013-01-01

26

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

ERIC Educational Resources Information Center

|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…

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

2009-01-01

27

Enhancing Treatment Team Process through Mindfulness-Based Mentoring in an Inpatient Psychiatric Hospital  

ERIC Educational Resources Information Center

|The authors investigated changes in treatment team functioning in an adult inpatient psychiatric hospital after the implementation of a mindfulness-based mentoring intervention. Using a multiple baseline across treatment teams design, the authors assessed levels of functioning of three treatment teams using a 50-item rating scale and then…

Singh, Nirbhay N.; Singh, Subhashni D.; Sabaawi, Mohamed; Myers, Rachel E.; Wahler, Robert G.

2006-01-01

28

Cost effectiveness of day and inpatient psychiatric treatment: results of a randomised controlled trial.  

PubMed Central

OBJECTIVE: To compare direct and indirect costs of day and inpatient treatment of acute psychiatric illness. DESIGN: Randomised controlled trial with outcome and costs assessed over 12 months after the date of admission. SETTING: Teaching hospital in an inner city area. SUBJECTS: 179 patients with acute psychiatric illness referred for admission who were suitable for random allocation to day hospital or inpatient treatment. 77 (43%) patients had schizophrenia. INTERVENTIONS: Routine inpatient or day hospital treatment. MAIN OUTCOME MEASURES: Direct and indirect costs over 12 months, clinical symptoms, social functioning, and burden on relatives over the follow up period. RESULTS: Clinical and social outcomes were similar at 12 months, except that inpatients improved significantly faster than day patients and burden on relatives was significantly less in the day hospital group at one year. Median direct costs to the hospital were 1923 pounds (95% confidence interval 750 pounds to 3174 pounds) per patient less for day hospital treatment than inpatient treatment. Indirect costs were greater for day patients; when these were included, overall day hospital treatment was 2165 pounds cheaper than inpatient treatment (95% confidence interval of median difference 737 pounds to 3593 pounds). Including costs to informants when appropriate meant that day hospital treatment was 1994 pounds per patient cheaper (95% confidence interval 600 pounds to 3543 pounds). CONCLUSIONS: Day patient treatment is cheaper for the 30-40% of potential admissions that can be treated in this way. Carers of day hospital patients may bear additional costs. Carers of all patients with acute psychiatric illness are often themselves severely distressed at the time of admission, but day hospital treatment leads to less burden on carers in the long term.

Creed, F.; Mbaya, P.; Lancashire, S.; Tomenson, B.; Williams, B.; Holme, S.

1997-01-01

29

Outpatient versus inpatient treatment in patients with pulmonary embolism: a meta-analysis.  

PubMed

Our aim was to study the safety of outpatient treatment in low risk patients with acute pulmonary embolism compared with inpatient treatment, the current clinical standard. We searched Medline, Web of Science, Cochrane and EMBASE databases and included studies on outpatient treatment of pulmonary embolism. The outcomes were 3-month recurrent venous thromboembolism, major bleeding and all-cause mortality. We identified 13 studies (1657 patients) with outpatients (discharge <24 h), three studies (256 patients) with early discharge patients (discharged within 72 h) and five studies (383 patients) with inpatients. The pooled incidence of recurrent venous thromboembolism was 1.7% (95% CI 0.92-3.1%) in outpatients, 1.1% (0.22-5.4%) in patients discharged early and 1.2% (0.16-8.1%) in inpatients. The pooled incidence of major bleeding was 0.97% (0.58-1.6%) in outpatients, 0.78% (0.16-3.7%) in early discharge patients and 1.0% (0.39-2.8%) in inpatients. The pooled incidence of mortality was 1.9% (0.79-4.6%) in outpatients, 2.3% (1.1-5.1%) in early discharge patients and 0.74% (0.04-11%) in inpatients. Incidences of recurrent venous thromboembolism, major bleeding and, after correction for malignancies, mortality were comparable between outpatients, patients discharged early and inpatients. We conclude that home treatment or early discharge of selected low-risk patients with pulmonary embolism is as safe as inpatient treatment. PMID:23100493

Zondag, Wendy; Kooiman, Judith; Klok, Frederikus A; Dekkers, Olaf M; Huisman, Menno V

2012-10-25

30

Protocol Development — Guidelines for Treatment Regimens  

Cancer.gov

All protocols sponsored by the Division of Cancer Treatment and Diagnosis (DCTD), National Cancer Institute (NCI), are reviewed for safety and scientific integrity. Cancer Therapy Evaluation Program (CTEP) staff have developed standardized guidelines to express chemotherapy regimens in a uniform, clear and consistent manner. The intention of the guidelines is to minimize undue risks to patients on DCTD sponsored investigational clinical trials. DCTD-sponsored protocols will not be approved unless they comply with the Guidelines for Treatment Regimen Expression and Nomenclature.

31

Efficacy of inpatient and home treatment in psychiatrically disturbed children and adolescents  

Microsoft Academic Search

In two German child and adolescent psychiatric treatment and research centers, a controlled treatment study was conducted\\u000a in which two randomized treatment groups (in-patient treatment and home treatment) were compared. Subjects were children and\\u000a adolescents with severe psychiatric disorders, for whom normal outpatient treatment was not sufficient (mean age of the patients\\u000a was 11 years and 9 months at the

F. Mattejat; B. R. Hirt; J. Wilken; M. H. Schmidt; H. Remschmidt

2001-01-01

32

Inpatient treatment of mood disorders in the era of de-institutionalisation, depression awareness campaigns and development of new antidepressants  

Microsoft Academic Search

Objective: To analyse changes in inpatient treatment for mood disorders during the period of de-institutionalisation, de-centralisation of service planning, economic recession, attempts to increase depression awareness and increasing biological treatment possibilities. A special interest is paid to whether de-institutionalisation at specialist level psychiatric care results in transfer of inpatient care into non-specialised institutions. Method: A register study of all inpatient

R. Kaltiala-Heino; P. Laippala; M. Joukamaa

2003-01-01

33

Let eating disorder patients decide: Providing choice may reduce early drop-out from inpatient treatment  

Microsoft Academic Search

Premature drop-out from treatment is a highly prevalent phenomenon among eating disorder (ED) patients. In a specialized inpatient treatment unit a major change was made in the admission strategy in 2001, giving a maximum of personal choice to the patients. A quasi-experimental research was carried out comparing 87 patients treated till 2000 ('old' strategy) with 87 patients treated from 2001

Walter Vandereycken; Maarten Vansteenkiste

2009-01-01

34

Effectiveness of Outpatient, Day Hospital, and Inpatient Psychotherapeutic Treatment for Patients with Cluster B Personality Disorders  

Microsoft Academic Search

Background: For patients with cluster B personality disorders there is no consensus regarding the optimal treatment setting. The aim of this study was to compare the effectiveness of different psychotherapeutic settings for patients with cluster B personality disorders, i.e. outpatient, day hospital, and inpatient treatment. Methods: The study was conducted between March 2003 and June 2008 in 6 mental health

Anna Bartak; Helene Andrea; Marieke D. Spreeuwenberg; Uli M. Ziegler; Jack Dekker; Bert V. Rossum; Elisabeth F. M. Hamers; Wubbo Scholte; Janneke Aerts; Jan J. V. Busschbach; Roel Verheul; Theo Stijnen; Paul M. G. Emmelkamp

2011-01-01

35

Inpatient Treatment for Children With Obesity: Weight Loss, Psychological Well-being, and Eating Behavior  

Microsoft Academic Search

2 Zeepreventorium, Pediatric Health Center Objective Evaluated the effects of a 10-month inpatient treatment program and implemented as a nondiet healthy lifestyle approach. In addition, the effects of two extended treatment programs were compared to a standard cognitive-behavioral treatment program for mainte- nance of the treatment gains. Methods A within-subjects design was employed to evaluate treatment outcome, including a 14-month

Caroline Braet; Veerle Decaluwé; Ellen Moens; Yves Rosseel

2004-01-01

36

MidTerm Effectiveness of Behavioral and Psychodynamic Inpatient Treatments of Severe Obesity Based on a Randomized Study  

Microsoft Academic Search

Background: The objective of this study was to compare the effectiveness of psychodynamic and behavioral inpatient treatments of severely obese patients regarding weight and distress. Methods: In a longitudinal study obese patients (body mass index, BMI ?35) were randomly assigned to behavioral or to psychodynamic inpatient treatment. Mostly female (n = 267; 85%) obese patients with psychiatric and somatic comorbidity

M. E. Beutel; A. Dippel; M. Szczepanski; R. Thiede; J. Wiltink

2006-01-01

37

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

ERIC Educational Resources Information Center

|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,…

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

2007-01-01

38

Summary of combined treatment under endoscope on 70 esophagus cancer inpatients  

NASA Astrophysics Data System (ADS)

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.

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

1993-03-01

39

Changes in Body Image During Inpatient Treatment for Eating Disorders Predict Outcome  

Microsoft Academic Search

This study investigated changes and predictors during inpatient treatment of 55 adult in a transdiagnostic sample of patients with eating disorders. Patients were assessed at admission and discharge with the Body Attitude Test (BAT), Symptom Check List 90 Revised, Circumplex of Interpersonal Problems, Body Mass Index (BMI) and Eating Disorder Inventory 2 (EDI-2). Significant changes were found in all measures.

Marit Danielsen; Øyvind Rø

2012-01-01

40

Interpersonal violence exposure and alcohol treatment utilization among medical inpatients with alcohol dependence  

Microsoft Academic Search

The goal of this study was to examine the association between interpersonal violence exposure and utilization of alcohol treatment after medical hospitalizations among adults with alcohol dependence. We analyzed data collected from a prospective cohort of 238 adults with alcohol dependence who were inpatients in a large urban hospital. Participants who reported interpersonal violence victimization had 1.6 times the odds

Emily F. Rothman; Debbie M. Cheng; Alison Pedley; Jeffrey H. Samet; Tibor Palfai; Jane M. Liebschutz; Richard Saitz

2008-01-01

41

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

Microsoft Academic Search

Operationalizing treatment efficacy has become essential in the field of psychotherapy. Managed health care now requires psychotherapy\\u000a to produce measurable outcomes and define success concretely. This requirement has resulted in research attempting to identify\\u000a empirically supported and evidence-based treatments. This article presents a review of adolescent residential and inpatient\\u000a outcome literature, for the purpose of identifying elements of successful programs

Joanna E. Bettmann; Rachael A. Jasperson

2009-01-01

42

Effects of a Combined Inpatient-Outpatient Treatment of Obese Children and Adolescents  

Microsoft Academic Search

SummaryBackground: The program The combined DAK therapy for obesity in children and adolescents’ funded and conducted by the Deutsche Angestellten-Krankenkasse (DAK), a German health insurance company, commenced in 2003. The treatment program lasts for 1 year and comprises of 2 phases: an initial inpatient therapy for 6 weeks followed by a home-based outpatient treatment of the overweight children, adolescents, and

Sibylle Adam; Joachim Westenhöfer; Birgit Rudolphi; Hanna-Kathrin Kraaibeek

2009-01-01

43

Inpatient versus day hospital treatment for chronic, combat-related posttraumatic stress disorder: a naturalistic comparison.  

PubMed

This study adopted a quasi-experimental design to compare the treatment outcomes of inpatient-outpatient programs and day hospital programs for chronic, combat-related posttraumatic stress disorder. Data were drawn from 202 Vietnam veterans who had completed treatment at four programs across Australia. The veterans were assessed on a range of psychological and social variables at intake to the programs and followed up at 3 and 9 months after discharge. A significant main effect was found for time, with veterans from both program models demonstrating improvements that were maintained over the 9-month follow-up period. Group by time effects were not significant, which suggests that inpatient-outpatient programs are not more efficacious than the less expensive day hospital alternatives. In line with current mental health policy directions, the current study lends broad support to the recommendation that treatment services for veterans with posttraumatic stress disorder be delivered in the least restrictive environment. PMID:11923653

Creamer, Mark; Forbes, David; Biddle, Dirk; Elliott, Peter

2002-03-01

44

Palliative In-Patient Cancer Treatment in an Anthroposophic Hospital: I. Treatment Patterns and Compliance with Anthroposophic Medicine  

Microsoft Academic Search

Background: Complementary and alternative medicine (CAM) and most of all anthroposophic medicine (AM) are important features of cancer treatment in Switzerland. While the number of epidemiological investigations into the use of such therapies is increasing, there is a distinct lack of reports regarding the combination of conventional and CAM methods. Patients and Methods: 144 in-patients with advanced epithelial cancers were

Peter Heusser; Sarah Berger Braun; Renatus Ziegler; Manuel Bertschy; Silke Helwig; Brigitte van Wegberg; Thomas Cerny

2006-01-01

45

[Guideline conformity and outcome of inpatient treatment for schizophrenia. A clinical comparison].  

PubMed

Patient outcome and guideline conformity in inpatient schizophrenia treatment was systematically evaluated and compared with 597 patients across seven psychiatric hospitals. Patient structure and treatment processes showed a great variability between hospitals. Patient characteristics, especially mental state, and the chronicity of the disease were the strongest predictors of clinical outcome. Outcome evaluation using quality indicators is only possible after case-mix adjustment taking into account prognostic factors. A poorer average clinical outcome was associated with lower guideline conformity in a variety of treatment domains. After case-mix adjustment, benchmarking is an opportunity to improve quality of treatment and promote guideline conformity. PMID:15759161

Janssen, B; Weinmann, S; Berger, M; Härter, M; Held, T; Leipert, M; Luderer, H J; Schwarz, M; Steinert, T; Gaebel, W

2005-03-01

46

Bipolar affective disorders and suicide during psychiatric in-patient treatment.  

PubMed

On the basis of the known literature and our own results on patients' suicide, reflections are made with regard to the group of suicide cases with bipolar affective illnesses that commit suicide during inpatient psychiatric treatment. In our own studies, we diagnosed mania in as many as 8% of all suicide cases. Risk factors for suicidal behavior in bipolar affective disorder are discussed, especially in terms of psychopathology, and the social consequences of the disease are discussed. PMID:16020169

Wolfersdorf, Manfred; Lehle, Bernd; Adler, Lothar

2005-01-01

47

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

Microsoft Academic Search

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

Manfred Fichter; Marian Cebulla; Nobert Quadflieg; Silke Naab

2008-01-01

48

Inpatient treatment of male pathological gamblers in Germany  

Microsoft Academic Search

Pathological gambling is viewed as a disease of unknown cause which requires treatment. Demographic and psychological traits of fifty-eight male patients are described. A control group of fifty-four patients with other addictions was used to determine the validity of a diagnostic test which aims to differentiate between harmless gambling behavior and addiction to gambling. This test is described along with

Jürgen Schwarz; Andreas Lindner

1992-01-01

49

Short-term outcome of anorexia nervosa in adolescents after inpatient treatment: a prospective study.  

PubMed

The current study describes the short-term outcome of adolescent inpatient population suffering from anorexia nervosa (AN) and analyzes the clinical predictors of poor outcome in these patients. Fifty-seven female AN patients (mean = 15.8, SD = 1.3) admitted for inpatient treatment to a specialized eating disorder unit at a university medical center were reassessed 1 year after being discharged. Assessments were made at the beginning and at the end of the inpatient treatment as well as at the 1-year follow-up. Self-rating data and expert-rating interview data were obtained. Adequate data for 55 (96.5%) cases allowed for the assignment of an outcome category. A total of 28.1% of the patients' cases showed a good outcome, meaning the patients fully recovered, and 8.8% had an intermediate outcome, and 59.6% of the patients' cases had a poor outcome. Significant predictors of poor outcome included the patient's BMI at the beginning of the treatment as well as psychiatric comorbidity, and purging behavior. Adolescent AN is a severe disorder with a poor outcome in a substantial amount of adolescents. PMID:19399545

Salbach-Andrae, Harriet; Schneider, Nora; Seifert, Katja; Pfeiffer, Ernst; Lenz, Klaus; Lehmkuhl, Ulrike; Korte, Alexander

2009-04-28

50

Treatment Responses of Inpatient Eating Disorder Women with and without Co-occurring Obsessive-compulsive Disorder  

Microsoft Academic Search

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

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

2007-01-01

51

Dental prosthetic treatment needs of inpatients with schizophrenia in Taiwan: a cross-sectional study  

PubMed Central

Background The need to obtain information on the dental prosthetic treatment needs (DPTNs) of inpatients with schizophrenia is unrecognized. This study aims to assess the DPTNs of this population and investigate the association between these needs and related factors. Methods The results of an oral health survey involving 1,103 schizophrenic adult inpatients in a long-term care institution in Taiwan were used. Chi-square tests and multiple logistic analyses were used to measure the independent effects of the characteristics of each subject on their DPTNs. Results Of the subjects, 805 (73.0%) were men and 298 (27.0%) were women. The mean age was 50.8 years. A total of 414 (37.5%) required fixed prosthesis, whereas 700 (63.5%) needed removable prosthesis. Multivariate analyses show that fixed prosthesis is associated with age only after adjusting for other potential independent variables. Older subjects who had a lower educational attainment or a longer length of stay required removable prosthesis. Conclusions The findings of this study show that the DPTNs of schizophrenic inpatients are not being met. Therefore, a special approach to the dental prosthetic treatment of these patients should be developed.

2013-01-01

52

Evaluation of factors influencing medication compliance in inpatient treatment of psychotic disorders  

Microsoft Academic Search

Rationale  Short- and long-term compliance to prescribed antipsychotic drugs is of particular concern in regard to medication choice\\u000a and treatment outcome in the care of psychotic disorders.\\u000a \\u000a \\u000a \\u000a Objective  We evaluated patient-related and treatment-related factors associated with medication compliance in inpatients with a diagnosis\\u000a of schizophrenia, schizoaffective disorder, or other psychotic disorder.\\u000a \\u000a \\u000a \\u000a Methods  Within a naturalistic study in seven psychiatric hospitals, individuals with a

Birgit Janssen; Wolfgang Gaebel; Martin Haerter; F. Komaharadi; Birgit Lindel; Stefan Weinmann

2006-01-01

53

Interpersonal violence exposure and alcohol treatment utilization among medical inpatients with alcohol dependence.  

PubMed

The goal of this study was to examine the association between interpersonal violence exposure and utilization of alcohol treatment after medical hospitalizations among adults with alcohol dependence. We analyzed data collected from a prospective cohort of 238 adults with alcohol dependence who were inpatients in a large urban hospital. Participants who reported interpersonal violence victimization had 1.6 times the odds (adjusted odds ratio = 1.64, 95% confidence interval = 0.92-2.91) of receiving alcohol treatment during the year after hospitalization compared to participants with no violence exposure. Recent (past 3 months) exposure to violence was not more strongly related to receipt of treatment than any lifetime violence exposure. Results suggest that a history of interpersonal violence victimization may be associated with an increased odds of alcohol treatment utilization following a medical hospitalization. Therefore, clinicians should be optimistic about identifying and referring patients who have experienced interpersonal violence to alcohol treatment. Moreover, given the potentially high prevalence of interpersonal violence exposure among inpatient populations at large urban hospitals, alcohol treatment providers should develop methods to address both alcohol dependence and violence recovery. PMID:17869052

Rothman, Emily F; Cheng, Debbie M; Pedley, Alison; Samet, Jeffrey H; Palfai, Tibor; Liebschutz, Jane M; Saitz, Richard

2007-09-14

54

Use of holding, restraints, seclusion and time-out in child and adolescent psychiatric in-patient treatment  

Microsoft Academic Search

.   The aim of the study was to analyse the use of holding, restraints, seclusion and time-out in child and adolescent psychiatric\\u000a in-patient treatment in Finland. The study included 504 child and adolescent psychiatric in-patients in the year 2000. Time-out\\u000a had been used for 28 %, holding for 26 %, seclusion for 8 %, and mechanical restraints for 4 %

A. Sourander; H. Ellilä; M. Välimäki; J. Piha

2002-01-01

55

Safety and effectiveness of olanzapine versus conventional antipsychotics in the acute treatment of first-episode schizophrenic inpatients  

Microsoft Academic Search

Objective: To assess the safety and effectiveness of olanzapine compared to typical antipsychotics in the treatment of first-episode schizophrenics in acute psychiatric inpatient wards. Methods: Data were collected from a prospective, comparative, nonrandomized, open, observational study of 904 inpatients with schizophrenia. One hundred and fifty-eight patients fulfilled the criteria for first-episode schizophrenia, defined as (1) the International Classification of Diseases:

Julio Bobes; Juan Gibert; Antonio Ciudad; Enrique Alvarez; Fernando Cañas; José-Luis Carrasco; Josep Gascón; Juan-Carlos Gómez; Miguel Gutiérrez

2003-01-01

56

Psychopathic traits and change on indicators of dynamic risk factors during inpatient forensic psychiatric treatment.  

PubMed

The main objective of the present study was to investigate the impact of treatment on forensic psychiatric inpatients, examining changes on 22 indicators of five dynamic risk factors for violence (i.e., egocentrism, hostility, impulsivity, lack of insight, and negative distrustful attitudes), and to relate these potential changes to level of psychopathy assessed with the Hare Psychopathy Checklist - Revised (PCL-R). Also, we studied the relationship between psychopathy and treatment compliance, as indicated by the attendance rate of therapeutic activities. Eighty-seven male patients (due to missing data on at least one measure, sample size varies from 58 to 87; 42 patients have complete datasets) were administered a standardized psychological assessment battery (self-report inventories, performance-based personality test, observer ratings) upon admission (T1) and after on average 20 months of treatment (T2). Upon admission, psychopathy (median split, PCL-R score?22) was significantly related to a higher score on five of the 22 indicators of dynamic risk. The analyses showed no significant differences between psychopathic and non-psychopathic patients on the indicators of dynamic risk factors during 20 months of inpatient forensic psychiatric treatment. However, psychopaths showed the expected pattern of treatment noncompliance, compared to non-psychopaths. The clinical and research implications of these findings are discussed. PMID:22579382

Hildebrand, Martin; de Ruiter, Corine

2012-05-10

57

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

PubMed Central

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.

Heinz, Jurgen; Fiori, Wolfgang; Heusser, Peter

2013-01-01

58

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

PubMed

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

Heinz, Jürgen; Fiori, Wolfgang; Heusser, Peter; Ostermann, Thomas

2013-01-31

59

Postdischarge Impact of C-L Psychiatry Treatment in Obstetrical Inpatients  

PubMed Central

Purpose. Twenty-eight women, referred to C-L Psychiatry during their obstetrical inpatient stay were interviewed six months post-discharge to determine how they experienced the consultation process, whether they recollected and adhered to treatment recommendations, and whether they developed or had a recurrence of mental health problems post-discharge. Method. Semi-structured telephone interviews were conducted by a psychologist who had not been involved with patient care. Results. There was strong congruence between reason for referral as stated in psychiatric consult notes and participants' recollections and strong congruence and compliance regarding treatment recommendations. Sixty-four percent of women had concerns regarding mood post-discharge, of whom 66% sought professional help within six months. Participants' recommendations for improving the effectiveness of the C-L service to obstetrical inpatients pertained mainly to sensitivity to patients' feelings, consistency of message and personnel, and post-discharge follow-up. Conclusions. Obstetrical patients had good recollection of their experience of C-L psychiatry, and post-discharge compliance with treatment recommendations was high. A post-discharge telephone call might further enhance treatment compliance and encourage women who are struggling with mood difficulties to seek help. Contact between C-L psychiatry and patients' primary care physician may also enhance care post-discharge.

Sloan, Eileen Patricia; Kirsh, Sharon

2011-01-01

60

[Acute inpatient conservative multimodal treatment of complex and multifactorial orthopedic diseases in the ANOA concept].  

PubMed

In Germany there is a clear deficit in the non-operative treatment of chronic and complex diseases and pain disorders in acute care hospitals. Only about 20?% of the treatments are carried out in orthopedic hospitals. Hospitals specialized in manual medicine have therefore formed a working group on non-operative orthopedic manual medicine acute care clinics (ANOA). The ANOA has developed a multimodal assessment procedure called the OPS 8-977 which describes the structure and process quality of multimodal and interdisciplinary diagnosis and treatment of the musculoskeletal system. Patients are treated according to clinical pathways oriented on the clinical findings. The increased duration of treatment in the German diagnosis-related groups (DRG) system is compensated for with a supplemental remuneration. Thus, complex and multifactorial orthopedic diseases and pain disorders are conservatively and appropriately treated as inpatient departments of acute care hospitals. PMID:24052170

Psczolla, M

2013-10-01

61

Six- and twelve-month abstinence rates in inpatient alcoholics treated with aversion therapy compared with matched inpatients from a treatment registry.  

PubMed

Two hundred forty-nine patients who were treated for alcoholism in an inpatient multimodal treatment program that included aversion therapy were matched post hoc on 17 baseline variables with patients from a national treatment outcome registry. The latter patients received inpatient treatment that emphasized individual and group counseling as the primary therapeutic elements but did not include aversion therapy for alcohol. Six- and 12-month abstinence rates from alcohol and all mood-altering chemicals are reported. The patients treated with aversion therapy for alcohol had higher alcohol abstinence rates at 6 and 12 months (p less than 0.01). The abstinence rates from all mood-altering chemicals were higher in the aversion group at 6 months (p less than 0.05) but not at 12 months. The largest differences between treatment groups in 6-month alcohol abstinence rates were noted for males (p less than 0.001), those over 35 (p less than 0.001), daily drinkers (p less than 0.001), and those with alcohol-related work performance problems (p less than 0.05). PMID:1755521

Smith, J W; Frawley, P J; Polissar, L

1991-10-01

62

Drop-out from adolescent and young adult inpatient treatment for anorexia nervosa.  

PubMed

We examined factors predictive of dropout from inpatient treatment for anorexia nervosa (AN) among adolescents in a prospective study of 359 consecutive hospitalizations for AN (DSM-IV). Patients were assessed at admission (clinical, socio-demographic, and psychological data). Multivariate analyses were performed. Drop-out (i.e. leaving hospital before the target weight is achieved) occurred in 24% (n=86) of hospitalizations; in 42.3% (n=30) of the cases, dropout was initiated by the treatment team and in 58.6% (n=41) by the patients and/or their parents. 18.6% (16/86) occurred during the first half of the inpatient program. Frequency of drop-out was significantly higher when the patient was living with only one parent, had been hospitalized previously, had a lower BMI at admission and was over 18 at admission. These elements should draw the attention of the clinician, so that he/she can prepare hospitalization with patients presenting lower admission BMI, particularly by motivational interventions for a better therapeutic alliance, and by the deployment of intensive accompaniment of single parents. Further studies aiming to replicate these results, and including the evaluation of other clinical dimensions such as impulsivity and other personality traits, are needed to elucidate this important topic. PMID:23639255

Hubert, Tamara; Pioggiosi, Philippe; Huas, Caroline; Wallier, Jenny; Maria, Anne-Solène; Apfel, Alexandre; Curt, Florence; Falissard, Bruno; Godart, Nathalie

2013-04-29

63

Idiopathic pulmonary thromboembolism in the course of intensive psychiatric inpatient care: case report and treatment guidelines.  

PubMed

Idiopathic thromboembolism can occur in psychiatric patients who have been inactive during a period of inpatient hospital treatment. These patients are usually treated with antipsychotic medication which has also been reported to increase risk for thromboembolic disease. Here the authors describe a patient with neither prior history of thromboembolism nor any medical risk factors for thromboembolic disease, who was admitted with an acute relapse of psychotic illness. During the course of her intensive psychiatric treatment, she had chest pain and CT-pulmonary arteriogram revealed bilateral lower lobe pulmonary embolism. She was anticoagulated and made a full medical recovery. Treatment with high dosages of typical and atypical antipsychotic medication and a lack of mobility related to intensive nursing care and sedation were likely risk factors in her development of pulmonary emboli. PMID:22962386

McInerney, Shane J; McDonald, Colm

2012-09-07

64

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

PubMed Central

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.

Page, Stephen J.

2013-01-01

65

Six- and twelve-month abstinence rates in inpatient alcoholics treated with either faradic aversion or chemical aversion compared with matched inpatients from a treatment registry.  

PubMed

Two hundred forty-nine patients who were treated for alcoholism in an inpatient multimodal treatment program that included aversion therapy were matched post hoc on 17 baseline variables with patients from a national treatment outcome registry. The latter patients received inpatient treatment that emphasized individual and group counseling as the primary therapeutic elements but did not include aversion therapy for alcohol. Six- and 12-month abstinence rates from alcohol and all mood-altering chemicals are reported. The patients treated with aversion therapy for alcohol had higher alcohol abstinence rates at 6 and 12 months (p < 0.01). The abstinence rates from all mood-altering chemicals were higher in the aversion group at 6 months (p < 0.05) but not at 12 months. These comparisons pooled faradic aversion and chemical aversion results. In order to determine whether or not the faradic aversion gave comparable results to the chemical aversion, the two groups were separately analyzed. No significant differences in outcome were found. In fact, the faradic aversion group showed a slight (nonsignificant) increase in abstinence rate. PMID:9046442

Smith, J W; Frawley, P J; Polissar, N L

1997-01-01

66

Clinical features of patients with anorexia nervosa: Assessment of factors influencing the duration of in-patient treatment  

Microsoft Academic Search

We investigated that factors affecting the duration of in-patient treatment of patients with anorexia nervosa by comparing pretreatment clinical features with the length of hospitalization in 55 patients. Only patients who had completed the entire course of treatment were included in our analysis. Longer hospitalization was correlated with: poor social adaptation; anxiety and\\/or personality disorders before onset; older age at

Shin-Ichi Nozoe; Yuji Soejima; Mitsuki Yoshioka; Tetsurou Naruo; Akinori Masuda; Nobuatsu Nagai; Hiromitsu Tanaka

1995-01-01

67

Using the Suicide Index Score to Predict Treatment Outcomes among Psychiatric Inpatients.  

PubMed

For many suicidal people, the desire to die is moderated by a competing desire to live. This study aimed to demonstrate the ability of a wish-to-live versus wish-to-die index score to measure ambivalence and trichotomize suicidal inpatients into distinct stratified risk groups. Analyses revealed that index scores calculated for patients at treatment start significantly discriminated among the groups at index and uniquely predicted suicidal ideation, hopelessness, and depression scores across treatment. On average, patients with wish-to-live and wish-to-die orientations resolved suicidal ideation by discharge. Changes in suicidal ideation among ambivalently oriented patients were more variable. Clinical and research implications are discussed. PMID:23725632

Lento, René M; Ellis, Thomas E; Hinnant, Benjamin J; Jobes, David A

2013-06-01

68

Protocol for treatment of diabetic foot ulcers  

Microsoft Academic Search

Each year, 82,000 limb amputations are performed in patients with diabetes mellitus. The majority of these amputations could be avoided by following strict protocols. The collective experience treating patients with neuropathic diabetic foot ulcers of 4 major diabetic foot programs in the United States and Europe were analyzed. The following protocol has been developed for patients with diabetic foot ulcers:

Harold Brem; Peter Sheehan; Andrew J. M Boulton

2004-01-01

69

The effect of prospective payment on admission and treatment policy: Evidence from inpatient rehabilitation facilities.  

PubMed

We examine provider responses to the Medicare inpatient rehabilitation facility (IRF) prospective payment system (PPS), which simultaneously reduced marginal reimbursement and increased average reimbursement. IRFs could respond to the PPS by changing the number of patients admitted, admitting different types of patients, or changing the intensity of care. We use Medicare claims data to separately estimate each type of provider response. We also examine changes in patient outcomes and spillover effects on other post-acute care providers. We find that costs of care initially fell following the PPS, which we attribute to changes in treatment decisions rather than the characteristics of patients admitted to IRFs within the diagnostic categories we examine. However, the probability of admission to IRFs increased after the PPS due to the expanded admission policies of providers. We find modest spillover effects in other post-acute settings and negative health impacts for only one of three diagnostic groups studied. PMID:23994598

Sood, Neeraj; Huckfeldt, Peter J; Grabowski, David C; Newhouse, Joseph P; Escarce, José J

2013-07-02

70

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

PubMed

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

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

2013-09-03

71

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

PubMed Central

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).

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

2013-01-01

72

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

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 study evaluates the effectiveness of a comprehensive self-management educational program by a cluster randomized trial within inpatient cardiac rehabilitation in Germany. Furthermore, subgroup-related treatment effects will be explored. Study results will contribute to a better understanding of both the effectiveness and mechanisms of a self-management group program as part of cardiac rehabilitation. Trial registration German Clinical Trials Register: DRKS00004841; WHO International Clinical Trials: = DRKS00004841

2013-01-01

73

Treatment goal-planning: outcome findings of a British prospective multi-centre study of adolescent inpatient units.  

PubMed

A set of 16 treatment goals, related to 4 areas of adolescent functioning, were defined and employed in the initial and discharge assessments of 276 patients, admitted to 4 inpatient units, examined during a multi-centre prospective study of adolescent psychiatric hospitalizations. At discharge, subjects showed a substantial improvement across all treatment goals; least improvement was observed amongst those goals most frequently targeted. The clinical investigators consider the treatment goal definitions used in this study a meaningful way of measuring psychiatric disturbances in adolescence as well as a useful measure of change in an inpatient population. Further development of the treatment goal definitions would produce a robust clinical and audit tool. PMID:8846209

Rothery, D; Wrate, R; McCabe, R; Aspin, J; Bryce, G

1995-07-01

74

The Effects of Modafinil Treatment on Neuropsychological and Attentional Bias Performance During 7Day Inpatient Withdrawal From Methamphetamine Dependence  

Microsoft Academic Search

The cognitive benefits of modafinil to patients undergoing 7-day inpatient withdrawal from methamphetamine (MA) dependence were examined as part of a double-blind, randomized, placebo-controlled pilot trial. Recent evidence has identified modafinil-related improvements in treatment outcomes for MA-dependent patients; however, the benefits to cognition function, which is critical to treatment success but known to be impaired, has yet to be examined.

Robert Hester; Nicole Lee; Amy Pennay; Suzi Nielsen; Jason Ferris

2010-01-01

75

A Brief Behavioral Activation Treatment for DepressionA Randomized Pilot Trial within an Inpatient Psychiatric Hospital  

Microsoft Academic Search

The brief behavioral activation treatment for depression (BATD) is a relatively uncomplicated, time-efficient, and cost-effective method for treating depression. Because of these features, BATD may represent a practical intervention within managed care-driven, inpatient psychiatric hospitals. Based on basic behavioral theory and empirical evidence supporting activation strategies, we designed a treatment to increase systematically exposure to positive activities and thereby help

Derek R. Hopko; C. W. Lejuez; James P. Lepage; Sandra D. Hopko; Daniel W. McNeil

2003-01-01

76

Symptomatic treatment of opiate withdrawal syndrome by low-dose buprenorphine in an in-patient setting  

Microsoft Academic Search

Summary The present study aims to assess the effectiveness of buprenorphine treatment in countering predictable withdrawal from street opiates in 68 opiate-addicts who requested admission to an in-patient opiate detoxification facility. Buprenorphine was administered at flexible doses, on a patient-blind clinical basis. Withdrawal was assessed by scoring a range of symptoms at the start of treatment (T0) and three more

Andrea Fuscone; Mariapia Correale; Mauro Romualdo; Walter Bianchi

77

Decline in in-patient treatments of genital warts among young Australians following the national HPV vaccination program  

PubMed Central

Background There has been a rapid decline in the number of young heterosexuals diagnosed with genital warts at outpatient sexual health services since the national human papillomavirus (HPV) vaccination program started in Australia in 2007. We assessed the impact of the vaccination program on the number of in-patient treatments for genital warts. Methods Data on in-patient treatments of genital warts in all private hospitals were extracted from the Medicare website. Medicare is the universal health insurance scheme of Australia. In the vaccine period (2007–2011) and pre-vaccine period (2000–2007) we calculated the percentage change in treatment numbers and trends in annual treatment rates in private hospitals. Australian population data were used to calculate rates. Summary rate ratios of average annual trends were determined. Results Between 2000 and 2011, 6,014 women and 936 men aged 15–44?years underwent in-patient treatment for genital warts in private hospitals. In 15–24?year old women, there was a significant decreasing trend in annual treatment rates of vulval/vaginal warts in the vaccine period (overall decrease of 85.3% in treatment numbers from 2007 to 2011) compared to no significant trend in the pre-vaccine period (summary rate ratio (SRR)?=?0.33, p?treatment rates of penile warts in the vaccine period (decrease of 70.6%) compared to an increasing trend in the pre-vaccine period (SRR?=?0.76, p?=?0.02). In 25–34?year old men there was a significant decreasing trend in the vaccine period compared to no change in the pre-vaccine period (SRR?=?0.81, p?=?0.04) and in 35–44?year old men there was no significant change in rates of penile warts both periods, but the rate of change was greater in the vaccine period (SRR?=?0.70, p?=?0.02). Conclusions The marked decline in in-patient treatment of vulval/vaginal warts in the youngest women is probably attributable to the HPV vaccine program. The moderate decline in in-patient treatments for penile warts in men probably reflects herd immunity.

2013-01-01

78

A Review of Treatment Improvement Protocol (TIP) Series 42  

Microsoft Academic Search

Treatment Improvement Protocol (TIP) 42 was developed in response to the recognized prevalence of co-occurring disorders (COD) and research showing the failure of treatment informed by either a mental health or addiction model of change (Drake, Mueser, Brunette, & McHugo, 2004; Hendrickson, Schmal, & Ekleberry, 2004). Based on the work of a consensus panel that gathered information from evidence-based treatment

Manuela Waddell; Alphonse Lennarz; Marilyn Freimuth

2008-01-01

79

Cortisol predicts behavioral dysregulation and length of stay among children admitted for psychiatric inpatient treatment.  

PubMed

Individual differences in behavioral regulation system (BRS) and stress response system (SRS) functioning may reflect greater biological sensitivity to context. The current study tested whether children's cortisol, a measure of the SRS, was related to observed dysregulated behavior, an indicator of the BRS, in a sample of children admitted for acute psychiatric inpatient care. In addition, cortisol and dysregulated behavior were tested as unique predictors of length of hospitalization over and above demographic factors, prior treatment history, and caretaker-reported psychiatric symptoms. The latter variables were tested as potential moderators of the relations of BRS and SRS functioning to length of hospitalization. Plasma cortisol was collected on the morning following hospital admission for 544 children (ages 6-12; 73% boys; 61% ethnic minority). Dysregulated behavior was operationalized as the mean number of timeouts administered by staff for noncompliant behavior per day of hospitalization. Caretakers reported on youth internalizing and externalizing symptomatology. Higher cortisol was modestly associated with greater dysregulated behavior. In a model including both cortisol and dysregulated behavior, each predicted longer hospitalization. Cortisol was positively related to length of stay only for children previously hospitalized, and the relation of dysregulated behavior to length of stay was stronger for older children. Dysregulated behavior and cortisol are related but independent predictors of acute psychiatric hospitalization duration. Direct measures of the SRS can add to the clinical picture regarding hospitalization in ways that observed behavior and caretaker report alone cannot. PMID:22417195

Luebbe, Aaron M; Elledge, L Christian; Kiel, Elizabeth J; Stoppelbein, Laura

2012-01-01

80

Short term effects of inpatient cognitive behavioral treatment of adolescents with anxious-depressed school absenteeism: an observational study  

Microsoft Academic Search

This observational study examined the changes during inpatient cognitive-behavioral treatment (CBT) of adolescents with chronic\\u000a anxious-depressive school absenteeism with or without comorbid disruptive symptoms. 147 adolescents (aged 12–18 years) with\\u000a a specific phobia or other anxiety disorder or a depressive episode or a mixed disorder of conduct and emotions and who had\\u000a completely ceased to attend school or showed irregular school

Daniel Walter; Christopher Hautmann; Saada Rizk; Maike Petermann; Johannes Minkus; Judith Sinzig; Gerd Lehmkuhl; Manfred Doepfner

2010-01-01

81

Associations among attachment characteristics, patients’ assessment of therapeutic factors, and treatment outcome following inpatient psychodynamic group psychotherapy  

Microsoft Academic Search

Within a multisite study, including 289 inpatients from six different hospitals who underwent interpersonal-psychodynamic group psychotherapy, associations among attachment characteristics, therapeutic factors, and treatment outcome were investigated. Attachment characteristics were assessed with an interview-based measure (Adult Attachment Prototype Rating [AAPR]) as well as an attachment self-report (Bielefeld Questionnaire of Client Expectations [BQCE]). Therapeutic factors were measured retrospectively with the Düsseldorf

Helmut Kirchmann; Robert Mestel; Karin Schreiber-Willnow; Dankwart Mattke; Klaus-Peter Seidler; Elke Daudert; Ralf Nickel; Rainer Papenhausen; Jochen Eckert; Bernhard Strauss

2009-01-01

82

Clinical characteristics and treatment outcome in a representative sample of depressed inpatients – Findings from the Munich Antidepressant Response Signature (MARS) project  

Microsoft Academic Search

Depression is a common and often difficult-to-treat clinical condition with a high rate of patients showing insufficient treatment response and persistence of symptoms. We report the characteristics of a representative sample of depressed inpatients participating in the Munich Antidepressant Response Signature (MARS) project. Eight hundred and forty-two inpatients admitted to a psychiatric hospital for treatment of a major depressive episode,

Johannes M. Hennings; Toshimi Owashi; Elisabeth B. Binder; Sonja Horstmann; Andreas Menke; Stefan Kloiber; Tatjana Dose; Bastian Wollweber; Derek Spieler; Thomas Messer; Rita Lutz; Heike Künzel; Thomas Bierner; Thomas Pollmächer; Hildegard Pfister; Thomas Nickel; Annette Sonntag; Manfred Uhr; Marcus Ising; Florian Holsboer; Susanne Lucae

2009-01-01

83

Cortisol Predicts Behavioral Dysregulation and Length of Stay Among Children Admitted for Psychiatric Inpatient Treatment  

Microsoft Academic Search

Individual differences in behavioral regulation system (BRS) and stress response system (SRS) functioning may reflect greater biological sensitivity to context. The current study tested whether children's cortisol, a measure of the SRS, was related to observed dysregulated behavior, an indicator of the BRS, in a sample of children admitted for acute psychiatric inpatient care. In addition, cortisol and dysregulated behavior

Aaron M. Luebbe; L. Christian Elledge; Elizabeth J. Kiel; Laura Stoppelbein

2012-01-01

84

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

ERIC Educational Resources Information Center

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,…

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

2011-01-01

85

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

PubMed Central

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.

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

2013-01-01

86

Increased physical activity not decreased energy intake is associated with inpatient medical treatment for anorexia nervosa in adolescent females.  

PubMed

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

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

2013-04-18

87

Effectiveness of short-term specialized inpatient treatment for war-related posttraumatic stress disorder: A role for adventure-based counseling and psychodrama  

Microsoft Academic Search

Psychological tests were administered to 24 participants of an inpatient posttraumatic stress disorder (PTSD) treatment program both immediately before and following completion of treatment. Responses were compared to a treatment\\/wait list comparison group composed of 24 subjects awaiting entry into the program. All treatment\\/wait list comparison group subjects received weekly PTSD outpatient group therapy. Significant improvements were found in the

Kim G. Ragsdale; Robert D. Cox; Penny Finn; Richard M. Eisler

1996-01-01

88

Medicare Inpatient Treatment for Elderly Non-dementia Psychiatric Illnesses 1992–2002; Length of Stay and Expenditures by Facility Type  

Microsoft Academic Search

We summarize Medicare utilization and payment for inpatient treatment of non-dementia psychiatric illnesses (NDPI) among the\\u000a elderly during 1992 and 2002. From 1992 to 2002, overall mean Medicare expenditures per elderly NDPI inpatient stay declined\\u000a by $2,254 (in 2002 dollars) and covered days by 2.8. However, these changes are complicated by expanded use of skilled nursing\\u000a facilities and hospital psychiatric

Donald R. Hoover; Ayse Akincigil; Jonathan D. Prince; Ece Kalay; Judith A. Lucas; James T. Walkup; Stephen Crystal

2008-01-01

89

Improved Protocol for the Treatment of Graft Versus Host Disease.  

National Technical Information Service (NTIS)

The patent application discloses monoclonal antibodies known as TA-1, T101, and UCHT1 covalently linked to separate ricin toxins, are combined in a mixture, and used in an improved protocol in the treatment of human donor bone marrow prior to the infusion...

D. M. Neville R. J. Youle

1983-01-01

90

Personality disorders and outcome of inpatient treatment for depression: a 1-year prospective follow-up study.  

PubMed

This study examines the relationship of personality disorders (PDs) with the outcome of an inpatient treatment for depression. One hundred sixty-eight inpatients with unipolar depression (41% with PD according to SCID-II) were assessed at admission, discharge, and 1-year follow-up. Patients without as well as with PD showed a significant and comparable intake-to-discharge symptom reduction in all inventories. At posttreatment, patients with PD scored higher in self-report measures of symptom severity (Brief Symptom Inventory, Beck Depression Inventory) than patients without PD, due to their higher symptom levels at intake. However, there was no difference in clinician-rated therapy outcome (Hamilton Rating Scale for Depression [17-item version], Global Assessment of Functioning Scale, Clinical Global Impression Scale) between both patient groups at discharge. At 1-year follow-up, patients without PD maintained their treatment outcome, whereas patients with PD showed a slight increase in symptom severity, compared to discharge. The results suggest that a difference in acute treatment outcome between depressed patients with and without PD may be found using self-ratings but not expert ratings of symptom severity. Furthermore, the importance of subsequent outpatient treatment that takes into account the special needs of depressed patients with comorbid PD is highlighted. PMID:22928855

Unger, Theresa; Hoffmann, Sabine; Köhler, Stephan; Mackert, Arthur; Fydrich, Thomas

2012-08-28

91

Terbinafine in onychomycosis of the toenail: A novel treatment protocol  

Microsoft Academic Search

Background: Current treatment of onychomycosis of the toenail is poor and relapse is common.Objective: Our purpose was to assess the efficacy and safety of oral terbinafine and placebo in onychomycosis of the toenail with the use of a novel treatment protocol.Methods: This was a randomized, double-blin, 48-week study. Twelve weeks of terbinafine (250 mg daily) or placebo was followed by

Alan Watson; John Marley; David Ellis; Tony Williams

1995-01-01

92

Inpatient treatment of women with postpartum psychiatric disorders – the role of the male partners  

Microsoft Academic Search

Summary Postpartum psychiatric disorders are stressful events for all members of the family. The male partners contribute to the women’s coping process. To evaluate the men’s supportive function we investigated 31 partners of 34 women with postpartum psychiatric disorders. Three male partners were unreachable although we tried to contact them intensively. All the women examined were in-patients of a mother-child

M. Grube

2005-01-01

93

Brief Family Treatment Intervention to Promote Continuing Care Among Alcoholic Patients in Inpatient Detoxification: A Randomized Pilot Study  

PubMed Central

Alcoholic patients in inpatient detoxification were randomized to treatment as usual (TAU) or to a brief family treatment (BFT) intervention to promote continuing care post-detox. BFT consisted of meeting with the patient and an adult family member (in person or over the phone) with whom the patient lived, to review and recommend potential continuing care plans for the patient. Results showed that BFT patients (N=24), were significantly more likely than TAU patients (N=21), to enter a continuing care program after detoxification. This was a medium to large effect size. In the 3 months after detoxification, days using alcohol or drugs (a) trended lower for treatment-exposed BFT patients who had an in-person family meeting than TAU counterparts (medium effect), and (b) were significantly lower for patients who entered continuing care regardless of treatment condition (large effect).

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

2008-01-01

94

Temperament and character dimensions in opiate addicts: comparing subjects who completed inpatient treatment in therapeutic communities vs. incompleters.  

PubMed

The aim of this study was to compare temperamental profiles of patients who completed inpatient treatment of drug dependence with those who failed to complete the program. One hundred forty four opiate addicts, all resident in therapeutic communities and screened to exclude Axis I disorders, were assessed using the Temperament and Character Inventory (TCI). After one year, the TCI scores were compared between those who were still resident and those who had dropped out. Significant differences between groups were found in Reward Dependence, Persistence, Cooperativeness, Self-Transcendence. Temperament and character features may have an influence on motivation and on the adherence to treatment and community rules, as they modulate the maintenance of ongoing behaviors and the sensitivity to social rewards. The findings suggest that personality assessment with TCI in opiate addicts may be helpful in screening procedures to increase the efficiency of treatment and rehabilitative strategies. PMID:17891663

Zoccali, R; Muscatello, M R A; Bruno, A; Bilardi, F; De Stefano, C; Felletti, E; Isgrò, S; Micalizzi, V; Micò, U; Romeo, A; Meduri, M

2007-01-01

95

Mandible condylar hyperplasia: a review of diagnosis and treatment protocol  

PubMed Central

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.

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

2013-01-01

96

Brief family treatment intervention to promote aftercare among substance abusing patients in inpatient detoxification: Transferring a research intervention to clinical practice  

Microsoft Academic Search

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

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

2008-01-01

97

Brief family treatment intervention to promote aftercare among male substance abusing patients in inpatient detoxification: A quasi-experimental pilot study  

Microsoft Academic Search

We developed a brief family treatment (BFT) intervention for substance abusing patients in inpatient detoxification to promote aftercare treatment post-detox. BFT consisted of meeting with the patient and a family member (spouse or parent) with whom the patient lived to review and recommend potential aftercare plans for the patient. A phone conference was used when logistics prevented an in-person family

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

2007-01-01

98

The integration of behavioral principles and a psychodynamic viewpoint in the treatment of adolescents on an intermediate inpatient unit.  

PubMed

This paper describes an approach to setting up an inpatient intermediate-term unit integrating behavioral methods with a psychodynamic viewpoint to facilitate the treatment of severely disturbed adolescents. The need to provide a safe and structured environment for these youngsters is critical to the establisment of what Erikson has described as basic trust. The milieu needs to feel safe and predictable to provide a synergistic relationship with other modalities of treatment. This can usually be accomplished by utilizing behavioral principles within the milieu. Case examples are provided in which interventions on the unit can provide increased feelings of security which then translate into the patient being able to understand, express and work through feelings and decrease the probability of acting these feelings out. An important consideration is also given to intra and inter-staff dynamics and countertransference reactions which impede the exploration of feelings and encourage patients to act out the staff's forbidden unconscious impulses. PMID:8029375

Adelsberg, M

1994-01-01

99

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

Microsoft Academic Search

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 integrity was assessed via permanent products and teacher self-report assessments resulting from TIPP completion. Results

Lisa M. Hagermoser Sanetti; Thomas R. Kratochwill

2009-01-01

100

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

ERIC Educational Resources Information Center

|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

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

2009-01-01

101

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

ERIC Educational Resources Information Center

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…

Substance Abuse and Mental Health Services Administration, 2005

2005-01-01

102

Biomechanics and orthodontic treatment protocol in maxillofacial distraction osteogenesis  

PubMed Central

As in the traditional combined surgical and orthodontic procedures, an Orthodontist can plays vital role in treatment planning and the orthodontic treatment of patient undergoing distraction osteogenesis. This role includes predistraction assessment of the craniofacial skeleton and occlusal function, pre-distraction, and post-distraction orthodontic care. Based on clinical evaluation, dental study models, photographic analysis, cephalometric evaluation, and three-dimensional computed tomographic analysis, the Orthodontist, in collaboration with the Surgeon, plans distraction device placement and the predicted vectors of distraction. Finally, as in other forms of orthognathic surgery, the practice of distraction osteogenesis depends on the cooperation and planning between orthodontist and surgeon as a team. Purpose of this paper is to review biomechanics and orthodontic treatment protocol of distraction osteogenesis in the maxillofacial region.

Maheshwari, Sandhya; Verma, Sanjeev K.; Tariq, Mohd.; Prabhat, K. C.; Kumar, Shailendra

2011-01-01

103

Neural network based on adaptive resonance theory as compared to experts in suggesting treatment for schizophrenic and unipolar depressed in-patients  

Microsoft Academic Search

A modified neural network based on adaptive resonance theory (ART) was trained with the records of 211 psychiatric inpatients (74 schizophrenic, 50 unipolar depressed, 34 bipolar depressed, 20 bipolar manic, 33 other) who improved by at least 40 points of the GAFS during 8 weeks of treatment. Thereafter, a comparison was made between the clinical response of another 26 schizophrenic

Ilan Modai; Asher Israel; Shalom Mendel; Evor L. Hines; Ronit Weizman

1996-01-01

104

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

|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…

Boxer, Paul

2010-01-01

105

Sustained effects of comprehensive inpatient rehabilitative treatment and sleeping neck support in patients with chronic cervicobrachialgia: a prospective and randomized clinical trial.  

PubMed

The objective of this study was to investigate the long-term efficacy of inpatient rehabilitation using sleeping neck support in patients suffering from chronic cervicobrachialgia. A prospective, randomized clinical trial with a 12-month follow-up was done. A total of 149 patients suffering from chronic cervicobrachialgia received a 4-week inpatient rehabilitation programme. The patients were randomly divided into two groups. The patients in one group were given a special neck pillow to use during and after the rehabilitative treatment (n=76); the patients in the other group were not given the pillow (n=73). Two weeks before, during, and after (3, 6, 9, and 12 months) the 4-week treatment period, the patients completed a questionnaire dealing with the intensity of their cervicobrachial complaints (pain intensity, muscular tension, paraesthesia, and sleep disorders caused by pain or paraesthesia). During the inpatient treatment period, no significant differences were detected between the groups; however, 1-12 months after discharge, the group with sleeping neck support showed a significantly (P<0.05) smaller increase in the intensity of cervical spine pain. Sleep disturbances caused by pain were also reduced significantly (P<0.001 after 3 months, respectively, P<0.05 after 12 months). Inpatient rehabilitative treatment has sustained effects in patients suffering from chronic cervicobrachialgia, particularly when a sleeping neck support is added. PMID:19008684

Bernateck, Michael; Karst, Matthias; Merkesdal, Sonja; Fischer, Michael J; Gutenbrunner, Christoph

2008-12-01

106

Stages of change, treatment outcome and therapeutic alliance in adult inpatients with chronic anorexia nervosa  

PubMed Central

Background Anorexia nervosa (AN) is associated with high rates of chronicity and relapse risk is a considerable therapeutic challenge in the disorder. The aim of the present study was to investigate the association of stages of change and outcome with a focus on the relapse struggle in the maintenance stage in patients with predominantly chronic AN. Further, therapeutic alliance and stages of change associations were explored. Methods As an instrument measuring relapse struggle in the maintenance stage, we applied the short form of the University of Rhode Island Change Assessment-Short (URICA-S). We assessed stages of change in 39 patients with a predominantly chronic course of AN in early, middle, and late stages of inpatient psychotherapy. General symptom severity as assessed by the SCL-90-R and weight change were investigated as outcome measures. Results In-line with earlier evidence, contemplation significantly predicted therapeutic alliance. Further, we demonstrated that relapse risk as operationalized by URICA-S maintenance is an important predictor of general psychopathology. BMI change was not predicted by stages of change. Conclusions The URICA-S maintenance scale might be applied to help identify patients at relapse risk. High URICA-S maintenance scores could be considered as one critical aspect of AN patients who might especially benefit from relapse-preventing aftercare programs.

2013-01-01

107

A case-matched comparison of readmission patterns between primary methamphetamine-using and primary cocaine-using adolescents engaged in inpatient substance-abuse treatment  

Microsoft Academic Search

ObjectiveIn the United States and Canada, elevated patterns of methamphetamine-related treatment admissions among youth have triggered questions about appropriate substance-abuse treatment strategies for methamphetamine-using adolescents. This study aimed to provide a comparative examination of the readmission patterns of primary methamphetamine-using and primary cocaine-using adolescents to a cognitive behavioral therapy (CBT)-based alcohol-and-drug inpatient treatment program.

Russell Callaghan; Lawren Taylor; J. Charles Victor; Tim Lentz

2007-01-01

108

In-Patient Treatment of Fibromyalgia: A Controlled Nonrandomized Comparison of Conventional Medicine versus Integrative Medicine including Fasting Therapy  

PubMed Central

Fibromyalgia poses a challenge for therapy. Recent guidelines suggest that fibromyalgia should be treated within a multidisciplinary therapy approach. No data are available that evaluated multimodal treatment strategies of Integrative Medicine (IM). We conducted a controlled, nonrandomized pilot study that compared two inpatient treatment strategies, an IM approach that included fasting therapy and a conventional rheumatology (CM) approach. IM used fasting cure and Mind-Body-Medicine as specific methods. Of 48 included consecutive patients, 28 were treated with IM, 20 with CM. Primary outcome was change in the Fibromyalgia Impact Questionnaire (FIQ) score after the 2-week hospital stay. Secondary outcomes included scores of pain, depression, anxiety, and well being. Assessments were repeated after 12 weeks. At 2 weeks, there were significant improvements in the FIQ (P < 0.014) and for most of secondary outcomes for the IM group compared to the CM group. The beneficial effects for the IM approach were reduced after 12 weeks and no longer statistically significant with the exception of anxiety. Findings indicate that a multimodal IM treatment with fasting therapy might be superior to CM in the short term and not inferior in the mid term. Longer-term studies are warranted to assess the clinical impact of integrative multimodal treatment in fibromyalgia.

Michalsen, Andreas; Li, Chenying; Kaiser, Katharina; Ludtke, Rainer; Meier, Larissa; Stange, Rainer; Kessler, Christian

2013-01-01

109

Ergonomic evaluation: part of a treatment protocol for musculoskeletal injuries.  

PubMed

Ergonomic analyses and interventions are used as primary prevention methods to reduce physical stressors in the workplace and to prevent work-related musculoskeletal disorders (WMSDs). These methods can also be used for the treatment of injured employees. In this study, 103 employees with WMSDs resulting in more than 5 days away from usual work received an ergonomic evaluation which consisted of observation of usual work tasks, recommendations to minimize identified stressors, and case coordination. The goal of the intervention was to make simple job changes that would assist employees to return safely to usual job duties. The process for implementing this protocol for health care, airline, and university employees is described. The results show that after ergonomic evaluations were performed, the majority of recommendations were fully or partially (89%) implemented. Behavior changes were more likely to occur than administrative and equipment changes (p < .001). Occupational health nurses can use a similar program to enhance treatment plans for clients with WMSDs. PMID:16255528

Grayson, Deborah; Dale, Ann Marie; Bohr, Paula; Wolf, Laurie; Evanoff, Bradley

2005-10-01

110

Neural network based on adaptive resonance theory as compared to experts in suggesting treatment for schizophrenic and unipolar depressed in-patients.  

PubMed

A modified neural network based on adaptive resonance theory (ART) was trained with the records of 211 psychiatric inpatients (74 schizophrenic, 50 unipolar depressed, 34 bipolar depressed, 20 bipolar manic, 33 other) who improved by at least 40 points on the GAFS during 8 weeks of treatment. Thereafter, a comparison was made between the clinical response of another 26 schizophrenic patients and 28 unipolar depressed inpatients, to treatment suggested by the trained ART (N = 21) and by the consensus of two senior psychiatrists (N = 33). The patients were allocated blindly and randomly to the two treatment groups. The BPRS (for the schizophrenic patients) or the HDRS (for the unipolar depressed patients) was completed weekly for 5 weeks. Results showed no difference between decisions regarding treatment by the ART network and by the experts. Length of hospital stay was also similar. All ART suggestions included supportive psychotherapy. High potency antipsychotics were suggested for 7 schizophrenic inpatients, clozapine for one and the addition of community therapy for another. Depressed patients got a variety of treatment suggestions. No contraindicated treatment was suggested by ART; however, two incomplete treatment suggestions were dropped from the study. In conclusion, in a prospective study ART was successful in learning treatment strategies and performed under supervision similar to experts. PMID:9087885

Modai, I; Israel, A; Mendel, S; Hines, E L; Weizman, R

1996-12-01

111

Contributions of a poetry writing group to the treatment of severely disturbed psychiatric inpatients  

Microsoft Academic Search

A poetry writing group in a Veterans Administration Hospital had unexpected advantages for the treatment of patients. As an elective group that de-emphasized the discussion of emotions and concentrated instead on technique and writing of poems, it attracted a variety of patients. Some were initially too disorganized to participate effectively in other treatment groups on the ward, but were able

Sybil Houlding; Peter Holland

1988-01-01

112

The prevalence of cognitive impairment in a rural in-patient substance misuse treatment programme  

Microsoft Academic Search

Cognitive impairment is one factor known to affect people's ability to participate in substance misuse treatment because of the range of cognitive, behavioural and emotional problems such impairment can cause. Some of the behaviours described as common features of cognitive impairment, such as impaired self-monitoring and self-regulation and lack of initiative are seen in some treatment modalities to be causes

Julaine Allan; Michael Kemp; Annette Golden

2012-01-01

113

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

ERIC Educational Resources Information Center

|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…

Bettmann, Joanna E.; Jasperson, Rachael A.

2009-01-01

114

Self-reported symptoms and treatment outcome among non-offending involuntary inpatients  

Microsoft Academic Search

The mediating effects of patient legal status on the accuracy of self-reported psychiatric symptoms have not been systematically explored. Problematically, involuntary hospitalization may be associated with a decreased willingness to accurately report symptoms, which may negatively impact choice of treatment intervention and subsequent treatment outcome. The following study examined the association of patient legal status with self-reported psychiatric symptoms and

Derek R. Hopko; Patricia M. Averill; Katherine Cowan; Nurun Shah

2002-01-01

115

Serious assaults by inpatients.  

PubMed

Forty-nine hospital wards in the United States and Canada were surveyed during specified periods for one year to document assaults by inpatients on staff or other patients. Nine (5.7%) of the 158 assaults by adult psychiatric inpatients were sufficiently severe to require medical treatment. Four others occurred on the only children's service studied. Only one (2.6%) of 39 assaults on adult nonpsychiatric units required medical care. Injuries were rarely serious, with only four assaults in any setting leading to bedrest or missed workdays. The overall rate of assault (assaults per bed per year) on 27 adult psychiatric units was 1.36; for assaults requiring treatment, the rate was 0.08. The rate of assault of any kind on 22 adult nonpsychiatric units was 0.28 assaults per bed per year. PMID:2775342

Reid, W H; Bollinger, M F; Edwards, J G

1989-01-01

116

Willingness of patients with ankylosing spondylitis to pay for inpatient treatment is influenced by the treatment environment and expectations of improvement  

PubMed Central

Methods: 120 patients participating in a randomised trial comparing 3 weeks' treatment in a spa resort in Austria or in the Netherlands with a control group completed a WTP questionnaire before and after spa treatment. Patients indicated on a payment card the maximal co-payment they wanted to contribute for three scenarios that included (a) two levels of improvement in pain and stiffness and (b) two treatment environments: a rehabilitation hospital and a spa resort. Results: At baseline, patients wanted to contribute more for the same improvement after treatment in a spa resort compared with a rehabilitation hospital (p<0.003), and were prepared to pay more when expected effects were higher (p<0.001). No differences were found between men and women, pain, or income. After the trial none of the treatment groups showed a change in their WTP. Conclusion: The WTP of patients with AS for inpatient treatment is influenced by the treatment environment and the expected improvement. Experiencing treatment in a spa resort does not influence the co-payment.

Boonen, A; Severens, J; van Tubergen, A; Landewe, R; Bonsel, G; van der Heijde, D; van der Linden, S.

2005-01-01

117

Criminally Committed Inpatients in a Residential Forensic Pre-Release Treatment Program: An Exploratory Study.  

ERIC Educational Resources Information Center

Investigation was conducted into the demographic, psychopathological, and offense characteristics of forensic psychiatric patients in residential treatment program. Descriptive findings, including victim variables, are presented. Select case vignettes, including offense profiles, are described. Clinical implications for risk assessment and…

Koetting, Mark G.; Grabarek, Joanna; Van Hasselt, Vincent B.; Hazelwood, Robert R.

2003-01-01

118

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

PubMed Central

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.

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

2013-01-01

119

A randomized experimental test of the efficacy of EMDR treatment on negative body image in eating disorder inpatients.  

PubMed

Eye Movement Desensitization and Reprocessing (EMDR) therapy is being used by some clinicians to treat eating disorders. Although there is anecdotal and case study data supporting its use, there are no controlled studies examining its effectiveness with this population. This study examined the short and long-term effects of EMDR in a residential eating disorders population. A randomized, experimental design compared 43 women receiving standard residential eating disorders treatment (SRT) to 43 women receiving SRT and EMDR therapy (SRT+EMDR) on measures of negative body image and other clinical outcomes. SRT+EMDR reported less distress about negative body image memories and lower body dissatisfaction at posttreatment, 3-month, and 12-month follow-up, compared to SRT. Additional comparisons revealed no differences between the conditions pre to posttreatment on other measures of body image and clinical outcomes. The empirical evidence reported here suggests that EMDR may be used to treat specific aspects of negative body image in conjunction with SRT, but further research is necessary to determine whether or not EMDR is effective for treating the variety of eating pathology presented by eating disorder inpatients. PMID:18821365

Bloomgarden, Andrea; Calogero, Rachel M

120

Effects of Alcohol and Drug Use on Inpatient and Residential Treatment Among Youth with Severe Emotional Disturbance in Medicaid-Funded Behavioral Health Care Plans  

Microsoft Academic Search

This study examined the use of alcohol and recreational drugs among 875 youth with severe emotional disturbance (SED) enrolled in Medicaid-funded behavioral health care plans, and whether co-occurring SED and substance use affected the subsequent likelihood of receiving inpatient and\\/or residential treatment. Youth at five sites nationwide were interviewed about their use of drugs and alcohol, while interviews with their

Judith A. Cook; Jane Burke-Miller; Genevieve Fitzgibbon; Dennis D. Grey; Craig Anne Heflinger; Robert I. Paulson; Al Stein-Seroussi; Kelly J. Kelleher; Christina W. Hoven; Virginia Mulkern

2004-01-01

121

Criminally Committed Inpatients in a Residential Forensic PreRelease Treatment Program  

Microsoft Academic Search

An exploratory investigation of the demographic, psycho-pathological, and offense characteristics of a group of forensic psychiatric patients (n = 25) in a residential treatment program was conducted. Participants were residing in the program as a transitional step to returning to the community after having been found not guilty by reason of insanity or incompetent to stand trial and having been

Mark G. Koetting; Joanna Grabarek; Vincent B. Van Hasselt; Robert R. Hazelwood

2003-01-01

122

Clinical characteristics and treatment outcome in a representative sample of depressed inpatients - findings from the Munich Antidepressant Response Signature (MARS) project.  

PubMed

Depression is a common and often difficult-to-treat clinical condition with a high rate of patients showing insufficient treatment response and persistence of symptoms. We report the characteristics of a representative sample of depressed inpatients participating in the Munich Antidepressant Response Signature (MARS) project. Eight hundred and forty-two inpatients admitted to a psychiatric hospital for treatment of a major depressive episode, recurrent or bipolar depression were thoroughly characterized with respect to demographic factors, clinical history, and the degree of HPA-axis dysregulation evaluated by means of combined dex/CRH tests, and the predictive value of these factors for treatment outcome is investigated. 80.8% of patients responded to treatment (i.e., improvement in symptom severity of at least 50%) and 57.9% reached remission (i.e., near absence of residual depressive symptoms) at discharge after a mean treatment period of 11.8 weeks. Regression analysis identified early partial response (within 2 weeks) as the most important positive predictor for achieving remission. Previous ineffective treatment trials in the current episode and presence of a migration background are potent negative predictors for treatment outcome. In addition, remitters were characterized by a more pronounced normalization of an initially dysregulated HPA-axis. We could show that a large majority of inpatients suffering from depression benefits from antidepressant treatment during hospitalization. However, a considerable number of patients failed to achieve remission. We demonstrated that this subgroup can be characterized by a set of demographic, clinical and neuroendocrine variables allowing to predict unfavorable outcome at an early stage of treatment. PMID:18586274

Hennings, Johannes M; Owashi, Toshimi; Binder, Elisabeth B; Horstmann, Sonja; Menke, Andreas; Kloiber, Stefan; Dose, Tatjana; Wollweber, Bastian; Spieler, Derek; Messer, Thomas; Lutz, Rita; Künzel, Heike; Bierner, Thomas; Pollmächer, Thomas; Pfister, Hildegard; Nickel, Thomas; Sonntag, Annette; Uhr, Manfred; Ising, Marcus; Holsboer, Florian; Lucae, Susanne

2008-06-30

123

One-year follow-up after multimodal inpatient treatment for cocaine and methamphetamine dependencies.  

PubMed

Of a randomly selected sample of 214 patients treated with aversion therapy for cocaine dependence in four chemical dependency units operated by Schick Shadel Hospitals, 156 were followed up 12 to 20 months posttreatment (average 15.2 months). Significant other validation was obtained in 33%. Total abstinence from cocaine for the group overall was 53% at one year post treatment, and current abstinence of at least 6 months at follow-up was 68.6%. Those treating with aversion for cocaine alone had a one-year abstinence of 39% and a current abstinence of 62.4%. Those treating with aversion for alcohol and cocaine had a one-year total abstinence from cocaine of 69% and a current abstinence of 76%. Those treating with aversion for cocaine and marijuana had a one-year total abstinence from cocaine of 50% and a current abstinence of 65%. Those treating with aversion for alcohol, cocaine, and marijuana had a one-year total abstinence from cocaine of 73% and a current abstinence of 73%. One-year total abstinence from alcohol was 54% for those receiving aversion for both alcohol and cocaine and 77% for those receiving aversion for alcohol, cocaine, and marijuana. Current abstinence from alcohol at follow-up was 68% and 81%, respectively. One-year total abstinence from marijuana was 42% for those treating with aversion for cocaine and marijuana and 64% for those treating with aversion for alcohol, cocaine, and marijuana. Current abstinence at follow-up from marijuana was 61% and 81%, respectively. The use of aversion therapy for both alcohol and cocaine in alcoholics who were also using cocaine was associated with higher total abstinence rates (88% vs. 55%) from cocaine when compared with alcoholics who used cocaine but received no aversion as part of their program. The conclusion is tentative since the follow-up rate in this study was lower than that of the previous study (64% vs. 84%). Being around other users accounted for 49% of relapse situations. Family/Work stress was associated with relapse in 33% of cases and unpleasant feelings in 24% of cases. The use of both reinforcement treatments and the use of support following treatment were associated with improved abstinence rates from cocaine. Those patients who reported losing all urges for cocaine after treatment had a total abstinence from cocaine of 90%, those who reported losing all the uncontrollable urges had a total abstinence of 64%, and those who reported still having the urge reported only 33% total abstinence from cocaine. PMID:1336066

Frawley, P J; Smith, J W

1992-01-01

124

A Randomized Controlled Trial of Adjunctive Family Therapy and Treatment as Usual Following Inpatient Treatment for Anorexia Nervosa Adolescents  

Microsoft Academic Search

Research on treatments in anorexia nervosa (AN) is scarce. Although most of the therapeutic programs used in ‘real world practice’ in AN treatment resort to multidisciplinary approaches, they have rarely been evaluated.ObjectiveTo compare two multidimensional post-hospitalization outpatients treatment programs for adolescents with severe AN: Treatment as Usual (TAU) versus this treatment plus family therapy (TAU+FT).MethodSixty female AN adolescents, aged 13

Nathalie Godart; Sylvie Berthoz; Florence Curt; Fabienne Perdereau; Zoé Rein; Jenny Wallier; Anne-Sophie Horreard; Irène Kaganski; Réjane Lucet; Frédéric Atger; Maurice Corcos; Jacques Fermanian; Bruno Falissard; Martine Flament; Ivan Eisler; Philippe Jeammet

2012-01-01

125

Treatment of Plantar Fasciitis in Recreational Athletes: Two Different Therapeutic Protocols  

Microsoft Academic Search

Plantar fasciitis (PF) commonly causes inferior heel pain and occurs in up to 10% of the US population. Treatment protocols in most studies include the use of ice therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching and strengthening protocols. The aim of the current study was to examine the effectiveness of 2 different therapeutic approaches on the treatment of PF in

Panagiotis Karagounis; Maria Tsironi; George Prionas; Georgios Tsiganos; Panagiotis Baltopoulos

2011-01-01

126

Qualitative analysis of models with different treatment protocols to prevent antibiotic resistance  

Microsoft Academic Search

This paper is concerned with the qualitative analysis of two models [S. Bonhoeffer, M. Lipsitch, B.R. Levin, Evaluating treatment protocols to prevent antibiotic resistance, Proc. Natl. Acad. Sci. USA 94 (1997) 12106] for different treatment protocols to prevent antibiotic resistance. Detailed qualitative analysis about the local or global stability of the equilibria of both models is carried out in term

Hong-Rui Sun; Xinxin Lu; Shigui Ruan

2010-01-01

127

Inpatient Falls  

PubMed Central

In this 2 part series, analysis of the risk stratification tools that are available, definition for the scope of the problem, and potential solutions through a review of the literature are presented. A systematic review was used to identify articles for risk stratification and interventions. Three risk stratification systems are discussed, St Thomas’s Risk Assessment Tool in Falling Elderly Inpatients, Morse Fall Scale, and the Hendrich Fall Risk Model. Of these scoring systems, the Hendrich Fall Risk Model is the easiest to use and score. Predominantly, multifactorial interventions are used to prevent patient falls. Education and rehabilitation are common themes in studies with statistically significant results. The second article presents a guide to implementing a quality improvement project around hospital falls. A 10-step approach to Plan-Do-Study-Act (PDSA) cycles is described. Specific examples of problems and analysis are easily applicable to any institution. Furthermore, the sustainability of interventions and targeting new areas for improvement is discussed. Although specific to falls in the hospitalized patient, the goal is to present a stepwise approach which is broadly applicable to other areas requiring quality improvement.

Cumbler, Ethan U.; Simpson, Jennifer R.; Rosenthal, Laura D.; Likosky, David J.

2013-01-01

128

Covariation of self- and other-directed aggression among inpatient youth: Continuity in the transition to treatment and shared risk factors  

PubMed Central

Although other-directed and self-directed aggression covary in very high risk youth, these forms of aggression infrequently are studied simultaneously. Understanding better their covariation is an important task for improving services to high risk youth. In this study, data from the clinical records of 476 youth admitted to secure inpatient treatment were analyzed to examine relations among self- and other-directed aggression exhibit prior to and during inpatient treatment. Analyses tested the hypotheses that self- and other-directed aggression would tend to covary and display continuity from pre-treatment to in-treatment. Also tested were the hypotheses that youth with histories of co-occurring self- and other-directed aggression would show the highest levels of aggression during treatment and the greatest degree of personal and contextual risk upon entering treatment. These hypotheses were largely supported. Exploratory analyses revealed interesting discontinuities in aggression (aggression emitted only before or during treatment) with critical implications for research and practice with youth receiving clinical care, especially those in institutional placements.

Boxer, Paul

2010-01-01

129

Inpatient Pediatric Bed Requirements for Health Service Area VI.  

National Technical Information Service (NTIS)

Information about the delivery of inpatient pediatric care in the 27 communities comprising Health Service Area VI of Massachusetts is reported by the North Shore Health Planning Council, Peabody, Massachusetts. Trends in pediatric inpatient treatment are...

1976-01-01

130

Influence of childhood adversities and defense styles on the 1-year follow-up of psychosomatic psychotherapeutic inpatient treatment  

Microsoft Academic Search

The current study explores the connection between reported sexual abuse and physical maltreatment during childhood and immature defense styles as affecting the 1-year follow-up of inpatients who had undergone psychodynamic group therapy. Early traumatization was assessed using a structured patient interview and the defense styles by means of the questionnaire on defense styles. Reduction in psychological distress and improvement in

Ralf Nickel; U. T. Egle

2005-01-01

131

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

|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…

Stefansson, Ragnar; Hesse, Morten

2008-01-01

132

Economic burden of inpatient and outpatient antibiotic treatment for methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections: a comparison of linezolid, vancomycin, and daptomycin  

PubMed Central

Background Previous economic analyses evaluating treatment of methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infections (cSSTI) failed to include all direct treatment costs such as outpatient parenteral antibiotic therapy (OPAT). Our objective was to develop an economic model from a US payer perspective that includes all direct inpatient and outpatient costs incurred by patients with MRSA cSSTI receiving linezolid, vancomycin, or daptomycin. Methods A 4-week decision model was developed for this economic analysis. Published literature and database analyses with validation by experts provided clinical, resource use, and cost inputs on data such as efficacy rate, length of stay, adverse events, and OPAT services. Base-case analysis assumed equal efficacy and equal length of stay for treatments. We conducted several sensitivity analyses where assumptions on resource use or efficacy were varied. Costs were reported in year-end 2011 US dollars. Results Total treatment costs in the base-case were lower for linezolid ($10,571) than vancomycin ($11,096), and daptomycin ($13,612). Inpatient treatment costs were $740 more, but outpatient costs, $1,266 less with linezolid than vancomycin therapy due to a switch to oral linezolid when the patient was discharged. Compared with daptomycin, both inpatient and outpatient treatment costs were lower with linezolid by $87 and $2,954 respectively. In sensitivity analyses, linezolid had lower costs compared with vancomycin and daptomycin when using differential length of stay data from a clinical trial, and using success rates from a meta-analysis. In a scenario without peripherally inserted central catheter line costs, linezolid became slightly more expensive than vancomycin (by $285), but remained less costly than daptomycin (by $2,316). Conclusion Outpatient costs of managing MRSA cSSTI may be reduced by 30%–50% with oral linezolid compared with vancomycin or daptomycin. Results from this analysis support potential economic benefit and cost savings of using linezolid versus traditional OPAT when total inpatient and outpatient medical costs are evaluated.

Stephens, Jennifer M; Gao, Xin; Patel, Dipen A; Verheggen, Bram G; Shelbaya, Ahmed; Haider, Seema

2013-01-01

133

Quality of life changes following inpatient and outpatient treatment in obsessive-compulsive disorder: a study with 12 months follow-up  

PubMed Central

Background Quality of life (QoL) is increasingly recognized as a critical outcome parameter in mental health studies. The aim of this study was to investigate different domains of the QoL in persons with obsessive-compulsive disorder (OCD) before and after a multimodal, disorder-specific in- and outpatient treatment. Methods Data of 73 persons with OCD treated in an inpatient setting followed by outpatient treatment were analyzed. The World Health Organization Quality of Life abbreviated (a multidimensional measure of the QoL) and the Beck Depression Inventory were administered prior to (baseline) and 12 months after the inpatient treatment (follow-up). Results At baseline, participants reported a significantly diminished psychological, social, physical, and global QoL compared to the German general population. Environmental QoL was not impaired in the present sample. The QoL was significantly improved at follow-up, except for social QoL, but remained below norm values. The QoL improvement was predicted by improvements of depressive symptoms. Conclusions The results indicate that persons with OCD suffer from a very low QoL. The QoL was significantly improved after 12 months of intensive state-of-the-art treatment. However, the QoL indices remained considerably lower than population norm values, indicating the need for additional research into novel treatment options for persons with OCD.

2013-01-01

134

Accelerated lofexidine treatment regimen compared with conventional lofexidine and methadone treatment for in-patient opiate detoxification  

Microsoft Academic Search

This open study compares an accelerated 5-day lofexidine regimen with orthodox 10-day lofexidine and methadone regimens in the treatment of opiate withdrawal in 61 polysubstance abusing opiate addicts. Significant differences in levels of withdrawal symptoms were found on days 11, 13–15 and 17–20, symptoms resolving most rapidly in the 5-day lofexidine treatment group, whilst withdrawal responses in the 10-day lofexidine

Jennifer Bearn; Michael Gossop; John Strang

1998-01-01

135

A CBT Approach to Inpatient Psychiatric Hospitalization  

ERIC Educational Resources Information Center

|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…

Masters, Kim J.

2005-01-01

136

Inpatient diabetology. The new frontier.  

PubMed

Tight glycemic control is now an imperative of outpatient diabetes care. The inpatient arena remains under the influence of an ineffective paradigm characterized by tolerance for hyperglycemia and a reluctance to use insulin intensively. This article is a call to action against the lip service paid to inpatient diabetes care. The compelling in vitro and in vivo evidence for the benefit of intensive insulin-mediated glycemic control is summarized. The linchpin of current inpatient care is a commonly used insulin sliding scale. This autopilot approach as the sole mode of treatment for inpatient hyperglycemia has been strongly condemned. Nevertheless, it continues to survive. The evidence supports the compelling argument that the adverse effect of hyperglycemia on hospital length of stay, morbidity, and mortality is substantial. Clinicians, nurses, administrators, and insurers ought to look critically at the prevailing paradigm and spearhead the much-needed revolution in inpatient diabetology. The issue of glycemic targets, the need for noninvasive blood glucose monitoring, and the role of nursing staff in this revolution are raised. We call for the banning of the insulin sliding scale use as the sole diabetes order. Also, the use of basal insulin via continuous intravenous insulin infusion or subcutaneous insulin analogs should be embraced. Educating nurses, house staff, and other frontline professionals in the adverse consequences of the current paradigm is essential. Inpatient glycemic control matters; clinical and financial outcomes are at stake. It behooves the health care system and the diabetic public to address the contemporary state of inpatient diabetology as soon as possible. PMID:15109346

Abourizk, Nicolas N; Vora, Chaula K; Verma, Parveen K

2004-05-01

137

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

PubMed

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

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

2004-12-01

138

A Treatment Protocol for Vascular Occlusion from Particulate Soft Tissue Augmentation  

PubMed Central

Treatment protocols exist for vascular obstruction due to injections with hyaluronic acids. Options for vascular insult due to non-hyaluronic acid products are less defined. The authors report two cases of vascular insult due to calcium hydroxylapatite and discuss treatment options. Patients who have vascular occlusion due to calcium hydroxylapatite require immediate intervention. The authors’ suggested protocol is elucidated and presented as a basis for future discussions and clinical trials.

Downie, Jeanine; Beer, Jacob

2012-01-01

139

Nursing interventions in inpatient psychiatry.  

PubMed

ACCESSIBLE SUMMARY: The use of a standardized nursing language enhances nursing quality. The Nursing Interventions Classification (NIC) considers any treatment by nurses that improve patient outcomes. The present study identifies nursing interventions in journal articles on adult psychiatric inpatient nursing care. These interventions are compared with the NIC entries to elucidate how well this classification covers the realities of nursing in inpatient psychiatric settings. The NIC encompasses most interventions mentioned in the articles. Only a few interventions need to be added to the NIC classification or require a reorganization of the taxonomy. ABSTRACT: The successful application of the Nursing Interventions Classification (NIC) in inpatient psychiatry depends on whether the classification adequately describes nursing care in this setting. The present study aimed to identify nursing interventions mentioned in journal articles on psychiatric inpatient nursing care and to compare these with the labels, definitions and activities described in the NIC to elucidate how well the classification covers these interventions. The MedLine, PsychInfo, Cochrane and CINAHL databases were searched for journal articles about nursing care in the adult inpatient setting. A qualitative content analysis approach was used to indentify nursing interventions in the articles. About 84% of the statements (terms and definitions) are encompassed by the interventions listed by the NIC. Very few interventions need to be added to the NIC classification or necessitate a reorganization of the taxonomy. Nevertheless, the further development of the NIC will promote its use in the daily work of psychiatric nurses and enhance the quality of nursing care in the inpatient setting. PMID:23421591

Frauenfelder, F; Müller-Staub, M; Needham, I; van Achterberg, T

2013-02-20

140

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 ...

141

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

PubMed Central

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.

Boxer, Paul

2010-01-01

142

Protocols in Cleft Lip and Palate Treatment: Systematic Review  

PubMed Central

Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs). Method. Searches were made in PubMed, Embase, and Cochrane Library on cleft lip and/or palate. From the 170 articles found in the searches, 28 were considered adequate to guide clinical practice. Results. A scarce number of RCTs were found approaching cleft treatment. The experimental clinical approaches analyzed in the 28 articles were infant orthopedics, rectal acetaminophen, palatal block with bupivacaine, infraorbital nerve block with bupivacaine, osteogenesis distraction, intravenous dexamethasone sodium phosphate, and alveoloplasty with bone morphogenetic protein-2 (BMP-2). Conclusions. Few randomized controlled trials were found approaching cleft treatment, and fewer related to surgical repair of this deformity. So there is a need for more multicenter collaborations, mainly on surgical area, to reduce the variety of treatment modalities and to ensure that the cleft patient receives an evidence-based clinical practice.

de Ladeira, Pedro Ribeiro Soares; Alonso, Nivaldo

2012-01-01

143

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

Microsoft Academic Search

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

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

2010-01-01

144

Cognitive Therapy With Depressed Inpatients: Specific Effects on Dysfunctional Cognitions  

Microsoft Academic Search

Specificity of cognitive change following cognitive therapy for depression was assessed in 39 depressed inpatients who completed either a standard inpatient treatment (pharmacotherapy and milieu management) or the standard treatment plus cognitive therapy. Following treatment, patients in both groups endorsed fewer dysfunctional cognitions on 2 of 4 measures of cognitive distortion. Compared with patients receiving only the standard treatment, patients

Mark A. Whisman; Ivan W. Miller; William H. Norman; Gabor I. Keitner

1991-01-01

145

Intraosseous Vascular Access in the Treatment of Chemical Warfare Casualties Assessed by Advanced Simulation: Proposed Alteration of Treatment Protocol  

Microsoft Academic Search

Current treatment protocols for chemical warfare casu- alties assume no IV access during the early treatment stages. Time constraints in mass casualty scenarios, im- paired manual dexterity of medical personnel wearing protective gear, and victims' complex clinical presenta- tions render standard IV access techniques impractical. A newly developed spring-driven, trigger-operated in- traosseous infusion device may offer an effective solu- tion.

Amir Vardi; Haim Berkenstadt; Inbal Levin; Ariel Bentencur; Amitai Ziv

2004-01-01

146

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

PubMed Central

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.

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

2012-01-01

147

[Insulin therapy among inpatients].  

PubMed

To identify patients with known diabetes or hospital-related hyperglycemia. To establish blood glucose targets according to patient's clinical state. To draw up protocols by using basal, bolus (nutritional/prandial), and supplemental insulin and not "sliding scale insulin". To avoid hypoglycaemia particularly during intravenous insulin protocols in intensive care unit. To set up glucose monitoring with a regular training of medical staff. To perform HbA1c during hospital stay to plan the treatment after discharge. To organize follow-up of the patients with hospital-related hyperglycemia. PMID:23588189

Feldman-Billard, Sylvie; Altman, Jean-Jacques

2013-04-12

148

Brief Family Treatment Intervention to Promote Aftercare Among Male Substance Abusing Patients in Inpatient Detoxification: A Quasi-Experimental Pilot Study  

PubMed Central

We developed a brief family treatment (BFT) intervention for substance abusing patients in inpatient detoxification to promote aftercare treatment post-detox. BFT consisted of meeting with the patient and a family member (spouse or parent) with whom the patient lived to review and recommend potential aftercare plans for the patient. A phone conference was used when logistics prevented an in-person family meeting. Results indicated that male substance abusing patients who received BFT (N=14), as compared with a matched treatment as usual (TAU) comparison group (N=14) that did not, showed a trend toward being more likely to enter an aftercare program and to attend more days of aftercare in the 3 months after detoxification. The magnitude of these differences favoring BFT over TAU was midway between a medium and a large effect size. Days using alcohol or drugs in the 3 months after detox were lower for treatment-exposed BFT patients who had an in-person family meeting than TAU counterparts (trend, medium effect), and for patients who entered aftercare regardless of treatment condition (significant large effect).

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

2007-01-01

149

Evaluation of a 15-week CHOP protocol for the treatment of canine multicentric lymphoma.  

PubMed

Dose intense CHOP protocols have been shown to improve outcome for people with non-Hodgkin's lymphoma, but evaluation of dose intense CHOP protocols for canine lymphoma is currently limited. The hypothesis of this retrospective study was that a 15-week dose intense CHOP protocol would have shorter treatment duration with similar efficacy to other doxorubicin-based multidrug protocols. Thirty-one client owned dogs with multicentric lymphoma were treated with a 15-week CHOP chemotherapy protocol with an overall response rate of 100% and a median progression-free interval (PFI) of 140 days [95% confidence interval (CI) 91-335 days]. Dogs that had two or more treatment delays had significantly prolonged PFI and overall survival in multivariate analysis. Dose intensity did not correlate with patient outcome. Dogs experiencing multiple treatment delays secondary to adverse events may receive their individual maximally tolerated dose while dogs with no adverse events may be underdosed. Future studies should focus on individual patient dose optimization. PMID:22548975

Burton, J H; Garrett-Mayer, E; Thamm, D H

2012-05-02

150

Post-culture treatment protocols for PLGA membrane scaffolds.  

PubMed

The interactions of post-culture treatments reagents used for fixing, lysing and cell quantification on poly(lactide-co-glycolide) (PLGA) flat sheet membrane scaffolds are presented. Lysing with Alkaline buffer solution/Triton X-100/MilliQ water (ATM) and fixing with 10% Neutral Buffered Formalin (10% NBF) had no affect on membrane structure while fixing with 95% ethanol caused smoothing of the surface, shrinkage and a reduction in surface area of 55, 48 and 33, for 100:0, 75:25 and 50:50 (PLA:PGA), respectively. PicoGreen assay was selected for cell (560pZIPv.neo) quantification since the background noise would not affect readings for cell numbers over 3,000 cells/cm(2), while the background reading was too high for MTT and Methylene Blue (MB). MB at 0.5% (w/v) was, however, deemed suitable for visualising cell morphology on the membranes. Furthermore ATM buffer was suitable for the PicoGreen assay, which allows the same samples to be used for quantification of alkaline phosphatase activity. PMID:19821075

Ellis, Marianne J; Forsey, Richard; Chaudhuri, Julian B

2009-10-11

151

Treatment protocols to reduce renal injury during shock wave lithotripsy  

PubMed Central

Purpose of review Growing concern over the acute and long-term adverse effects associated with shock wave lithotripsy calls for treatment strategies to reduce renal injury and improve the efficiency of stone breakage in shock wave lithotripsy. Recent findings Experimental studies in the pig model show that lithotripter settings for power and shock wave rate and the sequence of shock wave delivery can be used to reduce trauma to the kidney. Step-wise power ramping as is often used to acclimate the patient to shock waves causes less tissue trauma when the initial dose is followed by a brief (3–4 min) pause in shock wave delivery. Slowing the firing rate of the lithotripter to 60 shock waves/min or slower is also effective in reducing renal injury and has the added benefit of improving stone breakage outcomes. Neither strategy to reduce renal injury – not power ramping with ‘pause-protection’ nor delivering shock waves at reduced shock wave rate – have been tested in clinical trials. Summary Technique in lithotripsy is critically important, and it is encouraging that simple, practical steps can be taken to improve the safety and efficacy of shock wave lithotripsy.

McAteer, James A.; Evan, Andrew P.; Williams, James C.; Lingeman, James E.

2010-01-01

152

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

Code of Federal Regulations, 2010 CFR

...inpatient operating costs under the inpatient psychiatric facility prospective payment system...Inpatient Hospital Services of Inpatient Psychiatric Facilities § 412.405 Preadmission...inpatient operating costs under the inpatient psychiatric facility prospective payment...

2010-10-01

153

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

ERIC Educational Resources Information Center

|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…

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

2011-01-01

154

A protocol-based treatment for intradialytic hypotension in hospitalized hemodialysis patients  

Microsoft Academic Search

Human serum albumin is used in hemodialysis (HD) units as treatment for hypotension despite its high cost and undetermined efficacy. During a 4-month period in 1995, albumin was used in 22% of 1,296 consecutive HD treatments in the HD unit or intensive care units (ICUs) at our tertiary-care hospital. We evaluated the safety and efficacy of a protocol designed to

Stefano Emili; Nancy A. Black; Richard V. Paul; Connie J. Rexing; Michael E. Ullian

1999-01-01

155

Brief Strategic Therapy vs Cognitive Behavioral Therapy for the Inpatient and Telephone-Based Outpatient Treatment of Binge Eating Disorder: The STRATOB Randomized Controlled Clinical Trial  

PubMed Central

This paper describes the results of the STRATOB (Systemic and STRATegic psychotherapy for OBesity) study, a two-arm randomized controlled clinical trial (RCT) comparing Brief Strategic Therapy (BST, Nardone or Arezzo model) with the gold standard CBT (Cognitive Behavioral Therapy) for the inpatient and telephone-based outpatient treatment of obese people with Binge Eating Disorder (BED) seeking treatment for weight reduction. Primary outcome measure of the randomized trial was change in the Global Index of the Outcome Questionnaire (OQ 45.2). Secondary outcome measures were BED remission (weekly binge episodes < 2) and weight loss. Data were collected at baseline, at discharge from the hospital (c.a. 1 month after) and after 6 months from discharge.. No significant difference between groups (BST vs CBT) was found in the primary outcome at discharge. However, a greater improvement was seen in the BST vs the CBT group (P<.01) in the primary outcome at 6 months. About secondary outcomes, no significant difference between groups were found in weight change both at discharge and at 6 months. Notably, a significant association emerged between treatment groups and BED remission at 6 months in favor of BST (only 20% of patients in BST group reported a number of weekly binge episodes > 2 vs 63.3% in CBT group).

Castelnuovo, Gianluca; Manzoni, Gian Mauro; Villa, Valentina; Cesa, Gian Luca; Molinari, Enrico

2011-01-01

156

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

PubMed Central

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.

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

2013-01-01

157

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

SciTech Connect

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.

Capala, J.; Coderre, J.A.; Liu, H.B. [and others

1996-12-31

158

An evaluation of in-patient alcohol\\/drug treatment using psycho-social functioning and substance use criteria  

Microsoft Academic Search

This thesis conducted an evaluation of Australian alcohol\\/drug treatment effectiveness by examining the interaction of client psychosocial and substance use characteristics with the characteristics of two different treatment programmes of different durations and operating from different philosophical positions. Information was gathered from clients in treatment at various stages of their engagement with their programmes of choice with the aim of

Mario Antony Farina

1998-01-01

159

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

PubMed Central

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.

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

2008-01-01

160

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

PubMed Central

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.

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

2011-01-01

161

Implementing an evidence-based detoxification protocol for alcoholism in a residential addictions treatment facility.  

PubMed

Chemical dependency, commonly known as substance abuse and use disorders, continues to plague residents of the United States. Because treatment has expanded beyond the walls of the acute care hospital, advanced practice nurses play a pivotal role in caring for clients addicted to various substances. This article describes how an advanced practice nurse in collaboration with the medical director and a director of nursing at a residential treatment center in southern New Jersey oversaw the development of an evidence-based detoxification treatment protocol for alcohol dependency, emphasizing the critical role of nurses in assuring that clinical practice is rooted in current evidence. PMID:23998766

Rundio, Albert

2013-07-16

162

Staged Protocol in Treatment of Open Distal Tibia Fracture: Using Lateral MIPO  

PubMed Central

Background To evaluate the radiological, clinical results in patients with open distal tibia factures, who were treated with a staged treatment protocol using the lateral minimally invasive plate osteosynthesis (MIPO) technique. Methods From January 2007 to June 2009, 10 patients with open distal tibia fractures (Gustilo-Anderson classification II, 3; IIIA, 1; IIIB, 6) were treated using a staged treatment protocol. The initial debridement and application of an external fixator were performed within 24 hours and the mean interval from injury to definitive surgical treatment was 15 days (range, 6 to 52 days). Eight weeks later, an additional bone graft was performed in 3 patients. The follow-up duration was more than 1 year. Results The mean fracture healing time was 21 weeks (range, 17 to 28 weeks), and the average Iowa ankle rating score was 84.5 points. At the last follow-up, there was no non-union, angular deformity > 5°, shortening > 10 mm or infection. In 10 patients, 2 patients had a superficial wound infection, and another 2 patients showed limitation of ankle joint motion. Conclusions This staged treatment protocol using a lateral MIPO technique is a useful alternative method for achieving high functional recovery with good healing and low complication rates in patients with an open distal tibia fracture.

Kang, Dong Hwa

2011-01-01

163

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

ERIC Educational Resources Information Center

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…

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

2011-01-01

164

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

ERIC Educational Resources Information Center

|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…

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

2011-01-01

165

Does case mix matter for substance abuse treatment? A comparison of observed and case mix-adjusted readmission rates for inpatient substance abuse treatment in the Department of Veterans Affairs.  

PubMed Central

OBJECTIVE: To develop a case mix model for inpatient substance abuse treatment to assess the effect of case mix on readmission across Veterans Affairs Medical Centers (VAMCs). DATA SOURCES/STUDY SETTING: The computerized patient records from the 116 VAMCs with inpatient substance abuse treatment programs between 1987 and 1992. STUDY DESIGN: Logistic regression was used on patient data to model the effect of demographic, psychiatric, medical, and substance abuse factors on readmission to VAMCs for substance abuse treatment within six months of discharge. The model predictions were aggregated for each VAMC to produce an expected number of readmissions. The observed number of readmissions for each VAMC was divided by its expected number to create a measure of facility performance. Confidence intervals and rankings were used to examine how case mix adjustment changed relative performance among VAMCs. DATA COLLECTION/EXTRACTION METHODS: Ward where care was provided and ICD-9-CM diagnosis codes were used to identify patients receiving treatment for substance abuse (N = 313,886). PRINCIPAL FINDINGS: The case mix model explains 36 percent of the observed facility level variation in readmission. Over half of the VAMCs had numbers of readmissions that were significantly different than expected. There were also noticeable differences between the rankings based on actual and case mix-adjusted readmissions. CONCLUSIONS: Secondary data can be used to build a reasonably stable case mix model for substance abuse treatment that will identify meaningful variation across facilities. Further, case mix has a large effect on facility level readmission rates for substance abuse treatment. Uncontrolled facility comparisons can be misleading. Case mix models are potentially useful for quality assurance efforts.

Phibbs, C S; Swindle, R W; Recine, B

1997-01-01

166

Diagnostic, treatment, and prevention protocols for canine heartworm infection in animal sheltering agencies.  

PubMed

The high prevalence of heartworm infection in shelter dogs creates a dilemma for shelter managers, who frequently operate with insufficient funding, staffing, and expertise to comply with heartworm guidelines developed for owned pet dogs. The purpose of this study was to survey canine heartworm management protocols used by 504 animal sheltering agencies in the endemic states of Alabama, Florida, Georgia, and Mississippi. Open-admission shelters, which tended to be larger and more likely to perform animal control functions, were less likely (41%) to test all adult dogs than were limited-admission shelters (80%), which tended to be smaller non-profit humane agencies, and foster programs (98%) based out of private residences. Open-admission shelters were more likely to euthanize infected dogs (27%) or to release them without treatment (39%), whereas limited-admission shelters and foster programs were more likely to provide adulticide therapy (82% and 89%, respectively). Of the 319 agencies that treated infections, 44% primarily used a standard two-dose melarsomine protocol, and 35% primarily used a three-dose split-treatment melarsomine protocol. Long-term low-dose ivermectin was the most common treatment used in 22% of agencies. Open-admission shelters were less likely (35%) to provide preventive medications for all dogs than were limited-admission shelters (82%) and foster programs (97%). More agencies used preventives labeled for monthly use in dogs (60%) than ivermectin products labeled for livestock (38%). The most common reason diagnostic testing and preventive medication was not provided was cost. These results indicate a lack of protocol uniformity among agencies and insufficient resources to identify, treat, and prevent infection. Sheltering agencies and companion animal health industries should develop guidelines that are feasible for use in sheltering agencies and provide improved access to preventive and treatment strategies for management of Dirofilaria immitis. PMID:21353743

Colby, Kathleen N; Levy, Julie K; Dunn, Kiri F; Michaud, Rachel I

2011-01-19

167

Treatment outcome of 600 chemically dependent patients treated in a multimodal inpatient program including aversion therapy and pentothal interviews.  

PubMed

A sample of 600 patients treated in a multimodal treatment program using aversion therapy and narcotherapy at three Schick freestanding addiction treatment hospitals and one Schick unit in a general hospital were followed-up. Contact was made a minimum of 12 months and as many as 20 months after completion of treatment (mean 14.7 mos.). Telephone contact was made by an independent research organization with 427 of the patients (71.2%). Of these, 65.1% were totally abstinent for 1 year after treatment and 60.2% were abstinent until follow-up a mean of 14.7 months later. Fifty-two percent of the alcoholics were using or dependent on other drugs at admission. Seventy-five of these treated for cocaine dependence and 47 treated for marijuana dependence. The cocaine 12 month and "total" abstinence (mean 14.7 mos.) rates for the 49 contacted patients were 83.7% and 81.6%, respectively. The marijuana 12 month and "total" abstinence (mean 14.7 mos.) rates for the 30 contacted patients was 70.0% for both groups. Abstinence rates for alcohol and/or other drugs were also calculated including noncontacted patients who had chart documented evidence of relapse. The most powerful predictor of success was whether or not all urges to drink or use had been eliminated (presumably by aversion therapy). Of additional importance was the use of support groups and reinforcement treatments after completion of the initial hospitalization. The two most prominent factors initiating a relapse were "intrapersonal determinants" such as stress from work or marriage/family relationships and "interpersonal determinants" such as being around others who were drinking/using or being at a celebration or special event. The two factors were of equal importance in the alcoholics. However, interpersonal determinants were far more important in the cocaine and marijuana treated patients. Increased utilization of reinforcement treatments was associated with decreased urges to drink/use and increased abstinence rates. In contrast, increased frequency of support group utilization was associated with increased urges to drink/use and lower abstinence rates. This suggests the need to take seriously patient reports of "urges" in the first year after treatment and to carefully assess the cause and initiate or update an individualized plan of treatment. Such treatment may include increased reinforcement treatments, treatment of depression, and additional assistance in coping with intrapersonal and interpersonal determinants of relapse. PMID:8105103

Smith, J W; Frawley, P J

168

Relationship between assault frequency and length of hospitalization in older patients with dementia--determining the maximum benefit of inpatient treatment.  

PubMed

In this quantitative study, the author examined the relationship between duration of hospitalization and frequency of assaultive behavior in 42 older long-term patients with dementia in a Canadian psychiatric hospital. The study instrument used for data collection was existing incident reporting forms routinely completed in Canadian regional psychiatric hospitals. A secondary analysis was conducted using data previously collected on a regular basis by the psychiatric hospital serving as the study site. A significant negative correlation was found between the number of assaults committed and the number of months spent in the hospital, with significantly fewer assaults occurring in the second year of hospitalization compared with the first year. Male patients were observed to be significantly more assaultive than female patients. Findings suggest that the maximum benefit for patients hospitalized for assaultive behavior is obtained during the first 2 years of inpatient treatment and that patients within this population who are no longer assaultive may be more appropriately cared for in nursing homes. Based on these findings, resources should be allocated to assist with the transition of formerly assaultive patients with dementia from a psychiatric hospital to a nursing home. This scenario forecasts the development of a challenging new role for nurses. PMID:17436865

Savage, Troy

2007-04-01

169

Treatment of peri-implant diseases: a review of the literature and protocol proposal.  

PubMed

Over 100,000 implants were placed in the UK in 2010. As the numbers of patients with implant-retained prostheses increases, operators are encountering an increasing number of biological implant complications, most commonly peri-implant mucositis and peri-implantitis. The effective management of these complications is crucial to maintain patients' oral health. In particular, in contrast to common periodontal infections, some peri-implant infections may benefit from surgical intervention as a first line approach. Clinical Relevance: This article reviews the literature on the treatment options for peri-implant mucositis and peri-implantitis and proposes a protocol for their treatment. PMID:23971346

Armas, Joshé; Culshaw, Shauna; Savarrio, Lee

170

Prospective comparison of short and long GnRH agonist protocols using recombinant gonadotrophins for IVF\\/ICSI treatments  

Microsoft Academic Search

This is a prospective comparative study investigating cost and effectiveness of IVF\\/ intracytoplasmic sperm injection (ICSI) treatments after stimulation with recombinant gonadotrophins following either the short or long gonadotrophin-releasing hormone (GnRH) agonist protocol. Patients in the short protocol (n = 120) were administered buserelin nasal sprays from day 2 of the menstrual cycle and recombinant FSH from day 5. Patients

Chi-Hong Ho; Shee-Uan Chen; Fu-Shiang Peng; Chih-Yuan Chang; Yih-Ron Lien; Yu-Shih Yang

2008-01-01

171

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

NASA Astrophysics Data System (ADS)

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.

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

2010-11-01

172

Reliability, validity and responsiveness of the German Short Musculoskeletal Function Assessment Questionnaire in patients undergoing surgical or conservative inpatient treatment  

Microsoft Academic Search

Objective: The patient-based evaluation of outcome is gaining increased importance. The aim of the study was to demonstrate the reliability,\\u000a validity and responsiveness of the German version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA-D)\\u000a in patients undergoing surgical or conservative treatment. Methods: Three hundred and thirty-two patients suffering from osteoarthritis of the hip or knee, rheumatoid arthritis or rotator

Nicole Wollmerstedt; Stephan Kirschner; Herrmann Faller; Achim König

2006-01-01

173

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

PubMed

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

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

2013-01-08

174

Prospective comparison of short and long GnRH agonist protocols using recombinant gonadotrophins for IVF/ICSI treatments.  

PubMed

This is a prospective comparative study investigating cost and effectiveness of IVF/ intracytoplasmic sperm injection (ICSI) treatments after stimulation with recombinant gonadotrophins following either the short or long gonadotrophin-releasing hormone (GnRH) agonist protocol. Patients in the short protocol (n = 120) were administered buserelin nasal sprays from day 2 of the menstrual cycle and recombinant FSH from day 5. Patients in the long protocol (n = 120) were administered buserelin from the previous mid-luteal phase and recombinant FSH after achieving down-regulation. The average age and basal FSH concentrations of both groups were similar. The serum LH concentrations during ovarian stimulation were significantly higher with the short protocol. The total cost of recombinant gonadotrophins (US$527 +/- 184 versus US$795 +/- 244, P < 0.001) was significantly lower in the short protocol, but there was no significant difference in delivery rates (47.5 versus 36.7%) between the short and long protocols. LH flare-up during the short protocol does not seem to impair the treatment outcome. Using recombinant gonadotrophins, the short GnRH agonist protocol is an effective and cheaper choice for IVF/ICSI treatments. PMID:18492366

Ho, Chi-Hong; Chen, Shee-Uan; Peng, Fu-Shiang; Chang, Chih-Yuan; Lien, Yih-Ron; Yang, Yu-Shih

2008-05-01

175

Comparison of three radiotherapy treatment planning protocols of definitive external-beam radiation for localized prostate cancer  

Microsoft Academic Search

Background. Three radiotherapy treatment planning (RTTP) protocols for definitive external-beam radiation for localized prostate cancer, designed and clinically applied at Kyoto University, were compared. Methods. Treatment plans were created according to three different RTTP protocols (old three-dimensional conformal radiotherapy [3D-CRT], new 3D-CRT, and intensity-modulated radiotherapy [IMRT]) on computed tomography (CT) data sets of five patients with localized prostate cancer. The

SuYu Zhu; Takashi Mizowaki; Yasushi Nagata; Kenji Takayama; Yoshiki Norihisa; Shinsuke Yano; Masahiro Hiraoka

2005-01-01

176

Sex between psychiatric inpatients  

Microsoft Academic Search

This report reviews the literature on the subject of sexual activity between psychiatric inpatients. The author discusses the psychological reasons why patients engage in sexual activity as well as the possible psychological effects. In addition, the author discusses medical considerations including concerns about injury, pregnancy, and venereal disease and legal implications including issues related to wrongful life, wrongful birth and

Renée L. Binder

1985-01-01

177

Milk loss and treatment costs associated with two treatment protocols for clinical mastitis in dairy cows.  

PubMed

The objective of this study was to compare milk loss and treatment costs for cows with clinical mastitis that were given antibiotics in addition to supportive treatment or supportive treatment alone. Between January 1994 and January 1996, 116,876 daily milk records on 676 lactations were taken at the University of Illinois Dairy Research Farm. Clinical mastitis was diagnosed during 124 lactations with 25,047 daily milk records, and 1417 of the daily milk records were on days when clinical mastitis was present. Cows with clinical mastitis were randomly assigned to one of 2 treatment groups: N (supportive treatment only) or A (antibiotics in addition to supportive treatment). Extent of antibiotic and supportive treatment varied according to twice daily severity scores. Projected and actual daily milk yields were estimated utilizing a random regression test-day model, and the differences were summed over 305 d of lactation to estimate lactational milk yield loss. The actual amount of discarded milk was added to milk yield loss to determine total milk loss per lactation. A cost analysis that included milk loss and treatment costs was then performed. Cows with clinical mastitis that were given only supportive treatment lost 230 +/- 172 kg (mean +/- standard error of mean [SEM]) more milk and incurred 94 +/- 51 dollars (SEM) more cost per lactation than cows given antibiotics and supportive treatment. Cows given only supportive treatment showed a response pattern of 305-d milk yield loss and economic loss per lactation that varied 2 to 3 times as much as cows treated with antibiotics. Based on reduced milk loss, better reliability (less variable response), and lower economic loss, the addition of antibiotics to supportive treatment was more efficacious and cost effective than supportive treatment alone. PMID:15328296

Shim, E H; Shanks, R D; Morin, D E

2004-08-01

178

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

PubMed Central

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.

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

179

Evaluation of a suicide prevention training curriculum for substance abuse treatment providers based on Treatment Improvement Protocol Number 50.  

PubMed

Substance use disorders (SUDs) confer risk for suicide yet there are no empirically supported suicide prevention training curricula tailored to SUD treatment providers. We assessed the efficacy of a 2-hour training that featured a suicide prevention training video produced by the Department of Veterans Affairs. The video was based on Treatment Improvement Protocol Number 50 (TIP 50) a practical manual to manage suicide risk produced by the Substance Abuse and Mental Health Services Administration. The training was provided in small groups to 273 SUD treatment providers in 18 states. Results were evaluated using self-report assessments obtained at pre-test, post-test, and 2-month follow-up. Statistically significant changes (p < .001) within subjects were obtained on self-efficacy, knowledge, and frequency of suicide prevention practice behaviors. The positive results together with the brevity of the training and its ease of implementation indicate high potential for widespread adoption and the importance of further study. PMID:22417671

Conner, Kenneth R; Wood, Jane; Pisani, Anthony R; Kemp, Janet

2012-03-13

180

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

ERIC Educational Resources Information Center

|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…

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

181

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

ERIC Educational Resources Information Center

|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,…

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

182

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

ERIC Educational Resources Information Center

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…

CDM Group, Inc.

183

Substance Abuse Treatment and Family Therapy. A Treatment Improvement Protocols TIP 39.  

National Technical Information Service (NTIS)

Family therapy has a long and solid history within the broad mental health field. Substance abuse treatment, on the other hand, developed in considerable isolation. Indeed, until the 1970s, alcoholism counselors typically outright rejected the predominant...

2005-01-01

184

Enhanced recovery after surgery (ERAS) protocols: Time to change practice?  

PubMed Central

Radical cystectomy with pelvic lymph node dissection remains the standard treatment for patients with muscle invasive bladder cancer. Despite improvements in surgical technique, anesthesia and perioperative care, radical cystectomy is still associated with greater morbidity and prolonged in-patient stay after surgery than other urological procedures. Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. The key elements of ERAS protocols include preoperative counselling, optimization of nutrition, standardized analgesic and anesthetic regimens and early mobilization. Despite the significant body of evidence indicating that ERAS protocols lead to improved outcomes, they challenge traditional surgical doctrine, and as a result their implementation has been slow. The present article discusses particular aspects of ERAS protocols which represent fundamental shifts in surgical practice, including perioperative nutrition, management of postoperative ileus and the use of mechanical bowel preparation.

Melnyk, Megan; Casey, Rowan G.; Black, Peter; Koupparis, Anthony J.

2011-01-01

185

2-stage treatment protocol for management of temporomandibular joint ankylosis with secondary deformities in adults: our institution’s experience  

Microsoft Academic Search

PurposeTreatment of adult patients with temporomandibular joint (TMJ) ankylosis and secondary deformities is a challenging problem. Although various techniques including arthroplasties, orthognathic surgery, autogenous bone graft and distraction osteogeneis (DO), have been described for the management of the patient with this condition, an appropriate treatment protocol has not been established. The purpose of the present report is to describe a

Songsong Zhu; Jihua Li; En Luo; Ge Feng; Yongqing Ma; Jing Hu

186

Comparing Voice-Therapy and Vocal-Hygiene Treatments in Dysphonia Using a Limited Multidimensional Evaluation Protocol  

ERIC Educational Resources Information Center

|Purpose: This study evaluates the effectiveness of two different programs of voice-treatment on a heterogeneous group of dysphonic speakers and the stability of therapeutic progress for longterm follow-up post-treatment period, using a limited multidimensional protocol of evaluation. Method: Forty-two participants with voice disorders were…

Rodriguez-Parra, Maria J.; Adrian, Jose A.; Casado, Juan C.

2011-01-01

187

Should we establish a new protocol for the treatment of peripartum myocardial infarction?  

PubMed

Peripartum myocardial infarction is a rare event that is associated with high mortality rates. The differential diagnosis includes coronary artery dissection, coronary artery thrombosis, vascular spasm, and stenosis. Our evaluation of 2 cases over a 5-year time period has led to a hypothesis that peripartum myocardial infarction is an immune-mediated event secondary to coronary endothelial sensitization by fetal antigen. In our patients, we supplemented standard medical therapy with immunotherapy consisting of corticosteroids, plasmapheresis, and intravenous immunoglobulin. Herein, we present our most recent case-that of a 29-year-old black woman (gravida V, para IV), 2 weeks postpartum with no relevant medical history. She presented with a 1-week history of chest pain. Initial electrocardiographic and cardiac biomarkers were consistent with acute coronary syndrome. Echocardiography revealed reduced systolic function with inferior-wall hypokinesis. Angiography revealed diffuse disease with occlusion of the left anterior descending coronary artery not amenable to revascularization. We were successful in treating the myocardial infarction without the use of catheter-based interventions, by modifying the immunologic abnormalities. Two cases do not make a protocol. Yet we believe that this case and our earlier case lend credence to the hypothesis that peripartum myocardial infarction arises from sensitization by fetal antigens. This concept and the immune-modifying treatment protocol that we propose might also assist in understanding and treating other inflammatory-disease states such as peripartum cardiomyopathy and standard acute myocardial infarction. All of this warrants further investigation. PMID:22740744

Houck, Philip D; Strimel, William J; Gantt, D Scott; Linz, Walter J

2012-01-01

188

Should We Establish a New Protocol for the Treatment of Peripartum Myocardial Infarction?  

PubMed Central

Peripartum myocardial infarction is a rare event that is associated with high mortality rates. The differential diagnosis includes coronary artery dissection, coronary artery thrombosis, vascular spasm, and stenosis. Our evaluation of 2 cases over a 5-year time period has led to a hypothesis that peripartum myocardial infarction is an immune-mediated event secondary to coronary endothelial sensitization by fetal antigen. In our patients, we supplemented standard medical therapy with immunotherapy consisting of corticosteroids, plasmapheresis, and intravenous immunoglobulin. Herein, we present our most recent case—that of a 29-year-old black woman (gravida V, para IV), 2 weeks postpartum with no relevant medical history. She presented with a 1-week history of chest pain. Initial electrocardiographic and cardiac biomarkers were consistent with acute coronary syndrome. Echocardiography revealed reduced systolic function with inferior-wall hypokinesis. Angiography revealed diffuse disease with occlusion of the left anterior descending coronary artery not amenable to revascularization. We were successful in treating the myocardial infarction without the use of catheter-based interventions, by modifying the immunologic abnormalities. Two cases do not make a protocol. Yet we believe that this case and our earlier case lend credence to the hypothesis that peripartum myocardial infarction arises from sensitization by fetal antigens. This concept and the immune-modifying treatment protocol that we propose might also assist in understanding and treating other inflammatory-disease states such as peripartum cardiomyopathy and standard acute myocardial infarction. All of this warrants further investigation.

Houck, Philip D.; Strimel, William J.; Gantt, D. Scott; Linz, Walter J.

2012-01-01

189

Inpatient Hospitalization in Addiction Treatment for Patients with a History of Suicide Attempt: A Case of Support for Treatment Performance Measures  

Microsoft Academic Search

This study attempts to validate substance use disorder (SUD) treatment performance measures (PM) in a naturalistic treatment setting. Despite its significance in healthcare systems and in SUD populations, suicidality is one patient characteristic that remains unexplored in the context of SUD PMs. The current study focused on the extent to which the care processes encouraged by SUD PMs were associated

Joseph E. Glass; Mark A. Ilgen; Jamie J. Winters; Regan L. Murray; Brian E. Perron; Stephen T. Chermack

2010-01-01

190

Changes in Defensiveness and in Affective Distress Following Inpatient Treatment of Eating Disorders: Rorschach Comprehensive System and Self-Report Measures  

Microsoft Academic Search

Conceptualizing eating disorders (EDs) as forming a coping mechanism against facing psychic pain, in this study, we examined the contribution of weight stabilization and ED behaviors to psychological outcomes of affective distress, defensiveness, and contact with inner\\/external reality among 2 subgroups of adolescent inpatients with (a) “restricting type” anorexia (AN–R) and (b) bingeing\\/purging type EDs (B\\/P). We administered Rorschach Comprehensive

Lily Rothschild; Liza Lacoua; Yohanan Eshel; Daniel Stein

2008-01-01

191

Predicting Readmission to a Child Psychiatric Inpatient Unit: The Impact of Parenting Styles  

Microsoft Academic Search

The risk of rehospitalization after a child receives psychiatric inpatient treatment is generally high. Although disorder-specific\\u000a behavior contributes to the need for treatment, other environmental variables may also play a role in the need for inpatient\\u000a psychiatric treatment. Therefore, we examined the influence of parenting styles (authoritarian, authoritative, and permissive)\\u000a on children’s risk for readmission to an inpatient psychiatric facility.

Paula J. Fite; Laura Stoppelbein; Leilani Greening

2009-01-01

192

Inpatient hospitalization in addiction treatment for patients with a history of suicide attempt: a case of support for treatment performance measures.  

PubMed

This study attempts to validate substance use disorder (SUD) treatment performance measures (PM) in a naturalistic treatment setting. Despite its significance in healthcare systems and in SUD populations, suicidality is one patient characteristic that remains unexplored in the context of SUD PMs. The current study focused on the extent to which the care processes encouraged by SUD PMs were associated with improved outcomes in patients with a prior suicide attempt as compared to those without. We abstracted Addiction Severity Index and health services data from the VA medical record for 381 veterans who initiated outpatient SUD treatment and completed baseline intake measures at a Midwestern VA hospital. Cox proportional hazard regressions examined how baseline characteristics, prior suicide attempts, and PM status predicted the time until hospitalization for psychiatric or substance use problems. Prior suicide attempts significantly interacted with treatment engagement, and hospitalization risk was significantly higher among individuals with a prior suicide attempt who did not meet PMs. This study provides initial observational evidence that past suicide attempts may be a factor that should be considered when defining performance standards that influence the processes of SUD treatment. Future research on PMs should take into account the differences on indicators of high risk and poor treatment outcomes. PMID:21053754

Glass, Joseph E; Ilgen, Mark A; Winters, Jamie J; Murray, Regan L; Perron, Brian E; Chermack, Stephen T

2010-09-01

193

A 10-year analysis of the "Amsterdam" protocol in the treatment of zygomatic complex fractures.  

PubMed

Despite many publications on the epidemiology, incidence and aetiology of zygomatic complex (ZC) fractures there is still a lack of information about a consensus in its treatment. The aim of the present study is to investigate retrospectively the Amsterdam protocol for surgical treatment of ZC fractures. The 10 years results and complications are presented. The study population consisted of 236 patients (170 males, 66 females, 210 ZC fractures, 26 solitary zygomatic arch fractures) with a mean age of 39.3 (SD: ±15.6) years (range 4-87 years). The mean cause of injury was traffic accident followed by violence and fall. A total of 225 plates and 943 screws were used. Twenty-eight patients presented with complications, including wound infection (9 patients) and transient paralysis of the facial nerve (one patient). Seven patients (2.8%) needed surgical retreatment of whom four patients needed secondary orbital floor reconstruction as these patients developed enophthalmos and diplopia. In conclusion this report provides important data for reaching a consensus for the treatment of these types of fractures. PMID:23375533

Forouzanfar, Tymour; Salentijn, Erik; Peng, Gina; van den Bergh, Bart

2013-01-30

194

External-beam Co-60 radiotherapy for canine nasal tumors: a comparison of survival by treatment protocol.  

PubMed

A retrospective analysis of survival times in dogs with intranasal tumors was performed comparing those treated using hypofractionated or full course Co-60 radiotherapy protocols alone or with surgical adjuvant therapy and those receiving no radiation treatment. One hundred thirty-nine dogs presented to the University of Minnesota Veterinary Medical Center for treatment of histologically-confirmed nasal neoplasia between July 1983 and October 2001 met the criteria for review. Statistically analyzed parameters included age at diagnosis, tumor histologic classification, fractionation schedule (number of treatments, and number of treatment days/week) (classified as hypofractionated if 2 or less treatments/week); calculated minimum tumor dose/fraction; calculated total minimum tumor dose (classified as hypofractionated if less than 37 Gy in six or fewer fractions); number of radiotherapy portals, a treatment gap of more than 7 days in a full course (3-5 treatments/week, 3-3.5 week treatment time) radiotherapy protocol, the influence of eye shields on survival following single portal DV fields, the survey radiographic extent of the disease, and the presence or absence of cytoreductive surgery. There was a significant relationship only between protocols using 3 or more treatments/week and at least 37 Gy cumulative minimum tumor dose and survival. However, there was no significant relationship between either total minimum tumor dose or dose/fraction and survival and there were no significant relationships between survival and any of the other variables analyzed including tumor histologic type. PMID:17950765

Yoon, J H; Feeney, D A; Jessen, C R; Walter, P A

2007-10-24

195

Awareness of Substance Abuse Problems Among Dually-Diagnosed Psychiatric Inpatients  

Microsoft Academic Search

This study examines the ability to acknowledge the need for treatment of mental illness and substance abuse problems among dually-diagnosed inpatients before and after an inpatient substance abuse treatment program. A cohort of 264 consecutively admitted patients diagnosed with a mental illness and substance use disorder were entered into a dual diagnosis treatment program. Perceptions of patients diagnosed with a

Jill RachBeisel; Lisa Dixon; Jean Gearon

1999-01-01

196

Intravenous immunoglobulin in the treatment of primary trigeminal neuralgia refractory to carbamazepine: a study protocol[ISRCTN33042138  

Microsoft Academic Search

BACKGROUND: We have recently reported successful treatment of patients with chronic pain syndromes using human pooled intravenous immunoglobulin (IVIG) in a prospective, open-label cohort study. A randomised, placebo controlled, double blinded study is needed to confirm these results. We chose to study patients with carbamazepine resistant primary Trigeminal Neuralgia (rpTN), as these had responded particularly well to IVIG. A protocol

Andreas Goebel; Andrew Moore; Rosamund Weatherall; Norbert Roewer; Robert Schedel; Guenter Sprotte

2003-01-01

197

PROTOCOL DEVELOPMENT FOR THE PREDICTION OF THE FATE OF ORGANIC PRIORITY POLLUTANTS IN BIOLOGICAL WASTEWATER TREATMENT SYSTEMS  

EPA Science Inventory

Research was conducted on biodegradability of toxic and/or hazardous organic priority pollutant compounds. The studies have produced a biodegradation testing protocol to provide a scientific basis for predicting the fate of these compounds in typical activated sludge treatment pl...

198

Using Hypnotic Inquiry Protocols to Monitor Treatment Progress and Stability in Multiple Personality Disorder  

Microsoft Academic Search

Thirty-two patients with multiple personality disorder (MPD), who had been integrated for a minimum of 27 months, were reassessed for the stability of their fusions, using a research hypnotic inquiry protocol. The occasional discovery of unsuspected alters or the persistence of alters believed fused led to the protocol's adaptation for monitoring clinical progress and stability. The technique and the patients'

Richard P. Kluft

1985-01-01

199

Early signaling, referral, and treatment of adolescent chronic pain: a study protocol  

PubMed Central

Background Chronic pain is prevalent among young people and negatively influences their quality of life. Furthermore, chronic pain in adolescence may persist into adulthood. Therefore, it is important early on to promote the self-management skills of adolescents with chronic pain by improving signaling, referral, and treatment of these youngsters. In this study protocol we describe the designs of two complementary studies: a signaling study and an intervention study. Methods and design The signaling study evaluates the Pain Barometer, a self-assessed signaling instrument for chronic pain in adolescents. To evaluate the feasibility of the Pain Barometer, the experiences of youth-health care nurses will be evaluated in semi-structured interviews. Also, we will explore the frequencies of referral per health-care provider. The intervention study evaluates Move It Now, a guided self-help intervention via the Internet for teenagers with chronic pain. This intervention uses cognitive behavioural techniques, including relaxation exercises and positive thinking. The objective of the intervention is to improve the ability of adolescents to cope with pain. The efficacy of Move It Now will be examined in a randomized controlled trial, in which 60 adolescents will be randomly assigned to an experimental condition or a waiting list control condition. Discussion If the Pain Barometer is proven to be feasible and Move It Now appears to be efficacious, a health care pathway can be created to provide the best tailored treatment promptly to adolescents with chronic pain. Move It Now can be easily implemented throughout the Netherlands, as the intervention is Internet based. Trial registration Dutch Trial Register NTR1926

2012-01-01

200

The Effect of Inpatient Care on Measured Health Needs in Children and Adolescents  

ERIC Educational Resources Information Center

|Background: The concept of "health need" relates patient problems in symptom and psychosocial domains to available appropriate treatments. We studied the effectiveness of inpatient treatment in modifying measured "Health Needs" in children and adolescents admitted to UK inpatient units. Methods: A prospective cohort study of 150 children and…

Jacobs, Brian; Green, Jonathan; Kroll, Leopold; Tobias, Catherine; Dunn, Graham; Briskman, Jacqueline

2009-01-01

201

Predictors of dropout from inpatient dialectical behavior therapy among women with borderline personality disorder  

Microsoft Academic Search

Inpatient dialectical behavior therapy (DBT) is an effective treatment for borderline personality disorder (BPD), but often treatment is ended prematurely and predictors of dropout are poorly understood. We, therefore, studied predictors of dropout among 60 women with BPD during inpatient DBT. Non-completers had higher experiential avoidance and trait anxiety at baseline, but fewer life-time suicide attempts than completers. There was

Nicolas Rüsch; Sarah Schiel; Patrick W. Corrigan; Florian Leihener; Gitta A. Jacob; Manfred Olschewski; Klaus Lieb; Martin Bohus

2008-01-01

202

Inpatient vs. outpatient pain management: results of a randomised controlled trial  

Microsoft Academic Search

Inpatient and outpatient cognitive behavioural pain management programmers for mixed chronic pain patients were compared. Patients were randomly allocated to the 4 week inpatient programme or to the 8 half day per week outpatient programme, or to a waiting list control group. Staff, teaching materials, and setting were the same for the two treatment groups. Patients were assessed pre-treatment, and

A. C. de C. Williams; P. H. Richardson; M. K. Nicholas; C. E. Pither; V. R. Harding; K. L. Ridout; J. A. Ralphs; I. H. Richardson; D. M. Justins; J. H. Chamberlain

1996-01-01

203

Inpatient Pediatric Care. Guideline Series.  

National Technical Information Service (NTIS)

Guidelines adopted by the Health Systems Agency of Southwestern Pennsylvania to facilitate the development of an inpatient pediatric care program are presented. Using the guidelines, subarea planning councils, in collaboration with health systems agency s...

1978-01-01

204

Surveillance after treatment of children with developmental dysplasia of the hip: current UK practice and the proposed Stanmore protocol.  

PubMed

Monitoring of a patient with developmental dysplasia of the hip (DDH) is required after initial treatment to ensure early detection and correction of complications or poor progression. We established the current practice of surveillance in DDH in the UK. A protocol has been designed at this unit with the aim of identifying the stages in the progression of DDH when imaging of the hip is necessary to detect failure or possible complications of treatment. The outcomes and secondary procedure rates under the surveillance protocol used at this unit, for a UK population, have been reviewed with a minimum of 5 years of follow-up. Frequency of follow-up has been reported as yearly or more frequently until skeletal maturity by 70% of respondents. Ninety patients presenting with DDH were managed under the protocol developed at this unit, with equivalent outcomes as those in patients who reported yearly follow-up. Following our proposed protocol we believe it is possible to limit disruption to the patient's life, reduce costs and maintain compliance and ensure timely detection of any complications, without significant increase in secondary procedure rates. PMID:23812086

Wright, Jonathan; Tudor, Francois; Luff, Thomas; Hashemi-Nejad, Aresh

2013-11-01

205

Effectiveness of two intensive treatment methods for smoking cessation and relapse prevention in patients with coronary heart disease: study protocol and baseline description  

PubMed Central

Background There is no more effective intervention for secondary prevention of coronary heart disease than smoking cessation. Yet, evidence about the (cost-)effectiveness of smoking cessation treatment methods for cardiac inpatients that also suit nursing practice is scarce. This protocol describes the design of a study on the (cost-)effectiveness of two intensive smoking cessation interventions for hospitalised cardiac patients as well as first results on the inclusion rates and the characteristics of the study population. Methods/design An experimental study design is used in eight cardiac wards of hospitals throughout the Netherlands to assess the (cost-)effectiveness of two intensive smoking cessation counselling methods both combined with nicotine replacement therapy. Randomization is conducted at the ward level (cross-over). Baseline and follow-up measurements after six and 12 months are obtained. Upon admission to the cardiac ward, nurses assess patients’ smoking behaviour, ensure a quit advice and subsequently refer patients for either telephone counselling or face-to-face counselling. The counselling interventions have a comparable structure and content but differ in provider and delivery method, and in duration. Both counselling interventions are compared with a control group receiving no additional treatment beyond the usual care. Between December 2009 and June 2011, 245 cardiac patients who smoked prior to hospitalisation were included in the usual care group, 223 in the telephone counselling group and 157 in the face-to-face counselling group. Patients are predominantly male and have a mean age of 57?years. Acute coronary syndrome is the most frequently reported admission diagnosis. The ultimate goal of the study is to assess the effects of the interventions on smoking abstinence and their cost-effectiveness. Telephone counselling is expected to be more (cost-)effective in highly motivated patients and patients with high SES, whereas face-to-face counselling is expected to be more (cost-)effective in less motivated patients and patients with low SES. Discussion This study examines two intensive smoking cessation interventions for cardiac patients using a multi-centre trial with eight cardiac wards. Although not all eligible patients could be included and the distribution of patients is skewed in the different groups, the results will be able to provide valuable insight into effects and costs of counselling interventions varying in delivery mode and intensity, also concerning subgroups. Trial registration Dutch Trial Register NTR2144

2012-01-01

206

The treatment of obesity with a very-low-calorie liquid-formula diet: an inpatient/outpatient comparison using skimmed-milk protein as the chief protein source.  

PubMed

Fifty obese patients were givena 1.34 MJ (320 kcal) formula diet (containing 44 g/day carbohydrate, milk protein supplying 24--29 g protein/day in a total of 31 g/day, fat 2 g/day and the RDA of minerals and vitamins) for four to 12 weeks, either as inpatients (22) or outpatients (28). This regime was followed by a 3.35 MJ (800 kcal) conventional diet as outpatients. All but six outpatients completed the trial. Substantial weight losses were achieved in all patients with a total mean loss of 8.4 kg at four weeks and 11.0 kg at eight weeks. At four weeks the mean weight loss was 9.6 kg for inpatients and 7.2 kg for outpatients (P less than 0.05). There was no statistical difference in weight between the groups at eight weeks. Patients who continued on the 1.34 MJ formula diet for 12 weeks continued to lose weight but those on the 3.35 MJ conventional diet did not. Nitrogen-balance studies were carried out on the inpatients. During the first four weeks there was a small net loss of nitrogen (56 g, equivalent to 350 g protein) but equilibrium was achieved by the fifth or sixth week. There was no evidence of protein deficiency as judged by unchanged serum total protein, albumin, haemoglobin, RBC and PCV. Equilibrium between intake and excretion of sodium and potassium was also achieved throughout, and serum electrolytes were unchanged. A large number of other routine clinical and laboratory tests showed the treatment was safe. Serum bilirubin was elevated (18--48 per cent) and increased slightly above normal in two outpatients. Serum cholesterol was decreased by 21 per cent and triglycerides by 45 per cent after three weeks. Serum lipids in hyperlipaemic patients were normalised. It is concluded that the very-low-calorie formula diet provides a safe and very effective method of weight reduction, and the advantages of hospital compared with outpatient treatment are small. PMID:721370

Howard, A N; Grant, A; Edwards, O; Littlewood, E R; McLean Baird, I

1978-01-01

207

Defects of pars interarticularis in athletes: a protocol for nonoperative treatment.  

PubMed

The purpose of this study was to report the results of a specific treatment protocol for athletes with spondylolysis or spondylolisthesis of the lumbar spine. A retrospective study with recent follow-up was performed on 82 patients treated with restriction of activity, bracing, and physical therapy. All of the patients were involved in sports at first onset of symptoms. Sixty-six patients were boys and 16 were girls. Activities involving repetitive hyperextension and/or extension rotation of the lumbar spine were described as painful in 98% of the patients. Of the 62 patients with spondylolysis, 53 (85%) had an L5 defect and nine (15%) an L4 defect (90% of these 62 patients' defects were located in the most caudad mobile vertebra). Thirty-seven patients had bilateral pars defects, and 25 had unilateral defects. Eight patients had normal roentgenograms, but these eight had abnormal bone scans. Nine patients with spondylolysis underwent posterolateral fusion. Average follow-up was 4.2 years. Fifty-two (84%) had excellent results, eight had good results, and two had fair results. Twenty patients had a spondylolisthesis: 12 were grade I, six were grade II, and two were grade III. Twelve patients (60%) required surgery; 9 had excellent results, one had good results, one had a fair result, and one had a poor result. Pars defects must be suspected in the differential of low back pain in young athletes. Oblique radiographs are frequently diagnostic; however, if the history and examination are suggestive despite normal plain films, a bone scan should be obtained. Nonoperative management of pars defects is frequently successful.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8274809

Blanda, J; Bethem, D; Moats, W; Lew, M

1993-10-01

208

Apyrase treatment of myocardial infarction according to a clinically applicable protocol fails to reduce myocardial injury in a porcine model  

PubMed Central

Background Ectonucleotidase dependent adenosine generation has been implicated in preconditioning related cardioprotection against ischemia-reperfusion injury, and treatment with a soluble ectonucleotidase has been shown to reduce myocardial infarct size (IS) when applied prior to induction of ischemia. However, ectonucleotidase treatment according to a clinically applicable protocol, with administration only after induction of ischemia, has not previously been evaluated. We therefore investigated if treatment with the ectonucleotidase apyrase, according to a clinically applicable protocol, would reduce IS and microvascular obstruction (MO) in a large animal model. Methods A percutaneous coronary intervention balloon was inflated in the left anterior descending artery for 40 min, in 16 anesthetized pigs (40-50 kg). The pigs were randomized to 40 min of 1 ml/min intracoronary infusion of apyrase (10 U/ml, n = 8) or saline (0.9 mg/ml, n = 8), twenty minutes after balloon inflation. Area at risk (AAR) was evaluated by ex vivo SPECT. IS and MO were evaluated by ex vivo MRI. Results No differences were observed between the apyrase group and saline group with respect to IS/AAR (75.7 ± 4.2% vs 69.4 ± 5.0%, p = NS) or MO (10.7 ± 4.8% vs 11.4 ± 4.8%, p = NS), but apyrase prolonged the post-ischemic reactive hyperemia. Conclusion Apyrase treatment according to a clinically applicable protocol, with administration of apyrase after induction of ischemia, does not reduce myocardial infarct size or microvascular obstruction.

2010-01-01

209

[Inpatient violence: frequency, risk factors, preventive strategies].  

PubMed

In contrast to Angloamerican and Scandinavian countries inpatient violence was not regarded as a problem in German-speaking countries for a long time. Only recently it has become a topic of increasing interest for clinical practice and research, whereby the present data exhibit significant parallels to the international development. After the discussion of methodological problems (e. g. varying definitions, sources of information, ways of registration) the paper presents the current state of knowledge about inpatient violence:Underestimation in general, mainly with respect to female patients; only a few patients are responsible for the majority of assaults; victims are rather staff members than fellow patients; discrepancy between the mostly minor physical, though major emotional consequences for victims; considerably negative effects on patient-staff interactions and ward climate. Aside from patient-related actuarial and dynamic risk factors (social origin, previous history of aggressive behaviour, dissocial personality traits and - partly - diagnoses, acute intoxication, substance abuse, lack of insight and compliance, psychotic symptoms) external/contextual factors as patient-staff ratio, ward size, structure and climate, staff-attitudes, recognition of early warning signs and handling of risk situations are of major importance for the frequency and severity of incidents. Intervention and prevention strategies are focussing - aside from medication - on the aforementioned staff-related factors and patient-staff interactions. They are the principal basis for sufficient inpatient treatment beyond the problem of violence. PMID:11602920

Schanda, H; Taylor, P

2001-10-01

210

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

Code of Federal Regulations, 2012 CFR

...as inpatient operating costs under...prospective payment system. 412.405...as inpatient operating costs under...prospective payment system. The prospective payment system includes payment for inpatient operating costs of...

2012-10-01

211

Processing of cardiovascular allografts: effectiveness of European Homograft Bank (EHB) antimicrobial treatment (cool decontamination protocol with low concentration of antibiotics)  

Microsoft Academic Search

To assess the effectiveness of antimicrobial treatment by using cool decontamination protocol with low concentration of antibiotics\\u000a during processing of cardiovascular allografts, 948 allografts processed during a 2-year period were analysed. Five hundred\\u000a and fourty one donors aged <62 years were classified in: multiorgan donors (MOD) with non-transplantable hearts; recipients\\u000a of cardiac transplantation (RHT); and non-beating heart cadavers with a warm

M. Tabaku; R. Jashari; H. F. Carton; A. Du Verger; B. Van Hoeck; A. Vanderkelen

2004-01-01

212

Skeletal Class III and anterior open bite treatment with different retention protocols: a report of three cases.  

PubMed

The treatment of skeletal class III and anterior open bite can be unstable and orthodontists frequently observe relapse. Here, we report on the management of three patients with skeletal class III profiles and open bites treated by orthodontic camouflage. Each received a retention protocol involving the use of two separate appliances during the night and day accompanied by myofunctional therapy. Long-term follow-up revealed a stable outcome. PMID:22984106

Farret, Milton Meri Benitez; Farret, Marcel Marchiori; Farret, Alessandro Marchiori

2012-09-01

213

Clinical assessment of medication adherence among HIV-infected children: examination of the Treatment Interview Protocol (TIP)  

Microsoft Academic Search

This paper presents findings of a multi-site study designed to document: (1) caregivers’ regimen knowledge; (2) barriers to adherence; and (3) the relationships between adherence, regimen knowledge and barriers. Fifty-one predominately female, African American parents and caregivers of HIV-infected children completed the Treatment Interview Protocol (TIP), a brief, structured interview designed to assess regimen knowledge and barriers to adherence. TIP

S. L. Marhefka; J. J. Farley; J. R. Rodrigue; L. L. Sandrik; J. W. Sleasman; V. J. Tepper

2004-01-01

214

Clinical Characteristics of Older Psychiatric Inpatients with Borderline Personality Disorder  

Microsoft Academic Search

This case study investigation considers typical and potentially unique characteristics of older (> 50 years) Borderline Personality Disorder (BPD) patients and describes their impact on an inpatient psychiatric unit encompassing a therapeutic milieu setting and multidisciplinary treatment teams. The somatization of symptoms, in particular, and the associated therapeutic, medical, and psychopharmacological interventions, result in prolonged and elaborate treatments that undermine

Brian Trappler; Jill Backfield

2001-01-01

215

Benefit of using muscle relaxants in the routine treatment protocol of oral submucosal fibrosis: a pilot study.  

PubMed

The aim of this present work is to describe the nature and extent of fibrosis within muscle and to correlate this with the mouth opening (MO) in OSE patients and to prove our results in improvement of mouth opening in patients with OSMF with use of "muscle relaxants" along with other modalities of treatment . The study was conducted on 40 patients who visited our outpatient department with grade 3 (<19 mm) mouth opening. 20 of these patients underwent the routine treatment protocol of weekly injection of hyaluronidase with hydrocortisone and antioxidant capsules with added lycopene for 1 month. The remaining test subjects in addition to the routine injections and antioxidants were given skeletal muscle relaxants like thiocolchicoside or chlorzoxazone. The mouth opening (interincisal distance of maxillary and mandibular incisors at maximum possible mouth opening) was measured and graded as follows: grade 1 (>40 mm), grade 2 (20-39 mm) and grade 3 (<19 mm) with the help of vernier callipers after the study period of 1 month. 17 out of the 20 test patients who received muscle relaxants in addition to the routine protocol showed marked improvement with shift from grade 3 (<19 mm) to grade 1 (>40 mm) i.e. a greater than 20 mm improvement in mouth opening. Using muscle relaxants as a adjuvant therapy in the routine protocol of treatment of oral submucosal fibrosis will not only cater and halt the problem of fibrosis but also will take care of the muscle spasm and inflammation which also inadvertently contribute to the restricted mouth opening. We found excellent improvement on adding muscle relaxants to the routine protocol which was not just an objective but also a subjective success. PMID:23024934

Nichlani, Sunil Srichand; Jagade, Mohan V; Ganeshan, Arunprabhu

2011-09-09

216

Health care reform: clinical implications for inpatient psychiatric nursing.  

PubMed

1. Shorter hospitalizations and increasing acuity have had an impact on all areas of inpatient services, making it necessary for health care providers to adapt quickly in order to remain competitive and continue to be able to provide quality services. 2. New modalities are being incorporated rapidly into existing units in an attempt to meet the changing needs of today's health care environment. These new programs greatly alter the traditional milieu and require a different treatment approach. 3. Inpatient hospitalization requires a rapid progression through three phases of treatment: assessment, stabilization, and discharge planning. The psychiatric nurse is instrumental in all three phases. PMID:7884689

McGihon, N N

1994-11-01

217

Treatment of Co-Occurring Substance Abuse and Suicidality among Adolescents: A Randomized Trial  

ERIC Educational Resources Information Center

|Objective: This study tested a cognitive-behavioral treatment protocol for adolescents with a co-occurring alcohol or other drug use disorder (AOD) and suicidality in a randomized clinical trial. Method: Forty adolescents (M[subscript age] = 15 years; 68% female, 89% White) and their families recruited from an inpatient psychiatric hospital were…

Esposito-Smythers, Christianne; Spirito, Anthony; Kahler, Christopher W.; Hunt, Jeffrey; Monti, Peter

2011-01-01

218

Treatment for Adolescents Following a Suicide Attempt: Results of a Pilot Trial.  

ERIC Educational Resources Information Center

|Objective: To compare the efficacy of a skills-based treatment protocol to a supportive relationship therapy for adolescents after a suicide attempt. Method: Thirty-nine adolescents (12-17 years old) and parents who presented to a general pediatric emergency department or inpatient unit of a child psychiatric hospital after a suicide attempt were…

Donaldson, Deidre; Spirito, Anthony; Esposito-Smythers, Christianne

2005-01-01

219

Diagnostic, treatment, and prevention protocols for canine heartworm infection in animal sheltering agencies  

Microsoft Academic Search

The high prevalence of heartworm infection in shelter dogs creates a dilemma for shelter managers, who frequently operate with insufficient funding, staffing, and expertise to comply with heartworm guidelines developed for owned pet dogs. The purpose of this study was to survey canine heartworm management protocols used by 504 animal sheltering agencies in the endemic states of Alabama, Florida, Georgia,

Kathleen N. Colby; Julie K. Levy; Kiri F. Dunn; Rachel I. Michaud

2011-01-01

220

Effects of different infrared beak treatment protocols on chicken welfare and physiology.  

PubMed

Infrared beak trimming provides an alternative to conventional trimming, purporting to provide a welfare-friendly means of trimming. The infrared system can be adjusted to use multiple plate and power settings. In the present study, we used 2 different plate sizes (27/23C, less severe; 25/23C, more severe) with each of 3 power settings: high (52), moderate (48), and low (44). These birds, along with conventionally (hot blade; HB) trimmed birds were maintained in an industry egg-laying facility. Physiological and behavioral measures were taken at 5, 10, 20, and 30 wk. All birds followed a similar growth curve; birds from the 27/23C (48) protocol were the heaviest across all ages and 25/23C (44) birds were the lightest. Upper and lower beak growth curves showed birds trimmed with 25/23C protocols had shorter upper and lower beaks compared with 27/23C protocols or HB. Birds trimmed using 27/23 (44) and (48) had consistently longer upper and lower mandibles. Amount of feed wasted was greatest in HB and 27/23C birds and tended to be reduced in 27/23 (48) and 25/23 (48) and (52) birds (P < 0.10). Beak-related behaviors (eating, drinking, and pecking) were measured to observe the effects of trimming protocol on beak usage, which could indicate beak pain or morphological changes that inhibit normal behaviors. Walking behavior was also measured to assess overall activity. Behavior analysis revealed that compared with HB-trimmed birds, those of 27/23C protocols walked and drank more at a young age. At 5 and 10 wk of age, a test feather was attached to the cage and pecking at as well as the damage score of the feather were determined. Birds from 27/23C (44) and (48) protocols pecked significantly more at the feather than HB, whereas HB and 25/23C (52) birds had the highest damage score. The results from the study suggest that infrared protocols can be optimized for superior productivity as well as animal well-being. PMID:22700492

Dennis, R L; Cheng, H W

2012-07-01

221

Is there an impact of global and local disasters on psychiatric inpatient admissions?  

Microsoft Academic Search

Background: Disasters of the magnitude of September 11, 2001 have a serious public health impact. By dominating media broadcasts, this effect is not limited to the site of the disaster. We tested the hypothesis whether such extraordinary burden results in an increase of psychiatric inpatient treatment. As such we analysed all psychiatric inpatient admissions in the Canton of Zurich\\/Switzerland. To

Helene Haker; Christoph Lauber; Tina Malti; Wulf Rössler

2004-01-01

222

Collaborative Assessment and Management of Suicidality in an Inpatient Setting: Results of a Pilot Study  

Microsoft Academic Search

Patients hospitalized for psychiatric reasons exhibit significantly elevated risk of suicide, yet the research literature contains very few outcome studies of interventions designed for suicidal inpatients. This pilot study examined the inpatient feasibility and effectiveness of The Collaborative Assessment and Management of Suicidality (CAMS), a structured evidence-based method for risk assessment and treatment planning (Jobes, 2006). The study used an

Thomas E. Ellis; Kelly L. Green; Jon G. Allen; David A. Jobes; Michael R. Nadorff

2012-01-01

223

The Impact of Transfer Patients on Medicare Inpatient Cost per Discharge  

Microsoft Academic Search

The cost of inpatient transfer cases has concerned hospitals as well as rate-setters. Reform of transfer payment in Medicare's Prospective Payment System has been suggested to ensure access and adequate treatment for these cases in a period where inpatient revenue has been declining. This analysis indicates that both transfer cases received and cases transferred to other hospitals have above average

William Buczko

1997-01-01

224

Dynamics and Dilemmas in Working with Families in Inpatient CAMH Services  

Microsoft Academic Search

Working with the families of children and adolescents who are being treated in an Inpatient Child and Adolescent Mental Health facility can be both a vital part of the composite treatment package, and also a potential locus of tension, ambivalence and family—team rivalries. This article looks in detail at how collaborative principles put into practice in Inpatient CAMHS settings can

Vivienne Gross; Jon Goldin

2008-01-01

225

Improving outcomes in high-risk populations using REACH: an inpatient cardiac risk reduction program.  

PubMed

The high prevalence of cardiovascular disease and its associated mortality rates mandate that risk reduction strategies be addressed in high-risk populations, including those diagnosed with atherosclerotic vascular disease, heart failure, and diabetes mellitus. Hospital-based systems that can identify and guide management of these high-risk populations can be effective adjuncts to patient care.In 2001, an inpatient cardiovascular risk assessment program called REACH was developed at Advocate Lutheran General Hospital (ALGH), a community teaching hospital in Illinois. REACH uses an intranet-based data repository capable of prospectively identifying high-risk patients by displaying an alert on the inpatient computerized medical record. Management and education protocols are accessed through various links. An assessment and treatment plan is incorporated into the discharge instructions and sent to the primary care physician.A total of 9035 patients at ALGH were included in the analysis (n = 2807 at baseline and n = 6007 at year 6). Adherence to pharmacological therapy and monitoring of lipid profile improved in all 5 of the inpatient populations. Statistically significant improvement was noted in all outcomes in the cardiovascular and stroke populations (P < 0.05). In populations with diabetes and heart failure, all but one showed a statistically significant improvement. In the peripheral vascular disease population, 2 of the 5 showed statistically significant improvement. Adherence to outcome criteria in all high-risk populations over the 6-year time frame resulted in a 119% change in guideline compliance.The REACH program successfully uses patient information systems to provide a quality improvement tool that promotes optimal patient management of high-risk vascular disease states. PMID:19726930

Patel, Parag V; Gilski, Donna; Morrison, Jeanette

2009-09-01

226

Inpatient rehabilitation outcome: a matter of diagnosis?  

PubMed Central

Background Patients with comorbidities are becoming more and more common in Italian rehabilitative wards. These comorbidities are considered a major problem for inpatient rehabilitation, due to the fact that they cause longer lengths of stay, higher costs, and lower functional results. Methods To investigate the possible relationships between comorbidity, functional impairment, age, and type of discharge in patients hospitalized in postacute rehabilitation facilities, we planned an observational study. A total of 178 consecutive inpatients (average age: 78 years [range: 39–99]) from postacute rehabilitation facilities were recruited. Primary diagnosis, comorbidity rating (Cumulative Illness Rating Scale – Geriatric version, CIRS-G) and functional impairment score (Functional Independence Measure, FIM™) were evaluated at admission. The FIM™ rating was also assessed at hospital discharge. Results A total of 178 of the 199 enrolled patients completed the rehabilitation treatment (89.4%). The average length of stay was 46 ± 24 days. CIRS-G showed an average comorbidity score for each patient of 4.45 ± 1.69. The average FIM™ rating was 79 ± 24.88 at admission, and 91.9 ± 25.7 at discharge. Diagnosis at admission (grouped according to the International Classification of Diseases 9-CM) seemed to correlate with functional results, since lower rehabilitative efficiency was obtained for patients who had a history of stroke. Conclusion The number and type of comorbidities (CIRS-G) in rehabilitation inpatients do not seem to affect functional outcomes of treatment. The determining factor for a lower level of functional recovery seems to be the diagnosis at admission.

Bejor, Maurizio; Ramella, Francesca Chiara; Toffola, Elena Dalla; Comelli, Mario; Chiappedi, Matteo

2013-01-01

227

ENVIRONMENTAL TECHNOLOGY VERIFICATION: DEVELOPMENT OF A PROTOCOL FOR TESTING COMMERCIALLY PRODUCED STORMWATER TREATMENT DEVICES  

EPA Science Inventory

Over the past decade, there has been an increasing array of commercially available products for the treatment of nonpoint source pollution from urban stormwater. These products incorporate various approaches to stormwater treatment such as: in-line subsurface treatment chambers...

228

Thomas Jefferson University study finds deviating from radiation protocols increases risk of treatment failure and death  

Cancer.gov

Implementing measures to ensure radiation therapy protocols are followed not only decreases deviations, but it can also improve overall survival in cancer patients, Thomas Jefferson University Hospital researchers suggest in a first-of-its kind study presented during a plenary session at the American Society for Radiation Oncology (ASTRO) 54th Annual Meeting in Boston. Thomas Jefferson University Hospital is home to the Kimmel Cancer Center.

229

The Increase of Treatment Options at the End of Life: Impact on the Social Work Role in an Inpatient Hospital Setting  

Microsoft Academic Search

Treatment choices for cancer patients are becoming increasingly complex as medicine advances and doctors are able to offer more treatment options at the end of life. Research data shows that 22% of all Medicare patients start a new chemotherapy regimen in the last month of life. In a study released in 2004, data showed treatment within two weeks of death

Alison Snow; Jocelyn Warner; Felice Zilberfein

2008-01-01

230

Uptake of a web-based oncology protocol system: how do cancer clinicians use eviQ cancer treatments online?  

PubMed Central

Background The use of computerized systems to support evidence-based practice is commonplace in contemporary medicine. Despite the prolific use of electronic support systems there has been relatively little research on the uptake of web-based systems in the oncology setting. Our objective was to examine the uptake of a web-based oncology protocol system (http://www.eviq.org.au) by Australian cancer clinicians. Methods We used web-logfiles and Google Analytics to examine the characteristics of eviQ registrants from October 2009-December 2011 and patterns of use by cancer clinicians during a typical month. Results As of December 2011, there were 16,037 registrants; 85% of whom were Australian health care professionals. During a typical month 87% of webhits occurred in standard clinical hours (08:00 to 18:00 weekdays). Raw webhits were proportional to the size of clinician groups: nurses (47% of Australian registrants), followed by doctors (20%), and pharmacists (14%). However, pharmacists had up to three times the webhit rate of other clinical groups. Clinicians spent five times longer viewing chemotherapy protocol pages than other content and the protocols viewed reflect the most common cancers: lung, breast and colorectal. Conclusions Our results demonstrate eviQ is used by a range of health professionals involved in cancer treatment at the point-of-care. Continued monitoring of electronic decision support systems is vital to understanding how they are used in clinical practice and their impact on processes of care and patient outcomes.

2013-01-01

231

Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol  

Microsoft Academic Search

BACKGROUND: There are many examples of physicians using treatments inappropriately, despite clear evidence about the circumstances under which the benefits of such treatments outweigh their harms. When such over- or under- use of treatments occurs for common diseases, the burden to the healthcare system and risks to patients can be substantial. We propose that a major contributor to inappropriate treatment

Jamie C Brehaut; Roy Poses; Kaveh G Shojania; Alison Lott; Malcolm Man-Son-Hing; Elise Bassin; Jeremy Grimshaw

2007-01-01

232

Inpatient Suicide in a Chinese Psychiatric Hospital  

ERIC Educational Resources Information Center

|Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64…

Li, Jie; Ran, Mao-Sheng; Hao, Yuantao; Zhao, Zhenhuan; Guo, Yangbo; Su, Jinghua; Lu, Huixian

2008-01-01

233

DESIGN OF NIDA CTN PROTOCOL 0047: SCREENING, MOTIVATIONAL ASSESSMENT, REFERRAL, AND TREATMENT IN EMERGENCY DEPARTMENTS (SMART-ED)  

PubMed Central

Background Medical settings such as emergency departments (EDs) present an opportunity to identify and provide services for individuals with substance use problems who might otherwise never receive any form of assessment, referral, or intervention. Although Screening, Brief Intervention, and Referral to Treatment (SBIRT) models have been extensively studied and are considered effective for individuals with alcohol problems presenting in emergency departments and other medical settings, the efficacy of such interventions has not been established for drug users presenting in EDs. Objectives This paper describes the design of a NIDA Clinical Trials Network protocol testing the efficacy of an SBIRT model in medical EDs, highlighting considerations that that are pertinent to the design of other studies targeting substance use behaviors in medical treatment settings. Methods The protocol is described, and critical design decisions are discussed. Results Design challenges included defining treatment conditions, study population, and site characteristics; developing the screening process; choosing the primary outcome; balancing brevity and comprehensiveness of assessment; and selecting the strategy for statistical analysis. Conclusion Many of the issues arising in the design of this study will be relevant to future studies of interventions for addictions in medical settings. Scientific Significance Optimal trial design is critical to determining how best to integrate substance abuse interventions into medical care.

Donovan, Dennis M.; Adinoff, Bryon; Crandall, Cameron; Forcehimes, Alyssa A.; Lindblad, Robert; Mandler, Raul N.; Oden, Neal; Perl, Harold I.; Walker, Robrina

2011-01-01

234

Protocol for a randomised controlled trial of treatment of asymptomatic candidiasis for the prevention of preterm birth [ACTRN12610000607077  

Microsoft Academic Search

Background  Prevention of preterm birth remains one of the most important challenges in maternity care. We propose a randomised trial\\u000a with: a simple Candida testing protocol that can be easily incorporated into usual antenatal care; a simple, well accepted, treatment intervention;\\u000a and assessment of outcomes from validated, routinely-collected, computerised databases.\\u000a \\u000a \\u000a \\u000a \\u000a Methods\\/Design  Using a prospective, randomised, open-label, blinded-endpoint (PROBE) study design, we aim

Christine L Roberts; Jonathan M Morris; Kristen R Rickard; Warwick B Giles; Judy M Simpson; George Kotsiou; Jennifer R Bowen

2011-01-01

235

Therapist effects on outcome and alliance in inpatient psychotherapy.  

PubMed

As an addition to the ongoing discussion concerning the magnitude of therapist effects on outcome in psychotherapy, we investigated therapist variability in a large inpatient psychotherapy sample. We included global symptomatic outcome (Global Severity Index of the Symptom Checklist-90 Revised [SCL-90-R]; German version, Franke, 1995) and alliance (Helping Alliance Questionnaire; German version, Bassler, Potratz & Krauthauser, 1995) ratings of 2554 inpatients who were treated by 50 psychotherapists. Multilevel regression analyses (HLM; Raudenbush, Bryk, Cheong, & Congdon, 2004) were used for analyses. Overall, therapists accounted for a much greater variability on alliance (33%) than on outcome (3%). Therapists were differentially effective with regard to their patients' symptom severity at the beginning of treatment, and therapists differed in the degree that a positive alliance was associated with therapeutic outcome. The relatively small therapist effect on outcome is attributed to compensatory mechanisms in the specific context of inpatient therapy. PMID:18302211

Dinger, Ulrike; Strack, Micha; Leichsenring, Falk; Wilmers, Fabian; Schauenburg, Henning

2008-03-01

236

Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial  

PubMed Central

Background Post-discharge support is a key component of effective treatment for hospitalized smokers, but few hospitals provide it. Many hospitals and care settings fax-refer smokers to quitlines for follow-up; however, less than half of fax-referred smokers are successfully contacted and enrolled in quitline services. “Warm handoff” is a novel approach to care transitions in which health care providers directly link patients with substance abuse problems with specialists, using face-to-face or phone transfer. Warm handoff achieves very high rates of treatment enrollment for these vulnerable groups. Methods The aim of this study—“EQUIP” (Enhancing Quitline Utilization among In-Patients)—is to determine the effectiveness, and cost-effectiveness, of warm handoff versus fax referral for linking hospitalized smokers with tobacco quitlines. This study employs a two-arm, individually randomized design. It is set in two large Kansas hospitals that have dedicated tobacco treatment interventionists on staff. At each site, smokers who wish to remain abstinent after discharge will be randomly assigned to groups. For patients in the fax group, staff will provide standard in-hospital intervention and will fax-refer patients to the state tobacco quitline for counseling post-discharge. For patients in the warm handoff group, staff will provide brief in-hospital intervention and immediate warm handoff: staff will call the state quitline, notify them that a warm handoff inpatient from Kansas is on the line, then transfer the call to the patients’ mobile or bedside hospital phone for quitline enrollment and an initial counseling session. Following the quitline session, hospital staff provides a brief check-back visit. Outcome measures will be assessed at 1, 6, and 12?months post enrollment. Costs are measured to support cost-effectiveness analyses. We hypothesize that warm handoff, compared to fax referral, will improve care transitions for tobacco treatment, enroll more participants in quitline services, and lead to higher quit rates. We also hypothesize that warm handoff will be more cost-effective from a societal perspective. Discussion If successful, this project offers a low-cost solution for more efficiently linking millions of hospitalized smokers with effective outpatient treatment—smokers that might otherwise be lost in the transition to outpatient care. Trial registration Clinical Trials Registration NCT01305928

2012-01-01

237

Negotiating time: the significance of timing in ending inpatient work  

Microsoft Academic Search

This paper discusses work with young people during their stay on an NHS psychiatric inpatient unit, especially focusing on the end of treatment and the appropriate timing of discharge into the community. When approaching the end of an admission, various factors are considered that seem particularly relevant to the decision of when a young person may be ready to leave

Sarah Gustavus Jones

2007-01-01

238

PRN prescribing in psychiatric inpatients – potential for pharmacokinetic drug interactions  

Microsoft Academic Search

Medications are commonly prescribed to psychiatric inpatients on a PRN (pro re nata\\/as required) basis, allowing drugs to be administered on patient request or at nurses' discretion for psychiatric symptoms, treatment side effects or physical complaints. However, there has been no formal study of the pharmacokinetic implications of PRN prescribing. The objective of the study was to determine the prevalence

Simon J. C. Davies; Martin S. Lennard; Parviz Ghahramani; Peter Pratt; Andrea Robertson; John Potokar

2007-01-01

239

Negotiating Time: The Significance of Timing in Ending Inpatient Work  

ERIC Educational Resources Information Center

|This paper discusses work with young people during their stay on an NHS psychiatric inpatient unit, especially focusing on the end of treatment and the appropriate timing of discharge into the community. When approaching the end of an admission, various factors are considered that seem particularly relevant to the decision of when a young person…

Jones, Sarah Gustavus

2007-01-01

240

Negotiating Time: The Significance of Timing in Ending Inpatient Work  

ERIC Educational Resources Information Center

This paper discusses work with young people during their stay on an NHS psychiatric inpatient unit, especially focusing on the end of treatment and the appropriate timing of discharge into the community. When approaching the end of an admission, various factors are considered that seem particularly relevant to the decision of when a young person…

Jones, Sarah Gustavus

2007-01-01

241

Orthopaedic Injuries following Falls by Hospital In-Patients  

Microsoft Academic Search

Background: Falls are one of the most frequent episodes on the hospital wards. Objective: To identify orthopaedic injuries sustained by in-patients falling on the hospital wards and to find out what treatment these required along with the additional time and cost that this incurred. Methods: A retrospective analysis of 900 incident forms and case records was undertaken for a 3-year

J. B. Nadkarni; K. P. Iyengar; C. Dussa; S. Watwe; K. Vishwanath

2005-01-01

242

Feasibility of Dialectical Behavior Therapy for Suicidal Adolescent Inpatients.  

ERIC Educational Resources Information Center

|Objective: To evaluate the feasibility of dialectical behavior therapy (DBT) implementation in a general child and adolescent psychiatric inpatient unit and to provide preliminary effectiveness data on DBT versus treatment as usual (TAU). Method: Sixty-two adolescents with suicide attempts or suicidal ideation were admitted to one of two…

Katz, Laurence Y.; Cox, Brian J.; Gunasekara, Shiny; Miller, Alec L.

2004-01-01

243

Basal-bolus insulin protocols enter the computer age.  

PubMed

Diabetes affects approximately one quarter of all hospitalized patients. Poor inpatient glycemic control has been associated with increased risk for multiple adverse events including surgical site infections, prolonged hospital length of stay, and mortality. Inpatient glycemic control protocols based on physiologic basal-bolus insulin regimens have been shown to improve glycemia and clinical outcomes and are recommended by the American Diabetes Association, the American Association of Clinical Endocrinologists, and the Society of Hospital Medicine for inpatient glycemic management of noncritically ill patients. The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act will catalyze widespread computerized medication order entry implementation over the next few years. Here, we focus on the noncritical care setting and review the background on inpatient glycemic management as it pertains to computerized order entry, the translation and efficacy of computerizing glycemic control protocols, and the barriers to computerizing glycemic protocols. PMID:22015856

Wei, Nancy J; Wexler, Deborah J

2012-02-01

244

Basal-Bolus Insulin Protocols Enter the Computer Age  

PubMed Central

Diabetes affects approximately one quarter of all hospitalized patients. Poor inpatient glycemic control has been associated with increased risk for multiple adverse events including surgical site infections, prolonged hospital length of stay, and mortality. Inpatient glycemic control protocols based on physiologic basal-bolus insulin regimens have been shown to improve glycemia and clinical outcomes and are recommended by the American Diabetes Association, the American Association of Clinical Endocrinologists, and the Society of Hospital Medicine for inpatient glycemic management of noncritically ill patients. The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act will catalyze widespread computerized medication order entry implementation over the next few years. Here, we focus on the noncritical care setting and review the background on inpatient glycemic management as it pertains to computerized order entry, the translation and efficacy of computerizing glycemic control protocols, and the barriers to computerizing glycemic protocols.

Wei, Nancy J.; Wexler, Deborah J.

2011-01-01

245

Optic Neuritis Treatment Trial (ONTT): Operations Manual: 1. Study Protocol, 2. Study Procedures, 3. Appendix.  

National Technical Information Service (NTIS)

The Optic Neuritis Treatment Trial (ONTT) is a multi-center clinical trial designed to determine the value of corticosteroids in the treatment of optic neuritis and to further investigate the relationship of optic neuritis and multiple sclerosis. In July,...

1988-01-01

246

Integrating spiritual assessment into a psychiatric inpatient unit.  

PubMed

This paper describes a successful effort to quantitatively assess and address different domains of spirituality as part of a "biopsychosocialspiritual" treatment model on an inpatient psychiatry unit. A "spiritual health profile" can be easily obtained and integrated into the treatment planning, actual treatment, and discharge planning processes. Spiritual functioning varies in meaningful ways that correlate with psychiatric impairment. Addressing spiritual health status holds promise as a way of enhancing psychiatric outcomes. PMID:20877557

McGee, Michael D; Torosian, Jennifer

2006-12-01

247

Integrating Spiritual Assessment into a Psychiatric Inpatient Unit  

PubMed Central

This paper describes a successful effort to quantitatively assess and address different domains of spirituality as part of a “biopsychosocialspiritual” treatment model on an inpatient psychiatry unit. A “spiritual health profile” can be easily obtained and integrated into the treatment planning, actual treatment, and discharge planning processes. Spiritual functioning varies in meaningful ways that correlate with psychiatric impairment. Addressing spiritual health status holds promise as a way of enhancing psychiatric outcomes.

Torosian, Jennifer

2006-01-01

248

A Proposed Roadmap for Inpatient Neurology Quality Indicators  

PubMed Central

Background/Purpose: In recent years, there has been increasing pressure to measure and report quality in health care. However, there has been little focus on quality measurement in the field of neurology for conditions other than stroke and transient ischemic attack. As the number of evidence-based treatments for neurological conditions grows, so will the demand to measure the quality of care delivered. The purpose of this study was to review essential components of hospital performance measures for neurological disease and propose potential quality indicators for commonly encountered inpatient neurological diagnoses. Methods: We determined the most common inpatient neurological diagnoses at a major tertiary care medical center by reviewing the billing database. We then searched PubMed and the National Guidelines Clearinghouse to identify treatment guidelines for these conditions. Guideline recommendations with class I/level A evidence were evaluated as possible quality indicators. Results: We found 94 guidelines for 14 inpatient neurological conditions other than stroke and transient ischemic attack. Of these, 36 guidelines contained at least 1 recommendation with class I evidence. Based on these, potential quality indicators for intracerebral hemorrhage, subarachnoid hemorrhage, pneumococcal meningitis, coma following cardiac arrest, encephalitis, Guillain-Barre syndrome, multiple sclerosis, and benign paroxysmal positional vertigo are proposed. Conclusions: There are several inpatient neurological conditions with treatments or diagnostic test routines supported by high levels of evidence that could be used in the future as quality indicators.

Douglas, Vanja C.; Josephson, S. Andrew

2011-01-01

249

Continuity of Offender Treatment for Substance Use Disorders from Institution to Community. Treatment Improvement Protocol (TIP) Series 30.  

ERIC Educational Resources Information Center

This TIP, on the best practice recommendations for the treatment of substance abuse, presents guidelines for ensuring continuity of care as offenders with substance use disorders move from incarceration to the community. Research indicates that treatment gains may be lost if treatment is not continued after the offender is released from…

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

250

Using RFID yoking proof protocol to enhance inpatient medication safety.  

PubMed

The low birth rate has led to an aging society; the burgeoning number of elderly patients may affect the medical quality and result in negative medical incidents. There are many factors that lead to medical errors, such as similar medication names, erroneous labels and packaging, as well as staff shortages, fatigue and carelessness. Determining how to reduce medical errors has become an important issue. As RFID exhibits powerful identification characteristics, it can help nurses to quickly identify patients and their corresponding medicine. Currently, there are numerous practical applications for improving the efficiency of Radio Frequency Identification (RFID) systems. In this paper, we use an RFID yoking proof mechanism which conforms to EPCglobal Class 1 Generation 2 standards to improve patient safety and reduce medical errors. Our scheme can achieve different goals such as resist numerous known attacks, achieve mutual authentication, anonymity and non-repudiation. It also provides a practical medical care and offer higher quality of medical care. The pharmacist cannot deny that this prescription was confirmed for the patient and the nurse cannot also deny he or she dispensed this medicine to the patient for protecting the patients' interests. PMID:21811800

Chen, Chin-Ling; Wu, Chun-Yi

2011-08-03

251

Partial hospitalization. An alternative to inpatient care.  

PubMed

Despite problems with research designs, sample sizes, differing areas of focus, and various research instruments, psychiatry can be encouraged by studies pointing to the following: Partial hospitalization can offer a viable alternative to inpatient hospitalization with less stigma and less family burden for patients. Such patients fare as well or better than their inpatient counterparts. When families or stable living situations are not available, the most acute patients can be treated and housed in a supervised living situation. Social and familial roles can be maintained. Partial hospitalization is helpful in reducing length and expense of full-time hospitalization when used as an transition to more traditional outpatient treatment and community life. This does not lead to increased rates of readmission or to exacerbating other symptoms or pathology. Partial hospitalization has grown steadily in the past 20 years. The question is no longer whether partial hospitalization works, but "what kind of patient can be best treated by partial hospitalization?" Innovative programs are sprouting. The 1980s bring fiscal, educational, and clinical challenges to partial hospitalization programs everywhere. PMID:4059096

Pang, J

1985-09-01

252

Folate augmentation of treatment - evaluation for depression (FolATED): protocol of a randomised controlled trial  

Microsoft Academic Search

Clinical depression is common, debilitating and treatable; one in four people experience it during their lives. The majority of sufferers are treated in primary care and only half respond well to active treatment. Evidence suggests that folate may be a useful adjunct to antidepressant treatment: 1) patients with depression often have a functional folate deficiency; 2) the severity of such

Seren Haf Roberts; Emma Bedson; Dyfrig Hughes; Keith Lloyd; David B Menkes; Stuart Moat; Munir Pirmohamed; Gary Slegg; Johannes Thome; Richard Tranter; Rhiannon Whitaker; Clare Wilkinson; Ian Russell

2007-01-01

253

Implementation of an Intensive Treatment Protocol for Adolescents with Panic Disorder and Agoraphobia  

ERIC Educational Resources Information Center

|New and innovative ways of implementing cognitive-behavioral therapy (CBT) are required to address the varied needs of youth with anxiety disorders. Brief treatment formats may be useful in assisting teens to return to healthy functioning quickly and can make treatment more accessible for those who may not have local access to providers of CBT.…

Angelosante, Aleta G.; Pincus, Donna B.; Whitton, Sarah W.; Cheron, Daniel; Pian, Jessica

2009-01-01

254

Substance Abuse among Older Adults. Treatment Improvement Protocol (TIP) Series 26.  

ERIC Educational Resources Information Center

As alcohol and other drug disorders become acknowledged as major problems, the need increases for current information on the scope of the problem and appropriate treatment. This TIP serves to educate treatment providers with information about older adults who, in general, are more likely to hide their substance abuse, less likely to seek…

Cook, Paddy; Davis, Carolyn; Howard, Deborah L.; Kimbrough, Phyllis; Nelson, Anne; Paul, Michelle; Shuman, Deborah; Brooks, Margaret K.; Dogoloff, Mary Lou; Vitzthum, Virginia; Hayws, Elizabeth

255

Gender Identity Disorder in Young Boys: A Parent and Peer-Based Treatment Protocol  

Microsoft Academic Search

Gender identity disorder (GID) as a psychiatric category is currently under debate. Because of the psychosocial consequences of childhood GID and the fact that childhood GID, in most cases, appears to have faded by the time of puberty, we think that a cost-effective treatment approach that speeds up the fading process would be beneficial. Our treatment approach is informed by

Heino F. L. Meyer-Bahlburg

2002-01-01

256

Placement Predictors of Geropsychiatric Inpatients  

Microsoft Academic Search

This retrospective study examined all admissions from home to the Houston Veterans Affairs Medical Center geropsychiatric inpatient unit during a 20-month period. Mini-Mental State Examination, Brief Psychiatric Rating Scale, Hamilton Rating Scale for Depression, Cohen-Mansfield Agitation Inventory, and Global Assessment of Functioning were administered on admission and discharge. We found that patients admitted with a diagnosis of dementia were at

Hernando Ponce; Victor Molinari; Mark E. Kunik; Claudia Orengo; Pauline Skinner; Pam Rezabek; Anesia Okezie; Devi Khalsa; Richard Workman

1998-01-01

257

Inpatient Management of Parkinson Disease  

PubMed Central

Parkinson disease (PD) is usually managed through outpatient clinical care. Reasons for hospital admissions are either directly related to PD or may reflect comorbidities. When hospitalized, patients with PD may face many challenges. Most commonly these are related to medication management, falls, mental status changes, infections, and emergence of psychiatric symptoms. Timely recognition and proper management of PD-specific hospitalization-related problems may be delayed, given the common lack of expertise in PD management of hospital physicians, nurses, and allied health professionals. With increasing prevalence of PD, it is expected that more patients will require inpatient hospital care. It is therefore very important to recognize problems that may arise upon hospitalization of a patient with PD and provide education to health care professionals involved in the inpatient care of patients with PD. This approach may lead to reductions in complication rates and duration of hospital stays. Aim: In this review, we outline the most common reasons for hospitalization of patients with PD, discuss challenges related to inpatient hospital care of patients with PD, and comment on future directions aimed at optimizing hospitalization outcomes in the population with PD.

Videnovic, Aleksandar

2012-01-01

258

Two years experience with quality assurance protocol for patient related Rapid Arc treatment plan verification using a two dimensional ionization chamber array  

Microsoft Academic Search

Purpose  To verify the dose distribution and number of monitor units (MU) for dynamic treatment techniques like volumetric modulated\\u000a single arc radiation therapy - Rapid Arc - each patient treatment plan has to be verified prior to the first treatment. The\\u000a purpose of this study was to develop a patient related treatment plan verification protocol using a two dimensional ionization\\u000a chamber

Daniela Wagner; Hilke Vorwerk

2011-01-01

259

State Variation in Out-of-Home Medicaid Mental Health Services for Children and Youth: An Examination of Residential Treatment and Inpatient Hospital Services  

Microsoft Academic Search

This research investigated state variation in the use of out-of-home mental health services among children and youth enrolled\\u000a in Medicaid during 2003. Medicaid claims from three states were used to describe the demographic and diagnostic characteristics\\u000a of children and youth under age 22 who received mental health services in general hospitals, psychiatric hospitals, psychiatric\\u000a residential treatment facilities, and other residential

Jonathan Brown; Brenda Natzke; Henry Ireys; Matthew Gillingham; Morris Hamilton

2010-01-01

260

Internet-based treatment for adults with depressive symptoms: the protocol of a randomized controlled trial  

Microsoft Academic Search

BACKGROUND: Depression is a highly prevalent condition, affecting more than 15% of the adult population at least once in their lives. Guided self-help is effective in the treatment of depression. The purpose of this study is to investigate the effectiveness of two Internet-based guided self-help treatments with adults reporting elevated depressive symptoms. Other research questions concern the identification of potential

Lisanne Warmerdam; Annemieke van Straten; Pim Cuijpers

2007-01-01

261

A Qualitative Study of the Treatment Improvement Protocols (TIPs): An Assessment of the Use of TIPs by Individuals Affiliated with the Addiction Technology Transfer Centers (ATTCs).  

ERIC Educational Resources Information Center

|Evaluated the Addiction Technology Transfer Centers (ATTCs) of the Center for Substance Abuse Treatment (CSAT) as a means of diffusion of innovations, focusing on use of the Treatment Improvement Protocols (TIPs). Qualitative studies at 6 ATTCs that included 57 interviews show that the CSAT is at the forefront of providing resources to the…

Hayashi, Susan W.; Suzuki, Marcia; Hubbard, Susan M.; Huang, Judy Y.; Cobb, Anita M.

2003-01-01

262

Axillary treatment for patients with early breast cancer and lymph node metastasis: systematic review protocol  

PubMed Central

Background For patients with early breast cancer and lymph node metastasis, axillary treatment is widely recommended. This is either surgical removal of the axillary lymph nodes, or axillary radiotherapy. The rationale for axillary treatment is that it will reduce the risk of recurrence in the axilla, and may improve survival. However, both treatments are associated with adverse effects, such as lymphedema, pain and sensory loss, and are costly to the health services and to patients. With improvements in adjuvant therapy, routine axillary treatment may no longer offer any overall advantage. Objectives To assess the short and long term benefits and adverse effects of routine axillary treatment (axillary lymph node clearance or axillary radiotherapy) for patients with lymph node positive early-stage breast cancer. Methods/Design Criteria for potentially eligibility for the study will be that the participants are men and women with early breast cancer and lymph nodes with metastasis. The study compares either axillary treatment with no axillary treatment, or axillary node clearance with axillary radiotherapy, and the study is a randomized trial. Primary outcomes are axillary recurrence, disease-free and overall survival. Secondary outcomes include breast or chest wall recurrence, distant metastasis, time to axillary recurrence, axillary recurrence-free survival, arm morbidity, quality of life and health economic costs. The search strategy will include the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and WHO International Clinical Trials Registry Platform (ICTRP) search portal. Two independent reviewers will assess studies for inclusion in the review, assess study quality and extract data. Characteristics of included studies will be described. Meta-analysis will be conducted using ReVman software. Comment This review addresses an important clinical question, and results will inform clinical practice and health care policy.

2013-01-01

263

A protocol for a trial of homeopathic treatment for irritable bowel syndrome  

PubMed Central

Background Irritable bowel syndrome is a chronic condition with no known cure. Many sufferers seek complementary and alternative medicine including homeopathic treatment. However there is much controversy as to the effectiveness of homeopathic treatment. This three-armed study seeks to explore the effectiveness of individualised homeopathic treatment plus usual care compared to both an attention control plus usual care and usual care alone, for patients with irritable bowel syndrome. Methods/design This is a three-armed pragmatic randomised controlled trial using the cohort multiple randomised trial methodology. Patients are recruited to an irritable bowel syndrome cohort from primary and secondary care using GP databases and consultants lists respectively. From this cohort patients are randomly selected to be offered, 5 sessions of homeopathic treatment plus usual care, 5 sessions of supportive listening plus usual care or usual care alone. The primary clinical outcome is the Irritable Bowel Syndrome Symptom Severity at 26 weeks. From a power calculation, it is estimated that 33 people will be needed for the homeopathic treatment arm and 132 for the usual care arm, to detect a minimal clinical difference at 80 percent power and 5 percent significance allowing for loss to follow up. An unequal group size has been used for reasons of cost. Analysis will be by intention to treat and will compare homeopathic treatment with usual care at 26 weeks as the primary analysis, and homeopathic treatment with supportive listening as an additional analysis. Discussion This trial has received NHS approval and results are expected in 2013. Trial registration Current Controlled Trials ISRCTN90651143

2012-01-01

264

Folate Augmentation of Treatment - Evaluation for Depression (FolATED): protocol of a randomised controlled trial  

PubMed Central

Background Clinical depression is common, debilitating and treatable; one in four people experience it during their lives. The majority of sufferers are treated in primary care and only half respond well to active treatment. Evidence suggests that folate may be a useful adjunct to antidepressant treatment: 1) patients with depression often have a functional folate deficiency; 2) the severity of such deficiency, indicated by elevated homocysteine, correlates with depression severity, 3) low folate is associated with poor antidepressant response, and 4) folate is required for the synthesis of neurotransmitters implicated in the pathogenesis and treatment of depression. Methods/Design The primary objective of this trial is to estimate the effect of folate augmentation in new or continuing treatment of depressive disorder in primary and secondary care. Secondary objectives are to evaluate the cost-effectiveness of folate augmentation of antidepressant treatment, investigate how the response to antidepressant treatment depends on genetic polymorphisms relevant to folate metabolism and antidepressant response, and explore whether baseline folate status can predict response to antidepressant treatment. Seven hundred and thirty patients will be recruited from North East Wales, North West Wales and Swansea. Patients with moderate to severe depression will be referred to the trial by their GP or Psychiatrist. If patients consent they will be assessed for eligibility and baseline measures will be undertaken. Blood samples will be taken to exclude patients with folate and B12 deficiency. Some of the blood taken will be used to measure homocysteine levels and for genetic analysis (with additional consent). Eligible participants will be randomised to receive 5 mg of folic acid or placebo. Patients with B12 deficiency or folate deficiency will be given appropriate treatment and will be monitored in the 'comprehensive cohort study'. Assessments will be at screening, randomisation and 3 subsequent follow-ups. Discussion If folic acid is shown to improve the efficacy of antidepressants, then it will provide a safe, simple and cheap way of improving the treatment of depression in primary and secondary care. Trial registration Current controlled trials ISRCTN37558856

Roberts, Seren Haf; Bedson, Emma; Hughes, Dyfrig; Lloyd, Keith; Moat, Stuart; Pirmohamed, Munir; Slegg, Gary; Tranter, Richard; Whitaker, Rhiannon; Wilkinson, Clare; Russell, Ian

2007-01-01

265

Task-oriented aerobic exercise in chronic hemiparetic stroke: training protocols and treatment effects.  

PubMed

Stroke is the leading cause of disability in older Americans. Each year 750,000 Americans suffer a stroke, two thirds of whom are left with neurological deficits that persistently impair function. Principal among them is hemiparetic gait that limits mobility and increases fall risk, promoting a sedentary lifestyle. These events propagate disability by physical deconditioning and "learned non-use," with further functional declines accelerated by the sarcopenia and fitness decrements of advancing age. Conventional rehabilitation care typically provides little or no structured therapeutic exercise beyond the subacute stroke recovery period, based on natural history studies showing little or no further functional motor recovery beyond 6 months after stroke. Emerging evidence suggests that new models of task-oriented exercise have the potential to improve motor function even years after stroke. This article presents treadmill as a task-oriented training paradigm to optimize locomotor relearning while eliciting cardiovascular conditioning in chronic stroke patients. Protocols for exercise testing and longitudinal aerobic training progression are presented that provide fundamental formulas that safely approach the complex task of customizing aerobic training to gait deficit severity in the high CVD risk stroke population. The beneficial effects of 6 months task-oriented treadmill exercise on cardiovascular-metabolic fitness, energy cost of hemiparetic gait, ADL mobility task performance, and leg strength are discussed with respect to the central and peripheral neuromuscular adaptations targeted by the training. Collectively, these findings constitute one initial experience in a much broader neuroscience and exercise rehabilitation development of task-oriented training paradigms that offer a multisystems approach to improving both neurological and cardiovascular health outcomes in the chronic stroke population. PMID:15736000

Macko, R F; Ivey, F M; Forrester, L W

2005-01-01

266

In vivo dosimetry with TLD in conservative treatment of breast cancer patients treated with the EORTC protocol 22881.  

PubMed

Two anthropomorphic phantom breasts and six patients with breast carcinoma were irradiated according the prescriptions of the EORTC protocol 22881 on the conservative management of breast carcinoma by tumorectomy and radiotherapy. During the implantation procedure for an iridium-192 boost, three tubes were implanted, enabling the measurement with TLD rods of the dose within the breasts of the phantom and the patients during one fraction of the external x-ray therapy and during the interstitial therapy. Measured doses were compared with calculated values from a 2-D dose planning system. In general a fair agreement was found between the measured and calculated doses in points within the breast for the external beam therapy as well as for the interstitial treatment. PMID:8369132

Hamers, H P; Johansson, K A; Venselaar, J L; de Brouwer, P; Hansson, U; Moudi, C

1993-01-01

267

Ultrasound guided injection of dexamethasone versus placebo for treatment of plantar fasciitis: protocol for a randomised controlled trial  

PubMed Central

Background Plantar fasciitis is the most commonly reported cause of chronic pain beneath the heel. Management of this condition commonly involves the use of corticosteroid injection in cases where less invasive treatments have failed. However, despite widespread use, only two randomised trials have tested the effect of this treatment in comparison to placebo. These trials currently offer the best available evidence by which to guide clinical practice, though both were limited by methodological issues such as insufficient statistical power. Therefore, the aim of this randomised trial is to compare the effect of ultrasound-guided corticosteroid injection versus placebo for treatment of plantar fasciitis. Methods The trial will be conducted at the La Trobe University Podiatry Clinic and will recruit 80 community-dwelling participants. Diagnostic ultrasound will be used to diagnose plantar fasciitis and participants will be required to meet a range of selection criteria. Participants will be randomly allocated to one of two treatment arms: (i) ultrasound-guided injection of the plantar fascia with 1 mL of 4 mg/mL dexamethasone sodium phosphate (experimental group), or (ii) ultrasound-guided injection of the plantar fascia with 1 mL normal saline (control group). Blinding will be applied to participants and the investigator performing procedures, measuring outcomes and analysing data. Primary outcomes will be pain measured by the Foot Health Status Questionnaire and plantar fascia thickness measured by ultrasound at 4, 8 and 12 weeks. All data analyses will be conducted on an intention-to-treat basis. Conclusion This will be a randomised trial investigating the effect of dexamethasone injection on pre-specified treatment outcomes in people with plantar fasciitis. Within the parameters of this protocol, the trial findings will be used to make evidence-based recommendations regarding the use of corticosteroid injection for treatment of this condition. Trial Registration Australian New Zealand Clinical Trials Registry. ACTRN12610000239066.

2010-01-01

268

A PROTOCOL FOR DETERMINING WWF SETTLING VELOCITIES FOR TREATMENT PROCESS DESIGN ENHANCEMENT  

EPA Science Inventory

Urban wet weather flows (WWF) contain a high proportion of suspended solids (SS) which must be rapidly reduced before release to receiving waters. Site specific, storm-event data evaluations for designing WWF-treatment facilities differs from dry-weather flow design. WWF-sett...

269

Systematic Outpatient Treatment of Sexual Trauma in Women: Application of Cognitive and Behavioral Protocols  

ERIC Educational Resources Information Center

|Effective therapies for treating posttraumatic stress disorder (PTSD) have been described in the literature, particularly cognitive and behavioral interventions, and have consistently demonstrated a reduction in PTSD symptoms. However, the applied versions of cognitive and behavioral treatments offered in most programs diverge from the forms of…

Castillo, Diane T.

2004-01-01

270

Assessment of a standard treatment protocol on visual outcome following presumed bacterial endophthalmitis  

PubMed Central

AIMS—The aim of this prospective study was, firstly, to judge the effect of early aggressive treatment with a standardised regimen of high dose broad spectrum intraocular and systemic antibiotics on visual outcome and, secondly, to assess the sensitivity of isolated organisms to the treatment regimen utilised.?METHODS—Thirty two consecutive patients presenting with presumed bacterial endophthalmitis were treated and completed follow up. In every case, intraocular sampling was undertaken and treatment with intraocular vancomycin, amikacin, and systemic ciprofloxacin was commenced immediately, followed by systemic steroids 1 day later.?RESULTS—In 69% of patients vision improved with 47% achieving a final visual acuity of 6/36 or better and 31% achieving 6/12 or better. Of the intraocular samples taken from post-surgical and post-traumatic cases, 10/27 (37%) and 3/5 (60%) were culture positive, respectively. All the bacteria isolated were sensitive to at least one of the three antibiotics used.?CONCLUSIONS—The study demonstrated that the combination of vancomycin, amikacin, and ciprofloxacin is adequate as a standard regimen for the treatment of most patients with suspected bacterial endophthalmitis. The prognosis for a good visual outcome, however, remains poor with 15/27 (55%) post-surgical and 2/5 (40%) post-traumatic cases achieving a final acuity of 6/60 or less.??

Okhravi, N; Towler, H; Hykin, P; Matheson, M; Lightman, S

1997-01-01

271

Actual Outcome in Infants with Congenital Diaphragmatic Hernia: The Role of a Standardized Postnatal Treatment Protocol  

Microsoft Academic Search

Background: Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly with a high rate of mortality and morbidity. Objective: Our aim was to determine a possible effect of standardized treatment on outcome in infants with CDH. Methods: All prenatally diagnosed patients with unilateral CDH born alive between January 2006 and December 2009 at the Erasmus MC or the University Hospital

L. van den Hout; T. Schaible; T. E. Cohen-Overbeek; W. Hop; J. Siemer; K. van de Ven; L. Wessel; D. Tibboel; I. Reiss

2011-01-01

272

Acceptance and Commitment Therapy for Anxiety Disorders: Three Case Studies Exemplifying a Unified Treatment Protocol  

Microsoft Academic Search

Acceptance and Commitment Therapy (ACT) is an innovative acceptance-based behavior therapy that has been applied broadly and successfully to treat a variety of clinical problems, including the anxiety disorders. Throughout treatment ACT balances acceptance and mindfulness processes with commitment and behavior change processes. As applied to anxiety disorders, ACT seeks to undermine excessive struggle with anxiety and experiential avoidance––attempts to

Joanna Arch; Emmanuel Espejo; Melody Keller; David Langer

2009-01-01

273

Protocol: Effect of intravitreal bevacizumab (avastin) in the treatment of macular edema: A systematic review of randomized controlled trials  

PubMed Central

Cystoid macular edema (CME) is a relatively common painless condition usually accompanied by blurred vision. The prevalence of CME varied from 5% to 47% depending on cause of pathology. There are several treatments available for ME including intravitreal use of bevacizumab that has been used in different doses in few studies. However, there is still scarcity of data available on the use of bevacizumab for the treatment of ME. A systematic review is needed to provide a foundational base to discuss and synthesize the available information on the effectiveness and safety of intravitreal bevacizumab in macular edema, so that recommendations and policies can be built regarding controversial use of bevacizumab in macular edema. We have planned to perform a systematic review with an objective to compare the effects of a single injection of 1.25 mg intravitreal bevacizumab (avastin) in the improvement of visual acuity, macular edema, and thickness with other interventions/controls for the treatment of macular edema at 3 and 6 months interval using randomized controlled trials. This is only a protocol of the review and we will be conducting a full length review, addressing the issue in future.

Qazi, Hammad A.

2012-01-01

274

Proposed Treatment Protocol for Frostbite: A Retrospective Analysis of 17 Cases Based on a 3-Year Single-Institution Experience  

PubMed Central

Background This paper discusses the treatment protocol for patients with frostbite. Methods We performed a retrospective analysis of a series of 17 patients with second- and higher-degree frostbite who had been treated at our medical institution between 2010 and 2012. Results Our clinical series of patients (n=17) included 13 men and four women, whose mean age was 42.4±11.6 years (range, 22-67 years). The sites of injury include the foot in six patients (35.3%), the hand in six patients (35.3%) and the facial region in five patients (29.4%). Seven patients with second-degree frostbite were completely cured with only conservative treatment during a mean period of 12.7±3.3 days (range, 8-16 days). Of the five patients with third-degree frostbite, two underwent skin grafting following debridement, and the remaining three achieved a complete cure with conservative treatment during a mean period of 35±4.3 days (range, 29-39 days). Five patients with fourth-degree frostbite were treated with surgical procedures including amputation. Conclusions With the appropriate conservative management in the early stage of onset, surgeons should decide on surgery after waiting for a sufficient period of time until the demarcation of the wound. Continuous management of patients is also needed to achieve functional recovery after a complete cure has been achieved. This should also be accompanied by patient education for the avoidance of re-exposure to cold environments.

Woo, Eun-Kyung; Hur, Gi-Yeun; Koh, Jang-Hyu; Seo, Dong-Kook; Choi, Jai-Ku; Jang, Young-Chul

2013-01-01

275

Incidence and risk factors for infection in oral cancer patients undergoing different treatments protocols  

PubMed Central

Background Over the past decade, advances in cancer treatments have been counterbalanced by a rising number of immunosuppressed patients with a multitude of new risk factors for infection. Hence, the aim of this study was to determine risk factors, infectious pathogens in blood and oral cavity of oral cancer patients undergoing different treatment procedures. Methods The present prospective cohort analysis was conducted on the patients undergoing treatment in the radiotherapy unit of Regional Cancer Institute, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, during the period of January 2007 to October 2009. Total 186 patients with squamous cell carcinoma of oral cavity were analyzed in the study. Based on treatment procedures patients were divided into three groups, group I were under radiotherapy, group II under chemotherapy and group III were of radio chemotherapy together. Clinical isolates from blood and oral cavity were identified by following general microbiological, staining and biochemical methods. The absolute neutrophile counts were done by following the standard methods. Results Prevalent bacterial pathogens isolated were Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis, Proteus vulgaris and the fungal pathogens were Candida albicans, Aspergillus fumigatus. The predominant gram negative bacteria, Pseudomonas aeruginosa and Klebsiella pneumonia were isolated from blood of radiotherapy and oral cavity of chemotherapy treated cases respectively. The predominance of gram positive bacteria (Staphylococcus aureus and Staphylococcus epidermidis) were observed in blood of chemotherapy, radio chemotherapy cases and oral cavity of radiotherapy, radio chemotherapy treated cases. Our study also revealed the presence of C. albicans fungi as most significant oral cavity pathogens in radiotherapy and radio chemotherapy cases. Conclusion Gram positive bacteria and Gram negative were reported from the blood of all the three groups of patients. Oral mucositis played a significant role in oral cavity infection and make patients more prone to C. albicans infection.

2012-01-01

276

New protocol for commencing the GnRH antagonist in assisted conception treatment cycles: elimination of the premature LH surge with similar pregnancy rates.  

PubMed

GnRH antagonists have been used with increasing frequency in assisted reproduction treatments over the past few years and have been associated with quicker and more profound LH suppression and shorter treatment cycles than conventional GnRH agonists. Usually, these are commenced on day 6 of FSH stimulation without allowing for patient variation in response to treatment. The study was aimed at individualising this protocol to the patients' ovarian response. The control group included 215 treatment cycles where the GnRH antagonist was commenced on day 6 of FSH stimulation. A new individualised protocol was formulated, applied to practice and 172 treatment cycles following that were analysed. The study group had no premature LH surges (LH > 10 iu x mL(-1)) compared to the control group who had a rate of 4.1%. There was also a higher fertilisation and clinical pregnancy rate in the study group (P = 0.06). It is concluded that the new individualised GnRH antagonist protocol eliminates premature LH surges in assisted conception treatment cycles and may improve clinical pregnancy rates compared to the conventional protocol of "day 6 commencement". PMID:15762300

Mavrides, Andreas; Lavery, Stuart; Trew, Geoffrey

277

Predicting response to physiotherapy treatment for musculoskeletal shoulder pain: protocol for a longitudinal cohort study  

PubMed Central

Background Shoulder pain affects all ages, with a lifetime prevalence of one in three. The most effective treatment is not known. Physiotherapy is often recommended as the first choice of treatment. At present, it is not possible to identify, from the initial physiotherapy assessment, which factors predict the outcome of physiotherapy for patients with shoulder pain. The primary objective of this study is to identify which patient characteristics and baseline measures, typically assessed at the first physiotherapy appointment, are related to the functional outcome of shoulder pain 6 weeks and 6 months after starting physiotherapy treatment. Methods/Design Participants with musculoskeletal shoulder pain of any duration will be recruited from participating physiotherapy departments. For this longitudinal cohort study, the participants care pathway, including physiotherapy treatment will be therapist determined. Potential prognostic variables will be collected from participants during their first physiotherapy appointment and will include demographic details, lifestyle, psychosocial factors, shoulder symptoms, general health, clinical examination, activity limitations and participation restrictions. Outcome measures (Shoulder Pain and Disability Index, Quick Disability of the Arm, Shoulder and Hand, and Global Impression of Change) will be collected by postal self-report questionnaires 6 weeks and 6 months after commencing physiotherapy. Details of attendance and treatment will be collected by the treating physiotherapist. Participants will be asked to complete an exercise dairy. An initial exploratory analysis will assess the relationship between potential prognostic factors at baseline and outcome using univariate statistical tests. Those factors significant at the 5% level will be further considered as prognostic factors using a general linear model. It is estimated that 780 subjects will provide more than 90% power to detect an effect size of less than 0.25 adjusted for other variables which have a co-efficient of determination (R-squared) with the outcome of up to 0.5. Assuming a 22% loss to follow up at 6 months, 1000 participants will initially be recruited. Discussion This study may offer service users and providers with guidance to help identify whether or not physiotherapy is likely to be of benefit. Clinicians may have some direction as to what key factors indicate a patient’s likely response to physiotherapy.

2013-01-01

278

A comprehensive inpatient discharge system.  

PubMed Central

Our group has developed a computer system that supports all phases of the inpatient discharge process. The system fills in most of the physician's discharge order form and the nurse's discharge abstract, using information available from sign-out, order entry, scheduling, and other databases. It supplies information for referrals to outside institutions, and provides a variety of instruction materials for patients. Discharge forms can be completed in advance, so that the patient is not waiting for final paperwork. Physicians and nurses can work on their components independently, rather than in series. Response to the system has been very favorable.

O'Connell, E. M.; Teich, J. M.; Pedraza, L. A.; Thomas, D.

1996-01-01

279

The wreathing protocol: the imbrication of hypnosis and EMDR in the treatment of dissociative identity disorder and other dissociative responses. Eye Movement Desensitization Reprocessing.  

PubMed

Dissociative Identity Disorder (DID), a chronic childhood onset posttraumatic stress disorder, is currently recognized as a treatable condition. It is considered the paradigmatic dissociative condition and carries with it extreme posttraumatic symptomatology. Therapists skilled in the treatment of DID are typically fluent in the uses of hypnosis for stabilization, affect management, building a safe place and grounding to name of few. EMDR, which has come to the forefront of clinical awareness in the last ten years, seems aptly suited for the treatment of trauma, but can be destabilizing. This paper proposes a protocol, called Wreathing Protocol, for the imbricated use of EMDR and hypnosis in the treatment of not only DID (though this will be the primary focus of the paper), but also Dissociative Disorder Not Otherwise Specified (DDNOS) and chronic Posttraumatic Stress Disorder (PTSD). This protocol is useful to advanced clinicians skilled in both modalities independently. The sequential steps of the Wreathing Protocol will be described and illustrated by a clinical vignette on DID. The clinical implications of the use of the Wreathing Protocol will be discussed in DID as well as the chronic post traumatic spectrum. PMID:11269630

Fine, C G; Berkowitz, A S

280

Meningoencephalitis of unknown origin: investigation of prognostic factors and outcome using a standard treatment protocol.  

PubMed

Meningoencephalitis of unknown origin (MUO) is a common inflammatory CNS disease in dogs, with a variable and unpredictable outcome. MRI and cerebrospinal fluid (CSF) features were prospectively evaluated to establish their utility as prognostic markers for predicting mortality, relapse and long-term outcome in 39 dogs with MUO. MRI and CSF analysis were performed at initial diagnosis and three months into treatment with prednisolone and cytosine arabinoside. When possible, MRI was repeated every 12 months thereafter. Median survival time was 26 days. All deaths occurred within 52 days of diagnosis (22/39; 56 per cent). One-third (13/39) died within 72 hours of diagnosis. Outcome was good or excellent in 12/17 surviving dogs. Loss of the cerebral sulci and foramen magnum herniation on MRI were associated with increased risk of mortality. An abnormal CSF analysis at the three-month re-examination was associated with increased risk of relapse (P=0.04). The combination of MRI and CSF analysis provided a greater sensitivity for predicting relapse than one modality alone. Discontinuing treatment before MRI lesions resolved always resulted in relapse. The presence of certain MRI characteristics may indicate an increased risk of mortality. Dogs alive three months following diagnosis have a very low risk of death due to MUO. PMID:23462382

Lowrie, M; Smith, P M; Garosi, L

2013-03-05

281

Psychotropic PRN: A model for best practice management of acute psychotic behavioural disturbance in inpatient psychiatric settings  

Microsoft Academic Search

PRN, or 'as needed', medications are administered frequently by mental health nurses in psychiatric inpatient settings to manage difficult and disturbed behaviour when other strategies fail. Research indicates that approximately 50% of psychiatric inpatients receive a PRN medication at some stage of their treatment. Although evidence indicates that traditional antipsychotics and benzodiazepines are equally effective in managing acute agitation and

Kim Usher; Lauretta Luck

2004-01-01

282

Lifestyle modification and metformin as long-term treatment options for obese adolescents: study protocol  

PubMed Central

Background Childhood obesity is a serious health concern affecting over 155 million children in developed countries worldwide. Childhood obesity is associated with significantly increased risk for development of type 2 diabetes, cardiovascular disease and psychosocial functioning problems (i.e., depression and decreased quality of life). The two major strategies for management of obesity and associated metabolic abnormalities are lifestyle modification and pharmacologic therapy. This paper will provide the background rationale and methods of the REACH childhood obesity treatment program. Methods/design The REACH study is a 2-year multidisciplinary, family-based, childhood obesity treatment program. Seventy-two obese adolescents (aged 10-16 years) and their parents are being recruited to participate in this randomized placebo controlled trial. Participants are randomized to receive either metformin or placebo, and are then randomized to a moderate or a vigorous intensity supervised exercise program for the first 12-weeks. After the 12-week exercise program, participants engage in weekly exercise sessions with an exercise facilitator at a local community center. Participants engage in treatment sessions with a dietitian and social worker monthly for the first year, and then every three months for the second year. The primary outcome measure is change in body mass index and the secondary outcome measures are changes in body composition, risk factors for type 2 diabetes and cardiovascular disease, changes in diet, physical activity, and psychosocial well-being (e.g., quality of life). It is hypothesized that participants who take metformin and engage in vigorous intensity exercise will show the greatest improvements in body mass index. In addition, it is hypothesized that participants who adhere to the REACH program will show improvements in body composition, physical activity, diet, psychosocial functioning and risk factor profiles for type 2 diabetes and cardiovascular disease. These improvements are expected to be maintained over the 2-year program. Discussion The findings from this study will advance the knowledge regarding the long-term efficacy and sustainability of interventions for childhood obesity. Trial Registration ClinicalTrials.gov number NCT00934570

2009-01-01

283

Protocol for a randomised controlled trial of treatment of asymptomatic candidiasis for the prevention of preterm birth [ACTRN12610000607077  

PubMed Central

Background Prevention of preterm birth remains one of the most important challenges in maternity care. We propose a randomised trial with: a simple Candida testing protocol that can be easily incorporated into usual antenatal care; a simple, well accepted, treatment intervention; and assessment of outcomes from validated, routinely-collected, computerised databases. Methods/Design Using a prospective, randomised, open-label, blinded-endpoint (PROBE) study design, we aim to evaluate whether treating women with asymptomatic vaginal candidiasis early in pregnancy is effective in preventing spontaneous preterm birth. Pregnant women presenting for antenatal care <20 weeks gestation with singleton pregnancies are eligible for inclusion. The intervention is a 6-day course of clotrimazole vaginal pessaries (100 mg) and the primary outcome is spontaneous preterm birth <37 weeks gestation. The study protocol draws on the usual antenatal care schedule, has been pilot-tested and the intervention involves only a minor modification of current practice. Women who agree to participate will self-collect a vaginal swab and those who are culture positive for Candida will be randomised (central, telephone) to open-label treatment or usual care (screening result is not revealed, no treatment, routine antenatal care). Outcomes will be obtained from population databases. A sample size of 3,208 women with Candida colonisation (1,604 per arm) is required to detect a 40% reduction in the spontaneous preterm birth rate among women with asymptomatic candidiasis from 5.0% in the control group to 3.0% in women treated with clotrimazole (significance 0.05, power 0.8). Analyses will be by intention to treat. Discussion For our hypothesis, a placebo-controlled trial had major disadvantages: a placebo arm would not represent current clinical practice; knowledge of vaginal colonisation with Candida may change participants' behaviour; and a placebo with an alcohol preservative may have an independent affect on vaginal flora. These disadvantages can be overcome by the PROBE study design. This trial will provide definitive evidence on whether screening for and treating asymptomatic candidiasis in pregnancy significantly reduces the rate of spontaneous preterm birth. If it can be demonstrated that treating asymptomatic candidiasis reduces preterm births this will change current practice and would directly impact the management of every pregnant woman. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12610000607077

2011-01-01

284

A Phase I/II Protocol Using {sup 252}Cf for the Treatment of Cervical Carcinoma  

SciTech Connect

For this clinical study, external photon beam irradiation will be given in a standard fashion with intravenous cisplatinum (CDDP) every week as a radiosensitizing agent. We will incorporate {sup 252}Cf as the brachytherapy source replacing {sup 192}Ir, theoretically improving patient outcomes with its lack of cell cycle and oxygen dependence, and a therapeutic ratio possibly greater than unity. Local tumor control and control of systemic disease are potentially feasible using {sup 252}Cf to initially debulk and destroy local bulky tumor with CDDP and X rays to enhance treatment efficacy and treat minimal microscopic and distant micrometastases. The initial {sup 22}Cf dose will be 1 Gy per weekly fraction with 0.25-Gy increments toward a 2.5-Gy limit. Patients will be stratified according to their stage, toxicities and outcomes will be monitored closely, and the study will be halted if undo morbidities are noted.

Anita Mahajan; Mark J. Rivard; Evelyn R. Nunez; David E. Wazer

2000-11-12

285

PSYCHIATRIC INPATIENT SERVICES IN GENERAL HOSPITALS  

PubMed Central

Traditional asylum care of psychiatric patients leads to the isolation, confinement, and restraint of the patients, and to isolation of psychiatric practice from the rest of medicine. Modern psychiatric advances have demonstrated the disadvantages to both patients and their families of such isolation, confinement and restraint. It is in the best interests of patients and professional workers that inpatient psychiatric services be continuous with, and contiguous to, other medical services and to rehabilitation services of all kinds. Examination of currently available information reveals a shortage of psychiatric beds in California, particularly for diagnosis and brief treatment. Thus, not only is there a need to develop psychiatric inpatient facilities, but also an opportunity to develop them along several different lines. Since both the Hill-Burton Act (federal) and the Short-Doyle Act (state) give financial assistance to only those psychiatric services established in general hospitals or affiliated with general hospitals, this requirement calls for examination in the light of experience with services so operated. At first, the Short-Doyle Act was perceived as a panacea for the psychiatric ills of the state. Now it is beginning to be recognized as one method of providing additional mental health resources, rather than the exclusive method. As more short-term cases are treated in local, tax-supported, psychiatric units in general hospitals, an impact can be expected on the state hospital program. In its administration of the Short-Doyle Act, the Department of Mental Hygiene attempts to respond to community needs as locally determined. It tries to insure local option and encourage local responsibility while furthering high standards of staffing and of service.

Hume, Portia Bell; Rudin, Edward

1960-01-01

286

Cognitive Control Differences in Violent Juvenile Inpatients.  

ERIC Educational Resources Information Center

Used stepwise discriminant analysis on calibration sample (n=135) of juvenile inpatients to determine which variables best distinguished violent inpatients. Cross-validated model on 123 subjects. Violent subjects were more likely to be younger males with family history of criminal behavior and extensive discord. Violent subjects showed differences…

Calicchia, John A.; And Others

1993-01-01

287

Role of the Inpatient Nutrition Education Coordinator  

Microsoft Academic Search

An opportunity existed to improve the inpatient nutrition education process to ensure 100% of patients on therapeutic diets had a plan for nutrition education documented in the medical record prior to discharge. Our standard required 100% of inpatients on a therapeutic diet to have a documented plan for nutrition education in their medical record. Unit dietitians were required to assess

G. J. Jatho; P. J. Petnicki; C. K. McNamee

1998-01-01

288

What determines adherence to treatment in cardiovascular disease prevention? Protocol for a mixed methods preference study.  

PubMed

Background Significant gaps exist between guidelines-recommended therapies for cardiovascular disease prevention and current practice. Fixed-dose combination pills ('polypills') potentially improve adherence to therapy. This study is a preference study undertaken in conjunction with a clinical trial of a polypill and seeks to examine the underlying reasons for variations in treatment adherence to recommended therapy. Methods/design A preference study comprising: (1) Discrete Choice Experiment for patients; and (2) qualitative study of patients and providers. Both components will be conducted on participants in the trial. A joint model combining the observed adherence in the clinical trial (revealed preference) and the Discrete Choice Experiment data (stated preference) will be estimated. Estimates will be made of the marginal effect (importance) of each attribute on overall choice, the extent to which respondents are prepared to trade-off one attribute for another and predicted values of the level of adherence given a fixed set of attributes, and contextual and socio-demographic characteristics. For the qualitative study, a thematic analysis will be used as a means of exploring in depth the preferences and ultimately provide important narratives on the experiences and perspectives of individuals with regard to adherence behaviour. Ethics and dissemination Primary ethics approval was received from Sydney South West Area Health Service Human Research Ethics Committee (Royal Prince Alfred Hospital zone). In addition to usual scientific forums, the findings will be reported back to the communities involved in the studies through site-specific reports and oral presentations. PMID:22080542

Jan, Stephen; Usherwood, Tim; Brien, Jo Anne; Peiris, David; Rose, John; Hayman, Noel; Howard, Kirsten; Redfern, Julie; Laba, Tracey; Cass, Alan; Patel, Anushka

2011-01-01

289

Hygienic-dietary recommendations for major depression treatment: Study protocol of a randomized controlled trial  

PubMed Central

Background Depression is a highly prevalent and disabling mental disorder with an incidence rate which appears to be increasing in the developed world. This fact seems to be at least partially related to lifestyle factors. Some hygienic-dietary measures have shown their efficacy as a coadjuvant of standard treatment. However, their effectiveness has not yet been proved enough in usual clinical practice. Methods Multicenter, randomized, controlled, two arm-parallel, clinical trial involving 300 patients over 18 years old with a diagnosis of Major Depression. Major depression will be diagnosed by means of the Mini-International Neuropsychiatric Interview. The Beck Depression Inventory total score at the end of the study will constitute the main efficacy outcome. Quality of Life and Social and Health Care Services Consumption Scales will be also administered. Patients will be assessed at three different occasions: baseline, 6-month follow-up and 12-month follow-up. Discussion We expect the patients in the active lifestyle recommendations group to experience a greater improvement in their depressive symptoms and quality of life with lower socio-sanitary costs. Trial registration ISRCTN73931675

2012-01-01

290

Attributional Style, Hope, and Initial Response to Selective Serotonin Reuptake Inhibitors Youth Psychiatric Inpatients  

Microsoft Academic Search

We investigated the role of attributional style in inpatients’ initial response to treatment, particularly to SSRIs, and explored\\u000a possible psychological factors implicated in response to SSRIs. One hundred youth psychiatric inpatients completed questionnaires\\u000a at admission and discharge on attributional style, hopelessness, self-esteem, and depressive symptoms; medication status was\\u000a recorded. Change in depressive symptoms from admission to discharge varied depending on

Thomas E. Joiner Jr; Jessica S. Brown; Kathryn H. Gordon; Mark R. Rouleau; Karen Dineen Wagner

2005-01-01

291

Nurse-led inpatient care: opening the ‘black box’  

Microsoft Academic Search

With recent evaluations contradicting early reports of improved outcomes from nurse-led inpatient care, the ‘black box’ of nurse-led care must be opened in order to examine the model of treatment. We present findings on the processes of care in one nurse-led unit (NLU), compared with an acute ward. Patterns and quality of nursing care were quantified using bar-code technology to

Bronagh Walsh; Andrea Steiner; Jerry Warr; Lisa Sheron; Ruth Pickering

2003-01-01

292

Effects of music on major depression in psychiatric inpatients  

Microsoft Academic Search

The study was to assess the effectiveness of soft music for treatment of major depressive disorder inpatients in Kaohsiung City, Taiwan. A pretest-posttest with a two-group repeated measures design was used. Patients with major depressive disorder were recruited through referred by the psychiatric physicians. Subjects listened to their choice of music for 2 weeks. Depression was measured with the Zung’s

Wei-Chi Hsu; Hui-Ling Lai

2004-01-01

293

A prospective cohort study of surgical treatment for back pain with degenerated discs; study protocol  

PubMed Central

Background The diagnosis of discogenic back pain often leads to spinal fusion surgery and may partly explain the recent rapid increase in lumbar fusion operations in the United States. Little is known about how patients undergoing lumbar fusion compare in preoperative physical and psychological function to patients who have degenerative discs, but receive only non-surgical care. Methods Our group is implementing a multi-center prospective cohort study to compare patients with presumed discogenic pain who undergo lumbar fusion with those who have non-surgical care. We identify patients with predominant low back pain lasting at least six months, one or two-level disc degeneration confirmed by imaging, and a normal neurological exam. Patients are classified as surgical or non-surgical based on the treatment they receive during the six months following study enrollment. Results Three hundred patients discogenic low back pain will be followed in a prospective cohort study for two years. The primary outcome measure is the Modified Roland-Morris Disability Questionnaire at 24-months. We also evaluate several other dimensions of outcome, including pain, functional status, psychological distress, general well-being, and role disability. Conclusion The primary aim of this prospective cohort study is to better define the outcomes of lumbar fusion for discogenic back pain as it is practiced in the United States. We additionally aim to identify characteristics that result in better patient selection for surgery. Potential predictors include demographics, work and disability compensation status, initial symptom severity and duration, imaging results, functional status, and psychological distress.

Deyo, Richard A; Mirza, Sohail K; Heagerty, Patrick J; Turner, Judith A; Martin, Brook I

2005-01-01

294

An inpatient child passenger safety program.  

PubMed

Background. Our institution implemented an Inpatient Child Passenger Safety (CPS) program for hospitalized children to improve knowledge and compliance with the Massachusetts CPS law, requiring children less than 8 years old or 57 inches tall to be secured in a car seat when in a motor vehicle. Methods. After the Inpatient CPS Program was piloted on 3 units in 2009, the program was expanded to all inpatient units in 2010. A computerized nursing assessment tool identifies children in need of a CPS consult for education and/or car seat. Results. With the expanded Inpatient CPS Program, 3650 children have been assessed, 598 consults initiated, and 325 families have received CPS education. Car seats were distributed to 419 children; specialty car seats were loaned to 134 families. Conclusions. With a multidisciplinary approach, we implemented an Inpatient CPS Program for hospitalized children providing CPS education and car seats to families in need. PMID:24137036

Elliott, Lindsey Nichole; Digirolamo, Barbara; McMahon, Maria; Damian, Frances; Brostoff, Marcie; Shermont, Herminia; Mooney, David Patrick; Lee, Lois Kaye

2013-11-01

295

Follow-up of adolescent psychiatric inpatients.  

PubMed

Psychiatric hospital services for adolescents have steadily increased in recent years and great interest has been generated in determining treatment outcome. In this study, 74 adolescent inpatients completed structured telephone interviews one year after discharge. The questions probed school, job, and family adjustment, as well as drug and alcohol use, participation in treatment, and legal problems. At the time of discharge, they had undergone objective, standardized psychologic tests including personally, locus of control, and parent-adolescent communication assessments. Statistically, the discharge locus of control test correlated with several areas studied. The more external the locus of control at discharge, the greater the likelihood of poor peer relations, poor family relations, and poor job adjustment at one-year follow-up. The discharge personality alienation scale was found to correlate inversely to school adjustment one year later. High emotional discomfort shown by the personality test was associated with increased likelihood of being in treatment at follow-up. Finally, a statistical profile of the adolescents one year after discharge is presented. PMID:7414380

Davis, D M; Gonzalez, V; Piat, J

1980-09-01

296

Optimal treatment intensity in children with Down syndrome and myeloid leukaemia: data from 56 children treated on NOPHO-AML protocols and a review of the literature  

Microsoft Academic Search

Children with Down syndrome (DS) and myeloid leukaemia have a significantly higher survival rate than other children, but\\u000a they also experience considerable treatment-related toxicity. We analysed data on 56 children with DS who were treated on\\u000a the Nordic Society for Paediatric Haematology and Oncology-acute myeloid leukaemia (NOPHO-AML)88 and NOPHO-AML93 protocols\\u000a and reviewed the literature. In the dose-intensive NOPHO-AML88 protocol, 8

Lotte Abildgaard; Eva Ellebæk; Göran Gustafsson; Jonas Abrahamsson; Liisa Hovi; Gudmundur Jonmundsson; Bernward Zeller; Henrik Hasle

2006-01-01

297

Effectiveness of cognitive-behavioral therapy modified for inpatients with depression.  

PubMed

The effectiveness among inpatients with depression of a modified cognitive behavior therapy (CBT) program was examined. A group of 300 inpatient admissions with a primary diagnosis of depression attending a private psychiatric clinic were assessed at the beginning and end of a two-week CBT program. The effectiveness of the treatment was demonstrated by improvements on the Beck depression inventory (BDI), the health of the nation outcome scales, locus of control of behaviour scale, and the global assessment of function. The changes on the BDI for patients with depression were benchmarked against estimates generated from published studies. The degree of change in a two-week period for inpatients with depression was similar to that observed in efficacy studies of CBT that typically run over a more extended time. Implications for integrating CBT with inpatient services are discussed. PMID:23738192

Page, Andrew C; Hooke, Geoff R

2011-12-06

298

Effectiveness of Cognitive-Behavioral Therapy Modified for Inpatients with Depression  

PubMed Central

The effectiveness among inpatients with depression of a modified cognitive behavior therapy (CBT) program was examined. A group of 300 inpatient admissions with a primary diagnosis of depression attending a private psychiatric clinic were assessed at the beginning and end of a two-week CBT program. The effectiveness of the treatment was demonstrated by improvements on the Beck depression inventory (BDI), the health of the nation outcome scales, locus of control of behaviour scale, and the global assessment of function. The changes on the BDI for patients with depression were benchmarked against estimates generated from published studies. The degree of change in a two-week period for inpatients with depression was similar to that observed in efficacy studies of CBT that typically run over a more extended time. Implications for integrating CBT with inpatient services are discussed.

Page, Andrew C.; Hooke, Geoff R.

2012-01-01

299

Criminal behaviour in female schizophrenic inpatients  

Microsoft Academic Search

Summary  \\u000a As there is a scarcity of studies devoted specifically to the criminal behaviour of female schizophrenic patients the present\\u000a study was undertaken. First, a group of 146 consecutive female inpatients with DSM-IV schizophrenia was compared with regard\\u000a to their criminal behaviour with both the comparison group of 432 female inpatients all grouped together and with subgroups\\u000a divided by diagnosis.

J. Modestin; S. Mauron; T. Erni

2002-01-01

300

The optimized acupuncture treatment for neck pain caused by cervical spondylosis: a study protocol of a multicentre randomized controlled trial  

PubMed Central

Background Neck pain is one of the chief symptoms of cervical spondylosis (CS). Acupuncture is a well-accepted and widely used complementary therapy for the management of neck pain caused by CS. In this paper, we present a randomized controlled trial protocol evaluating the use of acupuncture for CS neck pain, comparing the effects of the optimized acupuncture therapy in real practice compared with sham and shallow acupuncture. Methods/Design This trial uses a multicentre, parallel-group, randomized, sham acupuncture and shallow acupuncture, controlled single-blind design. Nine hospitals are involved as trial centres. 945 patients who meet inclusion criteria are randomly assigned to receive optimized acupuncture therapy, sham acupuncture or shallow acupuncture by a computerized central randomization system. The interventions past for 4 weeks with eight to ten treatments in total. The group allocations and interventions are concealed to patients and statisticians. The Northwick Park Neck Pain Questionnaire (NPQ) is used as the primary outcome measure, and the McGill Pain Questionnaire (MPQ) and The Short Form (36) Health Survey (SF-36) are applied as secondary outcome measures. The evaluation is performed at baseline, at the end of the intervention, and at the end of the first month and the third month during follow-up. The statistical analyses will include baseline data comparison and repeated measures of analysis of variance (ANOVA) for primary and secondary outcomes of group and time differences. Adverse events (AEs) will be reported if they occur. Discussion This trial is a multicentre randomized control trial (RCT) on the efficacy of acupuncture for CS neck pain and has a large sample size and central randomization in China. It will strictly follow the CONSORT statement and STRICTA extension guideline to report high-quality study results. By setting the control groups as sham and shallow acupuncture, this study attempts to reveal the effects of real acupuncture versus placebo or non-classic acupuncture treatment and evaluate whether classic Chinese medical acupuncture is effective on CS neck pain. This study will provide evidence for the effects of acupuncture on CS neck pain. Trial Registration Chinese Clinical Trial Registry: ChiCTR-TRC-00000184.

2012-01-01

301

Inpatient management of diabetic foot disorders: a clinical guide.  

PubMed

The implementation of an inpatient diabetic foot service should be the goal of all institutions that care for patients with diabetes. The objectives of this team are to prevent problems in patients while hospitalized, provide curative measures for patients admitted with diabetic foot disorders, and optimize the transition from inpatient to outpatient care. Essential skills that are required for an inpatient team include the ability to stage a foot wound, assess for peripheral vascular disease, neuropathy, wound infection, and the need for debridement; appropriately culture a wound and select antibiotic therapy; provide, directly or indirectly, for optimal metabolic control; and implement effective discharge planning to prevent a recurrence. Diabetic foot ulcers may be present in patients who are admitted for nonfoot problems, and these ulcers should be evaluated by the diabetic foot team during the hospitalization. Pathways should be in place for urgent or emergent treatment of diabetic foot infections and neuropathic fractures/dislocations. Surgeons involved with these patients should have knowledge and interest in limb preservation techniques. Prevention of iatrogenic foot complications, such as pressure sores of the heel, should be a priority in patients with diabetes who are admitted for any reason: all hospitalized diabetic patients require a clinical foot exam on admission to identify risk factors such as loss of sensation or ischemia. Appropriate posthospitalization monitoring to reduce the risk of reulceration and infection should be available, which should include optimal glycemic control and correction of any fluid and electrolyte disturbances. PMID:23970716

Wukich, Dane K; Armstrong, David G; Attinger, Christopher E; Boulton, Andrew J M; Burns, Patrick R; Frykberg, Robert G; Hellman, Richard; Kim, Paul J; Lipsky, Benjamin A; Pile, James C; Pinzur, Michael S; Siminerio, Linda

2013-09-01

302

Behavioral Contagion Reconsidered: Self-Harm Among Adolescent Psychiatric Inpatients: A Five-Year Study  

PubMed Central

Objective The objective of this study was to examine the occurrence of behavioral contagion among inpatient adolescent psychiatric patients in terms of past self-harm related behaviors. Our goal was to isolate persistent self-harm behavior from self-harm behavior that could be considered truly contagious. Method We employed 5 years retrospective cohort study design in order to compare the occurrence of self-harm as inpatients among those with and without histories of self-harm behavior. Results Our results indicate that the spontaneous occurrence of self-harm among inpatients without a history of self-harm is very low. While there appears to be a group that exhibits self-harm as inpatients, the tendency in this group is more towards a reduction of the intensity or a cessation of self-harming behavior. Conclusions Contagious self-harm does not appear to be a problem among inpatients with long stays on psychiatric treatment units. The overall tendency among inpatient adolescent psychiatric patients, especially those among those with histories of self-harm behavior is away from self-harming behavior.

Cawthorpe, D.; Somers, D.; Wilkes, T.; Phil, M

2003-01-01

303

Clinical pharmacy in inpatient care.  

PubMed

The aim of this paper is to describe how interventions by clinical pharmacists can provide quality pharmaceutical care to inpatients. Evidence-based pharmacotherapy is necessary for the practice of clinical pharmacy. The use of published data, patient-specific data, and data generated by conducted research are discussed with respect to unit dose computer systems, nutrition teams, and pharmacokinetic services, based on the experience of an European hospital pharmacy. Incorporating evidence into clinical pharmacy activities results in added value to these services. The implementation of evidence-based pharmacotherapy is not an easy task for three reasons: a lack of scientific evidence in many medical areas, a lack of authority of pharmacists in Europe to take an active part in decision-making for drug prescribing, and reluctance of some physicians to accept pharmacists within the health care team. Also, efforts are required to change education programs at the universities in Europe to better prepare clinical pharmacists in pharmacotherapy and pharmaceutical care. PMID:11034053

Bonal, J F

2000-10-01

304

Differential diagnosis of psychosis in a deaf inpatient with language dysfluency.  

PubMed

This case report demonstrates challenges diagnosing psychosis in language dysfluent deaf patients. Treatment of a 34-year-old deaf man on an inpatient psychiatric unit is described. He had a history of physical aggression and possible symptoms of paranoia and thought disorganization, in addition to learning difficulties and minimal language skills. The patient was placed on a combined hearing/deaf inpatient unit, received specialized programming for deaf patients and was prescribed risperidone and divalproex sodium to treat his aggressive behavior and possible psychosis. Uncertainty if the patient were having psychotic symptoms remained throughout his hospitalization, although he improved behaviorally and was discharged after 13 months of treatment. The patient's pre-existing language deficits made accurate diagnosis and appropriate treatment challenging. It is important for clinicians to be aware of the frequency of language dysfluency in the deaf inpatient population and have a strategy for evaluating and treating this complex subgroup of deaf people. PMID:23538291

Weiler, Courtney; Landsberger, Sarah A; Diaz, David R

2013-04-01

305

Treatment of Co-Occurring Substance Abuse and Suicidality Among Adolescents: A Randomized Trial  

Microsoft Academic Search

Objective: This study tested a cognitive–behavioral treatment protocol for adolescents with a co-occurring alcohol or other drug use disorder (AOD) and suicidality in a randomized clinical trial. Method: Forty adolescents (Mage = 15 years; 68% female, 89% White) and their families recruited from an inpatient psychiatric hospital were randomly assigned to an integrated outpatient cognitive–behavioral intervention for co-occurring AOD and

Christianne Esposito-Smythers; Anthony Spirito; Christopher W. Kahler; Jeffrey Hunt; Peter Monti

2011-01-01

306

Efficacy of Group Motivational Interviewing (GMI) for Psychiatric Inpatients With Chemical Dependence  

Microsoft Academic Search

Dually diagnosed patients with chemical dependency and a comorbid psychiatric disorder typically show poor compliance with aftercare treatment, which may result in costly and pervasive individual and societal problems. In this study, the authors investigated the effect of adding motivational interviewing in a group format to standard treatment for dually diagnosed psychiatric inpatients. The patients (n = 101) all received

Elizabeth J. Santa Ana; Edelgard Wulfert; Paul J. Nietert

2007-01-01

307

The effect of inpatient cognitive-behavioral therapy for eating disorders on temperament and character  

Microsoft Academic Search

Personality traits seem to have an important role in the development, clinical expression, course, and treatment response in eating disorders (EDs). We investigated the effects of an inpatient cognitive-behavioral treatment (CBT) on the measures of temperament and character (Temperament and Character Inventory (TCI)) in 149 consecutive patients with EDs. Baseline assessment included anthropometry, the Eating Disorder Examination (EDE), the Beck

Riccardo Dalle Grave; Simona Calugi; Francesca Brambilla; Giovanni Abbate-Daga; Secondo Fassino; Giulio Marchesini

2007-01-01

308

Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial  

Microsoft Academic Search

Dialectical Behavioral Therapy (DBT) was initially developed and evaluated as an outpatient treatment program for chronically suicidal individuals meeting criteria for borderline personality disorder (BPD). Within the last few years, several adaptations to specific settings have been developed. This study aims to evaluate a three-month DBT inpatient treatment program. Clinical outcomes, including changes on measures of psychopathology and frequency of

Martin Bohus; Brigitte Haaf; Timothy Simms; Matthias F. Limberger; Christian Schmahl; Christine Unckel; Klaus Lieb; Marsha M. Linehan

2004-01-01

309

Evaluation of inpatient Dialectical-Behavioral Therapy for Borderline Personality Disorder — a prospective study  

Microsoft Academic Search

Dialectical-Behavioral Therapy for Borderline Personality Disorder (DBT) developed by M. Linehan is specifically designed for the outpatient treatment of chronically suicidal patients with borderline personality disorder. Research on DBT therapy, its course and its results has focused to date on treatments in an outpatient setting.Hypothesizing that the course of therapy could be accelerated and improved by an inpatient setting at

Martin Bohus; Brigitte Haaf; Christian Stiglmayr; Ulrike Pohl; Renate Böhme; Marsha Linehan

2000-01-01

310

GENERAL PRINCIPLES FOR SHORT-TERM INPATIENT WORK WITH MULTIPLE PERSONALITY-DISORDER PATIENTS  

Microsoft Academic Search

This article offers a conceptualization of the treatment course for patients with multiple personalities and describes a series of stages for the psychotherapy. A short-term inpatient unit can serve different functions during the course of treatment, ranging from diagnostic assessment, to education of both patient and therapist, to a secure holding environment in times of crisis.

David K. Sakheim; Elizabeth P. Hess; Aldine Chivas

1988-01-01

311

C4-3: Implementation of a Screening Brief Intervention and Referral to Treatment (SBIRT) Protocol in Primary Care.  

PubMed

Background/Aims Substance abuse in the United States is a serious public health concern; however, routine screening is inconsistent in primary care. In partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), Kaiser Permanente Colorado (KPCO) implemented the Screening Brief Intervention and Referral to Treatment (SBIRT) protocol in one primary care clinic over a 3-month period in order to determine staff perceptions, barriers, and solutions for wide-scale implementation. Methods Based on prior feasibility studies, clinic staff were engaged in order to anticipate barriers and solutions to improve implementation success. A quantitative survey of team functioning and clinic priority for implementing SBIRT was also conducted prior to implementation. Screening was conducted by front desk staff of all adult Health Maintenance Visits (ages 19-64 years) using a 3-question paper questionnaire, followed by Brief Intervention delivered by the behavioral medicine specialist (BMS) in the case of positive screening result. This workflow was determined by the clinic despite prior feasibility results indicating optimal workflow consisting of screening by Medical Assistants and Nurses during the rooming process due to multiple competing demands from the organization during the implementation period. Results A total of 1097 eligible patients were seen during the 3-month implementation, 321 (29%) were screened for alcohol use, and 15 (5%) required additional Brief Intervention with the BMS. Positive results of implementation included improved awareness by physicians of alcohol use, better communication among members of the care team, and integration of the BMS as a resource for the care team. Barriers included patient resistance, competing demands on the clinic, and lack of information on screening recorded in the medical record. Post-study debriefing with primary care and BMS staff led to a commitment by clinic leadership and staff to revise workflow and explore regional implementation strategies. Solutions include additional training regarding clinical utility of screening and options for normalizing screening for patients and solutions for recording screening in the EMR. Conclusions Through continued use of SBIRT, this clinic will also demonstrate the value of screening for drug and alcohol use to the region in order to promote wider dissemination. PMID:24085993

Rahm, Alanna Kulchak; Martin, Carmen; Boggs, Jennifer; Price, David; Beck, Arne; Dearing, James; Backer, Thomas

2013-09-01

312

C4-3: Implementation of a Screening Brief Intervention and Referral to Treatment (SBIRT) Protocol in Primary Care  

PubMed Central

Background/Aims Substance abuse in the United States is a serious public health concern; however, routine screening is inconsistent in primary care. In partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), Kaiser Permanente Colorado (KPCO) implemented the Screening Brief Intervention and Referral to Treatment (SBIRT) protocol in one primary care clinic over a 3-month period in order to determine staff perceptions, barriers, and solutions for wide-scale implementation. Methods Based on prior feasibility studies, clinic staff were engaged in order to anticipate barriers and solutions to improve implementation success. A quantitative survey of team functioning and clinic priority for implementing SBIRT was also conducted prior to implementation. Screening was conducted by front desk staff of all adult Health Maintenance Visits (ages 19–64 years) using a 3-question paper questionnaire, followed by Brief Intervention delivered by the behavioral medicine specialist (BMS) in the case of positive screening result. This workflow was determined by the clinic despite prior feasibility results indicating optimal workflow consisting of screening by Medical Assistants and Nurses during the rooming process due to multiple competing demands from the organization during the implementation period. Results A total of 1097 eligible patients were seen during the 3-month implementation, 321 (29%) were screened for alcohol use, and 15 (5%) required additional Brief Intervention with the BMS. Positive results of implementation included improved awareness by physicians of alcohol use, better communication among members of the care team, and integration of the BMS as a resource for the care team. Barriers included patient resistance, competing demands on the clinic, and lack of information on screening recorded in the medical record. Post-study debriefing with primary care and BMS staff led to a commitment by clinic leadership and staff to revise workflow and explore regional implementation strategies. Solutions include additional training regarding clinical utility of screening and options for normalizing screening for patients and solutions for recording screening in the EMR. Conclusions Through continued use of SBIRT, this clinic will also demonstrate the value of screening for drug and alcohol use to the region in order to promote wider dissemination.

Rahm, Alanna Kulchak; Martin, Carmen; Boggs, Jennifer; Price, David; Beck, Arne; Dearing, James; Backer, Thomas

2013-01-01

313

Best practices: increased attendance in inpatient group psychotherapy improves patient outcomes.  

PubMed

This column describes an initiative that promoted increased attendance in group psychotherapy and its effect on patient outcomes. Information on patient- and staff-rated outcomes, readmission rates, and patient satisfaction was gathered for 2,782 inpatients in a private psychiatric facility in Australia. On average, after the initiative was implemented, patients went from attending one session per day to two sessions. Inpatients admitted after implementation had better patient- and staff-rated outcomes and lower rates of readmission within one month of discharge. However, patients' treatment satisfaction ratings declined. These findings indicate that increasing attendance in group psychotherapy can be a useful adjunct to hospital treatment. PMID:19339314

Page, Andrew C; Hooke, Geoffrey R

2009-04-01

314

Pretreatment with low-energy shock waves induces renal vasoconstriction during standard SWL: a treatment protocol known to reduce lithotripsy-induced renal injury  

PubMed Central

Introduction and Objective A great deal of effort has been focused on developing new treatment protocols to reduce tissue injury to improve the safety of shock wave lithotripsy. This has led to the discovery that pretreatment of the kidney with a series of low-energy shock waves (SWs) will substantially reduce the hemorrhagic lesion that normally results from a standard clinical dose of high-energy SWs. Because renal blood flow is reduced following low- or high-energy SWL, and may therefore contribute to this effect, this study was designed to test the hypothesis that the pretreatment protocol induces renal vasoconstriction sooner than the standard protocol for SW delivery. Methods Female farm pigs (6-weeks old) were anesthetized with isoflurane and the lower pole of the right kidney treated with SWs using the HM3 lithotripter. Pulsed Doppler sonography was used to measure resistive index (RI) in blood vessels as a reflection of resistance/impedance to blood flow. RI was recorded from a single intralobar artery located in the targeted pole of the kidney, and measurements taken from pigs given sham SW treatment (Group 1; no SWs, n = 4), a standard clinical dose of high-energy SWs (Group 2; 2000 SWs, 24 kV, 120 SWs/min, n = 7), low-energy SW pretreatment followed by high-energy SWL (Group 3; 500 SWs, 12 kV, 120 SWs/min + 2000 SWs, 24 kV, 120 SWs/min, n = 8) and low-energy SW pretreatment alone (Group 4; 500 SWs, 12 kV, 120 SWs/min, n = 6). Results Baseline RI (~ 0.61) was similar for all groups. Pigs receiving sham SW treatment (Group 1) had no significant change in RI. A standard clinical dose of high-energy SWs (Group 2) did not significantly alter RI during treatment, but did increase RI at 45-min into the post-SWL period. Low-energy SWs did not alter RI in Group 3 pigs, but subsequent treatment with a standard clinical dose of high-energy SWs resulted in a significantly earlier (at 1000 SWs) and greater (two-fold) rise in RI than that observed in Group 2 pigs. This rise in RI during the low/high-energy SWL treatment protocol was not due to a delayed vasoconstrictor response of pretreatment, as low-energy SW treatment alone (Group 4) did not increase RI until 65 min into the post-SWL period. Conclusions The pretreatment protocol induces renal vasoconstriction during the period of SW application whereas the standard protocol shows vasoconstriction occurring only during the post-SWL period. Thus the earlier and greater rise in RI during the pretreatment protocol may be causally associated with a reduction in tissue injury.

Handa, Rajash K.; Bailey, Michael R.; Paun, Marla; Gao, Sujuan; Connors, Bret A.; Willis, Lynn R.; Evan, Andrew P.

2008-01-01

315

Neonatal Abstinence Syndrome (NAS): Transitioning Methadone Treated Infants From An Inpatient to an Outpatient Setting  

PubMed Central

Background Each year in the US approximately 50,000 neonates receive inpatient pharmacotherapy for the treatment of neonatal abstinence syndrome (NAS). Objective To compare the safety and efficacy of a traditional inpatient only approach with a combined inpatient and outpatient methadone treatment program. Design/Methods Retrospective review (2007-9). Infants were born to mothers maintained on methadone or buprenorphine in an antenatal substance abuse program. All infants received methadone for NAS treatment as inpatient. Methadone weaning for the traditional group (75 pts) was inpatient while the combined group (46 pts) was outpatient. Results Infants in the traditional and combined groups were similar in demographics, obstetrical risk factors, birth weight, GA and the incidence of prematurity (34 & 31%). Hospital stay was shorter in the combined than in the traditional group (13 vs 25d; p < 0.01). Although the duration of treatment was longer for infants in the combined group (37 vs 21d, p<0.01), the cumulative methadone dose was similar (3.6 vs 3.1mg/kg, p 0.42). Follow-up: Information was available for 80% of infants in the traditional and 100% of infants in the combined group. All infants in the combined group were seen ? 72 hours from hospital discharge. Breast feeding was more common among infants in the combined group (24 vs. 8% p<0.05). Following discharge there were no differences between the two groups in hospital readmissions for NAS. Prematurity (<37w GA) was the only predictor for hospital readmission for NAS in both groups (p 0.02, OR 5). Average hospital cost for each infant in the combined group was $13,817 less than in the traditional group. Conclusions A combined inpatient and outpatient methadone treatment in the management of NAS decreases hospital stay and substantially reduces cost. Additional studies are needed to evaluate the potential long term benefits of the combined approach on infants and their families.

Backes, Carl H.; Backes, Carl R.; Gardner, Debra; Nankervis, Craig A.; Giannone, Peter J.; Cordero, Leandro

2013-01-01

316

TRICARE; elimination of the non-availability statement (NAS) requirement for non-emergency inpatient mental health care. Final rule.  

PubMed

This final rule eliminates the requirement that states a NAS is needed for non-emergency inpatient mental health care in order for a TRICARE Standard beneficiary's claim to be paid. Currently, NAS are required for non-emergency inpatient mental health care for TRICARE Standard beneficiaries who live within a military treatment facility catchment area. At this time, the number of NASs issued is negligible as most mental health admissions are emergency admissions. Requiring a NAS for a relatively few non-emergency inpatient mental health admissions is disproportionate to the cost of maintaining the systems necessary to process and coordinate the NAS. PMID:23476989

2013-02-26

317

Nutritional care of medical inpatients: a health technology assessment  

PubMed Central

Background The inspiration for the present assessment of the nutritional care of medical patients is puzzlement about the divide that exists between the theoretical knowledge about the importance of the diet for ill persons, and the common failure to incorporate nutritional aspects in the treatment and care of the patients. The purpose is to clarify existing problems in the nutritional care of Danish medical inpatients, to elucidate how the nutritional care for these inpatients can be improved, and to analyse the costs of this improvement. Methods Qualitative and quantitative methods are deployed to outline how nutritional care of medical inpatients is performed at three Danish hospitals. The practices observed are compared with official recommendations for nutritional care of inpatients. Factors extraneous and counterproductive to optimal nutritional care are identified from the perspectives of patients and professional staff. A review of the literature illustrates the potential for optimal nutritional care. A health economic analysis is performed to elucidate the savings potential of improved nutritional care. Results The prospects for improvements in nutritional care are ameliorated if hospital management clearly identifies nutritional care as a priority area, and enjoys access to management tools for quality assurance. The prospects are also improved if a committed professional at the ward has the necessary time resources to perform nutritional care in practice, and if the care staff can requisition patient meals rich in nutrients 24 hours a day. At the kitchen production level prospects benefit from a facilitator contact between care and kitchen staff, and if the kitchen staff controls the whole food path from the kitchen to the patient. At the patient level, prospects are improved if patients receive information about the choice of food and drink, and have a better nutrition dialogue with the care staff. Better nutritional care of medical patients in Denmark is estimated to hold a cost savings potential reaching approximately USD 22 million. Conclusion Every hospital and every bed ward has its strengths and weaknesses, but none of the participating bed wards fully satisfy nutritional care success criteria. All organisational levels have a significant potential for improvements of nutritional care of medical inpatients.

Lassen, Karin O; Olsen, Jens; Grinderslev, Edvin; Kruse, Filip; Bjerrum, Merete

2006-01-01

318

Association of Family Structure to Later Criminality: A Population-Based Follow-Up Study of Adolescent Psychiatric Inpatients in Northern Finland  

ERIC Educational Resources Information Center

|The influence of family structure on criminality in adolescents is well acknowledged in population based studies of delinquents, but not regarding adolescent psychiatric inpatients. The association of family structure to criminality was examined among 508 adolescents receiving psychiatric inpatient treatment between 2001 and 2006. Family…

Ikaheimo, Olli; Laukkanen, Matti; Hakko, Helina; Rasanen, Pirkko

2013-01-01

319

Factors affecting staff morale on inpatient mental health wards in England: a qualitative investigation  

PubMed Central

Background Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale. Method We conducted individual and group interviews with staff of a full range of disciplines and levels of seniority on seven NHS in-patient wards of varying types in England. Results Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation. Conclusions Increasing employee voice, designing jobs so as to maximise autonomy within clear and well-structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms.

2011-01-01

320

A clinical trial protocol for second line treatment of malignant brain tumors with BNCT at University of Tsukuba.  

PubMed

We have evaluated the efficacy and safety of boron neutron capture therapy (BNCT) for recurrent glioma and malignant brain tumor using a new protocol. One of the two patients enrolled in this trial is a man with recurrent glioblastoma and the other is a woman with anaplastic meningioma. Both are still alive and no severe adverse events have been observed. Our findings suggest that NCT will be safe as a palliative therapy for malignant brain tumors. PMID:21778066

Aiyama, H; Nakai, K; Yamamoto, T; Nariai, T; Kumada, H; Ishikawa, E; Isobe, T; Endo, K; Takada, T; Yoshida, F; Shibata, Y; Matsumura, A

2011-07-20

321

Amoeba Protocol.  

National Technical Information Service (NTIS)

The Amoeba distributed operating system, which supports the transaction as its communication primitive, is addressed. The protocol that the Amoeba system uses to carry out sequences of transactions reliably and efficiently is analyzed in terms of process ...

J. C. Mulder

1988-01-01

322

Characteristics of fever, etiologic factors, antibiotic use and prognosis in febrile dermatology inpatients.  

PubMed

Background? Generally, fever is observed in >30% of hospitalized patients. However, little is known about fever in dermatology inpatients. Objectives? The aim of this study was to investigate and document the incidence, characteristics, and etiologic factors of fever in febrile dermatology inpatients and to describe the practice of antibiotic use and prognosis in the same group. Methods? The medical records for 928 inpatients were retrospectively analyzed. Results? The incidence of fever was found to be 16.2%. Mean length of hospital stay was found to be longer in febrile patients. Of the 176 febrile episodes, 79 (44.9%) occurred in patients without infections, 43 (24.4%) in patients with community-acquired infections, 25 (14.2%) in patients with healthcare-associated infections, 18 (10.2%) in patients classified with fever of non-infectious/infectious causes, and 11 (6.3%) in a group for whom the etiologic factors of fever were undetermined. Antibiotic treatment was started in 36.2% of febrile inpatients. The overall mortality rate was 0.6%. Conclusions? This is the first study to investigate febrile episodes in dermatology inpatients. Fever is a frequently encountered symptom in dermatology inpatients. Febrile episodes resulted from mostly non-infectious entities, mainly consisting of inflammatory dermatologic disorders. Antibiotics were ordered in a higher percentage of patients in the febrile group. Dermatologists started prophylactic or empiric antibiotic therapy in febrile patients with non-infectious or inflammatory diagnoses on the assumption that these patients had an increased risk for infection as a result of impaired skin integrity and use of immunosuppressive drug therapy. The overall mortality rate was very low in the study group of dermatology inpatients. PMID:23432609

Göktay, Fatih; Ceran, Nurgül; Ayd?ngöz, Ikbal Esen; Mansur, Ay?e Tülin

2013-02-22

323

42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.  

Code of Federal Regulations, 2010 CFR

...Method of payment under the inpatient psychiatric facility prospective payment system...Inpatient Hospital Services of Inpatient Psychiatric Facilities § 412.432 Method of payment under the inpatient psychiatric facility prospective payment...

2010-10-01

324

42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.  

Code of Federal Regulations, 2010 CFR

...Method of payment under the inpatient psychiatric facility prospective payment system...Inpatient Hospital Services of Inpatient Psychiatric Facilities § 412.432 Method of payment under the inpatient psychiatric facility prospective payment...

2009-10-01

325

Comparing single-site with multisite rTMS for the treatment of chronic tinnitus - clinical effects and neuroscientific insights: study protocol for a randomized controlled trial  

PubMed Central

Background Several years ago, repetitive transcranial magnetic stimulation (rTMS) of the auditory cortex has been introduced as a treatment approach for chronic tinnitus. Even if this treatment is beneficial for a subgroup of patients, the overall effects are limited. This limitation may be due to the fact that the auditory cortex is only one of several brain areas involved in tinnitus. Whereas auditory areas are considered to code for tinnitus loudness, conscious perception of and attention allocation to tinnitus is supposed to be reflected by network activity involving frontal and parietal cortical areas. The aim of the present study is to influence this frontoparietal network more efficiently by perturbing the most important nodes with rTMS. Methods/design This is a randomized, double-blind, parallel-group study. Patients receive rTMS treatment on 10 consecutive working days using either the multisite rTMS protocol (left dorsolateral prefrontal, 1,000 stimuli, 20 Hz; left temporoparietal, 1,000 stimuli, 1 Hz; right temporoparietal stimulation, 1,000 stimuli, 1 Hz) or a single-site protocol (unilateral stimulation of the temporoparietal cortex, 3,000 stimuli, 1 Hz). Individuals aged 18 to 70 years with chronic tinnitus ?6-month duration and a Tinnitus Handicap Inventory score ?38 are recruited for the study. A total of 50 patients are needed to detect a clinical relevant change of tinnitus severity (??=?0.05; 1 – ??=?0.80). Primary outcome measures are the change in the Tinnitus Questionnaire score from baseline to the end of treatment as well as the number of treatment responders as defined by a reduction in the Tinnitus Questionnaire score of ?5 points. Furthermore, changes in brain structure and activity are assessed using (functional) magnetic resonance imaging and electroencephalography in the resting state. Those measurements are also performed in 25 healthy control subjects. Discussion This study is designed to reveal whether network stimulation is superior to single-site stimulation in the treatment of chronic tinnitus. Furthermore, the comparison between tinnitus patients and healthy controls and the longitudinal effects of both rTMS treatment protocols on brain structure and function allow inferences to be made about the neural correlates of tinnitus. Trial registration Clinical Trials: NCT01663324

2013-01-01

326

Inpatient–Outpatient Cost Shifting in Washington Hospitals  

Microsoft Academic Search

This paper empirically investigates the phenomenon known as “cost shifting” across inpatient and outpatient hospital services. That is, we examine whether, when faced with lower government reimbursement for outpatient services, providers raise inpatient prices for non-government patients (and analogously for lower inpatient government reimbursement). Using a panel of hospitals from Washington State, we find that private, nonprofit hospitals do cost

Daniel L. Friesner; Robert Rosenman

2004-01-01

327

Inpatient Hemodialysis Initiation: Reasons, Risk Factors and Outcomes  

Microsoft Academic Search

Background\\/Aims: Inpatient initiation of chronic hemodialysis is considered undesirable because of cost and possible harms of hospitalization. We examined the patient characteristics and outcomes associated with inpatient initiation. Methods: In a prospective cohort study of incident dialysis patients, the independent association of inpatient hemodialysis initiation with patient outcomes was assessed in multivariable analyses with adjustment for patient characteristics and propensity

Deidra C. Crews; Bernard G. Jaar; Laura C. Plantinga; Hania S. Kassem; Nancy E. Fink; Neil R. Powe

2010-01-01

328

Use of McKenzie cervical protocol in the treatment of radicular neck pain in a machine operator  

PubMed Central

A case of mechanical neck pain with radiation into the upper extremity in a 53-year-old man is presented. The use of standard chiropractic manipulative therapy was not an option due to patient apprehension. A reduction of symptoms was reported with certain spinal movements. This made the patient a candidate for the use of spinal loading strategies as described by McKenzie. The application of McKenzie cervical therapy resulted in improved symptoms and function in this individual. The McKenzie protocol, and its use in the management of neck pain, is discussed. ImagesFigure 1Figure 2Figure 3

Rathore, Sundeep

2003-01-01

329

Impulse control disorders in psychiatric inpatients.  

PubMed

The aim of this study was to examine the prevalence of impulse control disorders (ICDs) in a European psychiatric inpatient sample. Two hundred thirty four consecutive psychiatric inpatients (62% female) were examined using a module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) that has been developed for ICDs (SCID-ICD). In addition to intermittent explosive disorder, pyromania, kleptomania, pathological gambling, and trichotillomania, the proposed ICDs not otherwise specified were assessed, including compulsive buying, nonparaphilic compulsive sexual behavior, pathological internet use, and pathological skin picking. Based on the SCID-ICD, a lifetime ICD rate of 23.5% and a current ICD rate of 18.8% were found. The most frequent ICDs were pathological skin picking (lifetime 7.3%, current 6.8%), compulsive buying (lifetime 6.8%, current 6.0%), and intermittent explosive disorder (lifetime 5.6%, current 3.4%). In contrast, referring to admission diagnoses taken from patients' charts only 3.8% of the inpatients were diagnosed with any current ICD. Individuals with comorbid ICD were significantly younger and had more admission diagnoses other than ICD. The results suggest high rates of ICDs among psychiatric inpatients that remain to be under-diagnosed in clinical routine. PMID:21546096

Müller, Astrid; Rein, Katharina; Kollei, Ines; Jacobi, Andrea; Rotter, Andrea; Schütz, Patricia; Hillemacher, Thomas; de Zwaan, Martina

2011-05-05

330

Patterns of decline among inpatient procedures.  

PubMed Central

This paper explores how the new financial incentives and organizational structures that prevail in the hospital industry have affected the mix of services provided by hospitals. Using data from the Agency for Health Care Policy and Research's Healthcare Cost and Utilization Project, the authors studied the 150 procedures that were most frequently performed on inpatients in 1980. They found that (a) 37 of the 150 procedures declined in use more than 40 percent by 1987, (b) patients that continued to receive one of the 37 procedures in 1987 on an inpatient basis tended to be more severely ill than in 1980, and (c) rates of decline were disproportionately large for Medicaid recipients. Three main factors have contributed to the decline in inpatient use of these procedures. Most important has been the shift from inpatient to outpatient settings, a result of new technologies and pressures from reimbursement mechanisms and utilization review policies. Some procedures have been replaced by less invasive, more effective approaches. Other procedures are now considered ineffective by the medical community and have been largely abandoned as a result. Images p674-a p675-a p676-a p679-a p681-a

Duffy, S Q; Farley, D E

1995-01-01

331

Inpatient pulmonary rehabilitation: does it make sense?  

Microsoft Academic Search

Among the nonpharmacological therapies, pulmonary rehabilitation (PR) is particularly appropriate for patients with chronic respiratory impairment who, despite any optimal drug management, are still symptomatic and experience restriction in every day activities. Pulmonary rehabilitation performed in inpatient, outpatient, or home settings demonstrates short–and long–term clinical efficacy. Although disease severity does not inherently dictate candidacy for exercise training, the degree of

E. M. Clini; M. Romagnoli

2005-01-01

332

A comparison of inpatient and outpatient ASCT  

Microsoft Academic Search

Outpatient high-dose chemotherapy and autologous stem cell transplantation (ASCT) has been shown to be feasible in terms of physical morbidity and mortality outcomes, but few data exist on the psychosocial impact of delivering such aggressive therapy in this manner. The purpose of this observational study was to compare effects of inpatient (n = 20) and outpatient (n = 21) modes

N Summers; U Dawe; DA Stewart

2000-01-01

333

Factors determining inpatient satisfaction with care  

Microsoft Academic Search

The objective of the study was to identify factors associated with satisfaction among inpatients receiving medical and surgical care for cardiovascular, respiratory, urinary and locomotor system diseases.Two weeks after discharge, 533 patients completed a Patient Judgments Hospital Quality questionnaire covering seven dimensions of satisfaction (admission, nursing and daily care, medical care, information, hospital environment and ancillary staff, overall quality of

Phi Linh Nguyen Thi; S. Briancon; F. Empereur; F. Guillemin

2002-01-01

334

Confirmatory factor analysis of the antisocial process screening device with a clinical inpatient population.  

PubMed

Research linking psychopathic tendencies to childhood behavior problems is predicated on the assumption that the findings are based on using psychometrically sound measures of psychopathic tendencies. Although evaluated with community samples, the psychometric properties of such measures have not been evaluated with inpatient clinical populations thereby limiting conclusions. Hence, the goal of the present study was to evaluate the factor structure of a widely used measure-the Antisocial Process Screening Device (APSD)-with an inpatient population. Parents of 328 children (M age = 8.90 years) completed the APSD at the time of their child's admission for treatment. Although confirmatory factor analyses supported the three- and two-factor solutions proposed by the authors of the measure, the two-factor structure was more parsimonious. Factors of the two-factor model were also related to symptoms of childhood behavior disorders. The findings extend current research on the APSD's factor structure to an inpatient population. PMID:18577599

Fite, Paul J; Greening, Leilani; Stoppelbein, Laura; Fabiano, Gregory A

2008-06-24

335

Multimodal Assessment of Dissociation in Adolescents: Inpatients and Juvenile Sex Offenders  

Microsoft Academic Search

Two samples of adolescents were studied to assess the validity of several measures of dissociation. The first sample included 70 males from a residential treatment program for adolescent sex offenders (ASO). The second were 47 psychiatric inpatients. The measures included the DSM-IV field trial questionnaire for Dissociative Disorders of Childhood, Child Dissociative Checklist, Adolescent-Dissociative Experiences Schedule, Trauma Symptom Checklist for

William N. Friedrich; Paul N. Gerber; Brett Koplin; Marlene Davis; Jeff Giese; Charlene Mykelbust; Dennis Franckowiak

2001-01-01

336

Treating Inpatients with Comorbid Depression and Alcohol Use Disorders: A Comparison of Acceptance and Commitment Therapy  

ERIC Educational Resources Information Center

|Inpatients involuntarily committed to a chemical dependency unit and exhibiting a co-occurring depressive disorder received either individual sessions of acceptance and commitment therapy (ACT) or treatment as usual (TAU) within the context of an ongoing 12-step program. Results indicated significant, but equivalent, reductions in levels of…

Petersen, Connie L.; Zettle, Robert D.

2009-01-01

337

Differing Levels of Superstitious Beliefs among Three Groups: Psychiatric Inpatients, Churchgoers, and Students.  

ERIC Educational Resources Information Center

This study investigated the level of superstitious belief among 175 persons in three categories: persons undergoing inpatient psychiatric treatment, churchgoers, and college students. A 50-item inventory consisting of positive and negative common superstitions, including a 5-item invalidity subscale, was administered. Using a 2 (male, female) x 3…

Robinson, Sheryl L.

338

Predicting Specialty Psychiatric Inpatient Care in General Hospitals: Agreement Between Two Independent Methods  

Microsoft Academic Search

In a follow up to previous work (Kiesler, Simpkins, & Morton, 1989), we predicted where in a general hospital a psychiatric patient would be treated: psychiatric unit, chemical dependency unit, or scatter bed. Independent a priori clinical assumptions and multiple-discriminant function predictions were compared for 5,033 patients receiving psychiatric inpatient treatment in general hospitals with specialized units in the 1980

Charles A. Kiesler; Celeste G. Simpkins; Teru L. Morton

1991-01-01

339

Does readiness to change predict subsequent alcohol consumption in medical inpatients with unhealthy alcohol use?  

Microsoft Academic Search

We studied whether readiness to change predicts alcohol consumption (drinks per day) 3 months later in 267 medical inpatients with unhealthy alcohol use. We used 3 readiness to change measures: a 1 to 10 visual analog scale (VAS) and two factors of the Stages of Change Readiness and Treatment Eagerness Scale: Perception of Problems (PP) and Taking Action (TA). Subjects with

Nicolas Bertholet; Debbie M. Cheng; Tibor P. Palfai; Jeffrey H. Samet; Richard Saitz

2009-01-01

340

Dialectical Behavior Therapy for Suicidal Adolescent InpatientsA Case Study  

Microsoft Academic Search

Dialectical behavior therapy (DBT) is an empirically supported treatment for chronically parasuicidal adult women with borderline personality disorder. It has recently been modified for use with other psychiatric disorders and populations. In this article, the authors briefly review the theoretical and research basis for the use of DBT with parasuicidal adolescent inpatients, and a case study is presented. The case

Laurence Y. Katz; Brian J. Cox

2002-01-01

341

Comparative Efficacy of Spirituality, Cognitive, and Emotional Support Groups for Treating Eating Disorder Inpatients  

Microsoft Academic Search

Spiritual interventions are rarely used in contemporary treatment programs and little empirical evidence is available concerning their effectiveness. The purpose of the present study was to evaluate the effectiveness of a spiritual group intervention for eating disorder inpatients. We compared the effectiveness of a Spirituality group with Cognitive and Emotional Support groups using a randomized, control group design. Participants were

P. Scott Richards; Michael E. Berrett; Randy K. Hardman; Dennis L. Eggett

2006-01-01

342

Inpatients' expectations and experiences of hospital pharmacy services: qualitative study.  

PubMed

INTRODUCTION: Hospital pharmacists' have traditionally focused on the manufacture and supply of medicines. However, the increasing complexity and range of medicines and a greater awareness of medication errors has facilitated a change towards a patient-centred role. Given this movement, it is surprising that a search of the published literature shows very little research that evaluated patients' views of hospital-based pharmacy services. OBJECTIVE: To explore inpatients' expectations and experiences of hospital-based pharmacy services. STUDY SETTING AND DESIGN: Face-to-face semi-structured interviews with inpatients admitted to acute medical wards of three NHS general hospitals. PRINCIPAL FINDINGS: Seventy-four inpatients were interviewed: 37 were male with average age 73 years (age range of 19 -86 years). The predominate number of participants (62/74, 84%) being in the 65-80 years of age group. Thematic analysis of the data was driven by three themes; patients' expectations of the pharmacist's involvement in their treatment and care, the patients' experiences of any interaction that may have taken place and the patients' evaluation of their interaction with the pharmacist. CONCLUSIONS: There was a dichotomy of expectations and opinions from patients about the role of hospital pharmacists and the services being provided. As pharmacists' roles are developing towards a patient-orientated model in which pharmacists have direct contact with patients and their care, it is important to ensure that patients are aware of these developments to help them maximize the benefit they derive from their country's health-care system. PMID:23647781

Morecroft, Charles W; Thornton, David; Caldwell, Neil A

2013-05-01

343

The ACCESS study a Zelen randomised controlled trial of a treatment package including problem solving therapy compared to treatment as usual in people who present to hospital after self-harm: study protocol for a randomised controlled trial  

Microsoft Academic Search

Background  People who present to hospital after intentionally harming themselves pose a common and important problem. Previous reviews\\u000a of interventions have been inconclusive as existing trials have been under powered and done on unrepresentative populations.\\u000a These reviews have however indicated that problem solving therapy and regular written communications after the self-harm attempt\\u000a may be an effective treatment. This protocol describes a

Simon Hatcher; Cynthia Sharon; Allan House; Sunny Collings; Varsha Parag; Nicola Collins

2011-01-01

344

Two years experience with quality assurance protocol for patient related Rapid Arc treatment plan verification using a two dimensional ionization chamber array  

PubMed Central

Purpose To verify the dose distribution and number of monitor units (MU) for dynamic treatment techniques like volumetric modulated single arc radiation therapy - Rapid Arc - each patient treatment plan has to be verified prior to the first treatment. The purpose of this study was to develop a patient related treatment plan verification protocol using a two dimensional ionization chamber array (MatriXX, IBA, Schwarzenbruck, Germany). Method Measurements were done to determine the dependence between response of 2D ionization chamber array, beam direction, and field size. Also the reproducibility of the measurements was checked. For the patient related verifications the original patient Rapid Arc treatment plan was projected on CT dataset of the MatriXX and the dose distribution was calculated. After irradiation of the Rapid Arc verification plans measured and calculated 2D dose distributions were compared using the gamma evaluation method implemented in the measuring software OmniPro (version 1.5, IBA, Schwarzenbruck, Germany). Results The dependence between response of 2D ionization chamber array, field size and beam direction has shown a passing rate of 99% for field sizes between 7 cm × 7 cm and 24 cm × 24 cm for measurements of single arc. For smaller and larger field sizes than 7 cm × 7 cm and 24 cm × 24 cm the passing rate was less than 99%. The reproducibility was within a passing rate of 99% and 100%. The accuracy of the whole process including the uncertainty of the measuring system, treatment planning system, linear accelerator and isocentric laser system in the treatment room was acceptable for treatment plan verification using gamma criteria of 3% and 3 mm, 2D global gamma index. Conclusion It was possible to verify the 2D dose distribution and MU of Rapid Arc treatment plans using the MatriXX. The use of the MatriXX for Rapid Arc treatment plan verification in clinical routine is reasonable. The passing rate should be 99% than the verification protocol is able to detect clinically significant errors.

2011-01-01

345

Recommendations for Pharmacological Management of Inpatient Aggression in Children and Adolescents  

PubMed Central

Objective. While there has been a great deal of speculation by clinical researchers over the last three decades on effective and safe methods for the pharmacological management of aggression in children and adolescents, it is only in the last decade that there have been well-designed studies available to address this issue. Medication is commonly used to control aggression in children and adolescents in inpatient units. Also, there exists a need for evidence-based guidelines for the use of these different pharmacological agents for managing pediatric aggression on inpatient units. The aims of this article are to provide a systemic review and to provide treatment guidelines based on these limited but currently available studies. Methods. The articles reviewed in this study were obtained through a PubMed search using the key words ‘children,’ ‘adolescents,’ ‘aggression,’ ‘inpatient,’ ‘ziprasidone,’ ‘lithium,’ and ‘risperidone.’ A total of 499 studies were generated. Only studies focusing on pharmacological management of inpatient pediatric aggression with mean duration less than six weeks and published during January 1980 to August 2009 were included. Only English articles were considered. A total of 13 studies met these criteria, which were included in the review without any further statistical analysis. Recommendations are made on this available evidenced-based literature. Results. There is some evidence for the standing use of oral lithium, haloperidol, olanzapine, and risperidone for aggression related to specific psychiatric diagnoses. Intramuscular ziprasidone and olanzapine administered as needed were found to be effective for the rapid management of moderate to severe aggression. Oral or intramuscular diphenhydramine administered as needed was found to be useful for managing mild aggression due to a placebo effect. Conclusions. Studies are available on managing aggression in children and adolescents in inpatient treatment settings but are limited. Further studies on the use of various psychotropic medications are needed in order to develop comprehensive guidelines for the safe and effective pharmacological management of child and adolescent inpatient aggression.

Kulkarni, Guarav; Barzman, Drew

2010-01-01

346

Training parents to implement pediatric feeding protocols  

Microsoft Academic Search

Four different multicomponent training packages were evaluated to increase the treatment integrity of parents implementing pediatric feeding protocols. In Study 1 we exposed 3 parents to a training package that consisted of written protocols (baseline), verbal instruc- tions, therapist modeling, and rehearsal training. Results suggested that the package was successful in increasing treatment integrity of the feeding protocols to high

MICHAEL M. MUELLER; Cathleen C Piazza; James W Moore; MICHAEL E. KELLEY; STEPHANIE A. BETHKE; A NGELA E. PRUETT; AMANDA J. OBERDORFF; STACY A. LAYER

2003-01-01

347

An in-patient model for positive airway pressure desensitization: a report of 2 pediatric cases.  

PubMed

Application of positive airway pressure is frequently indicated in pediatric patients with a diagnosis of obstructive sleep apnea. Adherence to equipment use is often less than optimal and can be more challenging when working with children with special needs. An in-patient protocol was designed utilizing various techniques and strategies from the medical adherence literature and applied to 2 cases. This protocol utilizes specialists from various disciplines, including respiratory therapists, psychologists, physicians, nurses, and child life therapists, as well as parental involvement. This paper outlines this protocol using 2 case studies. Both patients successfully used their equipment for greater than 4 hours at night by the end of their hospital stay of 4 days and maintained or advanced these gains at follow-up. These 2 cases suggest that more research should be conducted to further evaluate the effectiveness of similar programs. PMID:22152821

Harford, Kelli-Lee; Jambhekar, Supriya; Com, Gulnur; Bylander, Lisa; Pruss, Kristi; Teagle, Jana; Ward, Wendy

2011-12-06

348

Assertive Community Treatment (ACT)  

MedlinePLUS

... community treatment? Assertive community treatment (ACT) is a model of psychiatric care that can be very effective ... it the most. Similar to the “treatment team” model of an inpatient psychiatric unit, which includes nurses, ...

349

Predictors of remission in depression to individual and combined treatments (PReDICT): study protocol for a randomized controlled trial  

PubMed Central

Background Limited controlled data exist to guide treatment choices for clinicians caring for patients with major depressive disorder (MDD). Although many putative predictors of treatment response have been reported, most were identified through retrospective analyses of existing datasets and very few have been replicated in a manner that can impact clinical practice. One major confound in previous studies examining predictors of treatment response is the patient’s treatment history, which may affect both the predictor of interest and treatment outcomes. Moreover, prior treatment history provides an important source of selection bias, thereby limiting generalizability. Consequently, we initiated a randomized clinical trial designed to identify factors that moderate response to three treatments for MDD among patients never treated previously for the condition. Methods/design Treatment-naïve adults aged 18 to 65?years with moderate-to-severe, non-psychotic MDD are randomized equally to one of three 12-week treatment arms: (1) cognitive behavior therapy (CBT, 16 sessions); (2) duloxetine (30–60?mg/d); or (3) escitalopram (10–20?mg/d). Prior to randomization, patients undergo multiple assessments, including resting state functional magnetic resonance imaging (fMRI), immune markers, DNA and gene expression products, and dexamethasone-corticotropin-releasing hormone (Dex/CRH) testing. Prior to or shortly after randomization, patients also complete a comprehensive personality assessment. Repeat assessment of the biological measures (fMRI, immune markers, and gene expression products) occurs at an early time-point in treatment, and upon completion of 12-week treatment, when a second Dex/CRH test is also conducted. Patients remitting by the end of this acute treatment phase are then eligible to enter a 21-month follow-up phase, with quarterly visits to monitor for recurrence. Non-remitters are offered augmentation treatment for a second 12-week course of treatment, during which they receive a combination of CBT and antidepressant medication. Predictors of the primary outcome, remission, will be identified for overall and treatment-specific effects, and a statistical model incorporating multiple predictors will be developed to predict outcomes. Discussion The PReDICT study’s evaluation of biological, psychological, and clinical factors that may differentially impact treatment outcomes represents a sizeable step toward developing personalized treatments for MDD. Identified predictors should help guide the selection of initial treatments, and identify those patients most vulnerable to recurrence, who thus warrant maintenance or combination treatments to achieve and maintain wellness. Trial registration Clinicaltrials.gov Identifier: NCT00360399. Registered 02 AUG 2006. First patient randomized 09 FEB 2007.

2012-01-01

350

Efficacy of customised foot orthoses in the treatment of Achilles tendinopathy: study protocol for a randomised trial  

Microsoft Academic Search

BACKGROUND: Achilles tendinopathy is a common condition that can cause marked pain and disability. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. The exception to this is eccentric calf muscle exercises, which have become a standard non-surgical intervention for Achilles tendinopathy. Foot orthoses have

Shannon E Munteanu; Karl B Landorf; Hylton B Menz; Jill L Cook; Tania Pizzari; Lisa A Scott

2009-01-01

351

International Study to Predict Optimized Treatment for Depression (iSPOT-D), a randomized clinical trial: rationale and protocol  

Microsoft Academic Search

BACKGROUND: Clinically useful treatment moderators of Major Depressive Disorder (MDD) have not yet been identified, though some baseline predictors of treatment outcome have been proposed. The aim of iSPOT-D is to identify pretreatment measures that predict or moderate MDD treatment response or remission to escitalopram, sertraline or venlafaxine; and develop a model that incorporates multiple predictors and moderators. METHODS\\/DESIGN: The

Leanne M Williams; A John Rush; Stephen H Koslow; Stephen R Wisniewski; Nicholas J Cooper; Charles B Nemeroff; Alan F Schatzberg; Evian Gordon

2011-01-01

352

Reducing the duration between gonadotropin-releasing hormone (GnRH) and prostaglandin F?? treatment in the Ovsynch protocol to 6 days improved ovulation to second GnRH treatment, but inclined to reduce fertility.  

PubMed

The aim of this study was to test Ovsynch (OVS) versus modified OVS (decreasing the interval between first GnRH and PGF2? to 6d) protocols on pregnancy per artificial insemination (AI) and OVS outcomes in cyclic dairy cows. Cyclic cows (n=920) were assigned to 1 of 2 groups: the OVS7 group (n=459) received the OVS protocol [GnRH treatment, PGF2? treatment 7d later, a second GnRH (GnRH2) treatment 56 h later, and timed AI (TAI) 16 to 18 h after the GnRH2 treatment], and the OVS6 group (n=461) received a modified OVS protocol, in which the interval between the first GnRH and PGF2? was decreased to 6d (GnRH treatment, PGF2? treatment 6d later, GnRH2 treatment 56 h later, and TAI 16 to 18h after the GnRH2 treatment). The response to the first GnRH of OVS was similar between OVS7 (54.5%, 250/459) and OVS6 (54.2%, 250/461) groups. The ovulatory response to GnRH2 of OVS was higher in OVS6 (91.3%, 421/461) than OVS7 (84.5%, 388/459). The follicle size (mean ± standard error of the mean) at the time of TAI was smaller in OVS6 (15.23 ± 0.11 mm) than OVS7 (16.04 ± 0.11 mm). When all cows were evaluated, the pregnancy per AI at 31 d tended to be lower in OVS6 (38.0%, 175/461) than in OVS7 (43.8%, 201/459). Moreover, the pregnancy per AI at 31 d was lower in OVS6 (40.9%, 172/421) compared with OVS7 (50.3%, 195/388) in synchronized cows. In conclusion, although the modified OVS protocol decreased the follicle size at the time of AI and increased the ovulatory response to GnRH2 of OVS, it unexpectedly reduced fertility in cyclic lactating dairy cows. PMID:23567055

Yilmazbas-Mecitoglu, G; Karakaya, E; Keskin, A; Alkan, A; Gumen, A

2013-04-05

353

A treatment protocol for restoring occlusal vertical dimension using an overlay removable partial denture as an alternative to extensive fixed restorations: a clinical report.  

PubMed

Treatment options for patients with severe attrition resulting in reduced occlusal vertical dimension are often limited to fixed prosthesis to reestablish proper occlusal vertical dimension and functional occlusion. In some cases such as when there are limited finances, minimal esthetic concerns, and medical considerations fixed prosthesis may not be the ideal treatment option. Overlay removable partial dentures (ORPDs) can be used as a provisional or interim prosthesis as well as permanent prosthesis in these cases. While ORPDs can provide a reversible and relatively inexpensive treatment for patients with a significantly compromised dental status, there is not much scientific evidence in the literature on ORPDs. Most studies published on ORPDs to date are primarily reviews and clinical reports. In this article, literatures on ORPDs are summarized and a patient treated with interim and permanent ORPDs is presented. This article reviews previously published literatures on the use of ORPDs. Indications, advantages and disadvantages are discussed. Treatment protocol with an example of the prosthodontic treatment of a patient with severely worn dentition with an interim ORPD and later a permanent ORPD are discussed in details. PMID:19915723

Patel, Mit B; Bencharit, Sompop

2009-10-30

354

The study protocol of the Norwegian randomized controlled trial of electroconvulsive therapy in treatment resistant depression in bipolar disorder  

Microsoft Academic Search

BACKGROUND: The treatment of depressive phases of bipolar disorder is challenging. The effects of the commonly used antidepressants in bipolar depression are questionable. Electroconvulsive therapy is generally considered to be the most effective treatment even if there are no randomized controlled trials of electroconvulsive therapy in bipolar depression. The safety of electroconvulsive therapy is well documented, but there are some

Ute Kessler; Arne E Vaaler; Helle Schøyen; Ketil J Oedegaard; Per Bergsholm; Ole A Andreassen; Ulrik F Malt; Gunnar Morken

2010-01-01

355

Profile of compulsive gamblers in treatment: Update and comparisons  

Microsoft Academic Search

Previous empirical studies of pathological gamblers have reported on members of self-help groups or on inpatient populations of Veterans Administration Hospitals (VA). The current study profiles demographic, gambling, and psychosocial characteristics for 186 pathological gamblers (172 male, 14 female) admitted for inpatient treatment at Taylor Manor Hospital, a private psychiatric hospital. Inpatient gamblers in treatment are relatively young, mostly employed,

Joseph Ciarrocchi; Richard Richardson

1989-01-01

356

Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey  

PubMed Central

Background Suicide prevention by mental health services requires an awareness of the antecedents of suicide amongst high risk groups such as psychiatric in-patients. The goal of this study was to describe the social and clinical characteristics of people who had absconded from an in-patient psychiatric ward prior to suicide, including aspects of the clinical care they received. Methods We carried out a national clinical survey based on a 10-year (1997-2006) sample of people in England and Wales who had died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death. Results There were 1,851 cases of suicide by current psychiatric in-patients, 14% of all patient suicides. 1,292 (70%) occurred off the ward. Four hundred and sixty-nine of these patients died after absconding from the ward, representing 25% of all in-patient suicides and 38% of those that occurred off the ward. Absconding suicides were characterised by being young, unemployed and homeless compared to those who were off the ward with staff agreement. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were proportionally more likely than in-patients on agreed leave to have been legally detained for treatment, non-compliant with medication, and to have died in the first week of admission. Whilst absconding patients were significantly more likely to have been under a high level of observation, clinicians reported more problems in observation due to either the ward design or other patients on the ward. Conclusion Measures that may prevent absconding and subsequent suicide amongst in-patients might include tighter control of ward exits, and more intensive observation of patients, particularly in the early days of admission. Improving the ward environment to provide a supportive and less intimidating experience may contribute to reduced risk.

2010-01-01

357

Transcutaneous vagus nerve stimulation for the treatment of depression: a study protocol for a double blinded randomized clinical trial  

PubMed Central

Background Depressive disorders are the most common form of mental disorders in community and health care settings. Unfortunately, the treatment of Major Depressive Disorder (MDD) is far from satisfactory. Vagus nerve stimulation (VNS) is a relatively new and promising physical treatment for depressive disorders. One particularly appealing element of VNS is the long-term benefit in mood regulation. However, because this intervention involves surgery, perioperative risks, and potentially significant side effects, this treatment has been limited to those patients with treatment-resistant depression who have failed medication trials and exhausted established somatic treatments for major depression, due to intolerance or lack of response. This double-blinded randomized clinical trial aims to overcome these limitations by introducing a novel method of stimulating superficial branches of the vagus nerve on the ear to treat MDD. The rationale is that direct stimulation of the afferent nerve fibers on the ear area with afferent vagus nerve distribution should produce a similar effect as classic VNS in reducing depressive symptoms without the burden of surgical intervention. Design One hundred twenty cases (60 males) of volunteer patients with mild and moderate depression will be randomly divided into transcutaneous vagus nerve stimulation group (tVNS) and sham tVNS group. The treatment period lasts 4 months and all clinical and physiological measurements are acquired at the beginning and the end of the treatment period. Discussion This study has the potential to significantly extend the application of VNS treatment for MDD and other disorders (including epilepsy, bipolar disorder, and morbid obesity), resulting in direct benefit to the patients suffering from these highly prevalent disorders. In addition, the results of this double-blinded clinical trial will shed new light on our understanding of acupuncture point specificity, and development of methodologies in clinical trials of acupuncture treatment. Trials registration Clinical Trials. ChiCTR-TRC-11001201 http://www.chictr.org/cn/

2012-01-01

358

Discharge planning strategies for acutely homeless inpatients.  

PubMed

Medical and psychiatric inpatients who become unexpectedly homeless during the course of the hospital stay present an extremely complex and time-consuming challenge to social work staff. The sudden shift from domiciled to undomiciled status creates a crisis for both the patient and the institution. Unanticipated homelessness among inpatients is usually associated with multiple high-risk factors which contribute to the rejection of such patients by numerous community facilities and services. Social workers are under pressure to both effect a timely and safe discharge when acute care ends, and to avoid placing such persons in the shelter system where follow-up care is nonexistent or inadequate. This paper reviews characteristics of persons who become acutely homeless during a hospital admission and suggests approaches which may be used to identify and prevent this perplexing syndrome. PMID:2781442

Christ, W R; Hayden, S L

1989-01-01

359

Study design to examine the potential role of assessment reactivity in the Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED) protocol  

PubMed Central

Background Screening, brief intervention, and referral to treatment (SBIRT) approaches to reducing hazardous alcohol and illicit drug use have been assessed in a variety of health care settings, including primary care, trauma centers, and emergency departments. A major methodological concern in these trials, however, is “assessment reactivity,” the hypothesized impact of intensive research assessments to reduce alcohol and drug use and thus mask the purported efficacy of the interventions under scrutiny. Thus, it has been recommended that prospective research designs take assessment reactivity into account. The present article describes the design of the National Institute on Drug Abuse Clinical Trials Network protocol, Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED), which addresses the potential bias of assessment reactivity. Methods/design The protocol employs a 3-arm design. Following an initial brief screening, individuals identified as positive cases are consented, asked to provide demographic and locator information, and randomly assigned to one of the three conditions: minimal screening only, screening?+?assessment, or screening?+?assessment?+?brief intervention. In a two-stage process, the randomization procedure first reveals whether or not the participant will be in the minimal-screening-only condition. Participants in the other two groups receive a more extensive baseline assessment before it is revealed whether they have been randomized to also receive a brief intervention. Comparing the screening only and screening?+?assessment conditions will allow determination of the incremental effect of assessment reactivity. Discussion Assessment reactivity is a potential source of bias that may reduce and/or lead to an underestimation of the purported effectiveness of brief interventions. From a methodological perspective, it needs to be accounted for in research designs. The SMART-ED design offers an approach to minimize assessment reactivity as a potential source of bias. Elucidating the role of assessment reactivity may offer insights into the mechanisms underlying SBIRT as well as suggest clinical options incorporating assessment reactivity as a treatment adjunct. ClinicalTrials.gov Identifier NCT01207791.

2012-01-01

360

Qualify of Life of Forensic Psychiatric Inpatients  

Microsoft Academic Search

In this article, the quality of life (QoL) of mentally disordered offenders was investigated. The data of 44 forensic psychiatric inpatients were analyzed using the Lancashire Quality of Life Profile (LQoLP), Rehabilitation Evaluation Hall and Baker (REHAB), and the Psychopathy Checklist-Revised (PCL-R). Outcome on the LQoLP was compared with data of hospitalized male psychiatric patients. Results show that the QoL

Chijs van Nieuwenhuizen; Henk Nijman

2009-01-01

361

Normative pediatric visual acuity using single surrounded HOTV optotypes on the electronic visual acuity tester following the amblyopia treatment study protocol  

PubMed Central

Purpose To provide normative pediatric visual acuity data using HOTV optotypes presented on the Electronic Visual Acuity Tester following the Amblyopia Treatment Study (ATS) protocol. Methods Monocular testing was conducted on 384 healthy full-term children ranging from 3 to 10 years of age (mean, 5.4 years; SD = 1.8 years). A total of 373 children completed monocular testing of each eye. In addition, 23 adults (mean, 28.7 years; SD = 4.9 years) were tested for comparison. Both monocular visual acuity and interocular acuity differences were recorded. Results Mean visual acuity improved by slightly more than one line (0.12 logMAR) from 3 years of age to adulthood, increasing from 0.08 logMAR to ?0.04 logMAR (F6,400 = 26.3, p < 2.0 × 10?26). At all ages, mean interocular acuity difference was less than one line on a standard acuity chart (overall mean difference = 0.04 logMAR; SD = 0.06 logMAR). Conclusions These results represent the first normative data reported for HOTV optotypes using the ATS protocol on the Electronic Visual Acuity Tester. These data may play an important role in clinical practice, screening, and clinical research.

Drover, James R.; Felius, Joost; Cheng, Christina S.; Morale, Sarah E.; Wyatt, Lauren; Birch, Eileen E.

2008-01-01

362

The impact of unstructured games of fantasy and role playing on an inpatient unit for adolescents.  

PubMed

Games of fantasy and role playing such as Dungeons and Dragons (1983) have become increasingly popular among adolescents and young adults. This article reviews the negative impact of such games on an adolescent inpatient treatment setting. The unrestricted play of such games contributed to the disruption of a treatment setting, resistances to treatment, reinforcement of character pathology, disruption of individual treatments, and to the normalization of violence. When such games begin to be played on a psychiatric inpatient unit or are prominent in discussions of individual patients, treaters should examine them in the context of their potential to reinforce and foster resistance and maladaptive patterns of relating to the environment. Treaters are also encouraged to attempt to understand the meaning and risks of such games in the context of an individual patient's psychiatric difficulties and of group dynamics, both within the patient group and between patients and treaters. PMID:8349395

Ascherman, L I

1993-07-01

363

Collaborative Assessment and Management of Suicidality in an Inpatient Setting: Results of a Pilot Study  

PubMed Central

Patients hospitalized for psychiatric reasons exhibit significantly elevated risk of suicide, yet the research literature contains very few outcome studies of interventions designed for suicidal inpatients. This pilot study examined the inpatient feasibility and effectiveness of The Collaborative Assessment and Management of Suicidality (CAMS), a structured evidence-based method for risk assessment and treatment planning (Jobes, 2006). The study used an open-trial, case-focused design to assess an inpatient adaptation of CAMS, spread over a period averaging 51 days. The intervention was provided via individual therapy to a convenience sample of 20 patients (16 females and four males, average age 36.9) who were hospitalized with recent histories of suicidal ideation and behavior. Results showed statistically and clinically significant reductions in depression, hopelessness, suicide cognitions, and suicidal ideation, as well as improvement on factors considered “drivers” of suicidality. Treatment effect sizes were in the large range (Cohen’s d > .80) across several outcome measures, including suicidal ideation. Although these findings must be considered preliminary due to the lack of a randomized control group, they merit attention from clinicians working with patients at risk for suicide. This study also supports the feasibility of implementing a structured, suicide-specific intervention for at-risk patients in inpatient settings.

Ellis, Thomas E.; Green, Kelly L.; Allen, Jon G.; Jobes, David A.; Nadorff, Michael R.

2013-01-01

364

Periodontal treatment to improve glycaemic control in diabetic patients: study protocol of the randomized, controlled DIAPERIO trial  

PubMed Central

Background Periodontitis is a common, chronic inflammatory disease caused by gram-negative bacteria leading to destruction of tissues supporting the teeth. Epidemiological studies have consistently shown increased frequency, extent and severity of periodontitis among diabetic adults. More recently, some controlled clinical trials have also suggested that periodontal treatment could improve glycaemic control in diabetic patients. However current evidence does not provide sufficient information on which to confidently base any clinical recommendations. The main objective of this clinical trial is to assess whether periodontal treatment could lead to a decrease in glycated haemoglobin levels in metabolically unbalanced diabetic patients suffering from chronic periodontitis. Methods The DIAPERIO trial is an open-label, 13-week follow-up, randomized, controlled trial. The total target sample size is planned at 150 participants, with a balanced (1:1) treatment allocation (immediate treatment vs delayed treatment). Periodontal treatment will include full mouth non-surgical scaling and root planing, systemic antibiotherapy, local antiseptics (chlorhexidine 0.12%) and oral health instructions. The primary outcome will be the difference in change of HbA1c between the two groups after the 13-weeks' follow-up. Secondary outcomes will be the difference in change of fructosamine levels and quality of life between the two groups. Discussion The DIAPERIO trial will provide insight into the question of whether periodontal treatment could lead to an improvement in glycaemic control in metabolically unbalanced diabetic patients suffering from periodontitis. The results of this trial will help to provide evidence-based recommendations for clinicians and a draft framework for designing national health policies. Trial registration Current Controlled Trials ISRCTN15334496

Vergnes, Jean-Noel; Arrive, Elise; Gourdy, Pierre; Hanaire, Helene; Rigalleau, Vincent; Gin, Henri; Sedarat, Cyril; Dorignac, Georges; Bou, Christophe; Sixou, Michel; Nabet, Cathy

2009-01-01

365

Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol  

PubMed Central

Background Hip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function. Methods The trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS) and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline. Conclusions The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA. Trial Registration Australian New Zealand Clinical Trials Registry reference: ACTRN12610000439044

2010-01-01

366

The Relative Efficacy and Treatment Distress of EMDR and a Cognitive-Behavior Trauma Treatment Protocol in the Amelioration of Posttraumatic Stress Disorder  

Microsoft Academic Search

The growing body of research into treatment efficacy with Posttraumatic Stress Disorder (PTSD) has, by-and-large, been limited to evaluating treatment components or comparing a specific treatment against wait-list controls. This has led to two forms of treatment, Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavior Therapy (CBT), vying for supremacy without a controlled study actually comparing them. The present research

Grant J. Devilly; Susan H. Spence

1999-01-01

367

Improvement in cognitive and psychosocial functioning and self image among adolescent inpatient suicide attempters  

Microsoft Academic Search

BACKGROUND: Psychiatric treatment of suicidal youths is often difficult and non-compliance in treatment is a significant problem. This prospective study compared characteristics and changes in cognitive functioning, self image and psychosocial functioning among 13 to 18 year-old adolescent psychiatric inpatients with suicide attempts (n = 16) and with no suicidality (n = 39) METHODS: The two-group pre-post test prospective study

Ulla Hintikka; Mauri Marttunen; Mirjami Pelkonen; Eila Laukkanen; Heimo Viinamäki; Johannes Lehtonen

2006-01-01

368

Treatment of traumatized refugees with Sertraline versus Venlafaxine in combination with psychotherapy - study protocol for a randomized clinical trial  

PubMed Central

Background Sufficient evidence is lacking to draw final conclusions on the efficiency of medical and psychological treatments of traumatized refugees with PTSD. The pharmacological treatments of choice today for post-traumatic stress disorder are antidepressants from the subgroup selective serotonin reuptake inhibitors, especially Sertraline. The evidence for the use of selective serotonin reuptake inhibitors in the treatment of complex post-traumatic stress disorder in traumatized refugees is very limited. Venlafaxine is a dual-action antidepressant that works on several pathways in the brain. It influences areas in the brain which are responsible for the enhanced anxiety and hyper-arousal experienced by traumatized refugees and which some studies have found to be enlarged among patients suffering from post-traumatic stress disorder. Design This study will include approximately 150 patients, randomized into two different groups treated with either Sertraline or Venlafaxine. Patients in both groups will receive the same manual-based cognitive behavioral therapy, which has been especially adapted to this group of patients. The treatment period will be 6 to 7 months. The trial endpoints will be post-traumatic stress disorder and depressive symptoms and social functioning, all measured on validated ratings scales. Furthermore the study will examine the relation between a psycho-social resources and treatment outcome based on 15 different possible outcome predictors. Discussion This study is expected to bring forward new knowledge on treatment and clinical evaluation of traumatized refugees and the results are expected to be used in reference programs and clinical guidelines. Trial registration ClinicalTrials.gov NCT01569685

2013-01-01

369

A myoelectric-controlled virtual hand for the assessment and treatment of phantom limb pain in trans-radial upper extremity amputees: a research protocol.  

PubMed

At least 90% of individuals of limb amputees experience phantom limb pain (PLP). Recent clinical research suggests that providing patients with the mirror image representation of the amputated limb may alleviate PLP. However, mirror therapy cannot be used with bilateral amputees, as visual feedback is dependent on the movement of the intact limb. To overcome this limitation, we designed a novel myoelectric-controlled virtual reality (VR) system for the treatment of phantom limb pain in trans-radial upper extremity amputees. The proposed system allows the patient to directly control the virtual limb by recognizing stump muscle patterns recorded with EMG sensors. The hypothesis behind this strategy is that the VR image of the amputated limb induces better limb imagery than the reflected image of their intact limb and, therefore, is more effective in reducing PLP. A research protocol to test this hypothesis is described. PMID:20543301

Gaggioli, Andrea; Amoresano, Amedeo; Gruppioni, Emanuele; Verni, Gennaro; Riva, Giuseppe

2010-01-01

370

A Randomized Trial of Two Behavioral Interventions to Improve Outcomes Following Inpatient Detoxification for Alcohol Dependence  

PubMed Central

To determine if the addition of a behavioral intervention during alcohol detoxification would facilitate initiation of subsequent care, we randomized 150 detoxification patients to receive: treatment as usual (TAU), a Motivation Enhancement Therapy (MET) intervention, or a Peer-delivered Twelve Step Facilitation (P-TSF) intervention. The main outcome was the initiation of any type of subsequent care (i.e., professional treatment or self-help) within 30 and 90 days of discharge. Other outcomes included: alcohol and drug use, completion of subsequent professional treatment, and readmission for detoxification. The mean age of the participants was 45 years; 65% were men, and 84% were white. At the 30-day follow-up, there was no significant difference among the groups in the rate of initiation of any type of subsequent care (82%, 74%, and 82% respectively, p = 0.617); however, the MET group had significantly more patients initiate subsequent inpatient treatment by the 90-day follow-up compared to the P-TSF group (31% and 61%, p = 0.007) and a greater proportion of MET participants completed subsequent inpatient treatment compared to both TAU and P-TSF. There were no differences in drinking-related outcomes (e.g., number of days before first drink, percent days abstinent) between the groups. We conclude that MET during detoxification may provide additional benefits in terms of initiating and maintaining patients in aftercare inpatient treatment programs.

Blondell, Richard D.; Frydrych, Lynne M.; Jaanimagi, Urmo; Ashrafioun, Lisham; Homish, Gregory G.; Foschio, Elisa M.; Bashaw, Heather L.

2011-01-01

371

Snoring and the role of the GDP: British Society of Dental Sleep Medicine (BSDSM) pre-treatment screening protocol  

Microsoft Academic Search

Snoring is not necessarily a benign condition; it can be linked to the serious condition obstructive sleep apnoea (OSA). In some cases mandibular repositioning devices can be an effective treatment for simple snoring and mild to moderate sleep apnoea, and these devices can be provided by dentists (with appropriate training and in line with Dental Protection Ltd guidelines). Until now,

J. Stradling; R. Dookun

2009-01-01

372

Evaluation of New Preanalysis Sample Treatment Tools and DNA Isolation Protocols To Improve Bacterial Pathogen Detection in Whole Blood  

Microsoft Academic Search

New approaches using molecular technologies are continu- ously being developed to improve the diagnosis of bloodstream infections. A critical issue in the success of the application of molecular methods is the sample treatment and\\/or nucleic acid isolation (2). The low concentration of pathogens and the presence of PCR-inhibitory compounds in blood are important challenges that should be dealt with during

Wendy L. J. Hansen; Cathrien A. Bruggeman; Petra F. G. Wolffs

2009-01-01

373

Diabetes treatment patterns and goal achievement in primary diabetes care (DiaRegis) - study protocol and patient characteristics at baseline  

Microsoft Academic Search

BACKGROUND: Patients with type 2 diabetes are at an increased risk for disease and treatment related complications after the initial approach of oral mono\\/dual antidiabetic therapy has failed. Data from clinical practice with respect to this patient group are however scarce. Therefore we set up a registry in primary care documenting the course and outcomes of this patient group. METHODS:

Peter Bramlage; Christiane Binz; Anselm K Gitt; Michael Krekler; Tanja Plate; Evelin Deeg; Diethelm Tschöpe

2010-01-01

374

Interaction between Extended in-sewer storage and Wastewater Treatment Plant Performance - a protocol to avoid problems  

Microsoft Academic Search

Recent legislation (UK and European) has compelled many sewer system operators to retain more flow and load within sewer networks. The systems used typically increase in-sewer retention times. A project funded by UKWIR has reviewed existing knowledge about the interaction between extended in-sewer storage and treatment plants, together with available models. The study utilised a questionnaire survey and dynamic simulation

R M Ashley; J Dudley; J Vollertsen; J R Blanksby; A Jack; A J Saul

375

Rationale for the Diabetic Retinopathy Clinical Research Network Treatment Protocol for Center-involved Diabetic Macular Edema  

Microsoft Academic Search

ObjectiveDescribe the underlying principles used to develop a web-based algorithm that incorporated intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for diabetic macular edema (DME) in a Diabetic Retinopathy Clinical Research Network (DRCR.net) randomized clinical trial.

Lloyd Paul Aiello; Roy W. Beck; Neil M. Bressler; David J. Browning; K. V. Chalam; Matthew Davis; Frederick L. Ferris; Adam Glassman; Raj Maturi; Cynthia R. Stockdale; Trexler Topping

376

Stereotactic ablative radiotherapy for comprehensive treatment of oligometastatic tumors (SABR-COMET): Study protocol for a randomized phase II trial  

PubMed Central

Background Stereotactic ablative radiotherapy (SABR) has emerged as a new treatment option for patients with oligometastatic disease. SABR delivers precise, high-dose, hypofractionated radiotherapy, and achieves excellent rates of local control. Survival outcomes for patients with oligometastatic disease treated with SABR appear promising, but conclusions are limited by patient selection, and the lack of adequate controls in most studies. The goal of this multicenter randomized phase II trial is to assess the impact of a comprehensive oligometastatic SABR treatment program on overall survival and quality of life in patients with up to 5 metastatic cancer lesions, compared to patients who receive standard of care treatment alone. Methods After stratification by the number of metastases (1-3 vs. 4-5), patients will be randomized between Arm 1: current standard of care treatment, and Arm 2: standard of care treatment + SABR to all sites of known disease. Patients will be randomized in a 1:2 ratio to Arm 1:Arm 2, respectively. For patients receiving SABR, radiotherapy dose and fractionation depends on the site of metastasis and the proximity to critical normal structures. This study aims to accrue a total of 99 patients within four years. The primary endpoint is overall survival, and secondary endpoints include quality of life, toxicity, progression-free survival, lesion control rate, and number of cycles of further chemotherapy/systemic therapy. Discussion This study will provide an assessment of the impact of SABR on clinical outcomes and quality of life, to determine if long-term survival can be achieved for selected patients with oligometastatic disease, and will inform the design of a possible phase III study. Trial registration Clinicaltrials.gov identifier: NCT01446744

2012-01-01

377

Treatment of atrial fibrillation with a dual defibrillator in heart failure patients (TRADE HF): protocol for a randomized clinical trial  

PubMed Central

Background Heart failure(HF) and atrial fibrillation(AF) frequently coexist in the same patient and are associated with increased mortality and frequent hospitalizations. As the concomitance of AF and HF is often associated with a poor prognosis, the prompt treatment of AF in HF patients may significantly improve outcome. Methods/design Recent implantable cardiac resynchronization (CRT) devices allow electrical therapies to treat AF automatically. TRADE-HF (trial registration: NCT00345592; http://www.clinicaltrials.gov) is a prospective, randomized, double arm study aimed at demonstrating the efficacy of an automatic, device-based therapy for treatment of atrial tachycardia and fibrillation(AT/AF) in patients indicated for CRT. The study compares automatic electrical therapy to a traditional more usual treatment of AT/AF: the goal is to demonstrate a reduction in a combined endpoint of unplanned hospitalizations for cardiac reasons, death from cardiovascular causes or permanent AF when using automatic atrial therapy as compared to the traditional approach involving hospitalization for symptoms and in-hospital treatment of AT/AF. Discussion CRT pacemaker with the additional ability to convert AF as well as ventricular arrhythmias may play a simultaneous role in rhythm control and HF treatment. The value of the systematic implantation of CRT ICDs with the capacity to deliver atrial therapy in HF patients at risk of AF has not yet been explored. The TRADE-HF study will assess in CRT patients whether a strategy based on automatic management of atrial arrhythmias might be a valuable option to reduce the number of hospital admission and to reduce the progression the arrhythmia to a permanent form. Trial registration NCT00345592

2011-01-01

378

State Variation in Out-of-Home Medicaid Mental Health Services for Children and Youth: An Examination of Residential Treatment and Inpatient Hospital Services. Administration and Policy in Mental Health and Mental Health Services Research, vol. 37, no. 4  

Microsoft Academic Search

Using Medicaid data from 2003, this article describes the demographics and diagnoses of youth under 22 receiving mental health services in general and psychiatric hospitals, psychiatric residential treatment facilities, and other residential treatment settings. The research found that treatment stays and costs in these facilities varied considerably from state to state, findings which may call for more research on state

Jonathan Brown; Brenda Natzke; Henry Ireys; Matthew Gillingham; Morris Hamilton

2009-01-01

379

The Role of Negative Affectivity and Negative Reactivity to Emotions in Predicting Outcomes in the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders  

PubMed Central

The present study aimed to understand the contributions of both the trait tendency to experience negative emotions and how one relates to such experience in predicting symptom change during participation in the Unified Protocol (UP), a transdiagnostic treatment for emotional disorders. Data were derived from a randomized controlled trial comparing the UP to a wait-list control / delayed-treatment condition. First, effect sizes of pre- to post-treatment change for frequency of negative emotions and several variables measuring reactivity to emotional experience (emotional awareness and acceptance, fear of emotions, and anxiety sensitivity) were examined. Second, the relative contributions of change in negative emotions and emotional reactivity in predicting symptom (clinician-rated anxiety, depression, and severity of principal diagnosis) reductions were investigated. Results suggested that decreases in the frequency of negative emotions and reactivity to emotions following participation in the UP were both large in magnitude. Further, two emotional reactivity variables (fear of emotions and anxiety sensitivity) remained significantly related to symptom outcomes when controlling for negative emotions, and accounted for significant incremental variance in their prediction. These findings lend support to the notion that psychological health depends less on the frequency of negative emotions and more on how one relates to these emotions when they occur.

Sauer-Zavala, Shannon; Boswell, James F.; Gallagher, Matthew W.; Bentley, Kate H.; Ametaj, Amantia; Barlow, David H.

2012-01-01

380

Cleanroom Protocol  

NSDL National Science Digital Library

This is a description for a learning module from Maricopa Advanced Technology Education Center. This PDF describes the module; access may be purchased by visiting the MATEC website. The final module of MATEC's contamination curriculum develops your learners' skills in specific cleanroom protocols: wafer handling and transfer, area wipedowns, and area or equipment isolation. The instruction stresses that contaminants travel via many channels- air, people, process equipment, manufacturing process, wiping materials, wafer handling, electrostatic discharge, and chemicals. MATEC aims to make each learner acutely aware that minimizing contamination in the cleanroom requires his or her personal commitment. The module also discusses the automated systems used in modern and upcoming 300-mm fabs.

2012-12-21

381

Efficacy of customised foot orthoses in the treatment of Achilles tendinopathy: study protocol for a randomised trial  

PubMed Central

Background Achilles tendinopathy is a common condition that can cause marked pain and disability. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. The exception to this is eccentric calf muscle exercises, which have become a standard non-surgical intervention for Achilles tendinopathy. Foot orthoses have also been advocated as a treatment for Achilles tendinopathy, but the long-term efficacy of foot orthoses for this condition is unknown. This manuscript describes the design of a randomised trial to evaluate the efficacy of customised foot orthoses to reduce pain and improve function in people with Achilles tendinopathy. Methods One hundred and forty community-dwelling men and women aged 18 to 55 years with Achilles tendinopathy (who satisfy inclusion and exclusion criteria) will be recruited. Participants will be randomised, using a computer-generated random number sequence, to either a control group (sham foot orthoses made from compressible ethylene vinyl acetate foam) or an experimental group (customised foot orthoses made from semi-rigid polypropylene). Both groups will be prescribed a calf muscle eccentric exercise program, however, the primary difference between the groups will be that the experimental group receive customised foot orthoses, while the control group receive sham foot orthoses. The participants will be instructed to perform eccentric exercises 2 times per day, 7 days per week, for 12 weeks. The primary outcome measure will be the total score of the Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaire. The secondary outcome measures will be participant perception of treatment effect, comfort of the foot orthoses, use of co-interventions, frequency and severity of adverse events, level of physical activity and health-related quality of life (assessed using the Short-Form-36 questionnaire - Version two). Data will be collected at baseline, then at 1, 3, 6 and 12 months. Data will be analysed using the intention to treat principle. Discussion This study is the first randomised trial to evaluate the long-term efficacy of customised foot orthoses for the treatment of Achilles tendinopathy. The study has been pragmatically designed to ensure that the study findings are generalisable to clinical practice. Trial registration Australian New Zealand Clinical Trials Registry Number: ACTRN12609000829213.

Munteanu, Shannon E; Landorf, Karl B; Menz, Hylton B; Cook, Jill L; Pizzari, Tania; Scott, Lisa A

2009-01-01

382

Inpatient care for the aircraft carrier battle group.  

PubMed

A case series of 417 consecutive ward admissions onboard the USS Forrestal (CV59) is presented. During the 1-year study period, the inpatient ward was open for 260 days while the ship was underway, including workups and extended Mediterranean deployment. The case series displays the variety of clinical inpatient care provided in the shipboard environment. The 10 most clinically challenging patients demonstrate the complexity of care provided. Implication for inpatient care capability afloat are discussed. PMID:7659220

Bohnker, B K

1995-06-01

383

Virtual reality exposure therapy as treatment for pain catastrophizing in fibromyalgia patients: proof-of-concept study (Study Protocol)  

Microsoft Academic Search

Background  Albeit exercise is currently advocated as one of the most effective management strategies for fibromyalgia syndrome (FMS);\\u000a the implementation of exercise as a FMS treatment in reality is significantly hampered by patients' poor compliance. The inference\\u000a that pain catastrophizing is a key predictor of poor compliance in FMS patients, justifies considering the alteration of pain\\u000a catastrophizing in improving compliance towards

Linzette D Morris; Karen A Grimmer-Somers; Bruce Spottiswoode; Quinette A Louw

2011-01-01

384

The EVERT (effective verruca treatments) trial protocol: a randomised controlled trial to evaluate cryotherapy versus salicylic acid for the treatment of verrucae  

PubMed Central

Background Verrucae are a common, infectious and sometimes painful problem. The optimal treatment for verrucae is unclear due to a lack of high quality randomised controlled trials. The primary objective of this study is to compare the clinical effectiveness of two common treatments for verrucae: cryotherapy using liquid nitrogen versus salicylic acid. Secondary objectives include a comparison of the cost-effectiveness of the treatments, and an investigation of time to clearance of verrucae, recurrence/clearance of verrucae at six months, patient satisfaction with treatment, pain associated with treatment, and use of painkillers for the treatments. Methods/Design This is an open, pragmatic, multicentre, randomised controlled trial with two parallel groups: cryotherapy using liquid nitrogen delivered by a healthcare professional for a maximum of 4 treatments (treatments 2-3 weeks apart) or daily self-treatment with 50% salicylic acid for a maximum of 8 weeks. Two hundred and sixty-six patients aged 12 years and over with a verruca are being enrolled into the study. The primary outcome is complete clearance of all verrucae as observed on digital photographs taken at 12 weeks compared with baseline and assessed by an independent healthcare professional. Secondary outcomes include self-reported time to clearance of verrucae, self-reported clearance of verrucae at 6 months, cost-effectiveness of the treatments compared to one another, and patient acceptability of both treatments including possible side effects such as pain. The primary analysis will be intention to treat. It is planned that recruitment will be completed by December 2009 and results will be available by June 2010. Trial registration Current Controlled Trials ISRCTN18994246.

2010-01-01

385

Study protocol: a dissemination trial of computerized psychological treatment for depression and alcohol/other drug use comorbidity in an Australian clinical service  

PubMed Central

Background The rise of the internet and related technologies has significant implications for the treatment of complex health problems, including the combination of depression and alcohol/other drug (AOD) misuse. To date, no research exists to test the real world uptake of internet and computer-delivered treatment programs in clinical practice. This study is important, as it is the first to examine the adoption of the SHADE treatment program, a DVD-based psychological treatment for depression and AOD use comorbidity, by clinicians working in a publicly-funded AOD clinical service. The study protocol that follows describes the methodology of this dissemination trial. Methods/design 19 clinicians within an AOD service on the Central Coast of New South Wales, Australia, will be recruited to the trial. Consenting clinicians will participate in a baseline focus group discussion designed to explore their experiences and perceived barriers to adopting innovation in their clinical practice. Computer comfort and openness to innovation will also be assessed. Throughout the trial, current, new and wait-list clients will be referred to the research program via the clinical service, which will involve clients completing a baseline and 15-week follow-up clinical assessment with independent research assistants, comprising a range of mental health and AOD measures. Clinicians will also complete session checklists following each clinical session with a client, outlining the extent to which the SHADE computer program was used. Therapeutic alliance will be measured at intake and discharge from both the clinician and client perspectives. Discussion This study will provide comprehensive data on the factors associated with the adoption of an innovative, computer-delivered evidence-based treatment program, SHADE, by clinicians working in an AOD service. The results will contribute to the development of a model of dissemination of SHADE, which could be applied to a range of technological innovations. Clinical trials registry Australian Clinical Trial Registration Number: ACTRN12611000382976.

2012-01-01

386

Primary care management for optimized antithrombotic treatment [PICANT]: study protocol for a cluster-randomized controlled trial  

PubMed Central

Background Antithrombotic treatment is a continuous therapy that is often performed in general practice and requires careful safety management. The aim of this study is to investigate whether a best-practice model that applies major elements of case management and patient education, can improve antithrombotic management in primary healthcare in terms of reducing major thromboembolic and bleeding events. Methods This 24-month cluster-randomized trial will be performed with 690 adult patients from 46 practices. The trial intervention will be a complex intervention involving general practitioners, healthcare assistants, and patients with an indication for oral anticoagulation. To assess adherence to medication and symptoms in patients, as well as to detect complications early, healthcare assistants will be trained in case management and will use the Coagulation-Monitoring List (Co-MoL) to regularly monitor patients. Patients will receive information (leaflets and a video), treatment monitoring via the Co-MoL and be motivated to perform self-management. Patients in the control group will continue to receive treatment as usual from their general practitioners. The primary endpoint is the combined endpoint of all thromboembolic events requiring hospitalization and all major bleeding complications. Secondary endpoints are mortality, hospitalization, strokes, major bleeding and thromboembolic complications, severe treatment interactions, the number of adverse events, quality of anticoagulation, health-related quality of life, and costs. Further secondary objectives will be investigated to explain the mechanism by which the intervention is effective: patients’ assessment of chronic illness care, self-reported adherence to medication, general practitioners’ and healthcare assistants’ knowledge, and patients’ knowledge and satisfaction with shared decision making. Practice recruitment is expected to take place between July and December 2012. Recruitment of eligible patients will start in July 2012. Assessment will occur at three time points: baseline and follow-up after 12 months and after 24 months. Discussion The efficacy and effectiveness of individual elements of the intervention, such as antithrombotic interventions, self-management concepts in orally anticoagulated patients, and the methodological tool of case management, have already been extensively demonstrated. This project foresees the combination of several proven instruments, as a result of which we expect to profit from a reduction in the major complications associated with antithrombotic treatment. Trial registration Current Controlled Trials ISRCTN41847489

2012-01-01

387

Oral flucloxacillin and phenoxymethylpenicillin versus flucloxacillin alone for the emergency department outpatient treatment of cellulitis: study protocol for a randomised controlled trial  

PubMed Central

Background Oral flucloxacillin, either alone or in combination with phenoxymethylpenicillin, is a commonly prescribed antibiotic for the treatment of cellulitis, particularly in Ireland and the United Kingdom. This study aims to establish the non-inferiority of oral monotherapy (flucloxacillin alone) to dual therapy (flucloxacillin and phenoxymethylpenicillin) for the outpatient treatment of cellulitis in adults. Methods/design This study is a multicentre, randomised, double-blind, placebo-controlled trial of adults who present to the emergency department (ED) with cellulitis that is deemed treatable on an outpatient basis with oral antibiotics. After fulfilling specified inclusion and exclusion criteria, informed consent will be taken. Patients will be given a treatment pack containing 7 days of treatment with flucloxacillin 500 mg four times daily and placebo or flucloxacillin 500 mg four times daily and phenoxymethylpenicillin 500 mg four times daily. The primary outcome measure under study is the proportion of patients in each group in which there is greater than or equal to a 50% reduction in the area of diameter of infection from the area measured at enrolment at the end-of-treatment visit (7 to 10 days). Secondary endpoints include a health-related quality of life measurement as rated by the SF-36 score and the Extremity Soft Tissue Infection Score (not validated), compliance and adverse events. Patients will be followed up by telephone call at 3 days, end-of-treatment visit (EOT) at 7 to 10 days and test-of-cure (TOC) visit at 30 days. To achieve 90% power, a sample size of 172 patients per treatment arm is needed. This assumes a treatment success rate of 85% with oral flucloxacillin and phenoxymethylpenicillin, an equivalence threshold ? = 12.5% and an ? = 0.025. Non-inferiority will be assessed using a one-sided confidence interval on the difference of proportions between the two groups. Standard analysis including per-protocol and intention-to-treat will be performed. Discussion This trial aims to establish the non-inferiority of flucloxacillin monotherapy to dual therapy in the treatment of uncomplicated cellulitis among ED patients. In doing so, this trial will bridge a knowledge gap in this understudied and common condition and will be relevant to clinicians across several different disciplines. Trial registration EudraCT Number 2008-006151-42

2013-01-01

388

Rounding with scribes: employing scribes in a pediatric inpatient setting.  

PubMed

Using scribes to document patient encounters for physicians offers both benefits and challenges. A pediatric hospital recounts its experience adding scribes to its inpatient rounding teams. PMID:22375478

Tegen, Anne; O'Connell, Jennifer

2012-01-01

389

Changing trends in inpatient care for psychiatrically hospitalized youth: 1991-2008.  

PubMed

Research has focused on changes in the psychiatric treatment of youth in outpatient settings, but less is known about trends in inpatient care. This study documents changes in the lengths of stay (LOS), clinical profiles of youth, and medication use within an inpatient setting in Massachusetts between 1991 and 2008. A chart review of 233 medical records of psychiatrically hospitalized youth was conducted at three points in time (1991, 1998, and 2008). Sample includes youth between ages 4 and 18. Clinical data, including LOS, diagnoses and other clinical variables, and number and type of medications prescribed were compared across sample years. Findings indicate a significant decrease in the LOS coupled with a concurrent increase in psychotropic medication use between each successive sample year. The prescription of anti-psychotic medications, in particular, increased significantly. On clinical indices, findings show that there was an increase in the diagnosis of bipolar spectrum disorders and a concurrent decrease in unipolar diagnoses in the 2008 sample. Attention-deficit and developmental disorders showed little change. Trauma-related disorders were significantly less frequently diagnosed in 2008. Children hospitalized in 1998 and 2008 had more prior hospitalizations and presented with greater acuity than those in the 1991 sample. Results highlight important changes that have occurred in child/adolescent inpatient settings over the past two decades. Data suggest that these changes have not resulted in decreased rates of inpatient hospitalization for youth with more severe psychiatric disorders. PMID:22855261

Meagher, Susan M; Rajan, Anjana; Wyshak, Grace; Goldstein, Joel

2013-06-01

390

Acceptability of low molecular weight heparin thromboprophylaxis for inpatients receiving palliative care: qualitative study  

PubMed Central

Objective To find out what inpatients with advanced cancer who are receiving palliative care think about the effect of thromoprophylaxis on overall quality of life. Design Qualitative study using audiotaping of semistructured interviews. Setting Regional cancer centre in Wales. Participants 28 inpatients with advanced metastatic cancer receiving palliative care and low molecular weight heparin. Main outcome measures Recurring themes on the effect of thromboprophylaxis on overall quality of life. Results Major emerging themes showed that patients knew about the risks of venous thromboembolism and the purpose of treatment with heparin. Media coverage had raised awareness about venous thromboembolism, and many had previous experience of thromboprophylaxis. All found low molecular weight heparin an acceptable intervention, and many said that it improved their quality of life by giving them a feeling of safety and reassurance. Antiembolic stockings were considered uncomfortable and had a negative impact on quality of life. Patients were concerned that because they had advanced disease they might not be eligible for thromboprophylaxis. Conclusion Low molecular weight heparin is acceptable to inpatients with advanced cancer receiving palliative care and has a positive impact on overall quality of life. Antiembolic stockings are an unacceptable intervention in this patient group. Guidelines on thromboprophylaxis are urgently needed for palliative care inpatient units and hospices.

Noble, S I R; Nelson, A; Turner, C; Finlay, I G

2006-01-01

391

Virtual reality exposure therapy as treatment for pain catastrophizing in fibromyalgia patients: proof-of-concept study (Study Protocol)  

PubMed Central

Background Albeit exercise is currently advocated as one of the most effective management strategies for fibromyalgia syndrome (FMS); the implementation of exercise as a FMS treatment in reality is significantly hampered by patients' poor compliance. The inference that pain catastrophizing is a key predictor of poor compliance in FMS patients, justifies considering the alteration of pain catastrophizing in improving compliance towards exercises in FMS patients. The aim of this study is to provide proof-of-concept for the development and testing of a novel virtual reality exposure therapy (VRET) program as treatment for exercise-related pain catastrophizing in FMS patients. Methods Two interlinked experimental studies will be conducted. Study 1 aims to objectively ascertain if neurophysiological changes occur in the functional brain areas associated with pain catastrophizing, when catastrophizing FMS subjects are exposed to visuals of exercise activities. Study 2 aims to ascertain the preliminary efficacy and feasibility of exposure to visuals of exercise activities as a treatment for exercise-related pain catastrophizing in FMS subjects. Twenty subjects will be selected from a group of FMS patients attending the Tygerberg Hospital in Cape Town, South Africa and randomly allocated to either the VRET (intervention) group or waiting list (control) group. Baseline neurophysiological activity for subjects will be collected in study 1 using functional magnetic resonance imaging (fMRI). In study 2, clinical improvement in pain catastrophizing will be measured using fMRI (objective) and the pain catastrophizing scale (subjective). Discussion The premise is if exposing FMS patients to visuals of various exercise activities trigger the functional brain areas associated with pain catastrophizing; then as a treatment, repeated exposure to visuals of the exercise activities using a VRET program could possibly decrease exercise-related pain catastrophizing in FMS patients. Proof-of-concept will either be established or negated. The results of this project are envisaged to revolutionize FMS and pain catastrophizing research and in the future, assist health professionals and FMS patients in reducing despondency regarding FMS management. Trial registration PACTR201011000264179

2011-01-01

392

Vitamin D Deficiency Among Psychiatric Inpatients  

PubMed Central

Objective: Previous studies in northern Europe and Australia have indicated that vitamin D deficiency is common in psychiatric patients. This study aimed to determine the prevalence of vitamin D deficiency among psychiatric inpatients in a large North American city. The association of vitamin D status with clinical characteristics was also explored, and subgroups of patients that are more vulnerable to vitamin D deficiency were identified. Method: This descriptive study looked at 107 unselected consecutive admissions to a psychiatric inpatient service in New York City between September and early December 2010. All patients were aged 18 years and older. Psychiatric diagnoses were established by attending psychiatrists as part of the routine assessment using criteria from the DSM-IV. Serum levels of 25-hydroxyvitamin D were measured by high-performance liquid chromatography, tandem mass spectrometry. A vitamin D–deficient state was defined as serum 25-hydroxyvitamin D level ? 20 ng/mL. Results: Fifty-six (52.3%) patients were classified as deficient in vitamin D. Age and 25-hydroxyvitamin D level were significantly correlated (P = .001). Seventy-one percent of patients from age 18 to 34 years were deficient in vitamin D; this rate was significantly higher than the rate of deficiency in older patients (P = .017). No significant relationships were found between 25-hydroxyvitamin D level and gender, race/ethnicity, glycosylated hemoglobin, body mass index, and major psychiatric diagnostic categories. Conclusions: A high percentage of psychiatric inpatients are deficient in vitamin D. Younger patients were more at risk for deficiency. Screening for vitamin D deficiency should be part of the health assessment of patients with major psychiatric illnesses.

Charles, Richard A.; Orendain, Geraldine C. M.; Joseph, Michel D.; Abanishe, James O.

2012-01-01

393

An efficient protocol for inducing pseudopregnancy using estradiol dipropionate and follicular development associated with changes in reproductive hormones after prostaglandin F2alpha treatment in pseudopregnant sows  

PubMed Central

Background Utilization of estrus synchronization program in livestock industry would provide greater options for reproductive management in herd. To develop a convenient method for estrus synchronization in pigs, we determined the effective protocol using estradiol dipropionate (EDP) for the establishment of pseudopregnancy and investigated follicular development during the estrus synchronization with prostaglandin F2alpha (PGF2alpha) in association with reproductive hormone profiles in pseudopregnant sows. Methods In Experiment 1, the effective dose (0, 10, 20, or 30 mg) and timing (5, 8, 11 or 13 days after ovulation) of a single administration of EDP in cyclic pigs for the induction of pseudopregnancy were investigated. In Experiment 2, four pseudopregnant sows were treated with PGF2alpha twice at a 24-h interval between 24 and 28 days after EDP treatment. The changes in plasma concentrations of reproductive hormones were analyzed by time-resolved fluoroimmunoassay. Follicular development and ovulation following PGF2alpha administration were monitored by transrectal ultrasonography. Results High efficiency (greater than 80%) of pseudopregnancy was achieved with a single treatment with 20 mg of EDP at 8 and 11 days after ovulation (equivalent to 9-13 days after the onset of estrus). Plasma estradiol-17beta concentrations in pseudopregnant sows were significantly higher between 12 h and 7 days than before EDP treatment. Total inhibin concentrations significantly decreased following EDP treatment and remained low for 14 days. The number of small follicles was increased from 6.3 +/- 2.6 at PGF2alpha treatment to 22.8 +/- 4.8 at 3 days later; this was associated with increased plasma concentrations of inhibin. Onset of estrus was detectable in all sows on 5.3 +/- 0.3 days after PGF2alpha treatment and the number of ovulated follicles was 15.5 +/- 1.4 detected at 7.6 +/- 0.2 days after the treatment. Conclusions This study has defined the effective dose and timing of EDP treatment for inducing pseudopregnancy in cyclic pigs. Our results also indicated that EDP caused a lowering of inhibin concentrations during pseudopregnancy and small numbers of follicles from 20 to 28 days after EDP. In contrast, EDP-induced pseudopregnancy appears to have no adverse effect on follicular development and subsequent ovulation following PGF2alpha administration.

2011-01-01

394

Protocol Interactions and the Chosen Protocol Attack  

Microsoft Academic Search

There are many cases in the literature in which reuse of the same key material for dierent functions can open up security holes. In this paper, we discuss such interactions between protocols, and present a new attack, called the chosen protocol attack, in which an attacker may write a new protocol using the same key material as a target protocol,

John Kelsey; Bruce Schneier; David Wagner

1997-01-01

395

Alanine/EPR dosimetry applied to the verification of a total body irradiation protocol and treatment planning dose calculation using a humanoid phantom  

SciTech Connect

Purpose: To avoid complications in total body irradiation (TBI), it is important to achieve a homogeneous dose distribution throughout the body and to deliver a correct dose to the lung which is an organ at risk. The purpose of this work was to validate the TBI dose protocol and to check the accuracy of the 3D dose calculations of the treatment planning system. Methods: Dosimetry based on alanine/electron paramagnetic resonance (EPR) was used to measure dose at numerous locations within an anthropomorphic phantom (Alderson) that was irradiated in a clinical TBI beam setup. The alanine EPR dosimetry system was calibrated against water calorimetry in a Co-60 beam and the absorbed dose was determined by the use of ''dose-normalized amplitudes'' A{sub D}. The dose rate of the TBI beam was checked against a Farmer ionization chamber. The phantom measurements were compared to 3D dose calculations from a treatment planning system (Pinnacle) modeled for standard dose calculations. Results: Alanine dosimetry allowed accurate measurements which were in accordance with ionization chamber measurements. The combined relative standard measurement uncertainty in the Alderson phantom was U{sub r}(A{sub D})=0.6%. The humanoid phantom was irradiated to a reference dose of 10 Gy, limiting the lung dose to 7.5 Gy. The ratio of the average measured dose midplane in the craniocaudal direction to the reference dose was 1.001 with a spread of {+-}4.7% (1 sd). Dose to the lung was measured in 26 locations and found, in average, 1.8% lower than expected. Lung dose was homogeneous in the ventral-dorsal direction but a dose gradient of 0.10 Gy cm{sup -1} was observed in the craniocaudal direction midline within the lung lobe. 3D dose calculations (Pinnacle) were found, in average, 2% lower compared to dose measurements on the body axis and 3% lower for the lungs. Conclusions: The alanine/EPR dosimetry system allowed accurate dose measurements which enabled the authors to validate their TBI dose protocol. Dose calculations based on a collapsed cone convolution dose algorithm modeled for regular treatments are accurate within 3% and can further be improved when the algorithm is modeled for TBI.

Schaeken, B.; Lelie, S.; Meijnders, P.; Van den Weyngaert, D.; Janssens, H.; Verellen, D. [NuTeC-EPR Dosimetry Laboratory, Xios Hogeschool Limburg, Technologiecentrum 27, 3590 Diepenbeek (Belgium) and Department of Radiotherapy, ZNA-Middelheim, Lindendreef 1, 2020 Antwerp (Belgium); NuTeC-EPR Dosimetry Laboratory, Xios Hogeschool Limburg, Technologiecentrum 27, 3590 Diepenbeek (Belgium); Department of Radiotherapy, ZNA-Middelheim, Lindendreef 1, 2020 Antwerp (Belgium); NuTeC-EPR Dosimetry Laboratory, Xios Hogeschool Limburg, Technologiecentrum 27, 3590 Diepenbeek (Belgium); UZ-Brussels, Laarbeeklaan 1, 1090 Brussels (Belgium)

2010-12-15

396

Treatment outcome of adult Burkitt Lymphoma in Japanese patients with modified LMB protocol : a single center retrospective analysis.  

PubMed

The prognosis of adult Burkitt lymphoma (BL) has improved in western countries since the introduction of high-dose methotrexate (HD-MTX)-containing chemotherapy. Here we analyzed nine consecutive Japanese patients diagnosed with BL at our institution. All except for the three elderly (> 70 years) patients were treated with a regimen including 13 g/m(2) HD-MTX in total, divided into 3 cycles. The median follow-up period was 56 months (range 38-118). All the nine patients achieved complete remission and have not shown any disease progression, including the three elderly patients who received reduced doses or alternative treatments. These observations suggest that chemotherapy including 13 g/m(2) HD-MTX in total is tolerable and effective in Japanese adult BL patients aged < 70 and that BL is curable even if developed in those who are > 70 years. PMID:22104309

Nishikii, Hidekazu; Nakamura, Naoya; Kondo, Yuzuru; Okoshi, Yasushi; Suzukawa, Kazumi; Hasegawa, Yuichi; Yokoyama, Yasuhisa; Sakata-Yanagimoto, Mamiko; Enami, Terukazu; Noguchi, Masayuki; Chiba, Shigeru

2011-01-01

397

Treatment of primary glioblastoma multiforme with cetuximab, radiotherapy and temozolomide (GERT) - phase I/II trial: study protocol  

PubMed Central

Background The implementation of combined radiochemotherapy (RCHT) with temozolomide (TMZ) has lead to a significant increase in overall survival times in patients with Glioblastoma multiforme (GBM), however, outcome still remains unsatisfactory. The majority of GBMs show an overexpression and/or amplification of the epidermal growth factor receptor (EGFR). Therefore, addition of EGFR-inhibition with cetuximab to the current standard treatment approach with radiotherapy and TMZ seems promising. Methods/design GERT is a one-armed single-center phase I/II trial. In a first step, dose-escalation of TMZ from 50 mg/m2 to 75 mg/m2 together with radiotherapy and cetuximab will be performed. Should safety be proven, the phase II trial will be initiated with the standard dose of 75 mg/m2 of TMZ. Cetuximab will be applied in the standard application dose of 400 mg/m2 in week 1, thereafter at a dose of 250 mg/m2 weekly. A total of 46 patients will be included into this phase I/II trial. Primary endpoints are feasibility and toxicity, secondary endpoints are overall and progression-free survival. An interim analysis will be performed after inclusion of 15 patients into the main study. Patients' enrolment will be performed over a period of 2 years. The observation time will end 2 years after inclusion of the last patient. Discussion The goal of this study is to evaluate the safety and efficacy of combined RCHT-immunotherapy with TMZ and cetuximab as first-line treatment for patients with primary GBM.

Combs, Stephanie E; Heeger, Steffen; Haselmann, Renate; Edler, Lutz; Debus, Jurgen; Schulz-Ertner, Daniela

2006-01-01

398

Psychological treatments for common mental health problems experienced by informal carers of adults with chronic physical health conditions (Protocol)  

PubMed Central

Background Improved life expectancy is resulting in increased outpatient treatment of people with chronic physical health conditions and reliance on the provision of informal care in the community. However, informal care is also associated with increased risk of experiencing common mental health difficulties such as depression and anxiety. Currently there is a lack of evidence-based treatments for such difficulties, resulting in poor health outcomes for both the informal carer and care recipient. Methods/Design Electronic databases will be systemically searched for randomised controlled trials examining the effectiveness of psychological interventions targeted at treating depression or anxiety experienced by informal carers of patients with chronic physical health conditions. Database searches will be supplemented by contact with experts, reference and citation checking and grey literature. Both published and unpublished research in English language will be reviewed with no limitations on year or source. Individual, group and patient-carer dyad focused interventions will be eligible. Primary outcomes of interest will be validated self-report or clinician administered measures of depression or anxiety. If data allows a meta-analysis will examine: (1) the overall effectiveness of psychological interventions in relation to outcomes of depression or anxiety; (2) intervention components associated with effectiveness. Discussion This review will provide evidence on the effectiveness of psychological interventions for depression and anxiety experienced by informal carers of patients with chronic physical health conditions. In addition, it will examine intervention components associated with effectiveness. Results will inform the design and development of a psychological intervention for carers of people with chronic physical health conditions experiencing depression and anxiety. PROSPERO registration number: CRD42012003114

2013-01-01

399

Aerosols Protocol  

NSDL National Science Digital Library

The purpose of this activity is to measure the aerosol optical thickness of the atmosphere (how much of the sun's light is scattered or absorbed by particles suspended in the air). Students point a GLOBE sun photometer at the sun and record the largest voltage reading they obtain on a digital voltmeter connected to the photometer. Students observe sky conditions near the sun, perform the Cloud, Optional Barometric Pressure (optional) and Relative Humidity Protocols, and measure current air temperature. Intended outcomes are that students will understand the concept that the atmosphere prevents all of the sun's light from reaching Earth's surface and they learn what causes hazy skies. Supporting background materials for both student and teacher are included.

The GLOBE Program, UCAR (University Corporation for Atmospheric Research)

2003-08-01

400

Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital.  

PubMed

Aim: Cancer remains a major health problem in all communities worldwide. Rising healthcare costs associated with treating advanced cancers present a significant economic challenge. It is a need of the hour that the health sector should devise cost-effective measures to be put in place for better affordability of treatments. To achieve this objective, information generation through indigenous hospital data on unit cost of in-patient cancer chemotherapy in medical oncology became imperative and thus hallmark of this study. Design and Setting: The present prospective hospital based study was conducted in Medical Oncology Department of tertiary care teaching hospital. Materials and Methods: After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. Results: The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96). This includes expenditure incurred both by the hospital and the patient (out of pocket). Conclusion: The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients. PMID:24125973

Wani, Mohammad Ashraf; Tabish, S A; Jan, Farooq A; Khan, Nazir A; Wafai, Z A; Pandita, K K

401

42 CFR 412.428 - Publication of Updates to the inpatient psychiatric facility prospective payment system.  

Code of Federal Regulations, 2010 CFR

...Publication of Updates to the inpatient psychiatric facility prospective payment system...Hospital Services of Inpatient Psychiatric Facilities § 412.428 Publication of Updates to the inpatient psychiatric facility prospective payment...

2009-10-01

402

42 CFR 412.428 - Publication of Updates to the inpatient psychiatric facility prospective payment system.  

Code of Federal Regulations, 2010 CFR

...Publication of Updates to the inpatient psychiatric facility prospective payment system...Hospital Services of Inpatient Psychiatric Facilities § 412.428 Publication of Updates to the inpatient psychiatric facility prospective payment...

2010-10-01

403

Task Force Report on Acute Short-Term Inpatient Psychiatric Services.  

National Technical Information Service (NTIS)

Qualitative and quantitative guidelines for both adult short-term inpatient psychiatric services and short-term inpatient psychiatric services for children and adolescents are presented. The guidelines for the short-term inpatient psychiatric services for...

1981-01-01

404

42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.  

Code of Federal Regulations, 2012 CFR

...the inpatient psychiatric facility. Subject to the provisions...an inpatient psychiatric facility receiving PIP may convert...the inpatient psychiatric facility no longer meets the requirements...and for costs of an approved education program and other costs...

2012-10-01

405

42 CFR 405.1206 - Expedited determination procedures for inpatient hospital care.  

Code of Federal Regulations, 2010 CFR

...determination procedures for inpatient hospital care. 405.1206 Section 405...determination procedures for inpatient hospital care. (a) Beneficiary's right...beneficiary requires inpatient hospital care, the beneficiary is not...

2010-10-01

406

5 CFR 890.905 - Limits on inpatient hospital and physician charges.  

Code of Federal Regulations, 2013 CFR

...2013-01-01 false Limits on inpatient hospital and physician charges. 890.905...BENEFITS PROGRAM Limit on Inpatient Hospital Charges, Physician Charges, and FEHB...Payments § 890.905 Limits on inpatient hospital and physician charges. (a)...

2013-01-01

407

Study protocol: a randomized controlled trial of a computer-based depression and substance abuse intervention for people attending residential substance abuse treatment  

PubMed Central

Background A large proportion of people attending residential alcohol and other substance abuse treatment have a co-occurring mental illness. Empirical evidence suggests that it is important to treat both the substance abuse problem and co-occurring mental illness concurrently and in an integrated fashion. However, the majority of residential alcohol and other substance abuse services do not address mental illness in a systematic way. It is likely that computer delivered interventions could improve the ability of substance abuse services to address co-occurring mental illness. This protocol describes a study in which we will assess the effectiveness of adding a computer delivered depression and substance abuse intervention for people who are attending residential alcohol and other substance abuse treatment. Methods/Design Participants will be recruited from residential rehabilitation programs operated by the Australian Salvation Army. All participants who satisfy the diagnostic criteria for an alcohol or other substance dependence disorder will be asked to participate in the study. After completion of a baseline assessment, participants will be randomly assigned to either a computer delivered substance abuse and depression intervention (treatment condition) or to a computer-delivered typing tutorial (active control condition). All participants will continue to complete The Salvation Army residential program, a predominantly 12-step based treatment facility. Randomisation will be stratified by gender (Male, Female), length of time the participant has been in the program at the commencement of the study (4 weeks or less, 4 weeks or more), and use of anti-depressant medication (currently prescribed medication, not prescribed medication). Participants in both conditions will complete computer sessions twice per week, over a five-week period. Research staff blind to treatment allocation will complete the assessments at baseline, and then 3, 6, 9, and 12 months post intervention. Participants will also complete weekly self-report measures during the treatment period. Discussion This study will provide comprehensive data on the effect of introducing a computer delivered, cognitive behavioral therapy based co-morbidity treatment program within a residential substance abuse setting. If shown to be effective, this intervention can be disseminated within other residential substance abuse programs. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000618954

2012-01-01

408

The influence of a biopsychosocial-based treatment approach to primary overt hypothyroidism: a protocol for a pilot study  

PubMed Central

Background Hypothyroidism is a prevalent endocrine condition. Individuals with this disease are commonly managed through supplementation with synthetic thyroid hormone, with the aim of alleviating symptoms and restoring normal thyroid stimulating hormone levels. Generally this management strategy is effective and well tolerated. However, there is research to suggest that a significant proportion of hypothyroid sufferers are being inadequately managed. Furthermore, hypothyroid patients are more likely to have a decreased sense of well-being and more commonly experience constitutional and neuropsychiatric complaints, even with pharmacological intervention. The current management of hypothyroidism follows a biomedical model. Little consideration has been given to a biopsychosocial approach to this condition. Within the chiropractic profession there is growing support for the use of a biopsychosocial-based intervention called Neuro-Emotional Technique (NET) for this population. Methods/Design A placebo-controlled, single-blinded, randomised clinical pilot-trial has been designed to assess the influence of Neuro-Emotional Technique on a population with primary overt hypothyroidism. A sample of 102 adults (?18 years) who meet the inclusion criteria will be randomised to either a treatment group or a placebo group. Each group will receive ten treatments (NET or placebo) over a six week period, and will be monitored for six months. The primary outcome will involve the measurement of depression using the Depression, Anxiety and Stress Scale (DASS). The secondary outcome measures to be used are; serum thyroid stimulating hormone, serum free-thyroxine, serum free-triiodothyronine, serum thyroid peroxidase auto-antibodies, serum thyroglobulin auto-antibodies as well as the measurement of functional health and well-being using the Short-Form-36 Version 2. The emotional states of anxiety and stress will be measured using the DASS. Self-measurement of basal heart rate and basal temperature will also be included among the secondary outcome measures. The primary and secondary measures will be obtained at commencement, six weeks and six months. Measures of basal heart rate and basal temperature will be obtained daily for the six month trial period, with recording to commence one week prior to the intervention. Discussion The study will provide information on the influence of NET when added to existing management regimens in individuals with primary overt hypothyroidism. Trial Registration ANZCTR Number: 12607000040460

2010-01-01

409

Effectiveness of heat-sensitive moxibustion in the treatment of lumbar disc herniation: study protocol for a randomized controlled trial  

PubMed Central

Background Lumbar disc herniation is a common and costly problem. Moxibustion is employed to relieve symptoms and might therefore act as a therapeutic alternative. Many studies have already reported encouraging results in heat-sensitive moxibustion for lumbar disc herniation. Hence, we designed a randomized controlled clinical trial to investigate the effectiveness of heat-sensitive moxibustion compared with conventional moxibustion. Methods This trial is a multicenter, prospective, randomized controlled clinical trial. The 316 eligible patients are randomly allocated to two different groups. The experimental group is treated with heat-sensitive moxibustion (n = 158); while the control group (n = 158) is treated with conventional moxibustion. The moxibustion locations are different for the groups. The experimental group selects heat-sensitization acupoints from the region which consists of bilateral Da Changshu (BL25) and Yao Shu (Du2). Meanwhile, fixed acupoints are used in control group; patients in both groups receive 18 sessions in 2 weeks. Discussion The study design guarantees a high internal validity for the results. It is one large-scale randomized controlled trial to evaluate the efficacy of heat-sensitive moxibustion compared to conventional moxibustion and may provide evidence for this therapy as a treatment for moderate and severe lumbar disc herniation. Moreover, the result may uncover the inherent laws to improve the therapeutic effect with suspended moxibustion. Trial Registration The trial is registered at Chinese Clinical Trials Registry: ChiCTR-TRC-09000604. The application date was 27 November 2009. The first patient was randomized on the 16 June 2011.

2011-01-01

410

Transfusion protocol in trauma  

PubMed Central

Blood and blood components are considered drugs because they are used in the treatment of diseases. As with any drug, adverse effects may occur, necessitating careful consideration of therapy. Like any other therapeutic decision, the need for transfusion should be considered on the basis of risks and benefits and alternative treatments available to avoid over- and under-transfusion. This review is focused on the blood transfusion protocol in trauma patients with hemorrhagic shock. Besides, issues related to emergency and massive transfusion have also been elaborated. We conducted a comprehensive MEDLINE search and reviewed the relevant literature, with particular reference to emergency medical care in trauma.

Kaur, Paramjit; Basu, Sabita; Kaur, Gagandeep; Kaur, Ravneet

2011-01-01

411

Safe and effective prescribing practices at the point of discharge from an inpatient psychiatry unit.  

PubMed

This article illustrates the value of specific prescribing practices in three important areas--treatment adherence, prevention of suicide by overdose/accidental overdose, and communication and accountability--in achieving the safe and seamless discharge of psychiatric patients from an inpatient psychiatry unit. Psychiatric patients are at particular risk for adverse clinical events upon discharge from the hospital. Achieving safe and effective prescribing practices in mental health care requires an understanding of the elements that contribute to a patient's successful discharge from an inpatient unit. The implementation of specific prescribing practices, such as open communication with patients and families and collaboration among healthcare providers, can improve adherence to treatment, reduce the risk of overdose and suicide, ensure a seamless transition to the next provider of care, and facilitate best outcomes for patients. PMID:22261979

Fernandes, Virginia; Flak, Edred

2012-01-01

412

Readiness to Quit Smoking and Quit Attempts Among Australian Mental Health Inpatients  

PubMed Central

Introduction: Mental health inpatients smoke at higher rates than general population smokers. However, provision of nicotine-dependence treatment in inpatient settings is low, with barriers to the provision of such care including staff views that patients do not want to quit. This paper reports the findings of a survey of mental health inpatients at a psychiatric hospital in New South Wales, Australia, assessing smoking and quitting motivations and behaviors. Methods: Smokers (n = 97) were surveyed within the inpatient setting using a structured survey tool, incorporating the Fagerström Test for Nicotine Dependence, Reasons for Quitting Scale, Readiness and Motivation to Quit Smoking Questionnaire, and other measures of smoking and quitting behavior. Results: Approximately 47% of smokers reported having made at least one quit attempt within the past 12 months, despite nearly three quarters (71.2%) being classified as in a “precontemplative” stage of change. Multinomial logistic regressions revealed that self-reporting “not enjoying being a smoker” and having made a quit attempt in the last 12 months predicted having advanced beyond a precontemplative stage of change. A high self-reported desire to quit predicted a quit attempt having been made in the last 12 months. Conclusions: The majority of smokers had made several quit attempts, with a large percentage occurring recently, suggesting that the actual quitting behavior should be considered as an important indication of the “desire to quit.” This paper provides further data supporting the assertion that multimodal smoking cessation interventions combining psychosocial and pharmacological support should be provided to psychiatric inpatients who smoke.

2013-01-01

413

Experience with the dermatology inpatient hospital service for adults: Mayo Clinic, 2000-2010.  

PubMed

Background? There is a paucity of medical literature describing the role of dermatology inpatient hospital services for patients with severe dermatologic disease. A diminishing number of US hospitals have a dedicated dermatology inpatient service run by dermatologists. Objectives? To describe the role of a dermatology-run inpatient service in treatment of severe dermatologic disease from 2000 to 2010 at our institution. Methods? We studied demographic characteristics, indications for admission and length of stay for the adult (age, >18?years) dermatology inpatient hospital service over the most recent decade. We compared data from the first 5.5?years with the subsequent 5.5?years and with previously published data. Results? A total of 1732 patients had 2216 inpatient admissions to the adult service from 2000 to 2010. The mean (SD) age was 61.3 (17.7) years (age range 18-100?years). Median duration of admission was 3?days interquartile range (IQR), 2-5?days. The most common indications for admission were dermatitis (44.2%), psoriasis (17.4%) and cutaneous T-cell lymphoma (9.2%). We compared admissions from 2000 to mid-2005 (n?=?1260) to admissions from mid-2005 to 2010 (n?=?956). Statistically significant changes included median length of stay (decreased from 4?days [IQR, 3-6?days] to 3?days [IQR, 2-4?days] P?

Storan, E R; McEvoy, M T; Wetter, D A; El-Azhary, R A; Bridges, A G; Camilleri, M J; Davis, M D P

2012-10-16

414

42 CFR 412.404 - Conditions for payment under the prospective payment system for inpatient hospital services of...  

Code of Federal Regulations, 2010 CFR

...system for inpatient hospital services of psychiatric facilities. 412.404 Section 412...Inpatient Hospital Services of Inpatient Psychiatric Facilities § 412.404 Conditions...system for inpatient hospital services of psychiatric facilities. (a) General...

2009-10-01

415

42 CFR 412.404 - Conditions for payment under the prospective payment system for inpatient hospital services of...  

Code of Federal Regulations, 2010 CFR

...system for inpatient hospital services of psychiatric facilities. 412.404 Section 412...Inpatient Hospital Services of Inpatient Psychiatric Facilities § 412.404 Conditions...system for inpatient hospital services of psychiatric facilities. (a) General...

2010-10-01

416

Timing of prostaglandin F2? treatment in an estrogen-based protocol for timed artificial insemination or timed embryo transfer in lactating dairy cows.  

PubMed

Objectives were to investigate progesterone concentrations and fertility comparing 2 different intervals from PGF(2?) treatment and induced ovulation in an estrogen-based ovulation synchronization protocol for timed artificial insemination (TAI) or timed embryo transfer (TET) in lactating dairy cows. A total of 1,058 lactating Holstein cows [primiparous (n=371) and multiparous (n=687)], yielding 34.1 ± 0.33 kg of milk/d at various days in milk were randomly assigned to receive treatment with PGF(2?) on either d 7 or 8 of the following protocol: d 0: 2mg of estradiol benzoate + controlled internal drug release device; d 8: controlled internal drug release device removal + 1.0mg of estradiol cypionate; d 10: TAI or d 17: TET. Only cows with a corpus luteum at d 17 received an embryo and all cows received GnRH at TET. Pregnancy diagnoses were performed by detection (transrectal ultrasonography) of an embryo on d 28 or a fetus on d 60. Fertility [pregnancy per artificial insemination (P/AI) or pregnancy per embryo transfer (P/ET)] was affected by breeding technique (AI vs. ET) and time of PGF(2?) treatment (d 7 vs. 8) at the 28-d pregnancy diagnosis for TAI [32.9% (238) vs. 20.6% (168)] and TET cows [47% (243) vs. 40.7% (244)] and at the 60-d pregnancy diagnosis for TAI [30% (238) vs. 19.2% (168)] and TET cows [37.9% (243) vs. 33.5% (244)]. The progesterone (P4) concentration at d 10 altered fertility in TAI cows, with higher P/AI in cows with P4 concentration <0.1 ng/mL compared with cows with P4 concentration ? 0.1 ng/mL, and in ET cows, with higher P/ET in cows with P4 concentration <0.22 ng/mL compared with cows with P4 concentration ? 0.22 ng/mL. Prostaglandin F(2?) treatment at d 7 increased the percentage of cows with P4 <0.1 ng/mL on d 10 [39.4 (85) vs. 23.2 (54)]. Reducing the period between PGF(2?) and TAI from 72 to 48 h in dairy cows resulted in a clear reduction in fertility in cows bred by TAI and a subtle negative effect in cows that received TET. The earlier PGF(2?) treatment benefits are most likely mediated through gamete transport, fertilization, or early embryo development and a more subtle effect of earlier PGF(2?) treatment that may be mediated through changes in the uterine or hormonal environment that manifests itself after ET on d 7. PMID:23498008

Pereira, M H C; Sanches, C P; Guida, T G; Rodrigues, A D P; Aragon, F L; Veras, M B; Borges, P T; Wiltbank, M C; Vasconcelos, J L M

2013-03-15

417

Effectiveness of osteopathic manipulative treatment in neonatal intensive care units: protocol for a multicentre randomised clinical trial  

PubMed Central

Introduction Neonatal care has been considered as one of the first priorities for improving quality of life in children. In 2010, 10% of babies were born prematurely influencing national healthcare policies, economic action plans and political decisions. The use of complementary medicine has been applied to the care of newborns. One previous study documented the positive effect of osteopathic manipulative treatment (OMT) in reducing newborns’ length of stay (LOS). Aim of this multicentre randomised controlled trial is to examine the association between OMT and LOS across three neonatal intensive care units (NICUs). Methods and analysis 690 preterm infants will be recruited from three secondary and tertiary NICUs from north and central Italy and allocated into two groups, using permuted-block randomisation. The two groups will receive standard medical care and OMT will be applied, twice a week, to the experimental group only. Outcome assessors will be blinded of study design and group allocation. The primary outcome is the mean difference in days between discharge and entry. Secondary outcomes are difference in daily weight gain, number of episodes of vomit, regurgitation, stooling, use of enema, time to full enteral feeding and NICU costs. Statistical analyses will take into account the intention-to-treat method. Missing data will be handled using last observation carried forward (LOCF) imputation technique. Ethics and dissemination Written informed consent will be obtained from parents or legal guardians at study enrolment. The trial has been approved by the ethical committee of Macerata hospital (n°22/int./CEI/27239) and it is under review by the other regional ethics committees. Results Dissemination of results from this trial will be through scientific medical journals and conferences. Trial registration This trial has been registered at http://www.clinicaltrials.org (identifier NCT01645137).

Cerritelli, Francesco; Pizzolorusso, Gianfranco; Renzetti, Cinzia; D'Incecco, Carmine; Fusilli, Paola; Perri, Paolo Francesco; Tubaldi, Lucia; Barlafante, Gina

2013-01-01

418

Intensified treatment with high dose Rifampicin and Levofloxacin compared to standard treatment for adult patients with Tuberculous Meningitis (TBM-IT): protocol for a randomized controlled trial  

PubMed Central

Background Tuberculous meningitis is the most severe form of tuberculosis. Mortality for untreated tuberculous meningitis is 100%. Despite the introduction of antibiotic treatment for tuberculosis the mortality rate for tuberculous meningitis remains high; approximately 25% for HIV-negative and 67% for HIV positive patients with most deaths occurring within one month of starting therapy. The high mortality rate in tuberculous meningitis reflects the severity of the condition but also the poor antibacterial activity of current treatment regimes and relatively poor penetration of these drugs into the central nervous system. Improving the antitubercular activity in the central nervous system of current therapy may help improve outcomes. Increasing the dose of rifampicin, a key drug with known poor cerebrospinal fluid penetration may lead to higher drug levels at the site of infection and may improve survival. Of the second generation fluoroquinolones, levofloxacin may have the optimal pharmacological features including cerebrospinal fluid penetration, with a ratio of Area Under the Curve (AUC) in cerebrospinal fluid to AUC in plasma of >75% and strong bactericidal activity against Mycobacterium tuberculosis. We propose a randomized controlled trial to assess the efficacy of an intensified anti-tubercular treatment regimen in tuberculous meningitis patients, comparing current standard tuberculous meningitis treatment regimens with standard treatment intensified with high-dose rifampicin and additional levofloxacin. Methods/Design A randomized, double blind, placebo-controlled trial with two parallel arms, comparing standard Vietnamese national guideline treatment for tuberculous meningitis with standard treatment plus an increased dose of rifampicin (to 15 mg/kg/day total) and additional levofloxacin. The study will include 750 patients (375 per treatment group) including a minimum of 350 HIV-positive patients. The calculation assumes an overall mortality of 40% vs. 30% in the two arms, respectively (corresponding to a target hazard ratio of 0.7), a power of 80% and a two-sided significance level of 5%. Randomization ratio is 1:1. The primary endpoint is overall survival, i.e. time from randomization to death during a follow-up period of 9 months. Secondary endpoints are: neurological disability at 9 months, time to new neurological event or death, time to new or recurrent AIDS-defining illness or death (in HIV-positive patients only), severe adverse events, and rate of treatment interruption for adverse events. Discussion Currently very few options are available for the treatment of TBM and the mortality rate remains unacceptably high with severe disabilities seen in many of the survivors. This trial is based on the hypothesis that current anti-mycobacterial treatment schedules for TBM are not potent enough and that outcomes will be improved by increasing the CSF penetrating power of this regimen by optimising dosage and using additional drugs with better CSF penetration. Trial registration International Standard Randomised Controlled Trial Number ISRCTN61649292

2011-01-01

419

Characteristics of Hospital Inpatient Falls across Clinical Departments  

Microsoft Academic Search

Background: Hospital inpatient falls are common and may lead to injuries and prolonged hospitalization. Although hospital studies have reported overall fall rates and injuries associated with falls, few have addressed population characteristics and circumstances of falls across clinical departments within a hospital setting. Objective: To determine inpatient fall rates in an urban public hospital and to explore associated characteristics across

René Schwendimann; Hugo Bühler; Sabina De Geest; Koen Milisen

2008-01-01

420

Hospital Inpatient Education. Survey Findings and Analyses, 1975.  

ERIC Educational Resources Information Center

|A national study of inpatient education was conducted in 1975 by the American Hospital Association to obtain a current assessment of organized patient education programs in hospitals in order to guide the subsequent development of effective inpatient education programs. The survey sought information about organizational structures relating to…

American Hospital Association, Chicago, IL.

421

Self-Reported Suicidal Ideation in Adolescent Psychiatric Inpatients  

Microsoft Academic Search

In an investigation of the psychosocial correlates of suicidal ideation in adolescent inpatients, the Beck Sca