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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

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

3

Inpatient Treatment of Children and Adolescents  

E-print Network

hospitalizations provide little added benefit over shorter inpatient programs. Follow-up with community mental health is highly correlated with successful outcomes and is an integral part of maintaining goals. The therapeutic alliance is positively correlated...

Barfield, Sharon T.; Petr, Chris

2001-10-01

4

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

Code of Federal Regulations, 2011 CFR

... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL...Under the Prospective Payment System for Inpatient Operating...treatment: Inpatient hospital payment adjustment for low-volume... (d) Eligibility of new hospitals for the...

2011-10-01

5

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

Code of Federal Regulations, 2013 CFR

... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL...Under the Prospective Payment System for Inpatient Operating...treatment: Inpatient hospital payment adjustment for low-volume... (d) Eligibility of new hospitals for the...

2013-10-01

6

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

Code of Federal Regulations, 2012 CFR

... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL...Under the Prospective Payment System for Inpatient Operating...treatment: Inpatient hospital payment adjustment for low-volume... (d) Eligibility of new hospitals for the...

2012-10-01

7

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

... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL...Under the Prospective Payment System for Inpatient Operating...treatment: Inpatient hospital payment adjustment for low-volume... (d) Eligibility of new hospitals for the...

2014-10-01

8

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

Code of Federal Regulations, 2010 CFR

... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL...Under the Prospective Payment System for Inpatient Operating...treatment: Inpatient hospital payment adjustment for low-volume... (d) Eligibility of new hospitals for the...

2010-10-01

9

Utilization of outpatient mental health services after inpatient alcoholism treatment  

Microsoft Academic Search

It is generally agreed that use of aftercare services following discharge from alcoholism treatment is optimum for patients\\u000a to achieve long-term recovery. However, the quantity and duration of utilization of such services in non-experimental settings\\u000a are generally unknown. Using secondary data sources, we studied 5,635 alcoholics completing formal extended inpatient treatment\\u000a and 1,860 alcoholics discharged from brief inpatient hospitalizations in

Brenda M. Booth; Cynthia A. Loveland Cook; Frederic C. Blow; Janice Y. Bunn

1992-01-01

10

The Impact of Evidence on Physicians' Inpatient Treatment Decisions  

PubMed Central

OBJECTIVE Previous studies have shown that most medical inpatients receive treatment supported by strong evidence (evidence-based treatment), but they have not assessed whether and how physicians actually use evidence when making their treatment decisions. We investigated whether physicians would change inpatient treatment if presented with the results of a literature search. DESIGN Before-after study. SETTING Large public teaching hospital. PARTICIPANTS Random sample of 146 inpatients cared for by 33 internal medicine attending physicians. INTERVENTIONS After physicians committed to a specific diagnosis and treatment plan, investigators performed standardized literature searches and provided the search results to the attending physicians. MEASUREMENTS AND MAIN RESULTS The primary study outcome was the number of patients whose attending physicians would change treatment due to the literature searches. These changes were evaluated by blinded peer review. A secondary outcome was the proportion of patients who received evidence-based treatment before and after the literature searches. Attending physicians changed treatment for 23 (18%) of 130 eligible patients (95% confidence interval, 12% to 24%) as a result of the literature searches. Overall, 86% of patients (112 of 130) received evidence-based treatments before the searches and 87% (113 of 130) after the searches. Changes were not related to whether patients were receiving evidence-based treatment before the search (P = .6). Panels of peer reviewers judged the quality of patient care as improved or maintained for 18 (78%) of the 23 patients with treatment changes. CONCLUSIONS Searching the literature could improve the treatment of many medical inpatients, including those already receiving evidence-based treatment. PMID:15109337

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

2004-01-01

11

Motivational predictors of alcoholics' responses to inpatient treatment.  

PubMed

Motivational patterns of 60 alcoholic inpatients were assessed by use of the Interview Questionnaire (IntQ) and were related to staff judgments regarding patients' success or failure in completing an inpatient treatment program. The IntQ was administered soon after intake, one month later, and at the end of treatment. It elicits patients' idiographic accounts of their current concerns and patients' nomothetic ratings of them on variables related to commitment, active participation in goal striving, and goal valence, value, expectancy, and imminence. Structural variables demonstrated significant stability over the first two IntQ administrations, whereas goal content and affect variables did not. Stepwise discriminant analysis of treatment outcome as well as correlational analyses indicated that successful outcomes were significantly related to smaller size of community, concerns appetitive to treatment, lack of concerns about avoiding alcohol, and expecting goal attainments to occur sooner. Goal orientations toward treatment and alcohol were related to other variables in ways consistent with the view that recovery from alcohol is associated with having emotionally positive alternative goals. PMID:3812126

Klinger, E; Cox, W M

1986-01-01

12

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

13

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

14

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

E-print Network

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

Smith, Vivien

2012-06-26

15

A controlled trial of cognitive behavioral treatment of panic in alcoholic inpatients with comorbid panic disorder  

Microsoft Academic Search

Patients entering a 4-week inpatient alcoholism treatment program were screened for anxiety symptoms. Those with panic disorder with or without agoraphobia were randomly assigned to two groups. The treatment group received 12 hours of cognitive-behavioral treatment (CBT) for panic disorder in addition to the regular alcoholism treatment program; the control group received the regular program. Dropouts from the treatment group

Rudradeo C Bowen; Carl D'Arcy; David Keegan; A Senthilselvan

2000-01-01

16

In-patient treatment for resistant obsessive-compulsive disorder.  

PubMed

Obsessive Compulsive Disorder is one of the increasing psychological disorders. If not detected early and treated properly, obsessive-compulsive disorder usually becomes an incapacitating illness adversely affecting almost all aspects of the patient's life. Outpatient behavioral and pharmacotherapies frequently fail. This is a report on a severe case of obsessive-compulsive disorder that was treated as an in-patient with both behavior and pharmacotherapies, she was then followed up for 5 years with no relapse. The case reflects the importance and the need for in-patient units for severe resistant obsessive compulsive cases especially in Saudi Arabia where we have an increasing number of such cases. PMID:11533781

Al-Sughayir, M A

2000-02-01

17

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

ERIC Educational Resources Information Center

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

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

2006-01-01

18

In-patient treatment for resistant obsessive-compulsive disorder.  

PubMed

Obsessive Compulsive Disorder is one of the increasing psychological disorders. If not detected early and treated properly, obsessive-compulsive disorder usually becomes an incapacitating illness adversely affecting almost all aspects of the patient`s life. Outpatient behavioral and pharmacotherapies frequently fail. This is a report on a severe case of obsessive-compulsive disorder that was treated as an in-patient with both behavior and pharmacotherapies, she was then followed up for 5 years with no relapse. The case reflects the importance and the need for in-patient units for severe resistant obsessive compulsive cases especially in Saudi Arabia where we have an increasing number of such cases. PMID:24276732

Al-Sughayir, M A

2000-04-01

19

Adverse impact of coercive treatments on psychiatric inpatients' satisfaction with care.  

PubMed

Consumers' satisfaction with inpatient mental health care is recognized as a key quality indicator that prospectively predicts functional and clinical outcomes. Coercive treatment experience is a frequently cited source of dissatisfaction with inpatient care, yet more research is needed to understand the factors that influence consumers' perceptions of coercion and its effects on satisfaction, including potential "downstream" effects of past coercive events on current treatment satisfaction. The current study examined associations between objective and subjective indices of coercive treatments and patients' satisfaction with care in a psychiatric inpatient sample (N = 240). Lower satisfaction ratings were independently associated with three coercive treatment variables: current involuntary admission, perceived coercion during current admission, and self-reported history of being refused a requested medication. Albeit preliminary, these results document associations between patients' satisfaction ratings and their subjective experiences of coercion during both current and prior hospitalizations. PMID:23054144

Strauss, Jennifer L; Zervakis, Jennifer B; Stechuchak, Karen M; Olsen, Maren K; Swanson, Jeffrey; Swartz, Marvin S; Weinberger, Morris; Marx, Christine E; Calhoun, Patrick S; Bradford, Daniel W; Butterfield, Marian I; Oddone, Eugene Z

2013-08-01

20

Changes in body image during inpatient treatment for eating disorders predict outcome.  

PubMed

This study investigated changes and predictors during inpatient treatment of 55 adult in a transdiagnostic sample of patients with eating disorders. Patients were assessed at admission and discharge with the Body Attitude Test (BAT), Symptom Check List 90 Revised, Circumplex of Interpersonal Problems, Body Mass Index (BMI) and Eating Disorder Inventory 2 (EDI-2). Significant changes were found in all measures. Regression analyses showed that BAT changes during treatment were the strongest predictor of EDI-2 changes. No predictors of changes in BMI were found. Improvement of body image is important for the efficacy of inpatient treatment. PMID:22703568

Danielsen, Marit; Rø, Øyvind

2012-01-01

21

Cost Savings from Assertive Community Treatment Services in an Era of Declining Psychiatric Inpatient Use  

PubMed Central

Objective To assess, during a period of decreasing psychiatric inpatient utilization, cost savings from Assertive Community Treatment (ACT) programs for individuals with severe mental illnesses. Data Source U.S. Department of Veterans Affairs' (VA) national administrative data for entrants into ACT programs. Study Design An observational study of the effects of ACT enrollment on mental health inpatient utilization and costs in the first 12 months following enrollment. ACT enrollees (N = 2010) were propensity score matched to ACT-eligible non-enrollees (N = 4020). An instrumental variables generalized linear regression approach was used to estimate enrollment effects. Results Instrumental variables estimates indicate that between FY2001 and FY2004, entry into ACT resulted in a net increase of $4529 in VA costs. Trends in inpatient use among ACT program entrants suggest this effect remained stable after FY2004. However, eligibility for ACT declined 37 percent, because fewer patients met an eligibility standard based on high prior psychiatric inpatient use. Conclusions Savings from ACT programs depend on new enrollees' intensity of psychiatric inpatient utilization prior to entering the ACT program. Although a program eligibility standard based on prior psychiatric inpatient use helped to sustain the savings from VA ACT programs, over time, it also resulted in an unintended narrowing of program eligibility. PMID:22594523

Slade, Eric P; McCarthy, John F; Valenstein, Marcia; Visnic, Stephanie; Dixon, Lisa B

2013-01-01

22

Influence of gender and menopausal status on antidepressant treatment response in depressed inpatients  

Microsoft Academic Search

The present study investigated the influence of gender and menopausal status on treatment response in depressed inpatients, treated with either imipramine or fluvoxamine. The patients were divided into three groups: men, premenopausal women and postmenopausal women. A multivariate analysis was performed using the difference in Hamilton score (pretreatment — post-treatment) for imipramine and fluvoxamine as dependent variable. The following independent

M. Vermeiden; WW van den Broek; Pgh Mulder; TK Birkenhäger

2010-01-01

23

Inpatient treatment for war-related Post-Traumatic Stress Disorder: Initial findings on a longer-term outcome study  

Microsoft Academic Search

Symptom checklists and a follow-up questionnaire were mailed to the first 180 graduates of an inpatient Post Traumatic Stress Treatment program. Eighty-six of the 180 responded to the survey. Their responses were compared to measures obtained on them while they were inpatients at the treatment program. Significant differences were found on one symptom checklist, while positive trends toward symptom reduction

Raymond M. Scurfield; Shawn K. Kenderdine; Richard J. Pollard

1990-01-01

24

Developing psychodynamic group treatment methods for aggressive male inpatients.  

PubMed

Group psychotherapy is one intervention that can be used for aggressive male inpatients. This paper reports relevant literature and clinical applications for conducting a psychodynamic psychotherapy group designed to help patients (a) identify, understand, and deal with underlying problems resulting in aggressive behavior; (b) improve interpersonal relationships; and (c) find more appropriate ways of expressing feelings, particularly those associated with aggressive behavior. The review of literature focuses on therapeutic approaches for dealing with aggressive feelings in group therapy; men's issues in group psychotherapy, including stages of group development for men and the expression of aggression; and the outcome of aggressive behavior in response to group therapy. Clinical applications discussed are preparation for the group; the group contract, including the "group as a whole" approach; patient selection; modeling authority; and countertransference and projective identification. PMID:8920340

Lanza, M L; Satz, H; Stone, J; Kayne, H L

1996-01-01

25

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

ERIC Educational Resources Information Center

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

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

2007-01-01

26

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

27

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

28

Prediction of community outcome in schizophrenia 1 year after discharge from inpatient treatment  

Microsoft Academic Search

This longitudinal study aimed at identifying predictors of community outcome from a broad range of neuropsychological, clinical\\u000a psychopathologic, sociodemographic, and treatment related factors. N = 96 schizophrenia patients were assessed both at baseline during inpatient treatment and 1 year after discharge from hospital\\u000a (follow-up). At follow-up functional outcome was measured by the Global Assessment of Functioning Scale (GAF) and the Social\\u000a Adjustment Scale

Andreas Wittorf; Georg Wiedemann; Gerhard Buchkremer; Stefan Klingberg

2007-01-01

29

Pediatric Feeding Disorders: Effectiveness of Multidisciplinary Inpatient Treatment of Gastrostomy-Tube Dependent Children  

Microsoft Academic Search

Effectiveness of multidisciplinary inpatient treatment of feeding-disordered children was sought through retrospective chart review of 40 gastrostomy-tube (i.e., G-tube) dependent children, ages 22 months to 7 years, with co-occurring medical conditions. Treatment effect analyzed from pre- and posttreatment measures of oral and G-tube caloric intakes resulted in a significant difference from admission to discharge for both oral intake, t(39) =

Sonya L. Cornwell; Kimberly Kelly; Laura Austin

2010-01-01

30

[Treatment motivation and results of inpatient psychotherapy for women with depressive disorders: a prospective study].  

PubMed

Whether the treatment results in inpatient psychotherapy are significantly influenced by the patient's motivation is a subject of discussion. The goal of this study was to assess whether the primary motivation for therapy in depressive women influences the results of psychotherapeutic treatment. In a prospective study, the monitored results from 64 female inpatients (32 who were highly motivated to enter therapy, and 32 who were minimally motivated) were compared to each other. The period of observation was six weeks. As instruments of assessment, the Fragebogen zur Therapiemotivation (FMP) (Questonnaire on Motivation for Entering Therapy) and the Beck Depression Inventory (BDI) were aministered upon admission; after the fourth and sixth weeks of therapy, the Veränderungsfragebogen des Erlebens und Verhaltens (VEV) (Questionnaire of Changes in Experience and Behavior) was administered as well. All patients who had applied for a pension were found in the group of less motivated patients and consolidated into a subgroup. The analysis was carried out according to the intent-to-treat principle. The variance analysis for the repeat measurements showed significant differences on all the FMP scales and on the BDI (all P< 0.001). The measurements with VEV likewise resulted in a significant difference (P< 0.01). The subgroup of "pension patients" showed significantly less change in all three of the above measurements. Patients with depressive symptomology who essentially are relatively highly motivated for therapy could profit significantly more from inpatient psychosomatic treatment than those who are less motivated. Establishing and developing motivation prior to inpatient hospitalization could possibly contribute to more efficient and cost-effective clinical treatment. Where legal proceedings pertaining to a pension are pending, relatively less motivated patients fare significantly worse not only in their motivational development for therapy, but also in their final treatment results. It should be noted, however, that the relatively small random sample, the restricted blinding, which was only partially possible, could have led to possible distortions. PMID:16463240

Nickel, C; Muehlbacher, M; Kettler, C; Tritt, K; Egger, C; Lahmann, C; Pedrosa Gil, F; Leiberich, P; Bachler, E; Buschmann, W; Forthuber, P; Fartacek, R; Mitterlehner, F; Rother, W; Loew, T; Nickel, M

2006-01-01

31

A multivariate process model of adolescent 12-step attendance and substance use outcome following inpatient treatment.  

PubMed

A common recommendation for youth treated for substance abuse is to attend 12-step groups. However, little is known regarding the effects of this adult-derived prescription on substance use outcomes for teens. This study examined (a) the relation between 12-step attendance and substance use outcome in the 6 months postdischarge from inpatient care and (b) a process model of how 12-step attendance during the first 3 months postdischarge affects proximal outcomes of motivation, coping, and self-efficacy, measured at 3 months, and how these, in turn, affect ultimate substance use outcome in the following 3 months. Adolescent inpatients (N = 99) were assessed during treatment and 3 and 6 months postdischarge. Results revealed modest beneficial effects of 12-step attendance, which were mediated by motivation but not by coping or self-efficacy. Findings suggest that closer attention be paid to motivational factors in the treatment of adolescent substance abuse. PMID:11130156

Kelly, J F; Myers, M G; Brown, S A

2000-12-01

32

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

33

Relating Callous-Unemotional Traits to Physically Restrictive Treatment Measures Among Child Psychiatric Inpatients  

Microsoft Academic Search

We examined the association of callous-unemotional (C\\/U) traits with the rates of seclusion and restraint among a sample of\\u000a child psychiatric inpatients (N = 101). Analyses focused on the incremental value of C\\/U traits as a predictor over and above the influence of other risk\\u000a factors for physically restrictive treatment measures found in previous research, including gender, age, verbal intelligence,\\u000a ethnicity, the

Kurt K. StellwagenPatricia; Patricia K. Kerig

2010-01-01

34

Trends for inpatient treatment of tubal pregnancy in Maryland  

Microsoft Academic Search

OBJECTIVE: The purpose of this study was to determine the burden of tubal pregnancy in Maryland in hospitalized patients and to elicit treatment trends. STUDY DESIGN: Patients who were admitted with tubal pregnancy from January 1, 1994, through March 31, 1999, were identified with the use of the Maryland Health Service Cost Review Commission discharge database. Combining this with census

Catherine A. Sewell; Geoffrey W. Cundiff

2002-01-01

35

Inpatient treatment of functional motor symptoms: a long-term follow-up study.  

PubMed

Functional neurological disorders are common, disabling and often difficult to treat. There is little consensus on the best approach to management. Multidisciplinary inpatient approaches are employed in some centres for patients with severe refractory symptoms, but their efficacy and, in particular, long-term outcomes are uncertain. We conducted a study using questionnaires completed retrospectively by patients treated at a specialised multidisciplinary inpatient programme at the National Hospital for Neurology and Neurosurgery. Consecutive patients with functional motor symptoms admitted to this centre between 2006 and 2008 were invited to participate. Questionnaires were sent at least 2 years after discharge. We contacted 32 patients, and 26 responded. The majority had symptoms for at least 3 years prior to admission; 58 % of patients reported benefit from the programme on discharge. This self-reported benefit to symptoms and function was after a 2-year follow-up period in the majority of patients, but return to work or cessation of health-related financial benefits was uncommon even in those who improved. Seventy-four percent of those questioned stated they would recommend the programme to others with similar symptoms. Attribution of symptoms to stress or emotional state was correlated with favourable outcome. Our data suggest that multidisciplinary inpatient treatment for patients with refractory functional motor symptoms provides self-reported benefit in the long-term. Prospective analysis of such interventions and the determinants of benefit need assessment in order to improve the service and target treatment to patients most likely to benefit. PMID:22584953

Saifee, T A; Kassavetis, P; Pareés, I; Kojovic, M; Fisher, L; Morton, L; Foong, J; Price, G; Joyce, E M; Edwards, M J

2012-09-01

36

Treatment of avoidant personality traits in a German armed forces inpatient psychiatric setting.  

PubMed

Military duty places high demands on the soldiers' social adaptability and competences. Avoidant personality traits can lead to interpersonal conflicts and at least to mental disorders. 192 German Armed Forces soldiers were treated in a multimodal inpatient psychiatric treatment setting at a Bundeswehr hospital between 2007 and 2010. 129 of these patients received a social skills group training (group training of social competence [GSC]) as part of this setting. A comparison group (n=63) did not participate but got unspecific treatment elements instead. The Symptom Checklist 90-Revised (SCL-90-R) and the Inventory on Competence and Control Beliefs (Fragebogen zu Kompetenz- und Kontrollüberzeugungen [FKK]) were applied. Symptom severity in the SCL-Global Severity Index, sum scale of the SCL-90-R and the four primary scales of the FKK showed significant improvements both immediately after treatment and at follow-up. No significant influence of the form of treatment (with/without GSC), age, gender, diagnosis, and deployments on the treatment result was established in the analysis of covariance. The data suggest that an inpatient psychiatric treatment setting focused on avoidant personality traits has a favorable effect on psychiatric symptom severity in military personnel. Social skills group training as a treatment component does not seem to be significantly superior to the standard setting. PMID:23495468

Zimmermann, Peter; Alliger-Horn, Christina; Kowalski, Jens T; Plate, Stefan; Wallner, Franziska; Wolff, Elisabeth; Ströhle, Andreas

2013-02-01

37

42 CFR 424.14 - Requirements for inpatient services of inpatient psychiatric facilities.  

Code of Federal Regulations, 2010 CFR

... (1) For treatment that could reasonably...recertification. (1) Inpatient services furnished... (i) For treatment that could reasonably...were— (i) Intensive treatment services; ...supervision of inpatient psychiatric...

2010-10-01

38

Postdischarge Impact of C-L Psychiatry Treatment in Obstetrical Inpatients  

PubMed Central

Purpose. Twenty-eight women, referred to C-L Psychiatry during their obstetrical inpatient stay were interviewed six months post-discharge to determine how they experienced the consultation process, whether they recollected and adhered to treatment recommendations, and whether they developed or had a recurrence of mental health problems post-discharge. Method. Semi-structured telephone interviews were conducted by a psychologist who had not been involved with patient care. Results. There was strong congruence between reason for referral as stated in psychiatric consult notes and participants' recollections and strong congruence and compliance regarding treatment recommendations. Sixty-four percent of women had concerns regarding mood post-discharge, of whom 66% sought professional help within six months. Participants' recommendations for improving the effectiveness of the C-L service to obstetrical inpatients pertained mainly to sensitivity to patients' feelings, consistency of message and personnel, and post-discharge follow-up. Conclusions. Obstetrical patients had good recollection of their experience of C-L psychiatry, and post-discharge compliance with treatment recommendations was high. A post-discharge telephone call might further enhance treatment compliance and encourage women who are struggling with mood difficulties to seek help. Contact between C-L psychiatry and patients' primary care physician may also enhance care post-discharge. PMID:21808741

Sloan, Eileen Patricia; Kirsh, Sharon

2011-01-01

39

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

PubMed Central

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

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

2013-01-01

40

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

ERIC Educational Resources Information Center

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

Jackson, Afton; Shannon, Lisa

2013-01-01

41

Turning the tables: inpatients as decision makers in the treatment mall program at a state hospital.  

PubMed

Professionals have traditionally accomplished rehabilitative program development at public inpatient psychiatric facilities with limited input from program users. This report describes initial results and observations associated with the introduction of a user-controlled decision-making council built into the program development design of an evolving treatment mall at a state facility. Participant productivity and the satisfaction expressed by participants with regards to this approach captured the attention of staff facilitators and clinical managers, providing a sound basis for future impact studies. PMID:16450935

Webster, Steven L; Harmon, Susan H

2006-01-01

42

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

43

Development and implementation of a pharmacist-managed inpatient warfarin protocol  

PubMed Central

Because of the complexities of warfarin administration and its bleeding complications, a pharmacist-managed protocol for warfarin administration was developed at Baylor University Medical Center. The protocol incorporated current clinical guidelines and evidence-based medicine. Clinical outcomes under the protocol were compared with those of usual care, physician management, in a pilot study. Twenty-nine patients were enrolled in the protocol group and 22 in the control group between August 2004 and November 2004. Results showed that patients in both groups achieved therapeutic ranges of warfarin within 6 days. However, the pharmacist-managed patients exhibited a trend toward fewer adverse drug reactions (7% vs 14%) and fewer supratherapeutic international normalized ratios (17% vs 27%) than the control group, although the difference was not statistically significant. Based on these results and the results of similar larger studies showing the effectiveness of pharmacist-managed warfarin administration, Baylor University Medical Center made the protocol available for use in the hospital in May 2005. PMID:16252031

2005-01-01

44

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

45

Implementation of a Symptom-Triggered Benzodiazepine Protocol for Alcohol Withdrawal in Family Medicine Inpatients  

Microsoft Academic Search

Purpose: The purpose of this pilot study was to review the implementation of symptom-triggered benzodiazepine therapy and evaluate the feasibility and outcomes as compared with a previous hospital standard of fixed-dose phe- nobarbital protocol for alcohol withdrawal on a family medicine service. Methods: This retrospective chart review of 46 patients' medical records was performed on admissions to the fam- ily

Sharon See; Sarah Nosal; Wendy Brooks Barr; Robert Schiller

2009-01-01

46

The Alcohol Treatment Unit Computerized Medical Record (ATU CMR): A Clinician-Entered Inpatient Record  

PubMed Central

Described is an Alcohol Treatment Unit Computerized Medical Record (ATU CMR) system developed at the Jerry L. Pettis Memorial Veterans' Hospital in Loma Linda, CA. The system is used by multiple providers for the administrative and clinical management of patients admitted to an inpatient Alcohol Treatment Unit. This clinician-entered computer-generated medical record system replaces the handwritten record, from patient intake to discharge. Multiple choice options allow for the standardization of language while free text capabilities provide expression of more detailed patient information; data output is formatted into natural English sentences. Savings of costly personnel time, increased communication between multiple care providers, improved patient care, and creation of a research database in ASCII format are among the benefits experienced by using this system. The ATU CMR is now an indispensable part of the Alcohol Treatment Unit.

Chang, M.M.; Gino, A.; Yahiku, P.Y.; King, C.A.; MacMurray, J.P.; Ferry, L.H.; Smith, L.; Young, R.; Bozzetti, L.

1988-01-01

47

Needs of persons with serious mental illness following discharge from inpatient treatment: patient and family views.  

PubMed

Patients with serious mental illnesses often struggle with persistent symptoms that interfere with daily functioning in the community. The first days and weeks following inpatient treatment for an acute episode may be a critical time for patients to connect with the recommended community follow-up. Residual symptoms may interfere with their ability to access and benefit from these services to meet their needs. A descriptive study was conducted to explore perceptions of patients and families of patients' needs, functioning, coping and social support in the first 4 weeks after inpatient treatment. Results suggested that these patients had residual symptoms after discharge that interfered with functioning despite the availability of follow-up services. Patients identified unmet needs related to their illness. Family members identified concerns related to the lack of improvement in their ill relatives over time. Patients expressed satisfaction with care and felt supported by their families. Both patients and families seemed to lack a thorough understanding of goals for follow-up care. PMID:22835746

Gerson, Linda D; Rose, Linda E

2012-08-01

48

[Regression in inpatient-analytic psychotherapy. Reflections on indications and treatment strategy from the viewpoint of applied ego psychology].  

PubMed

This paper points out the differences in the dynamic processes of the regression between patients with neurotic ego-structures and those with disturbances of the ego-development during the psychoanalytic inpatient therapy. The main consequence is, that the indication for inpatient therapy is depending on the sufficient ego-strength, but not on the stage of the ego-development, and that the tactic of the treatment, its clinical organization and the structure of communication in the hospital should be adapted to the ego-structure. General criteria are that the inpatient treatment of neurotic patients should be limited to three of four months at most to avoid artificial splitting mechanisms, and that the treatment of ego-disturbed patients should be organized as an integrative one and managed by a special kind of team-cooperation in order to further the integrating and differenciating ego functions. PMID:7080697

Ermann, M

1982-01-01

49

Predictors of treatment outcome of Inpatient Psychotherapy for Adolescents with personality pathology.  

PubMed

Little is known about the effectiveness of treatment programmes for personality disordered adolescents. This study investigates the treatment outcome of Inpatient Psychotherapy for Adolescents (IPA), i.e. an intensive programme for treatment refractory adolescents with personality pathology. In addition, this study examines predictors of treatment outcome. One hundred and nine adolescents admitted for treatment of their personality problems were followed up during their stay in IPA. Axis I and Axis II disorders were measured using semi-structured interviews, and the adolescents completed several questionnaires to measure symptom severity (global indices of distress), personality styles and functioning, and quality of life at both start and 12 months after start of treatment. Patients showed improvement in level of symptom severity, personality functioning and quality of life (d ranging from 0.49 to 0.97). As for level of symptom severity, 29% of the adolescents moved into a normative range of symptom severity. Higher levels of self-criticism significantly predicted poorer outcome in terms of symptom severity. Type of personality disorder did not predict treatment outcome. IPA is a potentially effective treatment programme for (a subgroup of) treatment refractory adolescents with personality pathology. PMID:24700734

Feenstra, Dine J; Laurenssen, Elisabeth M P; Hutsebaut, Joost; Verheul, Roel; Busschbach, Jan J V

2014-05-01

50

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

ERIC Educational Resources Information Center

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

Park, Jung Min; Ryan, Joseph P.

2009-01-01

51

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

PubMed Central

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

2013-01-01

52

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

PubMed

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

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

2014-12-01

53

Changes in Conflict, Symptoms, and Well-Being during Psychodynamic and Cognitive-Behavioral Alcohol Inpatient Treatment  

Microsoft Academic Search

Background: According to Grawe’s psychological therapy approach, conflict reduction can be expected not only in psychodynamic, but also in cognitive-behavioral therapy (CBT). This was tested in an effectiveness study. Changes in cognitive conflicts, along with those of symptom severity and well-being were analyzed during alcohol inpatient treatment. Methods: Four times during treatment, groups of patients receiving psychodynamic therapy (n =

Jürgen Hoyer; Jens Fecht; Wolf Lauterbach; Ralf Schneider

2001-01-01

54

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

55

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

Microsoft Academic Search

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

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

2010-01-01

56

COMPUTER SUPPORT FOR PROTOCOL-BASED TREATMENT OF CANCER1  

E-print Network

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

Sergot, Marek

57

The application of dialectical behavior therapy for patients with borderline personality disorder on inpatient units.  

PubMed

Inpatient treatment of individuals with borderline personality disorder (BPD) is typically fraught with difficulty and failure. Patients and staff often become entangled in intense negative therapeutic spirals that obliterate the potential for focused, realistic, and effective treatment interventions. We describe an inpatient treatment approach to BPD patients which is an application of Dialectical Behavior Therapy (DBT), a cognitive-behavioral therapy for patients with BPD which has been shown to be effective in reducing suicidal behavior, hospitalization, and treatment dropout and improving interpersonal functioning and anger management. The inpatient DBT staff creates a validating treatment milieu and focuses on orienting and educating new patients and identifying and prioritizing their treatment targets. Inpatient DBT treatment techniques include contingency management procedures, skills training and coaching, behavioral analysis, structured response protocols to suicidal and egregious behaviors on the unit, and consultation team meetings for DBT staff. PMID:11525079

Swenson, C R; Sanderson, C; Dulit, R A; Linehan, M M

2001-01-01

58

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

59

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

PubMed Central

Background Chronic heart failure requires a complex treatment regimen on a life-long basis. Therefore, self-care/self-management is an essential part of successful treatment and comprehensive patient education is warranted. However, specific information on program features and educational strategies enhancing treatment success is lacking. This trial aims to evaluate a patient-oriented and theory-based self-management educational group program as compared to usual care education during inpatient cardiac rehabilitation in Germany. Methods/Design The study is a multicenter cluster randomized controlled trial in four cardiac rehabilitation clinics. Clusters are patient education groups that comprise HF patients recruited within 2 weeks after commencement of inpatient cardiac rehabilitation. Cluster randomization was chosen for pragmatic reasons, i.e. to ensure a sufficient number of eligible patients to build large-enough educational groups and to prevent contamination by interaction of patients from different treatment allocations during rehabilitation. Rehabilitants with chronic systolic heart failure (n?=?540) will be consecutively recruited for the study at the beginning of inpatient rehabilitation. Data will be assessed at admission, at discharge and after 6 and 12 months using patient questionnaires. In the intervention condition, patients receive the new patient-oriented self-management educational program, whereas in the control condition, patients receive a short lecture-based educational program (usual care). The primary outcome is patients’ self-reported self-management competence. Secondary outcomes include behavioral determinants and self-management health behavior (symptom monitoring, physical activity, medication adherence), health-related quality of life, and treatment satisfaction. Treatment effects will be evaluated separately for each follow-up time point using multilevel regression analysis, and adjusting for baseline values. Discussion This study evaluates the effectiveness of a comprehensive self-management educational program by a cluster randomized trial within inpatient cardiac rehabilitation in Germany. Furthermore, subgroup-related treatment effects will be explored. Study results will contribute to a better understanding of both the effectiveness and mechanisms of a self-management group program as part of cardiac rehabilitation. Trial registration German Clinical Trials Register: DRKS00004841; WHO International Clinical Trials: = DRKS00004841 PMID:23968340

2013-01-01

60

Screening for Trauma-Related Sleep Disturbance in Women Admitted for Specialized Inpatient Treatment  

Microsoft Academic Search

The authors designed a Sleep Disturbance Screening questionnaire to assist clinicians in disentangling trauma-related factors that contribute to sleep disturbance from other common factors, such as depression. They administered the questionnaire to 129 female psychiatric inpatients, most of whom were treated in a specialty program for trauma-related disorders. Confirmatory and exploratory factor analyses distinguished four sleep disturbance scales, two pertaining

Jon G. Allen; David A. Console; John R. Brethour Jr; Janis Huntoon; Jim Fultz; April B. Stein

2000-01-01

61

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

ERIC Educational Resources Information Center

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

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

2011-01-01

62

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

63

Underdiagnosis of alcohol dependence in psychiatric inpatients.  

PubMed

Alcoholism is prevalent among psychiatric inpatients, and accurately diagnosing alcohol problems is a critical step in treatment planning. The authors diagnosed alcohol dependence in 35 psychiatric inpatients by blind review of interview protocols and hospital records. They then examined the frequency with which admitting and attending clinicians diagnosed alcohol abuse and dependence in these patients. Alcoholism was underdiagnosed; 24% of the clinicians' diagnoses included no alcoholism diagnosis, 39% were alcohol abuse, and only 37% were alcohol dependence. Underdiagnosis was strongly associated with the presence of a comorbid psychosis, as well as with patients' denial of alcoholism and with less severe alcoholism. The authors discuss the patient and clinician variables which may contribute to underdiagnosing alcoholism and recommend educational and administrative measures to improve clinicians' diagnostic sensitivity. PMID:1746500

Woodward, B; Fortgang, J; Sullivan-Trainor, M; Stojanov, H; Mirin, S M

1991-01-01

64

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

65

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

PubMed

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

Casher, Michael Ira

2013-01-01

66

The effects of modafinil treatment on neuropsychological and attentional bias performance during 7-day inpatient withdrawal from methamphetamine dependence.  

PubMed

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. The first 20 participants recruited to the study were administered either 200 mg of modafinil (once daily) or placebo, and a neuropsychological test battery (including an MA version of the emotional Stroop task) at admission (n = 17) and discharge (n = 14). Follow-up interviews were conducted at 1-month postdischarge (n = 13). After participant withdrawals (3 in each group), treatment was associated with a significant improvement in immediate verbal memory recall and nonsignificant trend toward improvement on executive function and delayed memory tasks. No benefit was seen for measures of verbal learning, visual memory, processing speed, or verbal fluency. All participants showed a significant attentional bias for MA-related stimuli on the emotional Stroop task. The magnitude of bias predicted both retention in treatment and relapse potential at follow-up but was not significantly ameliorated by modafinil treatment. While nonsignificant, the effect sizes of modafinil-related improvements in executive function and memory were consistent with those found in more robustly powered studies of cognitive benefits in attention-deficit/hyperactivity disorder and schizophrenia, supporting the need for further research. PMID:21186923

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

2010-12-01

67

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

PubMed

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

Morgan, Vanessa

2014-03-01

68

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

69

[Vocational Inpatient and Post-treatment Proposals in Cardiac Rehabilitation Patients (BERUNA): Results of a Randomized Controlled Trial.  

PubMed

Background: The "Verband Deutscher Rentenversicherungsträger (VDR)" required the intense focus on vocational rehabilitation of medical problems since the early 1990s. By integrating elements of the working environment in the structures and processes of medical rehabilitation, vocational problems can be identified early in order to take appropriate countermeasures. Post-treatment proposals offer a way to provide a reliable long-term success. Objective: The intention of this study is the implementation and the investigation of effectiveness of an intensified vocational program that integrates besides the in-patient rehabilitation post-treatment proposals as well. Methods: Cardiac rehabilitation patient occurring special vocational problems participe. The recruited patients were randomized to either the vocational program or the common cardiac rehabilitation. Primary outcome was the vocational reintegration 12 months after the end of rehabilitation. The database was collected through a query of the pension insurance accounts and questionnaires. Results: 306 people were included to the study at the beginning of rehabilitation. Rates of response: 95% of the survey to the end of rehabilitation, 77% of the survey 6 months and 73% of the survey 12 months after the end of rehabilitation. The sample was characterized by great interferences of their professional involvement and a high demand for vocational treatments. At the beginning of the rehabilitation 50% of study participants intended to make an application for reduction-pension. Nevertheless, one year after the end of rehabilitation a surprisingly high rate of vocational reintegration by over 70% in both groups (IG: 72%, KG: 75%, p<0.929) was indicated. The majority of the unemployed patients at the beginning of rehabilitation remained in the unemployment (IG: 69%, KG: 65%, p<0.757). The participation rate at the post-treatment proposals was 42%. Conclusion: The results show that vocational programs in rehabilitation need to be revised, including with regard to the question, whether and in what way post-treatment proposals must be changed. PMID:25494343

Huber, D; Hoerschelmann, N; Hoberg, E; Karoff, J; Karoff, M; Kittel, J

2014-12-01

70

Cutaneous Ulcers: Treatment Protocols in the Home  

PubMed Central

When a systematic, coordinated treatment plan is used, many seemingly refractory ulcers can be treated in the home. Communication between the treatment team, which includes the patient, must be maintained. This article describes the various preventive measures, debriding, cleansing, granulating and epithelializing agents, their modes of action and their methods of application.

McNairn, Noreen

1979-01-01

71

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

72

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

73

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

PubMed Central

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

grosse Holtforth, Martin

2014-01-01

74

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

75

Fertility preservation with ovarian stimulation protocols prior to cancer treatment.  

PubMed

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

Kasum, Miro; Šimuni?, Velimir; Oreškovi?, Slavko; Beketi?-Oreškovi?, Lidija

2014-03-01

76

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

77

[Treatment in psychiatric day hospital in comparison with inpatient wards in different European health care systems--objectives of EDEN project].  

PubMed

The paper presents the objectives and design of an ongoing multicenter randomized, controlled trial EDEN (European Day Hospital EvaluatioN). The EDEN-study aims to evaluate the efficacy of acute psychiatric treatment in a day hospital setting in five European centres: Dresden, London, Michalovce, Prague and Wroclaw. The main hypothesis is that day hospital treatment for acute psychiatric patients is as effective as conventional inpatient hospital care. The objectives of the study are to evaluate the viability and effectiveness of day hospitals for acute psychiatric treatment, to identify subgroups of patients with a more or less favourable outcome so that the treatment setting might be specifically applied and to ascertain the cost-effectiveness of day hospital treatment compared to conventional inpatient treatment. The study utilises a Randomised Controlled Trial (RCT) design with repeated measures at a maximum of six time points: at admission (t1), one week after admission (t2), four weeks after admission (t3), discharge (t4), three months after discharge (t5), and 12 months after discharge (t6). A combination of well-established standardised assessment instruments and open questions is used in 6 time periods. If the findings accept the main hypothesis of the study, some practical consequences could be inevitable: at a mental health policy level, these results could lead to an increase in the capacity of day hospitals; at the clinical level clinicians could redefine their concepts of care to consider the day hospital as an alternative to conventional inpatient treatment; from economic point of view could lead to reduction of treatment costs. PMID:12647460

Kiejna, Andrzej; Kallert, Thomas W; Rymaszewska, Joanna

2002-01-01

78

Enkephalinase inhibition and precursor amino acid loading improves inpatient treatment of alcohol and polydrug abusers: double-blind placebo-controlled study of the nutritional adjunct SAAVE.  

PubMed

We investigated the effects of the amino acid and vitamin mixture SAAVE in inpatient, chemically-dependent subjects to evaluate the role of neurotransmitters in facilitating recovery and adjustment to a detoxified, sober state. SAAVE is formulated from amino acids that are precursors for neurotransmitters and neuromodulators thought to be involved in alcohol and drug seeking behavior. In a double-blind, placebo-controlled, randomized study of 62 alcoholics and polydrug abusers, SAAVE patients had a significantly reduced stress response as measured by the skin conductance level (SCL), and significantly improved Physical Scores and BESS Scores (behavioral, emotional, social and spiritual). After detoxification there was a six-fold decrease in AMA rates when comparing SAAVE vs. placebo groups. In this inpatient treatment experience SAAVE facilitated the rate of recovery and allowed patients to respond more fully and more quickly to the behavioral goals of the program, for example as measured by the BESS Score. The use of SAAVE to achieve enkephalinase inhibition and precursor amino acid loading in the acute inpatient treatment environment provides the practitioner with the potential ability to restore the neurochemical changes inherent to alcoholism and drug abuse. These findings increase our understanding of the clinically relevant neurobiological mechanisms which underlie compulsive disease. PMID:3072969

Blum, K; Trachtenberg, M C; Elliott, C E; Dingler, M L; Sexton, R L; Samuels, A I; Cataldie, L

1988-01-01

79

Are you Sleeping? Pilot Comparison of Self-Reported and Objective Measures of Sleep Quality and Duration in an Inpatient Alcoholism Treatment Program  

PubMed Central

Sleep disturbances are common among alcohol-dependent individuals and can increase risk of relapse. The current study compares subjective and objective measures of sleep quality and duration and describes the prevalence of baseline sleep disturbances in an inpatient population of alcoholics undergoing their first week of detoxification. At baseline, the PSQI revealed that 79% of participants were above the cutoff score (?5) for clinically meaningful sleep disturbances (mean = 12.57, SD = 4.38). Actigraphy results revealed that average sleep efficiency was 75.89%. Sleep efficiency scores were significantly correlated with self-reported sleep efficiency (P = 0.04, r = 0.47). Sleep duration measured by the actigraphy watches was not significantly correlated with self-reported sleep duration (P = 0.65, r = 0.10). Ongoing assessment of sleep disturbances may be a valuable tool for informing the development of customized sleep interventions in a similar inpatient alcohol treatment sample. PMID:23115479

Brooks, Alyssa T.; Krumlauf, Michael C.; Whiting, Barbara P.; Clark, Rosa J.; Wallen, Gwenyth R.

2012-01-01

80

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

81

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

ERIC Educational Resources Information Center

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

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

2005-01-01

82

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

Microsoft Academic Search

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

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

2011-01-01

83

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

ERIC Educational Resources Information Center

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

Sacks, Stanley; Ries, Richard K.

2005-01-01

84

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

ERIC Educational Resources Information Center

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

Substance Abuse and Mental Health Services Administration, 2005

2005-01-01

85

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

86

DSM-III-R Axis I and II disorders in agoraphobic inpatients with and without panic disorder before and after psychosocial treatment.  

PubMed

Panic disorder patients with agoraphobia (n = 32) and agoraphobic patients without panic disorder (n = 18) who were participants in an inpatient behavioral-psychodynamic treatment program were assessed repeatedly from pretreatment to 2-year posttreatment follow-up. At pretreatment, there were statistical trends for more of the panic with agoraphobia patients to have obsessive-compulsive disorder and alcohol abuse/dependence, and for more of the agoraphobia without panic patients to have generalized anxiety disorder and avoidant personality disorder. There was also a trend for more of the panic with agoraphobia patients to have met criteria for major depression during the 2-year follow-up period. PMID:7792336

Hoffart, A; Thornes, K; Hedley, L M

1995-01-31

87

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

88

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

89

Perceptions of 12Step Interventions Among UK Substance-Misuse Patients Attending Residential Inpatient Treatment in a UK Treatment Setting  

Microsoft Academic Search

In spite of a considerable evidence base suggesting the benefits of participation in Alcoholics Anonymous and other 12-step fellowships, most studies have been conducted in the United States. Preliminary studies have suggested that clients in addiction treatment in the United Kingdom may be more ambivalent about 12-step groups, and the current article examines barriers and pathways to engagement in 12-step

Romina S. Lopez Gaston; David Best; Ed Day; William White

2010-01-01

90

An Inpatient Vocational Rehabilitation Unit.  

ERIC Educational Resources Information Center

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

Bielefeld, Martin

91

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

92

Substance Abuse Treatment For Adults in the Criminal Justice System. Treatment Improvement Protocol (TIP) Series 44  

ERIC Educational Resources Information Center

This Treatment Improvement Protocol (TIP) provides guidelines for counselors and criminal justice personnel who treat offenders with substance use disorders. TIPs are best-practice guidelines that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel of experts in the…

Bartlett, Catalina; Dinsmore, Janet; Gilbert, J. Max; Kornblum, Annette; Latham, Joyce; Oliff, Helen; Paisner, Susan; Sutton, David

2005-01-01

93

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

PubMed Central

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

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

2014-01-01

94

Changes in Physical Fitness, Bone Mineral Density and Body Composition During Inpatient Treatment of Underweight and Normal Weight Females with Longstanding Eating Disorders  

PubMed Central

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

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

2012-01-01

95

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

PubMed

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

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

2008-03-01

96

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

97

Mandibular trauma treatment: A comparison of two protocols.  

PubMed

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

Boffano, P; Kommers, S-C; Roccia, F; Forouzanfar, T

2014-12-01

98

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

PubMed

We developed a brief family treatment (BFT) intervention for substance abusing patients in inpatient detoxification to promote aftercare treatment post-detox. BFT consisted of meeting with the patient and a family member (spouse or parent) with whom the patient lived to review and recommend potential aftercare plans for the patient. A phone conference was used when logistics prevented an in-person family meeting. Results indicated that male substance abusing patients who received BFT (N=14), as compared with a matched treatment as usual (TAU) comparison group (N=14) that did not, showed a trend toward being more likely to enter an aftercare program and to attend more days of aftercare in the 3 months after detoxification. The magnitude of these differences favoring BFT over TAU was midway between a medium and a large effect size. Days using alcohol or drugs in the 3 months after detox were lower for treatment-exposed BFT patients who had an in-person family meeting than TAU counterparts (trend, medium effect), and for patients who entered aftercare regardless of treatment condition (significant large effect). PMID:17223279

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

2007-08-01

99

Dissociative disorders among alcohol-dependent inpatients  

Microsoft Academic Search

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

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

2007-01-01

100

Severe hyponatraemia in hospital inpatients  

Microsoft Academic Search

A prospective study of severe hyponatraemia in adult hospital inpatients showed that 44 patients had plasma sodium concentrations below 125 mmol(mEq)\\/1. Eighteen cases (41%) were iatrogenic, caused by diuretic treatment or postoperative administration of intravenous 5% dextrose, or both. Chest infection, a seldom-recognised and ill-understood cause of hyponatraemia, proved more common than carcinoma of the bronchus. Thirty-one patients had symptoms

P G Kennedy; D M Mitchell; B I Hoffbrand

1978-01-01

101

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

PubMed Central

This paper describes the results of the STRATOB (Systemic and STRATegic psychotherapy for OBesity) study, a two-arm randomized controlled clinical trial (RCT) comparing Brief Strategic Therapy (BST, Nardone or Arezzo model) with the gold standard CBT (Cognitive Behavioral Therapy) for the inpatient and telephone-based outpatient treatment of obese people with Binge Eating Disorder (BED) seeking treatment for weight reduction. Primary outcome measure of the randomized trial was change in the Global Index of the Outcome Questionnaire (OQ 45.2). Secondary outcome measures were BED remission (weekly binge episodes < 2) and weight loss. Data were collected at baseline, at discharge from the hospital (c.a. 1 month after) and after 6 months from discharge.. No significant difference between groups (BST vs CBT) was found in the primary outcome at discharge. However, a greater improvement was seen in the BST vs the CBT group (P<.01) in the primary outcome at 6 months. About secondary outcomes, no significant difference between groups were found in weight change both at discharge and at 6 months. Notably, a significant association emerged between treatment groups and BED remission at 6 months in favor of BST (only 20% of patients in BST group reported a number of weekly binge episodes > 2 vs 63.3% in CBT group). PMID:21559234

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

2011-01-01

102

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

PubMed Central

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

2014-01-01

103

Selected Protocols for the Treatment of Hematologic Malignancies in Adults  

E-print Network

for steroid- refractory chronic graft-versus-host-disease Protocol # 13-281 STEM CELL TRANSPLANT LEUKEMIA Hodgkin Lymphoma Mantle Cell Lymphoma STEM CELL TRANSPLANT Graft-Versus-Host Disease Corey Cutler, MD, MPH haploidentical (BMT CTN #1101)* Protocol # 12-188 Trial of regulatory T-cells plus low-dose interleukin-2

Liu, Xiaole Shirley

104

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

105

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

106

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

107

Facilitating Problem Drinking Clients' Transition from Inpatient to Outpatient Care.  

ERIC Educational Resources Information Center

Reports on use of transition groups to improve linkages between inpatient and outpatient alcoholism treatment. Notes that clients who had access to transition group had more favorable outcomes than did clients who had no access to the group. Sees group as especially useful for inpatients who had encounters with outpatient clinic before their…

Hanson, Meredith; And Others

1994-01-01

108

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

Microsoft Academic Search

The purpose of this study was to explore the prevalence rates of co-occurring mental health problems among 70 flight attendants\\u000a in substance abuse treatment. Results indicated that flight attendants in treatment were more likely to experience alcohol\\u000a dependency than drug dependency. A high proportion of participants reported clinical levels of anxiety, major depressive disorder,\\u000a dysthymia, and dependent personality disorder. Quality

Gail Horton; Naelys Diaz; John Mcilveen; Michael Weiner; Donald Mullaney

2011-01-01

109

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

PubMed

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

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

2015-03-01

110

[Premature termination of inpatient psychotherapy].  

PubMed

This systematic review examines the frequency and possible causes of premature termination of psychotherapeutic treatments. The literature search focused on adult patients who drop-out of acute and rehabilitative inpatient psychosomatic care in Germany. The weighted average drop-out-rate of the 15 included studies was 12.5%. Young age, unemployment, inability to work, the diagnosis of an eating disorder, a somatoform disorder or a personality disorder and a low impairment at intake show a relation to a higher risk for a premature termination of the treatment. Beside these sociodemographic and clinical variables, the motivation for treatment as well as treatment expectations seem to play a role in the prediction of attrition. PMID:24760412

Reuter, Laurence; Scheidt, Carl Eduard

2014-08-01

111

The outpatient treatment of deep vein thrombosis delivers cost savings to patients and their families, compared to inpatient therapy  

Microsoft Academic Search

Background: The outpatient treatment of deep vein thrombosis (DVT) with low-molecular-weight heparin (LMWH) has been shown to be cost-effective from the perspective of a third party payer. The aim of this study is to determine if some or all of these cost savings to third party payers are shifted to patients and their families. Methods: A prospective cohort study with

Marc A Rodger; Christine Gagné-Rodger; Heather E Howley; Marc Carrier; Doug Coyle; Philip S Wells

2003-01-01

112

[Therapeutic factors of inpatient analytic group psychotherapy].  

PubMed

Several change mechanisms, their interrelationship, and their relation to outcome as well as to long-term follow-ups have been investigated in an inpatient group therapy. Eight of initially ten patients finished a long-term group in an inpatient setting for severe neurotics and personality disorders. Successful patients were able to change significant behavior characteristics, to develop a higher cohesiveness towards the group and especially to use aspects of family reenactment in order to change internalized significant object representations. The results indicate that important changes occur early during the treatment. The contributing change mechanisms and their interdependency are described and discussed in detail. PMID:1494633

Tschuschke, V; Catina, A; Beckh, T; Salvini, D

1992-01-01

113

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

114

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

PubMed

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

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

2014-09-01

115

An Uncontrolled Evaluation of Inpatient and Outpatient Cognitive-Behavior Therapy for Bulimia Nervosa  

Microsoft Academic Search

Inpatient (n = 27) and outpatient (n = 22) cognitive-behavior therapy programs for bulimia nervosa were evaluated in an uncontrolled experiment. Both treatment conditions included exposure with response prevention and cognitive restructuring. Inpatient treatment had a mean length of stay of 5 weeks. Outpatient treatment lasted 15 weeks. Both groups were followed after the end of treatment. The results showed

Donald A. Williamson; Rita C. Prather; Sandra M. Bennett; C. J. Davis; Philip C. Watkins; Charles E. Grenier

1989-01-01

116

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

PubMed

Although there is evidence for the efficacy of psychodynamic therapy (PDT) in anxiety disorders, results are not yet satisfactory, for example, if rates of remission and response are considered. To address this problem, a unified psychodynamic protocol for anxiety disorders (UPP-ANXIETY) is proposed that integrates the treatment principles of those methods of PDT that have proven to be efficacious in anxiety disorders. In addition, this protocol is transdiagnostic, implying that it is applicable to various forms of anxiety disorders and related disorders (generalized anxiety disorder, social phobia, panic disorders, avoidant personality disorder). Based on supportive-expressive therapy, the UPP-ANXIETY represents an integrated form of psychodynamic therapy that allows for a flexible use of empirically supported treatment principles. UPP-ANXIETY encompasses the following 9 treatment principles (modules): (1) socializing the patient for psychotherapy, (2) motivating and setting treatment goals, (3) establishing a secure helping alliance, (4) identifying the core conflict underlying anxiety, (5) focusing on the warded-off wish/affect, (6) modifying underlying internalized object relations, (7) changing underlying defenses and avoidance, (8) modifying underlying response of self, and (9) termination and relapse prevention. Some principles are regarded as core components to be used in every treatment (principles 3-8). A unified protocol for the psychodynamic treatment of anxiety disorders has several advantages, that is (1) integrating the most effective treatment principles of empirically supported psychodynamic treatments for anxiety disorders can be expected to further improve the efficacy of PDT; (2) using a unified protocol in efficacy studies has the potential to enhance the evidence-based status of PDT by aggregating the evidence; (3) a unified protocol will facilitate both training in PDT and transfer of research to clinical practice; and (4) thus, a unified protocol can be expected to have a significant impact on the health care system. We are planning to test the UPP-ANXIETY in a multicenter randomized controlled trial. PMID:24377407

Leichsenring, Falk; Salzer, Simone

2014-06-01

117

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

Microsoft Academic Search

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

Paula J. Fite; Laura Stoppelbein; Leilani Greening

2009-01-01

118

Thermal Treatment Protocol Development and Scale-up  

Technology Transfer Automated Retrieval System (TEKTRAN)

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

119

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...

120

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.

121

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

122

[Vaginal candidiasis--treatment protocols using miconazole and fluconazole].  

PubMed

The incidence of fungal infections is growing in the last 20 years. The epidemiological studies show that 45% of all vaginal infections are caused by Candida albicans or other Candida species. 7 out of 10 women suffer from yeast infection at least once in a lifetime and 4 out of 10 have multiple recurrences. 20-55% of women have asyptomatic vaginal colonization with Candida species. It is strongly believed that fungal infection is not sexually transmitted disease. The route of transmission is oral and it is estrogene dependant. The diagnosis is based on macroscopic, microscopic examination (KOH preparation), culture and rarely Pap test. Treatment of vaginal candidiosis is based on two principles: elimination of predisposing factors antifungal treatment Local treatment is the first line of choice in cases of acute vaginal yeast infection with 84-90% success rate. There are a variety of local preparations on our market including Nizoral, Clotrimazole, Canesten, Gyno-Daktarine, Gyno-Pevaryl, Miconazole. Different groups of broad spectrum oral antimycotics are also used including Nystatine, Ketoconazole (Nizoral), Fluconazole (Diflucan, Fungolon, Mycosyst), itraconazole (Orungal). The treatment of chronic, recurrent and resistant forms of vaginal candidosis is carried out with prolonged local and/or systemic therapy for a period of at least 6 months. Different regimes of therapy are proposed. Fluconazole is an oral drug of choice for continuous treatment of vaginal yeast infection with the least toxicity. PMID:14619753

Mazne?kova, V

2003-01-01

123

A survey of hospital inpatient education in Texas  

E-print Network

is an establishment with organized medical staffs; permanent facilities that include inpatient beds; and medical services, including physician services and continuous nursing services to provide diagnosis and treatment for patients who have a variety of medical... the nursing department to coordinate inpatient education. 7. Evaluation of patient education programs appears to be non- existent, except for observing the patient and/or family performance of self-care tasks before the patient is discharged from...

Cochran, Susan Carol

1978-01-01

124

The treatment strategies of autoimmune disease may need a different approach from conventional protocol: A review  

PubMed Central

Autoimmune disease (AD) is one of the emerging noncommunicable diseases. Remission is a possibility in AD, but current treatment strategies are not able to achieve this. We have well-established protocols for infections, oncology, metabolic diseases, and transplantation which are often used as models for the management of AD. Studies and observations suggest that in contrast to diseases used as a role model, AD has wide variability, different causative and pathogenic process, which is highly dynamic, making the current treatment strategies to fall short of expected complete remission. In this brief review, it is attempted to highlight the current understanding of AD and the probable gaps in the treatment strategies. Few hypothetical suggestions to modify the treatment protocols are presented. PMID:23248391

Chandrashekara, S.

2012-01-01

125

Methotrexate Treatment Protocols and the Central Nervous System: Significant Cure With Significant Neurotoxicity  

Microsoft Academic Search

Methotrexate can influence the central nervous system through several metabolic toxic pathways. These effects can be categorized as immediate, acute to subacute, or chronic neurologic syndromes. The acute to subacute syndrome occurs frequently in acute lymphoblastic leukemia treatment protocols, generally manifesting with focal neurologic signs and changes seen on magnetic resonance imaging and single photon emission computed tomography. While in

Avinoam Shuper; Batya Stark; Liora Kornreich; Ian J. Cohen; Shraga Aviner; Adam Steinmetz; Jeremiah Stein; Yaacov Goshen; Isaac Yaniv

2000-01-01

126

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

ERIC Educational Resources Information Center

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

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

2011-01-01

127

Carcinoma ex pleomorphic adenoma: Diagnostic dilemma and treatment protocol.  

PubMed

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

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

2014-07-01

128

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

129

Treatment protocols to reduce renal injury during shock wave lithotripsy  

PubMed Central

Purpose of review Growing concern over the acute and long-term adverse effects associated with shock wave lithotripsy calls for treatment strategies to reduce renal injury and improve the efficiency of stone breakage in shock wave lithotripsy. Recent findings Experimental studies in the pig model show that lithotripter settings for power and shock wave rate and the sequence of shock wave delivery can be used to reduce trauma to the kidney. Step-wise power ramping as is often used to acclimate the patient to shock waves causes less tissue trauma when the initial dose is followed by a brief (3–4 min) pause in shock wave delivery. Slowing the firing rate of the lithotripter to 60 shock waves/min or slower is also effective in reducing renal injury and has the added benefit of improving stone breakage outcomes. Neither strategy to reduce renal injury – not power ramping with ‘pause-protection’ nor delivering shock waves at reduced shock wave rate – have been tested in clinical trials. Summary Technique in lithotripsy is critically important, and it is encouraging that simple, practical steps can be taken to improve the safety and efficacy of shock wave lithotripsy. PMID:19195131

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

2010-01-01

130

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

SciTech Connect

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

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

1996-12-31

131

Compliance with treatment and follow-up protocols in project MATCH: predictors and relationship to outcome.  

PubMed

Treatment and follow-up session attendance data from Project MATCH, a multisite clinical trial investigating patient-treatment matching, were analyzed to study compliance. High rates of compliance to both therapy and research protocols were achieved, enhancing treatment integrity and data quality. Strong baseline predictors of compliance did not emerge, and the small relationships found were consistent with reports from previous studies. Attendance at therapy sessions was moderately correlated with research follow-up participation. Treatment compliance predicted drinking outcome, underscoring the importance of retaining patients in treatment. Future studies should examine the associations between compliance and structural features of the treatment environment, treatment delivery, and context-features that are often under the control of the clinician/investigator. PMID:9756050

Mattson, M E; Del Boca, F K; Carroll, K M; Cooney, N L; DiClemente, C C; Donovan, D; Kadden, R M; McRee, B; Rice, C; Rycharik, R G; Zweben, A

1998-09-01

132

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

ERIC Educational Resources Information Center

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

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

2009-01-01

133

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

134

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

PubMed

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

Rundio, Albert

2013-09-01

135

New, Combined, and Reduced Dosing Treatment Protocols Cure Trypanosoma cruzi Infection in Mice  

PubMed Central

The development of treatment protocols with reduced toxicity and equivalent or improved efficacy for Trypanosoma cruzi infection is a priority. We tested the effectiveness of benznidazole (BZ), nifurtimox (NFX), other prospective drugs in intermittent and combined treatment protocols to cure T. cruzi infection initiated with susceptible and drug-resistant parasite strains. A 40-day course of BZ, NFX, or the oxaborale AN4169 cured 100% of mice, whereas posaconazole (POS), and NTLA-1 (a nitro-triazole) cured approximately 90% and 20% of mice, respectively. Reducing the overall dosage of BZ or NFX by using an intermittent (once every 5 days) schedule or combining 5 daily doses of POS with 7 intermittent doses of BZ also provided approximately 100% cure. T. cruzi strains resistant to BZ were also found to be resistant to other drugs (POS), and extending the time of treatment or combining drugs did not increase cure rates with these isolates. Thus, dosing schedules for anti–T. cruzi compounds should be determined empirically, and compounds targeting different pathways may be combined to yield effective therapies with reduced toxicity. This work also suggests that standard treatment protocols using BZ and NFX may be significantly overdosing patients, perhaps contributing to the adverse events. PMID:23945371

Bustamante, Juan M.; Craft, Julie M.; Crowe, Byron D.; Ketchie, Sarah A.; Tarleton, Rick L.

2014-01-01

136

Clinical exposure protocols for HIFU treatments of cancer of the liver and kidney  

NASA Astrophysics Data System (ADS)

High-intensity focused ultrasound surgery (HIFU) is a technique that is finding increasingly widespread clinical application. The potential of HIFU for the noninvasive treatment of deep-seated tumors is being explored. Treatment of these tumors uses an extracorporeal approach. A number of different devices are now available for delivering clinical HIFU treatments. This paper sets out methods for characterization of HIFU transducers and exposure protocols that would allow treatments to be compared. Clinical trials for the treatment of tumors of the liver and kidney are underway in the UK at the Royal Marsden Hospital, London and the Churchill Hospital, Oxford. This paper describes the physical and technical characteristics of the two devices being used to deliver treatments, and uses these as a basis for discussing the ultrasonic procedures that can be used, and the rationale for their choice. Clinical reference is given for illustrative purposes. The wide variety of exposure protocols that is being used in different clinical centers means that there is at present no uniformity of reporting in the literature. This paper therefore sets out recommended information that should be included in order that transducers and treatments can be compared.

Ter Haar, Gail R.; Rivens, Ian H.; Kennedy, James E.; Wu, Feng

2001-05-01

137

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

PubMed

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

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

2011-03-22

138

Inpatient care in Kazakhstan: A comparative analysis  

PubMed Central

Background: Reforms in inpatient care are critical for the enhancement of the efficiency of health systems. It still remains the main costly sector of the health system, accounting for more than 60% of all expenditures. Inappropriate and ineffective use of the hospital infrastructure is also a big issue. We aimed to analyze statistical data on health indices and dynamics of the hospital stock in Kazakhstan in comparison with those of developed countries. Materials and Methods: Study design is comparative quantitative analysis of inpatient care indicators. We used information and analytical methods, content analysis, mathematical treatment, and comparative analysis of statistical data on health system and dynamics of hospital stock in Kazakhstan and some other countries of the world [Organization for Economic Cooperation and Development (OECD), USA, Canada, Russia, China, Japan, and Korea] over the period 2001-2011. Results: Despite substantial and continuous reductions over the past 10 years, hospitalization rates in Kazakhstan still remain high compared to some developed countries, including those of the OECD. In fact, the hospital stay length for all patients in Kazakhstan in 2011 is around 9.9 days, hospitalization ratio per 100 people is 16.3, and hospital beds capacity is 100 per 10,000 inhabitants. Conclusion: The decreased level of beds may adversely affect both medical organization and health system operations. Alternatives to the existing inpatient care are now being explored. The introduction of the unified national healthcare system allows shifting the primary focus on primary care organizations, which can decrease the demand on inpatient care as a result of improving the health status of people at the primary care level. PMID:24516484

Kumar, Ainur B.; Izekenova, Aigulsum; Abikulova, Akmaral

2013-01-01

139

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

140

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

PubMed

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

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

2014-01-01

141

The Bill Henderson Protocol: Consumer Perspectives and Practices on an Alternative Dietary Intervention for Cancer Treatment and Cure  

Microsoft Academic Search

This study sought to describe how consumers found the Bill Henderson protocol, a dietary intervention for cancer treatment, and to describe their perceptions and evaluation of its effects. In all, 630 surveys were completed online. Most respondents were ages 55 to 74 years old, well-educated, and had experience with a cancer diagnosis. Most respondents identified the Bill Henderson protocol through

Stacey Page; Cynthia Mannion; Laurie Heilman Bell; Marja Verhoef

2011-01-01

142

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

PubMed

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

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

2015-03-01

143

Treatment times of Class II malocclusion: four premolar and non-extraction protocols.  

PubMed

The purpose of this study was to retrospectively compare the treatment times of Class II division 1 malocclusion subjects treated with four first premolar extractions or a non-extraction protocol and fixed edgewise appliances. Eighty-four patients were selected and divided into two groups. Group 1, treated with four first premolar extractions, consisted of 48 patients (27 males and 21 females) with a mean age of 13.03 years and group 2, treated without extractions, consisted of 36 patients (18 males and 18 females) with a mean age of 13.13 years. Group 2 was subdivided into two subgroups, 2A consisting of 16 patients treated in one phase and 2B consisting of 20 patients treated in two phases. The initial and final Treatment Priority Index (TPI), initial ages, initial mandibular crowding, and treatment times of groups 1 and 2 were compared with t-tests. These variables were also compared between group 1 and the subgroups with analysis of variance followed by Tukey's tests. The treatment times for groups 1 and 2 and subgroups 2A and 2B were 2.36, 2.47, 2.25, and 2.64 years, respectively, which were not significantly different. Treatment times with non-extraction and four premolar extraction protocols are similar. PMID:21393372

Janson, Guilherme; Valarelli, Danilo Pinelli; Valarelli, Fabrício Pinelli; de Freitas, Marcos Roberto

2012-04-01

144

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

145

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

PubMed

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

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

2012-01-01

146

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

147

Characteristics Associated with Inpatient Versus Outpatient Status in Older Adults with Bipolar Disorder  

Microsoft Academic Search

Objectives: This is an exploratory analysis of ambulatory and inpatient services utilization by older persons with type I bipolar disorder experiencing elevated mood. The association between type of treatment setting and the person’s characteristics is explored within a framework that focuses upon predisposing, enhancing, and need characteristics. Method: Baseline assessments were conducted with the first 51 inpatients and 49 outpatients

Rayan K. Al Jurdi; Herbert C. Schulberg; Rebecca L. Greenberg; Mark E. Kunik; Ariel Gildengers; Martha Sajatovic; Benoit H. Mulsant; Robert C. Young

2012-01-01

148

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

Microsoft Academic Search

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

Edgar J. Nottingham; Robert A. Neimeyer

1992-01-01

149

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

ERIC Educational Resources Information Center

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

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

150

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

151

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

152

Programmed Instruction, Self-Control, and In-Patient Psychiatry.  

ERIC Educational Resources Information Center

The extension of the instructional programming process, as outlined by Markle and Tiemann (1967), to the treatment of psychiatric in-patients is described. Three case studies are presented as examples of the application of the programming procedures as derived from the Constructional Model of Dr. Israel Goldiamond. The emphasis throughout all…

Layng, Terrence; And Others

153

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

154

A simple and efficient protocol for the treatment of zebrafish colonies infected with parasitic nematodes.  

PubMed

Abstract Our zebrafish colony experienced a period of increased mortality rate of 6.5 times more deaths per month in a colony of over 13,000 zebrafish (Danio rerio), which developed over 3 months. We observed that before death, affected fish appeared emaciated, often with an abdominal bulge. We performed dissection on 18 fish that had this appearance and found in 15 that their gut was infected with a nematode that closely resembled Pseudocapillaria tomentosa. We devised a treatment protocol for this nematode infection, which involved addition of fenbendazole, a drug used to treat nematode infections in cattle and sheep, to the fish feed. Fenbendazole produced no severe side effects in the fish and several treatments have effectively eradicated the parasite from our colony. The mortality rate of our fish has decreased to a value of 0.7%/month (p<0.001, equal to that before the infection). We propose this protocol as an inexpensive alternative to having to rederive an entire colony from bleached eggs, and as a prophylactic measure used in quarantine facilities on a regular basis. PMID:23808385

Maley, David; Laird, Angela S; Rinkwitz, Silke; Becker, Thomas S

2013-09-01

155

Substance Abuse Treatment and Domestic Violence. Treatment Improvement Protocol (TIP) Series 25.  

ERIC Educational Resources Information Center

The major goal of this TIP, on the best practice guidelines to improve the treatment of substance abuse, is to provide clinicians, educators, and paraprofessionals with the latest findings concerning domestic violence. The information is intended to educate providers about the needs and behaviors of batterers and survivors, and how to tailor…

Cook, Paddy; Gartner, Constance Grant; Markl, Lise; Henderson, Randi; Brooks, Margaret K.; Wesson, Donald; Dogoloff, Mary Lou; Vitzthum, Virginia; Hayes, Elizabeth

156

Prosecuting Assaultive Forensic and Psychiatric Inpatients  

ERIC Educational Resources Information Center

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

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

2008-01-01

157

Inpatient Suicide in a Chinese Psychiatric Hospital  

ERIC Educational Resources Information Center

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

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

2008-01-01

158

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

PubMed

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

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

2014-09-01

159

A Proposed Roadmap for Inpatient Neurology Quality Indicators  

PubMed Central

Background/Purpose: In recent years, there has been increasing pressure to measure and report quality in health care. However, there has been little focus on quality measurement in the field of neurology for conditions other than stroke and transient ischemic attack. As the number of evidence-based treatments for neurological conditions grows, so will the demand to measure the quality of care delivered. The purpose of this study was to review essential components of hospital performance measures for neurological disease and propose potential quality indicators for commonly encountered inpatient neurological diagnoses. Methods: We determined the most common inpatient neurological diagnoses at a major tertiary care medical center by reviewing the billing database. We then searched PubMed and the National Guidelines Clearinghouse to identify treatment guidelines for these conditions. Guideline recommendations with class I/level A evidence were evaluated as possible quality indicators. Results: We found 94 guidelines for 14 inpatient neurological conditions other than stroke and transient ischemic attack. Of these, 36 guidelines contained at least 1 recommendation with class I evidence. Based on these, potential quality indicators for intracerebral hemorrhage, subarachnoid hemorrhage, pneumococcal meningitis, coma following cardiac arrest, encephalitis, Guillain-Barre syndrome, multiple sclerosis, and benign paroxysmal positional vertigo are proposed. Conclusions: There are several inpatient neurological conditions with treatments or diagnostic test routines supported by high levels of evidence that could be used in the future as quality indicators. PMID:23983832

Douglas, Vanja C.; Josephson, S. Andrew

2011-01-01

160

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

PubMed Central

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

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

2012-01-01

161

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

PubMed

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

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

2012-01-01

162

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

163

Equity in utilization of cancer inpatient services by income classes.  

PubMed

Equity in health care services has been prioritized on the Korean government's policy agenda since the government-driven national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiaries. The purpose of this study is to identify disparities in the utilization of health care services, especially cancer inpatient services among different income groups in Jeju Island of South Korea. We analyzed the national health insurance data about qualification of beneficiaries and utilization of health care services consumed by Jeju Island's residents for 1 year of period (from January to December 2000) and acquired their utilization features of cancer inpatient services. The independent variable was 10 different income levels according to the national health insurance fee imposed on each household in 2000. The dependent variable was the volume of cancer inpatient services utilized, that was measured by admission days and costs for treatment. The utilization of cancer inpatient services in the 10 different income groups was analyzed in three geographical categories of medical institutions: (1) within Jeju Island; (2) outside Jeju Island; (3) South Korea in total. We calculated the concentration-indices of cancer inpatient services utilization in admission days and cost as a pair amongst these three geographical categories each. Both of the concentration-indices were negative for the category of 'within Jeju Island', positive for that of 'outside Jeju Island', and positive for that of 'South Korea in total'. These results suggest the relatively poor experience considerable inequality in the utilization of cancer inpatient services in Jeju Island, because lower income groups have higher incidence rates in most cancers and inevitably have more needs in health services. PMID:15802154

Kim, Chul-Woung; Lee, Sang-Yi; Hong, Seong-Chul

2005-05-01

164

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

PubMed Central

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

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

2014-01-01

165

Clinical Associations of Deliberate Self-Injury and Its Impact on the Outcome of Community-Based and Long-Term Inpatient Treatment for Personality Disorder  

Microsoft Academic Search

Background: Deliberate self-injury (DSI) is significantly associated with personality disorder (PD). There are gaps in our knowledge of DSI as an indicator of severity of psychopathology, as moderator of outcome and with regard to its response to different treatment programs and settings. Methods: We compare 2 samples of PD with (n = 59) and without (n = 64) DSI in

Marco Chiesa; Rachel Sharp; Peter Fonagy

2011-01-01

166

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

167

Using a Delphi consensus process to develop an acupuncture treatment protocol by consensus for women undergoing Assisted Reproductive Technology (ART) treatment  

PubMed Central

Background Assisted reproductive technologies (ART) are increasingly utilised for resolving difficulties conceiving. These technologies are expensive to both the public purse and the individual consumers. Acupuncture is widely used as an adjunct to ART with indications that it may assist reducing the time to conception and increasing live birth rates. Heterogeneity is high between treatment protocols. The aim of this study was to examine what fertility acupuncturists consider key components of best practice acupuncture during an ART cycle, and to establish an acupuncture protocol by consensus. Methods Fifteen international acupuncturists with extensive experience treating women during ART interventions participated in 3 rounds of Delphi questionnaires. The first round focused on identifying the parameters of acupuncture treatment as adjunct to ART, the second round evaluated statements derived from the earlier round, and the third evaluated specific parameters for a proposed trial protocol. Consensus was defined as greater than 80% agreement. Results Significant agreement was achieved on the parameters of best practice acupuncture, including an acupuncture protocol suitable for future research. Study participants confirmed the importance of needling aspects relating to the dose of acupuncture, the therapeutic relationship, tailoring treatment to the individual, and the role of co-interventions. From two rounds of the Delphi a consensus was achieved on seven treatment parameters for the design of the acupuncture treatment to be used in a clinical trial of acupuncture as an adjunct to ART. The treatment protocol includes the use of the traditional Chinese medicine acupuncture, use of manual acupuncture, a first treatment administered between day 6–8 of the stimulated ART cycle which is individualised to the participant, two treatments will be administered on the day of embryo transfer, and will include points SP8, SP10, LR3, ST29, CV4, and post transfer include: GV20, KD3, ST36, SP6, and PC6. Auricular points Shenmen and Zigong will be used. Practitioner intent or yi will be addressed in the treatment protocol. Conclusions Despite a lack of homogeneity in the research and clinical literature on ART and acupuncture, a consensus amongst experts on key components of a best practice treatment protocol was possible. Such consensus offers guidance for further research. PMID:22769059

2012-01-01

168

Heparin-based treatment to prevent symptomatic deep venous thrombosis, pulmonary embolism or death in general medical inpatients is not supported by best evidence.  

PubMed

Prevention of venous thromboembolism (VTE) in medical patients is controversial. In contrast to surgical patients, the evidence supporting the use of heparin-based treatment for prevention of VTE (HVTEp) may not justify current guidelines. This study aims to determine whether current clinical guidelines for HVTEp are appropriate for medical patients. We searched medical databases for original randomised placebo-controlled studies of HVTEp in medical patients, excluding those with stroke and in intensive care. From 401 potentially relevant studies, we selected eight, which included over 16?000 patients. HVTEp decreased the incidence of all deep venous thromboses (DVT): 4.3% in the placebo group versus 2.3% in the treatment group, P = 0.002, number needed to treat, 50. However, this treatment effect was not seen for symptomatic DVT: 1.2% versus 0.9%, P = 0.18, odds ratio (OR) 0.72 (0.45-1.16). Similarly, HVTEp did not decrease the incidence of pulmonary embolism (PE): 0.54% versus 0.27%, P = 0.3, OR 0.57 (0.21-1.53), or fatal PE: 0.1% versus 0.0%, P = 0.3, OR 0.2 (0.01-4.11). Furthermore, HVTEp did not decrease total mortality: 5.63% versus 5.39%, P = 0.92, OR 0.96 (0.78-1.18). The use of HVTEp in hospitalised general medical patients does not result in a significant reduction in symptomatic DVT, PE, fatal PE or total mortality. The best evidence does not support the recommendations of the current clinical guidelines. PMID:25367724

Spencer, A; Cawood, T; Frampton, C; Jardine, D

2014-11-01

169

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

PubMed Central

Background There is no more effective intervention for secondary prevention of coronary heart disease than smoking cessation. Yet, evidence about the (cost-)effectiveness of smoking cessation treatment methods for cardiac inpatients that also suit nursing practice is scarce. This protocol describes the design of a study on the (cost-)effectiveness of two intensive smoking cessation interventions for hospitalised cardiac patients as well as first results on the inclusion rates and the characteristics of the study population. Methods/design An experimental study design is used in eight cardiac wards of hospitals throughout the Netherlands to assess the (cost-)effectiveness of two intensive smoking cessation counselling methods both combined with nicotine replacement therapy. Randomization is conducted at the ward level (cross-over). Baseline and follow-up measurements after six and 12 months are obtained. Upon admission to the cardiac ward, nurses assess patients’ smoking behaviour, ensure a quit advice and subsequently refer patients for either telephone counselling or face-to-face counselling. The counselling interventions have a comparable structure and content but differ in provider and delivery method, and in duration. Both counselling interventions are compared with a control group receiving no additional treatment beyond the usual care. Between December 2009 and June 2011, 245 cardiac patients who smoked prior to hospitalisation were included in the usual care group, 223 in the telephone counselling group and 157 in the face-to-face counselling group. Patients are predominantly male and have a mean age of 57?years. Acute coronary syndrome is the most frequently reported admission diagnosis. The ultimate goal of the study is to assess the effects of the interventions on smoking abstinence and their cost-effectiveness. Telephone counselling is expected to be more (cost-)effective in highly motivated patients and patients with high SES, whereas face-to-face counselling is expected to be more (cost-)effective in less motivated patients and patients with low SES. Discussion This study examines two intensive smoking cessation interventions for cardiac patients using a multi-centre trial with eight cardiac wards. Although not all eligible patients could be included and the distribution of patients is skewed in the different groups, the results will be able to provide valuable insight into effects and costs of counselling interventions varying in delivery mode and intensity, also concerning subgroups. Trial registration Dutch Trial Register NTR2144 PMID:22587684

2012-01-01

170

Treatment of chronic constipation with lactitol sweetened yoghurt supplemented with guar gum and wheat bran in elderly hospital in-patients.  

PubMed

The faecal output of 33 elderly hospitalized patients was followed daily for 4 weeks. After an observation period of 1 week 18 patients received during the following 2 weeks a 150 ml portion of yoghurt containing lactitol, guar gum and wheat bran (fibre yoghurt group) twice daily. Fifteen control patients received the same volume of yoghurt without lactitol, guar gum or wheat bran (control yoghurt group). The study design was randomized double-blind. The mean faecal output increased 1.6-fold in patients receiving fibre yoghurt, while the corresponding value for control patients was 1.2 (p less than 0.05). About 50% of the fibre yoghurt group and 25% of the controls considered the treatment effective. Some in the fibre yoghurt group experienced meteorism and loose stools. No significant changes were observed in blood glucose, serum cholesterol or triglyceride values, body weights or faecal pH values in either group. PMID:2852540

Rajala, S A; Salminen, S J; Seppänen, J H; Vapaatalo, H

1988-06-01

171

Family Functioning in Suicidal Inpatients With Intimate Partner Violence  

PubMed Central

Background: Intimate partner violence (IPV) is commonly bidirectional with both partners perpetrating and being victims of aggressive behaviors. In these couples, family dysfunction is reported across a broad range of family functions: communication, intimacy, problem solving, expression or control of anger, and designation of relationship roles. This study reports on the perceived family functioning of suicidal inpatients. Method: In this descriptive, cross-sectional study of adult suicidal inpatients, participants completed assessments of recent IPV and family functioning. Recruited patients were between 18 and 65 years of age and English fluent, had suicidal ideation, and were living with an intimate partner for at least the past 6 months. Intimate partner violence was assessed using the Conflict Tactics Scale-Revised, and family functioning was measured using the McMaster Family Assessment Device. The study was conducted from August 2004 through February 2005. Results: In 110 inpatients with suicidal ideation and IPV, family functioning was perceived as poor across many domains, although patients did report family strengths. Gender differences were not found in the overall prevalence of IPV, but when the sample was divided into good and poor family functioning, women with poorer family functioning reported more psychological abuse by a partner. For both genders, physical and psychological victimization was associated with poorer family functioning. Conclusion: Among psychiatric inpatients with suicidal ideation, IPV occurred in relationships characterized by general dysfunction. Poorer general family functioning was associated with the perception of victimization for both genders. The high prevalence of bidirectional IPV highlights the need for the development of couples treatment for this population of suicidal psychiatric inpatients. PMID:18185819

Heru, Alison M.; Stuart, Gregory L.; Recupero, Patricia Ryan

2007-01-01

172

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

Microsoft Academic Search

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

Richard P. Kluft

1985-01-01

173

Cognitive Control Differences in Violent Juvenile Inpatients.  

ERIC Educational Resources Information Center

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

Calicchia, John A.; And Others

1993-01-01

174

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

175

Reducing inpatient suicide risk: using human factors analysis to improve observation practices.  

PubMed

In 1995, the Joint Commission began requiring that hospitals report reviewable sentinel events as a condition of maintaining accreditation. Since then, inpatient suicide has been the second most common sentinel event reported to the Joint Commission. The Joint Commission emphasizes the need for around-the-clock observation for inpatients assessed as at high risk for suicide. However, there is sparse literature on the observation of psychiatric patients and no systematic studies or recommendations for best practices. Medical errors can best be reduced by focusing on systems improvements rather than individual provider mistakes. The author describes how failure modes and effects analysis (FMEA) was used proactively by an inpatient psychiatric treatment team to improve psychiatric observation practices by identifying and correcting potential observation process failures. Collection and implementation of observation risk reduction strategies across health care systems is needed to identify best practices and to reduce inpatient suicides. PMID:19297628

Janofsky, Jeffrey S

2009-01-01

176

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

177

Evaluation of cardiopulmonary biomarkers during classic adulticide treatment versus the American Heartworm Society recommended treatment protocol in dogs infected by Dirofilaria immitis.  

PubMed

Adulticide treatment of dogs with canine heartworm disease causes the death of the adult Dirofilaria immitis lodged in the vascular system of the host. During the death of the worms, pulmonary thromboembolisms (PTE), pulmonary inflammation, congestive heart failure, or renal disease are possible consequences. The aim of this study was to evaluate cardiopulmonary biomarkers and renal parameters during adulticide treatment of canine heartworm to compare the classic two-injection treatment protocol versus the American Heartworm Society (AHS) recommended protocol. Fourteen heartworm-infected dogs with high parasite burdens were divided in three groups and allocated to adulticide protocols as follows: Group A (n=5) was treated with the classic two-injection protocol; group B (n=5) was treated using the AHS recommended protocol, and group C (n=4) was treated as for group B but received diminishing anti-inflammatory doses of prednisone. To assess cardiorespiratory status, cardiac troponin I (cTnI), myoglobin, and D-dimer were measured. Renal function was evaluated by measuring urea, creatinine, and urine protein:creatinine (UP:C). Serum and urine samples were collected day 0 (day of diagnosis), 7 and 14 days after the first dose of adulticide, and 1 month after the last adulticide injection. Dogs that received classic treatment presented pathologic concentrations of D-dimer more frequently and showed higher average D-dimer levels, which may indicate the presence of more severe PTE. Group C showed the highest levels of D-dimer during treatment, which may be due to an exacerbation of PTE caused by the administration of prednisone. CTnI and myoglobin values remained above reference values in all groups during the study but reached the lowest values 1 month after the last injection. Levels of urea and creatinine were within normal ranges in all groups, and 28.5% of the dogs were proteinuric on day 0, progressing to better UP:C values at the end of the treatment, except in group A. The results of this study justify the treatment of canine heartworm disease using the AHS recommended adulticide guidelines and recommends re-evaluation of the role of glucocorticosteroids in the prevention and treatment of PTE. PMID:25224786

Carretón, E; Morchón, R; Simón, F; Juste, M C; González-Miguel, J; Montoya-Alonso, J A

2014-11-15

178

Group CBT for psychosis: A longitudinal, controlled trial with inpatients.  

PubMed

Individual cognitive behaviour therapy for psychosis (CBTp) is a recommended treatment in the acute phase and beyond. However, less is known about the effectiveness of group CBTp in acute care. This mixed methods study explored the implementation and effectiveness of brief group CBTp with inpatients. This prospective trial compared inpatients who received either a four week group CBTp program or treatment as usual (TAU). Participants (n = 113 at baseline) completed self-report measures of distress, confidence and symptoms of psychosis at baseline, post-intervention and one month follow up. CBTp group participants also completed a brief open-ended satisfaction questionnaire. Using complete case analysis participants who received CBTp showed significantly reduced distress at follow up compared to TAU and significantly increased confidence across the study and follow up period. However, these effects were not demonstrated using a more conservative intention-to-treat analysis. Qualitative analysis of the satisfaction data revealed positive feedback with a number of specific themes. The study suggests that brief group CBTp with inpatients may improve confidence and reduce distress in the longer term. Participants report that the groups are acceptable and helpful. However, given the methodological limitations involved in this 'real world' study more robust evidence is needed. PMID:25577190

Owen, Mary; Sellwood, William; Kan, Stephen; Murray, John; Sarsam, May

2015-02-01

179

Economic aspects of nursing in inpatient naturopathy: vidence from Germany.  

PubMed

The costs of nursing in Germany are defined in terms of "nursing-relevant secondary diagnoses." However, the further development of the German-DRG system reveals nursing diagnoses play a constantly declining role with regard to increasing severity and revenue assurance. In particular, additional therapeutic nursing services performed, for example, by specially trained, certified nurses in acute hospitals focusing on naturopathy are not adequately defined. In this study, researchers analyzed naturopathic care, especially the nursing costs for inpatient care of multi-morbid cardiac patients, with a particular focus on a holistic, comprehensive treatment. Results indicated the nursing costs in an inpatient acute hospital with a naturopathic focus are significantly higher than nursing costs in hospitals operating exclusively according to conventional medicine. Questions about adequate determination of the costs of DRGs for professional groups such as the nursing service need to be addressed. PMID:23923242

Romeyke, Tobias; Stummer, Harald

2013-01-01

180

Outcome of a heartworm treatment protocol in dogs presenting to Louisiana State University from 2008 to 2011: 50 cases.  

PubMed

Since 2008, the American Heartworm Society has recommended using a three-dose melarsomine protocol (a single intramuscular injection of melarsomine dihydrochloride at 2.5mg/kg, followed approximately 1 month later with two doses administered 24h apart) for all heartworm-positive dogs, with doxycycline given at 10mg/kg twice daily for 4 weeks prior to administration of melarsomine. To report the efficacy and side effects of this standard heartworm treatment protocol in 50 dogs presenting to our hospital from 2008 to 2011, information on the history, clinical, laboratory, and diagnostic imaging findings and treatment was obtained from medical records. When possible, additional follow-up information was obtained through telephone interviews with referring veterinarians and owners. Twenty-six dogs (52%) experienced minor complications, such as injection site reactions, gastrointestinal signs (vomiting, diarrhea, inappetance), and behavioral changes (lethargy, depression) during or after heartworm treatment. Twenty-seven dogs (54%) experienced respiratory signs (coughing, dyspnea) and heart failure attributed to progressive heartworm disease and worm death. Seven dogs (14%) died within the treatment period. Owners frequently reported behavioral changes, such as depression and lethargy, suspected to be secondary to pain. Fifty percent of owners surveyed indicated that, prior to the diagnosis, they either were not currently administering heartworm preventative, or they had recently adopted the dog from a shelter that did not administer preventatives. After treatment, 100% were administering heartworm preventatives to their pet. Eighteen dogs (36%) received a heartworm antigen test 6 months after adulticide therapy, 12 of which tested negative and six tested positive. Four of the dogs with a positive test at 6 months had negative tests 1 month later with no additional treatment. Adverse effects were common with the recommended protocol, but the majority of these were mild. Dogs in Class 1 (i.e., heartworm positive but otherwise largely lacking clinical evidence of disease) did not experience any major adverse effects or death. PMID:24953753

Maxwell, Elizabeth; Ryan, Kirk; Reynolds, Caryn; Pariaut, Romain

2014-11-15

181

Characteristics Associated with Inpatient Death  

PubMed Central

Objective More than half of pediatric deaths occur in the hospital inpatient setting. An analysis of pediatric deaths can potentially help with understanding why children die and provide opportunities to improve the care for this patient population. This study’s primary objective was to obtain a broad understanding of inpatient mortality across academic, children’s hospitals. Patients and Methods A non-concurrent cohort study of hospitalized children from 37 academic, children’s hospitals during calendar year 2005. The primary outcome measure was death. Associated patient level characteristics included age, gender, race, diagnostic grouping, and insurance status. Important epidemiologic measures included standardized mortality and standardized mortality ratios (SMRs). Results There were 427,615 patients discharged from participating institutions during the study period of which 4,529 (1.1%) died. Neonates had the highest mortality rate (4.03%; OR 8.66; p < .001) followed by those > 18 years (1.4%; OR 2.86; P < .001). The standardized mortality ranged from 0.46 (APR-DRG 663: Other Anemia and Disorders of Blood) to 30.0 (APR-DRG 383: Cellulitis and Other Bacterial Skin Infection). When deaths were compared by institution, there was considerable variability in both the number of children who died and the SMRs at those institutions. Conclusions Patient characteristics, like age, severity, and diagnosis, were all substantive factors associated with the death of children. Opportunities to improve the environment of care by reducing variability within and between hospitals may improve mortality for hospitalized children. PMID:20457682

Khandelwal, Sachin; He, Jianping; Hall, Matthew; Stockwell, David C.; Turenne, Wendy M.; Shah, Samir S.

2011-01-01

182

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

183

Predictors of Dropout from Inpatient Opioid Detoxification with Buprenorphine: A Chart Review  

PubMed Central

Inpatient withdrawal treatment (detoxification) is common in opioid dependence, although dropout against medical advice often limits its outcome. This study aimed to assess baseline predictors of dropout from inpatient opioid detoxification with buprenorphine, including age, gender, current substance use, and type of postdetoxification planning. A retrospective hospital chart review was carried out for inpatient standard opioid detoxifications using buprenorphine taper, in a detoxification ward in Malmö, Sweden (N = 122). Thirty-four percent of patients (n = 42) dropped out against medical advice. In multivariate logistic regression, dropout was significantly associated with younger age (OR 0.93 [0.89–0.97]) and negatively predicted by inpatient postdetoxification plan (OR 0.41 [0.18–0.94]), thus favouring an inpatient plan as opposed to outpatient treatment while residing at home. Dropout was unrelated to baseline urine toxicology. In opioid detoxification, patients may benefit from a higher degree of postdetoxification planning, including transition to residential treatment, in order to increase the likelihood of a successful detoxification and treatment entry. Young opioid-dependent patients may need particular attention in the planning of detoxification. PMID:25530903

Hallén, Emma

2014-01-01

184

Basal-bolus insulin protocols enter the computer age.  

PubMed

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

Wei, Nancy J; Wexler, Deborah J

2012-02-01

185

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

186

Inpatient procedures in elderly women: An analysis over time  

PubMed Central

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

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

2013-01-01

187

Using RFID yoking proof protocol to enhance inpatient medication safety.  

PubMed

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

Chen, Chin-Ling; Wu, Chun-Yi

2012-10-01

188

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...

189

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

Microsoft Academic Search

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

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

1988-01-01

190

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.

191

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

192

Updated 10/2012 Inpatient Units/Residential Alcohol Rehabilitation Centers*  

E-print Network

Updated 10/2012 Inpatient Units/Residential Alcohol Rehabilitation Centers* Please note patient Rushford Treatment Center 1250 Silver Street Middletown, CT 860-346-0300 / 203-630- 5220 888-203-2916 800 Connecticut Avenue Bridgeport, CT 203-367-8621 Intensive, 4 phase residential treatment program. LOS 6- 12

Oliver, Douglas L.

193

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

194

Treating Hyperglycemia and Diabetes With Insulin Therapy: Transition From Inpatient to Outpatient Care  

PubMed Central

Abstract and Introduction Abstract Context Intensive insulin therapy is recommended to control glucose elevations in the critically ill and has been shown to significantly improve outcomes among hospital inpatients with acute hyperglycemia or newly diagnosed diabetes. Once discharged, the hyperglycemic patient may require ongoing outpatient care, most often under the attention of a primary care physician. Evidence acquisition The purpose of this review is to provide a background of in-hospital hyperglycemia management and discharge planning in preparation for continued outpatient care. Primary data sources were identified through a PubMed search (1990–2007) using keywords, such as diabetes, hyperglycemia, in-hospital, discharge, and insulin. Evidence synthesis Hyperglycemia protocols with strict glycemic goals have been shown to improve morbidity and mortality among critically ill inpatients. Discharge planning should prepare patients for self-care and give them the survival skills necessary to maintain glycemic control. In preparation for discharge, patients are usually transitioned from insulin infusions to subcutaneous insulin administered through an appropriate basal-prandial regimen. Conclusion A thorough understanding of hyperglycemia history and treatment will allow the primary care physician to deliver optimal diabetes care and thereby improve both short-term and long-term outcomes for those patients with critical illnesses and hyperglycemia or diabetes. Introduction Hyperglycemia, when left untreated, can have a negative impact on the patient's prognosis and outcome during the hospital stay and after discharge.[1–5] The prevalence of hyperglycemia in hospitalized patients is high, and may be associated with multiple factors: First, about 20.8 million Americans have diabetes, 6.2 million of whom (around one third) have not been diagnosed.[1,6] Furthermore, diabetes itself may contribute to hospitalization because it can lead to cardiovascular disease, renal damage, stroke, and/or other complications.[7–9] Finally, hyperglycemia may be induced during periods of acute metabolic stress or traumatic injury, develop as a result of surgery, or arise as an adverse effect of treatment with certain medications.[2,9–11] Several investigators have reported newly occurring hyperglycemia in association with acute hospital admissions, and others have shown the progression from normal glucose homeostasis to hyperglycemia during critical illnesses.[12,13] Cely and colleagues[13] found that among medical inpatients, even those with normal baseline glucose levels had hyperglycemia for at least a portion of time while in the intensive care unit (ICU), with duration of hyperglycemia increasing by 19% for each 1.0% increase in glycated hemoglobin A1C (A1C) (Figure 1).[13] For many individuals, therefore, plasma glucose is an important consideration during in-hospital medical care. Thus, identifying hyperglycemia in new critically ill inpatients is a medical priority necessary to ensure optimal care and improved outcomes. Table 1 lists parameters for normoglycemia and glycemic targets for most patients.[7,14,15] The American Diabetes Association (ADA) also specifies that in critically ill patients, blood glucose values should be kept as close to 110 mg/dL as possible and generally under 140 mg/dL.[7] Stress hyperglycemia and diabetes have been associated with a significantly higher mortality rate, increased length of hospital stay, poor cardiovascular outcomes, and greater need for ICU admission compared with normoglycemia.[1,3,4] In fact, Umpierrez and colleagues[1] reported an in-hospital mortality rate 3 times higher in ICU patients with new hyperglycemia (no prior history of diabetes and admission or in-hospital fasting glucose level > 126 mg/dL or random blood glucose level > 200 mg/dL on ? 2 determinations) than in those with normoglycemia (31% vs 10%, P < .01), and 3 times higher than in patients with known diabetes (31% vs 11%, P < .01). Furthermore, this increase in mortality was

Lavernia, Frank

2008-01-01

195

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

ERIC Educational Resources Information Center

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

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

2013-01-01

196

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

197

Modified constraint induced movement therapy enhanced by a neuro-development treatment-based therapeutic handling protocol: two case studies.  

PubMed

Modified Constraint Induced Movement Therapy (CIMT) and Neuro-Developmental Treatment (NDT) are both intervention strategies that focus on active practice to optimize function. CIMT involves constraint of the less involved upper extremity during function and NDT includes facilitation of optimal postural control and symmetry to enhance the ability to complete a given motor function. The purpose of this article is to describe an intervention protocol for children with hemiplegia that integrates key NDT and CIMT principles. Two children participated in a modified CIMT (mCIMT)/NDT program 2 hours a day for two months. The children wore a constraint on the less involved arm and participated in guided play with early intervention members and parents. Play was individualized to developmental level and incorporated principles of NDT. Function was measured pre- and post-intervention using the PDMS-2, QUEST, ACQUIRE Therapy Motor Patterns, and ACQUIRE Functional Activities. Both children demonstrated motor skill acquisition, improved quality of functional use, and increased frequency of bilateral hand use. Parents found the protocol challenging but manageable in their daily routines. The inclusion of NDT principles within a mCIMT protocol may be an effective intervention to maximize functional motor skill acquisition in children with hemiplegia. Additional research is warranted to support this intervention. PMID:22699102

Haynes, Marjorie Prim; Phillips, Dawn

2012-01-01

198

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

Cancer.gov

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

199

Dysfunctional Patients with Temporomandibular Disorders: Evaluating the Efficacy of a Tailored Treatment Protocol.  

ERIC Educational Resources Information Center

Forty-eight dysfunctional patients with temporomandibular disorders (TMD) were randomly assigned to treatments consisting of an intraoral appliance, stress management, and either nondirective supportive counseling or cognitive therapy. Results support tailored treatment of dysfunctional TMD. (KW)

Turk, Dennis C.; And Others

1996-01-01

200

CTEP & CC Protocols - Credit Report  

Cancer.gov

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

201

The Role of Optimal Healing Environments in Patients Undergoing Cancer Treatment: Clinical Research Protocol Guidelines  

Microsoft Academic Search

Integrative cancer care (ICC) is the treatment of patients with cancer, under physician supervision, with ap- propriate conventional treatments in a healing context based on insights from research on nutrition, biochem- istry, exercise, and psycho-oncology. It uses validated techniques and practitioners of complementary and al- ternative medicine (CAM), and strategies for enhancing treatment and side-effect management such as chronomodulated chemotherapy,

Keith I. Block; Penny Block; Charlotte Gyllenhaal

2004-01-01

202

Clinical Protocol Manager  

E-print Network

Protocol This trial protocol has been provided by the authors to give readers additional information about their work. Protocol for: Agnelli G, Buller HR, Cohen A, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 2013. DOI: 10.1056/NEJMoa1302507This Supplement contains the following items: 1) Final protocol with summary of changes from the original protocol 2) Final statistical analysis plan with summary of changes from the original statistical analysis planClinical Protocol CV185056 Page: 1 Protocol Number: CV185056

Raphael Pak Phd; Ospedale S. Maria Della Misericordia; Via Gerardo Dottori N; Località S. Andrea Delle Fratte; Melanie Noble

203

Older female inpatients in Arkansas.  

PubMed

The purpose of this study was to examine age and Major Diagnostic Categories (MDCs) and compare the variables to mortality and length of stay among inpatient women age 50 and over. Archival statistical data were obtained for 2,238 inpatients in a private, nonprofit hospital in 1998. The ages ranged from 50 to 107 years old, with a mean age of 71.21 years. Quantitative analyses were conducted to examine the data from a private, nonprofit hospital and determine if there were significant relationships between age, major diagnostic category, length of stay, and mortality in older women. The MDC distribution indicated that the highest frequency of diseases and disorders were in the following three systems: circulatory system, musculoskeletal system and connective tissue, and the digestive system. The average length of stay was 8.01 days. The 30-day readmission percentage and the 365-day readmission percentage were 12.24% and 28.02%, respectively. The mortality rate was 6%. In addition, 63.97% went home after discharge, and 67.07% were Medicare recipients. The risk of musculoskeletal diseases and disorders increased with age (p = .0001). The conditional probability of death was nearly nine times higher for the diseases of the nervous system, myeloproliferative diseases and disorders, poorly differentiated neoplasms and respiratory diseases. As age increased, the probabilities of a long hospital stay decreased. The mortality analyses found that the lowest probabilities of survival were in categories of myeloproliferative diseases and disorders, poorly differentiated neoplasms, and infectious and parasitic diseases. According to current health statistics, our society is getting older. Not only are people living longer, they are accessing more health care (American Association for World Health, 1999). Overall, the average life expectancy at birth has been identified at 76.5 years. The female has a longer life expectancy than the male, averaging 5.8 years longer. The highest life expectancy has been identified in the white female, who can expect to live to 79. The black woman has the second-highest life expectancy, 74.7 years. Peters, Kochanek, and Murphy reported an all-time-low age-adjusted death rate for the United States and a continuing trend in the decline in mortality for all age groups. With a growing number of people living longer, there is a need to know about the most common health issues that affect quality of life. The top three national causes of death in older Americans were diseases of the heart, malignant neoplasms, and cerebrovascular diseases/stroke. Arkansas health statistics mirror the national statistics. In April 1999, the Arkansas Department of Health reported that 30.5% percent of all female deaths were caused by heart disease. Malignant neoplasms were responsible for 20.1%, followed by cerebrovascular diseases at 10.8%. Other than three Connecticut hospital studies that explored the relationship of diagnosis code, mortality, and readmission, research is meager in this area. There is a need for hospital-based research that addresses the diagnosis categories and the relationship to age and other variables. PMID:11233503

Johnson, M; Duncan, L; Rothenberger, A; Thomas, J

2001-03-01

204

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

PubMed Central

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

2012-01-01

205

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

Microsoft Academic Search

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

Daniela Wagner; Hilke Vorwerk

2011-01-01

206

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

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

2014-10-01

207

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

Code of Federal Regulations, 2011 CFR

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

2011-10-01

208

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

Code of Federal Regulations, 2012 CFR

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

2012-10-01

209

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

Code of Federal Regulations, 2010 CFR

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

2010-10-01

210

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

Code of Federal Regulations, 2013 CFR

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

2013-10-01

211

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

PubMed

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

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

2014-11-27

212

Effects of acupuncture treatment on depression insomnia: a study protocol of a multicenter randomized controlled trial  

PubMed Central

Background More than 70% of patients with depression who see their doctors experience insomnia. Insomnia treatment is a very important link for depression treatment. Furthermore, antidepression treatment is also important for depression insomnia. In acupuncture, LU-7 (Lie Que) and KID-6 (Zhao Hai), which are two of the eight confluence points in meridian theory, are used as main points. An embedded needle technique is used, alternately, at two groups of points to consolidate the treatment effect. These two groups of points are BL-15 (Xin Shu) with BL-23 (Shen Shu) and BL-19 (Dan Shu) with N-HN-54 (An Mian). The effectiveness of these optimized acupuncture formulas is well proven in the practice by our senior acupuncturists in Guangdong Provincial Hospital of TCM. This study has been designed to examine whether this set of optimized clinical formulas is able to increase the clinical efficacy of depression insomnia treatment. Methods/design In this randomized controlled multicenter trial, all the eligible participants are diagnosed with depression insomnia. All participants are randomly assigned to one of two groups in a ratio of 1:1 and receive either conventional acupuncture treatment or optimized acupuncture treatment. Patients are evaluated using the Pittsburgh Sleep Quality Index(PSQI)and the Hamilton rating scale(HAMD) for depression. The use of antidepression and hypnotics drugs is also considered. Results are obtained at the start of treatment, 1 and 2 months after treatment has begun, and at the end of treatment. The entire duration of the study will be approximately 36 months. Discussion A high quality of trial methodologies is utilized in the study, and the results may provide better evidence for the effectiveness of acupuncture as a treatment for depression insomnia. The optimized acupuncture formula has potential benefits in increasing the efficacy of treating depression insomnia. Trial registration The trial was registered in Chinese Clinical Trial Register (ChiCR-TRC-00000481) on 12 August 2009. PMID:23286297

2013-01-01

213

Rural and Urban Hospitals' Role in Providing Inpatient Care, 2010  

MedlinePLUS

... CDC/NCHS, National Hospital Discharge Survey, 2010. How did rural hospital inpatients differ from urban hospital inpatients ... CDC/NCHS, National Hospital Discharge Survey, 2010. How did patients' first-listed diagnoses differ in rural and ...

214

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

215

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

216

The efficacy of rational-emotive group therapy in psychiatric inpatients  

Microsoft Academic Search

The impact of rational-emotive theory and therapy upon the practice of clinical psychology has been profound, and many purportedly objective experimental tests of its efficacy as a mode of treatment have been reported. Yet the great majority of these reports have failed to utilize actual clinical populations. This study evaluated rational-emotive group therapy with psychiatric inpatients. Results supported the claim

Rebecca H. Jacobsen; Arthur S. Tamkin; John B. Blount

1987-01-01

217

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

ERIC Educational Resources Information Center

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

Petersen, Connie L.; Zettle, Robert D.

2009-01-01

218

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

219

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

220

Using Nursing Theory and a Structured Psychoeducational Curriculum With Inpatient Groups  

Microsoft Academic Search

Involving patients in groups has been identified as one way of optimizing patient treatment options while maximizing staff resources and containing costs. In this article, literature on the use of groups by nurses in an inpatient setting is reviewed, and the development of a program involving a psychoeducational group curriculum incorporating Orlando’s nursing theory is described. The program was found

Mertie L. Potter; Robert B. Williams; Rosemary Costanzo

2004-01-01

221

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

222

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

223

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

224

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

Code of Federal Regulations, 2010 CFR

...Guarantee of payment for inpatient hospital or inpatient CAH services furnished...MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Scope of Hospital Insurance Benefits §...

2010-10-01

225

Inpatient Hemodialysis Initiation: Reasons, Risk Factors and Outcomes  

Microsoft Academic Search

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

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

2010-01-01

226

Recommendations for Pharmacological Management of Inpatient Aggression in Children and Adolescents  

PubMed Central

Objective. While there has been a great deal of speculation by clinical researchers over the last three decades on effective and safe methods for the pharmacological management of aggression in children and adolescents, it is only in the last decade that there have been well-designed studies available to address this issue. Medication is commonly used to control aggression in children and adolescents in inpatient units. Also, there exists a need for evidence-based guidelines for the use of these different pharmacological agents for managing pediatric aggression on inpatient units. The aims of this article are to provide a systemic review and to provide treatment guidelines based on these limited but currently available studies. Methods. The articles reviewed in this study were obtained through a PubMed search using the key words ‘children,’ ‘adolescents,’ ‘aggression,’ ‘inpatient,’ ‘ziprasidone,’ ‘lithium,’ and ‘risperidone.’ A total of 499 studies were generated. Only studies focusing on pharmacological management of inpatient pediatric aggression with mean duration less than six weeks and published during January 1980 to August 2009 were included. Only English articles were considered. A total of 13 studies met these criteria, which were included in the review without any further statistical analysis. Recommendations are made on this available evidenced-based literature. Results. There is some evidence for the standing use of oral lithium, haloperidol, olanzapine, and risperidone for aggression related to specific psychiatric diagnoses. Intramuscular ziprasidone and olanzapine administered as needed were found to be effective for the rapid management of moderate to severe aggression. Oral or intramuscular diphenhydramine administered as needed was found to be useful for managing mild aggression due to a placebo effect. Conclusions. Studies are available on managing aggression in children and adolescents in inpatient treatment settings but are limited. Further studies on the use of various psychotropic medications are needed in order to develop comprehensive guidelines for the safe and effective pharmacological management of child and adolescent inpatient aggression. PMID:20376274

Kulkarni, Guarav; Barzman, Drew

2010-01-01

227

[ES-IPO-97 treatment protocol for prognostically poor Ewing's sarcoma forms in children: results of implementation].  

PubMed

The paper shows the high efficiency and moderate toxicity of inductive treatment in children with Young sarcoma and primitive neuroectodermal tumors by ES-Ipo-97 protocol that includes alternate chemotherapy by the scheme: vincristine, 1.5 mg/m2/day, on days 1, 8, 15; adriamycin, 37.5 mg/m2/day, on days 1 and 2 as 24-hour infusion; cyclophosphanum, 2.1 g/m2/day, on days 1 and 2 (Block A); iphosphamide, 2.4 g/m2/day on days 1 to 5, etoposide, 100 mg/m2/day, on days 1-5 (Block B). It provides evidence for that this therapy is promising and awaits further developments. PMID:10961143

Ptushkina, E A; Ivanova, N M; Dolgopolov, I S; Izhogin, D G; Petrosian, A S; Glekov, I V; Durnov, L A; Mentkevich, G L

2000-01-01

228

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

229

Depression in Geriatric and Adult Medical Inpatients.  

ERIC Educational Resources Information Center

Administered two scales for the evaluation of depression to two groups of medical inpatients: adults (N=201) and geriatric subjects (N=178). Results confirmed a high presence of depressive symptoms among patients with medical problems, particularly among geriatric subjects. Factors most predictive of depressive symptoms are identified. (JAC)

Magni, Guido; And Others

1985-01-01

230

Hopelessness Depression in Depressed Inpatient Adolescents  

Microsoft Academic Search

The hopelessness theory of depression hypothesizes the existence of a hopelessness subtype of depression, characterized by its specific cause, symptoms, course, therapy, and prevention. Data from depressed inpatient adolescents (N = 160) were used to evaluate (a) the relation between hopelessness and the hypothesized symptoms of hopelessness depression; and (b) the latent structure of the relation between hopelessness and the

Mark A. Whisman; Aureen Pinto

1997-01-01

231

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

PubMed Central

Cystoid macular edema (CME) is a relatively common painless condition usually accompanied by blurred vision. The prevalence of CME varied from 5% to 47% depending on cause of pathology. There are several treatments available for ME including intravitreal use of bevacizumab that has been used in different doses in few studies. However, there is still scarcity of data available on the use of bevacizumab for the treatment of ME. A systematic review is needed to provide a foundational base to discuss and synthesize the available information on the effectiveness and safety of intravitreal bevacizumab in macular edema, so that recommendations and policies can be built regarding controversial use of bevacizumab in macular edema. We have planned to perform a systematic review with an objective to compare the effects of a single injection of 1.25 mg intravitreal bevacizumab (avastin) in the improvement of visual acuity, macular edema, and thickness with other interventions/controls for the treatment of macular edema at 3 and 6 months interval using randomized controlled trials. This is only a protocol of the review and we will be conducting a full length review, addressing the issue in future. PMID:23853638

Qazi, Hammad A.

2012-01-01

232

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

233

Screening and Assessing Adolescents for Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 31.  

ERIC Educational Resources Information Center

This TIP is designed to teach juvenile justice, health services, education, and substance abuse treatment personnel about how to identify, screen, and assess people 11-to-21 years old who may be experiencing substance-related problems. It details warning signs of substance use disorders, when to screen, when to assess, what domains besides…

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

234

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

235

GENetic and clinical Predictors Of treatment response in Depression: the GenPod randomised trial protocol  

Microsoft Academic Search

BACKGROUND: The most effective pharmacological treatments for depression inhibit the transporters that reuptake serotonin (Selective Serotonin Reuptake Inhibitors – SSRIs) and noradrenaline (Noradrenaline Reuptake Inhibitors – NaRIs) into the presynaptic terminal. There is evidence to suggest that noradrenaline and serotonin enhancing drugs work through separate mechanisms to produce their clinical antidepressant action. Although most of the current evidence suggests there

Laura Thomas; Jean Mulligan; Victoria Mason; Debbie Tallon; Nicola Wiles; Philip Cowen; David Nutt; Michael O'Donovan; Deborah Sharp; Tim Peters; Glyn Lewis

2008-01-01

236

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

PubMed Central

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

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

2014-01-01

237

Intralesional cryotherapy versus excision and corticosteroids or brachytherapy for keloid treatment: study protocol for a randomised controlled trial  

PubMed Central

Background Keloids are a burden for patients due to physical, aesthetic and social complaints and treatment remains a challenge because of therapy resistance and high recurrence rates. The main goal of treatment is to improve the quality of life (QoL); this implies that, apart from surgical outcomes, patient-reported outcome measures (PROMs) need to be taken into account. Decision making in keloid treatment is difficult due to heterogeneity of the condition and the lack of comparative studies. Methods/Design This is a multicentre, randomised controlled open trial that compares 1) intralesional cryotherapy versus excision and corticosteroids for primary keloids, and 2) intralesional cryotherapy versus excision and brachytherapy for therapy-resistant keloids. The primary outcome is the Patient and Observer Scar Assessment Scale (POSAS), a 12-item scale (with score 12 indicating the best and 120 indicating the worst scar imaginable). A difference of six points on the total score is considered to be of clinical importance. Secondary outcomes are recurrence rates, volume reduction, Skindex-29 scores, SF-36 scores and complication rates. Primary and secondary outcome measurements are taken at baseline, and at 2, 12, 26 and 52 weeks postoperatively. For analysis, a linear mixed model is used. A total of 176 patients will be included over a period of 2.5 years. The protocol is approved by the Medical Ethics Committee of the Erasmus University Medical Centre Rotterdam and follows good clinical practice guidelines. Discussion The outcomes of this study will improve evidence-based decision making for the treatment of keloids, as well as patient education. Trial registration Dutch Trial Register NTR4151. PMID:24354714

2013-01-01

238

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

239

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

PubMed Central

Background Shoulder pain affects all ages, with a lifetime prevalence of one in three. The most effective treatment is not known. Physiotherapy is often recommended as the first choice of treatment. At present, it is not possible to identify, from the initial physiotherapy assessment, which factors predict the outcome of physiotherapy for patients with shoulder pain. The primary objective of this study is to identify which patient characteristics and baseline measures, typically assessed at the first physiotherapy appointment, are related to the functional outcome of shoulder pain 6 weeks and 6 months after starting physiotherapy treatment. Methods/Design Participants with musculoskeletal shoulder pain of any duration will be recruited from participating physiotherapy departments. For this longitudinal cohort study, the participants care pathway, including physiotherapy treatment will be therapist determined. Potential prognostic variables will be collected from participants during their first physiotherapy appointment and will include demographic details, lifestyle, psychosocial factors, shoulder symptoms, general health, clinical examination, activity limitations and participation restrictions. Outcome measures (Shoulder Pain and Disability Index, Quick Disability of the Arm, Shoulder and Hand, and Global Impression of Change) will be collected by postal self-report questionnaires 6 weeks and 6 months after commencing physiotherapy. Details of attendance and treatment will be collected by the treating physiotherapist. Participants will be asked to complete an exercise dairy. An initial exploratory analysis will assess the relationship between potential prognostic factors at baseline and outcome using univariate statistical tests. Those factors significant at the 5% level will be further considered as prognostic factors using a general linear model. It is estimated that 780 subjects will provide more than 90% power to detect an effect size of less than 0.25 adjusted for other variables which have a co-efficient of determination (R-squared) with the outcome of up to 0.5. Assuming a 22% loss to follow up at 6 months, 1000 participants will initially be recruited. Discussion This study may offer service users and providers with guidance to help identify whether or not physiotherapy is likely to be of benefit. Clinicians may have some direction as to what key factors indicate a patient’s likely response to physiotherapy. PMID:23800352

2013-01-01

240

A guideline for the inpatient care of children with pyelonephritis  

PubMed Central

BACKGROUND AND OBJECTIVES: Febrile urinary tract infections and pyelonephritis are common in children and frequently lead to hospitalization for management, especially in the child who appears toxic. The American Academy of Pediatrics (AAP) practice parameter on the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children provides experience and evidence-based guidelines for the practitioner caring for children between the ages of 2 months to 2 years. No established guideline exists for older children and the AAP guideline does not specifically focus on inpatient care. METHODS: We conducted a comprehensive review of recently published literature and practice guidelines to develop a consensus on the inpatient diagnosis and management of children with pyelonephritis. RESULTS: Eight recommendations are proposed for the diagnosis and management, including revised guidelines for the imaging studies postpyelonephritis on the basis of current best evidence. CONCLUSION: Proper diagnosis of pyelonephritis, timely initiation of appropriate therapy and identification of children at risk for renal injury will help to reduce immediate as well as long-term complications due to chronic kidney disease. PMID:20716830

Chishti, Aftab S.; Maul, Erich C.; Nazario, Rubén J.; Bennett, Jeffrey S.; Kiessling, Stefan G.

2010-01-01

241

Use of mobile assessment technologies in inpatient psychiatric settings.  

PubMed

Mobile electronic devices (i.e., PDAs, cellphones) have been used successfully as part of research studies of individuals with severe mental illness living in the community. More recently, efforts have been made to incorporate such technologies into outpatient treatments. However, few attempts have been made to date to employ such mobile devices among hospitalized psychiatric patients. In this article, we evaluate the potential use of such devices in inpatient psychiatric settings using 33 hospitalized patients with schizophrenia. Employing an Experience Sampling Method approach, we provide support for the feasibility of using such devices, along with examples of potentially clinically-relevant information that can be obtained using such technologies, including assessment of fluctuations in the severity of psychotic symptoms and negative mood in relation to social context, unit location, and time of day. Following these examples, we discuss issues related to the potential use of mobile electronic devices by patients hospitalized at inpatient psychiatric settings including issues related to patients' compliance, assessment schedules, questionnaire development, confidentiality issues, as well as selection of appropriate software/hardware. Finally, we delineate some issues and areas of inquiry requiring additional research and development. PMID:25042959

Kimhy, David; Vakhrusheva, Julia; Liu, Ying; Wang, Yuanjia

2014-08-01

242

Treatment of acute promyelocytic leukemia with PETHEMA LPA 99 protocol: a Tunisian single center experience.  

PubMed

Acute promyelocytic leukemia (APL) has now become the most curable of all subtypes of acute myeloid leukemia. A cure rate of 75-80% can be anticipated with a combination of all-trans retinoic acid (ATRA) and anthracyclines. In Tunisia, the ATRA era began in 1998 with the use, consecutively, of two regimens of a combination of ATRA with anthracycline and cytarabine (APL93), and without cytarabine (LPA99). From 2004, 39 patients with confirmed APL either by t(15;17) or PML/RARA were treated by the PETHEMA LPA 99 trial. The rationale of this protocol by avoiding cytarabine is to reduce death in complete remission (CR) without increasing the incidence of relapse. Thirty-three patients achieved CR (84.6%). The remaining six patients were considered as failure due to early death: three caused by differentiation syndrome (DS) and three died from central nervous system hemorrhage. Baseline blood cell count (WBC) >10 x 10(9)/l (P=0.26) and creatinine >1.4 mg/dl (P=0.42) were not predictive of mortality. DS was observed in 11 patients (30.5%) with a median onset time of 12 days (range: 3-23 days) and median WBC of 29 x 10(9)/L (range: 1.2 x 10(9)-82.7 x 10(9)/l). DS was severe in seven cases, moderate in four, and fatal in three cases. Body mass index > or =30 (P=0.044) and baseline WBC > or =20 x 10(9)/l (P=0.025) are independent predictors of DS. The median follow-up of this study is 36 months. Thirty patients are alive in continuous complete remission; two patients died in CR from septic shock and secondary myelodysplastic syndrome respectively; one patient died 47 months after achieving two relapses. Event free survival from diagnosis was 80% and overall survival was 82%. Our results are quite acceptable and can be improved by reducing mortality rate. PMID:20670478

Jeddi, Ramzi; Ghédira, Héla; Menif, Samia; Ben Neji, Hend; Ben Amor, Ramzi; Kacem, Karima; Aissaoui, Lamia; Bouteraâ, Walid; Abdennebi, Yosr; Raihane, Ben Lakhal; Gouider, Emna; Raouf, Hafsia; Hèla, Ben Abid; Saad, Ali; Zaher, Belhadjali; Meddeb, Balkis

2010-08-01

243

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

244

Self-Help Program Components and Linkage to Aftercare Following Inpatient Detoxification  

PubMed Central

Many patients fail to initiate aftercare for addictive disease rehabilitation following detoxification. This study of 136 inpatients compared characteristics of those who initiated aftercare (behavior therapy or self-help programs) during the week following discharge with those who did not. Among this group of patients, 77% (91/119) linked to aftercare. Self-help treatment related components were associated with increased aftercare treatment attendance rates and included: having a copy of the “12 Steps” (81% vs. 46%, P = .002), having read self-help literature (73% vs. 42%, P = .007) and having telephone numbers of self-help program members (50% vs. 18%, P = .008). Those who initiated aftercare treatment were also more likely to have remained abstinent from drugs and alcohol (81% vs. 39%, P <.001). Having self-help treatment-related components were associated with increased rates of aftercare attendance following hospital inpatient detoxification. PMID:19197592

Frydrych, Lynne M.; Greene, Benjamin J.; Blondell, Richard D.; Purdy, Christopher H.

2009-01-01

245

Self-help program components and linkage to aftercare following inpatient detoxification.  

PubMed

Many patients fail to initiate aftercare for addictive disease rehabilitation following detoxification. This study of 136 inpatients compared characteristics of those who initiated aftercare (behavior therapy or self-help programs) during the week following discharge with those who did not. Among this group of patients, 77% (91/119) linked to aftercare. Self-help treatment related components were associated with increased aftercare treatment attendance rates and included: having a copy of the "12 Steps" (81% vs. 46%, P = .002), having read self-help literature (73% vs. 42%, P = .007), and having telephone numbers of self-help program members (50% vs. 18%, P = .008). Those who initiated aftercare treatment were also more likely to have remained abstinent from drugs and alcohol (81% vs. 39%, P < .001). Having self-help treatment related components was associated with increased rates of aftercare attendance following hospital inpatient detoxification. PMID:19197592

Frydrych, Lynne M; Greene, Benjamin J; Blondell, Richard D; Purdy, Christopher H

2009-01-01

246

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

247

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

PubMed

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

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

2014-11-24

248

The State of Inpatient Psychiatry for Youth in Ontario: Results of the ONCAIPS Benchmarking Survey  

PubMed Central

Objective: Little is known about inpatient psychiatry settings and the services they provide for children and adolescents in Ontario. This paper provides the first broad description of unit characteristics, services provided, and patient characteristics in these settings. Method: Nominated representatives from Ontario hospitals with generic mental health beds (i.e., providing inpatient care across diagnostic groups) for children and adolescents were surveyed regarding data from April 2009 to March 2010. Response rate was 93%. Additional data were extracted from the Ontario Network of Child and Adolescent Inpatient Psychiatry Services (ONCAIPS) Directory and Ministry of Health and Long Term Care (MOHLTC) website. Results: Settings provided primarily crisis services with some planned elective admissions. Higher rates of involuntary admissions, briefer stays, lower interdisciplinary diversity, and lower occupancy were typical of settings with higher proportions of crisis admissions. Services most commonly provided included stabilization, assessment, pharmacotherapy, and mental health education. Bed numbers provincially, beds per staff, and prominence of suicide risk, mood disorders, and utilization of cognitive and behavioural approaches were comparable to trends internationally. Inter-setting disparities were observed in access to inpatient services for different age and diagnostic groups, and availability of psychiatry and different professions. Conclusions: Lack of consistent performance and outcome evaluation, common measures, availability of psychiatry and interdisciplinary supports, and dissimilar treatments provincially, suggest the need to consider potential improvements through systematic monitoring of setting performance and outcomes, and development of provincial best practice standards for staffing and treatment. PMID:24516475

Greenham, Stephanie L.; Persi, Joseph

2014-01-01

249

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

250

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

251

Development and Evaluation of Evidence-Informed Clinical Nursing Protocols for Remote Assessment, Triage and Support of Cancer Treatment-Induced Symptoms  

PubMed Central

The study objective was to develop and evaluate a template for evidence-informed symptom protocols for use by nurses over the telephone for the assessment, triage, and management of patients experiencing cancer treatment-related symptoms. Guided by the CAN-IMPLEMENT© methodology, symptom protocols were developed by, conducting a systematic review of the literature to identify clinical practice guidelines and systematic reviews, appraising their quality, reaching consensus on the protocol template, and evaluating the two symptom protocols for acceptability and usability. After excluding one guideline due to poor overall quality, the symptom protocols were developed using 12 clinical practice guidelines (8 for diarrhea and 4 for fever). AGREE Instrument (Appraisal of Guidelines for Research and Evaluation) rigour domain subscale ratings ranged from 8% to 86% (median 60.1 diarrhea; 40.5 fever). Included guidelines were used to inform the protocols along with the Edmonton Symptom Assessment System questionnaire to assess symptom severity. Acceptability and usability testing of the symptom populated template with 12 practicing oncology nurses revealed high readability (n = 12), just the right amount of information (n = 10), appropriate terms (n = 10), fit with clinical work flow (n = 8), and being self-evident for how to complete (n = 5). Five nurses made suggestions and 11 rated patient self-management strategies the highest for usefulness. This new template for symptom protocols can be populated with symptom-specific evidence that nurses can use when assessing, triaging, documenting, and guiding patients to manage their-cancer treatment-related symptoms. PMID:23476759

Stacey, Dawn; Macartney, Gail; Carley, Meg; Harrison, Margaret B.; (COSTaRS), The Pan-Canadian Oncology Symptom Triage and Remote Support Group

2013-01-01

252

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

253

Internet-based self-help treatment for depression in multiple sclerosis: study protocol of a randomized controlled trial  

PubMed Central

Background Depression in MS patients is frequent but often not treated adequately. An important underlying factor may be physical limitations that preclude face-to-face contact. Internet-based treatment showed to be effective for depressive symptoms in general and could thus be a promising tool for treatment in MS. Methods/design Here, we present a study protocol to investigate the effectiveness of a 5 week Internet-based self-help problem solving treatment (PST) for depressive symptoms in MS patients in a randomized controlled trial. We aim to include 166 MS patients with moderate to severe depressive symptoms who will be randomly assigned to an Internet-based intervention (with or without supportive text-messages) or waiting list control group. The primary outcome is the change in depressive symptoms defined by a change in the sum score on the Beck Depression Inventory (BDI-II). Secondary outcomes will include measures of anxiety, fatigue, cognitive functioning, physical and psychological impact of MS, quality of life, problem solving skills, social support, mastery, satisfaction and compliance rate. Assessments will take place at baseline (T0), within a week after the intervention (T1), at four months (T2) and at ten months follow-up (T3: only the intervention group). The control group will be measured at the same moments in time. Analysis will be based on the intention-to-treat principle. Discussion If shown to be effective, Internet-based PST will offer new possibilities to reach and treat MS patients with depressive symptoms and to improve the quality of care. Trial Registration The Dutch Cochrane Center, NTR2772 PMID:22967202

2012-01-01

254

[Medication prescribed to inpatients: the client's knowledge].  

PubMed

Errors along the process of medicine administration are some concerns referred to by nurses, and their occurrence can be minimized by providing clients with some guidance regarding medicine-based therapy. This descriptive study aimed at identifying inpatients level of information concerning medication prescribed to them. Exploratory and descriptive methodology was used. Seventy-six adult inpatients were interviewed. Their age ranged from 18 to 60 years, and 69.7% of them were female. Twenty-eight percent did not know the name of the first medicine prescribed to them, and 55% were not able to give information about their dosage. A reasonable number of clients knew nothing about medication they were using, or had misconceptions about it. A thorough understanding is paramount to Nursing professionals on their role to provide their patients with information on medication they are taking during their hospitalization time. PMID:15320612

Zanetti, Ana Carolina Guidorizzi; Afonso, Izabela Ramos Moreira; Freire, Claudia Câmara; Cassiani, Silvia Helena De Bortoli; Teles Filho, Paulo Celso Prado

2003-01-01

255

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

256

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

257

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

PubMed Central

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

2014-01-01

258

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

259

Chemoimmunotherapy for hemophagocytic lymphohistiocytosis: long-term results of the HLH-94 treatment protocol  

PubMed Central

Hemophagocytic lymphohistiocytosis (HLH) used to have a dismal prognosis. We report the final results of HLH-94, the largest prospective diagnostic/therapeutic HLH study so far. The treatment includes immunosuppressive and cytotoxic therapy aiming at clinical remission, followed by HSCT in patients with familial, persistent, or recurrent disease. Altogether, 249 patients fulfilled inclusion criteria and started HLH-94 therapy (July 1994-December 2003); 227 (91%) were followed-up for ? 5 years. At 6.2 years median follow-up, estimated 5-year probability of survival was 54% ± 6%. Seventy-two patients (29%) died before HSCT, 64 within 1 year, 97% of whom had active disease. In 124 patients who underwent HSCT, 5-year survival was 66 ± 8%; tendency to increased survival (P = .064) in patients with nonactive disease at HSCT. Patients with familial disease had a 5-year survival of 50% ± 13%; none survived without HSCT. Patients deceased during the first 2 months more often had jaundice, edema, and elevated creatinine. Forty-nine patients (20%) were alive without signs of HLH activity and off-therapy > 1-year without HSCT; they presented at older age (P < .001), were more often female (P = .011), and less often had CNS disease (P < .001) or hepatomegaly (P = .007). To conclude, HLH-94 chemoimmunotherapy has considerably improved outcome in HLH. Collaborative efforts are needed to further reduce early mortality, HSCT-related mortality, and neurologic late effects. PMID:21900192

Horne, AnnaCarin; Aricò, Maurizio; Egeler, R. Maarten; Filipovich, Alexandra H.; Gadner, Helmut; Imashuku, Shinsaku; Ladisch, Stephan; Webb, David; Janka, Gritta

2011-01-01

260

The clinical impact of inpatient hypoglycemia.  

PubMed

Hypoglycemia is common in hospitalized patients and is associated with poor outcomes, including increased mortality. Older individuals and those with comorbidities are more likely to suffer the adverse consequences of inpatient hypoglycemia. Observational studies have shown that spontaneous inpatient hypoglycemia is a greater risk factor for death than iatrogenic hypoglycemia, suggesting that hypoglycemia acts as a marker for more severe illness, and may not directly cause death. Initial randomized controlled trials of intensive insulin therapy in intensive care units demonstrated improvements in mortality with tight glycemic control, despite high rates of hypoglycemia. However, follow-up studies have not confirmed these initial findings, and the largest NICE-SUGAR study showed an increase in mortality in the tight control group. Despite these recent findings, a causal link between hypoglycemia and mortality has not been clearly established. Nonetheless, there is potential for harm from inpatient hypoglycemia, so evidence-based strategies to treat hyperglycemia, while preventing hypoglycemia should be instituted, in accordance with current practice guidelines. PMID:24685363

Brutsaert, Erika; Carey, Michelle; Zonszein, Joel

2014-01-01

261

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

262

A protocol for measuring pull-off stress of wound-treatment polymers.  

PubMed

Skin wounds and burns compromise the body's natural barrier to bacteria and other pathogens. While many forms of wound dressings are available, polymeric films are advantageous for various reasons, ranging from the ease of application to durability. One common drawback of using polymeric films for a wound bandage is that the films tend to adhere to common inanimate objects. Patients spend hours in contact with soft and hard materials pressed against their skin, which, if the skin was dressed with a polymeric film, would inflict further wound damage upon body movement. In this work, we present a novel technique that allowed for measuring polymeric tackiness, after a long incubation period, with materials regularly encountered in a hospital or home setting, and soft fabrics. The polymers were exposed to an environment intended to simulate daily conditions and the technique is designed to perform multiple experiments simultaneously with ease. Four commercially available polymers (new-skin, no-sting skin-prep, skin shield, and Silesse) were tested as proof-of-concept to gather preliminary data for an overall assessment of wound treatment efficacy, resulting in the estimation of pull-off stress of the polymers from a specimen of porcine skin. Silesse did not reveal a measurable tackiness, no-sting skin-prep had the highest mean tackiness (13.8 kPa), while the mean tackiness between new-skin and skin shield was approximately equal (9.8 kPa vs. 10.1 kPa, respectively), p = 0.05. Future work on polymeric fluids for wound dressing applications should include tensile stress and dynamic viscosity estimations. PMID:24718322

Kheyfets, Vitaly O; Thornton, Rita C; Kowal, Mikala; Finol, Ender A

2014-07-01

263

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

PubMed Central

Background The diagnosis of discogenic back pain often leads to spinal fusion surgery and may partly explain the recent rapid increase in lumbar fusion operations in the United States. Little is known about how patients undergoing lumbar fusion compare in preoperative physical and psychological function to patients who have degenerative discs, but receive only non-surgical care. Methods Our group is implementing a multi-center prospective cohort study to compare patients with presumed discogenic pain who undergo lumbar fusion with those who have non-surgical care. We identify patients with predominant low back pain lasting at least six months, one or two-level disc degeneration confirmed by imaging, and a normal neurological exam. Patients are classified as surgical or non-surgical based on the treatment they receive during the six months following study enrollment. Results Three hundred patients discogenic low back pain will be followed in a prospective cohort study for two years. The primary outcome measure is the Modified Roland-Morris Disability Questionnaire at 24-months. We also evaluate several other dimensions of outcome, including pain, functional status, psychological distress, general well-being, and role disability. Conclusion The primary aim of this prospective cohort study is to better define the outcomes of lumbar fusion for discogenic back pain as it is practiced in the United States. We additionally aim to identify characteristics that result in better patient selection for surgery. Potential predictors include demographics, work and disability compensation status, initial symptom severity and duration, imaging results, functional status, and psychological distress. PMID:15913458

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

2005-01-01

264

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

265

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

PubMed Central

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

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

2015-01-01

266

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

Code of Federal Regulations, 2010 CFR

...Special treatment of certain hospitals located in Puerto Rico...MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment...Inpatient Operating Costs for Hospitals Located in Puerto Rico...

2010-10-01

267

Two RFID-Based Solutions for Secure Inpatient Medication Administration  

Microsoft Academic Search

Medication error can easily cause serious health damage to inpatients in hospital. Consequently, the whole society has to\\u000a spend huge amount of extra resources for additional therapies and medication on those affected inpatients. In order to prevent\\u000a medication errors, secure inpatient medication administration system is required in a hospital. Using RFID technology, such\\u000a administration system provides automated medication verification for

Yi-Chung Yen; Nai-Wei Lo; Tzong-Chen Wu

268

Development and validation of a simple protocol to rapidly determine the performance of biofilters for VOC treatment  

Microsoft Academic Search

A protocol has been developed for the rapid determination of complete elimination characteristics of target pollutants in waste air biofilters. The protocol involves the determination of two pollutant concentration profiles along the height of a three-segment biofilter under carefully chosen conditions. The combination of the data results in 12 points on the elimination capacity vs load curve which is sufficient

Marc A. Deshusses; Camdon T. Johnson

2000-01-01

269

Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder--a prospective study.  

PubMed

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 the beginning of outpatient DBT, we developed a treatment program of inpatient therapy for this patient group according to the guidelines of DBT. It consists of a three-month inpatient treatment prior to long-term outpatient therapy. In this pilot study 24 female patients were compared at admission to the hospital, and at one month after discharge with respect to psychopathology and frequency of self-injuries. Significant improvements in ratings of depression, dissociation, anxiety and global stress were found. A highly significant decrease in the number of parasuicidal acts was also reported. Analysis of the average effect sizes shows a strong effect which prompts the development of a randomized controlled design. PMID:10957822

Bohus, M; Haaf, B; Stiglmayr, C; Pohl, U; Böhme, R; Linehan, M

2000-09-01

270

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

Code of Federal Regulations, 2011 CFR

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

2011-10-01

271

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

Code of Federal Regulations, 2013 CFR

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

2013-10-01

272

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

Code of Federal Regulations, 2012 CFR

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

2012-10-01

273

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

Code of Federal Regulations, 2010 CFR

... Furnishing of inpatient hospital services directly or under...MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Conditions for... Furnishing of inpatient hospital services directly or...

2010-10-01

274

42 CFR 409.62 - Lifetime maximum on inpatient psychiatric care.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Lifetime maximum on inpatient psychiatric care...Hospital Insurance Benefits § 409.62 Lifetime maximum on inpatient psychiatric care. There is a lifetime maximum of 190 days on inpatient...

2010-10-01

275

Modeling Trajectory of Depressive Symptoms Among Psychiatric Inpatients: A Latent Growth Curve Approach  

PubMed Central

Objectives Changes in the parameters of inpatient psychiatric care have inspired a sizable literature exploring correlates of prolonged intervention as well as symptom change over varying lengths of hospitalization. However, existing data offer limited insight regarding the nature of symptom change over time. Objectives of this longitudinal research were to (a) model the trajectory of depressive symptoms within an inpatient psychiatric sample, (b) identify characteristics associated with unique patterns of change, and (c) evaluate the magnitude of expected gains using objective clinical benchmarks. Methods Participants included psychiatric inpatients treated between April 2008 and December 2010. Latent growth curve modeling was used to determine the trajectory of Beck Depression Inventory II depressive symptoms in response to treatment. Age, gender, trauma history, prior hospitalization, and DSM-IV diagnoses were examined as potential moderators of recovery. Results Results indicate a nonlinear model of recovery, with symptom reductions greatest following admission and slowing gradually over time. Female gender, probable trauma exposure, prior psychiatric hospitalization, and primary depressive diagnosis were associated with more severe trajectories. Diagnosis of alcohol/substance use, by contrast, was associated with more moderate trajectories. Objective benchmarks occurred relatively consistently across patient groups with clinically significant change occurring between 2–4 weeks post-admission. Conclusion The nonlinear trajectory of recovery observed in these data provides insight regarding the dynamics of inpatient recovery. Across all patient groups, symptom reduction was most dramatic in the initial week of hospitalization. However, notable improvement continued for several weeks post-admission. Results suggest timelines for adequate inpatient care are largely contingent on program-specific goals. PMID:23759452

Clapp, Joshua D.; Grubaugh, Anouk L.; Allen, Jon G.; Mahoney, Jane; Oldham, John M.; Fowler, J. Christopher; Ellis, Tom; Elhai, Jon D.; Frueh, B. Christopher

2014-01-01

276

[Treatment of acute lymphoblastic leukemia in children according to the ALL-BFM-90m protocol in the Russian Federation and the Republic of Belarus].  

PubMed

Prognosis for children treated according to the BFM-90m protocol (Berlin-Frankfurt-Munster Group) for acute lymphoblastic leukemia (ALL) improved significantly as compared with previous modalities. Methotrexate was used in the dose of 1,000 mg/m2, 36 h. The paper presents the 10-year results for this modification. Patients aged 0-15 years were treated at hematological hospitals of Moscow, other Russian towns and in Minsk, Belarus, (July 5, 1990-November 11, 2000). BFM-90m treatment was given to 682 children out of 1,326 with primary diagnosis of ALL; a comparative trial of the MB-91 protocol hed been carried out at the same clinics since 1991. During 10 years, recurrence-free survival was 72% while overall survival--77%. Toxicity of side-effects was tolerable. The BFM-90m treatment showed significantly better results in both countries. PMID:12455360

Miakova, N V; Ale?nikova, O V; Hartmann, R; Rudneva, A E; Trubina, N M; Fechina, L G; Timakov, A M; Shamardina, A V; Lebedev, V V; Varfolomeeva, S Iu; Dudkin, S D; Dyshlevaia, Z M; Timofeeva, V N; Rumiantsev, A G; Henze, H; Karachunski?, A I

2002-01-01

277

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

PubMed Central

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

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

2015-01-01

278

Cannabis Use and Dependence among French Schizophrenic Inpatients  

PubMed Central

Background: To assess the prevalence of cannabis use and dependence in a population of schizophrenic inpatients and to compare schizophrenics with and without cannabis consumption. Methods: One hundred one schizophrenic patients were examined during their first week of hospitalization. They answered the PANNS scale of schizophrenia, the CAGE and the Fagerström questionnaire, and the DSM-IV-TR criteria for cannabis, alcohol, opiates, and nicotine use dependence were checked. We also assessed socio-demographic characteristics, the motive of cannabis consumption, and the number of cannabis joints and alcoholic drinks taken. Results: The prevalence of cannabis consumption was 33.6% among schizophrenic inpatients. Schizophrenics consuming cannabis were younger than non-schizophrenics (33.3 vs. 44.7?years p?treatment. PMID:25076916

Lejoyeux, Michel; Basquin, Anne; Koch, Marie; Embouazza, Houcine; Chalvin, Florence; Ilongo, Michaelle

2014-01-01

279

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

280

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

281

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

PubMed Central

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

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

2014-01-01

282

Nurse Absenteeism and Staffing Strategies for Hospital Inpatient Units  

E-print Network

Nurse Absenteeism and Staffing Strategies for Hospital Inpatient Units Wen-Ya Wang1 , Diwakar Gupta Engineering Department, University of Minnesota Inpatient staffing costs are significantly affected by nurse hospitals to study which factors, including unit culture, short-term workload, and shift type, explain nurse

Gupta, Diwakar

283

Adverse drug events caused by medication errors in medical inpatients  

Microsoft Academic Search

Principles: In view of growing concern in recent years regarding medication errors as causes of adverse drug events (ADEs), we explore the fre- quency and characteristics of error-associated ADEs in medical inpatients. Methods: All patients with ADEs or ADE- related hospital admission in a cohort of medi- cal inpatients identified by \\

Beat Hardmeier; Suzanne Braunschweig; Marzia Cavallaro; Malgorzata Roos; Christiane Pauli-Magnus; Max Giger; Peter J. Meier; Karin Fattinger

2004-01-01

284

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

285

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

286

[In-patient education after renal transplantation].  

PubMed

Patients with end-stage renal disease who receive a kidney through transplantation enter a new phase in their illness trajectory. The question emerged which knowledge and skills are essential for a safe self-management immediately after the transplantation. The aim of this project was to develop an evidence-based in-patient education programme for renal transplant recipients. A participative action research approach was chosen. An interprofessional group, led by an advanced practice nurse, initiated the project. Based on a systematic literature review and on qualitative interviews with both patients and experts, an in-patient educational programme was developed and implemented. The main elements of the programme focused on taking medications appropriately and on the observation and interpretation of symptoms. The content of the programme was documented in a brochure for patients. The structure of the programme was documented in a guideline with a standardised procedure. The procedure was based on patients' needs and preferences, and therefore provides tailored education. Besides the support received in gaining relevant knowledge, patients are supported in developing practical skills, problem solving, and decision making. An initial evaluation revealed that patients with cognitive impairment have special needs for education that exceeds what exists in the developed programme. As the programme is revised, additional contents on psychosocial issues will be included and the programme will be planned along the clinical pathway. Furthermore, it should begin during the pre-transplant period and continue in a longterm follow-up. PMID:21964935

Schmid-Mohler, Gabriela; Albiez, Thomas; Schäfer-Keller, Petra; Fehr, Thomas; Biotti, Beatrice; Spirig, Rebecca

2011-10-01

287

Clinical Outcomes of a Specialised Inpatient Unit for Adults with Mild to Severe Intellectual Disability and Mental Illness  

ERIC Educational Resources Information Center

Background: Limitations of general psychiatric services have led to the development of specialised psychiatric programmes for patients with intellectual disability (ID) and mental health needs. Few studies have examined treatment outcomes of specialised inpatient units, and no studies have explored how the effects of intervention may differ for…

Lunsky, Y.; White, S. E.; Palucka, A. M.; Weiss, J.; Bockus, S.; Gofine, T.

2010-01-01

288

Management of personality disorders in acute in-patient settings. Part 2: Less-common personality disorders  

Microsoft Academic Search

Less-common personality disorders affecting patients admitted to in-patient units are discussed in some detail. These disorders are rarely a direct cause of admission, but they are often associated with other Axis I disorders and can therefore be obstacles to successful treatment. A knowledge of the clinical picture and underlying dynamics and an awareness of countertransference feelings that these patients are

Leonard Fagin

2004-01-01

289

Inpatient glycemic control: an evolving paradigm.  

PubMed

In 2001, Van den Berghe et al published a landmark study of intensive insulin therapy in the setting of a surgical intensive care unit (ICU). Increased attention was also focused on the observational evidence indicating that hyperglycemia is associated with increased morbidity and mortality among diverse patient populations. Because of the dramatic reduction in mortality with normalization of glucose levels in the single center, the Van den Berghe study led to widespread adoption of this practice in ICUs worldwide. Hospitals also began to implement rational subcutaneous insulin protocols based on the American Diabetes Association technical review, replacing the ineffective practice of sliding-scale insulin. Logistical challenges have included coordination of multiple hospital departments and achieving multidisciplinary consensus on goals and methods. Subsequent to the initial Van den Berghe study, other multicenter trials have been fraught with an increased frequency of hypoglycemia and have failed to consistently demonstrate improved outcomes with intensive insulin therapy. Hospitals and expert panels are in the process of examining the combined evidence and considering modifying treatment goals. We recommend continued focus on avoiding hyperglycemia with less aggressive glycemic targets in the critically ill and rational subcutaneous insulin in the noncritically ill, avoiding a return to the obsolescence of sliding-scale insulin. PMID:19491537

Yalla, Naga M; Reynolds, L Raymond

2009-05-01

290

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

291

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

292

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

293

Integrating acupuncture in an inpatient setting.  

PubMed

Acupuncture, a licensed health care profession in the United States, is poorly integrated into the American health care system, despite the evidence of its effectiveness. The purpose of this study was to offer a phenomenological description of the experience of acupuncturists who delivered acupuncture care in a tertiary teaching hospital in New York City. We analyzed data using methodology proposed by Colaizzi and identified four major clusters of themes: (a) acupuncturists' excitement about practicing in a hospital setting and frustration about organizational obstacles to effective acupuncture integration; (b) pride in being holistic practitioners; (c) attempts to preserve the holism and effectiveness of acupuncture while adjusting to the limitations of an inpatient setting, and (d) acupuncturists' realization that the medical staff knew very little about acupuncture and "it's all about trust." Practitioners of other healing traditions and therapies might find our study helpful in their own efforts toward similar integration. PMID:25079502

Kielczynska, B Basia; Kligler, Benjamin; Specchio, Eileen

2014-09-01

294

Development and validation of a simple protocol to rapidly determine the performance of biofilters for VOC treatment  

SciTech Connect

A protocol has been developed for the rapid determination of complete elimination characteristics of target pollutants in waste air biofilters. The protocol involves the determination of two pollutant concentration profiles along the height of a three-segment biofilter under carefully chosen conditions. The combination of the data results in 12 points on the elimination capacity vs load curve which is sufficient to fully characterize a system. The protocol conditions were chosen to enable characterization of biofiltration systems with VOC elimination capacities ranging from 20 to 120 g m{sup {minus}3} h{sup {minus}1}. The protocol was then applied to 18 different VOCs, and the results compared well with previously published data, when available. Maximum removal performance of classes of compounds in the biofilter followed the sequence alcohols > esters > ketones >aromatics alkanes. An attempt was made to correlate the pollutant elimination with Henry's coefficient, and the octanol/water partition coefficient and trends were obtained. The results suggest that biodegradation of VOCs in biofilters is influenced both by the pollutant availability and to a lesser extent by the hydrophobicity of the treated compounds.

Deshusses, M.A.; Johnson, C.T.

2000-02-01

295

The Status of Psychiatric Inpatient Group Therapy: Past, Present, and Future  

Microsoft Academic Search

This article examines the history, current conditions, and future possibilities of psychiatric inpatient group psychotherapy. Attention is directed toward exploring the purpose, structure, theoretical perspectives, and empirical research of inpatient group therapy. Trends in inpatient care are contextualized within a historical perspective and current politics of care. Future challenges to the viability of inpatient groups, including fiscal pressures, high patient

Seija Emond; Brian Rasmussen

2012-01-01

296

Detecting back irrelevant responding on the Personality Assessment Inventory in a psychiatric inpatient setting.  

PubMed

The present studies focus on strategies for detecting back irrelevant responding (BIR) on the Personality Assessment Inventory (PAI; L. C. Morey, 1991). Moderate BIR levels can greatly affect the clinical scales of the PAI. Further, the PAI's Inconsistency and Infrequency validity scales are less than optimal for detecting BIR. L. C. Morey and C. J. Hopwood (2004) developed an alternative strategy for detecting BIR that involves comparison of 2 scales from the PAI short-form with the same 2 scales from the PAI full-instrument. The present study examines how different BIR levels affect the clinical, treatment, and interpersonal scales of the PAI in 2 psychiatric inpatient samples. The effectiveness of various strategies for detecting BIR in an inpatient setting is also discussed. Consistent with previous research, moderate rates of BIR impacted several PAI scales in a meaningful way. The Inconsistency and Infrequency validity scales of the PAI were relatively ineffective for detecting low-to-moderate BIR levels. Conversely, the short-form full-instrument comparison strategy was much more sensitive to BIR. Finally, a new BIR detection indicator is presented that improves sensitivity rates for detecting all BIR levels in an acute setting. The implications of these results for detecting BIR in inpatient settings are discussed. PMID:18085939

Siefert, Caleb J; Kehl-Fie, Kendra; Blais, Mark A; Chriki, Lyvia

2007-12-01

297

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

PubMed

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 self-mutilating acts, were assessed for 50 female patients meeting criteria for BPD. Thirty-one patients had participated in a DBT inpatient program, and 19 patients had been placed on a waiting list and received treatment as usual in the community. Post-testing was conducted four months after the initial assessment (i.e. four weeks after discharge for the DBT group). Pre-post-comparison showed significant changes for the DBT group on 10 of 11 psychopathological variables and significant reductions in self-injurious behavior. The waiting list group did not show any significant changes at the four-months point. The DBT group improved significantly more than participants on the waiting list on seven of the nine variables analyzed, including depression, anxiety, interpersonal functioning, social adjustment, global psychopathology and self-mutilation. Analyses based on Jacobson's criteria for clinically relevant change indicated that 42% of those receiving DBT had clinically recovered on a general measure of psychopathology. The data suggest that three months of inpatient DBT treatment is significantly superior to non-specific outpatient treatment. Within a relatively short time frame, improvement was found across a broad range of psychopathological features. Stability of the recovery after one month following discharge, however, was not evaluated and requires further study. PMID:15033496

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

2004-05-01

298

The effects of exercise on oxidative stress (TBARS) and BDNF in severely depressed inpatients.  

PubMed

Exercise can be an effective treatment for depression. Although the efficacy of exercise is well established, little is known concerning the biological changes associated with the antidepressant effects of exercise. A randomized, controlled trial was conducted to evaluate the effects of adding exercise to the usual treatment on the thiobarbituric acid-reactive substances (TBARS) and brain-derived neurotrophic factor (BDNF) serum levels of severely depressed inpatients. Twenty-six participants were randomized to an exercise group (n=15, exercise+treatment as usual) or a control group (n=11, treatment as usual). The participants in the exercise group completed a targeted dose of 16.5 kcal/kg/week of aerobic exercise, three times per week, throughout their hospitalizations. The control group did not exercise during their hospitalizations. The mean hospitalization length was of 21.63 (4.5)×23.82 (5.7) days for exercise and control groups, respectively. The exercise group performed a median of nine sessions. After adjusting for previous tobacco use, a significant group×time interaction was found for TBARS serum levels (p=0.02). A post hoc Bonferroni test revealed differences between the exercise and control groups at discharge. A significant time effect (p<0.001) but no group×time interaction was found (p=0.13) for BDNF serum levels. Adding exercise to the usual treatment of severely depressed inpatients decreases the TBARS serum levels of severely depressed inpatients after 3 weeks. Adding exercise had no additional effects on BDNF serum levels. PMID:24487616

Schuch, Felipe Barreto; Vasconcelos-Moreno, Mirela Paiva; Borowsky, Carolina; Zimmermann, Ana Beatriz; Wollenhaupt-Aguiar, Bianca; Ferrari, Pamela; de Almeida Fleck, Marcelo Pio

2014-10-01

299

Predictors of specialized inpatient admissions for adults with intellectual disability.  

PubMed

Abstract Individuals with intellectual disability (ID) have complex mental health needs and may seek specialized ID psychiatric services. This study reports on predictors of specialized inpatient admissions for 234 individuals with ID who received outpatient services at a psychiatric hospital. Overall, from 2007-2012, 55 of the 234 outpatients were triaged into the specialized inpatient unit. Aggression towards others and psychotropic polypharmacy significantly predicted these admissions. Unlike previous research, schizophrenia and level of ID did not predict admissions, suggesting that these factors may have a differential impact in specialized versus mainstream inpatient services. Findings are discussed in relation to how specialized inpatient units can be most responsive to these vulnerable patients and the factors that may impact clinical decision making. PMID:25551266

Modi, Miti; McMorris, Carly; Palucka, Anna; Raina, Poonam; Lunsky, Yona

2015-01-01

300

42 CFR 409.83 - Inpatient hospital coinsurance.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 false Inpatient hospital coinsurance. 409.83 Section...MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Hospital Insurance Deductibles and...

2010-10-01

301

42 CFR 409.82 - Inpatient hospital deductible.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 false Inpatient hospital deductible. 409.82 Section...MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Hospital Insurance Deductibles and...

2010-10-01

302

Modeling neuroscience patient flow and inpatient bed management  

E-print Network

Massachusetts General Hospital (MGH) experiences consistently high demand for its more than 900 inpatient beds. On an average weekday, the hospital admits about 220 patients, with the emergency department (ED) and the ...

Hiltrop, Jonas

2014-01-01

303

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

304

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

PubMed Central

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

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

2013-01-01

305

Inpatient management of women with gestational and pregestational diabetes in pregnancy.  

PubMed

For women with type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM), poor maternal glycemic control can significantly increase maternal and fetal risk for adverse outcomes. Outpatient medical and nutrition therapy is recommended for all women with diabetes in order to facilitate euglycemia during the antepartum period. Despite intensive outpatient therapy, women with diabetes often require inpatient diabetes management prior to delivery as maternal hyperglycemia can significantly increase neonatal risk of hypoglycemia. Consensus guidelines recommend maternal glucose range of 80-110 mg/dL in labor. The most optimal inpatient strategies for the prevention of hyperglycemia and hypoglycemia proximate to delivery remain unclear and will depend upon factors such as maternal diabetes diagnosis, her baseline insulin resistance, duration and route of delivery etc. Low dose intravenous insulin and dextrose protocols are necessary to achieve optimal predelivery glycemic control for women with T1DM and T2DM. For most with GDM however, euglycemia can be maintained without intravenous insulin. Women treated with a subcutaneous insulin pump during the antepartum period represent a unique challenge to labor and delivery staff. Strategies for self-managed subcutaneous insulin infusion (CSII) use prior to delivery require intensive education and coordination of care with the labor team in order to maintain patient safety. Hospitalization is recommended for most women with diabetes prior to delivery and in the postpartum period despite appropriate outpatient glycemic control. Women with poorly controlled diabetes in any trimester have an increased baseline maternal and fetal risk for adverse outcomes. Common indications for antepartum hospitalization of these women include failed outpatient therapy and/or diabetic ketoacidosis (DKA). Inpatient management of DKA is a significant cause of maternal and fetal morbidity and remains a common indication for hospitalization of the pregnant woman with diabetes. Changes in maternal physiology increase insulin resistance and the risk for DKA. A systematic approach to its management will be reviewed. PMID:24414141

Garrison, Etoi A; Jagasia, Shubhada

2014-02-01

306

Socioeconomic Disparity in Inpatient Mortality Following Traumatic Injury in Adults  

PubMed Central

Background Prior studies have demonstrated that race and insurance status predict inpatient trauma mortality, but have been limited by their inability to adjust for direct measures of socioeconomic status (SES) and comorbidities. Our study aims to identify whether a relationship exists between SES and inpatient trauma mortality, after adjusting for known confounders. Methods Trauma patients aged 18–65 years with Injury Severity Scores (ISS) ? 9 were identified using the 2003–2009 Nationwide Inpatient Sample. Median household income (MHI) by zip code, available by quartiles, was used to measure SES. Multiple logistic regression analyses were performed to determine odds of inpatient mortality by MHI quartile, adjusting for ISS, type of injury, comorbidities, and patient demographics. Results 267,621 patients met inclusion criteria. Patients in lower wealth quartiles had significantly higher unadjusted inpatient mortality compared with the wealthiest quartile. Adjusted odds of death were also higher compared with the wealthiest quartile for Q1 (OR 1.13, 95% CI 1.06–1.20), Q2 (OR 1.09, 95% CI 1.02–1.17), and Q3 (OR 1.11, 95% CI 1.04–1.19). Conclusions Median household income predicts inpatient mortality after adult trauma, even after adjusting for race, insurance status, and comorbidities. Efforts to mitigate trauma disparities should address SES as an independent predictor of outcomes. PMID:23972652

Ali, Mays T.; Hui, Xuan; Hashmi, Zain G.; Dhiman, Nitasha; Scott, Valerie K.; Efron, David; Schneider, Eric B.; Haider, Adil H.

2013-01-01

307

Two RFID-based solutions for secure inpatient medication administration.  

PubMed

Medication error can easily cause serious health damage to inpatients in hospital. Consequently, the whole society has to spend huge amount of extra resources for additional therapies and medication on those affected inpatients. In order to prevent medication errors, secure inpatient medication administration system is required in a hospital. Using RFID technology, such administration system provides automated medication verification for inpatient's medicine doses and generates corresponding medication evidence, which may be audited later for medical dispute. Recently, Peris-Lopez et al. (Int. J. Med. Inform., 2011) proposed an IS-RFID system to enhance inpatient medication safety. Nevertheless, IS-RFID system does not detect the denial of proof attack efficiently and the generated medication evidence cannot defend against counterfeit evidence generated from the hospital. That is, the hospital possesses enough privilege from the design of IS-RFID system to modify generated medication evidence whenever it is necessary. Hence, we design two lightweight RFID-based solutions for secure inpatient medication administration, one for online verification environment and the other for offline validation situation, to achieve system security on evidence generation and provide early detection on denial of proof attack. PMID:21732130

Yen, Yi-Chung; Lo, Nai-Wei; Wu, Tzong-Chen

2012-10-01

308

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

309

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

310

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

PubMed Central

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

2013-01-01

311

Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting.  

PubMed

To examine the effectiveness of dialectical behavior therapy for inpatients with borderline personality disorder (BPD), small sample sizes and, predominantly, tests of statistical significance have been used so far. We studied 1423 consecutively admitted individuals with BPD, who were seeking a 3-month inpatient treatment. They completed the Borderline Symptom List (BSL) as the main outcome measure, and other self-rating measures at pre- and post-treatment. Therapy outcome was defined in three ways: effect size (ES), response based on the reliable change index, and remission compared to the general population symptom level. Non-parametric conditional inference trees were used to predict dropouts. In the pre-post comparison of the BSL, the ES was 0.54 (95% CI: 0.49-0.59). The response rate was 45%; 31% remained unchanged, and 11% deteriorated. Approximately 15% showed a symptom level equivalent to that of the general population. A further 10% of participants dropped out. A predictive impact on dropout was demonstrated by substance use disorders and a younger age at pre-treatment. In future research, follow-up assessments should be conducted to investigate the extent to which response and remission rates at post-treatment remain stable over time. A consistent definition of response appears to be essential for cross-study and cross-methodological comparisons. PMID:23727659

Kröger, Christoph; Harbeck, Susanne; Armbrust, Michael; Kliem, Sören

2013-08-01

312

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

313

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

314

Assessing the impact of group treatment for aggressive inpatients  

Microsoft Academic Search

The purpose of this research was to determine if psychodynamic group psychotherapy decreases the occurrence of physical assault by male group members. The design of the study was a randomized clinical trial. Patients assigned to the control group received the customary clinical care. Patients assigned to the Group Therapy attended a psychodynamic psychotherapy group to help them cope with their

Marilyn Lewis Lanza; Helene Satz; James Stone; Herbert L. Kayne

1995-01-01

315

Inpatient Treatment for Children and Adolescents with Substance Abuse Issues  

E-print Network

of the articles found in the extensive review. The empirically based studies conveyed support for intense and structured milieu-based interventions (individual therapy, family therapy, group therapy, utilization of the AA/NA model, and aftercare services). Trained...

Oelklaus, Kirsten; Petr, Chris

2001-11-01

316

Evidence-Based Complementary and Alternative Medicine in Inpatient Care: Take a Look at Europe.  

PubMed

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

Romeyke, Tobias; Stummer, Harald

2014-11-17

317

Situational determinants of inpatient self-harm.  

PubMed

Auto-aggressive individuals have a higher likelihood of engaging in interpersonal violence, and vice versa. It is unclear, however, whether ward circumstances are involved in determining whether aggression-prone patients will engage in auto-aggressive or outwardly directed aggressive behavior. The current study focuses on the situational antecedents of self-harming behavior and outwardly directed aggression of psychiatric inpatients. Inwardly and outwardly aggressive behavior were monitored on a locked 20-bed psychiatric admissions ward for 3.5 years with the Staff Observation Aggression Scale-Revised (SOAS-R). A map of the ward was attached to each SOAS-R form, enabling staff members to specify locations of aggressive incidents. Time of onset, location, and provoking factors of auto-aggressive incidents were compared to those connected to aggression against others or objects. Of a total of 774 aggressive incidents, 154 (20%) concerned auto-aggressive behavior. Auto-aggression was significantly more prevalent during the evening (i.e., 50% compared to 32%), and reached its highest level between 8 and 9 P.M. (17% compared to 7%). The majority of self-harming acts (66%) were performed on patients' bedrooms. Outwardly directed aggression was particularly common in the day-rooms (24%), the staff office (19%), the hallways of the ward (14%), and the dining rooms (10%). Provoking factors of auto-aggressive behavior are less often of an interactional nature compared to outwardly directed aggression. The results suggest that a lack of stimulation and interaction with others increases the risk of self-injurious behavior. Practical and testable measures to prevent self-harm are proposed. PMID:12079033

Nijman, Henk L I; à Campo, Joost M L G

2002-01-01

318

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

PubMed Central

Background Depressive disorders are the most common form of mental disorders in community and health care settings. Unfortunately, the treatment of Major Depressive Disorder (MDD) is far from satisfactory. Vagus nerve stimulation (VNS) is a relatively new and promising physical treatment for depressive disorders. One particularly appealing element of VNS is the long-term benefit in mood regulation. However, because this intervention involves surgery, perioperative risks, and potentially significant side effects, this treatment has been limited to those patients with treatment-resistant depression who have failed medication trials and exhausted established somatic treatments for major depression, due to intolerance or lack of response. This double-blinded randomized clinical trial aims to overcome these limitations by introducing a novel method of stimulating superficial branches of the vagus nerve on the ear to treat MDD. The rationale is that direct stimulation of the afferent nerve fibers on the ear area with afferent vagus nerve distribution should produce a similar effect as classic VNS in reducing depressive symptoms without the burden of surgical intervention. Design One hundred twenty cases (60 males) of volunteer patients with mild and moderate depression will be randomly divided into transcutaneous vagus nerve stimulation group (tVNS) and sham tVNS group. The treatment period lasts 4 months and all clinical and physiological measurements are acquired at the beginning and the end of the treatment period. Discussion This study has the potential to significantly extend the application of VNS treatment for MDD and other disorders (including epilepsy, bipolar disorder, and morbid obesity), resulting in direct benefit to the patients suffering from these highly prevalent disorders. In addition, the results of this double-blinded clinical trial will shed new light on our understanding of acupuncture point specificity, and development of methodologies in clinical trials of acupuncture treatment. Trials registration Clinical Trials. ChiCTR-TRC-11001201 http://www.chictr.org/cn/ PMID:23241431

2012-01-01

319

42 CFR 483.360 - Consultation with treatment team physician.  

Code of Federal Regulations, 2010 CFR

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

2010-10-01

320

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

Code of Federal Regulations, 2010 CFR

...payment system for inpatient hospital services of psychiatric...MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Services of...

2010-10-01

321

Accounting for the transition from inpatient to outpatient surgery.  

PubMed

This article reports on some of the factors that have advanced and impeded hospital progress in moving from inpatient to outpatient surgery. Early on, patients, physicians, and hospital administrators all agreed that outpatient surgery had an intuitive appeal. Patients liked it because they didn't have to go in the hospital. Physicians liked it because they could get in and out of the outpatient surgery center more easily than the main hospital operating room. Administrators recognized the inherent appeal of outpatient procedures but were unable or unwilling to switch services from inpatient to outpatient for a variety of reasons. First, empty hospital beds and diminished scope of inpatient operations are a threat to the power of administrators. Moving surgery from inpatient to outpatient settings reduces inhouse operations. Second, reimbursement incentives were definitely in favor of continued inpatient care long after technology was in place for outpatient care. The third and most critical reason was that cost data on outpatient operations were just not available for making decisions on when to move into the outpatient setting. This review of the literature was intended to document the lack of relevant cost-based accounting. Instead, many other factors that more directly slowed progress were encountered. More than anything, this illustrates the erratic course of progress in health care reform. PMID:10172630

Welsh, F

1995-06-01

322

Training parents to implement pediatric feeding protocols  

Microsoft Academic Search

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

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

2003-01-01

323

Efficacy of manual therapy treatments for people with cervicogenic dizziness and pain: protocol of a randomised controlled trial  

PubMed Central

Background Cervicogenic dizziness is a disabling condition characterised by postural unsteadiness that is aggravated by cervical spine movements and associated with a painful and/or stiff neck. Two manual therapy treatments (Mulligan’s Sustained Natural Apophyseal Glides (SNAGs) and Maitland’s passive joint mobilisations) are used by physiotherapists to treat this condition but there is little evidence from randomised controlled trials to support their use. The aim of this study is to conduct a randomised controlled trial to compare these two forms of manual therapy (Mulligan glides and Maitland mobilisations) to each other and to a placebo in reducing symptoms of cervicogenic dizziness in the longer term and to conduct an economic evaluation of the interventions. Methods Participants with symptoms of dizziness described as imbalance, together with a painful and/or stiff neck will be recruited via media releases, advertisements and mail-outs to medical practitioners in the Hunter region of NSW, Australia. Potential participants will be screened by a physiotherapist and a neurologist to rule out other causes of their dizziness. Once diagnosed with cervciogenic dizziness, 90 participants will be randomly allocated to one of three groups: Maitland mobilisations plus range-of-motion exercises, Mulligan SNAGs plus self-SNAG exercises or placebo. Participants will receive two to six treatments over six weeks. The trial will have unblinded treatment but blinded outcome assessments. Assessments will occur at baseline, post-treatment, six weeks, 12 weeks, six months and 12 months post treatment. The primary outcome will be intensity of dizziness. Other outcome measures will be frequency of dizziness, disability, intensity of cervical pain, cervical range of motion, balance, head repositioning, adverse effects and treatment satisfaction. Economic outcomes will also be collected. Discussion This paper describes the methods for a randomised controlled trial to evaluate the effectiveness of two manual therapy techniques in the treatment of people with cervicogenic dizziness for which there is limited established evidence-based treatment. Trial registration ACTRN12611000073909 PMID:23078200

2012-01-01

324

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

PubMed Central

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

2013-01-01

325

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

326

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

327

Preventable inpatient time: adequacy of electronic patient information systems.  

PubMed Central

OBJECTIVES: This study assessed hospital electronic patient information systems (EPIS) for inclusion of variables associated with avoidable and extended hospitalization (preventable inpatient time). METHODS: We searched MEDLINE and HealthSTAR databases to identify predictors of preventable inpatient time. We then audited the admissions process and the handwritten medical record at 1 hospital, and the EPIS at all hospitals, affiliated with the Yale University School of Medicine for inclusion of the predictors. RESULTS: Whereas the written medical record included all 58 predictors, the EPIS of the 10 hospitals surveyed included an average of only 38% of the predictors. CONCLUSIONS: The conventional approach to information gathering during hospital admission is highly inefficient. Revising EPIS to include predictors of preventable inpatient time could enhance efficiency and quality, while reducing costs, of hospital care. PMID:10589326

Katz, D L; Mazhari, R; Kalus, R; Nawaz, H

1999-01-01

328

Oral flucloxacillin and phenoxymethylpenicillin versus flucloxacillin alone for the emergency department outpatient treatment of cellulitis: study protocol for a randomised controlled trial  

PubMed Central

Background Oral flucloxacillin, either alone or in combination with phenoxymethylpenicillin, is a commonly prescribed antibiotic for the treatment of cellulitis, particularly in Ireland and the United Kingdom. This study aims to establish the non-inferiority of oral monotherapy (flucloxacillin alone) to dual therapy (flucloxacillin and phenoxymethylpenicillin) for the outpatient treatment of cellulitis in adults. Methods/design This study is a multicentre, randomised, double-blind, placebo-controlled trial of adults who present to the emergency department (ED) with cellulitis that is deemed treatable on an outpatient basis with oral antibiotics. After fulfilling specified inclusion and exclusion criteria, informed consent will be taken. Patients will be given a treatment pack containing 7 days of treatment with flucloxacillin 500 mg four times daily and placebo or flucloxacillin 500 mg four times daily and phenoxymethylpenicillin 500 mg four times daily. The primary outcome measure under study is the proportion of patients in each group in which there is greater than or equal to a 50% reduction in the area of diameter of infection from the area measured at enrolment at the end-of-treatment visit (7 to 10 days). Secondary endpoints include a health-related quality of life measurement as rated by the SF-36 score and the Extremity Soft Tissue Infection Score (not validated), compliance and adverse events. Patients will be followed up by telephone call at 3 days, end-of-treatment visit (EOT) at 7 to 10 days and test-of-cure (TOC) visit at 30 days. To achieve 90% power, a sample size of 172 patients per treatment arm is needed. This assumes a treatment success rate of 85% with oral flucloxacillin and phenoxymethylpenicillin, an equivalence threshold ? = 12.5% and an ? = 0.025. Non-inferiority will be assessed using a one-sided confidence interval on the difference of proportions between the two groups. Standard analysis including per-protocol and intention-to-treat will be performed. Discussion This trial aims to establish the non-inferiority of flucloxacillin monotherapy to dual therapy in the treatment of uncomplicated cellulitis among ED patients. In doing so, this trial will bridge a knowledge gap in this understudied and common condition and will be relevant to clinicians across several different disciplines. Trial registration EudraCT Number 2008-006151-42 PMID:23732051

2013-01-01

329

Can virtual nature improve patient experiences and memories of dental treatment? A study protocol for a randomized controlled trial  

PubMed Central

Background Dental anxiety and anxiety-related avoidance of dental care create significant problems for patients and the dental profession. Distraction interventions are used in daily medical practice to help patients cope with unpleasant procedures. There is evidence that exposure to natural scenery is beneficial for patients and that the use of virtual reality (VR) distraction is more effective than other distraction interventions, such as watching television. The main aim of this randomized controlled trial is to determine whether the use of VR during dental treatment can improve the overall dental experience and recollections of treatment for patients, breaking the negative cycle of memories of anxiety leading to further anxiety, and avoidance of future dental appointments. Additionally, the aim is to test whether VR benefits dental patients with all levels of dental anxiety or whether it could be especially beneficial for patients suffering from higher levels of dental anxiety. The third aim is to test whether the content of the VR distraction can make a difference for its effectiveness by comparing two types of virtual environments, a natural environment and an urban environment. Methods/design The effectiveness of VR distraction will be examined in patients 18 years or older who are scheduled to undergo dental treatment for fillings and/or extractions, with a maximum length of 30 minutes. Patients will be randomly allocated into one of three groups. The first group will be exposed to a VR of a natural environment. The second group will be exposed to a VR of an urban environment. A third group consists of patients who receive standard care (control group). Primary outcomes relate to patients’ memories of the dental treatment one week after treatment: (a) remembered pain, (b) intrusive thoughts and (c) vividness of memories. Other measures of interest are the dental experience, the treatment experience and the VR experience. Trial registration Current Controlled Trials ISRCTN41442806 PMID:24655569

2014-01-01

330

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

331

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

332

42 CFR 456.101 - UR plan required for inpatient hospital services.  

Code of Federal Regulations, 2010 CFR

...plan required for inpatient hospital services. 456.101 Section...MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...CONTROL Utilization Control: Hospitals Utilization Review (ur...plan required for inpatient hospital services. (a) A...

2010-10-01

333

42 CFR 412.509 - Furnishing of inpatient hospital services directly or under arrangement.  

Code of Federal Regulations, 2010 CFR

... Furnishing of inpatient hospital services directly or under...MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.509...

2010-10-01

334

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

Code of Federal Regulations, 2013 CFR

...PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES...Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient Operating Costs...The rules applicable to new hospitals are set forth...

2013-10-01

335

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

...psychiatric facility's payment is based on the 1997-based...psychiatric facility's payment is based on the 2002-based...inpatient prospective payment system regulations. (f...charge ratio to— (1) New inpatient...

2014-10-01

336

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

Code of Federal Regulations, 2010 CFR

...psychiatric facility's payment is based on the 1997-based...psychiatric facility's payment is based on the 2002-based...inpatient prospective payment system regulations. (f...charge ratio to— (1) New inpatient...

2010-10-01

337

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

Code of Federal Regulations, 2012 CFR

...psychiatric facility's payment is based on the 1997-based...psychiatric facility's payment is based on the 2002-based...inpatient prospective payment system regulations. (f...charge ratio to— (1) New inpatient...

2012-10-01

338

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

Code of Federal Regulations, 2011 CFR

...psychiatric facility's payment is based on the 1997-based...psychiatric facility's payment is based on the 2002-based...inpatient prospective payment system regulations. (f...charge ratio to— (1) New inpatient...

2011-10-01

339

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

Code of Federal Regulations, 2013 CFR

...psychiatric facility's payment is based on the 1997-based...psychiatric facility's payment is based on the 2002-based...inpatient prospective payment system regulations. (f...charge ratio to— (1) New inpatient...

2013-10-01

340

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

...PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES...Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient Operating Costs...The rules applicable to new hospitals are set forth...

2014-10-01

341

78 FR 50495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care; Hospital Prospective Payment System and Fiscal...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital...

2013-08-19

342

76 FR 51475 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and FY 2012...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital...

2011-08-18

343

76 FR 25787 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital...

2011-05-05

344

77 FR 53257 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital...

2012-08-31

345

75 FR 78901 - Payment for Inpatient and Outpatient Health Care Professional Services at Non-Departmental...  

Federal Register 2010, 2011, 2012, 2013

...Payment for Inpatient and Outpatient Health Care Professional Services at Non-Departmental...Charges Associated With Non-VA Outpatient Care AGENCY: Department of Veterans Affairs...payments for inpatient and outpatient health care professional services and other...

2010-12-17

346

78 FR 27485 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital...

2013-05-10

347

75 FR 7218 - Payment for Inpatient and Outpatient Health Care Professional Services at Non-Departmental...  

Federal Register 2010, 2011, 2012, 2013

...Payment for Inpatient and Outpatient Health Care Professional Services at Non-Departmental...Charges Associated With Non-VA Outpatient Care AGENCY: Department of Veterans Affairs...payments for inpatient and outpatient health care professional services and other...

2010-02-18

348

77 FR 27869 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital...

2012-05-11

349

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

...payment rate for inpatient operating costs and a regional prospective payment rate for inpatient operating costs for each region, as follows...that are attributable to wages and labor-related costs, for area differences in...

2014-10-01

350

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

Code of Federal Regulations, 2010 CFR

...payment rate for inpatient operating costs and a regional prospective payment rate for inpatient operating costs for each region, as follows...that are attributable to wages and labor-related costs, for area differences in...

2010-10-01

351

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

Code of Federal Regulations, 2011 CFR

...payment rate for inpatient operating costs and a regional prospective payment rate for inpatient operating costs for each region, as follows...that are attributable to wages and labor-related costs, for area differences in...

2011-10-01

352

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

Code of Federal Regulations, 2013 CFR

...payment rate for inpatient operating costs and a regional prospective payment rate for inpatient operating costs for each region, as follows...that are attributable to wages and labor-related costs, for area differences in...

2013-10-01

353

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

Code of Federal Regulations, 2012 CFR

...payment rate for inpatient operating costs and a regional prospective payment rate for inpatient operating costs for each region, as follows...that are attributable to wages and labor-related costs, for area differences in...

2012-10-01

354

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

Code of Federal Regulations, 2012 CFR

...false Limits on inpatient hospital and physician charges. 890.905 Section 890.905 Administrative...HEALTH BENEFITS PROGRAM Limit on Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments § 890.905...

2012-01-01

355

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

...false Limits on inpatient hospital and physician charges. 890.905 Section 890.905 Administrative...HEALTH BENEFITS PROGRAM Limit on Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments § 890.905...

2014-01-01

356

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

Code of Federal Regulations, 2013 CFR

...false Limits on inpatient hospital and physician charges. 890.905 Section 890.905 Administrative...HEALTH BENEFITS PROGRAM Limit on Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments § 890.905...

2013-01-01

357

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

Code of Federal Regulations, 2011 CFR

...false Limits on inpatient hospital and physician charges. 890.905 Section 890.905 Administrative...HEALTH BENEFITS PROGRAM Limit on Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments § 890.905...

2011-01-01

358

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

Federal Register 2010, 2011, 2012, 2013

...0938-AQ55 Medicare Program; Hospital Inpatient Value-Based Purchasing Program; Correction...Medicare Program; Hospital Inpatient Value-Based Purchasing Program.'' DATES...typographical errors with the numerical values expressed in Tables 5 and 7,...

2011-07-05

359

Pain management among medical in-patients in Blantyre, Malawi  

PubMed Central

Background Pain is a leading symptom which influences patients to seek medical attention. The management of pain among patients attending in-patient care in southern African countries has been little described. Information regarding the prevalence of pain and the quality of its management may be useful in guiding clinical decisions, training of health workers and health care quality improvements. Methods A hospital-based audit was conducted to estimate the prevalence of pain and examine the quality of its management among patients admitted to adult medical wards at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi in 2004. Data were abstracted from ward charts of consecutive patients' who had been either been discharged or had died within a specified period. Characteristics of interest included; socio-demographic data, presence or absence of pain at admission, characterization or description of pain when present, and drug treatment given. Data were analyzed to obtain frequencies and proportions of the characteristics and assess the prevalence of pain and quality of care. Results A total of 121 patients' case notes were reviewed and the prevalence of pain was recorded for 91 (75.2%) of the patients. Clinicians had recorded pertinent information regarding pain management with the following frequency: pain severity or intensity 5/91 (5.5%), alleviating factors 5 (5.5%), pain radiation 7 (7.7%), exacerbating factors in 9 (9.9%) and periodicity in 43 (47.3%) of the cases. Males with pain were more than 3 times more likely to receive analgesic as compared to females, p < 0.01. Paracetamol was the commonest analgesic prescribed. Conclusion Inadequate management of pain among patients attending medical wards at QECH was found. There is need for prospective studies to further characterize pain management and identify pain management gaps in Malawi. Interviews of clinicians and documentation of observations within clinical practice are likely to be of value. PMID:19323817

Muula, Adamson S; Misiri, Humphreys E

2009-01-01

360

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

361

Inpatient falls: the impact of family and personal caregivers.  

PubMed

The impact of family and personal caregivers on inpatients with fall-related injuries in a Taiwanese medical center is investigated in this study. Taiwan has a prevalent custom for families to accompany their hospitalized loved ones during hospital stays. During the 95-day data collection period, 228 falls occurred. Results showed that if no family members were present when a patient fell, the fall-related injury was less serious. Nurses in Taiwan tend to depend on family members to help provide patient care. Regardless of whether an inpatient has a family member present, frequent bedside nursing visits are important to prevent falls. PMID:19616163

Tzeng, Huey-Ming; Yin, Chang-Yi

2009-08-01

362

Private in-patient psychiatry in the USA  

PubMed Central

The US healthcare system is in the midst of major changes driven by four forces: the growing consensus in the country that the current system is financially unsustainable; managed care and parity legislation; the Affordable Care Act 2010; and the ageing of the ‘baby boomer’ generation. How these forces will combine and interact is unclear. The current state of in-patient psychiatric care and trends affecting the private practice of in-patient psychiatry over the next few years will be described. PMID:25285222

Russakoff, L. Mark

2014-01-01

363

Local pressure protocol, including Meniett, in the treatment of Ménière's disease: short-term results during the active stage.  

PubMed

Treatment of Ménière's disease (MD) is still controversial and pressure changes transmitted to the inner ear have been reported to have effects similar to those of other non-surgical therapies. This paper reports on a clinical trial of MD patients which has been carried out using a portable piece of equipment, called Meniett, which delivers a pulsed, controlled, positive pressure to the middle ear, provided that a ventilation tube (VT) has previously been inserted. A comparison was made of the number of vertigo spells during the 2 months before treatment and during the 40-day treatment period. In addition, within this latter period a comparison was made between use of VT and use of VT + Meniett. Use of VT only had a positive effect in 90% of patients, with either absence (n = 10: 50%) or marked reduction (n = 8; 40%) in episodes of vertigo. When Meniett was also applied, stabilization of the positive effect on vertigo was registered, with a concomitant improvement in hearing threshold in 2 patients (10%). Although a longer and more reliable long-term follow-up of this treatment is needed, it is possible to propose the use of this therapeutic approach as it has been proven to induce a dramatic improvement in the symptoms affecting patients with Ménière's disease during reactivation of the disease. PMID:11813899

Barbara, M; Consagra, C; Monini, S; Nostro, G; Harguindey, A; Vestri, A; Filipo, R

2001-12-01

364

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

Microsoft Academic Search

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

Kim L Bennell; Thorlene Egerton; Yong-Hao Pua; J Haxby Abbott; Kevin Sims; Ben Metcalf; Fiona McManus; Tim V Wrigley; Andrew Forbes; Anthony Harris; Rachelle Buchbinder

2010-01-01

365

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

366

Clinical course, costs and predictive factors for response to treatment in carpal tunnel syndrome: the PALMS study protocol  

PubMed Central

Background Carpal tunnel syndrome (CTS) is the most common neuropathy of the upper limb and a significant contributor to hand functional impairment and disability. Effective treatment options include conservative and surgical interventions, however it is not possible at present to predict the outcome of treatment. The primary aim of this study is to identify which baseline clinical factors predict a good outcome from conservative treatment (by injection) or surgery in patients diagnosed with carpal tunnel syndrome. Secondary aims are to describe the clinical course and progression of CTS, and to describe and predict the UK cost of CTS to the individual, National Health Service (NHS) and society over a two year period. Methods/Design In this prospective observational cohort study patients presenting with clinical signs and symptoms typical of CTS and in whom the diagnosis is confirmed by nerve conduction studies are invited to participate. Data on putative predictive factors are collected at baseline and follow-up through patient questionnaires and include standardised measures of symptom severity, hand function, psychological and physical health, comorbidity and quality of life. Resource use and cost over the 2 year period such as prescribed medications, NHS and private healthcare contacts are also collected through patient self-report at 6, 12, 18 and 24 months. The primary outcome used to classify treatment success or failures will be a 5-point global assessment of change. Secondary outcomes include changes in clinical symptoms, functioning, psychological health, quality of life and resource use. A multivariable model of factors which predict outcome and cost will be developed. Discussion This prospective cohort study will provide important data on the clinical course and UK costs of CTS over a two-year period and begin to identify predictive factors for treatment success from conservative and surgical interventions. PMID:24507749

2014-01-01

367

Cellular versus acellular matrix devices in treatment of diabetic foot ulcers: study protocol for a comparative efficacy randomized controlled trial  

PubMed Central

Background Diabetic foot ulcers (DFUs) represent a significant source of morbidity and an enormous financial burden. Standard care for DFUs involves systemic glucose control, ensuring adequate perfusion, debridement of nonviable tissue, off-loading, control of infection, local wound care and patient education, all administered by a multidisciplinary team. Unfortunately, even with the best standard of care (SOC) available, only 24% or 30% of DFUs will heal at weeks 12 or 20, respectively. The extracellular matrix (ECM) in DFUs is abnormal and its impairment has been proposed as a key target for new therapeutic devices. These devices intend to replace the aberrant ECM by implanting a matrix, either devoid of cells or enhanced with fibroblasts, keratinocytes or both as well as various growth factors. These new bioengineered skin substitutes are proposed to encourage angiogenesis and in-growth of new tissue, and to utilize living cells to generate cytokines needed for wound repair. To date, the efficacy of bioengineered ECM containing live cellular elements for improving healing above that of a SOC control group has not been compared with the efficacy of an ECM devoid of cells relative to the same SOC. Our hypothesis is that there is no difference in the improved healing effected by either of these two product types relative to SOC. Methods/Design To test this hypothesis we propose a randomized, single-blind, clinical trial with three arms: SOC, SOC plus Dermagraft® (bioengineered ECM containing living fibroblasts) and SOC plus Oasis® (ECM devoid of living cells) in patients with nonhealing DFUs. The primary outcome is the percentage of subjects that achieved complete wound closure by week 12. Discussion If our hypothesis is correct, then immense cost savings could be realized by using the orders-of-magnitude less expensive acellular ECM device without compromising patient health outcomes. The article describes the protocol proposed to test our hypothesis. Trial registration ClinicalTrials.gov: NCT01450943. Registered: 7 October 2011 PMID:23298410

2013-01-01

368

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

369

Treatment of specific phobias with Eye Movement Desensitization and Reprocessing (EMDR): protocol, empirical status, and conceptual issues.  

PubMed

This paper considers the current empirical status of Eye Movement Desensitization and Reprocessing (EMDR) as a treatment method for specific phobias, along with some conceptual and practical issues in relation to its use. Both uncontrolled and controlled studies on the application of EMDR with specific phobias demonstrate that EMDR can produce significant improvements within a limited number of sessions. With regard to the treatment of childhood spider phobia, EMDR has been found to be more effective than a placebo control condition, but less effective than exposure in vivo. The empirical support for EMDR with specific phobias is still meagre, therefore, one should remain cautious. However, given that there is insufficient research to validate any method for complex or trauma related phobias, that EMDR is a time-limited procedure, and that it can be used in cases for which an exposure in vivo approach is difficult to administer, the application of EMDR with specific phobias merits further clinical and research attention. PMID:10225501

De Jongh, A; Ten Broeke, E; Renssen, M R

1999-01-01

370

COMPLIANCE WITH AFTERCARE TREATMENT, INCLUDING DISULFIRAM, AND EFFECT ON OUTCOME IN ALCOHOL-DEPENDENT PATIENTS  

Microsoft Academic Search

Aim: To delineate the features of treatment compliance which predicted outcome during aftercare treatment in a series of patients that completed an inpatient program at the Lisbon Regional Alcohology Centre (CRAS). Methods: Seventy-four alcohol dependent patients, sequentially admitted to the inpatient treatment of CRAS, were followed over 6 months after discharge. This study focused on the predictive value of the

DOMINGOS NETO; R ITA LAMBAZ; AO EDUARDO TAVARES

371

Protocol Building Blocks Protocol Design  

E-print Network

­? 'a) ­? 'a end (* sig *) + 6 #12; + + Non­Standard Protocol Stacks Fast TCP over Ethernet structure; + + Standard TCP/IP Protocol Stack device/OS device driver Ethernet IP TCP Application structure Dev = Ethernet Dev = Ethernetâ??Device (...) structure Eth = Eth (structure Dev = Dev) structure Tcp = Tcp (structure

Biagioni, Edoardo S.

372

Efficacy of three treatment protocols for adolescents with social anxiety disorder: A 5-year follow-up assessment  

Microsoft Academic Search

Few studies have reported long-term follow-up data in adults and even fewer in adolescents. The purpose of this work is to report on the longest follow-up assessment in the literature on treatments for adolescents with social phobia. A 5-year follow-up assessment was conducted with subjects who originally received either Cognitive Behavioral Group Therapy for Adolescents (CBGT-A), Social Effectiveness Therapy for

Luis-Joaquin Garcia-Lopez; Jose Olivares; Deborah Beidel; Anne-Marie Albano; Samuel Turner; Ana I. Rosa

2006-01-01

373

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.

374

The DOMUS study protocol: a randomized clinical trial of accelerated transition from oncological treatment to specialized palliative care at home  

PubMed Central

Background The focus of Specialized Palliative Care (SPC) is to improve care for patients with incurable diseases and their families, which includes the opportunity to make their own choice of place of care and ultimately place of death. The Danish Palliative Care Trial (DOMUS) aims to investigate whether an accelerated transition process from oncological treatment to continuing SPC at home for patients with incurable cancer results in more patients reaching their preferred place of care and death. The SPC in this trial is enriched with a manualized psychological intervention. Methods/Design DOMUS is a controlled randomized clinical trial with a balanced parallel-group randomization (1:1). The planned sample size is 340 in- and outpatients treated at the Department of Oncology at Copenhagen University Hospital. Patients are randomly assigned either to: a) standard care plus SPC enriched with a standardized psychological intervention for patients and caregivers at home or b) standard care alone. Inclusion criteria are incurable cancer with no or limited antineoplastic treatment options. Discussion Programs that facilitate transition from hospital treatment to SPC at home for patients with incurable cancer can be a powerful tool to improve patients’ quality of life and support family/caregivers during the disease trajectory. The present study offers a model for achieving optimal delivery of palliative care in the patient’s preferred place of care and attempt to clarify challenges. Trial registration Clinicaltrials.gov Identifier: NCT01885637 PMID:25242890

2014-01-01

375

An Evaluation of the "Treatment Integrity Planning Protocol" and Two Schedules of Treatment Integrity Self-Report: Impact on Implementation and Report Accuracy  

ERIC Educational Resources Information Center

The evidence-based practice movement has focused on identifying, disseminating, and promoting the adoption of evidence-based interventions. Despite advances in this movement, numerous barriers, such as the lack of treatment integrity assessment methods, remain as challenges in implementation. Accurate teacher self-report could be an efficient…

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

2011-01-01

376

Virtual reality exposure therapy as treatment for pain catastrophizing in fibromyalgia patients: proof-of-concept study (Study Protocol)  

PubMed Central

Background Albeit exercise is currently advocated as one of the most effective management strategies for fibromyalgia syndrome (FMS); the implementation of exercise as a FMS treatment in reality is significantly hampered by patients' poor compliance. The inference that pain catastrophizing is a key predictor of poor compliance in FMS patients, justifies considering the alteration of pain catastrophizing in improving compliance towards exercises in FMS patients. The aim of this study is to provide proof-of-concept for the development and testing of a novel virtual reality exposure therapy (VRET) program as treatment for exercise-related pain catastrophizing in FMS patients. Methods Two interlinked experimental studies will be conducted. Study 1 aims to objectively ascertain if neurophysiological changes occur in the functional brain areas associated with pain catastrophizing, when catastrophizing FMS subjects are exposed to visuals of exercise activities. Study 2 aims to ascertain the preliminary efficacy and feasibility of exposure to visuals of exercise activities as a treatment for exercise-related pain catastrophizing in FMS subjects. Twenty subjects will be selected from a group of FMS patients attending the Tygerberg Hospital in Cape Town, South Africa and randomly allocated to either the VRET (intervention) group or waiting list (control) group. Baseline neurophysiological activity for subjects will be collected in study 1 using functional magnetic resonance imaging (fMRI). In study 2, clinical improvement in pain catastrophizing will be measured using fMRI (objective) and the pain catastrophizing scale (subjective). Discussion The premise is if exposing FMS patients to visuals of various exercise activities trigger the functional brain areas associated with pain catastrophizing; then as a treatment, repeated exposure to visuals of the exercise activities using a VRET program could possibly decrease exercise-related pain catastrophizing in FMS patients. Proof-of-concept will either be established or negated. The results of this project are envisaged to revolutionize FMS and pain catastrophizing research and in the future, assist health professionals and FMS patients in reducing despondency regarding FMS management. Trial registration PACTR201011000264179 PMID:21529375

2011-01-01

377

HPA axis hyperactivity and cardiovascular mortality in mood disorder inpatients.  

PubMed

Depression is associated with an increased risk of cardiovascular disease (CVD), coronary heart disease (CHD) and cardiac death. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis function is frequent in major depression and hypercortisolemia may be a mediating factor in these relationships. The aim of this study was to assess HPA axis function measured with the dexamethasone suppression test (DST) in relation to CVD and CHD mortality in a cohort of 382 inpatients with mood disorder admitted to the department of Psychiatry at the Karolinska University Hospital between 1980 and 2000. Death certificates ascertained that 75 patients had died of cardiovascular disease and 30 patients of CHD during the mean follow-up of 18 years. DST non-suppression and higher baseline serum cortisol predicted CVD death. In male inpatients with mood disorder, the DST non-suppressor status was significantly associated with CVD death but not with CHD death. In depressed female inpatients the DST non-suppression was not associated with cardiovascular mortality. Baseline serum cortisol and post-dexamethasone serum cortisol levels at 4:00 p.m. showed a trend to be higher in female CVD/CHD victims. Effect of aging on HPA axis functioning was shown in male CHD deaths. HPA axis dysregulation may be a mediating factor between depression and increased risk of cardiovascular death in male mood disorder inpatients indicating that HPA-axis hyperactivity is a long term risk factor for cardiovascular mortality. PMID:19054568

Jokinen, Jussi; Nordström, Peter

2009-07-01

378

Family Burden of Demented and Depressed Elderly Psychiatric Inpatients.  

ERIC Educational Resources Information Center

Found no significant differences in burden for relatives of demented and depressed patients admitted to geriatric psychiatry inpatient unit. Although at follow-up depressed patients were more improved than demented patients, their caregivers did not experience any greater decrease in burden. Families of depressed patients may require as much…

Liptzin, Benjamin; And Others

1988-01-01

379

Psychological Dysfunction and Physical Health among Elderly Medical Inpatients.  

ERIC Educational Resources Information Center

Evaluated 150 geriatric medical inpatients for psychological dysfunction. Found 27.3 percent of subjects had at least one psychological disorder and 15.3 percent of total sample had a depressive disorder. Comorbid depression was associated with greatest level of psychological distress and dysfunction, and with poorest physical health status.…

Rapp, Stephen R.; And Others

1988-01-01

380

Resigned Professionalism? Non-Acute Inpatients and Resident Education  

ERIC Educational Resources Information Center

A growing group of inpatients on acute clinical teaching units have non-acute needs, yet require attention by the team. While anecdotally, these patients have inspired frustration and resource pressures in clinical settings, little is known about the ways in which they influence physician perceptions of the learning environment. This qualitative…

Vanstone, Meredith; Watling, Christopher; Goldszmidt, Mark; Weijer, Charles; Lingard, Lorelei

2014-01-01

381

Predictors of Inpatient Utilization among Veterans with Dementia.  

PubMed

Dementia is prevalent and costly, yet the predictors of inpatient hospitalization are not well understood. Logistic and negative binomial regressions were used to identify predictors of inpatient hospital utilization and the frequency of inpatient hospital utilization, respectively, among veterans. Variables significant at the P < 0.15 level were subsequently analyzed in a multivariate regression. This study of veterans with a diagnosis of dementia (n = 296) and their caregivers found marital status to predict hospitalization in the multivariate logistic model (B = 0.493, P = 0.029) and personal-care dependency to predict hospitalization and readmission in the multivariate logistic model and the multivariate negative binomial model (B = 1.048, P = 0.007, B = 0.040, and P = 0.035, resp.). Persons with dementia with personal-care dependency and spousal caregivers have more inpatient admissions; appropriate care environments should receive special care to reduce hospitalization. This study was part of a larger clinical trial; this trial is registered with ClinicalTrials.gov NCT00291161. PMID:24982674

Godwin, Kyler M; Morgan, Robert O; Walder, Annette; Bass, David M; Judge, Katherine S; Wilson, Nancy; Snow, A Lynn; Kunik, Mark E

2014-01-01

382

Recovery and outcome of delirium in elderly medical inpatients  

Microsoft Academic Search

This study investigates the relationships between delirium, cognitive impairment and acute illness severity with adverse clinical outcomes; in-hospital mortality, hospital length of stay, or new entry to a care home. It is a prospective observational study of medical inpatients 70 years or older, with repeated measurements of cognition, delirium status, delirium severity, and severity of physical illness every 3 days

Dimitrios Adamis; Adrian Treloar; Finbarr C. Martin; Alastair J. D. Macdonald

2006-01-01

383

Sexual Behavior of Psychiatric Inpatients: Hospital Responses and Policy Formulation  

Microsoft Academic Search

Historically, inpatient sexuality has been aneglected issue in hospital policy. Recent studies haveconfirmed sexual activity among individuals with mentalillness and have noted several areas of concern surrounding patient care and sexuality. Wesurveyed private mental health facilities within thestate of Ohio. Twenty-five percent of the respondinghospitals had a formal sexual policy and the majority (72%) said that sexual behavior was aninfrequent

Peter F. Buckley; Ilse R. Wiechers

1999-01-01

384

Smoking Assessment and Cessation Skills in the Inpatient Medicine Clerkship.  

ERIC Educational Resources Information Center

Analysis of 61 inpatient medical writeups by 23 third year medicine clerks found smoking history notations in 74 percent but quantification of exposure much less commonly. None detailed patient addiction or willingness to quit, or included smoking cessation in the patient plan. Students' smoking assessment and cessation skills are seen as poorly…

Hull, Alan L.; Kleinhenz, Mary Ellen

1990-01-01

385

Managing Bipolar Youths in a Psychiatric Inpatient Emergency Service  

ERIC Educational Resources Information Center

Among the youths referred to our Psychiatric Inpatient Emergency Service, we focused on bipolar disorder (BD), to explore predictive elements for the outcome. Fifty-one patients (30 males, 21 females, age range 8-18 years, mean age 14.2 plus or minus 3.1 years) received a diagnosis of BD, according to historical information, prolonged…

Masi, Gabriele; Mucci, Maria; Pias, Paola; Muratori, Filippo

2011-01-01

386

Predictors of Specialized Inpatient Admissions for Adults with Intellectual Disability  

ERIC Educational Resources Information Center

Individuals with intellectual disability (ID) have complex mental health needs and may seek specialized ID psychiatric services. This study reports on predictors of specialized inpatient admissions for 234 individuals with ID who received outpatient services at a psychiatric hospital. Overall, from 2007-2012, 55 of the 234 outpatients were triaged…

Modi, Miti; McMorris, Carly; Palucka, Anna; Raina, Poonam; Lunsky, Yona

2015-01-01

387

A comprehensive RFID solution to enhance inpatient medication safety.  

PubMed

Errors involving medication administration can be costly, both in financial and in human terms. Indeed, there is much potential for errors due to the complexity of the medication administration process. Nurses are often singled out as the only responsible of these errors because they are in charge of drug administration. Nevertheless, the interventions of every actor involved in the process and the system design itself contribute to errors (Wakefield et al. (1998). Proper inpatient medication safety systems can help to reduce such errors in hospitals. In this paper, we review in depth two recent proposals (Chien et al. (2010); Huang and Ku (2009)) that pursue the aforementioned objective. Unfortunately, they fail in their attempt mainly due to their security faults but interesting ideas can be drawn from both. These security faults refer to impersonation and replay attacks that could produce the generation of a forged proof stating that certain medication was administered to an inpatient when it was not. We propose a leading-edge solution to enhance inpatient medication safety based on RFID technology that overcomes these weaknesses. Our solution, named Inpatient Safety RFID system (IS-RFID), takes into account the Information Technology (IT) infrastructure of a hospital and covers every phase of the drug administration process. From a practical perspective, our system can be easily integrated within hospital IT infrastructures, has a moderate cost, is very ease to use and deals with security aspects as a key point. PMID:21112242

Peris-Lopez, Pedro; Orfila, Agustin; Mitrokotsa, Aikaterini; van der Lubbe, Jan C A

2011-01-01

388

Markedly improved outcomes and acceptable toxicity in adolescents and young adults with acute lymphoblastic leukemia following treatment with a pediatric protocol: a phase II study by the Japan Adult Leukemia Study Group.  

PubMed

The superiority of the pediatric protocol for adolescents with acute lymphoblastic leukemia (ALL) has already been demonstrated, however, its efficacy in young adults remains unclear. The ALL202-U protocol was conducted to examine the efficacy and feasibility of a pediatric protocol in adolescents and young adults (AYAs) with BCR-ABL-negative ALL. Patients aged 15-24 years (n=139) were treated with the same protocol used for pediatric B-ALL. The primary objective of this study was to assess the disease-free survival (DFS) rate and its secondary aims were to assess toxicity, the complete remission (CR) rate and the overall survival (OS) rate. The CR rate was 94%. The 5-year DFS and OS rates were 67% (95% confidence interval (CI) 58-75%) and 73% (95% CI 64-80%), respectively. Severe adverse events were observed at a frequency that was similar to or lower than that in children treated with the same protocol. Only insufficient maintenance therapy significantly worsened the DFS (hazard ratio 5.60, P<0.001). These results indicate that this protocol may be a feasible and highly effective treatment for AYA with BCR-ABL-negative ALL. PMID:25325302

Hayakawa, F; Sakura, T; Yujiri, T; Kondo, E; Fujimaki, K; Sasaki, O; Miyatake, J; Handa, H; Ueda, Y; Aoyama, Y; Takada, S; Tanaka, Y; Usui, N; Miyawaki, S; Suenobu, S; Horibe, K; Kiyoi, H; Ohnishi, K; Miyazaki, Y; Ohtake, S; Kobayashi, Y; Matsuo, K; Naoe, T

2014-01-01

389

Markedly improved outcomes and acceptable toxicity in adolescents and young adults with acute lymphoblastic leukemia following treatment with a pediatric protocol: a phase II study by the Japan Adult Leukemia Study Group  

PubMed Central

The superiority of the pediatric protocol for adolescents with acute lymphoblastic leukemia (ALL) has already been demonstrated, however, its efficacy in young adults remains unclear. The ALL202-U protocol was conducted to examine the efficacy and feasibility of a pediatric protocol in adolescents and young adults (AYAs) with BCR–ABL-negative ALL. Patients aged 15–24 years (n=139) were treated with the same protocol used for pediatric B-ALL. The primary objective of this study was to assess the disease-free survival (DFS) rate and its secondary aims were to assess toxicity, the complete remission (CR) rate and the overall survival (OS) rate. The CR rate was 94%. The 5-year DFS and OS rates were 67% (95% confidence interval (CI) 58–75%) and 73% (95% CI 64–80%), respectively. Severe adverse events were observed at a frequency that was similar to or lower than that in children treated with the same protocol. Only insufficient maintenance therapy significantly worsened the DFS (hazard ratio 5.60, P<0.001). These results indicate that this protocol may be a feasible and highly effective treatment for AYA with BCR–ABL-negative ALL. PMID:25325302

Hayakawa, F; Sakura, T; Yujiri, T; Kondo, E; Fujimaki, K; Sasaki, O; Miyatake, J; Handa, H; Ueda, Y; Aoyama, Y; Takada, S; Tanaka, Y; Usui, N; Miyawaki, S; Suenobu, S; Horibe, K; Kiyoi, H; Ohnishi, K; Miyazaki, Y; Ohtake, S; Kobayashi, Y; Matsuo, K; Naoe, T

2014-01-01

390

The addition of STEPPS in the treatment of patients with bipolar disorder and comorbid borderline personality features: a protocol for a randomized controlled trial  

PubMed Central

Background Bipolar disorder (BD) and borderline personality disorder (BPD) both are severe and chronic psychiatric disorders. Both disorders have overlapping symptoms, and current research shows that the presence of a BPD has an adverse effect on the course of BD. The limited research available shows an unfavorable illness course, a worse prognosis and response to medication, longer treatment duration, more frequent psychiatric admissions, higher drop-out, increased risk of substance abuse, increased risk of suicide, and more impairment of social and occupational functioning. However, there is no research available on the effect of specific psychotherapeutic treatment for this patients. Methods/Design This paper presents the protocol of a RCT to investigate the presence of borderline personality features in patients treated for BD (study part 1) and the effectiveness of STEPPS (Systems Training for Emotional Predictability and Problem Solving) added to treatment as usual (TAU) for BD compared to TAU in patients with BD and comorbid borderline personality features (study part 2). STEPPS is a validated and effective intervention for BPD. The study population consists of patients treated for BD at specialized outpatient clinics for BD in the Netherlands. At first the prevalence of comorbid borderline personality features in outpatients with BD is investigated. Inclusion criteria for study part 2 is defined as having three or more of the DSM-IV-TR diagnostic criteria of BPD, including impulsivity and anger bursts. Primary outcomes will be the frequency and severity of manic and depressive recurrences as well as severity, course and burden of borderline personality features. Secondary outcomes will be quality of life, utilizing mental healthcare and psychopathologic symptoms not primarily related to BD or BPD. Assessment will be at baseline, at the end of the intervention, and at 12 and 18 months follow-up. Discussion This will be the first randomized controlled trial of a specific intervention in patients with BD and comorbid BPD or borderline personality features. There are no recommendations in the guideline of treatment of bipolar disorders for patients with this complex comorbidity. We expect that a combined treatment aimed at mood disorder and emotion regulation will improve treatment outcomes for these patients. PMID:24912456

2014-01-01

391

Inpatient deaths from acute myocardial infarction, 1982-92: analysis of data in the Nottingham heart attack register.  

PubMed Central

OBJECTIVE: To assess longitudinal trends in admissions, management, and inpatient mortality from acute myocardial infarction over 10 years. DESIGN: Retrospective analysis based on the Nottingham heart attack register. SETTING: Two district general hospitals serving a defined urban and rural population. SUBJECTS: All patients admitted with a confirmed acute myocardial infarction during 1982-4 and 1989-92 (excluding 1991, when data were not collected). MAIN OUTCOME MEASURES: Numbers of patients, background characteristics, time from onset of symptoms to admission, ward of admission, treatment, and inpatient mortality. RESULTS: Admissions with acute myocardial infarction increased from 719 cases in 1982 to 960 in 1992. The mean age increased from 62.1 years to 66.6 years (P < 0.001), the duration of stay fell from 8.7 days to 7.2 days (P < 0.001), and the proportion of patients aged 75 years and over admitted to a coronary care unit increased significantly from 29.1% to 61.2%. A higher proportion of patients were admitted to hospital within 6 hours of onset of their symptoms in 1989-92 than in 1982-4, but 15% were still admitted after the time window for thrombolysis. Use of beta blockers increased threefold between 1982 and 1992, aspirin was used in over 70% of patients after 1989, and thrombolytic use increased 1.3-fold between 1989 and 1992. Age and sex adjusted odds ratios for inpatient mortality remained unchanged over the study period. CONCLUSIONS: Despite an increasing uptake of the "proved" treatments, inpatient mortality from myocardial infarction did not change between 1982 and 1992. PMID:9251546

Brown, N.; Young, T.; Gray, D.; Skene, A. M.; Hampton, J. R.

1997-01-01

392

Diagnostic and treatment delay, quality of life and satisfaction with care in colorectal cancer patients: a study protocol  

PubMed Central

Background Due to recent improvements in colorectal cancer survival, patient-reported outcomes, including health-related quality of life and satisfaction with care, have become well-established endpoints to determine the impact of the disease on the lives of patients. The aim of this study is to determine prospectively, in a cohort of colorectal cancer incident cases: a) health-related quality of life, b) satisfaction with hospital-based care, and c) functional status. A secondary objective is to determine whether diagnostic/therapeutic delay influence quality of life or patients’ satisfaction levels. Methods/design Single-centre prospective follow-up study of colorectal cancer patients diagnosed during the period 2011–2012 (n?=?375). This project was approved by the corresponding ethics review board, and informed consent is obtained from each patient. After diagnosis, patients are interviewed by a trained nurse, obtaining information on sociodemographic characteristics, family history of cancer, first symptoms, symptom perception and reaction to early symptoms. Quality of life is assessed with the EORTC QLQ-C30 and QLQ-CR29 questionnaires, and patients’ satisfaction with care is determined using the EORTC IN-PATSAT32. Functional status is measured with the Karnofsky Performance Status Scale. Clinical records are also reviewed to collect information on comorbidity, tumour characteristics, treatment, hospital consultations and exploratory procedures. Symptoms-to-diagnosis interval is defined as the time from the date of first symptoms until the cytohistological confirmation of cancer. Treatment delay is defined as the time between diagnosis and surgical treatment. All the patients will be followed-up for a maximum of 2 years. For survivors, assessments will be re-evaluated at one and two years after the diagnosis. Multiple linear/logistic regression models will be used to identify variables associated with the patients’ functional status, quality of life and satisfaction with care score. Changes in quality of life over time will be analysed with linear mixed-effects regression models. Discussion The results will provide a deeper understanding of the impact of colorectal cancer from a more patient-centred approach, allowing us to identify groups of patients in need of additional attention, as well as areas for improvement. Special attention will be given to the relationship between diagnostic/therapeutic delay and patients’ quality of life and satisfaction with the care received. PMID:23845102

2013-01-01

393

Partnering Effectively With Inpatient Leaders for Improved Emergency Department Throughput  

PubMed Central

The boarding of patients is a root cause of overcrowding in a majority of emergency departments (EDs) nationwide. It reduces capacity to treat ED patients, decreases bed utilization, and compromises quality, safety, and the patient experience. Because of its systemic nature, it can only be effectively addressed through attention and commitment by all stakeholders. Once emergency departments have addressed throughput challenges they can solve on their own, they are ready to focus on proactive communication and teamwork with inpatient leaders to identify and transfer potential admissions more efficiently. No-delay nurse reports are an important tool to reduce time from admit orders to arrival on patient units. An effective hospital-wide flow committee also removes barriers for admitting patients quickly from the emergency department and addresses a revised January 1, 2014, Joint Commission standard that requires goal setting and measurement to mitigate and better manage the boarding of patients. This article discusses who should attend, the scope of the committee charter, how to use a hospital-wide throughput dashboard to measure results, and includes a sample agenda. It is recommended that the committee also assess and evaluate the effectiveness of the surge plan at least every three years to ensure that it meets goals identified by the committee. This article also shares best practices associated with two key tactics to support an effective hospital-wide throughput committee: inpatient bed huddles to expedite inpatient admissions and inpatient leader rounding, where the inpatient leader rounds on boarded ED patients to ensure safety and quality while also establishing ownership for the transition.

Baker, Stephanie J.; Esbenshade, Angie

2015-01-01

394

Treatment. Technical Assistance Packet.  

ERIC Educational Resources Information Center

Treatment is one component of a strategy to reduce substance abuse. It can include detoxification; inpatient counseling; outpatient counseling; therapeutic communities; and self help groups. Referrals can take place in settings such as emergency rooms; employee assistance programs; churches; and physicians' offices. Unmet treatment needs can cause…

Join Together, Boston, MA.

395

Treatment of forefoot problems in older people: study protocol for a randomised clinical trial comparing podiatric treatment to standardised shoe advice  

PubMed Central

Background Foot problems in general and forefoot problems in particular can lead to a decrease in mobility and a higher risk of falling. Forefoot problems increase with age and are more common in women than in men. Around 20% of people over 65 suffer from non-traumatic foot problems and 60% of these problems are localised in the forefoot. Little is known about the best way to treat forefoot problems in older people. The aim of this study is to compare the effects of two common modes of treatment in the Netherlands: shoe advice and podiatric treatment. This paper describes the design of this study. Methods The study is designed as a pragmatic randomised clinical trial (RCT) with 2 parallel intervention groups. People aged 50 years and over who have visited their general practitioner (GP) with non traumatic pain in the forefoot in the preceding year and those who will visit their GP during the recruitment period with a similar complaint will be recruited for this study. Participants must be able to walk unaided for 7 metres and be able to fill in questionnaires. Exclusion criteria are: rheumatoid arthritis, neuropathy of the foot or pain caused by skin problems (e.g. warts, eczema). Inclusion and exclusion criteria will be assessed by a screening questionnaire and baseline assessment. Those consenting to participation will be randomly assigned to either a group receiving a standardised shoe advice leaflet (n = 100) or a group receiving podiatric treatment (n = 100). Primary outcomes will be the severity of forefoot pain (0-10 on a numerical rating scale) and foot function (Foot Function 5-pts Index and Manchester Foot Pain and Disability Index). Treatment adherence, social participation and quality of life will be the secondary outcomes. All outcomes will be obtained through self-administered questionnaires at the start of the study and after 3, 6, 9 and 12 months. Data will be analysed according to the "intention-to-treat" principle using multilevel level analysis. Discussion Strength of this study is the comparison between two common primary care treatments for forefoot problems, ensuring a high external validity of this trial. Trial registration Netherlands Trial Register (NTR): NTR2212 PMID:21453476

2011-01-01

396

Antipsychotic treatment for children and adolescents with schizophrenia spectrum disorders: protocol for a network meta-analysis of randomised trials  

PubMed Central

Introduction Antipsychotic treatment in early-onset schizophrenia (EOS) lacks a rich evidence base, and efforts to rank different drugs concerning their efficacy have not proven any particular drug superior. In contrast to the literature regarding adult-onset schizophrenia (AOS), comparative effectiveness studies in children and adolescents are limited in number and size, and only a few meta-analyses based on conventional methodologies have been conducted. Methods and analyses We will conduct a network meta-analysis of all randomised controlled trials (RCTs) that evaluate antipsychotic therapies for EOS to determine which compounds are efficacious, and to determine the relative efficacy and safety of these treatments when compared in a network meta-analysis. Unlike a contrast-based (standard) meta-analysis approach, an arm-based network meta-analysis enables statistical inference from combining both direct and indirect comparisons within an empirical Bayes framework. We will acquire eligible studies through a systematic search of MEDLINE, the Cochrane Central Registry of Controlled Trials, Clinicaltrials.gov and Centre for Reviews and Dissemination databases. Eligible studies should randomly allocate children and adolescents presenting with schizophrenia or a related non-affective psychotic condition to an intervention group or to a control group. Two reviewers will—independently and in duplicate—screen titles and abstracts, complete full text reviews to determine eligibility, and subsequently perform data abstraction and assess risk of bias of eligible trials. We will conduct meta-analyses to establish the effect of all reported therapies on patient-relevant efficacy and safety outcomes when possible. Ethics and dissemination No formal ethical procedures regarding informed consent are required as no primary data collection is undertaken. The review will help facilitate evidence-based management, identify key areas for future research, and provide a framework for conducting large systematic reviews combining direct and indirect comparisons. The study will be disseminated by peer-reviewed publication and conference presentation. Trial registration number PROSPERO CRD42013006676. PMID:25304189

Pagsberg, A K; Tarp, S; Glintborg, D; Stenstrøm, A D; Fink-Jensen, A; Correll, C U; Christensen, R

2014-01-01

397

Efficacy of Different Protocols of Radioiodine Therapy for Treatment of Toxic Nodular Goiter: Systematic Review and Meta-Analysis of the Literature  

PubMed Central

Context: To evaluate treatment success and hypothyroidism following main methods of radioiodine therapy of toxic nodular goiter (TNG); calculated versus fixed dose and high versus low dose of radioiodine. Evidence Acquisitions: We searched MEDLINE and SCOPUS databases from inception till July 2013, for clinical trials that compared two different methods of radioiodine administration in TNG. The trials were classified into two groups, those that compared fixed versus calculated dosimetry method and those that assessed high fixed dose versus low fixed dose method. Treatment response was defined as euthyroidism or hypothyroidism, one year after radioiodine administration. We calculated the risk ratio and risk difference of treatment response as well as permanent hypothyroidism as outcome variables. Random effects model was used for data pooling. Results: The literature search yielded 2538 articles. Two randomized and five non-randomized clinical trials with 669 patients met the eligibility criteria for the meta-analysis. Patients with TNG who were treated according to the calculated method had 9.6% higher cure rate (risk ratio=1.17) and only 0.3% more permanent hypothyroidism compared to patients treated with the fixed dose method. There was no significant difference in the amount of administered radio-iodine in the two groups. Patients treated with fixed high dose had 18.1% more cure rate (risk ratio = 1.2) and 23.9% more permanent hypothyroidism (risk ratio = 2.40) compared to patients treated by fixed low dose protocols. Conclusions: Calculated radioiodine therapy may be preferred to fixed dose method in patients with TNG. High dose methods are associated with more response and more hypothyroidism. PMID:24803943

Rokni, Haleh; Sadeghi, Ramin; Moossavi, Zohreh; Treglia, Giorgio; Zakavi, Seyed Rasoul

2014-01-01

398

Significant improvements in cognitive performance post-transcranial, red/near-infrared light-emitting diode treatments in chronic, mild traumatic brain injury: open-protocol study.  

PubMed

This pilot, open-protocol study examined whether scalp application of red and near-infrared (NIR) light-emitting diodes (LED) could improve cognition in patients with chronic, mild traumatic brain injury (mTBI). Application of red/NIR light improves mitochondrial function (especially in hypoxic/compromised cells) promoting increased adenosine triphosphate (ATP) important for cellular metabolism. Nitric oxide is released locally, increasing regional cerebral blood flow. LED therapy is noninvasive, painless, and non-thermal (cleared by the United States Food and Drug Administration [FDA], an insignificant risk device). Eleven chronic, mTBI participants (26-62 years of age, 6 males) with nonpenetrating brain injury and persistent cognitive dysfunction were treated for 18 outpatient sessions (Monday, Wednesday, Friday, for 6 weeks), starting at 10 months to 8 years post- mTBI (motor vehicle accident [MVA] or sports-related; and one participant, improvised explosive device [IED] blast injury). Four had a history of multiple concussions. Each LED cluster head (5.35 cm diameter, 500 mW, 22.2 mW/cm(2)) was applied for 10 min to each of 11 scalp placements (13 J/cm(2)). LEDs were placed on the midline from front-to-back hairline; and bilaterally on frontal, parietal, and temporal areas. Neuropsychological testing was performed pre-LED, and at 1 week, and 1 and 2 months after the 18th treatment. A significant linear trend was observed for the effect of LED treatment over time for the Stroop test for Executive Function, Trial 3 inhibition (p=0.004); Stroop, Trial 4 inhibition switching (p=0.003); California Verbal Learning Test (CVLT)-II, Total Trials 1-5 (p=0.003); and CVLT-II, Long Delay Free Recall (p=0.006). Participants reported improved sleep, and fewer post-traumatic stress disorder (PTSD) symptoms, if present. Participants and family reported better ability to perform social, interpersonal, and occupational functions. These open-protocol data suggest that placebo-controlled studies are warranted. PMID:24568233

Naeser, Margaret A; Zafonte, Ross; Krengel, Maxine H; Martin, Paula I; Frazier, Judith; Hamblin, Michael R; Knight, Jeffrey A; Meehan, William P; Baker, Errol H

2014-06-01

399

Bee venom acupuncture for the treatment of chronic low back pain: study protocol for a randomized, double-blinded, sham-controlled trial  

PubMed Central

Background Chronic non-specific low back pain is the most common medical problem for which patients seek complementary and alternative medical treatment, including bee venom acupuncture. However, the effectiveness and safety of such treatments have not been fully established by randomized clinical trials. The aim of this study is to determine whether bee venom acupuncture is effective for improving pain intensity, functional status and quality of life of patients with chronic non-specific low back pain. Methods/design This study is a randomized, double-blinded, sham-controlled clinical trial with two parallel arms. Fifty-four patients between 18 and 65 years of age with non-radicular chronic low back pain experiencing low back pain lasting for at least the previous three months and ?4 points on a 10-cm visual analog scale for bothersomeness at the time of screening will be included in the study. Participants will be randomly allocated into the real or sham bee venom acupuncture groups and treated by the same protocol to minimize non-specific and placebo effects. Patients, assessors, acupuncturists and researchers who prepare the real or sham bee venom acupuncture experiments will be blinded to group allocation. All procedures, including the bee venom acupuncture increment protocol administered into predefined acupoints, are designed by a process of consensus with experts and previous researchers according to the Standards for Reporting Interventions in Clinical Trials of Acupuncture. Bothersomeness measured using a visual analogue scale will be the primary outcome. Back pain-related dysfunction, pain, quality of life, depressive symptoms and adverse experiences will be measured using the visual analogue scale for pain intensity, the Oswestry Disability Index, the EuroQol 5-Dimension, and the Beck’s Depression Inventory. These measures will be recorded at baseline and 1, 2, 3, 4, 8 and 12 weeks. Discussion The results from this study will provide clinical evidence on the efficacy and safety of bee venom acupuncture in patients with chronic non-specific low back pain. Trial registration This study is registered with the United States National Institutes of Health Clinical Trials Registry: NCT01491321 PMID:23317340

2013-01-01

400

A simulation framework for mapping risks in clinical processes: the case of in-patient transfers  

PubMed Central

Objective To model how individual violations in routine clinical processes cumulatively contribute to the risk of adverse events in hospital using an agent-based simulation framework. Design An agent-based simulation was designed to model the cascade of common violations that contribute to the risk of adverse events in routine clinical processes. Clinicians and the information systems that support them were represented as a group of interacting agents using data from direct observations. The model was calibrated using data from 101 patient transfers observed in a hospital and results were validated for one of two scenarios (a misidentification scenario and an infection control scenario). Repeated simulations using the calibrated model were undertaken to create a distribution of possible process outcomes. The likelihood of end-of-chain risk is the main outcome measure, reported for each of the two scenarios. Results The simulations demonstrate end-of-chain risks of 8% and 24% for the misidentification and infection control scenarios, respectively. Over 95% of the simulations in both scenarios are unique, indicating that the in-patient transfer process diverges from prescribed work practices in a variety of ways. Conclusions The simulation allowed us to model the risk of adverse events in a clinical process, by generating the variety of possible work subject to violations, a novel prospective risk analysis method. The in-patient transfer process has a high proportion of unique trajectories, implying that risk mitigation may benefit from focusing on reducing complexity rather than augmenting the process with further rule-based protocols. PMID:21486883

Ong, Mei-Sing; Westbrook, Johanna I; Magrabi, Farah; Coiera, Enrico; Wobcke, Wayne

2011-01-01

401

Treatment of reducible unstable fractures of the distal radius: randomized clinical study comparing the locked volar plate and external fixator methods: study protocol  

PubMed Central

Background Various treatments are available for reducible unstable fractures of the distal radius, such as closed reduction combined with fixation by external fixator (EF), and rigid internal fixation using a locked volar plate (VP). Although there are studies comparing these methods, there is no conclusive evidence indicating which treatment is best. The hypothesis of this study is that surgical treatment with a VP is more effective than EF from the standpoint of functional outcome (patient-reported). Methods/Design The study is randomized clinical trial with parallel groups and a blinded evaluator and involves the surgical interventions EF and VP. Patients will be randomly assigned (assignment ratio 1:1) using sealed opaque envelopes. This trial will include consecutive adult patients with an acute (up to 15 days) displaced, unstable fracture of the distal end of the radius of type A2, A3, C1, C2 or C3 by the Arbeitsgemeinschaft für Osteosynthesefragen–Association for the Study of Internal Fixation classification and type II or type III by the IDEAL32 classification, without previous surgical treatments of the wrist. The surgical intervention assigned will be performed by three surgical specialists familiar with the techniques described. Evaluations will be performed at 2, and 8 weeks, 3, 6 and 12 months, with the primary outcomes being measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and measurement of pain (Visual Analog Pain Scale and digital algometer). Secondary outcomes will include radiographic parameters, objective functional evaluation (goniometry and dynamometry), and the rate of complications and method failure according to the intention-to-treat principle. Final postoperative evaluations (6 and 12 months) will be performed by independent blinded evaluators. For the Student’s t-test, a difference of 10 points in the DASH score, with a 95% confidence interval, a statistical power of 80%, and 20% sampling error results in 36 patients per group. Discussion Results from this study protocol will improve the current evidence regarding to the surgical treatment these fractures. Trial registration ISCRTN09599740 PMID:24597699

2014-01-01

402

Maintenance interventions for overweight or obese children and adolescents who participated in a treatment program: study protocol for a systematic review  

PubMed Central

Background Childhood overweight and obesity are associated with significant health consequences. Early and successful treatment of this public health issue is necessary. Although several intervention programs for children result in weight loss or stabilisation in the short term, preventing relapse after weight loss remains an important challenge. Weight loss maintenance approaches in childhood are thought to be promising, but a structured overview of these maintenance interventions is lacking. The aim of the systematic review described in this protocol is to provide an overview of reports published about maintenance interventions in childhood overweight and obesity following initial treatment, in order to guide future directions in the development of maintenance programs for childhood obesity. Methods/design The electronic databases PubMed, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, Scopus, and SocINDEX will be searched for this review. Reference lists of eligible study reports will be scanned for relevant references. Article selection including risk of bias assessment will be performed independently in an unblinded standardised manner by three authors. All reports describing a maintenance intervention in overweight or obese children with a mean or median age of <18 years who have followed a treatment program, regardless of the type of intervention, will be included. Data extraction will be performed using a predesigned pilot-tested data extraction sheet that covers participant characteristics, details about the treatment preceding the maintenance intervention, and the maintenance intervention itself. Body mass index standard deviation score (BMI-SDS or BMI-Z-score) will be used to compare studies. If possible, a meta-analysis will be performed using the inverse-variance random-effects method. Studies that are not included in the meta-analysis will be described in a narrative way in tables and/or in the text. Discussion This systematic review will give an overview of the existing knowledge on programs and initiatives aimed at long-term maintenance of a healthy or reduced weight in children and adolescents following initial treatment of overweight. It will form a basis for future research and practice in this area, a topic on which studies are scarce but highly necessary. Systematic review registration PROSPERO CRD42014008698 PMID:25281061

2014-01-01

403

Continuous quality improvement (CQI) in addiction treatment settings: design and intervention protocol of a group randomized pilot study  

PubMed Central

Background Few studies have designed and tested the use of continuous quality improvement approaches in community based substance use treatment settings. Little is known about the feasibility, costs, efficacy, and sustainment of such approaches in these settings. Methods/Design A group-randomized trial using a modified stepped wedge design is being used. In the first phase of the study, eight programs, stratified by modality (residential, outpatient) are being randomly assigned to the intervention or control condition. In the second phase, the initially assigned control programs are receiving the intervention to gain additional information about feasibility while sustainment is being studied among the programs initially assigned to the intervention. Discussion By using this design in a pilot study, we help inform the field about the feasibility, costs, efficacy and sustainment of the intervention. Determining information at the pilot stage about costs and sustainment provides value for designing future studies and implementation strategies with the goal to reduce the time between intervention development and translation to real world practice settings. PMID:24467770

2014-01-01

404

Inpatients' and outpatients' satisfaction: the mediating role of perceived quality of physical and social environment.  

PubMed

This study analyses the processes through which the physical environment of health care settings impacts on patients' well-being. Specifically, we investigate the mediating role of perceptions of the physical and social environments, and if this process is moderated by patients' status, that is, if the objective physical environment impacts inpatients' and outpatients' satisfaction by different social-psychological processes. Patients (N=206) evaluated the physical and social environments of the care unit where they were receiving treatment, and its objective physical conditions were independently evaluated by two architects. Results showed that the objective environmental quality affects satisfaction through perceptions of environmental quality, and that patients' status moderates this relationship. For inpatients, it is the perception of quality of the social environment that mediates the relationship between objective environmental quality and satisfaction, whereas for outpatients it is the perception of quality of the physical environment. This moderated mediation is discussed in terms of differences on patients' experiences of health care environments. PMID:23454733

Campos Andrade, Cláudia; Lima, Maria Luísa; Pereira, Cícero Roberto; Fornara, Ferdinando; Bonaiuto, Marino

2013-05-01

405

A proposed protocol on HDR cylinder treatments: proof of avoidance of re-planning of CT based fractionated treatment, using a critical, statistical and graphical analysis of clinical data  

PubMed Central

Purpose An evaluation of CT plan data, using cylinder applicators, in fractionated HDR treatments of cervical cancers has been investigated in this clinical study. Critical and statistical analysis of the data, for each patient and fraction, for plan dose, doses for bladder and rectum have been enumerated and reported. Plans were done for each patient, following CT scans after insertion of the applicator in the respective cases. This process involved time for CT-scan and re-plan, in each fraction, adding cost of treatments for the poor patients. Material and methods This study on HDR brachytherapy for cervical cancer patients has applied the Co-60 BEBIG Multisource Unit. Cylinder applicators have been applied for treatments. A selection of twenty nine patients, out of a few hundred representative female patients, in the age group of 40-70 years, has been analyzed and presented in this paper. Radiation oncologists inserted the applicator and fixed it in more than 600 treatments. This study, therefore, aimed at their insertion technique, CT-planning by radiation oncology physicists and the delivery of the treatments. Details of set up and technique has been explained, where bladder and rectum doses has been assessed within the tolerance limit [1]. Results Statistical analysis of data from the treatment plans, substantiates the conclusion of the argument that there is no need to do CT-plans for each subsequently prescribed number of fractions as the doses in plan, bladder and rectum are restricted within the limits of tolerance. Data in Table 1 are analyzed in various graphs. This utilized the Empirical Null Distribution of Group Differences. A graphic study of dose distribution is reported to assure the expected variation of dose from the central tandem. This analysis proves to substantiate a protocol that no re-plan for fractionated delivery is essential following the approval of the first plan. Conclusions The goal of this study was to critically evaluate the outcome of fractionated cylinder treatments of cervical cancers. This resulted in the set up technique for insertion of applicators and treatment plan, following a CT-scan and the assertion of the argument that re-plans are not necessary for multiple HDR cylinder treatments for the same patient [2, 3]. PMID:23346144

Banu, Parveen A.; Rukhsana, Naheed; Ahmed, Mushfika; Yasmin, Zebunnesa

2012-01-01

406

The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study: protocol for an international multicentre randomised controlled trial  

PubMed Central

Introduction Postoperative delirium is one of the most common complications of major surgery, affecting 10–70% of surgical patients 60?years and older. Delirium is an acute change in cognition that manifests as poor attention and illogical thinking and is associated with longer intensive care unit (ICU) and hospital stay, long-lasting cognitive deterioration and increased mortality. Ketamine has been used as an anaesthetic drug for over 50?years and has an established safety record. Recent research suggests that, in addition to preventing acute postoperative pain, a subanaesthetic dose of intraoperative ketamine could decrease the incidence of postoperative delirium as well as other neurological and psychiatric outcomes. However, these proposed benefits of ketamine have not been tested in a large clinical trial. Methods The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study is an international, multicentre, randomised controlled trial. 600 cardiac and major non-cardiac surgery patients will be randomised to receive ketamine (0.5 or 1?mg/kg) or placebo following anaesthetic induction and prior to surgical incision. For the primary outcome, blinded observers will assess delirium on the day of surgery (postoperative day 0) and twice daily from postoperative days 1–3 using the Confusion Assessment Method or the Confusion Assessment Method for the ICU. For the secondary outcomes, blinded observers will estimate pain using the Behavioral Pain Scale or the Behavioral Pain Scale for Non-Intubated Patients and patient self-report. Ethics and dissemination The PODCAST trial has been approved by the ethics boards of five participating institutions; approval is ongoing at other sites. Recruitment began in February 2014 and will continue until the end of 2016. Dissemination plans include presentations at scientific conferences, scientific publications, stakeholder engagement and popular media. Registration details The study is registered at clinicaltrials.gov, NCT01690988 (last updated March 2014). The PODCAST trial is being conducted under the auspices of the Neurological Outcomes Network for Surgery (NEURONS). Trial registration number NCT01690988 (last updated December 2013). PMID:25231491

Avidan, Michael S; Fritz, Bradley A; Maybrier, Hannah R; Muench, Maxwell R; Escallier, Krisztina E; Chen, Yulong; Ben Abdallah, Arbi; Veselis, Robert A; Hudetz, Judith A; Pagel, Paul S; Noh, Gyujeong; Pryor, Kane; Kaiser, Heiko; Arya, Virendra Kumar; Pong, Ryan; Jacobsohn, Eric; Grocott, Hilary P; Choi, Stephen; Downey, Robert J; Inouye, Sharon K; Mashour, George A

2014-01-01

407

A pilot double-blind randomised placebo-controlled dose–response trial assessing the effects of melatonin on infertility treatment (MIART): study protocol  

PubMed Central

Introduction High levels of oxidative stress can have considerable impact on the outcomes of in vitro fertilisation (IVF). Recent studies have reported that melatonin, a neurohormone secreted from the pineal gland in response to darkness, has significant antioxidative capabilities which may protect against the oxidative stress of infertility treatment on gametes and embryos. Early studies of oral melatonin (3–4?mg/day) in IVF have suggested favourable outcomes. However, most trials were poorly designed and none have addressed the optimum dose of melatonin. We present a proposal for a pilot double-blind randomised placebo-controlled dose–response trial aimed to determine whether oral melatonin supplementation during ovarian stimulation can improve the outcomes of assisted reproductive technology. Methods and analyses We will recruit 160 infertile women into one of four groups: placebo (n=40); melatonin 2?mg twice per day (n=40); melatonin 4?mg twice per day (n=40) and melatonin 8?mg twice per day (n=40). The primary outcome will be clinical pregnancy rate. Secondary clinical outcomes include oocyte number/quality, embryo number/quality and fertilisation rate. We will also measure serum melatonin and the oxidative stress marker, 8-hydroxy-2?-deoxyguanosine at baseline and after treatment and levels of these in follicular fluid at egg pick-up. We will investigate follicular blood flow with Doppler ultrasound, patient sleepiness scores and pregnancy complications, comparing outcomes between groups. This protocol has been designed in accordance with the SPIRIT 2013 Guidelines. Ethics and dissemination Ethical approval has been obtained from Monash Health HREC (Ref: 13402B), Monash University HREC (Ref: CF14/523-2014000181) and Monash Surgical Private Hospital HREC (Ref: 14107). Data analysis, interpretation and conclusions will be presented at national and international conferences and published in peer-reviewed journals. Trial registration number ACTRN12613001317785. PMID:25180056

Fernando, Shavi; Osianlis, Tiki; Vollenhoven, Beverley; Wallace, Euan; Rombauts, Luk

2014-01-01

408

Evaluation of the Implementation of a Rapid Response Treatment Protocol for Patients with Acute Onset Stroke: Can We Increase the Number of Patients Treated and Shorten the Time Needed?  

PubMed Central

Aims This study aims to evaluate the implementation of a rapid response treatment protocol for patients presenting with acute onset ischemic stroke. Improvements of routines surrounding the admission and treatment of patients with intravenous thrombolysis (IVT), such as door-to-needle (DTN) times, and increasing the numbers of patients treated are discussed. Methods We conducted a retrospective analysis of all patients (n = 320) treated with IVT for acute onset ischemic stroke at the Stavanger University Hospital, Norway, between 2003 and 2012. In 2009, a succession of changes to pre- and intra-hospital routines were made as well as an improvement in the education of primary health care physicians, nurses and paramedics involved in the treatment of acute onset stroke patients (rapid response treatment protocol). Analyses of DTN times, onset-to-needle times and the number of patients treated per year were carried out to ascertain the effect of the changes made. The primary aim was to analyze DTN times to look for any changes, and the secondary aim was to analyze changes in the number of patients treated per year. Results In the years after the implementation of the rapid treatment protocol, we saw an improvement in the median DTN time with a decrease from 73 to 50 min in the first year (p = 0.03), a decrease of 45 min in the second year (p = 0.01) and a decrease of 31 min in the third year (p < 0.001). Similarly, an improvement in the number of patients treated per year was seen after enhancements in the treatment chain were made. A significant, 27-fold increase was shown when the number of patients treated in 2012 was compared with all patients treated in all years prior to the implementation of the rapid treatment protocol. Conclusions The implementation of the rapid treatment protocol for acute onset ischemic stroke patients led to a significant decrease in the DTN time at our center. These improvements also produced an increase in the number of patients treated per year. The extension of the therapeutic window from 3 to 4.5 h for the use of intravenous recombinant tissue plasminogen activator also played a role in the increased treatment numbers. PMID:25076956

Advani, Rajiv; Naess, Halvor; Kurz, Martin W.

2014-01-01

409

42 CFR 483.354 - General requirements for psychiatric residential treatment facilities.  

Code of Federal Regulations, 2010 CFR

...requirements for psychiatric residential treatment facilities. 483.354 Section 483...or Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric...requirements for psychiatric residential treatment facilities. A psychiatric...

2010-10-01

410

Chronic allograft nephropathy (CAN) in early renal protocol biopsies: does treatment of borderline and subclinical acute rejections prevent development and progression of CAN?  

PubMed

Histological markers of chronic allograft nephropathy (CAN) in early protocol biopsies may ultimately result in deterioration of graft function. The aim of our study was to evaluate risk factors of early CAN histology and to determine whether treatment of borderline and subclinical acute rejections (BR/SAR) at 1-month posttransplant, prevents development and/or progression of CAN at 6-month biopsy. Thirty-five paired kidney allograft biopsies at 1 and 6 months after transplantation were blindly reviewed using Banff'97 criteria. The mean CAN score (sum of histological markers for chronicity) increased significantly at 6-month biopsy (1.83 +/- 1.46 vs 4.66 +/- 2.35; p < 0.01). No CAN was present in 27/70 biopsies (38.6%), 71.4% showed progression and 28.6% were with stable CAN at 6-month biopsy. When compared according to the progression, mean histological index (HI) score (sum of acute/chronic changes) in progressed CAN group (pCAN) increased significantly at 6-month biopsy (5.0 +/- 3.0 vs 9.5 +/- 2.8; p < 0.001). At 1-month biopsy, BR/SAR were found in 68% and 70%, in the pCAN and stable (sCAN) groups, respectively. The percentage of treated BR/SAR in sCAN group was significantly higher (57.1 vs 23.5%; p < 0.05), and the score of acute histological lesions lower (1.08 +/- 0.95 vs 0.35 +/- 0.66; p < 0.01) at 6-month biopsy. In conclusion, 1-month protocol biopsy may be valuable to uncover BR/SAR and the presence of early CAN in stable renal allografts. Progression of CAN at 6-month biopsy in our study was found to be associated with a greater number of untreated BR/SAR at 1-month biopsy. This observation may have important implications in the design of clinical trials aimed to prevent the progression of CAN. PMID:16400232

Masin-Spasovska, J; Spasovski, G; Polenakovi?, M; Dzikova, S; Petrusevska, G; Dimova, B; Lekovski, Lj; Popov, Z; Ivanovski, N

2005-12-01

411

Early rehabilitation after surgery improves functional outcome in inpatients with brain tumours.  

PubMed

Clinical experience suggests that application of the fundamental principles of rehabilitation medicine can improve the care of patients with cancer. Despite the high incidence of neurological and functional deficits in patients affected by brain tumours (BTs), rehabilitation treatment of this population is not as well established as it is for patients with other neurological conditions. To assess functional outcome in brain tumour inpatients who underwent early rehabilitation after surgery. 75 patients who had undergone neurosurgery for primary BTs and 75 patients affected by stroke were enrolled in a case-control study. All patients were evaluated by means of a core set of clinical scales (Functional Independence Measure, Sitting Balance score, Standing Balance score, Hauser Index, Massachusetts General Hospital Functional Ambulation Classification). Patients were evaluated before the beginning (T0) and at the end (T1) of rehabilitation treatment. The neurorehabilitation programme consisted of individual 60-min sessions of treatment, administered once a day, six days a week, for four consecutive weeks. Speech therapy was included when aphasia was diagnosed. All the measures of outcome were indicative of substantial improvements for neuro-oncological and for stroke patients (P = 0.000). Analysis of subgroups showed that patients affected by meningioma achieved better results (in efficiency terms) as regards independence in activities of daily living (P = 0.02) and mobility (P = 0.04) compared with patients affected by glioblastoma or stroke. Rehabilitation after surgery can improve functional outcome, justifying the delivery of rehabilitation services, even during the acute phase, to BTs inpatients, irrespective of tumour type. PMID:22124725

Bartolo, Michelangelo; Zucchella, Chiara; Pace, Andrea; Lanzetta, Gaetano; Vecchione, Carmine; Bartolo, Marcello; Grillea, Giovanni; Serrao, Mariano; Tassorelli, Cristina; Sandrini, Giorgio; Pierelli, Francesco

2012-05-01

412

Depressive Experiences in Inpatients with Borderline Personality Disorder  

Microsoft Academic Search

We investigate the quality of dependent and self-critical depressive experiences in a hospitalized sample of depressed (n = 17), depressed borderline (n = 29), and borderline non-depressed inpatients (n = 10). Subjects were administered structured diagnostic interviews for axis I and axis II along with the Symptom Checklist-90-Revised\\u000a Depression Scale (SCL-90-R-DS) and the Depressive Experiences Questionnaire (DEQ). As predicted, there were no differences\\u000a between the three

Kenneth N. Levy; William S. Edell; Thomas H. McGlashan

2007-01-01

413

Assessing Behavioral Coping Preferences of Psychiatric Inpatients: A Pilot Study  

PubMed Central

Background Recently there has been increased concern about excessive restraint and seclusion on inpatient psychiatric units and the resulting injuries and deaths. Individual crisis management strategies may be one way to reduce restraint and seclusion, which may include active engagement of inpatients in behavioral coping plans. Method We developed a 5-question Coping Agreement Questionnaire (CAQ) asking inpatients for their preferences on how to prevent loss of control if they become agitated. Nurses completed the CAQ with each patient to find alternatives to restraint and seclusion. A total of 264 admissions were reviewed, with the following diagnoses: mood disorders (n = 111 [42%]), schizophrenia or other psychotic disorders (n = 69 [26%]), or substance use disorders (n = 58 [22%]). One hundred thirty-seven patients (52%) were male. Results Many CAQ answers differed by diagnosis, sex, age, and ethnicity. For example, when asked how staff could help if they were about to lose control, all groups rated “talk with me” highly, although substance abusers preferred to “sit by self in room.” Adolescent patients were more often upset by not having visitors, whereas elderly patients reported being upset by having visitors. Overall, white patients gave more answers to CAQ questions than did black or Hispanic patients. Conclusions The findings have implications for practice on 3 levels. First, overall implications for the milieu were suggested by patients' preferences. Second, responses that differed by group suggested that optimal case management strategies may vary according to population characteristics. Third, patients may be engaged on the basis of individual preferences as active partners in managing their behavior during inpatient hospitalization. PMID:19242577

Hellerstein, David J.; Seirmarco, Gretchen; Almeida, Goretti; Batchelder, Sarai

2008-01-01

414