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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

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

3

Therapeutic recreation treatment time during inpatient rehabilitation  

PubMed Central

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

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

2011-01-01

4

Group treatment of adult male inpatients abused as children  

Microsoft Academic Search

Recent research indicates that childhood abuse experiences characterize a large subset of psychiatric inpatients. This paper presents a time-limited pilot group developed for adult male abuse survivors in an inpatient setting using: (1) techniques adapted from the existing literature on treatment of abuse survivors; and (2) approaches deriving from the interface of theory and current manifestations of distress. The eclectic

Lisa Y. Zaidi

1994-01-01

5

Mortality in alcoholic patients given inpatient treatment.  

PubMed

Data on mortality during a 48-month follow-up period in a group of 1410 alcoholics who had received inpatient treatment were evaluated. In 1266 patients known to be either living or deceased the death rate was 7.6%. The percentage of deceased subjects was highest in the group over 50 years of age. The mortality rate was higher for men (9.8%) than for women (4.8%); for those with more than one divorce (16.8%); for those who were not fit for work (18.1%) or were retired at the start of the treatment (43.3%); who were employed in the alcohol business (21.7%); who had reduced their alcohol consumption before treatment (13.4%); who were unemployed 6 months after discharge (12.4%). The mortality rate was higher for those with high scores on a scale assessing calmness in a personality inventory (7.9%) and low scores on a questionnaire assessing motivation (10.9%) and insight into the need of change (12.4%). Alcohol-related illness before the index treatment played an important role: the mortality rate was higher for those who had had Wernicke-Korsakoff syndrome (40%), delirium tremens (15.3%), pancreatitis (13.9%) or cardiomyopathy (14.1%). The mortality rate was higher for treatment dropouts (12.9%) and for those who regularly or occasionally took sleeping pills (28.5%), psychoactive drugs (15.1%) or other drugs (11.5%) during treatment. In the follow-up periods substance use had a great effect on mortality. The mortality rate for those patients who still abstained from alcohol after 6 months (4.4%) was only a third of that for the patients who had relapsed (12.4%).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8081182

Feuerlein, W; Küfner, H; Flohrschütz, T

1994-07-01

6

Effects of a single-session assertiveness music therapy role playing protocol for psychiatric inpatients.  

PubMed

The purpose of this study was to implement and measure the effectiveness of a single-session assertiveness music therapy role playing protocol for psychiatric inpatients. Participants (N=133) were randomly assigned by group to one of three conditions: (a) Assertiveness Music Therapy, (b) No Music Assertiveness, or (c) Music No Assertiveness. Participants in both assertiveness conditions role played a number of different commonly occurring scenarios at an inpatient psychiatric facility and in the community. There were no significant between-group differences in posttest quality of life, locus of control, or other subscales. However, participants in both assertiveness conditions tended to have slightly higher internal locus of control and overall quality of life scores than participants in the music no assertiveness condition. Additionally, the assertiveness music therapy condition had higher attendance rates than the other conditions. A higher percentage of participants from both the assertiveness music therapy and music no assertiveness conditions indicated they thought their session was the most helpful/therapeutic group therapy session in which they had participated; this was not the case for the assertiveness no music condition. Future research is warranted to measure the effects of protocols that can help psychiatric patients generalize skills learned in treatment. PMID:22097104

Silverman, Michael J

2011-01-01

7

The Effects of Cognitive-Behavioral Treatment for Forensic Inpatients  

Microsoft Academic Search

The effects of an intramural cognitive-behavioral treatment for forensic inpatients with personality disorders in a high-security hospital were examined. Treatment was aimed at modifying maladaptive coping and social skills, at enhancing social awareness, at reducing egoistic and oppositional behaviors, and at reducing psychological complaints. The patients, who all had committed serious crimes (violence, arson, sexual offences), participated voluntarily in the

Irma G. H. Timmerman; Paul M. G. Emmelkamp

2005-01-01

8

[Nurturance of children during inpatient psychiatric treatment of their parents].  

PubMed

About a third of all inpatients in psychiatric hospitals are parents of children aged below 18 years. The mental illness of a parent and especially the need of inpatient treatment burdens families. This study was contributed to assess parental stress, behavioural and emotional problems of the children and the needs of psychiatric inpatients for support. Barriers and hindrances as well as positive experience with support for their children were assessed. All psychiatric hospitals in a county with about 1.5 million inhabitants in South-West Germany participated in this study. From 643 inpatients after drop-out 83 (54 female, 29 male) patients with non full aged children were questioned with inventories as the SDQ, the PSS and further assessments. Diagnoses and biographic data were assessed by the documentation of the German Association of psychiatry and psychotherapy. Parents reported about an increased level of stress by parenthood (PSS mean 41.9, SD 9.4). Psychopathology of the children influenced the stress of the mentally ill parents. 40% of the patients are dissatisfied with the care of their children during their inpatient treatment, but 51% have strong resentments against the youth welfare custodies and do not ask for support. Our results prove the high negative attitude of mentally ill parents against youth welfare service which must be reduced by active information policy and offers in collaboration with the treating psychiatrist of the parents. PMID:19143235

Kölch, Michael; Schmid, Marc

2008-01-01

9

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

Code of Federal Regulations, 2012 CFR

...2012-10-01 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...

2012-10-01

10

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

Code of Federal Regulations, 2011 CFR

...2011-10-01 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...

2011-10-01

11

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

12

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

Code of Federal Regulations, 2013 CFR

...2013-10-01 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...

2013-10-01

13

Correlates of Burnout in Inpatient Substance Abuse Treatment Therapists.  

ERIC Educational Resources Information Center

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

Elman, Barnett D.; Dowd, Edmund Thomas

1997-01-01

14

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

Microsoft Academic Search

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

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

2011-01-01

15

The impact of evidence on physicians’ inpatient treatment decisions  

Microsoft Academic Search

OBJECTIVE: Previous studies have shown that most medical inpatients receive treatment supported by strong evidence (evidence-based treatment),\\u000a but they have not assessed whether and how physicians actually use evidence when making their treatment decisions. We investigated\\u000a whether physicians would change inpatient treatment if presented with the results of a literature search.\\u000a \\u000a \\u000a DESIGN: Before-after study.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: Large public teaching hospital.\\u000a \\u000a \\u000a \\u000a \\u000a PARTICIPANTS:

Brian P. Lucas; Arthur T. Evans; Brendan M. Reilly; Yuri V. Khodakov; Kalyani Perumal; Louis G. Rohr; Joseph A. Akamah; Tunji M. Alausa; Christopher A. Smith; Jeremy P. Smith

2004-01-01

16

Inpatient Treatment of Children and Adolescents  

E-print Network

). Of the seven additional outcome studies included from the 1990's, none were a true experimental design with control group. One study had a waiting-list control group with a comparison group, but did not make random assignment (5). One study was quasi-experimental...). Of the seven studies, which were not analyses, five gave followup measures. The body of outcome research on this topic is quite limited, especially in the following ways: • Lack of experimental or even quasi-experimental designs. • Length of stay and treatment...

Barfield, Sharon T.; Petr, Chris

2001-10-01

17

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

18

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

Microsoft Academic Search

The current study examined descriptive characteristics of women 35 years and older seeking inpatient treatment for an eating disorder. A second purpose was to compare characteristics and treatment experiences of midlife patients to young adult patients. Participants were 193 women admitted for treatment to a residential eating disorders facility. All of the women received the standard inpatient treatment package offered

Maryelizabeth forman; William N. Davis

2005-01-01

19

Perceptions Of Treatment Helpfulness And Depressive Symptomology In Psychiatric Inpatients On A Cognitive Therapy Unit  

Microsoft Academic Search

This study examined 123 psychiatric inpatients' perceptions of treatment helpfulness using the Treatment Experience Questionnaire (TEQ), a measure that includes perceived elpfulness ratings for specific cognitive and non-cognitive aspects of treatment. It was predicted that (a) the inpatients on the cognitive therapy unit would perceive the cognitive therapy components of the program as more helpful than the non-cognitive components, and

Robert D. Friedberg; Donald J. Viglione; Bobby L. Stinson; Kathleen G. Beal; Raymond A. Fidaleo; Bobbie Celeste

1999-01-01

20

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

21

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

22

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

23

Cost variation in child and adolescent psychiatric inpatient treatment  

Microsoft Academic Search

Publicly available costs data for child and adolescent psychiatric inpatient services do not allow links to be made with patients’\\u000a needs and outcomes. Without this information commissioners may reduce the role of inpatient services on the basis of budgetary\\u000a impacts alone. This study estimates the support costs before, during and after an inpatient admission and explores the associations\\u000a between costs,

Jennifer K. Beecham; Jonathan Green; Brian Jacobs; Graham Dunn

2009-01-01

24

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

25

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

26

Psychology treatment time during inpatient spinal cord injury rehabilitation  

PubMed Central

Background Rehabilitation psychologists are integral members of spinal cord injury (SCI) rehabilitation teams. Objective To describe specific information regarding types and intensity of treatments delivered by rehabilitation psychologists to patients with various levels of SCI. Methods Utilizing a taxonomy of psychological interventions as a framework, rehabilitation psychologists documented time spent on specific psychology interventions for each interaction they had with 600 patients with traumatic SCI at 6 inpatient SCI rehabilitation centers. Associations of patient and injury characteristics with time spent on various psychological interventions were examined using ordinary least squares stepwise regression models. Results Psychologists focus the majority of the time they spend with patients with SCI on psychotherapeutic interventions of processing emotions, emotional adjustment, and family coping, while educational efforts focus mostly on coping and adjusting to the new injury. There was wide variation in the amount of time spent on psychotherapeutic and psychoeducational interventions; patient, injury, and clinician characteristics explained little of the variation in time spent. Conclusions Variations observed in psychological treatment delivery mirror real-world human complexity and clinical experience; they are not explained well by patient and injury characteristics and set the stage for future analyses to associate treatments with outcomes. PMID:21675358

Huston, Toby; Gassaway, Julie; Wilson, Catherine; Gordon, Samuel; Koval, Jill; Schwebel, Andrea

2011-01-01

27

Epidemiology, symptoms, and treatment characteristics of hyponatremic psychiatric inpatients.  

PubMed

Hyponatremia is a common phenomenon in psychiatry occurring as an adverse effect to drugs or following polydipsia. We performed a retrospective in-depth analysis of hyponatremia cases in a large unselected population of psychiatric inpatients. During a 3-year period, all cases of hyponatremia were identified among patients admitted to a large psychiatric state and university hospital by the institution's electronic laboratory database. Demographic, treatment-related, and laboratory data were obtained by consecutive chart review, respectively. Hyponatremia occurred in 347 (4.9%) of 7113 cases, of which the majority (78%) displayed only a mild manifestation. Symptoms were recorded in 28.8% of cases, already occurred in mild forms, and comprised gait impairment (45%, including falls), confusion (30%), sedation (26%), and dyspepsia (41%). Age, female sex, nonpsychiatric drug polypharmacy-particularly with thiazides and/or angiotensin-converting enzyme inhibitors-and diagnosis of a mood disorder were associated with more severe hyponatremia, respectively. The proportion of hyponatremic patients treated with venlafaxine, trazodone, carbamazepine, oxcarbazepine, and first-generation antipsychotics, respectively, was significantly higher in the hyponatremia sample than in the normonatremic population. This was, surprisingly, not the case with selective serotonin reuptake inhibitors or any other antidepressant drug class. We found prescription with second-generation antipsychotics to be significantly associated with less severe hyponatremia.Hyponatremia may be mainly attributed to the syndrome of inappropriate antidiuretic hormone secretion, as indicated by decreased serum osmolarity in our sample. Besides old age and female sex, treatment with certain drugs-rather than whole drug classes-carries a substantially increased risk. PMID:24052056

Lange-Asschenfeldt, Christian; Kojda, Georg; Cordes, Joachim; Hellen, Florence; Gillmann, Andreas; Grohmann, Renate; Supprian, Tillmann

2013-12-01

28

[Outpatient treatment of metacarpal and phalangeal fractures leads to similar outcomes compared to inpatient treatment].  

PubMed

Metacarpal and phalangeal fracture fixation may be conducted in ambulatory or inpatient settings. However, to date, little is known about the outcomes of the surgical treatment of metacarpal and phalangeal fractures in the two population groups. The aim of this study was to compare the surgical outcomes of patients undergoing treatment for metacarpal and phalangeal fractures in the ambulatory setting as compared to those in in-hospital settings. All patients who were surgically treated for metacarpal and phalangeal fractures at our institution were enrolled in this study. All patients treated non-surgically, as well as those who had sustained open fractures, were excluded from the study. A total of 85 patients met our inclusion criteria. Based on the length of hospital stay, patients were divided into two groups: inpatient (>?24 hours) and outpatient (inpatient group had a significantly higher mean Cooney score (mean: 93.5; range, 70-100; SD 8.8; 95?% CI?=?87.2, 99.8) after metacarpal fracture fixation than the outpatient group (mean: 82.5; range: 55-100; SD 14.5; 95?% CI?=?75.3, 89.7) (p?=?0.01). There was no statistically significant difference on comparing the mean proportion of total active motion (% TAM) relative to the contralateral uninjured side between the inpatient and outpatient groups (p?>?0.05). The overall complication rate was 20.7?% (n?=?11). The most common complication was postoperative infection with six cases (three inpatients; three outpatients). Outpatient surgical treatment of metacarpal and phalangeal fractures results in similar outcomes compared to inpatient treatment. Outpatient treatment of metacarpal and phalangeal fractures should be considered whenever possible. PMID:21984426

Paulus, C; Suero, E M; Schütz, L; Josten, C; Citak, M

2011-10-01

29

Pharmacological Treatment of Behavioural and Psychological Symptoms of Dementia in Psychogeriatric Inpatient Units  

Microsoft Academic Search

Objective: This study involved an examination of the current patterns of pharmacological treatment of patients with behavioural and psychological symptoms of dementia (BPSD) in psychogeriatric inpatient units.Method: An audit was conducted of discharge medications of patients with BPSD who were hospitalized at three separate inpatient units in Perth, Western Australia over a 1-year period.Results: Prescribing patterns were found to be

Sam Restifo; Vivienne Lemon; Flavie Waters

2011-01-01

30

Psychopathological features of anorectic patients who dropped out of inpatient treatment as assessed by the Minnesota Multiphasic Personality Inventory  

Microsoft Academic Search

BACKGROUND: Anorexia nervosa often requires inpatient treatment that includes psychotherapeutic intervention in addition to physical and nutritional management for severe low body weight. However, such patients sometimes terminate inpatient treatment prematurely because of resistance to treatment, poor motivation for treatment, unstable emotions, and problematic behaviors. In this study, the psychopathological factors related to the personality of anorexic patients that might

Takehiro Nozaki; Satoko Motoyama; Tatsuyuki Arimura; Chihiro Morita; Chikako Koreeda-Arimura; Keisuke Kawai; Masato Takii; Chiharu Kubo

2007-01-01

31

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

ERIC Educational Resources Information Center

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

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

2009-01-01

32

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

Microsoft Academic Search

The treatment outcome of a high-intensity inpatient sex offender treatment program was evaluated by comparing the sexual recidivism rates of 472 treated and 282 untreated sex offenders. The program is designed for moderate- to high-risk sex offenders and follows the principles of effective correctional treatment. The current investigation is an extension of an earlier study (Nicholaichuk et al., 2000) with

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

2009-01-01

33

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

Microsoft Academic Search

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

Walter Vandereycken; Maarten Vansteenkiste

2009-01-01

34

Outcome at Six and Twelve Months Post Inpatient Treatment for Cocaine and Alcohol Dependence  

Microsoft Academic Search

This study presents outcome rates for inpatient treatment for alcohol, cocaine and other drug dependence. The abstinence rates at six and twelve months post discharge and other demographic information are compiled on 1,627 patients admitted to an impatient treatment unit for the rehabilitation of cocaine, alcohol and other drug dependence. The percent of the 1,627 patients with the diagnosis of

Norman S. Miller; Robert B. Millman; Susan Keskinen

1991-01-01

35

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

Microsoft Academic Search

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

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

2011-01-01

36

Benefits of Auricular Acupuncture in Tobacco-Free Inpatient Dual-Diagnosis Treatment  

Microsoft Academic Search

Objective: Auricular acupuncture was first introduced in the United States in 1974 in for use in outpatient detoxification and substance abuse treatment. We began offering auricular acupuncture in an inpatient dual diagnosis treatment program for patients with substance abuse and mental illness to help with nicotine withdrawal, since the program is totally tobacco free. This paper reports on a study

Elizabeth B. Stuyt; Julie L. Meeker

2006-01-01

37

THEORETICAL AND PRACTICAL FOUNDATIONS OF AN INPATIENT POST-TRAUMATIC STRESS DISORDER AND ALCOHOLISM TREATMENT PROGRAM  

Microsoft Academic Search

This article describes the structure and process of the first inpatient program in the Department of Veterans Affairs for the treatment of post-traumatic stress disorder (PTSD) and alcoholism. The therapeutic community setting utilizes lifespan developmental and social learning models to provide patients with 1) a framework for understanding what has happened to them, 2) tools for more effective coping in

RICHARD W. SEIDEL; FRED D. GUSMAN; FRANCIS R. ABUEG

1994-01-01

38

An Analysis of the Nature and Justification of Treatment Decisions in Inpatient Settings  

Microsoft Academic Search

Mental health professionals (N = 83) employed at 2 inpatient settings participated in a study on the nature and justification of assessment and treatment decision making. Clinical psychologists, psychiatrists, a psychiatric nursing service staff group (comprising registered nurses, licensed practical nurses, and nursing assistants), social workers, nonpsychiatric physicians, physician assistants, mental health workers\\/psychiatric technicians who had at least a high

Joseph J. Plaud; Nancy Vogeltanz; Frederick R. Ackley

1993-01-01

39

Summary of combined treatment under endoscope on 70 esophagus cancer inpatients  

NASA Astrophysics Data System (ADS)

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

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

1993-03-01

40

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

Microsoft Academic Search

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

Joanna E. Bettmann; Rachael A. Jasperson

2009-01-01

41

Identifying young adults at risk of Medicaid enrollment lapses after inpatient mental health treatment  

PubMed Central

Objective This study sought to describe Medicaid disenrollment rates and risk factors among young adults, known as emerging adults, after discharge from inpatient psychiatric treatment. Methods Participants were a statewide population of Medicaid-enrolled 18–26 year olds discharged from inpatient psychiatric treatment (n=1176). Medicaid disenrollment within 365 days post discharge, and predictors of disenrollment from the 180-day pre-discharge period were identified from administrative records. Classification and Regression Tree analysis and probit regression were both used for multivariable modeling. Results Thirty-two percent (n=379) disenrolled within a year of inpatient discharge. Both analytical approaches converged on four main risk factors: Medicaid enrollment categories for persons with a non-disabled low-income parent or child in low-income household, age 18 or 20 at discharge, a pre-discharge gap in Medicaid enrollment, and no antecedent primary care utilization. By contrast, the 48% of the population (n=567) continuously enrolled prior to discharge and in enrollment categories of disabled adults or foster care had only a 13% disenrollment rate. Conclusions A substantial minority of Medicaid-enrolled emerging adults in inpatient psychiatric care are disenrolled from Medicaid within a year after discharge. While about half of the population had low risk of disenrollment, the remaining half was at substantial risk. Risk factors largely reflect legal status changes that occur in these “transition-age youth”. Identifying those at high risk for disenrollment during inpatient treatment and ensuring continuous health care coverage should improve access to needed post-discharge supports. Regular primary care visits may also help reduce unintended Medicaid disenrollment in this population. PMID:24382689

Davis, Maryann; Abrams, Michael T.; Wissow, Lawrence S.; Slade, Eric P.

2014-01-01

42

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.

43

[Individually arranged and continuously reevaluated treatment goals as an instrument for improving inpatient psychotherapy  

PubMed

An agreement about individual therapy goals at the beginning of inpatient psychotherapy improves motivation and engagement of patients, and makes orientation about the planned therapy easier. Furthermore, therapy goals are an effective tool in the quality-assurance of the therapeutic process. On our ward, therapy goals are negotiated individually between patient and therapist some time before admission. The therapy goals of our inpatients are documented and concretized weekly. First empiric results showed, that individual therapy goals are an interesting instrument not only for the evaluation of the therapeutic process, but also for the evaluation of outcome. The introduction of individualized treatment goals in the treatment setting was well accepted by patients and team members. PMID:11781884

Sack, Martin; Schmidt-Ott, Gerhard; Lempa, Wolfgang; Lamprecht, Friedhelm

1999-01-01

44

[Inpatient treatment of mother and child in psychiatry: relevant data of mother and child].  

PubMed

A mentally ill mother may directly increase the probability for the child to develop clinically relevant psychiatric disorders during lifetime. To avoid separation and to support attachment relationships in-patient treatment of mother and child on the psychiatric ward is recommended. The records of 64 cases of (in retrospect) inpatient treatment of mother and child have been categorized and analysed and the relevant data have been evaluated. The results of the evaluation showed that all of these mothers and their children were confronted with numerous difficult living conditions and psychosocial stress in the past and in the present. These findings are similar to and comparable with results from studies of women with postnatal depression. PMID:15633072

Rothenburg, Sonja; Cranz, Bettina; Hartmann, Hans-Peter; Petermann, Franz

2005-01-01

45

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

46

The effect of a 4-week treatment with reboxetine on metabolic parameters of depressed inpatients  

Microsoft Academic Search

In the present study, we examined several metabolic parameters in a group of 19 acutely depressed inpatients with major depression\\u000a (DSM-IV) at baseline and investigated their development after 4 weeks of antidepressant treatment with reboxetine (8–12 mg\\u000a per day). We performed oral glucose tolerance tests and additionally assessed free saliva cortisol and post-dexamethasone\\u000a cortisol levels, as well as whole cholesterol, HDL- and

Georgios Paslakis; Maria Gilles; Florian Lederbogen; Claudia Schilling; Barbara Scharnholz; Michael Deuschle

2011-01-01

47

Aggression and psychopathology in treatment-resistant inpatients with schizophrenia and schizoaffective disorder  

Microsoft Academic Search

Positive psychotic symptoms, such as threat\\/“control-override” delusions or command hallucinations, have been related to aggression in patients with schizophrenia. However, retrospective data collection has hampered evaluation of the direct influence of psychopathology on aggressive behavior. In this study, we monitored aggressive behavior and psychopathology prospectively and in close temporal proximity in 157 treatment-resistant inpatients diagnosed with chronic schizophrenia or schizoaffective

Karen A. Nolan; Jan Volavka; Pal Czobor; Brian Sheitman; Jean-Pierre Lindenmayer; Leslie L. Citrome; Joseph McEvoy; Jeffrey A. Lieberman

2005-01-01

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

Cultural sensitivity training in mental health: treatment of Orthodox Jewish psychiatric inpatients.  

PubMed

We describe some of the cultural/religious issues which arose in the treatment of major psychiatric disorders among Orthodox Jewish inpatients at SUNY Health Science Center's University Hospital (SUH) in Brooklyn, New York. The distinct ways in which cultural and religious factors impacted on presentation, therapeutic interventions, and transference-countertransference reactions are noted. Specific reference is made to the use of religion by patients and families as a means of defense, rationalization or power-brokering. Via case vignettes, we explore ways of distinguishing between culturally appropriate vs. maladaptive behaviors in the Orthodox population. Practical solutions are suggested for sensitive ways to surmount culture-based barriers to effective inpatient therapy in this group. PMID:10950360

Sublette, E; Trappler, B

2000-01-01

51

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

PubMed

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

Forman, Maryelizabeth; Davis, William N

2005-01-01

52

Heterogeneity and the Longitudinal Recovery of Functioning During Inpatient Psychiatric Rehabilitation for Treatment-Refractory Severe Mental Illness  

Microsoft Academic Search

Introduction. Few studies adequately capture the heterogeneity of severe mental illness (SMI) in recovery outcomes. In this study, we examine the between-person and within-person variance in the longitudinal recovery of key functional domains during a comprehensive inpatient psychiatric rehabilitation program for a severe, treatment-refractory population with SMI. Method. We reviewed clinical assessment data collected over 10 years from an inpatient

Nancy H. Liu; Kee-Hong Choi; Felice Reddy; William D. Spaulding

2011-01-01

53

[Reproducibility of a German scale for assessing the need for inpatient treatment in surgery].  

PubMed

During the past years, the assessment of the appropriateness of hospital utilization has become increasingly important in the German health care system. Previous evaluations by regional review organizations in several states demonstrated the need for a standardized, reliable, and valid instrument to evaluate the appropriateness of inpatient care. Objective of the study is to test the reliability of a German adaptation of the "Appropriateness Evaluation Protocol" (AEP). Among all 2672 admissions from the department of surgery of a regional medical center during one calendar year, 54 patients were randomly selected to evaluate the inter-rater reliability and 51 patients to test intra-rater reliability. Overall agreement, specific agreement and Kappa statistics were estimated for every hospital admissions and all consecutive hospital days. The German AEP showed an inter-rater agreement of 74% (62-86%) for hospital admissions (Kappa = 0.44) and 84% (79%-88%) for all hospital days (K = 0.55). Intra-rater reliability was 88% (79%-97%) for hospital admissions (K = 0.60) and 88% (85%-92%) for all hospital days (K = 0.70). The observed agreement is independent of length of hospital stay and proportion of appropriate days. A standardized instrument with known metric properties is essential for quality management in hospitals to prepare for an increasingly consolidating health care market in Germany. The German AEP is a reliable instrument, which will allow to identify inefficiencies in the management of surgical inpatients. PMID:11210596

Schneeweiss, S; Sangha, O; Siebert, H; Hübner, M; Fuhrmann, J; Wildner, M; Witte, J

2000-01-01

54

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

Microsoft Academic Search

Background  To assess comorbid DSM-IV-TR Axis I disorders in adolescent inpatients referred for treatment of substance use disorders.\\u000a \\u000a \\u000a \\u000a Methods  151 patients (mean age 16.95 years, SD = 1.76; range 13 - 22) were consecutively assessed with the Composite International\\u000a Diagnostic Interview (CIDI) and standardized clinical questionnaires to assess mental disorders, symptom distress, psychosocial\\u000a variables and detailed aspects of drug use. A consecutively

Tobias Langenbach; Alexandra Spönlein; Eva Overfeld; Gaby Wiltfang; Niklas Quecke; Norbert Scherbaum; Peter Melchers; Johannes Hebebrand

2010-01-01

55

A randomised controlled trial of outpatient versus inpatient integrated treatment of dual diagnosis patients: a failed but informative study  

Microsoft Academic Search

The co-occurrence of severe mental illness (SMI) and substance use disorder (SUD) in dual diagnosis patients is common and associated with negative treatment outcomes. Therefore, integrated treatments, combining proven effective mental health and substance abuse interventions, have emerged. However, evidence about the effectiveness of integrated outpatient versus inpatient treatment for dual diagnosis patients from randomised controlled trials is lacking. The

Mascha Nuijten; Peter Blanken; Bas van der Hoorn; Wim van den Brink; Vincent Hendriks

2012-01-01

56

A randomised controlled trial of outpatient versus inpatient integrated treatment of dual diagnosis patients: a failed but informative study  

Microsoft Academic Search

The co-occurrence of severe mental illness (SMI) and substance use disorder (SUD) in dual diagnosis patients is common and associated with negative treatment outcomes. Therefore, integrated treatments, combining proven effective mental health and substance abuse interventions, have emerged. However, evidence about the effectiveness of integrated outpatient versus inpatient treatment for dual diagnosis patients from randomised controlled trials is lacking. The

Mascha Nuijten; Peter Blanken; Bas van der Hoorn; Wim van den Brink; Vincent Hendriks

2011-01-01

57

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

58

Trends in Inpatient Treatment Intensity among Medicare Beneficiaries at the End of Life  

PubMed Central

Objective Although an increasing fraction of Medicare beneficiaries die outside the hospital, the proportion of total Medicare expenditures attributable to care in the last year of life has not dropped. We sought to determine whether disproportionate increases in hospital treatment intensity over time among decedents are responsible for the persistent growth in end-of-life expenditures. Data Source The 1985–1999 Medicare Medical Provider Analysis and Review (MedPAR) and Denominator files. Study Design We sampled inpatient claims for 20 percent of all elderly fee-for-service Medicare decedents and 5 percent of all survivors between 1985 and 1999 and calculated age-, race-, and gender-adjusted per-capita inpatient expenditures and rates of intensive care unit (ICU) and intensive procedure use. We used the decedent-to-survivor expenditure ratio to determine whether growth rates among decedents outpaced growth relative to survivors, using the growth rate among survivors to control for secular trends in treatment intensity. Data Collection The data were collected by the Centers for Medicare and Medicaid Services. Principal Findings Real inpatient expenditures for the Medicare fee-for-service population increased by 60 percent, from $58 billion in 1985 to $90 billion in 1999, one-quarter of which were accrued by decedents. Between 1985 and 1999 the proportion of beneficiaries with one or more intensive care unit (ICU) admission increased from 30.5 percent to 35.0 percent among decedents and from 5.0 percent to 7.1 percent among survivors; those undergoing one or more intensive procedure increased from 20.9 percent to 31.0 percent among decedents and from 5.8 percent to 8.5 percent among survivors. The majority of intensive procedures in the United States were performed in the more numerous survivors, although in 1999 50 percent of feeding tube placements, 60 percent of intubations/tracheostomies, and 75 percent of cardiopulmonary resuscitations were in decedents. The proportion of beneficiaries dying in a hospital decreased from 44.4 percent to 39.3 percent, but the likelihood of being admitted to an ICU or undergoing an intensive procedure during the terminal hospitalization increased from 38.0 percent to 39.8 percent and from 17.8 percent to 30.3 percent, respectively. One in five Medicare beneficiaries who died in the hospital in 1999 received mechanical ventilation during their terminal admission. Conclusions Inpatient treatment intensity for all fee-for-service beneficiaries increased between 1985 and 1999 regardless of survivorship status. Absolute changes in per-capita hospital expenditures, ICU admissions, and intensive inpatient procedure use were much higher among decedents. Relative changes were similar except for ICU admissions, which grew faster among survivors. The secular decline in in-hospital deaths has not resulted in decreased per capita utilization of expensive inpatient services in the last year of life. This could imply that net hospital expenditures for the dying might have been even higher over this time period if the shift toward hospice had not occurred. PMID:15032959

Barnato, Amber E; Mcclellan, Mark B; Kagay, Christopher R; Garber, Alan M

2004-01-01

59

Inpatient cancer treatment: an analysis of financial and nonfinancial performance measures by hospital-ownership type.  

PubMed

This study uses longitudinal data of inpatient treatment from the Agency for Healthcare Research and Quality's (AHRQ's) Healthcare Cost and Utilization Project (HCUP) to examine the differences in historical trends and build future projections of charges, costs, and lengths of stay (LOS) for inpatient treatment of four of the most prevalent cancer types: breast, colon, lung, and prostate. We stratify our data by hospital ownership type and for the aforementioned four major cancer types. We use the Kruskal Wallis (nonparametric ANOVA) Test and time series models to analyze variance and build projections, respectively, for mean charges per discharge, mean costs per discharge, mean LOS per discharge, mean charges per day, and mean costs per day. We find that significant differences exist in both the mean charges per discharge and mean charges per day for breast, colon, lung, and prostate cancers and in the mean LOS per discharge for breast cancer. Additionally, we find that both mean charges and mean costs are forecast to continue increasing while mean LOS are forecast to continue decreasing over the forecast period 2008 to 2012. The methodologies we employ may be used by individual hospital systems, and by health care policy-makers, for various financial planning purposes. Future studies could examine additional financial and nonfinancial variables for these and other cancer types, test for geographic disparities, or focus on procedural-level hospital measures. PMID:21294439

Newton, Ashley N; Ewer, Sid R

2010-01-01

60

Protocol for treatment of diabetic foot ulcers.  

PubMed

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: (1) measurement of the wound by planimetry; (2) optimal glucose control; (3) surgical debridement of all hyperkeratotic, infected, and nonviable tissue; (4) systemic antibiotics for deep infection, drainage, and cellulitis; (5) offloading; (6) moist-wound environment; and (7) treatment with growth factors and/or cellular therapy if the wound is not healing after 2 weeks with this protocol and a new epithelial layer is not forming. In addition, the pathogenesis of diabetic foot ulcers is discussed, as well as the associated costs and complications, including amputation. Debridement, wound-bed preparation, antibiotics, various types of dressings, biological therapies, growth factors, and offloading are described as treatment modalities for patients with diabetic foot ulcers. In diabetic foot ulcers, availability of the above modalities, in combination with early recognition and comprehensive treatment, ensure rapid healing and minimize morbidity, mortality, and costs, as well as eliminate amputation in the absence of ischemia and osteomyelitis. PMID:15147985

Brem, Harold; Sheehan, Peter; Boulton, Andrew J M

2004-05-01

61

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

62

Moclobemide and maprotiline in the treatment of inpatients with major depressive disorder.  

PubMed

A double-blind study with the substituted benzamide moclobemide, a novel reversible, short acting MAOI with predominant inhibition of MAO-A, and maprotiline, the most selective noradrenaline reuptake inhibitor available at present has been conducted in n = 40 severely depressed inpatients suffering from predominantly endogenous depressions. No significant differences between the two drugs were found using global HRSD, HAMA and self rating scales. Regarding the clinical profile moclobemide seemed to be more effective in retarded depressives, maprotiline was superior in alleviating depressive agitation and sleep disturbances. The latter symptoms were responsible for three cases of treatment withdrawal in the moclobemide group. No case of hypertensive crisis could be registered, though patients were not subject to food restrictions. Maximal concentrations of moclobemide in CSF were reached two hours after oral application, compared to tricyclic antidepressants a high CSF/plasma ratio could be detected. PMID:2677241

Laux, G; Beckmann, H; Classen, W; Becker, T

1989-01-01

63

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

64

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

PubMed Central

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

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

2013-01-01

65

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

PubMed

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 rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129-1139) using Acceptance and Commitment Therapy (ACT) in the treatment of psychosis. Psychiatric inpatients with psychotic symptoms were randomly assigned to enhanced treatment as usual (ETAU) or ETAU plus individual sessions of ACT. At discharge from the hospital, results suggested short-term advantages in the ACT group in affective symptoms, overall improvement, social impairment, and distress associated with hallucinations. In addition, more participants in the ACT condition reached clinically significant symptom improvement at discharge. Although 4-month rehospitalization rates were lower in the ACT group, these differences did not reach statistical significance. Decreases in the believability of hallucinations during treatment were observed only in the ACT condition, and change in believability was strongly associated with change in distress after controlling for change in the frequency of hallucinations. Results are interpreted as largely consistent with the findings of Bach and Hayes and warrant further investigations with larger samples. PMID:15893293

Gaudiano, Brandon A; Herbert, James D

2006-03-01

66

The effect of a 4-week treatment with reboxetine on metabolic parameters of depressed inpatients.  

PubMed

In the present study, we examined several metabolic parameters in a group of 19 acutely depressed inpatients with major depression (DSM-IV) at baseline and investigated their development after 4 weeks of antidepressant treatment with reboxetine (8-12 mg per day). We performed oral glucose tolerance tests and additionally assessed free saliva cortisol and post-dexamethasone cortisol levels, as well as whole cholesterol, HDL- and LDL-cholesterol, triglycerides, free fatty acids, waist and hip circumference, heart rate, systolic and diastolic blood pressure. Furthermore, we evaluated the incidence of a metabolic syndrome and investigated the metabolic changes in depressed patients with and without a metabolic syndrome. We found 42.1% of patients to fulfil the criteria for a metabolic syndrome. Overall, reboxetine was well tolerated with essentially no side effects during the observation period. A 4-week treatment with reboxetine showed a beneficial effect on several metabolic parameters that was independent from treatment outcome and could therefore theoretically be attributed to the pharmacological profile of the drug. Due to the preliminary character of the present investigation, no conclusions about the clinical efficacy of reboxetine can be drawn. PMID:21053006

Paslakis, Georgios; Gilles, Maria; Lederbogen, Florian; Schilling, Claudia; Scharnholz, Barbara; Deuschle, Michael

2011-04-01

67

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

68

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

Microsoft Academic Search

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

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

2010-01-01

69

[The mortality rate of alcoholic patients 4 years after inpatient treatment].  

PubMed

Data on mortality during a 48-month follow-up period in a group of 1410 alcoholics who had received inpatient treatment were evaluated. In 1266 patients known to be either living or deceased the death rate was 7.6%. The percentage of deceased subjects was highest in the group over 50 years of age. The mortality rate was higher for men (9.8%) than for women (4.8%); for those with more than one divorce (16.8%); for those who were not fit for work (18.1%) or were retired at the start of the treatment (43.3%); who were employed in the alcohol business (21.7%); who had reduced their alcohol consumption before treatment (13.4%); who were unemployed 6 months after discharge (12.4%). The mortality rate was higher for those with high scores on a scale assessing calmness in a personality inventory (7.9%) and low scores on a questionnaire assessing motivation (10.9%) and insight into the need of change (12.4%). Alcohol-related illness before the index treatment played an important role: the mortality rate was higher for those who had had Wernicke-Korsakoff-syndrome (40%), delirium tremens (15.3%), pancreatitis (13.9%) or cardiomyopathy (14.1%). The mortality rate was higher for treatment dropouts (12.9%) and for those who regularly or occasionally took sleeping pills (28.5%), psychoactive drugs (15.1%) or other drugs (11.5%) during treatment. In the follow-up periods substance use had a great effect on mortality. The mortality rate for those patients who still abstained from alcohol for after 6 months (4.4%) was only a third of that the patients who had relapsed (12.4%).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7709499

Feuerlein, W; Küfner, H; Flohrschütz, T

1995-02-01

70

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

71

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

PubMed Central

We summarize Medicare utilization and payment for inpatient treatment of non-dementia psychiatric illnesses (NDPI) among the elderly during 1992 and 2002. From 1992 to 2002, overall mean Medicare expenditures per elderly NDPI inpatient stay declined by $2,254 (in 2002 dollars) and covered days by 2.8. However, these changes are complicated by expanded use of skilled nursing facilities and hospital psychiatric units, and decreased use of long-stay hospitals and general hospital beds. This suggests that inpatient treatment for NDPI is shifting into less expensive settings which may reflect cost-cutting strategies, preferences for less restrictive settings, and outpatient treatment advances. PMID:18293080

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

2010-01-01

72

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

73

Changing pattern of drug use in individuals with severe drug dependence following inpatient treatment.  

PubMed

Ninety-seven subjects (92 of whom were opiate users) admitted to an inpatient treatment unit were followed 3, 6, 9, and 12 months after discharge using the Substance Abuse Assessment Questionnaire (SAAQ).(1) The subjects presented problems of severe drug use, frequently complicated by additional difficulties; 67% of the sample completed detoxification. Significant reductions in daily drug use were seen at 12 months for each major class of drug, except cannabis. One-third of daily opiate users had been abstinent from opiates for at least one month prior to the final follow-up. Most changes took place between admission and the 3-month follow-up, and these improvements were maintained across the sample as a whole. Within the sample, fluctuations in drug use were observed, with subjects both relapsing to, and remitting from, drug use. Subjects who achieved at least one 3-month period of abstinence were more likely to have been employed at admission, and also more likely to have committed an offence immediately prior to admission, than those who did not achieve this level of abstinence. These results suggest that detoxification programmes produce benefits which can be maintained in the medium term. Further longitudinal studies are required to investigate the triggers for both relapse and remission. PMID:24946196

Ghodse, A; Dunmore, E; Sedgwick, P M; Howse, K; Gauntlett, N; Clancy, C

1997-01-01

74

Lifetime Diagnosis of Major Depression as a Multivariate Predictor of Treatment Outcome for Inpatients with Substance Use Disorders from Abstinence-Based Programs  

Microsoft Academic Search

A multisite, longitudinal study of patients undergoing inpatient alcohol and drug dependence treatment was conducted in private inpatient facilities, consisting of 4339 subjects from 38 independent programs enrolled in a national addiction treatment outcomes registry. Structured interviews were conducted upon admission, including documentation of current alcohol\\/drug disorder (DSM-III-R) and lifetime diagnosis of major depressive syndrome; structured interviews were conducted prospectively

Norman S. Miller; Norman G. Hoffmann; Fred Ninonuevo; Boris M. Astrachan

1997-01-01

75

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

76

COMPUTER SUPPORT FOR PROTOCOL-BASED TREATMENT OF CANCER1  

E-print Network

SiS prototype, this is particularly evident in the user interface and its combined use of graphical, form-basedCOMPUTER 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

Sergot, Marek

77

Urinary incontinence: treatment using behavioral therapy protocol  

Microsoft Academic Search

Objective: Confirm previously reported cure rate of 88% with standard protocol using multiple behavioral therapies (BT) in a larger patient population.Methods: Consecutive patients referred to a single physician for urinary incontinence (UI) who met protocol criteria for BT were prospectively followed through their course of therapy and for up to 24 months after completion. Descriptive analysis of outcomes and comparison

Sandra F. Reilley

2000-01-01

78

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

79

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

80

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

81

Evaluation of a pilot training program in alcohol screening, brief intervention, and referral to treatment for nurses in inpatient settings.  

PubMed

Alcohol screening, brief intervention, and referral to treatment (SBIRT) is a set of clinical strategies for reducing the burden of alcohol-related injury, disease, and disability. SBIRT is typically considered a physician responsibility but calls for interdisciplinary involvement requiring basic SBIRT knowledge and skills training for all healthcare disciplines. The purpose of this pilot study was to design, implement, and evaluate a theory-driven SBIRT training program for nurses in inpatient settings (RN-SBIRT) that was developed through an interdisciplinary collaboration of nursing, medical, and public health professionals and tailored for registered nurses in the inpatient setting. In this three-phase study, we evaluated (1) RN-SBIRT's effectiveness for changing nurses' alcohol-related knowledge, clinical practice, and attitudes and (2) the feasibility of implementing the inpatient curriculum. In a quasi-experimental design, two general medical units at our facility were randomized to receive RN-SBIRT or a self-directed Web site on alcohol-related care. We performed a formative evaluation of RN-SBIRT, guided by the RE-AIM implementation framework. After training, nurses in the experimental condition had significant increases in Role Adequacy for working with drinkers and reported increased performance and increased competence for a greater number of SBIRT care tasks. Despite some scheduling challenges for the nurses to attend RN-SBIRT, nurse stakeholders were highly satisfied with RN-SBIRT. Results suggest that with adequate training and ongoing role support, nurses in inpatient settings could play active roles in interdisciplinary initiatives to address unhealthy alcohol use among hospitalized patients. PMID:24622525

Broyles, Lauren M; Gordon, Adam J; Rodriguez, Keri L; Hanusa, Barbara H; Kengor, Caroline; Kraemer, Kevin L

2013-01-01

82

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

PubMed Central

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

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

2013-01-01

83

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

Microsoft Academic Search

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

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

1996-01-01

84

Changes of attachment status among women with personality disorders undergoing inpatient treatment  

Microsoft Academic Search

Background: Attachment has increasingly received attention in psychotherapy and has been used as a predictor of process and outcome. Studies investigating changes of attachment styles during psychotherapy are very rare. Method: Forty women with either borderline (BPD) or avoidant personality disorders (AVPD), treated as inpatients, were investigated using an attachment interview (interpersonal relations assessment (IRA)), and questionnaires to determine therapy

Bernhard M. Strauss; Robert Mestel; Helmut A. Kirchmann

2011-01-01

85

Rhinosinusitis treatment protocol: Changing provider habits in primary care  

Microsoft Academic Search

Objective: Sinus infections are common and represent a high cost to the health care industry. Clinical protocols can be used to develop cost-effective treatment strategies. Our objective was to show that a protocol for rhinosinusitis can change provider practice patterns in primary care. Study Design and Setting: We used a literature search, survey of primary caregivers, and chart review from

William C. Kinney

2002-01-01

86

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

87

Brief family treatment intervention to promote continuing care among alcohol-dependent patients in inpatient detoxification: a randomized pilot study.  

PubMed

Alcohol-dependent patients in inpatient detoxification were randomized to treatment-as-usual (TAU) intervention or brief family treatment (BFT) intervention to promote continuing care postdetoxification. BFT consisted of meeting with the patient and an adult family member (in person or over the phone) with whom the patient lived to review and recommend potential continuing care plans for the patient. Results showed that BFT patients (n = 24) were significantly more likely than TAU patients (n = 21) to enter a continuing care program after detoxification. This was a medium to large effect size. In the 3 months after detoxification, days using alcohol or drugs (a) trended lower for treatment-exposed BFT patients who had an in-person family meeting than for TAU counterparts (medium effect), and (b) were significantly lower for patients who entered continuing care regardless of treatment condition (large effect). PMID:17614242

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

2008-04-01

88

Social work and case management treatment time during inpatient spinal cord injury rehabilitation  

PubMed Central

Background There is a lack of published evidence regarding the amount and type of social work and case management (SW/CM) services that an individual with traumatic spinal cord injury (SCI) receives during acute inpatient rehabilitation. Such information is needed to assist in resource planning, benchmarking, and research on interventions and outcomes. Methods As part of the SCIRehab study social workers and case managers at six inpatient rehabilitation facilities documented details (including time spent) about the interventions provided to 600 patients with traumatic SCI during acute inpatient rehabilitation. Associations between patient and injury characteristics and time spent on these activities were examined. Results Patients received a mean total of 10 hours of SW/CM services, with a mean of 72.8 total minutes per week. The majority of the patients received SW/CM time spent on interdisciplinary conferencing on the patient's behalf (96%), discharge planning and services (89%), financial planning (67%), community/in-house services (66%), supportive counseling (56%), and initial assessment (54%). A minority of the patients received peer advocacy (12%), classes (24%), and education topics (30%). Total hours per stay and minutes per week varied by level of injury group. The most time per week was dedicated to patients with high tetraplegia ASIA Impairment Scale (AIS) A–C and the least to patients with C5–C8 AIS A–C. The patient and injury characteristics studied did not explain the variance seen in time spent on specific SW/CM services. Conclusions These descriptive data may be helpful in resource planning to anticipate and address individual patient needs and to plan for department-level training and hiring. These data also may pave the way to studying relationships of interventions with patient outcomes. PMID:21675360

Hammond, Flora M.; Gassaway, Julie; Abeyta, Nichola; Freeman, Erma S.; Primack, Donna

2011-01-01

89

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

90

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

91

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

92

Lamb eimeriosis: applied treatment protocols in dairy sheep production systems.  

PubMed

The effect of different treatment protocols using the triazinone compounds diclazuril and toltrazuril on Eimeria oocyst excretion, diarrhoea and weight gain was evaluated in the present study. The protocols were designed in order to best fit to common management practices in dairy production systems as applied in Greece. During the first two trials comparative preventive (11 days after birth) and therapeutic (18 days after birth) single treatments using either drug were performed on an intensive farm. In Trial 3 the efficacy of a repeated diclazuril treatment after weaning (at the start and 4 weeks later) of the animals in a semi-intensive farm was tested. The last trial was performed in order to assess the effect of a single oral dose of toltrazuril after weaning of the animals on the same farm. During an observation period of 6-7 weeks after treatment animals in all trials were clinically examined for diarrhoea and faecal samples were regularly monitored for Eimeria oocysts at weekly intervals. Body weight was also determined at the start and end of each trial. A single treatment with toltrazuril resulted in a significant reduction of oocyst excretion over the study period compared to the control, with very high efficacy values during the first 2-3 weeks after treatment, irrespective of the treatment protocol and the management system applied. This in general could not be confirmed in the protocols using diclazuril, which showed a much lower and mostly variable efficacy pattern. PMID:23428203

Saratsis, Anastasios; Karagiannis, Isidoros; Brozos, Christos; Kiossis, Evagellos; Tzanidakis, Nikolaos; Joachim, Anja; Sotiraki, Smaragda

2013-09-01

93

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

ERIC Educational Resources Information Center

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

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

2010-01-01

94

Predicting Response to Intensive Multimodal Inpatient Treatment: A Comparison of Single and Multiple Class Latent Growth Curve Modeling Approaches  

PubMed Central

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

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

2013-01-01

95

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

96

42 CFR 424.13 - Requirements for inpatient services of hospitals other than inpatient psychiatric facilities.  

Code of Federal Regulations, 2013 CFR

...the patient for inpatient medical treatment or medically required inpatient diagnostic study; or (ii) Special...and documented in the medical record prior to discharge...signed and documented in the medical record and as...

2013-10-01

97

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

ERIC Educational Resources Information Center

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

Boxer, Paul

2010-01-01

98

Prevalence and risk factors of inpatient aggression by adults with intellectual disabilities and severe challenging behaviour: a long-term prospective study in two Dutch treatment facilities.  

PubMed

Over five years, various types of aggressive incidents by 421 intellectually disabled inpatients were recorded on a daily basis, using an adapted version of the Modified Overt Aggression Scale. Stable patient characteristics (e.g., gender, intelligence, DSM IV classification at the start of treatment) and pre-treatment scores of two treatment outcome measures (e.g., Adult Behavior Checklist and Dynamic Risk Outcome Scale) were used to predict aggression during the treatment. At an overall average of one incident per patient per week, about ten times more aggression occurred on admission compared to resocialisation wards, and the 20% most aggressive individuals caused 50% of the verbal and 80% of the physical incidents. The best predictor of aggressive behaviour was aggression early in treatment, followed by coping skills deficits and impulsiveness. The relevance of the results for the treatment of aggressive behaviour and methodological issues in the recording of inpatient aggression are discussed. PMID:23711630

Drieschner, Klaus H; Marrozos, Isabel; Regenboog, Maarten

2013-08-01

99

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

100

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

PubMed

Fibromyalgia poses a challenge for therapy. Recent guidelines suggest that fibromyalgia should be treated within a multidisciplinary therapy approach. No data are available that evaluated multimodal treatment strategies of Integrative Medicine (IM). We conducted a controlled, nonrandomized pilot study that compared two inpatient treatment strategies, an IM approach that included fasting therapy and a conventional rheumatology (CM) approach. IM used fasting cure and Mind-Body-Medicine as specific methods. Of 48 included consecutive patients, 28 were treated with IM, 20 with CM. Primary outcome was change in the Fibromyalgia Impact Questionnaire (FIQ) score after the 2-week hospital stay. Secondary outcomes included scores of pain, depression, anxiety, and well being. Assessments were repeated after 12 weeks. At 2 weeks, there were significant improvements in the FIQ (P < 0.014) and for most of secondary outcomes for the IM group compared to the CM group. The beneficial effects for the IM approach were reduced after 12 weeks and no longer statistically significant with the exception of anxiety. Findings indicate that a multimodal IM treatment with fasting therapy might be superior to CM in the short term and not inferior in the mid term. Longer-term studies are warranted to assess the clinical impact of integrative multimodal treatment in fibromyalgia. PMID:23431352

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

2013-01-01

101

Treatment Characteristics of Patients With Dementia: Comparing Two Different Psychiatric Inpatient Settings  

Microsoft Academic Search

Objective: Patients with dementia in 2 German community psychiatric hospitals with different treatment settings were investigated prospectively and treatment variables compared. Method: In each of the hospitals, which differ in treatment settings (Gütersloh specialized vs. Detmold integrated), 50 patients with dementia consecutively admitted were screened and compared according to personal data, clinical instruments, medication, and diagnosis. Results: No relevant differences

Volker Haude; Monika Lüdeke; Heike Dohse; Sabine Reiswig; Anette Liebler; Hans-Joerg Assion; Miriam Basilowski; Ingrid Börner

2009-01-01

102

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

103

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, Marcio

2013-01-01

104

Protocol for the successful treatment of pressure ulcers.  

PubMed

Bed-bound patients with pressure ulcers are almost twice as likely to die as are those without pressure ulcers. If pressure ulcers are treated with a comprehensive regimen upon early recognition, nearly all stage IV ulcers can be avoided. Furthermore, such a regimen can significantly reduce the comorbidities, mortalities, and costs of treatments resulting from stage IV ulcers. The costs of treatments for comorbidities after the ulcer progresses to stage IV far outweigh the costs for early treatment of the ulcer before it progresses beyond the early stages. We describe herein the 4 stages of pressure ulcers, as well as the pathogeneses, costs, and complications associated with these wounds. A comprehensive 12-step detailed protocol for treatment of pressure ulcers is described; this includes recognizing that every patient with limited mobility is at risk for developing a sacral, ischial, trochanteric, or heel ulcer; daily assessment of the skin; objective measurement of every wound; immediate initiation of a treatment protocol; mechanical debridement of all nonviable tissue; establishment of a moist wound-healing environment; nutritional supplementation for malnourished patients; pressure relief for the wound; elimination of drainage and cellulitus; biological therapy for patients whose wounds fail to respond to more traditional therapies; physical therapy; and palliative care. Availability of the described treatment modalities, in combination with early recognition and regular monitoring, ensures rapid healing and minimizes morbidity, mortality, and costs. PMID:15223496

Brem, Harold; Lyder, Courtney

2004-07-01

105

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

106

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

107

Is auricular acupuncture beneficial in the inpatient treatment of substance-abusing patients? A pilot study  

Microsoft Academic Search

Patients with comorbid substance abuse problems who were admitted to a psychiatric unit of a general hospital over an 11-month period were offered treatment with auricular acupuncture. Subsequently and retrospectively, the medical records of these patients were examined to assess compliance, side effects, impact on course, and acceptance of discharge recommendations. Patient's continuation of treatment in destination programs was also

Michael I. Gurevich; Dorothy Duckworth; John E. Imhof; Jack L. Katz

1996-01-01

108

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

109

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

110

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

111

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

ERIC Educational Resources Information Center

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

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

2003-01-01

112

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

113

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

114

What is "effective treatment" for a schizophrenic inpatient with persistent treatment-resistant psychosis and severe violent behavior?: a case of ECT.  

PubMed

Aggressive behavior among treatment-resistant schizophrenic patients is a major clinical challenge whose prevalence is underestimated.In our 420-bed psychiatric hospital, some 15% of patients exhibit active psychosis and high rates of verbal/physical aggression necessitating physical restraints. In addition to their condition, these individuals endanger staff and other patients, consume extensive resources, and induce a sense of clinical helplessness.Physicians managing such complex patients face dilemmas regarding choice of treatment, criteria for treatment decisions, treatment goals, and outcome assessments. We address some of these by following the progress of a persistently psychotic severely aggressive treatment-resistant inpatient treated with repeated electroconvulsive therapy (ECT). The motivation for this report was our desire to examine whether there was objective evidence to support our clinically based treatment decisions.To this end, we compiled a retrospective chronological life chart recording ECT administrations and aggression using case note information. Physical restraint was chosen as the outcome measure, as it was accurately documented. Because it was used only after all other means failed, a recorded incident represents an extreme peak of ongoing aggressive behavior. PMID:24263278

Isakov, Victoria; Tsvelikhovsky, Irena; Goldin, Vladimir; Silver, Henry

2013-12-01

115

[Comparative analysis of the treatment of inpatients with community-acquired pneumonia and its different outcomes].  

PubMed

The aim of the work was to compare the quality of medical care provided to patients with severe community-acquired pneumonia (CAP) and its different outcomes. (complete recovery, or death--25 patients in either group). In the latter group, the patients did not undergo adequate clinical and instrumental examination at the pre-hospital stage). Most recovered patients were given high doses of ceftriaxone, clarithromycin and ambroxol or low doses of systemic glucocorticoids. A pulmonologist participated in the treatment of these patients twice as frequently as in the treatment of the patients of the latter group. Effects of high doses of systemic glucocorticoids remains debatable. PMID:23789451

Vizel', A A; Lysenko, G V

2013-01-01

116

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

117

[Acute and chronic alcohol abuse--effect on inpatient treatment of trauma surgery patients].  

PubMed

The effect of alcoholism on the length of stay and costs of hospital treatment is not well documented. The posttraumatic course of treatment of 75 alcohol intoxicated patients was prospectively followed. A shortened MAST-test served to identify chronic alcoholised patients. The obtained data were compared with a control group according to the matched-pair method. The course of treatment of 44 drunken patients without signs of chronic alcoholism was not different from the control group. However 31 chronic alcohol intoxicated patients showed a clearly different course from the control group. The hospital stay was nearly doubled (13.5 days) compared to the control group (7.5 days). There were explicitly more consultations of specialists (26 vs. 9) necessary and the complication rate (9 vs. 1) during the hospital stay was significantly increased. Chronic alcoholism of traumatised patients yields to a cost increase of the hospital treatment. The high complication rate forces an intensive supervision of the affected patients. These results have to be taken into account by calculations of reimbursement rates for the field of trauma surgery. PMID:7975941

Ring, T; Sattler, R W

1994-01-01

118

Clinical and medico-legal aspects of home-based care by nurses as an alternative for inpatient treatment in child and adolescent psychiatry.  

PubMed

Increasing economic restrictions in the supply of inpatient care require the establishment of alternative treatment modalities also in the field of child and adolescent psychiatry. Therefore, home-treatment offers the possibility of effective interventions in the natural environment of the severely disturbed child and its family. In our study practical implementation of therapy was in the hands of nurses specializing in child and adolescent psychiatry. Various aspects of their therapeutic work with disordered children are focussed. Specific characteristics and problems of home-treatment-including interventions in the patient's psychosocial surroundings--are illuminated from the nurse's point of view. PMID:10994218

Göpel, C; Schmidt, M H; Blanz, B; Lay, B

2000-01-01

119

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

120

Discovery of an intravenous hepatoselective glucokinase activator for the treatment of inpatient hyperglycemia.  

PubMed

Glucokinase (hexokinase IV) continues to be a compelling target for the treatment of type 2 diabetes given the wealth of supporting human genetics data and numerous reports of robust clinical glucose lowering in patients treated with small molecule allosteric activators. Recent work has demonstrated the ability of hepatoselective activators to deliver glucose lowering efficacy with minimal risk of hypoglycemia. While orally administered agents require a considerable degree of passive permeability to promote suitable exposures, there is no such restriction on intravenously delivered drugs. Therefore, minimization of membrane diffusion in the context of an intravenously agent should ensure optimal hepatic targeting and therapeutic index. This work details the identification a hepatoselective GKA exhibiting the aforementioned properties. PMID:24239482

Stevens, Benjamin D; Litchfield, John; Pfefferkorn, Jeffrey A; Atkinson, Karen; Perreault, Christian; Amor, Paul; Bahnck, Kevin; Berliner, Martin A; Calloway, Jessica; Carlo, Anthony; Derksen, David R; Filipski, Kevin J; Gumkowski, Mike; Jassal, Charanjeet; MacDougall, Margit; Murphy, Brendan; Nkansah, Paul; Pettersen, John; Rotter, Charles; Zhang, Yan

2013-12-15

121

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

122

Standardized Hypnosis Treatment for Irritable Bowel Syndrome: The North Carolina Protocol  

Microsoft Academic Search

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

Olafur S. Palsson

2006-01-01

123

A clinical study of competency to consent to hospitalization and treatment in geriatric inpatients.  

PubMed

This study used a Competency Questionnaire modified for medical surgical patients (CQ-Med). Twenty-nine patients (ages 65-94 years) admitted to a geriatric medicine unit were studied. Along with the CQ-Med, patients were administered several WAIS-R subtests, the Blessed Dementia Scale (BDS), and Mini Mental State Exam (MMSE). Additionally, a blind forensic evaluation for competency to consent to hospitalization and treatment was performed for the purpose of validation of the CQ-Med. Results of the study found that, as expected, increased age was correlated with decreasing performance on the CQ-Med and decreased findings of competence by clinical exam. However, there was great variability within each age group, demonstrating individual differences in the progress of declining competency. CQ-Med scores also correlated well with the WAIS-R subtest raw and scaled scores. Scores on the MMSE and BDS were less well correlated. The CQ-Med may be a useful adjunct in assessing declining competency in geriatric patients. PMID:19486444

Billick, Stephen B; Perez, Dolores R; Garakani, Amir

2009-07-01

124

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

125

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

126

Adolescent Runaway Behavior from an Inpatient Setting  

Microsoft Academic Search

This retrospective study has attempted to identify those factors which place an adolescent at risk for running away from an inpatient treatment program. Significant findings associated with adolescent runaway behavior from an inpatient setting include a history of adoption, abuse (sexual and\\/or physical), a history of running away, especially frequent runaway episodes, and runs outside of the city of residence.

Mark Siegel; Mark T. Callesen

1993-01-01

127

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

128

Task-shifting an inpatient triage, assessment, and treatment program improves the quality of care for hospitalized Malawian children  

PubMed Central

Objective We aimed to improve pediatric inpatient surveillance at a busy referral hospital in Malawi with 2 new programs: (1) the provision of vital sign equipment and implementation of an inpatient triage program (ITAT) that includes a simplified pediatric severity-of-illness score; (2) task-shifting ITAT to a new cadre of health care workers called “Vital Sign Assistants” (VSAs). Methods This study, conducted on the pediatric inpatient ward of a large referral hospital in Malawi, was divided into 3 phases, each lasting 4 weeks. In Phase A, we collected baseline data. In Phase B, we provided 3 new automated vital sign poles and implemented ITAT with current hospital staff. In Phase C, VSAs were introduced and performed ITAT. Our primary outcome measures were the number of vital sign assessments performed and clinician notifications to reassess patients with high ITAT scores. Results We enrolled 3,994 patients who received 5,155 vital sign assessments. Assessment frequency was equal between Phases A (0.67 assessments/patient) and B (0.61 assessments/patient), but increased 3.6-fold in Phase C (2.44 assessments/patient, p<0.001). Clinician notifications increased from Phases A (84) and B (113) to Phase C (161, p=0.002). Inpatient mortality fell from Phase A (9.3%) to Phases B (5.7) and C (6.9%). Conclusions ITAT with VSAs improved vital sign assessments and nearly doubled clinician notifications of patients needing further assessment due to high ITAT scores, while equipment alone made no difference. Task-shifting ITAT to VSAs may improve outcomes in pediatric hospitals in the developing world. PMID:23600592

Olson, Dan; Preidis, Geoffrey A.; Milazi, Robert; Spinler, Jennifer K.; Lufesi, Norman; Mwansambo, Charles; Hosseinipour, Mina C.; McCollum, Eric D.

2013-01-01

129

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

Microsoft Academic Search

A large body of literature has shown a high prevalence of personality disorders in substance abusers. We compared a sample\\u000a of substance abusers treated in a prison setting with substance abusers treated in a non-prison inpatient setting rated with\\u000a the Millon Clinical Multiaxial Inventory-III. Baserate scores indicated a prevalence of 95% of personality disorders. A logistic\\u000a regression analysis correctly identified

Ragnar Stefánsson; Morten Hesse

2008-01-01

130

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

PubMed

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

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

2004-12-01

131

Managing orthopedics and neurosciences costs through standard treatment protocols.  

PubMed

High-cost, high-volume specialty programs such as orthopedics and neurosciences find themselves in a position of evaluating the costs and in some cases the appropriateness of medical practices in response to payer scrutiny and provider selection processes. Orthopedics and neurosciences programs are at a stage of development analogous to that of cardiovascular care several years ago. Many of the same trends have come into play, such as payer "carve-outs" for orthopedic services, payer selection of centers of excellence based on cost and quality, reduction of Medicare reimbursement, greater use of high-cost technology, the decline of profitability due to "older, sicker, and tougher" patients, and the recent emergence of national orthopedic specialty networks oriented to national contracts for care. In an era in which payers demand value on both sides of the cost-plus-quality equation, programs are challenged to maximize the return on a patient population rife with "no-win" situations. In the orthopedic service line these include a high proportion of Medicare patients and chronic conditions such as workers' compensation medical back cases or repetitive motion injuries, which can be elusive to diagnose and expensive to treat. Many hospitals continue to lose money on joint replacement surgeries, the largest-volume orthopedic inpatient service, primarily because of the high Medicare population and the cost of implants. Neuroservices, while still relatively well reimbursed, face a rising proportion of Medicare payments as patients live longer and develop chronic, degenerative conditions. Inpatient days are decreasing due to payer pressures to limit hospital stays and to shift inpatient care to outpatient services. Some hospitals "have lost interest in (the orthopedic) service line during the last five years because of recent trends in orthopedic-related inpatient volume and payment." But by managing costs strategically, both the neurosciences and orthopedics service lines can provide substantial revenue as well as the opportunity to achieve a "center of excellence" competitive position in a managed care environment. This Special Report outlines the process and advantages of managing costs and quality of care strategically, that is, in a manner which helps these programs meet internal cost and clinical goals while responding to market situations. The hospital, physicians, and patients all benefit as costs are reduced, quality is enhanced, and the service line's competitive position is strengthened. PMID:10171865

McGinnity, E S; Pluth, T E

1994-06-01

132

Accelerated treatment protocols: full arch treatment with interim and definitive prostheses.  

PubMed

With the advent of titanium, root form implants and osseointegration, dental treatment has undergone a metamorphosis in recent years. These new techniques enable dentists to provide anchorage for various kinds of prostheses that improve masticatory function, esthetics, and comfort for patients. Implant treatment protocols have been improved relative to implant macro- and micro-geometries, surgical and prosthetic components, and treatment times. Over the past 20 years, immediate occlusal function (also known as loading) has been established as a predictable treatment modality, provided certain specific criteria are met. In many cases, edentulous patients, crippled by the loss of their teeth, can undergo outpatient surgical and prosthetic procedures and return to a masticatory function that is near normal--sometimes after only one day of surgical and prosthetic treatment. This treatment option is also available for patients with advanced, generalized periodontal disease. Computer-assisted design/Computer-assisted manufacturing (CAD/CAM) has transformed how dental prostheses are made, offering improved accuracy, longevity, and biocompatibility; along with reduced labor costs and fewer complications than casting technologies. This article reviews the principles associated with immediate occlusal loading and illustrates one specific accelerated prosthodontic treatment protocol used to treat edentulous and partially edentulous patients with interim and definitive prostheses. PMID:23220303

Drago, Carl

2012-01-01

133

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

PubMed

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

Palsson, Olafur S

2006-01-01

134

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

135

Study protocol: cluster randomised controlled trial to assess the clinical and cost effectiveness of a staff training intervention in inpatient mental health rehabilitation units in increasing service users' engagement in activities  

PubMed Central

Background This study focuses on people with complex and severe mental health problems who require inpatient rehabilitation. The majority have a diagnosis of schizophrenia whose recovery has been delayed due to non-response to first-line treatments, cognitive impairment, negative symptoms and co-existing problems such as substance misuse. These problems contribute to major impairments in social and everyday functioning necessitating lengthy admissions and high support needs on discharge to the community. Engagement in structured activities reduces negative symptoms of psychosis and may lead to improvement in function, but no trials have been conducted to test the efficacy of interventions that aim to achieve this. Methods/design This study aims to investigate the clinical and cost-effectiveness of a staff training intervention to increase service users’ engagement in activities. This is a single-blind, two-arm cluster randomised controlled trial involving 40 inpatient mental health rehabilitation units across England. Units are randomised on an equal basis to receive either standard care or a “hands-on”, manualised staff training programme comprising three distinct phases (predisposing, enabling and reinforcing) delivered by a small team of psychiatrists, occupational therapists, service users and activity workers. The primary outcome is service user engagement in activities 12 months after randomisation, assessed using a standardised measure. Secondary outcomes include social functioning and costs and cost-effectiveness of care. Discussion The study will provide much needed evidence for a practical staff training intervention that has potential to improve service user functioning, reducing the need for hospital treatment and supporting successful community discharge. The trial is registered with Current Controlled Trials (Ref ISRCTN25898179). PMID:23981710

2013-01-01

136

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

137

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.

138

A Treatment Protocol for Vascular Occlusion from Particulate Soft Tissue Augmentation  

PubMed Central

Treatment protocols exist for vascular obstruction due to injections with hyaluronic acids. Options for vascular insult due to non-hyaluronic acid products are less defined. The authors report two cases of vascular insult due to calcium hydroxylapatite and discuss treatment options. Patients who have vascular occlusion due to calcium hydroxylapatite require immediate intervention. The authors’ suggested protocol is elucidated and presented as a basis for future discussions and clinical trials. PMID:22808309

Downie, Jeanine; Beer, Jacob

2012-01-01

139

A hand therapy protocol for the treatment of lunate overload or early Kienbock's disease.  

PubMed

We describe a hand therapy protocol aimed at unloading the wrist and increasing blood supply to the wrist, specifically to the lunate. The protocol was used in a series of patients with clinical radial wrist pain, dysfunction and changes on wrist imaging studies. The patients were not candidates for surgical treatment. Application of the therapy protocol improved objective and subjective parameters such as pain and motion, and may provide a viable treatment option for patients with lunate overload or early Kienbock's disease that are not candidates for surgery. PMID:23465629

Wollstein, Ronit; Wollstein, Adi; Rodgers, John; Ogden, Thomas J

2013-01-01

140

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

PubMed Central

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

2013-01-01

141

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

Microsoft Academic Search

A sample of 600 patients treated in a multimodal treatment program using aversion therapy and narcotherapy at three Schick freestanding addiction treatment hospitals and one Schick unit in a general hospital were followed-up. Contact was made a minimum of 12 months and as many as 20 months after completion of treatment (mean 14.7 mos.). Telephone contact was made by an

James W. Smith; P. Joseph Frawley

1993-01-01

142

Analysis of Violent Behavior in Vietnam Combat Veteran Psychiatric Inpatients with Posttraumatic Stress Disorder  

Microsoft Academic Search

This study tested the hypothesis that male Vietnam veterans seeking inpatient treatment for PTSD (n = 228) exhibit more violent behavior compared with a mixed diagnostic group of male psychiatric Inpatients without PTSD (n = 64) and a community sample of Vietnam veterans with PTSD not undergoing inpatient treatment (n = 273). Violent acts assessed included property destruction, threats without

Miles McFall; Alan Fontana; Murray Raskind; Robert Rosenheck

1999-01-01

143

Protocols in cleft lip and palate treatment: systematic review.  

PubMed

Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs). Method. Searches were made in PubMed, Embase, and Cochrane Library on cleft lip and/or palate. From the 170 articles found in the searches, 28 were considered adequate to guide clinical practice. Results. A scarce number of RCTs were found approaching cleft treatment. The experimental clinical approaches analyzed in the 28 articles were infant orthopedics, rectal acetaminophen, palatal block with bupivacaine, infraorbital nerve block with bupivacaine, osteogenesis distraction, intravenous dexamethasone sodium phosphate, and alveoloplasty with bone morphogenetic protein-2 (BMP-2). Conclusions. Few randomized controlled trials were found approaching cleft treatment, and fewer related to surgical repair of this deformity. So there is a need for more multicenter collaborations, mainly on surgical area, to reduce the variety of treatment modalities and to ensure that the cleft patient receives an evidence-based clinical practice. PMID:23213503

de Ladeira, Pedro Ribeiro Soares; Alonso, Nivaldo

2012-01-01

144

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...

145

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

146

The mediating role of non-suicidal self-injury in the relationship between impulsivity and suicidal behavior among inpatients receiving treatment for substance use disorders.  

PubMed

Several theories posit a direct role of impulsivity in suicidal behavior. The interpersonal-psychological theory of suicidal behavior (IPTS) argues that the relationship between impulsivity and suicidal behavior is explained by the painful and/or provocative experiences (PPEs) often encountered by impulsive individuals. It thus seems plausible that nonsuicidal self-injury (NSSI), itself associated with impulsivity, might account for the relationship between impulsivity and suicidal behavior. We examined data from 93 adult inpatients (54.8% male) seeking treatment for substance use disorders. Patients completed a structured interview assessing prior suicidal behavior and a series of self-report questionnaires examining impulsivity, NSSI, and psychopathology. Four impulsivity dimensions (negative urgency, positive urgency, lack of premeditation, lack of perseverance) were associated with lifetime number of suicide attempts and/or suicide potential. Furthermore, results supported our hypotheses, as all but one relation was better accounted for by NSSI and, in the one exception, the direct effect was non-significant. Findings are consistent with the IPTS and suggest that suicidal behavior may not be a direct manifestation of impulsivity, but facilitated through exposure to PPEs capable of altering an individual?s relationship to pain and fear of death. PMID:24768248

Anestis, Michael D; Tull, Matthew T; Lavender, Jason M; Gratz, Kim L

2014-08-15

147

[Evidence-based treatment protocol to manage patellar dislocation].  

PubMed

Patellar dislocation is a common knee injury with mainly lateral dislocations, leading to ruptures of the medial patellofemoral ligament in most of the cases. Reliable data and prognostic factors for stability of the patellofemoral joint and satisfaction of the patient after either conservative or operative treatment have not been established yet. Until now, there are no randomized controlled trials for recurrent patellar dislocation at all. As a synopsis of the randomized controlled trials about first-time patellar dislocation, no significant difference between operative and conservative management is evident. This applies to both children and adolescents as well as to adults. There is a clear tendency towards first-line conservative therapy after traumatic patellar dislocation. Operative treatment is only required in case of accompanying injuries like osteochondral fractures or in case of recurrent dislocations. Further prospective randomized controlled trials with standardized operative and conservative treatment and patient cohorts of sufficient size are necessary in the future. PMID:22527955

Petri, M; Krettek, C; Jagodzinski, M

2012-05-01

148

The relationship between Clinical Trial Network protocol involvement and quality of substance use disorder treatment.  

PubMed

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 participating 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

2014-02-01

149

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

PubMed Central

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

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

2012-01-01

150

Proton Beam Therapy for Hepatocellular Carcinoma: A Comparison of Three Treatment Protocols  

SciTech Connect

Background: Our previous results for treatment of hepatocellular carcinoma (HCC) with proton beam therapy revealed excellent local control with low toxicity. Three protocols were used to avoid late complications such as gastrointestinal ulceration and bile duct stenosis. In this study, we examined the efficacy of these protocols. Methods and Materials: The subjects were 266 patients (273 HCCs) treated by proton beam therapy at University of Tsukuba between January 2001 and December 2007. Three treatment protocols (A, 66 GyE in 10 fractions; B, 72.6 GyE in 22 fractions; and C, 77 GyE in 35 fractions) were used, depending on the tumor location. Results: Of the 266 patients, 104, 95, and 60 patients were treated with protocols A, B, and C, respectively. Seven patients with double lesions underwent two different protocols. The overall survival rates after 1, 3 and 5 years were 87%, 61%, and 48%, respectively (median survival, 4.2 years). Multivariate analysis showed that better liver function, small clinical target volume, and no prior treatment (outside the irradiated field) were associated with good survival. The local control rates after 1, 3, and 5 years were 98%, 87%, and 81%, respectively. Multivariate analysis did not identify any factors associated with good local control. Conclusions: This study showed that proton beam therapy achieved good local control for HCC using each of three treatment protocols. This suggests that selection of treatment schedules based on tumor location may be used to reduce the risk of late toxicity and maintain good treatment efficacy.

Mizumoto, Masashi; Okumura, Toshiyuki; Hashimoto, Takayuki [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Fukuda, Kuniaki [Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Oshiro, Yoshiko; Fukumitsu, Nobuyoshi [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Abei, Masato [Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Kawaguchi, Atsushi [Biostatistics Center, Kurume University, Fukuoka (Japan); Hayashi, Yasutaka; Ookawa, Ayako; Hashii, Haruko; Kanemoto, Ayae [Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Moritake, Takashi [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Tohno, Eriko [Department of Diagnostic Radiology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Tsuboi, Koji [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Sakae, Takeji [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Sakurai, Hideyuki, E-mail: hsakurai@pmrc.tsukuba.ac.jp [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan)

2011-11-15

151

Treatment of pulmonary embolism: The use of low-molecular-weight heparin in the inpatient and outpatient settings.  

PubMed

Pulmonary embolism (PE) remains a major clinical problem associated with considerable mortality and morbidity. In patients with PE, appropriate anticoagulant therapy has been shown to significantly reduce both recurrence and mortality. Low-molecular-weight heparin (LMWH) is at least as effective as unfractionated heparin (UFH) in the treatment of PE, with a similar risk of bleeding. Furthermore, LMWH offers more predictable pharmacokinetics and anticoagulant effects. As a result, current guidelines from both the American College of Chest Physicians and the joint American College of Physicians/American Academy of Family Physicians recommend the use of LMWH over UFH (in patients with submassive PE). Outpatient treatment with LMWH has been shown to be feasible in many patients, and offers the potential for cost-savings and improvements in health-related quality of life. Further data are needed to support an evidence-based recommendation for the use of LMWH in the outpatient treatment of PE. PMID:18327398

Hull, Russell D

2008-03-01

152

Genetics of emergent suicidality during antidepressive treatment--data from a naturalistic study on a large sample of inpatients with a major depressive episode.  

PubMed

Factors contributing to treatment-emergent suicidal ideation (TESI) using antidepressants have been in the focus of recent research strategies. We investigated previously established clinical predictors of TESI and combined these with several polymorphisms of candidate genes in patients with major depressive disorder. Common polymorphisms involved in the tryptophan hydroxylase 1 (TPH1) and 2 (TPH2), serotonin transporter, monoamine oxidase A (MAOA) and brain-derived neurotrophic factor (BDNF) were investigated in a naturalistic inpatient study of the German research network on depression. We compared patients showing TESI with non-TESI suicidal patients and with non-suicidal patients using univariate tests to detect relevant factors, which were further tested in logistic regression and CART (Classification and Regression Trees) analyses. Of the 269 patients, TESI occurred in 22 patients (17 female), 117 patients were defined as non-TESI suicidal patients, and 130 patients were classified as non-suicidal. When comparing cases with both control groups we found the TPH2 rs1386494 (C/T) polymorphism to be moderately associated with TESI (Univariate tests: TESI vs. non-suicidality: p=0.005; adjusted: p=0.09; TESI vs. non-TESI suicidal patients: p=0.0024; adjusted: p=0.086). This polymorphism remained the only significant genetic factor in addition to clinical predictors in logistic regression and CART analyses. CART analyses suggested interactions with several clinical predictors. Haplotype analyses further supported a contribution of this polymorphism in TESI. The TPH2 rs1386494 (C/T) polymorphism might contribute to the genetic background of TESI. This polymorphism has been previously associated with committed suicide and major depressive disorder. The small number of cases warrants replication in larger patient samples. Lack of a placebo control group hampers definite conclusions on an association with antidepressive treatment. PMID:23063133

Musil, Richard; Zill, Peter; Seemüller, Florian; Bondy, Brigitta; Meyer, Sebastian; Spellmann, Ilja; Bender, Wolfram; Adli, Mazda; Heuser, Isabella; Fisher, Robert; Gaebel, Wolfgang; Maier, Wolfgang; Rietschel, Marcella; Rujescu, Dan; Schennach, Rebecca; Möller, Hans-Jürgen; Riedel, Michael

2013-07-01

153

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.

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

2014-01-01

154

Hypnotherapeutic treatment for anxiety-related relational discord: a short-term hypnotherapeutic protocol.  

PubMed

Hypnotherapeutic interventions are currently used to treat both anxiety disorders and relational discord between couples, yet few hypnotherapeutic interventions specifically address anxiety disorders within the context of a romantic partnership. This article explores a short-term hypnotherapeutic treatment protocol designed for couples' therapy in which the relational dynamic has been impacted by one partner's anxiety disorder. Anxiety not only causes suffering for the anxious patient, but can negatively impact intimate relationships as well. The hypnotherapeutic treatment protocol advanced in this article is specifically designed to address relational discord which is fueled by the presence of one partner's anxiety, and complements more standard individual treatment for anxiety disorders. Strategies to assess for the presence of relational discord with individual patients presenting with an anxiety disorder are included, as well as implications for longer-term couples' treatment. PMID:24938075

Daitch, Carolyn

2014-04-01

155

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

PubMed Central

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

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

2013-01-01

156

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

PubMed Central

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

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

2008-01-01

157

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

158

Do comprehensive, coordinated, recovery-oriented services alter the pattern of use of treatment services? Mental health treatment study impacts on SSDI beneficiaries' use of inpatient, emergency, and crisis services.  

PubMed

Current arrangements for financing and delivering behavioral health services to U.S. working-age adults with severe and persistent mental disorders (SPMD) have major inadequacies in funding for and access to critical elements of a recovery-oriented, comprehensive, and coordinated package of community-based treatment and rehabilitation services. This study presents results from a nation-wide 2-year randomized trial, involving 2,238 SSDI beneficiaries with SPMD, of a comprehensive intervention including evidence-based treatment and employment services. Estimates of impacts of the MHTS service intervention package, from a variety of regression specifications, showed clearly significant treatment group reductions in four outcomes (hospital stays and days, ER visits for mental health problems, and psychiatric crisis visits); these estimates suggest annual inpatient hospital treatment cost savings in excess of approximately $900 to 1,400. Negative estimated MHTS effects on three other utilization outcomes (hospital stays and days for mental health problems, overall ER visits) generally did not achieve statistical significance. Possible study implications for cost offsets from further expansions/replications of the MHTS intervention model are considered within the context of health reform. PMID:24481541

Salkever, David; Gibbons, Brent; Ran, Xiaotao

2014-10-01

159

Feasibility of Dialectical Behavior Therapy for Suicidal Adolescent Inpatients  

Microsoft Academic Search

ObjectiveTo evaluate the feasibility of dialectical behavior therapy (DBT) implementation in a general child and adolescent psychiatric inpatient unit and to provide preliminary effectiveness data on DBT versus treatment as usual (TAU).

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

2004-01-01

160

Treatment of oral cancer: the need for defined protocols and specialist centres. variations in the treatment of oral cancer.  

PubMed

The authors of this study aimed to identify treatment philosophies for oral cancer within the west of Scotland and to investigate any survival differences associated with the various treatment options by means of a retrospective review of case notes and cancer registry data. All patients with squamous cancer of the tongue or floor of the mouth were identified from the West of Scotland Cancer Registry for the period 1984-1990. A total of 206 patients were available for study. Five different treatment protocols were identified: 5% of patients underwent biopsy only, 16% biopsy plus radiotherapy, 11% excisional biopsy, 25% radical surgery, and 42% radical surgery plus radiotherapy. Tumour staging by the TNM classification was an important factor that determined outcome. When adjusting for T stage and nodal involvement, there was a significant effect of treatment protocol on both the disease-free period (P < 0.001) and on survival (P < 0.001). The treatment options were used differently by individual clinicians and were related to stage of the disease. One hundred and forty-four (70%) of the patients were treated by a single combined head and neck unit based within the plastic surgery unit at Canniesburn Hospital. The remaining 62 were treated in 13 different units throughout the west of Scotland. For those not treated in the combined head and neck unit, the increased hazard for recurrence was 1.43 (95% confidence interval (CI) 1.01-2.02), and the increased hazard ratio for death was 1.48 (95% CI 1.06-2.06) when adjusting for tumour stage, and nodal involvement. Treatment philosophies for oral cancer have a significant effect on outcome. There is a need to develop clearly defined protocols based on staging and site of disease. We believe that treatment should be carried out within a multidisciplinary setting in a combined head and neck cancer unit. PMID:11824876

Robertson, A G; Robertson, C; Soutar, D S; Burns, H; Hole, D; McCarron, P

2001-01-01

161

Class II treatment success rate in 2- and 4premolar extraction protocols  

Microsoft Academic Search

This study compared the occlusal success rate of Class II orthodontic treatment results with either 2- or 4-premolar extraction protocols. Group 1 comprised dental study models of 81 patients treated with 2 premolar extractions, and group 2 comprised dental study models of 50 patients treated with 4 premolar extractions. The initial mean ages of the groups were 13.9 and 12.9

Guilherme Janson; Adriana da Costa Brambilla; José Fernando Castanha Henriques; Marcos Roberto de Freitas; Leniana Santos Neves

2004-01-01

162

NIMH collaborative multimodal treatment study of children with ADHD (MTA): Design, methodology, and protocol evolution  

Microsoft Academic Search

The steering committee of the collaborative six-site Multimodal Treatment Study of Children with Attention-Deficit\\/Hyperactivity Disorder (the MTA) had to develop a common protocol consistent with public health goals and with scientific and clinical state of the art. With the aid of statistical, educational, and public health consultation, the steering committee balanced the stated objectives of the RFA against budgetary, clinical,

L. E. Arnold; H. B. Abikoff; D. P. Cantwell; C. K. Conners; G. R. Elliott; L. L. Greenhill; L. Hechtman; S. P. Hinshaw; B. Hoza; P. S. Jensen; H. C. Kraemer; J. S. March; J. H. Newcorn; W. E. Pelham; J. E. Richters; E. Schiller; J. B. Severe; J. M. Swanson; D. Vereen; K. C. Wells

1997-01-01

163

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

164

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

Microsoft Academic Search

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

Lily Rothschild; Liza Lacoua; Yohanan Eshel; Daniel Stein

2008-01-01

165

Program of the university clinic of toxicology, skopje, republic of macedonia in treatment of drug addiction (buprenorfin treatment protocol).  

PubMed

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

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

2011-01-01

166

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

167

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

168

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

169

Association between level of personality organization as assessed with theory-driven profiles of the Dutch Short Form of the MMPI and outcome of inpatient treatment for personality disorder.  

PubMed

The association between level of personality organization as assessed by theory-driven profile interpretation of the MMPI (Hathaway & McKinley, 1943) Dutch Short Form and treatment outcome was investigated in a naturalistic follow-up study among 121 psychotherapy inpatients who had been treated for their severe personality pathology. Treatment outcome was measured with the Brief Symptom Inventory (De Beurs & Zitman, 2006). Personality organization was associated with severity of psychopathology at baseline, the end of treatment, and 36 months after baseline. At 36 months after baseline, all patients except those with the high-level borderline organization profile and the psychotic borderline profile maintained their improvement. Contrary to expectations, (a) personality organization did not differentiate between patients with successful and unsuccessful out-comes, and (b) patients with a neurotic personality organization did not respond better than those with a borderline personality organization. Because of the small N, conclusions are tentative. PMID:24870848

Scholte, Wubbo R; Eurelings-Bontekoe, Elisabeth H M; Tiemens, Bea G; Verheul, Roel; Meerman, Anke; Hutschemaekers, Giel J M

2014-01-01

170

Integrative Practice: Presentation of an Inpatient Family Therapy Program  

Microsoft Academic Search

An inpatient family therapy program for treating complex combinations of individual, couple, and family problems is presented within a holistic treatment framework. The treatment context and scheduled program form treatment guidelines, yet the single case treatment approach may be tailored. A case vignette illustrates how theories and methods from both the individual and systemic therapy traditions are implemented as integrative

Terje Tilden

2008-01-01

171

Risk factors for suicides of inpatients with depressive psychoses  

Microsoft Academic Search

Research on identifying the relevant risk factors for suicides is faced with a multitude of methodological problems. The\\u000a present study attempts to improve on some of these problems and to isolate those risk factors that are accessible in the early\\u000a stages of the treatment of inpatients. A total of 3792 inpatients with monopolar or bipolar depression were treated during\\u000a the

Martin Krupinski; Alfred Fischer; Renate Grohmann; Rolf Engel; Mathias Hollweg; Hans-Jürgen Möller

1998-01-01

172

A prospective multicentre study of in-patient treatment for alcoholics: 18- and 48-month follow-up (munich evaluation for alcoholism treatment, MEAT)  

Microsoft Academic Search

Summary In a prospective multicentre study of 1410 alcoholics (73% men) data were collected at five different times: admission, discharge, 6, 18 and 48 months after discharge. The details from the 21 treatment centres involved were acquired from staff-members; follow-up data on patients were collected by personal interviews and\\/or mailed questionnaires. In all, 85%, 84% and 81% of the patients

Wilhelm Feuerlein; Heinrich Kiifner

1989-01-01

173

Attachment Styles in Alcoholic Inpatients  

Microsoft Academic Search

Despite the fact that addiction has often been identified as an attachment disorder, empirical studies on this topic are rather scarce. In our study we explore attachment style (secure vs. insecure) in alcoholic inpatients and its relationship with perceived parenting and alcohol-related and psychiatric problems in a sample of 101 alcoholic inpatients (Belgium). Our results reveal that in comparison to

Ann De Rick; Stijn Vanheule

2007-01-01

174

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

ERIC Educational Resources Information Center

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

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

175

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

PubMed Central

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

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

2012-01-01

176

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

177

Hydromorphone efficacy and treatment protocol impact on tolerance and ?-opioid receptor regulation  

PubMed Central

This study examined the antinociceptive (analgesic) efficacy of hydromorphone and hydromorphone-induced tolerance and regulation of ?-opioid receptor density. Initially s.c. hydromorphone’s time of peak analgesic (tail-flick) effect (45 min) and ED50 using standard and cumulative dosing protocols (0.22 mg/kg, 0.37mg/kg, respectively) were determined. The apparent analgesic efficacy (t) of hydromorphone was then estimated using the operational model of agonism and the irreversible ?-opioid receptor antagonist clocinnamox. Mice were injected with clocinnamox (0.32–25.6 mg/kg, i.p.) and 24 h later, the analgesic potency of hydromorphone was determined. The t value for hydromorphone was 35, which suggested that hydromorphone is a lower analgesic efficacy opioid agonist. To examine hydromorphone-induced tolerance, mice were continuously infused s.c. with hydromorphone (2.1–31.5mg/kg/day) for 7 days and then morphine cumulative dose response studies were performed. Other groups of mice were injected with hydromorphone (2.2-22 mg/kg/day) once, or intermittently every 24 h for 7 days. Twenty-four h after the last injection, mice were tested using morphine cumulative dosing studies. There was more tolerance with infusion treatments compared to intermittent treatment. When compared to higher analgesic efficacy opioids, hydromorphone infusions induced substantially more tolerance. Finally, the effect of chronic infusion (31.5mg/kg/day) and 7 day intermittent (22mg/kg/day) hydromorphone treatment on spinal cord ?-opioid receptor density was determined. Hydromorphone did not produce any change in ?-opioid receptor density following either treatment. These results support suggestions that analgesic efficacy is correlated with tolerance magnitude and regulation of ?-opioid receptors when opioid agonists are continuously administered. Taken together, these studies indicate that analgesic efficacy and treatment protocol are important in determining tolerance and regulation of ?-opioid receptors. PMID:18789923

Kumar, Priyank; Sunkaraneni, Soujanya; Sirohi, Sunil; Dighe, Shveta V.; Walker, Ellen A.; Yoburn, Byron C.

2008-01-01

178

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

179

Treatment of a patient with cleidocranial dysplasia using a single-stage implant protocol.  

PubMed

This patient report describes the treatment of a 45-year-old Caucasian woman with cleidocranial dysplasia who had significant dental problems that greatly affected her quality of life. The patient had orthodontic treatment in her earlier years along with surgical removal of supernumerary teeth. Using implants, the maxillary and mandibular arches were restored with fixed screw-retained prostheses. Eight implants and six implants were placed in the maxilla and mandible, respectively. Both arches were immediately loaded following the Teeth in a Day™ protocol using an all-acrylic resin provisional prosthesis. Five months later, definitive maxillary and mandibular prostheses were fabricated. The patient has been followed for a period of 5 years, and all postoperative evaluations have been uneventful. PMID:22003879

Petropoulos, Vicki C; Balshi, Thomas J; Wolfinger, Glenn J; Balshi, Stephen F

2011-10-01

180

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

Microsoft Academic Search

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

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

1996-01-01

181

Dissociative disorders among alcohol-dependent inpatients.  

PubMed

The aim of this study was to determine the prevalence of dissociative disorders among inpatients with alcohol dependency. The Dissociative Experiences Scale was used to screen 111 alcohol-dependent patients consecutively admitted to the inpatient unit of a dependency treatment center. Subgroups of 29 patients who scored 30.0 or above and 25 patients who scored below 10.0 were then evaluated with the Dissociative Disorders Interview Schedule and the Structured Interview for DSM-IV Dissociative Disorders. The interviewers were blind to the Dissociative Experiences Scale scores. Of the 54 patients evaluated, 10 (9.0% of the original 111) patients had a dissociative disorder. A considerable number of the remaining patients reported a high level of dissociative experiences. Among the dissociative disorder group, nine patients had dissociative disorder not otherwise specified and one patient had depersonalization disorder. Female gender, younger age, history of suicide attempt, childhood emotional and sexual abuse, and neglect were more frequent in the dissociative disorder group than among non-dissociative patients. The dissociative disorder group also had somatization disorder, borderline personality disorder, and lifetime major depression more frequently. For 9 of the 10 dissociative patients, dissociative symptoms started before the onset of alcohol use. Although the probability of having a comorbid dissociative disorder was not higher among alcohol-dependent inpatients than among the general psychiatric inpatients, the dissociative subgroup had distinct features. Many patients without a dissociative disorder diagnosis (predominantly men) provided hints of subtle dissociative psychopathology. Implications of comorbid dissociative disorders and dissociative experiences on prevention and treatment of alcohol dependency and the importance of gender-specific characteristics in this relationship require further study. PMID:17462744

Evren, Cuneyt; Sar, Vedat; Karadag, Figen; Tamar Gurol, Defne; Karagoz, Mustafa

2007-08-30

182

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

183

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

184

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

185

Realizable protocols for optimal administration of drugs in mathematical models for anti-angiogenic treatment.  

PubMed

Two mathematical models for tumour anti-angiogenesis, one originally formulated by Hahnfeldt et al. (1999, Tumor development under angiogenic signaling: a dynamical theory of tumor growth, treatment response, and postvascular dormancy. Cancer Res., 59, 4770-4775) and a modification of this model by Ergun et al. (2003, Optimal scheduling of radiotherapy and angiogenic inhibitors. Bull. Math. Biol., 65, 407-424) are considered as optimal control problem with the aim of maximizing the tumour reduction achievable with an a priori given amount of angiogenic agents. For both models, depending on the initial conditions, optimal controls may contain a segment along which the dosage follows a so-called singular control, a time-varying feedback control. In this paper, for these cases, the efficiency of piecewise constant protocols with a small number of switchings is investigated. Through comparison with the theoretically optimal solutions, it will be shown that these protocols provide generally excellent suboptimal strategies that for many initial conditions come within a fraction of 1% of the theoretically optimal values. When the duration of the dosages are a priori restricted to a daily or semi-daily regimen, still very good approximations of the theoretically optimal solution can be achieved. PMID:20513667

Ledzewicz, Urszula; Marriott, John; Maurer, Helmut; Schättler, Heinz

2010-06-01

186

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

187

Comprehensive evidence-based program teaching self-management of auditory hallucinations on inpatient psychiatric units.  

PubMed

Patients hearing command hallucinations to harm whose only self-management strategies are to obey these commands, can represent serious safety concerns on inpatient psychiatric units. A comprehensive evidence-based program teaching self-management of auditory hallucinations on inpatient psychiatric units is described that includes five components: suggestions for staff education; patient self-assessment tools; an interview guide and safety protocol; a course to teach strategies for managing distressing voices and commands to harm; suggestions to improve staff communication; and a plan to extend the program from inpatient care settings into the community by sharing materials with community case managers and caregivers when patients are discharged. PMID:20144034

Buccheri, Robin Kay; Trygstad, Louise Nigh; Buffum, Martha D; Lyttle, Kathleen; Dowling, Glenna

2010-03-01

188

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

Code of Federal Regulations, 2010 CFR

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

2010-10-01

189

Developing a safe antifungal treatment protocol to eliminate Batrachochytrium dendrobatidis from amphibians.  

PubMed

Batrachochytrium dendrobatidis is one of the most pathogenic microorganisms affecting amphibians in both captivity and in nature. The establishment of B. dendrobatidis free, stable, amphibian captive breeding colonies is one of the emergency measures that is being taken to save threatened amphibian species from extinction. For this purpose, in vitro antifungal susceptibility testing and the development of efficient and safe treatment protocols are required. In this study, we evaluated the use of amphotericin B and voriconazole to treat chytridiomycosis in amphibians. The concentration at which the growth of five tested B. dendrobatidis strains was inhibited was 0.8 ?g/ml for amphotericin B and 0.0125 ?g/ml for voriconazole. To completely eliminate a mixture of sporangia and zoospores of strain IA042 required 48 h of exposure to 8 ?g/ml of amphotericin B or 10 days to 1.25 ?g/ml of voriconazole. Zoospores were killed within 0.5 h by 0.8 ?g/ml of amphotericin B, but even after 24 h exposure to 1.25 ?g/ml of voriconazole they remained viable. Amphotericin B was acutely toxic for Alytes muletensis tadpoles at 8 ?g/ml, whereas toxic side effects were not noticed during a seven-day exposure to voriconazole at concentrations as high as 12.5 ?g/ml. The voriconazole concentrations remained stable in water during this exposure period. On the basis of this data, experimentally inoculated postmetamorphic Alytes cisternasii were sprayed once daily for 7 days with a 1.25 ?g/ml solution of voriconazole in water which eliminated the B. dendrobatidis infection from all treated animals. Finally, treatment of a naturally infected colony of poison dart frogs (Dendrobatidae) using this protocol, combined with environmental disinfection, cleared the infection from the colony. PMID:20718611

Martel, A; Van Rooij, P; Vercauteren, G; Baert, K; Van Waeyenberghe, L; Debacker, P; Garner, T W J; Woeltjes, T; Ducatelle, R; Haesebrouck, F; Pasmans, F

2011-02-01

190

Protocols for the Initial Treatment of Moderately Severe Juvenile Dermatomyositis: Results of a Children's Arthritis and Rheumatology Research Alliance Consensus Conference  

PubMed Central

Objective To use juvenile dermatomyositis (JDM) survey data and expert opinion to develop a small number of consensus treatment protocols which reflect current initial treatment of moderately severe JDM. Methods A consensus meeting was held in Toronto, Ontario, Canada on December 1-2, 2007. Nominal group technique was used to achieve consensus on treatment protocols which represented typical management of moderately severe JDM. Consensus was also reached on which patients these protocols would be applicable to (inclusion and exclusion criteria), initial investigations which should be done prior to initiating one of these protocols, data which should be collected to evaluate these protocols, concomitant interventions that would be required or recommended. Results Three protocols were developed which described the first 2 months of treatment. All protocols included corticosteroids and methotrexate. One protocol also included intravenous gammaglobulin. Consensus was achieved for all issues that were addressed by conference participants, although there were some areas of controversy Conclusions This study shows that it is possible to achieve consensus on the initial treatment of JDM, despite considerable variation in clinical practice. Once these protocols are extended beyond 2 months, these protocols will be available for clinical use. By using methods which account for differences between patients (confounding by indication), the comparative effectiveness of the protocols will be evaluated. In the future, the goal will be to identify the optimal treatment of moderately severe JDM. PMID:20191521

Huber, Adam M.; Giannini, Edward H.; Bowyer, Suzanne L.; Kim, Susan; Lang, Bianca; Lindsley, Carol B.; Pachman, Lauren M.; Pilkington, Clarissa; Reed, Ann M.; Rennebohm, Robert M.; Rider, Lisa G.; Wallace, Carol A.; Feldman, Brian M.

2010-01-01

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

The use of antiepileptic drugs in learning disabled people with epilepsy: an audit of adult in-patients in a treatment and continuing care service.  

PubMed

The primary aim of the audit described was to examine antiepileptic drug use among adult in-patients with learning disability. A secondary aim was to examine investigation in those patients. For the purposes of this paper "Learning disability" is synonymous with ICD-10 "Mental Retardation", "Mental Handicap" or "Intellectual Impairment" and should not be confused with the North American use of the term which refers to discrete, specific problems in mental abilities such as reading. A total of 75 adult patients on both the Northgate and Prudhoe sites (managed by Northgate and Prudhoe NHS Trust) were identified as being treated with antiepileptic drugs (AEDs) for postulated epilepsy. Only 12 (16%) patients were being treated with three AEDs or more, the remainder being on either one or two AEDs. All patients with a history of status epilepticus were prescribed rectal diazepam or, more rarely, intranasal midazolam. The number and type of investigations performed on patients varied widely and was sometimes limited by the patient's ability to co-operate with procedures. Overall, 28 patients were identified who might benefit from a reduction in the number of AEDs prescribed. In 15 of these patients antiepileptic drug regime was currently being reduced. The increased utilization of sleep/sedated electroencephalogram (EEG) and magnetic resonance imaging (MRI--for partial seizures), where practical, may also increase diagnostic accuracy in identifying epilepsy and its aetiology. Audit will be repeated in 12 months. PMID:11749106

Tiffin, P A; Perini, A F

2001-10-01

193

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

194

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

ERIC Educational Resources Information Center

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

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

2011-01-01

195

Dental anxiety in 6-7-year-old children treated in accordance with conventional restorative treatment, ART and ultra-conservative treatment protocols  

Microsoft Academic Search

Abstract:Objective. To test the hypothesis that dental anxiety levels of children treated in accordance with the conventional restorative treatment (CRT) are higher than in children treated with the atraumatic restorative treatment (ART) or ultra-conservative treatment (UCT) protocols. Materials and methods. In total, 302 children aged 6-7-years old, with at least two dentine carious lesions, constituted the sample. A parallel group

D. M. de Menezes Abreu; S. C. Leal; J. Mulder; J. E. F. M. Frencken

2011-01-01

196

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

E-print Network

the water out, scrub the bucket, rinse, and start again with fresh water. The last liter of waterLangerhans Lab Protocols Water treatment & aging.docx revised 1/30/13 by JW Page 1 of 1 Water salinity) Marine Mix or Instant Ocean 2. Fill bucket with tap water, to brim. 3. Put air stone and heater

Langerhans, Brian

197

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

EPA Science Inventory

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

198

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

Cost-of-Illness in Psoriasis: Comparing Inpatient and Outpatient Therapy  

PubMed Central

Treatment modalities of chronic plaque psoriasis have dramatically changed over the past ten years with a still continuing shift from inpatient to outpatient treatment. This development is mainly caused by outpatient availability of highly efficient and relatively well-tolerated systemic treatments, in particular BioLogicals. In addition, inpatient treatment is time- and cost-intense, conflicting with the actual burst of health expenses and with patient preferences. Nevertheless, inpatient treatment with dithranol and UV light still is a major mainstay of psoriasis treatment in Germany. The current study aims at comparing the total costs of inpatient treatment and outpatient follow-up to mere outpatient therapy with different modalities (topical treatment, phototherapy, classic systemic therapy or BioLogicals) over a period of 12 months. To this end, a retrospective cost-of-illness study was conducted on 120 patients treated at the University Medical Centre Mannheim between 2005 and 2006. Inpatient therapy caused significantly higher direct medical, indirect and total annual costs than outpatient treatment (13,042 € versus 2,984 €). Its strong influence on cost levels was confirmed by regression analysis, with total costs rising by 104.3% in case of inpatient treatment. Patients receiving BioLogicals produced the overall highest costs, whereas outpatient treatment with classic systemic antipsoriatic medications was less cost-intense than other alternatives. PMID:24194911

Steinke, Sabine I. B.; Peitsch, Wiebke K.; Ludwig, Alexander; Goebeler, Matthias

2013-01-01

200

Predictors of quality of life in inpatients with schizophrenia.  

PubMed

Shortening hospital stays has become a key focus in psychiatric care in recent years. However, patients with schizophrenia account for about 60% of inpatients in psychiatry departments in Japan. This study was designed to investigate the relationship between quality of life (QOL) and key indicators for long-term hospital stays among schizophrenia inpatients. A further aim was to elucidate the clinical determinants of QOL among long-stay inpatients. The study sample consisted of 217 inpatients with schizophrenia. Age, duration of illness, duration of hospitalization, years of education, body mass index, neurocognitive function, drug-induced extrapyramidal symptoms, involuntary movements, psychiatric symptoms, and dose equivalents of antipsychotics and anticholinergic agents were used as index factors. Pearson linear correlation and regression analyses were performed to examine the associations between QOL and the above-mentioned factors. Negative symptoms, psychological discomfort, and resistance as rated on the Brief Psychiatric Rating Scale (BPRS) were correlated with all subscale scores of the Japanese version of the Schizophrenia Quality of Life Scale (JSQLS). Stepwise regression showed that negative symptoms, psychological discomfort, and resistance predicted the dysfunction of psycho-social activity score and the dysfunction of motivation and energy score on the JSQLS. This study shows that active treatment for negative symptoms, psychological discomfort, and resistance should be recommended to improve QOL among inpatients with schizophrenia. PMID:22370148

Fujimaki, Koichiro; Morinobu, Shigeru; Yamashita, Hidehisa; Takahashi, Terumichi; Yamawaki, Shigeto

2012-05-30

201

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

PubMed Central

Background Chronic pain is prevalent among young people and negatively influences their quality of life. Furthermore, chronic pain in adolescence may persist into adulthood. Therefore, it is important early on to promote the self-management skills of adolescents with chronic pain by improving signaling, referral, and treatment of these youngsters. In this study protocol we describe the designs of two complementary studies: a signaling study and an intervention study. Methods and design The signaling study evaluates the Pain Barometer, a self-assessed signaling instrument for chronic pain in adolescents. To evaluate the feasibility of the Pain Barometer, the experiences of youth-health care nurses will be evaluated in semi-structured interviews. Also, we will explore the frequencies of referral per health-care provider. The intervention study evaluates Move It Now, a guided self-help intervention via the Internet for teenagers with chronic pain. This intervention uses cognitive behavioural techniques, including relaxation exercises and positive thinking. The objective of the intervention is to improve the ability of adolescents to cope with pain. The efficacy of Move It Now will be examined in a randomized controlled trial, in which 60 adolescents will be randomly assigned to an experimental condition or a waiting list control condition. Discussion If the Pain Barometer is proven to be feasible and Move It Now appears to be efficacious, a health care pathway can be created to provide the best tailored treatment promptly to adolescents with chronic pain. Move It Now can be easily implemented throughout the Netherlands, as the intervention is Internet based. Trial registration Dutch Trial Register NTR1926 PMID:22686133

2012-01-01

202

Evaluation of a protocol for selective empiric treatment of fever without localising signs  

Microsoft Academic Search

A protocol for management of young febrile children at risk for bacteraemia has been used at Westmead Hospital, a university based hospital in the western Sydney region, since early 1994. Implementation of the protocol was retrospectively evaluated for the 12 month period 1 June 1994 to 31 May 1995, using the emergency department log book as the primary data source.

G J Browne; J M Ryan; P McIntyre

1997-01-01

203

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

204

Inpatient Management of Guillain-Barr? Syndrome  

PubMed Central

Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in the developed world. Guillain-Barré syndrome typically presents with ascending paralysis and is usually severe enough to warrant hospital admission for management. In the United States alone, GBS results in more than 6000 hospitalizations each year. Although GBS patients were historically cared for at tertiary referral centers, changing treatment practices have broadened the number of neurologists who care for the disease. This article provides a review of key issues in the inpatient management of GBS. A survey of the evidence base for treatment with plasma exchange or intravenous immunoglobulins is presented. Although either of these treatments can limit the severity of GBS, patients are still at risk for a broad range of complications, including respiratory failure, autonomic dysfunction, thromboembolic disease, pain, and psychiatric disorders. Awareness of these complications, their detection and management, may help limit the morbidity of GBS. PMID:23983841

Harms, Matthew

2011-01-01

205

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

206

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

PubMed Central

Background Ectonucleotidase dependent adenosine generation has been implicated in preconditioning related cardioprotection against ischemia-reperfusion injury, and treatment with a soluble ectonucleotidase has been shown to reduce myocardial infarct size (IS) when applied prior to induction of ischemia. However, ectonucleotidase treatment according to a clinically applicable protocol, with administration only after induction of ischemia, has not previously been evaluated. We therefore investigated if treatment with the ectonucleotidase apyrase, according to a clinically applicable protocol, would reduce IS and microvascular obstruction (MO) in a large animal model. Methods A percutaneous coronary intervention balloon was inflated in the left anterior descending artery for 40 min, in 16 anesthetized pigs (40-50 kg). The pigs were randomized to 40 min of 1 ml/min intracoronary infusion of apyrase (10 U/ml, n = 8) or saline (0.9 mg/ml, n = 8), twenty minutes after balloon inflation. Area at risk (AAR) was evaluated by ex vivo SPECT. IS and MO were evaluated by ex vivo MRI. Results No differences were observed between the apyrase group and saline group with respect to IS/AAR (75.7 ± 4.2% vs 69.4 ± 5.0%, p = NS) or MO (10.7 ± 4.8% vs 11.4 ± 4.8%, p = NS), but apyrase prolonged the post-ischemic reactive hyperemia. Conclusion Apyrase treatment according to a clinically applicable protocol, with administration of apyrase after induction of ischemia, does not reduce myocardial infarct size or microvascular obstruction. PMID:20047685

2010-01-01

207

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

208

42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.  

Code of Federal Regulations, 2012 CFR

...hospitalization of the patient for medical treatment or medically required inpatient diagnostic study; or (ii) Special...physician or by the hospital's medical staff. (2) Exception...because his or her underlying medical condition and...

2012-10-01

209

42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.  

Code of Federal Regulations, 2010 CFR

...hospitalization of the patient for medical treatment or medically required inpatient diagnostic study; or (ii) Special...physician or by the hospital's medical staff. (2) Exception...because his or her underlying medical condition and...

2010-10-01

210

42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.  

Code of Federal Regulations, 2011 CFR

...hospitalization of the patient for medical treatment or medically required inpatient diagnostic study; or (ii) Special...physician or by the hospital's medical staff. (2) Exception...because his or her underlying medical condition and...

2011-10-01

211

Evaluation of Patient Handoff Methods on an Inpatient Teaching Service  

PubMed Central

Background The patient handoff process can be a highly variable and unstructured period at risk for communication errors. The morning sign-in process used by resident physicians at teaching hospitals typically involves less rigorous handoff protocols than the resident evening sign-out process. Little research has been conducted on best practices for handoffs during morning sign-in exchanges between resident physicians. Research must evaluate optimal protocols for the resident morning sign-in process. Methods Three morning handoff protocols consisting of written, electronic, and face-to-face methods were implemented over 3 study phases during an academic year. Study participants included all interns covering the internal medicine inpatient teaching service at a tertiary hospital. Study measures entailed intern survey-based interviews analyzed for failures in handoff protocols with or without missed pertinent information. Descriptive and comparative analyses examined study phase differences. Results A scheduled face-to-face handoff process had the fewest protocol deviations and demonstrated best communication of essential patient care information between cross-covering teams compared to written and electronic sign-in protocols. Conclusion Intern patient handoffs were more reliable when the sign-in protocol included scheduled face-to-face meetings. This method provided the best communication of patient care information and allowed for open exchanges of information. PMID:23267259

Craig, Steven R.; Smith, Hayden L.; Downen, A. Matthew; Yost, W. John

2012-01-01

212

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

213

Use of BPRS-A percent change scores to identify significant clinical improvement: accuracy of treatment response classification in acute psychiatric inpatients  

Microsoft Academic Search

Use of Brief Psychiatric Rating Scale [Overall J.E., Gorham D.R., 1988. The Brief Psychiatric Rating Scale (BPRS): recent developments in ascertainment and scaling. Psychopharmacology Bulletin 24, 97–99] percent change scores (PCSs) to measure treatment effects may be problematic because two different item-weighting systems (0–6 and 1–7) have been employed to represent the seven rating options and PCSs have demonstrated sensitivity

David Lachar; Steven E Bailley; Howard M Rhoades; Roy V Varner

1999-01-01

214

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

215

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

216

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

Microsoft Academic Search

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

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

2011-01-01

217

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

218

competency Course Objective 1 1a Apply biomedical science knowledge to inpatient care of patients with acute medical conditions.  

E-print Network

for and explain the treatment for the most common inpatient diagnoses including chest pain, arrhythmia, CHF, COPD, PNA, PE/DVT, delirium, electrolyte abnormalities, acute diabetic respectful relationships, and show ability to help patients understand treatment options

Myers, Lawrence C.

219

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...

220

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

PubMed Central

Background Post-discharge support is a key component of effective treatment for hospitalized smokers, but few hospitals provide it. Many hospitals and care settings fax-refer smokers to quitlines for follow-up; however, less than half of fax-referred smokers are successfully contacted and enrolled in quitline services. “Warm handoff” is a novel approach to care transitions in which health care providers directly link patients with substance abuse problems with specialists, using face-to-face or phone transfer. Warm handoff achieves very high rates of treatment enrollment for these vulnerable groups. Methods The aim of this study—“EQUIP” (Enhancing Quitline Utilization among In-Patients)—is to determine the effectiveness, and cost-effectiveness, of warm handoff versus fax referral for linking hospitalized smokers with tobacco quitlines. This study employs a two-arm, individually randomized design. It is set in two large Kansas hospitals that have dedicated tobacco treatment interventionists on staff. At each site, smokers who wish to remain abstinent after discharge will be randomly assigned to groups. For patients in the fax group, staff will provide standard in-hospital intervention and will fax-refer patients to the state tobacco quitline for counseling post-discharge. For patients in the warm handoff group, staff will provide brief in-hospital intervention and immediate warm handoff: staff will call the state quitline, notify them that a warm handoff inpatient from Kansas is on the line, then transfer the call to the patients’ mobile or bedside hospital phone for quitline enrollment and an initial counseling session. Following the quitline session, hospital staff provides a brief check-back visit. Outcome measures will be assessed at 1, 6, and 12?months post enrollment. Costs are measured to support cost-effectiveness analyses. We hypothesize that warm handoff, compared to fax referral, will improve care transitions for tobacco treatment, enroll more participants in quitline services, and lead to higher quit rates. We also hypothesize that warm handoff will be more cost-effective from a societal perspective. Discussion If successful, this project offers a low-cost solution for more efficiently linking millions of hospitalized smokers with effective outpatient treatment—smokers that might otherwise be lost in the transition to outpatient care. Trial registration Clinical Trials Registration NCT01305928 PMID:22853047

2012-01-01

221

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

222

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

223

Using RFID Yoking Proof Protocol to Enhance Inpatient Medication Safety  

Microsoft Academic Search

The low birth rate has led to an aging society; the burgeoning number of elderly patients may affect the medical quality and\\u000a result in negative medical incidents. There are many factors that lead to medical errors, such as similar medication names,\\u000a erroneous labels and packaging, as well as staff shortages, fatigue and carelessness. Determining how to reduce medical errors\\u000a has

Chin-Ling Chen; Chun-Yi Wu

224

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

National Technical Information Service (NTIS)

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

1988-01-01

225

29 CFR 825.114 - Inpatient care.  

Code of Federal Regulations, 2013 CFR

...Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including any period of incapacity as defined in § 825.113(b), or any...

2013-07-01

226

29 CFR 825.114 - Inpatient care.  

Code of Federal Regulations, 2010 CFR

...Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including any period of incapacity as defined in § 825.113(b), or any...

2010-07-01

227

29 CFR 825.114 - Inpatient care.  

...Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including any period of incapacity as defined in § 825.113(b), or any...

2014-07-01

228

Impulse control disorders in psychiatric inpatients  

Microsoft Academic Search

The aim of this study was to examine the prevalence of impulse control disorders (ICDs) in a European psychiatric inpatient sample. Two hundred thirty four consecutive psychiatric inpatients (62% female) were examined using a module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) that has been developed for ICDs (SCID-ICD). In addition

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

2011-01-01

229

Psychosomatic inpatient rehabilitation: the german model.  

PubMed

The term 'psychosomatic' has many connotations, be it in the sense of a general biopsychosocial concept in medicine as outlined in the ICF (International Classification of Functioning, Disability and Health) of the World Health Organization, a holistic and person-centered view of the patient beyond the illness, the treatment of somatoform or somatic disorders, or special psychotherapeutic approaches. In Germany, there are also about 25,000 inpatient beds in 'psychosomatic rehabilitation hospitals', which treat approximately 5/1,000 inhabitants in the working age population per year. These institutions give an example of how to translate the theoretical concepts of psychosomatic medicine and of the ICF into clinical practice. 'Psychosomatic rehabilitation' aims at the prevention, treatment and compensation of chronic illness by a biopsychosocial approach. This includes a multilevel psychosomatic assessment and a multidimensional treatment focus including the reduction of symptoms, the training of capacities, the coping with chronic illness and impairment, the restoration of well-being and normal life, and the occupational reintegration including the search for a workplace, which allows work in spite of impairment. Scientific studies have shown that the psychological status, the motivation to work, the number of days on sickness leave and occupational reintegration can be improved, and that the system pays for the patients themselves, but also pension and health insurance companies. PMID:24970244

Linden, Michael

2014-01-01

230

Nonadherence to treatment protocol in published randomised controlled trials: a review  

E-print Network

diet, and/or executing lifestyle changes, corre- sponds with agreed recommendations from a health care provider’ [1]. Nonadherence to prescribed treatment can take a variety of forms, ranging from not starting treatment appointment with clinician... with participant-administered treatment mentioned checking adherence, and only five of these assessed the reliability of the adherence data using a second method. The most common methods to ascertain participant adherence involved counting pills (11 trials...

Dodd, Susanna; White, Ian R; Williamson, Paula

2012-06-18

231

Vocational rehabilitation for psychiatric inpatient Vietnam combat veterans.  

PubMed

A Department of Veterans Affairs (DVA) inpatient psychiatry program treating Vietnam veterans for symptoms of posttraumatic stress disorder provided day and evening treatment programs. The evening program, besides treating psychiatric trauma, incorporated the DVA mission of assisting patients with vocational rehabilitation and work force reentry. Although initially opposed to employment, Vietnam veterans accepted a treatment program with an emphasis on working and job training. Both programs were compared using the Ward Atmosphere Scale (WAS). No significant differences between the two programs were found. The results support the DVA's position that employment is a valuable component of psychiatric treatment. PMID:2119020

Pendorf, J E

1990-08-01

232

Treatment of Oral Cancer: The Need for Defined Protocols and Specialist Centres. Variations in the Treatment of Oral Cancer  

Microsoft Academic Search

The authors of this study aimed to identify treatment philosophies for oral cancer within the west of Scotland and to investigate any survival differences associated with the various treatment options by means of a retrospective review of case notes and cancer registry data. All patients with squamous cancer of the tongue or floor of the mouth were identified from the

A. G. Robertson; C. Robertson; D. S. Soutar; H. Burns; D. Hole; P. McCarron

2001-01-01

233

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

Microsoft Academic Search

Cats are at risk for heartworm infection (Dirofilaria immitis) wherever the disease is endemic in dogs. Diagnosis is more difficult in cats, and little information is available regarding effective palliative and curative treatments for infected cats. In contrast to the challenges of diagnosis and treatment, chemoprophylaxis is highly effective, and current guidelines call for preventive medications to be administered to

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

2011-01-01

234

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

235

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

Microsoft Academic Search

This article reviews the development and initial trial of a treatment for adolescents that targets negative emotionality and associated psychological difficulties—particularly anxiety and depressive disorders—as a more singular entity by utilizing an approach rooted in both emotion science and theory. The rationale for such an approach is based upon the perceived need for novel treatment approaches that target commonalities in

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

2009-01-01

236

Brief Interventions and Brief Therapies for Substance Abuse. Treatment Improvement Protocol (TIP) Series 34.  

ERIC Educational Resources Information Center

This TIP, on the best practice guidelines for treatment of substance use disorders, was compiled from an increasing body of research literature that documents the effectiveness of brief interventions and therapies in both the mental health and substance abuse treatment fields. It links research to practice by providing counselors with up-to-date…

CDM Group, Inc.

237

A pilot test of motivational interviewing groups for dually diagnosed inpatients  

Microsoft Academic Search

Motivational interviewing is a brief treatment approach designed to produce rapid, internally motivated change in addictive behaviors. Motivational interviewing shows promise for engaging clients with dual psychiatric and psychoactive substance use diagnoses in treatment. While initially developed as an individual treatment approach, key motivational enhancement principles may be applied to structured group interventions to facilitate its introduction to inpatient dual-diagnosis

Deborah H. A Van Horn; Donald A Bux

2001-01-01

238

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

239

Internet treatment for social anxiety disorder in Romania: study protocol for a randomized controlled trial  

PubMed Central

Background Social anxiety disorder (SAD) is one of the most common anxiety disorders and is associated with marked impairments. However, a small proportion of individuals with SAD seek and receive treatment. Internet-administrated cognitive behavior therapy (iCBT) has been found to be an effective treatment for SAD. This trial will be the first Internet-delivered guided self-help intervention for SAD in Romania. Methods Participants with social anxiety disorder (N = 96) will be recruited via newspapers, online banners and Facebook. Participants will be randomized to either: a) an active treatment, or b) a waiting list control group. The treatment will have a guided iCBT format and will last for nine weeks. Self-report questionnaires on social phobia, anxiety, depression, treatment credibility and irrational thinking will be used. All assessments will be collected pre, post and at follow-up (six months after intervention). Liebowitz Social Anxiety Scale – Self-Report version (LSAS-SR) will be the primary outcome measure and will be administrated on a weekly basis in both conditions. Discussion The present randomized controlled trial investigates the efficacy of an Internet-administered intervention in reducing social anxiety symptoms in a culture where this form of treatment has not been tested. This trial will add to the body of knowledge on the efficacy of iCBT, and the results might lead to an increase of the accessibility of evidence-based psychological treatment in Romania. Trial registration ClinicalTrials.gov: NCT01557894 PMID:23111108

2012-01-01

240

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

PubMed Central

Background The use of computerized systems to support evidence-based practice is commonplace in contemporary medicine. Despite the prolific use of electronic support systems there has been relatively little research on the uptake of web-based systems in the oncology setting. Our objective was to examine the uptake of a web-based oncology protocol system (http://www.eviq.org.au) by Australian cancer clinicians. Methods We used web-logfiles and Google Analytics to examine the characteristics of eviQ registrants from October 2009-December 2011 and patterns of use by cancer clinicians during a typical month. Results As of December 2011, there were 16,037 registrants; 85% of whom were Australian health care professionals. During a typical month 87% of webhits occurred in standard clinical hours (08:00 to 18:00 weekdays). Raw webhits were proportional to the size of clinician groups: nurses (47% of Australian registrants), followed by doctors (20%), and pharmacists (14%). However, pharmacists had up to three times the webhit rate of other clinical groups. Clinicians spent five times longer viewing chemotherapy protocol pages than other content and the protocols viewed reflect the most common cancers: lung, breast and colorectal. Conclusions Our results demonstrate eviQ is used by a range of health professionals involved in cancer treatment at the point-of-care. Continued monitoring of electronic decision support systems is vital to understanding how they are used in clinical practice and their impact on processes of care and patient outcomes. PMID:23497080

2013-01-01

241

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

242

Designing a treatment protocol with voriconazole to eliminate Aspergillus fumigatus from experimentally inoculated pigeons  

Microsoft Academic Search

To investigate the efficacy of voriconazole for the treatment of aspergillosis, three groups of six racing pigeons (Columba livia domestica) were inoculated in the apical part of the right lung with 2×107 conidia of an avian derived Aspergillus fumigatus strain. The minimal inhibitory concentration of voriconazole for this strain was 0.25?g\\/ml. In two groups, voriconazole treatment was started upon appearance

Lies A. Beernaert; Frank Pasmans; Kris Baert; Lieven Van Waeyenberghe; Koen Chiers; Freddy Haesebrouck; An Martel

2009-01-01

243

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

244

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

PubMed Central

Background Irritable bowel syndrome is a chronic condition with no known cure. Many sufferers seek complementary and alternative medicine including homeopathic treatment. However there is much controversy as to the effectiveness of homeopathic treatment. This three-armed study seeks to explore the effectiveness of individualised homeopathic treatment plus usual care compared to both an attention control plus usual care and usual care alone, for patients with irritable bowel syndrome. Methods/design This is a three-armed pragmatic randomised controlled trial using the cohort multiple randomised trial methodology. Patients are recruited to an irritable bowel syndrome cohort from primary and secondary care using GP databases and consultants lists respectively. From this cohort patients are randomly selected to be offered, 5 sessions of homeopathic treatment plus usual care, 5 sessions of supportive listening plus usual care or usual care alone. The primary clinical outcome is the Irritable Bowel Syndrome Symptom Severity at 26 weeks. From a power calculation, it is estimated that 33 people will be needed for the homeopathic treatment arm and 132 for the usual care arm, to detect a minimal clinical difference at 80 percent power and 5 percent significance allowing for loss to follow up. An unequal group size has been used for reasons of cost. Analysis will be by intention to treat and will compare homeopathic treatment with usual care at 26 weeks as the primary analysis, and homeopathic treatment with supportive listening as an additional analysis. Discussion This trial has received NHS approval and results are expected in 2013. Trial registration Current Controlled Trials ISRCTN90651143 PMID:23131064

2012-01-01

245

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

PubMed Central

Background Clinical depression is common, debilitating and treatable; one in four people experience it during their lives. The majority of sufferers are treated in primary care and only half respond well to active treatment. Evidence suggests that folate may be a useful adjunct to antidepressant treatment: 1) patients with depression often have a functional folate deficiency; 2) the severity of such deficiency, indicated by elevated homocysteine, correlates with depression severity, 3) low folate is associated with poor antidepressant response, and 4) folate is required for the synthesis of neurotransmitters implicated in the pathogenesis and treatment of depression. Methods/Design The primary objective of this trial is to estimate the effect of folate augmentation in new or continuing treatment of depressive disorder in primary and secondary care. Secondary objectives are to evaluate the cost-effectiveness of folate augmentation of antidepressant treatment, investigate how the response to antidepressant treatment depends on genetic polymorphisms relevant to folate metabolism and antidepressant response, and explore whether baseline folate status can predict response to antidepressant treatment. Seven hundred and thirty patients will be recruited from North East Wales, North West Wales and Swansea. Patients with moderate to severe depression will be referred to the trial by their GP or Psychiatrist. If patients consent they will be assessed for eligibility and baseline measures will be undertaken. Blood samples will be taken to exclude patients with folate and B12 deficiency. Some of the blood taken will be used to measure homocysteine levels and for genetic analysis (with additional consent). Eligible participants will be randomised to receive 5 mg of folic acid or placebo. Patients with B12 deficiency or folate deficiency will be given appropriate treatment and will be monitored in the 'comprehensive cohort study'. Assessments will be at screening, randomisation and 3 subsequent follow-ups. Discussion If folic acid is shown to improve the efficacy of antidepressants, then it will provide a safe, simple and cheap way of improving the treatment of depression in primary and secondary care. Trial registration Current controlled trials ISRCTN37558856 PMID:18005429

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

2007-01-01

246

Bright Light Therapy and\\/or Imipramine for Inpatients with Recurrent Non-Seasonal Depression  

Microsoft Academic Search

Abstract,INTRODUCTION: The aim of a double-blind study was to assess the efficacy of bright light therapy,and\\/or imipramine,in the treatment,of inpatients suf- fering with recurrent non-seasonal major depressive disorder. METHOD: 34 in-patients with DSM-III-R diagnosis of major,depressive disor- der, recurrent type, were randomly allocated into 3 treatment groups. After 4-day washout,period with baseline assessment,they underwent,3 weeks of different types of treatment:

Jan Prasko; Jiri Horacek; Jan Klaschka; Jirina Kosova; Ivana Ondrackova; Jiri Sipek

247

A Prospective Natural History Study of Quitting or Reducing Gambling With or Without Treatment: Protocol  

PubMed Central

Background Only a small percentage of gamblers ever seek treatment, often due to stigma, embarrassment, or a desire to handle their problems on their own. While the majority of pathological gamblers who achieve remittance do so without accessing formal treatment, factors related to successful resolution have not been thoroughly explored. Objective Employing a prospective natural history design, the study will therefore undertake an investigation to explore life events, motivating factors, and strategies used by problem gamblers to quit or reduce their gambling without formal treatment. Methods Prospective participants (19 years or older) currently gambling at problematic levels with strong intentions toward quitting gambling will be directed to fill out a Web-based survey. Eligible participants will subsequently complete a survey that will assess: (1) types, frequency, and amount of money spent on gambling, (2) life events experienced in the past 12 months, (3) level of autonomous motivation for change, and (4) use of treatment services. Every 3 months for the duration of one year following the completion of their baseline survey, participants will be sent an email notification requesting them to complete a follow-up survey similar in content to the baseline survey. The four surveys will assess whether participants have experienced changes in their gambling behaviors along with positive or negative life events and motivations for change since the last survey. Individuals who are in the action and maintenance stages of quitting gambling at follow-up will be also asked about their techniques and strategies used to quit or reduce gambling. At 18 months post baseline, participants will be asked to complete a fifth and final follow-up survey that will also assess whether participants have experienced any barriers to change and whether they resolved their gambling to low risk levels. Results The study has commenced in May 2013 and is currently in the recruitment stage. The study is scheduled to conclude in 2016. Conclusions As this study will examine the active ingredients in natural recovery from gambling problems, the results will inform ways of promoting change among the large number of problem gamblers who do not seek treatment as well as improve treatment for those who do seek help. The information gained will also be useful in identifying effective self-help strategies for those who face challenges in accessing treatment, may be incorporated in standard treatment, provide brief intervention techniques, as well as inform relapse prevention strategies. PMID:24297873

Cunningham, John A; Hodgins, David C

2013-01-01

248

Terminal Protocols  

Microsoft Academic Search

Terminal protocols provide basic services for the users of computer networks. This paper presents a survey of the architecture and mechanisms used in current terminal protocols. The paper disusses both parametric terminal protocols such as the CCITT X.3, X.28, and X.29 and virtual terminal protocols, such as the ARPANET TELNET protocol. Many of the problems encountered in terminal protocols recur

JOHN D. DAY

1980-01-01

249

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

ERIC Educational Resources Information Center

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

Eifert, Georg H.; Forsyth, John P.; Arch, Joanna; Espejo, Emmanuel; Keller, Melody; Langer, David

2009-01-01

250

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

ERIC Educational Resources Information Center

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

Castillo, Diane T.

2004-01-01

251

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

Microsoft Academic Search

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

Joanna Arch; Emmanuel Espejo; Melody Keller; David Langer

2009-01-01

252

Suggested treatment protocol for improving patency of femoral-infrapopliteal cryopreserved saphenous vein allografts  

Microsoft Academic Search

Purpose: Cryopreserved saphenous vein allografts are used for femoral-infrapopliteal bypass graft purposes when adequate autogenous vein is unavailable. Anticoagulation, immunosuppression therapy, or both have been suggested means for improving allograft patency. Immunosuppression has significant cost and morbidity and has produced variable results. Our successful treatment of luminal surface hypercoagulability associated with certain endovascular procedures prompted the use of an anticoagulation

C. J. Buckley; S. Abernathy; S. D. Lee; F. R. Arko; D. E. Patterson; L. G. Manning

2000-01-01

253

Developing, Implementing, and Evaluating a Treatment Protocol for Rural Substance Abusers.  

ERIC Educational Resources Information Center

Evaluation of an innovative substance abuse treatment program designed for rural areas involved 45 clients, 10 clinicians, and 2 program directors from three sites. Most clients felt the program was beneficial, but stressful. Clinicians found the program demanding to learn and adopt. Program directors liked the rural-specific design and the…

Clark, James J.; Leukefeld, Carl; Godlaski, Theodore; Brown, Cyndy; Garrity, John; Hays, Lon

2002-01-01

254

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

ERIC Educational Resources Information Center

This article reviews the development and initial trial of a treatment for adolescents that targets negative emotionality and associated psychological difficulties--particularly anxiety and depressive disorders--as a more singular entity by utilizing an approach rooted in both emotion science and theory. The rationale for such an approach is based…

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

2009-01-01

255

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...

256

Inpatient management of diabetic foot disorders: a clinical guide.  

PubMed

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

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

2013-09-01

257

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

258

42 CFR 412.404 - Conditions for payment under the prospective payment system for inpatient hospital services of...  

Code of Federal Regulations, 2013 CFR

...prospective payment system for inpatient hospital services of psychiatric facilities...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Services of Inpatient Psychiatric...

2013-10-01

259

42 CFR 412.404 - Conditions for payment under the prospective payment system for inpatient hospital services of...  

Code of Federal Regulations, 2012 CFR

...prospective payment system for inpatient hospital services of psychiatric facilities...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Services of Inpatient Psychiatric...

2012-10-01

260

42 CFR 412.404 - Conditions for payment under the prospective payment system for inpatient hospital services of...  

Code of Federal Regulations, 2011 CFR

...prospective payment system for inpatient hospital services of psychiatric facilities...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Services of Inpatient Psychiatric...

2011-10-01

261

42 CFR 412.404 - Conditions for payment under the prospective payment system for inpatient hospital services of...  

Code of Federal Regulations, 2010 CFR

...prospective payment system for inpatient hospital services of psychiatric facilities...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Services of Inpatient Psychiatric...

2010-10-01

262

Falls in an Inpatient Geriatric Psychiatric Population  

Microsoft Academic Search

BACKGROUND:Falls are a major health care concern for older adults in hospital settings. The incidence of falls on psychiatric units tends to be higher than that on general acute care hospital units, with estimated rates of 13.1 to 25 per 1,000 inpatient days compared to 3 to 5 per 1,000 inpatient days, respectively.OBJECTIVE:The purposes of this study were to quantify

Ellen Blair; Cynthia Gruman

2005-01-01

263

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

PubMed Central

Background Over the past decade, advances in cancer treatments have been counterbalanced by a rising number of immunosuppressed patients with a multitude of new risk factors for infection. Hence, the aim of this study was to determine risk factors, infectious pathogens in blood and oral cavity of oral cancer patients undergoing different treatment procedures. Methods The present prospective cohort analysis was conducted on the patients undergoing treatment in the radiotherapy unit of Regional Cancer Institute, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, during the period of January 2007 to October 2009. Total 186 patients with squamous cell carcinoma of oral cavity were analyzed in the study. Based on treatment procedures patients were divided into three groups, group I were under radiotherapy, group II under chemotherapy and group III were of radio chemotherapy together. Clinical isolates from blood and oral cavity were identified by following general microbiological, staining and biochemical methods. The absolute neutrophile counts were done by following the standard methods. Results Prevalent bacterial pathogens isolated were Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis, Proteus vulgaris and the fungal pathogens were Candida albicans, Aspergillus fumigatus. The predominant gram negative bacteria, Pseudomonas aeruginosa and Klebsiella pneumonia were isolated from blood of radiotherapy and oral cavity of chemotherapy treated cases respectively. The predominance of gram positive bacteria (Staphylococcus aureus and Staphylococcus epidermidis) were observed in blood of chemotherapy, radio chemotherapy cases and oral cavity of radiotherapy, radio chemotherapy treated cases. Our study also revealed the presence of C. albicans fungi as most significant oral cavity pathogens in radiotherapy and radio chemotherapy cases. Conclusion Gram positive bacteria and Gram negative were reported from the blood of all the three groups of patients. Oral mucositis played a significant role in oral cavity infection and make patients more prone to C. albicans infection. PMID:22817766

2012-01-01

264

CONTRAIS: CONservative TReatment for Adolescent Idiopathic Scoliosis: a randomised controlled trial protocol  

PubMed Central

Background Idiopathic scoliosis is a three-dimensional structural deformity of the spine that occurs in children and adolescents. Recent reviews on bracing and exercise treatment have provided some evidence for effect of these interventions. The purpose of this study is to improve the evidence base regarding the effectiveness of conservative treatments for preventing curve progression in idiopathic scoliosis. Methods/design Patients: Previously untreated girls and boys with idiopathic scoliosis, 9 to 17 years of age with at least one year of remaining growth and a curve Cobb angle of 25–40 degrees will be included. A total of 135 participants will be randomly allocated in groups of 45 patients each to receive one of the three interventions. Interventions: All three groups will receive a physical activity prescription according to the World Health Organisation recommendations. One group will additionally wear a hyper-corrective night-time brace. One group will additionally perform postural scoliosis-specific exercises. Outcome: Participation in the study will last until the curve has progressed, or until cessation of skeletal growth. Outcome variables will be measured every 6 months. The primary outcome variable, failure of treatment, is defined as progression of the Cobb angle more than 6 degrees, compared to the primary x-ray, seen on two consecutive spinal standing x-rays taken with 6 months interval. Secondary outcome measures include the SRS-22r and EQ5D-Y quality of life questionnaires, the International Physical Activity Questionnaire (IPAQ) short form, and Cobb angle at end of the study. Discussion This trial will evaluate which of the tested conservative treatment approaches that is the most effective for patients with adolescent idiopathic scoliosis. Trial registration NCT01761305 PMID:24007599

2013-01-01

265

The Cardiocerebral Resuscitation protocol for treatment of out-of-hospital primary cardiac arrest  

PubMed Central

Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol. PMID:22980487

2012-01-01

266

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

267

Assessment of aggression in inpatient settings.  

PubMed

The threat of violence is a major concern for all individuals working or receiving treatment in an inpatient psychiatric setting. One major focus in forensic psychology and psychiatry over the past several decades has been the development of risk assessments to aid in the identification of those individuals most at risk of exhibiting violent behavior. So-called second- and third-generation risk assessments were developed to improve the accuracy of decision making. While these instruments were developed for use in the community, many have proven to be effective in identifying patients more likely to exhibit institutional aggression. Because the purpose of risk assessment is the reduction of violence, dynamic factors were included in third-generation risk instruments to provide opportunities for intervention and methods for measuring change. Research with these instruments indicates that both static factors (second-generation) and dynamic factors (third-generation) are important in identifying those patients most likely to engage in institutional aggression, especially when the aggression is categorized by type (impulsive/reactive, organized/predatory/instrumental, psychotic). Recent research has indicated that developing a typology of aggressive incidents may provide insight both into precipitants to assaults as well as appropriate interventions to reduce such aggression. The extant literature suggests that both static and dynamic risk factors are important, but may be differentially related to the type of aggression exhibited and the characteristics of the individuals exhibiting the aggression. PMID:25296966

McDermott, Barbara E; Holoyda, Brian J

2014-10-01

268

Assessing overall functioning with adolescent inpatients.  

PubMed

The current study sought to evaluate the validity and reliability of a brief measure of overall functioning for adolescents. Clinicians were asked to complete the Overall Functioning Scale (OFS) for 72 adolescents consecutively admitted to the adolescent psychiatric inpatient service of a community safety net medical center. The results revealed that this new measure is related to the patients' length of stay, clinician-rated measures of social cognition and object relations, Global Assessment of Functioning (GAF) score at admission, as well as global rating of engagement in individual psychotherapy. The results also showed that the OFS was related to the patients' history of nonsuicidal self-harm as well as treatment outcome as assessed by measures of psychological health and well-being as well as symptoms. Hierarchical regressions reveal that the OFS shows incremental validity greater than the admission GAF score in predicting length of stay. The results also showed that the OFS demonstrates interrater reliability in the excellent range (intraclass correlation coefficient1,2) of 0.88. Clinical implications of the use of this tool and areas of future research are discussed. PMID:25259948

Haggerty, Greg; Forlenza, Nicholas; Poland, Charlotte; Ray, Sagarika; Zodan, Jennifer; Mehra, Ashwin; Goyal, Ajay; Baity, Matthew R; Siefert, Caleb J; Sobin, Sean; Leite, David; Sinclair, Samuel J

2014-11-01

269

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

270

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

Microsoft Academic Search

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

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

2004-01-01

271

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

Microsoft Academic Search

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

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

2000-01-01

272

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

Microsoft Academic Search

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

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

2007-01-01

273

VA Inpatient Rotation Objectives The trainee should have an understanding of the pre-operative, anesthetic,  

E-print Network

of allograft rejection surveillance and treatment of cellular and humoral rejection. · The trainee should have an understanding of the risk factors, prevention of, detection, and treatment of coronary allograft vasculopathy of inpatient work-up (for patients being evaluated for invasive cardiac procedures) with the Cardiac

Ford, James

274

The Implementation and Evaluation of Cognitive Milieu Therapy for Dual Diagnosis Inpatients: A Pragmatic Clinical Trial  

Microsoft Academic Search

Dual diagnosis is chronic psychiatric condition involving serious mental illness and substance abuse. Experts recommend the integration of treatment for concurrent substance abuse and serious psychiatric problems. The following pragmatic trial examined the implementation and outcomes of cognitive milieu therapy (CMT) among a group of dual diagnosis inpatients. CMT is an integrated treatment for both mental illness and substance abuse

Jørn Lykke; Irene Oestrich; Stephen F. Austin; Morten Hesse

2010-01-01

275

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.

276

Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol--Surgical Treatment of Neurological Hip Flexion Contracture  

PubMed Central

Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible. PMID:24707293

Nicodemo, Alberto; Arrigoni, Chiara; Bersano, Andrea; Masse, Alessandro

2014-01-01

277

Current treatment of convulsive status epilepticus - a therapeutic protocol and review.  

PubMed

The management of status epilepticus (SE) has changed in recent years. Substantial differences exist regarding the definition and time frame of a seizure, which has been operationally defined as lasting for 5 min. Not only have many new intravenous drugs, such as levetiracetam and lacosamide been introduced but other routes of administration, such as intranasal or buccal administration for midazolam, are also being developed. Optimal and successful therapy initiated at the appropriate moment, adequately tailored to the clinical state of the patient, determines the first step in the normalisation of vital functions and leads to the restoration of the physiological homeostatic mechanisms of the organism. The aim of this review is to present the current treatment options for the management of convulsive status epilepticus (CSE) that have been widely confirmed as the most effective in clinical trials and approved by the international neurology authorities as the actual therapeutic standards. We also intend to indicate distinct and unequivocal differentiation and therapeutic indications for each phase of CSE, including the precise doses of the related medications, to present practical guidelines for clinicians. The treatment of patients with CSE requires emergency physicians, neurologists and specialists in intensive care to work together to provide optimal care that should be initiated as soon as possible and conducted as a unified procedure to improve neurocritical care in patients who are transferred from the ambulance service, through the emergency department and finally to the neurology department or ICU. Appropriate treatment also involves avoiding mistakes associated with inadequate doses of medications, overdosing a patient or choosing an inappropriate medication. PMID:25293482

Mazurkiewicz-Be?dzi?ska, Maria; Szmuda, Marta; Zawadzka, Marta; Matheisel, Agnieszka

2014-01-01

278

Mobile phone text messaging for promoting adherence to anti-tuberculosis treatment: a systematic review protocol  

PubMed Central

Background In 2010, there were approximately 8.8 million incident cases of tuberculosis (TB) worldwide. The treatment of TB is at least six months long and may be complicated by a high pill burden. In addition, TB patients often do not take their medication on schedule simply because they forget. Mobile phone text messaging has the potential to help promote TB treatment adherence. We, therefore, propose to conduct a review of current best evidence for the use of mobile phone text messaging to promote patient adherence to TB treatment. Methods This is a systematic review of the literature. We will preferably include randomized controlled trials (RCTs). However, non-randomized studies (NRS) will be considered if there is an inadequate number of RCTs. We will search PubMed, EMBASE, CINAHL, CENTRAL, Science Citation Index, Africa-Wide Information, and WHOLIS electronic databases for eligible studies available by 30 November 2012 regardless of language or publication status. We will also check reference lists for additional studies, identify abstracts from conference proceedings and communicate with authors for any relevant material. At least two authors will independently screen search outputs, select studies, extract data and assess the risk of bias (using separate criteria for RCTs and NRS); resolving discrepancies by discussion and consensus. We will assess clinical heterogeneity by examining the types of participants, interventions and outcomes in each study and pool studies judged to be clinically homogenous. We will also assess statistical heterogeneity using the chi-square test of homogeneity and quantify it using the I-square statistic. If study results are found to be statistically homogeneous (that is heterogeneity P > 0.1), we will pool them using the fixed-effect meta-analysis. Otherwise, we will use random-effects meta-analysis. We will calculate risk ratios and their corresponding 95% confidence intervals for dichotomous outcomes, and mean differences for continuous outcomes. For other outcomes without quantitative data, a descriptive analysis will be used. Discussion Our results can be used by researchers and policy-makers to help inform them of the efficacy of mobile phone text messaging interventions to promote patient adherence to TB treatment. PMID:23324135

2013-01-01

279

MGBM system: new protocol for Class II non extraction treatment without cooperation.  

PubMed

This article describes a method to treat Class II malocclusions with no patient cooperation. The technique involves converting the Class II molar relationship to a Class I in the initial phase of treatment by moving the maxillary molars distally with superelastic coils and wire. Anchorage is provided by a transpalatal bar attached to the first premolars and connected to 2 palatal miniscrews. Once the molars are positioned correctly, the palatal miniscrews are removed and miniscrews are inserted bilaterally in the buccal bone between the first molar and the second premolar. These miniscrews serve as the anchorage for the retraction of the premolars, canines and incisors. PMID:17364039

Maino, B Giuliano; Gianelly, A Anthony; Bednar, John; Mura, Paola; Maino, Giovanna

2007-01-01

280

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

281

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

PubMed Central

Background Prevention of preterm birth remains one of the most important challenges in maternity care. We propose a randomised trial with: a simple Candida testing protocol that can be easily incorporated into usual antenatal care; a simple, well accepted, treatment intervention; and assessment of outcomes from validated, routinely-collected, computerised databases. Methods/Design Using a prospective, randomised, open-label, blinded-endpoint (PROBE) study design, we aim to evaluate whether treating women with asymptomatic vaginal candidiasis early in pregnancy is effective in preventing spontaneous preterm birth. Pregnant women presenting for antenatal care <20 weeks gestation with singleton pregnancies are eligible for inclusion. The intervention is a 6-day course of clotrimazole vaginal pessaries (100 mg) and the primary outcome is spontaneous preterm birth <37 weeks gestation. The study protocol draws on the usual antenatal care schedule, has been pilot-tested and the intervention involves only a minor modification of current practice. Women who agree to participate will self-collect a vaginal swab and those who are culture positive for Candida will be randomised (central, telephone) to open-label treatment or usual care (screening result is not revealed, no treatment, routine antenatal care). Outcomes will be obtained from population databases. A sample size of 3,208 women with Candida colonisation (1,604 per arm) is required to detect a 40% reduction in the spontaneous preterm birth rate among women with asymptomatic candidiasis from 5.0% in the control group to 3.0% in women treated with clotrimazole (significance 0.05, power 0.8). Analyses will be by intention to treat. Discussion For our hypothesis, a placebo-controlled trial had major disadvantages: a placebo arm would not represent current clinical practice; knowledge of vaginal colonisation with Candida may change participants' behaviour; and a placebo with an alcohol preservative may have an independent affect on vaginal flora. These disadvantages can be overcome by the PROBE study design. This trial will provide definitive evidence on whether screening for and treating asymptomatic candidiasis in pregnancy significantly reduces the rate of spontaneous preterm birth. If it can be demonstrated that treating asymptomatic candidiasis reduces preterm births this will change current practice and would directly impact the management of every pregnant woman. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12610000607077 PMID:21396091

2011-01-01

282

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

PubMed Central

Background Childhood obesity is a serious health concern affecting over 155 million children in developed countries worldwide. Childhood obesity is associated with significantly increased risk for development of type 2 diabetes, cardiovascular disease and psychosocial functioning problems (i.e., depression and decreased quality of life). The two major strategies for management of obesity and associated metabolic abnormalities are lifestyle modification and pharmacologic therapy. This paper will provide the background rationale and methods of the REACH childhood obesity treatment program. Methods/design The REACH study is a 2-year multidisciplinary, family-based, childhood obesity treatment program. Seventy-two obese adolescents (aged 10-16 years) and their parents are being recruited to participate in this randomized placebo controlled trial. Participants are randomized to receive either metformin or placebo, and are then randomized to a moderate or a vigorous intensity supervised exercise program for the first 12-weeks. After the 12-week exercise program, participants engage in weekly exercise sessions with an exercise facilitator at a local community center. Participants engage in treatment sessions with a dietitian and social worker monthly for the first year, and then every three months for the second year. The primary outcome measure is change in body mass index and the secondary outcome measures are changes in body composition, risk factors for type 2 diabetes and cardiovascular disease, changes in diet, physical activity, and psychosocial well-being (e.g., quality of life). It is hypothesized that participants who take metformin and engage in vigorous intensity exercise will show the greatest improvements in body mass index. In addition, it is hypothesized that participants who adhere to the REACH program will show improvements in body composition, physical activity, diet, psychosocial functioning and risk factor profiles for type 2 diabetes and cardiovascular disease. These improvements are expected to be maintained over the 2-year program. Discussion The findings from this study will advance the knowledge regarding the long-term efficacy and sustainability of interventions for childhood obesity. Trial Registration ClinicalTrials.gov number NCT00934570 PMID:19943971

2009-01-01

283

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

284

[Protocol for the treatment of haemangiomas and/or vascular malformations].  

PubMed

When facing any vascular lesion present in the first moments of life, it is necessary to determine whether one is dealing with a tumour or a vascular malformation, given the different evolution of both processes and, hence, the different treatments they require. Diagnosis is basically clinical, based on a correct anamnesis and a detailed physical exploration. The first thing is to establish whether the lesion was present at birth and has changed size significantly, which would lead one to think of a haemangioma or, on the contrary, whether it is congenital and of very slow growth, such as vascular malformations. Facing dubious lesions, it is recommendable to carry out a biopsy with immunohistochemistry for the GLUT-1 antibody, specific to haemangiomas. Amongst the image tests, the first choice is usually ecography-Doppler, which makes it possible to determine whether the lesion is of high or low flow and to distinguish whether one is dealing with a haemangioma or a vascular malformation. Depending on the type of lesion, its localisation and degree of affectation it might be necessary to carry out radiography, magnetic resonance, phlebography, angio-resonance, arteriography or lymphoscintigraphy to complete the study. In more particular cases, such as multiple haemangiomatosis, it is necessary to carry out an hepatic echography, blood concealed in faeces, gastroscopy and colonoscopy, as well a determination of thyroid hormones; and in venous or combined extensive malformations, a haemogram and coagulation tests. On the other hand, the possible repercussions on other organs make a multidisciplinary approach essential, with the participation of different specialists. Due to the wide spectrum covered by vascular anomalies, treatment must be individualised. PMID:15148519

Redondo, P; Fernández, M

2004-01-01

285

Designing a treatment protocol with voriconazole to eliminate Aspergillus fumigatus from experimentally inoculated pigeons.  

PubMed

To investigate the efficacy of voriconazole for the treatment of aspergillosis, three groups of six racing pigeons (Columba livia domestica) were inoculated in the apical part of the right lung with 2x10(7) conidia of an avian derived Aspergillus fumigatus strain. The minimal inhibitory concentration of voriconazole for this strain was 0.25 microg/ml. In two groups, voriconazole treatment was started upon appearance of the first clinical signs and continued for fourteen days. The third group was sham treated. The voriconazole-treated pigeons received voriconazole orally at a dose of 10 mg/kg body weight (BW) q12h (group 1) or 20 mg/kg BW q24h (group 2). Sixteen days post-inoculation all surviving pigeons were euthanized. Weight loss, clinical scores, daily mortality, lesions at necropsy and isolation of A. fumigatus were compared between all groups. In both voriconazole-treated groups, a significant reduction in clinical signs and lesions was observed. Administering voriconazole at 10 mg/kg BW q12h eliminated A. fumigatus and administering voriconazole at 20 mg/kg BW q24h reduced A. fumigatus isolation rates. Mild histological liver abnormalities were found in group 1 (10 mg/kg BW q12h), while mild histological as well as macroscopic liver abnormalities were found in group 2 (20 mg/kg BW q24h). In conclusion, voriconazole at 10 mg/kg BW q12h in pigeons reduces clinical signs and eliminates A. fumigatus in racing pigeons experimentally infected with A. fumigatus. PMID:19574001

Beernaert, Lies A; Pasmans, Frank; Baert, Kris; Van Waeyenberghe, Lieven; Chiers, Koen; Haesebrouck, Freddy; Martel, An

2009-11-18

286

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

287

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

PubMed

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

2013-02-26

288

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

289

Inpatient Medicine Clerkship Review 3/20/14 MEC subcommittee: Dr. John Dick, Dr. Hilary Ryder, Dr. Bob Hyde, Dr. Cathy Morrow, Dr. Pinto-  

E-print Network

the treatment for the most common inpatient diagnoses including chest pain, arrhythmia, CHF, COPD, PNA, PE/DVT, delirium (altered mental status), acute pain crisis patients understand treatment options. Performance Evals Skills Form Wards

Myers, Lawrence C.

290

How do surgeons decide to refer patients for adjuvant cancer treatment? Protocol for a qualitative study  

PubMed Central

Background Non-small cell lung cancer, breast cancer, and colorectal cancer are commonly diagnosed cancers in Canada. Patients diagnosed with early-stage non-small cell lung, breast, or colorectal cancer represent potentially curable populations. For these patients, surgery is the primary mode of treatment, with (neo)adjuvant therapies (e.g., chemotherapy, radiotherapy) recommended according to disease stage. Data from our research in Nova Scotia, as well as others’, demonstrate that a substantial proportion of non-small cell lung cancer and colorectal cancer patients, for whom practice guidelines recommend (neo)adjuvant therapy, are not referred for an oncologist consultation. Conversely, surveillance data and clinical experience suggest that breast cancer patients have much higher referral rates. Since surgery is the primary treatment, the surgeon plays a major role in referring patients to oncologists. Thus, an improved understanding of how surgeons make decisions related to oncology services is important to developing strategies to optimize referral rates. Few studies have examined decision making for (neo)adjuvant therapy from the perspective of the cancer surgeon. This study will use qualitative methods to examine decision-making processes related to referral to oncology services for individuals diagnosed with potentially curable non-small cell lung, breast, or colorectal cancer. Methods A qualitative study will be conducted, guided by the principles of grounded theory. The study design is informed by our ongoing research, as well as a model of access to health services. The method of data collection will be in-depth, semi structured interviews. We will attempt to recruit all lung, breast, and/or colorectal cancer surgeons in Nova Scotia (n???42), with the aim of interviewing a minimum of 34 surgeons. Interviews will be audiotaped and transcribed verbatim. Data will be collected and analyzed concurrently, with two investigators independently coding and analyzing the data. Analysis will involve an inductive, grounded approach using constant comparative analysis. Discussion The primary outcomes will be (1) identification of the patient, surgeon, institutional, and health-system factors that influence surgeons’ decisions to refer non-small cell lung, breast, and colorectal cancer patients to oncology services when consideration for (neo)adjuvant therapy is recommended and (2) identification of potential strategies that could optimize referral to oncology for appropriate individuals. PMID:23098262

2012-01-01

291

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

292

Acupuncture for the treatment of chronic obstructive pulmonary disease: a protocol of a systematic review  

PubMed Central

Introduction This review aims to evaluate the efficacy of acupuncture in the treatment of chronic obstructive pulmonary disease (COPD). Methods and analysis 14 databases will be searched from their inception. These include PubMed, AMED, EMBASE, the Cochrane Library, seven Korean medical databases (Korean Studies Information Service System, DBPIA, Oriental Medicine Advanced Searching Integrated System, Research Information Service System, KoreaMed, The Town Society of Science Technology and the Korean National Assembly Library), three Chinese Databases (China National Knowledge Infrastructure Database (CNKI), the Chongqing VIP Chinese Science and Technology Periodical Database (VIP), and the Wanfang Database). Only randomised clinical trials (RCTs) using acupuncture for COPD will be considered. The selection of the studies, data abstraction and validation will be performed independently by two researchers. Methodological quality will be assessed with the Cochrane risk of bias. Dissemination The systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically and in print. Updates of the review will be conducted to inform and guide the healthcare practice and policy. Trial registration number PROSPERO 2013: CRD42013004824. PMID:24776710

Choi, Tae-Young; Jun, Ji Hee; Choi, Jun-Young; Kim, Jong-In; Lee, Myeong Soo; Ernst, Edzard

2014-01-01

293

A case report of opium body packer; review of the treatment protocols and mechanisms of poisoning.  

PubMed

ABSTRACT Body packers are people who illegally carry drugs, mostly cocaine as well as opium and/or heroin, concealed within their bodies. The packets are inserted in the mouth, rectum, or vagina in order to get across borders without being detected. In this presentation we report a case of an opium body packer and review the available scientific literature by focusing on mechanisms of toxicity and treatment approach. The patient was a 35-year-old man who had lethargy, respiratory depression, tachycardia, normal blood pressure, hyperthermia, and pinpoint pupils on presentation. No past medical history was obtained and the only positive history was his travel from Afghanistan 2 days earlier, which he had given to emergency personnel before arriving at our hospital. Complete blood cells and kidney and liver tests were all in normal range. In the emergency department, the patient was treated with oxygen, naloxone, and hypertonic glucose. One dose of activated charcoal (1 g/kg) was administered orally. After intravenous injection of naloxone (4 mg), the lethargy, respiratory depression, and miosis were resolved. The patient was admitted to the intensive care unit and 90 min after admission, the patient redeveloped respiratory distress and lost consciousness. He was intubated and mechanically ventilated due to the suspicious of body packing. Plain abdominal x-ray showed multiple packets throughout the gastrointestinal tract; 81 packets were removed by surgery and three of them were left due to leaking. After removing the packets, the patient was treated conservatively. He suffered a pulmonary infection (aspiration pneumonia) and he regained consciousness after 4 days. Upon recovery the patient was seen by a psychiatrist prior to going to prison. Surgery is recommended for body packers who have significant signs or symptoms. PMID:20020970

Shadnia, Shahin; Faiaz-Noori, Mohammad-Reza; Pajoumand, Abdolkarim; Talaie, Haleh; Khoshkar, Ali; Vosough-Ghanbari, Sanaz; Abdollahi, Mohammad

2007-01-01

294

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

295

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

296

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

297

Inpatient Cognitive Behaviour Therapy for Anorexia Nervosa: A Randomized Controlled Trial  

PubMed Central

Background The aim of this study was to compare the immediate and longer-term effects of two cognitive behaviour therapy programmes for hospitalized patients with anorexia nervosa, one focused exclusively on the patients' eating disorder features and the other focused also on mood intolerance, clinical perfectionism, core low self-esteem or interpersonal difficulties. Both programmes were derived from enhanced cognitive behaviour therapy (CBT-E) for eating disorders. Methods Eighty consecutive patients with severe anorexia nervosa were randomized to the two inpatient CBT-E programmes, both of which involved 20 weeks of treatment (13 weeks as an inpatient and 7 as a day patient). The patients were then followed up over 12 months. The assessments were made blind to treatment condition. Results Eighty-one percent of the eligible patients accepted inpatient CBT-E, of whom 90% completed the 20 weeks of treatment. The patients in both programmes showed significant improvements in weight, eating disorder and general psychopathology. Deterioration after discharge did occur but it was not marked and it was restricted to the first 6 months. There were no statistically significant differences between the effects of the two programmes. Conclusions These findings suggest that both versions of inpatient CBT-E are well accepted by these severely ill patients and might be a viable and promising treatment for severe anorexia nervosa. There appears to be no benefit from using the more complex form of the treatment. PMID:24060628

Dalle Grave, Riccardo; Calugi, Simona; Conti, Maddalena; Doll, Helen; Fairburn, Christopher G.

2013-01-01

298

Identifying Opportunities for Inpatient-centric Technology Meredith Skeels  

E-print Network

conducted interviews with 16 inpatients and 5 visitors in several hospital wards to uncover opportunities the isolating hospital environment. Finally, novel interaction techniques could make technology more acces, Design, Human Factors. Author Keywords Healthcare, hospital, inpatient experience, technology design. 1

Hunt, Galen

299

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

300

Interrater reliability of the Observer Rating of Medication Taking scale in an inpatient mental health facility.  

PubMed

Non-adherence to medication remains a major barrier to recovery from mental illnesses. Identification of those patients likely to experience adherence difficulties is best undertaken during inpatient treatment, prior to discharge into the community. More objective assessments of adherence behaviours might assist staff to more effectively target support to those patients most in need. This study investigated the interrater reliability of an inpatient behavioural observation scale of patient engagement with medication: the Observer Rating of Medication Taking (ORMT) scale. Eight mental health nurses working in a psychiatric hospital inpatient setting were trained in the use of the ORMT using video-based vignettes. Working in pairs, staff then independently rated adherence behaviours of 13 inpatients in a rehabilitation unit (total of 160 ratings) over a 1-week period. Concurrently, two expert raters also undertook independent ratings of patient medication-taking behaviour using the ORMT. Interrater reliability was assessed across both staff and expert raters. The results indicated that the ORMT has satisfactory interrater reliability, and can be appropriately used in an inpatient setting. The observational location of raters on the ward influenced the range of medication-taking behaviours observed, and thus the extent of concordance between raters. Further research to determine if the ORMT predicts adherence in the community is warranted. PMID:25069738

Byrne, Mitchell K; Deane, Frank P; Murugesan, Ganapathi; Connaughton, Elizabeth

2014-12-01

301

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

Code of Federal Regulations, 2012 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...

2012-10-01

302

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

Code of Federal Regulations, 2011 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...

2011-10-01

303

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

304

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

Code of Federal Regulations, 2013 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...

2013-10-01

305

Reasons for premature termination of dialectical behavior therapy for inpatients with borderline personality disorder.  

PubMed

Although one of the main aims of dialectical behavior therapy (DBT) for borderline personality disorder (BPD) is to increase the retention rates, premature termination rates for DBT inpatient programs were found to be over 30%. The aim of the study was to identify the reasons for, and to analyze, patient characteristics that are associated with premature termination. We studied 541 inpatients with BPD, who were consecutively admitted for an open-door 3-month DBT inpatient treatment in Berlin, Germany. All participants completed several self-rating measures and participated in clinical interviews. Fourteen percent, who did not complete the full 84 days of assigned treatment, were expelled, mainly due to treatment-disturbing behaviors, or substance abuse or possession. Nearly 19% dropped out of treatment, mostly due to lack of motivation, arguments with others, and poor tolerance of emotional distress. Using non-parametric conditional inference trees, expulsion was associated with anorexia nervosa and alcohol abuse, whereas more than 9 suicide attempts, antisocial personality disorders, and more than 86 weeks in a psychiatric hospital were risk factors for dropout. We discussed measures and interventions that might lead to an adaptation of DBT inpatient programs. Future research should examine the symptom course and utilization of health-care services of non-completers. PMID:25058040

Kröger, Christoph; Röepke, Stefan; Kliem, Sören

2014-09-01

306

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

Microsoft Academic Search

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

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

2006-01-01

307

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

308

Inpatient Family Intervention: A Preliminary Report on Six-Month Outcome.  

ERIC Educational Resources Information Center

Recent research suggests that family attitudes may be significant determinants of relapse and hospital readmission among both schizophrenics and hospitalized depressives. To assess the incremental effectiveness of inpatient family intervention within the context of treatment for schizophrenic disorder and major affective disorder patients, a…

Haas, Gretchen L.; And Others

309

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

310

77 FR 5213 - Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA): Applicability to Hospital...  

Federal Register 2010, 2011, 2012, 2013

...Treatment and Labor Act (EMTALA): Applicability to Hospital Inpatients and Hospitals With Specialized Capabilities AGENCY: Centers...Medical Treatment and Labor Act (EMTALA) to hospital inpatients. DATES: Comment Date: To be...

2012-02-02

311

Eccentric treatment for patellar tendinopathy: a prospective randomised short-term pilot study of two rehabilitation protocols  

PubMed Central

Objective To compare the efficacy and safety of two eccentric rehabilitation protocols for patients with symptomatic patellar tendinopathy. A new eccentric overload training device was compared with the present standard eccentric rehabilitation programme on a decline board. Design Prospective, randomised clinical trial. Setting Sports rehabilitation clinic, university sports laboratory, supplemented with home exercises. Patients 20 competitive and recreational athletes, all with clinical diagnosis of patellar tendinopathy, verified by MRI or ultrasound imaging. Interventions A 12?week rehabilitation period, either with bilateral eccentric overload strength training using the Bromsman device twice a week or with unilateral eccentric body load training using a decline board twice a week, supplemented with daily home exercises. Outcome measures The primary outcome was pain and function, assessed by the Swedish Victorian Institute of Sport Assessment for Patella (VISA?P) score. Secondary outcome measures were isokinetic muscle torque, dynamic function and muscle flexibility, as well as pain level estimations using visual analogue scale (VAS). Side effects were registered. Results Both treatment groups improved in the short term according to the VISA?P scores during the 12?week rehabilitation period. However, there were no significant differences between the groups in terms of pain and function. After a 3?month rehabilitation period, most patients could be regarded as improved enough to be able to return to training and sports. No serious side effects were detected in either group. Conclusion In patients with patellar tendinopathy pain, two?legged eccentric overload training twice per week, using the new device (Bromsman), was as efficient and safe as the present standard daily eccentric one?legged rehabilitation?training regimen using a decline board. PMID:17289855

Frohm, Anna; Saartok, Tonu; Halvorsen, Kjartan; Renstrom, Per

2007-01-01

312

Suicidal Ideation in Inpatients With Acute Schizophrenia  

Microsoft Academic Search

Objective: Schizophrenia has been associated with a high rate of suicide. This study investigates the prevalence of suicidal ideation in a population of inpatients with acute schizophrenia, together with the clinical parameters associated with suicidal thoughts. Method: We assessed 93 schizophrenia patients. We matched subjects for age and sex and compared subjects with and without suicidal thoughts. We performed stepwise

Vassilis Kontaxakis; Beata Havaki-Kontaxaki; Maria Margariti; Sophia Stamouli; Costas Kollias; George Christodoulou

313

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

314

Impulse control disorders in psychiatric inpatients.  

PubMed

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

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

2011-08-15

315

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

316

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

317

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

318

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

PubMed Central

Background Suicide prevention by mental health services requires an awareness of the antecedents of suicide amongst high risk groups such as psychiatric in-patients. The goal of this study was to describe the social and clinical characteristics of people who had absconded from an in-patient psychiatric ward prior to suicide, including aspects of the clinical care they received. Methods We carried out a national clinical survey based on a 10-year (1997-2006) sample of people in England and Wales who had died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death. Results There were 1,851 cases of suicide by current psychiatric in-patients, 14% of all patient suicides. 1,292 (70%) occurred off the ward. Four hundred and sixty-nine of these patients died after absconding from the ward, representing 25% of all in-patient suicides and 38% of those that occurred off the ward. Absconding suicides were characterised by being young, unemployed and homeless compared to those who were off the ward with staff agreement. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were proportionally more likely than in-patients on agreed leave to have been legally detained for treatment, non-compliant with medication, and to have died in the first week of admission. Whilst absconding patients were significantly more likely to have been under a high level of observation, clinicians reported more problems in observation due to either the ward design or other patients on the ward. Conclusion Measures that may prevent absconding and subsequent suicide amongst in-patients might include tighter control of ward exits, and more intensive observation of patients, particularly in the early days of admission. Improving the ward environment to provide a supportive and less intimidating experience may contribute to reduced risk. PMID:20128891

2010-01-01

319

Attributable Inpatient Costs of Recurrent Clostridium difficile Infections.  

PubMed

Objective.?To determine the attributable inpatient costs of recurrent Clostridium difficile infections (CDIs). Design.?Retrospective cohort study. Setting.?Academic, urban, tertiary care hospital. Patients.?A total of 3,958 patients aged 18 years or more who developed an initial CDI episode from 2003 through 2009. Methods.?Data were collected electronically from hospital administrative databases and were supplemented with chart review. Patients with an index CDI episode during the study period were followed up for 180 days from the end of their index hospitalization or the end of their index CDI antibiotic treatment (whichever occurred later). Total hospital costs during the outcome period for patients with recurrent versus a single episode of CDI were analyzed using zero-inflated lognormal models. Results.?There were 421 persons with recurrent CDI (recurrence rate, 10.6%). Recurrent CDI case patients were significantly more likely than persons without recurrence to have any hospital costs during the outcome period (P < .001). The estimated attributable cost of recurrent CDI was $11,631 (95% confidence interval, $8,937-$14,588). Conclusions.?The attributable costs of recurrent CDI are considerable. Patients with recurrent CDI are significantly more likely to have inpatient hospital costs than patients who do not develop recurrences. Better strategies to predict and prevent CDI recurrences are needed. PMID:25333435

Dubberke, Erik R; Schaefer, Eric; Reske, Kimberly A; Zilberberg, Marya; Hollenbeak, Christopher S; Olsen, Margaret A

2014-11-01

320

[Early results of the treatment of Hodgkin's disease in adults using the seven-drug cytostatic protocol].  

PubMed

65 adult patients with Hodgkin's disease were treated acc. to multidrug protocol proposed by I. Koza et al. including doxorubicin, vincristine, vinblastine, bleomycin, procarbazine, lomustine and prednisone. 4 drugs (3 cytostatics and prednisone) including cycles were given repeatedly every 4 weeks. In the group of first line therapy (39 persons) 61.5% CR and 23% PR was obtained i.e. 84.5% therapeutic responses. The protocol used as salvage therapy resulted in 30% CR and 23% PR. Undesirable gastrointestinal effects were observed less commonly than after ABVD and CVPP schemes but myelosuppressive effect was more often seen and required attenuation of cytostatic drugs doses in the further cycles of therapy. The considered protocol seems to be a valuable one approaching to -but not achieving- the results of MOPP and ABVD schemes: is better tolerated because of elimination of strong emetic cytostatics (chlormethine and decarbazine) but late toxicity could be evaluable only after several years. PMID:1381821

Kotlarek-Haus, S; Gabry?, K; Wo?owiec, D; Kuliszkiewicz-Janus, M; Filip, A

1992-02-01

321

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

322

The effect of animal-assisted activity on inpatients with schizophrenia.  

PubMed

The aim of this study was to evaluate the effects of animal-assisted activity on self-esteem, control over activities of daily living, and other psycho-physiological aspects among Taiwanese inpatients with schizophrenia. Thirty participants were randomly assigned to either the treatment or control group. A weekly animal-assisted activity program was arranged for patients in the treatment group for 2 months. A questionnaire assessing self-esteem, self-determination, social support, and psychiatric symptoms was completed the week before and the week after the animal-assisted activity. Compared with the control group, the treatment group showed significant improvement on all measures except for social support and negative psychiatric symptoms. The results of this study showed that animal-assisted activity can promote significant improvements in many clinical aspects among inpatients with schizophrenia. Therefore, animal-assisted activity should be integrated into the treatment of institutionalized patients with schizophrenia. PMID:20000282

Chu, Cheng-I; Liu, Chao-Yin; Sun, Chi-Tzu; Lin, Jung

2009-12-01

323

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

PubMed Central

Patients hospitalized for psychiatric reasons exhibit significantly elevated risk of suicide, yet the research literature contains very few outcome studies of interventions designed for suicidal inpatients. This pilot study examined the inpatient feasibility and effectiveness of The Collaborative Assessment and Management of Suicidality (CAMS), a structured evidence-based method for risk assessment and treatment planning (Jobes, 2006). The study used an open-trial, case-focused design to assess an inpatient adaptation of CAMS, spread over a period averaging 51 days. The intervention was provided via individual therapy to a convenience sample of 20 patients (16 females and four males, average age 36.9) who were hospitalized with recent histories of suicidal ideation and behavior. Results showed statistically and clinically significant reductions in depression, hopelessness, suicide cognitions, and suicidal ideation, as well as improvement on factors considered “drivers” of suicidality. Treatment effect sizes were in the large range (Cohen’s d > .80) across several outcome measures, including suicidal ideation. Although these findings must be considered preliminary due to the lack of a randomized control group, they merit attention from clinicians working with patients at risk for suicide. This study also supports the feasibility of implementing a structured, suicide-specific intervention for at-risk patients in inpatient settings. PMID:22369081

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

2013-01-01

324

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

325

Investigating the efficacy of integrated cognitive behavioral therapy for adult treatment seeking substance use disorder patients with comorbid ADHD: study protocol of a randomized controlled trial  

PubMed Central

Background Attention deficit hyperactivity disorder (ADHD) frequently co-occurs with substance use disorders (SUD). The combination of ADHD and SUD is associated with a negative prognosis of both SUD and ADHD. Pharmacological treatments of comorbid ADHD in adult patients with SUD have not been very successful. Recent studies show positive effects of cognitive behavioral therapy (CBT) in ADHD patients without SUD, but CBT has not been studied in ADHD patients with comorbid SUD. Methods/design This paper presents the protocol of a randomized controlled trial to test the efficacy of an integrated CBT protocol aimed at reducing SUD as well as ADHD symptoms in SUD patients with a comorbid diagnosis of ADHD. The experimental group receives 15 CBT sessions directed at symptom reduction of SUD as well as ADHD. The control group receives treatment as usual, i.e. 10 CBT sessions directed at symptom reduction of SUD only. The primary outcome is the level of self-reported ADHD symptoms. Secondary outcomes include measures of substance use, depression and anxiety, quality of life, health care consumption and neuropsychological functions. Discussion This is the first randomized controlled trial to test the efficacy of an integrated CBT protocol for adult SUD patients with a comorbid diagnosis of ADHD. The rationale for the trial, the design, and the strengths and limitations of the study are discussed. Trial registration This trial is registered in http://www.clinicaltrials.gov as NCT01431235. PMID:23663651

2013-01-01

326

Profiling psychiatric inpatient suicide attempts in Japan.  

PubMed

Suicide is an adverse event that can occur even when patient are hospitalized in psychiatric facilities. This study delineates the demographic characteristics of suicide attempts in mental hospitals and psychiatric wards of general hospitals in Japan, a country where the suicide rate is remarkably high. Analyses of incident reports on serious suicide attempts in psychiatric inpatients were performed using prefectural incident records between April 1, 2001, and December 31, 2012. Suicide reports were included for 35 incidents that occurred over 11 years, and demonstrated that 83% of patients (n = 29) committed suicide and 17% (n = 6) survived their attempt with serious aftereffects, such as cognitive impairment or persistent vegetative state. The male/female ratio of inpatient suicide was 1.5:1. The mean age of the attempters was 50.5 years (SD = 18.2). The most common psychiatric diagnoses for those with suicide incident reports were schizophrenia spectrum disorders (51.4%) and affective disorders (40%). Hanging (60%) was the most common method of suicide attempt, followed by jumping in front of moving objects (14.3%) and jumping from height (11.4%). Fifty-four percent of suicides (n = 19) occurred within hospital sites and the remainder (46%; n = 16) occurred outside hospital sites (e.g., on medical leave or elopement) while they were still inpatients. PMID:25345233

Ikeshita, Katsumi; Shimoda, Shigero; Norimoto, Kazunobu; Arita, Keisuke; Shimamoto, Takuya; Murata, Kiyoshi; Makinodan, Manabu; Kishimoto, Toshifumi

2014-01-01

327

Education and employment needs and receipt of services in community and inpatient mental health settings.  

PubMed

The interRAI Education and Employment Clinical Assessment Protocol (EdEmp CAP) identifies three groups of individuals in community and inpatient mental health settings: those who are at risk of losing their employment or disrupting their education; those who require support in employment or educational participation; or those for whom interventions related to education and employment are not triggered. The EdEmp CAP was effective in identifying subpopulations who were at risk, but who did not receive any vocational rehabilitation or counseling. The EdEmp CAP can be used in clinical practice to identify individuals who might benefit from specific interventions in these areas. PMID:24468798

Kehyayan, Vahe; Hirdes, John P; Perlman, Christopher Michael

2014-08-01

328

Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation  

Microsoft Academic Search

Abstract:,Background.,The relationship,between,type,of chemoradiation treatment, site of disease, and swallowing function,has,not been,sufficiently examined,in patients,with head,and,neck,cancer,treated primarily with chemoradiation. Methods.,Fifty-three patients,with,advanced-stage,head and,neck,cancer,were,evaluated,before,and,3 months,after chemoradiation,treatment,to define their swallowing,disorders and,characterize,their swallowing,physiology,by site of lesion and,chemoradiation,protocol. One hundred,forty normal,sub- jects were,also studied. Results. The most,common,disorders,at baseline,and 3 months after treatment were reduced tongue base retraction, reduced tongue strength, and slowed or delayed laryngeal vestibule closure.

Jeri A. Logemann; Alfred W. Rademaker; Barbara Roa Pauloski; Cathy L. Lazarus; Bharat B. Mittal; Bruce Brockstein; Ellen MacCracken; Daniel J. Haraf; Everett E. Vokes; Lisa A. Newman; Dachao Liu

2006-01-01

329

Effect of a steam foot spa on geriatric inpatients with cognitive impairment: a pilot study  

PubMed Central

Purpose To investigate whether a steam foot spa improves cognitive impairment in geriatric inpatients. Methods Geriatric inpatients with cognitive impairment were given a steam foot spa treatment at 42°C for 20 minutes for 2 weeks (5 days/week). Physiological indicators such as blood pressure, percutaneous oxygen saturation, pulse, tympanic temperature, and sleep time and efficiency were assessed. Cognitive function and behavioral and psychological symptoms of dementia were assessed using the Mini-Mental State Examination, Dementia Mood Assessment Scale, and Dementia Behavior Disturbance scale. Results Significant decreases in systolic (P < 0.01) and diastolic blood pressure (P < 0.05) along with a significant increase in tympanic temperature (P < 0.01) were observed after the steam foot spas. A significant improvement was seen in the Mini-Mental State Examination score (P < 0.01) and the overall dementia severity items in Dementia Mood Assessment Scale (P < 0.05). Limitations Japanese people are very fond of foot baths. However, it is difficult to understand why inpatients cannot receive steam foot baths. In this study, a control group was not used. Raters and enforcers were not blinded. Conclusion The results of this pilot study suggest that steam foot spas mitigate cognitive impairment in geriatric inpatients. PMID:23717038

Koike, Yoshihisa; Kondo, Hideki; Kondo, Satoshi; Takagi, Masayuki; Kano, Yoshio

2013-01-01

330

Randomized double blind trial of ciprofloxacin prophylaxis during induction treatment in childhood acute lymphoblastic leukemia in the WK-ALL protocol in Indonesia  

PubMed Central

Objectives Toxic death is a big problem in the treatment of childhood acute lymphoblastic leukemia (ALL), especially in low-income countries. Studies of ciprofloxacin as single agent prophylaxis vary widely in success rate. We conducted a double-blind, randomized study to test the effects of ciprofloxacin monotherapy as prophylaxis for sepsis and death in induction treatment of the Indonesian childhood ALL protocol. Methods Patients were randomized to the ciprofloxacin arm (n = 58) and to the placebo arm (n = 52). Oral ciprofloxacin monotherapy or oral placebo was administered twice a day. All events during induction were recorded: toxic death, abandonment, resistant disease, and complete remission rate. Results Of 110 patients enrolled in this study, 79 (71.8%) achieved CR. In comparison to the placebo arm, the ciprofloxacin arm had lower nadir of absolute neutrophil count during induction with median of 62 (range: 5–884) versus 270 (range: 14–25,480) × 109 cells/L (P < 0.01), greater risks for experiencing fever (50.0% versus 32.7%, P = 0.07), clinical sepsis (50.0% versus 38.5%, P = 0.22), and death (18.9% versus 5.8%, P = 0.05). Conclusion In our setting, a reduced intensity protocol in a low-income situation, the data warn against using ciprofloxacin prophylaxis during induction treatment. A lower nadir of neutrophil count and higher mortality were found in the ciprofloxacin group. PMID:23403504

Widjajanto, Pudjo H; Sumadiono, Sumadiono; Cloos, Jacqueline; Purwanto, Ignatius; Sutaryo, Sutaryo; Veerman, Anjo JP

2013-01-01

331

In-patient management of diabetes: Controversies and guidelines  

PubMed Central

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.

2013-01-01

332

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

333

42 CFR 412.220 - Special treatment of certain hospitals located in Puerto Rico.  

Code of Federal Regulations, 2010 CFR

...false Special treatment of certain hospitals located in Puerto Rico. 412...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Operating Costs for Hospitals Located in Puerto Rico §...

2010-10-01

334

42 CFR 412.220 - Special treatment of certain hospitals located in Puerto Rico.  

Code of Federal Regulations, 2013 CFR

...false Special treatment of certain hospitals located in Puerto Rico. 412...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Operating Costs for Hospitals Located in Puerto Rico §...

2013-10-01

335

42 CFR 412.220 - Special treatment of certain hospitals located in Puerto Rico.  

Code of Federal Regulations, 2011 CFR

...false Special treatment of certain hospitals located in Puerto Rico. 412...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Operating Costs for Hospitals Located in Puerto Rico §...

2011-10-01

336

42 CFR 412.220 - Special treatment of certain hospitals located in Puerto Rico.  

Code of Federal Regulations, 2012 CFR

...false Special treatment of certain hospitals located in Puerto Rico. 412...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Operating Costs for Hospitals Located in Puerto Rico §...

2012-10-01

337

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

PubMed Central

Purpose To verify the dose distribution and number of monitor units (MU) for dynamic treatment techniques like volumetric modulated single arc radiation therapy - Rapid Arc - each patient treatment plan has to be verified prior to the first treatment. The purpose of this study was to develop a patient related treatment plan verification protocol using a two dimensional ionization chamber array (MatriXX, IBA, Schwarzenbruck, Germany). Method Measurements were done to determine the dependence between response of 2D ionization chamber array, beam direction, and field size. Also the reproducibility of the measurements was checked. For the patient related verifications the original patient Rapid Arc treatment plan was projected on CT dataset of the MatriXX and the dose distribution was calculated. After irradiation of the Rapid Arc verification plans measured and calculated 2D dose distributions were compared using the gamma evaluation method implemented in the measuring software OmniPro (version 1.5, IBA, Schwarzenbruck, Germany). Results The dependence between response of 2D ionization chamber array, field size and beam direction has shown a passing rate of 99% for field sizes between 7 cm × 7 cm and 24 cm × 24 cm for measurements of single arc. For smaller and larger field sizes than 7 cm × 7 cm and 24 cm × 24 cm the passing rate was less than 99%. The reproducibility was within a passing rate of 99% and 100%. The accuracy of the whole process including the uncertainty of the measuring system, treatment planning system, linear accelerator and isocentric laser system in the treatment room was acceptable for treatment plan verification using gamma criteria of 3% and 3 mm, 2D global gamma index. Conclusion It was possible to verify the 2D dose distribution and MU of Rapid Arc treatment plans using the MatriXX. The use of the MatriXX for Rapid Arc treatment plan verification in clinical routine is reasonable. The passing rate should be 99% than the verification protocol is able to detect clinically significant errors. PMID:21342509

2011-01-01

338

42 CFR 405.1206 - Expedited determination procedures for inpatient hospital care.  

Code of Federal Regulations, 2012 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)...

2012-10-01

339

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

Code of Federal Regulations, 2010 CFR

...2010-10-01 false Furnishing of inpatient hospital services directly or under arrangements...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Conditions for Payment Under... § 412.50 Furnishing of inpatient hospital services directly or under...

2010-10-01

340

5 CFR 890.905 - Limits on inpatient hospital and physician charges.  

...2014-01-01 false Limits on inpatient hospital and physician charges. 890.905...BENEFITS PROGRAM Limit on Inpatient Hospital Charges, Physician Charges, and FEHB...Payments § 890.905 Limits on inpatient hospital and physician charges. (a)...

2014-01-01

341

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

Federal Register 2010, 2011, 2012, 2013

...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

342

5 CFR 890.905 - Limits on inpatient hospital and physician charges.  

Code of Federal Regulations, 2012 CFR

...2012-01-01 false Limits on inpatient hospital and physician charges. 890.905...BENEFITS PROGRAM Limit on Inpatient Hospital Charges, Physician Charges, and FEHB...Payments § 890.905 Limits on inpatient hospital and physician charges. (a)...

2012-01-01

343

5 CFR 890.905 - Limits on inpatient hospital and physician charges.  

Code of Federal Regulations, 2011 CFR

...2011-01-01 false Limits on inpatient hospital and physician charges. 890.905...BENEFITS PROGRAM Limit on Inpatient Hospital Charges, Physician Charges, and FEHB...Payments § 890.905 Limits on inpatient hospital and physician charges. (a)...

2011-01-01

344

42 CFR 405.1206 - Expedited determination procedures for inpatient hospital care.  

Code of Federal Regulations, 2013 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)...

2013-10-01

345

5 CFR 890.905 - Limits on inpatient hospital and physician charges.  

Code of Federal Regulations, 2013 CFR

...2013-01-01 false Limits on inpatient hospital and physician charges. 890.905...BENEFITS PROGRAM Limit on Inpatient Hospital Charges, Physician Charges, and FEHB...Payments § 890.905 Limits on inpatient hospital and physician charges. (a)...

2013-01-01

346

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

Code of Federal Regulations, 2012 CFR

...2012-10-01 false Furnishing of inpatient hospital services directly or under arrangements...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Conditions for Payment Under... § 412.50 Furnishing of inpatient hospital services directly or under...

2012-10-01

347

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

Code of Federal Regulations, 2013 CFR

...2013-10-01 false Furnishing of inpatient hospital services directly or under arrangements...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Conditions for Payment Under... § 412.50 Furnishing of inpatient hospital services directly or under...

2013-10-01

348

5 CFR 890.905 - Limits on inpatient hospital and physician charges.  

Code of Federal Regulations, 2010 CFR

...2010-01-01 false Limits on inpatient hospital and physician charges. 890.905...BENEFITS PROGRAM Limit on Inpatient Hospital Charges, Physician Charges, and FEHB...Payments § 890.905 Limits on inpatient hospital and physician charges. (a)...

2010-01-01

349

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

Code of Federal Regulations, 2011 CFR

...2011-10-01 false Furnishing of inpatient hospital services directly or under arrangements...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Conditions for Payment Under... § 412.50 Furnishing of inpatient hospital services directly or under...

2011-10-01

350

42 CFR 413.40 - Ceiling on the rate of increase in hospital inpatient costs.  

Code of Federal Regulations, 2011 CFR

... Ceiling on the rate of increase in hospital inpatient costs. 413.40 Section... Ceiling on the rate of increase in hospital inpatient costs. (a) Introduction...increase in operating costs per case for hospital inpatient services furnished to...

2011-10-01

351

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

352

42 CFR 405.1206 - Expedited determination procedures for inpatient hospital care.  

Code of Federal Regulations, 2011 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)...

2011-10-01

353

Vitamin D Deficiency Among Psychiatric Inpatients  

PubMed Central

Objective: Previous studies in northern Europe and Australia have indicated that vitamin D deficiency is common in psychiatric patients. This study aimed to determine the prevalence of vitamin D deficiency among psychiatric inpatients in a large North American city. The association of vitamin D status with clinical characteristics was also explored, and subgroups of patients that are more vulnerable to vitamin D deficiency were identified. Method: This descriptive study looked at 107 unselected consecutive admissions to a psychiatric inpatient service in New York City between September and early December 2010. All patients were aged 18 years and older. Psychiatric diagnoses were established by attending psychiatrists as part of the routine assessment using criteria from the DSM-IV. Serum levels of 25-hydroxyvitamin D were measured by high-performance liquid chromatography, tandem mass spectrometry. A vitamin D–deficient state was defined as serum 25-hydroxyvitamin D level ? 20 ng/mL. Results: Fifty-six (52.3%) patients were classified as deficient in vitamin D. Age and 25-hydroxyvitamin D level were significantly correlated (P = .001). Seventy-one percent of patients from age 18 to 34 years were deficient in vitamin D; this rate was significantly higher than the rate of deficiency in older patients (P = .017). No significant relationships were found between 25-hydroxyvitamin D level and gender, race/ethnicity, glycosylated hemoglobin, body mass index, and major psychiatric diagnostic categories. Conclusions: A high percentage of psychiatric inpatients are deficient in vitamin D. Younger patients were more at risk for deficiency. Screening for vitamin D deficiency should be part of the health assessment of patients with major psychiatric illnesses. PMID:22943031

Charles, Richard A.; Orendain, Geraldine C. M.; Joseph, Michel D.; Abanishe, James O.

2012-01-01

354

Longitudinal assessment of inpatient use and functioning of seriously mentally ill veterans with and without co-occurring substance use disorders  

Microsoft Academic Search

The purpose of this study was to delineate differences in inpatient service utilization and functional and subjective outcomes between veterans with a serious mental illness (SMI) and those with co-occurring serious mental illnesses and substance abuse (SA) disorders.This study assessed 2-year inpatient utilization and outcomes for 682 SMI veterans enrolled in specialized psychosocial treatment programs which did not have a

Frederic C. Blow; Kristen Lawton Barry; Bonnie J. BootsMillerP; Laurel A. Copeland; Richard McCormick; Stephanie Visnic

1998-01-01

355

Communications protocol  

NASA Technical Reports Server (NTRS)

The present invention relates to an improved communications protocol which increases the efficiency of transmission in return channels on a multi-channel slotted Alohas system by incorporating advanced error correction algorithms, selective retransmission protocols and the use of reserved channels to satisfy the retransmission requests.

Zhou, Xiaoming (Inventor); Baras, John S. (Inventor)

2010-01-01

356

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

357

Early versus delayed inpatient stroke rehabilitation: A matched comparison conducted in Italy  

Microsoft Academic Search

Objective: To assess the specific influence of onset-admission interval (OAI) on rehabilitation results.Design: A case-control study in consecutive stroke inpatients, enrolled in homogeneous subgroups, matched for age (within 1 year) and Barthel Index (BI) score at admission, and different for OAI to the rehabilitation ward. The short OAI group began rehabilitation treatment within the first 20 days from stroke, medium

Stefano Paolucci; Gabriella Antonucci; Maria Grazia Grasso; Daniela Morelli; Elio Troisi; Paola Coiro; Maura Bragoni

2000-01-01

358

Mobility status after inpatient stroke rehabilitation: 1Year follow-up and prognostic factors  

Microsoft Academic Search

Paolucci S, Grasso MG, Antonucci G, Bragoni M, Troisi E, Morelli D, Coiro P, De Angelis D, Rizzi F. Mobility status after inpatient stroke rehabilitation: 1-year follow-up and prognostic factors. Arch Phys Med Rehabil 2001;82:2-8. Objectives: To evaluate the stability of mobility status achieved by stroke patients during hospital rehabilitation treatment over time and to identify reliable prognostic factors associated

Stefano Paolucci; Maria Grazia Grasso; Gabriella Antonucci; Maura Bragoni; Elio Troisi; Daniela Morelli; Paola Coiro; Domenico De Angelis; Francesco Rizzi

2001-01-01

359

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

360

42 CFR 412.140 - Participation, data submission, and validation requirements under the Hospital Inpatient Quality...  

Code of Federal Regulations, 2013 CFR

...submission, and validation requirements under the Hospital Inpatient Quality Reporting (IQR) Program... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems §...

2013-10-01

361

42 CFR 412.140 - Participation, data submission, and validation requirements under the Hospital Inpatient Quality...  

Code of Federal Regulations, 2012 CFR

...submission, and validation requirements under the Hospital Inpatient Quality Review (IQR) Program... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems §...

2012-10-01

362

42 CFR 412.140 - Participation, data submission, and validation requirements under the Hospital Inpatient Quality...  

Code of Federal Regulations, 2011 CFR

...submission, and validation requirements under the Hospital Inpatient Quality Review (IQR) Program... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems §...

2011-10-01

363

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...  

Code of Federal Regulations, 2011 CFR

...false Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals...140 Inpatient hospital services, nursing facility services, and intermediate care facility services for...

2011-10-01

364

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...  

Code of Federal Regulations, 2013 CFR

...false Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals...140 Inpatient hospital services, nursing facility services, and intermediate care facility services for...

2013-10-01

365

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...  

Code of Federal Regulations, 2010 CFR

...false Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals...140 Inpatient hospital services, nursing facility services, and intermediate care facility services for...

2010-10-01

366

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...  

Code of Federal Regulations, 2012 CFR

...false Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals...140 Inpatient hospital services, nursing facility services, and intermediate care facility services for...

2012-10-01

367

[Results of the treatment of patients with advanced Hodgkin's disease by the ABDiC and/or BVCPP protocols].  

PubMed

In 22 patients with phase IV of Hodgkin's disease refractory to treatment by the programmes MOPP and/or CVPP, and ABCD and/or BACOP, and in patients with recurrences after this treatment the ABDIC and/or BVCPP programmes were applied. In 5 cases this treatment was associated with radiotherapy. Complete remission lasting 30 months was achieved in one case. In 9 cases only clinical improvement was noted. Twelve patients failed to respond to this treatment. Ten patients died. The mean survival time of all patients from the beginning of treatment by ABDIC and BVCPP programmes to the end of the observation was 14 months, and the time from the diagnosis to the end of the observation was 69 months. The results of this treatment are not satisfactory. PMID:2482648

Leszko, B; S?omkowski, M; Pawelski, S; Kope?, I; Maj, S

1989-01-01

368

Self-Reported Suicidal Ideation in Adolescent Psychiatric Inpatients.  

ERIC Educational Resources Information Center

Administered Beck Scale for Suicide Ideation (BSI) to 108 adolescent inpatients diagnosed with mixed psychiatric disorders. Examined relationships of Beck Depression Inventory, Anxiety Inventory, and Hopelessness Scale with BSI. Results support use of BSI with adolescent inpatients. Findings indicated that hopelessness was related to suicidal…

Steer, Robert A.; And Others

1993-01-01

369

PATIENT SAFETY AND INPATIENT GLYCEMIC CONTROL: TRANSLATING CONCEPTS INTO ACTION  

Microsoft Academic Search

Objective: (1) To summarize current knowledge re- garding patient safety issues and their impact on inpatient glycemic control and (2) to provide a systematic and practi- cal approach to improving patient safety in this area. Methods: Insulin delivery in inpatient settings is ex- amined, as are the barriers to safe insulin therapy. A distinc- tion is made between safety strategies

Richard Hellman

2006-01-01

370

Characteristics of Hospital Inpatient Falls across Clinical Departments  

Microsoft Academic Search

Background: Hospital inpatient falls are common and may lead to injuries and prolonged hospitalization. Although hospital studies have reported overall fall rates and injuries associated with falls, few have addressed population characteristics and circumstances of falls across clinical departments within a hospital setting. Objective: To determine inpatient fall rates in an urban public hospital and to explore associated characteristics across

René Schwendimann; Hugo Bühler; Sabina De Geest; Koen Milisen

2008-01-01

371

Multifaceted Inpatient Psychiatry Approach to Reducing Readmissions: A Pilot Study  

ERIC Educational Resources Information Center

Context: Access to psychiatric services, particularly inpatient psychiatric care, is limited and lacks comprehensiveness in rural areas. Purpose: The purpose of this study was to evaluate the impact on readmission rates of a multifaceted inpatient psychiatry approach (MIPA) offered in a rural hospital. Methods: Readmissions within 30 days of…

Lang, Timothy P.; Rohrer, James E.; Rioux, Pierre A.

2009-01-01

372

Dual diagnosis in inpatient physicians: prevalence and clinical characteristics  

Microsoft Academic Search

Background: Despite evidence of dual diagnosis (DD) in impaired physicians, few studies have investigated its prevalence and clinical characteristics.Aims: To assess the prevalence and clinical characteristics of DD in a sample of inpatient physicians and to compare physician patients with DD to other inpatient physicians.Methods: A chart review of clinical and demographic data was conducted on 290 consecutive admissions to

Pilar Lusilla; Antoni Gual; Carlos Roncero; Eugeni Bruguera; Victoria Marcos; Sergi Valero; Miquel Casas

2008-01-01

373

Atypical depression among psychiatric inpatients: clinical features and personality traits  

Microsoft Academic Search

Objective: This study investigates the frequency and characteristics of Atypical Depression (AD) among depressed inpatients. Method: Twenty-one depressed inpatients received DSM-IV diagnoses, were rated on the Hamilton Depression Rating Scale (HAMD), and assessed for AD using the Atypical Depressive Disorder Scale. AD was defined as the presence of mood reactivity and two of four associated features: hyperphagia, hypersomnia, leaden paralysis,

Celeste N. Derecho; Scott Wetzler; Lata K. McGinn; William C. Sanderson; Gregory M. Asnis

1996-01-01

374

Suicide attempts and domestic violence among women psychiatric inpatients  

Microsoft Academic Search

Objective . Previous clinical observations, as well as empirical studies in fairly unique samples, suggest that there may be a relationship between domestic-violence victimization and suicide attempts. We wished to examine this relationship among psychiatric women inpatients. Methods. In this study among psychiatric inpatients, we compared women with versus without suicide attempts with regard to scores on a measure of

Randy A. Sansone; Jamie Chu; Michael W. Wiederman

2007-01-01

375

A Treatment Protocol for Restoring Occlusal Vertical Dimension Using an Overlay Removable Partial Denture as an Alternative to Extensive Fixed Restorations: A Clinical Report  

PubMed Central

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

Patel, Mit B; Bencharit, Sompop

2009-01-01

376

Protocol Building Blocks Protocol Design  

E-print Network

Advanced Language: SML ffl Implementation: SML/NJ ffl Systems Program: TCP/IP protocol stack + 3 #12; + + Standard TCP/IP Protocol Stack device/OS device driver Ethernet IP TCP Application structure Dev = Ethernetâ??Device (...) structure Eth = Eth (structure Dev = Dev) structure Ip = Ip (structure Lower = Eth) structure Tcp = Tcp

Biagioni, Edoardo S.

377

Determinants of completed railway suicides by psychiatric in-patients: case-control study.  

PubMed

Background Suicide prediction during psychiatric in-patient treatment remains an unresolved challenge. Aims To identify determinants of railway suicides in individuals receiving in-patient psychiatric treatment. Method The study population was drawn from patients admitted to six psychiatric hospitals in Germany during a 10-year period (1997-2006). Data from 101 railway suicide cases were compared with a control group of 101 discharged patients matched for age, gender and diagnosis. Results Predictors of suicide were change of therapist (OR = 22.86, P = 0.004), suicidal ideation (OR = 7.92, P<0.001), negative or unchanged therapeutic course (OR = 7.73, P<0.001), need of polypharmaceutical treatment (OR = 2.81, P = 0.04) and unemployment (OR = 2.72, P = 0.04). Neither restlessness nor impulsivity predicted in-patient suicide. Conclusions Suicidal ideation, unfavourable clinical course and the use of multiple psychotropic substances (reflecting the severity of illness) were strong determinants of railway suicides. The most salient finding was the vital impact of a change of therapist. These findings deserve integration into the clinical management of patients with serious mental disease. PMID:25257065

Lukaschek, Karoline; Baumert, Jens; Krawitz, Marion; Erazo, Natalia; Förstl, Hans; Ladwig, Karl-Heinz

2014-11-01

378

Rehabilitation Medicine in a Small Clinic: Effort of a private clinic with small inpatient facility in a province of Japan.  

PubMed

Dyna Rehabilitation Clinic is a small clinic located in Tochigi (Japan) with a capacity of 19 patients, serving as the core facility in providing borderless and seamless care in medicine, rehabilitation medicine, and long-term care; from inpatient rehabilitation for recovering patients to home-visit medical services and long-term care, including terminal care. In Japan, the managing physician of an authorized clinic with small inpatient facilities lives within the clinic's property or in the land adjacent to it and attends the inpatients while responding to local medical needs on a 24-hour basis, reflecting local climate, communities, and culture. Unlike a large-scale hospital, a clinic with a small-scale inpatient facilities specialized in rehabilitation with close links to local communities can still survive as a business and contribute to local society?-?Dyna Rehabilitation Clinic is a good example. Patients vary in their diseases, complications, age, family structure, living environment, financial status, sense of values, and the lives they lead. It is impossible to meet all such needs with one standard rehabilitation scheme?-?but, clinics with small inpatient facilities, such as Dyna Rehabilitation Clinic, can provide more treatment more flexibly, and fill in the gap. PMID:25237226

Kondo, Ken

2012-05-01

379

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

380

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

381

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

Microsoft Academic Search

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

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

2010-01-01

382

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

383

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

384

Assessing Reliability, Validity, and Clinical Utility of the BEST-Index in Measuring Living Skills Among Forensic Inpatients  

Microsoft Academic Search

The assessment of behavioral change as a result of inpatient treatment in forensic psychiatry is an important precondition for violence risk prediction in forensic psychiatry. In relation to a multitude of diagnostically based risk assessment instruments, there is a shortage of appropriate instruments with which to carry out valid and reliable therapeutic assessments that are behaviorally based and therefore appropriate

Thomas Ross; Val Reed; María Isabel Fontao; Friedemann Pfäfflin

2012-01-01

385

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

386

Comparison of peer assessment ratings (PAR) from 1-phase and 2-phase treatment protocols for class II malocclusions  

Microsoft Academic Search

The purpose of this study was to compare the dentoalveolar outcomes after 1-phase and 2-phase orthodontic treatment of Class II malocclusions. Class II subjects (n = 208) were randomized to 1-phase or 2-phase treatment with either bionator or headgear\\/biteplate. The peer assessment rating (PAR) was calculated from pretreatment, prephase 2, and final study models. Chi-square, Kruskal-Wallis, and Wilcoxon rank sum

Gregory J. King; Susan P. McGorray; Timothy T. Wheeler; Calogero Dolce; Marie Taylor

2003-01-01

387

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

PubMed Central

Background Hip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function. Methods The trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS) and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline. Conclusions The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA. Trial Registration Australian New Zealand Clinical Trials Registry reference: ACTRN12610000439044 PMID:20946621

2010-01-01

388

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

389

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

390

Healthcare Worker Perceived Barriers to Early Initiation of Antiretroviral and Tuberculosis Therapy among Tanzanian Inpatients  

PubMed Central

Setting Clinical trials have shown that early initiation of antiretroviral therapy in HIV-infected patients with tuberculosis saves lives, but models for implementation of this new strategy have been under-studied in real-world settings. Objective To identify the barriers and possible solutions for implementing concurrent early treatment with antiretroviral and anti-tuberculosis therapy in a large East African referral hospital where the prevalence of both infections is high. Design In-depth interviews among hospital administrators, laboratory technicians, nurses, pharmacists, and physicians. Results Twenty-six hospital staff identified six key barriers and corresponding solutions to promote rapid initiation of antiretroviral therapy in HIV-infected inpatients with tuberculosis. These include revising systems of medication delivery, integrating care between inpatient and outpatient systems, training hospital nurses to counsel and initiate medications in inpatients, and cultivating a team approach to consistent guideline implementation. Conclusion Most barriers identified by hospital staff were easily surmountable with reorganization, training, and policy changes at minimal cost. Efforts to reduce mortality for HIV and tuberculosis co-infected patients in accordance with new World Health Organization guidelines are currently hampered by implementation barriers in real-world settings. Our findings suggest that these can be overcome with strategic enactment of simple, realistic interventions to promote early dual treatment for HIV/tuberculosis co-infected patients. PMID:24551061

Wajanga, Bahati M. K.; Peck, Robert N.; Kalluvya, Samuel; Fitzgerald, Daniel W.; Smart, Luke R.; Downs, Jennifer A.

2014-01-01

391

Design of a randomized trial to evaluate the influence of mobile phone reminders on adherence to first line antiretroviral treatment in South India - the HIVIND study protocol  

PubMed Central

Background Poor adherence to antiretroviral treatment has been a public health challenge associated with the treatment of HIV. Although different adherence-supporting interventions have been reported, their long term feasibility in low income settings remains uncertain. Thus, there is a need to explore sustainable contextual adherence aids in such settings, and to test these using rigorous scientific designs. The current ubiquity of mobile phones in many resource-constrained settings, make it a contextually appropriate and relatively low cost means of supporting adherence. In India, mobile phones have wide usage and acceptability and are potentially feasible tools for enhancing adherence to medications. This paper presents the study protocol for a trial, to evaluate the influence of mobile phone reminders on adherence to first-line antiretroviral treatment in South India. Methods/Design 600 treatment naïve patients eligible for first-line treatment as per the national antiretroviral treatment guidelines will be recruited into the trial at two clinics in South India. Patients will be randomized into control and intervention arms. The control arm will receive the standard of care; the intervention arm will receive the standard of care plus mobile phone reminders. Each reminder will take the form of an automated call and a picture message. Reminders will be delivered once a week, at a time chosen by the patient. Patients will be followed up for 24 months or till the primary outcome i.e. virological failure, is reached, whichever is earlier. Self-reported adherence is a secondary outcome. Analysis is by intention-to-treat. A cost-effectiveness study of the intervention will also be carried out. Discussion Stepping up telecommunications technology in resource-limited healthcare settings is a priority of the World Health Organization. The trial will evaluate if the use of mobile phone reminders can influence adherence to first-line antiretrovirals in an Indian context. Trial Registration Trial registration: ISRCTN79261738. PMID:20346136

2010-01-01

392

Treatment of traumatized refugees with Sertraline versus Venlafaxine in combination with psychotherapy - study protocol for a randomized clinical trial  

PubMed Central

Background Sufficient evidence is lacking to draw final conclusions on the efficiency of medical and psychological treatments of traumatized refugees with PTSD. The pharmacological treatments of choice today for post-traumatic stress disorder are antidepressants from the subgroup selective serotonin reuptake inhibitors, especially Sertraline. The evidence for the use of selective serotonin reuptake inhibitors in the treatment of complex post-traumatic stress disorder in traumatized refugees is very limited. Venlafaxine is a dual-action antidepressant that works on several pathways in the brain. It influences areas in the brain which are responsible for the enhanced anxiety and hyper-arousal experienced by traumatized refugees and which some studies have found to be enlarged among patients suffering from post-traumatic stress disorder. Design This study will include approximately 150 patients, randomized into two different groups treated with either Sertraline or Venlafaxine. Patients in both groups will receive the same manual-based cognitive behavioral therapy, which has been especially adapted to this group of patients. The treatment period will be 6 to 7 months. The trial endpoints will be post-traumatic stress disorder and depressive symptoms and social functioning, all measured on validated ratings scales. Furthermore the study will examine the relation between a psycho-social resources and treatment outcome based on 15 different possible outcome predictors. Discussion This study is expected to bring forward new knowledge on treatment and clinical evaluation of traumatized refugees and the results are expected to be used in reference programs and clinical guidelines. Trial registration ClinicalTrials.gov NCT01569685 PMID:23663588

2013-01-01

393

Adapted motivational interviewing to improve the uptake of treatment for glaucoma in Nigeria: study protocol for a randomized controlled trial  

PubMed Central

Background Glaucoma is a chronic eye disease associated with irreversible visual loss. In Africa, glaucoma patients often present late, with very advanced disease. One-off procedures, such as laser or surgery, are recommended in Africa because of lack of or poor adherence to medical treatment. However, acceptance of surgery is usually extremely low. To prevent blindness, adherence to treatment needs to improve, using acceptable, replicable and cost-effective interventions. After reviewing the literature and interviewing patients in Bauchi (Nigeria) motivational interviewing (MI) was selected as the intervention for this trial, with adaptation for glaucoma (MIG). MI is designed to strengthen personal motivation for, and commitment to a specific goal by eliciting and exploring a person’s reasons for change within an atmosphere of acceptance and compassion. The aim of this study is to assess whether MIG increases the uptake of laser or surgery amongst glaucoma patients where this is the recommended treatment. The hypothesis is that MIG increases the uptake of treatment. This will be the first trial of MI in Africa. Methods This is a hospital based, single centre, randomized controlled trial of MIG plus an information sheet on glaucoma and its treatment (the latter being “standard care”) compared with standard care alone for glaucoma patients where the treatment recommended is surgery or laser. Those eligible for the trial are adults aged 17 years and above who live within 200 km of Bauchi with advanced glaucoma where the examining ophthalmologist recommends surgery or laser. After obtaining written informed consent, participants will be randomly allocated to MIG plus standard care, or standard care alone. Motivational interviewing will be delivered in Hausa or English by one of two MIG trained personnel. One hundred and fifty participants will be recruited to each arm. The primary outcome is the proportion of participants undergoing laser or surgery within two months of the date given to re attend for the procedure. MIG quality will be assessed using the validated MI treatment integrity scale. Discussion Motivational interviewing may be an important tool to increase the acceptance of treatment for glaucoma. The approach is potentially scalable and may be useful for other chronic conditions in Africa. Trial registration ISRCTN79330571 (Controlled-Trials.com). PMID:24773760

2014-01-01

394

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

395

Palliative inpatients in general hospitals: a one day observational study in Belgium  

PubMed Central

Background Hospital care plays a major role at the end-of-life. But little is known about the overall size and characteristics of the palliative inpatient population. The aim of our study was to analyse these aspects. Methods We conducted a one-day observational study in 14 randomly selected Belgian hospitals. Patients who met the definition of palliative patients were identified as palliative. Then, information about their socio-demographic characteristics, diagnoses, prognosis, and care plan were recorded and analysed. Results There were 2639 in-patients on the day of the study; 9.4% of them were identified as "palliative". The mean age of the group was 72 years. The primary diagnosis was cancer in 51% of patients and the estimated life expectancy was shorter than 3 months in 33% of patients and longer than 1 year in 28% of patients. The professional caregivers expected for most of the patients (73%), that the treatment would improve patient comfort rather than prolong life. Antibiotics, transfusions, treatments specific to the pathology, and artificial nutrition were administered in 90%, 78%, 57% and 50% of the patients, respectively, but were generally given with a view to controlling the symptoms. Conclusions This analysis presents a first national estimate of the palliative inpatient population. Our results confirm that hospitals play a major role at the end-of-life, with one out of ten inpatients identified as a "palliative" patient. These data also demonstrate the complexity of the palliative population and the substantial diversity of care that they can require. PMID:21362204

2011-01-01

396

The EVERT (effective verruca treatments) trial protocol: a randomised controlled trial to evaluate cryotherapy versus salicylic acid for the treatment of verrucae  

Microsoft Academic Search

BACKGROUND: Verrucae are a common, infectious and sometimes painful problem. The optimal treatment for verrucae is unclear due to a lack of high quality randomised controlled trials. The primary objective of this study is to compare the clinical effectiveness of two common treatments for verrucae: cryotherapy using liquid nitrogen versus salicylic acid. Secondary objectives include a comparison of the cost-effectiveness

E Sarah Cockayne

2010-01-01

397

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

398

Snoring and the role of the GDP: British Society of Dental Sleep Medicine (BSDSM) pre-treatment screening protocol  

Microsoft Academic Search

Snoring is not necessarily a benign condition; it can be linked to the serious condition obstructive sleep apnoea (OSA). In some cases mandibular repositioning devices can be an effective treatment for simple snoring and mild to moderate sleep apnoea, and these devices can be provided by dentists (with appropriate training and in line with Dental Protection Ltd guidelines). Until now,

J. Stradling; R. Dookun

2009-01-01

399

The Role of Negative Affectivity and Negative Reactivity to Emotions in Predicting Outcomes in the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders  

PubMed Central

The present study aimed to understand the contributions of both the trait tendency to experience negative emotions and how one relates to such experience in predicting symptom change during participation in the Unified Protocol (UP), a transdiagnostic treatment for emotional disorders. Data were derived from a randomized controlled trial comparing the UP to a wait-list control / delayed-treatment condition. First, effect sizes of pre- to post-treatment change for frequency of negative emotions and several variables measuring reactivity to emotional experience (emotional awareness and acceptance, fear of emotions, and anxiety sensitivity) were examined. Second, the relative contributions of change in negative emotions and emotional reactivity in predicting symptom (clinician-rated anxiety, depression, and severity of principal diagnosis) reductions were investigated. Results suggested that decreases in the frequency of negative emotions and reactivity to emotions following participation in the UP were both large in magnitude. Further, two emotional reactivity variables (fear of emotions and anxiety sensitivity) remained significantly related to symptom outcomes when controlling for negative emotions, and accounted for significant incremental variance in their prediction. These findings lend support to the notion that psychological health depends less on the frequency of negative emotions and more on how one relates to these emotions when they occur. PMID:22738907

Sauer-Zavala, Shannon; Boswell, James F.; Gallagher, Matthew W.; Bentley, Kate H.; Ametaj, Amantia; Barlow, David H.

2012-01-01

400

A randomized controlled trial comparing Circle of Security Intervention and treatment as usual as interventions to increase attachment security in infants of mentally ill mothers: Study Protocol  

PubMed Central

Background Psychopathology in women after childbirth represents a significant risk factor for parenting and infant mental health. Regarding child development, these infants are at increased risk for developing unfavorable attachment strategies to their mothers and for subsequent behavioral, emotional and cognitive impairments throughout childhood. To date, the specific efficacy of an early attachment-based parenting group intervention under standard clinical outpatient conditions, and the moderators and mediators that promote attachment security in infants of mentally ill mothers, have been poorly evaluated. Methods/Design This randomized controlled clinical trial tests whether promoting attachment security in infancy with the Circle of Security (COS) Intervention will result in a higher rate of securely attached children compared to treatment as usual (TAU). Furthermore, we will determine whether the distributions of securely attached children are moderated or mediated by variations in maternal sensitivity, mentalizing, attachment representations, and psychopathology obtained at baseline and at follow-up. We plan to recruit 80 mother-infant dyads when infants are aged 4-9 months with 40 dyads being randomized to each treatment arm. Infants and mothers will be reassessed when the children are 16-18 months of age. Methodological aspects of the study are systematic recruitment and randomization, explicit inclusion and exclusion criteria, research assessors and coders blinded to treatment allocation, advanced statistical analysis, manualized treatment protocols and assessments of treatment adherence and integrity. Discussion The aim of this clinical trial is to determine whether there are specific effects of an attachment-based intervention that promotes attachment security in infants. Additionally, we anticipate being able to utilize data on maternal and child outcome measures to obtain preliminary indications about potential moderators of the intervention and inform hypotheses about which intervention may be most suitable when offered in a clinical psychiatric outpatient context. Trial registration Current Controlled Trials ISRCTN88988596 PMID:24476106

2014-01-01

401

Study protocol: a dissemination trial of computerized psychological treatment for depression and alcohol/other drug use comorbidity in an Australian clinical service  

PubMed Central

Background The rise of the internet and related technologies has significant implications for the treatment of complex health problems, including the combination of depression and alcohol/other drug (AOD) misuse. To date, no research exists to test the real world uptake of internet and computer-delivered treatment programs in clinical practice. This study is important, as it is the first to examine the adoption of the SHADE treatment program, a DVD-based psychological treatment for depression and AOD use comorbidity, by clinicians working in a publicly-funded AOD clinical service. The study protocol that follows describes the methodology of this dissemination trial. Methods/design 19 clinicians within an AOD service on the Central Coast of New South Wales, Australia, will be recruited to the trial. Consenting clinicians will participate in a baseline focus group discussion designed to explore their experiences and perceived barriers to adopting innovation in their clinical practice. Computer comfort and openness to innovation will also be assessed. Throughout the trial, current, new and wait-list clients will be referred to the research program via the clinical service, which will involve clients completing a baseline and 15-week follow-up clinical assessment with independent research assistants, comprising a range of mental health and AOD measures. Clinicians will also complete session checklists following each clinical session with a client, outlining the extent to which the SHADE computer program was used. Therapeutic alliance will be measured at intake and discharge from both the clinician and client perspectives. Discussion This study will provide comprehensive data on the factors associated with the adoption of an innovative, computer-delivered evidence-based treatment program, SHADE, by clinicians working in an AOD service. The results will contribute to the development of a model of dissemination of SHADE, which could be applied to a range of technological innovations. Clinical trials registry Australian Clinical Trial Registration Number: ACTRN12611000382976. PMID:22770390

2012-01-01

402

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

PubMed Central

Background Achilles tendinopathy is a common condition that can cause marked pain and disability. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. The exception to this is eccentric calf muscle exercises, which have become a standard non-surgical intervention for Achilles tendinopathy. Foot orthoses have also been advocated as a treatment for Achilles tendinopathy, but the long-term efficacy of foot orthoses for this condition is unknown. This manuscript describes the design of a randomised trial to evaluate the efficacy of customised foot orthoses to reduce pain and improve function in people with Achilles tendinopathy. Methods One hundred and forty community-dwelling men and women aged 18 to 55 years with Achilles tendinopathy (who satisfy inclusion and exclusion criteria) will be recruited. Participants will be randomised, using a computer-generated random number sequence, to either a control group (sham foot orthoses made from compressible ethylene vinyl acetate foam) or an experimental group (customised foot orthoses made from semi-rigid polypropylene). Both groups will be prescribed a calf muscle eccentric exercise program, however, the primary difference between the groups will be that the experimental group receive customised foot orthoses, while the control group receive sham foot orthoses. The participants will be instructed to perform eccentric exercises 2 times per day, 7 days per week, for 12 weeks. The primary outcome measure will be the total score of the Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaire. The secondary outcome measures will be participant perception of treatment effect, comfort of the foot orthoses, use of co-interventions, frequency and severity of adverse events, level of physical activity and health-related quality of life (assessed using the Short-Form-36 questionnaire - Version two). Data will be collected at baseline, then at 1, 3, 6 and 12 months. Data will be analysed using the intention to treat principle. Discussion This study is the first randomised trial to evaluate the long-term efficacy of customised foot orthoses for the treatment of Achilles tendinopathy. The study has been pragmatically designed to ensure that the study findings are generalisable to clinical practice. Trial registration Australian New Zealand Clinical Trials Registry Number: ACTRN12609000829213. PMID:19852853

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

2009-01-01

403

Protocol Development — Guidelines Regarding the Inclusion of Pregnant and Breast-Feeding Women on Cancer Clinical Treatment Trials  

Cancer.gov

Pregnant women may not be arbitrarily excluded from participation in clinical cancer treatment trials. Exclusion of pregnant women from a particular trial must be based on a clear and compelling rationale or justification that shows that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research, or other circumstances that offer a clear and compelling reason for exclusion.

404

Short message service (SMS) interventions for the prevention and treatment of sexually transmitted infections: a systematic review protocol  

PubMed Central

Background Globally, the incidence of sexually transmitted infections (STI) is rising, posing a challenge to its control and appropriate management. Text messaging has become the most common mode of communication among almost six billion mobile phone users worldwide. Text messaging can be used to remind patients about clinic appointments, to notify patients that it is time for STI re-testing, and to facilitate patient communication with their health professionals with any questions and concerns they may have about their sexual health. While there are a handful of systematic reviews published on short message service (SMS) interventions in a variety of health settings and issues, none are related to sexual health. We plan to conduct a systematic review to examine the impact text messaging might have on interventions for the prevention and care of patients with STIs. Methods/Design Eligible studies will include both quantitative and qualitative studies published after 1995 that discuss the efficacy and effectiveness of SMS interventions for STI prevention and management using text messaging. Data will be abstracted independently by two reviewers using a standardized pre-tested data abstraction form. Inter-rater reliability scores will be obtained to ensure consistency in the inclusion and data extraction of studies. Heterogeneity will be assessed using the I2 test and subgroup analyses. A nonhypothesis driven inductive reasoning approach as well as a coding framework will be applied to analyze qualitative studies. A meta-analysis may be conducted if sufficient quantitative studies are found using similar outcomes. Discussion For this protocol, we identified ten related systematic reviews. The reviews were limited to a particular disease or setting, were not exclusive to SMS interventions, or were out of date. This systematic review will be the first comprehensive examination of studies that discuss the effectiveness of SMS on multiple outcomes that relate to STI prevention and management, covering diverse settings and populations. Findings of the systematic review and any additional meta-analyses will be published and presented to our key knowledge users. This information will provide the evidence that is required to appropriately adopt text messaging into standard practice in STI care. PMID:24433348

2014-01-01

405

Primary care management for optimized antithrombotic treatment [PICANT]: study protocol for a cluster-randomized controlled trial  

PubMed Central

Background Antithrombotic treatment is a continuous therapy that is often performed in general practice and requires careful safety management. The aim of this study is to investigate whether a best-practice model that applies major elements of case management and patient education, can improve antithrombotic management in primary healthcare in terms of reducing major thromboembolic and bleeding events. Methods This 24-month cluster-randomized trial will be performed with 690 adult patients from 46 practices. The trial intervention will be a complex intervention involving general practitioners, healthcare assistants, and patients with an indication for oral anticoagulation. To assess adherence to medication and symptoms in patients, as well as to detect complications early, healthcare assistants will be trained in case management and will use the Coagulation-Monitoring List (Co-MoL) to regularly monitor patients. Patients will receive information (leaflets and a video), treatment monitoring via the Co-MoL and be motivated to perform self-management. Patients in the control group will continue to receive treatment as usual from their general practitioners. The primary endpoint is the combined endpoint of all thromboembolic events requiring hospitalization and all major bleeding complications. Secondary endpoints are mortality, hospitalization, strokes, major bleeding and thromboembolic complications, severe treatment interactions, the number of adverse events, quality of anticoagulation, health-related quality of life, and costs. Further secondary objectives will be investigated to explain the mechanism by which the intervention is effective: patients’ assessment of chronic illness care, self-reported adherence to medication, general practitioners’ and healthcare assistants’ knowledge, and patients’ knowledge and satisfaction with shared decision making. Practice recruitment is expected to take place between July and December 2012. Recruitment of eligible patients will start in July 2012. Assessment will occur at three time points: baseline and follow-up after 12 months and after 24 months. Discussion The efficacy and effectiveness of individual elements of the intervention, such as antithrombotic interventions, self-management concepts in orally anticoagulated patients, and the methodological tool of case management, have already been extensively demonstrated. This project foresees the combination of several proven instruments, as a result of which we expect to profit from a reduction in the major complications associated with antithrombotic treatment. Trial registration Current Controlled Trials ISRCTN41847489 PMID:22929015

2012-01-01

406

Behavioral conceptualization, assessment, and treatment of pediatric feeding disorders.  

PubMed

Families of children with feeding disorders frequently present to primary care settings. Although providers are often knowledgeable about medical and developmental etiologies, behavioral etiologies may go unidentified and untreated. In this article, the authors review a biobehavioral approach for the assessment and treatment of feeding disorders. First, factors that affect the development of feeding behaviors are described including sensitive developmental periods for acquiring feeding skills and the effects of interpersonal relationships on feeding. Second, behavioral assessment and conceptualization strategies are discussed including the use of feeding questionnaires, caregiver interviews, and the use of feeding observations. Third, behavioral treatment strategies are described including the uses of feeding structure, manipulation of hunger, contingency management, shaping, and parent training. Finally, consideration of various behavioral treatment options are considered including the integration of psychology as part of an interdisciplinary team and the use of intensive behavioral treatment protocols that include inpatient behavioral programs. PMID:17647134

Fischer, Elizabeth; Silverman, Alan

2007-08-01

407

Can eating disorders become 'contagious' in group therapy and specialized inpatient care?  

PubMed

Eating disorders belong to the broad category of self-harming behaviours which may be acquired in a social learning process of imitation, identification and competition. Hence, we should question the possible dangers or unwanted side-effects in treating patients together within a common therapeutic setting. But little is known about the frequency and extent of possibly negative influences of treatment in a group format, the so-called risk of 'peer contagion' in group therapy and/or inpatient treatment. We review in this paper the rather scarce literature on this subject in order to stimulate more critical thinking and systematic research. PMID:21394837

Vandereycken, Walter

2011-01-01

408

Treatment of the humeral shaft fractures - minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace: study protocol for a randomised controlled trial  

PubMed Central

Background Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Non-operative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Surgical treatment is reserved for specific conditions. Modern concepts of internal fixation of long bone shaft fractures advocate relative stabilisation techniques with no harm to fracture zone. Recently described, minimally invasive bridge plate osteosynthesis has been shown to be a secure technique with good results for treating humeral shaft fractures. There is no good quality evidence advocating which method is more effective. This randomised controlled trial will be performed to investigate the effectiveness of surgical treatment of humeral shaft fractures with bridge plating in comparison with conservative treatment with functional brace. Methods/Design This randomised clinical trial aims to include 110 patients with humeral shaft fractures who will be allocated after randomisation to one of the two groups: bridge plate or functional brace. Surgical treatment will be performed according to technique described by Livani and Belangero using a narrow DCP plate. Non-operative management will consist of a functional brace for 6 weeks or until fracture consolidation. All patients will be included in the same rehabilitation program and will be followed up for 1 year after intervention. The primary outcome will be the DASH score after 6 months of intervention. As secondary outcomes, we will assess SF-36 questionnaire, treatment complications, Constant score, pain (Visual Analogue Scale) and radiographs. Discussion According to current evidence shown in a recent systematic review, this study is one of the first randomised controlled trials designed to compare two methods to treat humeral shaft fractures (functional brace and bridge plate surgery). Trial registration Current Controlled Trials: ISRCTN24835397 PMID:23924198

2013-01-01

409

Efficacy, quality of life, and acceptability outcomes of atypical antipsychotic augmentation treatment for treatment-resistant depression: protocol for a systematic review and network meta-analysis  

PubMed Central

Background Major depressive disorder (MDD) is a debilitating and costly mental disorder. Although commercially available antidepressants have proliferated over the last 20 years, a substantial number of patients either do not respond adequately to these drugs or are unable to tolerate their adverse effects. One common approach has been to augment conventional antidepressants with an adjunctive agent, but the optimal selection of atypical antipsychotic agents for adjunctive treatment of treatment-resistant depression (TRD) remains controversial. Methods/Design An electronic literature search of PubMed, the Cochrane Library, Embase, Web of Science, LiLACS, CINAHL, and PsycINFO for studies will be conducted with no restrictions on language, publication year, or publication type. Several clinical trial registry agencies, pharmaceutical company websites, and FDA reports will also be reviewed. Randomized clinical trials (RCTs) with atypical antipsychotic augmentation treatment for treatment-resistant depression will be considered. Data will be independently extracted by two reviewers. Traditional pairwise meta-analyses will be performed for RCTs that directly compare different treatment arms. Then, Bayesian network meta-analyses will be performed to compare the relative efficacy and acceptability of different atypical antipsychotic agents (and doses). A sensitivity analysis will be performed by excluding studies classified as a small sample size, having a high placebo effect. Discussion This systematic review and network meta-analysis will comparatively analyze the efficacy, quality of life, and acceptability profiles of atypical antipsychotic medications used for the adjunctive treatment of TRD. The findings should provide clinically relevant implications for comprehensively understanding the risk–benefit profiles of these adjunctive treatments. Systematic review registration PROSPERO CRD 42014009666. PMID:25373601

2014-01-01

410

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