Sample records for inpatient treatment protocol

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

    PubMed Central

    2013-01-01

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

  2. Assessing Treatment Outcome in Psychogeriatric Inpatients

    Microsoft Academic Search

    Courtney C. Kennedy; Paul Madra; John R. Reddon

    1999-01-01

    Ratings on the Global Assessment of Functioning (GAF) scale were obtained preand post-treatment from 37 male and 67 female psychogeriatric inpatients (age mean = 74.9, range = 54-91). Results indicated that a large treatment effect occurred, as GAF scores were significantly higher upon discharge than on admission (p < .0005, ES = 1.83). Pre-treatment GAF scores were also significantly correlated

  3. Inpatient vs outpatient treatment for substance dependence revisited

    Microsoft Academic Search

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

    1993-01-01

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

  4. Therapeutic recreation treatment time during inpatient rehabilitation

    PubMed Central

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

    2011-01-01

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

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  6. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  7. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  8. Group treatment of adult male inpatients abused as children

    Microsoft Academic Search

    Lisa Y. Zaidi

    1994-01-01

    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

  9. Referral to Inpatient Treatment Does not Necessarily Imply a Need for Inpatient Treatment.

    PubMed

    Stulz, Niklaus; Nevely, Anja; Hilpert, Matthias; Bielinski, Daniel; Spisla, Caesar; Maeck, Lienhard; Hepp, Urs

    2015-07-01

    We analyzed the dispositional decisions taken in a unit for clinical decision making (UCDM) which was set up to examine all emergency inpatient referrals to a psychiatric hospital. Hospitalization proved unnecessary for at least 17 % of the N = 2,026 inpatient referrals over a one year period. Instead, these patients were admitted to day-hospitals or outpatient treatments, resulting in annual cost savings of approximately 3.3 million. Merely 8 % of those non-admitted patients had to be hospitalized within 28 days of the decision for non-admission being taken. Thus, a specialized UCDM run by clinical experts can help identify cost-effective alternatives to hospitalization. PMID:24898612

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

    PubMed

    Silverman, Michael J

    2011-01-01

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

  11. Symptom-Triggered versus Standard Chlormethiazole Treatment of Inpatient Alcohol Withdrawal: Clinical Implications from a Chart Analysis

    Microsoft Academic Search

    Christian Lange-Asschenfeldt; Matthias J. Müller; Armin Szegedi; Ion Anghelescu; Christoph Klawe; Hermann Wetzel

    2003-01-01

    To evaluate clinical effectiveness and safety of 2 different detoxification treatment protocols, a chart analysis of hospital inpatients consecutively admitted for alcohol withdrawal during one year was undertaken. Records of 33 patients receiving symptom-triggered treatment (using a modified version of the revised Clinical Institute Withdrawal Assessment for Alcohol Scale) were compared with those of patients treated by applying a fixed-dose

  12. Exploring the relationship between brief inpatient treatment intensity and treatment outcomes for mood and anxiety disorders

    Microsoft Academic Search

    Sharon Tucker; Connie Luedtke; Wendy Moore

    2001-01-01

    Background: Few studies have identified effective nursing interventions for today's psychiatric settings. Objectives: This article reports findings from a study that explored the relationship between brief inpatient treatment intensity (average daily frequencies of treatment activities) and treatment outcomes (symptomatology, functioning, and readmission rates up to 3 months postdischarge) among 67 inpatients treated for mood and anxiety disorders. Design: By using

  13. Correlates of Burnout in Inpatient Substance Abuse Treatment Therapists.

    ERIC Educational Resources Information Center

    Elman, Barnett D.; Dowd, Edmund Thomas

    1997-01-01

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

  14. The impact of evidence on physicians’ inpatient treatment decisions

    Microsoft Academic Search

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

    2004-01-01

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

  15. Treatment - mother-infant inpatient units.

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    Microsoft Academic Search

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

    2011-01-01

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

  18. Risk profiles of treatment noncompletion for inpatients and outpatients undergoing alcohol disorder rehabilitation treatment

    PubMed Central

    Preuss, Ulrich W; Zimmermann, Jörg; Schultz, Gabriele; Watzke, Anna; Schmidt, Peggy; Löhnert, Bärbel; Soyka, Michael

    2012-01-01

    Background Rehabilitation treatment noncompletion is considered a risk factor for long term relapse in alcohol-dependent individuals. The aim of this analysis of in- and outpatients in alcohol dependence rehabilitation in Germany is to identify social, mental, and somatic risk profiles for treatment noncompletion. Methods A total of 92 individuals from an outpatient program and 303 individuals from two inpatient rehabilitation treatment units in three different locations in Germany were recruited and assessed with a structured interview and several measures of psychopathology (personality disorders, anxiety, depression, and impulsivity) at treatment admission, with termination at 12 months follow-up. Participants were subdivided into treatment completers and noncom-pleters for any reason. Results A total of 10.2% of inpatients and 16.1% of outpatients did not complete treatment. Compared with treatment completers, noncompleters had a significantly lower rate of continuous abstinence at 1-year follow-up, more recent alcohol consumption before admission, and a higher rate of borderline personality disorders. Among inpatients, an elevated rate of lifetime mental disorders, depression, and suicide attempts was found among treatment noncompleters; among outpatients, treatment noncompleters were more often than completers to be married but live separated. Conclusion Rates of treatment noncompletion in inpatient and outpatient rehabilitation programs correspond to results from previous research. Noncompletion is a significant correlate of relapse 1 year after treatment, and noncompleters show an elevated level of psychopathology. These findings may help rehabilitation treatment facilities to tailor specific therapies for these individuals to reduce risk for treatment noncompletion. PMID:24474864

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

    PubMed Central

    2011-01-01

    Background Mental health inpatients smoke at higher rates than the general population and are disproportionately affected by tobacco dependence. Despite the advent of smoke free policies within mental health hospitals, limited systems are in place to support a cessation attempt post hospitalisation, and international evidence suggests that most smokers return to pre-admission smoking levels following discharge. This protocol describes a randomised controlled trial that will test the feasibility, acceptability and efficacy of linking inpatient smoking care with ongoing community cessation support for smokers with a mental illness. Methods/Design This study will be conducted as a randomised controlled trial. 200 smokers with an acute mental illness will be recruited from a large inpatient mental health facility. Participants will complete a baseline survey and will be randomised to either a multimodal smoking cessation intervention or provided with hospital smoking care only. Randomisation will be stratified by diagnosis (psychotic, non-psychotic). Intervention participants will be provided with a brief motivational interview in the inpatient setting and options of ongoing smoking cessation support post discharge: nicotine replacement therapy (NRT); referral to Quitline; smoking cessation groups; and fortnightly telephone support. Outcome data, including cigarettes smoked per day, quit attempts, and self-reported 7-day point prevalence abstinence (validated by exhaled carbon monoxide), will be collected via blind interview at one week, two months, four months and six months post discharge. Process information will also be collected, including the use of cessation supports and cost of the intervention. Discussion This study will provide comprehensive data on the potential of an integrated, multimodal smoking cessation intervention for persons with an acute mental illness, linking inpatient with community cessation support. Trial Registration Australian and New Zealand Clinical Trials Registry ANZTCN: ACTRN12609000465257 PMID:21762532

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

    Microsoft Academic Search

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

    2003-01-01

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

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

    PubMed

    Brewster, D R

    2011-01-01

    This review focuses on how to reduce the high mortality of severe acute malnutrition (SAM) in African hospitals. The World Health Organization's 1999 manual for physicians (protocol) has not resulted in case-fatality rates of under 5%, even in published research studies from Africa, far less in district and central hospitals which do not record case-fatality rates. It is suggested that the following eight changes to the protocol need to be considered if we are serious about reducing case-fatality rates in African hospitals: (1) use of low lactose, low osmolality milk feeds during the early stage of treatment, especially for HIV-exposed infants and diarrhoeal cases; (2) more cautious use of high carbohydrate loads (ORS, ReSoMal, sucrose and 10% dextrose) during initial stabilisation; (3) more careful grading up and down of feed volumes according the child's responses during the early rehabilitation phase; (4) rapid rehydration of children in shock with Ringer's lactate, as for well-nourished children, with closer monitoring for heart failure; (5) greater use of 3rd-generation cephalosporin and fluoroquinolone antibiotics (e.g. ceftriaxone, ciprofloxacin) to treat sepsis owing to resistant organisms; (6) consider adding glutamine-arginine supplements as gut-protective agents in addition to zinc and vitamin A; (7) the addition of phosphate to existing potassium and magnesium supplements for those at risk of the refeeding syndrome; and (8) introduce better tools for diagnosis and clearer management of combined HIV and tuberculous infections in infants. Many will argue that these suggestions are unaffordable or impractical. On the contrary, cases of SAM requiring hospital admission need to be allocated more resources, including better nursing care, better diet and better medication. Resources made available for other childhood inpatient services such as ID and HIV dwarf those for severe malnutrition. Of course, prevention is always a better investment, including improving breastfeeding rates, improving complementary feeding practices and using ready-to-use therapeutic foods (RUTF) or similar supplements for those failing to thrive in the community, but SAM is unlikely to disappear from our hospitals, and these children need to be better managed if we are serious about reducing mortality. PMID:21575313

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  3. Glucose tolerance in depressed inpatients, under treatment with mirtazapine and in healthy controls.

    PubMed

    Hennings, J M; Ising, M; Grautoff, S; Himmerich, H; Pollmächer, T; Schaaf, L

    2010-02-01

    Impaired glucose tolerance and diabetes have been associated with depression, and antidepressant treatment is assumed to improve impaired glucose tolerance. However, antidepressant treatment is also considered as a risk factor for the development of diabetes. Reports about glucose tolerance under antidepressant treatment frequently lack appropriate control groups. We conducted the oral glucose tolerance test (OGTT) in 10 healthy controls selected from an epidemiological sample with a negative lifetime history of mental Axis I disorder. Controls were carefully matched to a sample of inpatients with major depression that participated in an OGTT before and after antidepressant treatment with mirtazapine. All participants underwent a standard OGTT protocol. In patients, a second (after 2 weeks) and a third (after 4-6 weeks) OGTT was performed under treatment with mirtazapine. Compared to healthy controls, we observed significantly impaired glucose tolerance in acutely depressed patients. Effect size calculation indicated a moderate to large effects on glucose and insulin concentrations in response to an OGTT. Although glucose tolerance improved under mirtazapine treatment, insulin sensitivity was still impaired and remained significantly lower in patients compared to controls. PMID:19834872

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

    PubMed

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

    2013-12-01

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

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

    PubMed

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

    2015-03-01

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

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

    PubMed Central

    2013-01-01

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

  7. Psychiatric Inpatient and Outpatient Evaluation of Music Therapy and Related Treatments

    Microsoft Academic Search

    Kira M. Travis

    2003-01-01

    Psychiatric inpatients and outpatients (N = 12) were asked to evaluate music therapy services received while admitted in treatment. Each subject was given an anonymous survey with rating, multiple choice, and ranking questions. Music therapy ranked high in the enjoyment category, average 1.58, and most patients agreed that music therapy helped them progress towards their treatment goals, average 1.67. Relaxation

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

    Microsoft Academic Search

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

    2006-01-01

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

  9. Instantiating and monitoring treatment protocols.

    PubMed Central

    Uckun, S.

    1994-01-01

    This paper presents a system for protocol-based treatment planning, plan execution, and execution monitoring. The approach, named SPIN, is developed as a component of the Guardian system. Guardian is an experimental architecture for intelligent patient monitoring and control. The paper describes and illustrates SPIN in a clinical scenario. PMID:7950014

  10. Social Recovery Model: An 8Year Investigation of Adolescent 12Step Group Involvement Following Inpatient Treatment

    Microsoft Academic Search

    John F. Kelly; Sandra A. Brown; Ana Abrantes; Christopher W. Kahler; Mark Myers

    2008-01-01

    Background: Despite widespread use of 12-step treatment approaches and referrals to Alcohol- ics Anonymous (AA) and Narcotics Anonymous (NA) by youth providers, little is known about the significance of these organizations in youth addiction recovery. Furthermore, existing evidence is based mostly on short-term follow-up and is limited methodologically. Methods: Adolescent inpatients ( n= 160; mean age = 16, 40% female)

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

    NASA Astrophysics Data System (ADS)

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

    1993-03-01

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

  12. Inpatient treatment of obese children: a multicomponent programme without stringent calorie restriction

    Microsoft Academic Search

    Caroline Braet; Ann Tanghe; Patrick De Bode; Hilde Franckx; Myriam Van Winckel

    2003-01-01

    This prospective clinical case-control study describes the effect of an inpatient multicomponent treatment programme for obese children and adolescents on their weight and psychological well being. We studied 38 patients and 38 controls on the waiting list, matched for age and gender, referred because of obesity, with a median age of 13 years (range 10-17 years) and a median adjusted

  13. The Therapeutic Alliance in Child Inpatient Treatment: Development and Initial Validation of a Family Engagement Questionnaire

    Microsoft Academic Search

    Leo Kroll; Jonathan Green

    1997-01-01

    This article presents the development and initial validation of an instrument to measure therapeutic engagement in the context of child and adolescent inpatient treatment - the Family Engagement Questionnaire. Despite considerable adult literature on therapeutic alliance and patient engagement, there has been relatively little work done in this area in child and adolescent psychiatry. The general literature on therapeutic alliance

  14. Dissociation predicts symptom-related treatment outcome in short-term inpatient psychotherapy

    Microsoft Academic Search

    Carsten Spitzer; Sven Barnow; Harald J. Freyberger; Hans Joergen Grabe

    2007-01-01

    Objective: Previous research has indicated that dissociation might be a negative predictor of treatment outcome in cognitive behavioural therapy for patients with obsessive- compulsive and anxiety disorders. Using a naturalistic design it was hypothesized that higher levels of dissociation predict poorer outcome in inpatients with affective, anxiety and somatoform disorders participating in a brief psychodynamic psychotherapy. Method: A total of

  15. Agitation in the inpatient psychiatric setting: a review of clinical presentation, burden, and treatment.

    PubMed

    Hankin, Cheryl S; Bronstone, Amy; Koran, Lorrin M

    2011-05-01

    Agitation among psychiatric inpatients (particularly those diagnosed with schizophrenia or bipolar disorder) is common and, unless recognized early and managed effectively, can rapidly escalate to potentially dangerous behaviors, including physical violence. Inpatient aggression and violence have substantial adverse psychological and physical consequences for both patients and providers, and they are costly to the healthcare system. In contrast to the commonly held view that inpatient violence occurs without warning or can be predicted by "static" risk factors, such as patient demographics or clinical characteristics, research indicates that violence is usually preceded by observable behaviors, especially non-violent agitation. When agitation is recognized, staff should employ nonpharmacological de-escalation strategies and, if the behavior continues, offer pharmacological treatment to calm patients rapidly. Given the poor therapeutic efficacy and potential for adverse events associated with physical restraint and seclusion, and the potential adverse sequelae of involuntary drug treatment, these interventions should be considered last resorts. Pharmacological agents used to treat agitation include benzodiazepines and first- and second-generation antipsychotic drugs. Although no currently available agent is ideal, recommendations for selecting among them are provided. There remains an unmet need for a non-invasive and rapidly acting agent that effectively calms without excessively sedating patients, addresses the patient's underlying psychiatric symptoms, and is reasonably safe and tolerable. A treatment with these characteristics could substantially reduce the clinical and economic burden of agitation in the inpatient psychiatric setting. PMID:21586995

  16. Motivation for therapy and the results of inpatient treatment of patients with a generalized anxiety disorder: A prospective study

    Microsoft Academic Search

    Cerstin Nickel; Karin Tritt; Christian Kettler; Claas Lahmann; Thomas Loew; Wolfhardt Rother; Marius Nickel

    2005-01-01

    Summary Whether the primary motivation for entering therapy significantly influences the results of inpatient psychotherapeutic treatment is subject to debate. The purpose of this study was to examine this question in women with generalized anxiety disorder. The monitored results from 54 female inpatients (29 who were highly motivated to enter therapy and 25 who were minimally motivated) were compared. The

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

    Microsoft Academic Search

    Joanna E. Bettmann; Rachael A. Jasperson

    2009-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  19. Changes in psychiatric inpatient treatment of children and youth in general hospitals: 1980-1985.

    PubMed

    Kiesler, C A; Simpkins, C

    1991-06-01

    Changes in the prevalence of inpatient psychiatric treatment of children and youth in short-term general hospitals between 1980 and 1985 were investigated. During that period, the locus of treatment of mental illness among children and youth shifted dramatically away from specialized facilities to general hospitals without psychiatric units. Among general hospitals without psychiatric units, the number of inpatient psychiatric episodes treated increased dramatically, patients' average length of stay almost doubled, and the total days of care provided more than tripled. The increased care was paid for primarily by Medicaid and commercial insurance. Total days of care for drug and alcohol problems among children and youth in general hospitals decreased substantially. The results suggest that general hospitals may be relying on psychiatric treatment to supplement revenues that were limited by Medicare's prospective payment system, which became effective during the period under study. PMID:1907594

  20. The school behaviors of children in three psychiatric treatment settings: An outpatient clinic, a day hospital, and an inpatient hospital

    Microsoft Academic Search

    Sara Goodman Zimet; Gordon K. Farley; Gregory D. Zimet

    1994-01-01

    Compares teachers' ratings of the school behaviors of children entering an outpatient clinic, a day psychiatric program, and\\u000a an inpatient psychiatric hospital. Many of the ratings did not discriminate among the three groups. Children starting outpatient\\u000a versus day treatment were rated as higher in aggression, anxiety, and hostile withdrawal, and children beginning outpatient\\u000a and day treatment versus inpatient treatment, were

  1. Substance Abuse: A 12-Month Outcome Study Following Inpatient Treatment.

    ERIC Educational Resources Information Center

    Petiet, Carole A.

    A 12-month outcome study was conducted on 129 patients discharged from a hospital-based substance abuse treatment program in an effort to identify the progress of patients after treatment, evaluate the treatment program, and improve the program based on the evaluation. Subjects completed two demographic questionnaires and a 12-month post-discharge…

  2. The psychiatric inpatient treatment of children and youth in general hospitals.

    PubMed

    Kiesler, C A; Simpkins, C; Morton, T

    1989-12-01

    National attention has recently focused on the mental health needs and services of children and youth. The lack of outpatient services and their coordination has been noted, as well as the consequent press towards inpatient care. We describe the inpatient treatment of children and adolescents (ages 0-18) in short-term, non-Federal general hospitals in 1980. Nationally, 128,300 children were treated for mental disorders in general hospitals at an estimated cost of over $1.5 billion. Compared to adults, children were more likely to be treated in scatter beds (vs. specialty units); have a diagnosis of mental disorder (vs. alcohol/drug disorder); stay much longer; and pay with commercial insurance. Previous work focusing on psychiatric units of general hospitals identified less than 40% of the total episodes, a figure very similar to that for adults. The majority of psychiatric inpatient episodes for children and youth in the United States takes place in short-term general hospitals. Community psychologists need to be aware of national trends in inpatient care and be involved in the development and promulgation of alternative models of care. PMID:2636541

  3. Military inpatient residential treatment of substance abuse disorders: the Eisenhower Army Medical Center experience.

    PubMed

    Mooney, Scott R; Horton, Philip A; Trakowski, John H; Lenard, Janet H; Barron, Mark R; Nave, Peggy V; Gautreaux, Melissa S; Lott, Heather D

    2014-06-01

    Opened in 2009, the Dwight D. Eisenhower Army Medical Center Inpatient Residential Treatment Facility (RTF) is the largest and most well-established inpatient substance use disorder treatment facility in the Department of Defense. The RTF is a 28-day inpatient treatment program that employs evidence-based practices and is based on Alcoholics/Narcotics Anonymous principles that are incorporated with a hybrid of military daily structure regime including early morning physical training. Family involvement is encouraged. The RTF is staffed by a multidisciplinary team specializing in addictions and admits Active/Activated Service Members (SMs) from all Service branches, typically those who have failed other military/civilian substance use disorder programs. Eighty-seven percent of SMs referred to the program successfully commenced, with continuous sobriety observed in over half of SMs 6 months later, and 1 year relapse rates comparable to other alcohol treatment programs. Limitations of our program evaluation efforts, lessons learned, and recommendations for the way ahead are shared. PMID:24902136

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

    PubMed Central

    Eli, Karin

    2014-01-01

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

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

    PubMed

    Eli, Karin

    2014-01-01

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

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

    Microsoft Academic Search

    Manfred Fichter; Marian Cebulla; Nobert Quadflieg; Silke Naab

    2008-01-01

    The goal of this study was to develop a cognitive–behavioral self-help manual for anorexia nervosa. Patients diagnosed with anorexia nervosa (N=102), binge eating\\/purging type (AN-B\\/P), were consecutively assigned to one of two conditions: 6-week manualized guided self-help or a wait-list control. All patients thereafter received inpatient treatment in a hospital for behavioral medicine. The primary outcome variable was the number

  7. Hypermentalizing in adolescent inpatients: treatment effects and association with borderline traits.

    PubMed

    Sharp, Carla; Ha, Carolyn; Carbone, Crystal; Kim, Sohye; Perry, Katie; Williams, Laurel; Fonagy, Peter

    2013-02-01

    Sharp et al. (2011) recently demonstrated that in adolescents with borderline traits the loss of mentalization is more apparent in the emergence of unusual alternative strategies (excessive theory of mind or hypermentalizing) than in the loss of the capacity per se (no mentalizing or undermentalizing). This suggests that hypermentalizing could be a worthwhile social-cognitive treatment target in adolescents with borderline traits. The aim of the current study was to examine (1) whether a reduction in excessive theory of mind or hypermentalizing is achieved between admission and discharge for adolescent inpatients; (2) whether the hypothesized reduction is more apparent in adolescents meeting criteria for BPD compared with psychiatric controls; and (3) whether other forms of mentalizing would also be sensitive to and malleable by inpatient treatment in the same way we expected hypermentalizing to be. The "Movie for the Assessment of Social Cognition" Task (Dziobek et al., 2006) was administered to consecutive admissions to an adolescent inpatient setting (n = 164) at admission and discharge, alongside measures of borderline symptomology and interview-based diagnosis of BPD. Results demonstrated that 41% (n = 68) of the sample met full or intermediate criteria for BPD on an interview-based measure of BPD. A relation between borderline traits and hypermentalizing that appears to be independent of internalizing and externalizing problems was demonstrated. Hypermentalizing, but not other forms of social-cognitive reasoning (as measured by the Child Eyes Test, Basic Empathy Scale and the Mentalizing Stories Test for Adolescents), was found to be malleable through a milieu-based inpatient treatment. Clinical implications of the findings for the organization of treatment settings for adolescents are discussed. PMID:23342954

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

    Microsoft Academic Search

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

    2007-01-01

    We analyzed the influence of co-occurring obsessive-compulsive disorder (OCD) on response to eating disorder (ED) treatment among 2,971 female inpatients. We assessed treatment response using Eating Disorder Inventory-2 and DSM-IV ED criteria. Multivariate analyses included sociodemographics, illness severity, and co-occurring Axis I\\/II diagnoses. ED inpatients with OCD had greater ED severity than those without OCD. However, no differences occurred in

  9. Predictors of drinking and functional outcomes for men and women following inpatient alcohol treatment

    PubMed Central

    Sugarman, Dawn E.; Kaufman, Julia S.; Trucco, Elisa M.; Brown, Jodi C.; Greenfield, Shelly F.

    2013-01-01

    Background and Objectives This prospective study uses path analytic models to examine baseline characteristics associated with both functioning and drinking outcomes 12 months after inpatient alcohol treatment. Methods Alcohol dependent participants (N = 101) were recruited during inpatient alcohol treatment and assessed monthly one year after discharge. Results Alcohol severity was negatively associated with education and self-efficacy; marital status was positively associated with self-efficacy; and education and self-efficacy were negatively associated with drinking outcomes. Low alcohol severity, not having a depression diagnosis, and being married were associated with less social support impairment, which was in turn associated with better drinking outcomes. Having a history of sexual abuse did not influence drinking outcomes. However, having a history of sexual abuse was negatively associated with global functioning. Conclusions and Scientific Significance Drinking outcomes were associated with education, self-efficacy, social support, and diagnosis of depression at baseline; however, global functioning one year following treatment was primarily and negatively associated with sexual abuse history. Future treatment research should include measures of both functioning and drinking behavior outcomes. PMID:24724879

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

    PubMed Central

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

    2013-01-01

    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

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

    PubMed Central

    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

    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.

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

    PubMed Central

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

    2015-01-01

    Background: There is limited evidence on the course of health service costs before and after psychiatric inpatient treatment, which might also be affected by source of cost data. Thus, this study examines: i) differences in health care costs before and after psychiatric inpatient treatment, ii) whether these differences vary by source of cost-data (self-report vs. administrative), and iii) predictors of cost differences over time. Methods: Sixty-one psychiatric inpatients gave informed consent to their statutory health insurance company to provide insurance records and completed assessments at admission and 6-month follow-up. These were compared to the self?reported treatment costs derived from the "Client Socio-demographic and Service Use Inventory" (CSSRI?EU) for two 6?month observation periods before and after admission to inpatient treatment to a large psychiatric hospital in rural Bavaria. Costs were divided into subtypes including costs for inpatient and outpatient treatment as well as for medication. Results: Sixty-one participants completed both assessments. Over one year, the average patient?reported total monthly treatment costs increased from € 276.91 to € 517.88 (paired Wilcoxon Z = ?2.27; P = 0.023). Also all subtypes of treatment costs increased according to both data sources. Predictors of changes in costs were duration of the index admission and marital status. Conclusion: Self-reported costs of people with severe mental illness adequately reflect actual service use as recorded in administrative data. The increase in health service use after inpatient treatment can be seen as positive, while the pre-inpatient level of care is a potential problem, raising the question whether more or better outpatient care might have prevented hospital admission. Findings may serve as a basis for future studies aiming at furthering the understanding of what to expect regarding appropriate levels of post-hospital care, and what factors may help or inhibit post-discharge treatment engagement. Future research is also needed to examine long-term effects of inpatient psychiatric treatment on outcome and costs. PMID:25774372

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

    PubMed

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

    2014-01-01

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

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

    Microsoft Academic Search

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

    2009-01-01

    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

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

    ERIC Educational Resources Information Center

    Park, Jung Min; Ryan, Joseph P.

    2009-01-01

    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…

  16. The Effect of Prospective Payment on Admission and Treatment Policy: Evidence from Inpatient Rehabilitation Facilities

    PubMed Central

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

    2013-01-01

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

  17. Inpatient psychotherapeutic treatment for cardiac patients with depression in Germany - short term results

    PubMed Central

    Barth, Jürgen; Paul, Juliane; Härter, Martin; Bengel, Jürgen

    2005-01-01

    The purpose of the PROTeCD(Psychotherapeutic Resource-Orientated Treatment for Cardiac Patients with Depression)-study was to develop and to evaluate a brief psychotherapeutic intervention for rehabilitation in-patients with coronary heart disease (CHD) and depressive disorders. In three cardiac rehabilitation hospitals all patients were screened for mental distress at admission. Patients generally stay for 3 to 4 weeks before being referred to outpatient care. Method: Those patients with elevated distress were interviewed for mental disorders and took part in the baseline-assessment. Patients diagnosed with a depressive disorder at baseline were randomised into the intervention or the usual care group. Efficacy was assessed at discharge from hospital (short-term). 59 subjects with CHD and co-morbid depressive disorder were randomised into the trial - 27 into the intervention group (IG) and 32 into the usual care group (UC). Patients in the intervention group received 4 to 6 individual psychotherapeutic sessions of 50 minutes each, including patient education and cognitive-behavioural treatment of depression. Outcome measures were depressive and anxiety symptoms in self report and interview. Results: There was no significant difference between intervention and usual care group in this short-term reduction of depressive symptoms, mental distress and anxiety. However, at discharge the patients still suffer from an increased level of distress compared to the recommended cut off scores of the assessment scales. Conclusion: Multimodal inpatient rehabilitation reduces depressive and anxiety symptoms in depressed CHD patients in short term independently of an additional psychotherapeutic intervention. PMID:19742062

  18. [Treatment protocol for sudden deafness].

    PubMed

    Arellano, B; García Berrocal, J R; Górriz, C; González, F M; Vicente, J; Ramírez Camacho, R

    1997-10-01

    There are two types of rapidly progressive sensorineural hearing loss: sudden hearing loss, which is generally unilateral and develops in less than 72 hours, and rapidly progressive sensorineural hearing loss, which develops over days or months. The origin of sudden deafness is difficult to establish. Several etiopathogenic factors have been postulated, such as viral infection, autoimmune origin, vascular and metabolic disease, rupture of the labyrinthine membrane, and, recently, immune-mediated inner ear disease. We made a retrospective study of 40 patients seen in our department. Patients were given a combined treatment with steroids, nimodipine, heparin, and oxygen. Patients were divided into two groups by intravenous or oral treatment. PMID:9489150

  19. A multi-institutional analysis of inpatient treatment for supraventricular tachycardia in newborns and infants.

    PubMed

    Seslar, Stephen P; Garrison, Michelle M; Larison, Cindy; Salerno, Jack C

    2013-02-01

    This study aimed to examine practice patterns in the inpatient medical treatment of newborns and infants with supraventricular tachycardia (SVT) using the Pediatric Health Information System (PHIS) database, a large, multi-institutional administrative database. A retrospective examination of pediatric hospital discharge data was performed during the study period from January 2003 to September 2008. Data were extracted from the index hospitalization of all individuals younger than 1 year with the principal discharge diagnosis of SVT. Those with coexisting congenital or acquired structural heart disease were excluded from the study. The analysis included 171 patients. No deaths occurred, and 95 % of the infants were discharged to home. More than half (53 %) of the patients spent a portion of their hospital stay in an intensive care unit (ICU) setting. Multidrug therapy was common, with 45 % of the patients receiving two or more antiarrhythmic agents on the day of discharge. The five most commonly used antiarrhythmic drugs, in order of decreasing frequency of use, were propranolol, digoxin, amiodarone, flecainide, and sotalol. The median hospital stay for the group was 4 days, and this value increased as a function of the number of antiarrhythmic drugs used (median, 7 days for three or more agents) and the need for intensive care (median, 6 days). The information provided in this study helps to define common practice patterns and should allow caregivers to provide meaningful expectations to families regarding their potential treatment course and to anticipate the hospital length of stay. PMID:22903738

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

    Microsoft Academic Search

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

    2010-01-01

    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

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

    Microsoft Academic Search

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

    2004-01-01

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

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

    PubMed Central

    2010-01-01

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

  3. Morton's interdigital neuroma: a comprehensive treatment protocol.

    PubMed

    Bennett, G L; Graham, C E; Mauldin, D M

    1995-12-01

    One hundred fifteen patients with signs and symptoms of Mortons' interdigital neuroma were studied in an attempt to evaluate the efficacy of a staged treatment program. The first stage consisted of patient education, footwear modifications, and metatarsal head relief. The second stage consisted of a steroid/local anesthetic injection into the affected interspace. The third stage was surgical excision of the inflamed interdigital nerve. Overall, 97 of 115 patients (85%) believed that they had improved with the treatment program. Twenty-four patients (21%) eventually required surgical excision of the nerve and 23 of 24 patients (96%) had satisfactory results. The results of the staged treatment protocol were very satisfactory and patient satisfaction was high. PMID:8749346

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  5. Treatment needs and acknowledgement of illness – importance for satisfaction with psychiatric inpatient treatment

    Microsoft Academic Search

    Knut W Soergaard; Mary Nivison; Vidje Hansen; Terje Oeiesvold

    2008-01-01

    BACKGROUND: Patient satisfaction is an important, but controversial part of health service evaluation. This study dealt with how acknowledgement of illness and treatment needs effected the distribution of positive, neutral and negative evaluations in a group of first time admitted patients to a psychiatric hospital. METHOD: The participants filled out a standardized user satisfaction form before discharge. The number of

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

    PubMed Central

    Page, Stephen J.

    2013-01-01

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

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

    Microsoft Academic Search

    M. Grube

    2005-01-01

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

  8. COMPUTER SUPPORT FOR PROTOCOL-BASED TREATMENT OF CANCER1

    E-print Network

    Sergot, Marek

    ]; for breast cancer [10, 20]; for ovarian cancer [21] and for head and neck cancer [23]. The main differencesCOMPUTER 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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2014-01-01

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

  12. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: Results from the pelvic inflammatory disease evaluation and clinical health (peach) randomized trial

    Microsoft Academic Search

    Roberta B. Ness; David E. Soper; Robert L. Holley; Jeffrey Peipert; Hugh Randall; Richard L. Sweet; Steven J. Sondheimer; Susan L. Hendrix; Antonio Amortegui; Giuliana Trucco; Thomas Songer; Judith R. Lave; Sharon L. Hillier; Debra C. Bass; Sheryl F. Kelsey

    2002-01-01

    Objective: Pelvic inflammatory disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic inflammatory disease are treated as outpatients, the effectiveness of this strategy remains unproven. Study Design: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and

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

    ERIC Educational Resources Information Center

    Boxer, Paul

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

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

    PubMed Central

    Chola, Lumbwe; Robberstad, Bjarne

    2009-01-01

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

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

    PubMed Central

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

    2012-01-01

    Research on treatments in anorexia nervosa (AN) is scarce. Although most of the therapeutic programs used in ‘real world practice’ in AN treatment resort to multidisciplinary approaches, they have rarely been evaluated. Objective To compare two multidimensional post-hospitalization outpatients treatment programs for adolescents with severe AN: Treatment as Usual (TAU) versus this treatment plus family therapy (TAU+FT). Method Sixty female AN adolescents, aged 13 to 19 years, were included in a randomized parallel controlled trial conducted from 1999 to 2002 for the recruitment, and until 2004 for the 18 months follow-up. Allocation to one of the two treatment groups (30 in each arm) was randomised. The TAU program included sessions for the patient alone as well as sessions with a psychiatrist for the patient and her parents. The TAU+FT program was identical to the usual one but also included family therapy sessions targeting intra-familial dynamics, but not eating disorder symptoms. The main Outcome Measure was the Morgan and Russell outcome category (Good or Intermediate versus Poor outcome). Secondary outcome indicators included AN symptoms or their consequences (eating symptoms, body mass index, amenorrhea, number of hospitalizations in the course of follow-up, social adjustment). The evaluators, but not participants, were blind to randomization. Results At 18 months follow-up, we found a significant group effect for the Morgan and Russell outcome category in favor of the program with family therapy (Intention-to-treat: TAU+FT :12/30 (40%); TAU : 5/29 (17.2%) p?=?0.05; Per Protocol analysis: respectively 12/26 (46.2%); 4/27 (14.8%), p?=?0.01). Similar group effects were observed in terms of achievement of a healthy weight (i.e., BMI?10th percentile) and menstrual status. Conclusions Adding family therapy sessions, focusing on intra-familial dynamics rather than eating symptomatology, to a multidimensional program improves treatment effectiveness in girls with severe AN. Trial Registration Controlled-trials.com ISRCTN71142875 PMID:22238574

  17. Physical therapy assessment and treatment protocol for nursing home residents.

    PubMed

    O'Neil, M B; Woodard, M; Sosa, V; Hunter, L; Mulrow, C D; Gerety, M B; Tuley, M

    1992-08-01

    This article describes a standard protocol for assessing physical function in elderly nursing home residents. Major physical dimensions that are measured with the protocol include range of motion, muscle force, muscle reflex activity, sensation, soft tissue status, balance/coordination, and posture. A practical, functionally prioritized treatment model based on the assessment is also presented. The standardized assessment and treatment plan may be useful to the physical therapist in (1) planning and prioritizing treatment, (2) identifying when goals have been met, (3) recognizing when there is a need for treatment plan modification, and (4) educating physical therapy students in applying problem-solving skills in their treatment sessions. PMID:1635944

  18. Incorporating Tiotropium Into a Respiratory Therapist-Directed Bronchodilator Protocol for Managing In-Patients With COPD Exacerbations Decreases Bronchodilator Costs

    Microsoft Academic Search

    Gail S Drescher; Bettye J Carnathan; Susan Imus; Gene L Colice

    BACKGROUND: Tiotropium is used in maintenance treatment of chronic obstructive pulmonary disease (COPD), but there are no guidelines on when to start tiotropium following an exacerbation. OBJECTIVE: To determine whether the addition of tiotropium to a respiratory-therapist-directed bronchodilator protocol affects bronchodilator costs for patients hospitalized for COPD exacerba- tion. METHODS: We retrospectively analyzed data on the number and type of

  19. Preventing Suicide Among Inpatients

    PubMed Central

    Sakinofsky, Isaac

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Bettmann, Joanna E.; Jasperson, Rachael A.

    2009-01-01

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

  2. Family Engagement, Consumer Satisfaction and Treatment Outcome in the New Era of Child and Adolescent In-Patient Psychiatric Care

    Microsoft Academic Search

    Mary Y. Brinkmeyer; Sheila M. Eyberg; Mathew L. Nguyen; Robert W. Adams

    2004-01-01

    This study examined the association between family engagement and consumer satisfaction for the seriously emotionally disturbed children and adolescents admitted to an in-patient psychiatric unit in a large medical center. Participants were 45 male and female in-patients, aged 7–17, and their parents. At the time their child was discharged, parents completed a demographic questionnaire, the Achenbach Child Behavior Checklist, and

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

    PubMed

    Bloomgarden, Andrea; Calogero, Rachel M

    2008-01-01

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

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

    E-print Network

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

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

    PubMed Central

    grosse Holtforth, Martin

    2014-01-01

    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

  6. The economic burden of inpatient paediatric care in Kenya: household and provider costs for treatment of pneumonia, malaria and meningitis

    PubMed Central

    Ayieko, Philip; Akumu, Angela O; Griffiths, Ulla K; English, Mike

    2009-01-01

    Background Knowledge of treatment cost is essential in assessing cost effectiveness in healthcare. Evidence of the potential impact of implementing available interventions against childhood illnesses in developing countries challenges us to define the costs of treating these diseases. The purpose of this study is to describe the total costs associated with treatment of pneumonia, malaria and meningitis in children less than five years in seven Kenyan hospitals. Methods Patient resource use data were obtained from largely prospective evaluation of medical records and household expenditure during illness was collected from interviews with caretakers. The estimates for costs per bed day were based on published data. A sensitivity analysis was conducted using WHO-CHOICE values for costs per bed day. Results Treatment costs for 572 children (pneumonia = 205, malaria = 211, meningitis = 102 and mixed diagnoses = 54) and household expenditure for 390 households were analysed. From the provider perspective the mean cost per admission at the national hospital was US $95.58 for malaria, US $177.14 for pneumonia and US $284.64 for meningitis. In the public regional or district hospitals the mean cost per child treated ranged from US $47.19 to US $81.84 for malaria and US $54.06 to US $99.26 for pneumonia. The corresponding treatment costs in the mission hospitals were between US $43.23 to US $88.18 for malaria and US $ 43.36 to US $142.22 for pneumonia. Meningitis was treated for US $ 189.41 at the regional hospital and US $ 201.59 at one mission hospital. The total treatment cost estimates were sensitive to changes in the source of bed day costs. The median treatment related household payments within quintiles defined by total household expenditure differed by type of facility visited. Public hospitals recovered up to 40% of provider costs through user charges while mission facilities recovered 44% to 100% of costs. Conclusion Treatments cost for inpatient malaria, pneumonia and meningitis vary by facility type, with mission and tertiary referral facilities being more expensive compared to primary referral. Households of sick children contribute significantly towards provider cost through payment of user fees. These findings could be used in cost effectiveness analysis of health interventions. PMID:19161598

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

    PubMed

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

    2014-12-01

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

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

    PubMed

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

    2015-06-01

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

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

    PubMed

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

    2014-03-01

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

  10. Adult Rhabdomyosarcoma Survival Improved with Treatment on Multimodality Protocols

    PubMed Central

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

    2014-01-01

    Purpose Rhabdomyosarcoma (RMS) is a pediatric sarcoma rarely occurring in adults. For unknown reasons, adults with RMS have worse outcomes. Methods We analyzed data from all patients who presented to XXXXXXXX between 1990 and 2011 with RMS diagnosed at age 16 or older. 148 patients met study criteria. Ten were excluded for lack of adequate data. Results Median age was 28 yrs. Tumor histology was: embryonal 54%, alveolar 33%, pleomorphic 12%, and NOS 2%. The tumor site was unfavorable in 67% of patients. 33 patients (24%) were low risk, 61 (44%) intermediate risk, and 44 (32%) high risk. 46% were treated on or according to a prospective RMS protocol. Five-year overall survival (OS) was 45% for non-metastatic patients. Failure rates at 5 years for non-metastatic patients were 34% locally and 42% distantly. Among patients with non-metastatic disease (n=94), significant factors associated with OS were histology, site, risk group, age, and protocol treatment. On multivariate analysis, risk group and protocol treatment were significant after adjusting for age. Five-yr OS was 54% for protocol patients vs 36% for non-protocol patients. Conclusions Survival in non-metastatic adult patients was significantly improved for those treated on RMS protocols, most of which are now open to adults. PMID:23414767

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

    PubMed Central

    Boxer, Paul

    2010-01-01

    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

  12. Inpatient Falls

    PubMed Central

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

    2013-01-01

    In this 2 part series, analysis of the risk stratification tools that are available, definition for the scope of the problem, and potential solutions through a review of the literature are presented. A systematic review was used to identify articles for risk stratification and interventions. Three risk stratification systems are discussed, St Thomas’s Risk Assessment Tool in Falling Elderly Inpatients, Morse Fall Scale, and the Hendrich Fall Risk Model. Of these scoring systems, the Hendrich Fall Risk Model is the easiest to use and score. Predominantly, multifactorial interventions are used to prevent patient falls. Education and rehabilitation are common themes in studies with statistically significant results. The second article presents a guide to implementing a quality improvement project around hospital falls. A 10-step approach to Plan-Do-Study-Act (PDSA) cycles is described. Specific examples of problems and analysis are easily applicable to any institution. Furthermore, the sustainability of interventions and targeting new areas for improvement is discussed. Although specific to falls in the hospitalized patient, the goal is to present a stepwise approach which is broadly applicable to other areas requiring quality improvement. PMID:24167647

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

    PubMed Central

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Substance Abuse and Mental Health Services Administration, 2005

    2005-01-01

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

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

    Microsoft Academic Search

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

    2010-01-01

    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

  16. How do Trends for Behavioral Health Inpatient Care Differ from Medical Inpatient Care in U.S. Community Hospitals?

    Microsoft Academic Search

    Yuhua Bao; Roland Sturm

    Background: Inpatient care in the United States accounts for one third of the health care expenditures. There exists a well-established trend towards fewer inpatient admissions and shorter lengths of stay for all inpatient care, which can be attributed to cost containment efforts through managed care and advances in treatment technologies. However, different illnesses may not necessarily share the same pattern

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

    PubMed Central

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

    2013-01-01

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

  18. Implementation of a smoking cessation treatment integrity protocol: Treatment discriminability, potency and manual adherence

    Microsoft Academic Search

    Susan E. Collins; Sandra Eck; Evelyn Kick; Martina Schröter; Iris Torchalla; Anil Batra

    2009-01-01

    Testing manual adherence and treatment discriminability and potency have become increasingly important to ensuring the internal validity of treatment studies [Moncher, F.J., & Prinz, R.J., (1991). Treatment fidelity in outcome studies. Clinical Psychology Review, 11, 247–266.]. The objective of this study was therefore to implement the treatment integrity protocol based on the standardized framework proposed by Waltz, Addis, Koerner and

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

    ERIC Educational Resources Information Center

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

    2005-01-01

    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…

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    Boxer, Paul

    2010-01-01

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

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

    PubMed

    Child, Sue; Sheaff, Rod; Boiko, Olga; Bateman, Alice; Gericke, Christian A

    2013-01-01

    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

  3. Mandibular trauma treatment: A comparison of two protocols

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  5. Inpatient aggression in community hospitals.

    PubMed

    Szabo, Katalin A; White, Christopher L; Cummings, Stephen E; Wang, Raziya S; Quanbeck, Cameron D

    2015-06-01

    Physical violence is a frequent occurrence in acute community psychiatry units worldwide. Violent acts by patients cause many direct injuries and significantly degrade quality of care. The most accurate tools for predicting near-term violence on acute units rely on current clinical features rather than demographic risk factors. The efficacy of risk assessment strategies to lower incidence of violence on acute units is unknown. A range of behavioral and psychopharmacologic treatments have been shown to reduce violence among psychiatric inpatients. PMID:25715971

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

    NASA Astrophysics Data System (ADS)

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

    2015-02-01

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

  7. Effects of providing patient progress feedback and clinical support tools to psychotherapists in an inpatient eating disorders treatment program: a randomized controlled study.

    PubMed

    Simon, Witold; Lambert, Michael J; Busath, Gregory; Vazquez, Aaron; Berkeljon, Arjan; Hyer, Kevin; Granley, Mac; Berrett, Michael

    2013-01-01

    Research on the effects of progress feedback and clinician problem-solving tools on patient outcome has been limited to a few clinical problems and settings (Shimokawa, Lambert, & Smart, 2010). Although these interventions work well in outpatient settings their effects so far have not been investigated with eating-disordered patients or in inpatient care. In this study, the effect of providing feedback interventions was investigated in a randomized clinical trial involving 133 females diagnosed with anorexia nervosa, bulimia nervosa, or eating disorders not otherwise specified. Comparisons were made between the outcomes of patients randomly assigned to either treatment-as-usual (TAU) or an experimental condition (Fb) within therapists (the same therapists provided both treatments). Patients in the Fb condition more frequently experienced clinically significant change than those who had TAU (52.95% vs. 28.6%). Similar trends were noted within diagnostic groups. In terms of pre to post change in mental health functioning, large effect sizes favored Fb over TAU. Patients' BMI improved substantially in both TAU and the feedback condition. The effects of feedback were consistent with past research on these approaches although the effect size was smaller in this study. Suggestions for further research are delineated. PMID:23656489

  8. Does stage-of-change predict dropout in a culturally diverse sample of adolescents admitted to inpatient substance-abuse treatment? A test of the Transtheoretical Model.

    PubMed

    Callaghan, Russell C; Hathaway, Andy; Cunningham, John A; Vettese, Lisa C; Wyatt, Sandi; Taylor, Lawren

    2005-10-01

    The Transtheoretical Model (TTM) () proposes that the stages-of-change construct can serve as useful tool for identifying those most at-risk of treatment dropout [Prochaska, J. O. (1999). How do people change, and how can we change to help many more people? In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change (pp. 227-255). Washington: American Psychological Association]. While researchers have found mixed support for this claim in adult samples, studies have not yet tested this issue in adolescent substance-abuse treatment settings. This paper reports findings from a Canadian study of adolescents (n = 130: 80 Caucasians, 50 Aboriginals) admitted to a hospital-based, residential substance-abuse treatment program. Two approaches were used to test the TTM's claim: (1) a hierarchical logistic regression model of dropout was developed using the subscales of the University of Rhode Island Change Assessment instrument (URICA), demographic variables, and subscales of the Addiction Severity Index (ASI); and (2) a chi-square analysis was employed to test the hypothesized relation between stage-of-change and dropout status. The findings demonstrated that the best predictive model of dropout included only the Precontemplation subscale of the URICA (OR: 4.3; 95% CI: 2.0-9.0). In addition, adolescents assigned to the Precontemplation stage manifested significantly higher rates of treatment attrition than individuals in the Contemplation or Preparation/Action stages. This study provides important empirical support for the predictive utility of the stage-of-change construct among a culturally diverse sample of adolescents admitted to an inpatient substance-abuse treatment program. PMID:16111832

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

    PubMed

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

    2014-01-01

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

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

    PubMed

    Draycott, Simon; Short, Roxanna; Kirkpatrick, Tim

    2015-05-01

    Psychopathy is a disorder that is partly defined by with maladaptive interpersonal behaviour and has significant effects on treatment outcomes. A previous study (Draycott et al., ) found that higher levels of psychopathy led to a specific interpersonal 'trajectory' amongst patients in a secure psychiatric treatment programme during the first 9?months of their admission. In that programme, more psychopathic patients became increasingly dominant over time, and less psychopathic patients became increasingly hostile. This study is a longer-term follow-up and extension of that study, extending the window of observation to 33?months of treatment. It was found that the more psychopathic patients' increased dominance returned to baseline levels by 33?months, as did the less psychopathic patients' increased hostility. This suggests that treatment for this group is not idiopathic but leaves unanswered the question as to what these divergent trajectories represent. Copyright © 2015 John Wiley & Sons, Ltd. PMID:25622564

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

    PubMed

    Hull, Russell D

    2008-03-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    PubMed

    Hilton, Michael F; Whiteford, Harvey A

    2008-07-01

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

  14. A Protocol-Based Decision for Choosing a Proper Surgical Treatment Option for Carotid Artery Stenosis

    PubMed Central

    Jang, E-Wook; Chung, Joonho; Seo, Kwon-Duk; Suh, Sang Hyun; Kim, Yong Bae

    2015-01-01

    Objective There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis. Materials and Methods A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established. Results CEA or CAS is indicated when the patient has a symptomatic stenosis ? 50%, or when the patient has an asymptomatic stenosis ? 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected. Conclusion We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis. PMID:26157689

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

    PubMed

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

    2014-04-01

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

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

    Microsoft Academic Search

    Paula J. Fite; Laura Stoppelbein; Leilani Greening

    2009-01-01

    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.

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

    ERIC Educational Resources Information Center

    Substance Abuse and Mental Health Services Administration, 2011

    2011-01-01

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

  18. Protocol 20. Factor Xa Protease treatment of fusion proteins containing a Factor Xa Protease recognition sequence

    E-print Network

    Lebendiker, Mario

    of cleavage. Component Volume/reaction Final concentration 10 µg fusion protein variable 0.25 µg/µl Factor XaProtocol 20. Factor Xa Protease treatment of fusion proteins containing a Factor Xa Protease recognition sequence Treatment of fusion proteins containing a Factor Xa Protease recognition sequence con

  19. 42 CFR 418.108 - Condition of participation: Short-term inpatient care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...inpatient provider has established patient care policies consistent with those of the hospice and agrees to abide by the palliative care protocols and plan of care established by the hospice for its patients; (3) That the hospice patient's...

  20. 42 CFR 418.108 - Condition of participation: Short-term inpatient care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...inpatient provider has established patient care policies consistent with those of the hospice and agrees to abide by the palliative care protocols and plan of care established by the hospice for its patients; (3) That the hospice patient's...

  1. 42 CFR 418.108 - Condition of participation: Short-term inpatient care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...inpatient provider has established patient care policies consistent with those of the hospice and agrees to abide by the palliative care protocols and plan of care established by the hospice for its patients; (3) That the hospice patient's...

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

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

    PubMed Central

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

    2013-01-01

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

  4. 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...

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

    PubMed Central

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

    2012-01-01

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

  6. An extended treatment protocol with pegylated interferon and ribavirin for hepatitis C recurrence after liver transplantation

    PubMed Central

    Hashemi, Nikroo; Araya, Victor; Tufail, Kashif; Thummalakunta, Laxmi; Feyssa, Eyob; Azhar, Ashaur; Niazi, Mumtaz; Ortiz, Jorge

    2011-01-01

    AIM: To evaluate the efficacy and tolerability of an extended treatment protocol and to determine the predictors of sustained virological response (SVR) after liver transplantation (LT). METHODS: Between August 2005 and November 2008, patients with recurrent hepatitis C virus (HCV) after LT were selected for treatment if liver biopsy showed at least grade 2 inflammation and/or stage 2 fibrosis. All patients were to receive pegylated interferon (PEG)/regimens combining ribavirin (RBV) for an additional 48 wk after HCV undetectability. RESULTS: Extended protocol treatment was initiated in thirty patients. Overall, 73% had end of treatment response and 60% had SVR. Nineteen patients completed treatment per protocol, of them, sixteen (84%) had end of treatment response, and fourteen (74%) achieved SVR. Both early virological response and 24-week virological response were individually associated with SVR but this association was not significant on multivariate analysis. Eleven patients (37%) discontinued therapy due to adverse effects. Cytopenias were the most common and most severe adverse effect, and required frquent growth factor use, dose adjustments and treatment cessations. The risk of rejection was not increased. CONCLUSION: Recurrent HCV after LT can be safely treated with extended virological response-guided therpy using PEG/RBV, but requires close monitoring for treatment-related adverse effects, particularly cytopenias. PMID:21866251

  7. Inpatient length of stay: a finite mixture modeling analysis.

    PubMed

    Singh, Chungkham Holendro; Ladusingh, Laishram

    2010-04-01

    Length of stay (LOS) in hospital for inpatient treatment is a measure of crucial recovery time. Using nationwide data on inpatient healthcare in India, a three-component finite mixture negative binomial model was found to provide a reasonable fit to the heterogeneous LOS distribution. Associated risk factors for short-stay, medium-stay and long-stay subgroups were identified from the respective negative binomial components. In addition, significant heterogeneities within each group were also found. PMID:19430985

  8. Proportion of inpatient days for mental disorders: 1969-1978.

    PubMed

    Kiesler, C A; Sibulkin, A E

    1983-07-01

    Mental hospitalization is an important part of the national picture of hospitalization. Total inpatient days for mental disorders, and their proportion of total hospital days for all disorders, is a statistic of considerable national import, yet there has never been a complete description of total inpatient days for mental disorders. The authors present data from the National Center for Health Statistics for nine years (data for only two years had been published previously), and correct them, and national totals, for the previous exclusion of data from residential treatment centers and community mental health centers. From 1969 through 1978, inpatient days for mental disorders fell from 168 million to 95 million. This decrease was more than accounted for by decreased psychiatric inpatient days at two sites: state mental hospitals and Veterans Administration psychiatric hospitals. The number of psychiatric inpatient days at all other sites increased during this time period. The authors also note a decrease in total inpatient days for all disorders over the decade. However, 85 percent of the total national decrease was accounted for by the decrease in psychiatric inpatient days. The authors stress the implications for public policy and the need for a more adequate national data base. PMID:6885014

  9. Therapeutic Treatment Protocol for Enuresis Using an Enuresis Alarm

    ERIC Educational Resources Information Center

    Shapira, Bettina E.; Dahlen, Penny

    2010-01-01

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

  10. The inpatient fracture neck of femur: an important subgroup of patients.

    PubMed

    Green, Carl M; Zeiton, Moez; Foulkes, Katherine; Barrie, Jim

    2014-12-01

    Fractured neck of femur (FNOF) is an increasing problem for the National Health Service (NHS) with 61,508 recorded on the National Hip Fracture Database (NHFD) in 2012–2013 and treatment of such patients is estimated to cost the NHS £1.5 billion per year. Inpatients falling in hospital and sustain a FNOF have rarely been studied as a separate group of patients to assess standards of patient care, time to operative management, and patient mortality. Of 694 patients sustaining an acute FNOF at a single trust between January 2012 and June 2013, 40 patients (5.8%) sustained an inpatient FNOF. 19 patients (47.5%) were male and 15 patients (37.5%) had an ASA grade of 4 or 5, compared to 153 patients (23.4%) and 127 patients (19.4%) respectively of “community” FNOF. 39 of 40 patients received operative management. Patients with an “inpatient” FNOF were less likely to be admitted to an orthopaedic ward within 4 h (30%) and receive operative management within 48 h (65%) according to “Blue Book” standards. Results according to best practice tariff (BPT) were also significantly reduced for the “inpatient” FNOF group, with 23 patients (57.5%) receiving operative management within 36 h and only 19 patients (47.5%) achieving BPT compared to 76.5% and 72.5% respectively for “community” FNOF patients. Mortality among inpatients reached 40% at 120 days and 50% at 1 year, significantly higher than community FNOF patients after multivariate analysis. Patients sustaining an “inpatient” FNOF are more likely to have significant medical co-morbidity and require aggressive medical and surgical management, especially due to their increased risk of mortality post-operatively. Such injuries have direct and indirect financial implications to a health care trust, which can be minimised by prompt management of these patients. This study highlights the need for a standardised protocol of management of this important subgroup of patients and for further work on falls prevention strategies within the National Health Service. PMID:25458059

  11. Orthodontic treatment protocol of Ehlers-Danlos syndrome type VI.

    PubMed

    Arun, Tulin; Nalbantgil, Didem; Sayinsu, Korkmaz

    2006-01-01

    Ehlers-Danlos syndrome (EDS) type VI is an autosomal recessive disorder of the connective tissue characterized by joint hypermobility, muscle hypotonia, scoliosis, and ocular fragility. In this case report, an EDS type VI patient with a skeletal and dental Class III malocclusion is presented and the clinical approach to his orthodontic problem is emphasized. A 17-year-old male patient presenting some major and minor symptoms of the syndrome was referred to our orthodontic department for diagnosis and treatment. The typical clinical signs confirmed the diagnosis of EDS type VI. He was a skeletal and dental Class III malocclusion patient (both mandibular protrusion and maxillary retrusion) with a noncontributory family history. He had severe crowding in the lower and upper dental arches with retruded incisors. His first treatment plan included orthognathic surgery, but because of the risks of bleeding and poor healing, we elected to treat the patient without surgery. PMID:16448289

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

    PubMed

    Daitch, Carolyn

    2014-04-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  14. Carcinoma ex pleomorphic adenoma: Diagnostic dilemma and treatment protocol.

    PubMed

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

    2014-07-01

    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

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

    Microsoft Academic Search

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

    1996-01-01

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

  16. Decreasing Psychological Distress in Cancer Inpatients Using FLEX Care®: A Pilot Study

    Microsoft Academic Search

    Paul G. Clark

    2010-01-01

    While the incidence of psychological distress among people receiving treatment for cancer in outpatient treatment settings has received attention by researchers, few studies have investigated the incidence of psychological distress in inpatient settings. Similarly, efficacy or effectiveness studies describing psychosocial interventions with cancer patients in inpatient settings are all but absent from the research literature. The purpose of this study

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

    PubMed

    Rundio, Albert

    2013-09-01

    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

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

    PubMed

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

    2013-01-01

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

  19. Protocol Directed Patient Care using a Computer

    PubMed Central

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

    1980-01-01

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

  20. Frequency, Characteristics and Management of Adolescent Inpatient Aggression

    PubMed Central

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

    2013-01-01

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

  1. Modern treatment of infected total knee arthroplasty with a 2-stage reimplantation protocol.

    PubMed

    Westrich, Geoffrey H; Walcott-Sapp, Sarah; Bornstein, Lindsey J; Bostrom, Mathias P; Windsor, Russell E; Brause, Barry D

    2010-10-01

    The purpose of this study was to determine if 2-stage reimplantation for the treatment of infected total knee arthroplasty (TKA) is still effective for treating contemporary pathogens, many of which are multidrug resistant (MDR). The medical records of all cases of infected TKAs from April 1998 to March 2006 were retrospectively reviewed for data on infecting organism and success of treatment. Of 72 patients (75 knees), with a minimum of 2 years of follow-up, who completed the protocol, the infection was eradicated in 90.7% (68/75 knees). Thirty-one (91.2%) of 34 of MDR infections and 42 (91.3%) of 46 of non-MDR infections were successfully treated. These results support previous studies that demonstrated the effectiveness of a 2-stage reimplantation protocol with a standard 1:8 minimal bactericidal titer for treating infections after TKA, including MDR organisms. PMID:20888545

  2. Are Contents of Physical Therapy in Nine Japanese Hospitals for Inpatients with Stroke Related to Inpatients’ and Physical Therapists’ Characteristics?

    PubMed Central

    Shinohara, Tomoyuki; Usuda, Shigeru

    2013-01-01

    [Purpose] This study investigated the factors that influence activities provided during physical therapy for stroke. [Subjects] Data were collected from 85 physical therapists and 216 inpatients with stroke. [Methods] Time spent on specific functional activities provided to inpatients with stroke was recorded at nine rehabilitation facilities. These were used as dependent variables. Physical therapists’ characteristics, including years since acquiring a license, gender, and treatment concepts influencing physical therapy for stroke, were recorded. Inpatients’ characteristics, including age, gender, affected side, days post stroke, score on the Modified Rankin Scale (mRS), and gait ability measured by the Functional Independence Measure (FIM gait), were also recorded. Physical therapists’ and inpatients’ characteristics were used as independent variables. The t-test, correlation coefficients, and analysis of covariance were used to investigate which independent variables correlated with which dependent variables. [Results] Pre-gait, advanced gait, and community mobility were significantly correlated with mRS and FIM gait (|rs| = 0.32–0.62). Time spent on other functional activities had a weak correlation with inpatients’ characteristics. Time spent on functional activities had no or few correlations with physical therapists’ characteristics. [Conclusion] Relationships between time spent on specific functional activities and physical therapists’ characteristics were weaker than those for inpatients’ characteristics. Physical therapy for stroke includes many factors. PMID:24259820

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

    PubMed

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

    2015-03-01

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

  4. A Comparative Study of Conservative versus Surgical Treatment Protocols for 77 Patients with Idiopathic Granulomatous Mastitis.

    PubMed

    Yabano?lu, Hakan; Çolako?lu, Tamer; Belli, Sedat; Aytac, Huseyin Ozgur; Bolat, Filiz Aka; Pourbagher, Ay?in; Tezcaner, Tugan; Yildirim, Sedat; Haberal, Mehmet

    2015-07-01

    The purpose of this study was to analyze the clinical features and demographic data of patients with idiopathic granulomatous mastitis (IGM) and to compare the results of conservative versus surgical treatment protocols. The demographic data, clinical findings, microbiological and pathologic features, scanning and treatment methods, recurrence, and recovery rates of 77 patients were analyzed retrospectively. The patients were divided into two groups based on the type of treatment received. Core biopsies were used to diagnose 37 patients: 26 using incisional biopsies and 14 using excisional biopsies. Of the patient population with IGM, 31 were treated with surgical excision, one with a simple mastectomy, and one with a subcutaneous mastectomy combined with a breast implant, whereas 44 were treated with steroids. The recovery rates of the 44 patients who were treated conservatively were 6 (1-15) months while for the 33 patients who were treated surgically, it was 1 (1-5) month (p = 0.001). Nine patients from the conservative treatment group experienced a recurrence while there were no recurrences in the surgically treated group (p = 0.009). Among all patients, the recurrence rate was 11.7% (9/77) while the average follow-up period was 16.57 ± 18.57 months. As a comparative study between conservative treatment protocols and surgical ones for patients with idiopathic granulomatous mastitis (IGM), this study is the largest to date. A wide surgical excision is the preferred approach for treating patients with IGM because of the low recurrence rate. PMID:25858348

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  6. [Retinoblastoma: preliminary results of national treatment protocol at Casablanca university medical center].

    PubMed

    El Kettani, A; Aderdour, S; Daghouj, G; Knari, S; Zaghloul, K; Zafad, S; Harif, M; Benchekroun, S

    2014-02-01

    Retinoblastoma is the most frequent intraocular cancer, affecting almost exclusively children. We report prospective study results assessing the national protocol for retinoblastoma treatment in Morocco. Treatment included, depending on stage and laterality, primary chemotherapy either to facilitate enucleation or to make conservative treatment possible, postoperative chemotherapy, enucleation and conservative treatments such as transpupillary thermotherapy, thermochemotherapy and cryotherapy. Radiation was used in a few cases. Close supervision was performed until the age of 5. The incidence of retinoblastoma within the study period was 18 new cases per year in our department. Observations of 32 children were included in the study: 18 unilateral retinoblastomas (56%) and 14 bilateral retinoblastomas (44%), for a total of 46 eyes. Leucocoria was the most frequent presenting symptom (69%). Buphthalmia or proptosis were present in 47% of cases. The stage of retinoblastoma was V/D or E (Reese-Elsworth/ABC) in 69.5% of cases. Enucleation was necessary for 28 eyes. Transpupillary thermotherapy or thermochemotherapy were used for 13 eyes (11 children) and cryotherapy for 13 eyes (10 children). After an average follow-up period of 52 months, among 32 children, 4 died and 2 abandoned treatment. Ocular salvage rate was 85.7% (12 eyes out of 14, among which 11 without radiation). Retinoblastoma is a genetic tumor, which occurs in two forms: sporadic, always unilateral, and hereditary, often bilateral. The latter is the most challenging case. Current treatment protocols rely primarily on chemotherapy and local treatments. The future is oriented toward purely local treatments such as intra-arterial chemotherapy and intraocular chemotherapy. PMID:24507074

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

    PubMed Central

    2013-01-01

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

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

    PubMed

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

    2013-01-01

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

  9. Cryptographically supported NFC tags in medication for better inpatient safety.

    PubMed

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

    2014-08-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

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

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

  12. Inpatient suicide prevention: promoting a culture and system of safety over 30 years of practice.

    PubMed

    Jayaram, Geetha

    2014-09-01

    In April 2012, the Joint Commission (JC) report noted that psychiatric hospitals were the most frequent setting for a sentinel event. In 2010-12, suicide was among the top 5 causes of a sentinel event and was a more frequent cause of sentinel events than medication errors. Suicide was ranked as the 10th leading cause of death among persons 10 years of age and older, accounting for 36,891 deaths in 2009. Previous research on suicide has focused on patient evaluation, disease management, symptom assessment, and the use of risk prevention tools, but few publications have reported on system-wide integrated approaches to successful suicide prevention. In this article on inpatient suicide prevention, I present the successful strategies based on epidemiological findings that have been used in one institution to reduce inpatient suicide risk. This report covers strategies that have been used for over 32 years in the treatment of more than 60,000 patients. The successful prevention efforts described in this article involved staff training and deployment, thorough patient assessment, environmental protections, complete handouts, and patient care protocols. PMID:25226203

  13. GHOST Protocol: Greatest Healing Opportunity for Soft Tissue, a Treatment Paradigm for Complex Sarcoma Reconstruction.

    PubMed

    Kobraei, Edward M; Eberlin, Kyle R; Ricci, Joseph A; Reish, Richard G; Winograd, Jonathan M; Cetrulo, Curtis L

    2015-06-01

    Modern sarcoma treatment has created new challenges for plastic surgeons. This study was designed to review the recent experience and practice patterns following complex sarcoma resection at a large sarcoma center. All cases from October 2013 to October 2014 involving rare nonepithelial tumors, a multidisciplinary surgical team, radiation and/or chemotherapy treatments, and plastic surgical reconstruction were included in the analysis. In addition to evaluating clinical outcomes, cases were reviewed to identify factors associated with excellent or poor patient care. Review of these cases formed the basis of the greatest healing opportunity for soft tissue (GHOST) protocol. Our patient population included seven males (64%) and four females (36%). All except one patient was exposed to radiotherapy, chemotherapy, or some combination. Diverse procedures were used for reconstruction. Early complications occurred in two patients (18%), and late complications in four patients (36%). Sarcoma resection was found to be highly morbid in our series. Patients with poor preoperative nutritional status were more likely to experience complications postoperatively. The decision to stage a reconstruction was complex and influenced by several factors. Multimodal sarcoma treatments may involve highly morbid procedures and create complex wounds. The GHOST protocol is a useful reference for plastic surgeons. PMID:26031266

  14. Mental health nurses establishing psychosocial interventions within acute inpatient settings.

    PubMed

    Mullen, Antony

    2009-04-01

    Acute inpatient units provide care for the most acutely unwell people experiencing a mental illness. As a result, the focus for care is on the containment of difficult behaviour and the management of those considered to be 'at high risk' of harm. Subsequently, recovery-based philosophies are being eroded, and psychosocial interventions are not being provided. Despite the pivotal role that mental health nurses play in the treatment process in the acute inpatient setting, a review of the literature indicates that mental health nursing practice is too custodial, and essentially operates within an observational framework without actively providing psychosocial interventions. This paper will discuss the problems with mental health nursing practice in acute inpatient units highlighted in the current literature. It will then put forward the argument for routine use of psychosocial interventions as a means of addressing some of these problems. PMID:19290971

  15. Inpatient Management of Guillain-Barré Syndrome

    PubMed Central

    Harms, Matthew

    2011-01-01

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

  16. Inpatient Medicine Clerkship Action Plan 1) Objectives

    E-print Network

    Myers, Lawrence C.

    conditions stressed in inpatient medicine and are able to ensure alternative learning opportunitiesInpatient Medicine Clerkship Action Plan 1) Objectives a. We fully support plans to alter course objectives to better represent conditions stressed in inpatient medicine 2) Essential Diagnoses a. We fully

  17. Prosecuting Assaultive Forensic and Psychiatric Inpatients

    ERIC Educational Resources Information Center

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

    2008-01-01

    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,…

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

    PubMed Central

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

    2013-01-01

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

  19. A conservative thermal injury treatment protocol for the appropriate Jehovah's Witness candidate.

    PubMed

    McGill, V; Kowal-Vern, A; Gamelli, R L

    1997-01-01

    The Jehovah's Witness (JW) members abstain from receiving blood transfusions or blood product infusions because these treatments are considered an extension of life. A JW who incurs significant thermal injury requires a protocol defining good clinical practices in life-threatening predicaments acceptable to JW members to avoid legal proceedings. Assessment of religious commitment, competency, family resources, and respect for the patient's refusal of treatments is required. Detailed documentation of the patient's position is necessary. Medical management should include standard critical care measures, blood conservation, restricted laboratory work, utilization of pediatric blood collection tubes, nonblood plasma expanders, erythropoietin administration, iron supplements, and aggressive nutritional support with appropriate surgical conservation measures during skin grafting procedures. With conservative management, a positive outcome can be attained without recourse to the legal system. PMID:9095422

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  2. 42 CFR 412.29 - Classification criteria for payment under the inpatient rehabilitation facility prospective...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...individual would require the intensive rehabilitation treatment...performed in another care setting covered under...services in other less intensive rehabilitation settings...significantly from an intensive inpatient hospital...2) Is a doctor of medicine or osteopathy;...

  3. A Survey of Standard Protocols for Endodontic Treatment in North of KSA.

    PubMed

    Iqbal, Azhar; Akbar, Iftikhar; Qureshi, Beenish; Sghaireen, Mohd G; Al-Omiri, Mahmoud K

    2014-01-01

    The objective of this study was to collect information regarding methods, materials, and attitudes employed during the endodontic treatment by dentists in north of Saudi Arabia. A questionnaire was designed and distributed among 300 dentists in north of Saudi Arabia to collect the data about the standard protocols of endodontic treatment. The collected data was analyzed by using the SPSS 10 computer software. Out of a total of 300 surveyed dentists, the 66% response rate showed that this study was true representation of the endodontic treatment performed by the dentists in north of Saudi Arabia. 152 (76%) were general dentists and 48 (24%) were endodontists. 18 (9%) were using rubber dam as the method of isolation during endodontic treatment. 173 (86.5%) were using only measurement radiographs for working length determination and 27 (13.5%) were using both electronic apex locator and measurement radiographs. 95 (47.5%) of the respondents were using standardized technique and 25 (12.5%) were using step-down as a root canal preparation technique. 127 (63.5%) of the respondents were using lateral condensation technique, with gutta percha points for root canal obturation. PMID:24944823

  4. Hypnosis and Guided Imagery Treatment for Gastrointestinal Disorders: Experience With Scripted Protocols Developed at the University of North Carolina.

    PubMed

    Palsson, Olafur S; van Tilburg, Miranda

    2015-01-01

    Completely scripted treatment courses for verbatim interventions are uncommon in the field of clinical hypnosis. This approach was adopted for by a North Carolina research team for treating gastrointestinal disorders 20 years ago and has been used in hypnosis treatment of irritable bowel syndrome and ulcerative colitis, as well as in guided imagery treatment for functional abdominal pain. Treatment with these scripted protocols is delivered in a fixed series of sessions over a 2- or 3-month period. They have been found efficacious for improving bowel symptoms in several clinical trials, even in patients who have been entirely unresponsive to medical treatment. Response rates in clinical trials have ranged from 53% to 94%, and the therapeutic benefits have been shown to be well maintained at 6-, 10-, or 12-month follow-ups in different studies. This article describes the development and research on these protocols and summarizes the advantages and limitations of this fully scripted treatment approach. PMID:26046714

  5. Influence of therapist competence and quantity of cognitive behavioural therapy on suicidal behaviour and inpatient hospitalisation in a randomised controlled trial in borderline personality disorder: Further analyses of treatment effects in the BOSCOT study

    PubMed Central

    Norrie, John; Davidson, Kate; Tata, Philip; Gumley, Andrew

    2013-01-01

    Objectives We investigated the treatment effects reported from a high-quality randomized controlled trial of cognitive behavioural therapy (CBT) for 106 people with borderline personality disorder attending community-based clinics in the UK National Health Service – the BOSCOT trial. Specifically, we examined whether the amount of therapy and therapist competence had an impact on our primary outcome, the number of suicidal acts†, using instrumental variables regression modelling. Design Randomized controlled trial. Participants from across three sites (London, Glasgow, and Ayrshire/Arran) were randomized equally to CBT for personality disorders (CBTpd) plus Treatment as Usual or to Treatment as Usual. Treatment as Usual varied between sites and individuals, but was consistent with routine treatment in the UK National Health Service at the time. CBTpd comprised an average 16 sessions (range 0–35) over 12 months. Method We used instrumental variable regression modelling to estimate the impact of quantity and quality of therapy received (recording activities and behaviours that took place after randomization) on number of suicidal acts and inpatient psychiatric hospitalization. Results A total of 101 participants provided full outcome data at 2 years post randomization. The previously reported intention-to-treat (ITT) results showed on average a reduction of 0.91 (95% confidence interval 0.15–1.67) suicidal acts over 2 years for those randomized to CBT. By incorporating the influence of quantity of therapy and therapist competence, we show that this estimate of the effect of CBTpd could be approximately two to three times greater for those receiving the right amount of therapy from a competent therapist. Conclusions Trials should routinely control for and collect data on both quantity of therapy and therapist competence, which can be used, via instrumental variable regression modelling, to estimate treatment effects for optimal delivery of therapy. Such estimates complement rather than replace the ITT results, which are properly the principal analysis results from such trials. Practitioner points Assessing the impact of the quantity and quality of therapy (competence of therapists) is complex. More competent therapists, trained in CBTpd, may significantly reduce the number of suicidal act in patients with borderline personality disorder. PMID:23420622

  6. The premature demise of public child and adolescent inpatient psychiatric beds : Part II: challenges and implications.

    PubMed

    Geller, Jeffrey L; Biebel, Kathleen

    2006-01-01

    Psychiatric disorders are the leading reason for hospitalization among 5-19 year olds. Current data, however, suggest there are fewer than necessary available services for children and adolescents requiring intensive, inpatient psychiatric care. Children and adolescents with behavioral health problems, the majority of whom do not receive appropriate treatment, have increased risk of school failure, family disruption, out-of-home placements, poor employment opportunities, and poverty in adulthood. This paper will examine the challenges inherent in serving children and adolescents with serious emotional disturbances, avenues of financing for treatment and services, and various loci of intervention for high-risk children, including inpatient settings and systems of care. The goals of this paper are to illustrate the complexities of working with children and adolescents most in need of intensive psychiatric services, to explore how inpatient services "fit" into existing treatment approaches, and to discuss the efficacy of downsizing or closing inpatient psychiatric units for this population. PMID:16927166

  7. Inpatient Cognitive Behavior Therapy for Adolescents with Anorexia Nervosa: Immediate and Longer-Term Effects

    PubMed Central

    Dalle Grave, Riccardo; Calugi, Simona; El Ghoch, Marwan; Conti, Maddalena; Fairburn, Christopher G.

    2014-01-01

    Introduction: Inpatient treatment for anorexia nervosa is often successful in restoring body weight, but a high percentage of patients relapse following discharge. The aim of the present study was to establish the immediate and longer-term effects of a novel inpatient program for adolescents that was designed to produce enduring change. Method: Twenty-seven consecutive patients with severe anorexia nervosa were admitted to a 20-week inpatient treatment program based on the enhanced cognitive behavior therapy (CBT-E). The patients were assessed before and after hospitalization, and 6 and 12?months later. Results: Twenty-six patients (96%) completed the program. In these patients, there was a substantial improvement in weight, eating disorder features, and general psychopathology that was well maintained at 12-month follow-up. Conclusion: These findings suggest that inpatient CBT-E is a promising approach to the treatment of adolescents with severe anorexia nervosa. PMID:24575055

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

    PubMed

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

    2014-01-01

    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

  9. Tinnitus in patients with temporo-mandibular joint disorder: Proposal for a new treatment protocol.

    PubMed

    Attanasio, Giuseppe; Leonardi, Alessandra; Arangio, Paolo; Minni, Antonio; Covelli, Edoardo; Pucci, Resi; Russo, Francesca Yoshie; De Seta, Elio; Di Paolo, Carlo; Cascone, Piero

    2015-06-01

    The present study was designed to verify the correlation between tinnitus and temporomandibular joint dysfunction.86 consecutive patients were enrolled in the study, all affected by subjective tinnitus without hearing impairment, from both genders, age between 18 and 60 years old. The final number of patients included in the study was 55. All patients received a temporo-mandibular joint examination. All the patients were asked to rate the severity of their symptoms before and after treatment using a VAS scale and the Tinnitus Handicap Inventory (THI) and they followed a standardized protocol for the investigation of tinnitus. All the subjects were monitored by the same researcher and they underwent the same splint treatment. The comparison between pre- and posttreatment phase scores showed in patients with predisposition of TMD and with TMD a statistically significant decrease of THI and VAS values. The characteristics of tinnitus and the degree of response to treatment confirmed the relationship between tinnitus and TMD. The authors believe that, when the most common causes of tinnitus, such as otologic disorders and neurological diseases are excluded, it is correct to evaluate the functionality of the temporo-mandibular joint and eventually treat its pathology to obtain tinnitus improvement or even resolution. PMID:25868942

  10. Heavy Drinkers Unlikely to Receive Treatment

    MedlinePLUS

    ... treatment only includes treatment a hospital (inpatient), a rehabilitation facility (inpatient or outpatient), or a mental health center. Source: 2002 to 2010 National Surveys on Drug Use and Health (NSDUHs). NSDUH is an annual ...

  11. Oral rehydration salts and diarrhoeal diseases: effects of changing inpatient management in Tonga.

    PubMed

    Finau, S A; Latu, R

    1987-06-01

    Methods of inpatient management of children with diarrhoeal diseases (DD) in 1978 and in 1980 were compared to assess the use of oral rehydration salts (ORS) and a national antidiarrhoeal programme (NAP). Inpatient notes of 369 children admitted with DD were reviewed. The management of DD differed significantly but the clinical outcome was similar, with the exception of the case-fatality rate. All deaths occurred within the first 24 h of admission, indicating that this difference was attributable to improved management of DD in the community rather than changes in the inpatient treatment regime. PMID:2441649

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

    EPA Science Inventory

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

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

    E-print Network

    Langerhans, Brian

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

  14. Physical activity as a treatment for depression: the TREAD randomised trial protocol

    PubMed Central

    2010-01-01

    Background Depression is one of the most common reasons for consulting a General Practitioner (GP) within the UK. Whilst antidepressants have been shown to be clinically effective, many patients and healthcare professionals would like to access other forms of treatment as an alternative or adjunct to drug therapy for depression. A recent systematic review presented some evidence that physical activity could offer one such option, although further investigation is needed to test its effectiveness within the context of the National Health Service. The aim of this paper is to describe the protocol for a randomised, controlled trial (RCT) designed to evaluate an intervention developed to increase physical activity as a treatment for depression within primary care. Methods/design The TREAD study is a pragmatic, multi-centre, two-arm RCT which targets patients presenting with a new episode of depression. Patients were approached if they were aged 18-69, had recently consulted their GP for depression and, where appropriate, had been taking antidepressants for less than one month. Only those patients with a confirmed diagnosis of a depressive episode as assessed by the Clinical Interview Schedule-Revised (CIS-R), a Beck Depression Inventory (BDI) score of at least 14 and informed written consent were included in the study. Eligible patients were individually randomised to one of two treatment groups; usual GP care or usual GP care plus facilitated physical activity. The primary outcome of the trial is clinical symptoms of depression assessed using the BDI four months after randomisation. A number of secondary outcomes are also measured at the 4-, 8- and 12-month follow-up points including quality of life, attitude to and involvement in physical activity and antidepressant use/adherence. Outcomes will be analysed on an intention-to-treat (ITT) basis and will use linear and logistic regression models to compare treatments. Discussion The results of the trial will provide information about the effectiveness of physical activity as a treatment for depression. Given the current prevalence of depression and its associated economic burden, it is hoped that TREAD will provide a timely contribution to the evidence on treatment options for patients, clinicians and policy-makers. Trial registration: ISRCTN 16900744 PMID:21073712

  15. Glycemic management in the inpatient setting.

    PubMed

    Schmeltz, Lowell R; Ferrise, Carla

    2012-04-01

    Hyperglycemia occurs frequently in hospitalized patients and affects patient outcomes, including mortality, inpatient complications, hospital length of stay, and overall hospital costs. Various degrees of glycemic control have been studied and consensus statements from the American Diabetes Association/American Association of Clinical Endocrinologists and The Endocrine Society recommend a target blood glucose range of 140 to 180 mg/dL in most hospitalized patients. Insulin is the preferred modality for treating all hospitalized patients with hyperglycemia, as it is adaptable to changing patient physiology over the course of hospitalization. Critically ill patients should receive intravenous insulin infusion, and all noncritically ill patients with hyperglycemia (individuals with and without diabetes) should be managed using a subcutaneous insulin algorithm with basal, nutritional, and correctional dose components. Hypoglycemia remains a limiting factor to achieving optimal glycemic targets. Similar to hyperglycemia, hypoglycemia is an independent risk factor for poor outcomes in hospitalized patients. Improvement in glycemic control throughout the hospital includes efforts from all health care providers. Institutions can encourage safe insulin use by using insulin algorithms, preprinted order sets, and hypoglycemia protocols, as well as by supporting patient and health care provider education. PMID:22615078

  16. Family Functioning in Suicidal Inpatients With Intimate Partner Violence

    PubMed Central

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

    2007-01-01

    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

  17. Types of Benzodiazepines Abused by Chemically Dependent Inpatients

    Microsoft Academic Search

    Robert Malcolm; Kathleen T. Brady; Amanda L. Johnston; Malcom Cunningham

    1993-01-01

    Records of inpatients (N=1,483) ove r a three-year period at an addiction treatment center were evaluated for the presence of benzodiazepine (BZ) dependence (N=136). The preferred BZ for 43% of the subjects was diazepam, and alprazolam for 14% of subjects. Chlordiazepoxide, lorazepam, and clorazepatc were each the preferred bZ for 4% of patients. Cocaine and opioid abusers were six times

  18. Alcoholics' Evaluations of Alcoholism Treatment

    Microsoft Academic Search

    Alisdair Mackenzie; Richard P. Allen

    2003-01-01

    A sample of alcoholics who have considerable experience as participants in alcoholism treatment are interviewed for their recommendations and criticisms of treatment. Inpatient Milieu and Alcoholics Anonymous were the most frequent choices of treatments considered beneficial. Among treatments not recommended were specific inpatient facilities. Our subjects' evaluations are compared with published reviews of treatment outcome studies. The relationships between treatment

  19. Prehospital midthigh trauma and traction splint use: recommendations for treatment protocols.

    PubMed

    Abarbanell, N R

    2001-03-01

    The present study was completed to establish an epidemiologic database defining the prehospital occurrence of midthigh trauma/suspected femoral shaft fractures, and the use of/need for traction splints (TS) in hope of developing recommendations for further treatment protocols. On review of 4,513 paramedic run reports for the 12-month period from January 1999 through December 1999, from a low-volume urban emergency medical services (EMS) system, 16 persons (0.35% total patients) presented with midthigh injuries. Data collected included patient chief complaint/injury, mechanism of injury, clinical findings, splint application, additional interventions, iatrogenic complications, patient age, and ambulance field time. Paramedics noted injuries suspicious for femoral shaft fractures in 5 patients (31.25% study patients, 0.11% total patients). TSs were applied successfully only twice (12.50% study patients, 0.04% total patients). Fourteen patients (87.50% study patients) were managed with long backboard immobilization, rigid splinting, and/or patient transportation in a position of comfort. No sequelae as a result of such care occurred. No inappropriate use, point estimate (PE) [(0)/(16) (0.00% to 20.60%)] or unmet need, PE [(0)/(4), 497) (0.00% to 0.08%)] of care was noted. The data presented in this study suggest that given similar EMS system characteristics, prehospital midthigh injuries/suspected femoral shaft fractures occur on an extremely rare basis, and treatment with long backboard immobilization, rigid splinting, and/or patient transportation in a position of comfort may constitute an acceptable course of care. Including TSs as essential ambulance equipment may be unnecessary. PMID:11239259

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

    PubMed Central

    2012-01-01

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

  1. Psychosomatic inpatient rehabilitation: the German model.

    PubMed

    Linden, Michael

    2014-01-01

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

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

    PubMed

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

    2014-11-15

    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

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

    PubMed Central

    Hallén, Emma

    2014-01-01

    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

  4. Effectiveness of a Nurse-Managed Protocol to Prevent Hypoglycemia in Hospitalized Patients with Diabetes

    PubMed Central

    Marelli, Giuseppe; Avanzini, Fausto; Iacuitti, Giuseppe; Planca, Enrico; Frigerio, Ilaria; Busi, Giovanna; Carlino, Liliana; Cortesi, Laura; Roncaglioni, Maria Carla; Riva, Emma

    2015-01-01

    Background. Hypoglycemia due to inadequate carbohydrate intake is a frequent complication of insulin treatment of diabetic in-patients. Objective. To assess the effectiveness of a nurse-managed protocol to prevent hypoglycemia during subcutaneous insulin treatment. Design. Prospective pre-post-intervention study. Methods. In 350 consecutive diabetic in-patients the incidence of hypoglycemia (blood glucose < 70?mg/dL) during subcutaneous insulin treatment was assessed before (phase A) and after (phase B) the protocol was adopted to permit (1) the patient to opt for substitutive food to integrate incomplete carbohydrate intake in the meal; (2) in case of lack of appetite or repeatedly partial intake of the planned food, prandial insulin administered at the end of the meal to be related to the actual amount of carbohydrates eaten; (3) intravenous infusion of glucose during prolonged fasting. Results. Eighty-four patients in phase A and 266 in phase B received subcutaneous insulin for median periods of, respectively, 7 (Q1–Q3 6–12) and 6 days (Q1–Q3 4–9). Hypoglycemic events declined significantly from 0.34 ± 0.33 per day in phase A to 0.19 ± 0.30 in phase B (P > 0.001). Conclusions. A nurse-managed protocol focusing on carbohydrate intake reduced the incidence of hypoglycemia in patients with diabetes receiving subcutaneous insulin in hospital. PMID:25961051

  5. Treatment outcome of adult patients with Burkitt lymphoma: results using the LMB protocol in Korea

    Microsoft Academic Search

    Moon Ki Choi; Hyun Jung Jun; Sung Yoon Lee; Kyung Ha Kim; Do Hyoung Lim; Kihyun Kim; Young Hyeh Ko; Won Seog Kim; Seok Jin Kim

    2009-01-01

    Burkitt lymphoma (BL) is a rare subtype of adult non-Hodgkin lymphoma, so studies on the outcome of adult BL, especially in\\u000a Asian patients, are scarce. We report our results using the LMB protocol on Korean adult BL patients. Thirty-eight newly diagnosed\\u000a BL patients were treated with the LMB protocol; 29 males and nine females with a median age of 47 years

  6. Timing of inpatient rehabilitation initiation in stroke patients: factors influencing early admission

    PubMed Central

    Safer, Vildan Binay; Koseoglu, Belma Fusun

    2015-01-01

    [Purpose] Early admission to inpatient rehabilitation is critical for reducing post-stroke disability. Assessing admission timing and other trends in inpatient rehabilitation are essential for improving health outcomes. This study is the first to evaluate the timing of admission of stroke patients to inpatient rehabilitation in Turkey. [Subjects and Methods] We retrospectively analyzed acute stroke survivors who were admitted to the inpatient rehabilitation program in the Ministry of Health, Ankara Physical Medicine and Rehabilitation Training and Research Hospital between January 2009 and December 2010. [Results] The mean onset of inpatient rehabilitation was 9.8 ± 6.7 weeks post-stroke in the entire cohort. Occurrence of ischemic stroke and undergoing acute stroke care at a teaching hospital were most strongly associated with early admission. These results did not change after multivariate analysis. [Conclusion] Turkish stroke survivors begin inpatient rehabilitation later than patients in other countries. The type of stroke and type of hospital in which the patient undergoes acute stroke treatment affects early admission.

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

    PubMed Central

    2014-01-01

    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

  8. Clinical Characteristics of Inpatients with Anaphylaxis in China

    PubMed Central

    Tang, Rui; Xu, Han-Yi; Chen, Shi; Sun, Jin-Lu; Hu, Hong; Li, Hai-Chao; Diao, Ying; Li, Zhi

    2015-01-01

    Objective. To analyze the clinical characteristics of inpatients with anaphylaxis and the factors that influenced those characteristics. Methods. Using the patient records from 1990 to 2013 from three highly ranked Chinese hospitals, we retrospectively analyzed the characteristics of 108 inpatients with anaphylaxis (not anaphylaxis admitted). Results. The mean patient age was 42 ± 20 years old and male-to-female ratio was 1?:?1.3. The number of patients with anaphylaxis increased gradually, and cases diagnosed after 2005 accounted for 68.5% of the 108 total cases. The most common trigger was medications. The most common clinical manifestations included cutaneous, nervous, respiratory, circulatory, and digestive signs and symptoms. Male patients were more likely to experience loss of consciousness. Multisystem involvement was more likely to develop in patients with low BP, whereas it was uncommon in those with anaphylaxis induced by antibiotics or anesthetics. Epinephrine was used as the first-line treatment for 56 cases. Conclusions. Inpatient with anaphylaxis was more common in female patients and the number increased gradually during the study period. The most common trigger was medications. Patients with low BP were prone to having multisystem involvement, whereas the cases of anaphylaxis induced by antibiotics and anesthetics were less likely to involve multiple organ systems.

  9. The Premature Demise of Public Child and Adolescent Inpatient Psychiatric Beds

    Microsoft Academic Search

    Jeffrey L. Geller; Kathleen Biebel

    2006-01-01

    Current trends on the national landscape of available treatment and delivery systems for children and adolescents with serious emotional disturbance indicate a sharp decline in the availability of inpatient psychiatric services. These trends are troubling as six to nine million children and adolescents in the United States suffer from some serious emotional disturbance, and the majority in need of treatment

  10. Basal-Bolus Insulin Protocols Enter the Computer Age

    PubMed Central

    Wei, Nancy J.; Wexler, Deborah J.

    2011-01-01

    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

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

    PubMed Central

    2012-01-01

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

  12. 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...

  13. 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

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

    2013-01-01

    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…

  14. A Feasibility study on Combining Internet-Based Cognitive Behaviour Therapy with Physical Exercise as Treatment for Panic Disorder-Treatment Protocol and Preliminary Results.

    PubMed

    Hovland, Anders; Johansen, Henning; Sjøbø, Trond; Vøllestad, Jon; Nordhus, Inger Hilde; Pallesen, Ståle; Havik, Odd E; Martinsen, Egil W; Nordgreen, Tine

    2015-06-01

    Internet-based cognitive behaviour therapy (ICBT) is a recommended, cost-effective and efficacious treatment for panic disorder (PD). However, treatment effects in psychiatric settings indicate that a substantial proportion fail to achieve remission. Physical exercise improves symptoms in patients with PD, and acts through mechanisms that can augment the effect of ICBT. The feasibility of combining these two interventions has not previously been investigated, and this was the aim of this study. The intervention comprised guided ICBT combined with one weekly session of supervised and two weekly sessions of unsupervised physical exercise for a total of 12 weeks. Treatment rationale, procedures and protocols are presented together with preliminary results for four patients with PD who have currently finished treatment. Quantitative and qualitative results are reported on the feasibility of adhering to the treatments, treatment outcome as assessed by clinician rating and estimation of reliable and clinically significant change for outcome measures, and participants' satisfactions with the combined treatment. The preliminary results indicate that the combined treatment is feasible to complete, and that the combination is perceived by the participants as beneficial. PMID:25785484

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

    Microsoft Academic Search

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

    2007-01-01

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

  16. Prevalence and cost of imaging in inpatient falls: the rising cost of falling

    PubMed Central

    Fields, Jessica; Alturkistani, Tahani; Kumar, Neal; Kanuri, Arjun; Salem, Deeb N; Munn, Samson; Blazey-Martin, Deborah

    2015-01-01

    Objective To quantify the type, prevalence, and cost of imaging following inpatient falls, identify factors associated with post-fall imaging, and determine correlates of positive versus negative imaging. Design Single-center retrospective cohort study of inpatient falls. Data were collected from the hospital’s adverse event reporting system, DrQuality. Age, sex, date, time, and location of fall, clinical service, Morse Fall Scale/fall protocol, admitting diagnosis, and fall-related imaging studies were reviewed. Cost included professional and facilities fees for each study. Setting Four hundred and fifteen bed urban academic hospital over 3 years (2008–2010). Patients All adult inpatient falls during the study period were included. Falls experienced by patients aged <18 years, outpatient and emergency patients, visitors to the hospital, and staff were excluded. Measurements and main results Five hundred and thirty inpatient falls occurred during the study period, average patient age 60.7 years (range 20–98). More than half of falls were men (55%) and patients considered at risk of falls (56%). Falls were evenly distributed across morning (33%), evening (34%), and night (33%) shifts. Of 530 falls, 178 (34%) patients were imaged with 262 studies. Twenty percent of patients imaged had at least one positive imaging study attributed to the fall and 82% of studies were negative. Total cost of imaging was $160,897, 63% ($100,700) from head computed tomography (CT). Conclusion Inpatient falls affect patients of both sexes, all ages, occur at any time of day and lead to expensive imaging, mainly from head CTs. Further study should be targeted toward clarifying the indications for head CT after inpatient falls and validating risk models for positive and negative imaging, in order to decrease unnecessary imaging and thereby limit unnecessary cost and radiation exposure.

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

    PubMed Central

    2014-01-01

    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

  18. Treatment of depressive disorders in primary care - protocol of a multiple treatment systematic review of randomized controlled trials

    PubMed Central

    2011-01-01

    Background Several systematic reviews have summarized the evidence for specific treatments of primary care patients suffering from depression. However, it is not possible to answer the question how the available treatment options compare with each other as review methods differ. We aim to systematically review and compare the available evidence for the effectiveness of pharmacological, psychological, and combined treatments for patients with depressive disorders in primary care. Methods/Design To be included, studies have to be randomized trials comparing antidepressant medication (tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), hypericum extracts, other agents) and/or psychological therapies (e.g. interpersonal psychotherapy, cognitive therapy, behavioural therapy, short dynamically-oriented psychotherapy) with another active therapy, placebo or sham intervention, routine care or no treatment in primary care patients in the acute phase of a depressive episode. Main outcome measure is response after completion of acute phase treatment. Eligible studies will be identified from available systematic reviews, from searches in electronic databases (Medline, Embase and Central), trial registers, and citation tracking. Two reviewers will independently extract study data and assess the risk of bias using the Cochrane Collaboration's corresponding tool. Meta-analyses (random effects model, inverse variance weighting) will be performed for direct comparisons of single interventions and for groups of similar interventions (e.g. SSRIs vs. tricyclics) and defined time-windows (up to 3 months and above). If possible, a global analysis of the relative effectiveness of treatments will be estimated from all available direct and indirect evidence that is present in a network of treatments and comparisons. Discussion Practitioners do not only want to know whether there is evidence that a specific treatment is more effective than placebo, but also how the treatment options compare to each other. Therefore, we believe that a multiple treatment systematic review of primary-care based randomized controlled trials on the most important therapies against depression is timely. PMID:22085705

  19. Chinese Herbal Medicine in the Treatment of Chronic Heart Failure: Three-Stage Study Protocol for a Randomized Controlled Trial

    PubMed Central

    Luo, Liangtao; Chen, Jianxin; Guo, Shuzhen; Wang, Juan; Gao, Kuo; Zhang, Peng; Chen, Chan; Zhao, Huihui; Wang, Wei

    2015-01-01

    Background. Chinese herbal medicine (CHM) has been used in the treatment of chronic heart failure (CHF) for a long time. Treatment based on syndrome differentiation and the main characteristic of TCM is the fundamental principle of TCM practice. In this study protocol, we have designed a trial to assess the efficacy and safety of CHM on CHF based on syndrome differentiation. Methods/Design. This is a three-stage trial of CHM in the treatment of CHF. The first stage is a literature review aiming to explore the common syndromes of CHF. The second is a multicentral, randomized, placebo-controlled trial to evaluate the efficacy and safety of CHM for the treatment of CHF. The third is a multicentral, randomized controlled clinical trial aiming to make cost-effectiveness analysis and evaluate the feasibility, compliance, and universality of CHM on CHF. Discussion. This trial will evaluate the efficacy, safety, feasibility, compliance, and universality of CHM on CHF. The expected outcome is to provide evidence-based recommendations for CHM on CHF and develop a prescription of CHM in the treatment of CHF. This trial is registered with NCT01939236 (Stage Two of the whole trial).

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

  1. Psychiatric Information Systems: An Analysis of Inpatient and Outpatient Unit Capabilities

    PubMed Central

    Wisdom, Jennifer; Bielavitz, Sarann; French, Robert

    2011-01-01

    This paper describes how a sample of inpatient and out-patient psychiatric treatment units use technology to aid in patient care through scheduling, tracking, billing, and documenting clinical services. We conducted semi-structured interviews (n = 68) at four inpatient and four outpatient psychiatric facilities in Oregon. Results indicate psychiatric facilities are assembling systems for managing information that include a combination of electronic linked clinical records, paper records, and unit-specific, unlinked databases. Barriers remain in (1) improving the sophistication of psychiatric information systems, (2) improving linkages of behavioral health with other medical information systems, and (3) increasing information technology support. PMID:21603591

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

    PubMed Central

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

    2014-01-01

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

  3. Inhospital mortality among clinical and surgical inpatients recently diagnosed with venous thromboembolic disease.

    PubMed

    Posadas-Martínez, María Lourdes; Vázquez, Fernando Javier; Grande-Ratti, María Florencia; de Quirós, Fernán González Bernaldo; Giunta, Diego Hernán

    2015-08-01

    Venous thromboembolism (VTE) is the most common cause of preventable mortality in hospitalized patients, and pulmonary embolism is responsible for 5-10 % of all hospital deaths. To estimate the hospital mortality in hospitalized patients who developed VTE during hospitalization. Prospective cohort of all adult inpatients >17 years admitted to the hospital between August 2006 and August 2013, and follow-up until discharge to measure death. VTE incident cases were captured prospectively from the Institutional Registry of Thromboembolic disease in a tertiary hospital care in Buenos Aires. In hospital global mortality and fatality rate of inpatients with VTE was calculated. The cumulative incidence of VTE was 1.8 % (95 % CI 1.77-1.93 %), representing 1.32 % (95 % CI 1.23-1.41 %) in the subgroup of surgical patients and 2.1 % (95 % CI 1.9-2.2 %) in clinical inpatients. The overall hospital mortality was 2.4 % (95 % CI 2.35-2.53); being 3.95 % (95 % CI 3.78-4.12) in clinical inpatients and 1.15 % (95 % CI 1.06-1.23) in surgical patients. The death in patients who had developed VTE, represented between 4 and 7 % of hospital deaths, and it increases with age in both clinical and surgical patients. In Argentina there are few data of hospital mortality in patients with VTE. This information is useful when assessing the need for resources for prevention, diagnosis and treatment in inpatients. PMID:25995104

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

    PubMed

    Kröger, Christoph; Roepke, Stefan; Röepke, Stefan; Kliem, Sören

    2014-09-01

    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

  5. Inpatient opiate detoxification in Geneva: follow-up at 1 and 6 months

    Microsoft Academic Search

    Barbara Broers; Francisco Giner; Patricia Dumont; Annie Mino

    2000-01-01

    The aim of this study was to identify predictors of treatment success and of relapse, 1 and 6 months after inpatient opiate detoxification in an 8-bed unit in Geneva. Of all 73 patients admitted between June 1994 and June 1995, a majority (73%) successfully finished opiate detoxification. Detoxification was performed mainly with methadone tapering; the average duration of hospitalisation was

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

    ERIC Educational Resources Information Center

    Robinson, Sheryl L.

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

  7. Treatment situation of male hypogonadotropic hypogonadism in pediatrics and proposal of testosterone and gonadotropins replacement therapy protocols

    PubMed Central

    Sato, Naoko; Hasegawa, Tomonobu; Hasegawa, Yukihiro; Arisaka, Osamu; Ozono, Keiichi; Amemiya, Shin; Kikuchi, Toru; Tanaka, Hiroyuki; Harada, Shohei; Miyata, Ichiro; Tanaka, Toshiaki

    2015-01-01

    Abstract Male hypogonadotropic hypogonadism (MHH), a disorder associated with infertility, is treated with testosterone replacement therapy (TRT) and/or gonadotropins replacement therapy (GRT) (TRT and GRT, together with HRT hormone replacement therapy). In Japan, guidelines have been set for treatment during adolescence. Due to the risk of rapid maturation of bone age, low doses of testosterone or gonadotropins have been used. However, the optimal timing and methods of therapeutic intervention have not yet been established. The objective of this study was to investigate the current situation of treatment for children with MHH in Japan and to review a primary survey involving councilors of the Japanese Society for Pediatric Endocrinology and a secondary survey obtained from 26 facilities conducting HRT. The subjects were 55 patients with MHH who reached their adult height after HRT. The breakdown of the patients is as follows: 7 patients with Kallmann syndrome, 6 patients with isolated gonadotropin deficiency, 18 patients with acquired hypopituitarism due to intracranial and pituitary tumor, 22 patients with classical idiopathic hypopituitarism due to breech delivery, and 2 patients with CHARGE syndrome. The mean age at the start of HRT was 15.7 yrs and mean height was 157.2 cm. The mean age at reaching adult height was 19.4 yrs, and the mean adult height was 171.0 cm. The starting age of HRT was later than the normal pubertal age and showed a significant negative correlation with pubertal height gain, but it showed no correlation with adult height. As for spermatogenesis, 76% of the above patients treated with hCG-rFSH combined therapy showed positive results, though ranging in levels; impaired spermatogenesis was observed in some with congenital MHH, and favorable spermatogenesis was observed in all with acquired MHH. From the above, we propose the establishment of a treatment protocol for the start low-dose testosterone or low-dose gonadotropins by dividing subjects into two groups to determine different treatment protocols, acquired and congenital MHH, and to conduct them at a timing closer to the onset of puberty, namely, at a timing near entrance to junior high school. We also propose a new HRT protocol using preemptive FSH therapy prior to GRT aimed at achieving future fertility in patients with congenital MHH. PMID:26019400

  8. Treatment situation of male hypogonadotropic hypogonadism in pediatrics and proposal of testosterone and gonadotropins replacement therapy protocols.

    PubMed

    Sato, Naoko; Hasegawa, Tomonobu; Hasegawa, Yukihiro; Arisaka, Osamu; Ozono, Keiichi; Amemiya, Shin; Kikuchi, Toru; Tanaka, Hiroyuki; Harada, Shohei; Miyata, Ichiro; Tanaka, Toshiaki

    2015-04-01

    Male hypogonadotropic hypogonadism (MHH), a disorder associated with infertility, is treated with testosterone replacement therapy (TRT) and/or gonadotropins replacement therapy (GRT) (TRT and GRT, together with HRT hormone replacement therapy). In Japan, guidelines have been set for treatment during adolescence. Due to the risk of rapid maturation of bone age, low doses of testosterone or gonadotropins have been used. However, the optimal timing and methods of therapeutic intervention have not yet been established. The objective of this study was to investigate the current situation of treatment for children with MHH in Japan and to review a primary survey involving councilors of the Japanese Society for Pediatric Endocrinology and a secondary survey obtained from 26 facilities conducting HRT. The subjects were 55 patients with MHH who reached their adult height after HRT. The breakdown of the patients is as follows: 7 patients with Kallmann syndrome, 6 patients with isolated gonadotropin deficiency, 18 patients with acquired hypopituitarism due to intracranial and pituitary tumor, 22 patients with classical idiopathic hypopituitarism due to breech delivery, and 2 patients with CHARGE syndrome. The mean age at the start of HRT was 15.7 yrs and mean height was 157.2 cm. The mean age at reaching adult height was 19.4 yrs, and the mean adult height was 171.0 cm. The starting age of HRT was later than the normal pubertal age and showed a significant negative correlation with pubertal height gain, but it showed no correlation with adult height. As for spermatogenesis, 76% of the above patients treated with hCG-rFSH combined therapy showed positive results, though ranging in levels; impaired spermatogenesis was observed in some with congenital MHH, and favorable spermatogenesis was observed in all with acquired MHH. From the above, we propose the establishment of a treatment protocol for the start low-dose testosterone or low-dose gonadotropins by dividing subjects into two groups to determine different treatment protocols, acquired and congenital MHH, and to conduct them at a timing closer to the onset of puberty, namely, at a timing near entrance to junior high school. We also propose a new HRT protocol using preemptive FSH therapy prior to GRT aimed at achieving future fertility in patients with congenital MHH. PMID:26019400

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

    SciTech Connect

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

    2014-06-01

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

  10. Pneumocystis jiroveci prophylaxis in patients undergoing Bendamustine treatment: the need for a standardized protocol.

    PubMed

    Abkur, Tarig Mohammed; Saeed, Mamoun; Ahmed, Saad Zeinalabdin; McArthur, Ryan; Leahy, Maeve; O'Leary, Hilary; O'Keeffe, Denis

    2015-04-01

    The decision for PJP prophylaxis depends on a physician's evaluation of multiple variables. The high rate of PJP infection described in this article combined with the known impaired T-cell function post Bendamustine treatment justifies considering all patients for PJP prophylaxis when they receive Bendamustine treatment. PMID:25914820

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

    Microsoft Academic Search

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

    2007-01-01

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

  12. Pneumocystis jiroveci prophylaxis in patients undergoing Bendamustine treatment: the need for a standardized protocol

    PubMed Central

    Abkur, Tarig Mohammed; Saeed, Mamoun; Ahmed, Saad Zeinalabdin; McArthur, Ryan; Leahy, Maeve; O'Leary, Hilary; O'Keeffe, Denis

    2015-01-01

    Key Clinical Message The decision for PJP prophylaxis depends on a physician's evaluation of multiple variables. The high rate of PJP infection described in this article combined with the known impaired T-cell function post Bendamustine treatment justifies considering all patients for PJP prophylaxis when they receive Bendamustine treatment. PMID:25914820

  13. Benefits of an inpatient pulmonary rehabilitation program: A prospective analysis

    Microsoft Academic Search

    Deborah G. Stewart; David F. Drake; Charles Robertson; Jennifer H. Marwitz; Jeffrey S. Kreutzer; David X. Cifu

    2001-01-01

    Stewart DG, Drake DF, Robertson C, Marwitz JH, Kreutzer JS, Cifu DX. Benefits of an inpatient pulmonary rehabilitation program: a prospective analysis. Arch Phys Med Rehabil 2001;82:347-52. Objective: To examine the effect of an inpatient pulmonary rehabilitation program on functional outcome, supplemental oxygen use, quality of life (QOL), and rehospitalization. Design: A prospective study. Setting: Inpatient pulmonary rehabilitation unit. Patients:

  14. Proactive tobacco treatment for low income smokers: study protocol of a randomized controlled trial

    PubMed Central

    2014-01-01

    Background There is a high prevalence of smoking and high burden of tobacco-related diseases among low-income populations. Effective, evidenced-based smoking cessation treatments are available, but low-income smokers are less likely than higher-income smokers to use these treatments, especially the most comprehensive forms that include a combination of pharmacotherapy and intensive behavioral counseling. Methods/Design The primary objectives of this randomized controlled trial are to compare the effects of a proactive tobacco treatment intervention compared to usual care on population-level smoking abstinence rates and tobacco treatment utilization rates among a diverse population of low-income smokers, and to determine the cost-effectiveness of proactive tobacco treatment intervention. The proactive care intervention systematically offers low-income smokers free and easy access to evidence-based treatments and has two primary components: (1) proactive outreach to current smokers in the form of mailed invitation materials and telephone calls containing targeted health messages, and (2) facilitated access to free, comprehensive, evidence-based tobacco cessation treatments in the form of NRT and intensive, telephone-based behavioral counseling. The study aims to include a population-based sample (N?=?2500) of adult smokers enrolled in the Minnesota Health Care Programs (MHCP), a state-funded health insurance plan for low-income persons. Baseline data is obtained from MHCP administrative databases and a participant survey that is conducted prior to randomization. Outcome data is collected from a follow-up survey conducted 12 months after randomization and MHCP administrative data. The primary outcome is six-month prolonged smoking abstinence at one year and is assessed at the population level. All randomized individuals are asked to complete the follow-up survey, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. Discussion There is a critical need to increase access to effective tobacco dependence treatments. This randomized trial evaluates the effects of proactive outreach coupled with free NRT and telephone counseling on the population impact of tobacco dependence treatment. If proven to be effective and cost-effective, national dissemination of proactive treatment approaches would reduce tobacco-related morbidity, mortality, and health care costs for low income Americans. Clinical trials registration ClinicalTrials.gov: NCT01123967 PMID:24716466

  15. Initial Experience with a New Transurethral Microwave Thermotherapy Treatment Protocol ‘30–Minute TUMT’

    Microsoft Academic Search

    Giuseppe Pace; Oscar Selvaggio; Fabrizio Palumbo; Francesco Paolo Selvaggi

    2001-01-01

    Objective: We report on our experience with a less invasive treatment for benign prostatic hyperplasia (BPH), a high–energy ‘30–minute’ treatment algorithm of transurethral microwave thermotherapy (TUMT). As initial investigators of this new device, we have tested its safety, tolerance and efficacy.Methods: From April 1998 to May 1999, all males attending our Outpatient Clinic for symptomatic BPH were evaluated with physical

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

    PubMed Central

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

    2014-01-01

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

  17. Treatment of mechanical valve thrombosis in the right heart: overview of the requirements for the new thrombolytic protocols.

    PubMed

    Sensoy, Baris; Canpolat, U?ur; Cay, Serkan; Ozeke, Ozcan; Acikgoz, Kadri; Kus, Ozgur; Tufekcioglu, Omac

    2015-03-01

    Prosthetic valve thrombosis (PVT) is a rare but serious complication of implanted mechanical valves. Intravenous thrombolytic treatment has emerged as an alternative to surgical therapy in the management of patients with stuck valves. As tricuspid valve replacement is a rare venture, the indications for such therapy and appropriate patient selection are evolving. As the type, dose, and route of administration of thrombolytic agents differ, major complications can be seen in the rapid infusion protocols. In patients with PVT, especially with right-sided valves, thrombolysis with intravenous slow infusion has given discrete, successive sessions guided by serial transthoracic echocardiography and cine/fluoroscopy which may be achieved with a low risk of complications and a high rate of success. Our report describes the management of two patients with PVT and discusses the current status of thrombolysis in such patients. PMID:25632837

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

    PubMed

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

    2014-01-01

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

  19. [Imaging protocols for the management of respiratory motions in the treatment planning of early stage lung cancer patients].

    PubMed

    Pócza, Tamás; Pesznyák, Csilla; Lövey, József; Bajcsay, András; Szilágyi, András; Almády, Balázs; Major, Tibor; Polgár, Csaba

    2015-06-01

    The aim of our work is to present the imaging techniques used at the National Institute of Oncology for taking into consideration the breathing motion at radiation therapy treatment planning. Internationally recommended imaging techniques, such as 4D CT, respiratory gating and ITV (Internal Target Volume) definition were examined. The different imaging techniques were analysed regarding the delivered dose during imaging, the required time to adapt the technique, and the necessary equipment. The differences in size of PTVs (Planning Target Volume) due to diverse volume defining methods were compared in 5 cases. For 4D CT breath monitoring is crucial, which requires special equipment. To decrease the relatively high exposure of 4D CT it is possible to scan only a few predefined breathing phases. The possible positions of the tumour can be well approximated with CT scans taken in the inhale maximum, the exhale maximum and in intermediate phase. The intermediate phase can be exchanged with an ordinary CT image set, and the extreme phase CT images can be ensured by given verbal instructions for the patient. This way special gating equipment is not required. Based on these 3 breathing phases an ITV can be defined. Using this ITV definition method the margin between the CTV (Clinical Target Volume) and the PTV can be reduced by 1 cm. Using this imaging protocol PTV can be reduced by 30%. A further 10% PTV reduction can be achieved with respiratory gating. In the routine clinical practice respiratory motion management with a 3-phase CT-imaging protocol the PTV for early-stage lung cancer can be significantly reduced without the use of 4D CT and/or respiratory gating. For special, high precision treatment techniques 4D CT is recommended. PMID:26035161

  20. Development and application of an analytical protocol for evaluation of treatment processes for landfill leachates. II. Evaluation of leachate treatment efficiency of different steps in a constructed pilot plant

    Microsoft Academic Search

    Lennart Mårtensson; Staffan Bergström; Britt-Marie Svensson; Lennart Mathiasson

    2007-01-01

    Different methods for treatment of leachate from a municipal solid waste (MSW) landfill were tested in a pilot plant. Raw leachate was pre-treated with aeration and sedimentation, followed by several parallel individual steps such as bioremediation, chemical oxidation, ozonation, and geo-bed filters. The efficiency of different treatment steps was evaluated according to one previously developed protocol, which includes measurements of

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

    ERIC Educational Resources Information Center

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

    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…

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

    EPA Science Inventory

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

  3. Treatment of Acute Rejection in Live Related Renal Allograft Recipients: A Comparison of Three Different Protocols

    Microsoft Academic Search

    R. Mittal; S. K. Agarwal; S. C. Dash; S. Saxena; S. C. Tiwari; S. N. Mehta; U. N. Bhuyan; N. K. Mehra

    1997-01-01

    We present our experience on the comparison of three different modes of steroid therapy, oral prednisolone (OP), intravenous dexamethasone (IVDX) and intravenous methylprednisolone (IVMP) in the treatment of acute rejection (AR) in renal allograft recipients. Between January 1980 and January 1992, 206 patients underwent live related renal transplantation. Before 1990, all received prednisolone (PRED) and azathioprine (AZA) only. After 1990,

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    EPA Science Inventory

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

  6. Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol—Surgical Treatment of Neurological Hip Flexion Contracture

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    Greenham, Stephanie L.; Persi, Joseph

    2014-01-01

    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

  8. Understanding the milieu experiences of patients on an acute inpatient psychiatric unit.

    PubMed

    Thibeault, Catherine A; Trudeau, Kenneth; d'Entremont, Marguerite; Brown, Teresa

    2010-08-01

    The role of inpatient mental health units is changing. Increasingly, people with acute and severe mental illness are admitted for short periods of intense treatment and are discharged quickly to community-based care. Reduction in average lengths of stay for psychiatric inpatients has been accompanied by a marginalization of the concept of therapeutic milieu in the mental health discourse. This phenomenological inquiry focuses on understanding the life-world of six people with acute psychiatric illness who were hospitalized on an acute inpatient psychiatric unit. Working together, a team of four, including mental health clinicians and consumers, developed and implemented this interpretive study using the phenomenology of Heidegger and Taylor. The principle investigator conducted the interviews, and the research team engaged in a complex interpretive process, reviewing narrative accounts, exploring personal meanings and key themes, and reconstructing shared meaning as lived and shared by participants. In this report, the authors describe patient experiences of a rule-bound, controlling, and sometimes oppressive milieu while highlighting patient experiences of healing and health as lived within that same milieu. The authors describe patients' embodied, dialectical, and often paradoxical experiences of fear and affirmation, alienation and connection, and abandonment and healing. The authors share selected narrative accounts to generate new understanding of patient experiences and suggest that the inpatient psychiatric milieu remains an important but often neglected component of psychiatric treatment. PMID:20650367

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

    PubMed Central

    2013-01-01

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

  10. Use of a multimodal conservative management protocol for the treatment of a patient with cervical radiculopathy

    PubMed Central

    Radpasand, Mohsen

    2011-01-01

    Objective The purpose of this study is to describe and discuss the treatment of a cervical disk herniation using a sequential multimodal conservative management approach. Clinical Features A 40-year-old man had complaints of headache and severe sharp neck pain radiating to his left shoulder down to his arm, forearm, and hand. Results of electromyography/nerve conduction studies were abnormal. Magnetic resonance imaging revealed a large disk protrusion at C5-C6 with indentation of the thecal sac and a spur at the posterior margin. Moderate left neural foraminal narrowing was present at C5-C6 with narrowed intervertebral disk space at C5-C6 and C6-C7. Intervention and Outcome High-velocity, low-amplitude chiropractic manipulation; electrotherapy; ice; and exercise were used for treatment. The Neck Disability Index was used as a primary and electromyography/nerve conduction studies as a secondary outcome measurement. Based on the Neck Disability Index, there was an overall 89.65% symptoms improvement from the baseline. Conclusions This case study demonstrated possible beneficial effects of the multimodal treatment approach in a patient with cervical radiculopathy. PMID:22027207

  11. Good Outcome Associated with a Standardized Treatment Protocol Using Selective Postoperative Radiation in Patients with Clinical Stage I Adenocarcinoma of the Endometrium

    Microsoft Academic Search

    Mark S. Carey; Gregory J. O'Connell; Curtis R. Johanson; Michael D. Goodyear; K. Joan Murphy; Dean M. Daya; Alex Schepansky; Ann Peloquin; Brenda J. Lumsden

    1995-01-01

    In 1982, a treatment protocol was instituted for the management of patients with clinical stage I adenocarcinoma of the endometrium. All pertinent historical, operative, and pathologic findings were reviewed by a multidisciplinary committee and 384 patients were prospectively assigned to either high- or low-risk categories. Patients were excluded from the study if they had clinically apparent extrauterine disease, clear cell

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

    PubMed

    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

    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

  13. Vascular effects of ovariectomy and chronic oestrogen treatment in rats: controversy or experimental protocol diversity?

    PubMed Central

    Chataigneau, Thierry; Schini-Kerth, Valérie B

    2005-01-01

    Several clinical studies have indicated that oestrogens have protective properties on the cardiovascular system. Although the beneficial effect has been attributable, at least in part, to their ability to stimulate the endothelial fomation of nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF), the underlying mechanism still remains unclear. In a study from this issue of British Journal of Pharmacology, Nawate et al. have examined the effects of rat ovariectomy and chronic treatment with 17?-oestradiol on the endothelial function as assessed ex vivo. The data indicate that acetylcholine-induced endothelium-dependent relaxations of the isolated mesenteric artery are affected by neither ovariectomy nor chronic hormonal treatment. Despite the maintained endothelium-dependent relaxation, the contribution of the two major endothelial factors NO and EDHF was changed. Indeed, ovariectomy increased the NO-mediated component of the relaxation, most likely as a consequence of the downregulation of the physiological allosteric inhibitor of endothelial NO synthase, caveolin-1. In addition, ovariectomy decreased the EDHF-mediated component of the relaxation and membrane hyperpolarization of the smooth muscle cells, an effect which might be explained by a concomitant decrease of the expression of the gap junction connexin-40 and connexin-43. Furthermore, chronic administration of 17?-estradiol to ovariectomized rats normalized all these effects. This study provides further experimental evidence indicating that the hormonal status plays a determinant role in the control of the endothelial formation of both NO and EDHF. PMID:15655505

  14. Management of Infection After Intramedullary Nailing of Long Bone Fractures: Treatment Protocols and Outcomes

    PubMed Central

    Makridis, Kostas G; Tosounidis, Theodoros; Giannoudis, Peter V

    2013-01-01

    Implant related sepsis is a relatively unusual complication of intra-medullary nail fixation of long bone fractures. Depending on the extent of infection, timing of diagnosis and progress of fracture union, different treatment strategies have been developed. The aim of this review article is to collect and analyze the existing evidence about the incidence and management of infection following IM nailing of long bone fractures and to recommend treatment algorithms that could be valuable in everyday clinical practice. After searching the P u b M e d /Medline databases, 1270 articles were found related to the topic during the last 20 years. The final review included 28 articles that fulfilled the inclusion criteria. Only a few prospective studies exist to report on the management of infection following IM nailing of long-bone fractures. In general, stage I (early) infections only require antibiotic administration with/without debridement. Stage II (delayed) infections can be successfully treated with debridement, IM reaming, antibiotic nails, and administration of antibiotics. Infected non-unions are best treated with exchange nailing, antibiotic administration and when infection has been eradicated with graft implantation if it is needed. Debridement, exchange nailing and systemic administration of antibiotics is the best indication for stage III (late) infections, while stage III infected non-unions can successfully be treated with nail removal and Ilizarov frame, especially when large bone defects exist. PMID:23919097

  15. The de facto national system of psychiatric inpatient care. Piecing together the national puzzle.

    PubMed

    Kiesler, C A; Simpkins, C

    1991-06-01

    National data regarding psychiatric inpatient episodes can be viewed in 2 ways. The normative method surveys the "specialty mental health sector." A more inclusive method includes smaller sites (e.g., the military), all of general hospital treatment (rather than only the psychiatric unit), residential treatment centers, and other residential care. The difference between the 2 methods represents approximately 725,000 episodes, at a direct cost of more than $6 billion. The more inclusive analysis of the years 1980 and 1985 reveals a strong shift to the private sector and an increase in inpatient care of children and youth that might be obscured by limiting national treatment statistics to the specialty mental health sector. PMID:1952419

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

    PubMed Central

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

    2013-01-01

    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

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

    PubMed Central

    2009-01-01

    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

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

    PubMed Central

    2014-01-01

    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

  19. Violence among psychiatric inpatients: a victim's perspective.

    PubMed

    Raveendranathan, D; Chandra, P S; Chaturvedi, S K

    2012-12-01

    OBJECTIVE. Violence in psychiatric wards results in serious consequences and there is need for research to assess it in various settings to enable improvements in safety within psychiatric facilities. This study aimed to assess the inpatient violence from victims' perspective, in settings where family members accompanied patients during inpatient stay and played a significant role in caregiving. METHODS. A total of 100 consecutive incidents of inpatient violence were examined. Family members present at the time of the incident were interviewed to assess putative causes and behaviour prior to the incident. RESULTS. Bipolar spectrum disorder was the most common diagnosis. Family members were the targets of violence in 70% of the incidents and 81% were provoked episodes. Also, 76% of the patients were identified by family member to be irritable just prior to the episode. As preventive measures, family members suggested a need for more staff, more sedation, and improved communication. CONCLUSIONS. The capability of family members to identify behaviour patterns of patients prior to the episode might help decrease the severity and consequence of violence. It is essential to provide culture-specific interventions to the family, which could enable them in handling violence and give better care for the patient. PMID:23271582

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

    PubMed Central

    2014-01-01

    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

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

    PubMed Central

    2014-01-01

    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

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

    PubMed Central

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

    2014-01-01

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

  3. Inpatient management of hospitalized patients with type 2 diabetes

    Microsoft Academic Search

    Andrew J. Ahmann

    2004-01-01

    Over the past 4 years, the scientific literature addressing issues relevant to inpatient hyperglycemia and its management\\u000a has grown dramatically but remains incomplete. The growing interest in inpatient diabetes management is particularly pertinent\\u000a given the epidemic rise in the prevalence of type 2 diabetes and the associated increase in the proportion of inpatients carrying\\u000a this diagnosis. The benefits of aggressive

  4. [Security rules in acute inpatient wards in psychiatric hospitals in the greater area of Athens].

    PubMed

    Koukia, E; Giannouli, E; Gonis, N; Douzenis, A

    2009-04-01

    This research concerns the recording of safety measures in acute mental health wards of psychiatric hospitals in the greater area of Athens. The practices of control and testing on patients performed by nurses are also reported. The total sample consists of 14 acute inpatient psychiatric wards. The results indicated that important differences were noticed in the controls and prohibitions. Moreover, the main characteristic was the lack of protocols and measures of safety, a situation that burdened nursing practice. The lack of rules and strategies that would promote the safety of patient, professionals and therapeutic milieu, were brought into light by nurses' quotes. PMID:22218133

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

    PubMed Central

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

    2015-01-01

    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

  6. Measuring inpatient and outpatient costs: A cost-function approach

    PubMed Central

    Carey, Kathleen; Stefos, Theodore

    1992-01-01

    In this article, the authors estimate a multiple-output cost function for a sample of 2,235 hospitals during the period 1984-88 to disaggregate total costs into inpatient and outpatient components. The results suggest that outpatient cost growth is roughly proportional to that of inpatient cost, despite much higher relative growth in revenues and utilization on the outpatient side. The stability in the outpatient/inpatient cost ratio implies that the increase in the outpatient-to-inpatient utilization ratio was offset by a decline in their relative unit costs. PMID:10127447

  7. 75 FR 7218 - Payment for Inpatient and Outpatient Health Care Professional Services at Non-Departmental...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-18

    ...Payment for Inpatient and Outpatient Health Care Professional Services at Non-Departmental...payments for inpatient and outpatient health care professional services and other...Payment for Inpatient and Outpatient Health Care Professional Services at...

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

    PubMed Central

    2014-01-01

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

  9. Treatable complications of cancer patients referred to an in-patient hospice

    Microsoft Academic Search

    Tatsuya Morita; You Tei; Hideki Shishido; Satoshi Inoue

    2003-01-01

    This paper illustrates the importance of accurate diagnoses and treatments of complications in terminally ill cancer patients. The paper reports on five hospice in-patients who completely recovered from life-threatening complications; three of them had been incorrectly labeled as “imminently dying” by the referring physicians.The paper concludes that it would be beneficial for patients to receive examinations and a trial of

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

    Microsoft Academic Search

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

    2001-01-01

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

  11. Inpatient transfer episodes among aged Medicare beneficiaries.

    PubMed

    Buczko, W

    1993-01-01

    Examination of data derived from Medicare provider analysis and review (MEDPAR) discharge records for 152,337 transfer episodes of aged Medicare beneficiaries indicates that aged Medicare transfer patients have initial stays comparable to non-transfers in terms of length of stay, case-mix intensity, and total charges. During the final part of the transfer episode, however, transfers are clearly more intense cases than non-transfers. Patients treated for stroke or cardiovascular conditions are more likely to be transferred than other Medicare aged inpatients. The transfer episodes examined appear to reflect clinical considerations based primarily on patient need for specialized care. PMID:10135346

  12. [Inpatient rehabilitation of adults with atopic dermatitis].

    PubMed

    Breuer, K; Kapp, A

    2006-07-01

    Atopic dermatitis is a chronic inflammatory skin disease which often persists until adulthood. In severe cases, eczematous lesions and pruritus are resistant to therapy and result in depression, impairment of professional activities and social withdrawal. The goal of inpatient rehabilitation measures is to keep the patient involved and active in professional and social activities. Rehabilitative measures include diagnostics and medical therapy according to current guidelines, instruction in basic medical information, psychological intervention (relaxation techniques, improvement of self-confidence), dietetic measures, exercise, and social advice. Patients with atopic dermatitis often have work-related problems which should be identified as early as possible during rehabilitation. PMID:16761162

  13. 42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  14. 42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  15. 42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  16. 42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  17. 42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  18. Program Redesign Based on the Model of Human Occupation: Inpatient Services for People Experiencing Acute Mental Illness in the UK.

    PubMed

    Melton, Jane; Forsyth, Kirsty; Metherall, Alan; Robinson, Jayne; Hill, Jonathan; Quick, Laura

    2008-01-01

    This paper discusses the current context of the UK mental health service system and the resulting need for program change within acute-care inpatient hospitals. The primary focus is to illustrate through practice example what can be done to support the delivery of client treatment packages by using the concepts described by the Model of Human Occupation (MOHO). The paper concentrates on explaining how MOHO has helped to guide program redesign and develop an Occupational Therapy Care Pathway to support occupation-focused services. The example given is of a hospital service in Gloucestershire, England, which provides inpatient care for people experiencing acute mental illness. PMID:23941371

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

    PubMed

    Kondo, Ken

    2012-05-01

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

  20. Associations Between Psychiatric Inpatient Bed Supply and the Prevalence of Serious Mental Illness in Veterans Affairs Nursing Homes

    PubMed Central

    Szymanski, Benjamin J.; McCarthy, John F.

    2013-01-01

    Objectives. We assessed whether reductions in inpatient psychiatric beds resulted in transinstitutionalization to nursing home care of patients with serious mental illness (SMI) within the Veterans Health Administration (VHA). Methods. We assessed trends in national and site-level inpatient psychiatric beds and nursing home patient demographics, service use, and functioning from the VHA National Patient Care Database, VHA Service Support Center Bed Control, and VHA Minimum Data Set. We estimated nursing home admission appropriateness using propensity score analyses based on Michigan Medicaid Nursing Facility Level of Care Determinations ratings. Results. From 1999 to 2007, the number of VHA inpatient psychiatric beds declined (43?894–40?928), the average inpatient length of stay decreased (33.1–19.0 days), and the prevalence of SMI in nursing homes rose (29.4%–43.8%). At site level, psychiatric inpatient bed availability was unrelated to SMI prevalence in nursing home admissions. However, nursing home residents with SMI were more likely to be inappropriately admitted than were residents without SMI (4.0% vs 3.2%). Conclusions. These results suggest the need for increased attention to the long-term care needs of individuals with SMI. Additional steps need to be taken to ensure that patients with SMI are offered appropriate alternatives to nursing home care and receive adequate screening before admission to nursing home treatment. PMID:23078462

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

    Microsoft Academic Search

    Michael J. Silverman

    2012-01-01

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

  2. A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques

    Microsoft Academic Search

    Philippe H. Dejonckere; Patrick Bradley; Pais Clemente; Guy Cornut; Lise Crevier-Buchman; Gerhard Friedrich; Paul Van De Heyning; Marc Remacle; Virginie Woisard

    2001-01-01

    The proposal of this basic protocol is an attempt to reach better agreement and uniformity concerning the methodology for\\u000a functional assessment of pathologic voices. The purpose is to allow relevant comparisons with the literature when presenting\\u000a \\/ publishing the results of voice treatment, e.g. a phonosurgical technique, or a new \\/ improved instrument or procedure for\\u000a investigating the pathological voice.

  3. Prediction of Psychiatric Inpatient Utilization: A Markov Chain Model.

    ERIC Educational Resources Information Center

    Sweillam, Attia; Tardiff, Kenneth

    1978-01-01

    This study sought to develop and test a method for predicting inpatient utilization in the New York State Department of Mental Hygiene. A Markov chain mathematical model was developed and tested ex post facto for its accuracy in prediction of inpatient workload by age groups for two successive fiscal years. (Author)

  4. Atypical depression among psychiatric inpatients: clinical features and personality traits

    Microsoft Academic Search

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

    1996-01-01

    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,

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

    PubMed Central

    2012-01-01

    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

  6. 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

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

    2014-01-01

    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

  7. Educational needs of inpatient oncology nurses in providing psychosocial care.

    PubMed

    Chen, Cheng Hsuan; Raingruber, Bonnie

    2014-02-01

    Patients with cancer have multiple psychosocial needs during inpatient admissions. However, nurses often are not sure how to best approach those psychosocial needs. Therefore, the purpose of this survey was to determine the educational needs of inpatient oncology nurses in terms of providing psychosocial care to patients and to determine the barriers that inpatient nurses experience when providing psychosocial care. Twenty-six inpatient oncology RNs participated in an online survey that assessed barriers to psychosocial care as well as educational needs. Nurses identified that time, lack of patient privacy, nurses' emotional energy, confusion about clinical guidelines, lack of experience with screening tools, not knowing how to approach sensitive topics, and poor communication between team members undermine psychosocial care. Inpatient nurses need additional training to provide excellent psychosocial care. PMID:24476738

  8. Adjustment of inpatient care reimbursement for nursing intensity.

    PubMed

    Welton, John M; Zone-Smith, Laurie; Fischer, Mary H

    2006-11-01

    The Centers for Medicare and Medicaid Services has begun an ambitious recalibration of the inpatient prospective payment system, the first since its introduction in 1983. Unfortunately, inpatient nursing care has been overlooked in the new payment system and continues to be treated as a fixed cost and billed at a set per-diem "room and board" fee despite the known variability of nursing intensity across different care settings and diagnoses. This article outlines the historical influences regarding costing, billing, and reimbursement of inpatient nursing care and provides contemporary evidence about the variability of nursing intensity and costs at acute care hospitals in the United States. A remedy is proposed to overcome the existing limitations of the Inpatient Prospective Payment System by creating a new nursing cost center and nursing intensity adjustment by DRG for each routine-and intensive-care day of stay to allow independent costing, billing, and reimbursement of inpatient nursing care. PMID:17242392

  9. Computerized method of visual acuity testing: adaptation of the amblyopia treatment study visual acuity testing protocol 1 1 Additional technical information about the Electronic Visual Acuity Tester and the Amblyopia Treatment Study visual acuity testing protocol application can be obtained from the lead author (pmoke@jaeb.org)

    Microsoft Academic Search

    Pamela S. Moke; Andrew H. Turpin; Roy W. Beck; Jonathan M. Holmes; Michael X. Repka; Eileen E. Birch; Richard W. Hertle; Raymond T. Kraker; Joseph M. Miller; Chris A. Johnson

    2001-01-01

    PURPOSE: To report a computerized method for determining visual acuity in children using the Amblyopia Treatment Study visual acuity testing protocol.METHODS: A computerized visual acuity tester was developed that uses a programmed handheld device that uses the Palm operating system (Palm, Inc, Santa Clara, California). The handheld device communicates with a personal computer running a Linux operating system and 17-inch

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

    PubMed

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

    2014-04-01

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

  11. 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

  12. Good outcome associated with a standardized treatment protocol using selective postoperative radiation in patients with clinical stage I adenocarcinoma of the endometrium.

    PubMed

    Carey, M S; O'Connell, G J; Johanson, C R; Goodyear, M D; Murphy, K J; Daya, D M; Schepansky, A; Peloquin, A; Lumsden, B J

    1995-05-01

    In 1982, a treatment protocol was instituted for the management of patients with clinical stage I adenocarcinoma of the endometrium. All pertinent historical, operative, and pathologic findings were reviewed by a multidisciplinary committee and 384 patients were prospectively assigned to either high- or low-risk categories. Patients were excluded from the study if they had clinically apparent extrauterine disease, clear cell or serous histologies, or microscopic ovarian metastasis. Patients were considered high-risk if they had one or more of the following factors: grade 3 tumor differentiation, myometrial invasion > 50% of the total wall thickness, pathologic cervical involvement, or adenosquamous histology. Two-hundred twenty-seven (59%) low-risk patients were followed without further treatment after surgery, while pelvic radiation was recommended for 157 (41%) high-risk patients. The 5-year relapse-free survival rates in the low- and high-risk groups were 95 and 81%, respectively. There were no treatment-related deaths. Severe or life threatening chronic radiotherapy complications occurred in 6 (5%) patients. Multivariate Cox analysis identified the following significant prognostic factors: grade, myometrial invasion, cervix involvement, and age. This treatment protocol represents a safe and effective method of managing patients with carcinoma of the endometrium and spares the need for radiation therapy in the low-risk patient. PMID:7729725

  13. Preparing for the inpatient rehabilitation PPS.

    PubMed

    Rielinger, J A

    2001-12-01

    To assess the financial impact of the inpatient rehabilitation prospective payment system (PPS) on its future revenues, the MetroHealth Center for Rehabilitation (MHCR), Cleveland, Ohio, undertook a three-phase process using data from calendar year 2000 to estimate its potential profit or loss for each case-mix group (CMG) identified in the final rule. This process entailed developing a database to facilitate the combination and comparison of patient-charge and clinical data by CMG, using the combined data to estimate costs by cost center, and using payment information included in the final rule to estimate revenues by CMG. Following the assessment, the MHCR decided to expand the database to assist clinicians in making informed decisions in their patient-assessment and care-delivery processes that would account for cost and revenue considerations under the PPS. PMID:11765633

  14. Leisure: how to promote inpatient motivation after discharge.

    PubMed

    Johnson, S W; McSweeney, M; Webster, R E

    1989-09-01

    1. A group of psychiatric inpatients followed plans to participate in leisure activities after discharge at significantly higher levels when treated with classes and written contracts; or classes, written contracts, and musical entertainment; rather than with classes alone. 2. Inpatient classes for psychiatric patients should be coupled with other interventions, such as contracts or musical entertainment, to assist patients to attain therapeutic goals after discharge. 3. The utilization of written goal-setting contracts seems to have merit as a routine nursing intervention with psychiatric inpatients. 4. The use of a written contract left with the patient may promote or enhance a nurse/patient transaction. PMID:2795549

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

    SciTech Connect

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

    2000-02-01

    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.

  16. Refinement of a Protocol for the Induction of Lactation in Nonpregnant Nonhuman Primates by Using Exogenous Hormone Treatment

    PubMed Central

    Smith, Shannon D; Amos, Joshua D; Beck, Krista N; Colvin, Lisa M; Franke, Kelly S; Liebl, Brooke E; Permar, Sallie R

    2014-01-01

    Obtaining sufficient quantities of milk from NHP is necessary for pharmacologic and immunologic studies required for the development and safety assessment of drugs and vaccines to be used in the maternal–infant setting. We previously induced lactation in nonpregnant female rhesus macaques (RM, Macaca mulatta) and African green monkeys (AGM, Chlorocebus sabaeus) for studies of immune responses in milk, but the volume collected was variable. To improve lactation induction protocols for nonbreeding nonhuman primates, we investigated serum hormone levels and collection protocols in AGM and RM. Here, we correlated milk volume with serum levels of endogenous and administered hormones: estradiol, prolactin, progesterone, and medroxyprogesterone in RM and AGM. We also investigated whether age, parity or the timing of milk collections were associated with the volume of milk collected from the AGM and RM in which lactation was induced by using exogenous hormones. We found an inverse correlation with serum estradiol and milk volume in the RM but no significant correlation between milk volumes and the remaining serum hormone levels in the induced RM or AGM. In addition, HIL AGM had higher peak estradiol levels than did naturally lactating AGM. A revised estradiol-sparing protocol increased milk volumes in the AGM. In addition, milk volume in RM was greater in the morning than the afternoon. In conclusion, we have refined a lactation induction protocol in nonpregnant primates, which is a needed alternative to using nursing primates for the assessment of drug levels and immune responses in milk. PMID:25650978

  17. Tablet Computers for Hospitalized Patients: A pilot study to improve inpatient engagement

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  19. Consumer views on A&E and inpatient care.

    PubMed

    Tingle, John

    2015-06-25

    John Tingle discusses the Care Quality Commission national survey results for hospital inpatient care along with results from the Patients Association and Royal College of Emergency Medicine patient survey report on A&E care. PMID:26110858

  20. Aggression in Inpatient Adolescents: The Effects of Gender and Depression.

    ERIC Educational Resources Information Center

    Knox, Michele; Carey, Michael; Kim, Wun Jung

    2003-01-01

    Examined differences in aggressive behavior among predominantly white adolescent inpatients with and without depression. Survey data indicated that depression and gender interacted significantly. Depressed females demonstrated more physical aggression than nondepressed females, and depressed males demonstrated less aggression than nondepressed…

  1. Ethnic and clinical characteristics of a Portuguese psychiatric inpatient population.

    PubMed

    Alexandre, Joana; Ribeiro, Raquel; Cardoso, Graça

    2010-04-01

    The present study examined the association between ethnicity and clinical characteristics of patients admitted to a psychiatric inpatient unit in Portugal. The only ethnicity-related terms routinely recorded in the medical records were "Black" (mainly from the African Portuguese-speaking countries of Cape Verde, Angola, Guinea, Sao Tome and Mozambique) and "White." Black immigrants appeared to be over-represented, comprising 19.6% of inpatients; and were younger and more frequently male when compared with White inpatients. They were more frequently diagnosed with schizophrenia and acute or transient psychosis, and less frequently diagnosed with delusional and personality disorders than White inpatients. These results are consistent with previous studies in the US and UK, and highlight the need for more culturally sensitive care in mental health services. PMID:20603391

  2. Modeling neuroscience patient flow and inpatient bed management

    E-print Network

    Hiltrop, Jonas

    2014-01-01

    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 ...

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

    PubMed

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

    1991-06-01

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

  4. Inpatients' Perspectives of Occupational Therapy in Acute Mental Health

    Microsoft Academic Search

    Julia Morris; Dip COT

    Background Research into service users' views of occupational therapy in acute mental health is extremely limited. This collaborative study between South West London and St George's Mental Health NHS Trust and Brunel University (UK) obtained inpatients' perspectives of occupational therapy.

  5. Improvement in inpatient glycemic care: pathways to quality.

    PubMed

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

    2015-04-01

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

  6. Protocol Online

    NSDL National Science Digital Library

    Long-Cheng Li (Protocol Online)

    2012-01-06

    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).

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

    PubMed Central

    2011-01-01

    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

  8. Influence of irrigation protocols on the bond strength of fiber posts cemented with a self-adhesive luting agent 24 hours after endodontic treatment.

    PubMed

    Lima, Jessica Ferraz Carvalho; Lima, Adriano Fonseca; Humel, Maria Malerba Colombi; Paulillo, Luis Alexandre Maffei Sartini; Marchi, Giselle Maria; Ferraz, Caio Cezar Randi

    2015-01-01

    The aim of this in vitro study was to evaluate the influence of different irrigation protocols on the bond strength, at different root depths, of fiber posts cemented with a self-adhesive cement 24 hours after endodontic treatment. Fifty-six bovine incisor roots were endodontically prepared and separated into 7 groups (n = 8) according to irrigation protocols: group 1, sterile saline (control); group 2, chlorhexidine (CHX) gel 2% and saline; group 3, sodium hypochlorite (NaOCl) 5.25% and saline; group 4, CHX and saline (final irrigation with ethylenediaminetetraacetic acid [EDTA] 17%); group 5, NaOCl and saline (final irrigation with EDTA); group 6, CHX and saline (final irrigation with NaOCl and EDTA); and group 7, NaOCl (final irrigation with CHX and EDTA). No statistically significant difference was found among the groups. Within the limitations of this study, it can be concluded that the different irrigation protocols did not influence the bond strength of self-adhesive resin cement, which presented similar behaviors at the 3 root depths studied. PMID:26147163

  9. A survey of hospital inpatient education in Texas 

    E-print Network

    Cochran, Susan Carol

    1978-01-01

    the observed and expected frequencies of the small, medium, and large hospitals' responses to the items on the survey. Inpatient education was defined for the survey as "educational activities with written goals and objectives for the patient and/or family... indicated that they have a need for inpatient education in their hospital. The most frequently cited programs for adult patient populations were: diabetes, preoperative, nutrition, respi ratory, and postnatal. For pediatric patient populations, the most...

  10. Aggression among Male Alcohol-Dependent Inpatients who Smoke Cigarettes

    Microsoft Academic Search

    Omer Saatcioglu; Rahsan Erim

    2009-01-01

    The authors aimed to explore the relation between nicotine dependence and the severity of aggression among Turkish male alcohol-dependent inpatients who smoked cigarettes, as well as the effect of aggression in these groups. Participants were 126 male alcohol-dependent inpatients who were given the Structured Clinical Interview for DSM-IV, Substance Use Disorder Module (A. Corapcioglu, O. Aydemir, & M. Yildiz, 1999;

  11. Young cases of schizophrenia identified in a national inpatient register

    Microsoft Academic Search

    Ch. Dalman; J. Broms; J. Cullberg; P. Allebeck

    2002-01-01

    .   Background: Psychiatric inpatient registers are often used in research in the Nordic countries. We aimed to investigate the validity\\u000a of recorded diagnoses of schizophrenia in the Swedish National Inpatient Register, in cases of early age at onset. We also\\u000a wanted to describe the accuracy of the diagnoses in cities\\/university clinics and country hospitals as well as in child and

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

    PubMed Central

    Gilliard, Nicolas; Eggli, Yves; Halfon, Patricia

    2006-01-01

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

  13. An occurrence of sepsis during inpatient fecal disimpaction.

    PubMed

    Darrow, Cory J; Devito, Justin F

    2014-01-01

    Functional constipation is a common pediatric problem that is often treated through well-established algorithms. Fecal disimpaction is the initial therapeutic step, and severe cases require hospitalization for intensive therapies. We describe a significant unexpected complication of this common clinical situation. An 8-year-old boy with suspected chronic functional constipation was hospitalized for disimpaction by continuous nasogastric administration of polyethylene glycol electrolyte (PEG-E) solution. On the sixth day of disimpaction, the patient abruptly developed fever, tachycardia, and tachypnea. Evaluation included blood culture, which grew Escherichia coli, and treatment with a course of appropriate antibiotics was provided. The safety of PEG-E solutions has been shown in studies of children with constipation, which made this patient's illness surprising. Several potential etiologies of his infection were considered, including bacterial translocation (BT). BT is defined as the passage of live microbes and microbial products from the gastrointestinal tract to extraintestinal sites, such as the bloodstream. It has been shown to occur in a variety of clinical conditions but is of unclear clinical significance. In this case, physical damage to the intestinal mucosa was thought to contribute to the potential occurrence of BT, and prolonged disimpaction was considered as a risk factor. E coli sepsis in a child undergoing inpatient nasogastric fecal disimpaction with PEG-E represents a clinical problem never before reported in the literature and should increase clinicians' indices of suspicion for uncommon complications of common procedures. PMID:24366993

  14. Patient engagement in the inpatient setting: a systematic review

    PubMed Central

    Prey, Jennifer E; Woollen, Janet; Wilcox, Lauren; Sackeim, Alexander D; Hripcsak, George; Bakken, Suzanne; Restaino, Susan; Feiner, Steven; Vawdrey, David K

    2014-01-01

    Objective To systematically review existing literature regarding patient engagement technologies used in the inpatient setting. Methods PubMed, Association for Computing Machinery (ACM) Digital Library, Institute of Electrical and Electronics Engineers (IEEE) Xplore, and Cochrane databases were searched for studies that discussed patient engagement (‘self-efficacy’, ‘patient empowerment’, ‘patient activation’, or ‘patient engagement’), (2) involved health information technology (‘technology’, ‘games’, ‘electronic health record’, ‘electronic medical record’, or ‘personal health record’), and (3) took place in the inpatient setting (‘inpatient’ or ‘hospital’). Only English language studies were reviewed. Results 17 articles were identified describing the topic of inpatient patient engagement. A few articles identified design requirements for inpatient engagement technology. The remainder described interventions, which we grouped into five categories: entertainment, generic health information delivery, patient-specific information delivery, advanced communication tools, and personalized decision support. Conclusions Examination of the current literature shows there are considerable gaps in knowledge regarding patient engagement in the hospital setting and inconsistent use of terminology regarding patient engagement overall. Research on inpatient engagement technologies has been limited, especially concerning the impact on health outcomes and cost-effectiveness. PMID:24272163

  15. Latent syphilis among inpatients in an Urban area of China.

    PubMed

    Liu, Ai-Ying; Zang, Wen-Jing; Yuan, Ling-Ling; Chai, Yong-Li; Wang, ShuQi

    2015-05-01

    We aimed at investigating the epidemiological features of latent syphilis among inpatients in an urban area of China. During the period of Jan 1999 to Dec 2007, 146 inpatients were positive for treponema pallidum particle agglutination (TPPA) assay from 22,454 inpatients who were admitted to the China Meitan General Hospital. The number of latent syphilis increased steadily during this period of time. From the 146 TPPA positive inpatients, 137 inpatients were diagnosed as latent syphilis. The number of male patients with latent syphilis was slightly more than the female, but there was no statistical significance (P>0.01). The number of male patients over 60 years old was 42 (30.66%), which was higher than other age groups (p<0.05). The number of female patients at the age range of 20-29 years was 20 (14.60%), which was higher than other age groups (p<0.05). Our results demonstrated that routine syphilis screening among inpatients proves to be one of the most effective precautionary measures to identify latent syphilis and thus to prevent transmission in urban areas in China. PMID:25948433

  16. 42 CFR 483.360 - Consultation with treatment team physician.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  17. 42 CFR 483.360 - Consultation with treatment team physician.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 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...

  18. 42 CFR 483.360 - Consultation with treatment team physician.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  19. 42 CFR 483.360 - Consultation with treatment team physician.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  20. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Special treatment: Referral centers. 412.96 Section...INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...Operating Costs § 412.96 Special treatment: Referral centers. (a)...

  1. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Special treatment: Referral centers. 412.96 Section...INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...Operating Costs § 412.96 Special treatment: Referral centers. (a)...

  2. Hostility and violence of acute psychiatric inpatients

    PubMed Central

    2005-01-01

    Objective The aim of the present study was to find out the extent of hostility and violence and the factors that are associated with such hostility and violence in a psychiatric intensive care unit. Methods Retrospective analysis of data prospectively collected in a 6-year period. Results No hostility was observed in 56.1%, hostility in 40.9%, and violence in 3.0% of the admitted cases. Seclusion was never used. Six cases (2,5‰) required physical restraint. Risk factors associated with violence were younger age, suicidal risk, and diagnosis of schizophrenia. Risk factors associated with hostile and violent behavior were younger age at the onset of the disorder, being single, having no children, lower GAF scores, higher BPRS hostility, SAPS, and CGI scores, lower BPRS anxiety-depression score, higher doses of psychoactive drugs, more frequent use of neuroleptics, diagnosis of mania, personality disorder, substance and alcohol related disorders, no diagnosis of depression. Conclusion The study confirms the low rate of violence among Italian psychiatric in-patients, the major relevance of clinical rather than socio-demographic factors in respect of aggressive behavior, the possibility of a no seclusion-no physical restraint policy, not associated either with higher rates of hostility or violence or with more severe drug side effects. PMID:16053528

  3. Incidence of fractures requiring inpatient care

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    2012-01-01

    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

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

    PubMed Central

    Patel, Mit B; Bencharit, Sompop

    2009-01-01

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

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

    PubMed Central

    2014-01-01

    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

  7. Cryptography and cryptographic protocols

    Microsoft Academic Search

    Oded Goldreich

    2003-01-01

    We survey the paradigms, approaches and techniques used to conceptualize, define and provide solutions to natural cryptographic problems. We start by presenting some of the central tools (e.g., computational difficulty, pseudorandomness, and zero-knowledge proofs), and next turn to the treatment of encryption and signature schemes. We conclude with an extensive treatment of secure cryptographic protocols both when executed in a

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

    Microsoft Academic Search

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

    2011-01-01

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

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

    Microsoft Academic Search

    Ellen Hoxmark; Mary Nivison; Rolf Wynn

    2010-01-01

    BACKGROUND: Mental distress measured by the HSCL-10 is used as an indicator of psychiatric disorders in population studies, where a higher level of mental distress has been shown to be related to demographic factors such as living conditions and level of education. The first aim of the study was to explore whether mental distress could be a valuable concept in

  10. [Problems in the standardization of inpatient health care in clinical toxicology].

    PubMed

    Ostapenko, Iu N; Litvinov, N N; Rozhkov, P G; Il'iashenko, K K; Gol'dfarb, Iu S

    2008-01-01

    Standardization of inpatient toxicological care is an urgent task to reduce mortality from acute chemical poisonings. Since 2005, health care standards and patient management protocols in poisonings with psychotropic and hypnotic agents, ethanol and other alcohols, and ethylene glycol have been developed and work is in progress on standards for intoxication with corrosive substances, soaps, detergents, carbon dioxide, other gases, smokes, and vapors. Major difficulties have been revealed. These are the lack of coincidence of the "Nomenclature of work and services in public health service" at the federal level with the similar regional documents; improper presentation of toxicological diagnostic and medical technologies; orientation of the Ministry of Health and Social Development of Russia towards only simple services; the "List of Essential and Most Important Drugs" that does not contain the heading "antidote agents" at all is to be completed. PMID:19227285

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

    ERIC Educational Resources Information Center

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

    2014-01-01

    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…

  12. Treatment outcome of young children with acute lymphoblastic leukaemia: achievements and directions implied from Shanghai Children's Medical Centre based SCMC-ALL-2005 protocol.

    PubMed

    Liang, Yang; Yang, Lin-Hai; Jiang, Hui; Yuan, Xiao-Jun; Sun, Li-Rong; Wang, Ning-Ling; Tang, Jing-Yan

    2015-04-01

    This multicenter study used the Shanghai Children's Medical Center (SCMC)-ALL-2005 protocol for treatment of young patients (<2 years old) with acute lymphoblastic leukaemia (ALL), which was designed to improve treatment outcome in Chinese paediatric patients. These aims were pursued through risk-directed stratification based on presenting clinical and genetic features, minimal residual disease (MRD) levels and treatment response. All the patients achieved completed remission with 5-year event-free survivals of 82·6 ± 9·7% (low risk), 52·6 ± 8·4% (intermediate risk), 28·6 ± 17·1% (high risk). Disease recurrence was detected in bone marrow, bone marrow plus testis, testis alone and central nervous system in 16 (24·2%), 1 (1·5%), 1 (1·5%) and 1 (1·5%) patients respectively. No deaths were reported during induction. The SCMC-ALL-2005 trial for ALL patients <2 years old indicated high remission induction and low infection and treatment-related mortality rates. PMID:25655921

  13. Situational determinants of inpatient self-harm.

    PubMed

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

    2002-01-01

    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

  14. Trends in Neutropenia-Related Inpatient Events

    PubMed Central

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

    2012-01-01

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

  15. De-escalation treatment protocols for human papillomavirus-associated oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis of current clinical trials.

    PubMed

    Masterson, Liam; Moualed, Daniel; Liu, Zi Wei; Howard, James E F; Dwivedi, Raghav C; Tysome, James R; Benson, Richard; Sterling, Jane C; Sudhoff, Holger; Jani, Piyush; Goon, Peter K C

    2014-10-01

    Iatrogenic complications associated with current treatment protocols for oropharyngeal squamous cell carcinoma are noted to cause high rates of acute and chronic morbidity. The aims of this study are to provide an overview of the current de-escalation trials for human papillomavirus positive (HPV+) oropharyngeal carcinoma and to evaluate the evidence supporting improved response to treatment of patients within this viral cohort. This study reviewed all completed or in progress randomised controlled trials (RCTs) assessing clinical interventions for human papillomavirus-associated locally advanced oropharyngeal squamous cell carcinoma. We utilised a validated 'risk of bias' tool to assess study quality. We identified nine RCTs that met the full inclusion criteria for this review (all of which are currently on-going and will report from 2015 onwards). Five RCTs performed a post hoc analysis by HPV status, which allowed meta-analysis of 1130 patients. The data reveal a significant difference in overall survival (hazard ratio (HR) 0.49 [95% confidence interval (CI) 0.35-0.69]), loco-regional failure (HR 0.43 [95% CI 0.17-1.11]) and disease specific survival (0.41 [95% 0.3-0.56]) in favour of the HPV+ category. In considering de-escalation treatment protocols, nine studies are currently ongoing. Our meta-analysis provides strong evidence for an improved prognosis in the viral associated cohort when treated by platinum based chemotherapy in combination with radiotherapy or primary radiotherapy. So far, one trial (with moderate to high risk of bias) suggests a reduced survival outcome for the HPV+ population when using the epidermal growth factor receptor (EGFR) inhibitor cetuximab. PMID:25091798

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

    PubMed Central

    2010-01-01

    Background The treatment of depressive phases of bipolar disorder is challenging. The effects of the commonly used antidepressants in bipolar depression are questionable. Electroconvulsive therapy is generally considered to be the most effective treatment even if there are no randomized controlled trials of electroconvulsive therapy in bipolar depression. The safety of electroconvulsive therapy is well documented, but there are some controversies as to the cognitive side effects. The aim of this study is to compare the effects and side effects of electroconvulsive therapy to pharmacological treatment in treatment resistant bipolar depression. Cognitive changes and quality of life during the treatment will be assessed. Methods/Design A prospective, randomised controlled, multi-centre six- week acute treatment trial with seven clinical assessments. Follow up visit at 26 weeks or until remission (max 52 weeks). A neuropsychological test battery designed to be sensitive to changes in cognitive function will be used. Setting: Nine study centres across Norway, all acute psychiatric departments. Sample: n = 132 patients, aged 18 and over, who fulfil criteria for treatment resistant depression in bipolar disorder, Montgomery Åsberg Depression Rating Scale Score of at least 25 at baseline. Intervention: Intervention group: 3 sessions per week for up to 6 weeks, total up to 18 sessions. Control group: algorithm-based pharmacological treatment as usual. Discussion This study is the first randomized controlled trial that aims to investigate whether electroconvulsive therapy is better than pharmacological treatment as usual in treatment resistant bipolar depression. Possible long lasting cognitive side effects will be evaluated. The study is investigator initiated, without support from industry. Trial registration NCT00664976 PMID:20178636

  17. Changes in Religious Coping and Relapse to Drug Use Among Opioid-Dependent Patients Following Inpatient Detoxification

    Microsoft Academic Search

    Eve S. Puffer; Linda M. Skalski; Christina S. Meade

    Relapse rates remain high among people with opioid dependence. Identifying psychosocial factors associated with outcomes is\\u000a important for informing behavioral treatments. This study examined religious coping, opioid use, and 12-step participation\\u000a among 45 participants receiving inpatient opioid detoxification at baseline and follow-up. At baseline, higher positive coping\\u000a was related to less frequent opioid use pre-admission (? = ?.44, p p p p < .05). Positive religious coping

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

    PubMed Central

    2012-01-01

    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

  19. Efficacy of multimodal, systematic non-surgical treatment of knee osteoarthritis for patients not eligible for a total knee replacement: a study protocol of a randomised controlled trial

    PubMed Central

    Skou, Soren Thorgaard; Roos, Ewa M; Laursen, Mogens Berg; Rathleff, Michael Skovdal; Arendt-Nielsen, Lars; Simonsen, Ole; Rasmussen, Sten

    2012-01-01

    Introduction It is recommended that non-operative treatment of knee osteoarthritis (KOA) should be individually tailored and include multiple treatment modalities. Despite these recommendations, no one has yet investigated the efficacy of combining several non-surgical treatment modalities in a randomised controlled study. The purpose of this randomised controlled study is to examine if an optimised, combined non-surgical treatment programme results in greater improvements in pain, function and quality of life in comparison with usual care in patients with KOA who are not eligible for total knee arthroplasty (TKA). Methods and analysis This study will include 100 consecutive patients from the North Denmark Region not eligible for TKA with radiographic KOA (K-L grade ?1) and mean pain during the previous week of ?60?mm (0–100). The participants will be randomised to receive either a 12-week non-surgical treatment programme consisting of patient education, exercise, diet, insoles, paracetamol and/or NSAIDs or usual care (two information leaflets containing information on KOA and advice regarding the above non-surgical treatment). The primary outcome will be the change from baseline to 12?months on the self-report questionnaire Knee Injury and Osteoarthritis Outcome Score (KOOS)4 defined as the average score for the subscale scores for pain, symptoms, activities of daily living and quality of life. Secondary outcomes include the five individual KOOS subscale scores, pain on a 100?mm Visual Analogue Scale, EQ-5D, self-efficacy, pain pressure thresholds, postural control and isometric knee flexion and knee extension strength. Ethics and dissemination This study was approved by the local Ethics Committee of The North Denmark Region (N-20110085) and the protocol conforms to the principles of the Declaration of Helsinki. Data collection will be completed by April 2014. Publications will be ready for submission in the summer of 2014. Trial registration number This study is registered with http://clinicaltrials.gov (NCT01535001). PMID:23151395

  20. Protocol Building Blocks Protocol Design

    E-print Network

    Biagioni, Edoardo S.

    ­? '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 PROTOCOL sharing type Address.T = ipâ??address val setâ??gateway: ... end (* sig *) structure Ip (structure

  1. The ETTAA study protocol: a UK-wide observational study of ‘Effective Treatments for Thoracic Aortic Aneurysm’

    PubMed Central

    Sastry, Priya; Hughes, Victoria; Hayes, Paul; Vallabhaneni, Srinivasa; Sharples, Linda; Thompson, Matt; Catarino, Pedro; Moorjani, Narain; Vale, Luke; Gray, Joanne; Cook, Andrew; Elefteriades, John A; Large, Stephen R

    2015-01-01

    Introduction Chronic thoracic aortic aneurysm (CTAA) affecting the arch or descending aorta is an indolent but life-threatening condition with a rising prevalence as the UK population ages. Treatment may be in the form of open surgical repair (OSR) surgery, endovascular stent grafting (ESG) or best medical therapy (BMT). Currently, there is no consensus on the best management strategy, and no UK-specific economic studies that assess outcomes beyond the chosen procedure, but this is required in the context of greater demand for treatment and limited National Health Service (NHS) resources. Methods and analysis This is a prospective, multicentre observational study with statistical and economic modelling of patients with CTAA affecting the arch or descending aorta. We aim to gain an understanding of how treatments are currently chosen, and to determine the clinical effectiveness and cost-effectiveness of the three available treatment strategies (BMT, ESG and OSR). This will be achieved by: (1) following consecutive patients who are referred to the teams collaborating in this proposal and collecting data regarding quality of life (QoL), medical events and hospital stays over a maximum of 5?years; (2) statistical analysis of the comparative effectiveness of the three treatments; and (3) economic modelling of the comparative cost-effectiveness of the three treatments. Primary study outcomes are: aneurysm growth, QoL, freedom from reintervention, freedom from death or permanent neurological injury, incremental cost per quality-adjusted life year gained. Ethics and dissemination The study will generate an evidence base to guide patients and clinicians to determine the indications and timing of treatment, as well as informing healthcare decision-makers about which treatments the NHS should provide. The study has achieved ethical approval and will be disseminated primarily in the form of a Health Technology Assessment monograph at its completion. Trial registration number ISRCTN04044627. PMID:26038360

  2. 42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...prospective payment system for inpatient rehabilitation facilities. 412.604 Section 412...SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for...

  3. 42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...prospective payment system for inpatient rehabilitation facilities. 412.604 Section 412...SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for...

  4. 42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...prospective payment system for inpatient rehabilitation facilities. 412.604 Section 412...SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for...

  5. 42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...prospective payment system for inpatient rehabilitation facilities. 412.604 Section 412...SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for...

  6. 42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...prospective payment system for inpatient rehabilitation facilities. 412.604 Section 412...SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for...

  7. Factors affecting interstate use of inpatient care by Medicare beneficiaries.

    PubMed Central

    Buczko, W

    1992-01-01

    This article examines the extent to which interstate inflow and outflow of patients affects their observed use of Medicare Part A inpatient care. Interstate patient flow can bias utilization rates and may be due to seasonal migration, interstate inpatient care market areas, or purposive seeking of specialized/high-quality care. Examination of state level patient flow data drawn from 1987 Medicare discharge indicate that most interstate patient flow occurs between adjacent states probably as an outgrowth of interstate markets. Regression analyses of patient flow data suggest that while seasonal migration is an important determinant of patient flow, its importance is secondary to that of indicators of the availability of specialized services. These findings suggest research questions that may be best answered in detailed analyses of inpatient utilization in interstate market areas and seasonal migration. PMID:1500288

  8. ThE BENEfITS Of INPATIENT DIABETES CARE: ImPROVINg Qu AlITy Of CARE AND ThE BOTTOm lINE

    Microsoft Academic Search

    Lanell Olson; John Muchmore; C. Bruce Lawrence

    2006-01-01

    Objective: To analyze the impact of a hospital-wide inpatient diabetes management program on quality of care, length of stay, and cost. Methods: A retrospective review was conducted for diabetes identification and treatment in a large tertiary care hospital in Oklahoma City, Oklahoma. Cultural change was accomplished by educating the healthcare profession- als and medical staff. Systems were implemented to bet-

  9. Accessing Patient Electronic Records Larry Lookup, RN, works on a busy general Medical unit as an inpatient RN in ABC hospital. He also has

    E-print Network

    Oliver, Douglas L.

    as an inpatient RN in ABC hospital. He also has experience working in the Emergency Department at another hospital prior to his employment at ABC. Larry has a personal interest in the care and treatment of cancer their surgery and post operative course for his own education. When he works on the oncology unit, he has found

  10. 42 CFR 412.428 - Publication of Updates to the inpatient psychiatric facility prospective payment system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...System for Inpatient Hospital Services of Inpatient...Federal Register information pertaining to updates...2002-based excluded hospital market basket. (c) The best available hospital wage index and information regarding...

  11. 42 CFR 412.428 - Publication of Updates to the inpatient psychiatric facility prospective payment system.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...System for Inpatient Hospital Services of Inpatient...Federal Register information pertaining to updates...2002-based excluded hospital market basket. (c) The best available hospital wage index and information regarding...

  12. 42 CFR 412.428 - Publication of Updates to the inpatient psychiatric facility prospective payment system.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...System for Inpatient Hospital Services of Inpatient...Federal Register information pertaining to updates...2002-based excluded hospital market basket. (c) The best available hospital wage index and information regarding...

  13. 42 CFR 412.428 - Publication of Updates to the inpatient psychiatric facility prospective payment system.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...System for Inpatient Hospital Services of Inpatient...Federal Register information pertaining to updates...2002-based excluded hospital market basket. (c) The best available hospital wage index and information regarding...

  14. 42 CFR 412.428 - Publication of Updates to the inpatient psychiatric facility prospective payment system.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...System for Inpatient Hospital Services of Inpatient...Federal Register information pertaining to updates...2002-based excluded hospital market basket. (c) The best available hospital wage index and information regarding...

  15. 42 CFR 412.434 - Reconsideration and appeals procedures of Inpatient Psychiatric Facilities Quality Reporting...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...system administrator, including each individual's name, email address, telephone number, and physical mailing address...inpatient psychiatric facility's reconsideration request, such as emails and other documents. (c) An inpatient psychiatric...

  16. 75 FR 78901 - Payment for Inpatient and Outpatient Health Care Professional Services at Non-Departmental...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-17

    ...Payment for Inpatient and Outpatient Health Care Professional Services at Non-Departmental...payments for inpatient and outpatient health care professional services and other...reasonable. Payment methodology for health care professional services...

  17. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...participation: Hospices that provide inpatient care directly. 418.110 Section 418...MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of participation: Organizational...participation: Hospices that provide inpatient care directly. A hospice that provides...

  18. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...participation: Hospices that provide inpatient care directly. 418.110 Section 418...MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of participation: Organizational...participation: Hospices that provide inpatient care directly. A hospice that provides...

  19. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...participation: Hospices that provide inpatient care directly. 418.110 Section 418...MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of participation: Organizational...participation: Hospices that provide inpatient care directly. A hospice that provides...

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

    PubMed Central

    2014-01-01

    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

  1. A myoelectric-controlled virtual hand for the assessment and treatment of phantom limb pain in trans-radial upper extremity amputees: a research protocol.

    PubMed

    Gaggioli, Andrea; Amoresano, Amedeo; Gruppioni, Emanuele; Verni, Gennaro; Riva, Giuseppe

    2010-01-01

    At least 90% of individuals of limb amputees experience phantom limb pain (PLP). Recent clinical research suggests that providing patients with the mirror image representation of the amputated limb may alleviate PLP. However, mirror therapy cannot be used with bilateral amputees, as visual feedback is dependent on the movement of the intact limb. To overcome this limitation, we designed a novel myoelectric-controlled virtual reality (VR) system for the treatment of phantom limb pain in trans-radial upper extremity amputees. The proposed system allows the patient to directly control the virtual limb by recognizing stump muscle patterns recorded with EMG sensors. The hypothesis behind this strategy is that the VR image of the amputated limb induces better limb imagery than the reflected image of their intact limb and, therefore, is more effective in reducing PLP. A research protocol to test this hypothesis is described. PMID:20543301

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

    PubMed Central

    2014-01-01

    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

  3. Cigarette smoking in Chinese male inpatients with schizophrenia: a cross-sectional analysis.

    PubMed

    Tang, Yi-lang; George, Tony P; Mao, Pei-xian; Cai, Zhuo-ji; Chen, Qi

    2007-01-01

    Given the high rates of cigarette smoking in schizophrenia in many published studies from around the world, we studied the relationship between smoking status and clinical characteristics in male Chinese schizophrenic inpatients. Two hundred seventy-nine schizophrenic inpatients were assessed using clinical data forms to ascertain historical, demographic and treatment variables and collateral information was also collected from case records and interviews with patients and family members. Current smokers (N=112) were compared with non-smokers (N=167) on clinical variables by independent sample t-tests and chi(2) tests, with adjustment for confounding variables using ANCOVA and binary logistic regression analysis. Compared to non-smokers, current smokers were significantly more likely to be divorced, have lower educational attainment, a more episodic course, have a greater number of previous psychotic relapses and more likely to be treated with clozapine. There was no correlation, however, between smoking consumption and schizophrenic psychopathology. Accordingly, cigarette smoking may be associated with certain clinical features in schizophrenic patients, and should be carefully screened for when making treatment and rehabilitation plans. PMID:16360170

  4. Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2015.

    PubMed

    2014-08-01

    This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2015 as required by the statute. This final rule finalizes a policy to collect data on the amount and mode (that is, Individual, Concurrent, Group, and Co-Treatment) of therapy provided in the IRF setting according to therapy discipline, revises the list of diagnosis and impairment group codes that presumptively meet the "60 percent rule'' compliance criteria, provides a way for IRFs to indicate on the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) form whether the prior treatment and severity requirements have been met for arthritis cases to presumptively meet the "60 percent rule'' compliance criteria, and revises and updates quality measures and reporting requirements under the IRF quality reporting program (QRP). This rule also delays the effective date for the revisions to the list of diagnosis codes that are used to determine presumptive compliance under the "60 percent rule'' that were finalized in FY 2014 IRF PPS final rule and adopts the revisions to the list of diagnosis codes that are used to determine presumptive compliance under the "60 percent rule'' that are finalized in this rule. This final rule also addresses the implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), for the IRF prospective payment system (PPS), which will be effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions. PMID:25122947

  5. Predicting inpatient mortality for pediatric trauma patients with blunt injuries: A better alternative

    Microsoft Academic Search

    Edward L. Hannan; Louise Szypulski Farrell; Philip S. Meaker; Arthur Cooper

    2000-01-01

    Purpose: The aim of this study was to identify significant independent predictors of inpatient mortality rates for pediatric victims of blunt trauma and to develop a formula for predicting the probability of inpatient mortality for these patients.Methods: Emergency department and inpatient data from 2,923 pediatric victims of blunt injury in the New York State Trauma Registry in 1994 and 1995

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

    PubMed Central

    2014-01-01

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

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

    Microsoft Academic Search

    J. Stradling; R. Dookun

    2009-01-01

    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,

  8. A prevalence study of bestiality (zoophilia) in psychiatric in-patients, medical in-patients, and psychiatric staff.

    PubMed

    Alvarez, W A; Freinhar, J P

    1991-01-01

    The prevalence of bestiality (both actual sexual contacts and sexual fantasy) was investigated in an experimental group (psychiatric in-patients) and two control populations (medical in-patients and psychiatric staff). Psychiatric patients were found to have a statistically significant higher prevalence rate (55%) of bestiality than the control groups (10% and 15% respectively). Implications of these findings are discussed. It is recommended that due to the obvious prevalence of this condition, questions exploring this previously ignored topic should be routinely included in the psychiatric interview. PMID:1778686

  9. Multicenter study "Medical-Occupational Rehabilitation Procedure Skin--optimizing and quality assurance of inpatient-management (ROQ)".

    PubMed

    Skudlik, Christoph; Weisshaar, Elke; Scheidt, Reginald; Wulfhorst, Britta; Diepgen, Thomas Ludwig; Elsner, Peter; Schönfeld, Michael; John, Swen Malte

    2009-02-01

    Scientifically based prevention and patient management concepts in occupational dermatology have substantially improved during recent years. Currently the public statutory employers' liability insurance bodies fund a multi-step intervention approach designed to provide quick preventive help for all levels of severity of occupational dermatoses. An administrative guideline (hierarchical multi-step intervention procedure for occupational skin diseases--"Stufenverfahren Haut") insures professional support and optimal patient orientation by the statutory insurers' representatives. For secondary prevention, the so-called dermatologist's procedure ("Hautarztverfahren") was recently updated in order to provide more rapid dermatologic consultations which are covered for by the public statutory employers' liability insurance bodies. Additionally, combined outpatient dermatologic and health-educational intervention seminars ("secondary individual prevention"[SIP]) are offered to affected employees in a nationwide scheme. For those cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed ("tertiary individual prevention"[TIP]). TIP requires 3 weeks inpatient treatment including intensive health care instruction and psychological counseling, followed by outpatient treatment by the local dermatologist. In 2005, a German prospective cohort multicenter study ("Medical-Occupational Rehabilitation Procedure Skin--optimizing and quality assurance of inpatient-management"-"Medizinisch-Berufliches Rehabilitationsverfahren Haut--Optimierung und Qualitätssicherung des Heilverfahrens"[ROQ]) started which will further standardize TIP and evaluate scientific sustainability in depth (3-year dermatological follow-up of 1,000 patients). The study is being funded by the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung [DGUV]). PMID:18759737

  10. Adults with CNS primitive neuroectodermal tumors/pineoblastomas: results of multimodal treatment according to the pediatric HIT 2000 protocol.

    PubMed

    Friedrich, Carsten; Müller, Klaus; von Hoff, Katja; Kwiecien, Robert; Pietsch, Torsten; Warmuth-Metz, Monika; Gerber, Nicolas U; Hau, Peter; Kuehl, Joachim; Kortmann, Rolf D; von Bueren, André O; Rutkowski, Stefan

    2014-02-01

    Central nervous system primitive neuroectodermal tumors (CNS-PNET) and pineoblastomas (PBL) are rare in adulthood. Knowledge on clinical outcome and the efficacy and toxicities of chemotherapy in addition to radiotherapy is limited. Patients older than 21 years at diagnosis were followed in the observational arm of the prospective pediatric multicenter trial HIT 2000. After surgery, craniospinal irradiation and maintenance or sandwich chemotherapy were recommended. Radiotherapy was normo- (35.2 Gy; tumor region, 55.0 Gy; metastasis, 49.6 Gy) or hyperfractionated (40.0 Gy; tumor bed, 68.0 Gy; metastasis, 50-60 Gy). Maintenance chemotherapy consisted of eight courses (vincristine, lomustine, cisplatin). Sandwich chemotherapy included two cycles of postoperative chemotherapy followed by radiotherapy, and four courses of maintenance chemotherapy. Seventeen patients (CNS-PNET, n = 7; PBL, n = 10), median age 30 years, were included. Eight patients had a postoperative residual tumor and four patients metastatic disease. The median follow-up of ten surviving patients was 41 months. The estimated rates for 3-year progression-free survival (PFS) and overall survival were 68 ± 12 and 66 ± 13%, respectively. PBL compared to CNS-PNET tended towards a better PFS, although the difference was not clear (p = 0.101). Both chemotherapeutic (maintenance, n = 6; sandwich, n = 8) protocols did not differ in their PFS and were feasible with acceptable toxicities. Intensified regimens of combined chemo- and radiotherapy are generally feasible in adults with CNS-PNET/PBL. The impact of intensified chemotherapy on survival should be further assessed. PMID:24407732

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

    Microsoft Academic Search

    Linzette D Morris; Karen A Grimmer-Somers; Bruce Spottiswoode; Quinette A Louw

    2011-01-01

    Background  Albeit exercise is currently advocated as one of the most effective management strategies for fibromyalgia syndrome (FMS);\\u000a the implementation of exercise as a FMS treatment in reality is significantly hampered by patients' poor compliance. The inference\\u000a that pain catastrophizing is a key predictor of poor compliance in FMS patients, justifies considering the alteration of pain\\u000a catastrophizing in improving compliance towards

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

    PubMed Central

    2014-01-01

    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

  13. Temperament and Personality Dimensions in Suicidal and Nonsuicidal Psychiatric Inpatients

    Microsoft Academic Search

    Maurizio Pompili; Zoltán Rihmer; Hagop S. Akiskal; Marco Innamorati; Paolo Iliceto; Kareen K. Akiskal; David Lester; Valentina Narciso; Stefano Ferracuti; Roberto Tatarelli; Eleonora De Pisa; Paolo Girardi

    2008-01-01

    Background: Suicide is a serious public health problem. In the international literature there is evidence to support the notion that certain temperaments and personality traits are often associated with suicidal behavior. Sampling and Methods: In this study, 150 psychiatric inpatients were investigated using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego autoquestionnaire, the Minnesota Multiphasic Personality Inventory, 2nd

  14. Predictors of Specialized Inpatient Admissions for Adults with Intellectual Disability

    ERIC Educational Resources Information Center

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

    2015-01-01

    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…

  15. Psychiatric Inpatient Admissions of Adults with Intellectual Disabilities: Predictive Factors

    ERIC Educational Resources Information Center

    Cowley, Amy; Newton, Jonathan; Sturmey, Peter; Bouras, Nick; Holt, Geraldine

    2005-01-01

    Information on admission to psychiatric inpatient units is lacking from the literature on contemporary services for people with intellectual disability and mental health needs. Here we report on predictors of admission for a cohort of 752 adults from this population living in community settings; 83 were admitted. We also report on two subsamples…

  16. Case report: Transition from paper to electronic inpatient physician notes

    Microsoft Academic Search

    Thomas H. Payne; Aharon E. tenBroek; Grant S. Fletcher; Mardi C. Labuguen

    2010-01-01

    UW Medicine teaching hospitals have seen a move from paper to electronic physician inpatient notes, after improving the availability of workstations, and wireless laptops and the technical infrastructure supporting the electronic medical record (EMR). The primary driver for the transition was to unify the medical record for all disciplines in one location. The main barrier faced was the time required

  17. Smoking Assessment and Cessation Skills in the Inpatient Medicine Clerkship.

    ERIC Educational Resources Information Center

    Hull, Alan L.; Kleinhenz, Mary Ellen

    1990-01-01

    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…

  18. Neurohospitalists: An emerging model for inpatient neurological care

    Microsoft Academic Search

    S. Andrew Josephson; John W. Engstrom; Robert M. Wachter

    2008-01-01

    Over the past decade, the hospitalist model has become a dominant system for the delivery of general adult and pediatric inpatient care. Similar forces, including national mandates to improve safety and quality and intense pressure to safely reduce length of hospital stays, that led to the remarkable growth of hospitalist medicine are now exerting pressure on neurologists. A neurohospitalist model,

  19. Evaluation of hospital inpatient complications: a planning approach

    Microsoft Academic Search

    Ronald J Lagoe; Gert P Westert

    2010-01-01

    BACKGROUND: Hospital inpatient complications are one of a number of adverse health care outcomes. Reducing complications has been identified as an approach to improving care and saving resources as part of the health care reform efforts in the United States. An objective of this study was to describe the Potentially Preventable Complications software developed as a tool for evaluating hospital

  20. Application of Faschingbauer's abbreviated MMPI to psychiatric inpatients

    Microsoft Academic Search

    Charles S. Newmark; Louise Cook; Mary Clarke; Thomas R. Faschingbauer

    1973-01-01

    Assessed the degree of interchangeability of an extracted 166-item MMPI developed by T. R. Faschingbauer in 1972 and the standard MMPI, with a sample of 228 psychiatric inpatients. Findings reveal that Faschingbauer's abbreviated MMPI scale and the standard MMPI were markedly similar and highly correlated, indicating that the abbreviated MMPI is a fairly accurate substitute for the MMPI in predicting

  1. Domains of Chronic Stress and Suicidal Behaviors among Inpatient Adolescents

    ERIC Educational Resources Information Center

    Pettit, Jeremy W.; Green, Kelly L.; Grover, Kelly E.; Schatte, Dawnelle J.; Morgan, Sharon T.

    2011-01-01

    Little is known about the role of chronic stress in youth suicidal behaviors. This study examined the relations between specific domains of chronic stress and suicidal behaviors among 131 inpatient youth (M age = 15.02 years) who completed measures of stress, suicidal ideation, suicide attempt, and suicide intent. After controlling for…

  2. Canine-assisted therapy in the inpatient setting.

    PubMed

    Snipelisky, David; Burton, M Caroline

    2014-04-01

    Canine-assisted therapy (CAT) is widely used in outpatient settings, yet there is little published literature regarding its use, efficacy, and safety in the inpatient setting. The primary objective of this review was to consolidate published information regarding CAT efficacy and safety in the inpatient population. The secondary objective was to review safety concerns associated with CAT. The databases PubMed, Ovid MEDLINE, and Web of Knowledge were searched using the dates April 2003-April 2013 with the terms "animal assisted therapy" and "pet therapy." Articles were reviewed for the relevance of CAT in the inpatient setting, and those meeting our criteria were included in the study. The references of selected articles also were reviewed and included if study criteria were met. The review of the literature resulted in 429 total articles using the search terms. Of the 429 articles, 177 were duplicates and 218 pertained to the outpatient setting or involved animal therapies other than canine, leaving 34 articles that met the search criteria. The bibliography review of the 34 articles yielded an additional 10 articles. Our review of the literature showed that in the inpatient setting, CAT is an effective therapy among patients of all ages and with various medical problems and is safe, with no transmitted infections reported. PMID:24937523

  3. Predictors of Inpatient Utilization among Veterans with Dementia

    PubMed Central

    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

    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

  4. Inpatient mental health professionals' perceptions of the discharge planning process

    Microsoft Academic Search

    Victoria Dawn Biro

    2004-01-01

    This study investigated perceptions of the discharge planning process by mental health professionals in a regional inpatient mental health service. The burden of mental illness in Australia is growing, with a corresponding increase in demand for services. Continuity of care and effective discharge planning for people with serious and enduring mental illness is considered a complex and multifaceted process. The

  5. Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Lumbar spinal stenosis is the most common reason for spinal surgery in older adults. Previous studies have shown that surgery is effective for severe cases of stenosis, but many patients with mild to moderate symptoms are not surgical candidates. These patients and their providers are seeking effective non-surgical treatment methods to manage their symptoms; yet there is a paucity of comparative effectiveness research in this area. This knowledge gap has hindered the development of clinical practice guidelines for non-surgical treatment approaches for lumbar spinal stenosis. Methods/design This study is a prospective randomized controlled clinical trial that will be conducted from November 2013 through October 2016. The sample will consist of 180 older adults (>60 years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Eligible subjects will be randomized into one of three pragmatic treatment groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise. All subjects will be treated for a 6-week course of care. The primary subjective outcome is the Swiss Spinal Stenosis Questionnaire, a self-reported measure of pain/function. The primary objective outcome is the Self-Paced Walking Test, a measure of walking capacity. The secondary objective outcome will be a measurement of physical activity during activities of daily living, using the SenseWear Armband, a portable device to be worn on the upper arm for one week. The primary analysis will use linear mixed models to compare the main effects of each treatment group on the changes in each outcome measure. Secondary analyses will include a responder analysis by group and an exploratory analysis of potential baseline predictors of treatment outcome. Discussion Our study should provide evidence that helps to inform patients and providers about the clinical benefits of three non-surgical approaches to the management of lumbar spinal stenosis symptoms. Trial registration ClinicalTrials.gov identifier: NCT01943435 PMID:24872875

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

    PubMed Central

    2012-01-01

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

  7. Baylisascaris procyonis larva migrans in two white-headed lemurs (Eulemur albifrons) in Spain and response to treatment derived from a human pediatric protocol.

    PubMed

    Jimenez Martinez, Maria-Angeles; Valderrabano Cano, Esther; Rois, Jose L

    2015-06-15

    Baylisascaris procyonis is a well-known ascaridoid nematode that causes larva migrans in humans and many other animal species. The North American raccoon (Procyon lotor) is the definitive host, which has been successfully introduced in the past decades to other geographical regions around the world. Two white-headed lemurs (Eulemuralbifrons) from a Zoological Park in Lugo, Spain, developed severe neurological signs within a brief period after being transferred from exhibit and placed in close contact with three captive raccoons from the same zoo. One lemur was euthanized due to the severity of disease progression and histopathology revealed granulomatous inflammation and ascaridoid larvae in kidneys, lung, spleen and brain. Larvae were identified as B. procyonis larvae by real time PCR. In light of the results, the cage mate with similar neurological signs was put on an albendazole treatment regimen adapted from a human pediatric protocol. The aggressive anthelmintic treatment likely contributed to the arrest of clinical signs and recovery of some motor skills. Importantly, Baylisascaris procyonis infection might occur in wild raccoon populations in Spain. PMID:25936436

  8. CUSP9* treatment protocol for recurrent glioblastoma: aprepitant, artesunate, auranofin, captopril, celecoxib, disulfiram, itraconazole, ritonavir, sertraline augmenting continuous low dose temozolomide

    PubMed Central

    Kast, Richard E.; Karpel-Massler, Georg; Halatsch, Marc-Eric

    2014-01-01

    CUSP9 treatment protocol for recurrent glioblastoma was published one year ago. We now present a slight modification, designated CUSP9*. CUSP9* drugs- aprepitant, artesunate, auranofin, captopril, celecoxib, disulfiram, itraconazole, sertraline, ritonavir, are all widely approved by regulatory authorities, marketed for non-cancer indications. Each drug inhibits one or more important growth-enhancing pathways used by glioblastoma. By blocking survival paths, the aim is to render temozolomide, the current standard cytotoxic drug used in primary glioblastoma treatment, more effective. Although esthetically unpleasing to use so many drugs at once, the closely similar drugs of the original CUSP9 used together have been well-tolerated when given on a compassionate-use basis in the cases that have come to our attention so far. We expect similarly good tolerability for CUSP9*. The combined action of this suite of drugs blocks signaling at, or the activity of, AKT phosphorylation, aldehyde dehydrogenase, angiotensin converting enzyme, carbonic anhydrase -2,- 9, -12, cyclooxygenase-1 and -2, cathepsin B, Hedgehog, interleukin-6, 5-lipoxygenase, matrix metalloproteinase -2 and -9, mammalian target of rapamycin, neurokinin-1, p-gp efflux pump, thioredoxin reductase, tissue factor, 20 kDa translationally controlled tumor protein, and vascular endothelial growth factor. We believe that given the current prognosis after a glioblastoma has recurred, a trial of CUSP9* is warranted. PMID:25211298

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

    PubMed Central

    2014-01-01

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

  10. Inpatient general medicine is evidence based

    Microsoft Academic Search

    D. L Sackett; J Ellis; I Mulligan; J Rowe

    1995-01-01

    SummaryFor many years clinicians have had to cope with the accusation that only 10-20% of the treatments they provide have any scientific foundation. Their interventions, in other words, are seldom \\

  11. Effects of managed care on programs and practices for the treatment of alcohol and drug dependence.

    PubMed

    Steenrod, S; Brisson, A; McCarty, D; Hodgkin, D

    2001-01-01

    Managed care is affecting the organization and financing of treatment services for alcohol and drug dependence. This paper examines the effects of managed care on program operations including the use of clinical protocols, the administrative burden, information systems, staffing, and program consolidation. It also reviews the effects of managed care on system performance related to employer-sponsored health plans, state employee health plans, and Medicaid and other public plans. Our review of managed care's influences on the alcohol and drug abuse treatment system finds evidence of systemic reductions in access to inpatient care and increased reliance on outpatient services. Moreover, although analyses of behavioral health carve-outs often suggest increases in the use of outpatient care, evaluations of substance abuse claims report reductions in ambulatory utilization for the treatment of alcohol and drug dependence. PMID:11449757

  12. 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

    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

    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

  13. 42 CFR 483.354 - General requirements for psychiatric residential treatment facilities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...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...

  14. 42 CFR 483.354 - General requirements for psychiatric residential treatment facilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...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...

  15. 42 CFR 483.354 - General requirements for psychiatric residential treatment facilities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...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...

  16. 42 CFR 483.354 - General requirements for psychiatric residential treatment facilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...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...

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

    PubMed Central

    2011-01-01

    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

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

    PubMed Central

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

    2014-01-01

    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

  19. My Road Ahead study protocol: a randomised controlled trial of an online psychological intervention for men following treatment for localised prostate cancer

    PubMed Central

    2014-01-01

    Background There is a need for psychosocial interventions for men with prostate cancer to promote adaptive coping with the challenges and distress associated with diagnosis, treatment and recovery. In addition, interventions are needed that help to overcome barriers to psychosocial treatment such as limited face-to-face psychosocial support services, a shortage of adequately trained professionals, geographical distance, perceived and personal stigma and a preference for consumer-centric and self-directed learning. My Road Ahead is an online cognitive behaviour therapy (CBT) intervention for prostate cancer. This protocol describes a randomised controlled trial (RCT) that will evaluate the efficacy of this online intervention alone, the intervention in combination with a moderated online forum, and the moderated online forum alone. Methods/design This study utilises a RCT design with three groups receiving: 1) the 6-module My Road Ahead intervention alone; 2) the My Road Ahead intervention plus a moderated online forum; and 3) the moderated online forum alone. It is expected that 150 men with localised prostate cancer will be recruited into the RCT. Online measures will assess men’s psychological distress as well as sexual and relationship adjustment at baseline, post-intervention, 3 month follow-up and 6 month follow-up. The study is being conducted in Australia and participants will be recruited from April 2012 to Feb 2014. The primary aim of this study is to evaluate the efficacy of My Road Ahead in reducing psychological distress. Discussion To our knowledge, My Road Ahead is the first self-directed online psychological intervention developed for men who have been treated for localised prostate cancer. The RCT will assess the efficacy of this intervention in improving psychological well-being, sexual satisfaction, relationship satisfaction and overall quality of life. If successful, this intervention could provide much needed support to men receiving treatment for localised prostate cancer in a highly accessible manner. Trial registration Australian New Zealand Clinical Trials Registry Identifier: ACTRN12611000278932 PMID:24517384

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

    PubMed Central

    2013-01-01

    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

  1. Treatment of neonatal jaundice with filtered sunlight in Nigerian neonates: study protocol of a non-inferiority, randomized controlled trial

    PubMed Central

    2013-01-01

    Background Severe neonatal jaundice and its progression to kernicterus is a leading cause of death and disability among newborns in poorly-resourced countries, particularly in sub-Saharan Africa. The standard treatment for jaundice using conventional phototherapy (CPT) with electric artificial blue light sources is often hampered by the lack of (functional) CPT devices due either to financial constraints or erratic electrical power. In an attempt to make phototherapy (PT) more readily available for the treatment of pathologic jaundice in underserved tropical regions, we set out to test the hypothesis that filtered sunlight phototherapy (FS-PT), in which potentially harmful ultraviolet and infrared rays are appropriately screened, will be as efficacious as CPT. Methods/design This prospective, non-blinded randomized controlled non-inferiority trial seeks to enroll infants with elevated total serum/plasma bilirubin (TSB, defined as 3 mg/dl below the level recommended by the American Academy of Pediatrics for high-risk infants requiring PT) who will be randomly and equally assigned to receive FS-PT or CPT for a total of 616 days at an inner-city maternity hospital in Lagos, Nigeria. Two FS-PT canopies with pre-tested films will be used. One canopy with a film that transmits roughly 33% blue light (wavelength range: 400 to 520 nm) will be used during sunny periods of a day. Another canopy with a film that transmits about 79% blue light will be used during overcast periods of the day. The infants will be moved from one canopy to the other as needed during the day with the goal of keeping the blue light irradiance level above 8 ?W/cm2/nm. Primary outcome: FS-PT will be as efficacious as CPT in reducing the rate of rise in bilirubin levels. Secondary outcome: The number of infants requiring exchange transfusion under FS-PT will not be more than those under CPT. Conclusion This novel study offers the prospect of an effective treatment for infants at risk of severe neonatal jaundice and avoidable exchange transfusion in poorly-resourced settings without access to (reliable) CPT in the tropics. Trial registration ClinicalTrials.gov Identifier: NCT01434810 PMID:24373547

  2. A retrospective observational study of the effectiveness of paliperidone palmitate on acute inpatient hospitalization rates.

    PubMed

    Bressington, Daniel; Stock, Jon; Hulbert, Sabina; MacInnes, Douglas

    2015-07-01

    This retrospective mirror-image observational study aimed to establish the effects of the long-acting antipsychotic injection paliperidone palmitate (PP) on acute inpatient hospitalization rates. We utilized routinely collected clinical data to compare the number and length of acute patient admissions 1 year before and 1 year after initiation of PP. A single cohort of 66 patients with a diagnosis of schizophrenia and who had received monthly injections of PP for at least 1 year were included in the analysis. The mean number of acute inpatient admissions fell from 0.86 in the year before PP initiation to 0.23 in the following year (P=0.001), and there was a numerical but nonsignificant decrease in the number of bed days from 32.48 to 31.22 over the study duration. The median number of bed days in the year before PP initiation was 20, and in the year after initiation it was 0. The median number of admissions also fell from 1 to 0 during the same period. The results of the study should be treated cautiously because of the limitations of the study design but suggest that patients with a diagnosis of schizophrenia who continue treatment with PP over 12 months experience a significant reduction in hospital admissions compared with the previous year. PMID:25882381

  3. A retrospective observational study of the effectiveness of paliperidone palmitate on acute inpatient hospitalization rates

    PubMed Central

    Stock, Jon; Hulbert, Sabina; MacInnes, Douglas

    2015-01-01

    This retrospective mirror-image observational study aimed to establish the effects of the long-acting antipsychotic injection paliperidone palmitate (PP) on acute inpatient hospitalization rates. We utilized routinely collected clinical data to compare the number and length of acute patient admissions 1 year before and 1 year after initiation of PP. A single cohort of 66 patients with a diagnosis of schizophrenia and who had received monthly injections of PP for at least 1 year were included in the analysis. The mean number of acute inpatient admissions fell from 0.86 in the year before PP initiation to 0.23 in the following year (P=0.001), and there was a numerical but nonsignificant decrease in the number of bed days from 32.48 to 31.22 over the study duration. The median number of bed days in the year before PP initiation was 20, and in the year after initiation it was 0. The median number of admissions also fell from 1 to 0 during the same period. The results of the study should be treated cautiously because of the limitations of the study design but suggest that patients with a diagnosis of schizophrenia who continue treatment with PP over 12 months experience a significant reduction in hospital admissions compared with the previous year. PMID:25882381

  4. Use of psychiatric inpatient capacities and diagnostic practice in Tashkent\\/Uzbekistan as compared to Berlin\\/Germany

    Microsoft Academic Search

    Adrian P. Mundt; Sardor Fakhriddinov; Maria Fayzirahmanova; Marion C. Aichberger; Sebastian Ivens; Meryam Schouler-Ocak; Renate Grohmann; Shakhnoza Magzumova; Andreas Heinz; Norman Sartorius; Andreas Ströhle

    Objectives  The present study shows a comparison of diagnoses used for the treatment of urban psychiatric inpatients in Tashkent\\/Uzbekistan\\u000a and Berlin\\/Germany. Differential diagnostic practices related to different traditions in psychopathology between the two settings\\u000a are analysed to explain part of the difference in relative frequencies of the diagnoses.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We conducted a cross-sectional survey of diagnoses used for the treatment of 845

  5. Use of CT scans and treatment planning software for validation of the dose component of food irradiation protocols

    NASA Astrophysics Data System (ADS)

    Borsa, Joseph; Chu, Rod; Sun, Jiansheng; Linton, Nick; Hunter, Craig

    2002-03-01

    The challenging problem of estimating the dose delivered to heterogeneous products by radiation modalities of limited penetration can be readily handled by using technologies developed for, and widely used in, radiation therapy applications. In particular, combining CT scanning with radiation treatment planning programs can simulate radiation processing with either photons or electrons, and can provide detailed, high resolution and accurate dose maps for any arbitrary product and package configuration. Such dose maps are an essential part of process validation. Comparison of the simulated dose distributions with measured dose maps verifies the soundness of this approach. The present communication presents results obtained with the simulation technique for a variety of common food items which are likely candidates for radiation processing.

  6. Coercive treatments in forensic psychiatry: a study of patients' experiences and preferences

    Microsoft Academic Search

    Camilla Haw; Jean Stubbs; Andrew Bickle; Inga Stewart

    2011-01-01

    The aim of this study was to report on forensic rehabilitation inpatients' experiences and preferences for physical restraint, seclusion and emergency intra-muscular medication using mixed qualitative and quantitative methods. Of 252 inpatients, 79 met the study inclusion criteria and 57 (72%) agreed to take part. Just over half thought they should have been subjected to coercive treatment. Although coercive treatments

  7. Changes in the Laboratory Data for Cancer Patients Treated with Korean-medicine-based Inpatient Care

    PubMed Central

    Yoon, Jeungwon; Cho, Chong-Kwan; Shin, Ji-Eun; Yoo, Hwa-Seung

    2014-01-01

    Objectives: The study aimed to determine changes in laboratory data for cancer patients receiving Korean medicine (KM) care, with a focus on patients’ functional status, cancer-coagulation factors and cancer immunity. Methods: We conducted an observational study of various cancer patients in all stages admitted to the East-West Cancer Center (EWCC), Dunsan Korean Hospital of Daejeon University, from Mar. 2011 to Aug. 2011. All patients were under the center’s multi-modality Korean-medicine-based inpatient cancer care program. The hospitalization stay at EWCC ranged from 9 to 34 days. A total of 80 patients were followed in their routine hematologic laboratory screenings performed before and after hospitalization. Patients were divided into three groups depending on the status of their treatment: prevention of recurrence and metastasis group, Korean medicine (KM) treatment only group, and combination of conventional and KM treatment group. The lab reports included natural killer (NK) cell count (CD16 + CD56), fibrinogen, white blood cell (WBC), lymphocytes, monocytes, neutrophil, red blood cell (RBC), hemoglobin, platelet, Erythrocyte Sedimentation Rate (ESR), and Eastern Cooperative Oncology Group (ECOG) performance status. Results: With a Focus on patients’ functional status, cancer-coagulation factors and cancer immunity, emphasis was placed on the NK cell count, fibrinogen count, and ECOG scores. Data generally revealed decreased fibrinogen count, fluctuating NK cell count and decreased ECOG, meaning improved performance status in all groups. The KM treatment only group showed the largest decrease in mean fibrinogen count and the largest increase in mean NK cell count. However, the group’s ECOG score showed the smallest decrease, which may be due to the concentration of late-cancer-stage patients in that particular group. Conclusions: Multi-modality KM inpatient care may have positive effect on lowering the cancer coagulation factor fibrinogen, but its correlation with the change in the NK cell count is not clear. PMID:25780686

  8. Collaborative care for the treatment of comorbid depression and coronary heart disease: a systematic review and meta-analysis protocol

    PubMed Central

    2014-01-01

    Background Depression and coronary heart disease (CHD) are frequently comorbid and portend higher morbidity, mortality and poorer quality of life. Prior systematic reviews of depression treatment randomized controlled trials (RCTs) in the population with CHD have not assessed the efficacy of collaborative care. This systematic review aims to bring together the contemporary research on the effectiveness of collaborative care interventions for depression in comorbid CHD populations. Methods/Design Electronic databases (Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, PsycINFO and CINAHL) will be searched using a sensitive search strategy exploding the topics CHD, depression and RCT. Full text inspection and bibliography searching will be conducted, and authors of included studies will be contacted to identify unpublished studies. Eligibility criteria are: population, depression comorbid with CHD; intervention, RCT of collaborative care defined as a coordinated model of care involving multidisciplinary health care providers, including: (a) primary physician and at least one other health professional (e.g. nurse, psychiatrist, psychologist), (b) a structured patient management plan that delivers either pharmacological or non-pharmacological intervention, (c) scheduled patient follow-up and (d) enhanced inter-professional communication between the multiprofessional team; comparison, either usual care, enhanced usual care, wait-list control group or no further treatment; and outcome, major adverse cardiac events (MACE), standardized measure of depression, anxiety, quality of life, cost-effectiveness. Screening, data extraction and risk of bias assessment will be undertaken by two reviewers with disagreements resolved through discussion. Meta-analytic methods will be used to synthesize the data collected relating to the outcomes. Discussion This review will evaluate the effectiveness and cost-effectiveness of collaborative care for depression in populations primarily with CHD. The results will facilitate integration of evidence-based practice for this precarious population. Systematic review registration PROSPERO CRD42014013653. PMID:25351999

  9. Design, rationale, and baseline characteristics of a cluster randomized controlled trial of pay for performance for hypertension treatment: study protocol

    PubMed Central

    2011-01-01

    Background Despite compelling evidence of the benefits of treatment and well-accepted guidelines for treatment, hypertension is controlled in less than one-half of United States citizens. Methods/design This randomized controlled trial tests whether explicit financial incentives promote the translation of guideline-recommended care for hypertension into clinical practice and improve blood pressure (BP) control in the primary care setting. Using constrained randomization, we assigned 12 Veterans Affairs hospital outpatient clinics to four study arms: physician-level incentive; group-level incentive; combination of physician and group incentives; and no incentives (control). All participants at the hospital (cluster) were assigned to the same study arm. We enrolled 83 full-time primary care physicians and 42 non-physician personnel. The intervention consisted of an educational session about guideline-recommended care for hypertension, five audit and feedback reports, and five disbursements of incentive payments. Incentive payments rewarded participants for chart-documented use of guideline-recommended antihypertensive medications, BP control, and appropriate responses to uncontrolled BP during a prior four-month performance period over the 20-month intervention. To identify potential unintended consequences of the incentives, the study team interviewed study participants, as well as non-participant primary care personnel and leadership at study sites. Chart reviews included data collection on quality measures not related to hypertension. To evaluate the persistence of the effect of the incentives, the study design includes a washout period. Discussion We briefly describe the rationale for the interventions being studied, as well as the major design choices. Rigorous research designs such as the one described here are necessary to determine whether performance-based payment arrangements such as financial incentives result in meaningful quality improvements. Trial Registration http://www.clinicaltrials.gov NCT00302718 PMID:21967830

  10. Protocol for a pre-implementation and post-implementation study on shared decision-making in the surgical treatment of women with early-stage breast cancer

    PubMed Central

    Savelberg, Wilma; Moser, Albine; Smidt, Marjolein; Boersma, Liesbeth; Haekens, Christel; van der Weijden, Trudy

    2015-01-01

    Background The majority of patients diagnosed with early-stage breast cancer are in a position to choose between having a mastectomy or lumpectomy with radiation therapy (breast-conserving therapy). Since the long-term survival rates for mastectomy and for lumpectomy with radiation therapy are comparable, patients’ informed preferences are important for decision-making. Although most clinicians believe that they do include patients in the decision-making process, the information that women with breast cancer receive regarding the surgical options is often rather subjective, and does not invite patients to express their preferences. Shared decision-making (SDM) is meant to help patients clarify their preferences, resulting in greater satisfaction with their final choice. Patient decision aids can be very supportive in SDM. We present the protocol of a study to ? test a patient decision aid and optimise strategies for the implementation of SDM regarding the treatment of early-stage breast cancer in the actual clinical setting. Methods/design This paper concerns a pre-implementation and post-implementation study, lasting from October 2014 to June 2015. The intervention consists of implementing SDM using a patient decision aid. The intervention will be evaluated using qualitative and quantitative measures, acquired prior to, during and after the implementation of SDM. Outcome measures are knowledge about treatment, perceived SDM and decisional conflict. We will also conduct face-to-face interviews with a sample of these patients and their care providers, to assess their experiences with the implementation of SDM and the patient decision aid. Ethics and dissemination This protocol was approved by the Maastricht University Medical Centre (MUMC) ethics committee. The findings will be disseminated through peer-reviewed journal articles and presentations at national conferences. Findings will be used to finalise a multi-faceted implementation strategy to test the implementation of SDM and a patient decision aid in terms of cost-effectiveness, in a multicentre cluster randomised controlled trial (RCT). Study registration number NTR4879. PMID:25829374

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

    PubMed

    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

    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

  12. Significant Improvements in Cognitive Performance Post-Transcranial, Red/Near-Infrared Light-Emitting Diode Treatments in Chronic, Mild Traumatic Brain Injury: Open-Protocol Study

    PubMed Central

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

    2014-01-01

    Abstract 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/cm2) was applied for 10?min to each of 11 scalp placements (13?J/cm2). 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

  13. Two randomized controlled clinical trials to study the effectiveness of prednisolone treatment in preventing and restoring clinical nerve function loss in leprosy: the TENLEP study protocols

    PubMed Central

    2012-01-01

    Background Nerve damage in leprosy often causes disabilities and deformities. Prednisolone is used to treat nerve function impairment (NFI). However, optimal dose and duration of prednisolone treatment has not been established yet. Besides treating existing NFI it would be desirable to prevent NFI. Studies show that before NFI is clinically detectable, nerves often show subclinical damage. Within the ‘Treatment of Early Neuropathy in LEProsy’ (TENLEP) study two double blind randomized controlled trials (RCT) will be carried out: a trial to establish whether prednisolone treatment of 32 weeks duration is more effective than 20 weeks in restoring nerve function in leprosy patients with clinical NFI (Clinical trial) and a trial to determine whether prednisolone treatment of early sub-clinical NFI can prevent clinical NFI (Subclinical trial). Methods Two RCTs with a follow up of 18 months will be conducted in six centers in Asia. In the Clinical trial leprosy patients with recent (< 6 months) clinical NFI, as determined by Monofilament Test and Voluntary Muscle Test, are included. The primary outcomes are the proportion of patients with restored or improved nerve function. In the Subclinical trial leprosy patients with subclinical neuropathy, as determined by Nerve Conduction Studies (NCS) and/or Warm Detection Threshold (WDT), and without any clinical signs of NFI are randomly allocated to a placebo group or treatment group receiving 20 weeks prednisolone. The primary outcome is the proportion of patients developing clinical NFI. Reliability and normative studies are carried out before the start of the trial. Discussion This study is the first RCT testing a prednisolone regimen with a duration longer than 24 weeks. Also it is the first RCT assessing the effect of prednisolone in the prevention of clinical NFI in patients with established subclinical neuropathy. The TENLEP study will add to the current understanding of neuropathy due to leprosy and provide insight in the effectiveness of prednisolone on the prevention and recovery of NFI in leprosy patients. In this paper we present the research protocols for both Clinical and Subclinical trials and discuss the possible findings and implications. Trial registration Netherlands Trial Register: NTR2300 Clinical Trial Registry India: CTRI/2011/09/002022 PMID:23249098

  14. Inpatient or Outpatient Rehabilitation after Herniated Disc Surgery? – Setting-Specific Preferences, Participation and Outcome of Rehabilitation

    PubMed Central

    Löbner, Margrit; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans J.; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C.; König, Hans-Helmut; Riedel-Heller, Steffi G.

    2014-01-01

    Objective To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes. Methods The longitudinal observational study referred to 534 consecutive disc surgery patients (18–55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. Results The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001). Conclusion The results suggest a “pre-selection” of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and improve rehabilitation effects such as return to work. PMID:24598904

  15. Impact of inpatient diabetes management, education, and improved discharge transition on glycemic control 12 months after discharge

    PubMed Central

    Wexler, Deborah J.; Beauharnais, Catherine C.; Regan, Susan; Nathan, David M.; Cagliero, Enrico; Larkin, Mary E.

    2012-01-01

    Aim To determine whether inpatient diabetes management and education with improved transition to outpatient care (IDMET) improves glycemic control after hospital discharge in patients with uncontrolled type 2 diabetes (T2DM). Methods Adult inpatients with T2DM and HbA1c?7.5% (11 mmol/mol) admitted for reasons other than diabetes to an academic medical center were randomly assigned to IDMET vs. usual care (UC). Linear mixed models estimated treatment-dependent differences in the change in HbA1c (measured at 3, 6, and 12 months) from baseline to 1 year follow-up. Results Thirty-one subjects had mean age 55 ± 12.6 years, with mean HbA1c of 9.7 ± 1.6% (82 ± 18 mmol/mol). Mean inpatient glucose was lower in the IDMET than in the UC group (176 ± 66 vs. 195 ± 74 mg/dl [9.7 vs. 10.8 mmol/l]), p=0.001. In the year after discharge, the average HbA1c reduction was greater in the IDMET compared to the UC group by 0.6% (SE 0.5%, [7 (SE 5) mmol/mol], p=0.3). Among patients newly discharged on insulin, the average HbA1c reduction was greater in the in the IDMET than in the UC group by 2.4% (SE 1.0%, [25 (SE 11) mmol/mol] p=0.04). Conclusions Inpatient diabetes management (IDMET) substantially improved glycemic control one year after discharge in patients newly discharged on insulin; patients previously treated with insulin did not benefit. PMID:23036785

  16. Incorporation of expert variability into breast cancer treatment recommendation in designing clinical protocol guided fuzzy rule system models.

    PubMed

    Garibaldi, Jonathan M; Zhou, Shang-Ming; Wang, Xiao-Ying; John, Robert I; Ellis, Ian O

    2012-06-01

    It has been often demonstrated that clinicians exhibit both inter-expert and intra-expert variability when making difficult decisions. In contrast, the vast majority of computerized models that aim to provide automated support for such decisions do not explicitly recognize or replicate this variability. Furthermore, the perfect consistency of computerized models is often presented as a de facto benefit. In this paper, we describe a novel approach to incorporate variability within a fuzzy inference system using non-stationary fuzzy sets in order to replicate human variability. We apply our approach to a decision problem concerning the recommendation of post-operative breast cancer treatment; specifically, whether or not to administer chemotherapy based on assessment of five clinical variables: NPI (the Nottingham Prognostic Index), estrogen receptor status, vascular invasion, age and lymph node status. In doing so, we explore whether such explicit modeling of variability provides any performance advantage over a more conventional fuzzy approach, when tested on a set of 1310 unselected cases collected over a fourteen year period at the Nottingham University Hospitals NHS Trust, UK. The experimental results show that the standard fuzzy inference system (that does not model variability) achieves overall agreement to clinical practice around 84.6% (95% CI: 84.1-84.9%), while the non-stationary fuzzy model can significantly increase performance to around 88.1% (95% CI: 88.0-88.2%), p<0.001. We conclude that non-stationary fuzzy models provide a valuable new approach that may be applied to clinical decision support systems in any application domain. PMID:22265814

  17. The efficacy of Helix aspersa Müller extract in the healing of partial thickness burns: a novel treatment for open burn management protocols.

    PubMed

    Tsoutsos, Dimosthenis; Kakagia, Despoina; Tamparopoulos, Konstantinos

    2009-01-01

    Snail extracts have been increasingly used in numerous dermatologic conditions and recent literature attributes healing, soothing and anti-aging properties to them. This study evaluates the efficacy of Helix aspersa extract in an open wound management protocol for deep partial thickness (PT) facial burns and compares it to moist exposure burn ointment(MEBO). A total of 27 adult patients with deep partial thickness facial burns (group A) were treated by application of a snail extract cream twice daily for a maximum period of 14 days or until full epithelialization. Times until debridement and epithelialization of the burn surface were compared with those of 16 patients (group B, control) treated by MEBO. Pain scores were recorded using a visual analogue scale (VAS) on the fourth post-burn day before and 30 min after application. Mean times for eschar detachment were 9 +/- 2 days (group A) and 11 +/- 2 days (group B) (p = 0.003) and for burn surface epithelialization were 11 +/- 2 days and 15 +/- 3 days respectively (p < 0.001). VAS pain scores after application in group A were significantly lower compared to group B (p < 0.001). Helix aspersa extract is a natural, safe and effective alternative treatment in open wound management of partial thickness burns in adults. PMID:19058081

  18. Protocol for a multicentre randomiSed controlled TRial of IntraVEnous immunoglobulin versus standard therapy for the treatment of transverse myelitis in adults and children (STRIVE)

    PubMed Central

    Absoud, M; Gadian, J; Hellier, J; Brex, P A; Ciccarelli, O; Giovannoni, G; Kelly, J; McCrone, P; Murphy, C; Palace, J; Pickles, A; Pike, M; Robertson, N; Jacob, A; Lim, M

    2015-01-01

    Introduction Transverse myelitis (TM) is an immune-mediated disorder of the spinal cord which causes motor and sensory disturbance and limited recovery in 50% of patients. Standard treatment is steroids, and patients with more severe disease appear to respond to plasma exchange (PLEX). Intravenous immunoglobulin (IVIG) has also been used as an adjunct to steroids, but evidence is lacking. We propose the first randomised control trial in adults and children, to determine the benefit of additional treatment with IVIG. Methods and analysis 170 adults and children aged over 1?year with acute first episode TM or neuromyelitis optica (with myelitis) will be recruited over a 2.5-year period and followed up for 12?months. Participants randomised to the control arm will receive standard therapy of intravenous methylprednisolone (IVMP). The intervention arm will receive the above standard therapy, plus additional IVIG. Primary outcome will be a 2-point improvement on the American Spinal Injury Association (ASIA) Impairment scale at 6?months postrandomisation by blinded assessors. Additional secondary and tertiary outcome measures will be collected: ASIA motor and sensory scales, Kurtzke expanded disability status scale, International Spinal Cord Injury (SCI) Bladder/Bowel Data Set, Client Services Receipt Index, Pediatric Quality of Life Inventory, EQ-5D, SCI Pain and SCI Quality of Life Data Sets. Biological samples will be biobanked for future studies. After 6-months' follow-up of the first 52 recruited patients futility analysis will be carried out. Health economics analysis will be performed to calculate cost-effectiveness. After 6?months’ recruitment futility analysis will be performed. Ethics and dissemination Research Ethics Committee Approval was obtained: 14/SC/1329. Current protocol: v3.0 (15/01/2015). Study findings will be published in peer-reviewed journals. Trial registration numbers This study is registered with EudraCT (REF: 2014-002335-34), Clinicaltrials.gov (REF: NCT02398994) and ISRCTN (REF: 12127581). PMID:26009577

  19. Inpatient hospital utilization among veterans with traumatic spinal cord injury

    Microsoft Academic Search

    Gregory P. Samsa; Pamela B. Landsman; Byron Hamilton

    1996-01-01

    Objective: To describe the pattern of inpatient hospital utilization, up to 15 years after injury, among a cohort of veterans with service-connected traumatic spinal cord injury (SCI).Patients: A cohort of 1,250 male veterans, with traumatic SCI occurring between 1970 and 1986, who visited the VA within 1 year of injury, was assembled from VA administrative files; diagnosis was verified by

  20. Cost allocation patterns between hospital inpatient and outpatient departments.

    PubMed Central

    Carey, K

    1994-01-01

    OBJECTIVE. This study examines changes in hospitals' cost allocation patterns between inpatient and outpatient departments in response to the implementation of the prospective payment system. DATA SOURCES AND STUDY SETTINGS. The analysis was carried out using data for 3,961 hospitals obtained from the Medicare Cost Reports and from the American Hospital Association for the years 1984 through 1988. STUDY DESIGN. A total operating cost function was estimated on the two outputs of discharges and outpatient visits. The estimation results were instrumental in disaggregating costs into inpatient and outpatient components. This was done cross-sectionally for each of the five years. PRINCIPAL FINDINGS. Comparison of this cost breakdown with that of hospital revenue provides evidence of distinct patterns in which nonteaching, rural, and small hospitals increasingly allocated greater costs to outpatient departments than did large, urban, and teaching hospitals. CONCLUSIONS. The results suggest that small rural hospitals turned to the outpatient side in the face of tough economic challenges over the period of study. Because differences in cost allocation patterns occur by particular hospital category, analyses that rely on accounting cost or revenue data in order to identify cost differences among those same categories may come to erroneous conclusions. In particular, because teaching hospitals apportion costs more heavily on the inpatient side, cost allocation differences cause upward bias in the PPS medical education adjustment. PMID:8063566

  1. Metabolic syndrome among psychiatric inpatients with schizophrenia in Indonesia.

    PubMed

    Marthoenis, Marthoenis; Aichberger, Marion C; Puteh, Ibrahim; Syahrial, Syahrial; Schouler-Ocak, Meryam

    2015-06-01

    Despite the fact that antipsychotic medication increases the risk of metabolic syndrome (MetS), the rate of MetS among psychiatric patients in Indonesia is rarely reported. This study aimed to investigate the prevalence of MetS among inpatients with schizophrenia in Indonesia. Eighty-six hospitalised psychiatric patients with schizophrenia were randomly recruited, and underwent physical examination including a blood test. MetS was assessed based on the International Diabetes Federation (IDF) criteria for South Asia. Among the sample, only eight patients (9.3%) met the IDF criteria for MetS. Women have a higher rate of MetS than men (23.8% vs 4.6%; p=0.02). Reduced high-density lipoprotein (HDL) cholesterol was the most frequent (81.4%) metabolic abnormality among them, followed by central obesity (29.1%), raised triglycerides (23.3%), raised fasting plasma glucose (12.8%), and raised blood pressure (10.5%). Among the various antipsychotics, no differences in MetS prevalence were observed in this population. The rate of MetS among the psychiatric inpatients in this study is lower compared both to the previously reported rate in the general population and to the findings among psychiatric patients with schizophrenia in developed countries. Several factors related to the reduced rate of MetS in this psychiatric inpatient population will be discussed. PMID:25910596

  2. Risk factors for inpatient venous thromboembolism despite thromboprophylaxis

    PubMed Central

    Wang, Tzu-Fei; Wong, Catherine A.; Milligan, Paul E.; Thoelke, Mark S.; Woeltje, Keith F.; Gage, Brian F.

    2015-01-01

    Introduction Venous thromboembolism (VTE) is the most common preventable cause of morbidity and mortality in the hospital. Adequate thromboprophylaxis has reduced the rate of hospital-acquired VTE substantially; however, some inpatients still develop VTE even when they are prescribed thromboprophylaxis. Predictors associated with thromboprophylaxis failure are unclear. In this study, we aimed to identify risk factors for inpatient VTE despite thromboprophylaxis. Materials and methods We conducted a case-control study to identify independent predictors for inpatient VTE. Among patients discharged from the BJC HealthCare system between January 2010 and May 2011, we matched 94 cases who developed in-hospital VTE while taking thromboprophylaxis to 272 controls who did not develop VTE. Matching was done by hospital, patient age, month and year of discharge. We used multivariate conditional logistic regression to develop a VTE prediction model. Results We identified five independent risk factors for in-hospital VTE despite thromboprophylaxis: hospitalization for cranial surgery, intensive care unit admission, admission leukocyte count >13,000/mm3, presence of an indwelling central venous catheter, and admission from a long-term care facility. Conclusions We identified five risk factors associated with the development of VTE despite thromboprophylaxis in the hospital setting. By recognizing these high-risk patients, clinicians can prescribe aggressive VTE prophylaxis judiciously and remain vigilant for signs or symptoms of VTE. PMID:24300584

  3. Dissociative disorders among Chinese inpatients diagnosed with schizophrenia.

    PubMed

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

    2010-01-01

    The purpose of this study was to assess the prevalence of dissociative disorders in a sample of Chinese psychiatric inpatients. Participants in the study were 569 consecutively admitted inpatients at Shanghai Mental Health Center, China, of whom 84.9% had a clinical diagnosis of schizophrenia based on the Chinese Classification and Diagnostic Criteria of Mental Disorders, Version 3. All participants completed a self-report measure of dissociation (the Dissociative Experiences Scale), and none had a prior diagnosis of a dissociative disorder. A total of 96 randomly selected participants were interviewed with a structured interview (the Dissociative Disorders Interview Schedule) and a clinical interview. These 96 patients did not differ significantly from the 473 patients who were not interviewed on any demographic measures or who did not complete the self-report dissociation measure. A total of 28 patients (15.3%, after weighting of the data) received a clinical diagnosis of a dissociative disorder based on Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria. Dissociative identity disorder was diagnosed in 2 patients (0.53%, after weighting). Compared to the patients without a dissociative disorder, patients with dissociative disorders were significantly more likely to report childhood abuse (57.1% vs. 22.1%), but the 2 groups did not differ significantly on any demographic measures. Dissociative disorders were readily identified in an inpatient psychiatric population in China. PMID:20603768

  4. A multi-site single-blind clinical study to compare the effects of STAIR Narrative Therapy to treatment as usual among women with PTSD in public sector mental health settings: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background This article provides a description of the rationale, design, and methods of a multisite clinical trial which evaluates the potential benefits of an evidence-based psychosocial treatment, STAIR Narrative Therapy, among women with posttraumatic stress disorder (PTSD) related to interpersonal violence who are seeking services in public sector community mental health clinics. This is the first large multisite trial of an evidence-based treatment for PTSD provided in the context of community settings that are dedicated to the treatment of poverty-level patient populations. Methods The study is enrolling 352 participants in a minimum of 4 community clinics. Participants are randomized into either STAIR Narrative Therapy or Treatment As Usual (TAU). Primary outcomes are PTSD, emotion management and interpersonal problems. The study will allow a flexible application of the protocol determined by patient need and preferences. Secondary analyses will assess the relationship of outcomes to different patterns of treatment implementation for different levels of baseline symptom severity. Discussion The article discusses the rationale and study issues related to the use of a flexible delivery of a protocol treatment and of the selection of treatment as it is actually practiced in the community as the comparator. Trial registration Clinicaltrials.gov identifier: NCT01488539. PMID:24886235

  5. 42 CFR 412.107 - Special treatment: Hospitals that receive an additional update for FYs 1998 and 1999.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Special treatment: Hospitals that receive an additional...INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...Operating Costs § 412.107 Special treatment: Hospitals that receive an...

  6. 42 CFR 412.107 - Special treatment: Hospitals that receive an additional update for FYs 1998 and 1999.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Special treatment: Hospitals that receive an additional...INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...Operating Costs § 412.107 Special treatment: Hospitals that receive an...

  7. 42 CFR 412.107 - Special treatment: Hospitals that receive an additional update for FYs 1998 and 1999.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Special treatment: Hospitals that receive an additional...INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...Operating Costs § 412.107 Special treatment: Hospitals that receive an...

  8. Sleep normalization and decrease in dissociative experiences: evaluation in an inpatient sample.

    PubMed

    van der Kloet, Dalena; Giesbrecht, Timo; Lynn, Steven Jay; Merckelbach, Harald; de Zutter, André

    2012-02-01

    We conducted a longitudinal study to investigate the relation between sleep experiences and dissociative symptoms in a mixed inpatient sample at a private clinic evaluated on arrival and at discharge 6 to 8 weeks later. Using hierarchical regression analyses and structural equation modeling, we found a link between sleep experiences and dissociative symptoms and determined that specifically decreases in narcoleptic experiences rather than insomnia accompany a reduction in dissociative symptoms. Although sleep improvements were associated with a general reduction in psychopathology, this reduction could not fully account for the substantial and specific effect that we found for dissociation. Our findings are consistent with Watson's (2001) hypothesis that disruptions in the sleep-wake cycle lead to intrusions of sleep phenomena into waking consciousness, resulting in dissociative experiences. Accordingly, sleep hygiene may contribute to the treatment or prevention of dissociative symptoms. PMID:21842964

  9. Correlates of sexual abuse in a sample of adolescent girls admitted to psychiatric inpatient care.

    PubMed

    Kanamüller, Juha; Riala, Kaisa; Nivala, Maija; Hakko, Helinä; Räsänen, Pirkko

    2014-01-01

    We examined correlations of child sexual abuse among 300 adolescent girls in psychiatric inpatient treatment. Diagnostic and Statistical Manual of Mental Disorders (4th ed.)-based psychiatric diagnoses were obtained from the Schedule for Affective Disorder and Schizophrenia for School-Age Children-Present and Lifetime and from data on family and behavioral characteristics from the European Addiction Severity Index (EuropASI). A total of 79 girls (26.3%) had experienced child sexual abuse during their lifetime. Child sexual abuse was associated with an adolescent's home environment, sibling status, smoking, posttraumatic stress disorder diagnosis, self-mutilating behavior, and suicidal behavior. At least 62% of the perpetrators were acquaintances of the victims. Correlates of child sexual abuse can be used to identify child sexual abuse victims and persons at heightened risk for child sexual abuse. PMID:25101753

  10. Improvement of relief algorithm to prevent inpatient's downfall accident with night-vision CCD camera

    NASA Astrophysics Data System (ADS)

    Matsuda, Noriyuki; Yamamoto, Takeshi; Miwa, Masafumi; Nukumi, Shinobu; Mori, Kumiko; Kuinose, Yuko; Maeda, Etuko; Miura, Hirokazu; Taki, Hirokazu; Hori, Satoshi; Abe, Norihiro

    2005-12-01

    "ROSAI" hospital, Wakayama City in Japan, reported that inpatient's bed-downfall is one of the most serious accidents in hospital at night. Many inpatients have been having serious damages from downfall accidents from a bed. To prevent accidents, the hospital tested several sensors in a sickroom to send warning-signal of inpatient's downfall accidents to a nurse. However, it sent too much inadequate wrong warning about inpatients' sleeping situation. To send a nurse useful information, precise automatic detection for an inpatient's sleeping situation is necessary. In this paper, we focus on a clustering-algorithm which evaluates inpatient's situation from multiple angles by several kinds of sensor including night-vision CCD camera. This paper indicates new relief algorithm to improve the weakness about exceptional cases.

  11. Predicting institutionalization after traumatic brain injury inpatient rehabilitation.

    PubMed

    Eum, Regina S; Seel, Ronald T; Goldstein, Richard; Brown, Allen W; Watanabe, Thomas K; Zasler, Nathan D; Roth, Elliot J; Zafonte, Ross D; Glenn, Mel B

    2015-02-15

    Risk factors contributing to institutionalization after inpatient rehabilitation for people with traumatic brain injury (TBI) have not been well studied and need to be better understood to guide clinicians during rehabilitation. We aimed to develop a prognostic model that could be used at admission to inpatient rehabilitation facilities to predict discharge disposition. The model could be used to provide the interdisciplinary team with information regarding aspects of patients' functioning and/or their living situation that need particular attention during inpatient rehabilitation if institutionalization is to be avoided. The study population included 7219 patients with moderate-severe TBI in the Traumatic Brain Injury Model Systems (TBIMS) National Database enrolled from 2002-2012 who had not been institutionalized prior to injury. Based on institutionalization predictors in other populations, we hypothesized that among people who had lived at a private residence prior to injury, greater dependence in locomotion, bed-chair-wheelchair transfers, bladder and bowel continence, feeding, and comprehension at admission to inpatient rehabilitation programs would predict institutionalization at discharge. Logistic regression was used, with adjustment for demographic factors, proxy measures for TBI severity, and acute-care length-of-stay. C-statistic and predictiveness curves validated a five-variable model. Higher levels of independence in bladder management (adjusted odds ratio [OR], 0.88; 95% CI 0.83, 0.93), bed-chair-wheelchair transfers (OR, 0.81 [95% CI, 0.83-0.93]), and comprehension (OR, 0.78 [95% CI, 0.68, 0.89]) at admission were associated with lower risks of institutionalization on discharge. For every 10-year increment in age was associated with a 1.38 times higher risk for institutionalization (95% CI, 1.29, 1.48) and living alone was associated with a 2.34 times higher risk (95% CI, 1.86, 2.94). The c-statistic was 0.780. We conclude that this simple model can predict risk of institutionalization after inpatient rehabilitation for patients with TBI. PMID:25203001

  12. Treatment of severe and moderate acute malnutrition in low- and middle-income settings: a systematic review, meta-analysis and Delphi process

    PubMed Central

    2013-01-01

    Background Globally, moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) affect approximately 52 million children under five. This systematic review evaluates the effectiveness of interventions for SAM including the World Health Organization (WHO) protocol for inpatient management and community-based management with ready-to-use-therapeutic food (RUTF), as well as interventions for MAM in children under five years in low- and middle-income countries. Methods We systematically searched the literature and included 14 studies in the meta-analysis. Study quality was assessed using CHERG adaptation of GRADE criteria. A Delphi process was undertaken to complement the systematic review in estimating case fatality and recovery rates that were necessary for modelling in the Lives Saved Tool (LiST). Results Case fatality rates for inpatient treatment of SAM using the WHO protocol ranged from 3.4% to 35%. For community-based treatment of SAM, children given RUTF were 51% more likely to achieve nutritional recovery than the standard care group. For the treatment of MAM, children in the RUSF group were significantly more likely to recover and less likely to be non-responders than in the CSB group. In both meta-analyses, weight gain in the intervention group was higher, and although statistically significant, these differences were small. Overall limitations in our analysis include considerable heterogeneity in many outcomes and an inability to evaluate intervention effects separate from commodity effect. The Delphi process indicated that adherence to standardized protocols for the treatment of SAM and MAM should have a marked positive impact on mortality and recovery rates; yet, true consensus was not achieved. Conclusions Gaps in our ability to estimate effectiveness of overall treatment approaches for SAM and MAM persist. In addition to further impact studies conducted in a wider range of settings, more high quality program evaluations need to be conducted and the results disseminated. PMID:24564235

  13. Esthetic outcomes in relation to implant-abutment interface design following a standardized treatment protocol in a multicenter randomized controlled trial--a cohort of 12 cases at 1-year follow-up.

    PubMed

    McGuire, Michael K; Scheyer, Todd; Ho, Daniel K; Stanford, Clark M; Feine, Jocelyne S; Cooper, Lyndon F

    2015-01-01

    The design of an implant-abutment interface may have an impact on the peri-implant soft tissue esthetics. In an ongoing randomized controlled trial (RCT) with 141 participants, the authors evaluated the peri-implant tissue responses around three different implant-abutment interface designs used to replace single teeth in the esthetic zone. The aim of this report is to describe the treatment protocol utilized in this ongoing RCT by (1) demonstrating in detail a clinical case treated under this protocol and (2) reporting peri-implant soft tissue responses in a cohort of 12 representative cases from the RCT at 1-year follow-up. Male and female adults requiring single implants in the anterior maxilla were enrolled in the RCT according to the study protocol. Five months following any required extraction and/or socket bone grafting/ridge augmentation, one of the following three implant-abutment interfaces was placed and immediately provisionalized: (1) conical interface (CI; OsseoSpeed, Dentsply Implants), n = 4; (2) flat-to-flat interface (FI; NobelSpeedy Replace, Nobel Biocare), n = 4; or (3) platform-switch interface (PS; NanoTite Certain Prevail, Biomet 3i), n = 4. Twelve weeks later, definitive crowns were delivered. Throughout the treatment, peri-implant buccal gingival zenith height and mesial/distal papilla height were measured on stereotactic device photographs, and pink esthetic scores (PES) were determined. The demographics of the participants in each of the three implant-abutment interface groups were very similar. All 12 study sites had ideal ridge form with a minimum width of 5.5 mm following implant site development performed according to the described treatment protocol. Using this treatment protocol for single-tooth replacement in the anterior maxilla, the clinicians were able to obtain esthetic peri-implant soft tissue outcomes with all three types of implant-abutment interface designs at 1-year follow-up as shown by the Canfield data and PES. The proposed treatment protocol for single-tooth replacement in the esthetic zone provides a reliable method to obtain and assess the esthetic outcome as a function of implant-abutment interface design and is now in its fifth year of follow-up. PMID:25738335

  14. Clinical effectiveness of grip strength in predicting ambulation of elderly inpatients

    PubMed Central

    Beseler, MR; Rubio, C; Duarte, E; Hervás, D; Guevara, MC; Giner-Pascual, M; Viosca, E

    2014-01-01

    Background Assessing the clinical effectiveness of measuring grip strength as a prognostic tool in recovering ambulation in bed-confined frail elderly patients. Methods A prospective study was carried out with 50 elderly inpatients (mean age: 81.6 years old). Manual muscle test was used for checking strength of hip flexor muscles, hip abductor muscles and knee extensor muscles. Grip strength was assessed by hydraulic dynamometer. Walking ability was assessed by functional ambulation categories and Functional Classification of Sagunto Hospital Ambulation. Existence of cognitive impairment (Short Portable Mental Status of Pfeiffer) and comorbidity (abbreviated Charlson index) were considered to be confounding variables. Statistical analysis Simple comparisons and mixed models of multiple ordinal regression. Results The sample presented generalized weakness in scapular (mean 4.22) and pelvic (mean 3.82) muscle. Mean hand grip values were similar: 11.98 kg right hand; 11.70 kg left hand. The patients had lost walking ability. After treatment, there was a statistically significant for scapular waist strength (P=0.001), pelvic waist strength (P=0.005) and walking ability (P=0.001). A statistically significant relationship in the regression analysis was found between the grip (right and left hands) and walking ability post-treatment (P=0.009; odds ratio 1.14 and P=0.0014 odds ratio 1.113 for each walking scale). The confounding variables showed no statistical significance in the results. Conclusion Grip strength is associated with walking ability in hospitalized frail elderly. Grip strength assessment by hydraulic dynamometry is useful in patients with poor collaboration. Walking ability training in frail elderly inpatients is useful. PMID:25395842

  15. Comparing high altitude treatment with current best care in Dutch children with moderate to severe atopic dermatitis (and asthma): study protocol for a pragmatic randomized controlled trial (DAVOS trial)

    PubMed Central

    2014-01-01

    Background About 10 to 20% of children in West European countries have atopic dermatitis (AD), often as part of the atopic syndrome. The full atopic syndrome also consists of allergic asthma, allergic rhinitis and food allergy. Treatment approaches for atopic dermatitis and asthma include intermittent anti-inflammatory therapy with corticosteroids, health education and self-management training. However, symptoms persist in a subgroup of patients. Several observational studies have shown significant improvement in clinical symptoms in children and adults with atopic dermatitis or asthma after treatment at high altitude, but evidence on the efficacy when compared to treatment at sea level is still lacking. Methods/Design This study is a pragmatic randomized controlled trial for children with moderate to severe AD within the atopic syndrome. Patients are eligible for enrolment in the study if they are: diagnosed with moderate to severe AD within the atopic syndrome, aged between 8 and 18 years, fluent in the Dutch language, have internet access at home, able to use the digital patient system Digital Eczema Center Utrecht (DECU), willing and able to stay in Davos for a six week treatment period. All data are collected at the Wilhelmina Children’s Hospital and DECU. Patients are randomized over two groups. The first group receives multidisciplinary inpatient treatment during six weeks at the Dutch Asthma Center in Davos, Switzerland. The second group receives multidisciplinary treatment during six weeks at the outpatient clinic of the Wilhelmina Children’s Hospital, Utrecht, the Netherlands. The trial is not conducted as a blind trial. The trial is designed with three components: psychosocial, clinical and translational. Primary outcomes are coping with itch, quality of life and disease activity. Secondary outcomes include asthma control, medication use, parental quality of life, social and emotional wellbeing of the child and translational parameters. Discussion The results of this trial will provide evidence for the efficacy of high altitude treatment compared to treatment at sea level for children with moderate to severe AD. Trial Registration Current Controlled Trials ISRCTN88136485. PMID:24670079

  16. Lightweight Streaming Protocol (LSP)

    Microsoft Academic Search

    Emir Mulabegovic; Dan Schonfeld; Rashid Ansari

    2002-01-01

    A new streaming protocol is proposed for multimedia applications. The proposed protocol, referred to as Lightweight Streaming Protocol (LSP), is an application layer protocol that sits atop UDP. The protocol is intended to improve the quality and reliability of media stream by borrowing features from reliable protocols such as retransmission and flow control while not sacrificing performance. The protocol offers

  17. Preemptive Genotyping for Personalized Medicine: Design of the Right Drug, Right Dose, Right Time – Using Genomic Data to Individualize Treatment Protocol

    PubMed Central

    Bielinski, Suzette J.; Olson, Janet E.; Pathak, Jyotishman; Weinshilboum, Richard M.; Wang, Liewei; Lyke, Kelly J.; Ryu, Euijung; Targonski, Paul V.; Van Norstrand, Michael D.; Hathcock, Matthew A.; Takahashi, Paul Y.; McCormick, Jennifer B.; Johnson, Kiley J.; Maschke, Karen J.; Rohrer Vitek, Carolyn R.; Ellingson, Marissa S.; Wieben, Eric D.; Farrugia, Gianrico; Morrisette, Jody A.; Kruckeberg, Keri J.; Bruflat, Jamie K.; Peterson, Lisa M.; Blommel, Joseph H.; Skierka, Jennifer M.; Ferber, Matthew J.; Black, John L.; Baudhuin, Linnea M.; Klee, Eric W.; Ross, Jason L.; Veldhuizen, Tamra L.; Schultz, Cloann G.; Caraballo, Pedro J.; Freimuth, Robert R.; Chute, Christopher G.; Kullo, Iftikhar J.

    2014-01-01

    Objective To report the design and implementation of the Right Drug, Right Dose, Right Time: Using Genomic Data to Individualize Treatment Protocol that was developed to test the concept that prescribers can deliver genome guided therapy at the point-of-care by using preemptive pharmacogenomics (PGx) data and clinical decision support (CDS) integrated in the electronic medical record (EMR). Patients and Methods We used a multivariable prediction model to identify patients with a high risk of initiating statin therapy within 3 years. The model was used to target a study cohort most likely to benefit from preemptive PGx testing among Mayo Clinic Biobank participants with a recruitment goal of 1000 patients. Cox proportional hazards model was utilized using the variables selected through the Lasso shrinkage method. An operational CDS model was adapted to implement PGx rules within the EMR. Results The prediction model included age, sex, race, and 6 chronic diseases categorized by the Clinical Classifications Software for ICD-9 codes (dyslipidemia, diabetes, peripheral atherosclerosis, disease of the blood-forming organs, coronary atherosclerosis and other heart diseases, and hypertension). Of the 2000 Biobank participants invited, 50% provided blood samples, 13% refused, 28% did not respond, and 9% consented but did not provide a blood sample within the recruitment window (October 4, 2012 – March 20, 2013). Preemptive PGx testing included CYP2D6 genotyping and targeted sequencing of 84 PGx genes. Synchronous real-time CDS is integrated in the EMR and flags potential patient-specific drug-gene interactions and provides therapeutic guidance. Conclusion These interventions will improve understanding and implementation of genomic data in clinical practice. PMID:24388019

  18. Cost-effectiveness of intermittent preventive treatment of malaria in infants (IPTi) for averting anaemia in Gabon: a comparison between intention to treat and according to protocol analyses

    PubMed Central

    2011-01-01

    Background In Gabon, the impact of intermittent preventive treatment of malaria in infants (IPTi) was not statistically significant on malaria reduction, but the impact on moderate anaemia was, with some differences between the intention to treat (ITT) and the according to protocol (ATP) trial analyses. Specifically, ATP was statistically significant, while ITT analysis was borderline. The main reason for the difference between ITT and ATP populations was migration. Methods This study estimates the cost-effectiveness of IPTi on the reduction of anaemia in Gabon, comparing results of the ITT and the ATP clinical trial analyses. Threshold analysis was conducted to identify when the intervention costs and protective efficacy of IPTi for the ATP cohort equalled the ITT cost-effectiveness ratio. Results Based on IPTi intervention costs, the cost per episode of moderate anaemia averted was US$12.88 (CI 95% 4.19, 30.48) using the ITT analysis and US$11.30 (CI 95% 4.56, 26.66) using the ATP analysis. In order for the ATP results to equal the cost-effectiveness of ITT, total ATP intervention costs should rise from 118.38 to 134 US$ ATP or the protective efficacy should fall from 27% to 18.1%. The uncertainty surrounding the cost-effectiveness ratio using ITT trial results was higher than using ATP results. Conclusions Migration implies great challenges in the organization of health interventions that require repeat visits in Gabon. This was apparent in the study as the cost-effectiveness of IPTp-SP worsened when drop out from the prevention was taken into account. Despite such challenges, IPTi was both inexpensive and efficacious in averting cases of moderate anaemia in infants. PMID:22004614

  19. Inpatient Health Services Utilization Among HIV-Infected Adult Patients in Care 2002–2007

    PubMed Central

    Yehia, Baligh R.; Fleishman, John A.; Hicks, Perrin L.; Ridore, Michelande; Moore, Richard D.; Gebo, Kelly A.

    2009-01-01

    Objective This study examines the frequency of inpatient hospitalization, the number of inpatient days, and factors associated with inpatient utilization in a multi-state HIV cohort between 2002 and 2007. Design A prospective cohort study of HIV-infected adults in care at 11 U.S. HIV primary and specialty care sites located in different geographic regions. Methods Demographic, clinical, and resource utilization data were collected from medical records for the years 2002–2007. Rates of resource use were calculated for number of hospital admissions, total inpatient days, and mean length of stay (LOS) per admission. Results Annual inpatient hospitalization rates significantly decreased from 35 to 27 per 100 persons from 2002 to 2007. The number of inpatient days per year significantly decreased over time, while mean LOS per admission was stable. Women, patients 50 years or older, Blacks, injection drug users, and patients without private insurance had higher hospitalization rates than their counterparts. Admission rates were lower for patients with high CD4 counts and low HIV-1 RNA levels. Conclusion Inpatient hospitalization rates and number of inpatient days decreased for HIV patients in this multi-state cohort between 2002 and 2007. Sociodemographic disparities in inpatient utilization persist. PMID:19841589

  20. Vancomycin versus daptomycin for the treatment of methicillin-resistant Staphylococcus aureus bacteremia due to isolates with high vancomycin minimum inhibitory concentrations: study protocol for a phase IIB randomized controlled trial

    PubMed Central

    2014-01-01

    Background Vancomycin is the standard first-line treatment for methicillin-resistant Staphylococcus aureus bacteremia. However, recent consensus guidelines recommend that clinicians consider using alternative agents such as daptomycin when the vancomycin minimum inhibitory concentration is greater than 1 ug/ml. To date however, there have been no head-to-head randomized trials comparing the safety and efficacy of daptomycin and vancomycin in the treatment of such infections. The primary aim of our study is to compare the efficacy of daptomycin versus vancomycin in the treatment of bloodstream infections due to methicillin-resistant Staphylococcus aureus isolates with high vancomycin minimum inhibitory concentrations (greater than or equal to 1.5 ug/ml) in terms of reducing all-cause 60-day mortality. Methods/Design The study is designed as a multicenter prospective open label phase IIB pilot randomized controlled trial. Eligible participants will be inpatients over 21-years-old with a positive blood culture for methicillin-resistant Staphylococcus aureus with vancomycin minimum inhibitory concentration of greater than or equal to 1.5ug/ml. Randomization into intervention or active control arms will be performed with a 1:1 allocation ratio. We aim to recruit 50 participants over a period of two years. Participants randomized to the active control arm will receive vancomycin dose-while those randomized to the intervention arm will receive daptomycin. Participants will receive a minimum of 14 days study treatment. The primary analysis will be conducted on the intention-to-treat principle. The Fisher’s exact test will be used to compare the 60-day mortality rate from index blood cultures (primary endpoint) between the two treatment arms, and the exact two-sided 95% confidence interval will be calculated using the Clopper and Pearson method. Primary analysis will be conducted using a two sided alpha of 0.05. Discussion If results from this pilot study suggest that daptomycin shows significant efficacy in the treatment of bloodstream infections due to methicillin-resistant Staphylococcus aureus isolates with high vancomycin minimum inhibitory concentrations, we aim to proceed with a larger scale confirmatory study. This would help guide clinicians and inform practice guidelines on the optimal treatment for such infections. Trial registration The trial is listed on clinicaltrials.gov (NCT01975662, date of registration: 29 October 2013). PMID:24943129

  1. Locoregionally Advanced Head and Neck Cancer Treated With Primary Radiotherapy: A Comparison of the Addition of Cetuximab or Chemotherapy and the Impact of Protocol Treatment

    SciTech Connect

    Caudell, Jimmy J.; Sawrie, Stephen M.; Spencer, Sharon A. [Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL (United States); Desmond, Renee A. [Department of Biostatistics, University of Alabama-Birmingham, Birmingham, AL (United States); Carroll, William R.; Peters, Glenn E. [Department of Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL (United States); Nabell, Lisle M. [Department of Hematology-Oncology, University of Alabama-Birmingham, Birmingham, AL (United States); Meredith, Ruby F. [Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL (United States); Bonner, James A. [Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL (United States)], E-mail: jabonner@uabmc.edu

    2008-07-01

    Purpose: The addition of platinum-based chemotherapy (ChRT) or cetuximab (ExRT) to concurrent radiotherapy (RT) has resulted in improved survival in Phase III studies for locoregionally advanced head and neck cancer (LAHNC). However the optimal treatment regimen has not been defined. A retrospective study was performed to compare outcomes in patients who were treated definitively with ExRT or ChRT. Methods: Cetuximab with concurrent RT was used to treat 29 patients with LAHNC, all of whom had tumors of the oral cavity, oropharynx, or larynx. All patients were T2 to T4 and overall American Joint Committee on Cancer Stage III to IVB, with a Karnofsky Performance Status (KPS) score of 60 or greater. ChRT was used to treat 103 patients with similar characteristics. Patients were evaluated for locoregional control (LRC), distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS). Median follow-up for patients alive at last contact was 83 months for those treated with ExRT and 53 months for those treated with ChRT. Cox proportional hazard models were used to assess independent prognostic factors. Results: The LRC, DMFS, and DSS were not significantly different, with 3-year rates of 70.7%, 92.4%, and 78.6% for ExRT and 74.7%, 86.6%, and 76.5% for ChRT, respectively. The OS was significantly different between the two groups (p = 0.02), with 3-year rates of 75.9% for ExRT and 61.3% for ChRT. OS was not significant when patients who were on protocol treatments of ExRT or ChRT were compared. Also, OS was not significant when multivariate analysis was used to control for potential confounding factors. Conclusion: In our single-institution retrospective review of patients treated with ExRT or ChRT, no significant differences were found in LRC, DMFS, DSS, or OS.

  2. Study protocol for a randomised, double-blinded, placebo-controlled, clinical trial of S-ketamine for pain treatment in patients with chronic pancreatitis (RESET trial)

    PubMed Central

    Juel, Jacob; Olesen, Søren Schou; Olesen, Anne Estrup; Poulsen, Jakob Lykke; Dahan, Albert; Wilder-Smith, Oliver; Madzak, Adnan; Frøkjær, Jens Brøndum; Drewes, Asbjørn Mohr

    2015-01-01

    Introduction Chronic pancreatitis (CP) is an inflammatory disease that causes irreversible damage to pancreatic tissue. Pain is its most prominent symptom. In the absence of pathology suitable for endoscopic or surgical interventions, pain treatment usually includes opioids. However, opioids often have limited efficacy. Moreover, side effects are common and bothersome. Hence, novel approaches to control pain associated with CP are highly desirable. Sensitisation of the central nervous system is reported to play a key role in pain generation and chronification. Fundamental to the process of central sensitisation is abnormal activation of the N-methyl-d-aspartate receptor, which can be antagonised by S-ketamine. The RESET trial is investigating the analgaesic and antihyperalgesic effect of S-ketamine in patients with CP. Methods and analysis 40 patients with CP will be enrolled. Patients are randomised to receive 8?h of intravenous S-ketamine followed by oral S-ketamine, or matching placebo, for 4?weeks. To improve blinding, 1?mg of midazolam will be added to active and placebo treatment. The primary end point is clinical pain relief as assessed by a daily pain diary. Secondary end points include changes in patient-reported outcome measures, opioid consumption and rates of side effects. The end points are registered through the 4-week medication period and for an additional follow-up period of 8?weeks to investigate long-term effects. In addition, experimental pain measures also serves as secondary end points, and neurophysiological imaging parameters are collected. Furthermore, experimental baseline recordings are compared to recordings from a group of healthy controls to evaluate general aspects of pain processing in CP. Ethics and dissemination The protocol is approved by the North Denmark Region Committee on Health Research Ethics (N-20130040) and the Danish Health and Medicines Authorities (EudraCT number: 2013-003357-17). The results will be disseminated in peer-reviewed journals and at scientific conferences. Trial registration number The study is registered at http://www.clinicaltrialsregister.eu (EudraCT number 2013-003357-17). PMID:25757947

  3. ‘Real World’ Comparison of First and Second-Generation Antipsychotics in Regard to Length of Inpatient Hospitalization and Number of Re-hospitalizations

    Microsoft Academic Search

    Claire Advokat; Benjamin D. Hill; Joseph E. Comaty

    2008-01-01

    The purpose of this study was to determine if Second-Generation Antipsychotics (SGAs), relative to First-Generation Antipsychotics\\u000a (FGAs), reduced either the length of stay (LOS) or number of re-hospitalizations of schizophrenic patients receiving treatment\\u000a in a state psychiatric hospital. Medical records were compared for the periods 1991–1994 and 2001–2004 for three inpatient\\u000a groups: those receiving FGAs, those receiving SGAs, and those

  4. Goal Attainment Scaling (GAS) in Relation to the Global Assessment of Functioning (GAF) Scale in Functional Disorders and Organic Disorders in Psychogeriatric Inpatients

    Microsoft Academic Search

    John R. Reddon; Natalie D. Dautovich; Christine A. North

    2001-01-01

    Goal Attainment Scaling (GAS) and the Global Assessment of Functioning (GAF) scale were used with 70 Functional Disorders (mean age = 74.0 years) and 58 Organic Disorders (mean age = 79.2 years) psychogeriatric inpatients to evaluate treatment outcome; 48.6% of the Functional Disorders patients were discharged home whereas 81.0% of the Organic Disorders patients were discharged to long-term\\/ continuing care

  5. Creating 'therapeutic landscapes' for mental health carers in inpatient settings: a dynamic perspective on permeability and inclusivity.

    PubMed

    Wood, Victoria J; Curtis, Sarah E; Gesler, Wil; Spencer, Ian H; Close, Helen J; Mason, James; Reilly, Joe G

    2013-08-01

    Although there has been a shift toward treatment in the home and the community, in the UK, inpatient facilities are still important in modern mental health care. 'Informal carers', including family members, often play an essential role, not only in providing care in the community but also in care of patients during periods of hospitalisation. UK National Health Service policies increasingly consider the position of these carers as 'partners' in the care process, but relatively little attention has been paid to their position within the hospital settings where treatment is provided for inpatients. This paper contributes to geographical work on carers experiences, by reporting how this issue emerged through a study focused on perceptions of a newly built hospital, compared with the inpatient facilities it replaced. We draw on qualitative research findings from discussion groups and interviews with informal carers. The material considered here focused especially on carers' views of aspects of the hospital environment that were important for wellbeing of carers and the people they look after. The carers' views were supplemented by relevant material drawn from other interviews from our wider study, which included service users and members of hospital staff. These accounts revealed how informal carers experienced the hospital environment; we interpret our findings through a conceptual framework that emphasises carers' experiences of a 'journey' along a 'caring pathway' to and through the hospital space. This perspective allows us to make a connection between three bodies of literature. The first relates to phenomenological interpretations of one's environmental perception, formed as one moves through the world. The second derives from the literature concerning 'permeability' of hospital institutions. Bringing these ideas together provides an innovative, dynamic perspective on a third strand of literature from health geography that examines hospitals as 'therapeutic landscapes'. The analysis helps to explore the extent to which carers in this study were positioned as 'outsiders' in the hospital space. PMID:23261254

  6. Hospitalists: an efficient, new breed of inpatient caregivers.

    PubMed

    Chaty, B

    1998-09-01

    Hospitalists are a relatively new segment of the physician population (primarily internists and critical care practitioners) specializing in managing the overall care of hospitalized patients, a responsibility traditionally assumed by primary care physicians. Managed care organizations, large medical groups, practice management companies, and hospitals that have adopted inpatient programs incorporating hospitalists report reductions in length of patient stays, decreased costs, and improved efficiency of delivery, with no adverse effect on patient satisfaction. Use of hospitalists is being encouraged by some managed care organizations, but local medical communities remain largely resistant to the introduction of hospitalist programs. Healthcare systems should proactively evaluate the benefits of instituting a hospitalist program. PMID:10182743

  7. Inpatient hospital complications and lengths of stay: a short report

    Microsoft Academic Search

    Ronald J Lagoe; Pamela E Johnson; Mark P Murphy

    2011-01-01

    Background  Increasingly, efforts are being made to link health care outcomes with more efficient use of resources. The current difficult\\u000a economic times and health care reform efforts provide incentives for specific efforts in this area.\\u000a \\u000a \\u000a \\u000a \\u000a Findings  This study defined relationships between inpatient complications for urinary tract infection and pneumonia and hospital lengths\\u000a of stay in three general hospitals in the metropolitan area

  8. Hypertension-related knowledge, practice and drug adherence among inpatients of a hospital in samarkand, uzbekistan.

    PubMed

    Malik, Amonov; Yoshida, Yoshitoku; Erkin, Toirov; Salim, Davlatov; Hamajima, Nobuyuki

    2014-08-01

    Hypertension is one of the most important preventable causes of premature morbidity and mortality in the world. Many people with hypertension both in developing and developed countries have no adequate control of their blood pressure (BP). Hypertension-related knowledge and practice of patients play an important role in controlling hypertension and in preventing its long-term complications. The objective here was to study hypertension-related knowledge, practice and drug adherence of inpatients, and to examine an association between the knowledge regarding hypertension with BP control status and drug adherence. We studied hypertension-related knowledge, practice and drug adherence of patients in a hospital setting. A cross-sectional study was conducted among 209 patients with the diagnosis of primary hypertension at the Samarkand State Medical Institute. The study was conducted from June to September 2012. Drug adherence was studied using the Morisky 4-item self-report measure of medication-taking behavior. The reasons for drug non-adherence were assessed using a self-administered questionnaire. Odds ratio (OR) and 95% confidence interval (CI) were estimated by a logistic model. The BP control rate and drug adherence of the patients were suboptimal (24.4% and 36.8%, respectively). Overall, 64.6% of patients had good or adequate and 35.5% had inadequate knowledge about hypertension. Good knowledge of patients was significantly associated with controlled BP (OR=5.4, 95% CI, 1.7-16.2) and drug adherence (OR=3.8, 95% CI, 1.4-10.8). In conclusion, the inpatients of the secondary hospital had sufficient general knowledge about hypertension, but they had inadequate knowledge about specific issues such as treatment for and symptoms of hypertension. Both drug adherence and BP control rate were suboptimal and significantly associated with hypertension knowledge. This study specifies potential areas of hypertension education that could be improved by patients' knowledge of hypertension. PMID:25741034

  9. HYPERTENSION-RELATED KNOWLEDGE, PRACTICE AND DRUG ADHERENCE AMONG INPATIENTS OF A HOSPITAL IN SAMARKAND, UZBEKISTAN

    PubMed Central

    MALIK, AMONOV; YOSHIDA, YOSHITOKU; ERKIN, TOIROV; SALIM, DAVLATOV; HAMAJIMA, NOBUYUKI

    2014-01-01

    ABSTRACT Hypertension is one of the most important preventable causes of premature morbidity and mortality in the world. Many people with hypertension both in developing and developed countries have no adequate control of their blood pressure (BP). Hypertension-related knowledge and practice of patients play an important role in controlling hypertension and in preventing its long-term complications. The objective here was to study hypertension-related knowledge, practice and drug adherence of inpatients, and to examine an association between the knowledge regarding hypertension with BP control status and drug adherence. We studied hypertension-related knowledge, practice and drug adherence of patients in a hospital setting. A cross-sectional study was conducted among 209 patients with the diagnosis of primary hypertension at the Samarkand State Medical Institute. The study was conducted from June to September 2012. Drug adherence was studied using the Morisky 4-item self-report measure of medication-taking behavior. The reasons for drug non-adherence were assessed using a self-administered questionnaire. Odds ratio (OR) and 95% confidence interval (CI) were estimated by a logistic model. The BP control rate and drug adherence of the patients were suboptimal (24.4% and 36.8%, respectively). Overall, 64.6% of patients had good or adequate and 35.5% had inadequate knowledge about hypertension. Good knowledge of patients was significantly associated with controlled BP (OR=5.4, 95% CI, 1.7–16.2) and drug adherence (OR=3.8, 95% CI, 1.4–10.8). In conclusion, the inpatients of the secondary hospital had sufficient general knowledge about hypertension, but they had inadequate knowledge about specific issues such as treatment for and symptoms of hypertension. Both drug adherence and BP control rate were suboptimal and significantly associated with hypertension knowledge. This study specifies potential areas of hypertension education that could be improved by patients’ knowledge of hypertension. PMID:25741034

  10. Associations between sleep disturbance and suicidal ideation in adolescents admitted to an inpatient psychiatric unit.

    PubMed

    Kaplan, Sebastian G; Ali, Shahzad K; Simpson, Brittany; Britt, Victoria; McCall, W Vaughn

    2014-01-01

    The goals of our study were to: 1) describe the incidence of disturbances in sleep quality, sleep hygiene, sleep-related cognitions and nightmares; and 2) investigate the association between these sleep-related disturbances and suicidal ideation (SI), in adolescents admitted to a psychiatric inpatient unit. Our sample consisted of 50 adolescents between the ages of 12 and 17 years (32 females and 18 males; 41 Caucasian and nine African American). Our cross-sectional design involved the administration of the Adolescent Sleep Wake Scale (ASWS), the Adolescent Sleep Hygiene Scale (ASHS), the Dysfunctional Beliefs and Attitudes about Sleep-Short version for use with children (DBAS-C10), the Disturbing Dreams and Nightmare Scale (DDNSI), and the Suicidal Ideation Questionnaire Jr (SIQ-JR). Analyses were conducted using Pearson correlations, as well as univariate and multivariate regression. Results indicated that our sample experienced sleep disturbances and SI to a greater degree than non-clinical samples. Sleep quality was correlated with nightmares, while sleep quality and nightmares were each correlated with SI. Sleep quality, dysfunctional beliefs, and nightmares each independently predicted SI. Our study was the first to use the four sleep measures with an adolescent psychiatric inpatient sample. It is important to develop sleep-related assessment tools in high-risk populations given the link between sleep disturbances and suicidality. Furthermore, a better understanding of the relationships between SI and sleep quality, sleep-related cognitions, and nightmares is needed to develop potential prevention and treatment options for suicidality in adolescents. PMID:24356389

  11. The relationship between social support, shared decision-making and patient’s trust in doctors: a cross-sectional survey of 2,197 inpatients using the Cologne Patient Questionnaire

    Microsoft Academic Search

    Oliver Ommen; Sonja Thuem; Holger Pfaff; Christian Janssen

    2011-01-01

    Objectives  Empirical studies have confirmed that a trusting physician–patient interaction promotes patient satisfaction, adherence to\\u000a treatment and improved health outcomes. The objective of this analysis was to investigate the relationship between social\\u000a support, shared decision-making and inpatient’s trust in physicians in a hospital setting.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A written questionnaire was completed by 2,197 patients who were treated in the year 2000 in six

  12. Unfulfilled expectations: a narrative study of individuals’ experiences of being a patient on an acute psychiatric inpatient ward in Scotland 

    E-print Network

    Stenhouse, Rosemary Clare

    2009-01-01

    This study examines people’s experiences of being a patient on an acute psychiatric inpatient ward in Scotland. Within the existing research base few studies focus on the patient’s experience of acute psychiatric inpatient ...

  13. PTSD Substance abuse comorbidity and treatment utilization

    Microsoft Academic Search

    Pamela J. Brown; Patricia R. Recupero; Robert Stout

    1995-01-01

    The present study investigates the prevalence of posttraumatic stress disorder (PTSD) among a sample of treatment-seeking substance abusers and examines the relationship between PTSD comorbidity and rates of inpatient substance abuse treatment. Eightyfour patients (48 male and 36 female) admitted for detoxification at a private hospital were administered self-report measures of lifetime stressor events, PTSD symptomatology, and prior treatment history.

  14. Homeless and Housed Inpatients with Schizophrenia: Disparities in Service Access upon Discharge from Hospital

    ERIC Educational Resources Information Center

    Burra, Tara A.; Hwang, Stephen W.; Rourke, Sean B.; Stergiopoulos, Vicky

    2012-01-01

    This study examines differences in services available at the time of discharge for homeless and housed psychiatric inpatients. Participants diagnosed with schizophrenia or schizoaffective disorder were recruited from a general hospital psychiatric inpatient unit. Thirty homeless individuals and 21 housed controls (matched for diagnosis, gender,…

  15. Impact of Moving Objects on Contaminant Concentration Distributions in an Inpatient Ward with

    E-print Network

    Chen, Qingyan "Yan"

    1 Impact of Moving Objects on Contaminant Concentration Distributions in an Inpatient Ward Moving objects can disturb stratified flow and contaminant concentration gradient in an inpatient ward of moving objects, such as a walking visitor, a walking caretaker, the changing of the sheet on a patient

  16. Psychological predictors of admission and discharge global assessment of functioning scale scores for geropsychiatric inpatients

    Microsoft Academic Search

    J. A. Whitney; M. E. Kunik; V. Molinari; F. G. Lopez; T. Karner

    2004-01-01

    This study examined psychological predictors of Global Assessment of Functioning Scale scores (GAF) at intake and at discharge for geropsychiatric inpatients. A total of 301 predominantly male geropsychiatric inpatients were recruited from the Houston Veterans Affairs Medical Center. Path analysis was used to test a model proposing causal paths of psychological predictors (cognitive status, depression, agitation, general psychiatric status) to

  17. Alexithymia and Personality in Relation to Social Anxiety in Male Alcohol-Dependent Inpatients

    Microsoft Academic Search

    Cüneyt EVREN; Bilge EVREN; Ercan DALBUDAK; Duran ÇAKMAK

    2008-01-01

    Objective: The aim of this study was to investigate the determinants of social anxiety symptoms in alcohol dependent inpatients. Method: Participants were 176 consecutively admitted male alcohol dependent inpatients. Patients were investigated with the Liebowitz Social Anxiety Scale (LSAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Toronto Alexithymia Scale (TAS-20) and Temperament and Character Inventory (TCI). Results: Subscales of

  18. A profile of mentally disordered offenders admitted to inpatient psychiatric services in the United States

    Microsoft Academic Search

    Henry J. Steadman; Marilyn J. Rosenstein; Robin L. MacAskill; Ronald W. Manderscheidt

    1988-01-01

    This research note presents data about mentally disordered offenders (MDOs) treated in inpatient psychiatric services. Data are derived from 1980 admission surveys by the Survey and Reports Branch, National Institute of Mental Health (NIMH). These data report for the first time inpatient services provided to MDOs by non-Federal general and private hospitals. A total of 31,773 MDOs were admitted, with

  19. Potentially avoidable inpatient nights among warfarin receiving patients; an audit of a single university teaching hospital

    Microsoft Academic Search

    Dónall Forde; Mortimer B O'Connor; Oonagh Gilligan

    2009-01-01

    BACKGROUND: Warfarin is an oral anticoagulant (OAT) that needs active management to ensure therapeutic range. Initial management is often carried out as an inpatient, though not requiring inpatient facilities. This mismatch results in financial costs which could be directed more efficaciously. The extent of this has previously been unknown. Here we aim to calculate the potential number of bed nights

  20. An Outcome Evaluation of an Inpatient Crisis Stabilization and Assessment Program for Youth

    ERIC Educational Resources Information Center

    Greenham, Stephanie L.; Bisnaire, Lise

    2008-01-01

    Objective: To describe characteristics and outcomes of youth aged 7 to 17 who received inpatient psychiatric and mental health services along different clinical pathways of a new service delivery model. Method: Participants included 211 admissions to an inpatient crisis stabilization and assessment program over a one-year period. Standardized…

  1. Evaluation of the effectiveness and cost-effectiveness of Families for Health V2 for the treatment of childhood obesity: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Effective programs to help children manage their weight are required. Families for Health focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health V1 showed sustained reductions in overweight after 2 years in a pilot evaluation, but lacks a randomized controlled trial (RCT) evidence base. Methods/design This is a multi-center, investigator-blind RCT, with parallel economic evaluation, with a 12-month follow-up. The trial will recruit 120 families with at least one child aged 6 to 11 years who is overweight (?91st centile BMI) or obese (?98th centile BMI) from three localities and assigned randomly to Families for Health V2 (60 families) or the usual care control (60 families) groups. Randomization will be stratified by locality (Coventry, Warwickshire, Wolverhampton). Families for Health V2 is a family-based intervention run in a community venue. Parents/carers and children attend parallel groups for 2.5 hours weekly for 10 weeks. The usual care arm will be the usual support provided within each NHS locality. A mixed-methods evaluation will be carried out. Child and parent participants will be assessed at home visits at baseline, 3-month (post-treatment) and 12-month follow-up. The primary outcome measure is the change in the children’s BMI z-scores at 12 months from the baseline. Secondary outcome measures include changes in the children’s waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. The parents’ BMI and mental well-being, family eating/activity, parent–child relationships and parenting style will also be assessed. Economic components will encompass the measurement and valuation of service utilization, including the costs of running Families for Health and usual care, and the EuroQol EQ-5D health outcomes. Cost-effectiveness will be expressed in terms of incremental cost per quality-adjusted life year gained. A de novo decision-analytic model will estimate the lifetime cost-effectiveness of the Families for Health program. Process evaluation will document recruitment, attendance and drop-out rates, and the fidelity of Families for Health delivery. Interviews with up to 24 parents and children from each arm will investigate perceptions and changes made. Discussion This paper describes our protocol to assess the effectiveness and cost-effectiveness of a parenting approach for managing childhood obesity and presents challenges to implementation. Trial registration Current Controlled Trials http://ISRCTN45032201 PMID:23514100

  2. Move more for life: the protocol for a randomised efficacy trial of a tailored-print physical activity intervention for post-treatment breast cancer survivors

    PubMed Central

    2012-01-01

    Background Due to early detection and advances in treatment, the number of women surviving breast cancer is increasing. Whilst there are many positive aspects of improved survival, breast cancer survival is associated with many long-term health and psychosocial sequelae. Engaging in regular physical activity post-diagnosis can reduce this burden. Despite this evidence, the majority of breast cancer survivors do not engage in regular physical activity. The challenge is to provide breast cancer survivors with appealing and effective physical activity support in a sustainable and cost-effective way. This article describes the protocol for the Move More for Life Study, which aims to assess the relative efficacy of two promising theory-based, print interventions designed to promote regular physical activity amongst breast cancer survivors. Method and design Breast cancer survivors were recruited from across Australia. Participants will be randomised into one of three groups: (1) A tailored-print intervention group, (2) a targeted-print intervention group, or (3) a standard recommendation control group. Participants in the tailored-print intervention group will receive 3 tailored newsletters in the mail over a three month period. Participants in the targeted-print group will receive a previously developed physical activity guidebook designed specifically for breast cancer survivors immediately after baseline. Participants in the standard recommendation control will receive a brochure detailing the physical activity guidelines for Australian adults. All participants will be assessed at baseline, and at 4 and 10 months post-baseline. Intervention efficacy for changing the primary outcomes (mins/wk aerobic physical activity; sessions/exercises per week resistance physical activity) and secondary outcomes (steps per day, health-related quality life, compliance with physical activity guidelines, fatigue) will be assessed. Mediation and moderation analyses will also be conducted. Discussion Given the growing number of cancer survivors, distance-based behaviour change programs addressing physical activity have the potential to make a significant public health impact. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: ACTRN12611001061921 PMID:22569139

  3. Treating the untreatable: a single case study of a psychopathic inpatient treated with schema therapy.

    PubMed

    Chakhssi, Farid; Kersten, Truus; de Ruiter, Corine; Bernstein, David P

    2014-09-01

    From its first conceptualization in modern psychiatry, psychopathy has been considered difficult if not impossible to treat. Schema Therapy (ST) is a psychotherapeutic approach that has shown efficacy in patients with borderline personality disorder. ST has recently been adapted for personality disordered forensic patients, including patients with high levels of psychopathy. The present case study examined the process of individual ST, combined with movement therapy and milieu therapy by the nursing staff, with a forensic inpatient with psychopathic features (Psychopathy Checklist-Revised total score = 28.4). The patient had been sentenced to a mandatory treatment order in relation to a sexual assault. We assessed change using independent assessments of psychopathic traits, cognitive schemas, and risk-related behaviors over the 4-year treatment period and a 3-year follow-up. We also assessed the quality of the working alliance. Reliable change analyses showed significant improvements in psychopathic traits, cognitive schemas, and risk-related outcomes. At 3 years posttreatment, the patient was living independently outside of the forensic institution without judicial supervision and he had not reoffended. While many questions remain about the effectiveness of psychotherapeutic treatment for psychopathic patients, our study challenges the view that they are untreatable. PMID:24684220

  4. Same agency, different teams: perspectives from home and inpatient hospice care.

    PubMed

    Lysaght Hurley, Susan; Barg, Frances K; Strumpf, Neville; Ersek, Mary

    2015-07-01

    Tremendous growth in hospice over the past 30 years in the United States has increased the number of terminally ill patients dying at home. Recently, however, more hospice patients are dying at inpatient facilities. To understand the varying perceptions about care in the home and inpatient hospice, we conducted semistructured interviews with 24 interdisciplinary team (IDT) members and analyzed the data using the constant comparative method. Core interdisciplinary tasks, including identifying the focus of energy, tailoring family caregiver involvement, acknowledging who is in charge, and knowing both sides differed in the home and inpatient settings. Despite the overarching umbrella of hospice care, home and inpatient hospice settings create different foci for IDT members, burdens and privileges for family caregivers, and control of the care plan. Key differences between home and inpatient hospice processes of care highlight the complexity of patient-centered end-of-life care in the United States. PMID:25294344

  5. Dissociative disorders in Turkish inpatients with conversion disorder.

    PubMed

    Tezcan, Ertan; Atmaca, Murad; Kuloglu, Murat; Gecici, Omer; Buyukbayram, Ayten; Tutkun, Hamdi

    2003-01-01

    The aim of our study was to determine the frequency of dissociative disorders (DDs) among inpatients with conversion disorder (CD) in a university clinic settled in Eastern Turkey. During a period of 24 months, 59 consecutively admitted adult CD patients were screened with the Dissociative Experience Scale (DES). Patients who scored above 30 (DDs group) did not differ by age or gender from a group of inpatients who scored below 10 on the scale (comparison group). All patients in the two groups were then interviewed in a blind manner using the Dissociative Disorders Interview Schedule (DDIS) and Structured Interview for DSM-IV Dissociative Disorders (SCID-D). According to the SCID-D, 18 of 59 patients (30.5%) received a diagnosis of dissociative disorder; nine of these 18 patients (50%) were diagnosed as having dissociative identity disorder, eight (44.4%) were diagnosed as having dissociative disorder not otherwise specified (NOS), and one (5.6%) was diagnosed as having dissociative amnesia. Accordingly to the DDIS, borderline personality disorder was frequent in the DDs group, and all of the patients in the DDs group reported sexual abuse and neglect during childhood, latency, or adolescence. A high proportion of CD patients have significant dissociative pathology. The proper diagnosis of these patients has important implications for their clinical course. PMID:12923711

  6. Suicidal patients as experienced by psychiatric nurses in inpatient care.

    PubMed

    Carlén, Pontus; Bengtsson, Anita

    2007-08-01

    Psychiatric nurses have a major influence on the lives of patients with suicidal behaviour in inpatient care. Despite this, there is a lack of knowledge about how nurses experience patients with suicidal behaviour in a deeper sense. The aim of this study was to investigate how psychiatric nurses experience patients with suicidal behaviour within an inpatient psychiatric context. Semi-structured interviews were carried out with 11 psychiatric nurses, each of whom had more than 5 years of experience caring for patients with suicidal behaviour. Data were analysed using qualitative latent content analysis. Two main themes emerged from the data analysis. These are 'labelled' and 'suffering'. In the nurses' natural attitude, they saw patients as being labelled with different conditions and/or behaviours based on objective signs. These were categorized into different groups or identities such as psychiatric diagnosis, mask wearer, screened-off, or the social, relapsing or determined patient. On reflection, however, the nurses described the patients' suffering in terms related to feelings of hopelessness, meaninglessness, and being out of control. The nurses' experiences of the patients as suffering were based on their subjective reflective experience of the patients. The study gives support to the conclusion that two main logic systems are represented in the care of patients with suicidal behaviour: technical practical and nursing perspectives. In order to ensure that these two logic systems combine, it is necessary for the psychiatric care organization to intervene to support the nurses in reflecting on their everyday work. PMID:17635625

  7. Cleanroom Protocol

    NSDL National Science Digital Library

    This is a description for a learning module from Maricopa Advanced Technology Education Center. This PDF describes the module; access may be purchased by visiting the MATEC website. The final module of MATEC's contamination curriculum develops your learners' skills in specific cleanroom protocols: wafer handling and transfer, area wipedowns, and area or equipment isolation. The instruction stresses that contaminants travel via many channels- air, people, process equipment, manufacturing process, wiping materials, wafer handling, electrostatic discharge, and chemicals. MATEC aims to make each learner acutely aware that minimizing contamination in the cleanroom requires his or her personal commitment. The module also discusses the automated systems used in modern and upcoming 300-mm fabs.

  8. DEVELOPMENT OF A JOINT TEST PROTOCOL FOR VALIDATION OF TREATMENTS OR MATERIALS FOR PREVENTING CORROSION TO COMPONENTS AND STRUCTURES FOR DOD MATERIEL

    Microsoft Academic Search

    Lawrence A. Gintert; Donald R. Skelton; Ralph P. I. Adler

    The impact of corrosion degradation on the maintenance costs and readiness for Department of Defense (DoD) materiel and equipment encourages a high priority on the evaluation of new or alternate techniques and materials for improved corrosion control. The development of a series of Joint Test Protocols (JTPs) for validation of alternatives to current corrosion protection methods used on a variety

  9. Electronic decision protocols for ART patient triaging to expand access to HIV treatment in South Africa: A cross sectional study for development and validation

    PubMed Central

    MITCHELL, Marc; HEDT, Bethany L.; ESHUN-WILSON, Ingrid; FRASER, Hamish; JOHN, Melanie-Anne; MENEZES, Colin; GROBUSCH, Martin P.; JACKSON, Jonathan; TALJAARD, Jantjie; LESH, Neal

    2012-01-01

    Background The shortage of doctors and nurses, along with future expansion into rural clinics, will require that the majority of clinic visits by HIV infected patients on antiretroviral therapy (ART) are managed by non-doctors. The goal of this study was to develop and evaluate a screening protocol to determine which patients needed a full clinical assessment and which patients were stable enough to receive their medications without a doctor’s consultation. For this study, we developed an electronic, handheld tool to guide non-physician counselors through screening questions. Methods Patients visiting two ART clinics in South Africa for routine follow-up visits between March 2007 – April 2008 were included in our study. Each patient was screened by non-physician counselors using the handheld device and then received a full clinical assessment. Clinicians’ report on whether full clinical assessment had been necessary was used as the gold standard for determining “required referral”. Observations were randomly divided into two datasets – 989 for developing a referral protocol and 200 for validating protocol performance. Results A third of patients had at least one physical complaint, and 16% had five or more physical complaints. 38% of patients required referral for full clinical assessment. We identify a subset of questions which are 87% sensitive and 47% specific for recommended patient referral. Conclusions The final screening protocol is highly sensitive and could reduce burden on ART clinicians by 30%. The uptake and acceptance of the handheld tool to support implementation of the protocol was high. Further examination of the data reveals several important questions to include in future referral algorithms to improve sensitivity and specificity. Based on these results, we identify a refined algorithm to explore in future evaluations. PMID:22178295

  10. New Dimensional Staging of Bisphosphonate-Related Osteonecrosis of the Jaw Allowing a Guided Surgical Treatment Protocol: Long-Term Follow-Up of 266 Lesions in Neoplastic and Osteoporotic Patients from the University of Bari

    PubMed Central

    Franco, Simonetta; Miccoli, Simona; Limongelli, Luisa; Tempesta, Angela; Favia, Giorgio; Maiorano, Eugenio; Favia, Gianfranco

    2014-01-01

    Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is the most serious side effect in patients receiving bisphosphonates (BPs) for neoplastic disease and osteoporosis. The aim of this study is to propose a new dimensional stage classification, guiding the surgical treatment of BRONJ patients, and to evaluate the success rate of this new management. From 2004 to 2013, 203 neoplastic and osteoporotic patients with 266 BRONJ lesions were referred to the Odontostomatology Unit of the University of Bari. All patients underwent surgery after suspension of BPs therapy and antibiotic treatment. The surgical procedure was complemented by piezosurgery and followed by the application of hyaluronate and amino acids. The new dimensional staging suggests the choice of the surgical approach, and allows the prediction of postoperative complications and soft and hard tissues healing time, guiding the surgical treatment protocol. This protocol could be a successful management strategy for BRONJ, considering the low recurrences rate and the good stabilisation of the surgical sites observed after a long-term follow-up. PMID:24995017

  11. Medications Prescribed and Occurrence of Falls in General Medicine Inpatients

    PubMed Central

    Cashin, Richard P; Yang, Meiti

    2011-01-01

    Background: Although falls are multifactorial, medications are a key risk factor that may be modifiable. Falls were among the most common occurrences entered into a risk identification system at the authors’ hospital. Objectives: To identify whether general medicine inpatients who had experienced a fall were taking any medications known to be associated with falls. Methods: The literature was reviewed to develop a list of high-risk medications that have been associated with falls. In a retrospective quality-improvement database-based study, information from the risk identification system was merged with data from the pharmacy dispensing system for general medicine inpatients who had experienced a fall. The primary end point was the percentage of patients with a documented fall who had a prescription for a high-risk medication. The number of such medications that had been prescribed for patients who fell was also calculated. Results: Eighty-one unique medications were found to be associated with falls. During the study period (April 1, 2008, to March 31, 2009), 151 patients experienced a fall. Of those, 144 (95.4%) were taking at least one high-risk medication. The mean number of high-risk medications per patient who experienced a fall was 2.2. Of all documented falls, a new high-risk medication had been started within 7 days before the fall for 74 (49.0%) and within 24 h before the fall for 17 (11.3%). The most commonly prescribed drugs during all time periods (i.e., within 24 h or 7 days before the fall or since the patient’s admission) were lorazepam and zopiclone. The pharmacy database did not track administration of medications, so it is possible that some of the drugs prescribed were not actually taken by the patient. Conclusion: Almost all inpatients who experienced a fall during the hospital stay had a prescription for at least one medication associated with a high risk for falls. Lorazepam and zopiclone were the drugs most commonly associated with falls in this hospital, and their use should be reviewed. PMID:22479083

  12. Treatment

    Cancer.gov

    The development of more effective and less toxic treatments is fundamental to improving outcomes for patients with cancer. NCI is leading efforts on several fronts to develop and evaluate new cancer treatments.

  13. Incidence, Types and Characteristics of Aggressive Behaviour in Treatment Facilities for Adults with Mild Intellectual Disability and Severe Challenging Behaviour

    ERIC Educational Resources Information Center

    Tenneij, N. H.; Koot, H. M.

    2008-01-01

    Background: Inpatient aggression in treatment facilities for persons with intellectual disability (ID) can have aversive consequences, for co-clients and staff, but also for the aggressors themselves. To manage and eventually prevent inpatient aggressive incidents, more knowledge about their types and characteristics is necessary. Method: In four…

  14. Outcome of treatment for alcohol abuse and involvement in alcoholics anonymous among previously untreated problem drinkers

    Microsoft Academic Search

    Christine Timko; Rudolf H. Moos; John W. Finney; Bernice S. Moos

    1994-01-01

    A sample of 515 initially untreated problem drinkers was followed for one year after contacting alcohol information and referral\\u000a or detoxification services. At a one-year follow-up, participants had self-selected into one of four groups: no treatment\\u000a (24%), Alcoholics Anonymous (AA) only (18%), outpatient treatment (25%), and residential or inpatient treatment (32%); some\\u000a outpatients also attended AA, and some inpatients also

  15. Accumulated coercion and short-term outcome of inpatient psychiatric care

    PubMed Central

    2010-01-01

    Background The knowledge of the impact of coercion on psychiatric treatment outcome is limited. Multiple measures of coercion have been recommended. The aim of the study was to examine the impact of accumulated coercive incidents on short-term outcome of inpatient psychiatric care Methods 233 involuntarily and voluntarily admitted patients were interviewed within five days of admission and at discharge or after maximum three weeks of care. Coercion was measured as number of coercive incidents, i.e. subjectively reported and in the medical files recorded coercive incidents, including legal status and perceived coercion at admission, and recorded and reported coercive measures during treatment. Outcome was measured both as subjective improvement of mental health and as improvement in professionally assessed functioning according to GAF. Logistic regression analyses were performed with patient characteristics and coercive incidents as independent and the two outcome measures as dependent variables Results Number of coercive incidents did not predict subjective or assessed improvement. Patients having other diagnoses than psychoses or mood disorders were less likely to be subjectively improved, while a low GAF at admission predicted an improvement in GAF scores Conclusion The results indicate that subjectively and professionally assessed mental health short-term outcome of acute psychiatric hospitalisation are not predicted by the amount of subjectively and recorded coercive incidents. Further studies are needed to examine the short- and long-term effects of coercive interventions in psychiatric care. PMID:20584301

  16. Outcome of HIV-infected patients transferred to a specialist inpatient unit.

    PubMed

    Whitehorn, J; Edwards, S G; Cartledge, J D; Miller, R F

    2011-04-01

    The British HIV Association (BHIVA) recommends that specialist clinical networks are involved in care of HIV-positive patients admitted to district general hospitals (DGHs) and that transfer to a specialist HIV treatment centre is considered for each patient. We audited our experience of 29 patients transferred to our specialist inpatient unit over a two year period. Fifteen (52%) patients were known to be HIV-infected before admission to the referring hospital. Ten (71%) of 14 patients with newly diagnosed HIV had an opportunistic infection at transfer. At the referring hospital the time taken to diagnose HIV infection ranged from one to 26 days (median = 3.5). Only five patients (17%) were transferred by 72 hours of admission to the referring hospital. The duration of stay at our centre was 1-212 days (median = 15): seven patients (24%) required admission to the intensive care unit. Seven patients died; of these, three had newly diagnosed HIV infection. This audit demonstrates that sick HIV-infected patients transferred to a specialist HIV unit had a poor outcome and lengthy hospital admissions. Our audit supports roll-out of HIV testing to avoid adverse outcomes associated with late diagnosis and development of clinical networks involving specialist HIV treatment centres in order to support provision of HIV care in DGHs. PMID:21515756

  17. Caring for inpatient boarders in the emergency department: improving safety and patient and staff satisfaction.

    PubMed

    Bornemann-Shepherd, Melanie; Le-Lazar, Jamie; Makic, Mary Beth Flynn; DeVine, Deborah; McDevitt, Kelly; Paul, Marcee

    2015-01-01

    Hospital capacity constraints lead to large numbers of inpatients being held for extended periods in the emergency department. This creates concerns with safety, quality of care, and dissatisfaction of patients and staff. The aim of this quality-improvement project was to improve satisfaction and processes in which nurses provided care to inpatient boarders held in the emergency department. A quality-improvement project framework that included the use of a questionnaire was used to ascertain employee and patient dissatisfaction and identify opportunities for improvement. A task force was created to develop action plans related to holding and caring for inpatients in the emergency department. A questionnaire was sent to nursing staff in spring 2012, and responses from the questionnaire identified improvements that could be implemented to improve care for inpatient boarders. Situation-background-assessment-recommendation (SBAR) communications and direct observations were also used to identify specific improvements. Post-questionnaire results indicated improved satisfaction for both staff and patients. It was recognized early that the ED inpatient area would benefit from the supervision of an inpatient director, managers, and staff. Outcomes showed that creating an inpatient unit within the emergency department had a positive effect on staff and patient satisfaction. PMID:24985747

  18. Effects of tailored neck-shoulder pain treatment based on a decision model guided by clinical assessments and standardized functional tests. A study protocol of a randomized controlled trial

    PubMed Central

    2012-01-01

    Background A major problem with rehabilitation interventions for neck pain is that the condition may have multiple causes, thus a single treatment approach is seldom efficient. The present study protocol outlines a single blinded randomised controlled trial evaluating the effect of tailored treatment for neck-shoulder pain. The treatment is based on a decision model guided by standardized clinical assessment and functional tests with cut-off values. Our main hypothesis is that the tailored treatment has better short, intermediate and long-term effects than either non-tailored treatment or treatment-as-usual (TAU) on pain and function. We sub-sequentially hypothesize that tailored and non-tailored treatment both have better effect than TAU. Methods/Design 120 working women with minimum six weeks of nonspecific neck-shoulder pain aged 20–65, are allocated by minimisation with the factors age, duration of pain, pain intensity and disability in to the groups tailored treatment (T), non-tailored treatment (NT) or treatment-as-usual (TAU). Treatment is given to the groups T and NT for 11?weeks (27 sessions evenly distributed). An extensive presentation of the tests and treatment decision model is provided. The main treatment components are manual therapy, cranio-cervical flexion exercise and strength training, EMG-biofeedback training, treatment for cervicogenic headache, neck motor control training. A decision algorithm based on the baseline assessment determines the treatment components given to each participant of T- and NT-groups. Primary outcome measures are physical functioning (Neck Disability Index) and average pain intensity last week (Numeric Rating Scale). Secondary outcomes are general improvement (Patient Global Impression of Change scale), symptoms (Profile Fitness Mapping neck questionnaire), capacity to work in the last 6?weeks (quality and quantity) and pressure pain threshold of m. trapezius. Primary and secondary outcomes will be reported for each group with effect size and its precision. Discussion We have chosen not to include women with psychological ill-health and focus on biomedical aspects of neck pain. Future studies should aim at including psychosocial aspects in a widened treatment decision model. No important adverse events or side-effects are expected. Trial registration Current Controlled Trials registration ISRCTN49348025. PMID:22607546

  19. Teaching Nursing Leadership: Comparison of Simulation versus Traditional Inpatient Clinical.

    PubMed

    Gore, Teresa N; Johnson, Tanya Looney; Wang, Chih-hsuan

    2015-01-01

    Nurse educators claim accountability to ensure their students are prepared to assume leadership responsibilities upon graduation. Although front-line nurse leaders and nurse executives feel new graduates are not adequately prepared to take on basic leadership roles, professional nursing organizations such as the American Nurses Association (ANA) and the Association of Colleges of Nursing (AACN) deem leadership skills are core competencies of new graduate nurses. This study includes comparison of a leadership-focused multi-patient simulation and the traditional leadership clinical experiences in a baccalaureate nursing leadership course. The results of this research show both environments contribute to student learning. There was no statistical difference in the overall score. Students perceived a statistically significant difference in communication with patients in the traditional inpatient environment. However, the students perceived a statistical significant difference in teaching-learning dyad toward simulation. PMID:25928758

  20. Inpatient vs. Observation: Will it ever be clear?

    PubMed

    2015-08-01

    Hospitals are still struggling with whether patients should be admitted or receive observation services despite efforts by the Centers for Medicare & Medicaid Services to clear up the confusion and conduct Probe and Educate audits. The two-midnight rule bases patient status on time in the hospital rather than clinical criteria, but case managers should still use decision-support software to determine if patients meet medical necessity criteria for an inpatient stay. Take a proactive approach and educate physicians up front about the level of detail the documentation should include to reflect the patient's conditions and intensity of service, and give them prompts in the medical record about what they should include. Notify patients that they are receiving observation services and that they may get a bill for their copay and pharmacy charges. PMID:26189318

  1. Self-care program for inpatients in a mental hospital.

    PubMed Central

    Voineskos, G.; Butler, J. A.; Bullock, L. J.; El-Gaaly, A. A.

    1975-01-01

    Summary: A self-care program for selected inpatients in a mental hospital has been developed and has been in operation for more than a year. The 12-bed unit operates without any nursing or other professional staff during the night and weekend. Certain factors, including the mental hospital as an organization, tend to hamper the development of this type of program as well as the progress and growth of other programs in psychiatric hospitals. It is suggested that the much needed progress in the mental hospital would be facilitated by an open-systems approach to its organization. Mental hospitals should consider the introduction of self-care programs for selected patients, mainly in view of their therapeutic potential, but also because of the financial savings such programs offer. PMID:1111874

  2. Predicting length of hospital stay for psychiatric inpatients.

    PubMed

    Kiesler, C A; Simpkins, C; Morton, T

    1990-02-01

    Medicare's use of diagnosis-related groups and the frequent acceptance of length of stay as an indicator of resource utilization has caused a surge of interest in the predictability of length of hospital stay for psychiatric inpatients. By constructing a weighted least squares regression model using data from the 1980 Hospital Discharge Survey, the authors were able to account for an increased amount of variance in length of stay for the major diagnostic categories of mental disorder and substance abuse for Medicare and Blue Cross/Blue Shield patients. The enhanced ability to predict length of stay is attributed to a carefully constructed data base and an increased number of predictor variables, particularly comorbidity. Knowledge of the presence or absence of a chemical dependency unit in the hospitals from which patients were discharged substantially increased the proportion of variance accounted for in the analysis. PMID:2105904

  3. Nursing administrators' experiences in managing PDA use for inpatient units.

    PubMed

    Lee, Ting-Ting

    2006-01-01

    The adoption of information technology in patient care has become a trend in healthcare organizations. The impact of this technology on end users has been widely studied, but little attention has been given to its influence from a management perspective. The purpose of this study was to explore nurse managers' perceived experiences in implementing a policy to adopt personal digital assistant technology. A descriptive, exploratory qualitative approach (one-on-one, in-depth interviews) was used to collect data from 16 nurse managers of inpatient units at a medical center in Taiwan. Interview data were analyzed according to Miles and Huberman's data reduction, data display, and conclusion verification process. The results revealed that nurse managers experienced the limitations of technology, training issues, doctors' obstructive influence, role conflict, and improvement of future personal digital assistant use. These results can be used to improve strategic organizational planning and in-service training programs to implement information systems. PMID:16980781

  4. The general adult inpatient psychiatric assessment scale (GAIPAS).

    PubMed

    Summers, W K; Marsh, G M; Chiong, B; Burgoyne, R M; Swenson, S W; Walker, N R

    1983-11-01

    The General Adult Inpatient Psychiatric Assessment Scale (GAIPAS) is a "here and now" testing instrument based on the general mental status examination. The unique features of the GAIPAS include high interrater reliability with minimal training, "forced choice" format, a scoring method for hostile patients, brief administration time, and a format that lends itself to direct key punch of data. The GAIPAS may be used to follow a symptom, a set of symptoms, or collapsed into a single number comparable to the Global Assessment Scale. Interrater reliability of GAIPAS by interviewer/observer design is given in detail. The GAIPAS is compared to the Brief Psychiatric Rating Scale (BPRS) and Global Assessment Scale (GAS) in the same population for interrater reliability. PMID:6582529

  5. Screening for understanding of research in the inpatient psychiatry setting.

    PubMed

    Hickman, Norval J; Prochaska, Judith J; Dunn, Laura B

    2011-09-01

    People with mental illness constitute a substantial proportion of smokers and an important population for smoking cessation research. Obtaining informed consent in this population is a critical ethical endeavor. We examined performance on a three-item instrument (3Q) designed to screen for understanding of several key elements of research: study purpose, risks, and benefits. Patients were clinically diagnosed with primary unipolar depression (n = 40), a primary psychotic disorder (n = 32), both mood and psychotic disorders (n = 17), and primary bipolar disorder (n = 14). Among an ethnically diverse sample of 124 psychiatric inpatients approached for a smoking cessation trial, 107 (86%) performed adequately on the 3Q (i.e., obtained a score of at least 3 out of a possible 6). Patients were better able to identify the study risks and benefits than to describe the study purpose. The 3Q appears to be a useful tool for researchers working with vulnerable psychiatric patients. PMID:21931239

  6. MORTALITY IN PERSONS WITH MENTAL DISORDERS IS SUBSTANTIALLY OVERESTIMATED USING INPATIENT PSYCHIATRIC DIAGNOSES

    PubMed Central

    Ioannidis, John P. A.; Sundquist, Kristina; Winkleby, Marilyn A.; Sundquist, Jan

    2013-01-01

    Mental disorders are associated with premature mortality, and the magnitudes of risk have commonly been estimated using hospital data. However, psychiatric patients who are hospitalized have more severe illness and do not adequately represent mental disorders in the general population. We conducted a national cohort study using outpatient and inpatient diagnoses for the entire Swedish adult population (N=7,253,516) to examine the extent to which mortality risks are overestimated using inpatient diagnoses only. Outcomes were all-cause and suicide mortality during 8 years of follow-up (2001–2008). There were 377,339 (5.2%) persons with any inpatient psychiatric diagnosis, vs. 680,596 (9.4%) with any inpatient or outpatient diagnosis, hence 44.6% of diagnoses were missed using inpatient data only. When including and accounting for prevalent psychiatric cases, all-cause mortality risk among persons with any mental disorder was overestimated by 15.3% using only inpatient diagnoses (adjusted hazard ratio [aHR], 5.89; 95% CI, 5.85–5.92) vs. both inpatient and outpatient diagnoses (aHR, 5.11; 95% CI, 5.08–5.14). Suicide risk was overestimated by 18.5% (aHRs, 23.91 vs. 20.18), but this varied widely by specific disorders, from 4.4% for substance use to 49.1% for anxiety disorders. The sole use of inpatient diagnoses resulted in even greater overestimation of all-cause or suicide mortality risks when prevalent cases were unidentified (~20–30%) or excluded (~25–40%). However, different methods for handling prevalent cases resulted in only modest variation in risk estimates when using both inpatient and outpatient diagnoses. These findings have important implications for the interpretation of hospital-based studies and the design of future studies. PMID:23806577

  7. Changes in Religious Coping and Relapse to Drug Use Among Opioid-Dependent Patients Following Inpatient Detoxification

    PubMed Central

    Skalski, Linda M.; Meade, Christina S.

    2013-01-01

    Relapse rates remain high among people with opioid dependence. Identifying psychosocial factors associated with outcomes is important for informing behavioral treatments. This study examined religious coping, opioid use, and 12-step participation among 45 participants receiving inpatient opioid detoxification at baseline and follow-up. At baseline, higher positive coping was related to less frequent opioid use pre-admission (? = ?.44, p < .001) and history of 12-step participation (OR = 2.33, p < .05). Decreases in negative coping after discharge predicted less opioid use (? = .55, p < .001), and increases in positive coping predicted more frequent 12-step program participation (? = .42, p < .05). Positive religious coping may be protective, while negative religious coping may be a barrier to treatment. PMID:21125425

  8. RFID security protocols

    Microsoft Academic Search

    Hoda Daou; Ayman Kayssi; Ali Chehab

    2008-01-01

    We implement and test four RFID security protocols: strong private authentication protocol, efficient mutual-authentication protocol, Dimitriou's lightweight protocol, and advanced semi-randomized access control, by emulating the RFID system. Then, we analyze the results to provide an evaluation of each protocol. RFID tags are very limited in terms of processing power, and cannot perform complex computations. Two types of analysis are

  9. A Simple Nutrition Screening Tool for Pediatric Inpatients.

    PubMed

    White, Melinda; Lawson, Karen; Ramsey, Rebecca; Dennis, Nicole; Hutchinson, Zoe; Soh, Xin Ying; Matsuyama, Misa; Doolan, Annabel; Todd, Alwyn; Elliott, Aoife; Bell, Kristie; Littlewood, Robyn

    2014-08-01

    Background: Pediatric nutrition risk screening tools are not routinely implemented throughout many hospitals, despite prevalence studies demonstrating malnutrition is common in hospitalized children. Existing tools lack the simplicity of those used to assess nutrition risk in the adult population. This study reports the accuracy of a new, quick, and simple pediatric nutrition screening tool (PNST) designed to be used for pediatric inpatients. Materials and Methods: The pediatric Subjective Global Nutrition Assessment (SGNA) and anthropometric measures were used to develop and assess the validity of 4 simple nutrition screening questions comprising the PNST. Participants were pediatric inpatients in 2 tertiary pediatric hospitals and 1 regional hospital. Results: Two affirmative answers to the PNST questions were found to maximize the specificity and sensitivity to the pediatric SGNA and body mass index (BMI) z scores for malnutrition in 295 patients. The PNST identified 37.6% of patients as being at nutrition risk, whereas the pediatric SGNA identified 34.2%. The sensitivity and specificity of the PNST compared with the pediatric SGNA were 77.8% and 82.1%, respectively. The sensitivity of the PNST at detecting patients with a BMI z score of less than -2 was 89.3%, and the specificity was 66.2%. Both the PNST and pediatric SGNA were relatively poor at detecting patients who were stunted or overweight, with the sensitivity and specificity being less than 69%. Conclusion: The PNST provides a sensitive, valid, and simpler alternative to existing pediatric nutrition screening tools such as Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), Screening Tool Risk on Nutritional status and Growth (STRONGkids), and Paediatric Yorkhill Malnutrition Score (PYMS) to ensure the early detection of hospitalized children at nutrition risk. PMID:25096546

  10. The utility and financial implications of obtaining routine laboratory screening upon admission for child and adolescent psychiatric inpatients.

    PubMed

    Feldman, Lance; Chen, Yixing

    2011-09-01

    The authors retrospectively explored the utility and fiscal implications of obtaining routine laboratory screening upon admission for child and adolescent psychiatric inpatients. A chart review of 153 sequential admissions (142 unique patients, with 11 patients admitted twice) over a recent 4-month period was conducted. Overall, 97.2% of all subjects who received a screening laboratory test had at least one abnormal finding. However, only four test results (<0.5%) actually had an impact on the psychiatric treatment plan or required immediate medical attention. With an average cost per patient for the full screening battery of $33-$122 and an average yearly direct cost to the inpatient unit of almost $38,000, potential alternatives to routine admission screenings are discussed. Given the cost of this relatively low yield outcome, these findings have important implications for psychiatric practice and cost-benefit analyses, which need to be further evaluated to better determine the actual utility of routine laboratory examinations upon admission. PMID:21926534

  11. Prevalence and Risk Factors of Violence by Psychiatric Acute Inpatients: A Systematic Review and Meta-Analysis

    PubMed Central

    Iozzino, Laura; Ferrari, Clarissa; Large, Matthew; Nielssen, Olav; de Girolamo, Giovanni

    2015-01-01

    Background Violence in acute psychiatric wards affects the safety of other patients and the effectiveness of treatment. However, there is a wide variation in reported rates of violence in acute psychiatric wards. Objectives To use meta-analysis to estimate the pooled rate of violence in published studies, and examine the characteristics of the participants, and aspects of the studies themselves that might explain the variation in the reported rates of violence (moderators). Method Systematic meta-analysis of studies published between January 1995 and December 2014, which reported rates of violence in acute psychiatric wards of general or psychiatric hospitals in high-income countries. Results Of the 23,972 inpatients described in 35 studies, the pooled proportion of patients who committed at least one act of violence was 17% (95% confidence interval (CI) 14–20%). Studies with higher proportions of male patients, involuntary patients, patients with schizophrenia and patients with alcohol use disorder reported higher rates of inpatient violence. Conclusion The findings of this study suggest that almost 1 in 5 patients admitted to acute psychiatric units may commit an act of violence. Factors associated with levels of violence in psychiatric units are similar to factors that are associated with violence among individual patients (male gender, diagnosis of schizophrenia, substance use and lifetime history of violence). PMID:26061796

  12. Different associations of alcohol cue reactivity with negative alcohol expectancies in mandated and inpatient samples of young adults

    PubMed Central

    Eddie, D.; Buckman, J.F.; Mun, E.Y.; Vaschillo, B.; Vaschillo, E.; Udo, T.; Lehrer, P.; Bates, M.E.

    2015-01-01

    Alcohol cue reactivity, operationalized as a classically conditioned response to an alcohol related stimulus, can be assessed by changes in physiological functions such as heart rate variability (HRV), which reflect real time regulation of emotional and cognitive processes. Although ample evidence links drinking histories to cue reactivity, it is unclear whether in-the-moment cue reactivity becomes coupled to a set of consolidated beliefs about the effects of alcohol (i.e., expectancies) and whether treatment helps dissociate the relation of positive versus negative expectancies to cue reactivity. This study examined the relationship between reactivity to alcohol picture cues and alcohol expectancies in two groups of emerging adults: an inpatient sample with alcohol use disorders (n=28) and a college student sample who previously were mandated to a brief intervention for violating university policies about alcohol use in residence halls (n=43). Sequential regression analysis was conducted using several HRV indices and self-report arousal ratings as cue reactivity measures. Results indicated that the relationship between cue reactivity and negative alcohol outcome expectancies differed for the two groups. Greater cue reactivity, assessed using HRV indices, was associated with more negative expectancies in the inpatient sample but with less negative expectancies in the mandated student sample, while an opposite trend was found for subjective arousal. The present findings highlight the importance of characterizing cue reactivity through multi-dimensional assessment modalities that include physiological markers such as HRV. PMID:23396175

  13. A descriptive study of symptom change as a function of attachment and emotion regulation in a naturalistic adolescent inpatient setting.

    PubMed

    Venta, Amanda; Sharp, Carla; Newlin, Elizabeth

    2015-01-01

    This is the first study to describe the relation between attachment security, emotion regulation, and symptom change in a sample of adolescents completing inpatient treatment in a naturalistic setting. We examined whether attachment security predicted symptom change, and whether emotion regulation capacities mediated this relation. A sample of n = 194 inpatient adolescents was assessed (65.5 % female, Mage = 15.45 years, SD = 1.44) at admission and discharge and analyses were conducted in accordance with the aforementioned objectives including testing of moderation and mediation models. We found that securely attached adolescents experienced greater reduction in internalizing symptoms from admission to discharge, even when controlling for length of stay. Nonacceptance of emotional responses mediated the relation between maternal attachment security and internalizing symptom change. These findings did not hold for externalizing symptoms, nor when paternal attachment was explored. Attachment plays an important role in symptom change for internalizing problems, with nonacceptance of emotional responses partially mediating this link. Possible explanations for the absence of moderation for paternal attachment and externalizing problems are discussed, as are explanations for the mediating effect of emotion regulation. PMID:24659132

  14. The Italian version of the Physical Therapy Patient Satisfaction Questionnaire - [PTPSQ-I(15)]: psychometric properties in a sample of inpatients

    PubMed Central

    2014-01-01

    Background In a previous study we described the translation, cultural adaptation, and validation of the Italian version of the PTPSQ [PTPSQ-I(15)] in outpatients. To the authors’ knowledge, the PTPSQ was never studied in a hospital setting. The aims of this study were: (1) to establish the psychometric properties of the Physical Therapy Patient Satisfaction Questionnaire [PTPSQ- I(15)] in a sample of Italian inpatients, and (2) to investigate the relationships between the characteristics of patients and physical therapists and the indicators of satisfaction. Methods The PTPSQ-I(15) was administered to inpatients in a Physical Medicine and Rehabilitation Unit. Reliability of the PTPSQ-I(15) was measured by internal consistency (Cronbach’s ?) and test-retest stability (ICC 3,1). The internal structure was investigated by factor analysis. Divergent validity was measured by comparing the PTPSQ-I(15) with a Visual Analogue Scale (VAS) for pain and with a 5-point Likert-type scale evaluating the Global Perceived Effect (GPE) of the physical therapy treatment. Results The PTPSQ-I(15) was administered to 148 inpatients, and 73 completed a second administration. The PTPSQ-I(15) showed high internal consistency (??=?0.949) and test-retest stability (ICC?=?0.996). Divergent validity was moderate for the GPE (r?=?? 0.502, P?inpatients demonstrated strong psychometric properties and its use can be recommended with Italian-speaking population. Further studies are suggested on the concurrent validity and on the psychometric properties of the PTPSQ-I(15) in different hospital settings or with other pathological conditions. PMID:24758356

  15. STREAM CONTROL TRANSMISSION PROTOCOL SESSION INITIATION PROTOCOL

    E-print Network

    Trajkovic, Ljiljana

    ) as a standard signaling protocol for service control in Third Generation (3G) wireless network. SIP Abstract In recent years, Session Initiation Protocol (SIP) developed by the Internet Engineering Task with the Internet Multimedia protocol H.323. SIP is also selected by Third Generation Partnership Project (3GPP

  16. Transboundary smoke haze pollution in Malaysia: inpatient health impacts and economic valuation.

    PubMed

    Othman, Jamal; Sahani, Mazrura; Mahmud, Mastura; Ahmad, Md Khadzir Sheikh

    2014-06-01

    This study assessed the economic value of health impacts of transboundary smoke haze pollution in Kuala Lumpur and adjacent areas in the state of Selangor, Malaysia. Daily inpatient data from 2005, 2006, 2008, and 2009 for 14 haze-related illnesses were collected from four hospitals. On average, there were 19 hazy days each year during which the air pollution levels were within the Lower Moderate to Hazardous categories. No seasonal variation in inpatient cases was observed. A smoke haze occurrence was associated with an increase in inpatient cases by 2.4 per 10,000 populations each year, representing an increase of 31 percent from normal days. The average annual economic loss due to the inpatient health impact of haze was valued at MYR273,000 ($91,000 USD). PMID:24682070

  17. 76 FR 59263 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-26

    ...2011. FOR FURTHER INFORMATION CONTACT: Brian...786-5229, Hospital inpatient wage...Long-term care hospital wage data. Caroline...Long-term care hospital quality measures. SUPPLEMENTARY INFORMATION: I....

  18. Results of inpatient survey show the case for safe staffing is undeniable.

    PubMed

    Osborne, Susan

    2015-06-01

    When are we going to learn lessons from the national NHS inpatient survey, published at the end of last month by the Care Quality Commission, which shows standards are sub-optimal in our cherished NHS? PMID:26036398

  19. 5 CFR 890.905 - Limits on inpatient hospital and physician charges.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...inpatient hospital services more than the amount determined to be equivalent to the Medicare part A payment under the DRG-based PPS. (b) Medicare participating providers may not collect from FEHB plans and retired enrolled individuals for physician...

  20. 20 CFR 10.810 - How are payments for inpatient medical services determined?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...services according to pre-determined, condition-specific rates based on the Inpatient Prospective Payment System (IPPS) devised by CMS (42 CFR parts...424, 485, and 489). Using this system, payment is derived by...

  1. 20 CFR 10.810 - How are payments for inpatient medical services determined?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...services according to pre-determined, condition-specific rates based on the Inpatient Prospective Payment System (IPPS) devised by CMS (42 CFR parts...424, 485, and 489). Using this system, payment is derived by...

  2. 75 FR 31118 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-02

    ...Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and...Payment Rates Implementing the Affordable Care Act AGENCY: Centers for Medicare &...

  3. 20 CFR 10.810 - How are payments for inpatient medical services determined?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...services according to pre-determined, condition-specific rates based on the Inpatient Prospective Payment System (IPPS) devised by CMS (42 CFR parts...424, 485, and 489). Using this system, payment is derived by...

  4. 42 CFR 456.201 - UR plan required for inpatient mental hospital services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    42 Public Health 4 2013-10-01...required for inpatient mental hospital services...Section 456.201 Public Health CENTERS FOR MEDICARE...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Utilization Control: Mental Hospitals...

  5. 42 CFR 456.201 - UR plan required for inpatient mental hospital services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    42 Public Health 4 2010-10-01...required for inpatient mental hospital services...Section 456.201 Public Health CENTERS FOR MEDICARE...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Utilization Control: Mental Hospitals...

  6. 42 CFR 456.201 - UR plan required for inpatient mental hospital services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    42 Public Health 4 2012-10-01...required for inpatient mental hospital services...Section 456.201 Public Health CENTERS FOR MEDICARE...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Utilization Control: Mental Hospitals...

  7. 42 CFR 456.201 - UR plan required for inpatient mental hospital services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    42 Public Health 4 2011-10-01...required for inpatient mental hospital services...Section 456.201 Public Health CENTERS FOR MEDICARE...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Utilization Control: Mental Hospitals...

  8. 42 CFR 456.201 - UR plan required for inpatient mental hospital services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    42 Public Health 4 2014-10-01...required for inpatient mental hospital services...Section 456.201 Public Health CENTERS FOR MEDICARE...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Utilization Control: Mental Hospitals...

  9. Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology

    PubMed Central

    Goldfarb, Stanley; McCullough, Peter A.; McDermott, John; Gay, Spencer B.

    2009-01-01

    Contrast-induced acute kidney injury (AKI) (also known as contrast-induced nephropathy) is an abrupt deterioration in renal function that can be associated with use of iodinated contrast medium. Although the increase in serum creatinine concentration is transient in most cases, contrast-induced AKI may lead to increased morbidity and mortality rates in selected at-risk populations. This review summarizes the findings of a multidisciplinary panel composed of computed tomography radiologists, interventional radiologists, cardiologists, and nephrologists convened to address the specialty-specific issues associated with minimizing the incidence of contrast-induced AKI. As part of this initiative, the panel developed specialty-specific protocols for preventing contrast-induced AKI, taking into account, for example, the variations in patient risk profile, inpatient or outpatient status, and staffing resources that characterize various clinical settings. The 3 protocols, each reflecting a consensus of expert opinion, address the prevention of contrast-induced AKI in interventional radiology, diagnostic computed tomography radiology, and interventional cardiology settings. The protocols are presented in the context of a review of recent guidelines and published reports of trials that discuss contrast-induced AKI and its prevention. The panel reviewed materials retrieved by a PubMed search covering the period January 1990 through January 2008 and used combinations of key words associated with the prevention and treatment of contrast-induced AKI. In addition, the panel reviewed the reference lists of selected articles and the tables of contents posted on the Web sites of selected journals for relevant publications not retrieved in the PubMed searches. PMID:19181651

  10. [Concurrent inpatient smoking cessation and alcohol abstinence programs for alcoholics and their outcomes].

    PubMed

    Yokoyama, Akira; Mizukami, Takeshi; Nakayama, Hideki; Takimura, Tsuyoshi; Sakuma, Hiroshi; Yoshimura, Atsushi; Yoneda, Junichi; Maesato, Hitoshi; Kimura, Mitsuru; Matsushita, Sachio; Higuchi, Susumu

    2014-12-01

    Alcoholics have a high prevalence of nicotine dependence, and smoking is a major contributor to their high mortality. Three weeks after admission to an addiction center in Japan, 193 alcoholic men who were participating in an 11-week concurrent inpatient smoking cessation and alcohol abstinence programs filled out an anonymous self-report questionnaire regarding smoking and drinking, and 6 months after the completion of the programs, 83 patients were asked to respond to a mailed questionnaire about their smoking and drinking status. Of the 193 subjects, 73.3% were current smokers, but many were highly motivated in regard to both smoking cessation and alcohol abstinence. The subjects' scores on a 0 to 10 point scale for rating motivation and confidence in regard to smoking cessation and smoking urge were significantly correlated with each other and with their scores for motivation and confidence in regard to alcohol abstinence and drinking urge. Three weeks after admission, varenicline treatment was well-tolerated, and the varenicline group had a high rate of smoking cessation than the smoker group not treated with varenicline (67.7% vs. 44.6%, p = 0.012). Forty-six (55.4%) of the 83 subjects who were mailed the questionnaire responded, and the drinking category was 'totally abstinent' in 35 subjects (42.2%), and 'mostly abstinent' in another 4 subjects (4.8%). Seventeen (20.5%) of the 83 subjects were non-smokers before treatment, but after treatment, 23 (50.0%) of the 46 responders and 20 (51.3%) of the 'totally or mostly abstinent' 39 responders were total or almost non-smokers. The response rate of 'totally or mostly abstinent' was higher among the 17 non-smokers before treatment than among the 66 smokers before treatment (70.6% vs. 40.9%, p = 0.033), and the age-adjusted odds ratio (95% confidence interval) for the response of 'totally or mostly abstinent' was 3.30 (1.03-10.56) for the non-smokers before treatment (vs. the smokers before treatment). In conclusion, smoking status had a great impact on the drinking status of treatment-seeking alcoholic men, and smoking cessation should be recommended to smoking alcoholics. PMID:25831952

  11. The Relationship Between Seclusion and Restraint Use and Childhood Abuse Among Psychiatric Inpatients

    Microsoft Academic Search

    Joseph H. Hammer; Justin Springer; Niels C. Beck; Anthony Menditto; James Coleman

    2011-01-01

    Seclusion and restraint (S\\/R) is a controversial topic in the field of psychiatry, due in part to the high rates of childhood physical and sexual abuse found among psychiatric inpatients. The trauma-informed care perspective suggests that the use of S\\/R with previously abused inpatients may result in retraumatization due to mental associations between childhood trauma and the experience during S\\/R.

  12. Application of a Quality Management System Model for Inpatient Medication Use; Approved Guideline—Second Edition

    Microsoft Academic Search

    Steven P. Gray; Susan Blonshine; Carl D. Mottram; Lucia M. Berte

    CLSI document HS10-A2—Application of a Quality Management System Model for Inpatient Medication Use; Approved Guideline—Second Edition describes the hospital inpatient medication system path of workflow, and provides information for medication system operations that will assist the hospital in improving its medication-related processes and meeting governmental and accreditation requirements. This document, when used with CLSI\\/NCCLS document HS1—A Quality Management System Model

  13. DRD4 receptor gene exon III polymorphism in inpatient suicidal adolescents

    Microsoft Academic Search

    G. Zalsman; A. Frisch; R. Lewis; E. Michaelovsky; H. Hermesh; L. Sher; E. Nahshoni; L. Wolovik; S. Tyano; A. Apter; R. Weizman; A. Weizman

    2004-01-01

    Summary. Some studies have suggested possible association of the dopamine receptor subtype 4 (DRD4) gene exon III 48?bp repeat polymorphism with novelty seeking behavior. As suicidal behavior in adolescents is linked to risk taking behavior, we evaluated the association of suicidality with DRD4 polymorphism in Israeli inpatient suicidal adolescents. Sixty-nine inpatient adolescents who recently attempted suicide were assessed by structured

  14. Pattern and Outcome of admission to a medical oncology inpatient service

    Microsoft Academic Search

    Faruk Tas; Andac Argon; Rian Disci; Erkan Topuz

    2007-01-01

    Background. Inpatient medical oncology has not been properly described in many countries including Turkey.Methods. We aimed in this article to describe the admissions to a medical oncology inpatient service within a 2-year period with\\u000a respect to patient characteristics, their malignancies, and outcome of admission.Results. A total of 5305 cancer patients were seen at our hospital, and 779 (14.7%) were hospitalized.

  15. Measuring population health risks using inpatient diagnoses and outpatient pharmacy data

    Microsoft Academic Search

    Yang Zhao; Randall P. Ellis; Arlene S. Ash; David Calabrese; John Z. Ayanian; James P. Slaughter; Lori Weyuker; Bruce Bowen

    2005-01-01

    OBJECTIVE: To examine and evaluate models that use inpatient encounter data and outpatient pharmacy claims data to predict future health care expenditures.\\u000aDATA SOURCES\\/STUDY DESIGN: The study group was the privately insured under-65 population in the 1997 and 1998 MEDSTAT Market Scan (R) Research Database. Pharmacy and disease profiles, created from pharmacy claims and inpatient encounter data, respectively, were used

  16. Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care

    Microsoft Academic Search

    Aaron T. Beck; David Guth; Robert A. Steer; Roberta Ball

    1997-01-01

    To ascertain how effective the Beck Depression Inventory for Primary Care (BDI-PC) was for differentiating medical inpatients who were and were not diagnosed with DSM-IV major depression disorders (MDD), this 7-item self-report instrument composed of cognitive and affective symptoms was administered to 50 medical inpatients along with the Depression subscale (HDS) from the Hospital Anxiety and Depression Scale (Zigmond &

  17. Using routine inpatient data to identify patients at risk of hospital readmission

    Microsoft Academic Search

    Stuart Howell; Michael Coory; Jennifer Martin; Stephen Duckett

    2009-01-01

    BACKGROUND: A relatively small percentage of patients with chronic medical conditions account for a much larger percentage of inpatient costs. There is some evidence that case-management can improve health and quality-of-life and reduce the number of times these patients are readmitted. To assess whether a statistical algorithm, based on routine inpatient data, can be used to identify patients at risk

  18. Treatment of antipsychotic-associated obesity with a GLP-1 receptor agonist—protocol for an investigator-initiated prospective, randomised, placebo-controlled, double-blinded intervention study: the TAO study protocol

    PubMed Central

    Ishøy, Pelle L; Knop, Filip K; Broberg, Brian V; Baandrup, Lone; Fagerlund, Birgitte; Jørgensen, Niklas R; Andersen, Ulrik B; Rostrup, Egill; Glenthøj, Birte Y; Ebdrup, Bjørn H

    2014-01-01

    Introduction Antipsychotic medication is widely associated with dysmetabolism including obesity and type 2 diabetes, cardiovascular-related diseases and early death. Obesity is considered the single most important risk factor for cardiovascular morbidity and mortality. Interventions against antipsychotic-associated obesity are limited and insufficient. Glucagon-like peptide-1 (GLP-1) receptor agonists are approved for the treatment of type 2 diabetes, but their bodyweight-lowering effects have also been recognised in patients with non-diabetes. The primary endpoint of this trial is weight loss after 3?months of treatment with a GLP-1 receptor agonist (exenatide once weekly) in patients with non-diabetic schizophrenia with antipsychotic-associated obesity. Secondary endpoints include physiological and metabolic measurements, various psychopathological and cognitive measures, and structural and functional brain MRI. Methods and analysis 40 obese patients with schizophrenia or schizoaffective disorder treated with antipsychotic drugs will be randomised to subcutaneous injection of exenatide once weekly (2?mg) or placebo for 3?months, adjunctive to their antipsychotic treatment. Ethics and dissemination The trial has been approved by the Danish Health and Medicines Authority, the National Committee on Health Research Ethics and the Danish Data Protection Agency. Trial participation presupposes theoral and written patient informed consent. An external, independent monitoring committee (Good Clinical Practice Unit at Copenhagen University Hospital) will monitor the study according to the GCP Guidelines. Trial data, including positive, negative and inconclusive results, will be presented at national and international scientific meetings and conferences. Papers will be submitted to peer-reviewed journals. Trial registration ClinicalTrials.gov identifier: NCT01794429; National Committee on Health Research Ethics project number: 36378; EudraCT nr: 2012-005404-17; The Danish Data Protection Agency project number: RHP-2012-027. PMID:24401727

  19. Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2008 rates.

    PubMed

    2007-08-22

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs to implement changes arising from our continuing experience with these systems, and to implement certain provisions made by the Deficit Reduction Act of 2005 (Pub. L. 109-171), the Medicare Improvements and Extension Act under Division B, Title I of the Tax Relief and Health Care Act of 2006 (Pub. L. 109-432), and the Pandemic and All Hazards Preparedness Act (Pub. L. 109-417). In addition, in the Addendum to this final rule with comment period, we describe the changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. We also are setting forth the rate of increase limits for certain hospitals and hospital units excluded from the IPPS that are paid on a reasonable cost basis subject to these limits, or that have a portion of a prospective payment system payment based on reasonable cost principles. These changes are applicable to discharges occurring on or after October 1, 2007. In this final rule with comment period, as part of our efforts to further refine the diagnosis related group (DRG) system under the IPPS to better recognize severity of illness among patients, for FY 2008, we are adopting a Medicare Severity DRG (MS DRG) classification system for the IPPS. We are also adopting the structure of the MS-DRG system for the LTCH prospective payment system (referred to as MS-LTC-DRGs) for FY 2008. Among the other policy decisions and changes that we are making, we are making changes related to: limited revisions of the reclassification of cases to MS-DRGs, the relative weights for the MS-LTC-DRGs; applications for new technologies and medical services add-on payments; the wage data, including the occupational mix data, used to compute the FY 2008 wage indices; payments to hospitals for the indirect costs of graduate medical education; submission of hospital quality data; provisions governing the application of sanctions relating to the Emergency Medical Treatment and Labor Act of 1986 (EMTALA); provisions governing the disclosure of physician ownership in hospitals and patient safety measures; and provisions relating to services furnished to beneficiaries in custody of penal authorities. PMID:17847578

  20. In-patient to isocenter KERMA ratios in CT

    SciTech Connect

    Huda, Walter; Ogden, Kent M.; Lavallee, Robert L.; Roskopf, Marsha L.; Scalzetti, Ernest M. [Department of Radiology and Radiological Science, Medical University of South Carolina (MUSC), 96 Jonathan Lucas Street (MSC 323), Charleston, South Carolina 29425-3230 (United States); Department of Radiology, SUNY Upstate Medical University, 750 E Adams Street, Syracuse, New York 13210 (United States)

    2011-10-15

    Purpose: To estimate in-patient KERMA for specific organs in computed tomography (CT) scanning using ratios to isocenter free-in-air KERMA obtained using a Rando phantom.Method: A CT scan of an anthropomorphic phantom results in an air KERMA K at a selected phantom location and air kerma K{sub CT} at the CT scanner isocenter when the scan is repeated in the absence of the phantom. The authors define the KERMA ratio (R{sub K}) as K/ K{sub CT}, which were experimentally determined in a Male Rando Phantom using lithium fluoride chips (TLD-100). R{sub K} values were obtained for a total of 400 individual point locations, as well as for 25 individual organs of interest in CT dosimetry. CT examinations of Rando were performed on a GE LightSpeed Ultra scanner operated at 80 kV, 120 kV, and 140 kV, as well as a Siemens Sensation 16 operated at 120 kV. Results: At 120 kV, median R{sub K} values for the GE and Siemens scanners were 0.60 and 0.64, respectively. The 10th percentile R{sub K} values ranged from 0.34 at 80 kV to 0.54 at 140 kV, and the 90th percentile R{sub K} values ranged from 0.64 at 80 kV to 0.78 at 140 kV. The average R{sub K} for the 25 Rando organs at 120 kV was 0.61 {+-} 0.08. Average R{sub K} values in the head, chest, and abdomen showed little variation. Relative to R{sub K} values in the head, chest, and abdomen obtained at 120 kV, R{sub K} values were about 12% lower in the pelvis and about 58% higher in the cervical spine region. Average R{sub K} values were about 6% higher on the Siemens Sensation 16 scanner than the GE LightSpeed Ultra. Reducing the x-ray tube voltage from 120 kV to 80 kV resulted in an average reduction in R{sub K} value of 34%, whereas increasing the x-ray tube voltage to 140 kV increased the average R{sub K} value by 9%. Conclusions: In-patient to isocenter relative KERMA values in Rando phantom can be used to estimate organ doses in similar sized adults undergoing CT examinations from easily measured air KERMA values at the isocenter (free in air). Conversion from in-patient air KERMA values to tissue dose would require the use of energy-appropriate conversion factors.