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1

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

PubMed Central

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

2013-01-01

2

A RFID Grouping Proof Protocol for Medication Safety of Inpatient  

Microsoft Academic Search

In order to provide enhanced medication safety for inpatients, the medical mechanism which adopts the modified grouping proof\\u000a protocol is proposed in this paper. By using the grouping proof protocol, the medical staffs could confirm the authentication\\u000a and integrity of a group of Radio-Frequency Identification (RFID) tags which are embedded on inpatient bracelets and the containers\\u000a of drugs. This mechanism

Hsieh-hong Huang; Cheng-yuan Ku

2009-01-01

3

Internet-based treatment of major depression for patients on a waiting list for inpatient psychotherapy: protocol for a multi-centre randomised controlled trial  

PubMed Central

Background Major depressive disorder (MDD) is a prevalent and severe disorder. Although effective treatments for MDD are available, many patients remain untreated, mainly because of insufficient treatment capacities in the health care system. Resulting waiting periods are often associated with prolonged suffering and impairment as well as a higher risk of chronification. Web-based interventions may help to alleviate these problems. Numerous studies provided evidence for the efficacy of web-based interventions for depression. The aim of this study is to evaluate a new web-based guided self-help intervention (GET.ON-Mood Enhancer-WL) specifically developed for patients waiting to commence inpatient therapy for MDD. Methods In a two-armed randomised controlled trial (n?=?200), the web-based guided intervention GET.ON-Mood Enhancer-WL in addition to treatment as usual (TAU) will be compared with TAU alone. The intervention contains six modules (psycho education, behavioural activation I & II, problem solving I & II, and preparation for subsequent inpatient depression therapy). The participants will be supported by an e-coach, who will provide written feedback after each module. Inclusion criteria include a diagnosis of MDD assessed with a structured clinical interview [SCID] and a waiting period of at least three weeks before start of inpatient treatment. The primary outcome is observer-rated depressive symptom severity (HRSD24). Further (explorative) questions include whether remission will be achieved earlier and by more patients during inpatient therapy because of the web-based preparatory intervention. Discussion If GET.ON-Mood Enhancer-WL is proven to be effective, patients may start inpatient therapy with reduced depressive symptom severity, ideally leading to higher remission rates, shortened inpatient therapy, reduced costs, and decreased waiting times. Trial registration German Clinical Trial Registration (DRKS): DRKS00004708. PMID:24279841

2013-01-01

4

Interpersonal Change Following Intensive Inpatient Treatment  

PubMed Central

Objective: Persons admitted for inpatient psychiatric care often present with interpersonal difficulties that disrupt adaptive social relations and complicate the provision of treatment. Whereas domains of psychosocial functioning in this population demonstrate clear growth in response to intervention, the impact of treatment on more complex patterns of interpersonal behavior has been largely overlooked within the existing literature. Interpersonal profiles characteristic of psychiatric inpatients were identified in the current study to determine rates of transition to adaptive functioning following hospitalization. Methods: Personality disturbance was assessed in 513 psychiatric inpatients using the Inventory of Interpersonal Problems. Scores were analyzed within a series of latent profile models to isolate unique interpersonal profiles at admission and at discharge. Longitudinal modeling was then employed to determine rates of transition from dysfunctional to adaptive profiles. Relationships with background characteristics, clinical presentation, and treatment response were explored. Results: Normative, Submissive, and Hostile/Withdrawn profiles emerged at both admission and discharge. Patients in the Normative profile demonstrated relatively moderate symptoms. Submissive and Hostile/Withdrawn profiles were related to known risk factors and elevated psychopathology. Approximately half of patients identified as Submissive or Hostile/Withdrawn transitioned to the Normative profile by discharge. Transition status evidenced modest associations with background characteristics and clinical presentation. Treatment engagement and reduction of clinical symptoms were strongly associated with adaptive transition. Conclusion: Maladaptive interpersonal profiles characteristic of psychiatric inpatients demonstrated categorical change following inpatient hospitalization. Enhanced therapeutic engagement and overall reductions in psychiatric symptoms appear to increase potential for interpersonal change. PMID:25162133

Clapp, Joshua D.; Grubaugh, Anouk L.; Allen, Jon G.; Oldham, John M.; Fowler, J. Christopher; Hardesty, Susan; Frueh, B. Christopher

2014-01-01

5

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

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Special treatment: Inpatient hospital payment adjustment...INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...Operating Costs § 412.101 Special treatment: Inpatient hospital payment...

2011-10-01

6

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

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Special treatment: Inpatient hospital payment adjustment...INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...Operating Costs § 412.101 Special treatment: Inpatient hospital payment...

2013-10-01

7

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

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Special treatment: Inpatient hospital payment adjustment...INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...Operating Costs § 412.101 Special treatment: Inpatient hospital payment...

2012-10-01

8

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

PubMed

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

Balester Mouret, Sylvain

2011-12-01

9

Studying inpatient treatment practices in schizophrenia: an integrated methodology.  

PubMed

A multi-phase research project examining current inpatient psychiatric practices and the relationships between different treatments and patient outcomes is described. The study sample includes Medicaid patients with a diagnosis of schizophrenia who have been treated in inpatient units of general hospitals in New York State. The research is focused at the heart of the debate concerning the appropriate role of inpatient psychiatric care within a balanced system of mental health services. Addressed are the conceptual issues that guided the project, research strategies, instrument development, measures used and the preliminary findings that informed successive phases. Design issues are reviewed in light of the conceptual and pragmatic decisions made with a multiple site design. A compelling argument is made about the need for a long-term treatment orientation that prepares patients for what lies ahead and that assures communication and continuity between inpatient and outpatient care. PMID:8584587

Boyer, C A; Olfson, M; Kellermann, S L; Hansell, S; Walkup, J; Rosenfield, S; Mechanic, D

1995-01-01

10

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

Code of Federal Regulations, 2010 CFR

...2010-10-01 false Special treatment: Inpatient hospital payment adjustment for low-volume hospitals. 412.101 Section 412.101 Public...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of...

2010-10-01

11

Examination of insomnia and insomnia treatment in psychiatric inpatients.  

PubMed

Despite the high comorbidity of insomnia with psychiatric illness, few studies have examined insomnia or insomnia treatments in psychiatric inpatients. The present study had two overall goals. First, we sought to describe insomnia symptoms in 76 US veterans hospitalized for a wide-range of psychiatric illnesses. Next, we sought to examine whether participation in one session of group therapy for insomnia was associated with improvement in Insomnia Severity Index (ISI) scores for a subset of these inpatients (n = 19). Data were extracted from the clinical charts of 140 inpatients admitted into the 26-bed psychiatric ward at the New Mexico VA Healthcare System. The majority of the veterans had clinical insomnia in the moderate-to-severe range, and only 18% of the sample reported no clinically-significant insomnia. There was a significant reduction in ISI scores approximately 1 week after attendance at the group therapy session, which appears to be unrelated to the length of hospitalization, but might be related to psychiatric stabilization. This is the first study to examine insomnia symptoms in a mixed, psychiatric inpatient population. Group therapy for insomnia might be a particularly useful treatment option given polypharmacy and substance dependency issues often arising in this population. PMID:21371228

Haynes, Patricia L; Parthasarathy, Sairam; Kersh, Brian; Bootzin, Richard R

2011-04-01

12

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

PubMed Central

Objective To compare the effectiveness and acceptability of outpatient polypectomy with inpatient polypectomy. Design Pragmatic multicentre randomised controlled non-inferiority study. Setting Outpatient hysteroscopy clinics in 31 UK National Health Service hospitals. Participants 507 women who attended as outpatients for diagnostic hysteroscopy because of abnormal uterine bleeding and were found to have uterine polyps. Interventions Participants were randomly assigned to either outpatient uterine polypectomy under local anaesthetic or inpatient uterine polypectomy under general anaesthesia. Data were collected on women’s self reported bleeding symptoms at baseline and at 6, 12, and 24 months. Data were also collected on pain and acceptability of the procedure at the time of polypectomy. Main outcome measures The primary outcome was successful treatment, determined by the women’s assessment of bleeding at six months, with a prespecified non-inferiority margin of 25%. Secondary outcomes included generic (EQ-5D) and disease specific (menorrhagia multi-attribute scale) quality of life, and feasibility and acceptability of the procedure. Results 73% (166/228) of women in the outpatient group and 80% (168/211) in the inpatient group reported successful treatment at six months (intention to treat relative risk 0.91, 95% confidence interval 0.82 to 1.02; per protocol relative risk 0.92, 0.82 to 1.02). Failure to remove polyps was higher (19% v 7%; relative risk 2.5, 1.5 to 4.1) and acceptability of the procedure was lower (83% v 92%; 0.90, 0.84 to 0.97) in the outpatient group Quality of life did not differ significantly between the groups. Four uterine perforations, one of which necessitated bowel resection, all occurred in the inpatient group. Conclusions Outpatient polypectomy was non-inferior to inpatient polypectomy. Failure to remove a uterine polyp was, however, more likely with outpatient polypectomy and acceptability of the procedure was slightly lower. Trial registration International Clinical Trials Registry 65868569. PMID:25801579

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

2015-01-01

13

Physical therapy treatment time during inpatient spinal cord injury rehabilitation  

PubMed Central

Background/objective To describe the nature and distribution of activities during physical therapy (PT) delivered in inpatient spinal cord injury (SCI) rehabilitation and discuss predictors (patient and injury characteristics) of the amount of time spent in PT for specific treatment activities. Methods Six hundred patients from six inpatient SCI centers were enrolled in the SCIRehab study. Physical therapists documented details, including time spent, of treatment provided during 37 306 PT sessions that occurred during inpatient SCI rehabilitation. Ordinary least squares regression models associated patient and injury characteristics with time spent in specific PT activities. Results SCIRehab patients received a mean total of 55.3 hours of PT over the course of their rehabilitation stay. Significant differences among four neurologic groups were seen in the amount of time spent on most activities, including the most common PT activities of strengthening exercises, stretching, transfer training, wheelchair mobility training, and gait training. Most PT work (77%) was provided in individual therapy sessions; the remaining 23% was done in group settings. Patient and injury characteristics explained only some of the variations seen in time spent on wheelchair mobility, transfer and bed mobility training, and range of motion/stretching. Conclusion Analysis yielded both expected and unexpected trends in SCI rehabilitation. Significant variation was seen in time spent on PT activities within and among injury groups. Providing therapeutic strengthening treatments consumed the greatest proportion of PT time. About one-quarter of all PT services were provided in group settings. Details about services provided, including time spent, will serve as a starting point in detailing the optimal treatment delivery for maximal outcomes. PMID:21675354

Taylor-Schroeder, Sally; LaBarbera, Jacqueline; McDowell, Shari; Zanca, Jeanne M.; Natale, Audrey; Mumma, Sherry; Gassaway, Julie; Backus, Deborah

2011-01-01

14

The use of groups in brief inpatient treatment of adolescents.  

PubMed

The authors describe a short-term inpatient program for adolescents that uses a variety of group sessions to help them deal with their immediate problems and, when necessary, prepare them for outpatient treatment. No attempt at complete ego reconstruction is made. The program includes family therapy and sessions on practical living skills, such as job hunting, productive use of leisure time, transportation, food planning, and renting and leasing. Assertiveness techniques are taught in small groups, and their use is encouraged on the unit, where staff attempt to create an acceptable social environment and provide a model for group decision-making. PMID:863408

Chiles, J A; Sanger, E

1977-06-01

15

A study of admissions and inpatients over the Christmas period using the appropriateness evaluation protocol (AEP).  

PubMed

The aim of the study was to examine appropriateness of admissions and inpatients over Christmas especially in the elderly. The study was a prospective audit of admissions and inpatients to the Whittington Hospital. The main outcome measures were appropriateness of admission or day of hospital residence using the Appropriateness Evaluation Protocol. The protocol was applied to admissions and inpatients over Christmas and control periods. The results showed that there was a significant difference in the number of elderly admissions between the control period and Christmas period, 94 (34%) vs. 104 (43%) (P=0.02). However there was no corresponding change in appropriateness of elderly admissions, ten (10.6%) vs. six (5.8%), (P=0.2). The inappropriateness of day of hospital residence increased from 10% on the control day to 20% on the study day (P=0.02). In conclusion elderly patients are not admitted more inappropriately over Christmas but their discharge at this time appears to be delayed resulting in inappropriate bed use. PMID:10989166

Henshaw; Pollock; Rai; Gluck

2000-08-01

16

Cocaine dependence treatment on an inpatient detoxification unit.  

PubMed

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

Wallace, B C

1987-01-01

17

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

18

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 facilities…

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

2011-01-01

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. PMID:24159352

Loew, Thomas

2013-01-01

20

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

PubMed

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

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

1998-01-01

21

Balance circuit classes to improve balance among rehabilitation inpatients: a protocol for a randomised controlled trial  

PubMed Central

Background Impaired balance and mobility are common among rehabilitation inpatients. Poor balance and mobility lead to an increased risk of falling. Specific balance exercise has been shown to improve balance and reduce falls within the community setting. However few studies have measured the effects of balance exercises on balance within the inpatient setting. The aim of this randomised controlled trial is to investigate whether the addition of circuit classes targeting balance to usual therapy lead to greater improvements in balance among rehabilitation inpatients than usual therapy alone. Methods/Design A single centre, randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. One hundred and sixty two patients admitted to the general rehabilitation ward at Bankstown-Lidcombe Hospital will be recruited. Eligible participants will have no medical contraindications to exercise and will be able to: fully weight bear; stand unaided independently for at least 30 seconds; and participate in group therapy sessions with minimal supervision. Participants will be randomly allocated to an intervention group or usual-care control group. Both groups will receive standard rehabilitation intervention that includes physiotherapy mobility training and exercise for at least two hours on each week day. The intervention group will also receive six 1-hour circuit classes of supervised balance exercises designed to maximise the ability to make postural adjustments in standing, stepping and walking. The primary outcome is balance. Balance will be assessed by measuring the total time the participant can stand unsupported in five different positions; feet apart, feet together, semi-tandem, tandem and single-leg-stance. Secondary outcomes include mobility, self reported physical functioning, falls and hospital readmissions. Performance on the outcome measures will be assessed before randomisation and at two-weeks and three-months after randomisation by physiotherapists unaware of intervention group allocation. Discussion This study will determine the impact of additional balance circuit classes on balance among rehabilitation inpatients. The results will provide essential information to guide evidence-based physiotherapy at the study site as well as across other rehabilitation inpatient settings. Trial registration The protocol for this study is registered with the Australian New Zealand, Clinical Trials Registry: ACTRN=12611000412932 PMID:23870654

2013-01-01

22

INPATIENT COGNITIVE BEHAVIORAL TREATMENT OF EATING DISORDER PATIENTS WITH DISSOCIATIVE DISORDERS  

Microsoft Academic Search

Although several investigations have noted an association between eating disorders and dissociative disorders, little work has addressed the treatment of patients with both conditions. As an inpatient ser- vice focused on severely-ill eating disorder patients, it became nec- essary to diagnose and treat concomitant dissociative disorders. We describe a cognitive-behavioral inpatient program developed and specifically adapted to treat eating disorder

Andrew P. Levin; Edward Spauster

23

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

24

Inpatient management of migraine.  

PubMed

Migraine is a frequently disabling disorder which may require inpatient treatment. Admission criteria for migraine include intractable migraine, nausea and/or vomiting, severe disability, and dependence on opioids or barbiturates. The inpatient treatment of migraine is based on observational studies and expert opinion rather than placebo-controlled trials. Well-established inpatient treatments for migraine include dihydroergotamine, neuroleptics/antiemetics, lidocaine, intravenous aspirin, and non-pharmacologic treatment such as cognitive-behavioral therapy. Short-acting treatments possibly associated with medication overuse, such as triptans, opioids, or barbiturate-containing compounds, are generally avoided. While the majority of persons with migraine are admitted on an emergency basis for only a few days, outcome studies and infusion protocols during elective admissions at tertiary headache centers suggest a longer length of stay may be needed for persons with intractable migraine. PMID:25704007

Marmura, Michael J; Goldberg, Stephanie Wrobel

2015-04-01

25

Experiences of specialist inpatient treatment for anorexia nervosa: a qualitative study from adult patients’ perspectives   

E-print Network

Background: Response to treatment in anorexia nervosa entails various challenges, including an increased risk of relapse and re-admission in those treated as inpatients. A better understanding of patients’ experiences ...

Smith, Vivien

2012-06-26

26

Feasibility and Effectiveness of Treatments for Post-Stroke Depression in Elderly Inpatients: Systematic Review  

Microsoft Academic Search

To determine the feasibility and effectiveness of antidepressive treatments for post-stroke depression in elderly medical inpatients, MEDLINE was searched for potentially relevant articles published from January 1987 to August 1997 using the keywords \\

Martin G. Cole; L. Michel Elie; Jane McCusker; François Bellavance; Asmaa Mansour

2001-01-01

27

Occupational therapy treatment time during inpatient spinal cord injury rehabilitation  

PubMed Central

Background Occupational therapy (OT) is a critical component of the rehabilitation process after spinal cord injury (SCI), the constitution of which has not been studied or documented in full detail previously. Objective To describe the type and distribution of SCI rehabilitation OT activities, including the amount of time spent on evaluation and treatment, and to discuss predictors (patient and injury characteristics) of the amount of time dedicated to OT treatment activities. Methods Six inpatient rehabilitation centers enrolled 600 patients with traumatic SCI in the first year of the SCIRehab. Occupational therapists documented 32 512 therapy sessions including time spent and specifics of each therapeutic activity. Analysis of variance and contingency tables/chi-square tests were used to test differences across neurologic injury groups for continuous and categorical variables. Results SCIRehab patients received a mean total of 52 hours of OT over the course of their rehabilitation stay. Statistically significant differences among four neurologic injury groups were seen in time spent on each OT activity. The activities that consumed the most OT time (individual and group sessions combined) were strengthening/endurance exercises, activities of daily living (ADLs), range of motion (ROM)/stretching, education, and a grouping of ‘therapeutic activities’ that included tenodesis training, fine motor activities, manual therapy, vestibular training, edema management, breathing exercise, cognitive retraining, visual/perceptual training desensitization, and don/doff adaptive equipment. Seventy-seven percent of OT work occurred in individual treatment sessions, with the most frequent OT activity involving ADLs. The variation in time (mean minutes per week) spent on OT ROM/stretching, ADLs, transfer training, assessment, and therapeutic activities can be explained in part by patient and injury characteristics, such as admission Functional Independence Measure (FIM) score, neurologic injury group, and the medical severity of illness score. Conclusion OT treatment patterns for patients with traumatic SCI show much variation in activity selection and time spent on activities, within and among neurologic level of injury groups. Some of the variation can be explained by patient and injury characteristics. Almost all patients with SCI participated in strengthening/endurance and ROM/stretching exercises during OT treatment and these two activities are where the most time was spent when therapy provided in individual and group settings was combined. ADL work consumed the most time in individual therapy sessions. PMID:21675355

Foy, Teresa; Perritt, Ginger; Thimmaiah, Deepa; Heisler, Lauren; Offutt, Jennifer Lookingbill; Cantoni, Kara; Hseih, Ching-Hui; Gassaway, Julie; Ozelie, Rebecca; Backus, Deborah

2011-01-01

28

A comparison of a token economy with standard inpatient treatment  

Microsoft Academic Search

Used the Nurses Observation Scale for Inpatient Evaluation (NOSIE-30) to evaluate a token economy ward at a large psychiatric hospital in comparison with 3 nontoken wards in the same unit. The token economy appeared to be more effective in generating a broad range of behavior changes, including both an increase in positive behaviors and a decrease in negative behaviors.

Jeffrey Schwartz; Alan S. Bellack

1975-01-01

29

Inpatient treatment for pathological gamblers in Germany: setting, utilization, and structure.  

PubMed

In Germany, there are two different approaches to inpatient treatment of pathological gambling (PG): Facilities focusing on addiction or on psychosomatic illness. However, little is known about how these differences influence utilization and structure of treatment. Therefore, in our study, we analyzed all known German gambling inpatient treatment centers concerning patients' sex, age and number of comorbid disorders and evaluated an expert assessment of the treatment system, access to treatment, and structure characteristics of inpatient treatment facilities. In 2011, 2,229 pathological gamblers were treated. This amounts to 1 % of all past-year pathological gamblers. 90 % of the patients were men, 93 % had at least one comorbid disorder. Access to treatment was mostly gained via psychosocial counseling centers, but was not readily available. Facilities with addiction departments treated less pathological gamblers per year (29.3 gamblers) than facilities with psychosomatic departments (53.3 gamblers) or with both departments (76.4 gamblers). Treatment duration was significantly longer in addiction departments treating PG as secondary diagnosis only, with a low rate of gamblers on all patients, or treating few gamblers. Some facilities specialized on PG and treated more gamblers, had a higher rate of gamblers on all patients, and offered specific treatment programs. The impact of this specialization on treatment outcome is still unclear. Although treatment numbers have risen steadily for the past years, only a small fraction of affected gamblers seek inpatient treatment. Therefore, awareness to the disease and access to treatment needs to be improved. PMID:24375259

Buchner, Ursula Gisela; Erbas, Beate; Stürmer, Marco; Arnold, Melanie; Wodarz, Norbert; Wolstein, Jörg

2015-03-01

30

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 PMID:23531019

2013-01-01

31

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

32

Multimodal Inpatient Treatment of Vietnam Combat Veterans with Post-Traumatic Stress Disorder  

Microsoft Academic Search

The present paper is a description of the therapeutic components of an intensive inpatient treatment unit for Vietnam veterans with Post-Traumatic Stress Disorder. The problems and symptoms of this patient population are multifaceted and are not adequately treated by any one therapy approach. The basic core of treatment described herein is based on group work utilizing psychotherapeutic, cognitive-behavioral, and Gestalt

James K. Besyner

1985-01-01

33

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

34

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

PubMed

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

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

2013-09-01

35

21 CFR 312.83 - Treatment protocols.  

Code of Federal Regulations, 2011 CFR

... 2011-04-01 false Treatment protocols. 312.83 Section 312.83 Food...Severely-debilitating Illnesses § 312.83 Treatment protocols. If the preliminary analysis of...ask the sponsor to submit a treatment protocol to be reviewed under the procedures...

2011-04-01

36

21 CFR 312.83 - Treatment protocols.  

Code of Federal Regulations, 2010 CFR

... 2010-04-01 false Treatment protocols. 312.83 Section 312.83 Food...Severely-debilitating Illnesses § 312.83 Treatment protocols. If the preliminary analysis of...ask the sponsor to submit a treatment protocol to be reviewed under the procedures...

2010-04-01

37

The importance of group cohesion in inpatient treatment of combat-related PTSD.  

PubMed

Post-traumatic stress disorder (PTSD) is the most widespread mental illness resulting from exposure to combat, necessitating an increase in the provision of group therapy. This pilot study examined the efficacy of, and treatment outcome predictors associated with, group inpatient treatment of combat-related PTSD. Participants included 38 active duty military personnel deployed during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), diagnosed with PTSD, and consecutive admissions to an inpatient PTSD treatment facility. A paired samples t-test revealed significant change in symptom severity and global functioning between pre- and post-treatment. Multiple regression analyses supported the predictive utility of baseline symptomatology and group cohesion (> 50% of the variance in treatment outcome), highlighting the importance of group cohesion in the efficacy of group treatment for combat-related PTSD. PMID:24611702

Ellis, Carilyn C; Peterson, Mary; Bufford, Rodger; Benson, Jon

2014-04-01

38

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

PubMed

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

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

2014-08-01

39

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

40

The appropriateness of the treatment setting for the inpatient post-acute treatment of alcohol dependence disorders in Switzerland  

PubMed Central

Background In Switzerland, a total of 1'000 patients a year are treated for alcohol-dependence in specialized institutions. Though the current literature suggests favoring outpatient treatment, whether outpatient or inpatient treatment is more efficient cannot be answered generally. For Germany, "AWMF"-treatment guidelines were formulated in order to treat patients with substance use disorders in the appropriate treatment settings. The aim of the present study was to test the hypothesis that the majority of patients treated in the largest specialized institution for alcohol abuse treatment in Switzerland were treated in the appropriate setting. Methods All completed treatments conducted in the Forel-Hospital – the largest clinic of its kind in Switzerland – between the 1st of January 2004 and the 20th of December 2006 were included in the investigation (n = 915). Patient and treatment characteristics were gathered using the information from the PSYREC and act-info questionnaire. The AWMF criteria were operationalized on the basis of the questionnaire. Results Applying the AWMF criteria resulted in the emergence of three groups: 73.7% of the study sample could clearly be assigned to the inpatient treatment group, and for 7.5% there was evidence supporting the allocation to an outpatient treatment setting. In 18.8% of the cases, however, the AWMF criteria did not allow an assignment to either of the treatment settings. Of the total sample, 18.5% of all patients apparently did not profit from the inpatient treatment setting, whereas for the vast majority (81.5%), a therapeutic progress was documented. In those patients who, according to the AWMF guidelines, did not need an inpatient setting, a larger proportion improved than in the group of the patients who needed an inpatient treatment in a specialized hospital. Furthermore, the logistic regression analyses revealed that the less severe the clinical state of a patient upon admittance, the higher the odds of improvement during the hospital stay. Conclusion The results serve as evidence that for at least three out of four patients treated in the investigated specialized institution, an inpatient treatment was appropriate. The principal reason for the necessity of an inpatient treatment setting was that this hospital population showed severe psychiatric, somatic or social irregularities. Only a very limited number of patients hospitalized in a specialized institution for the treatment of alcohol-related disorders can be treated in an outpatient setting. PMID:19570222

Rossegger, Astrid; Keller, Anne; Odenwald, Michael; Endrass, Jérôme

2009-01-01

41

Dropping out from a specialized inpatient treatment for eating disorders: the perception of patients and staff.  

PubMed

Most studies of treatment drop-outs have focused on demographic and clinical patient characteristics as possible predictors. To get a better insight in the meaning of dropping-out from therapy, during 1 year the viewpoints of patients and staff were compared in each case (N = 21 or 15.2%) of premature termination of an inpatient treatment program for eating disorders. Both patients and staff were reporting as important reasons of drop-out: not enough freedom, treatment being too difficult, and lack of trust. Contrary to the staff, patients were more often satisfied with the therapy and therefore did not expect further benefit in continuing the inpatient treatment. The findings are discussed mainly within the context of patient-staff interaction. The authors propose to abandon the term "drop-out" because of its negative connotation. PMID:20390617

Vandereycken, Walter; Devidt, Katrien

2010-01-01

42

Predictors of length of stay among OEF/OIF/OND veteran inpatient PTSD treatment noncompleters.  

PubMed

High rates of attrition occur in outpatient and inpatient evidence-based treatments (EBTs) targeting newly returning veterans from Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND) with posttraumatic stress disorder (PTSD). Traditionally, research has examined attrition as a dichotomous variable (i.e., noncompleters vs. completers) and focused almost exclusively on outpatient EBTs for PTSD. These studies have provided little information to inpatient psychiatric providers about timing-related predictors of treatment discontinuation. The present study attempted to mend these gaps by examining attrition as a continuous variable and investigated predictors of length of stay (LOS) among 282 OEF/OIF/OND male veterans, 69 of which did not complete the full 25-day intensive, multimodal inpatient PTSD EBT program. At admission, participants completed a series of clinician-rated, biological, and self-report assessments. Linear regression analyses were used to identify predictors of shorter LOS. The results demonstrated that less improvement in symptom reduction, overall functioning, and greater number of drugs used at admission were significant and unique predictors of shorter LOS. Overall, these findings reveal clinically relevant, timing-related predictors of attrition and provide generalizable clinical information to inpatient psychiatric providers. PMID:25162134

Szafranski, Derek D; Gros, Daniel F; Menefee, Deleene S; Wanner, Jill L; Norton, Peter J

2014-01-01

43

The importance of interpersonal treatment goals for depressed inpatients.  

PubMed

Increased understanding of the treatment goals of depressed patients may lead to improved treatments and assist researchers and program evaluators in choosing clinically relevant outcome measures. To characterize patients' depression treatment goals, we interviewed hospitalized depressed patients about their treatment goals. Common responses included improving relationships, decreasing sadness or anxiety, and finding a job or improving job performance. On a written questionnaire, patients also ranked decreasing suicidal thoughts highly. These results suggest that for many severely depressed individuals, primary treatment goals include improvements in social and occupational functioning in addition to symptomatic improvement. PMID:18340257

Uebelacker, Lisa A; Battle, Cynthia L; Friedman, Michael A; Cardemil, Esteban V; Beevers, Christopher G; Miller, Ivan W

2008-03-01

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

Experiential learning in psychotherapy: ropes course exposures as an adjunct to inpatient treatment.  

PubMed

Exposures to a high-ropes course are introduced as an adjunct intervention in the therapy of psychotherapy patients. A controlled study was conducted to investigate the effectiveness of high-ropes exposures as an add-on to inpatient treatment in a naturalistic setting. In a sample of 247 patients, depressive symptoms, trait anxiety, locus of control and self-efficacy were assessed at admission and discharge of treatment and at 24-month follow-up. Follow-up data were available for 104 patients who attended the ropes courses and 53 control patients who underwent an inpatient treatment programme as usual. At the end of treatment, more high-rope participants showed clinically significant change on trait anxiety than controls but not regarding depressive symptoms. High-rope participants showed better follow-up outcomes than controls in trait anxiety and self-efficacy but not in depressive symptoms and external locus of control. Moreover, during follow-up, in the high-rope group, more patients showed reliable improvements and fewer patients showed reliable deteriorations in trait anxiety as compared with controls. The study gives a preliminary indication that the high-rope interventions are a feasible and valuable add-on to inpatient psychotherapy. The study design, sample composition and loss to follow-up are discussed as potential limitations of the study.? PMID:21110401

Wolf, Markus; Mehl, Kilian

2011-01-01

46

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

PubMed Central

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

Eli, Karin

2014-01-01

47

Inpatient Treatment for Adult Survivors of Childhood Sexual Abuse: A Preliminary Outcome Study  

Microsoft Academic Search

The objective of this study was to examine the changes in psychiatric symptoms and interpersonal problems in 34 adults with a history of childhood sexual abuse and posttraumatic stress disorder who attended a 3-month inpatient treatment program. Levels of posttraumatic, depressive, and general psychiatric symptoms and interpersonal problems were assessed at pre-care evaluation, admission, discharge, and 1-year follow-up using the

Ellen K. K. Jepsen; Tron Svagaard; Mona I. Thelle; Leigh McCullough; Egil W. Martinsen

2009-01-01

48

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

49

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

50

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. PMID:23331491

2013-01-01

51

Impact of dissociation and interpersonal functioning on inpatient treatment for early sexually abused adults  

PubMed Central

Background Little is known about the possible predictors of treatment outcome in early chronically sexually abused adults. The current study aimed to investigate what impact initial levels of dissociation and pre-treatment negative change in interpersonal functioning have on treatment response after 3 months of first-phase trauma inpatient treatment as well as after a period of 1 year the patients returned to their usual lives. Methods The sample comprised 48 inpatients with childhood sexual abuse histories and mixed trauma-related disorders who were examined at discharge and prospectively followed up for a period of 1 year under naturalistic conditions. Outcome variables were general psychiatric symptoms and interpersonal problems as measured with the Symptom Check List-Revised (SCL-R) and the Inventory of Interpersonal Problems (IIP) Circumplex. Results The central findings were that pathological dissociation and deterioration in interpersonal functioning prior to admittance predicted general psychiatric symptom levels and interpersonal problems at the end of treatment and at 1-year follow-up. Pathological dissociation, involving memory and identity problems, alone predicted negative outcome at the end of treatment. The findings at 1-year follow-up indicate that it is not pathological dissociation in isolation that affects outcomes, but rather the interaction between dissociation and change in interpersonal functioning prior to treatment. Conclusion These findings indicate the need of addressing dissociation and interpersonal problems in treatment planning and favor an integrated treatment approach for complex trauma patients. Future research should investigate whether and how this leads to better outcome, including long-term maintenance of gains after the end of treatment. PMID:24386549

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

2013-01-01

52

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

ERIC Educational Resources Information Center

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

Jackson, Afton; Shannon, Lisa

2013-01-01

53

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.

54

The outcome of treatment for anorexia nervosa inpatients who required urgent hospitalization  

PubMed Central

Background This study was done to determine which psychosocial factors are related to the urgent hospitalization of anorexia nervosa patients (AN) due to extremely poor physical condition and to evaluate their outcome after inpatient treatment. Methods 133 hospitalized AN patients were classified into an urgent hospitalization (n?=?24) or a planned hospitalization (n?=?109) group. Multiple regression analysis was done of clinical features, body mass index (BMI), psychological tests [The Minnesota Multiphasic Personality Inventory (MMPI), alexithymia, relationship with parents, and the Eating Disorder Inventory (EDI)]. The effectiveness of treatment was prospectively determined two years after discharge by the Global Clinical Score (GCS). The hospitalized weight gain and the frequency of outpatient visits were evaluated. Results Of the factors assessed, only BMI at admission was related to the necessity of urgent hospitalization (??=?? 1.063, P?=?0.00). The urgent group had significantly more weight loss after discharge and poorer social adaptation on the GCS, even when the patient had a sufficient increase in body weight during inpatient treatment and an equivalent number of outpatient consultations. Conclusion None of the parameters of the psychosocial tests studied were significantly different between the groups. The outcome of the urgent group was poor. Two years after discharge they had difficulty maintaining weight and continued to have poor social adaptation. PMID:25225574

2014-01-01

55

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

Code of Federal Regulations, 2014 CFR

...Inpatient hospital payment adjustment for low-volume hospitals. 412.101 Section 412...Inpatient hospital payment adjustment for low-volume hospitals. (a) Definitions. ...incremental costs associated with a low volume of discharges. The amount of any...

2014-10-01

56

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

PubMed Central

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

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

2015-01-01

57

Effectiveness of Long-Term, Intensive, Inpatient Treatment for Seriously Disturbed Young Adults: A Reply to Bein  

Microsoft Academic Search

Bein's criticisms of Therapeutic Change: An Object Relations Perspective are based on a misreading of the book; on a confusion between two independent types of analysis that were conducted; on a lack of appreciation of the nature of severe psychopathology and of long-term inpatient treatment; and on an attempt to impose a methodology from studies of treatment efficacy onto the

Sidney J. Blatt; William H. Berman; Barry P. Cook; Richard Q. Ford

1998-01-01

58

The inpatient evaluation and treatment of a self-professed budding serial killer.  

PubMed

The authors present the case of a man who was hospitalized after claiming that he was about to become a serial killer. The patient presented with extensive written homicidal fantasies and homicidal intentions without evidence of actual homicidal acts. In addition to routine assessments, hospital staff members used case conferences, psychological testing, outside forensic consultation, and a forensic review process to make decisions regarding diagnosis, treatment planning, and discharge. The patient was discharged after 8 months of inpatient treatment and was apparently free of homicidal impulses or symptoms of severe mental illness. A 2-year court commitment allowed for the enactment and potential enforcement of a discharge plan that was endorsed by the patient, the hospital, and community care providers. The authors review diagnostic and risk management issues. Comparisons with known features of typical serial killers are made. PMID:12613432

Reisner, Andrew D; McGee, Mark; Noffsinger, Stephen G

2003-02-01

59

Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients  

PubMed Central

Background Stroke is one of the leading medical conditions in the Philippines. Over 500,000 Filipinos suffer from stroke annually. Provision of evidence-based medical and rehabilitation management for stroke patients has been a challenge due to existing environmental, social, and local health system issues. Thus, existing western guidelines on stroke rehabilitation were contextualized to draft recommendations relevant to the local Philippine setting. Prior to fully implementing the guidelines, an audit of current practice needs to be undertaken, thus the purpose of this audit protocol. Methods A clinical audit of current practices in stroke rehabilitation in the Philippines will be undertaken. A consensus list of data items to be captured was identified by the audit team during a 2-day meeting in 2012. These items, including patient demographics, type of stroke, time to referral for rehabilitation management, length of hospital stay, and other relevant descriptors of stroke management were included as part of the audit. Hospitals in the Philippines will be recruited to take part in the audit activity. Recruitment will be via the registry of the Philippine Academy of Rehabilitation Medicine, where 90% of physiatrists (medical doctors specialized in rehabilitation medicine) are active members and are affiliated with various hospitals in the Philippines. Data collectors will be identified and trained in the audit process. A pilot audit will be conducted to test the feasibility of the audit protocol, and refinements to the protocol will be undertaken as necessary. The comprehensive audit process will take place for a period of 3 months. Data will be encoded using MS Excel®. Data will be reported as means and percentages as appropriate. Subgroup analysis will be undertaken to look into differences and variability of stroke patient descriptors and rehabilitation activities. Conclusion This audit study is an ambitious project, but given the “need” to conduct the audit to identify “gaps” in current practice, and the value it can bring to serve as a platform for implementation of evidence-based stroke management in the Philippines to achieve best patient and health outcomes, the audit team is more than ready to take up the challenge. PMID:25784814

Gonzalez-Suarez, Consuelo B; Dizon, Janine Margarita R; Grimmer, Karen; Estrada, Myrna S; Liao, Lauren Anne S; Malleta, Anne-Rochelle D; Tan, Ma Elena R; Marfil, Vero; Versales, Cristina S; Suarez, Jimah L; So, Kleon C; Uyehara, Edgardo D

2015-01-01

60

Placement and Permanency Outcomes for Children in Out-of-Home Care by Prior Inpatient Mental Health Treatment  

ERIC Educational Resources Information Center

Objective: This longitudinal study followed 5,978 children in out-of-home care to examine whether placement and permanency outcomes differ between children with and without a history of inpatient mental health treatment. Method: Data were drawn from child welfare and Medicaid records from the state of Illinois. Logistic regression and survival…

Park, Jung Min; Ryan, Joseph P.

2009-01-01

61

Therapy Results and Follow-Up of an Integrated Inpatient Treatment for Severe Cases of Anorexia nervosa  

Microsoft Academic Search

The therapeutic elements of an inpatient treatment for anorexia nervosa are presented with the therapy results as well as a 2-year follow-up of 39 patients who were treated at Hamburg University Hospital from 1980 to 1983. The favorable results (high weight gain, short duration of therapy, distinct psychological improvement with a total of 53% of virtually cured patients at the

K. Engel; B. Wilfarth

1988-01-01

62

From Traditional Inpatient to Trauma-Informed Treatment: Transferring Control From Staff to Patient  

Microsoft Academic Search

Mental health professionals worldwide realize the imperative for reducing inpatient restraints and seclusion. The high incidence of posttraumatic stress disorder for inpatients and the resulting symptoms support the creation of a trauma-informed approach. The objective of the current article is to describe the experience of staff in a 20-bed unit transitioning from traditional inpatient care to a trauma-informed approach. The

Genevieve Chandler

2008-01-01

63

Evaluating Treatment Protocols to Prevent Antibiotic Resistance  

Microsoft Academic Search

The spread of bacteria resistant to antimicrobial agents calls for population-wide treatment strategies to delay or reverse the trend toward antibiotic resistance. Here we propose new criteria for the evaluation of the population-wide effects of treatment protocols for directly transmitted bacterial infections and discuss different usage patterns for single and multiple antibiotic therapy. A mathematical model suggests that the long-term

Sebastian Bonhoeffer; Marc Lipsitch; Bruce R. Levin

1997-01-01

64

Inpatient surgical treatment patterns for patients with uterine fibroids in the United States, 1998-2002.  

PubMed Central

OBJECTIVE: To analyze the impact of patient and organizational characteristics on surgical treatment patterns for patients with uterine fibroids. METHODS: Unadjusted means and percentages were calculated from a population-based inpatient sample (HCUPNIS). Multiple logistic regression analysis was used to estimate the prevalence odds ratios for the association of uterine fibroid treatments and covariates of interest. RESULTS: More than 1.2 million patients with a primary diagnosis of uterine fibroids were treated from 1998 to 2002. Of these, 84.4% received a hysterectomy and 12.3% received a myomectomy. Total abdominal hysterectomy was the most common procedure. The number of supracervical hysterectomies increased 18.1% over the five-year period. Black women and Asians/Pacific Islanders were more likely than white women to receive a myomectomy. All types of hysterectomies were more common in Medicaid patients compared with private/HMO patients. With the exception of patients in ZIP codes with a median income of <$25,000 per year, an inverse relationship was identified between income and hysterectomy rates. CONCLUSIONS: The management of uterine fibroids appears to differ across a variety of socioeconomic factors and institutional characteristics. This study suggests that additional research should be conducted to assess the impact of nonclinical factors on treatment decisions for patients with uterine fibroids. PMID:16353655

Becker, Edmund R.; Spalding, James; DuChane, Janeen; Horowitz, Ira R.

2005-01-01

65

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

PubMed

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

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

2014-12-01

66

Pathological Gambling: Influence of Quality of Life and Psychological Distress on Abstinence After Cognitive-Behavioral Inpatient Treatment  

Microsoft Academic Search

The aim of this study is to understand the influence of psychological distress and quality of life on the maintenance of therapy\\u000a success during a 1 year follow-up in pathological gamblers after inpatient cognitive-behavioral treatment. In a sample of\\u000a 281 pathological gamblers (247 men, 34 women) the following measures were taken: psychological distress (beginning and end\\u000a of treatment, and follow

Wiebke Sander; Anne Peters

2009-01-01

67

COMPUTER SUPPORT FOR PROTOCOL-BASED TREATMENT OF CANCER1  

E-print Network

COMPUTER SUPPORT FOR PROTOCOL-BASED TREATMENT OF CANCER1 PETER HAMMOND2 AND MAREK SERGOT3 July 1994 Cancer treatment is often carried out within protocol-based clinical trials. An oncology clinic may take of many protocols, the life-threatening nature of cancer and the toxicity of treatment side

Sergot, Marek

68

Hospital Inpatient versus HOme-based rehabilitation after knee arthroplasty (The HIHO study): study protocol for a randomized controlled trial  

PubMed Central

Background Formal rehabilitation programs are often assumed to be required after total knee arthroplasty to optimize patient recovery. Inpatient rehabilitation is a costly rehabilitation option after total knee arthroplasty and, in Australia, is utilized most frequently for privately insured patients. With the exception of comparisons with domiciliary services, no randomized trial has compared inpatient rehabilitation to any outpatient based program. The Hospital Inpatient versus HOme (HIHO) study primarily aims to determine whether 10 days of post-acute inpatient rehabilitation followed by a hybrid home program provides superior recovery of functional mobility on the 6-minute walk test (6MWT) compared to a hybrid home program alone following total knee arthroplasty. Secondarily, the trial aims to determine whether inpatient rehabilitation yields superior recovery in patient-reported function. Methods/Design This is a two-arm parallel randomized controlled trial (RCT), with a third, non-randomized, observational group. One hundred and forty eligible, consenting participants who have undergone a primary total knee arthroplasty at a high-volume joint replacement center will be randomly allocated when cleared for discharge from acute care to either 10 days of inpatient rehabilitation followed by usual care (a 6-week hybrid home program) or to usual care. Seventy participants in each group (140 in total) will provide 80% power at a significance level of 5% to detect an increase in walking capacity from 400 m to 460 m between the Home and Inpatient groups, respectively, in the 6MWT at 6 months post-surgery, assuming a SD of 120 m and a drop-out rate of <10%. The outcome assessor will assess participants at 10, 26 and 52 weeks post-operatively, and will remain blind to group allocation for the duration of the study, as will the statistician. Participant preference for rehabilitation mode stated prior to randomization will be accounted for in the analysis together with any baseline differences in potentially confounding characteristics as required. Discussion The HIHO Trial will be the first RCT to investigate the efficacy of inpatient rehabilitation compared to any outpatient alternative following total knee arthroplasty. Trial registration U.S. National Institutes of Health Clinical Trials Registry (http://clinicaltrials.gov) ref: NCT01583153 PMID:24341348

2013-01-01

69

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

ERIC Educational Resources Information Center

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

Oxman, Elaine B.; Chambliss, Catherine

70

Inpatient psychiatric-psychotherapeutic treatment of mothers with a generalized anxiety disorder – Does the co-admission of their children influence the treatment results?  

Microsoft Academic Search

Summary INTRODUCTION: Whether women who are admitted together with their children achieve inpatient psychotherapeutic treatment results that differ significantly from the results for women who are admitted alone is a subject of controversy. We compared both groups in a prospective, randomized, controlled study. METHODS: The monitored results of 29 female patients diagnosed with generalized anxiety disorder, 15 of whom were

Karin Tritt; Marius Nickel; Cerstin Nickel; Claas Lahmann; Ferdinand Mitterlehner; Peter Leiberich; Thomas Loew; Wolfhardt Rother

2004-01-01

71

Child abuse and treatment difficulty in inpatient treatment of children and adolescents.  

PubMed

This study examined the associations between abuse and staff perceived treatment difficulty in sixty-nine hospitalized children and adolescents. Subjects were rated on a treatment difficulty scale, and clinical charts were reviewed for evidence of physical abuse, sexual abuse, abuse between parents, and parental history of abuse. Subjects with histories of abuse were not rated as more difficult or less responsive to treatment than other patients. Physically abused youngsters were rated as more self-destructive and more accessible to treatment than non-abused children, while sexually abused youngsters were self-destructive and demanding, and their families were seen as more distant and unavailable. PMID:7805436

Barber, C C; Colson, D B; McParland, M Q; O'Malley, F; Pope, K K; Coyne, L

1994-01-01

72

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

PubMed Central

Background To assess comorbid DSM-IV-TR Axis I disorders in adolescent inpatients referred for treatment of substance use disorders. Methods 151 patients (mean age 16.95 years, SD = 1.76; range 13 - 22) were consecutively assessed with the Composite International Diagnostic Interview (CIDI) and standardized clinical questionnaires to assess mental disorders, symptom distress, psychosocial variables and detailed aspects of drug use. A consecutively referred subgroup of these 151 patients consisting of 65 underage patients (mean age 16.12, SD = 1.10; range 13 - 17) was additionally assessed with the modules for attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) using The Schedule for Affective Disorders and Schizophrenia for school-aged children (K-SADS-PL). Results 128 (84.8%) of the 151 patients were dependent on at least one substance, the remaining patients fulfilled diagnostic criteria for abuse only. 40.5% of the participants fulfilled criteria for at least one comorbid present Axis I disorder other than substance use disorders (67.7% in the subgroup additionally interviewed with the K-SADS-PL). High prevalences of present mood disorder (19.2%), somatoform disorders (9.3%), and anxiety disorders (22.5%) were found. The 37 female participants showed a significantly higher risk for lifetime comorbid disorders; the gender difference was significantly pronounced for anxiety and somatoform disorders. Data from the underage subgroup revealed a high prevalence for present CD (41.5%). 33% of the 106 patients (total group) who were within the mandatory school age had not attended school for at least a two-month period prior to admission. In addition, 51.4% had been temporarily expelled from school at least once. Conclusions The present data validates previous findings of high psychiatric comorbidity in adolescent patients with substance use disorders. The high rates of school refusal and conduct disorder indicate the severity of psychosocial impairment. PMID:20920182

2010-01-01

73

Decreasing inpatient length of stay at a military medical treatment facility.  

PubMed

This article describes an evidence-based approach to decreasing the length of stay of inpatient adults on the medicine oncology ward of a large urban military medical center. A strong and diverse team was formed, which worked together for the length of the project. A formalized approach involving weekly discharge-planning meetings with a discharge advocate as the planner, coupled with solid documentation, was adopted. There was a decrease in the average length of stay on the inpatient wards, resulting in cost savings for the facility. This approach using strong evidence can overcome institutional challenges, with a positive impact on patient care. PMID:25155531

Ferro, Allison; Mullens, Katrina; Randall, Seth

2014-09-01

74

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 PMID:23968340

2013-01-01

75

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. PMID:23433268

Page, Stephen J.

2013-01-01

76

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

2013-01-01

77

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

78

Efficacy and cost-effectiveness of an experimental short-term inpatient Dialectical Behavior Therapy (DBT) program: study protocol for a randomized controlled trial  

PubMed Central

Background Borderline Personality Disorder (BPD) is a serious psychiatric condition associated with substantial mortality, burden and public health costs. DBT is the treatment model with the largest number of published research articles showing effectiveness. However, some patients are not sufficiently engaged in outpatient treatment while presenting severe parasuicidal behavior, making hospitalization necessary. The Center for Personality Disorders Jelgersma developed an intensive 12-week inpatient DBT program that (i) rapidly reduces core borderline symptoms like suicidal behavior, (ii) minimizes the negative effects of an inpatient setting, and (iii) enhances compliance with outpatient treatment. We evaluate the (cost-) effectiveness of this experimental program. Methods/design Seventy patients, aged 18 to 45 years with a primary diagnosis of BPD, showing a chronic pattern of parasuicidal gestures and/or reporting high degrees of severity of other borderline symptoms, are randomly allocated to the control and intervention groups. Subjects in the control group receive standard outpatient DBT, provided in one of three regular mental health settings in GGZ Rivierduinen. Subjects in the intervention group receive 12 weeks of intensified inpatient DBT plus six months of standard DBT, provided in the Center for Personality Disorders Jelgersma. The primary outcome is the number of suicide attempts/self-harming acts. Secondary outcomes are severity of other borderline complaints, quality of life, general psychopathological symptoms and health care utilization and productivity costs. Data are gathered using a prospective, two (group: intervention and control) by five (time of measurement) repeated measures factorial design. Participants will complete three-monthly outcome assessments in the course of therapy: at baseline, and 12, 24, 36 and 52 weeks after the start of the treatment. The period of recruitment started in March 2012 and the study will end in December 2014. Discussion Highly suicidal outpatient patients can pose a dilemma for mental health care professionals. Although hospitalization seems inevitable under some circumstances, it has proven to be harmful in its own right. This paper outlines the background and methods of a randomized trial evaluating the possible surplus value of a short-term inpatient DBT program. PMID:24885551

2014-01-01

79

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. PMID:23506489

2013-01-01

80

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

81

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

82

Controlled inpatient study of tienilic acid in treatment of gout and hypertension.  

PubMed Central

Under inpatient controlled conditions 4 patients with gout and hypertension were treated with varying doses of tienilic acid, a new uricosuric diuretic. Plasma urate levels were reduced by an average of 50% in association with significantly increased urinary urate excretion. A twice-daily regimen was considerably more effective than a single morning dosage in reduction of plasma urate, though both regimens were equally effective in antihypertensive potency. The single daily regimen produced greater diurnal fluctuations in plasma urate and was more frequently associated with the development of acute gout attacks. PMID:7436563

Reardon, J A; Scott, J T

1980-01-01

83

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

84

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

PubMed Central

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

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

2013-01-01

85

Estimating average inpatient and outpatient costs and childhood pneumonia and diarrhoea treatment costs in an urban health centre in Zambia  

PubMed Central

Background Millions of children die every year in developing countries, from preventable diseases such as pneumonia and diarrhoea, owing to low levels of investment in child health. Investment efforts are hampered by a general lack of adequate information that is necessary for priority setting in this sector. This paper measures the health system costs of providing inpatient and outpatient services, and also the costs associated with treating pneumonia and diarrhoea in under-five children at a health centre in Zambia. Methods Annual economic and financial cost data were collected in 2005-2006. Data were summarized in a Microsoft excel spreadsheet to obtain total department costs and average disease treatment costs. Results The total annual cost of operating the health centre was US$1,731,661 of which US$1 284 306 and US$447,355 were patient care and overhead departments costs, respectively. The average cost of providing out-patient services was US$3 per visit, while the cost of in-patient treatment was US$18 per bed day. The cost of providing dental services was highest at US$20 per visit, and the cost of VCT services was lowest, with US$1 per visit. The cost per out-patient visit for under-five pneumonia was US$48, while the cost per bed day was US$215. The cost per outpatient visit attributed to under-five diarrhoea was US$26, and the cost per bed day was US$78. Conclusion In the face of insufficient data, a cost analysis exercise is a difficult but feasible undertaking. The study findings are useful and applicable in similar settings, and can be used in cost effectiveness analyses of health interventions. PMID:19845966

Chola, Lumbwe; Robberstad, Bjarne

2009-01-01

86

Evaluation of the Computerized Assessment System for Psychotherapy Evaluation and Research (CASPER) as a Measure of Treatment Effectiveness with Psychiatric Inpatients  

ERIC Educational Resources Information Center

Assessment procedures to evaluate inpatient treatment effectiveness can provide information to inform clinical practice. The Computerized Assessment System for Psychotherapy Evaluation and Research (CASPER) represents a standardized approach to assess patients' target problems that combines elements of individualized and nomothetic approaches.…

Kinnaman, Joanna E. Strong; Farrell, Albert D.; Bisconer, Sarah W.

2006-01-01

87

Experiences of adults abused as children after discharge from inpatient treatment: Informal social support and self-care practices related to trauma recovery  

Microsoft Academic Search

This qualitative study explored adults’ perceptions of experiences that were helpful and unhelpful to their recovery from the traumatic effects of childhood physical and sexual abuse. The authors conducted in-depth interviews with 30 participants approximately 6 months after discharge from an inpatient trauma treatment program. Participants reported that barriers to recovery postdischarge were lack of follow-up support immediately after discharge,

Carol Stalker; Kim Harper; Sally Palmer; Susan Gadbois

2005-01-01

88

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. PMID:23570454

2013-01-01

89

Use of identification wristbands among patients receiving inpatient treatment in a teaching hospital  

PubMed Central

OBJECTIVE: to evaluate the use of identification wristbands among patients hospitalized in inpatient units. METHOD: quantitative, descriptive and transversal research, with a sample of 385 patients. Data collection occurred through the observational method through the filling out of a structured questionnaire which aimed to check the presence of the identification wristband and the identifiers used. Descriptive statistics with absolute and relative frequencies was used for analysis. RESULTS: it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands. CONCLUSION: the study demonstrated the professionals' engagement in the process of patient identification, evidencing a high rate of conformity of the wristbands. Furthermore, it contributed to identify elements in the use of wristbands which may be improved for a safe identification process. PMID:25806629

Hoffmeister, Louíse Viecili; de Moura, Gisela Maria Schebella Souto

2015-01-01

90

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

PubMed

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 unit after delivery. The men's behaviour in the relationship, in their role as a partner, and as a father were rated in a categorical-qualitative way. We found that nearly one third of the male partners can be described as "supportive". This finding strongly correlates with the subjective experience of the corresponding wives of being supported by the male partners. However in the subgroup of women who had already suffered from prepartum psychiatric disorders with onset before index-delivery, the majority of the male partners were rated and experienced as "non-supportive". Additionally, ten of these men suffered from several DSM-IV/ICD-10 based psychiatric disorders themselves. Using the standardised questionnaire "operationalisierte psychodynamische Diagnostik" (OPD) we describe the higher ego-strength of the supportive male partners. We found that there was a reduction in the length of stay in the hospital in the families with supportive male partners. PMID:15959625

Grube, M

2005-09-01

91

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

PubMed

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

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

2015-04-01

92

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

PubMed

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

Morgan, Vanessa

2014-03-01

93

HIV Dynamics: Modeling, Data Analysis, and Optimal Treatment Protocols  

E-print Network

HIV Dynamics: Modeling, Data Analysis, and Optimal Treatment Protocols B. M. Adams 1 , H. T. Banks in model- ing HIV pathogenesis. After a brief discussion of motivation for and previous efforts in the development of mathematical models for progression of HIV infection and treatment, we discuss mathematical

94

Idiopathic condylar resorption: diagnosis, treatment protocol, and outcomes.  

PubMed

Idiopathic condylar resorption is a poorly understood progressive disease that affects the TMJ and that can result in malocclusion, facial disfigurement, TMJ dysfunction, and pain. This article presents the diagnostic criteria for idiopathic condylar resorption and a new treatment protocol for management of this pathologic condition. Idiopathic condylar resorption most often occurs in teenage girls but can occur at any age, although rarely over the age of 40 years. These patients have a common facial morphology including: (1) high occlusal and mandibular plane angles, (2) progressively retruding mandible, and (3) Class II occlusion with or without open bite. Imaging usually demonstrates small resorbing condyles and TMJ articular disk dislocations. A specific treatment protocol has been developed to treat this condition that includes: (1) removal of hyperplastic synovial and bilaminar tissue; (2) disk repositioning and ligament repair; and (3) indicated orthognathic surgery to correct the functional and esthetic facial deformity. Patients with this condition respond well to the treatment protocol presented herein with elimination of the disease process. Two cases are presented to demonstrate this treatment protocol and outcomes that can be achieved. Idiopathic condylar resorption is a progressive disease that can be eliminated with the appropriate treatment protocol. PMID:10587602

Wolford, L M; Cardenas, L

1999-12-01

95

Treatment of chronic anorexia nervosa: a 4-year follow-up of adult patients treated in an acute inpatient setting.  

PubMed

Despite evidence from a number of long-term follow-up studies of anorexia nervosa that nearly 50% of patients eventually make a full recovery, controlled trials of psychotherapy for anorexia nervosa are lacking. Those with severe and enduring problems represent a considerable therapeutic challenge. Thirty-four consecutive adult referrals to the inpatient treatment unit who fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for anorexia nervosa were examined pre-admission, post-discharge and 4 years after admission. Characteristics of remitted and non-remitted patients were examined. Secondary analyses considered the differences between patients with anorexia nervosa, restricting type and anorexia nervosa binging/purging type. The findings highlight a number of differences between patients with anorexia nervosa (restricting type) versus anorexia nervosa (binging/purging type) as well as remitted versus non-remitted patients. The use of a comprehensive battery of assessments found that resolution of eating disorder symptomatology was paralleled by improvements in emotional and psychological distress and improvement in body image perception and coping skills. Better results were obtained for those who had continuity of care on an outpatient basis. This pattern is particularly significant given the more 'chronic' nature of the sample that were older, with a higher incidence of binge-eating and purging than previous samples. Results provide some encouragement for the treatment of those adults with anorexia nervosa who typically have less favourable outcomes.? PMID:21312315

Long, Clive G; Fitzgerald, Kirsty-Anne; Hollin, Clive R

2012-01-01

96

Preventing Suicide Among Inpatients  

PubMed Central

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

Sakinofsky, Isaac

2014-01-01

97

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

98

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

PubMed Central

Background Severe mental disorders have a chronic course associated with a high risk for co-morbid somatic illnesses and premature mortality and oral health is critical for overall systemic health. But general health care needs in this population are often neglected. Some studies have aimed at determining the oral health status of psychiatric in-patients but to date, no emphasis has been placed on oral health of psychiatric patients in France. The goal of this study was to assess the oral health and treatment needs of institutionalized patients in a large psychiatric hospital, where a dental service was available and free, to compare it with the average population, with psychiatric in-patients in other countries and to provide recommendations for psychiatrists and care-giving staff. Methods The dental status (DMFT), the oral hygiene (OHIS: Simplified Oral Hygiene Index), the saliva flow rate were recorded on a randomized patient sample. Demographic and medical data were retrieved from the institutional clinical files. Results Among the 161 examined patients, 95 (59.0%) were men and 66 (41.0%) were women. The mean age was 46.9 ± 17.5 years. The majority was diagnosed schizophrenia (36.6%) or mood disorders (21.1%). The mean OHIS was 1.7 ± 1.1. Among the 147 patients who agreed to carry out the salivary examination, the average saliva flow rate was 0.3 g ± 0.3 g/min. Saliva flow under the average rest saliva flow (0.52 mg/min) was found for 80.3% of the patient. The mean DMFT was 15.8 ± 8.8 (D = 3.7 ± 4.4, M = 7.3 ± 9.4, F = 4.7 ± 4.9) and significantly increased with age (p < 0.001) and degree of disability (p = 0.003) (stepwise linear regression). Eighteen patients (11.2%) were edentulous. Conclusions The DMFT was similar to low income French population but psychiatric patients had almost 4 times more decayed teeth, slightly less missing teeth and 1.5 times less filled teeth. Oral health appeared to be better than in most other countries. But compared to general population, the still unmet dental and prosthetic needs indicated the major need of enhanced access to dental care and specific preventive programs. PMID:24053587

2013-01-01

99

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

2008-01-01

100

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. PMID:23690795

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

2013-01-01

101

Long-Term Effects of the Treatment of Depressive Female Inpatients in a Naturalistic Study: Is Early Improvement a Valid Predictor of Outcome?  

PubMed Central

Objectives. To examine the predictive value of early improvement for short- and long-term outcome in the treatment of depressive female inpatients and to explore the influence of comorbid disorders (CD). Methods. Archival data of a naturalistic sample of 277 female inpatients diagnosed with a depressive disorder was analyzed assessing the BDI at baseline, after 20 days and 30 days, posttreatment, and after 3 to 6 months at follow-up. Early improvement, defined as a decrease in the BDI score of at least 30% after 20 and after 30 days, and CD were analyzed using binary logistic regression. Results. Both early improvement definitions were predictive of remission at posttreatment. Early improvement after 30 days showed a sustained treatment effect in the follow-up phase, whereas early improvement after 20 days failed to show a persistent effect regarding remission at follow-up. CD were not significantly related neither at posttreatment nor at follow-up. At no time point CD moderated the prediction by early improvement. Conclusions. We show that early improvement is a valid predictor for short-term remission and at follow-up in an inpatient setting. CD did not predict outcome. Further studies are needed to identify patient subgroups amenable to more tailored treatments. PMID:25061526

grosse Holtforth, Martin

2014-01-01

102

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

PubMed Central

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

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

2014-01-01

103

Attachment characteristics and treatment outcome following inpatient psychotherapy: Results of a multisite study  

Microsoft Academic Search

The authors evaluated 617 patients at hospital admission using an interpersonal interview analyzed with the Adult Attachment Prototype Rating (Strauss, Lobo-Drost, & Pilkonis, 1999) in nine different psychotherapeutic hospitals. Attachment characteristics derived from this method served as predictors of treatment outcome. Outcome was quantified in all sites using the Symptom Checklist-90-Revised, Inventory of Interpersonal Problems, and, in a subsample, the

Bernhard Strauss; Helmut Kirchmann; Jochen Eckert; Audrey Lobo-Drost; Andrea Marquet; Rainer Papenhausen; Robert Mosheim; Wilfried Biebl; Anette Liebler; Klaus-Peter Seidler; Karin Schreiber-Willnow; Dankwart Mattke; Robert Mestel; Elke Daudert; Ralf Nickel; Henning Schauenburg; Diether Höger

2006-01-01

104

Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: Pilot results  

Microsoft Academic Search

Cognitive behavior therapy (CBT) has been demonstrated in a number of randomized controlled trials to be efficacious as an adjunctive treatment for psychotic disorders. Emerging evidence suggests the usefulness of CBT interventions that incorporate acceptance\\/mindfulness-based approaches for this population. The current study extended previous research by Bach and Hayes (2002. The use of Acceptance and Commitment Therapy to prevent the

Brandon A. Gaudiano; James D. Herbert

2006-01-01

105

Adult Rhabdomyosarcoma Survival Improved With Treatment on Multimodality Protocols  

SciTech Connect

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

Gerber, Naamit Kurshan [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wexler, Leonard H. [Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Singer, Samuel [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Alektiar, Kaled M. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Keohan, Mary Louise [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Shi, Weiji; Zhang, Zhigang [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wolden, Suzanne, E-mail: woldens@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

2013-05-01

106

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

107

[Protocol for the treatment of severe acute pancreatitis with necrosis].  

PubMed

The Severe Acute Pancreatic Unit of Edgardo Rebagliati Martins National Hospital was officially created in the year 2000. Up to date, we have cared for more than 195 patients with Pancreatic Necrosis. All of them have been treated under a management protocol presented by us. This has helped us to standardize treatment and also to compare results with work groups around the world. This Protocol comes from our own experience and that of our colleagues abroad with a wide knowledge in this kind of pathology abroad, with whom we maintain close ties. PMID:16021203

Barreda, Luis; Targarona, Javier; Rodriguez, César

2005-01-01

108

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. PMID:20309848

Boxer, Paul

2010-01-01

109

Cost-effectiveness of intensive inpatient treatments for severely obese children and adolescents in the Netherlands; a randomized controlled trial (HELIOS)  

Microsoft Academic Search

Background  Intensive combined lifestyle interventions are the recommended treatment for severely obese children and adolescents, but\\u000a there is a lack of studies and their cost-effectiveness. The objective of this study is to compare the cost-effectiveness\\u000a of two intensive one-year inpatient treatments and usual care for severely obese children and adolescents.\\u000a \\u000a \\u000a \\u000a \\u000a Methods\\/Design  Participants are 40 children aged 8-13 and 40 adolescents aged 13-18

Sabine Makkes; Jutka Halberstadt; Carry M Renders; Judith E Bosmans; Olga H van der Baan-Slootweg; Jacob C Seidell

2011-01-01

110

Using continuous quality improvement strategies to reduce repeated admissions for inpatient psychiatric treatment.  

PubMed

A multidisciplinary performance improvement team was chartered to examine the problem of repeated admissions to psychiatric hospitals. It was also asked to devise an intervention strategy to reduce the number of readmissions, including the number of patients with three or more admissions in a 12-month period and the number of days patients spend in hospital beds. Multivoting, benchmarking, and a review of medical records for 88 psychiatric patients who had been hospitalized three or more times in 1 year were the methods used to gather data on client characteristics. An analysis of the data suggested that these high-end users had similar patterns of service utilization prior to their hospitalizations. The team identified 11 of these patterns as triggers that appear to signal early stages of decompensation that can lead to hospitalization. The team implemented an early intervention and prevention system by using the triggers as criteria for initiating a change in treatment plans. A study of the effectiveness of the Triggers Intervention and Prevention System (TIPS) was undertaken over the next 2 years. An automated program for deriving the triggers from the emergency services database was developed. Initial results that TIPS is an effective means of reducing recidivism and that the triggers can identify high-end users. Some of the triggers were deemed to be more effective than others in the early identification of individuals who may need to be hospitalized. A comparison of hospitalization rates for the pre- and postimplementation periods of TIPS showed a significant reduction in the number of patients who had three or more hospitalizations, fewer total admissions, and a shorter average length of stay. During 1995, the triggers were successful in the early identification of all patients who had more than one admission. The teams used the Design, Measure, Assess, Improve method recommended by the Joint Commission on Accreditation of Healthcare Organizations. PMID:10167162

Frazier, R S; Amigone, D K; Sullivan, J P

1997-01-01

111

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

ERIC Educational Resources Information Center

This Treatment Improvement Protocol (TIP) provides guidelines for counselors and others working in the field of co-occurring substance use and mental disorders. TIPs are best-practice guidelines for the treatment of substance use disorders that make the latest research in substance abuse treatment available to counselors and educators. The content…

Sacks, Stanley; Ries, Richard K.

2005-01-01

112

Inpatient hemodialysis without anticoagulation in adults  

PubMed Central

Background Anticoagulation use during hemodialysis (HD) is standard practice but issues related to an increased risk of hemorrhage associated with inpatients make this a concern. Methods An anticoagulation-free protocol in which (i) the dialysis circuit is aggressively primed with normal saline (NS) in an attempt to flush it of all air, (ii) blood flow during the HD treatment is maximized to up to 400 mL/min, (iii) the dialysis circuit is flushed every 15 min with 100 mL of NS, and (iv) the use of bloodlines that lack a blood–air interface was developed and used for all adult inpatient HD treatments at Rush University Medical Center. The purpose of this study was to evaluate the rate of HD circuit clotting using this approach and to determine if factors such as access type, blood flow, arterial and venous bloodline pressures, the need for reversing the arterial and venous access lines for low blood flow or high venous or arterial bloodline pressures, or the amount of net ultrafiltration were associated with HD circuit clotting. Patients were excluded from analysis if they were on a heparin drip, clopidogrel, warfarin or direct thrombin inhibitors. We reviewed 400 HD treatments in 400 adult patients from 12/12 to 10/13. Results The HD access in these patients consisted of catheters in 45%, native AV fistulas in 40% and grafts in 15% of the patients. The average blood flow in the treatments was 378 ± 46 mL/min. In 5% of the treatments, the arterial and venous bloodlines were reversed. Only 4 of the 400 (1%) of the treatments clotted the dialysis circuit. Factors associated with clotting were lower achieved blood flows (225 ± 50 mL/min versus 379 ± 44 mL/min), higher arterial bloodline pressures (?198 ± 24 mmHg versus ?151 ± 45 mmHg) and reversal of arterial and venous access lines. Conclusion Our anticoagulation-free protocol allows inpatient HD to be performed in adults across all access types and with essentially no circuit clotting.

Sahota, Sheena; Rodby, Roger

2014-01-01

113

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

114

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. PMID:24179565

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

2013-01-01

115

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. PMID:24167647

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

2013-01-01

116

Scalp acupuncture treatment protocol for anxiety disorders: a case report.  

PubMed

Anxiety disorders are among the most common psychiatric illnesses, and acupuncture treatment is widely accepted in the clinic without the side effects seen from various medications. We designed a scalp acupuncture treatment protocol by locating two new stimulation areas. The area one is between Yintang (M-HN-3) and Shangxing (DU-23) and Shenting (DU-24), and the area two is between Taiyang (M-HN-9) and Tianchong (GB-9) and Shuaigu (GB-8). By stimulating these two areas with high-frequency continuous electric waves, remarkable immediate and long-term effects for anxiety disorders have been observed in our practice. The first case was a 70-year-old male with general anxiety disorder (GAD) and panic attacks at night. The scalp acupuncture treatment protocol was applied with electric stimulation for 45 minutes once every week. After four sessions of acupuncture treatments, the patient reported that he did not have panic attacks at night and he had no feelings of anxiety during the day. Follow-up 4 weeks later confirmed that he did not have any episodes of panic attacks and he had no anxiety during the day since his last acupuncture treatment. The second case was a 35-year-old male who was diagnosed with posttraumatic stress disorder (PTSD) with a history of providing frontline trauma care as a Combat Medics from the Iraq combat field. He also had 21 broken bones and multiple concussions from his time in the battlefield. He had symptoms of severe anxiety, insomnia, nightmares with flashbacks, irritability, and bad temper. He also had chest pain, back pain, and joint pain due to injuries. The above treatment protocol was performed with 30 minutes of electric stimulation each time in combination with body acupuncture for pain management. After weekly acupuncture treatment for the first two visits, the patient reported that he felt less anxious and that his sleep was getting better with fewer nightmares. After six sessions of acupuncture treatments, the patient completely recovered from PTSD, went back to work, and now lives a healthy and happy family life. The above cases and clinical observation show that the scalp acupuncture treatment protocol with electric stimulation has a significant clinic outcome for GAD, panic disorder and PTSD. The possible mechanism of action of scalp acupuncture on anxiety disorder may be related to overlapping modulatory effects on the cortical structures (orbitofrontal cortex [OFC]) and medial prefrontal cortex [mPFC]) and subcortical/limbic regions (amygdala and hippocampus), and biochemical effect of acupuncture through immunohistochemistry (norepinephrine, serotonin) performed directly to the brain tissue for anxiety disorders. PMID:25105075

He, Yuxin; Chen, Jia; Pan, Zimei; Ying, Zhou

2014-07-01

117

Scalp Acupuncture Treatment Protocol for Anxiety Disorders: A Case Report  

PubMed Central

Anxiety disorders are among the most common psychiatric illnesses, and acupuncture treatment is widely accepted in the clinic without the side effects seen from various medications. We designed a scalp acupuncture treatment protocol by locating two new stimulation areas. The area one is between Yintang (M-HN-3) and Shangxing (DU-23) and Shenting (DU-24), and the area two is between Taiyang (M-HN-9) and Tianchong (GB-9) and Shuaigu (GB-8). By stimulating these two areas with high-frequency continuous electric waves, remarkable immediate and long-term effects for anxiety disorders have been observed in our practice. The first case was a 70-year-old male with general anxiety disorder (GAD) and panic attacks at night. The scalp acupuncture treatment protocol was applied with electric stimulation for 45 minutes once every week. After four sessions of acupuncture treatments, the patient reported that he did not have panic attacks at night and he had no feelings of anxiety during the day. Follow-up 4 weeks later confirmed that he did not have any episodes of panic attacks and he had no anxiety during the day since his last acupuncture treatment. The second case was a 35-year-old male who was diagnosed with posttraumatic stress disorder (PTSD) with a history of providing frontline trauma care as a Combat Medics from the Iraq combat field. He also had 21 broken bones and multiple concussions from his time in the battlefield. He had symptoms of severe anxiety, insomnia, nightmares with flashbacks, irritability, and bad temper. He also had chest pain, back pain, and joint pain due to injuries. The above treatment protocol was performed with 30 minutes of electric stimulation each time in combination with body acupuncture for pain management. After weekly acupuncture treatment for the first two visits, the patient reported that he felt less anxious and that his sleep was getting better with fewer nightmares. After six sessions of acupuncture treatments, the patient completely recovered from PTSD, went back to work, and now lives a healthy and happy family life. The above cases and clinical observation show that the scalp acupuncture treatment protocol with electric stimulation has a significant clinic outcome for GAD, panic disorder and PTSD. The possible mechanism of action of scalp acupuncture on anxiety disorder may be related to overlapping modulatory effects on the cortical structures (orbitofrontal cortex [OFC]) and medial prefrontal cortex [mPFC]) and subcortical/limbic regions (amygdala and hippocampus), and biochemical effect of acupuncture through immunohistochemistry (norepinephrine, serotonin) performed directly to the brain tissue for anxiety disorders. PMID:25105075

Chen, Jia; Pan, Zimei; Ying, Zhou

2014-01-01

118

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

119

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

PubMed Central

Background Recent studies provide evidence for the effectiveness of Internet-based maintenance treatments for mental disorders. However, it is still unclear which participants might or might not profit from this particular kind of treatment delivery. Objective The study aimed to identify moderators of treatment outcome in a transdiagnostic Internet-based maintenance treatment (TIMT) offered to patients after inpatient psychotherapy for mental disorders in routine care. Methods Using data from a randomized controlled trial (N=400) designed to test the effectiveness of TIMT, we performed secondary analyses to identify factors moderating the effects of TIMT (intervention) when compared with those of a treatment-as-usual control condition. TIMT involved an online self-management module, asynchronous patient–therapist communication, a peer support group, and online-based progress monitoring. Participants in the control condition had unstructured access to outpatient psychotherapy, standardized outpatient face-to-face continuation treatment, and psychotropic management. Self-reports of psychopathological symptoms and potential moderators were assessed at the start of inpatient treatment (T1), at discharge from inpatient treatment/start of TIMT (T2), and at 3-month (T3) and 12-month follow-up (T4). Results Education level, positive outcome expectations, and diagnoses significantly moderated intervention versus control differences regarding changes in outcomes between T2 and T3. Only education level moderated change differences between T2 and T4. The effectiveness of the intervention (vs control) was more pronounced among participants with a low (vs high) education level (T2-T3: B=–0.32, SE 0.16, P=.049; T2-T4: B=–0.42, SE 0.21, P=.049), participants with high (vs low) positive outcome expectations (T2-T3: B=–0.12, SE 0.05, P=.02) and participants with anxiety disorder (vs mood disorder) (T2-T3: B=–0.43, SE 0.21, P=.04). Simple slope analyses revealed that despite some subgroups benefiting less from the intervention than others, all subgroups still benefited significantly. Conclusions This transdiagnostic Internet-based maintenance treatment might be suitable for a wide range of participants differing in various clinical, motivational, and demographic characteristics. The treatment is especially effective for participants with low education levels. These findings may generalize to other Internet-based maintenance treatments. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 28632626; http://www.controlled-trials.com/isrctn/pf/28632626 (Archived by WebCite at http://www.webcitation.org/6IqZjTLrx). PMID:24113764

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

2013-01-01

120

A protocol for systematic reviews of Ayurveda treatments  

PubMed Central

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

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

2010-01-01

121

An Inpatient Vocational Rehabilitation Unit.  

ERIC Educational Resources Information Center

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

Bielefeld, Martin

122

Mandibular trauma treatment: A comparison of two protocols  

PubMed Central

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

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

2015-01-01

123

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

PubMed Central

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

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

2014-01-01

124

Changes in physical fitness, bone mineral density and body composition during inpatient treatment of underweight and normal weight females with longstanding eating disorders.  

PubMed

The purpose of this study was to examine changes in aerobic fitness, muscular strength, bone mineral density (BMD) and body composition during inpatient treatment of underweight and normal weight patients with longstanding eating disorders (ED). Twenty-nine underweight (BMI < 18.5, n = 7) and normal weight (BMI ? 18.5, n = 22) inpatients (mean (SD) age: 31.0 (9.0) years, ED duration: 14.9 (8.8) years, duration of treatment: 16.6 (5.5) weeks) completed this prospective naturalistic study. The treatment consisted of nutritional counseling, and 2 × 60 min weekly moderate intensive physical activity in addition to psychotherapy and milieu therapy. Underweight patients aimed to increase body weight with 0.5 kg/week until the weight gain goal was reached. Aerobic fitness, muscular strength, BMD and body composition were measured at admission and discharge. Results showed an increase in mean muscular strength, total body mass, fat mass, and body fat percentage, but not aerobic capacity, among both underweight and normal weight patients. Lumbar spine BMD increased among the underweight patients, no changes were observed in BMD among the normal weight patients. Three out of seven underweight patients were still underweight at discharge, and only three out of nine patients with excessive body fat (i.e., >33%) managed to reduce body fat to normal values during treatment. These results calls for a more individualized treatment approach to achieve a more optimal body composition among both underweight and normal to overweight patients with longstanding ED. PMID:22470294

Bratland-Sanda, Solfrid; Martinsen, Egil W; Sundgot-Borgen, Jorunn

2012-01-01

125

Inpatient management of diabetes mellitus.  

PubMed

Inpatient hyperglycemia is associated with increased morbidity and mortality. The length of hospital stay and cost of care is higher for patients with diabetes than for others. Current evidence suggests that tight control of hyperglycemia in critically ill hospitalized patients with diabetes or acute hyperglycemia has been shown to reduce the risk of morbidity and mortality. In view of risk of severe hypoglycemia with near normal blood glucose target, latest consensus is to adopt a less stringent target of 140-180 mg/dl. The development of insulin analogs with more physiologic time-action profiles, improved insulin delivery systems, and standardized protocols for subcutaneous insulin administration and intravenous insulin infusion have improved the safety and convenience of insulin therapy for treating inpatients. PMID:21818996

Bhoraskar, Anil

2011-04-01

126

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

PubMed

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

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

2008-03-01

127

Has incentive payment improved venous thrombo-embolism risk assessment and treatment of hospital in-patients?  

PubMed Central

This paper focuses on financial incentives rewarding successful implementation of guidelines in the UK National Health Service (NHS). In particular, it assesses the implementation of National Institute for Health and Clinical Excellence (NICE) venous thrombo-embolism (VTE) guidance in 2010 on the risk assessment and secondary prevention of VTE in hospital in-patients and the financial incentives driving successful implementation introduced by the Commissioning for Quality and Innovation for Payment Framework (CQUIN) for 2010-2011. We systematically compared the implementation of evidence-based national guidance on VTE prevention across two specialities (general medicine and orthopaedics) in four hospital sites in the greater South West of England by auditing and evaluating VTE prevention activity for 2009 (i.e. before the 2010 NICE guideline) and late 2010 (almost a year after the guideline was published). Analysis of VTE prevention activity reported in 816 randomly selected orthopaedic and general medical in-patient medical records was complemented by a qualitative study into the practical responses to revised national guidance. This paper’s contribution to knowledge is to suggest that by financially rewarding the implementation of national guidance on VTE prevention, paradoxes and contradictions have become apparent between the ‘payment by volume system’ of Healthcare Resource Groups and the ‘payment by results’ system of CQUIN. PMID:24358864

Child, Sue

2013-01-01

128

A Pilot Study of Heart Rate Variability Biofeedback Therapy in the Treatment of Perinatal Depression on a Specialized Perinatal Psychiatry Inpatient Unit  

PubMed Central

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

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

2012-01-01

129

[Recommendation of an assessment protocol to describe geriatric inpatient rehabilitation of lower limb mobility based on ICF: an interdisciplinary consensus process].  

PubMed

Because of the growing demand of geriatric rehabilitation, objective and clear indication decisions are needed with respect to limited financial resources. The aim of an interdisciplinary consensus group was to critically evaluate the most commonly used tests of functional performance of the lower limbs and to recommend useful tests to document progress of inpatient rehabilitation. Assessment of standing, walking, walking with a dual-task, sit-to-stand transfer, lying-to-sit-to-stand transfer, and stair climbing were recommended to document functional performance of the lower limbs and to describe rehabilitation targets. Future research is needed, because reasonably validated assessment tools do not exist for all of these domains. In addition to a standardized assessment of physical capacity, physical activity and participation with regard to the International Classification of Functioning, Disability, and Health (ICF) context have to be assessed. Body fixed sensors seem to be a promising assessment tool to objectively document progress in rehabilitation. PMID:22159835

Jamour, M; Becker, C; Bachmann, S; de Bruin, E D; Grüneberg, C; Heckmann, J; Marburger, C; Nicolai, S E; Schwenk, M; Lindemann, U

2011-12-01

130

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

PubMed

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). PMID:17223279

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

2007-08-01

131

A Novel Protocol for Model Calibration in Biological Wastewater Treatment  

PubMed Central

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

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

2015-01-01

132

A Novel Protocol for Model Calibration in Biological Wastewater Treatment  

NASA Astrophysics Data System (ADS)

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

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

2015-02-01

133

A novel protocol for model calibration in biological wastewater treatment.  

PubMed

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

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

2015-01-01

134

Bed wise cost analysis of in-patient treatment of brachial plexus injury at a Level I trauma Center in India  

PubMed Central

Aim: The aim was to calculate, in monetary terms, total cost incurred by a Level I trauma center in providing in-patient care to brachial plexus injury patients during their preoperative and the postoperative stay. Subjects and Methods: All patients of brachial plexus injury admitted and discharged between January and December 2010 were included in the study. Total cost per bed was calculated under several cost heads in pre- and post-operative ward care. Intra-operative costs were excluded. Results: A total of 69 patients were admitted in the year 2010. Of these 60 were operated and the rest were planned conservative management. The total cost incurred by the trauma center in providing in-patient care to patients admitted in the ward, excluding high dependency unit, came out to be Rs. 3,650.00/patient/bed/day. Of this Rs. 2,234.645, the maximum amount was incurred in providing manpower alone. The average preoperative wait was 12 days (maximum 41 days and minimum 1-day). The average postoperative stay was 2 days. Total cost incurred in the preoperative period was Rs. 2,975,125 (US$ 59392) or Rs. 43,117/patient (US$ 861). It was Rs. 386,948 (US$ 7724) in the postoperative period (Rs. 6,449 or US$ 129/patient). Nine patients were not operated and had waited from 2 to 12 days before finally being planned for observant treatment. This itself cost the hospital Rs. 226,328 (US$ 4518). Conclusion: By just reducing the preoperative length of stay to 1-day the cost can be brought down by 93% for brachial plexus injury patients alone and the beds can be used to admit more critical patients. PMID:25126124

Pandey, Nityanand; Gupta, Deepak; Mahapatra, Ashok; Harshvardhan, Rajesh

2014-01-01

135

Placebo-controlled inpatient comparison of venlafaxine and fluoxetine for the treatment of major depression with melancholic features.  

PubMed

The objective of this study was to compare venlafaxine and fluoxetine with placebo in treating major depressive disorder with melancholic features. Adult inpatients with Diagnostic and Statistical Manual of Mental Disorders, fourth edition major depressive disorder with melancholia and 21-item Hamilton Depression Rating Scale (HAM-D??) scores > or =24 (n=289) were randomized to receive (double-blind) venlafaxine 225-375 mg/day, fluoxetine 60-80 mg/day, or placebo for 6 weeks. The primary outcome measures were HAM-D?? total score, HAM-D depressed mood item, Montgomery Asberg Depression Rating Scale total score and the Clinical Global Impressions-Severity (CGI-S) and Improvement (CGI-I) scores. Last observation carried forward (LOCF) was the primary analysis method. In the LOCF analysis, venlafaxine was statistically superior to placebo on the CGI-S (venlafaxine -1.7, placebo -1.1; P=0.003) and the HAM-D depressed mood item (venlafaxine -1.6, placebo -1.1; P=0.010); and to fluoxetine on the CGI-S (-1.2; P=0.012). No significant differences were observed on the other 12 LOCF primary efficacy comparisons. Increases in pulse and blood pressure, dry mouth, constipation, and lightheadedness were significantly more common with venlafaxine than fluoxetine. Venlafaxine was statistically superior to placebo on two of five primary and two of five secondary outcome measures and to fluoxetine on one primary and one secondary outcome measure (LOCF). Venlafaxine was not superior to fluoxetine or placebo in providing remission. PMID:19238088

Sheehan, David V; Nemeroff, Charles B; Thase, Michael E; Entsuah, Richard

2009-03-01

136

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

PubMed Central

Background Depressive disorders are often recurrent and place a high burden on patients and their relatives. Psychoeducational groups for relatives may reduce relatives’ burden, help prevent relapses in patients, and are recommended by the German “National Disease Management Guideline Unipolar Depression”. Since there is limited knowledge on the provision of psychoeducational groups for relatives of persons in inpatient depression treatment, we conducted a survey among acute care hospitals in Germany. Methods We conducted a two-step cross-sectional survey. Step I consisted of a questionnaire asking the heads of all psychiatric/psychosomatic acute care hospitals in Germany (N?=?512) whether psychoeducational groups for relatives were provided within depression treatment, and if not, the reasons for not implementing them. In group offering hospitals the person responsible for conducting psychoeducational groups received a detailed questionnaire on intervention characteristics (step II). We performed descriptive data analysis. Results The response rate was 50.2% (N?=?257) in step I and 58.4% in step II (N?=?45). 35.4% of the responding hospitals offered psychoeducational groups for relatives of patients with depressive disorders. According to the estimates of the respondents, relatives of about one in five patients took part in psychoeducational groups in 2011. Groups were mostly provided by two moderators (62.2%) as continuous groups (77.8%), without patients’ participation (77.8%), with up to ten participants (65.9%), consisting of four or fewer sessions (51.5%) which lasted between one and one and a half hours each (77.8%). The moderators in charge were mostly psychologists (43.9%) or physicians (26.8%). Approximately one third used published manuals. Reasons for not conducting such psychoeducational groups were lack of manpower (60.1%), time (44.9%) and financial constraints (24.1%). 25.3% mentioned adequate concepts of intervention as a required condition for initiating such groups. Conclusions Only a small proportion of relatives of patients with depressive disorders participated in psychoeducational groups in 2011 in Germany. Mostly short interventions were favoured and main implementation barriers were scarce resources. Brief interventions that fit with healthcare routine should be developed and tested within randomised controlled trials. This could promote the provision of psychoeducational groups for relatives as evidence-based practice in inpatient depression treatment in Germany. PMID:24885727

2014-01-01

137

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

ERIC Educational Resources Information Center

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

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

2004-01-01

138

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

139

[Comparison of ambulatory and inpatient treatment of acute deep venous thrombosis of the leg: subjective and economic aspects].  

PubMed

The frequency of clinical recurrence and pulmonary embolism in patients with acute deep venous thrombosis is reduced to the same extent by hospital treatment (with unfractionated heparin) as by treatment at home (with low-molecular-weight heparin). Very few data on subjective parameters of effectiveness have been published. We performed a prospective randomized trial comparing outpatient with in-hospital treatment in 28 patients. Six clinical and quality-of-life related parameters of effectiveness were assessed quantitatively: clinical course (with a score system), pain of venous congestion of the calf muscles (with Lowenberg's test), subjective perception of pain and general well-being (with visual analogue scales), satisfaction with the care provided, and absence from work. Subjective effectiveness was compared with the costs of each form of treatment. Outpatient treatment was significantly more effective than in-hospital treatment with regard to the objective parameters. It was, however, associated with less well-being and more pain than in-hospital treatment. The discrepancy is explained by eventually insufficient adjuvant treatment measures (which consisted of external leg compression by stockings and forced walking) and by anxiety brought on by the information that potentially lethal pulmonary embolism could occur despite anticoagulant therapy. Outpatient treatment was less costly. On the average and per patient it was CHF 3944 less expensive than treatment in hospital. An estimation reveals that the Swiss health care system would save about CHF 25 million per year if the 85% of patients with deep-vein thrombosis suitable for home care were given this form of treatment. We conclude that outpatient management is subjectively cost-effective but should be optimised to eliminate certain drawbacks associated with it. PMID:9784675

Frank, D; Blättler, W

1998-09-01

140

Do total smoking bans affect the recruitment and retention of adolescents in inpatient substance abuse treatment programs?  

Microsoft Academic Search

Adolescents engaged in substance abuse treatment manifest a rate of cigarette smoking approximately four times higher than that of youth in the general population (?80% vs. 20%) and a high rate of smoking persistence into adulthood. Although there has been a shift toward the implementation of no-smoking policies in substance abuse treatment programs, few studies have examined the relation between

Russell C. Callaghan; Joan M. Brewster; Joy Johnson; Lawren Taylor; Glenn Beach; Tim Lentz

2007-01-01

141

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

142

Changes in dynamic risk and protective factors for violence during inpatient forensic psychiatric treatment: predicting reductions in postdischarge community recidivism.  

PubMed

Empirical studies have rarely investigated the association between improvements on dynamic risk and protective factors for violence during forensic psychiatric treatment and reduced recidivism after discharge. The present study aimed to evaluate the effects of treatment progress in risk and protective factors on violent recidivism. For a sample of 108 discharged forensic psychiatric patients pre- and posttreatment assessments of risk (HCR-20) and protective factors (SAPROF) were compared. Changes were related to violent recidivism at different follow-up times after discharge. Improvements on risk and protective factors during treatment showed good predictive validity for abstention from violence for short- (1 year) as well as long-term (11 years) follow-up. This study demonstrates the sensitivity of the HCR-20 and the SAPROF to change and shows improvements on dynamic risk and protective factors are associated with lower violent recidivism long after treatment. PMID:24933171

De Vries Robbé, Michiel; de Vogel, Vivienne; Douglas, Kevin S; Nijman, Henk L I

2015-02-01

143

Substance Abuse Treatment for Persons with Child Abuse and Neglect Issues. Treatment Improvement Protocol (TIP) Series, 36.  

ERIC Educational Resources Information Center

This volume of the Treatment Improvement Protocol (TIP) Series examines treatment issues for both adult survivors of child abuse or neglect and adults in treatment who may be abusing or neglecting their own children. Chapters 1 through 3 focus primarily on adult survivors of child abuse and neglect. Chapter 1 defines child abuse and neglect,…

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

144

Pro re nata medication for psychiatric inpatients: time to act.  

PubMed

Pro re nata (PRN; 'as needed') medication is an archetypal mainstay for managing acute psychiatric inpatient symptoms and behaviours. Psychiatric and mental health nursing practices have circumnavigated the development of a uniform medical-ethical standard for the administration of PRN psychotropic medication. This paper examines the evidence for administration of PRN psychotropic medications and, in the context of evidence-based best practice, current mental health policy and professional ethics, proposes a standardized Australian PRN administration protocol. The procedures and circumstances leading to a nurse administering psychotropic PRN medication are divided into five simple steps, namely (i) medical prescription; (ii) nurse evaluation of patient indications for an intervention; (iii) nurse consideration of therapeutic options; (iv) obtaining patient informed consent; and (v) documentation of outcomes of PRN administration. The literature associated with each step is reviewed, along with national and international professional ethics, guidelines and patient rights documents pertaining to the care of mental health patients. Recommendations for best-practise care are discussed for each step. There is a lacuna of published evidence supporting the use of PRN medications in psychiatric inpatients. Yet there is published evidence that PRN medications are associated with increased risks of morbidity, inappropriate use, may result in above-recommended dosages or polypharmacy, and complicate the assessment of efficacy of regular scheduled medicines. Alternative non-pharmacological treatment options to PRN medication are effective and associated with fewer side-effects. There are no national explicit standards, operational criteria or quality assurance for the use of PRN medication in inpatient psychiatric units. Contemporary PRN practices are largely unregulated and driven by essentially anecdotal evidence, leaving the clinicians and the service open to claims of poor accountability and misuse (intentional and unintentional) of psychotropic medications. Development of best practice guidelines for the use of PRN administration is essential. PMID:18612858

Hilton, Michael F; Whiteford, Harvey A

2008-07-01

145

Development and Use of an Eating Disorder Assessment and Treatment Protocol  

ERIC Educational Resources Information Center

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

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

2006-01-01

146

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

ERIC Educational Resources Information Center

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

Substance Abuse and Mental Health Services Administration, 2011

2011-01-01

147

Pediatric Clerkship Inpatient Rotation  

E-print Network

Oral and Written Communication Professional Behavior OME NEW Peds IR Mid Eval Did Not Observe Unacceptable Fair Good Excellent Outstanding 9. Demonstrates reliability and professional responsibility and Management in the Pediatric Inpatient Rotation 1. Applies clinical knowledge in conducting a thorough history

Issa, Naoum

148

Thermal Treatment Protocol Development and Scale-up  

Technology Transfer Automated Retrieval System (TEKTRAN)

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

149

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 ...

150

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

PubMed

This 1-group, 4-week observational study aimed to (1) assess the feasibility of recruiting, retention, and completion of a 4-week auricular point acupressure (APA) treatment protocol for chronic pain in adult patients and (2) assess the effects of APA in pain reduction (pain severity and pain interference) among these patients. The participants received a 4-week APA treatment protocol in weekly cycles. Each weekly cycle included 5 days with APA seeds taped onto the ear and 2 days without. Each participant was called every day to monitor adherence to the treatment protocol (the actual times the participant pressed the seeds each day and the duration of applied pressure), to answer analgesic use, and to answer the pain intensity questionnaire. Thirty participants were initially enrolled in this study, but 5 did not continue. The retention rate was 83% (n = 25). Approximately 60% of the participants (n = 15) adhered to the 4-week APA and completed all data assessments. At baseline assessment, only 40% of all participants (n = 12 of 30) were confident that APA would reduce and eliminate pain; nonetheless, all participants reported fewer episodes of pain occurrences and pain intensity with the APA treatment. For the participants who completed the 4-week APA protocol (n = 15), 96% (n = 14) decreased analgesic medication intake and 88% (n = 13) felt "much better" after the APA treatment. Participants reported an average reduction of 63% in the worst pain intensity at day 7. By the end of the 4-week APA protocol, an even greater reduction in pain intensity was reported (66%, n = 10, at day 28). The participants who did not complete the treatment protocol reported an average pain reduction of 29%, which fluctuated to 22% before they dropped out. Auricular point acupressure is feasible for patients with chronic pain. The preliminary findings of this feasibility study show a reduction in pain intensity and improvement in physical function, which demonstrate the potential for APA as a treatment option for patients with chronic pain. PMID:24722613

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

2014-01-01

151

The relationship between Clinical Trial Network protocol involvement and quality of substance use disorder (SUD) treatment  

PubMed Central

The National Institute on Drug Abuse’s Clinical Trials Network (CTN) is a practice-based research network that partners academic researchers with community based substance use disorder (SUD) treatment programs designed primarily to conduct effectiveness trials of promising interventions. A secondary goal of the CTN is to widely disseminate results of these trials and thus improve the quality of SUD treatment in the US. Drawing on data from 156 CTN programs, this study examines the association between involvement in CTN protocols and overall treatment quality measured by a comprehensive index of 35 treatment services. Negative binomial regression models show that treatment programs that participated in a greater number of CTN protocols had significantly higher levels of treatment quality, an association that held after controlling for key organizational characteristics. These findings contribute to the growing body of research on the role of practice-based research networks in promoting health care quality. PMID:24080073

Abraham, Amanda J.; Knudsen, Hannah K.; Roman, Paul M.

2013-01-01

152

Generic Protocol for the Verification of Ballast Water Treatment Technology  

EPA Science Inventory

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

153

Protocols  

Cancer.gov

NCI's Cancer Therapy Evaluation Program (CTEP), Clinical Investigations Branch (CIB) organizes comprehensive programs of treatment clinical trials. Requests or questions regarding NCI priorities for clinical questions should be directed to the CIB investigator responsible for that disease area. A list of CTEP CIB staff and associated responsibilities can be found here.

154

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

SciTech Connect

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

Zeidan, Omar A. [Department of Radiation Oncology, M. D. Anderson Cancer Center Orlando, Orlando, FL (United States)]. E-mail: omar.zeidan@orhs.org; Langen, Katja M. [Department of Radiation Oncology, M. D. Anderson Cancer Center Orlando, Orlando, FL (United States); Meeks, Sanford L. [Department of Radiation Oncology, M. D. Anderson Cancer Center Orlando, Orlando, FL (United States); Manon, Rafael R. [Department of Radiation Oncology, M. D. Anderson Cancer Center Orlando, Orlando, FL (United States); Wagner, Thomas H. [Department of Radiation Oncology, M. D. Anderson Cancer Center Orlando, Orlando, FL (United States); Willoughby, Twyla R. [Department of Radiation Oncology, M. D. Anderson Cancer Center Orlando, Orlando, FL (United States); Jenkins, D. Wayne [Department of Radiation Oncology, M. D. Anderson Cancer Center Orlando, Orlando, FL (United States); Kupelian, Patrick A. [Department of Radiation Oncology, M. D. Anderson Cancer Center Orlando, Orlando, FL (United States)

2007-03-01

155

Early treatment protocol for skeletal Class III malocclusion.  

PubMed

Skeletal Class III malocclusion, with its unpredictable and unfavorable nature, has been characterized by a growth pattern with doubtful prognosis regarding orthodontic mechanics, even when performed early. For a long time, Class III malocclusion was regarded as a synonym of mandibular prognathism, regardless of the affected skeletal structures. Mandibular growth, essentially determined by genetic factors, could barely be controlled by early orthodontic interventions. Therefore, the treatment choice was to wait for the patient to grow, and then make an orthodontic intervention associated with an orthognathic surgery. Maxillary involvement in the etiology of Class III malocclusion was conclusive to change orthodontic therapeutics. Maxillary intramembranous growth has a better response to orthopedic treatment, based on growth control and redirection, thus contributing for early intervention success. In several cases, excellent results have been achieved with rapid maxillary expansion and protraction. The aim of this study was to describe and discuss the treatment of a patient with Class III malocclusion, whose treatment planning comprised two phases: interceptive (mechanical orthopedic appliances) and comprehensive (fixed orthodontic appliance). The results of this case showed that Class III malocclusion should be intercepted as early as possible to permit growth redirection, mainly when the maxilla is the primary etiologic factor or dental and/or functional factors are involved. Diagnosis, treatment planning and prognosis depend on patient age, growth potential and severity of malocclusion. Early intervention, adequate indication of appliances, and patient compliance are key factors for good outcomes. PMID:23780363

Oltramari-Navarro, Paula Vanessa Pedron; de Almeida, Renato Rodrigues; Conti, Ana Cláudia de Castro Ferreira; Navarro, Ricardo de Lima; de Almeida, Marcio Rodrigues; Fernandes, Leandra Sant'Anna Ferreira Parron

2013-01-01

156

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

157

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

PubMed Central

Background Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©). Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments. Methods A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a) establishing an advisory knowledge user team in each of three targeted settings; (b) assessing factors influencing nurses’ use of protocols using interviews/focus groups and a standardized survey instrument; (c) adapting protocols for local use, ensuring fidelity of the content; (d) selecting intervention strategies to overcome known barriers and implementing the protocols; (e) conducting think-aloud usability testing; (f) evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g) assessing satisfaction with remote support using symptom protocols and change in nurses’ barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing with comparisons across settings. Discussion Given the importance of patient safety, patient-centered care, and delivery of quality services, learning how to effectively implement evidence-informed symptom protocols in oncology healthcare services is essential for ensuring safe, consistent, and effective care for individuals with cancer. This study is likely to have a significant contribution to the delivery of remote oncology services, as well as influence symptom management by patients at home. PMID:23164244

2012-01-01

158

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 valued…

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

2011-01-01

159

Treatment protocol determines the efficacy of clindamycin in acute murine toxoplasmosis  

Microsoft Academic Search

To determine the contribution to the efficacy of clindamycin in acute murine toxoplasmosis of treatment protocol variables, groups of Swiss Webster mice inoculated intraperitoneally with 102 RH strain Toxoplasma gondii tachyzoites were treated with peroral clindamycin at 25, 50 and 400 mg\\/kgBM per day for 1, 2 and 3 weeks. While the lowest drug dose applied for a single week

T. Nikoli?; O. Djurkovi?-Djakovi?; B. Bobi?; A. Nikoli?; D. Babi?

1999-01-01

160

Carcinoma ex pleomorphic adenoma: Diagnostic dilemma and treatment protocol  

PubMed Central

Carcinoma ex pleomorphic adenoma (CXPA) is a carcinoma arising from a primary or recurrent benign pleomorphic adenoma. It often poses a diagnostic challenge to clinicians and pathologists. The entity is difficult to diagnose preoperatively. Pathological assessment is the gold standard for making the diagnosis. Treatment for CXPA often involves an ablative surgical procedure, which may be followed by radiotherapy. We report a case of a 65-year-old lady with a history of recurrent swelling in the left preauricular region and a history of surgery 10 years back, in the same region. Preoperatively, a diagnosis of pleomorphic adenoma of the parotid gland metastasizing to the cervical lymph node was made, but postoperatively it was reported as CXPA adenoma of the parotid gland. A radical parotidectomy involving en bloc resection of the facial nerve along with deep and superficial lobes of the parotid was performed followed by radiotherapy. The fact that pleomorphic adenomas are classified as benign tumors should not overshadow the wide range of biological behaviors associated with these tumors. On account of the potential for malignant transformation, surgical treatment must be properly performed. Surgery followed by radiotherapy should be considered as the standard care for a patient with carcinoma ex pleomorphic adenoma. PMID:25565746

Keerthi, R; Raut, Rohan P; Vaibhav, N; Ghosh, Abhishek

2014-01-01

161

Carcinoma ex pleomorphic adenoma: Diagnostic dilemma and treatment protocol.  

PubMed

Carcinoma ex pleomorphic adenoma (CXPA) is a carcinoma arising from a primary or recurrent benign pleomorphic adenoma. It often poses a diagnostic challenge to clinicians and pathologists. The entity is difficult to diagnose preoperatively. Pathological assessment is the gold standard for making the diagnosis. Treatment for CXPA often involves an ablative surgical procedure, which may be followed by radiotherapy. We report a case of a 65-year-old lady with a history of recurrent swelling in the left preauricular region and a history of surgery 10 years back, in the same region. Preoperatively, a diagnosis of pleomorphic adenoma of the parotid gland metastasizing to the cervical lymph node was made, but postoperatively it was reported as CXPA adenoma of the parotid gland. A radical parotidectomy involving en bloc resection of the facial nerve along with deep and superficial lobes of the parotid was performed followed by radiotherapy. The fact that pleomorphic adenomas are classified as benign tumors should not overshadow the wide range of biological behaviors associated with these tumors. On account of the potential for malignant transformation, surgical treatment must be properly performed. Surgery followed by radiotherapy should be considered as the standard care for a patient with carcinoma ex pleomorphic adenoma. PMID:25565746

Keerthi, R; Raut, Rohan P; Vaibhav, N; Ghosh, Abhishek

2014-07-01

162

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

163

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. PMID:19195131

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

2010-01-01

164

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

PubMed

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 a trend for more anger-hostility and perceived stigma among non-completers. Experiential avoidance and anxiety may be associated with dropout in inpatient DBT. Low life-time suicidality and high anger could reflect a subtype at risk for discontinuation of inpatient treatment. PMID:18299116

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

2008-12-01

165

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

PubMed

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

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

2012-03-01

166

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. PMID:23449809

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

2011-01-01

167

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

PubMed Central

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

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

2010-01-01

168

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

169

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

2011-03-22

170

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

PubMed Central

Background In 2009, 665 patients underwent total knee replacements (TKRs) at the Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH), representing nearly 1% of the national total. Pain control following the operation can be poor, and this can cause poor mobilization and potential long-term adverse events. Although high levels of pain are not associated with patient dissatisfaction, brief periods of pain may lead to neuronal remodeling and sensitization. Patient controlled oral analgesia (PCOA) may improve pain relief; however, the evidence to date has been inconclusive. Patient directed self management of pain (PaDSMaP) is a single center randomized controlled trial, which aims to establish if patient self-medication improves, or is equivalent to, treatment as usual and to create an educational package to allow implementation elsewhere. Methods/design Patients eligible for a TKR will be recruited and randomized in the outpatient clinic. All patients will undergo their operations according to normal clinical practice but will be randomized into two groups. Once oral medication has commenced, one group will have pain relief administered by nursing staff in the usual way (treatment as usual; TAU), whilst the second group will self manage their pain medication (patient directed self management of pain; PaDSMaP). Those recruited for self-medication will undergo a training program to teach the use of oral analgesics according to the World Health Organization (WHO) pain cascade and how to complete the study documentation. The primary endpoint of the trial is the visual analogue scale (VAS) pain score at 3 days or discharge, whichever is sooner. The follow-up time is 6 weeks with a planned trial period of 3 years. The secondary objectives are satisfaction with the management of patient pain post-operatively whilst an inpatient after primary TKR; overall pain levels and pain on mobilization; satisfaction with pain management information provided; global outcomes, such as quality of life (QOL) and activities of daily living (ADLs); time to mobilization and whether time to mobilization is associated with frequency of adverse events, improvements in QOL, ADLs and pain at 6 weeks after the operation; incidence of adverse events; quantity and type of pain medications used whilst an inpatient; the acceptability of PaDSMaP and/or TAU protocols for patients and the healthcare professionals involved in their care; to investigate the health-related costs associated with a PaDSMaP system; and to estimate the cost-effectiveness of PaDSMaP compared to TAU. Trial registration Current Controlled Trials ISRCTN: 10868989 PMID:23126312

2012-01-01

171

The Engagement Interview Protocol (EIP): improving the acceptance of mental health treatment among Chinese immigrants  

PubMed Central

Many depressed Chinese immigrants are unfamiliar with Western psychiatric terminology and have high levels of stigma toward psychiatric illnesses, making it difficult to engage them into psychiatric treatment. We have designed the Engagement Interview Protocol (EIP), a semi-standardized protocol that incorporates cultural components to a standard psychiatric evaluation. The EIP elicits patients’ narratives and uses anthropological questions to explore patients’ illness beliefs, which are integrated with patients’ information on medical and psychiatric history, psychosocial background and mental status examination so that treatment options can be negotiated in a culturally sensitive manner. In our field testing on depressed Chinese immigrants, the EIP model was found to be a practical tool that can be completed within the allotted one-hour time frame and was highly effective in facilitating the enrollment of patients in treatment for depression. The EIP is a concise, time-effective, user-friendly protocol that can be used both in research and real-world clinical settings with diverse patient populations. PMID:25076983

Yeung, Albert; Trinh, Nhi-Ha T.; Chang, Trina E.; Fava, Maurizio

2014-01-01

172

Protocol Directed Patient Care using a Computer  

PubMed Central

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

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

1980-01-01

173

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

PubMed

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

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

2015-03-01

174

Electrophysiological differences between high and low frequency rTMS protocols in depression treatment.  

PubMed

Repetitive transcranial magnetic stimulation (rTMS) is a rapidly expanding mean in drug resistant depression treatment. Yet, despite vast research in this field, exact neurophysiological mechanism of rTMS therapy still remains unclear. This results in difficulties choosing suitable rTMS parameters in advance and compromises thorough evaluation of efficacy after the treatment. In order to obtain more explicit assessment of rTMS therapy in the psychiatric field, we evaluated and compared the influence of two most widely used antidepressive rTMS protocols on EEG band power spectrum and relation to clinical test scores (MADRS, BDI, HAM-D17). Forty-five patients (12 male, 33 female, mean age 52.16 years) participated in the study. Twenty-three patients received high frequency (10 Hz) stimulation, the rest 22 were stimulated using low frequency (1 Hz) protocol. Both groups received 10 to 15 daily rTMS sessions. EEG recordings and clinical tests were obtained the day before rTMS course and same day after the last session. Majority (57.78%) of patients showed considerable improvement after the treatment. There were no notable differences in clinical test score drop between the two rTMS protocols. However, we found that different protocols resulted in significantly different electrophysiological changes. High frequency (10 Hz) rTMS resulted in widespread changes off EEG band power, including delta power increase on the left hemisphere and alpha power growth on the right. Theta power increase was also obtained in parietal-occipital areas. Low frequency (1 Hz) rTMS showed to have no major effect on basic EEG band power, however, we found a notable shift of frontal alpha power asymmetry towards the right hemisphere, which correlated with the clinical outcome. Our study results suggest that two widely used rTMS protocols strongly differ in their electrophysiological mechanisms. Low frequency stimulation finesse on frontal alpha power asymmetry shift, whereas high frequency protocol acts on wider electrophysiological changes in the brain. PMID:23093015

Valiulis, Vladas; Gerulskis, Giedrius; Dapšys, Kastytis; Vištartaite, Giedre; Šiurkute, Aldona; Ma?iulis, Valentinas

2012-01-01

175

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

PubMed Central

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

Kawashima, Hidekazu

2014-01-01

176

Comparison of treatment protocols for removing metallic foreign objects from the ventriculus of budgerigars (Melopsittacus undulatus).  

PubMed

To compare the efficacy of treatment protocols recommended to aid passage of metallic foreign objects from the ventriculus of birds, a 1-mm metal sphere, made from solder wire, was placed into the crop of each of 44 budgerigars (Melopsittacus undulatus). After survey radiographs confirmed the spheres were lodged in the ventriculus, birds were divided into 6 groups. Each group received 1 of 6 different treatment protocols: psyllium with grit, acidic drinking water, fine grit, coarse grit, cathartic emollients (peanut butter and mineral oil), and a control group. All birds were treated simultaneously with a chelating agent, dimercaptosuccinic acid (DMSA), to prevent heavy-metal toxicosis. Successive survey radiographs were used to monitor elimination of the spheres from the digestive tract. Of all protocols tested, birds treated with either fine or large grit had the shortest mean elimination time of the metal spheres. These results indicate that administration of grit particles, either fine or coarse, appears to be effective in hastening the passage of metallic foreign objects from the ventriculus of budgerigars. PMID:19999761

Lupu, Corina; Robins, Stephanie

2009-09-01

177

Changing the malaria treatment protocol policy in Timor-Leste: an examination of context, process, and actors’ involvement  

PubMed Central

In 2007 Timor-Leste, a malaria endemic country, changed its Malaria Treatment Protocol for uncomplicated falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. The change in treatment policy was based on the rise in morbidity due to malaria and perception of increasing drug resistance. Despite a lack of nationally available evidence on drug resistance, the Ministry of Health decided to change the protocol. The policy process leading to this change was examined through a qualitative study on how the country developed its revised treatment protocol for malaria. This process involved many actors and was led by the Timor-Leste Ministry of Health and the WHO country office. This paper examines the challenges and opportunities identified during this period of treatment protocol change. PMID:23672371

2013-01-01

178

Changing the malaria treatment protocol policy in Timor-Leste: an examination of context, process, and actors' involvement.  

PubMed

In 2007 Timor-Leste, a malaria endemic country, changed its Malaria Treatment Protocol for uncomplicated falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. The change in treatment policy was based on the rise in morbidity due to malaria and perception of increasing drug resistance. Despite a lack of nationally available evidence on drug resistance, the Ministry of Health decided to change the protocol. The policy process leading to this change was examined through a qualitative study on how the country developed its revised treatment protocol for malaria. This process involved many actors and was led by the Timor-Leste Ministry of Health and the WHO country office. This paper examines the challenges and opportunities identified during this period of treatment protocol change. PMID:23672371

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

2013-01-01

179

Frequency, Characteristics and Management of Adolescent Inpatient Aggression  

PubMed Central

Abstract Background Inpatient aggression is a serious challenge in pediatric psychiatry. Methods A chart review study in adolescent psychiatric inpatients consecutively admitted over 24 months was conducted, to describe aggressive events requiring an intervention (AERI) and to characterize their management. AERIs were identified based on specific institutional event forms and/or documentation of as-needed (STAT/PRN) medication administration for aggression, both recorded by nursing staff. Results Among 408 adolescent inpatients (age: 15.2±1.6 years, 43.9% male), 1349 AERIs were recorded, with ?1 AERI occurring in 28.4% (n=116; AERI+). However, the frequency of AERIs was highly skewed (median 4, range: 1–258). In a logistical regression model, the primary diagnosis at discharge of disruptive behavior disorders and bipolar disorders, history of previous inpatient treatment, length of hospitalization, and absence of a specific precipitant prior to admission were significantly associated with AERIs (R2=0.32; p<0.0001). The first line treatment of patients with AERIs (AERI+) was pharmacological in nature (95.6%). Seclusion or restraint (SRU) was used at least once in 59.4% of the AERI+ subgroup (i.e., in 16.9% of all patients; median within-group SRU frequency: 3). Treatment and discharge characteristics indicated a poorer prognosis in the AERI+ (discharge to residential care AERI+: 22.8%, AERI?: 5.6%, p<0.001) and a greater need for psychotropic polypharmacy (median number of psychotropic medications AERI+: 2; AERI?: 1, p<0.001). Conclusions Despite high rates of pharmacological interventions, SRU continue to be used in adolescent inpatient care. As both of these approaches lack a clear evidence base, and as adolescents with clinically significant inpatient aggression have increased illness acuity/severity and service needs, structured research into the most appropriate inpatient aggression management is sorely needed. PMID:23647136

Baeza, Immaculada; Saito, Ema; Amanbekova, Dinara; Ramani, Meena; Kapoor, Sandeep; Chekuri, Raja; De Hert, Marc; Carbon, Maren

2013-01-01

180

Patient experience and satisfaction with inpatient service: development of short form survey instrument measuring the core aspect of inpatient experience.  

PubMed

Patient experience reflects quality of care from the patients' perspective; therefore, patients' experiences are important data in the evaluation of the quality of health services. The development of an abbreviated, reliable and valid instrument for measuring inpatients' experience would reflect the key aspect of inpatient care from patients' perspective as well as facilitate quality improvement by cultivating patient engagement and allow the trends in patient satisfaction and experience to be measured regularly. The study developed a short-form inpatient instrument and tested its ability to capture a core set of inpatients' experiences. The Hong Kong Inpatient Experience Questionnaire (HKIEQ) was established in 2010; it is an adaptation of the General Inpatient Questionnaire of the Care Quality Commission created by the Picker Institute in United Kingdom. This study used a consensus conference and a cross-sectional validation survey to create and validate a short-form of the Hong Kong Inpatient Experience Questionnaire (SF-HKIEQ). The short-form, the SF-HKIEQ, consisted of 18 items derived from the HKIEQ. The 18 items mainly covered relational aspects of care under four dimensions of the patient's journey: hospital staff, patient care and treatment, information on leaving the hospital, and overall impression. The SF-HKIEQ had a high degree of face validity, construct validity and internal reliability. The validated SF-HKIEQ reflects the relevant core aspects of inpatients' experience in a hospital setting. It provides a quick reference tool for quality improvement purposes and a platform that allows both healthcare staff and patients to monitor the quality of hospital care over time. PMID:25860775

Wong, Eliza L Y; Coulter, Angela; Hewitson, Paul; Cheung, Annie W L; Yam, Carrie H K; Lui, Siu Fai; Tam, Wilson W S; Yeoh, Eng-Kiong

2015-01-01

181

Patient Experience and Satisfaction with Inpatient Service: Development of Short Form Survey Instrument Measuring the Core Aspect of Inpatient Experience  

PubMed Central

Patient experience reflects quality of care from the patients’ perspective; therefore, patients’ experiences are important data in the evaluation of the quality of health services. The development of an abbreviated, reliable and valid instrument for measuring inpatients’ experience would reflect the key aspect of inpatient care from patients’ perspective as well as facilitate quality improvement by cultivating patient engagement and allow the trends in patient satisfaction and experience to be measured regularly. The study developed a short-form inpatient instrument and tested its ability to capture a core set of inpatients’ experiences. The Hong Kong Inpatient Experience Questionnaire (HKIEQ) was established in 2010; it is an adaptation of the General Inpatient Questionnaire of the Care Quality Commission created by the Picker Institute in United Kingdom. This study used a consensus conference and a cross-sectional validation survey to create and validate a short-form of the Hong Kong Inpatient Experience Questionnaire (SF-HKIEQ). The short-form, the SF-HKIEQ, consisted of 18 items derived from the HKIEQ. The 18 items mainly covered relational aspects of care under four dimensions of the patient’s journey: hospital staff, patient care and treatment, information on leaving the hospital, and overall impression. The SF-HKIEQ had a high degree of face validity, construct validity and internal reliability. The validated SF-HKIEQ reflects the relevant core aspects of inpatients’ experience in a hospital setting. It provides a quick reference tool for quality improvement purposes and a platform that allows both healthcare staff and patients to monitor the quality of hospital care over time. PMID:25860775

Wong, Eliza L. Y.; Coulter, Angela; Hewitson, Paul; Cheung, Annie W. L.; Yam, Carrie H. K.; Lui, Siu fai; Tam, Wilson W. S.; Yeoh, Eng-kiong

2015-01-01

182

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

Code of Federal Regulations, 2010 CFR

...under the inpatient psychiatric facility prospective payment system. 412.405 Section...HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient...

2010-10-01

183

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.

184

Treatment protocol determines the efficacy of clindamycin in acute murine toxoplasmosis.  

PubMed

To determine the contribution to the efficacy of clindamycin in acute murine toxoplasmosis of treatment protocol variables, groups of Swiss Webster mice inoculated intraperitoneally with 10(2) RH strain Toxoplasma gondii tachyzoites were treated with peroral clindamycin at 25, 50 and 400 mg/kgBM per day for 1, 2 and 3 weeks. While the lowest drug dose applied for a single week prolonged survival time as compared to untreated animals, not even the highest dose applied for 1 or 2 weeks completely prevented mortality. Conversely, 100% protection was achieved with 3-week treatment courses at both 50 and 400 mg/kg per day. While both survival rates and survival times increased in parallel with the drug dose and treatment duration, the latter was shown to be critical to the outcome, suggesting the use of clindamycin as an antitoxoplasmic agent should be as a prolonged course. PMID:10221418

Nikoli?, T; Djurkovi?-Djakovi?, O; Bobi?, B; Nikoli?, A; Babi?, D

1999-02-01

185

Sex differences in outcomes of methadone maintenance treatment for opioid addiction: a systematic review protocol  

PubMed Central

Background Use of methadone for the treatment of opioid addiction is an effective harm-reduction approach, although variability in treatment outcomes among individuals has been reported. Men and women with opioid addiction have been known to differ in factors such as opioid use patterns and characteristics at treatment entry; however, little has been reported about differences in methadone treatment outcomes between men and women. Therefore, we present a protocol for a systematic review which aims to provide a summary of existing literature on sex differences in outcomes of methadone treatment for opioid addiction. Methods/Design Electronic search of PubMed/MEDLINE, EMBASE, PsycINFO, and CINAHL databases will be conducted using a priori defined search strategy. Two authors (MB and BBD) will independently screen potential articles for eligibility using pre-determined inclusion and exclusion criteria and extract key information using a data extraction form designed for this study. Discrepancies will be resolved using a third party (ZS). The primary outcome will be sex differences in response to treatment defined as abstinence from illicit opioid use. We will also assess sex differences in treatment outcomes including treatment retention, remission status post-treatment, polysubstance abuse, methadone dose, drug-related adverse events, health status, psychological status, mortality, criminal activity, high risk sexual behavior, social support/relations, and employment. A meta-analysis will be conducted if possible; risk of bias and overall quality of evidence will be assessed to determine confidence in the estimates. Discussion We anticipate that this review will highlight how men and women differ in methadone treatment outcomes and allow us to generate conclusions that can be applied to treatment in a clinical setting. Systematic review registration PROSPERO CRD42013006549 PMID:24887111

2014-01-01

186

Treatment Protocols to Reduce Injury and Improve Stone Breakage in SWL  

NASA Astrophysics Data System (ADS)

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

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

2008-09-01

187

Development of standardized insulin treatment protocols for spontaneous rodent models of type 1 diabetes.  

PubMed

Standardized protocols for maintaining near-normal glycemic levels in diabetic rodent models for testing therapeutic agents to treat disease are unavailable. We developed protocols for 2 common models of spontaneous type 1 diabetes, the BioBreeding diabetes-prone (BBDP) rat and nonobese diabetic (NOD) mouse. Insulin formulation, dose level, timing of dose administration, and delivery method were examined and adjusted so that glycemic levels remained within a normal range and fluctuation throughout feeding and resting cycles was minimized. Protamine zinc formulations provided the longest activity, regardless of the source of insulin. Glycemic control with few fluctuations was achieved in diabetic BBDP rats through twice-daily administration of protamine zinc insulin, and results were similar regardless of whether BBDP rats were acutely or chronically diabetic at initiation of treatment. In contrast, glycemic control could not be attained in NOD mice through administration of insulin twice daily. However, glycemic control was achieved in mice through daily administration of 0.25 U insulin through osmotic pumps. Whereas twice-daily injections of protamine zinc insulin provided glycemic control with only minor fluctuations in BBDP rats, mice required continuous delivery of insulin to prevent wide glycemic excursions. Use of these standard protocols likely will aid in the testing of agents to prevent or reverse diabetes. PMID:23114041

Grant, Christian W; Duclos, Shane K; Moran-Paul, Catherine M; Yahalom, Barak; Tirabassi, Rebecca S; Arreaza-Rubin, Guillermo; Spain, Lisa M; Guberski, Dennis L

2012-10-01

188

Development of Standardized Insulin Treatment Protocols for Spontaneous Rodent Models of Type 1 Diabetes  

PubMed Central

Standardized protocols for maintaining near-normal glycemic levels in diabetic rodent models for testing therapeutic agents to treat disease are unavailable. We developed protocols for 2 common models of spontaneous type 1 diabetes, the BioBreeding diabetes-prone (BBDP) rat and nonobese diabetic (NOD) mouse. Insulin formulation, dose level, timing of dose administration, and delivery method were examined and adjusted so that glycemic levels remained within a normal range and fluctuation throughout feeding and resting cycles was minimized. Protamine zinc formulations provided the longest activity, regardless of the source of insulin. Glycemic control with few fluctuations was achieved in diabetic BBDP rats through twice-daily administration of protamine zinc insulin, and results were similar regardless of whether BBDP rats were acutely or chronically diabetic at initiation of treatment. In contrast, glycemic control could not be attained in NOD mice through administration of insulin twice daily. However, glycemic control was achieved in mice through daily administration of 0.25 U insulin through osmotic pumps. Whereas twice-daily injections of protamine zinc insulin provided glycemic control with only minor fluctuations in BBDP rats, mice required continuous delivery of insulin to prevent wide glycemic excursions. Use of these standard protocols likely will aid in the testing of agents to prevent or reverse diabetes. PMID:23114041

Grant, Christian W; Duclos, Shane K; Moran-Paul, Catherine M; Yahalom, Barak; Tirabassi, Rebecca S; Arreaza-Rubin, Guillermo; Spain, Lisa M; Guberski, Dennis L

2012-01-01

189

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

190

Evaluation of a comprehensive inpatient rational-emotive therapy program: Some preliminary data  

Microsoft Academic Search

Mental health practitioners are faced with a profound challenge surrounding the prevalence of adult mental disorders, the need for inpatient treatment programs, and the costs of such programs. This paper describes the development of an adult inpatient psychiatric program based on Rational-Emotive Therapy. Specific elements of this program are described briefly, and preliminary outcome data presented on 372 patients. Concerns

Edgar J. Nottingham; Robert A. Neimeyer

1992-01-01

191

Cryptographically supported NFC tags in medication for better inpatient safety.  

PubMed

Reliable sources report that errors in drug administration are increasing the number of harmed or killed inpatients, during healthcare. This development is in contradiction to patient safety norms. A correctly designed hospital-wide ubiquitous system, using advanced inpatient identification and matching techniques, should provide correct medicine and dosage at the right time. Researchers are still making grouping proof protocol proposals based on the EPC Global Class 1 Generation 2 ver. 1.2 standard tags, for drug administration. Analyses show that such protocols make medication unsecure and hence fail to guarantee inpatient safety. Thus, the original goal of patient safety still remains. In this paper, a very recent proposal (EKATE) upgraded by a cryptographic function is shown to fall short of expectations. Then, an alternative proposal IMS-NFC which uses a more suitable and newer technology; namely Near Field Communication (NFC), is described. The proposed protocol has the additional support of stronger security primitives and it is compliant to ISO communication and security standards. Unlike previous works, the proposal is a complete ubiquitous system that guarantees full patient safety; and it is based on off-the-shelf, new technology products available in every corner of the world. To prove the claims the performance, cost, security and scope of IMS-NFC are compared with previous proposals. Evaluation shows that the proposed system has stronger security, increased patient safety and equal efficiency, at little extra cost. PMID:24957387

Özcanhan, Mehmet Hilal; Dalk?l?ç, Gökhan; Utku, Semih

2014-08-01

192

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

193

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

PubMed Central

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

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

2013-01-01

194

Formal heparin anticoagulation protocol improves safety of charcoal-based liver-assist treatments.  

PubMed

Extracorporeal devices have had limited effectiveness in liver failure due to consequences of inadequate anticoagulation. The purpose of this study was to evaluate an anticoagulation protocol developed for Liver Dialysis Unit (LDU) treatments. Twelve patients underwent 19 LDU treatments for acetaminophen overdose (n = 1), subacute liver failure (n = 1), and refractory encephalopathy in cirrhosis (n = 10). The initial 6 patients (group 1) were treated according to the manufacturer's recommendations. The subsequent 6 patients (group 2) were treated using a formal heparin anticoagulation protocol that included 2000 units in prime solution and 30 units/kg induction, activated clotting time (ACT) measurements, and heparin administered by dose-response curve to maintain 300-second ACT. Protamine reversal was used. Treatments were well tolerated and equally effective in both groups. Adequate (ACT > or = 250 seconds) and therapeutic (ACT 250-350 seconds) anticoagulation was maintained more consistently in group 2 (90.9% vs 50.0%, p < 0.0001; and 77.4% vs 45.8%, p < 0.001). There was less consumption of fibrinogen (12.1% vs 43.3%, p < 0.005) and platelets (13.8% vs 29.9%, p < 0.05) and a trend for less blood product used (8.3 vs 15.8 units/patient, p = 0.13) and fewer complications (16.7% vs 66.7%, p = 0.15) in group 2. Anticoagulation using ACT monitoring, heparin dose-response curves, and a target ACT of 300 seconds improves the safety of LDU treatments. PMID:16760725

Hillebrand, Donald J; Hill, Kevin B; Hu, Ke-Qin; Strutt, Marge; Wilson, Barry; Cottrell, Alfred; Teichman, Sigmund; Hay, Karen; Bull, Brian

2006-01-01

195

Evolving Prehospital, Emergency Department, and “Inpatient” Management Models for Geriatric Emergencies  

PubMed Central

Alternative management methods are essential to ensure high quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols for case-finding and rapid diagnosis to support early condition-specific treatment for older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to look beyond the diagnosis to address the influence of other factors on the patient's health: isolation and depression; finances and transportation; and chronic medical conditions and polypharmacy. This review article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care. PMID:23177599

Carpenter, Christopher R.; Platts-Mills, Timothy F.

2013-01-01

196

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

197

Opportunity for audit: establishing and monitoring the use of protocols for nurse-led treatments of minor injuries  

Microsoft Academic Search

During the last three years an integrated initiative has evolved in the casualty units of nine community hospitals in the Grampian region of Scotland. This has involved the development of nurse-led treatments for minor injuries based on a large number of assessment\\/treatment protocols. This paper describes how this change was used as an opportunity to initiate audit within clinical practice.

C. Macduff; S. Lawton; A. Leslie; M. Ironside

2001-01-01

198

Documentation Quality of Inpatient Code Status Discussions  

PubMed Central

Context Accurate documentation of inpatient code status discussions (CSDs) is important because of frequent patient care handoffs. Objective To examine the quality of inpatient CSD documentation and compare documentation quality across physician services. Methods This was a retrospective study of patients hospitalized between January 1 and June 30, 2011 with a new or canceled do-not-resuscitate (DNR) order at least 24 hours after hospital admission. We developed a chart abstraction tool to assess the documentation of five quality elements: 1) who the DNR discussion was held with, 2) patient goals/values, 3) prognosis, 4) treatment options and resuscitation outcomes, and 5) health care power of attorney (HCPOA). Results We identified 379 patients, of whom 235 (62%) had a note documenting a CSD. After excluding patients lacking a note from their primary service, 227 remained for analysis. Sixty-three percent of notes contained documentation of who the discussion was held with. Patient goals/values were documented in 43%, discussion of prognosis in 14%, treatment options and resuscitation outcomes in 40%, and HCPOA in 29%. Hospitalists were more likely than residents to document who the discussion was held with (P < 0.001) and patient goals/values (P < 0.001), whereas internal medicine residents were more likely to document HCPOA (P = 0.04). The mean number of elements documented for hospitalists was 2.40, followed by internal medicine residents at 2.07, and noninternal medicine trainees at 1.30 (P < 0.001). Conclusion Documentation quality of inpatient CSDs was poor. Our findings highlight the need to improve the quality of resident and attending CSD documentation. PMID:24681110

Thurston, Andrew; Wayne, Diane B.; Feinglass, Joseph; Sharma, Rashmi K.

2014-01-01

199

Medication-Assisted Treatment For Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series 43  

ERIC Educational Resources Information Center

TIP 43 provides best-practice guidelines for medication-assisted treatment of opioid addiction in opioid treatment programs (OTPs). The primary intended audience for this volume is substance abuse treatment providers and administrators who work in OTPs. Recommendations in the TIP are based on both an analysis of current research and determinations…

Tinkler, Emily; Vallejos Bartlett, Catalina; Brooks, Margaret; Gilbert, Johnatnan Max; Henderson, Randi; Shuman, Deborah, J.

2005-01-01

200

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

PubMed Central

Background Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians. Methods/Design Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers’s diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods — pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance — with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation protocol) methods, and assessment of implementation costs. Discussion If implementation is successful, the field will have a proven technology that helps Federally Qualified Health Centers and affiliated organizations provide addiction treatment and recovery support, as well as a proven strategy for implementing the technology. Seva also has the potential to improve core elements of addiction treatment, such as referral and treatment processes. A mobile technology for addiction treatment and accompanying implementation model could provide a cost-effective means to improve the lives of patients with drug and alcohol problems. Trial registration ClinicalTrials.gov (NCT01963234). PMID:24884976

2014-01-01

201

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

202

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. PMID:20877557

Torosian, Jennifer

2006-01-01

203

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

204

Prosecuting Assaultive Forensic and Psychiatric Inpatients  

ERIC Educational Resources Information Center

Inpatient assault of forensic and psychiatric staff is a complex and multifaceted issue. Hence, the consequences reported in the literature regarding prosecuting assaultive inpatients are quite variable. In this article, issues pertaining to the prosecution of violent inpatients are reviewed. Illustrative cases, challenges of prosecution,…

Angus, Kerri C.; Reddon, John R.; Chudleigh, Michele D.

2008-01-01

205

Screening, brief intervention, and referral to treatment (SBIRT) for offenders: protocol for a pragmatic randomized trial  

PubMed Central

Background Although screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based technique that, in some health-care settings, has been shown to cost-effectively reduce alcohol and drug use, research on the efficacy of SBIRT among criminal offender populations is limited. Such populations have a high prevalence of drug and alcohol use but limited access to intervention, and many are at risk for post-release relapse and recidivism. Thus, there exists a need for treatment options for drug-involved offenders of varying risk levels to reduce risky behaviors or enter treatment. Methods/design This protocol describes an assessment of SBIRT feasibility and effectiveness in a criminal justice environment. Eight-hundred persons will be recruited from a large metropolitan jail, with the experimental group receiving an intervention depending on risk level and the control group receiving minimal intervention. The intervention will assess the risk level for drug and alcohol misuse by inmates, providing those at low or medium risk a brief intervention in the jail and referring those at high risk to community treatment following release. In addition, a brief treatment (eight-session) option will be available. Using data from a 12-month follow-up interview, the primary study outcomes are a reduction in drug and alcohol use, while secondary outcomes include participation in treatment, rearrest, quality of life, reduction in HIV risk behaviors, and costs of SBIRT. Expected value Individual reductions in alcohol and drug use can have significant effects on public health and safety when observed over a large population at risk for substance-use problems. With wider dissemination statewide or nationwide, a relatively low-cost intervention such as SBIRT could offer demonstrated benefits in this population. Trial registration Clinical Trials Government Identifier, NCT01683643. PMID:24499609

2013-01-01

206

Inpatient charges and mental illness: Findings from the Nationwide Inpatient Sample 1999–2007  

PubMed Central

Inpatient costs related to mental illness are substantial, though declining as a percentage of overall mental health treatment costs. The public sector has become increasingly involved in funding and providing mental health services. Nationwide Inpatient Sample data for the years 1999–2007 were used to: 1) examine Medicare, Medicaid, and private insurance charges related to mental illness hospitalizations, including trends over time; and 2) examine trends in mental comorbidity with physical illness and its effect on charges. There were an estimated 12.4 million mental illness discharges during the 9-year period, with Medicare being the primary payer for 4.3 million discharges, Medicaid for 3.3 million, private insurance for 3.2 million, and 1.6 million for all other payers. Mean inflation-adjusted charges per hospitalization were US$17,528, US$15,651, US$10,539, and US$11,663, respectively. Charges to public sources increased for schizophrenia and dementia-related discharges, with little private/public change noted for mood disorders. Comorbid mood disorders increased dramatically from 1.5 million discharges in 1999 to 3.4 million discharges in 2007. Comorbid illness was noted in 14.0% of the 342 million inpatient discharges during the study period and was associated with increased charges for some medical conditions and decreased charges for other medical conditions. PMID:21935325

Banta, Jim E; Belk, Ivorie; Newton, Kedon; Sherzai, Abdullah

2010-01-01

207

Do aftercare services reduce inpatient psychiatric readmissions?  

PubMed Central

OBJECTIVE: To determine whether aftercare services reduce the likelihood that children and adolescents will be readmitted to inpatient psychiatric facilities. DATA SOURCES/STUDY SETTING: Analyses of data from the Fort Bragg Demonstration. Data were based on 204 sample individuals (children and adolescents), all of whom were discharged from inpatient facilities during the study period. STUDY DESIGN: These analyses use hazard modeling to examine the impact of aftercare services on the likelihood of readmission. Comparisons of individuals for whom the timing of aftercare services differ are adjusted for a wide range of individual characteristics, including client demographics, diagnosis, symptomatology, and psychosocial functioning. DATA COLLECTION/EXTRACTION METHODS: Detailed data on psychopathology, symptomatology, and psychosocial functioning were collected on individuals included in these analyses. This information was taken from structured diagnostic interviews and behavior checklists, including the Child Behavior Checklist and Diagnostic Interview Schedule for Children, completed by the child and his or her caretaker. Information on the use of mental health services was taken from insurance claims and a management information system, and was used to identify the period from discharge to readmission and to describe the client's use of outpatient therapy, case management, intermediate (or stepdown) services, and residential treatment centers during this period. PRINCIPAL FINDINGS/CONCLUSIONS: Using Cox models that allow for censoring and that include the use of aftercare services as time-varying covariates, we find that aftercare services generally do not influence the likelihood of inpatient readmission. For the lower middle class families included in this study, the estimated effect of aftercare is not statistically significant and has limited practical significance. When we look at specific forms of aftercare, we find that outpatient therapy has the largest effect and that stepdown services in intermediate settings have the smallest. We also identify family and individual characteristics that influence the likelihood of readmission. PMID:10445899

Foster, E M

1999-01-01

208

Modifying the ECC-based grouping-proof RFID system to increase inpatient medication safety.  

PubMed

RFID technology is increasingly used in applications that require tracking, identification, and authentication. It attaches RFID-readable tags to objects for identification and execution of specific RFID-enabled applications. Recently, research has focused on the use of grouping-proofs for preserving privacy in RFID applications, wherein a proof of two or more tags must be simultaneously scanned. In 2010, a privacy-preserving grouping proof protocol for RFID based on ECC in public-key cryptosystem was proposed but was shown to be vulnerable to tracking attacks. A proposed enhancement protocol was also shown to have defects which prevented proper execution. In 2012, Lin et al. proposed a more efficient RFID ECC-based grouping proof protocol to promote inpatient medication safety. However, we found this protocol is also vulnerable to tracking and impersonation attacks. We then propose a secure privacy-preserving RFID grouping proof protocol for inpatient medication safety and demonstrate its resistance to such attacks. PMID:24997856

Ko, Wen-Tsai; Chiou, Shin-Yan; Lu, Erl-Huei; Chang, Henry Ker-Chang

2014-09-01

209

Treatment regimens, protocols, dosage, and indications for UVA1 phototherapy: facts and controversies.  

PubMed

During the last three decades, ultraviolet A1 (UVA1) phototherapy has emerged as a specific phototherapeutic modality with distinct modes of action and some well established indications. Atopic dermatitis, localized scleroderma, and systemic lupus erythematosus seem to be the conditions with the best evidence regarding efficacy and safety of UVA1 phototherapy. Further indications for UVA1 include subacute prurigo, lichen sclerosus, dyshidrotic dermatitis, cutaneous T cell lymphoma, urticaria pigmentosa, and pityriasis rosea; nevertheless, there are some unknowns, uncertainties, and controversies concerning short- and long-term side effects, efficacy and dosage regimens of UVA1 phototherapy in some conditions. We describe and discuss treatment regimens, protocols, dosage, and indications for UVA1 phototherapy. PMID:23806161

Gambichler, Thilo; Terras, Sarah; Kreuter, Alexander

2013-01-01

210

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

2013-10-01

211

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. PMID:23983832

Douglas, Vanja C.; Josephson, S. Andrew

2011-01-01

212

The Relationship between Adjustment and Perceived Locus of Control for Female Psychiatric Inpatients.  

ERIC Educational Resources Information Center

Examines the longitudinal relationship between internal-external locus of control and adjustment using independent measures within two dissimilar treatment environments: a traditional ward and a token economy ward. Subjects were 65 female psychiatric inpatients. (CM)

Youkilis, Hildreth D.; Bootzin, Richard R.

1979-01-01

213

A stepped-wedge cluster randomised controlled trial for evaluating rates of falls among inpatients in aged care rehabilitation units receiving tailored multimedia education in addition to usual care: a trial protocol  

PubMed Central

Introduction Falls are the most frequent adverse event reported in hospitals. Approximately 30% of in-hospital falls lead to an injury and up to 2% result in a fracture. A large randomised trial found that a trained health professional providing individualised falls prevention education to older inpatients reduced falls in a cognitively intact subgroup. This study aims to investigate whether this efficacious intervention can reduce falls and be clinically useful and cost-effective when delivered in the real-life clinical environment. Methods A stepped-wedge cluster randomised trial will be used across eight subacute units (clusters) which will be randomised to one of four dates to start the intervention. Usual care on these units includes patient's screening, assessment and implementation of individualised falls prevention strategies, ongoing staff training and environmental strategies. Patients with better levels of cognition (Mini-Mental State Examination >23/30) will receive the individualised education from a trained health professional in addition to usual care while patient's feedback received during education sessions will be provided to unit staff. Unit staff will receive training to assist in intervention delivery and to enhance uptake of strategies by patients. Falls data will be collected by two methods: case note audit by research assistants and the hospital falls reporting system. Cluster-level data including patient's admissions, length of stay and diagnosis will be collected from hospital systems. Data will be analysed allowing for correlation of outcomes (clustering) within units. An economic analysis will be undertaken which includes an incremental cost-effectiveness analysis. Ethics and dissemination The study was approved by The University of Notre Dame Australia Human Research Ethics Committee and local hospital ethics committees. Results The results will be disseminated through local site networks, and future funding and delivery of falls prevention programmes within WA Health will be informed. Results will also be disseminated through peer-reviewed publications and medical conferences. Trial registration The study is registered with the Australian New Zealand Clinical Trials registry (ACTRN12612000877886). PMID:24430881

Hill, Anne-Marie; Waldron, Nicholas; Etherton-Beer, Christopher; McPhail, Steven M; Ingram, Katharine; Flicker, Leon; Haines, Terry P

2014-01-01

214

Long-stay in short-stay inpatient facilities: risk factors and barriers to discharge  

PubMed Central

Background The aim of the present study was to assess the characteristics of long-stay inpatients in public and private Italian acute inpatient facilities, to identify risk factors and correlates of the long duration of hospital stay in these patients, and to identify possible barriers to alternative placements. Methods All patients in 130 Italian public and private psychiatric inpatient units who had been hospitalized for more than 3 months during a specific index period were assessed with standardized assessment instruments and compared to patients discharged during the same index period, but staying in hospital for less than 3 months (short-stay inpatients). Assessed domains included demographic, clinical, and treatment characteristics, as well as process of care. Logistic regression analysis was used to identify specific variables predicting inpatient long-stay status. Reasons for delaying patient discharge, as reported by treatment teams, were also analyzed. Results No overall differences between long-stay and short-stay patients emerged in terms of symptom severity or diagnostic status. Admission to a private inpatient facility and display of violent behavior during hospital stay were the most powerful predictors of long-stay. Lack of housing and a shortage of community support were the reasons most commonly cited by treatment teams as barriers to discharge. Conclusion Extra-clinical factors are important determinants of prolonged hospitalization in acute inpatient settings. PMID:19698136

Gigantesco, Antonella; de Girolamo, Giovanni; Santone, Giovanni; Miglio, Rossella; Picardi, Angelo

2009-01-01

215

Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: randomized controlled trial of efficacy and economic effects.  

PubMed

Pediatric chronic pain, which can result in deleterious effects for the child, bears the risk of aggravation into adulthood. Intensive interdisciplinary pain treatment (IIPT) might be an effective treatment, given the advantage of consulting with multiple professionals on a daily basis. Evidence for the effectiveness of IIPT is scarce. We investigated the efficacy of an IIPT within a randomized controlled trial by comparing an intervention group (IG) (n=52) to a waiting-list control group (WCG) (n=52). We made assessments before treatment (PRE), immediately after treatment (POST), as well as at short-term (POST6MONTHS) and long-term (POST12MONTHS) follow-up. We determined a combined endpoint, improvement (pain intensity, disability, school absence), and investigated 3 additional outcome domains (anxiety, depression, catastrophizing). We also investigated changes in economic parameters (health care use, parental work absenteeism, subjective financial burden) and their relationship to the child's improvement. Results at POST showed that significantly more children in the IG than in the WCG were assigned to improvement (55% compared to 14%; Fisher P<.001; 95% confidence interval for incidence difference: 0.21% to 0.60%). Although immediate effects were achieved for disability, school absence, depression, and catastrophizing, pain intensity and anxiety did not change until short-term follow-up. More than 60% of the children in both groups were improved long-term. The parents reported significant reductions in all economic parameters. The results from the present study support the efficacy of the IIPT. Future research is warranted to investigate differences in treatment response and to understand the changes in economic parameters in nonimproved children. PMID:24060708

Hechler, Tanja; Ruhe, Ann-Kristin; Schmidt, Pia; Hirsch, Jessica; Wager, Julia; Dobe, Michael; Krummenauer, Frank; Zernikow, Boris

2014-01-01

216

Staphylococcus aureus in continuous culture: a tool for the rational design of antibiotic treatment protocols.  

PubMed

In vitro measures of the pharmacodynamics of antibiotics that account for the factors anticipated for bacteria in infected patients are central to the rational design of antibiotic treatment protocols. We consider whether or not continuous culture devices are a way to obtain these measures. Staphylococcus aureus PS80 in high-density continuous cultures were exposed to oxacillin, ciprofloxacin, vancomycin, gentamicin, daptomycin and linezolid. Contrary to results from low density retentostats as well as to predictions of traditional PK/MIC ratios, daily dosing with up to 100× MIC did not clear these cultures. The densities of S. aureus in these cultures oscillated with constant amplitude and never fell below 10(5) CFU per ml. Save for daptomycin "treated" populations, the densities of bacteria in these cultures remained significantly below that of similar antibiotic-free cultures. Although these antibiotics varied in their pharmacodynamic properties there were only modest differences in their mean densities. Mathematical models and experiments suggest that the dominant factor preventing clearance was wall-adhering subpopulations reseeding the planktonic population which can be estimated and corrected for. Continuous cultures provide a way to evaluate the potential efficacy of antibiotic treatment regimes in vitro under conditions that are more clinically realistic and comprehensive than traditional in vitro PK/PD indices. PMID:22911681

Udekwu, Klas I; Levin, Bruce R

2012-01-01

217

Evaluation of a discontinuous treatment protocol (VELCAP-S) for canine lymphoma.  

PubMed

Eighty-two dogs with lymphoma received a single 15-week course of chemotherapy, after which treatment was ceased until relapse. Fifty-six dogs (68%) achieved complete remission for a median 1st remission duration of 20 weeks. Forty-eight dogs relapsed, of which 30 repeated the induction cycle. In 22 of these dogs, 1st remission had been short, and they received maintenance chemotherapy; the other 8 dogs received 2 or 3 cycles of induction chemotherapy. Second remission rate for these 30 dogs was 87% (26 dogs). Overall disease control for the 38 dogs that remained on protocol was 44 weeks, which was not markedly shorter than for dogs treated with a previously reported protocol in which maintenance chemotherapy was instituted in all dogs after an identical 1st induction (VELCAP-L). Dogs that were febrile and dogs that were dyspneic were less likely to achieve a complete remission to induction chemotherapy. Of dogs that achieved a complete remission, those that were thrombocytopenic at entry had a shorter 1st remission, and dogs that were anorexic at entry had shorter overall disease control. There was a correlation between 1st remission duration and length of any subsequent remission obtained. The incidence of toxicity was high, particularly after the combination of doxorubicin and vincristine. Dose reductions because of toxicity did not markedly reduce remission duration. We conclude that discontinuous chemotherapy may reduce patient visits in a small number of patients because of long-term disease control. Delaying maintenance chemotherapy until after 2nd remission is achieved does not markedly affect overall disease control. PMID:11467592

Moore, A S; Cotter, S M; Rand, W M; Wood, C A; Williams, L E; London, C A; Frimberger, A E; L'Heureux, D A

2001-01-01

218

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...

219

Langerhans Lab Protocols Water treatment & aging.docx revised 1/30/13 by JW Page 1 of 1  

E-print Network

Langerhans Lab Protocols Water treatment & aging.docx revised 1/30/13 by JW Page 1 of 1 Water treatment and aging for fish tanks 1. To a scrubbed* 5 gallon bucket, add following: a. 2.5 mL Amquel Plus b salinity) Marine Mix or Instant Ocean 2. Fill bucket with tap water, to brim. 3. Put air stone and heater

Langerhans, Brian

220

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

Code of Federal Regulations, 2012 CFR

...facility prospective payment system. 412.405 Section 412...DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

2012-10-01

221

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

Code of Federal Regulations, 2013 CFR

...facility prospective payment system. 412.405 Section 412...DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

2013-10-01

222

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

Code of Federal Regulations, 2014 CFR

...facility prospective payment system. 412.405 Section 412...DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

2014-10-01

223

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

Code of Federal Regulations, 2011 CFR

...facility prospective payment system. 412.405 Section 412...DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

2011-10-01

224

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

225

Comparison of pregnancy outcome after letrozole versus clomiphene treatment for mild ovarian stimulation protocol in poor responders  

PubMed Central

Background: Poor ovarian response to controlled ovarian stimulation is one of the most important interest points in assisted reproduction. Mild ovarian stimulation seems to be preferable to high dose of FSH regimens in women with a history of poor ovarian response in previous protocol. Clomiphene citrate and letrozole alone or in combination with FSH have been used in mild ovarian stimulation protocol. Objective: To compare the efficacy of letrozole and clomiphene citrate for mild ovarian stimulation on assisted reproductive technology outcomes in poor responders. Materials and Methods: In a randomized control study, 184 women aged between 20 and 45 years with the history of poor response to ovarian stimulation who were candidate for ART were randomly subdivided into two groups: group I (n= 80), women who underwent the clomiphene/gonadotropin/antagonist protocol; and group II (n= 87), patients who underwent the letrozole/gonadotropin/antagonist protocol. Groups were compared regarding implantation, chemical and clinical pregnancy rates. Results: There was a significant difference in the mean endometrial thickness between two groups (9.16±1.2 mm vs. 8.3±0.3 mm). The implantation rate was significantly higher in letrozole group compare to clomiphene group (7.2 vs. 6.6%, p=0.024 respectively). No significant differences were found in chemical and clinical pregnancy rate between two groups. Conclusion: In mild ovarian stimulation protocol, letrozole and clomiphene have similar value for the poor responder. The optimal treatment strategy for these patients remains debated. PMID:25709627

Eftekhar, Maryam; Mohammadian, Farnaz; Davar, Robab; Pourmasumi, Soheila

2014-01-01

226

Monitoring Consumer Satisfaction With Inpatient Service Delivery: The Inpatient Evaluation of Service Questionnaire  

Microsoft Academic Search

Objective: To report on the development, testing and psychometric properties of a brief consumer satisfaction measure for use with psychiatric inpatients.Method: Focus group discussions with inpatients were used to develop a pool of items related to satisfaction with hospital stay. A second cohort of 72 inpatients was invited to rate the 51 items that emerged for importance in contributing to

Thomas Meehan; Helen Bergen; Terry Stedman

2002-01-01

227

One institution's experience in implementing protocols for glycemic management.  

PubMed

The objective for monitoring blood glucose is to determine the need for intervention. This article describes an institution's comprehensive program of protocols and education initiated to manage inpatient hyperglycemia. PMID:20543619

Corbin, Adele E; Carmical, Diana; Goetz, Jane A; Gadomski, Valerie O; Knochelmann, Carol; Whitmer, Kyra; Falciglia, Mercedes

2010-01-01

228

Boron neutron capture therapy applied to advanced breast cancers: Engineering simulation and feasibility study of the radiation treatment protocol  

NASA Astrophysics Data System (ADS)

This dissertation describes a novel Boron Neutron Capture Therapy (BNCT) application for the treatment of human epidermal growth factor receptor type 2 positive (HER2+) breast cancers. The original contribution of the dissertation is the development of the engineering simulation and the feasibility study of the radiation treatment protocol for this novel combination of BNCT and HER2+ breast cancer treatment. This new concept of BNCT, representing a radiation binary targeted treatment, consists of the combination of two approaches never used in a synergism before. This combination may offer realistic hope for relapsed and/or metastasized breast cancers. This treatment assumes that the boronated anti-HER2 monoclonal antibodies (MABs) are administrated to the patient and accumulate preferentially in the tumor. Then the tumor is destroyed when is exposed to neutron irradiation. Since the use of anti-HER2 MABs yields good and promising results, the proposed concept is expected to amplify the known effect and be considered as a possible additional treatment approach to the most severe breast cancers for patients with metastasized cancer for which the current protocol is not successful and for patients refusing to have the standard treatment protocol. This dissertation makes an original contribution with an integral numerical approach and proves feasible the combination of the aforementioned therapy and disease. With these goals, the dissertation describes the theoretical analysis of the proposed concept providing an integral engineering simulation study of the treatment protocol. An extensive analysis of the potential limitations, capabilities and optimization factors are well studied using simplified models, models based on real CT patients' images, cellular models, and Monte Carlo (MCNP5/X) transport codes. One of the outcomes of the integral dosimetry assessment originally developed for the proposed treatment of advanced breast cancers is the implementation of BNCT for HER2+ breast cancers for deep seated tumors using MITRII-FCB facility with an 8 cm diameter beam (port closest-to-tumor position), with boron concentrations in the tumor higher than 32 mug/g, and for a tumor-to-healthy tissue boron concentration ratio of 8:1. The therapeutic ratios for the proposed treatment would be higher than five for skin and adipose tissue and higher than three for tumor surrounding fibroglandular tissue. The microdosimetry study shows potential improvements in the therapeutic ratios based on the expected sub-cellular boron biodistributions. The engineering simulation study of clinical cases shows the advantages of using BNCT for HER+ breast cancers. Assuming an assured high efficiency of the boron agent delivery, the proposed concept can be considered for stage IV HER2+ breast cancers in treating the metastasized tumors in brain, head and neck, and lungs.

Sztejnberg Goncalves-Carralves, Manuel Leonardo

229

Implementation of a patient selection protocol for intra-arterial therapy increases treatment rates in patients with acute ischemic stroke  

PubMed Central

Background Strategies for patient selection for intra-arterial therapy (IAT) in acute ischemic stroke (AIS) are highly variable. The degree of protocol adoption and treatment rates associated with implementation of a service-wide patient selection IAT protocol were assessed. Methods All patients with AIS prospectively recorded in our stroke database from January 2007 to June 2009 were reviewed. The IAT patient selection protocol was implemented in March 2008. Patients were defined as likely to benefit (LTB) from IAT if they had brain imaging completed within 6 h from last known well time, NIH Stroke Scale score ?8, infarct volume ?100 ml and evidence of proximal artery occlusion. Results Of 1348 subjects identified, 118 (8.7%) met the criteria for LTB and 62 (52%) underwent IAT. There was a significant increase in rates of IAT among LTB patients after protocol implementation (61% vs 40%, p<0.02). In LTB patients, factors associated with IAT were stroke duration (OR 0.78, 95% CI 0.6 to 0.9 per hour), arrival within later calendar months during study period (OR 1.1, 95% CI 1.02 to 1.2 per month), intravenous tissue plasminogen activator (OR 0.6, 95% CI 0.4 to 0.9) and age (OR 0.98, 95% CI 0.95 to 1.02 per year). After multivariable adjustment, only stroke duration (OR 0.65, 95% CI 0.5 to 0.8 per hour) remained an independent predictor of IAT. Conclusions Most patients with AIS did not meet our criteria for LTB and only 52% of those defined as LTB received IAT. Protocol adoption increased the use of IAT over time; however, further exploration of factors associated with the reasons for non-treatment and the impact of IAT on outcomes is necessary. PMID:22611045

Rost, Natalia S; Smith, Eric E; Nogueira, Raul G; Fitzpatrick, Kaitlin M; Yoo, Albert J; Hirsch, Joshua A; Schwamm, Lee H

2013-01-01

230

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

PubMed Central

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 International Study to Predict Optimized Treatment - in Depression (iSPOT-D) is a multi-centre, international, randomized, prospective, open-label trial. It is enrolling 2016 MDD outpatients (ages 18-65) from primary or specialty care practices (672 per treatment arm; 672 age-, sex- and education-matched healthy controls). Study-eligible patients are antidepressant medication (ADM) naïve or willing to undergo a one-week wash-out of any non-protocol ADM, and cannot have had an inadequate response to protocol ADM. Baseline assessments include symptoms; distress; daily function; cognitive performance; electroencephalogram and event-related potentials; heart rate and genetic measures. A subset of these baseline assessments are repeated after eight weeks of treatment. Outcomes include the 17-item Hamilton Rating Scale for Depression (primary) and self-reported depressive symptoms, social functioning, quality of life, emotional regulation, and side-effect burden (secondary). Participants may then enter a naturalistic telephone follow-up at weeks 12, 16, 24 and 52. The first half of the sample will be used to identify potential predictors and moderators, and the second half to replicate and confirm. Discussion First enrolment was in December 2008, and is ongoing. iSPOT-D evaluates clinical and biological predictors of treatment response in the largest known sample of MDD collected worldwide. Trial registration International Study to Predict Optimised Treatment - in Depression (iSPOT-D) ClinicalTrials.gov Identifier: NCT00693849 URL: http://clinicaltrials.gov/ct2/show/NCT00693849?term=International+Study+to+Predict+Optimized+Treatment+for+Depression&rank=1 PMID:21208417

2011-01-01

231

Bee venom acupuncture, NSAIDs or combined treatment for chronic neck pain: study protocol for a randomized, assessor-blind trial  

PubMed Central

Background Chronic neck pain (CNP) is a common painful medical condition with a significant socioeconomic impact. In spite of widespread usage, the effectiveness and safety of combined treatments between conventional and complementary alternative medical treatment modalities has not been fully established in a rigorous randomized clinical trial (RCT). This pilot study will provide the clinical evidence to evaluate the feasibility and refine the protocol for a full-scale RCT on combined treatment of bee venom acupuncture (BVA) and non-steroidal anti-inflammatory drugs (NSAIDs) in patients with CNP. Methods/Design This is a randomized, single-blind clinical trial with three parallel arms. Sixty patients between 18 and 65 years of age with non-specific, uncomplicated neck pain lasting for at least three months will be enrolled. Participants will be randomly allocated into the BVA, NSAIDs or combined treatment group. Assessors and statisticians will be blinded to the random allocation. All researchers will receive training to ensure their strict adherence to the study protocol. Patients from the BVA and combined treatment group will be treated with a bee venom increment protocol into predefined acupoints for six sessions over a three week period. BVA intervention is developed through a comprehensive discussion among interdisciplinary spine disorder experts, according to the guidelines of Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). Patients from the NSAIDs and combined treatment groups will be prescribed loxoprofen (one tablet to be taken orally, three times a day for three weeks). Bothersomeness from CNP measured using a visual analogue scale (VAS) will be the primary outcome assessed at screening, visit two (baseline), four, six, eight (4th week assessment) and nine (8th week assessment) follow-up session. VAS for pain intensity, neck disability index (NDI), quality of life, depressive status and adverse experiences will also be analyzed. Discussion Our study results will contribute to feasibility evaluation and to relevant RCT protocol development for a full-scale RCT on combined treatment of BVA and NSAIDs for CNP patients. Trial registration This study is registered with the United States (US) National Institutes of Health Clinical Trials Registry: NCT01922466. PMID:24746224

2014-01-01

232

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...

233

Using music therapy protocols in the treatment of premature infants: An introduction to current practices  

Microsoft Academic Search

Medical music therapy, which has developed rapidly in the last 15 years, has been effectively used with preterm infants in neonatal intensive care units. The purpose of this article is to provide an introduction to current music therapy protocols for premature infants, as well as highlight research supporting the use of these procedures to address a variety of medical and

Lori F. Gooding

2010-01-01

234

Evaluation of Epithelial Integrity with Various Transepithelial Corneal Cross-Linking Protocols for Treatment of Keratoconus  

PubMed Central

Purpose. Corneal collagen cross-linking (CXL) has been demonstrated to stiffen cornea and halt progression of ectasia. The original protocol requires debridement of central corneal epithelium to facilitate diffusion of a riboflavin solution to stroma. Recently, transepithelial CXL has been proposed to reduce risk of complications associated with epithelial removal. Aim of the study is to evaluate the impact of various transepithelial riboflavin delivery protocols on corneal epithelium in regard to pain and epithelial integrity in the early postoperative period. Methods. One hundred and sixty six eyes of 104 subjects affected by progressive keratoconus underwent transepithelial CXL using 6 different riboflavin application protocols. Postoperatively, epithelial integrity was evaluated at slit lamp and patients were queried regarding their ocular pain level. Results. One eye had a corneal infection associated with an epithelial defect. No other adverse event including endothelial decompensation or endothelial damage was observed, except for epithelial damages. Incidence of epithelial defects varied from 0 to 63%. Incidence of reported pain varied from 0 to 83%. Conclusion. Different transepithelial cross-linking protocols have varying impacts on epithelial integrity. At present, it seems impossible to have sufficient riboflavin penetration without any epithelial disruption. A compromise between efficacy and epithelial integrity has to be found. PMID:25197559

Dick, H. Burkhard

2014-01-01

235

Effective inpatient medication reconciliation: The 10 commandments.  

PubMed

Medication Reconciliation (MedRec) is the comprehensive process of medication verification, clarification and documentation in an effort to avoid medication errors. There are many reasons that contribute to the inadequacies of current day inpatient MedRec. Among these include the limited medical literacy of patients, communication between providers and teams of providers, and the intrinsic difficulties of medical charting. Although the best approach to inpatient MedRec is not known, the following outlines the 10 most important aspects, or "Commandments", for effective inpatient MedRec. The tenets are not listed in any particular order of importance. PMID:25758318

Siu, Henry K

2015-04-01

236

42 CFR 441.154 - Active treatment.  

Code of Federal Regulations, 2011 CFR

... SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs § 441.154 Active treatment. Inpatient psychiatric services must...

2011-10-01

237

42 CFR 441.154 - Active treatment.  

Code of Federal Regulations, 2012 CFR

... SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs § 441.154 Active treatment. Inpatient psychiatric services must...

2012-10-01

238

Replacing the Last Week of a Motivational Inpatient Alcohol Withdrawal Programme by a Day-Clinic Setting  

Microsoft Academic Search

The impact on the motivation to treatment of a qualified alcohol withdrawal programme was evaluated in a pre\\/post setting. Over a period of 2 years we compared the results of replacing the last week of an inpatient setting by day-clinic treatment. In the first year, 202 patients were treated in a 3-week inpatient setting, whereas in the second year, 149

G. Reymann; H. J. Danziger

2001-01-01

239

Inpatient Management of Diabetic Foot Disorders: A Clinical Guide  

PubMed Central

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

2013-01-01

240

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

241

INtegration of DEPression Treatment into HIV Care in Uganda (INDEPTH-Uganda): study protocol for a randomized controlled trial  

PubMed Central

Background Despite 10 to% of persons living with HIV in sub-Saharan Africa having clinical depression, and the consequences of depression for key public health outcomes (HIV treatment adherence and condom use), depression treatment is rarely integrated into HIV care programs. Task-shifting, protocolized approaches to depression care have been used to overcome severe shortages of mental health specialists in developing countries, but not in sub-Saharan Africa and not with HIV clients. The aims of this trial are to evaluate the implementation outcomes and cost-effectiveness of a task-shifting, protocolized model of antidepressant care for HIV clinics in Uganda. Methods/Design INDEPTH-Uganda is a cluster randomized controlled trial that compares two task-shifting models of depression care - a protocolized model versus a model that relies on the clinical acumen of trained providers to provide depression care in ten public health HIV clinics in Uganda. In addition to data abstracted from routine data collection mechanisms and supervision logs, survey data will be collected from patient and provider longitudinal cohorts; at each site, a random sample of 150 medically stable patients who are depressed according to the PHQ-2 screening will be followed for 12 months, and providers involved in depression care implementation will be followed over 24 months. These data will be used to assess whether the two models differ on implementation outcomes (proportion screened, diagnosed, treated; provider fidelity to model of care), provider adoption of treatment care knowledge and practices, and depression alleviation. A cost-effectiveness analysis will be conducted to compare the relative use of resources by each model. Discussion If effective and resource-efficient, the task-shifting, protocolized model will provide an approach to building the capacity for sustainable integration of depression treatment in HIV care settings across sub-Saharan Africa and improving key public health outcomes. Trial registration INDEPTH-Uganda has been registered with the National Institutes of Health sponsored clinical trials registry (3 February 2013) and has been assigned the identifier NCT02056106. PMID:24962086

2014-01-01

242

Inpatient procedures in elderly women: An analysis over time  

PubMed Central

Objectives To describe inpatient surgical and diagnostic/therapeutic procedures in women ?65 years old and assess procedure trends over time. Study Design Procedure data for all women ?65 years was collected using the National Hospital Discharge Survey, a federal dataset drawn from a representative sampling of U.S. inpatient hospitals which includes patient and hospital demographics and ICD-9-CM diagnosis and procedure codes for admissions from 1979-2006. Main Outcome Measures Age-adjusted rates (AAR) per 1000 women were created using 1990 U.S. Census data to compare trends over time. Results Over 96 million procedures were performed in women age ?65 years from 1979-2006. Women age ?65 years constituted 17% of women with ?1 inpatient procedure in 1979, rising to 32% in 2006. The most common surgical procedures were lower extremity joint replacement, open reduction internal fixation, and cholecystectomy. The most common concurrent diagnosis was femoral neck fracture. Women with femoral neck fracture were more likely to undergo open reduction internal fixation compared to joint replacement. AARs for ORIF fell from 4.3 to 3.2 (p=.02) from 1979-2006, while AARs for joint replacement increased from 0.2 to 3.4 (p=<.001, 1979-1988; p=.14, 1990-2006). Conclusions The rate of women age ?65 years undergoing inpatient procedures has increased dramatically in the last 30 years. Hip fracture was the most common diagnosis for elderly women, highlighting the impact of osteoporosis and falls and the importance of prevention strategies and optimization of peri-operative care in this population. Further comparative study of hip fracture treatment strategies in this population is needed. PMID:23707727

OLIPHANT, Sallie S.; GHETTI, Chiara; MCGOUGH, Richard L.; WANG, Li; BUNKER, Clareann H.; LOWDER, Jerry L.

2013-01-01

243

Is There a "July Effect" for Inpatient Glycemic Control?  

PubMed

Objective: The period of resident turnover in teaching hospitals has been believed by some to lead to worsening of health outcomes or the so-called "July Effect". We sought to study glycemic control in patients admitted to medical floors looking for any adverse outcomes related to a"July effect".Methods: This is a single-center retrospective cohort study comparing inpatient glycemic control at the start and end of a single academic year (July 2009 to June 2010). A total of 100 inpatients with a diagnosis of diabetes mellitus were included in the first group (Group 1: July to September 2009) and 118 in the second group (Group 2: April to June 2010). Four capillary blood glucose measurements per day from Day 2 to Day 6 of hospitalization, as well as clinical data pertinent to glycemic management were collected.Results: Data analysis showed no significant difference in the overall inpatient glycemic control between the two groups. Mean glucose for Group 1 was 168.67 mg/dL and 168.59 mg/dl for Group 2. 67% of patients in Group 1 and 72.9% in Group 2 were within blood glucose range of 70 - 179 mg/dl, 32% of patients in Group 1 and 52% of patients in Group 2 were within the range of 140 - 179 mg/dL. Hypoglycemia occurred in 17% and 18.6% of patients for Group 1 and 2 respectively. No difference in diabetes treatment ordering practices of residents was detected.Conclusion: This study did not show any evidence to support the "July Effect" on overall inpatient glycemic control. PMID:25100361

Nicolas, Kristine; Raroque, Sabrina; Rowland, Douglas Y; Chaiban, Joumana T

2014-08-01

244

Prednisolone inclusion in a first-line multidrug cytostatic protocol for the treatment of canine lymphoma does not affect therapy results.  

PubMed

Chemotherapy protocols for canine lymphoma include the routine use of glucocorticoids for their lympholytic effect. However, glucocorticoids are associated with side effects (e.g. polyphagia, polyuria, and weight gain), limit the use of non-steroidal anti-inflammatory drugs, and can induce drug transporter expression that could lead to drug resistance. Despite these negative effects, there are no data to support the use of glucocorticoids as part of a multidrug chemotherapy protocol for the treatment of canine lymphoma. A prospective, randomized clinical trial was conducted in 81 dogs with multicentric lymphoma and no history of recent glucocorticoid use. All dogs were staged and treated with the same chemotherapy protocol (L-asparaginase, cyclophosphamide, doxorubicin, vincristine, and prednisolone) with half of the dogs receiving prednisolone. Both treatment groups were similar with respect to demographics, immunophenotype, and clinical stage, except for a higher number of substage b patients in the prednisolone group (5 vs. 14; P=0.015). Treatment results obtained with the initial treatment (complete response rate 75%, disease-free period 176 days) and rescue treatment (complete response rate 45%, disease-free period 133 days), overall survival (283 days) and adverse events (number and grade) were similar for both groups. In conclusion, prednisolone, as part of a multidrug chemotherapy protocol, has no additional effect on treatment results and can be omitted from first-line multidrug protocols used for the treatment of canine lymphoma. PMID:23746872

Zandvliet, M; Rutteman, G R; Teske, E

2013-09-01

245

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.

246

Follow-up of inpatient cocaine withdrawal for cocaine-using methadone patients  

Microsoft Academic Search

Significant proportions of opiate-dependent persons entering methadone treatment are also addicted to cocaine and continue to use cocaine during treatment. One standard response to cocaine use has been inpatient detoxification. This study examined the effectiveness of this procedure by comparing pre- and posttreatment urine toxicologies for methadone patients who had been hospitalized for cocaine withdrawal. The results showed a negligible

Andrew Rosenblum; Jeffrey Foote; Stephen Magura; Victor Sturiano; Neil Xu; Barry Stimmel

1996-01-01

247

The Relationship between Addiction and Psychopathology in a Sample of Inpatient Adult Alcoholics.  

ERIC Educational Resources Information Center

Since psychopathology may be linked to substance abuse behavior, one aspect of that relationship should have an effect on the development and consequences of the other. This study sought to determine whether psychopathology would decrease after a 28-day period of alcoholism treatment. Thirty Caucasian adults who had sought inpatient treatment for…

Beaty, Lee A.; Cipparrone, Nancy E.

248

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

249

Psychiatric Comorbidity Among Inpatient Substance Abusing Adolescents  

Microsoft Academic Search

We studied the association between type, severity and sequencing of psychopathology and these same dimensions of substance involvement among inpatient substance-abusing adolescents with comorbid psychiatric disorders. Adolescents (N = 140, 54% female; 15.9 years) meeting DSM-III-R criteria for a substance use disorder and at least one other Axis I psychiatric disorder were interviewed while inpatients in an adolescent psychiatric facility.

Ana M. Abrantes; Sandra A. Brown; Kristin L. Tomlinson

2004-01-01

250

CTEP & CC Protocols - Credit Report  

Cancer.gov

CTEP & CC Protocols - Credit Report Community Clinical Oncology Program Research Base Protocol Credit Assignment Approved, Active, and Closed Protocols Research Base North Central Cancer Treatment Group (NCCTG) qry_Credit_Report_Output_HTML_NCCTG

251

A comparison of two treatments for childhood apraxia of speech: methods and treatment protocol for a parallel group randomised control trial  

PubMed Central

Background Childhood Apraxia of Speech is an impairment of speech motor planning that manifests as difficulty producing the sounds (articulation) and melody (prosody) of speech. These difficulties may persist through life and are detrimental to academic, social, and vocational development. A number of published single subject and case series studies of speech treatments are available. There are currently no randomised control trials or other well designed group trials available to guide clinical practice. Methods/Design A parallel group, fixed size randomised control trial will be conducted in Sydney, Australia to determine the efficacy of two treatments for Childhood Apraxia of Speech: 1) Rapid Syllable Transition Treatment and the 2) Nuffield Dyspraxia Programme – Third edition. Eligible children will be English speaking, aged 4–12?years with a diagnosis of suspected CAS, normal or adjusted hearing and vision, and no comprehension difficulties or other developmental diagnoses. At least 20 children will be randomised to receive one of the two treatments in parallel. Treatments will be delivered by trained and supervised speech pathology clinicians using operationalised manuals. Treatment will be administered in 1-hour sessions, 4 times per week for 3?weeks. The primary outcomes are speech sound and prosodic accuracy on a customised 292 item probe and the Diagnostic Evaluation of Articulation and Phonology inconsistency subtest administered prior to treatment and 1?week, 1?month and 4?months post-treatment. All post assessments will be completed by blinded assessors. Our hypotheses are: 1) treatment effects at 1?week post will be similar for both treatments, 2) maintenance of treatment effects at 1 and 4?months post will be greater for Rapid Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment, and 3) generalisation of treatment effects to untrained related speech behaviours will be greater for Rapid Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment. This protocol was approved by the Human Research Ethics Committee, University of Sydney (#12924). Discussion This will be the first randomised control trial to test treatment for CAS. It will be valuable for clinical decision-making and providing evidence-based services for children with CAS. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12612000744853 PMID:22863021

2012-01-01

252

42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.  

Code of Federal Regulations, 2010 CFR

...the inpatient rehabilitation facility prospective payment system. 412.632 Section...HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment for Inpatient...

2010-10-01

253

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 structure…

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

2013-01-01

254

Evaluating the clinical effectiveness of a specialized perinatal psychiatry inpatient unit.  

PubMed

Women experiencing severe perinatal mental illness during pregnancy or postpartum have unique needs when psychiatric hospitalization is indicated. Although many countries have established mother-baby psychiatric units, similar facilities have not been available in the US. In 2011, the University of North Carolina at Chapel Hill inaugurated the first Perinatal Psychiatry Inpatient Unit in the US. We describe the unique characteristics of the patient population and report clinical outcomes guiding development and refinement of treatment protocols. Ninety-two perinatal patients were admitted between September 2011 and September 2012, and 91 completed self-report measures at admission and discharge. Perinatal unipolar mood disorder was the most frequent primary diagnosis (60.43 %), and 11 patients (12 %) were admitted with psychosis. The data document clinically and statistically significant improvements in symptoms of depression, anxiety, and active suicidal ideation between admission and discharge (p?

Meltzer-Brody, Samantha; Brandon, Anna R; Pearson, Brenda; Burns, Lynne; Raines, Christena; Bullard, Elizabeth; Rubinow, David

2014-04-01

255

SU-E-J-113: The Influence of Optimizing Pediatric CT Simulator Protocols On the Treatment Dose Calculation in Radiotherapy  

SciTech Connect

Purpose: To investigate the possibility of applying optimized scanning protocols for pediatric CT simulation by quantifying the dosimetric inaccuracy introduced by using a fixed HU to density conversion. Methods: The images of a CIRS electron density reference phantom (Model 062) were acquired by a Siemens CT simulator (Sensation Open) using the following settings of tube voltage and beam current: 120 kV/190mA (the reference protocol used to calibrate CT for our treatment planning system (TPS)); Fixed 190mA combined with all available kV: 80, 100, and 140; fixed 120 kV and various current from 37 to 444 mA (scanner extremes) with interval of 30 mA. To avoid the HU uncertainty of point sampling in the various inserts of known electron densities, the mean CT numbers of the central cylindrical volume were calculated using DICOMan software. The doses per 100 MU to the reference point (SAD=100cm, Depth=10cm, Field=10X10cm, 6MV photon beam) in a virtual cubic phantom (30X30X30cm) were calculated using Eclipse TPS (calculation model: AcurosXB-11031) by assigning the CT numbers to HU of typical materials acquired by various protocols. Results: For the inserts of densities less than muscle, CT number fluctuations of all protocols were within the tolerance of 10 HU as accepted by AAPM-TG66. For more condensed materials, fixed kV yielded stable HU with any mA combination where largest disparities were found in 1750mg/cc insert: HU{sub reference}=1801(106.6cGy), HU{sub minimum}=1799 (106.6cGy, error{sub dose}=0.00%), HU{sub maximum}=1815 (106.8cGy, error{sub dose}=0.19%). Yet greater disagreements were observed with increasing density when kV was modified: HU{sub minimum}=1646 (104.5cGy, error{sub dose}=- 1.97%), HU{sub maximum}=2487 (116.4cGy, error{sub dose}=9.19%) in 1750mg/cc insert. Conclusion: Without affecting treatment dose calculation, personalized mA optimization of CT simulator can be conducted by fixing kV for a better cost-effectiveness of imaging dose and quality especially for children. Unless recalibrated, kV should be constant for all anatomical sites if diagnostic CT scanner is used as a simulator. This work was partially supported by Capital Medical Development Scientific Research Fund of China.

Zhang, Y; Zhang, J; Hu, Q; Tie, J; Wu, H [Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiotherapy, Peking University Cancer Hospital ' Institute, Beijing (China); Deng, J [Department of Therapeutic Radiology, Yale University, New Haven, CT (United States)

2014-06-01

256

Impact of treatment of ADHD on intimate partner violence (ITAP), a study protocol.  

PubMed

BackgroundAttention-Deficit/Hyperactivity Disorder (ADHD) in adults is one of the predictive and treatable risk factors for delinquency, including intimate partner violence (IPV). Effective treatment of IPV needs to address personal dynamic risk factors, offender typology, and dynamics of the domestic violence. It is unknown whether treatment of ADHD symptoms contributes to a decrease in IPV. The ITAP study aims to investigate the relationship between treatment of ADHD symptoms and IPV in patients in forensic mental health care. Moreover, this study examines the role of comorbid psychopathology, subtype of the offender, and dynamics of the domestic violence.Methods/designThe ITAP study is a longitudinal observational study. Participants are followed one year through various assessments: one before starting treatment (t0), and four during treatment (8, 16, 24 and 52 weeks after start of the treatment). All participants receive treatment for IPV, ADHD, and comorbid psychopathology, if present. The primary outcome measure is the change in severity of IPV; the primary predictive variable is the change in severity of ADHD symptoms. The secondary outcome measure is the observation of the therapist about change in the offender¿s general violent behaviour, within and outside the partner relationship. Data are analysed in a multiple regression model with change in severity of IPV as the dependent variable and change in severity of ADHD symptoms as the primary predictor. Other predictive variables taken into account in the analyses are presence of comorbid psychopathology and personality disorder, subtype of the offender, and dynamics of the domestic violence. In addition, compliance with treatment and content of the treatment are documented.DiscussionResearch on the treatment process of IPV offenders and victims is complicated by many factors. This observational design will not allow inferences about causality but may reveal clinically important factors that contribute to more effective treatment of IPV.Trial registrationThe Netherlands National Trial Register (NTR), trial ID NTR3887. PMID:25428140

Buitelaar, Nannet J L; Posthumus, Jocelyne A; Scholing, Agnes; Buitelaar, Jan K

2014-11-27

257

Outpatient and Inpatient Services Satisfaction in Iranian Military Hospitals  

PubMed Central

Background Many diagnostic and treatment procedures are done in hospitals and clinics. Offering services in these areas have a prominent role in promoting patients’ satisfaction levels and their prospective about health services. Objectives This study is going to assess the satisfaction levels of patients referring to the six military hospital clinics in Iran. Materials and Methods In this cross-sectional study, 330 outpatients and 696 inpatients admitted to the six military hospital clinics in Iran were randomly questionnaires from June to August 2008. Basic socio-demographic data along with a clinic satisfaction level assessment questionnaire were filled for outpatients. A hospital satisfaction level assessment questionnaire also was applied to record inpatients’ data. All collected data were recorded and then analyzed tests X2 and ANOVAs was used and with significantly lower levels of 5% (P < 0.005). Results We found that 96% of the study population was satisfied with clinic services and more than 98% of the respondents were satisfied with inpatient ward services. In clinic services, the satisfaction level in numbering and waiting time, access to the clinic, physical environment, welfare and helping facilities, and personnel and physicians’ behavior were 78.2%, 80.6%, 89.1%, 91.2% and 93.6% respectively (P < 0.001). With regard to inpatient services, the satisfaction level of patients with physician services, nursing routine services, behavior of nurses, nutritional condition, welfare facilities, reception unit services, discharge unit services and accounting unit services were 94.7%, 91.9%, 91.9%, 91.5%, 91.5%, 91.2%, 90.8% and 88.2%, respectively (P = 0.013). Conclusions On the basis of the findings, most respondents reported having a favorable satisfaction with clinic and hospital health services. However, planning to reduce patient’s waiting time in clinics and training physicians to offer more instructions to the patients seems necessary. Since discharge and accounting unit services had the lowest satisfaction levels of inpatients services, responsible managers must have special attention to these official processes. PMID:24616797

Ameryoun, Ahmad; Pourtaghi, Gholamhossein; Yahaghi, Emad; Heidari, Somaie; Bahadori, Mohamadkarim; Ebrahimnia, Mehdi; Tahernezhad, Kayghobad

2013-01-01

258

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. PMID:16457707

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

2006-01-01

259

Transarterial RAdioembolization versus ChemoEmbolization for the treatment of hepatocellular carcinoma (TRACE): study protocol for a randomized controlled trial  

PubMed Central

Background Hepatocellular carcinoma is a primary malignant tumor of the liver that accounts for an important health problem worldwide. Only 10 to 15% of hepatocellular carcinoma patients are suitable candidates for treatment with curative intent, such as hepatic resection and liver transplantation. A majority of patients have locally advanced, liver restricted disease (Barcelona Clinic Liver Cancer (BCLC) staging system intermediate stage). Transarterial loco regional treatment modalities offer palliative treatment options for these patients; transarterial chemoembolization (TACE) is the current standard treatment. During TACE, a catheter is advanced into the branches of the hepatic artery supplying the tumor, and a combination of embolic material and chemotherapeutics is delivered through the catheter directly into the tumor. Yttrium-90 radioembolization (90Y-RE) involves the transarterial administration of minimally embolic microspheres loaded with Yttrium-90, a ?-emitting isotope, delivering selective internal radiation to the tumor. 90Y-RE is increasingly used in clinical practice for treatment of intermediate stage hepatocellular carcinoma, but its efficacy has never been prospectively compared to that of the standard treatment (TACE). In this study, we describe the protocol of a multicenter randomized controlled trial aimed at comparing the effectiveness of TACE and 90Y-RE for treatment of patients with unresectable (BCLC intermediate stage) hepatocellular carcinoma. Methods/design In this pragmatic randomized controlled trial, 140 patients with unresectable (BCLC intermediate stage) hepatocellular carcinoma, with Eastern Cooperative Oncology Group performance status 0 to 1 and Child-Pugh A to B will be randomly assigned to either 90Y-RE or TACE with drug eluting beads. Patients assigned to 90Y-RE will first receive a diagnostic angiography, followed by the actual transarterial treatment, which can be divided into two sessions in case of bilobar disease. Patients assigned to TACE will receive a maximum of three consecutive transarterial treatment sessions. Patients will undergo structural follow-up for a timeframe of two years post treatment. Post procedural magnetic resonance imaging (MRI) will be performed at one and three months post trial entry and at three-monthly intervals thereafter for two years to assess tumor response. Primary outcome will be time to progression. Secondary outcomes will be overall survival, tumor response according to the modified RECIST criteria, toxicities/adverse events, treatment related effect on total liver function, quality of life, treatment-related costs and cost-effectiveness. Trial registration NCT01381211 PMID:22913492

2012-01-01

260

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

261

Treatment of Refractory Status Epilepticus: Literature Review and a Proposed Protocol  

Microsoft Academic Search

Refractory status epilepticus describes continuing sei- zures despite adequate initial pharmacologic treatment. This situation is common in children, but few data are available to guide management. We review the literature related to the pharmacologic treatment and overall man- agement of refractory status epilepticus, including mida- zolam, pentobarbital, phenobarbital, propofol, inhaled anesthetics, ketamine, valproic acid, topiramate, leveti- racetam, pyridoxine, corticosteroids, the

Nicholas S. Abend; Dennis J. Dlugos

262

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

263

Parent-focused treatment for adolescent anorexia nervosa: a study protocol of a randomised controlled trial  

PubMed Central

Background Family-based treatment is an efficacious outpatient intervention for medically stable adolescents with anorexia nervosa. Previous research suggests family-based treatment may be more effective for some families when parents and adolescents attend separate therapy sessions compared to conjoint sessions. Our service developed a novel separated model of family-based treatment, parent-focused treatment, and is undertaking a randomised controlled trial to compare parent-focused treatment to conjoint family-based treatment. Methods/Design This randomised controlled trial will recruit 100 adolescents aged 12–18 years with DSM-IV anorexia nervosa or eating disorder not otherwise specified (anorexia nervosa type). The trial commenced in 2010 and is expected to be completed in 2015. Participants are recruited from the Royal Children’s Hospital Eating Disorders Program, Melbourne, Australia. Following a multidisciplinary intake assessment, eligible families who provide written informed consent are randomly allocated to either parent-focused treatment or conjoint family-based treatment. In parent-focused treatment, the adolescent sees a clinical nurse consultant and the parents see a trained mental health clinician. In conjoint family-based treatment, the whole family attends sessions with the mental health clinician. Both groups receive 18 treatment sessions over 6 months and regular medical monitoring by a paediatrician. The primary outcome is remission at end of treatment and 6 and 12 month follow up, with remission defined as being???95% expected body weight and having an eating disorder symptom score within one standard deviation of community norms. The secondary outcomes include partial remission and changes in eating pathology, depressive symptoms and self-esteem. Moderating and mediating factors will also be explored. Discussion This will be first randomised controlled trial of a parent-focused model of family-based treatment of adolescent anorexia nervosa. If found to be efficacious, parent-focused treatment will offer an alternative approach for clinicians who treat adolescents with anorexia nervosa. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12610000216011. PMID:24712855

2014-01-01

264

The effectiveness of opioid substitution treatments for patients with opioid dependence: a systematic review and multiple treatment comparison protocol  

PubMed Central

Background Opioids are psychoactive analgesic drugs prescribed for pain relief and palliative care. Due to their addictive potential, effort and vigilance in controlling prescriptions is needed to avoid misuse and dependence. Despite the effort, the prevalence of opioid use disorder continues to rise. Opioid substitution therapies are commonly used to treat opioid dependence; however, there is minimal consensus as to which therapy is most effective. Available treatments include methadone, heroin, buprenorphine, as well as naltrexone. This systematic review aims to assess and compare the effect of all available opioid substitution therapies on the treatment of opioid dependence. Methods/Design The authors will search Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. The title, abstract, and full-text screening will be completed in duplicate. When appropriate, multiple treatment comparison Bayesian meta-analytic methods will be performed to deduce summary statistics estimating the effectiveness of all opioid substitution therapies in terms of retention and response to treatment (as measured through continued opioid abuse). Discussion Using evidence gained from this systematic review, we anticipate disseminating an objective review of the current available literature on the effectiveness of all opioid substitution therapies for the treatment of opioid use disorder. The results of this systematic review are imperative to the further enhancement of clinical practice in addiction medicine. Systematic review registration PROSPERO CRD42013006507. PMID:25239213

2014-01-01

265

Effectiveness of cognitive behavioural therapy augmentation in major depression treatment (ECAM study): study protocol for a randomised clinical trial  

PubMed Central

Introduction Major depression is a serious mental disorder that causes substantial distress and impairment in individuals and places an enormous burden on society. Although antidepressant treatment is the most common therapy provided in routine practice, there is little evidence to guide second-line therapy for patients who have failed to respond to antidepressants. The aim of this paper is to describe the study protocol for a randomised controlled trial that measures the clinical effectiveness of cognitive behavioural therapy (CBT) as an augmentation strategy to treat patients with non-psychotic major depression identified as suboptimal responders to usual depression care. Methods and analysis The current study is a 16-week assessor-blinded randomised, parallel-groups superiority trial with 12-month follow-up at an outpatient clinic as part of usual depression care. Patients aged 20–65?years with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Major Depressive Disorder who have experienced at least one failed trial of antidepressants as part of usual depression care, will be randomly assigned to receive CBT plus treatment as usual, or treatment as usual alone. The primary outcome is the change in clinician-rated 17-item GRID-Hamilton Depression Rating Scale (GRID-HAMD) score at 16?weeks, and secondary outcomes include severity and change in scores of subjective depression symptoms, proportion of responders and remitters, safety and quality of life. The primary population will be the intention-to-treat patients. Ethics and dissemination All protocols and the informed consent form comply with the Ethics Guideline for Clinical Research (Japanese Ministry of Health, Labour and Welfare). Ethics review committees at the Keio University School of Medicine and the Sakuragaoka Memorial Hospital approved the study protocol. The results of the study will be disseminated at several research conferences and as published articles in peer-reviewed journals. The study will be implemented and reported in line with the CONSORT statement. Trial registration number UMIN Clinical Trials Registry: UMIN000001218. PMID:25335963

Nakagawa, Atsuo; Sado, Mitsuhiro; Mitsuda, Dai; Fujisawa, Daisuke; Kikuchi, Toshiaki; Abe, Takayuki; Sato, Yuji; Iwashita, Satoru; Mimura, Masaru; Ono, Yutaka

2014-01-01

266

RApid Primary care Initiation of Drug treatment for Transient Ischaemic Attack (RAPID¿TIA): study protocol for a pilot randomised controlled trial  

E-print Network

-30] and statin treatment is recommended for all patients who experience ischaemic stroke/TIA [6]. Approximately 50% of people referred to TIA clinics have not experienced a TIA or minor stroke [31]. Common alter- nate diagnoses include migraine, faints, vertigo... RapidTIA RApid Primary care Initiation of Drug treatment for TIA (RAPID TIA)– a pilot randomised controlled trial RApid Primary care Initiation of Drug treatment for Transient Ischaemic Attack (RAPID?TIA): study protocol for a pilot randomised...

Edwards, Duncan; Fletcher, Kate; Deller, Rachel; McManus, Richard; Lasserson, Daniel; Giles, Matthew; Sims, Don; Norrie, John; McGuire, Graham; Cohn, Simon; Whittle, Fiona; Hobbs, Vikki; Weir, Christopher; Mant, Jonathan

2013-07-02

267

42 CFR 418.108 - Condition of participation: Short-term inpatient care.  

Code of Federal Regulations, 2011 CFR

...inpatient care. Inpatient care must be available for pain control, symptom management, and respite purposes...Standard: Inpatient care for symptom management and pain control. Inpatient care for pain control and symptom management must be...

2011-10-01

268

42 CFR 418.108 - Condition of participation: Short-term inpatient care.  

Code of Federal Regulations, 2010 CFR

...inpatient care. Inpatient care must be available for pain control, symptom management, and respite purposes...Standard: Inpatient care for symptom management and pain control. Inpatient care for pain control and symptom management must be...

2010-10-01

269

42 CFR 412.62 - Federal rates for inpatient operating costs for fiscal year 1984.  

Code of Federal Regulations, 2014 CFR

...inpatient operating costs for fiscal year 1984. 412.62 Section 412.62 Public...inpatient operating costs for fiscal year 1984. (a) General rule. CMS determines...inpatient hospital discharge in fiscal year 1984 involving inpatient hospital...

2014-10-01

270

42 CFR 412.62 - Federal rates for inpatient operating costs for fiscal year 1984.  

Code of Federal Regulations, 2013 CFR

...inpatient operating costs for fiscal year 1984. 412.62 Section 412.62 Public...inpatient operating costs for fiscal year 1984. (a) General rule. CMS determines...inpatient hospital discharge in fiscal year 1984 involving inpatient hospital...

2013-10-01

271

42 CFR 412.62 - Federal rates for inpatient operating costs for fiscal year 1984.  

Code of Federal Regulations, 2011 CFR

...inpatient operating costs for fiscal year 1984. 412.62 Section 412.62 Public...inpatient operating costs for fiscal year 1984. (a) General rule. CMS determines...inpatient hospital discharge in fiscal year 1984 involving inpatient hospital...

2011-10-01

272

42 CFR 412.62 - Federal rates for inpatient operating costs for fiscal year 1984.  

Code of Federal Regulations, 2012 CFR

...inpatient operating costs for fiscal year 1984. 412.62 Section 412.62 Public...inpatient operating costs for fiscal year 1984. (a) General rule. CMS determines...inpatient hospital discharge in fiscal year 1984 involving inpatient hospital...

2012-10-01

273

42 CFR 418.108 - Condition of participation: Short-term inpatient care.  

Code of Federal Regulations, 2013 CFR

...inpatient care. Inpatient care must be available for pain control, symptom management, and respite purposes...Standard: Inpatient care for symptom management and pain control. Inpatient care for pain control and symptom management must be...

2013-10-01

274

42 CFR 418.108 - Condition of participation: Short-term inpatient care.  

Code of Federal Regulations, 2012 CFR

...inpatient care. Inpatient care must be available for pain control, symptom management, and respite purposes...Standard: Inpatient care for symptom management and pain control. Inpatient care for pain control and symptom management must be...

2012-10-01

275

42 CFR 418.108 - Condition of participation: Short-term inpatient care.  

Code of Federal Regulations, 2014 CFR

...inpatient care. Inpatient care must be available for pain control, symptom management, and respite purposes...Standard: Inpatient care for symptom management and pain control. Inpatient care for pain control and symptom management must be...

2014-10-01

276

A protocol for the use of computational fluid dynamics as a supportive tool for wastewater treatment plant modelling.  

PubMed

To date, computational fluid dynamics (CFD) models have been primarily used for evaluation of hydraulic problems at wastewater treatment plants (WWTPs). A potentially more powerful use, however, is to simulate integrated physical, chemical and/or biological processes involved in WWTP unit processes on a spatial scale and to use the gathered knowledge to accelerate improvement in plant models for everyday use, that is, design and optimized operation. Evolving improvements in computer speed and memory and improved software for implementing CFD, as well as for integrated processes, has allowed for broader usage of this tool for understanding, troubleshooting, and optimal design of WWTP unit processes. This paper proposes a protocol for an alternative use of CFD in process modelling, as a way to gain insight into complex systems leading to improved modelling approaches used in combination with the IWA activated sludge models and other kinetic models. PMID:25429444

Laurent, J; Samstag, R W; Ducoste, J M; Griborio, A; Nopens, I; Batstone, D J; Wicks, J D; Saunders, S; Potier, O

2014-01-01

277

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. PMID:21510852

2011-01-01

278

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. PMID:24086802

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

2013-01-01

279

Altrenogest treatment associated with a farrowing induction protocol to avoid early parturition in sows.  

PubMed

This study investigated the effect of altrenogest treatment on the farrowing development of sows, and birth weight (BW) and piglet survival until the third day of life. Three control groups were used: (i) sows that farrowed spontaneously before 114 day of gestation (CONT <114); (ii) sows that spontaneously farrowed at ?114 day of gestation (CONT ?114); (iii) sows that farrowed at ?114 day with cloprostenol treatment (CONTCLOPR). Other sows were treated with altrenogest (Regumate(®) ) for 3 days (days 111, 112 and 113 of gestation): one group gave birth spontaneously (ALT) and the other group received altrenogest until day 113 and cloprostenol on day 114 (ALTCLOPR). There were no differences (p > 0.05) in farrowing duration, BW, coefficient of variation (CV) of BW, stillborn piglets, mummified foetuses, percentage of light piglets and survival until Day 3 between sows with and without cloprostenol treatment, in both control (CONT ?114 vs CONTCLOPR) and altrenogest-treated sows (ALT vs ALTCLOPR). Further comparisons were performed taking into account three groups: sows with early delivery (CONT <114 - farrowing before 114 days of gestation; n = 56), sows with longer gestation (CONT ?114 - with and without cloprostenol treatment sows; n = 103) and ALT sows (with and without cloprostenol treatment; n = 105). Gestation length of CONT ?114 and ALT sows was similar (p > 0.05), but higher than in CONT <114 sows. There were no differences (p > 0.05) between groups in farrowing duration, CV of BW, and percentages of stillborn piglets and mummified foetuses. Sows of CONT <114 group had a larger litter size and a lower BW than sows of the other two groups (p < 0.05). Sows of CONT <114 group had a higher percentage of lighter piglets and a lower piglet survival rate (p < 0.05) than ALT sows. In conclusion, altrenogest treatment proved to be an efficient method to avoid early parturition in 3-5 parity sows resulting in heavier piglets at birth. PMID:22994857

Gaggini, T S; Perin, J; Arend, L S; Bernardi, M L; Wentz, I; Bortolozzo, F P

2013-06-01

280

Falls in the inpatient rehabilitation facility.  

PubMed

Older adults are rehabilitated for a variety of conditions in an inpatient rehabilitation facility (IRF), and they are often at an increased risk for falling during their stay. This article (1) provides an overview of the incidence, prevalence, and impact of falls in facilities that provide inpatient rehabilitation; (2) provides some key factors to be considered in the assessment of the patient admitted to the IRF for risk factors associated with falling; and (3) identifies strategies that can help reduce the risk of falling in patients admitted to an IRF. PMID:22537694

Ross, Marc K; Egan, Ethan; Zaman, Mohammed; Aziz, Besem; Dewald, Tad; Mohammed, Salem

2012-05-01

281

A roadmap to inpatient heart failure management.  

PubMed

Heart failure (HF) accounts for over 1 million primary hospitalizations in the USA each year and carries a tremendous burden on costs and patient outcomes. The clinical syndrome of HF is not a single disease, but represents the complex interplay between various cardiac and non-cardiac processes, each of which need to be individually addressed. This review provides an updated, contemporary roadmap for inpatient worsening chronic HF management with a focus on identifying and addressing initiating mechanisms, amplifying factors, and cardiac structural abnormalities. Inpatient risk stratification should guide patient education, team structuring, disposition, and post-discharge monitoring. PMID:25238886

Vaduganathan, Muthiah; Gheorghiade, Mihai

2015-01-01

282

A new protocol for the treatment of hand deformities in recessive dystrophic epidermolysis bullosa (13 cases).  

PubMed

The recessive form of dystrophic epidermolysis bullosa creates severe hand deformities with disabling functional limitations in the main daily activities. Typically, the thumb is contracted in adduction, the first web space is obliterated, the palm and digits are contracted in flexion and interdigital spaces are lost (pseudo-syndactyly). In this paper, we present our experience with a protocol based on the association of various internationally developed techniques: brachial plexus anesthesia with ketamine sedation, dynamic splinting and coverage of the wounds with allogenic keratinocytes sheets. The overall results obtained in the first 13 patients showed a good tolerance of the procedure, no anesthesiologic complication and marked improvement of the hand deformities. The long-term follow-up revealed a recurrence before 2 years in 2 hands, between 2 and 4 years in 7 hands and after 4 years in 6 hands. The conclusion is that an aggressive surgical attitude, along with an adequate intra and post-operative rehabilitation, ensures a good restoration of hand function and a satisfying delay of inevitable recurrence. PMID:9259950

Campiglio, G L; Pajardi, G; Rafanelli, G

1997-01-01

283

Hospital Costs and Inpatient Mortality among Children Undergoing Surgery for Congenital Heart Disease  

PubMed Central

Objective To determine the association between hospital costs and risk-adjusted inpatient mortality among children undergoing surgery for congenital heart disease (CHD) in U.S. acute-care hospitals. Data Sources/Study Settings Retrospective cohort study of 35,446 children in 2003, 2006, and 2009 Kids' Inpatient Database (KID). Study Design Cross-sectional logistic regression of risk-adjusted inpatient mortality and hospital costs, adjusting for a variety of patient-, hospital-, and community-level confounders. Data Collection/Extraction Methods We identified relevant discharges in the KID using the AHRQ Pediatric Quality Indicator for pediatric heart surgery mortality, and linked these records to hospital characteristics from American Hospital Association Surveys and community characteristics from the Census. Principal Findings Children undergoing CHD surgery in higher cost hospitals had lower risk-adjusted inpatient mortality (p = .002). An increase from the 25th percentile of treatment costs to the 75th percentile was associated with a 13.6 percent reduction in risk-adjusted mortality. Conclusions Greater hospital costs are associated with lower risk-adjusted inpatient mortality for children undergoing CHD surgery. The specific mechanisms by which greater costs improve mortality merit further exploration. PMID:24138064

Romley, John A; Chen, Alex Y; Goldman, Dana P; Williams, Roberta

2014-01-01

284

[The hospital and semi-inpatient clinic in the structure of psychiatric care for adolescents].  

PubMed

Comparative investigation of hospitalized mentally ill adolescents in two cities and an adolescent cohort under treatment in a newly created semi-inpatient unit and a dispensary resulted in a conclusion that assistance provided by hospital, semi-inpatient and dispensary units does not fully embrace the adolescents in whom borderline disorders are detected. New institutional forms are necessary to introduce in order to improve the medical aid to these patients (sanatoria, health camps, boarding schools for patients with pathologic deviations of behavior). PMID:3195272

Gurovich, I Ia; Visnevskaia, L Ia; Pre?s, V B; Nemirovski?, G M; Bole?ko, I G

1988-01-01

285

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.

286

Social Climate within Secure Inpatient Services for People with Intellectual Disabilities  

ERIC Educational Resources Information Center

Background: The social climate of inpatient facilities is thought to be an important contributor to treatment outcome. However, little research has focused on this construct within secure forensic services for people with intellectual disabilities (ID). Therefore, the objective of this study was to investigate the social climate of two different…

Langdon, P. E.; Swift, A.; Budd, R.

2006-01-01

287

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

288

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...

289

Effects of Different Infrared Beak Treatment Protocols on Chicken Welfare and Physiology  

Technology Transfer Automated Retrieval System (TEKTRAN)

Infrared beak treatment (IR) provides an alternative to the conventional hot blade beak trimming (HB), which purports to be more welfare friendly. To improve the efficiency of the IR system, different interface plates (25/23C and 27/23C) and lamp power settings (44, 48 and 52) were tested in this st...

290

MODEL PROTOCOL FOR THE COMPREHENSIVE EVALUATION OF PUBLICLY OWNED TREATMENT WORKS PERFORMANCE AND OPERATION  

EPA Science Inventory

This manual presents a systematic approach to conducting a comprehensive performance evaluation of municipal wastewater treatment plants. The objective of the evaluation is to identify and rank the causes of poor plant performance. Five major problem areas are addressed. They are...

291

Assertive Community Treatment for alcohol dependence (ACTAD): study protocol for a randomised controlled trial  

PubMed Central

Background Alcohol dependence is a significant and costly problem in the UK yet only 6% of people a year receive treatment. Current service provision based on the treatment of acute episodes of illness and emphasising personal choice and motivation results in a small proportion of these patients engaging with alcohol treatment. There is a need for interventions targeted at the population of alcohol dependent patients who are hard to engage in conventional treatment. Assertive Community Treatment (ACT), a model of care based on assertive outreach, has been used for treating patients with severe mental illnesses and presents a promising avenue for engaging patients with primary alcohol dependence. So far there has been little research on this. Methods/Design In this single blind exploratory randomised controlled trial, a total of 90 alcohol dependent participants will be recruited from community addiction services. After completing a baseline assessment, they will be assigned to one of two conditions: (1) ACT plus care as usual, or (2) care as usual. Those allocated to the ACT plus care as usual will receive the same treatment that is routinely provided by services, plus a trained key worker who will provide ACT. ACT comprises intensive and assertive contact at least once a week, over 50% of contacts in the participant's home or local community, and comprehensive case management across social and health care, for a period of one year. All participants will be followed up at 6 months and 12 months to assess outcome post randomisation. The primary outcome measures will be alcohol consumption: mean drinks per drinking day and percentage of days abstinent measured by the Time Line Follow Back interview. Secondary outcome measures will include severity of alcohol dependence, alcohol related problems, motivation to change, social network involvement, quality of life, therapeutic relationship and service use. Other outcome variables are treatment engagement including completion of assessment, detoxification and aftercare. Discussion Results of this trial will help clarify the potential beneficial effects of ACT for people with alcohol dependence and provide information to design a definitive trial. Trial registration number ISRCTN: ISRCTN22775534 PMID:22348423

2012-01-01

292

Moxibustion for the treatment of pressure ulcers: study protocol for a pilot, multicentre, randomised controlled trial  

PubMed Central

Introduction Pressure ulcers are common in the elderly and immobile. Currently, there are few proven effective treatments for pressure ulcers. This trial aims to evaluate the feasibility, efficacy and safety of moxibustion for pressure ulcers. Methods/analysis This is a multicentre, two-armed, parallel-design randomised controlled trial (RCT). 30 eligible patients with pressure ulcers will be randomised in a ratio of 1:1 to the treatment group and control group. The participants in the treatment group will undergo indirect moxibustion for 30?min before application of a dressing, one session daily, five sessions weekly for 4?weeks. The patients in the control group will only receive a dressing, applied in the same way as in the treatment group. Both groups will be followed up for 3?months. The primary outcome measures will be wound surface area (WSA) and proportion of ulcers healed within trial period (PUHTP). The secondary outcomes will be the Pressure Ulcer Scale for Healing (PUSH Tool), visual analogue scale (VAS) and adverse events. All outcomes will be evaluated at the beginning of the study, at the end of the second week, at 4?weeks after randomisation and at 1 and 3?months after treatment cessation. Ethics/dissemination This trial has undergone ethical scrutiny and been approved by the ethics review boards of First Affiliated Hospital of Heilongjiang University of Chinese Medicine and Second Affiliated Hospital of Heilongjiang University of Chinese Medicine (Permission number: HZYEYLP2014). The results of this study will provide clinical evidence for the feasibility, efficacy and safety of moxibustion for pressure ulcers. Trial registration number ChiCTR-TRC-13003959. PMID:25550296

Zhang, Qin-hong; Yue, Jin-huan; Li, Chao-ran; Sun, Zhong-ren

2014-01-01

293

Efficacy of milnacipran on poststroke depression on inpatient rehabilitation.  

PubMed

Post-stroke depression (PSD) has a negative impact on rehabilitation following stroke. No satisfactory antidepressant treatment for PSD has yet been developed. The present study examined the effect of milnacipran, a serotonin and norepinephrine reuptake inhibitor, on PSD patients. Eleven PSD patients taking milnacipran in a rehabilitation hospital were compared to age-matched, sex-matched, and severity of depression at admission-matched PSD patients hospitalized during 2001 who did not take any antidepressant as historical control. Severity of depression was measured using self-rating depression scale for depression (SDS) assessed at admission and discharge after 3 months inpatient rehabilitation. Activities of daily living (ADL) and quality of life (QOL) were measured, respectively, by the functional independence measure (FIM) and a self-completed questionnaire for QOL (QUIK) as outcomes of rehabilitation. For the SDS score, the group taking milnacipran showed significant improvement compared to the control group in our study. FIM was improved in both groups. In the end QUIK did not change significantly in either group. We found no major side-effects of milnacipran among the patients. These results suggest that milnacipran is a safe and effective treatment for PSD for inpatients undergoing rehabilitation. PMID:16401247

Yamakawa, Yuriko; Satoh, Shinji; Sawa, Shunji; Ohta, Hitoshi; Asada, Takashi

2005-12-01

294

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

295

42 CFR 409.68 - Guarantee of payment for inpatient hospital or inpatient CAH services furnished before...  

Code of Federal Regulations, 2010 CFR

... false Guarantee of payment for inpatient hospital or inpatient CAH services furnished before...HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Scope of Hospital Insurance Benefits § 409.68...

2010-10-01

296

The Conceptual Domain of Service Quality for Inpatient Nursing Services  

Microsoft Academic Search

This exploratory study examines the conceptual domain of service quality for inpatient nursing services. The findings suggest that the prevailing conceptual definition of service quality, as articulated by Parasuraman, Zeithaml, and Berry (1985, 1988), does not accurately describe service quality for the customers of inpatient nursing services. A definition of inpatient nursing service quality is provided, and an instrument based

Melissa M. Koerner

2000-01-01

297

High recovery of cell-free methylated DNA based on a rapid bisulfite-treatment protocol  

PubMed Central

Background Detection of cell-free methylated DNA in plasma is a promising tool for tumour diagnosis and monitoring. Due to the very low amounts of cell-free DNA in plasma, analytical sensitivity is of utmost importance. The vast majority of currently available methods for analysing DNA methylation are based on bisulfite-mediated deamination of cytosine. Cytosine is rapidly converted to uracil during bisulfite treatment, whereas 5-methylcytosine is only slowly converted. Hence, bisulfite treatment converts an epigenetic modification into a difference in sequence, amenable to analysis either by sequencing or PCR based methods. However, the recovery of bisulfite-converted DNA is very poor. Results Here we introduce an alternative method for the crucial steps of bisulfite treatment with high recovery. The method is based on an accelerated deamination step and alkaline desulfonation in combination with magnetic silica purification of DNA, allowing preparation of deaminated DNA from patient samples in less than 2 hours. Conclusions The method presented here allows low levels of DNA to be easily and reliably analysed, a prerequisite for the clinical usefulness of cell-free methylated DNA detection in plasma. PMID:22448717

2012-01-01

298

[An evaluation of the implementation of the national treatment protocol for uncomplicated malaria in rural areas of Burkina Faso].  

PubMed

The purpose of this study was to evaluate the implementation of a treatment protocol based on artemisinin-based combination therapy for the treatment of uncomplicated malaria in rural areas. Population and methods. A descriptive and comparative study was conducted in the rural health district of Houndé (Burkina Faso). The study involved health care providers, managers of essential drug depots and health centers, and patients receiving a prescription for an antimalarial drug. The data were entered and analyzed using the Epi Info 3.3.1 software package. The Chi-square test was used to compare proportions at the 0.05 level. A total of 130 prescribers and 30 managers of essential drug depots were interviewed in 28 health centers. In addition, 165 prescriptions including an antimalarial drug were collected. Of the 130 prescribers surveyed, 84.6% knew about the new treatment guidelines for uncomplicated malaria. The study found that 64.8% of the prescriptions were for ACTs, while quinine accounted for 35.2% of the prescriptions. Artesunate-amodiaquine combination therapy accounted for 98.1% of the prescriptions for antimalarial drug combination therapy. 82.4% of the prescriptions were adequate, with significantly more adequate prescriptions in clinics than in maternity hospitals (p = 0.009). Children under 5 years of age were treated better than other age groups (p < 0.001). In 89.7% of drug depots, there was evidence of a shortage of artemisinin-based combination drugs at least once in the two months before the study, most notably in the case of artesunate-amodiaquine therapy. The results highlight the importance of continuing training for treatment providers and of strict procedures for managing stocks of artemisinin-based combination drugs. PMID:23043741

Ouédraogo, Laurent Tinoaga; Drabo, Koiné Maxime; Zongo, Pinguédewendé Sylvie

2012-01-01

299

Efficacy and safety of pharmacological treatments for neuroborreliosis—protocol for a systematic review  

PubMed Central

Background Neuroborreliosis is a tick-borne infectious disease of the nervous system caused by Borrelia burgdorferi. Common clinical manifestations of neuroborreliosis are cranial nerve dysfunctions, polyradiculoneuritis, and meningitis. Diagnosis is usually based on clinical presentation, serologic testing, and analysis of cerebrospinal fluid. Many aspects of pharmacological treatment, such as choice of drug, dosage, and duration are subject of intense debate, leading to uncertainties in patients and healthcare providers alike. To approach the questions regarding pharmacological treatment of neuroborreliosis, we will perform a systematic review. Methods We will perform a comprehensive systematic literature search for potentially eligible studies that report outcomes after pharmacological interventions. To adequately consider the wealth of research that has been conducted so far, this review will evaluate randomized controlled trials (RCTs) and non-randomized studies on treatment of neuroborreliosis. We will assess potential risk of bias for each RCT meeting our selection criteria using the Cochrane risk of bias tool for RCTs. For non-randomized studies, we will use the Newcastle-Ottawa Scale and the recently piloted Cochrane risk of bias tool for non-randomized studies. Our primary outcome of interest will be neurological symptoms and the secondary outcomes will be disability, patient-reported outcomes (quality of life, and, if reported separately from other neurological symptoms, pain, fatigue, depression, cognition, and sleep), adverse events, and cerebrospinal fluid pleocytosis. Pooling of data and meta-analysis will only be deemed justified between studies with similar design (e.g., RCTs are only combined with other RCTs), characteristics (e.g., similar populations), and of acceptable heterogeneity (I2?treatment, and different doses of doxycycline. We will assess the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Discussion This systematic review will summarize the available evidence from RCTs and non-randomized studies regarding pharmacological treatment of neuroborreliosis. The available evidence will be summarized and discussed to provide a basis for decision-making for patients and healthcare professionals. Systematic review registration PROSPERO registration number: CRD42014008839 PMID:25336085

2014-01-01

300

Psychiatric Comorbidity Among Inpatient Substance Abusing Adolescents  

ERIC Educational Resources Information Center

We studied the association between type, severity and sequencing of psychopathology and these same dimensions of substance involvement among inpatient substance-abusing adolescents with comorbid psychiatric disorders. Adolescents (N = 140, 54% female; 15.9 years) meeting DSM-III-R criteria for a substance use disorder and at least one other Axis I…

Abrantes, Ana M.; Brown, Sandra A.; Tomlinson, Kristin L.

2004-01-01

301

Detecting Depression in Elderly Medical Inpatients.  

ERIC Educational Resources Information Center

Used Research Diagnostic Criteria to assess base rate of detection of depression in 150 elderly medical inpatients by nonpsychiatric physicians, and evaluated psychometric properties of screening instruments to assess depression. Found detection of depression by house staff extremely low (8.7 percent). Beck Depression Inventory (BDI), BDI…

Rapp, Stephen R.; And Others

1988-01-01

302

linical study on intrathecal baclofen for the treatment of severe spasticity: Developed protocol and obtained grant funding for the initial research project; confirmed efficacy and  

E-print Network

protocol and obtained grant funding for the initial research project; confirmed efficacy and showed cost effectiveness (with P. Nance). ew research technology: the first implementation in Canada of the isolated rat spinal cord preparation, allowing preclinical trials for the development of new drug treatments for use

Manitoba, University of

303

Study Protocol: Screening and Treatment of Alcohol-Related Trauma (START) – a randomised controlled trial  

PubMed Central

Background The incidence of mandibular fractures in the Northern Territory of Australia is very high, especially among Indigenous people. Alcohol intoxication is implicated in the majority of facial injuries, and substance use is therefore an important target for secondary prevention. The current study tests the efficacy of a brief therapy, Motivational Care Planning, in improving wellbeing and substance misuse in youth and adults hospitalised with alcohol-related facial trauma. Methods and design The study is a randomised controlled trial with 6 months of follow-up, to examine the effectiveness of a brief and culturally adapted intervention in improving outcomes for trauma patients with at-risk drinking admitted to the Royal Darwin Hospital maxillofacial surgery unit. Potential participants are identified using AUDIT-C questionnaire. Eligible participants are randomised to either Motivational Care Planning (MCP) or Treatment as Usual (TAU). The outcome measures will include quantity and frequency of alcohol and other substance use by Timeline Followback. The recruitment target is 154 participants, which with 20% dropout, is hoped to provide 124 people receiving treatment and follow-up. Discussion This project introduces screening and brief interventions for high-risk drinkers admitted to the hospital with facial trauma. It introduces a practical approach to integrating brief interventions in the hospital setting, and has potential to demonstrate significant benefits for at-risk drinkers with facial trauma. Trial Registration The trial has been registered in Australian New Zealand Clinical Trials Registry (ANZCTR) and Trial Registration: ACTRN12611000135910. PMID:23106916

2012-01-01

304

Predictors of Readmission after Inpatient Plastic Surgery  

PubMed Central

Background Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery. Methods The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission. Results A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD) (odds ratio [OR], 2.01; confidence interval [CI], 1.12-3.60; P=0.020), previous percutaneous coronary intervention (PCI) (OR, 2.69; CI, 1.21-5.97; P=0.015), hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; P<0.001), bleeding disorders (OR, 1.70; CI, 1.01-2.87; P=0.046), American Society of Anesthesiologists (ASA) class 3 or 4 (OR, 1.57; CI, 1.15-2.15; P=0.004), and obesity (body mass index ?30) (OR, 1.43; CI, 1.09-1.88, P=0.011) to be significant predictors of readmission. Conclusions Inpatient plastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations. PMID:24665418

Jain, Umang; Salgado, Christopher; Mioton, Lauren; Rambachan, Aksharananda

2014-01-01

305

Does cognitive behavior therapy alter emotion regulation in inpatients with a depressive disorder?  

PubMed Central

Introduction Emotion regulation plays an important role in the development and treatment of depression. The present study investigated whether the emotion regulation strategies, expressive suppression (ES) and cognitive reappraisal (CR) change in the course of cognitive behavior therapy (CBT) of depressive inpatients. Furthermore, it also examined whether changes in CR and ES correlated with positive treatment outcomes. Methods Forty-four inpatients from a psychotherapeutic hospital who suffered from a depressive disorder (mean age =36.4 years, standard deviation =13.4 years; 63.6% female) filled in the Emotion Regulation Questionnaire and the Beck Depression Inventory at admission and discharge. To detect changes in emotion regulation, and depression across treatment, data were analyzed using multivariate analyses of variance (MANOVA) for repeated measures, effect sizes, and Spearman correlations. A P-value of ?0.05 was considered statistically significant. Results Depression severity (F[1]=10.42, P=0.003; ?2=0.22) and CR (F[1]=4.71, P=0.04; ?2=0.11) changed significantly across CBT treatment. ES remained virtually stable. Post-treatment scores of CR were also positively correlated with reduction in depressive symptoms across treatment (?=0.30, P=0.05). Conclusion The results suggest that CBT affects emotion regulation in depressive inpatients only for CR and that higher post-treatment scores in CR were related to greater reduction in depressive symptoms across treatment. PMID:24872725

Forkmann, Thomas; Scherer, Anne; Pawelzik, Markus; Mainz, Verena; Drueke, Barbara; Boecker, Maren; Gauggel, Siegfried

2014-01-01

306

Protocols cure diseases, not patients: flaccid paresis in post-NSTEMI statin treatment.  

PubMed

An 82-year-old white woman presented at our Internal Medicine ward with flaccid tetraparesis. Two months earlier, she had suffered a non-ST elevation myocardial infarction treated with percutaneous coronary intervention (PCI) and stenting, and she had been prescribed the classical post-PCI therapy (?-blockers, statins and antiplatelet agents). At admission, she was haemodynamically stable and the physical examination revealed reduced reflexes in the four limbs. Urgent laboratory findings revealed mild hypokalaemia. Considering the high statin doses she was taking, we also performed an urgent creatine phosphokinase test, which indicated rhabdomyolysis. Statin therapy was immediately stopped and aggressive fluid treatment begun, supplemented with potassium for increased urinary potassium losses. The patient progressively regained muscle strength. PMID:25903205

Rosada, Javier; Rebelos, Eleni; Petruccelli, Stefania; Taddei, Marco

2015-01-01

307

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

308

Effects of lifestyle modification after breast cancer treatment: a systematic review protocol  

PubMed Central

Background There is no consensus in the literature regarding the effectiveness of lifestyle modification interventions, including recommendations about specific diet or exercise program for patients with breast cancer. Diet interventions and regular physical activity may reduce the risk of breast cancer and its recurrence. The primary aim of our study is to evaluate the effects of different lifestyle modification interventions (diet and physical activity) in the survival of patients with stages I to III breast cancer after treatment. Methods/design This review will be conducted according to the Cochrane Handbook for Systematic Reviews of Intervention and will be reported following the PRISMA statement recommendations. CENTRAL, MEDLINE and EMBASE databases will be searched for peer-reviewed literature. Randomized controlled trials of diet, exercise, or both, compared with usual care, after treatment of breast cancer stage I to III will be included in the systematic review. Two authors will independently screen titles and abstracts of studies for potential eligibility. Data will be combined using random-effect meta-analysis models with restricted maximum-likelihood as variance estimator, and will be presented as relative risk or standardized mean difference with 95% CI. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and summary of findings tables will be presented for patient important outcomes. Discussion Our study may improve the current understanding of the role that lifestyle-modifiable factors can play in saving or prolonging the lives of women who have been treated for breast cancer, and also on modifying their quality of life. Systematic review registration The review has been registered with PROSPERO (registration number CRD42014008743). PMID:24997590

2014-01-01

309

Treatment of bipolar disorder in the Netherlands and concordance with treatment guidelines: study protocol of an observational, longitudinal study on naturalistic treatment of bipolar disorder in everyday clinical practice  

PubMed Central

Background While various guidelines on the treatment of bipolar disorder have been published over the last decades, adherence to guidelines has been reported to be low. In this article we describe the protocol of a nationwide, multicenter, longitudinal, non-intervention study on the treatment of bipolar disorder in the Netherlands. Study aims are to provide information on the nature and content of outpatient treatment of bipolar disorder, to determine to what extent treatment is in concordance with the Dutch guideline for the treatment of bipolar disorder (2008), and to investigate the relationship of guideline concordance with symptomatic and functional outcome. Methods/Design Between December 2009 and February 2010, all psychiatrists registered as member of the Dutch Psychiatric Association received a questionnaire with questions about their treatment setting, and whether they would be willing to participate in further research. Psychiatrists treating adult outpatients with bipolar disorder were invited to participate. Consenting psychiatrist subsequently approached all their patients with bipolar disorder. The study is performed with written patient and caregiver surveys at baseline and after 12 months, including data on demographics, illness characteristics, organization of care, treatments received, symptomatic and functional outcome, quality of life, and burden of care for informal caregivers. Discussion This study will provide information on the naturalistic treatment of bipolar disorder in the Netherlands, as well as degree of concordance of this treatment with the Dutch guideline, and its relationship with symptomatic and functional outcome. Limitations of a survey-based study are discussed. PMID:24576061

2014-01-01

310

Cohort protocol paper: The Pain and Opioids In Treatment (POINT) study  

PubMed Central

Background Internationally, there is concern about the increased prescribing of pharmaceutical opioids for chronic non-cancer pain (CNCP). In part, this is related to limited knowledge about the long-term benefits and outcomes of opioid use for CNCP. There has also been increased injection of some pharmaceutical opioids by people who inject drugs, and for some patients, the development of problematic and/or dependent use. To date, much of the research on the use of pharmaceutical opioids among people with CNCP, have been clinical trials that have excluded patients with complex needs, and have been of limited duration (i.e. fewer than 12 weeks). The Pain and Opioids In Treatment (POINT) study is unique study that aims to: 1) examine patterns of opioid use in a cohort of patients prescribed opioids for CNCP; 2) examine demographic and clinical predictors of adverse events, including opioid abuse or dependence, medication diversion, other drug use, and overdose; and 3) identify factors predicting poor pain relief and other outcomes. Methods/Design The POINT cohort comprises around 1,500 people across Australia prescribed pharmaceutical opioids for CNCP. Participants will be followed-up at four time points over a two year period. POINT will collect information on demographics, physical and medication use history, pain, mental health, drug and alcohol use, non-adherence, medication diversion, sleep, and quality of life. Data linkage will provide information on medications and services from Medicare (Australia’s national health care scheme). Data on those who receive opioid substitution therapy, and on mortality, will be linked. Discussion This study will rigorously examine prescription opioid use among CNCP patients, and examine its relationship to important health outcomes. The extent to which opioids for chronic pain is associated with pain reduction, quality of life, mental and physical health, aberrant medication behavior and substance use disorders will be extensively examined. Improved understanding of the longer-term outcomes of chronic opioid therapy will direct community-based interventions and health policy in Australia and internationally. The results of this study will assist clinicians to better identify those patients who are at risk of adverse outcomes and who therefore require alternative treatment strategies. PMID:24646721

2014-01-01

311

Biofeedback for treatment of awake and sleep bruxism in adults: systematic review protocol  

PubMed Central

Background Bruxism is a disorder of jaw-muscle activity characterised by repetitive clenching or grinding of the teeth which results in discomfort and damage to dentition. The two clinical manifestations of the condition (sleep and awake bruxism) are thought to have unrelated aetiologies but are palliated using similar techniques. The lack of a definitive treatment has prompted renewed interest in biofeedback, a behaviour change method that uses electronic detection to provide a stimulus whenever bruxism occurs. This systematic review aims to provide a comprehensive overview of the state of research into biofeedback for bruxism; to assess the efficacy and acceptability of biofeedback therapy in management of awake bruxism and, separately, sleep bruxism in adults; and to compare findings between the two variants. Methods A systematic review of published literature examining biofeedback as an intervention directed at controlling primary bruxism in adults. We will search electronic databases and the grey literature using a predefined search strategy to identify randomised and non-randomised studies, technical reports and patents. Searches will not be restricted by language or date and will be expanded through contact with authors and experts, and by following up reference lists and citations. Two authors, working independently, will conduct screening of search results, study selection, data extraction and quality assessment and a third will resolve any disagreements. The primary outcomes of acceptability and effectiveness will be assessed using only randomised studies, segregated by bruxism subtype. A meta-analysis of these data will be conducted only if pre-defined conditions for quality and heterogeneity are met, otherwise the data will be summarized in narrative form. Data from non-randomised studies will be used to augment a narrative synthesis of the state of technical developments and any safety-related issues. PROSPERO registration number: CRD42013006880. Discussion Biofeedback is not new, but its place in the clinical management of bruxism remains unclear. New research, and the availability of miniaturized consumer-grade devices, makes a systematic review timely to guide treatment decisions and inform future research. PMID:24886985

2014-01-01

312

Physical therapy treatment in patients suffering from cervicogenic somatic tinnitus: study protocol for a randomized controlled trial  

PubMed Central

Background Tinnitus occurs in a large part of the general population with prevalences ranging from 10% to 15% in an adult population. One subtype is cervicogenic somatic tinnitus, arising from cervical spine dysfunctions, justifying cervical spine assessment and treatment. This study aims to investigate the effect of a standardized physical therapy treatment, directed to the cervical spine, on tinnitus. Additionally, a second aim is to identify a subgroup within the tinnitus population that benefits from physical therapy treatment. Methods and design This study is designed as a randomized controlled trial with delayed treatment design. Patients with severe subjective tinnitus (Tinnitus Functional Index (TFI) between 25 and 90 points), in combination with neck complaints (Neck Bournemouth Questionnaire (NBQ) >14 points) will be recruited from the University Hospital of Antwerp. Patients suffering from tinnitus with clear otological etiologies, severe depression, traumatic cervical spine injury, tumors, cervical spine surgery, or conditions in which physical therapy is contra-indicated, will be excluded. After screening for eligibility, baseline data such as TFI, NBQ, and a set of cervical biomechanical and sensorimotor tests will be collected. Patients are randomized in an immediate therapy group and in a group with a delayed start of therapy by 6 weeks. Patients will receive physical therapy with a maximum of 12 sessions of 30 min for a 6-week program. Data from the TFI and NBQ will be collected at baseline (week 0), at the start of therapy (weeks 0 or 6), at the end of therapy (weeks 6 or 12), 6 weeks after therapy (weeks 12 or 18), and 3 months after therapy (weeks 18 or 24). Secondary outcome measures will be collected at baseline and 6 weeks after the therapy (weeks 12 or 18), as the maximal therapy effect on the cervical spine dysfunctions is expected at that moment. Discussion This study is the first to investigate the effect of a standardized physical therapy treatment protocol on somatic tinnitus with a prospective comparative delayed design and with blinded evaluator for baseline, end of therapy, and 6 and 12 weeks after therapy. Trial registration 12 September 2013, ClinicalTrials.gov: NCT02016313 PMID:25056151

2014-01-01

313

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 PMID:23158080

2012-01-01

314

Change in Inpatient Rehabilitation Admissions for Individuals With Traumatic Brain Injury After Implementation of the Medicare Inpatient Rehabilitation Facility Prospective Payment System  

PubMed Central

Objective To evaluate the impact of Medicare’s inpatient rehabilitation facility (IRF) prospective payment system (PPS) on use of inpatient rehabilitation for individuals with traumatic brain injury (TBI). Design Retrospective cohort study of patients with TBI. Setting One hundred twenty-three level I and II trauma centers across the U.S. who contributed data to the National Trauma Data Bank. Participants Patients (N = 135,842) with TBI and an Abbreviated Injury Score of the head of 2 or greater admitted to trauma centers between 1995 and 2004. Interventions None. Main Outcome Measure Discharge location: IRF, skilled nursing facility, home, and other hospitals. Results Compared with inpatient rehabilitation admissions before IRF PPS came into effect, demographic characteristics of admitted patients changed. Those admitted to acute care trauma centers after PPS was enacted (January 2002) were older and nonwhite. No differences were found in rates of injury between men and women. Over time, there was a significant drop in the percent of patients being discharged to inpatient rehabilitation, which varied by region, but was found across all insurance types. In a logistic regression, after controlling for patient characteristics (age, sex, race), injury characteristics (cause, severity), insurance type, and facility, the odds of being discharged to an IRF after a TBI decreased 16% after Medicare’s IRF PPS system was enacted. Conclusions The enactment of the Medicare PPS appears to be associated with a reduction in the chance that patients receive inpatient rehabilitation treatment after a TBI. The impact of these changes on the cost, quality of care, and patient outcome is unknown and should be addressed in future studies. PMID:22840827

Hoffman, Jeanne M.; Brown, Elena Donoso; Chan, Leighton; Dikmen, Sureyya; Temkin, Nancy; Bell, Kathleen R.

2014-01-01

315

Variation in Inpatient Rehabilitation Utilization After Hospitalization for Burn Injury in the United States.  

PubMed

Approximately 45,000 individuals are hospitalized annually for burn treatment. Rehabilitation after hospitalization can offer a significant improvement in functional outcomes. Very little is known nationally about rehabilitation for burns, and practices may vary substantially depending on the region based on observed Medicare post-hospitalization spending amounts. This study was designed to measure variation in rehabilitation utilization by state of hospitalization for patients hospitalized with burn injury. This retrospective cohort study used nationally collected data over a 10-year period (2001 to 2010), from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SIDs). Patients hospitalized for burn injury (n = 57,968) were identified by ICD-9-CM codes and were examined to see specifically if they were discharged immediately after hospitalization (primary endpoint). Both unadjusted and adjusted likelihoods were calculated for each state taking into account the effects of age, insurance status, hospitalization at a burn center, and extent of burn injury by TBSA. The relative risk of discharge to inpatient rehabilitation varied by as much as 6-fold among different states. Higher TBSA, having health insurance, higher age, and burn center hospitalization all increased the likelihood of discharge to inpatient rehabilitation following acute care hospitalization. There was significant variation between states in inpatient rehabilitation utilization after adjusting for variables known to affect each outcome. Future efforts should be focused on identifying the cause of this state-to-state variation, its relationship to patient outcome, and standardizing treatment across the United States. PMID:25423440

Greene, Nathaniel H; Pham, Tam N; Esselman, Peter C; Rivara, Frederick P

2014-11-24

316

Comorbidity profiles and inpatient outcomes during hospitalization for heart failure: an analysis of the U.S. Nationwide inpatient sample  

PubMed Central

Background Treatment of heart failure (HF) is particularly complex in the presence of comorbidities. We sought to identify and associate comorbidity profiles with inpatient outcomes during HF hospitalizations. Methods Latent mixture modeling was used to identify common profiles of comorbidities during adult hospitalizations for HF from the 2009 Nationwide Inpatient Sample (n?=?192,327). Results Most discharges were characterized by "common" comorbidities. A "lifestyle" profile was characterized by a high prevalence of uncomplicated diabetes, hypertension, chronic pulmonary disorders and obesity. A "renal" profile had the highest prevalence of renal disease, complicated diabetes, and fluid and electrolyte imbalances. A "neurovascular" profile represented the highest prevalence of cerebrovascular disease, paralysis, myocardial infarction and peripheral vascular disease. Relative to the common profile, the lifestyle profile was associated with a 15% longer length of stay (LOS) and 12% greater cost, the renal profile was associated with a 30% higher risk of death, 27% longer LOS and 24% greater cost, and the neurovascular profile was associated with a 45% higher risk of death, 34% longer LOS and 37% greater cost (all p?

2014-01-01

317

Scaled-Up Mobile Phone Intervention for HIV Care and Treatment: Protocol for a Facility Randomized Controlled Trial  

PubMed Central

Background Adherence to prevention, care, and treatment recommendations among people living with HIV (PLHIV) is a critical challenge. Yet good clinical outcomes depend on consistent, high adherence to antiretroviral therapy (ART) regimens. Mobile phones offer a promising means to improve patient adherence and health outcomes. However, limited information exists on the impact that mobile phones for health (mHealth) programs have on ART adherence or the behavior change processes through which such interventions may improve patient health, particularly among ongoing clients enrolled in large public sector HIV service delivery programs and key populations such as men who have sex with men (MSM) and female sex workers (FSW). Objective Our aim is to evaluate an mHealth intervention where text message reminders are used as supportive tools for health providers and as motivators and reminders for ART clients to adhere to treatment and remain linked to care in Ghana. Using an implementation science framework, we seek to: (1) evaluate mHealth intervention effects on patient adherence and health outcomes, (2) examine the delivery of the mHealth intervention for improving HIV care and treatment, and (3) assess the cost-effectiveness of the mHealth intervention. Methods The 36-month study will use a facility cluster randomized controlled design (intervention vs standard of care) for evaluating the impact of mHealth on HIV care and treatment. Specifically, we will look at ART adherence, HIV viral load, retention in care, and condom use at 6 and 12-month follow-up. In addition, participant adoption and satisfaction with the program will be measured. This robust methodology will be complemented by qualitative interviews to obtain feedback on the motivational qualities of the program and benefits and challenges of delivery, especially for key populations. Cost-effectiveness will be assessed using incremental cost-effectiveness ratios, with health effects expressed in terms of viral load suppression and costs of resources used for the intervention. Results This study and protocol was fully funded, but it was terminated prior to review from ethics boards and study implementation. Conclusions This cluster-RCT would have provided insights into the health effects, motivational qualities, and cost-effectiveness of mHealth interventions for PLHIV in public sector settings. We are seeking funding from alternate sources to implement the trial. PMID:25650838

Green, Kimberly; Succop, Stacey M; Laar, Amos; Wambugu, Samuel

2015-01-01

318

Mortality among psychiatric inpatients in Singapore.  

PubMed

This study examines the Standardized Mortality Ratio (SMR) by age, sex and cause of death among psychiatric inpatients in Singapore. Mortality in mentally ill inpatients was found to be 2.79 times that of the general population. The SMR decreased with age and the SMR for those 70 years and above was lower than that reported in the literature. The mortality ratio was most accentuated in the younger patients, especially in the female. Excess mortality was observed in both the natural as well as the unnatural causes of death. Among the natural causes of death, infection and pneumonia showed high excess in mortality. In the unnatural causes of death, suicide was predominant. PMID:1876881

Lim, L C; Sim, L P; Chiam, P C

1991-06-01

319

Randomized Controlled Trial of Physician-directed versus Respiratory Therapy Consult Service-directed Respiratory Care to Adult Non-ICU Inpatients  

Microsoft Academic Search

Although current evidence suggests that respiratory care protocols can enhance allocation of respira- tory care services while conserving costs, a randomized trial is needed to address shortcomings of available studies. We therefore conducted a randomized controlled trial comparing respiratory care for adult non-ICU inpatients directed by a Respiratory Therapy Consult Service (RTCS) versus respira- tory care by managing physicians. Eligible

JAMES K. STOLLER; EDWARD J. MASCHA; LUCY KESTER; DAVID HANEY

1998-01-01

320

Cytosine arabinoside in addition to VCAA-based protocols for the treatment of canine lymphoma with bone marrow involvement: does it make the difference?  

PubMed

Cytosine arabinoside (ara-C) is a component of many protocols for the treatment of acute leukaemia and non-Hodgkin lymphomas in humans. The aim of the study was to prospectively evaluate the efficacy of ara-C in a myeloablative regimen in a cohort of canine lymphomas with bone marrow involvement. Seventeen dogs were enrolled. Eight were treated with a VCAA-based protocol (Group 1) and nine with the same regimen added with ara-C (Group 2). Ara-C was administered on a 5-day schedule as an i.v. continuous infusion at the dose of 150 mg m(-2) per day for five consecutive days. During treatment complete remission (CR) was achieved in two dogs in Group 1 and in eight dogs in Group 2. CR rate was significantly higher in Group 2 (P < 0.01). Median survival was 72.5 days (range 6-174) in Group 1 and 243 days (range 73-635) in Group 2. Survival was significantly longer in Group 2 (P < 0.001). Both protocols were well tolerated, with a low incidence of adverse events. Ara-C added to a VCAA-based protocol appears to be safe and beneficial in dogs with stage V lymphoma. Incorporation of the nucleoside analogue might be crucial for the development of future therapeutic strategies in dogs. PMID:19178667

Marconato, L; Bonfanti, U; Stefanello, D; Lorenzo, M R; Romanelli, G; Comazzi, S; Zini, E

2008-06-01

321

Day Hospital Mentalization-Based Treatment (MBT-DH) versus treatment as usual in the treatment of severe borderline personality disorder: protocol of a randomized controlled trial  

PubMed Central

Background Severe borderline personality disorder is associated with a very high psychosocial and economic burden. Current treatment guidelines suggest that several manualized treatments, including day hospital Mentalization-Based Treatment (MBT-DH), are effective in these patients. However, only two randomized controlled trials have compared manualized MBT-DH with treatment as usual. Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH, the possible influence of researcher allegiance in one of the trials, and potential problems with the generalization of findings to mental health systems in other countries, this multi-site randomized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherlands. Methods/design The trial is being conducted at two sites in The Netherlands. Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of???20 on the Borderline Personality Disorder Severity Index were randomly allocated to MBT-DH or treatment as usual. The MBT-DH program consists of a maximum of 18 months’ intensive treatment, followed by a maximum of 18 months of maintenance therapy. Specialist treatment as usual is provided by the City Crisis Service in Amsterdam, a service that specializes in treating patients with personality disorders, offering manualized, non-MBT interventions including family interventions, Linehan training, social skills training, and pharmacotherapy, without a maximum time limit. Patients are assessed at baseline and subsequently every 6 months up to 36 months after the start of treatment. The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index. Secondary outcome measures include parasuicidal behaviour, symptomatic distress, social and interpersonal functioning, personality functioning, attachment, capacity for mentalizing and quality of life. Cost-effectiveness is assessed in terms of the cost per quality-adjusted life year. Outcomes will be analyzed using multilevel analyses based on intention-to-treat principles. Discussion Severe borderline personality disorder is a serious psychological disorder that is associated with high burden. This multi-site randomized trial will provide further data concerning the efficacy and cost-effectiveness of MBT-DH for these patients. Trial registration NTR2175 PMID:24886402

2014-01-01

322

42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.  

Code of Federal Regulations, 2010 CFR

...false Conditions for payment under the prospective payment system for inpatient rehabilitation...HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment for Inpatient...

2010-10-01

323

A Markov decision process to dynamically match hospital inpatient staffing to demand  

Microsoft Academic Search

Appropriate inpatient staffing levels minimize hospital cost and increase patient safety. Hospital inpatient units dynamically adjust premium staffing (above base staffing) levels by attempting to match their daily demand. Historically, inpatient managers subjectively adjust daily staffing from observing the morning inpatient inventory. Inpatient units strive to match staff with demand in a complex patient throughput environment where service rates and

James R. Broyles; Jeffery K. Cochran; Douglas C. Montgomery

2011-01-01

324

42 CFR 136a.34 - Care and treatment of people losing eligibility.  

Code of Federal Regulations, 2013 CFR

...undergoing treatment may still be provided services for a limited period in the following circumstances; (1) Inpatients in IHS and IHS funded facilities and those receiving inpatient care under contract, including contract health services, may...

2013-10-01

325

42 CFR 136a.34 - Care and treatment of people losing eligibility.  

Code of Federal Regulations, 2014 CFR

...undergoing treatment may still be provided services for a limited period in the following circumstances; (1) Inpatients in IHS and IHS funded facilities and those receiving inpatient care under contract, including contract health services, may...

2014-10-01

326

42 CFR 136a.34 - Care and treatment of people losing eligibility.  

Code of Federal Regulations, 2011 CFR

...undergoing treatment may still be provided services for a limited period in the following circumstances; (1) Inpatients in IHS and IHS funded facilities and those receiving inpatient care under contract, including contract health services, may...

2011-10-01

327

42 CFR 136a.34 - Care and treatment of people losing eligibility.  

Code of Federal Regulations, 2010 CFR

...undergoing treatment may still be provided services for a limited period in the following circumstances; (1) Inpatients in IHS and IHS funded facilities and those receiving inpatient care under contract, including contract health services, may...

2010-10-01

328

42 CFR 136a.34 - Care and treatment of people losing eligibility.  

Code of Federal Regulations, 2012 CFR

...undergoing treatment may still be provided services for a limited period in the following circumstances; (1) Inpatients in IHS and IHS funded facilities and those receiving inpatient care under contract, including contract health services, may...

2012-10-01

329

Quality of Life During and After Inpatient Stroke Rehabilitation  

Microsoft Academic Search

Background and Purpose—Very limited longitudinal data are available that assess the health-related quality of life (HRQOL) of stroke survivors after discharge from inpatient rehabilitation. The purpose of this research was to assess changes in HRQOL during inpatient rehabilitation and again 6 months after discharge. Methods—This was a prospective study of all eligible patients admitted to an inpatient stroke rehabilitation hospital

Wilma M. Hopman; Jane Verner

2010-01-01

330

Detailed protocol for administration of intralesional IL-2 for the treatment of Stage IIIc and IV M1a metastatic melanoma based on current NCCN guidelines.  

PubMed

Melanoma claims approximately 9,000 lives in the United States annually. Patients who present with satellite, in-transit, or distant cutaneous metastases have limited treatment options and the prognosis for patients with metastatic disease remains poor. Surgical excision remains the most common treatment modality for cutaneous metastases, but may not address concurrent subclinical in-transit metastases. Other palliative treatment options include Bacillus Calmette-Guérin (BCG) and isolated limb perfusion (ILP). Although intravenous IL-2 has been used for treatment of metastatic melanoma since 1998, intralesional IL-2 has only now been included in the most recent National Comprehensive Cancer Network (NCCN) guidelines after case series and phase I/II clinical trials have shown promising results against Stage IIIc and IV M1a melanoma. Intralesional IL-2 protocols have varied markedly from study to study and there are no consensus guidelines available to help direct treatment. Herein, we present a detailed protocol for the administration of intralesional IL-2 that has been successfully used at two different institutions for treatment of cutaneous melanoma metastases. PMID:25419744

Patel, Forum; Wilken, Reason; Burrall, Barbara; Martinez, Steve; Wells, Victoria; King, Brett; Maverakis, Emanual

2014-11-01

331

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. PMID:22776567

2012-01-01

332

Effects of atypical and typical antipsychotic treatments on sexual function in patients with schizophrenia: 12-month results from the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) study  

Microsoft Academic Search

Purpose. – Sexual dysfunction in patients with schizophrenia can reduce quality of life and treatment compliance. This report will compare the effects of selected atypical and typical antipsychotics on sexual function in a large, international population of outpatients with schizophrenia who were treated over 1 year.Subjects and methods. – Outpatients with schizophrenia, who initiated or changed antipsychotic treatment, and entered

Martin Dossenbach; Yulia Dyachkova; Sebnem Pirildar; Martin Anders; Afaf Khalil; Aleksander Araszkiewicz; Tamara Shakhnovich; Aly Akram; Jan Pecenak; Margaret McBride; Tamas Treuer

2006-01-01

333

A service-level action research intervention to improve identification and treatment of cannabis and related mental health issues in young Indigenous Australians: a study protocol  

PubMed Central

Introduction Regular cannabis use is associated with negative mental health impacts including psychosis, depression and anxiety. Rates of cannabis use have increased in Aboriginal and Torres Strait Islander communities in northern Australia within the last two decades, presenting a significant increased risk to young people's mental health in these regions. Improved screening, early detection and treatment for cannabis-related mental health issues are urgently required. This paper describes a service-level action research intervention and evaluation protocol for use in the few services where it is possible to engage young Aboriginal and Torres Strait Islander Australians. Methods/Design The protocol is being developed in two services where youth mental health is core business: a primary healthcare centre and a youth service in the Cairns and hinterland region, far north Queensland. The protocol calls first for baseline data to be collected using staff and client surveys; network mapping; and analysis of screening, treatment and referral rates. The protocol's intervention phase is driven by service needs identified from baseline data. Intervention strategies focus on implementing/enhancing cannabis screening instruments and processes in line with current best practice; enhancing networks with external drug and mental health services; developing culturally acceptable training and resources; developing activities aiming to reduce cannabis use in young Aboriginal and Torres Strait Islander clients using the services. The protocol requires implementation of the multilevel intervention within each service for 1?year, with follow-up data then collected and compared to baseline. Process evaluation identifies the more effective intervention strategies and documents the challenges to be overcome for full implementation. Ethics and dissemination Ethics approval was provided by The James Cook University, Human Research Ethics Committee. Ethics Approval Number H5322. Peer-reviewed publications will also be used to disseminate the finding. Results will also be discussed with stakeholder organisations. PMID:25082422

Bohanna, India; Bird, Katrina; Copeland, Jan; Roberts, Nicholas; Clough, Alan

2014-01-01

334

Protocol Development  

Cancer.gov

Skip to Content Home | Investigator Resources | Protocol Development | Initiatives/Programs/Collaborations | Links to More Resources | Funding Opportunities | About CTEP Home | Sitemap | Contact CTEP Search this site Protocol Development Protocol

335

In-patient management of diabetes: Controversies and guidelines.  

PubMed

Hyperglycemia is associated with adverse outcomes in hospitalized patients with and without previously known diabetes. Some therapies that are used in the in-patient setting, including glucocorticoids, enteral and parenteral nutrition are associated with new onset hyperglycemia even in previously normoglycemic patients. Current guidelines advise that fasting and premeal blood glucose (BG) be maintained at < 140 mg/dl, with maximal random BG < 180 mg/dl in non-critically ill-patients. In critically ill-patients, intravenous (IV) insulin infusion therapy with BG targets of 140-180 effectively maintains glycemic control with a low risk for hypoglycemia. Protocols targeting "tight" glycemic control, defined as BG 80-110 mg/dl, are no longer recommended due to the high frequency of severe hypoglycemia. Rational use of basal bolus insulin (BBI) regimens in non-critical care and IV insulin infusions in critical care settings has been demonstrated to effectively achieve and maintain recommended BG targets with low risk for hypoglycemia. The safety of BBI relies upon provider awareness of prescribing recommendations for initiating and adjusting insulin regimens according to changes in overall clinical and nutritional status, as well as careful review of daily BG measurements. Smooth transition of care to the out-patient setting is facilitated by providing oral and written instructions regarding the timing and dosing of insulin as well as education in basic skills for home management. PMID:24910825

Korytkowski, Mary T

2013-12-01

336

Follow-up of inpatient cocaine withdrawal for cocaine-using methadone patients.  

PubMed

Significant proportions of opiate-dependent persons entering methadone treatment are also addicted to cocaine and continue to use cocaine during treatment. One standard response to cocaine use has been inpatient detoxification. This study examined the effectiveness of this procedure by comparing pre- and posttreatment urine toxicologies for methadone patients who had been hospitalized for cocaine withdrawal. The results showed a negligible effect on cocaine abstinence (less than 1 out of 10 patients abstinent 12 weeks after detox) and a modest reduction in the frequency of cocaine use (one-quarter decline in urine tests positive after 12 weeks). These findings raise serious doubts about the cost-effectiveness of inpatient cocaine detoxification. Better strategies need to be implemented to enhance the chances of remaining abstinent once detoxified. PMID:9219143

Rosenblum, A; Foote, J; Magura, S; Sturiano, V; Xu, N; Stimmel, B

1996-01-01

337

42 CFR 412.62 - Federal rates for inpatient operating costs for fiscal year 1984.  

Code of Federal Regulations, 2010 CFR

...false Federal rates for inpatient operating costs for fiscal year 1984. 412.62 Section...Payment Federal Rates for Inpatient Operating Costs § 412.62 Federal rates for inpatient operating costs for fiscal year 1984. (a) General...

2010-10-01

338

42 CFR 412.71 - Determination of base-year inpatient operating costs.  

Code of Federal Regulations, 2010 CFR

...Determination of base-year inpatient operating costs. 412.71 Section 412.71 Public...Prospective Payment System for Inpatient Operating Costs § 412.71 Determination of base-year inpatient operating costs. (a) Base-year costs....

2010-10-01

339

42 CFR 412.50 - Furnishing of inpatient hospital services directly or under arrangements.  

Code of Federal Regulations, 2013 CFR

...CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR...Prospective Payment Systems for Inpatient Operating Costs and Inpatient Capital-Related Costs § 412.50 Furnishing of inpatient...

2013-10-01

340

42 CFR 412.50 - Furnishing of inpatient hospital services directly or under arrangements.  

Code of Federal Regulations, 2010 CFR

...CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR...Prospective Payment Systems for Inpatient Operating Costs and Inpatient Capital-Related Costs § 412.50 Furnishing of inpatient...

2010-10-01

341

42 CFR 412.50 - Furnishing of inpatient hospital services directly or under arrangements.  

Code of Federal Regulations, 2011 CFR

...CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR...Prospective Payment Systems for Inpatient Operating Costs and Inpatient Capital-Related Costs § 412.50 Furnishing of inpatient...

2011-10-01

342

42 CFR 412.50 - Furnishing of inpatient hospital services directly or under arrangements.  

Code of Federal Regulations, 2014 CFR

...CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR...Prospective Payment Systems for Inpatient Operating Costs and Inpatient Capital-Related Costs § 412.50 Furnishing of inpatient...

2014-10-01

343

42 CFR 412.50 - Furnishing of inpatient hospital services directly or under arrangements.  

Code of Federal Regulations, 2012 CFR

...CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR...Prospective Payment Systems for Inpatient Operating Costs and Inpatient Capital-Related Costs § 412.50 Furnishing of inpatient...

2012-10-01

344

76 FR 39006 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program; Correction  

Federal Register 2010, 2011, 2012, 2013, 2014

...RIN 0938-AQ55 Medicare Program; Hospital Inpatient Value-Based Purchasing Program...26490) entitled ``Medicare Program; Hospital Inpatient Value-Based Purchasing Program...A Overview of the January 7, 2011 Hospital Inpatient VBP Program Proposed...

2011-07-05

345

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...Terminations, and Procedures for Inpatient Hospital Discharges § 405.1206 Expedited...determination procedures for inpatient hospital care. (a)...

2010-10-01

346

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

Code of Federal Regulations, 2010 CFR

...under the inpatient psychiatric facility prospective payment system. 412.432 Section...HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient...

2010-10-01

347

42 CFR 412.428 - Publication of Updates to the inpatient psychiatric facility prospective payment system.  

Code of Federal Regulations, 2010 CFR

...to the inpatient psychiatric facility prospective payment system. 412.428 Section...HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient...

2010-10-01

348

Maximizing foodservice in an inpatient hospice setting.  

PubMed

The philosophy of maximizing patient comfort and enhancing quality of life impacts on all aspects of foodservice in an inpatient hospice setting. The foodservice department's focus in the palliative care environment is to meet patients' physical, psychological, and social needs. The menu incorporates variety and comfort foods to meet the special requests of hospice patients. Food production and delivery provides for flexibility in meal preferences and meal serving times. Finally, sanitation standards and inservice training extend beyond the main foodservice operation to include the hospice "family" kitchen to protect the hospice patient from food-borne infections. PMID:7806183

Kidd, K D; Lane, M P

1993-01-01

349

Characteristics of Inpatient Care and Rehabilitation for Acute First-Ever Stroke Patients  

PubMed Central

Purpose The purpose of this study was to analyze the status of inpatient care for acute first-ever stroke at three general hospitals in Korea to provide basic data and useful information on the development of comprehensive and systematic rehabilitation care for stroke patients. Materials and Methods This study conducted a retrospective complete enumeration survey of all acute first-ever stroke patients admitted to three distinct general hospitals for 2 years by reviewing medical records. Both ischemic and hemorrhagic strokes were included. Survey items included demographic data, risk factors, stroke type, state of rehabilitation treatment, discharge destination, and functional status at discharge. Results A total of 2159 patients were reviewed. The mean age was 61.5±14.4 years and the ratio of males to females was 1.23:1. Proportion of ischemic stroke comprised 54.9% and hemorrhagic stroke 45.1%. Early hospital mortality rate was 8.1%. Among these patients, 27.9% received rehabilitation consultation and 22.9% underwent inpatient rehabilitation treatment. The mean period from admission to rehabilitation consultation was 14.5 days. Only 12.9% of patients were transferred to a rehabilitation department and the mean period from onset to transfer was 23.4 days. Improvements in functional status were observed in the patients who had received inpatient rehabilitation treatment after acute stroke management. Conclusion Our analysis revealed that a relatively small portion of patients who suffered from an acute first-ever stroke received rehabilitation consultation and inpatient rehabilitation treatment. Thus, applying standardized clinical practice guidelines for post-acute rehabilitation care is needed to provide more effective and efficient rehabilitation services to patients with stroke. PMID:25510773

Chang, Won Hyuk; Shin, Yong-Il; Lee, Sam-Gyu; Oh, Gyung-Jae; Lim, Young Shil

2015-01-01

350

A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis of the hip or knee: protocol of a prospective randomised controlled clinical trial  

PubMed Central

Background The increasing age of the population, especially in the western world, means that the prevalence of osteoarthritis is also increasing, with corresponding socioeconomic consequences. Although there is no curative intervention at present, in accordance with US and European guidelines, pharmacotherapeutic and non-pharmacological approaches aim at pain control and the reduction of functional restriction. It has been established that hydrotherapy for osteoarthritis of the hip or knee joint using serial cold and warm water stimulation not only improves the range of movement but also reduces pain significantly and increases quality of life over a period of up to three months. Weight reduction is important for patients with osteoarthritis of the hip or knee. In addition, conventional physiotherapy and exercise therapy have both been shown, at a high level of evidence, to be cost-effective and to have long-term benefits for pain relief, movement in the affected joint, and patient quality of life. Methods/design The study design consists of a prospective randomised controlled three-armed clinical trial, which will be carried out at a specialist clinic for integrative medicine, to investigate the clinical effects of hydrotherapy on osteoarthritis of the knee or hip joint, in comparison with conventional physiotherapy. One hundred and eighty patients diagnosed with osteoarthritis of hip or knee will be randomly assigned to one of three intervention groups: hydrotherapy, physiotherapy, and both physiotherapy and hydrotherapy of the affected joint. In the first group, patients will receive Kneipp hydrotherapy daily, with water applied in the form of alternate cold and warm thigh affusions (alternating cold and warm water stimulation is particularly relevant to the knee and hip regions). Patients in the second group will receive physiotherapy of the hip or knee joint three times a week. Patients in the physiotherapy-hydrotherapy combination group will receive both joint-specific physiotherapy three times a week and alternate cold and warm thigh affusions every day. Follow-up assessments will be on three levels: clinical assessment by the investigator; subjective patient assessment consisting of a patient diary, and questionnaires on admission and at the end of the treatment phase; and a final telephone assessment by the external evaluation centre. Assessments will be made at baseline, after two weeks of inpatient treatment, and finally after a further ten weeks of follow-up. The primary outcome measure will be pain intensity of the affected joint in the course of inpatient treatment, judged by the patient and the investigator. Secondary outcomes include health-related quality of life and joint-specific pain and mobility in the course of the study. Statistical analysis of the results will be on an intention-to-treat basis. Conclusion This study methodology has been conceived according to the standards of the CONSORT recommendations. The results will contribute to establishing hydrotherapy as a non-invasive, non-interventional, reasonably priced, therapeutic option with few side effects, in the concomitant treatment of osteoarthritis of the hip or knee. Trial Registration Trial registration number: NCT 00950326 PMID:19689824

Schencking, Martin; Otto, Adriane; Deutsch, Tobias; Sandholzer, Hagen

2009-01-01

351

Clinical Protocol / Procedure Page 1 of 5 Clinical Manual -Nursing Practice Manual  

E-print Network

Clinical Protocol / Procedure Page 1 of 5 Clinical Manual - Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROTOCOL / PROCEDURE FOR: Neurologic Assessment of the Adult Inpatient POLICY: 1. The Glasgow Coma Scale (GCS) (appendix A

Oliver, Douglas L.

352

Non-Hodgkin's lymphoma protocols in the treatment of patients with Burkitt's lymphoma and lymphoblastic lymphoma: a report on 58 patients.  

PubMed

Lymphoblastic lymphoma (LBL) and Burkitt's lymphoma belong to the very aggressive lymphomas requiring intensive therapy. We retrospectively analyzed 29 patients with Burkitt's lymphoma and 29 patients with LBL who received induction therapy with a CHOP-like lymphoma protocol. Patients with Burkitt's lymphoma (with a median age of 54.5 years) have a CR rate of 72% and a lymphoma free long-time survival of 55%. The International Prognostic Index was the most valuable prognostic factor for survival. Patients with LBL with a median age of 45 years had a CR rate of 55% and a lymphoma-free survival of 38%. Stage was the most predictive prognostic factor. Our data suggest that for older patients (>50) treatment with lymphoma protocols may yield response rates that are comparable to the results of patients with disseminated diffuse large cell lymphoma. Younger patients with risk factors should be treated with more intensive therapy like ALL-protocols. The role of auto-transplantation after high dose therapy (HDT) however as part of primary treatment still needs to be evaluated in clinical trials. One of four patients with LBL who received HDT and one of four patients with Burkitt's lymphoma who received HDT achieved long-term remission. PMID:10613454

Kaiser, U; Uebelacker, I; Havemann, K

1999-12-01

353

42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.  

Code of Federal Regulations, 2013 CFR

... Method of payment under the inpatient rehabilitation facility prospective payment system. ...SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.632 Method of...

2013-10-01

354

42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.  

Code of Federal Regulations, 2012 CFR

... Method of payment under the inpatient rehabilitation facility prospective payment system. ...SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.632 Method of...

2012-10-01

355

42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.  

Code of Federal Regulations, 2014 CFR

... Method of payment under the inpatient rehabilitation facility prospective payment system. ...SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.632 Method of...

2014-10-01

356

42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.  

Code of Federal Regulations, 2011 CFR

... Method of payment under the inpatient rehabilitation facility prospective payment system. ...SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.632 Method of...

2011-10-01

357

Design and Implementation of an Inpatient Disease Management Program  

Microsoft Academic Search

Objective :T o describe the development and implementation of an inpatient disease management program. Study Design: Prospective observational study. Patients and Methods: On the basis of opportuni- ties for improving quality or efficiency of inpatient and emergency department care, 4 diagnoses, including congestive heart failure (CHF), gastroin- testinal hemorrhage, community-acquired pneumo- nia, and sickle-cell crisis were selected for imple- mentation

Gregory S. Cooper; Keith B. Armitage; Bimal Ashar; Ottorino Costantini; Frederick A. Creighton; Pauline Raiz; Richard C. K. Wong; Mark D. Carlson

358

Reducing restraint use in a public psychiatric inpatient service  

Microsoft Academic Search

The use of behavioral restraint in psychiatric inpatients can have physically and emotionally damaging effects. However, staff may view the use of restraint as a routine and acceptable means of maintaining safety. The goal of this project was to reduce the use of restraint in a public psychiatric inpatient service that serves an economically disadvantaged urban population. Six interventions that

Robert E. McCue; Leonel Urcuyo; Yehezkel Lilu; Teresa Tobias; Michael J. Chambers

2004-01-01

359

Nurse Absenteeism and Staffing Strategies for Hospital Inpatient Units  

E-print Network

Nurse Absenteeism and Staffing Strategies for Hospital Inpatient Units Wen-Ya Wang1 , Diwakar Gupta-based and labor-intensive service environments. Key words : Absenteeism, Staffing, Hospital operations 1 Absenteeism and Staffing Strategies for Hospital Inpatient Units 2 Jawad 2001, Bell et al. 2008, Sochalski et

Gupta, Diwakar

360

Dissociative Disorders Among Chinese Inpatients Diagnosed with Schizophrenia  

Microsoft Academic Search

The purpose of this study was to assess the prevalence of dissociative disorders in a sample of Chinese psychiatric inpatients. Participants in the study were 569 consecutively admitted inpatients at Shanghai Mental Health Center, China, of whom 84.9% had a clinical diagnosis of schizophrenia based on the Chinese Classification and Diagnostic Criteria of Mental Disorders, Version 3. All participants completed

Junhan Yu; Colin A. Ross; Benjamin B. Keyes; Ying Li; Yunfei Dai; Tianhong Zhang; Lanlan Wang; Qing Fan; Zeping Xiao

2010-01-01

361

Systematic review of evidence for different treatment settings in anorexia nervosa  

PubMed Central

AIM: To compare outcomes in anorexia nervosa (AN) in different treatment settings: inpatient, partial hospitalization and outpatient. METHODS: Completed and published in the English language, randomized controlled trials comparing treatment in two or more settings or comparing different lengths of inpatient stay, were identified by database searches using terms “anorexia nervosa” and “treatment” dated to July 2014. Trials were assessed for risk of bias and quality according to the Cochrane handbook by two authors (Madden S and Hay P) Data were extracted on trial quality, participant features and setting, main outcomes and attrition. RESULTS: Five studies were identified, two comparing inpatient treatment to outpatient treatment, one study comparing different lengths of inpatient treatment, one comparing inpatient treatment to day patient treatment and one comparing day patient treatment with outpatient treatment. There was no difference in treatment outcomes between the different treatment settings and different lengths of inpatient treatment. Both outpatient treatment and day patient treatment were significantly cheaper than inpatient treatment. Brief inpatient treatment followed by evidence based outpatient care was also cheaper than prolonged inpatient care for weight normalization also followed by evidence based outpatient care. CONCLUSION: There is preliminary support for AN treatment in less restrictive settings but more research is needed to identify the optimum treatment setting for anorexia nervosa. PMID:25815264

Madden, Sloane; Hay, Phillipa; Touyz, Stephen

2015-01-01

362

Effects of group songwriting on depression and quality of life in acute psychiatric inpatients: a randomized three group effectiveness study  

Microsoft Academic Search

The purpose of this study was to determine the immediate effects of group psychoeducational songwriting on quality of life, depression, and treatment perceptions in acute psychiatric inpatients during a randomized three group design. Participants were randomly assigned by cluster to one of three conditions: Group songwriting (n = 33), psychoeducation (n = 32), or recreational music therapy (n = 40). Quality of life and depression were

Michael J. Silverman

2012-01-01

363

Protocol Online  

NSDL National Science Digital Library

Protocol Online is a database of research protocols in a variety of life science fields. It contains protocols contributed by worldwide researchers as well as links to web protocols hosted by worldwide research labs, biotech companies, personal web sites. The data is stored in a MySql relational database. Protocol Online also hosts discipline specific discussion forums (BioForum), and provides a free PubMed search and alerting service (PubAlert).

Long-Cheng Li (Protocol Online)

2012-01-06

364

Use of movies for group therapy of psychiatric inpatients: theory and practice.  

PubMed

This paper reports on the use of cinema therapy at a psychiatry clinic for inpatients. The program, "Watching Cinema Group Therapy," was used with over 500 inpatients over the course of one year. We found that using movies for group psychotherapy sessions encouraged the patients to talk about their beliefs, thoughts, and feelings while discussing the characters and stories. We also used the movies as a reward for patients who had developed a therapeutic alliance. It motivated the patients to be active instead of simply remaining in their rooms. As a follow-up to full-length films, it was more useful to show short scenes to patients who had been administered high doses of drugs. Movies can be an important, positive, and productive means of treatment and teaching. PMID:24611706

Yazici, Esra; Ulus, Fuat; Selvitop, Rabia; Yazici, Ahmet Bülent; Aydin, Nazan

2014-04-01

365

Design of a mobile, safety-critical in-patient glucose management system.  

PubMed

Diabetes mellitus is one of the most widespread diseases in the world. People with diabetes usually have long stays in hospitals and need specific treatment. In order to support in-patient care, we designed a prototypical mobile in-patient glucose management system with decision support for insulin dosing. In this paper we discuss the engineering process and the lessons learned from the iterative design and development phases of the prototype. We followed a user-centered development process, including real-life usability testing from the outset. Paper mock-ups in particular proved to be very valuable in gaining insight into the workflows and processes, with the result that user interfaces could be designed exactly to the specific needs of the hospital personnel in their daily routine. PMID:21893886

Höll, Bernhard; Spat, Stephan; Plank, Johannes; Schaupp, Lukas; Neubauer, Katharina; Beck, Peter; Chiarugi, Franco; Kontogiannis, Vasilis; Pieber, Thomas R; Holzinger, Andreas

2011-01-01

366

'Boarded' patients prefer halls on inpatient floors.  

PubMed

If you can board patients upstairs rather than in your ED, not only will you free space in your department, but you will be giving patients what they want, based on the results of a recent study. Because this change involves other units, buy-in must be obtained from administration. You can make a case with administration based not only on improved safety and care, but also on patient satisfaction. Initial costs for boarding patients in inpatient halls will be higher because additional staff will be needed, but these can be offset by reducing the number of patients who leave without being seen. Spreading care over several units will relieve the pressure on ED nurses. PMID:17722405

2007-07-01

367

Antimicrobial resistance pattern in Escherichia coli causing urinary tract infection among inpatients  

PubMed Central

Background & objectives: Recent studies suggest an increasing antimicrobial resistance among Escherichia coli causing urinary tract infection (UTI). We undertook this study to know the resistance pattern of E. coli causing UTI in patients admitted to a tertiary care hospital in north India, and to know the treatment given and response of the patients. Methods: The details of E. coli grown from urine samples and their antibiotic sensitivity pattern were collected from the laboratory registers and the patient details were collected from the case records. The urine samples received were processed using standard methods and antibiotic susceptibility was done by Kirby-Bauer disk diffusion test. Results: Of the total 311 E. coli isolates, 119 (38.2%) were isolated from in-patients, which were considered for the study. Of these 119 E. coli isolates, 91 (76.51%) were multi drug resistant (MDR). The isolates showed high levels of resistance to ampicillin (88.4%), amoxicillin-clavulanic acid (74.4%), norfloxacin (74.2%), cefuroxime (72.2%), ceftriaxone (71.4%) and co-trimoxazole (64.2%). The isolates were sensitive to amikacin (82.6%), piperacillin-tazobactum (78.2%), nitrofurantoin (82.1%) and imipenem (98.9%). Ceftriaxone was most commonly used for empirical therapy for UTI among inpatients in our hospital. Of the 93 cases of UTI due to MDR E. coli, 73 improved on treatment and 12 worsened, which were referred to higher centres. Interpretation & conclusions: Our study showed that 76.5 per cent of E. coli isolates from urine samples of inpatients were MDR. Diabetes, chronic renal disease and catherization were some of the risk factors associated. The high rate of resistance could be because only inpatients were included and the increased usage of cephalosporins in our hospital for empirical therapy. PMID:25109731

Niranjan, V.; Malini, A.

2014-01-01

368

Data Mining Application in Customer Relationship Management for Hospital Inpatients  

PubMed Central

Objectives This study aims to discover patients loyal to a hospital and model their medical service usage patterns. Consequently, this study proposes a data mining application in customer relationship management (CRM) for hospital inpatients. Methods A recency, frequency, monetary (RFM) model has been applied toward 14,072 patients discharged from a university hospital. Cluster analysis was conducted to segment customers, and it modeled the patterns of the loyal customers' medical services usage via a decision tree. Results Patients were divided into two groups according to the variables of the RFM model and the group which had significantly high frequency of medical use and expenses was defined as loyal customers, a target market. As a result of the decision tree, the predictable factors of the loyal clients were; length of stay, certainty of selectable treatment, surgery, number of accompanying treatments, kind of patient room, and department from which they were discharged. Particularly, this research showed that when a patient within the internal medicine department who did not have surgery stayed for more than 13.5 days, their probability of being a classified as a loyal customer was 70.0%. Conclusions To discover a hospital's loyal patients and model their medical usage patterns, the application of data-mining has been suggested. This paper suggests practical use of combining segmentation, targeting, positioning (STP) strategy and the RFM model with data-mining in CRM. PMID:23115740

2012-01-01

369

Inpatients’ opinions on a hospital in Portugal  

PubMed Central

Background: Little is known about the relationship between the opinions of inpatients and the degree to which hospitals are improving in performance over time. The aim of this study was to determine the personal assessment level of inpatients or their representatives regarding aspects of health care in an internal medicine ward. Methods: We carried out a questionnaire in September 2011 with 284 discharged patients and patient representatives, focusing on their opinions about the department, health professionals and amenities, with response options ranging from 1 (very bad) to 5 (very good). The relationships between domains from the questionnaire and socio-demographic factors were examined using a t-test and one-way ANOVA. Results: The response rate was 78%. The patients showed a slightly higher mean score (m) for factors in the medical care domain than did the patient representatives (m = 4.51 vs. m = 4.27; p = 0.014). The mean score of all the items in all domains was 4.24; this allowed us to determine the difference from the overall mean (DIFM) for medical care (DIFM = 0.18; p = 0.000), foods (DIFM = –0.31; p = 0.000), diagnostic tests (DIFM = –0.15; p = 0.036) and transport (DIFM = –0.41; p = 0.000). Respondents with a medium or higher educational level gave lower scores to the domains food (m = 3.74; p = 0.004), diagnostic tests (m = 3.72; p = 0.04) and transport (m = 3.62; p = 0.025) than those with lower educational levels. The domains facilities (m = 2.4; p = 0.04) and diagnostic tests (m = 3.63; p = 0.009) were given lower scores by those aged <50 years compared with older respondents. Conclusions: Our findings suggest that the evaluation of the responders will allow the hospital management to make improvements in the quality of care. PMID:24555037

Silva, Carina C; Oliveira, Agripino

2013-01-01

370

Prospective analysis of bedside percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults  

PubMed Central

OBJECTIVES—Although there is general agreement that surgery is the best treatment for chronic subdural haematoma (CSDH), the extent of the surgical intervention is not well defined.?METHODS— The less invasive surgical technique of bedside percutaneous subdural tapping and spontaneous haematoma efflux after twist drill craniostomy under local anaesthesia was prospectively analysed in 118 adult patients, 99 with unilateral and 19 with bilateral CSDH.?RESULTS—The mean number of subdural tappings was 3.2. Ninety two of the patients with unilateral CSDH were successfully treated by up to five subdural tappings, 95% of the patients with bilateral CSDH were successfully treated by up to 10 subdural tappings. The mean duration of inpatient treatment was 12 days. In 11 patients (9%) the treatment protocol had to be abandoned because of two acute subdural bleedings, two subdural empyemas, and seven cases of insufficient haematoma efflux and no neurological improvement. The only significant predictor for failure of the described treatment protocol was septation visible on preoperative CT.?CONCLUSIONS—The described therapy protocol is—apart from a purely conservative treatment—the least invasive presently available surgical technique for treating chronic subdural haematoma. Its results are comparable with other modern treatment protocols. Thus, it can be recommended in all patients as a first and minimally invasive therapy, especially in patients in a poor general condition. Patients with septation visible on preoperative CT should be excluded from this form of treatment.?? PMID:10864602

Reinges, M.; Hasselberg, I.; Rohde, V.; Kuker, W.; Gilsbach, J.

2000-01-01

371

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. PMID:22776534

2012-01-01

372

Interleukin-1beta, interleukin-1 receptor antagonist levels in patients with subacute sclerosing panencephalitis and the effects of different treatment protocols.  

PubMed

Subacute sclerosing panencephalitis is a rare progressive inflammatory disease of the central nervous system caused by a persistent aberrant measles virus infection. Cytokines are polypeptides that regulate immune responses and inflammatory reactions. Interleukin-1beta has been implicated as a central mediator of tissue damage and destruction in a number of central nervous system diseases. Interleukin-1 receptor antagonist could function as an important anti-inflammatory cytokine. We studied interleukin-1beta and interleukin-1 receptor antagonist levels in the cerebrospinal fluids of patients with subacute sclerosing panencephalitis and evaluated the effects of different treatment protocols on these cytokines. Interleukin-1beta and interleukin-1 receptor antagonist levels were measured in 15 patients who had a recent diagnosis of subacute sclerosing panencephalitis (group 1), 6 patients who had been treated with isoprinosine (group 2), 5 patients with intraventricular interferon-alpha (group 3), and 6 patients with interferon-beta (group 4). The results were compared within the groups and also with the results of 10 patients with other neurologic disease (group 5). The interleukin-1beta concentrations in cerebrospinal fluid and sera were all below the detection limits (3.9 pg/mL). Interleukin-1 receptor antagonist levels were not statistically different, except for the group treated with intraventricular interferon-alpha. Interleukin-1 receptor antagonist levels were 170 +/- 52, 175 +/- 58, 1605 +/- 518, 77.5 +/- 24, and 108 +/- 18 pg/mL in groups 1 to 5, respectively. Interleukin-1 receptor antagonist levels and cerebrospinal fluid serum ratios were significantly increased during interferon-alpha treatment. In conclusion, interleukin-1 and interleukin-1 receptor antagonist levels were not elevated in the patients with subacute sclerosing panencephalitis. The only treatment protocol that affects interleukin-1 receptor antagonist levels in cerebrospinal fluid was intraventricular interferon-alpha. Further studies on higher numbers of patients may better document the immunologic status of patients with subacute sclerosing panencephalitis and the effects of different treatment modes. PMID:11417607

Haspolat, S; Anlar, B; Köse, G; Coskun, M; Yegin, O

2001-06-01

373

Estimating Inpatient Hospital Prices from State Administrative Data and Hospital Financial Reports  

PubMed Central

Objective To develop a tool for estimating hospital-specific inpatient prices for major payers. Data Sources AHRQ Healthcare Cost and Utilization Project State Inpatient Databases and complete hospital financial reporting of revenues mandated in 10 states for 2006. Study Design Hospital discharge records and hospital financial information were merged to estimate revenue per stay by payer. Estimated prices were validated against other data sources. Principal Findings Hospital prices can be reasonably estimated for 10 geographically diverse states. All-payer price-to-charge ratios, an intermediate step in estimating prices, compare favorably to cost-to-charge ratios. Estimated prices also compare well with Medicare, MarketScan private insurance, and the Medical Expenditure Panel Survey prices for major payers, given limitations of each dataset. Conclusions Public reporting of prices is a consumer resource in making decisions about health care treatment; for self-pay patients, they can provide leverage in negotiating discounts off of charges. Researchers can also use prices to increase understanding of the level and causes of price differentials among geographic areas. Prices by payer expand investigational tools available to study the interaction of inpatient hospital price setting among public and private payers—an important asset as the payer mix changes with the implementation of the Affordable Care Act. PMID:23662642

Levit, Katharine R; Friedman, Bernard; Wong, Herbert S

2013-01-01

374

Tablet computers for hospitalized patients: a pilot study to improve inpatient engagement.  

PubMed

Inadequate patient engagement in hospital care inhibits high-quality care and successful transitions to home. Tablet computers may provide opportunities to engage patients, particularly during inactive times between provider visits, tests, and treatments, by providing interactive health education modules as well as access to their personal health record (PHR). We conducted a pilot project to explore inpatient satisfaction with bedside tablets and barriers to usability. Additionally, we evaluated use of these devices to deliver 2 specific Web-based programs: (1) an interactive video to improve inpatient education about hospital safety, and (2) PHR access to promote inpatient engagement in discharge planning. We enrolled 30 patients; 17 (60%) were aged 40 years or older, 17 (60%) were women, 17 (60%) owned smartphones, and 6 (22%) owned tablet computers. Twenty-seven (90%) reported high overall satisfaction with the device, and 26 (87%) required ? 30 minutes for basic orientation (70% required ? 15 minutes). Twenty-five (83%) independently completed an interactive educational module on hospital patient safety. Twenty-one (70%) accessed their personal health record (PHR) to view their medication list, verify scheduled appointments, or send a message to their primary care physician. Next steps include education on high-risk medications, assessment of discharge barriers, and training clinical staff (such as respiratory therapists, registered nurses, or nurse practitioners) to deliver tablet interventions. PMID:24523051

Greysen, S Ryan; Khanna, Raman R; Jacolbia, Ronald; Lee, Herman M; Auerbach, Andrew D

2014-06-01

375

Medicare Beneficiaries and the Impact of Gaining Prescription Drug Coverage on Inpatient and Physician Spending  

PubMed Central

Objective To assess whether gaining prescription drug coverage produces cost offsets in Medicare spending on inpatient and physician services. Data Source Two-year panels constructed from 1995 to 2000 Medicare Current Beneficiary Survey, a dataset of Medicare claims and health care surveys from the Medicare population. Study Design We estimated a series of fixed-effects panel models to calculate adjusted changes in Medicare spending as drug coverage was acquired (Gainers) relative to the spending of beneficiaries who never had drug coverage (Nevers). Explanatory variables in the model include age, calendar year, income, and health status. Principal Findings Assessments of inpatient and physician services spending provided no evidence of overt selection behavior prior to the acquisition of drug coverage (i.e., there were no preswitch spikes in Medicare spending for Gainers). After enrollment, the medical spending of Gainers resembled those of beneficiaries who never had drug coverage. Overall, the multivariate models showed no systematic postenrollment changes in either inpatient or physician spending that could be attributed to the acquisition of drug coverage. Conclusions We found no consistent evidence that drug coverage either increases or reduces spending for hospital and physician services. This does not necessarily mean that drug therapy does not substitute for or complement other medical treatments, but rather that neither effect predominates across the Medicare population as a whole. PMID:16174134

Briesacher, Becky A; Stuart, Bruce; Ren, Xiaoqang; Doshi, Jalpa A; Wrobel, Marian V

2005-01-01

376

Improvement in inpatient glycemic care: pathways to quality.  

PubMed

The management of inpatient hyperglycemia is a focus of quality improvement projects across many hospital systems while remaining a point of controversy among clinicians. The association of inpatient hyperglycemia with suboptimal hospital outcomes is accepted by clinical care teams; however, the clear benefits of targeting hyperglycemia as a mechanism to improve hospital outcomes remain contentious. Glycemic management is also frequently confused with efforts aimed at intensive glucose control, further adding to the confusion. Nonetheless, several regulatory agencies assign quality rankings based on attaining specified glycemic targets for selected groups of patients (Surgical Care Improvement Project (SCIP) measures). The current paper reviews the data supporting the benefits associated with inpatient glycemic control projects, the components of a successful glycemic control intervention, and utilization of the electronic medical record in implementing an inpatient glycemic control project. PMID:25715828

Aloi, Joseph A; Mulla, Christopher; Ullal, Jagdeesh; Lieb, David C

2015-04-01

377

42 CFR 409.83 - Inpatient hospital coinsurance.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Inpatient hospital coinsurance. 409.83 Section 409.83...HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Hospital Insurance Deductibles and Coinsurance §...

2010-10-01

378

42 CFR 409.82 - Inpatient hospital deductible.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Inpatient hospital deductible. 409.82 Section 409.82 ...HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Hospital Insurance Deductibles and Coinsurance §...

2010-10-01

379

In-Patient Rehab Not Always Needed After New Knee  

MedlinePLUS

... features on this page, please enable JavaScript. In-Patient Rehab Not Always Needed After New Knee People ... Replacement Rehabilitation THURSDAY, March 26, 2015 (HealthDay News) -- Patients who choose at-home physical therapy instead of ...

380

[Inpatient management of adolescent psychiatric patients. A single day study].  

PubMed

The distribution of disorders in a one-day sample of 1806 adolescents receiving inpatient psychiatric care and classified with the diagnostic system ICD-9 is described. Of the inpatient psychiatric facilities for adolescents in the Federal Republic of Germany and West Berlin, 85% responded to our questionnaire. The main findings were: 1) More of the inpatients were male than female (1:0.8); 2) 80% of the patients were being treated at non-university facilities; 3) differences in diagnose between university and other hospitals were small and concerned only psychosis, eating disorders and oligophrenia; 4) the most frequent diagnoses were psychosis and neurosis (20% each), followed by special symptoms/syndromes and conduct disorders (between 10% and 15% each) and emotional disorders (10%); 5) other disorders were less common (under 10% each); 6) a comparison of the different Länder in the Federal Republic indicated that some regions do not have enough inpatient facilities. PMID:1887692

Braun-Scharm, H; Räder, K; Martinius, J

1991-06-01

381

Study protocol: systematic review and meta-analysis of randomized controlled trials in first-line treatment of squamous non-small cell lung cancer  

PubMed Central

Background There is a high unmet need for effective treatments for patients with squamous non-small cell lung cancer (NSCLC). Eli Lilly and Company is conducting a phase III, randomized, multicenter, open-label study of gemcitabine plus cisplatin plus necitumumab (GC?+?N) versus gemcitabine plus cisplatin (GC) for the first-line treatment of patients with stage IV squamous NSCLC. Given GC is not the only treatment commonly used for the treatment of squamous NSCLC, this study was designed to compare the survival, toxicity, and quality of life outcomes of current treatment strategies for squamous NSCLC in the first-line setting. Methods/Design A systematic review and meta-analysis (including indirect comparisons) of treatments used in squamous NSCLC will be conducted to assess the clinical efficacy (overall and progression-free survival), health-related quality of life (HRQoL), and safety (grade 3–4 toxicity) of GC?+?N compared to other treatments used in squamous NSCLC. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines will be followed for all aspects of this study. A systematic literature review will be conducted to identify randomized controlled trials evaluating chemotherapy treatment in first-line NSCLC. Eligible articles will be restricted to randomized controlled trials (RCTs) among chemotherapy-naïve advanced NSCLC cancer patients that report outcome data (survival, toxicity, or quality of life) for patients with squamous histology. Following data extraction and validation, data consistency and study heterogeneity will be assessed. A network meta-analysis will be conducted based on the available hazard ratios for overall and progression-free survival, odds ratios for published toxicity data, and mean difference of HRQoL scales. Sensitivity analyses will be conducted. Discussion This is a presentation of the study protocol only. Results and conclusions are pending completion of this study. Systematic review registration PROSPERO CRD42014008968 PMID:25227571

2014-01-01

382

A Systematic Review of Music Therapy Practice and Outcomes with Acute Adult Psychiatric In-Patients  

PubMed Central

Background and Objectives There is an emerging evidence base for the use of music therapy in the treatment of severe mental illness. Whilst different models of music therapy have been developed in mental health care, none have specifically accounted for the features and context of acute in-patient settings. This review aimed to identify how music therapy is provided for acute adult psychiatric in-patients and what outcomes have been reported. Review Methods A systematic review using medical, psychological and music therapy databases. Papers describing music therapy with acute adult psychiatric in-patients were included. Analysis utilised narrative synthesis. Results 98 papers were identified, of which 35 reported research findings. Open group work and active music making for nonverbal expression alongside verbal reflection was emphasised. Aims were engagement, communication and interpersonal relationships focusing upon immediate areas of need rather than longer term insight. The short stay, patient diversity and institutional structure influenced delivery and resulted in a focus on single sessions, high session frequency, more therapist direction, flexible use of musical activities, predictable musical structures, and clear realistic goals. Outcome studies suggested effectiveness in addressing a range of symptoms, but were limited by methodological shortcomings and small sample sizes. Studies with significant positive effects all used active musical participation with a degree of structure and were delivered in four or more sessions. Conclusions No single clearly defined model exists for music therapy with adults in acute psychiatric in-patient settings, and described models are not conclusive. Greater frequency of therapy, active structured music making with verbal discussion, consistency of contact and boundaries, an emphasis on building a therapeutic relationship and building patient resources may be of particular importance. Further research is required to develop specific music therapy models for this patient group that can be tested in experimental studies. PMID:23936399

Carr, Catherine; Odell-Miller, Helen; Priebe, Stefan

2013-01-01

383

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

384

Raising the awareness of inpatient nursing staff about medication errors  

Microsoft Academic Search

Objective The study objective was to design and implement an educational programme to raise the awareness of in-patient nursing staff\\u000a about medication errors and other medication-related safety issues. Method A sample of in-patient nursing staff in Al Ain hospital (n = 370) was included in the study and completed a self-reported questionnaire about medication errors. A structured program\\u000a was developed and used

Asim Ahmed Elnour; Nagy Hassan Ellahham; Huria Ismail Al Qassas

2008-01-01

385

Anticipating the impact of insurance expansion on inpatient urological surgery  

PubMed Central

PURPOSE The Affordable Care Act (ACA) is expected to provide coverage for nearly twenty-five million previously uninsured individuals. Because the potential impact of the ACA for urological care remains unknown, we estimated the impact of insurance expansion on the utilization of inpatient urological surgeries using Massachusetts (MA) healthcare reform as a natural experiment. METHODS We identified nonelderly patients who underwent inpatient urological surgery from 2003 through 2010 using inpatient databases from MA and two control states. Using July 2007 as the transition point between pre- and post-reform periods, we performed a difference-indifferences (DID) analysis to estimate the effect of insurance expansion on overall and procedure-specific rates of inpatient urological surgery. We also performed subgroup analyses according to race, income and insurance status. RESULTS We identified 1.4 million surgeries performed during the study interval. We observed no change in the overall rate of inpatient urological surgery for the MA population as a whole, but an increase in the rate of inpatient urological surgery for non-white and low income patients. Our DID analysis confirmed these results (all 1.0%, p=0.668; non-whites 9.9%, p=0.006; low income 6.6%, p=0.041). At a procedure level, insurance expansion caused increased rates of inpatient BPH procedures, but had no effect on rates of prostatectomy, cystectomy, nephrectomy, pyeloplasty or PCNL. CONCLUSIONS Insurance expansion in Massachusetts increased the overall rate of inpatient urological surgery only for non-whites and low income patients. These data inform key stakeholders about the potential impact of national insurance expansion for a large segment of urological care. PMID:25506058

Ellimoottil, Chandy; Miller, Sarah; Wei, John T.; Miller, David C.

2014-01-01

386

From inpatient to inn status. A new residential model.  

PubMed

This article presents a new residential model that has been developed at the Massachusetts Mental Health Center. The "dormitory-inn" provides an alternative to 24-hour inpatient hospitalization for patients who traditionally would have been admitted and retained on inpatient services. Issues covered include hours and location, referrals, requirements for staff, medical and nursing coverage, and a review of the efficacy of the program. PMID:4059089

Gudeman, J E; Dickey, B; Hellman, S; Buffett, W

1985-09-01

387

Cost drivers of inpatient mental health care: a systematic review.  

PubMed

Aims. New reimbursement schemes for inpatient mental health care are imminent in the UK and Germany. The shared intention is to reflect cost differences between patients in reimbursement rates. This requires understanding of patient characteristics that influence hospital resource use. The aim of this review was to show which associations between mental health care per diem hospital costs and patient characteristics are supported by current evidence. Methods. A systematic review of the literature published between 1980 and 2012 was carried out. The search strategy included electronic databases and hand-searching. Furthermore, reference lists, citing articles and related publications were screened and experts were contacted. Results. The search found eight studies. Dispersion in per diem costs was moderate, as was the ability to explain it with patient characteristics. Six patient characteristics were identified as the most relevant variables. These were (1) age, (2) major diagnostic group, (3) risk, (4) legal problems, (5) the ability to perform activities of daily living and (6) presence of psychotic or affective symptoms. Two non-patient-related factors were identified. These were (1) day of stay and (2) treatment site. Conclusions. Idiosyncrasies of mental health care complicated the prediction of per diem hospital costs. More research is required in European settings since transferability of results is unlikely. PMID:24330922

Wolff, J; McCrone, P; Koeser, L; Normann, C; Patel, A

2015-02-01

388

A methodology to estimate the potential to move inpatient to one day surgery  

PubMed Central

Background The proportion of surgery performed as a day case varies greatly between countries. Low rates suggest a large growth potential in many countries. Measuring the potential development of one day surgery should be grounded on a comprehensive list of eligible procedures, based on a priori criteria, independent of local practices. We propose an algorithmic method, using only routinely available hospital data to identify surgical hospitalizations that could have been performed as one day treatment. Methods Moving inpatient surgery to one day surgery was considered feasible if at least one surgical intervention was eligible for one day surgery and if none of the following criteria were present: intervention or affection requiring an inpatient stay, patient transferred or died, and length of stay greater than four days. The eligibility of a procedure to be treated as a day case was mainly established on three a priori criteria: surgical access (endoscopic or not), the invasiveness of the procedure and the size of the operated organ. Few overrides of these criteria occurred when procedures were associated with risk of immediate complications, slow physiological recovery or pain treatment requiring hospital infrastructure. The algorithm was applied to a random sample of one million inpatient US stays and more than 600 thousand Swiss inpatient stays, in the year 2002. Results The validity of our method was demonstrated by the few discrepancies between the a priori criteria based list of eligible procedures, and a state list used for reimbursement purposes, the low proportion of hospitalizations eligible for one day care found in the US sample (4.9 versus 19.4% in the Swiss sample), and the distribution of the elective procedures found eligible in Swiss hospitals, well supported by the literature. There were large variations of the proportion of candidates for one day surgery among elective surgical hospitalizations between Swiss hospitals (3 to 45.3%). Conclusion The proposed approach allows the monitoring of the proportion of inpatient stay candidates for one day surgery. It could be used for infrastructure planning, resources negotiation and the surveillance of appropriate resource utilization. PMID:16784523

Gilliard, Nicolas; Eggli, Yves; Halfon, Patricia

2006-01-01

389

Annual cost of hospitalization, inpatient rehabilitation, and sick leave for head and neck cancers in Germany  

PubMed Central

Background Data on the economic burden of head and neck cancers (HNCs) in Germany is scarce. About 16%–28% of these cancers are associated with human papillomavirus (HPV) infection. Therefore, the study reported here aimed to assess the annual costs of HPV-related HNCs incurred by hospitalization, inpatient rehabilitation, and sick leave in Germany in 2008. Methods A cross-sectional retrospective analysis of five German databases covering hospital treatment, inpatient rehabilitation, and sick leave in 2008 was performed. All hospital, inpatient rehabilitation, and sick leave cases due to HNCs in 2008 were analyzed. Associated numbers of HNC hospitalizations, health care resource use, and costs were identified and extracted using the International Classification of Diseases, tenth revision (ICD-10; World Health Organization, Geneva, 1990) codes C01–C06, C09–C14, and C32 as the main diagnoses. Resources were valued with German official prices in 2008 euros (€). The annual costs of HPV-related HNCs were estimated based on the percentage of HNCs likely to be attributable to HPV infection. Results In 2008, there were 63,857 hospitalizations, 4898 inpatient rehabilitations, and 17,494 sick leaves due to HNCs, representing costs of €365.78 million. The estimated annual costs associated with HPV-related HNCs were €78.22 million, mainly attributed to males (80%). Direct costs accounted for 84% (80% for hospital treatment, 4% for inpatient rehabilitation) and indirect costs due to sick leave accounted for 16% of HPV-related HNC costs. Conclusion The economic burden of HPV-related HNCs in Germany in 2008 has been underestimated, since costs incurred by outpatient management, outpatient chemotherapy, long-term care, premature retirement, and premature death were not included. However, as far as we are aware, this study is the first analysis to investigate the economic burden of HNCs in Germany. The estimated annual costs of HPV-related HNCs contribute to a significant economic burden in Germany and should be considered when assessing the health and economic benefits of HPV vaccination in both sexes. PMID:23717047

Klussmann, Jens P; Schädlich, Peter K; Chen, Xiaoyu; Rémy, Vanessa

2013-01-01

390

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

Microsoft Academic Search

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

Andrew M McMillan; Karl B Landorf; Mark F Gilheany; Adam R Bird; Adam D Morrow; Hylton B Menz

2010-01-01

391

Functional Magnetic Resonance Imaging Clinical Trial of a Dual-Processing Treatment Protocol for Substance-Dependent Adults  

ERIC Educational Resources Information Center

Objectives: Empirical evidence suggests substance dependence creates stress system dysregulation which, in turn, may limit the efficacy of verbal-based treatment interventions, as the recovering brain may not be functionally capable of executive level processing. Treatment models that target implicit functioning are necessary. Methods: An RCT was…

Matto, Holly C.; Hadjiyane, Maria C.; Kost, Michelle; Marshall, Jennifer; Wiley, Joseph; Strolin-Goltzman, Jessica; Khatiwada, Manish; VanMeter, John W.

2014-01-01

392

Changing the facial features of patients with Treacher Collins syndrome: protocol for 3-stage treatment of hard and soft tissue hypoplasia in the upper half of the face.  

PubMed

Treacher Collins syndrome is a disorder characterized by various congenital soft tissue anomalies involving hypoplasia of the zygoma, maxilla, and mandible. A variety of treatments have been reported to date. These treatments can be classified into 2 major types. The first type involves osteotomy for hard tissue such as the zygoma and mandible. The second type involves plastic surgery using bone grafting in the malar region and soft tissue repair of eyelid deformities. We devised a new treatment to comprehensively correct hard and soft tissue deformities in the upper half of the face of Treacher Collins patients. The aim was to "change facial features and make it difficult to tell that the patients have this disorder." This innovative treatment strategy consists of 3 stages: (1) placement of dermal fat graft from the lower eyelid to the malar subcutaneous area, (2) custom-made synthetic zygomatic bone grafting, and (3) Z-plasty flap transposition from the upper to the lower eyelid and superior repositioning and fixation of the lateral canthal tendon using a Mitek anchor system. This method was used on 4 patients with Treacher Collins syndrome who had moderate to severe hypoplasia of the zygomas and the lower eyelids. Facial features of these patients were markedly improved and very good results were obtained. There were no major complications intraoperatively or postoperatively in any of the patients during the series of treatments. In synthetic bone grafting in the second stage, the implant in some patients was in the way of the infraorbital nerve. Thus, the nerve was detached and then sutured under the microscope. Postoperatively, patients had almost full restoration of sensory nerve torpor within 5 to 6 months. We devised a 3-stage treatment to "change facial features" of patients with hypoplasia of the upper half of the face due to Treacher Collins syndrome. The treatment protocol provided a very effective way to treat deformities of the upper half of the face in patients with Treacher Collins syndrome. PMID:23511742

Mitsukawa, Nobuyuki; Saiga, Atsuomi; Satoh, Kaneshige

2014-07-01

393

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

PubMed Central

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 controversies as to the cognitive side effects. The aim of this study is to compare the effects and side effects of electroconvulsive therapy to pharmacological treatment in treatment resistant bipolar depression. Cognitive changes and quality of life during the treatment will be assessed. Methods/Design A prospective, randomised controlled, multi-centre six- week acute treatment trial with seven clinical assessments. Follow up visit at 26 weeks or until remission (max 52 weeks). A neuropsychological test battery designed to be sensitive to changes in cognitive function will be used. Setting: Nine study centres across Norway, all acute psychiatric departments. Sample: n = 132 patients, aged 18 and over, who fulfil criteria for treatment resistant depression in bipolar disorder, Montgomery Åsberg Depression Rating Scale Score of at least 25 at baseline. Intervention: Intervention group: 3 sessions per week for up to 6 weeks, total up to 18 sessions. Control group: algorithm-based pharmacological treatment as usual. Discussion This study is the first randomized controlled trial that aims to investigate whether electroconvulsive therapy is better than pharmacological treatment as usual in treatment resistant bipolar depression. Possible long lasting cognitive side effects will be evaluated. The study is investigator initiated, without support from industry. Trial registration NCT00664976 PMID:20178636

2010-01-01

394

Incidence of fractures requiring inpatient care  

PubMed Central

Background The overall incidence of fractures has been addressed in several studies, but there are few data on different types of fractures that require inpatient care, even though they account for considerable healthcare costs. We determined the incidence of limb and spine fractures that required hospitalization in people aged ? 16 years. Patients and methods We collected data on the diagnosis (ICD10 code), procedure code (NOMESCO), and 9 additional characteristics of patients admitted to the trauma ward of Central Finland Hospital between 2002 and 2008. Incidence rates were calculated for all fractures using data on the population at risk. Results and interpretation During the study period, 3,277 women and 2,708 men sustained 3,750 and 3,030 fractures, respectively. The incidence of all fractures was 4.9 per 103 person years (95% CI: 4.8–5.0). The corresponding numbers for women and men were 5.3 (5.1–5.4) and 4.5 (4.3–4.6). Fractures of the hip, ankle, wrist, spine, and proximal humerus comprised two-thirds of all fractures requiring hospitalization. The proportion of ankle fractures (17%) and wrist fractures (9%) was equal to that of hip fractures (27%). Four-fifths of the hospitalized fracture patients were operated. In individuals aged < 60 years, fractures requiring hospitalization were twice as common in men as in women. In individuals ? 60 years of age, the opposite was true. PMID:24694275

Somersalo, Axel; Kautiainen, Hannu; Lönnroos, Eija; Heinänen, Mikko; Kiviranta, Ilkka

2014-01-01

395

Impact of neoadjuvant chemotherapy with PELF-protocoll versus surgery alone in the treatment of advanced gastric carcinoma  

PubMed Central

Background In a retrospective study we analyzed the impact of neoadjuvant chemotherapy (CTx) with the PELF - protocol (Cisplatin, Epirubicin, Leukovorin, 5-Fluoruracil) on mortality, recurrence and prognosis of patients with advanced gastric carcinoma, UICC stages Ib-III. Methods 64 patients were included. 26 patients received neoadjuvant CTx followed by surgical resection, 38 received surgical resection only. Tumor staging was performed by endoscopy, endosonography, computed tomography and laparoscopy. Patients staged Ib – III received two cycles of CTx according to the PELF-protocol. Adjuvant chemotherapy was not performed at all. Results Complete (CR) or partial response (PR) was seen in 20 patients (77%), 19% showing CR and 58% PR. No benefit was observed in 6 patients (23%). Two of these 6 patients displayed tumor progression during CTx. Major toxicity was defined as grade 3 to 4 neutropenia or gastrointestinal side effects. One patient died under CTx because of neutropenia and was excluded from the overall patient collective. The curative resection rate was 77% after CTx and 74% after surgery only. The perioperative morbidity rate after CTx was 39% versus 66% after resection only. Recurrence rate after CTx was 38% and 61% after surgery alone; we detected an effective reduction of locoregional recurrence (12% vs. 26%). The overall survival was 38% after CTx and 42% after resection only. The 5-year survival rates were 45% in responders, 20% in non - responders and 42% in only resected patients. A subgroup analysis indicates that responders with stage III tumors may benefit with respect to their 5-year survival in comparable patients without neoadjuvant CTx. As to be expected, non-responders with stage III tumors did not benefit with respect to their survival. The 5-year-survival was approximated using a Kaplan-Meier curve and compared using a log-rank test. Conclusion In patients with advanced gastric carcinoma, neoadjuvant CTx with the PELF- protocol significantly reduces the recurrence rate, especially locoregionally, compared to surgery alone. In our study, there was no overall survival benefit after a 5-year follow-up period. Alone a subgroup of patients with stage III tumors appear to benefit significantly in the long term from neoadjuvant CTx. PMID:24461063

2014-01-01

396

Heavy Drinkers Unlikely to Receive Treatment  

MedlinePLUS

... or outpatient), rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private doctor’s office, self-help group, prison, or jail. Specialty treatment only includes treatment a ...

397

Internal structure of the MMPI-2 Addiction Potential Scale in alcoholic and psychiatric inpatients.  

PubMed

Recently, Weed, Butcher, McKenna, and Ben-Porath (1992) introduced two new scales for assessing alcohol and drug abuse with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989): the Addiction Potential Scale (APS), an empirically derived measure similar to the MacAndrew Alcoholism Scale (MAC; MacAndrew, 1965), and the Addiction Acknowledgement Scale. Like the MAC, the APS was designed to identify the personality dimensions associated with substance abuse. Although there has been evidence to support the discriminative validity of the APS among samples of abusers, nonabusers, and psychiatric inpatients (Greene, Weed, Butcher, Arrendondo, & Davis, 1992; Weed et al., 1992), there has been no attempt to determine the personality dimensions tapped by the APS. Thus our study investigated the internal complexities of the APS. Using MMPI-2 protocols from a sample of alcoholic and psychiatric inpatients, we subjected the APS to a principal components analysis with subsequent varimax rotation. Both qualitative and quantitative methods were used to name the components that were identified. Five components consistently emerged across settings: Satisfaction/Dissatisfaction with Self, Powerlessness/Lack of Self-Efficacy, Antisocial Acting-Out, Surgency, and Risk-Taking/Recklessness, Clinical advantage gained from a knowledge of the internal structure of the APS was illustrated using 6 patients from the alcoholic sample. A rational approach to validating the empirical structure of the APS was discussed as a potential avenue for future research. PMID:8576831

Sawrie, S M; Kabat, M H; Dietz, C B; Greene, R L; Arredondo, R; Mann, A W

1996-02-01

398

Enhancing the patient involvement in outcomes: a study protocol of personalised outcome measurement in the treatment of substance misuse  

PubMed Central

Background Involving patients in treatment is becoming increasingly popular in mental health [Sales & Alves: Personalized evaluation of psychological treatments: A review of tools and research designs, submitted]. However, in substance misuse treatment settings, the patient perspective about treatment tends to be overlooked. This has been cited as a key priority by Orford et al. [Addiction, 103: 875-885, 2008] who included patient feedback about treatment as one of ten areas requiring an urgent paradigm shift in addiction research and practice. This project will apply an innovative method to involve substance misuse patients in psychological therapies, by asking them to suggest topics to evaluate their treatment. These topics suggested by patients can be written as a list of personalised items, so-called as patient-generated outcome measures (PGOM). Despite its patient-friendly features, PGOM’s have never been used in this population, which is what this project aims to overcome. Methods/design This project is part of an International Exchange Platform on Personalising Addiction Treatment. Data will be collected in two phases (pre-post study and focus groups with patients) to explore the following: 1). How reliable and sensitive to change are PGOM’s and standardised measures in substance misuse treatment? 2). Do PGOM’s add relevant information to standardised measures? 3). What are the views of substance misuse patients about personalised outcome assessment? 4). Development of guidelines on using PGOM’s in this population Discussion This research will potentially demonstrate the diversity of personal problems among patients seeking substance misuse treatment, suggesting the relevance of PGOM as a method to personalise outcome measurement and, ultimately, guiding treatment provision. It is expected that, as in previous studies, PGOM’s will be perceived as helpful and patient-friendly tools, where patients may express their own concerns in a semi-structured setting. Similarly to other populations, we also expect PGOM’s to be reliable, valid and sensitive to clinical changes in substance misuse treatment, as well as more content informative than their standardised counterparts. If these results are achieved, we might hypothesize that PGOM’s are a potentially valid supplement to traditional standardised scales, by providing a closer insight to what motivates patients to participate in substance misuse treatment programmes. PMID:24341378

2013-01-01

399

STUDY PROTOCOL Open Access Cocaine Addiction Treatments to improve Control and reduce Harm (CATCH): New Pharmacological Treatment Options for Crack-Cocaine Dependence in the Netherlands  

E-print Network

Background: Cocaine, particularly in its base form (’crack’), has become one of the drugs of most concern in the Netherlands, being associated with a wide range of medical, psychiatric and social problems for the individual, and with significant public order consequences for society. Available treatment options for cocaine dependent users are limited, and a substantial part of the cocaine dependent population is not reached by the addiction treatment system. Psychosocial interventions for cocaine dependence generally show modest results, and there are no registered pharmacological treatments to date, despite the wide range of medications tested for this type of dependence. The present study (Cocaine Addiction Treatments to improve Control and reduce Harm; CATCH) investigates the possibilities and problems associated with new pharmacological treatments for crack dependent patients. Methods/Design: The CATCH-study consists of three separate randomised controlled, open-label, parallel-group feasibility trials, conducted at three separate addiction treatment institutes in the Netherlands. Patients are either new referrals or patients already in treatment. A total of 216 eligible outpatients are randomised using prerandomisation double-consent design and receive either 12 weeks treatment with oral topiramate (n = 36; Brijder Addiction Treatment, The Hague), oral modafinil (n = 36; Arkin, Amsterdam), or oral dexamphetamine sustainedrelease

Mascha Nuijten; Peter Blanken; Wim Van Den Brink; Vincent Hendriks

400

Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services  

PubMed Central

Background The debate on appropriate financing systems in inpatient psychiatry is ongoing. In this context, it is important to control resource use in terms of length of stay (LOS), which is the most costly factor in inpatient care and the one that can be influenced most easily. Previous studies have shown that psychiatric diagnoses provide only limited justification for explaining variation in LOS, and it has been suggested that measures such as psychopathology might be more appropriate to predict resource use. Therefore, we investigated the relationship between LOS and psychopathological syndromes or symptoms at admission as well as other characteristics such as sociodemographic and clinical variables. Methods We considered routine medical data of patients admitted to the Psychiatric University Hospital Zurich in the years 2008 and 2009. Complete data on psychopathology at hospital admission were available in 3,220 inpatient episodes. A subsample of 2,939 inpatient episodes was considered in final statistical models, including psychopathology as well as complete datasets of further measures (e.g. sociodemographic, clinical, treatment-related and psychosocial variables). We used multivariate linear as well as logistic regression analysis with forward selection procedure to determine the predictors of LOS. Results All but two syndrome scores (mania, hostility) were positively related to the length of stay. Final statistical models showed that syndromes or symptoms explained about 5% of the variation in length of stay. The inclusion of syndromes or symptoms as well as basic treatment variables and other factors led to an explained variation of up to 25%. Conclusions Psychopathological syndromes and symptoms at admission and further characteristics only explained a small proportion of the length of inpatient stay. Thus, according to our sample, psychopathology might not be suitable as a primary indicator for estimating LOS and contingent costs. This might be considered in the development of future costing systems in psychiatry. PMID:21801366

2011-01-01

401

Management of snakebite cases by national treatment protocol at Jalpaiguri District Hospital in West Bengal in the year 2010--a retrospective study.  

PubMed

Snakebite remains a public health problem in India, occurring most frequently in the summer and rainy seasons. Bites are maximal in lower limbs. Victims are typically male and between 17 and 27 years of age. Children and the elderly have higher mortality. The worst affected states are Kerala, Maharashtra, Tamil Nadu, Orissa, Assam and West Bengal. There was no uniform guideline for treatment of snakebite cases. The five common venomous Indian snakes biting humans are common cobra, krait, Russell's viper, saw scaled viper and the hump nose pit viper. Seventy per cent of all snakebites are non-venomous. Even in bites by venomous snakes, envenomation occurs in only 50% of cases. Immobilisation is much more important than tight ligature, which may cause gangrene. Only a minority need antivenom, which is expensive, short in supply and may cause severe reaction. Antivenom treatment is recommended on the basis of local and systemic signs and symptoms and 20 minutes whole blood clotting test (20WBCT). Delay in starting AVS treatment is the main cause of mortality and morbidity. Skin test is of no value. But antivenom should not be used unless specifically indicated. The "Do it RIGHT" approach of national treatment protocol indicates the initial steps to be taken before reaching a hospital or primary healthcare facility. And it resulted in a 66% decline in the amount of ASV administration and an absolute reduction of mortality by 24%. However first aid treatment of the bitten limb/area with broad-spectrum antibiotics, injection tetanus antitoxin and Supportive treatment with blood transfusion, ventilatory support, anticholinesterase and peritoneal dialysis may also be required. PMID:22315862

Ghosh, Manab Kumar

2011-08-01

402

A new treatment protocol using photobiomodulation and muscle/bone/joint recovery techniques having a dramatic effect on a stroke patient's recovery: a new weapon for clinicians.  

PubMed

The subject of this case study is a 29-year-old woman who suffered a brainstem stroke. She remained severely dizzy, had a non-functional left hand secondary to weakness, severe spasticity in the right hand, a right lateral sixth nerve palsy and was unable to ambulate on presentation. The stroke occurred 2 years before presentation. The subject had been treated for 21 months at two different stroke rehabilitation centres before presentation. Our stroke protocol includes photobiomodulation administered with the XR3T-1 device and 'muscle/bone/joint/soft tissue' recovery techniques. The patient was seen once a week for 8 weeks and treatment sessions lasted approximately 60 min. The results were dramatic: after 8 weeks of implementation of our protocol, the patient demonstrated positive change in every area of her deficits as determined by improvements in physical examination findings. The gains achieved at 8 weeks have been maintained to this day and she continues to be treated once every 4 weeks. PMID:22967677

Boonswang, N Ab; Chicchi, Mary; Lukachek, Adele; Curtiss, Donna

2012-01-01

403

The Effects of Inpatient Hybrid Closed-Loop Therapy Initiated Within 1 Week of Type 1 Diabetes Diagnosis  

PubMed Central

Abstract Background This article describes our experience with inpatient hybrid closed-loop control (HCLC) initiated shortly after the diagnosis of type 1 diabetes in a randomized trial designed to assess the effectiveness of inpatient HCLC followed by outpatient sensor-augmented pump (SAP) therapy on the preservation of ?-cell function. Subjects and Methods Forty-eight individuals with newly diagnosed type 1 diabetes and positive pancreatic autoantibodies (7.8–37.7 years old) received inpatient HCLC therapy for up to 93?h, initiated within 7 days of diagnosis. Results On initiation of HCLC, mean glucose concentration was 240±100?mg/dL. During the first day of HCLC, median of the participant's mean glucose concentrations fell rapidly to 146?mg/dL, a level of control that was sustained on Days 2 and 3 (138?mg/dL and 139?mg/dL, respectively). By Day 3, the median percentage of glucose values >250 and <60?mg/dL was <1%. During the first 2 weeks of SAP treatment at home, the median participant mean glucose level was 126?mg/dL (interquartile range, 117, 137?mg/dL), and the median percentage of values between 71 and 180?mg/dL was 85% (interquartile range, 80%, 90%). Conclusions Inpatient HCLC followed by outpatient SAP therapy can provide a safe and effective means to rapidly reverse glucose toxicity and establish near-normal glycemic control in patients with newly diagnosed type 1 diabetes. PMID:23570538

2013-01-01

404

Inpatient Treatment for Children and Adolescents with Substance Abuse Issues  

E-print Network

The report revealed that the bulk of the literature collectively examines adults and adolescents, rather than investigating the unique issues that adolescents with substance abuse issues have. The review explored outcome studies for in...

Oelklaus, Kirsten; Petr, Chris

2001-11-01

405

Age structure at diagnosis affects aggression in a psychiatric inpatient population: age structure affecting inpatient aggression.  

PubMed

Study of inpatient aggression in psychiatric inpatient units (PIUs), where vulnerable patients interact intensely in small groups, is hampered by a lack of systematic monitoring of aggressive events in the context of group dynamics. Our current study examines the relationship between aggression and group structure in the PIU of a general tertiary-care hospital over a 9-month period. The severity of aggression was monitored daily using the Overt Aggression Scale (OAS). Clinical data including the daily number and mean age of subpopulations with different diagnoses were acquired. Cross-correlation function and autoregressive integrated moving average modeling were used to assess the effects of various group structure parameters on the incidence of aggressive events in the PIU. The daily total OAS score correlated positively with the daily mean age of patients with schizophrenia and bipolar disorder. By contrast, the OAS total score demonstrated a negative correlation with the daily mean age of patients with major depression. The age of the patients at diagnosis is an important group structure that affects the incidence of aggression in a PIU. PMID:25453640

Cho, Un Jung; Lee, JooYoung; Kim, Hyo-Won; Lee, Jung Sun; Joo, Yeon-Ho; Kim, Seong-Yoon; Kim, Chang Yoon; Shin, Yong-Wook

2014-12-30

406

Assessing an enoxaparin dosing protocol in morbidly obese patients.  

PubMed

The effect of obesity on the pharmacokinetics of enoxaparin is not clearly understood and traditional treatment doses in morbidly obese patients (body mass index [BMI] > 40 kg/m(2)) can lead to over anticoagulation. Our institution developed an inpatient protocol with reduced enoxaparin doses (0.75 mg/kg/dose based on actual body weight) for patients with a weight >200 kg or BMI > 40 kg/m(2). The primary objective was to determine if modified enoxaparin treatment doses would achieve therapeutic anti-Xa levels (goal range 0.6-1.0 IU/mL) in morbidly obese patients. Thirty-one patients were included in our study and had a median body weight of 138 kg (range 105-197) and a median BMI of 46.2 kg/m(2) (range 40.1-62). The initial peak anti-Xa levels were in therapeutic range in 15 of 31 patients (48 %) with an initial mean anti-Xa level of 0.92 IU/mL. Twenty-four patients (77 %) achieved therapeutic anti-Xa levels in goal range during their hospitalization, with a mean enoxaparin dose of 0.71 mg/kg. Bleeding and thrombotic events were minimal and all patients that achieved an anti-Xa level in goal range did so with a dose less than 1 mg/kg of enoxaparin. PMID:25087072

Lalama, Jeffrey T; Feeney, Megan E; Vandiver, Jeremy W; Beavers, K Diane; Walter, Leah N; McClintic, Jacqueline R

2015-05-01

407

Brain imaging predictors and the international study to predict optimized treatment for depression: study protocol for a randomized controlled trial  

PubMed Central

Background Approximately 50% of patients with major depressive disorder (MDD) do not respond optimally to antidepressant treatments. Given this is a large proportion of the patient population, pretreatment tests that predict which patients will respond to which types of treatment could save time, money and patient burden. Brain imaging offers a means to identify treatment predictors that are grounded in the neurobiology of the treatment and the pathophysiology of MDD. Methods/Design The international Study to Predict Optimized Treatment in Depression is a multi-center, parallel model, randomized clinical trial with an embedded imaging sub-study to identify such predictors. We focus on brain circuits implicated in major depressive disorder and its treatment. In the full trial, depressed participants are randomized to receive escitalopram, sertraline or venlafaxine-XR (open-label). They are assessed using standardized multiple clinical, cognitive-emotional behavioral, electroencephalographic and genetic measures at baseline and at eight weeks post-treatment. Overall, 2,016 depressed participants (18 to 65 years old) will enter the study, of whom a target of 10% will be recruited into the brain imaging sub-study (approximately 67 participants in each treatment arm) and 67 controls. The imaging sub-study is conducted at the University of Sydney and at Stanford University. Structural studies include high-resolution three-dimensional T1-weighted, diffusion tensor and T2/Proton Density scans. Functional studies include standardized functional magnetic resonance imaging (MRI) with three cognitive tasks (auditory oddball, a continuous performance task, and Go-NoGo) and two emotion tasks (unmasked conscious and masked non-conscious emotion processing tasks). After eight weeks of treatment, the functional MRI is repeated with the above tasks. We will establish the methods in the first 30 patients. Then we will identify predictors in the first half (n?=?102), test the findings in the second half, and then extend the analyses to the total sample. Trial registration International Study to Predict Optimized Treatment - in Depression (iSPOT-D). ClinicalTrials.gov, NCT00693849. PMID:23866851

2013-01-01

408

Corticosteroid treatment for community-acquired pneumonia - the STEP trial: study protocol for a randomized controlled trial  

PubMed Central

Background Community-acquired pneumonia (CAP) is the third-leading infectious cause of death worldwide. The standard treatment of CAP has not changed for the past fifty years and its mortality and morbidity remain high despite adequate antimicrobial treatment. Systemic corticosteroids have anti-inflammatory effects and are therefore discussed as adjunct treatment for CAP. Available studies show controversial results, and the question about benefits and harms of adjunct corticosteroid therapy has not been conclusively resolved, particularly in the non-critical care setting. Methods/Design This randomized multicenter study compares a treatment with 7 days of prednisone 50 mg with placebo in adult patients hospitalized with CAP independent of severity. Patients are screened and enrolled within the first 36 hours of presentation after written informed consent is obtained. The primary endpoint will be time to clinical stability, which is assessed every 12 hours during hospitalization. Secondary endpoints will be, among others, all-cause mortality within 30 and 180 days, ICU stay, duration of antibiotic treatment, disease activity scores, side effects and complications, value of adrenal function testing and prognostic hormonal and inflammatory biomarkers to predict outcome and treatment response to corticosteroids. Eight hundred included patients will provide an 85% power for the intention-to-treat analysis of the primary endpoint. Discussion This largest to date double-blind placebo-controlled multicenter trial investigates the effect of adjunct glucocorticoids in 800 patients with CAP requiring hospitalization. It aims to give conclusive answers about benefits and risks of corticosteroid treatment in CAP. The inclusion of less severe CAP patients will be expected to lead to a relatively low mortality rate and survival benefit might not be shown. However, our study has adequate power for the clinically relevant endpoint of clinical stability. Due to discontinuing glucocorticoids without tapering after seven days, we limit duration of glucocorticoid exposition, which may reduce possible side effects. Trial registration 7 September 2009 on ClinicalTrials.gov: NCT00973154. PMID:24974155

2014-01-01

409

Trends in Neutropenia-Related Inpatient Events  

PubMed Central

Purpose: Neutropenic complications (NCs) after myelosuppressive chemotherapy are associated with significant morbidity and mortality. We described NC rates by using US hospital discharge data. Materials and Methods: This cross-sectional analysis used data from the US National Inpatient Sample database. Hospital discharges with cancer diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code) from 1989 to 2007 were analyzed for the ICD-9-CM neutropenia code. NC rates per 10,000 discharges were calculated for all adult discharges without radiation therapy (study population, all cancers); lung cancer, breast cancer, and non-Hodgkin's lymphoma (NHL); and all three combined. The use of growth factors and myelosuppressive chemotherapy from 1994 to 2008 was estimated by using the IMS Health Drug Distribution Database. Results: Estimated lung cancer and breast cancer discharges remained relatively steady, whereas NHL discharges increased. NC rates for each study cancer increased two-fold until the late 1990s before stabilizing and/or declining. The average hospital stay for all three cancers decreased from 10.4 days to 7.1 days. The mortality rates for NCs for the three cancers combined decreased at a fairly constant rate from 10% in 1989 to 5.4% in 2007. Estimated discharges for NCs from 1989 to 2007 ranged from 111,000 to 169,000 for the study population, from 57,000 to 103,000 for all cancers, and from 21,000 to 40,000 for the three study cancers. The use of growth factors and myelosuppressive chemotherapy increased from 1994 to 2008. Conclusion: Whereas the number of hospitalizations with cancer diagnoses has remained steady since 1989, hospitalizations for NCs increased approximately two-fold from 1989 to 1997 and then stabilized. PMID:22942808

Kozma, Chris M.; Dickson, Michael; Chia, Victoria; Legg, Jason; Barron, Richard

2012-01-01

410

42 CFR 483.360 - Consultation with treatment team physician.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 false Consultation with treatment team physician. 483.360 Section...or Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric...21 § 483.360 Consultation with treatment team physician. If a...

2011-10-01

411

42 CFR 483.360 - Consultation with treatment team physician.  

Code of Federal Regulations, 2014 CFR

...2014-10-01 false Consultation with treatment team physician. 483.360 Section...or Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric...21 § 483.360 Consultation with treatment team physician. If a...

2014-10-01

412

42 CFR 483.360 - Consultation with treatment team physician.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 false Consultation with treatment team physician. 483.360 Section...or Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric...21 § 483.360 Consultation with treatment team physician. If a...

2013-10-01

413

42 CFR 483.360 - Consultation with treatment team physician.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 false Consultation with treatment team physician. 483.360 Section...or Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric...21 § 483.360 Consultation with treatment team physician. If a...

2010-10-01

414

Evidence-based complementary and alternative medicine in inpatient care: take a look at europe.  

PubMed

The aim of this report is to provide the reader an overview of the complex therapy currently used within the German health system. Complex therapies in inpatient care in Germany establish the basis for an integrative and interdisciplinary provision of services. They define minimal criteria for the organization of a hospital, enable the integration of different therapeutic approaches, and therefore, lead to an intensive and holistic treatment by a specially trained team. The German model can be viewed as a pilot program for the introduction of integrative patient-centered care in other hospitals around the world. PMID:25404750

Romeyke, Tobias; Stummer, Harald

2015-04-01

415

Special issues in the care of ultra-orthodox Jewish psychiatric in-patients.  

PubMed

This article reviews the literature regarding psychiatric care of ultra-orthodox Jewish patients. The discussion describes common areas of difficulty working with members of this population in an in-patient setting, including ritual observance, gender dynamics, and countertransference. It provides guidelines for mental health professionals to distinguish between culturally-appropriate and pathological behavior in an effort to avoid misdiagnosis, and offers strategies for overcoming these challenges. It suggests possible adjustments to standard treatment plans which may prove effective in this population and recommends further resources, including the involvement of trained chaplains, for especially complicated situations. PMID:20940273

Popovsky, Rabbi Mark A

2010-09-01