Sample records for aftercare

  1. Benign positional vertigo - aftercare (United States)

    Vertigo - positional - aftercare; Benign paroxysmal positional vertigo - aftercare; BPPV - aftercare; Dizziness - positional vertigo ... Your health care provider may have treated your vertigo with the Epley maneuver . These are head movements ...

  2. Bacterial vaginosis -- aftercare (United States)

    ... this page: // Bacterial vaginosis - aftercare To use the sharing features on this ... to back after you use the bathroom. Preventing Bacterial Vaginosis You can help prevent bacterial vaginosis by: Not ...

  3. Tailbone trauma - aftercare (United States)

    ... page: // Tailbone trauma - aftercare To use the sharing features on this ... fractured one of these bones. More about Your Injury Most tailbone injuries lead to bruising and pain. ...

  4. Metatarsal stress fractures - aftercare (United States)

    ... page: // Metatarsal stress fractures - aftercare To use the sharing features on ... that connect your ankle to your toes. A stress fracture is a break in the bone that ...

  5. Sacroiliac joint pain - aftercare (United States)

    ... this page: // Sacroiliac joint pain - aftercare To use the sharing features on this page, please enable JavaScript. The sacroiliac joint (SIJ) is a term used to describe the ...

  6. Abortion - surgical - aftercare (United States)

    ... this page: // Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  7. Aftercare for Teenagers: Matching Services and Needs. (United States)

    Fertman, Carl I.


    Explored how drug and alcohol aftercare case management service for adolescents (n=18) contributed to maintenance of drug- and alcohol-free behavior, adherence to aftercare plans, and participation of schools and families in aftercare plans. Found different patterns of outcome results for each of four identified groups of adolescents. Results…

  8. Explorative study on the aftercare of pediatric brain tumor survivors: a parents' perspective

    NARCIS (Netherlands)

    Aukema, E.J.; Last, B.F.; Schouten-van Meeteren, A.Y.N.; Grootenhuis, M.A.


    Whilst the need for aftercare for long-term sequelae of brain tumor survivors is well known and evident, information from a parent's perspective is lacking on whether the need for aftercare is detected in time, and whether the aftercare is timely initiated and meets the needs for aftercare. A survey

  9. The effectiveness of aftercare for juvenile and young adult offenders

    NARCIS (Netherlands)

    James, C.; Asscher, J.J.; Stams, G.J.J.M.; van der Laan, P.H.


    This study examined the New Perspectives Aftercare Program (NPAP) for serious juvenile and young adult offenders in The Netherlands. Participants (n = 127) were randomly assigned to NPAP (n = 66) or existing aftercare services ("treatment as usual" [TAU], n = 61). The aim was to determine whether NP

  10. Juvenile Justice Bulletin: Aftercare Services. Juvenile Justice Practices Series. (United States)

    Gies, Steve V.

    This bulletin examines aftercare services that provide youth with comprehensive health, education, family, and vocational services upon their release from the juvenile justice system. Aftercare can be defined as reintegrative services that prepare out-of-home placed juveniles for reentry into the community by reestablishing the necessary…

  11. Site-specific criteria for the completion of landfill aftercare. (United States)

    Laner, David; Fellner, Johann; Brunner, Paul H


    Municipal solid waste (MSW) landfills need to be managed after closure to assure long-term environmental compatibility. Aftercare can be completed when the authorities consider the landfill not likely to pose a threat to humans and the environment. In this work, a methodology for deriving site-specific aftercare completion criteria is presented and its application is illustrated via a case study. The evaluation method combines models addressing waste emission behavior, long-term barrier performance, and pollutant migration to assess the potential impact of landfill emissions on the environment. Based on the definition of acceptable impact levels at certain points of compliance, scenario- and pollutant-specific aftercare completion criteria are derived. The methodology was applied to a closed MSW landfill in Austria and potential aftercare durations were determined. While landfill gas emissions may become environmentally tolerable within decades at the site, leachate-related aftercare measures were expected to be necessary for centuries (primarily as a result of ammonium). Although the evaluation comes with large uncertainties, it allows for linking aftercare intensity and duration with respect to an environmentally compatible state of the landfill in the absence of aftercare. However, further case studies including regulatory review and acceptance are needed to use the methodology in a decision support tool on aftercare completion.

  12. Efficacy of Outpatient Aftercare for Adolescents with Alcohol Use Disorders: A Randomized Controlled Study (United States)

    Kaminer, Yifrah; Burleson, Joseph A.; Burke, Rebecca H.


    The effectiveness of active aftercare for adolescents with alcohol use disorders in maintaining treatment gains is evaluated. Findings show that active aftercare interventions were effective in slowing the posttreatement relapse of alcohol use in adolescents. Impacts of active aftercare on number of drinking days and heavy drinking days are also…

  13. The influence of distance on utilization of outpatient mental health aftercare following inpatient substance abuse treatment. (United States)

    Schmitt, Susan K; Phibbs, Ciaran S; Piette, John D


    This study examined whether substance abuse patients who live farther from their source of outpatient mental health care were less likely to obtain aftercare following an inpatient treatment episode. For those patients who did receive aftercare, distance was evaluated as a predictor of the volume of care received. A national sample of 33,952 veterans discharged from Department of Veterans Affairs (VA) inpatient substance abuse treatment programs was analyzed using a two-part choice model utilizing logistic and linear regression. Patients living farther from their source of outpatient mental health care were less likely to obtain aftercare following inpatient substance abuse treatment. Patients who traveled 10 miles or less were 2.6 times more likely to obtain aftercare than those who traveled more than 50 miles. Only 40% of patients who lived more than 25 miles from the nearest aftercare facility obtained any aftercare services. Patients who received aftercare services had fewer visits if they lived farther from their source of aftercare. Lack of geographic access (distance) is a barrier to outpatient mental health care following inpatient substance abuse treatment, and influences the volume of care received once the decision to obtain aftercare is made. Aftercare services must be geographically accessible to ensure satisfactory utilization.

  14. Male and Female Perceptions of Aftercare Services and Supports (United States)

    Huscroft-D'Angelo, Jacqueline


    Youth depart residential care with many continued risk factors, unique needs, and challenges as they reintegrate into the home, school, and community settings. Currently, there is limited research on needs and best practices in aftercare services and supports for youth departing from residential settings and even less is known about how these…

  15. Aftercare Following Syndesmotic Screw Placement: A Systematic Review

    NARCIS (Netherlands)

    T. Schepers (Tim); E.M.M. van Lieshout (Esther); H.J.P. van der Linden (Hans); V.M. de Jong; J.C. Goslings (Johannes)


    textabstractFor ankle fractures, in general, several studies have been published on immobilization (e.g., cast or boot) versus early motion after surgical treatment. However, no studies have been performed to determine the best aftercare strategy for surgically treated patients with ankle fractures

  16. Suicidal ideation among adolescents with alcohol use disorders during treatment and aftercare. (United States)

    Kaminer, Yifrah; Burleson, Joseph A; Goldston, David B; Burke, Rebecca H


    The objectives of this study are to assess the magnitude and course of suicidal ideation during outpatient treatment and aftercare for adolescents with alcohol use disorders (AUD). One hundred seventy-seven adolescents meeting eligibility criteria, including no past 30-day suicidal behavior, participated in 9 weeks of outpatient cognitive-behavioral group therapy. Treatment completers were randomized into: (1) No-Active, (2) In-Person, or (3) Telephone aftercare conditions for a period of 12 weeks. No specific intervention for suicidal behavior was provided during the study. The Suicide Ideation Questionnaire (SIQ-JR, Reynolds, 1988) was administered at baseline, end of treatment, and end of aftercare. The results are as follows, a higher baseline suicidal ideation was associated with higher retention at the end of treatment and through aftercare. The In-Person Aftercare condition showed a significant decrease in suicidal ideation, relative to the No-Active Aftercare condition. There was a trend for similarly reduced severity of suicidal ideation in the Telephone Aftercare condition. In conclusion, the type of aftercare and resulting decrease in AUD may play a role in the reduction in suicidal ideation. The mechanism of change by which suicidal ideation is reduced in adolescents in treatment for AUD needs to be further explored.

  17. Social reinforcement of substance abuse treatment aftercare participation: Impact on outcome. (United States)

    Lash, Steven J; Burden, Jennifer L; Monteleone, Brian R; Lehmann, Lauren P


    Although adherence to aftercare therapy in substance abuse treatment is associated with improved outcome, little research has explored the effects of adherence interventions on outcome. We compared 20 graduates of our 28-day intensive treatment program who received a standard aftercare orientation with 20 graduates who received this intervention plus social reinforcement of aftercare group therapy attendance. The social reinforcement group showed less alcohol use than the standard care group at a 6-month follow-up assessment as measured by the Addiction Severity Index (ASI), but not less drug use. Additionally, compared to standard care, the social reinforcement participants were more likely to be abstinent at the 6-month follow up (76% vs. 40%). The groups did not differ on hospital readmission rates over a 12-month follow-up period. Additionally, the social reinforcement group showed better long-term aftercare attendance compared to the standard care group.

  18. Addiction Treatment in America: After Money or Aftercare?

    Directory of Open Access Journals (Sweden)

    David Miller


    Full Text Available There are approximately 14,500 clinics and programs in America that provide treatment for all types of addictive behaviors we call “Reward Deficiency Syndrome (RDS”. While most of these have good intentions to provide needed help to the victims of RDS, we propose herein that most of their efforts, especially during periods of aftercare, are not based on the existing scientific evidence. We use “aftercare” to refer to any form of program or therapy following primary treatment including 12-Step programs. Very few programs actually provide any evidenced-based treatment approaches during this most vulnerable period in recovery. In this trieste we are suggesting that a hypodopaminergic trait (genetic and/or state (epigenetic is critical in terms of continued motivation to use/abuse of alcohol or other drugs and can lead to relapse. While there is evidence for the approved FDA drugs to treat drug addiction (e.g. alcohol, opiates, nicotine these drugs favor a short-term benefit by blocking dopamine. We argue instead for the utilization of long-term benefits that induce “dopamine homeostasis”, or in simpler terms “normalcy”. We suggest that this could be accomplished through a number of holistic modalities including, but not limited to, dopamine-boosting diets, hyper-oxygenation, heavy metal detoxification, exercise, meditation, yoga, and most importantly, brain neurotransmitter balancing with nutraceuticals such as KB220 variants. We embrace 12-step programs and fellowships but not as a stand-alone modality, especially during aftercare. We also provide some scientific basis for why resting state functional connectivity (rsfMRI is so important and may be the cornerstone in terms of how to treat RDS. We postulate that since drugs, food, smoking, gambling, and even compulsive sexual behavior could reduce rsfMRI then modalities (following required research, that can restore this impaired cross talk between various brain regions (e

  19. Endeavors in an experimental study on the effectiveness of an aftercare program in the Netherlands: research note

    NARCIS (Netherlands)

    James, C.; Asscher, J.J.; Dekovic, M.; van der Laan, P.H.; Stams, G.J.J.M.


    This article addresses our endeavors and experiences conducting a Randomized Controlled Trial (RCT) to evaluate a promising aftercare intervention in the Netherlands. New Perspectives Aftercare Program (NPAP) is an intensive reentry program for serious juvenile and young adult offenders, aged 16 to

  20. Fresh Start: A Meta-Analysis of Aftercare Programs for Juvenile Offenders (United States)

    Weaver, Robert D.; Campbell, Derek


    Objectives: A meta-analysis was conducted in order to generate more understanding regarding the efficacy of aftercare programs in reducing the recidivism rates of juvenile offenders reentering their communities following a period of custody. Method: 30 eligible primary studies were obtained through a systematic literature review and were coded.…

  1. Report on Third International Intensive Aftercare Conference in Norrköping, Sweden

    DEFF Research Database (Denmark)

    Jones, Christina; Bäckman, Carl; Egerod, Ingrid


    The third international conference on intensive care unit (ICU) diaries and intensive aftercare took place in Norrköping, Sweden, on 28 November 2013. The conference was organized by Carl Bäckman and colleagues, Vrinnevi Hospital and NOFI, and represented by Sissell Storli. More than 100 clinicians...

  2. A randomized controlled study of exposure therapy as aftercare for alcohol use disorder

    DEFF Research Database (Denmark)

    Mellentin, Angelina Isabella; Nielsen, Bent; Nielsen, Anette Søgaard;


    Background It is well documented that individuals with Alcohol Use Disorder (AUD) respond well during evidence-based psychological treatment, but also that a large proportion relapses when discharged from treatment and confronted with alcohol in real life. Cue Exposure Treatment (CET) focuses...... on exposing individuals to alcohol cues in order to reduce cravings as well as the likelihood of relapse. The aims of the study are: 1) to investigate whether CET aftercare delivered via a smartphone or in group sessions increases the effect of Cognitive Behavioural Treatment in groups of alcohol dependent...... as an investigator-blinded randomized controlled trial. A total of 300 consecutively enrolled alcohol use disorder individuals recruited from an alcohol outpatient clinic will be randomized into one of the three following aftercare groups after concluding primary treatment: (1) CET as a smartphone application; (2...

  3. Group processes and process evaluations in a new treatment setting: inpatient group psychotherapy followed by internet-chat aftercare groups. (United States)

    Haug, Severin; Sedway, Jan; Kordy, Hans


    Little is known about processes characterizing therapeutic Internet-chat groups, which offer a novel way of providing group therapy over distances. In this study group processes and group evaluations were examined in a treatment setting where face-to-face inpatient groups are followed by chat aftercare groups. For a sample of 121 patients who participated in both treatment modalities, group processes and group evaluations were modeled using hierarchical linear modeling. The group evaluations followed a consistent upward course from the beginning of therapy until the end of chat aftercare. For the process measures Activity and Emotional Reactivity, the initial scores at the beginning of the chat groups were lower than at the end of the inpatient treatment, but higher than at admission. During chat aftercare, Activity and Emotional Reactivity scores increased less than during the inpatient phase, but on average Activity and Emotional Reactivity were higher during Internet-chat aftercare. The predictive value of the acquaintance of the therapist from inpatient treatment and the course of group evaluations during inpatient treatment on the course of group evaluations during chat aftercare were examined.

  4. Aftercare services for patients with severe mental disorder: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Majid Barekatain


    Full Text Available Background: Although evidences emphasize on the importance of aftercare programs to achieve continuity of care, different studies have revealed controversial results about the outcome. The objective of this study was to investigate the effect of aftercare program on outcome measures of patients with severe mental disorders. Materials and Methods: Of a total 123 eligible patients with severe mental disorders, 61 patients were randomly assigned to the intervention group and 62 patients to the control group. The interventions included follow-up phone calls, home visits, and psychoeducation for families. Assessments were performed on hospital admission, discharge and the following 3 rd , 6 th and 12 th month. Young Mania Rating Scale (YMRS, Hamilton Depression Rating Scale (HDRS, Positive and Negative Syndrome Scale (PANSS, Global Assessment of Functioning (GAF, Clinical Global Impression (CGI, and the World Health Organization Quality of Life Questionnaire (WHO-QOL were used. Data were analyzed through Chi square, t-test, Mann-Whitney-U, and Repeated Measures Analysis of Co-Variance. Results: Mean of the HDRS scores revealed significant difference between the two groups when HDRS scores on the admission day were controlled (P = 0.028. The level of functioning was significantly different between the two groups based on the sequential assessments of GAF (P = 0.040. One year after the onset of trial, the number of psychiatric readmissions were significantly different between the two groups (P = 0.036. Conclusion: Readmission rates could be reduced by aftercare services, through the first year, after discharge of patients with severe mental disorders. On the other hand, higher levels of functioning would be expected after one year.

  5. Identifying Aftercare Supports for Out-of-Home Transitions: A Descriptive Analysis of Youth Perceptions and Preparedness (United States)

    Trout, Alexandra L.; Huscroft-D'Angelo, Jacqueline; Epstein, Michael H.; Kavan, Jane


    Youth served in residential care often demonstrate significant educational and behavioral gains during treatment; however, struggles evidenced during the reunification and reintegration process underscore the importance of continued aftercare services and supports. While these needs have been widely noted in the literature, little is known about…

  6. A novel approach in calculating site-specific aftercare completion criteria for landfills in The Netherlands: Policy developments. (United States)

    Brand, Ellen; de Nijs, Ton C M; Dijkstra, Joris J; Comans, Rob N J


    As part of a more circular economy, current attention on waste is shifting from landfilling towards the prevention, re-use and recycling of waste materials. Although the need for landfills is decreasing, there are many landfills around the world that are still operational or at the point of starting the aftercare period. With traditional aftercare management, these landfills require perpetual aftercare at considerable cost due to monitoring and regular maintenance of liners. In an attempt to lower these aftercare costs, and to prevent that future generations become responsible for finding a sustainable solution of present day waste, the Dutch government takes action to explore the possibilities of sustainable landfill management. A project was started to investigate whether the use of source-oriented treatment techniques (so-called active treatment) of landfills can result in a sustainable emission reduction to soil and groundwater. During the next decade, sustainable landfill management is tested at three selected pilot landfills in the Netherlands. To enable this pilot testing and to determine its success after the experimental treatment period, a new methodology and conceptual framework was developed. The aim of this paper is to describe the development of the new methodology, and in particular the policy decisions, needed to determine whether the pilot experiments will be successful. The pilot projects are considered successful when the concentrations in the leachate of the pilot landfills have sufficiently been reduced and for longer periods of time and comply with the derived site-specific Environmental Protection Criteria (EPC). In that case, aftercare can be reduced, and it can be determined whether sustainable landfill management is economically feasible for further implementation.

  7. Labyrinthitis - aftercare (United States)

    ... NOT overeat. Exercise regularly, if possible. Get enough sleep. Limit caffeine and alcohol. Help ease stress by using relaxation techniques, such as: Deep breathing Guided imagery Meditation Progressive muscle relaxation Tai chi Yoga

  8. Episiotomy - aftercare (United States)

    ... ice packs in the first 24 hours after birth decreases the swelling and helps with pain. Take warm baths, but wait until 24 hours after you have given birth. Make sure that the bathtub is cleaned with a ... like ibuprofen to relieve pain. You can do many other things to help ...

  9. Provider Experiences with Prison Care and Aftercare for Women with Co-occurring Mental Health and Substance Use Disorders: Treatment, Resource, and Systems Integration Challenges. (United States)

    Johnson, Jennifer E; Schonbrun, Yael Chatav; Peabody, Marlanea E; Shefner, Ruth T; Fernandes, Karen M; Rosen, Rochelle K; Zlotnick, Caron


    Incarcerated women with co-occurring mental health and substance use disorders (COD) face complex psychosocial challenges at community reentry. This study used qualitative methods to evaluate the perspectives of 14 prison and aftercare providers about service delivery challenges and treatment needs of reentering women with COD. Providers viewed the needs of women prisoners with COD as distinct from those of women with substance use alone and from men with COD. Providers described optimal aftercare for women with COD as including contact with the same provider before and after release, access to services within 24-72 hours after release, assistance with managing multiple social service agencies, assistance with relationship issues, and long-term follow-up. Providers also described larger service system and societal issues, including systems integration and ways in which a lack of prison and community aftercare resources impacted quality of care and reentry outcomes. Practice and policy implications are provided.

  10. Fewer re-admissions and bed days following an intensive transitional post-discharge aftercare programme for a mixed diagnostic group of patients

    DEFF Research Database (Denmark)

    Nilsson, Maria; Mir, Shazia; Larsen, Jens Knud;


    BACKGROUND: The organization of aftercare is important for a successful outcome; still the optimal organization has not been fully explored. An intensive transitional post-discharge aftercare (TA) programme, for a mixed group of non-psychotic patients, was recently developed. Patients with non......), receiving less intensive outpatient aftercare. METHODS: Number of re-admissions, bed days and emergency visits after 10 weeks, 6 months and 1 year was retrospectively collected from electronic patient registers. Descriptive statistics, independent samples T-tests and repeated-measures analysis of variance...... was used to compare the groups. RESULTS: The majority of patients in both groups suffered from affective disorders, followed by personality disorders and a small number of other psychiatric diagnoses. Service use in the TA group was lower than in the RC group with fewer bed days after 10 weeks (P = 0...

  11. Differential effectiveness of residential versus outpatient aftercare for parolees from prison-based therapeutic community treatment programs

    Directory of Open Access Journals (Sweden)

    Messina Nena P


    Full Text Available Abstract Background Research has indicated that more intense treatment is associated with better outcomes among clients who are appropriately matched to treatment intensity level based on the severity of their drug/alcohol problem. This study examined the differential effectiveness of community-based residential and outpatient treatment attended by male and female drug-involved parolees from prison-based therapeutic community substance abuse treatment programs based on the severity of their drug/alcohol problem. Methods Subjects were 4,165 male and female parolees who received prison-based therapeutic community substance abuse treatment and who subsequently participated in only outpatient or only residential treatment following release from prison. The dependent variable of interest was return to prison within 12 months. The primary independent variables of interest were alcohol/drug problem severity (low, high and type of aftercare (residential, outpatient. Chi-square analyses were conducted to examine the differences in 12-month RTP rates between and within the two groups of parolees (residential and outpatient parolees based on alcohol/drug problem severity (low severity, high severity. Logistic regression analyses were performed to determine if aftercare modality (outpatient only vs. residential only was a significant predictor of 12-month RTP rates for subjects who were classified as low severity versus those who were classified as high severity. Results Subjects benefited equally from outpatient and residential aftercare, regardless of the severity of their drug/alcohol problem. Conclusion As states and the federal prison system further expand prison-based treatment services, the demand and supply of aftercare treatment services will also increase. As this occurs, systems and policies governing the transitioning of individuals from prison- to community-based treatment should include a systematic and validated assessment of post

  12. A controlled clinical trial of implantretained mandibular overdentures : 10 years’ results of clinical aspects and aftercare of IMZ implants and Bra°nemark implants

    NARCIS (Netherlands)

    Meijer, Henny J.A.; Raghoebar, Gerry M.; Van’t Hof, Martin A.; Visser, Anita


    The aim of this prospective randomized controlled clinical trial was to evaluate the clinical outcomes and prosthetic aftercare of edentulous patients with a mandibular overdenture retained by two IMZ implants or two Bra°nemark implants during a 10-year period. Patients were allocated to the IMZ gro

  13. Care and Aftercare Related to Implant-Retained Dental Crowns in the Maxillary Aesthetic Region : A 5-Year Prospective Randomized Clinical Trial

    NARCIS (Netherlands)

    Visser, Anita; Raghoebar, Gerry M.; Meijer, Henny J. A.; Meijndert, Leo; Vissink, Arjan


    Aim: To prospectively assess surgical and prosthetic care and aftercare related to the placement of implant-retained dental crowns after local bone augmentation in patients missing one tooth in the maxillary aesthetic region. Methods: Ninety-three patients were randomly allocated to one of three loc

  14. A controlled clinical trial of implant-retained mandibular overdentures; five-years' results of clinical aspects and aftercare of IMZ implants and Branemark implants

    NARCIS (Netherlands)

    Meijer, HJA; Raghoebar, GM; Van 't Hof, MA; Visser, A; Geertman, ME; Van Oort, RP


    The aim of this prospective randomized controlled clinical trial was to evaluate a set of clinical items and prosthetic aftercare of edentulous patients with a mandibular overdenture retained by 2 IMZ implants or 2 Branemark implants during a 5-years' period. Patients were allocated to the IMZ group

  15. A controlled clinical trial of implant-retained mandibular overdentures : 10 years' results of clinical aspects and aftercare of IMZ implants and Branemark implants

    NARCIS (Netherlands)

    Meijer, HJA; Raghoebar, GM; Van't Hof, MA; Visser, A


    The aim of this prospective randomized controlled clinical trial was to evaluate the clinical outcomes and prosthetic aftercare of edentulous patients with a mandibular overdenture retained by two IMZ implants or two Branemark implants during a 10-year period. Patients were allocated to the IMZ grou

  16. An art therapy intervention for cancer patients in the ambulant aftercare - results from a non-randomised controlled study. (United States)

    Geue, K; Richter, R; Buttstädt, M; Brähler, E; Singer, S


    Art therapy in psycho-oncology is gaining increasing importance, but systematic evaluations of its effects are rare. The aim of this study is to investigate the effects of an art therapy intervention for cancer patients in ambulant aftercare on psychological distress and coping. The intervention consisted of 22 sessions. At three points of measurement (t1: before intervention, t2: following intervention, t3: 6 months after t2), participants responded to questionnaires (Freiburg Questionnaire on Coping with Illness, Perceived Adjustment to Chronic Illness Scale, Hospital Anxiety and Depression Scale). A group of haemato-oncological patients served as the comparison group (CG). Pre-post comparisons and analyses of variance were applied for statistical analysis. Relevant confounders were controlled. Fifty-four patients (intervention group, IG) with various cancer diagnoses completed the intervention. One hundred and twenty-nine data sets were available for the CG. Analyses of variance included group membership (IG vs. CG) and the following factors: gender, other psychosocial help and major life events. None of these variables was a predictor for changes in depression, anxiety and coping. Therefore, we could not prove intervention effects over time. Our results contradict those of preliminary studies and raise important questions. Further work on evaluating art therapy is necessary to explore which intervention concepts in which setting at which treatment stage show significant effects. Therefore, controlling for relevant confounders is needed.

  17. Motivational aftercare planning to better care: Applying the principles of advanced directives and motivational interviewing to discharge planning for people with mental illness. (United States)

    Kisely, Steve; Wyder, Marianne; Dietrich, Josie; Robinson, Gail; Siskind, Dan; Crompton, David


    Improving the input of people with mental illness into their recovery plans can potentially lead to better outcomes. In the present study, we evaluated the introduction of motivational aftercare planning (MAP) into the discharge planning of psychiatric inpatients. MAP is a manualized intervention combining motivational interviewing with advance directives. We measured changes in the level of patient input into discharge planning following training staff in the use of MAP. This included the following: (i) documentation of early relapse signs along with successful past responses; (ii) evidence of aftercare planning; and (iii) the use of the patients' own words in the plan. We used a ward-level controlled before-and-after design comparing one intervention ward with two control wards. We used anonymized recovery plans, with a goal of 50 plans per ward before and after the intervention, to look for evidence of patient input into care planning with a standardized checklist. There were also qualitative interviews with individuals discharged from the unit. We reviewed 100 intervention ward plans and 197 control ones (total n = 297). There were no significant differences in recovery plans from intervention and control wards at baseline. Following MAP training, the intervention ward improved significantly (e.g. identification of triggers increased from 52 to 94%, χ(2)  = 23.3, d.f. =1, P planning. MAP increased inpatient input into discharge planning and was valued by participants. The effect on subsequent health service use needs evaluation.

  18. State of the art and perspectives of a after-care soil protection. Background information; Stand und Perspektiven des nachsorgenden Bodenschutzes. Hintergrund

    Energy Technology Data Exchange (ETDEWEB)

    Frauenstein, Joerg


    The purpose of the German Federal Soil Protection Act is a sustainable protection or re-establishment of the functions of the soil. Harmful changes of soils are to be avoided. Soils, contaminated sites as well as water pollutions are to be reorganized in such a way that the danger threshold permanently is remained under. The 'after-care soil protection' contains a graduated procedure. It covers the systematic work procedures acquisition, investigation and evaluation of suspected cases and surfaces suspicious to contaminated sites regarding to the potential of danger, the identification of the demand of redevelopment, the redevelopment of determined harmful changes of soil and contaminated sites as well as measures of the after-care after final acceptance of a remedial action.

  19. Skiers thumb - aftercare (United States)

    ... thumb; Ulnar collateral ligament injury; Gamekeeper's thumb References Safran MA, Zachazewski J, Stone DA. Ulnar collateral ligament ... of the thumb (gamekeeper's or skier's thumb). In: Safran MA, Zachazewski J, Stone DA. Instructions for Sports ...

  20. Wrist sprain - aftercare (United States)

    ... a moderate injury and may require splinting or casting to stabilize the joint. Grade 3 -- Ligaments are ... anti-inflammatory medicine. Chronic sprains may need steroid injections and possibly surgery.

  1. Dizziness and vertigo - aftercare (United States)

    ... lifestyle choices to help you cope: Get enough sleep. Eat a well-balanced, healthy diet. DO NOT overeat. Exercise regularly, if possible. Learn and practice ways to relax, such as guided imagery, progressive muscle relaxation, yoga, tai chi, or meditation.

  2. Shoulder separation - aftercare (United States)

    ... and top of your shoulder blade A severe shoulder separation You may need surgery right away if you have: Numbness in your fingers Cold fingers Muscle weakness in your arm Severe deformity of the joint

  3. Radial head fracture - aftercare (United States)

    ... Philadelphia, PA: Elsevier Saunders; 2015:chap 6. Prawer A. Radius and ulna fractures. In: Eiff M, Hatch R, eds. Fracture Management for Primary Care . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap ... PhD, and the A.D.A.M. Editorial team. Related MedlinePlus Health ...

  4. Minor burns - aftercare (United States)

    ... the burn: Use cool water, not ice. The extreme cold from ice can injure the tissue even more. If possible, especially if the burn is caused by chemicals, hold the burned skin under cool running water for 10 to 15 minutes until it ...

  5. Iliotibial band syndrome -- aftercare (United States)

    ... for arch supports (orthotics) to wear in your shoes. Once you can do stretching and strengthening exercises without pain, you can gradually begin running or cycling again. Slowly build up distance and speed. Self- ...

  6. Rib fracture - aftercare (United States)

    ... painful pressure on your ribs. These include doing crunches and pushing, pulling, or lifting heavy objects. Follow- ... that you cough up Shortness of breath Side effects of pain medicine such as nausea, vomiting, or ...

  7. Hamstring strain - aftercare (United States)

    ... Elsevier Saunders; 2015:chap 88. Reider B, Davies GJ, Provencher MT. Muscle strains about the hip and thigh. In: Reider B, Davies GJ, Provencher MT, eds. Orthopaedic Rehabilitation of the Athlete . ...

  8. Postherpetic neuralgia - aftercare (United States)

    Herpes zoster - postherpetic neuralgia; Varicella-zoster - postherpetic neuralgia ... Postherpetic neuralgia can: Limit your everyday activities and make it hard to work. Affect how involved you are with ...

  9. Ankle fracture - aftercare (United States)

    ... or more than your provider advises you to take. NOT give aspirin to children. Check with your provider about taking anti-inflammatory medicines like Ibuprofen or Naprosyn ... to take the medicines as it can affect healing. Acetaminophen ( ...

  10. Achilles tendon rupture - aftercare (United States)

    Heel cord tear; Calcaneal tendon rupture ... MRI scan to see what type of Achilles tendon tear you have. An MRI is a type ... partial tear means at least some of the tendon is still OK. A full tear means your ...

  11. Kneecap dislocation - aftercare (United States)

    ... Armstrong B. Rehabilitation of the knee following sports injury. Clin Sports Med . 2010;29:81-106. PMID: 19945588 www. ... gov/pubmed/22071844 . Miller RH, Azar FM. Knee injuries. In: Canale ... Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015: ...

  12. Collateral ligament (CL) injury - aftercare (United States)

    ... Disorders, Pain, and Rehabilitation . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 66. Miller III RH, Azar, ... Beaty: Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 45. Niska JA, Petrigliano FA, ...

  13. Colles wrist fracture – aftercare (United States)

    ... . Prawer A. Radius and ulna fractures. In: Eiff MP, Hatch RL, eds. Fracture Management for Primary Care . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2011:chap ...

  14. 从中医整体观辨治和调护运动神经元病%Treatment and aftercare of motor neuron disease based on overall view of traditional Chinese medicine

    Institute of Scientific and Technical Information of China (English)

    王少卿; 高颖


    Motor neuron disease is a chronic progressive neurological degenerative diseases ,the etiology and pathogenesis is complex and the prognosis is poor .In the opinion of TCM ,motor neuron disease begins from zhongjiao ,and then transmits up to the heart and lung and down to the liver and kidney .Although the main pathological changes are located in the spleen and kidney ,the TCM treatment can not be constrained by the spleen and kidney nourished method .Hexible use of Chinese medicine treatment ,give attention to insidc and outside4 of body ,tonifying deficiency ,the treatment and aftercare of motor neuron disease should base on the overall view and syndrome differentiation .%运动神经元病是一种慢性进展性神经系统变性疾病,病因病机复杂,预后转归不良。中医认为本病起于中焦,上至心肺,下至肝肾。虽然其主要病位在脾肾,但中医治法却不可拘泥于补脾益肾,当从整体观出发,灵活运用中医治法,标本兼顾,补虚泄实,辨治和调护运动神经元病。

  15. Can we omit scintiscanning of the skeleton in follow-up aftercare of carcinoma of the breast. A prospective study of 630 cases. Ist die Skelettszintigraphie in der Nachsorge des Mammakarzinoms entbehrlich. Eine prospektive Studie ueber 630 Faelle

    Energy Technology Data Exchange (ETDEWEB)

    Schuenemann, H. (Onkologische Klinik Bad Trissl, Oberaudorf (Germany, F.R.))


    630 women patients of the Bad Trissl clinic were admitted in 1987/88 to a prospective study to find out whether scintiscanning, or radionuclide imaging, of the skeleton can be omitted completely or in part in the after care and follow-up of carcinoma of the breast. The initial criterion was a postoperative carcinoma of the breast without metastasizing in the skeleton at the time the study began or the patient was admitted to the study. Careful pain anamnesis was performed by means of prepared questions, and a detailed clinical examination conducted to detect any pain in the skeleton of the patient concerned. This was followed by whole body scintiscanning of the skeleton and complementary X-ray films, if necessary additional examinations. It was found that clinical findings and imaging methods agreed in 545 patients. In 55 cases a finding that was clinically suspicious of metastases or doubtful, could be refuted by both scintiscan and by X-ray, osseous metastasizing would have been overlooked without skeleton scintiscan in 14 patients only (2.2%), 11 of these 14 patients were high-risk patients (negative hormonal receptor status, axillary lymph node metastases). Hence, it will be sufficient to employ scintiscanning in the aftercare and follow-up of carcinoma of the breast on a risk-adapted basis provided this is preceded by careful pain analysis and clinical examination. Failure to detect metastasizing in the skeleton will then occur in only 3 of 630 patients (0.48%). In this manner 40% of scintiscans can be omitted in future. (orig.).

  16. Anterior cruciate ligament (ACL) injury -- aftercare (United States)

    ... Activity After your injury, you should not play sports or other activities until you and your doctor decide what treatment is best for you. If you have surgery to repair your ACL: You will need physical therapy to regain the full use of your knee. ...

  17. Urinary tract infection in girls - aftercare (United States)

    Symptoms of urinary tract infection (UTI) should begin to improve within 1 to 2 days in most girls. The advice below may not ... Elder JS. Urinary tract infections. In: Kliegman RM, Stanton BF, ... NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, ...

  18. Heel pain and Achilles tendonitis -- aftercare (United States)

    ... walking or standing on your foot References Achilles Tendinitis. In: Safran MR, Zachazewski J, Stone DA, eds. ... Related MedlinePlus Health Topics Heel Injuries and Disorders Tendinitis Browse the Encyclopedia A.D.A.M., Inc. ...

  19. Aftercare and Rehabilitation in a Community Mental Health Center (United States)

    Scoles, Pascal; Fine, Eric W.


    The community, state mental hospitals, and a community mental health center work together to provide an environment conducive to the continued well being of chronic mental patients in an area of West Philadelphia, Pennsylvania. The authors describe a program that involves day care centers and the patients' everyday living. (Author)

  20. Aftercare Guidelines for Drug and Alcohol Program Advisors (United States)


    including cirrhosis , alcohol related cancer, pancreatitis, etc.) every year. It is, without a doubt, one of the world’s most abused substances. Who...injured cells and strengthen their defenses against other diseases. Usually, a high protein , low carbohydrate diet will be recommended to control the...after intake of sugar and then a rapid plunge. If their erratic blood sugar level is not controlled, alcoholics suffer chronic symptoms of depression

  1. Section 25 aftercare under supervision: the first eighteen months' experience. (United States)

    Davies, S; Bruce, J; Fallows, S


    Supervised discharge was introduced, against much professional opposition, in the Mental Health (Patients in the Community) Act 1995. All patients subject to supervised discharge (SD) in a large health district were identified by medical records departments, and the outcome of their SD on 1 October 1997, eighteen months after the legislation came into effect, was assessed. In that first eighteen months, half of the general, rehabilitation and forensic psychiatrists in the trust used SD for 22 patients. Of the 12 orders in effect for over six months, six were renewed at six months and three at one year. In spite of professional hostility and scepticism about the clinical practicalities of SD, the use of the new power has gradually increased with experience. Outcomes to date seem generally positive, but further definitive research is needed.

  2. Abstinence versus Harm Reduction: Considering Follow-Up and Aftercare in First Nations Addictions Treatment (United States)

    van der Woerd, Kimberly A.; Cox, David N.; Reading, Jeff; Kmetic, Andrew


    Research on alcohol and substance use in First Nations populations frequently describes the nature of the problem, and the severity of the risk factors, but seldom addresses possible interventions and the effectiveness of the treatments that clients do engage in. This paper reviews a participatory evaluation of the 6-week residential "Namgis…

  3. Botulinum toxin assessment, intervention and aftercare for paediatric and adult drooling : international consensus statement

    NARCIS (Netherlands)

    Reddihough, D.; Erasmus, C.E.; Johnson, H.; McKellar, G.M.; Jongerius, P.H.


    Many individuals with neurological problems or anatomical abnormalities of the jaw, lips or oral cavity may drool, which can impact on health and quality of life. A thorough evaluation of the patient's history, examination of the oral region by a speech pathologist and, in individuals over 3 years,

  4. The untapped potential of smartphone sensors for stroke rehabilitation and after-care. (United States)

    Zhang, Melvyn W; Chew, Poh Yim; Yeo, Leonard L; Ho, Roger C


    With the increasing incidences of cerebrovascular disease, as well as the morbidity and mortality associated with it, it is of no surprise that there have been much global governmental interest in the primary prevention of this disorder; or at least in the secondary and tertiary prevention and rehabilitation of individuals who have suffered disabilities arising from a recent cerebrovascular attack. Developers and clinicians have not considered one of the key areas in Stroke prevention and management, which is that of secondary prevention, and in particular that of tapping onto smartphone technologies for stroke rehabilitation. There has been much interest in the development of devices for rehabilitation of stroke patients instead. One of the concerns with regards to conventional bio and mechanical sensors are the costs involved in development, as well as the costs involved when stroke survivors and their caregivers are required to purchase the devices for monitoring and rehabilitation. In view of the current limitations, the S3 Rehab application, which makes use of the smartphone build in sensors, has been conceptualized and has been developed for the two major platforms (Apple and Android platforms). The authors believe that by tapping onto these sensors and by programming a smartphone application that is specifically catered for rehabilitation, it would keep costs minimal for researchers, patients and caregivers. Whilst there is a growing interest in wearable devices and sensors, it is important for developers and researchers to be cognizant that certain interventions, such as rehabilitation could still be done through a smartphone device, instead of investing in new research and development. There are various untapped potential in the smartphone that researchers and developers need to be cognizant of.

  5. Outpatient pulmonary rehabilitation – rehabilitation models and shortcomings in outpatient aftercare

    Directory of Open Access Journals (Sweden)

    Dietl, Markus


    Full Text Available Background: The chronic obstructive pulmonary disease (COPD and the bronchial asthma are widespread diseases. They need long-lasting and sustainable rehabilitation. Objectives: The goal of this HTA is to describe the present supply and the economic relevance of out-patient pulmonary rehabilitation in conjunction with its social aspects. A further target is to derivate options for actions in the health-care system and possible research necessities. Methods: Relevant publications are identified by means of a structured search in 37 database accessed through the German Institute of Medical Documentation and Information (DIMDI. In addition a manual search of identified reference lists has been done. The present report includes German and English literature published from 2004 to 2009. The methodological quality was assessed by two independent researchers according to pre-defined quality criteria of evidence based medicine. Results: Among 860 publications 31 medical studies, four economic studies and 13 ethical studies meet the inclusion criteria. The studies cover rehabilitation programmes in 19 countries. The majority of them has a high level of evidence (1A to 2C. The pulmonary rehabilitation programmes differ by the setting (in-patient, out-patient, in-home, community-based, by the length of intervention (from two weeks to 36 months, by the way and the frequency of intervention and by the duration of the follow-up treatment. Overall out-patient rehabilitation programmes achieve the same positive effects for COPD patients as in-patient programmes do. This is especially true for physical performance and health related quality of life. There are only a few studies dealing with asthma. Therefore, valid statements cannot be given. The results for cost-effectiveness are not distinct enough. Discussion: Goals of pulmonary rehabilitation like prevention and adequate treatment of acute exacerbations, the minimisation of hospitalisation and the reduction of mortality are attained in out-patient as well as in in-patient pulmonary rehabilitation. Regarding the best frequency of training units per week or the duration and the content of a unit further research is needed. Final results for the ideal length of an in-patient rehabilitation are still missing. None of the studies deals with the analysis of the different treatment forms of a COPD which are frequently defined by an alteration of in-patient and out-patient treatments and participation in sports clubs or self-help groups. There are some other limitations of the studies. The results concerning self-management programmes are not distinct. (Self- Selection leads to high drop-out rates. Many studies have only small sample sizes. Confounder and long-time effects are seldom researched, relevant economic evaluations do not exist The improvement of health related quality of life is primarily obtained by an improved disease management than by an improvement of a medical parameter. Conclusion: Out-patient pulmonary rehabilitation is as effective as in-patient pulmonary rehabilitation. But there is a critical shortage of out-patient pulmonary rehabilitation supply in Germany. Domains for further research are the evaluation of models for integrated care, the length, frequency and content of training programmes, psychiatric assessments and the cost-effectiveness of out-patient pulmonary rehabilitation.

  6. [An art education programme for groups in the psycho-oncological after-care]. (United States)

    Geue, Kristina; Buttstädt, Marianne; Richter, Robert; Böhler, Ursula; Singer, Susanne


    In this paper the formal and contentual structure of the outpatient art education programme for oncological patients is presented. The group intervention was comprised of 22 separate sessions. The course consisted of 3 phases. The first unit helped to foster mutual understanding and to learn various experimental drawing techniques using a given topic. The second unit merged into the shaping of personal thoughts and feelings with the aim of encouraging self-perception and reflection. The aim in the third phase is to create a personal book. The effects of the intervention for the participants were examined in studies. The art therapist as well as the supervisor sees development of better coping strategies, contact with other patients and enhancement of scope of action through the regular activities as main effects. Participants reported the enlargement of means of expression, emotional stabilization, coping with illness, personal growth and contacts with other patients as meanings. This art education course enlarges the field of psycho-oncological interventions in outpatient care with a low-treshhold and resource-oriented creative programme.

  7. Alcoholics Anonymous Attendance, Aftercare, and Outcome: A Secondary Analysis of Two Years Posthospitalization Data (United States)


    clinical experience has found that it was a very difficult task for clients with schizoid or avoident personality disorders to effect a successful...which affect the social, psychological, and biological functioning of persons dealing with alcohol problems (Mendelson and Mello, 1979; 1 Purposive...necessary to describe persons with alcohol-related problems" (p. 1055).5 While the heterogeneity of alcohol problems Is evident and Increasingly

  8. Case management in aftercare of involuntarily committed patients with substance abuse

    DEFF Research Database (Denmark)

    Lindahl, Marianne Larsson; Berglund, Mats; Tönnesen, Hanne


    Case management has since the 1970s been widely used to co-ordinate services for mental health patients. The methodology has expanded to support patients in many different types of conditions. This study is one of very few randomized trials on case management in a European setting. It examined...

  9. Issues in chemical dependency treatment and aftercare for people with learning differences. (United States)

    Campbell, J A; Essex, E L; Held, G


    Without major adaptations, current substance abuse treatment models may not be productive for people with learning differences. The study described in this article examined ways to create accessibility to generic chemical dependency treatment for people with learning differences. A key informant survey of chemical dependency workers and developmental disabilities workers was conducted to determine the needs of chemical dependency treatment programs, staff, and people with learning differences in making treatment accessible. Training and information needs were identified, and responses were compared between the two groups of providers. Chemical dependency treatment staff need more information and training on differing learning and socialization skills, differences in reading comprehension, and personal prejudices or stereotypes. In-depth screening is also required to determine the appropriateness of integrated or specialized services or some combination of both.

  10. [Hepatitis C: diagnosis, anti-viral therapy, after-care. Hungarian consensus guideline]. (United States)

    Hunyady, Béla; Gerlei, Zsuzsanna; Gervain, Judit; Horváth, Gábor; Lengyel, Gabriella; Pár, Alajos; Rókusz, László; Szalay, Ferenc; Telegdy, László; Tornai, István; Werling, Klára; Makara, Mihály


    Approximately 70,000 people are infected with hepatitis C virus in Hungary, and more than half of them are not aware of their infection. From the point of infected individuals early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases and complications (liver cirrhosis, liver failure and liver cancer) and can increase work productivity and life expectancy. Furthermore, these could from prevent further spread of the virus as well as reduce substantially long term financial burden of related morbidity, as a socioeconomic aspect. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can clear the virus in 40-45% of previously not treated (naïve), and in 5-21% of previous treatment-failure patients. Addition of a direct acting first generation protease inhibitor drug (boceprevir or telaprevir) to the dual therapy increases the chance of sustained viral response to 63-75% and 59-66%, respectively. These two protease inhibitors are available and financed for a segment of Hungarian patients since May 2013. Between 2013 and February 2015, other direct acting antivirals and interferon-free combination therapies have been registered for the treatment of chronic hepatitis C with a potential efficacy over 90% and typically with a short duration of 8-12 weeks. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and/or fibrosis in the liver. Non-invasive methods (elastography and biochemical methods) are accepted and preferred for staging liver damage (fibrosis). For initiation of treatment accurate and timely molecular biology tests are mandatory. Eligibility for treatment is a subject of individual central medical review. Due to budget limitations therapy is covered only for a proportion of patients by the National Health Insurance Fund. Priority is given to those with urgent need based on a Hungarian Priority Index system reflecting primarily the stage of liver disease, and considering also additional factors, i.e., activity and progression of liver disease, predictive factors of treatment and other special issues. Approved treatments are restricted to the most cost-effective combinations based on the cost per sustained viral response value in different patient categories with consensus between professional organizations, National Health Insurance Fund and patient organizations. More expensive therapies might be available upon co-financing by the patient or a third party. Interferon-free treatments and shorter therapy durations preferred as much as financially feasible. A separate budget is allocated to cover interferon-free treatments for the most-in-need interferon ineligible/intolerant patients, and for those who have no more interferon-based therapy option.

  11. Patients’ narratives of lived experiences of intensive care during after-care

    DEFF Research Database (Denmark)

    Nilsson, Karen; Berner, Susanne; Hertz, Iben


    -care. Several studies have investigated psychological consequences. Additionally, the meaning of dreams and follow-up care been explored. It may therefore seem appropriate to further investigate patients individual experiences in order to search for a deeper understanding of the dimensions that influence...... and critical interpretation and discussion. RESULTS. The preliminary findings indicate that there are three categories of lived experiences of intensive care. CONCLUSIONS. This clinical nursing research provides new basic knowledge useful in the efforts to enhance patient psychological processing after...

  12. Botulinum toxin assessment, intervention and aftercare for paediatric and adult niche indications including pain: international consensus statement. (United States)

    Rawicki, B; Sheean, G; Fung, V S C; Goldsmith, S; Morgan, C; Novak, I


    Evidence is emerging for the use of botulinum neurotoxin type-A (BoNT-A) for niche indications including pain independent of spasticity. Pain indications such as chronic nociceptive back pain, piriformis syndrome, chronic myofascial pain, pelvic pain, complex regional pain syndrome, facial pain and neuropathic pain are outlined in this paper. Of these, class I evidence is available for the treatment of chronic nociceptive low back pain, piriformis syndrome, myofascial pain, facial pain, neuropathic pain and plantar fasciitis. Peri-operative use of BoNT-A is emerging, with indications including planning for surgery and facilitating surgery, as well as healing and improving analgesia post-operatively. Evidence is limited, although there are some reports that clinicians are successfully using BoNT-A peri-operatively. There is class I evidence showing pre-operative use of BoNT-A has a beneficial effect on outcomes following adductor-release surgery. The use of BoNT for treatment of tremor, other than neck tremor in the setting of cervical dystonia, including evidence for upper limb tremor, cranial tremor and non-dystonic neck tremor is reviewed. The evidence is variable at this stage, and further study is required to develop definitive recommendations for the clinical utility of BoNT-A for these indications.

  13. 49 CFR 40.303 - What happens if the SAP believes the employee needs additional treatment, aftercare, or support... (United States)


    ... 49 Transportation 1 2010-10-01 2010-10-01 false What happens if the SAP believes the employee... the Return-to-Duty Process § 40.303 What happens if the SAP believes the employee needs additional...? (a) As a SAP, if you believe that ongoing services (in addition to follow-up tests) are needed...

  14. Differential effectiveness of residential versus outpatient aftercare for parolees from prison-based therapeutic community treatment programs


    Messina Nena P; Prendergast Michael L; Dang Jeff; Burdon William M; Farabee David


    Abstract Background Research has indicated that more intense treatment is associated with better outcomes among clients who are appropriately matched to treatment intensity level based on the severity of their drug/alcohol problem. This study examined the differential effectiveness of community-based residential and outpatient treatment attended by male and female drug-involved parolees from prison-based therapeutic community substance abuse treatment programs based on the severity of their d...

  15. Preventing repetition of attempted suicide--I. Feasibility (acceptability, adherence, and effectiveness) of a Baerum-model like aftercare

    DEFF Research Database (Denmark)

    Hvid, Marianne; Wang, August G


    Repetition after attempted suicide is high with only limited research been put into effect studies. The Baerum-model from Norway offers a practical and affordable intervention. Our aim was to study the acceptability and effectiveness of a Baerum-model like intervention after attempted suicide using...... a quasi-experimental design. During a period in 2004, attempted suicide patients were offered follow-up care by a rapid-response outreach programme, an intervention lasting 6 months; a control group was established prospectively from a similar period in 2002. The design was an intent-to-treat analysis....... The outcome was measured by: 1) participation by acceptance and adherence, 2) repetition of suicide attempt and suicide, and 3) including the number of repetitive acts in 1 year after the attempted suicide episode. Follow-up period was 1 year. Participation was 70%. There was a significant lower repetition...

  16. Preventing repetition of attempted suicide-I. Feasibility (acceptability, adherence, and effectiveness) of a Baerum-model like aftercare

    DEFF Research Database (Denmark)

    Hvid, M.; Wang, August Gabriel


    Repetition after attempted suicide is high with only limited research been put into effect studies. The Baerum-model from Norway offers a practical and affordable intervention. Our aim was to study the acceptability and effectiveness of a Baerum-model like intervention after attempted suicide using...... a quasi-experimental design. During a period in 2004, attempted suicide patients were offered follow-up care by a rapid-response outreach programme, an intervention lasting 6 months; a control group was established prospectively from a similar period in 2002. The design was an intent-to-treat analysis....... The outcome was measured by: 1) participation by acceptance and adherence, 2) repetition of suicide attempt and suicide, and 3) including the number of repetitive acts in 1 year after the attempted suicide episode. Follow-up period was 1 year. Participation was 70%. There was a significant lower repetition...

  17. Reintegration, Supervised Release, and Intensive Aftercare of juvenile Criminals in America.%美国未成年犯罪人的释放安置

    Institute of Scientific and Technical Information of China (English)




  18. Integrating into the Mental Health System from the Criminal Justice System: Jail Aftercare Services for Persons with a Severe Mental Illness (United States)

    Davis, Kristin; Fallon, John; Vogel, Sue; Teachout, Alexandra


    This article describes a mental health evidence based practice, Assertive Community Treatment (ACT). While ACT has scientific support, it has not been rigorously tested for persons with a severe mental illness and repeated forensic involvement. This article provides preliminary evidence that ACT is best suited for reentry into the mental health…

  19. Designing a theory- and evidence-based tailored eHealth rehabilitation aftercare program in Germany and the Netherlands: study protocol


    Reinwand, Dominique; Kuhlmann, Tim; Wienert, Julian; de Vries, Hein; Lippke, Sonia


    Background Cardiac rehabilitation programs aim to improve health status and to decrease the risk of further cardiac events. Persons undergoing rehabilitation often have difficulties transferring the learned health behaviors into their daily routine after returning home and maybe to work. This includes physical activity as well as fruit and vegetable consumption. Computer-based tailored interventions have been shown to be effective in increasing physical activity as well as fruit and vegetable...

  20. A nested case-control study of the risk of suicide attempts after discharge from psychiatric care

    DEFF Research Database (Denmark)

    Christiansen, Erik; Jensen, Børge


    abuse with mental illness raised risk in an additive way. We found only small gender differences in risk. In order to lower the risk of suicide attempts, we need to improve after-care when discharging from psychiatric care. A differentiation between the possibilities of after-care for different mental...

  1. 76 FR 2135 - Office of Juvenile Justice and Delinquency Prevention Proposed Plan for Fiscal Year 2011 (United States)


    ... so that it protects public safety, holds offenders accountable, and provides treatment and..., elected officials, tribal leaders, clergy, faith-based organizations, and especially families and young..., family strengthening, recreational activities, and extended reentry aftercare to help...

  2. 75 FR 77855 - Privacy Act of 1974; System of Records (United States)


    ... Responsibility and Values Education and Training Program (Prevent) Offices, Navy Drug Screening Laboratories, and..., Counseling and Assistance Centers, Personal Responsibility and Values Education and Training Program (Prevent..., aftercare plans, and other information pertaining to a member's participation in substance abuse...

  3. ICU-recovery in Scandinavia

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Risom, Signe S; Thomsen, Thordis;


    The aim of our study was to describe and compare models of intensive care follow-up in Denmark, Norway and Sweden to help inform clinicians regarding the establishment and continuation of ICU aftercare programmes.......The aim of our study was to describe and compare models of intensive care follow-up in Denmark, Norway and Sweden to help inform clinicians regarding the establishment and continuation of ICU aftercare programmes....

  4. The Support and Aftercare System with Chinese Characteristics for Reintegrating Released Prisoners and Persons who have Completed the Re-education- through - labour Programme%有中国特色的对刑满释放、解除劳教人员的帮扶救助制度

    Institute of Scientific and Technical Information of China (English)




  5. Suicide and Deliberate Self-harm in Children and Adolescents. A Research Update. Research Review. (United States)

    Kerfoot, Michael


    Reviews research on adolescent suicide and deliberate self-harm. Shows that in the UK suicide is the second most common cause of death among 15- to 24-year-olds, and that deliberate self-harm is linked to depression, substance misuse, and family functioning and precedes one-third of adolescent suicides. Discusses problems in aftercare of…

  6. Measuring Effects of a Skills Training Intervention for Drug Abusers. (United States)

    Hawkins, J. David; And Others


    A test was conducted of a supplemental skills training and social-network-development aftercare program with 130 drug abusers from four residential therapeutic communities. The intervention produced positive effects on subjects' performance at the conclusion of treatment. Performance improved in situations involving avoidance of drug use, coping…

  7. Supportive Housing in Foster Care: The Views of Young People (United States)

    Sinkkonen, Hanna-Maija; Kyttälä, Minna


    This study investigated Finnish young people's experiences of supportive housing. Supportive housing is an after-care programme that should support the transition from foster care to independent adulthood. It is directed mainly at young people who have been taken into foster care by social workers. The sample consisted of 39 young people (23…

  8. Developments in inguinal hernia repair

    NARCIS (Netherlands)

    Voorbrood, C.E.H.


    Performing inguinal hernia surgery in a high volume clinic allows for gaining expertise and achieving considerable experience and knowledge. This results in the recognition of benefits of tailored treatment, selection of patients, and structured aftercare rendering improvement of patients' outcome a

  9. Imaging scatterers in landfills using seismic interferometry

    NARCIS (Netherlands)

    Konstantaki, L.A.; Dragnov, D.S.; Heimovaara, T.J.; Ghose, R.


    A significant problem with landfills is their aftercare period. A landfill is considered to be safe for the environment only after a relatively long period of time. Until it reaches such a condition, it has to be periodically treated. Not only are treatments very expensive, but they could be dangero

  10. Strategies for Incorporating Women-Specific Sexuality Education into Addiction Treatment Models (United States)

    James, Raven


    This paper advocates for the incorporation of a women-specific sexuality curriculum in the addiction treatment process to aid in sexual healing and provide for aftercare issues. Sexuality in addiction treatment modalities is often approached from a sex-negative stance, or that of sexual victimization. Sexual issues are viewed as addictive in and…

  11. Psychosocial care and shelter following the Bijlmermeer air disaster.

    NARCIS (Netherlands)

    Kroon, M.B.R.; Overdijk, W.I.E.


    This article describes the organization of the psychosocial aid and aftercare for survivors in the context of the Bijlmermeer air disaster that took place in 1992 in Amsterdam, The Netherlands. It is based on an examination of the relevant city documents and media coverage, and on interviews with ci

  12. How to bridge the gap between hospital and home?

    NARCIS (Netherlands)

    Kersten, D.; Hackenitz, E.


    Many countries have separate organizations for delivering nursing care to patients in the hospital and to patients at home in the community. This separation creates extra difficulties in organizing continuous care for patients discharged from hospital who need nursing aftercare (in The Netherlands,

  13. Promising Practices in Drug Treatment: Findings from Southeast Asia (United States)

    Libretto, Salvatore; Nemes, Susanna; Namur, Jenny; Garrett, Gerald; Hess, Lauren; Kaplan, Linda


    In a study to evaluate the drug treatment and aftercare efforts sponsored by the State Department's International Narcotics and Law Enforcement Affairs Bureau, residential Therapeutic Community (TC) treatment programs in three countries in Southeast Asia--Malaysia, Singapore, and Thailand--were examined to identify promising practices and to…

  14. The Epidemiology of Infectious Gastroenteritis Related Reactive Arthritis in U.S. Military Personnel: A Case-Control Study (United States)


    enterotoxigenic E. coli (ETEC)[10,24], Cryptosporidium spp[25,26], Giardia lamblia[27], Strongyloides stercoralis[28], and possibly Schistosoma...Specifically, approximately 13% of the 12 N.A.A cases were seen for physical therapy , 4% for lumbago, and 3% for aftercare following surgery. None of

  15. Supportive Care Needs for Women With Gynecological Cancer and Their Relatives During the Prediagnostic Period

    DEFF Research Database (Denmark)

    Holt, Kamila Adellund; Hansen, Helle Ploug; Mogensen, Ole


    The prediagnostic process for gynecological cancer has become quite rapid. It gives the woman limited time to handle new information about her illness and make decisions. The existing support initiatives in Denmark focus on aftercare rather than on needs for support in the prediagnostic period....

  16. Efficacy of Group Motivational Interviewing (GMI) for Psychiatric Inpatients with Chemical Dependence (United States)

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


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

  17. Bringing Innovation to the Health Care Sector

    DEFF Research Database (Denmark)

    Günzel, Franziska; Tomcyzk, David

    are not the parties that save money in the aftercare process. Using a Stackelberg model, this paper introduces an alternative model for determining how much each participant contributes to the cost of implementing the innovation using a value-based, rather than cost-based, decision- making process. We conclude...... with discussion regarding how to generalize the model to other innovations....

  18. Quantification of long term emission potential from landfills

    NARCIS (Netherlands)

    Heimovaara, T.J.


    Novel approaches for the after-care of Municipal Solid Waste (MSW) landfills are based on technological measures to reduce the long term emission potential in a short time period. Biological degradation in landfills is a means to significantly reduce the long term emission potential. Leachate emissi

  19. Developments in inguinal hernia repair

    NARCIS (Netherlands)

    Voorbrood, C E H


    Performing inguinal hernia surgery in a high volume clinic allows for gaining expertise and achieving considerable experience and knowledge. This results in the recognition of benefits of tailored treatment, selection of patients, and structured aftercare rendering improvement of patients´ outcome a

  20. Particuliere reclassering en overheid in Nederland sinds 1823

    NARCIS (Netherlands)

    Heinrich, Jean-Paul


    This study deals with the historical development of the relationship between the Dutch Government and the private after-care and rehabilitation organisations from 1823 until today. The first chapter covers the period that starts with the foundation of The Dutch Fellowship for Moral Reformation of Pr

  1. Pemoline in attention deficit disorder and alcoholism: a case study. (United States)

    Turnquist, K; Frances, R; Rosenfeld, W; Mobarak, A


    Diagnosis of attention deficit disorder in a 35-year-old man and treatment with pemoline substantially improved his response to alcoholism treatment and aftercare. The authors conclude that treatment of attention deficit disorder may aid in rehabilitation of alcoholic patients.

  2. Challenges of Imprisonment in the Nigerian Penal System: The Way Forward

    Directory of Open Access Journals (Sweden)

    Gloria D Shajobi-Ibikunle


    Full Text Available This paper traces the customary methods of dealing with offenders prior to colonial rule in Nigeria to the current state of facilities and operations in Nigerian prisons. It critically analyses the condition of the incarcerated offender, the measures put in place for their rehabilitation vis a vis the united nations standard minimum rules for the treatment of offenders. It finds that the prisons are overcrowded, conditions are deplorable with inadequate rehabilitation and aftercare provisions. This paper recommends greater use of fines by courts; restitution, mediation, probation and community service as non-custodial measures for minor and non-violent offenders. Several measures are recommended for rehabilitation and aftercare of convicts.

  3. Preservation in Disaster Situations: a case study of the Valvilla Wool Mill Museum, Finland

    Directory of Open Access Journals (Sweden)

    Heidi Wirilander


    Full Text Available This article discusses the role of documentation and rescue planning in minimizing collection damages in disaster situations. The topic is surveyed through a case study of a fire that occurred in 2003 at the Valvilla Wool Mill museum in Hyvinkää, in Southern Finland. This incident caused significant damage to the authenticity and integrity of the museum’s archival collection. Both the fire and the extinguishing of the fire caused severe damage to items in the archival collection. Deterioration continued during aftercare, causing serious secondary collection damage because the methods of the first aid and aftercare were spontaneously planned and applied. By using the Valvilla Wool Mill museum’s incident as an illustrative case study, the article analyses how the documentation and rescue planning influenced collection damage and demonstrates the kinds of effects rescue work can have on the authenticity and integrity of cultural heritage items.

  4. From a dump to a energy park and recycling park. The Rhine-Main dump park in Floersheim-Wicker; Von der Muellkippe zum Energie- und Recyclingpark. Der Rhein-Main-Deponiepark in Floersheim-Wicker

    Energy Technology Data Exchange (ETDEWEB)

    Mehler, Gerd [Rhein-Main Deponie GmbH, Floersheim am Main (Germany)


    If dumps are shut down, aftercare measures are necessary for a time period of several decades. The question arises whether the infrastructure, operating equipment and operating personnel of dumps can be used in the aftercare phase for subsequent utilisations. Under this aspect, the author of the contribution under consideration reports on the Rhine-Main dump park in Floersheim-Wicker (Federal Republic of Germany). Subsequently to the introduction according to the subsequent utilisation of dump locations, the author reports on the concept of the Rhine Main dump park, on the power generation in the Rhine-Main dump park, on the processing of wastes to fuels for the power production and on the dump as recycling park.

  5. [Dentoalveolar traumatology]. (United States)

    Schoen, P J; Raghoebar, G M; Jansma, J; Vissink, A


    The dentist will be confronted unexpectedly with a dentoalveolar trauma patient. This patient has to be seen immediately and has to be treated adequately. The risk of overlooking trauma-related signs when examining these patients, can be minimized by following a strict protocol. This article describes a protocol for examination and treatment of a patient with a dentoalveolar trauma. The prognosis after treatment of the trauma is discussed. Also some recommendations regarding aftercare and prevention are presented.

  6. Particuliere reclassering en overheid in Nederland sinds 1823


    Heinrich, Jean-Paul


    This study deals with the historical development of the relationship between the Dutch Government and the private after-care and rehabilitation organisations from 1823 until today. The first chapter covers the period that starts with the foundation of The Dutch Fellowship for Moral Reformation of Prisoners (Het Nederlandsch Genootschap tot Zedelijke Verbetering der Gevangenen, hereafter referred to as ’the Fellow-ship’) in 1823, and ends with the introduction of the new Penal Code in 1886. Th...

  7. Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices


    Zimmermann Heinz; Eggli Stefan; Benneker Lorin M; Schwab Patrik R; Exadaktylos Aristomenis K


    Abstract Background In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an in...

  8. Total costs of ownership - a comparison between incineration plant and landfill placed in the metropolian area of Sao Paulo; Kostenvergleich einer Deponie mit einer ''Waste to Energy'' Anlage im Grossraum Sao Paulo nach der Methode des Total Costs of Ownership

    Energy Technology Data Exchange (ETDEWEB)

    Bauer, W.P. [IA GmbH - Wissensmanagement und Ingenieurleistungen (Germany); Koenig, T. [GfA - Gemeinsames Kommunalunternehmen fuer Abfallwirtschaft Anstalt des oeffentlichen Rechts der Landkreise Fuerstenfeldbruck und Dachau (Germany); Scholz, W. [Bayerisches Ministerium fuer Umwelt, Gesundheit und Verbraucherschutz (Germany). Technisches Kooperationsprojekt Bayern - Sao Paulo


    This paper describes a study which offers a decision support for executives, who compare in a draft both systems according to the method of Total Costs of Ownership (TCO), regarding the total life time and including the aftercare of landfill. Description of the proceeding to calculate the TCO of an incineration plant and a landfill. Investments and operational costs of the landfill and the incineration plant are described and the results of the calculation are shown and interpreted. (orig.)

  9. Quantification of long term emission potential from landfills


    Heimovaara, T.J.


    Novel approaches for the after-care of Municipal Solid Waste (MSW) landfills are based on technological measures to reduce the long term emission potential in a short time period. Biological degradation in landfills is a means to significantly reduce the long term emission potential. Leachate emission to the groundwater is considered to be one of the largest long-term impacts related to landfilling. Currently we are starting up a research program, partly subsidized by the Dutch Technology fou...

  10. Taking an integral and eco-contemplative perspective on the phenomenon of addiction in dislocated societies: Beyond “acceptance” and towards soul-making in non-dual awareness


    Rabi, Shahar


    This dissertation is an attempt to think more broadly and deeply about the phenomenology of addiction in dislocated societies. It introduces integral philosophy and its approaches to recovery by bringing awareness to what needs to be addressed and added to acceptance based aftercare programs and curriculum development. Based on the proposed philosophical exploration, this dissertation examines and expands the term ‘psychological flexibility’ to include psychocultural diversity and psychosocia...

  11. A randomized clinical trial of home-based telepsychiatric outpatient care via videoconferencing: design, methodology, and implementation

    Directory of Open Access Journals (Sweden)

    Ines Hungerbuehler


    Full Text Available Background Healthcare providers are continuously challenged to find innovative, cost-effective alternatives and to scale up existent services to meet the growing demand upon mental health care delivery. Due to continuous advances in technologies, telepsychiatry has become an effective tool for psychiatric care. In 2012, the Institute of Psychiatry of the University of São Paulo Medical School started a randomized clinical trial of home-based telepsychiatric outpatient care via videoconferencing. Objective The objective of this article is to describe the design, methodology and implementation of a pilot project, which aimed to verify the applicability and efficiency of psychiatric attendance via Internet-based videoconferencing in a resource-constrained environment. Methods The project consisted of a 12 months follow-up study with a randomized clinical trial, which compared various quality indicators between home-based telepsychiatric aftercare via videoconferencing and face-to-face aftercare. Results The final sample comprised 107 outpatients (53 in the telepsychiatry group and 54 in the control group. Among 1,227 realized consultations, 489 were held by videoconferencing. Satisfaction with the aftercare by videoconferencing and the medication delivery was high among patients. Attending psychiatrists were satisfied with the assistance by videoconferencing. Discussion The experiences during this pilot project have overall been very positive and psychiatric outpatient care by videoconferencing seems viable to treat patients even in a resource-constrained environment.

  12. Monitoring physical and psychosocial symptom trajectories in ovarian cancer patients receiving chemotherapy

    Directory of Open Access Journals (Sweden)

    Meraner Verena


    Full Text Available Abstract Background Diagnosis and treatment of ovarian cancer (OC entail severe symptom burden and a significant loss of quality of life (QOL. Somatic and psychological impairments may persist well beyond active therapy. Although essential for optimal symptom management as well as for the interpretation of treatment outcomes, knowledge on the course of QOL-related issues is scarce. This study aimed at assessing the course of depressive symptoms, anxiety, fatigue and QOL in patients with OC over the course of chemotherapy until early after-care. Methods 23 patients were assessed longitudinally (eight time points with regard to symptom burden (depression, anxiety, fatigue, and QOL by means of patient-reported outcome instruments (HADS, MFI-20, EORTC QLQ-C30/-OV28 and clinician ratings (HAMA/D at each chemotherapy cycle and at the first two aftercare visits. Results Statistically significant decrease over time was found for depressive symptoms and anxiety as well as for all fatigue scales. With regard to QOL, results indicated significant increase for 11 of 15 QOL scales, best for Social (effect size = 1.95; p p p p = 0.009 decreased, Attitudes towards Disease and Treatment (e.s. = 1.80; p Conclusions The present study underlines the importance of longitudinal assessment of QOL in order to facilitate the identification of symptom burden in OC patients. We found that patients show high levels of fatigue, anxiety and depressive symptoms and severely impaired QOL post-surgery (i.e. at start of chemotherapy but condition improves considerably throughout chemotherapy reaching nearly general population symptoms levels until aftercare.

  13. Medical Surveillance Monthly Report (MSMR). Volume 14, Number 1, April 2007 (United States)


    or suspected carrier: group B streptococcus 47 3.8 Chronic disease of tonsils and adenoids 31 7.5 Aftercare following surgery 36 2.9 Peritonsillar...abscess 29 7.1 Observation following other accident (e.g., motor vehicle) 31 2.5 Acute tonsillitis 26 6.3 Tuboplasty or vasoplasty after previous...Glaucoma 14,496 (62) 8,781 (60) 16 (114) Female genital pain 19,489 (53) 12,207 (54) 548 (65) Cataracts 1,611 (102) 911 (96) 13 (116) Kidney stones

  14. Immigration and recommended care after a suicide attempt in Europe: equity or bias? (United States)

    Bursztein Lipsicas, Cendrine; Mäkinen, Ilkka Henrik; Wasserman, Danuta; Apter, Alan; Bobes, Julio; Kerkhof, Ad; Michel, Konrad; Renberg, Ellinor Salander; van Heeringen, Kees; Värnik, Airi; Schmidtke, Armin


    This report describes the investigation of care recommendations in the medical system across European countries to immigrants who attempted suicide. Data from seven European countries with 8865 local and 2921 immigrant person-cases were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour and ensuing MONSUE (Monitoring Suicidal Behaviour in Europe) project. The relationship between immigrant status and type of aftercare recommended was analysed with binary logistic regression, adjusting for gender, age, method of attempt and the Centre collecting the data. Clear disparities were identified in the care recommendation practices toward immigrants, compared with hosts, over and above differing policies by the European Centres.

  15. Tri-Service Disability Evaluation Systems Database Analysis and Research. Annual Report 2011 (United States)


    43 6.1 367: Disorders of refraction and accommodation 8 6.7 401: Essential hypertension 41 5.8 P11: Operations on the cornea 8 6.7 300: Anxiety...aftercare 501 2.6 682: Other cellulitis and abscess 104 2.9 682: Other cellulitis and abscess 463 2.4 300: Anxiety, dissociative and somatoform...procedures 25 3.9 295: Schizophrenic disorders 165 3.6 682: Other cellulitis and abscess 24 3.7 998: Other complications of procedures 164 3.6

  16. Selenium supplementation in radiotherapy patients: do we need to measure selenium levels in serum or blood regularly prior radiotherapy? (United States)

    Muecke, Ralph; Micke, Oliver; Schomburg, Lutz; Kisters, Klaus; Buentzel, Jens; Huebner, Jutta; Kriz, Jan


    Considering the review by Puspitasari and colleagues, an additional discussion of the endpoints of the Se supplementation studies described would be helpful. In our view, selenium can safely be given to selenium-deficient cancer patients prior to and during radiotherapy. Therefore, in order to help the radiation oncologist in decision making, we strongly advocate to determine the selenium status prior to and during a potential adjuvant selenium supplementation, e.g. when trying to ease the side-effects of radiation treatment or in the aftercare situation when the selenium status may become insufficient.

  17. Guide book mammary glands ultrasonography. A textbook according to the DEGUM and KBV guidelines. 3. upd. ed.; Kursbuch Mammasonografie. Ein Lehratlas nach den Richtlinien der DEGUM und der KBV

    Energy Technology Data Exchange (ETDEWEB)

    Madjar, Helmut [Deutsche Klinik fuer Diagnostik, Wiesbaden (Germany). Fachbereich Gynaekologie DEGUM-Stufe III


    The text book on the ultrasonography of mammary glands is based on the concept of a three-step course system. The large amount of pathological indications is supposed to communicate knowledge that is required to find an adequate diagnosis based on ultrasonsographic imaging. The book includes the following chapters: Basics of ultrasonic mammography; diagnostic techniques; sono-anatomy of breast and axilla; standardized diagnosis; mastopathy; cysts and intracystic tumors; prostheses; abscesses; benign solid tumors; scars; carcinomas; lymph nodes; interventional sonography; preoperative staging; preventive diagnostics; aftercare, relapses; 3D-sonography, panorama-scan, real-time compound-scan; CARI technique; Doppler sonography; elastography; examination questions on ultrasonic mammography.

  18. A designated centre for people with disabilities operated by St John of God Community Services Limited, Kildare

    LENUS (Irish Health Repository)

    Smyth, B P


    We conducted a prospective follow-up study of consecutive opiate dependent patients admitted to a residential addiction treatment service for detoxification. We measured the rate of relapse following discharge, and sought to identify factors that were associated with early relapse (i.e., a return to daily opiate use). Follow-up interviews were conducted with 109 patients, of whom, 99 (91%) reported a relapse. The initial relapse occurred within one week in 64 (59%) cases. Multivariate survival analysis revealed that earlier relapse was significantly predicted by younger age, greater heroin use prior to treatment, history of injecting, and a failure to enter aftercare. Unexpectedly, those who were in a relationship with an opiate user had significantly delayed relapse. Those who completed the entire six-week inpatient treatment programme also had a significantly delayed relapse. In order to reduce relapse and the associated increased risk of fatal overdose, services providing residential opiate detoxification should prepare people for admission, strive to retain them in treatment for the full admission period and actively support their entry into planned aftercare in order to improve outcome.

  19. Utilization of outpatient mental health services after inpatient alcoholism treatment. (United States)

    Booth, B M; Cook, C A; Blow, F C; Bunn, J Y


    It is generally agreed that use of aftercare services following discharge from alcoholism treatment is optimum for patients to achieve long-term recovery. However, the quantity and duration of utilization of such services in non-experimental settings are generally unknown. Using secondary data sources, we studied 5,635 alcoholics completing formal extended inpatient treatment and 1,860 alcoholics discharged from brief inpatient hospitalizations in Department of Veterans Affairs medical centers. Weekly use of outpatient mental health services (OPMH) prior to hospital admission was equally low for both patient groups (approximately 2-3% of patients) until four weeks prior to admission, at which time OPMH use increased, particularly for the extended treatment group. In the four weeks after discharge, use of OPMH services was substantially higher for patients with extended treatment compared to those with brief hospitalizations (40% vs. 18%), with 22% of patients completing treatment utilizing such services in the first week after discharge. Utilization steadily decreased until only 8% and 4% of both groups, respectively, were using OPMH services at the end of six months after discharge. Study results suggest the need to examine barriers to outpatient mental health utilization after discharge as well as interventions to increase compliance with long-term aftercare.

  20. Lapse and relapse following inpatient treatment of opiate dependence.

    LENUS (Irish Health Repository)

    Smyth, B P


    We conducted a prospective follow-up study of consecutive opiate dependent patients admitted to a residential addiction treatment service for detoxification. We measured the rate of relapse following discharge, and sought to identify factors that were associated with early relapse (i.e., a return to daily opiate use). Follow-up interviews were conducted with 109 patients, of whom, 99 (91%) reported a relapse. The initial relapse occurred within one week in 64 (59%) cases. Multivariate survival analysis revealed that earlier relapse was significantly predicted by younger age, greater heroin use prior to treatment, history of injecting, and a failure to enter aftercare. Unexpectedly, those who were in a relationship with an opiate user had significantly delayed relapse. Those who completed the entire six-week inpatient treatment programme also had a significantly delayed relapse. In order to reduce relapse and the associated increased risk of fatal overdose, services providing residential opiate detoxification should prepare people for admission, strive to retain them in treatment for the full admission period and actively support their entry into planned aftercare in order to improve outcome.

  1. A designated centre for people with disabilities operated by Muiriosa Foundation, Kildare

    LENUS (Irish Health Repository)

    Smyth, B P


    We conducted a prospective follow-up study of consecutive opiate dependent patients admitted to a residential addiction treatment service for detoxification. We measured the rate of relapse following discharge, and sought to identify factors that were associated with early relapse (i.e., a return to daily opiate use). Follow-up interviews were conducted with 109 patients, of whom, 99 (91%) reported a relapse. The initial relapse occurred within one week in 64 (59%) cases. Multivariate survival analysis revealed that earlier relapse was significantly predicted by younger age, greater heroin use prior to treatment, history of injecting, and a failure to enter aftercare. Unexpectedly, those who were in a relationship with an opiate user had significantly delayed relapse. Those who completed the entire six-week inpatient treatment programme also had a significantly delayed relapse. In order to reduce relapse and the associated increased risk of fatal overdose, services providing residential opiate detoxification should prepare people for admission, strive to retain them in treatment for the full admission period and actively support their entry into planned aftercare in order to improve outcome.

  2. Evaluation of a safer male circumcision training programme for traditional surgeons and nurses in the Eastern Cape, South Africa. (United States)

    Peltzer, Karl; Nqeketo, Ayanda; Petros, George; Kanta, Xola


    Training designed to improve circumcision knowledge, attitude and practice was delivered over 5 days to 34 traditional surgeons and 49 traditional nurses in the Eastern Cape, South Africa. Training included the following topics: initiation rites; statutory regulation of traditional male circumcision and initiation into Manhood (TCIM); structure and function of the male sex organs; procedure of safe circumcision, infection control; sexually transmitted infections (STIs); HIV/AIDS; infection control measures; aftercare of the initiate including after care of the circumcision wound and initiate as a whole; detection and early management of common complications of circumcision; nutrition and fluid management; code of conduct and ethics; and sexual health education. The evaluation of the training consisted of a prospective assessment of knowledge and attitude immediately prior to and after training. Significant improvement in knowledge and/or attitudes was observed in legal aspects, STI, HIV and environmental aspects, attitudes in terms of improved collaboration with biomedical health care providers, normal and abnormal anatomy and physiology, sexually transmitted infections and including HIV, circumcision practice and aftercare of initiates. We concluded that safer circumcision training can be successfully delivered to traditional surgeons and nurses.

  3. Diagnostics of cognitive functions of treated clients with an anamnesis of long-term drug use

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    Ondřej Krupčík


    Full Text Available Clients in treatment and aftercare programmes with a history of long-term abuse of substances like alcohol, cannabis, methamphetamine or heroin often exhibit serious problems while coming back to the working process and managing complex responsibilities and difficulties. It is very important to find a job in the aftercare process for many reasons. It is a source of living, it enables clients to plan their own housing, and it makes repayment of debts possible. Job is also important for establishing new social relations which are not connected with problematic drug environment. Last but not least employment contributes to a reconstruction of a healthy rhythm of life and meaningful spending of time. Thus it is very important for decreasing a probability of a relapse. This process can be disrupted by the deteriorated cognitive functioning. These problems may not be evident in an everyday life routine while talking with friends or performing automatic activities, but can be evident in demanding working tasks, because the job usually requires concentration, memory, decision making etc. The Goal of this study is an evaluation of potential benefits an individual cognitive performance assessment can have in treatment and aftercare. The paper summarizes pilot research in which a complete Neuro-psychological battery of diagnostic methods such as Auditory Verbal Learning Test (AVLT, Verbal fluency Test (FAS, Trail Making Test (TMT, Rey-Osterrieth Complex Figure (ROCF, Benton Visual Retention Test (BVRT, Stroop Colour Word Test (SCWT and Numeric square is used for assessment of cognitive functions of a small sample of treated clients (N=24. We present two case histories with detailed results. In some cases, in line with the expectations, the worsened cognitive functioning is evident. We recommend a cognitive training focused on attention and memory for three clients. In other cases, surprisingly, we can find normal cognitive functions quality, but another

  4. Gender and racial/ethnic differences in addiction severity, HIV risk, and quality of life among adults in opioid detoxification: results from the National Drug Abuse Treatment Clinical Trials Network

    Directory of Open Access Journals (Sweden)

    Bruce Burchett


    Full Text Available Li-Tzy Wu1,2, Walter Ling3, Bruce Burchett1, Dan G Blazer1,2, Jack Shostak2, George E Woody41Department of Psychiatry and Behavioral Sciences, School of Medicine, 2Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; 3David Geffen School of Medicine, NPI/Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA; 4Department of Psychiatry, School of Medicine, University of Pennsylvania and Treatment Research Institute, Philadelphia, PA, USAPurpose: Detoxification often serves as an initial contact for treatment and represents an opportunity for engaging patients in aftercare to prevent relapse. However, there is limited information concerning clinical profiles of individuals seeking detoxification, and the opportunity to engage patients in detoxification for aftercare often is missed. This study examined clinical profiles of a geographically diverse sample of opioid-dependent adults in detoxification to discern the treatment needs of a growing number of women and whites with opioid addiction and to inform interventions aimed at improving use of aftercare or rehabilitation.Methods: The sample included 343 opioid-dependent patients enrolled in two national multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-002. Patients were recruited from 12 addiction treatment programs across the nation. Gender and racial/ethnic differences in addiction severity, human immunodeficiency virus (HIV risk, and quality of life were examined.Results: Women and whites were more likely than men and African Americans to have greater psychiatric and family/social relationship problems and report poorer health-related quality of life and functioning. Whites and Hispanics exhibited higher levels of total HIV risk scores and risky injection drug use scores than African Americans, and Hispanics showed a higher level of unprotected sexual behaviors than whites. African Americans were

  5. Logistic considerations for a successful institutional approach to the endovascular repair of ruptured abdominal aortic aneurysms. (United States)

    Mayer, Dieter; Rancic, Zoran; Pfammatter, Thomas; Hechelhammer, Lukas; Veith, Frank J; Donas, Konstantin; Lachat, Mario


    The value of emergency endovascular aneurysm repair (EVAR) in the setting of ruptured abdominal aortic aneurysm remains controversial owing to differing results. However, interpretation of published results remains difficult as there is a lack of generally accepted protocols or standard operating procedures. Furthermore, such protocols and standard operating procedures often are reported incompletely or not at all, thereby making interpretation of results difficult. We herein report our integrated logistic system for the endovascular treatment of ruptured abdominal aortic aneurysms. Important components of this system are prehospital logistics, in-hospital treatment logistics, and aftercare. Further studies should include details about all of these components, and a description of these logistic components must be included in all future studies of emergency EVAR for ruptured abdominal aortic aneurysms.

  6. Current developments in pediatric liver transplantation

    Institute of Scientific and Technical Information of China (English)


    In 1953, the pioneer of human orthotopic liver transplantation(LT), Thomas E Starzl, was the first to attemptan orthotopic liver transplant into a 3 years old patientsuffering from biliary atresia. Thus, the first LT in humanswas attempted in a disease, which, up until today,remains the main indication for pediatric LT (pLT). Duringthe last sixty years, refinements in diagnostics and surgicaltechnique, the introduction of new immunosuppressivemedications and improvements in perioperative pediatriccare have established LT as routine procedure forchildhood acute and chronic liver failure as well asinherited liver diseases. In contrast to adult recipients,pLT differs greatly in indications for LT, allocation practice,surgical technique, immunosuppression and postoperativelife-long aftercare. Many aspects are focus ofongoing preclinical and clinical research. The presentreview gives an overview of current developments andthe clinical outcome of pLT, with a focus on alternativesto full-size deceased-donor organ transplantation.

  7. [Refixation of sternoclavicular luxation with a suture anchor system]. (United States)

    Lehmann, W; Laskowski, J; Grossterlinden, L; Rueger, J M


    Luxations of the sternoclavicular joint are rare injuries. We present a case of anterior dislocation which was caused by a minor fall onto the right shoulder. Diagnosis was delayed by 2 weeks which prevented treatment by closed reduction. As an alternative surgical treatment a PDS cord around the clavicle and the first rib was used to stabilize the clavicle at the vertical level. Subsequently, fixation to the medial side was achieved by a suture anchor that was placed into the manubrium. The presented case highlights this simple and safe method to treat dislocations of the sternoclavicular joint in which standard treatment cannot be performed. A detailed description for each operation step is given and our experience in terms of aftercare and outcome is reported.

  8. Women's experiences of coping with pregnancy termination for fetal abnormality. (United States)

    Lafarge, Caroline; Mitchell, Kathryn; Fox, Pauline


    Pregnancy termination for fetal abnormality (TFA) can have significant psychological consequences. Most previous research has been focused on measuring the psychological outcomes of TFA, and little is known about the coping strategies involved. In this article, we report on women's coping strategies used during and after the procedure. Our account is based on experiences of 27 women who completed an online survey. We analyzed the data using interpretative phenomenological analysis. Coping comprised four structures, consistent across time points: support, acceptance, avoidance, and meaning attribution. Women mostly used adaptive coping strategies but reported inadequacies in aftercare, which challenged their resources. The study's findings indicate the need to provide sensitive, nondirective care rooted in the acknowledgment of the unique nature of TFA. Enabling women to reciprocate for emotional support, promoting adaptive coping strategies, highlighting the potential value of spending time with the baby, and providing long-term support (including during subsequent pregnancies) might promote psychological adjustment to TFA.

  9. A social work contribution to suicide prevention through assertive brief psychotherapy and community linkage: use of the Manchester Short Assessment of Quality of Life (MANSA). (United States)

    Petrakis, Melissa; Joubert, Lynette


    There is a striking absence of literature articulating and evaluating clinical social work contributions to suicide prevention, despite considerable practice in this important field. This article reports on a model of assertive brief psychotherapeutic intervention and facilitated linkage to community services utilized in a prospective cohort study of emergency department suicide attempt aftercare. A key outcome measure, the Manchester Short Assessment of Quality of Life (MANSA), was used with 65 patients to assess psychosocial domains at initial presentation, 4-weeks, 3-months, and 6-months. There were significant improvements in the domains of work, finance, leisure, social life, living situation, personal safety and health by 3 months. There were highly significant correlations between psychosocial improvements and improved depression scores.

  10. Present situation and prospect of post-discharge bladder function support of patients with spinal cord injury%脊髓损伤患者出院后膀胱功能支持现状的研究进展

    Institute of Scientific and Technical Information of China (English)

    刘秀梅; 黎婷


    Spinal cord injury is severely disabling. In developed countries, the incidence of spinal cord injury is 11.5% - 53.4% per million population. The quality of life of patients with spinal cord injury and their survival rates in China are lower than that of developed countries, however the urinary tract complication is the first cause of their late death. Comparing the bladder function training and rehabilitation at home and abroad, the major causes of lower bladder function rehabilitation and aftercare level in China may be associated with the following aspects:imperfect rehabilitation health care system, lack of professional talents, weak rehabilitation consciousness, etc. So the fundamental measures to improve the bladder function rehabilitation include the improvement of rehabilitation health care system and professional training of rehabilitation team, and participation of orthopedic doctors in the rehabilitation training guidance of patients and their families.

  11. Sober-living houses and changes in the personal networks of individuals in recovery

    Directory of Open Access Journals (Sweden)

    David G. Mueller


    Full Text Available Social networks are an important source of support for many people in recovery from alcohol abuse. The present study investigated the role of one particular source of support for recovery in changing the personal networks of people in recovery, sober-living houses. In a randomized, longitudinal design changes in the network size, heterogeneity, and composition of usual aftercare and sober-living home residents were examined. Beneficial changes were found, such as increases in the number of recovering alcoholics and overall network size among sober-living home residents, particularly those who stayed six months or longer. Networks also became more homogeneous with respect to non-drinking among residents. The importance of changes in networks is discussed as well as the need for network-level analyses of personal recovery networks.

  12. Sober-Living Houses and Changes in the Personal Networks of Individuals in Recovery. (United States)

    Mueller, David G; Jason, Leonard A


    Social networks are an important source of support for many people in recovery from alcohol abuse. The present study investigated the role of one particular source of support for recovery in changing the personal networks of people in recovery, sober-living houses. In a randomized, longitudinal design changes in the network size, heterogeneity, and composition of usual aftercare and sober-living home residents were examined. Beneficial changes were found, such as increases in the number of recovering alcoholics and overall network size among sober-living home residents, particularly those who stayed six months or longer. Networks also became more homogeneous with respect to non-drinking among residents. The importance of changes in networks is discussed as well as the need for network-level analyses of personal recovery networks.

  13. Psychological and environmental determinants of relapse in crack cocaine smokers. (United States)

    Wallace, B C


    The paper reviews approaches to relapse in the treatment of cocaine abusers. Approaches reveal a common mechanism underlying relapse that involves drug craving, recall of euphoria, environmental cues, denial, myths of being able to sell or use drugs, and painful affect states necessitating use of a multifaceted clinical technique. Empirical validation of a common mechanism underlying relapse establishes a typology of psychological and environmental determinants of relapse for crack cocaine smokers (N = 35) who relapse after hospital detoxification and return a second time. Major findings are that relapse follows a painful emotional state (40%), failure to enter arranged aftercare treatment (37%), or encounters with conditioned environmental stimuli (34%), and involves narcissistic psychopathology and denial (28.5%) and interpersonal stress (24%); 85.7% involve multideterminants. Case examples illustrate the role of multideterminants in relapse. The paper educates clinicians to the integrated theory and multifaceted clinical technique necessary for efficacious treatment of cocaine patients, while the typology predicts probable relapse situations.

  14. Health care transition in Germany – standardization of procedures and improvement actions

    Directory of Open Access Journals (Sweden)

    Pieper C


    Full Text Available Claudia Pieper, Izabela KolankowskaInstitute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, North Rhine-Westphalia, GermanyAbstract: Previous studies have assessed an increase in the number of people in need and emphasized the advantages of structured discharge management and health care transition. Therefore, our study evaluated the status quo of transition in a major German city after standardization of procedures and implementation of standard forms. Satisfaction with handling of standard forms and improvement of procedures was evaluated. Additionally, patients who had recently been hospitalized were asked about the hospital discharge process. The results show that the recent efforts of standardization helped to improve interface management for health care workers and patients and showed further improvement options.Keywords: hospital discharge process, standard forms, long-term care, aftercare

  15. Rituximab for subcutaneous delivery: Clinical management principles from a nursing perspective. (United States)

    Carlson, Julia; Cox, Keith; Bedwell, Kylie; Ku, Mathew


    Nurses play an integral role in administering treatments to patients with non-Hodgkin's lymphomas. Intravenous (IV) rituximab was approved by the Australian Therapeutic Goods Administration in 1998, and a novel subcutaneous (SC) formulation was approved in 2014. Fixed-dose SC rituximab is highly concentrated; co-formulation with a fully human recombinant vorhyaluronidase alfa enzyme helps overcome the physiological barriers of the SC space, facilitating drug dispersion. Despite a different pharmacokinetic profile to the IV preparation, SC rituximab demonstrates a comparable efficacy/safety profile. Most frequently occurring rituximab-related adverse events include neutropenia, nausea and constipation, and administration-related reactions are more frequent with the SC preparation. Compared with IV, SC delivery reduces treatment times and nurse workload, and patients report greater comfort and convenience. This article sets out nursing considerations for optimal administration of SC rituximab, including premedication, drug handling/preparation, injection technique, after-care and management of adverse events, particularly administration-related reactions.

  16. Emission model for landfills with mechanically-biologically pretreated waste, with the emphasis on modelling the gas balance; Emissionsprognosemodell fuer Deponien mit mechanisch-biologisch vorbehandelten Abfaellen - Schwerpunkt: Modellierung des Gashaushaltes

    Energy Technology Data Exchange (ETDEWEB)

    Danhamer, H.


    The objective of this work was to determine influence factors on processes going on in landfills with mechanically-biologically pretreated waste (MBP-landfills) in order to predict emissions. For this purpose a computer based model has been developed. The model allows to simulate the gas, water and heat balance as well as settlement processes and was called DESIM2005 (version MB). It is based on theoretical modeling approaches as well as data from lab and reactor experiments. The main focus of model application was to determine factors influencing the gas phase and the emissions of landfill gas and methane during operation and aftercare of MBP-landfills. By performing simulations the effects of changing parameters for the processes gas transport and biological degradation as well as the effects of different qualities in waste pretreatment and of varying landfill operation techniques were investigated. Possibilities for increasing the environmental sustainability of landfills containing mechanically-biologically pretreated waste were shown. (orig.)

  17. An empirical description of phases of maintenance following treatment for alcohol dependence. (United States)

    Murphy, S A; Hoffman, A L


    This article reports two longitudinal prospective studies conducted sequentially to describe participants' maintenance of abstinence experiences up to 36 months posttreatment. Study 1 reports responses of 102 subjects who maintained alcohol abstinence following treatment and who were assessed for duration and intensity of symptoms associated with postacute withdrawal at baseline, 3, 6, and 12 months. A decreasing linear trend of symptoms was found as time of alcohol abstinence increased. Study 2 obtained interview and survey data from 23 successful abstainers from Study 1 at 12, 18, and 36 months posttreatment to describe coping strategies, perceptions of relapse risk, extent and duration of "aftercare," and substitute addictions as these phenomena developed and changed over time. Multiple occasions of data collection supported the description of three phases of maintenance: symptom stabilization/management accompanied by a cognitive paradigm shift, distancing self from alcohol-dependent behavior, and normalization of life processes.

  18. Sinus pilonidalis in patients of German military hospitals: a review

    Directory of Open Access Journals (Sweden)

    Kueper, Janina


    Full Text Available Pilonidal sinus disease (PSD most commonly presents in young men when hair follicles enter through damaged epithelium and cause an inflammatory reaction. This results in the formation of fistular tracts. We reviewed studies based on a shared cohort of patients who presented at German military hospitals with PSD. The effect of the morphology of the sinus, perioperative protocol, and aftercare of the surgical treatment on the recurrence of PSD were evaluated. The drainage of acute abscesses before surgery, the application of methylene blue during surgery and open wound treatment were generally found to reduce the recurrence rate. A positive family history, postoperative epilation and primary suture as the healing method were found to elevate the recurrence rate. Long-term follow up of over 15 years was found to be a vital component of patient care as only 60% of the overall recurrences recorded had taken place by year 5 postoperatively.

  19. [Dutch Preventive Youth Health Care Service guideline on children born too early and/or too small for gestational age]. (United States)

    van der Pal, Sylvia M; Heerdink, Nen; Kamphuis, Mascha; Pols, Margreet A


    In children who are born prematurely or whose birth weight is too low for gestational age (small for gestational age (SGA)) intensive care and follow up are desirable.However, obstacles include the shared care of children born very preterm (care service (and other professionals) and the identification of possible late onset health problems in children born late preterm (32-37 weeks of gestation). This guideline is multidisciplinary and evidence based and is relevant to all professionals involved in the care of this group of children. The main recommendations are: (a) timely and complete transfer of information after discharge from hospital; (b) structured exchange of information in aftercare; (c) assigning a case manager to each child; (d) monitoring growth and development by adjusting age for preterm birth, and (e) using special growth charts for children born preterm to evaluate growth and development.

  20. Psycho-social correlates of unmarried teenage mothers. (United States)

    Singh, A; Singh, S


    A study of psychosocial correlates of institutionalized unwed teenage mothers, based on a sample of 44 teenagers at After-care Homes in Amritsar and Jullundur and a control group from Chandigarh, matched for age and occupation. EPI and Mittal's Adjustment Inventory were used and subjects were interviewed regarding their socioeconomic status, family size, home atmosphere, birth order, motivation for sex and number of sex partners. Monthly family income was somewhat lower among the unwed mothers and they came from larger and more frequently from broken homes; they were most often the eldest child. The most common reason for engaging in intercourse was promise of marriage; 59% had sex with only 1 partner. EPI scores for unmarried mothers suggests an antisocial personality; they are also found to be maladjusted with regard to all 4 areas (home, health/emotional, social, and school) covered by the Adjustment Inventory.


    Directory of Open Access Journals (Sweden)

    Jedlinská Martina


    Full Text Available This article aims to acquaint the reader with the characteristics and problems of care for patients with dementia and options selected inpatient care for these patients in the Pardubice region. The theoretical part provides an overview of the issue of care for patients with dementia or dementia. The empirical part focuses on the description of selected characteristics of clients in the health-care facility, which is an example of good practice care for the elderly. In these age group is the greatest prevalence of dementia and syndrom of dementia as diagnosed disease. The discussion paper presents a reflection on the possible reasons for placing these clients in various types of inpatient facilities after discharge from aftercare and the circumstances of care for these clients.

  2. [Amputation and prosthesis attachment of the lower extremities]. (United States)

    Matthes, I; Beirau, M; Ekkernkamp, A; Matthes, G


    Approximately 61,000 amputations are performed in Germany per year. In most cases the lower limbs are affected. The reasons for amputations are arteriosclerosis, diabetes mellitus, severe infections, tumors and complex trauma to the extremities. A decision must be made concerning whether a salvage procedure or amputation is appropriate, specially after trauma. In cases where the need for amputation is clear, the site of amputation needs to be planned in advance with the aim of creating a stump which allows sufficient prosthetic attachment. Adjuvant pain therapy is mandatory, especially in order to avoid subsequent phantom pain. The type of prosthetic restoration is influenced by the grade of mobility and personal requirements of patients. Moreover, aftercare and adjusted rehabilitation are recommended.

  3. A comparison of four telephone-based counseling styles for recovering stimulant users. (United States)

    Farabee, David; Cousins, Sarah J; Brecht, Mary-Lynn; Antonini, Valerie P; Lee, Anne B; Brummer, Julie; Hemberg, Jordana; Karno, Mitchell; Rawson, Richard A


    The continuing development and refinement of empirically supported interventions to increase participation in posttreatment care and promote sustained abstinence from illicit drug use is a priority for the addictions field. The purpose of this study was to assess the combined and relative effectiveness of four types of counseling styles, delivered by telephone, relative to a no call control condition. Stimulant users (N = 302) were randomized to one of four low-cost, telephone support protocols (unstructured/nondirective, unstructured/directive, structured/nondirective, structured/directive) or a standard referral to aftercare without telephone counseling (control). All of the study participants were nearing the completion of (or had completed) an intensive phase of structured, outpatient stimulant abuse treatment. Drug use and aftercare participation were assessed at 3 and 12 months following randomization. Intent-to-treat analyses showed no significant time-by-group interactions for these primary outcomes. Subsequent analyses, however, revealed a significant difference between the aggregated call groups and the control group at the time of the 3-month follow-up. The mean ASI drug use severity composite score for subjects in the call conditions declining from .058 at baseline to .048 at 3 months, whereas the no call/control group average score increased from .053 to .062 (χ (1) = 4.95, p = .026). A similar-and slightly stronger-effect was found when the study sample was restricted to those reporting any use during the month prior to the baseline interview (n = 152). This study provides modest support for the telephone-based counseling approaches strategies examined in this project. Subsequent research will assess interactions between patient characteristics and counseling styles, and improved identification of which treatment graduates might be more likely to benefit from this type of continuing support. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  4. Network psycho-social emergency support. Implementation plans. Vol. 2. Quality standards of education and training; Netzwerk Psychosoziale Notfallversorgung. Umsetzungsrahmenplaene. Bd. 2. Qualitaet in Aus- und Fortbildung

    Energy Technology Data Exchange (ETDEWEB)

    Beerlage, Irmtraud; Springer, Silke; Hering, Thomas; Arndt, Dagmar; Noerenberg, Liane


    This report focuses on the steps taken to ensure the implementation of a quality-assured, German-wide harmoniously and structurally integrated and organized emergency psycho-social support (EPSS) on the basis of recommendations -presented on behalf of the German Federal Ministry of the Interior in July 2004 -on the implementation of EPSS as an integral part of civil protection. At the level of the German Laender, a call for action was issued with regard to statutory mandated regulations for the integration of EPSS in relief actions by defined executive positions of psycho-social support measures as well as in short-term and long-term psycho-social aftercare, which has been extensively organized in advance. At federal level, a call for action was issued with regard to the provision of expert and management resources for a concerted crisis management of the Federal Government and the German Laender, also with regard to EPSS. This particularly refers to the convening of an accreditation committee for the evaluation of educational measures in connection with EPSS and with the objective of introducing uniform federal quality standards as well as creating a German-wide available database based on a uniform federal query of EPSS resources for short-term and long-term aftercare for victims, next-of-kin and bereaved as well as for emergency personnel involved in civil protection.The report contains the results of further clarification processes with regard to the implementation of the recommendations, which are principally embraced by the authorities, organizations, churches and associations involved in the development, in co-ordination with the contracting party. Volume II includes a synopsis of currently available possibilities to finance EPSS for emergency personnel as well as victims, next-of-kin and bereaved and the legal foundations, as well as derived recommendations in consideration of municipal and inner-institutional regulations of authorities and organizations


    Directory of Open Access Journals (Sweden)

    M.H. Saheb-Zamani


    Full Text Available Twenty to twenty-five years ago, the Community Mental Health Center (CHMC, had scarcely been heard of. Today, it is indeed a movement, and apparently widespread. A total of ten services considered to be necessary to provide adequate mental health services: (1 in patient, (2 out-patient, (3 partial hospitalization, (4 emergency, (5 consultation, (6 diagn1ostic, (7 rehabilitative, (8 precare and aftercare, (9 training, (10 research and evaluation services. This Concept of Community Mental Health would include as many community agents as possible in co-operative efforts. To the average educated layman, and, unfortunately to most mental health practitioners the community mental health care has become synonymous with the provision of mere psycho-therapy. The community mental health center has not succeeded in becoming inductor of catalytic agent in the growth of its patients, nor has it become significantly involved with the community as a scrcla1 system. These are grim facts. But new hope has begun to appear. It is contained in four revolutions now under way – revolutions in understanding, in research, in nu1ternal and child care and in education for mental health.

  6. Program and staff characteristics in successful treatment. (United States)

    Brown, E R


    Women come to drug treatment with lower self-esteem (Regan et al. 1984), more social isolation, and more difficult life situations than men. Women are more likely to present with mental health comorbidity such as depression (Regan et al. 1982). Treatment programs modeled on outcome research on male patients may not yield strategies that are successful with women. Only in the past decade has research been undertaken into the specific population characteristics of women in drug treatment. Programs must be designed with a clear understanding of women's psychological makeup and particular life stress, including the need to care for their children and the reality of physical and sexual abuse. Drug treatment often unmasks a variety of psychosocial problems that, if not adequately addressed by the drug treatment program, may result in relapse into drug use. Many women live in poverty and are inadequately educated, two factors that can interfere with reintegration of the recovered addict into the community. Thus, the drug treatment program, to provide successful long-term outcomes with respect to drug use, must provide long-term aftercare that includes attention to the variety of social, medical, and emotional problems faced by women who use drugs.

  7. Effects of Exercise Interventions and Physical Activity Behavior on Cancer Related Cognitive Impairments: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Philipp Zimmer


    Full Text Available This systematic review analyzes current data on effects of exercise interventions and physical activity behavior on objective and subjective cancer related cognitive impairments (CRCI. Out of the 19 studies which met all inclusion criteria, five RCTs investigated rodents, whereas the other 14 trials explored humans and these included six RCTs, one controlled trial, two prospective noncontrolled trials, one case series, one observational study, and three cross-sectional studies. The results from animal models revealed positive effects of exercise during and after chemotherapy or radiation on structural alterations of the central nervous system, physiological as well as neuropsychological outcomes. The overall study quality in patient studies was poor. The current data on intervention studies showed preliminary positive effects of Asian-influenced movement programs (e.g., Yoga with benefits on self-perceived cognitive functions as well as a reduction of chronic inflammation for breast cancer patients in the aftercare. Exercise potentially contributes to the prevention and rehabilitation of CRCI. Additional RCTs with standardized neuropsychological assessments and controlling for potential confounders are needed to confirm and expand preliminary findings.

  8. Late Effects Following Treatment of Hodgkin Lymphoma During Childhood and Adolescence. Results of the Hodgkin Lymphoma Late Effects Research Project. (United States)

    Dörffel, W; Riepenhausen, M; Lüders, H; Brämswig, J


    Survival rates have been excellent in patients treated for Hodgkin lymphoma (HL) during childhood and adolescence. Unfortunately, severe treatment related late effects have been observed. It was therefore an important aim of the cooperative pediatric HL therapy studies in Germany to reduce the number of late effects without jeopardizing the excellent treatment results. Progress and relapses of HL were analyzed to obtain important information for the future salvage therapy. All late effects were documented and their etiologies analyzed. Information obtained from bacterial infections and late deaths following splenectomy were used to inform patients at risk and their local physicians about necessary preventive measurements. Procarbazine was recognized as major gonadotoxic agent in boys and eliminated successively from the treatment regimens. Parenthood was normal in female patients when compared to the German female population documenting normal ovarian function except in patients with pelvic radiation. Radiation was the most important risk factor for thyroid diseases, cardiac late effects and subsequent malignant neoplasms, especially thyroid and breast cancer. A special screening program was initiated for women with chest radiotherapy, since they had a high risk of breast cancer already at a young age. The results of the HL Late Effects Research Project are important for the aftercare of patients and for the design of future HL treatment regimens.

  9. Standard guidelines of care: Laser and IPL hair reduction

    Directory of Open Access Journals (Sweden)

    Buddhadev Rajesh


    Full Text Available Laser-assisted hair removal, Laser hair removal, Laser and light-assisted hair removal, Laser and light-assisted, long-term hair reduction, IPL photodepilation, LHE photodepilation; all these are acceptable synonyms. Laser (Ruby, Nd Yag, Alexandrite, Diode, intense pulse light, light and heat energy system are the different light-/Laser-based systems used for hair removal; each have its advantages and disadvantages. The word "LONG-TERM HAIR REDUCTION" should be used rather than permanent hair removal. Patient counseling is essential about the need for multiple sessions. Physicians′ qualifications: Laser hair removal may be practiced by any dermatologist, who has received adequate background training during postgraduation or later at a centre that provides education and training in Lasers or in focused workshops providing such training. The dermatologist should have adequate knowledge of the machines, the parameters and aftercare. The physician may allow the actual procedure to be performed under his/her direct supervision by a trained nurse assistant/junior doctor. However, the final responsibility for the procedure would lie with the physician. Facility: The procedure may be performed in the physician′s minor procedure room. Investigations to rule out any underlying cause for hair growth are important; concurrent drug therapy may be needed. Laser parameters vary with area, type of hair, and the machine used. Full knowledge about the machine and cooling system is important. Future maintenance treatments may be needed.

  10. Persistent psychotic symptoms after long-term heavy use of mephedrone: A two-case series. (United States)

    Barrio, Pablo; Gaskell, Matthew; Goti, Javier; Vilardell, Sergi; Fàbregas, Josep Maria


    Mephedrone (4-methylmethcathinone) is a synthetic stimulant drug of the cathinone class. Similar effects to those of cocaine and ecstasy are reported by users, with a high addictive potential. Given its increasing rate of consumption in Europe, it is getting more and more attention from the addiction field. In spite of that, little is known about the long-term consequences of prolonged heavy use. The two following cases might depict some of them. Case 1 was a middle-age man who reported three years of intravenous use of mephedrone. He used to binge for several days in a row. Psychotic symptoms appeared after a few months, especially paranoid delusions. Sent to aftercare in a therapeutic community, delusions kept reappearing after prolonged abstinence. A good response to risperidone was observed. Case 2 was a young man who used mephedrone heavily for two years, always snorted. Upon admission to the therapeutic community, the patient reported auditory hallucinations that partially remitted with olanzapine. Both cases showed a good insight and no personality deterioration. Given its similarities to other substances that are known to induce psychotic symptoms, and the increasing consumption of mephedrone around Europe, similar cases are expected in the near future. Conventional antipsychotic treatment seems a reasonable pharmacological approach.

  11. Follow-up after treatment for breast cancer (United States)

    Sisler, Jeffrey; Chaput, Genevieve; Sussman, Jonathan; Ozokwelu, Emmanuel


    Objective To offer FPs a summary of evidence-based recommendations to guide their follow-up survivorship care of women treated for breast cancer. Quality of evidence A literature search was conducted in MEDLINE from 2000 to 2016 using the search words breast cancer, survivorship, follow-up care, aftercare, guidelines, and survivorship care plans, with a focus on review of recent guidelines published by national cancer organizations. Evidence ranges from level I to level III. Main message Survivorship care involves 4 main tasks: surveillance and screening, management of long-term effects, health promotion, and care coordination. Surveillance for recurrence involves only annual mammography, and screening for other cancers should be done according to population guidelines. Management of the long-term effects of cancer and its treatment addresses common issues of pain, fatigue, lymphedema, distress, and medication side effects, as well as longer-term concerns for cardiac and bone health. Health promotion emphasizes the benefits of active lifestyle change in cancer survivors, with an emphasis on physical activity. Survivorship care is enhanced by the involvement of various health professionals and services, and FPs play an important role in care coordination. Conclusion Family physicians are increasingly the main providers of follow-up care after breast cancer treatment. Breast cancer should be viewed as a chronic medical condition even in women who remain disease free, and patients benefit from the approach afforded other chronic conditions in primary care. PMID:27737976

  12. The dement in the community: Social work practice with people with dementia revisited. (United States)

    Manthorpe, Jill


    While social work practice with people with dementia and their families has a long but largely hidden history, it is an emerging area of specialism. The increased incidence, prevalence and recognition of dementia suggest that this area of practice will expand and so learning from previous practice may offer helpful insights. This paper describes and reflects upon social work practice with 'dements' in the 1950s in England. It draws on a reading of a small book written by a psychiatric social worker, Miss M (Muriel) H Bree, outlining her role in providing after-care to patients with neuro-syphilis who had been discharged from hospital to live with their families between 1942 and 1952 through her consideration of 275 case records and seven illustrative case studies. As a historical document, Bree's account presents a rich description of the patients and their social circumstances in post-war Britain; an account of practice from a hospital based setting that reached into the community, and of the engagement of a social worker with her clients and their family members. Threads and continuities with contemporary social work practice with people with dementia are explored; particularly work with family carers, younger people with dementia, and the value placed upon continuity of care.

  13. Challenges and opportunities of a paperless baseline survey in Sri Lanka

    DEFF Research Database (Denmark)

    Knipe, Duleeka W; Pearson, Melissa; Borgstrøm, Rasmus;


    BACKGROUND: Personal digital assistants (PDAs) have been shown to reduce costs associated with survey implementation and digitisation, and to improve data quality when compared to traditional paper based data collection. Few studies, however, have shared their experiences of the use of these devi......BACKGROUND: Personal digital assistants (PDAs) have been shown to reduce costs associated with survey implementation and digitisation, and to improve data quality when compared to traditional paper based data collection. Few studies, however, have shared their experiences of the use...... of these devices in rural settings in Asia. This paper reports on our experiences of using a PDA device for data collection in Sri Lanka as part of a large cluster randomised control trial. FINDINGS: We found that PDAs were useful for collecting data for a baseline survey of a large randomised control trial (54...... precise mapping of households, and hence distinct settlements to be identified as randomisation clusters. Future users should be mindful that to save costs the piloting should be completed before programming. In addition consideration of a local after-care service is important to avoid costs and time...

  14. A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note. (United States)

    Sillanpää, Petri J; Mäenpää, Heikki M; Mattila, Ville M; Visuri, Tuomo; Pihlajamäki, Harri


    Patellar dislocations are associated with injuries to the medial patellofemoral ligament (MPFL). Several techniques for MPFL reconstruction have been recently published with some disadvantages involved, including large skin incisions and donor site morbidity. Arthroscopic stabilizing techniques carry the potential of inadequate restoration of MPFL function. We present a minimally invasive technique for MPFL reconstruction using adductor magnus tendon autograft. This technique is easily performed, safe, and provides a stabilizing effect equal to current MPFL reconstructions. Skin incision of only 3-4 cm is located at the level of the proximal half of the patella. After identifying the distal insertion of the adductor magnus tendon, a tendon harvester is introduced to harvest the medial two-thirds of the tendon, while the distal insertion is left intact. The adductor magnus tendon is cut at 12-14 cm from its distal insertion and transferred into the patellar medial margin. Two suture anchors are inserted through the same incision at the superomedial aspect of the patella in the anatomic MPFL origin. The graft is tightened at 30 degrees knee flexion. Aftercare includes 4 weeks of brace treatment with restricted range of motion.

  15. The Danish Depression Database

    Directory of Open Access Journals (Sweden)

    Videbech P


    Full Text Available Poul Videbech,1 Anette Deleuran2 1Mental Health Centre Glostrup, Department of Clinical Medicine, University of Copenhagen, Glostrup, 2Psychiatric Centre Amager, Copenhagen S, Denmark Aim of database: The purpose of the Danish Depression Database (DDD is to monitor and facilitate the improvement of the quality of the treatment of depression in Denmark. Furthermore, the DDD has been designed to facilitate research. Study population: Inpatients as well as outpatients with depression, aged above 18 years, and treated in the public psychiatric hospital system were enrolled. Main variables: Variables include whether the patient has been thoroughly somatically examined and has been interviewed about the psychopathology by a specialist in psychiatry. The Hamilton score as well as an evaluation of the risk of suicide are measured before and after treatment. Whether psychiatric aftercare has been scheduled for inpatients and the rate of rehospitalization are also registered. Descriptive data: The database was launched in 2011. Every year since then ~5,500 inpatients and 7,500 outpatients have been registered annually in the database. A total of 24,083 inpatients and 29,918 outpatients have been registered. The DDD produces an annual report published on the Internet. Conclusion: The DDD can become an important tool for quality improvement and research, when the reporting is more complete. Keywords: quality assurance, suicide, somatic diseases, national database

  16. Does mental health service integration affect compulsory admissions?

    Directory of Open Access Journals (Sweden)

    André I. Wierdsma


    Full Text Available Background: Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services. Methods: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991–1993 and 2001–2003. We included patients aged 18–60, who had a first emergency compulsory admission (n=830. Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up. Results: Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district. Conclusions: Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions.

  17. Guideline for radioimmunotherapy of CD20{sup +} follicular B-cell non-Hodgkin's lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, M.; Gruenwald, F.; Knapp, W.H. [Deutsche Gesellschaft fuer Nuklearmedizin, Kassel (Germany); Truemper, L.; Schilling, C. v.; Dreyling, M. [Deutsche Gesellschaft fuer Haematologie und Onkologie, Kassel (Germany)


    This guideline is a prerequisite for the quality management in the treatment of non-Hodgkon-lymphomas in patients with relapsed or refractory follicular lymphoma after rituximab therapy and as consolidation therapy after first remission following CHOP like treatment using radioimmunotherapy. It is based on an interdisciplinary consensus and contains background information and definitions as well as specified indications and detailed contraindications of treatment. Essential topics are the requirements for institutions performing the therapy. For instance, presence of an expert for medical physics, intense cooperation with all colleagues committed to treatment of lymphomas, and a certificate of instruction in radiochemical labelling and quality control are required. Furthermore, it is specified which patient data have to be available prior to performance of therapy and how treatment has to be carried out technically. Here, quality control and documentation of labelling are of great importance. After treatment, clinical quality control is mandatory (work-up of therapy data and follow-up of patients). Essential elements of follow-up are specified in detail. The complete treatment inclusive after-care has to be realised in close cooperation with those colleagues (hemato-oncologists) who propose, in general, radioimmuno-therapy under consideration of the development of the disease. (orig.)

  18. Guideline for radioimmunotherapy of rituximab relapsed or refractory CD20{sup +} follicular B-cell non-Hodgkin's lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, M.; Behr, T.; Gruenwald, F.; Knapp, W.H. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Truemper, L.; Schilling, C. von [Deutsche Gesellschaft fuer Haematologie und Onkologie e.V., Muenchen (Germany)


    This guideline is a prerequisite for the quality management in the treatment of non-Hodgkin-lymphomas using radioimmunotherapy. It is based on an interdisciplinary consensus and contains background information and definitions as well as specified indications and detailed contraindications of treatment. Essential topics are the requirements for institutions performing the therapy. For instance, presence of an expert for medical physics, intense cooperation with all colleagues committed to treatment of lymphomas, and a certificate of instruction in radiochemical labelling and quality control are required. Furthermore, it is specified which patient data have to be available prior to performance of therapy and how the treatment has to be carried out technically. Here, quality control and documentation of labelling are of greatest importance. After treatment, clinical quality control is mandatory (work-up of therapy data and follow-up of patients). Essential elements of follow-up are specified in detail. The complete treatment inclusive after-care has to be realised in close cooperation with those colleagues (haematology-oncology) who propose, in general, radioimmunotherapy under consideration of the development of the disease. (orig.)

  19. [Is rehabilitation worth it? : Review of economic evaluations of rehabilitation in Germany]. (United States)

    Krauth, Christian; Bartling, Tim


    Because of demographic change, the rehabilitation sector in Germany is going to face increasing demands in the future. Limited budgets make the optimal allocation of resources a top priority. To support decisions about the optimal scope and design of rehabilitation, studies on health economics are of utmost importance. The aim of this article is to provide an overview of the evaluation of rehabilitation with regard to health economics in Germany.Based on a comprehensive literature research, 17 studies on the cost-effectiveness of rehabilitation in Germany were identified. The health economics evaluation focuses on four main topics: patient education (5 studies), the comparison of outpatient and inpatient rehabilitation (7 studies), medico-occupational rehabilitation programs (2 studies) and aftercare programs (3 studies). All four topics show that innovative rehabilitation technologies can be cost-effective. Significant potential savings in program costs of 25-35% are demonstrated in outpatient rehabilitation (with comparable effectiveness with inpatient care). Designated patient education programs often lead to significant savings with indirect costs, by reducing periods of unfitness to work and extending the long-term ability to work. This review article also points out that some relevant areas of rehabilitation, such as the flexibilization of rehabilitation programs or the efficient organization of access to rehabilitation, have not been evaluated sufficiently on the basis of health economics. This article ends with the requirement to carry out more economics-based rehabilitation studies.

  20. Benefits and costs of substance abuse treatment programs for state prison inmates: results from a lifetime simulation model. (United States)

    Zarkin, Gary A; Cowell, Alexander J; Hicks, Katherine A; Mills, Michael J; Belenko, Steven; Dunlap, Laura J; Houser, Kimberly A; Keyes, Vince


    Reflecting drug use patterns and criminal justice policies throughout the 1990s and 2000s, prisons hold a disproportionate number of society's drug abusers. Approximately 50% of state prisoners meet the criteria for a diagnosis of drug abuse or dependence, but only 10% receive medically based drug treatment. Because of the link between substance abuse and crime, treating substance abusing and dependent state prisoners while incarcerated has the potential to yield substantial economic benefits. In this paper, we simulate the lifetime costs and benefits of improving prison-based substance abuse treatment and post-release aftercare for a cohort of state prisoners. Our model captures the dynamics of substance abuse as a chronic disease; estimates the benefits of substance abuse treatment over individuals' lifetimes; and tracks the costs of crime and criminal justice costs related to policing, adjudication, and incarceration. We estimate net societal benefits and cost savings to the criminal justice system of the current treatment system and five policy scenarios. We find that four of the five policy scenarios provide positive net societal benefits and cost savings to the criminal justice system relative to the current treatment system. Our study demonstrates the societal gains to improving the drug treatment system for state prisoners.

  1. A randomised comparison of cognitive behavioural therapy

    Directory of Open Access Journals (Sweden)

    Carlijn de Roos


    Full Text Available Background : Building on previous research with disaster-exposed children and adolescents, a randomised clinical trial was performed in the treatment of trauma-related symptoms. In the current study two active treatments were compared among children in a broad age range and from a wide diversity of ethnic populations. Objective : The primary aim was to compare the effectiveness and efficiency of Cognitive Behavioural Therapy (CBT and Eye Movement Desensitisation and Reprocessing (EMDR. Design : Children (n=52, aged 4–18 were randomly allocated to either CBT (n=26 or EMDR (n=26 in a disaster mental health after-care setting after an explosion of a fireworks factory. All children received up to four individual treatment sessions over a 4–8 week period along with up to four sessions of parent guidance. Blind assessment took place pre- and post-treatment and at 3 months follow-up on a variety of parent-rated and self-report measures of post-traumatic stress disorder symptomatology, depression, anxiety, and behaviour problems. Analyses of variance (general linear model repeated measures were conducted on the intention-to-treat sample and the completers. Results : Both treatment approaches produced significant reductions on all measures and results were maintained at follow-up. Treatment gains of EMDR were reached in fewer sessions. Conclusion : Standardised CBT and EMDR interventions can significantly improve functioning of disaster-exposed children.For the abstract in other languages, please see Supplementary files under Reading Tools online

  2. Elevated bladder cancer risk due to colorants--a statewide case-control study in North Rhine-Westphalia, Germany. (United States)

    Golka, Klaus; Heitmann, Peter; Gieseler, Frank; Hodzic, Jasmin; Masche, Nicolas; Bolt, Hermann M; Geller, Frank


    Occupational exposure to aromatic amines is a known bladder cancer risk factor, whereas the impact of exposure to azo dyes, which may release aromatic amines in humans, is at present controversial. Therefore, the impact of occupational exposures to colorants was investigated in 156 bladder cancer cases and 336 controls in the state of North Rhine-Westphalia. All bladder cancer cases and controls (diagnosed with prostate cancer) requested after-care treatment. The subjects were investigated using a questionnaire for all occupations ever performed for more than 6 mo and for exposures to several possible occupational and nonoccupational bladder carcinogens. The relative bladder cancer risk was adjusted for age and smoking. The adjusted odds ratio (OR) for bladder cancer was elevated in 7 painters (OR 1.98, 95% CI 0.64-6.11), 4 hairdressers (OR 4.9, 95% CI 0.85-28.39), and 16 cases who reported a wood processing occupation (OR 1.19, 95% CI 0.58-2.41). Ten of these 16 cases reported chronic exposure to colorants (OR 1.84, 95% CI 0.68-4.95). The results of this epidemiological study confirm the hypothesis that individuals exposed to colorants show an elevated bladder cancer risk.

  3. Using the level of Service Inventory-Revised to improve assessment and treatment in drug court. (United States)

    Guastaferro, Wendy P


    More than 2,000 drug courts in the United States provide supervision and substance-abuse treatment to thousands of offenders. Yet the treatment continuum from assessment to aftercare is underexplored. The effectiveness of the Level of Service Inventory-Revised (LSI-R) as a risk assessment tool is well established. However, fewer studies have considered its use in guiding treatment strategies. In using the LSI-R, the drug court program relied on the structured interview protocol (not the risk classification scores) to identify criminogenic needs that then helped determine placement in a high- or low-needs treatment track. To evaluate the effectiveness of these treatment placement decisions, this research used the LSI-R scores to examine individual and group differences (N = 182). Significant and substantive differences at the individual and group levels were found thus providing empirical support for using the LSI-R as a link between assessment and treatment. Implications for developing standards and practice protocols for drug courts are discussed.

  4. [Patient education as a constituent of a patient-oriented approach in rehabilitation]. (United States)

    Faller, H; Reusch, A; Ströbl, V; Vogel, H


    Patient education is a central component of patient-oriented medical rehabilitation. The aim of patient education is to provide patients with the fundamentals of acting as competent partners in the rehabilitation process. Thus, the goals of educational group programmes are compliance, self-management, and empowerment, which are aspired by means of providing information, training skills, and modifying attitudes. According to expert opinions, such programmes should comply with certain minimum criteria regarding aims, methods, and frameworks, which can then be complemented by additional quality criteria. Furthermore, educational programmes should meet all the substantial requirements and standards of the respective medical area and exhibit proven effectiveness. A nationwide survey of rehabilitation institutions has shown that the implementation of patient education does not meet the quality requirements in all cases, particularly regarding patient-oriented didactics, standardisation, manual-use and evaluation. An additional quality feature is marked by the skills and qualifications of the educators. Instructors should be competent in leading and moderating groups and using various methods and media in order to fulfill the standards of modern educational concepts. As ample evidence has shown, patient participation and improved self-efficacy are indispensable when trying to promote healthy lifestyles in patients. Additional opportunities for enhancing patient orientation and optimizing patient education are provided by measures of behavioural planning and after-care as attempts to convey the behavioural changes in the patients' everyday lives.

  5. Posttraumatic stress symptoms after exposure to two fire disasters: comparative study. (United States)

    Van Loey, Nancy E; van de Schoot, Rens; Faber, Albertus W


    This study investigated traumatic stress symptoms in severely burned survivors of two fire disasters and two comparison groups of patients with "non-disaster" burn injuries, as well as risk factors associated with acute and chronic stress symptoms. Patients were admitted to one out of eight burn centers in The Netherlands or Belgium. The Impact of Event Scale (IES) was administered to 61 and 33 survivors respectively of two fire disasters and 54 and 57 patients with "non-disaster" burn etiologies at 2 weeks, 3, 6, 12 and 24 months after the event. We used latent growth modeling (LGM) analyses to investigate the stress trajectories and predictors in the two disaster and two comparison groups. The results showed that initial traumatic stress reactions in disaster survivors with severe burns are more intense and prolonged during several months relative to survivors of "non-disaster" burn injuries. Excluding the industrial fire group, all participants' symptoms on average decreased over the two year period. Burn severity, peritraumatic anxiety and dissociation predicted the long-term negative outcomes only in the industrial fire group. In conclusion, fire disaster survivors appear to experience higher levels of traumatic stress symptoms on the short term, but the long-term outcome appears dependent on factors different from the first response. Likely, the younger age, and several beneficial post-disaster factors such as psychosocial aftercare and social support, along with swift judicial procedures, contributed to the positive outcome in one disaster cohort.

  6. 浅谈胸痹患者的中医护理体会%On TCM Nursing of Patients with Chest Obstruction

    Institute of Scientific and Technical Information of China (English)

    胡婷婷; 孙晓琳


    Chest obstruction,which is very common in clinical treatment,refers to a feeling of tightness and pain of the chest,even the pain covering the whole back.The major symptom of the disease is that the patients suffer great pain,unable to lie in bed.Coronary atherosclerotic heart disease,angina pectoris,myocardial infarction all belong to chest obstruction.This article is divided into five parts to elaborate the experience of TCM nursing,including general nursing,diet aftercare,dialectical care,emotional adjustment,prevention and regulation.%胸痹是胸部闷痛,甚则胸痛彻背,喘息不得卧为主症的一种疾病,在临床中发病率极高,现代医学中的冠状动脉粥样硬化性心脏病、心绞痛、心肌梗死等,可属本证范畴.文章从一般护理、饮食调护、辨证施护、情志调节、预防调摄五方面阐述了中医护理体会.

  7. Substance use treatment barriers for patients with frequent hospital admissions. (United States)

    Raven, Maria C; Carrier, Emily R; Lee, Joshua; Billings, John C; Marr, Mollie; Gourevitch, Marc N


    Substance use (SU) disorders adversely impact health status and contribute to inappropriate health services use. This qualitative study sought to determine SU-related factors contributing to repeated hospitalizations and to identify opportunities for preventive interventions. Fifty Medicaid-insured inpatients identified by a validated statistical algorithm as being at high-risk for frequent hospitalizations were interviewed at an urban public hospital. Patient drug/alcohol history, experiences with medical, psychiatric and addiction treatment, and social factors contributing to readmission were evaluated. Three themes related to SU and frequent hospitalizations emerged: (a) barriers during hospitalization to planning long-term treatment and follow-up, (b) use of the hospital as a temporary solution to housing/family problems, and (c) unsuccessful SU aftercare following discharge. These data indicate that homelessness, brief lengths of stay complicating discharge planning, patient ambivalence regarding long-term treatment, and inadequate detox-to-rehab transfer resources compromise substance-using patients' likelihood of avoiding repeat hospitalization. Intervention targets included supportive housing, detox-to-rehab transportation, and postdischarge patient support.

  8. [Assumption of medical risks and the problem of medical liability in ancient Roman law]. (United States)

    Váradi, Agnes


    The claim of an individual to assure his health and life, to assume and compensate the damage from diseases and accidents, had already appeared in the system of the ancient Roman law in the form of many singular legal institutions. In lack of a unified archetype of regulation, we have to analyse the damages caused in the health or corporal integrity of different personal groups: we have to mention the legal interpretation of the diseases or injuries suffered by serves, people under manus or patria potestas and free Roman citizens. The fragments from the Digest od Justinian do not only demonstrate concrete legal problems, but they can serve as a starting point for further theoretical analyses. For example: if death is the consequence of a medical failure, does the doctor have any kind of liability? Was after-care part of the healing process according to the Roman law? Examining these questions, we should not forget to talk about the complex liability system of the Roman law, the compensation of the damages caused in a contractual or delictual context and about the lex Aquilia. Although these conclusions have no direct relation with the present legal regulation of risk assumption, we have to see that analysing the examples of the Roman law can be useful for developing our view of a certain theoretical problem, like that of the modern liability concept in medicine as well.

  9. Contact lens wear and dry eyes: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Markoulli M


    Full Text Available Maria Markoulli, Sailesh Kolanu School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia Abstract: The number of contact lens wearers worldwide has remained relatively stable over the past decade, despite the investment that has gone into contact lens technology. This is largely because 10%–50% of wearers dropout of contact lens wear within 3 years of commencement; the most common reason cited being contact lens discomfort (CLD. Of the symptoms reported, sensation of dry eye is the most common. Given the outcome of reduced wearing time, increased chair time, and ultimate contact lens discontinuation, the challenge is to identify the warning signs of CLD early on. Clinically detectable changes such as conjunctival staining, conjunctival indentation, conjunctival epithelial flap formation, lid wiper epitheliopathy, Demodex blepharitis, and meibomian gland dysfunction have been linked to CLD, highlighting the need to perform regular aftercare visits to identify these changes. At a cellular level, conjunctival metaplasia and reduced goblet cell density have been linked to CLD, leading to a downstream effect on the tear film breakup time of contact lens wearers. These factors suggest a strong link between CLD and friction, raising the need to target this as a means of minimizing CLD. The purpose of this review is to identify the clinical signs that relate to CLD as a means of earlier detection and management in order to combat contact lens dropout. Keywords: contact lens discomfort, dry eye disease, lid wiper epitheliopathy, tear film biomarkers, meibomian gland dysfunction

  10. Evaluation and selection of decision-making methods to assess landfill mining projects. (United States)

    Hermann, Robert; Baumgartner, Rupert J; Vorbach, Stefan; Ragossnig, Arne; Pomberger, Roland


    For the first time in Austria, fundamental technological and economic studies on recovering secondary raw materials from large landfills have been carried out, based on the 'LAMIS - Landfill Mining Austria' pilot project. A main focus of the research - and the subject of this article - was to develop an assessment or decision-making procedure that allows landfill owners to thoroughly examine the feasibility of a landfill mining project in advance. Currently there are no standard procedures that would sufficiently cover all the multiple-criteria requirements. The basic structure of the multiple attribute decision making process was used to narrow down on selection, conceptual design and assessment of suitable procedures. Along with a breakdown into preliminary and main assessment, the entire foundation required was created, such as definitions of requirements to an assessment method, selection and accurate description of the various assessment criteria and classification of the target system for the present 'landfill mining' vs. 'retaining the landfill in after-care' decision-making problem. Based on these studies, cost-utility analysis and the analytical-hierarchy process were selected from the range of multiple attribute decision-making procedures and examined in detail. Overall, both methods have their pros and cons with regard to their use for assessing landfill mining projects. Merging these methods or connecting them with single-criteria decision-making methods (like the net present value method) may turn out to be reasonable and constitute an appropriate assessment method.

  11. A community intervention trial of multimodal suicide prevention program in Japan: A Novel multimodal Community Intervention program to prevent suicide and suicide attempt in Japan, NOCOMIT-J

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    Suzuki Yuriko


    Full Text Available Abstract Background To respond to the rapid surge in the incidence of suicide in Japan, which appears to be an ongoing trend, the Japanese Multimodal Intervention Trials for Suicide Prevention (J-MISP have launched a multimodal community-based suicide prevention program, NOCOMIT-J. The primary aim of this study is to examine whether NOCOMIT-J is effective in reducing suicidal behavior in the community. Methods/DesignThis study is a community intervention trial involving seven intervention regions with accompanying control regions, all with populations of statistically sufficient size. The program focuses on building social support networks in the public health system for suicide prevention and mental health promotion, intending to reinforce human relationships in the community. The intervention program components includes a primary prevention measures of awareness campaign for the public and key personnel, secondary prevention measures for screening of, and assisting, high-risk individuals, after-care for individuals bereaved by suicide, and other measures. The intervention started in July 2006, and will continue for 3.5 years. Participants are Japanese and foreign residents living in the intervention and control regions (a total of population of 2,120,000 individuals. Discussion The present study is designed to evaluate the effectiveness of the community-based suicide prevention program in the seven participating areas. Trial registration UMIN Clinical Trials Registry (UMIN-CTR UMIN000000460.

  12. Family of origin and current relationship influences on codependency. (United States)

    Prest, L A; Benson, M J; Protinsky, H O


    This study investigated codependency in Caucasian individuals within the framework of Bowen's Family Systems Theory. The sample consisted of a group of couples, in which one member of the couple was a recovering alcoholic in an aftercare program, and a group of matched, comparison couples. Participants completed a demographic questionnaire, the Friel Codependency Assessment Inventory, and the Personal Authority in the Family System (PAFS) Questionnaire. The findings confirmed that codependency levels were higher in clinical than in comparison couples. Moreover, within the clinical group, there was little difference between alcoholics and their spouses with respect to dysfunction in their families of origin, current families, or their codependency levels. The findings further suggested that the etiology and function of codependency are different in clinical and nonclinical families. In the clinical sample, the family of origin and current relationship characteristics were related to codependency in patterns consistent with previous theory and research. For the nonclinical sample, however, the findings contradicted conventional codependency theory. The findings suggest that, in contrast to clinical populations, codependency in nonclinical populations has some links with favorable characteristics of family functioning.

  13. Enterprise Model for Vendor Development: A Study at Selected Technology Park

    Directory of Open Access Journals (Sweden)

    Abdul Aziz Ab. Latif


    Full Text Available The study addresses the issues of skills enhancement that need be implemented in three distinct phases of enterprise development. Phase I is the developmental phase where potential entrepreneurs are provided with skills needed for venture take-off or start-up. Phase II is the enterprise creation phase while Phase III is the market development phase. This paper also discusses the multiple roles of the Techno Center during each of these distinct phases. Based on the analysis, the study found that there are gaps across industrial sub-sectors in term of various skills needed to create sustainable enterprise and entrepreneur development. Those gaps are cognitive, interpersonal, technical, creativity, computation, communication, intrapersonal, conceptual, managerial, analytical, technological, acoustic, design, self-management, innovative, basic managerial, supervisory, and marketing. The Techno Centre Enterprise Development Model highlights the central and multiple roles required of The Techno Centre in order to effectively provide support and services during various phases of enterprise development. The services include skill development, networking and linkages services; technology transfer and consultancy services; advisory services; and after-care services have different contents at different stages of the enterprise development.Key words: technology park, sustainable enterprise, technology transfer

  14. Optimal management of the critically ill: anaesthesia, monitoring, data capture, and point-of-care technological practices in ovine models of critical care. (United States)

    Chemonges, Saul; Shekar, Kiran; Tung, John-Paul; Dunster, Kimble R; Diab, Sara; Platts, David; Watts, Ryan P; Gregory, Shaun D; Foley, Samuel; Simonova, Gabriela; McDonald, Charles; Hayes, Rylan; Bellpart, Judith; Timms, Daniel; Chew, Michelle; Fung, Yoke L; Toon, Michael; Maybauer, Marc O; Fraser, John F


    Animal models of critical illness are vital in biomedical research. They provide possibilities for the investigation of pathophysiological processes that may not otherwise be possible in humans. In order to be clinically applicable, the model should simulate the critical care situation realistically, including anaesthesia, monitoring, sampling, utilising appropriate personnel skill mix, and therapeutic interventions. There are limited data documenting the constitution of ideal technologically advanced large animal critical care practices and all the processes of the animal model. In this paper, we describe the procedure of animal preparation, anaesthesia induction and maintenance, physiologic monitoring, data capture, point-of-care technology, and animal aftercare that has been successfully used to study several novel ovine models of critical illness. The relevant investigations are on respiratory failure due to smoke inhalation, transfusion related acute lung injury, endotoxin-induced proteogenomic alterations, haemorrhagic shock, septic shock, brain death, cerebral microcirculation, and artificial heart studies. We have demonstrated the functionality of monitoring practices during anaesthesia required to provide a platform for undertaking systematic investigations in complex ovine models of critical illness.

  15. Posttraumatic stress symptoms after exposure to two fire disasters: comparative study.

    Directory of Open Access Journals (Sweden)

    Nancy E Van Loey

    Full Text Available This study investigated traumatic stress symptoms in severely burned survivors of two fire disasters and two comparison groups of patients with "non-disaster" burn injuries, as well as risk factors associated with acute and chronic stress symptoms. Patients were admitted to one out of eight burn centers in The Netherlands or Belgium. The Impact of Event Scale (IES was administered to 61 and 33 survivors respectively of two fire disasters and 54 and 57 patients with "non-disaster" burn etiologies at 2 weeks, 3, 6, 12 and 24 months after the event. We used latent growth modeling (LGM analyses to investigate the stress trajectories and predictors in the two disaster and two comparison groups. The results showed that initial traumatic stress reactions in disaster survivors with severe burns are more intense and prolonged during several months relative to survivors of "non-disaster" burn injuries. Excluding the industrial fire group, all participants' symptoms on average decreased over the two year period. Burn severity, peritraumatic anxiety and dissociation predicted the long-term negative outcomes only in the industrial fire group. In conclusion, fire disaster survivors appear to experience higher levels of traumatic stress symptoms on the short term, but the long-term outcome appears dependent on factors different from the first response. Likely, the younger age, and several beneficial post-disaster factors such as psychosocial aftercare and social support, along with swift judicial procedures, contributed to the positive outcome in one disaster cohort.

  16. Use of dialectical behavior therapy in a partial hospital program for women with borderline personality disorder. (United States)

    Simpson, E B; Pistorello, J; Begin, A; Costello, E; Levinson, J; Mulberry, S; Pearlstein, T; Rosen, K; Stevens, M


    Dialectical behavior therapy, an outpatient psychosocial treatment for chronically suicidal women with borderline personality disorder, has been adapted for use in a partial hospital program for women. Patients attend the program for a minimum of five days of individual and group therapy, and full census is 12 women. About 65 percent of participants meet at least three criteria for borderline personality disorder, and most have suicidal and self-injurious behavior. Their comorbid diagnoses include trauma-related diagnoses and anxiety disorders, severe eating disorders, substance abuse, and depression. The partial hospital program is linked to an aftercare program offering six months of outpatient skills training based on dialectical behavior therapy. Both programs focus on teaching patients four skills: mindfulness (attention to one's experience), interpersonal effectiveness, emotional regulation, and distress tolerance. Two years of operation of the women's partial hospital program provides promising anecdotal evidence that dialectical behavioral therapy, an outpatient approach, can be effectively modified for partial hospital settings and a more diverse population.

  17. Trends in drop out, drug free discharge and rates of re-presentation: a retrospective cohort study of drug treatment clients in the North West of England

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    McVeigh Jim


    Full Text Available Abstract Background Governments aim to increase treatment participation by problematic drug users. In the UK this has been achieved by fiscal investment, an expanded workforce, reduced waiting times and coercive measures (usually criminal justice (CJ led. No assessment of these measures on treatment outcomes has been made. Using established monitoring systems we assessed trends in 'dropped out' and 'discharged drug free' (DDF, since the launch of the national drug strategy, and rates of treatment re-presentation for these cohorts. Methods A longitudinal dataset of drug users (1997 to 2004/05, n = 26,415 was used to identify people who dropped out of, and were DDF from, services for years 1998 to 2001/02, and re-presentations of these people in years to 2004/05. Trends in drop out and DDF, baseline comparisons of those DDF and those who dropped out and outcome comparisons for those referred from the CJ system versus other routes of referral were examined using chi square. Logistic regression analyses identified variables predicting drop out versus DDF and subsequent re-presentation versus no re-presentation. Results The proportion of individuals dropping out has increased from 7.2% in 1998 to 9.6% in 2001/02 (P Conclusion Increasing numbers in treatment is associated with an increased proportion dropping out and an ever-smaller proportion DDF. Rates of drop out are significantly higher for those coerced into treatment via the CJ system. Rates of re-presentation are similar for those dropping out and those DDF. Encouragingly, those who need to re-engage with treatment, particularly those who drop out, are doing so more quickly. The impact of coercion on treatment outcomes and the appropriateness of aftercare provision require further consideration.

  18. Clinical Presentation and Microbial Analyses of Contact Lens Keratitis; an Epidemiologic Study

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    Seyed Ahmad Rasoulinejad


    Full Text Available Introduction: Microbial keratitis is an infective process of the cornea with a potentially and serious visual impairments. Contact lenses are a major cause of microbial keratitis in the developed countries especially among young people. Therefore, the purpose of the present study was to evaluate the frequency and microbiological characteristic of CLK in patients referred to the emergency department (ED of teaching hospitals, Babol, Iran. Methods: This is a cross-sectional study of all patients with contact lens induced corneal ulcers admitted to the teaching hospitals of Babol, Iran, from 2011- 2013. An ophthalmologist examined patients with the slit-lamp and clinical features of them were noted (including pain, redness, foreign body sensation, chemosis, epiphora, blurred vision, discomfort, photophobia, discharge, ocular redness and swelling. All suspected infectious corneal ulcers were scraped for microbial culture and two slides were prepared. Data were analyzed using SPSS software, version 18.0. Results: A total of 14 patients (17 eyes were recruited into the study (100% female. The patients’ age ranged from 16-37 years old (mean age 21.58±7.23 years. The most prevalent observed clinical signs were pain and redness. Three samples reported as sterile. The most common isolated causative organism was pseudomonas aeroginosa (78.6%, Staphylococcus aureus 14.3%, and enterobacter 7.1%, respectively. Treatment outcome was excellent in 23.5%, good in 47.1%, and poor in 29.4% of cases. Conclusion: Improper lens wear and care as well as the lack of awareness about the importance of aftercare visits have been identified as potential risk factors for the corneal ulcer among contact lens wearers. Training and increasing the awareness of adequate lens care and disinfection practices, consulting with an ophthalmologist, and frequent replacement of contact lens storage cases would greatly help reducing the risk of microbial keratitis.

  19. Titanium elastic nailing in pediatric femoral diaphyseal fractures

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    Singh Roop


    Full Text Available Background: The need for operative fixation of pediatric femoral fractures is increasingly being recognised in the present decade. The conventional traction and casting method for management of pediatric femoral fractures is giving way for the operative stabilisation of the fracture. Methods : Thirty five pediatric patients in age group 6-14 years with diaphyseal femoral fractures were stabilised with two titanium nails. Patients were followed up clinically and radiologically for two years. The final results were evaluated using the criteria of Flynn et al. Technical problems and complications associated with the procedure were also analysed. Results : Overall results observed were excellent in 25, satisfactory in 8 and poor in 2 patients. Hospital time averaged 12.30 days in the series. All the fractures healed with an average time to union of 9.6 (6-14.4 weeks. Return to school was early with an average of 7.8 weeks. The soft tissue discomfort near the knee produced by the nails ends was the most common problem encountered. Shortening was observed in three cases and restriction of knee flexion in 5 patients. There was no delayed union, infection or refractures. Per operative technical problems included failure of closed reduction in 2 cases and cork screwing of nails in one case. Conclusion : We believe that with proper operative technique and aftercare TENs may prove to be an ideal implant for pediatric femoral fracture fixation. The most of the complication associated with the procedure are infact features of inexact technique and can be eliminated by strictly adhering to the basic principles and technical aspects.

  20. The population-based oncological health care study OVIS – recruitment of the patients and analysis of the non-participants

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    Raspe Heiner


    Full Text Available Abstract Background The ageing of the population is expected to bring an enormous growth in demand for oncological health care. In order to anticipate and respond to future trends, cancer care needs to be critically evaluated. The present study explores the possibility of conducting representative and population-based research on cancer care on the basis of data drawn from the Cancer Registry. Methods A population-based state-wide cohort study (OVIS has been carried out in Schleswig-Holstein, Germany. All patients with malignant melanoma, breast, or prostate cancer were identified in the Cancer Registry. Epidemiological data were obtained for all the patients and screened for study eligibility. A postal questionnaire requesting information on diagnosis, therapy, QoL and aftercare was sent to eligible patients. Results A total of 11,489 persons diagnosed with the cancer types of interest in the period from January 2002 to July 2004 were registered in the Cancer Registry. Of the 5,354 (47% patients who gave consent for research, 4,285 (80% of consenters completed the questionnaire. In terms of relevant epidemiological variables, participants with melanoma were not found to be different from non-participants with the same diagnosis. However, participants with breast or prostate cancer were slightly younger and had smaller tumours than patients who did not participate in our study. Conclusion Population-based cancer registry data proved to be an invaluable resource for both patient recruitment and non-participant analysis. It can help improve our understanding of the strength and nature of differences between participants and non-respondents. Despite minor differences observed in breast and prostate cancer, the OVIS-sample seems to represent the source population adequately.

  1. [Media use and physical activity patterns of adolescent participants in obesity therapy: Analysis of the impact of selected sociodemographic factors]. (United States)

    Wulff, Hagen; Wagner, Petra


    To meet the challenge of obesity, effective therapeutic concepts for adolescents focusing on lifestyle changes are necessary. Particularly relevant are nutrition and physical activity patterns associated with media use, which can be influenced by sociodemographic factors. For the optimization of obesity therapy approaches, it is essential to analyze these sociodemographic factors to adjust the aims, content, and methods of interventions, and to use the potential of media in treatment concepts. Thus, the research question is: what are the media and physical activity patterns of 11- to 17-year-old participants in obesity therapy, depending on sociodemographic factors? The national multicenter study was conducted from 2012 to 2013. A questionnaire was administered to 564 participants aged 13.4 ± 1.6 (mean ± standard deviation) years. Standardized instruments were used to assess the variables physical activity, media use, and sociodemographic factors. Participants were physically active for 1 h on 3.3 ± 1.8 days per week, 8.5 % daily. Televisions, mobile phones, and computers were available in all sociodemographic groups and were used for 2 h per day. Sociodemographic differences can be seen in the extent of media usage (h/day). These differences can be found between girls and boys concerning their usage of mobile phones (2.49 vs. 1.90; p  media usage and physical activity. Compared with existing literature, the survey results reveal reduced activity and increased media use, which vary among the groups. Thus, differentiated therapy approaches appear to be reasonable. Future research needs to evaluate to what extent media, despite the risks, can contribute to the methodological support of therapy, training, and aftercare concepts.

  2. Meniscectomy: indications, procedure, outcomes, and rehabilitation

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    Anetzberger H


    motion and preventing secondary damage. It is the surgical therapy that dictates the aftercare, and with regards to the latter, there are clear differences between meniscectomy and meniscal repair. Keywords: meniscectomy, osteoarthritis, meniscus pathology, meniscus function

  3. Current state and future prospects of remedial soil protection. Background

    Energy Technology Data Exchange (ETDEWEB)

    Frauenstein, Joerg


    The legal basis for soil protection in the Federal Republic of Germany is: -The Act on Protection against Harmful Changes to Soil and on Rehabilitation of Contaminated Sites (Federal Soil Protection Act) (Bundes-Bodenschutzgesetz - BBodSchG) of 1998 [1] -The Federal Soil Protection and Contaminated Sites Ordinance (BBodSchV) of 1999 [2]. In Germany, the Federal Government has legislative competence in the field of soil protection. The Lander (German federal states), in turn, are responsible for enforcement of the BBodSchG and the BBodSchV; they may also issue supplementary procedural regulations. According to Article 1 BBodschG, the purpose of the Act is inter alia to protect and restore the functions of the soil on a permanent sustainable basis. These actions shall include prevention of harmful soil changes as well as rehabilitating soil, contaminated sites and waters contaminated by such sites in such a way that any contamination remains permanently below the hazard threshold. Whilst prevention aims to protect and preserve soil functions on a long-term basis, the object of remediation is mainly to avert concrete hazards in a spatial, temporal and manageable causative context. ''Remedial soil protection'' encompasses a tiered procedure in which a suspicion is verified successively and with least-possible effort and in which the circumstances of the individual case at hand are taken into account in deciding whether or not a need for remediation exists. It comprises the systematic stages of identifying, investigating and assessing suspect sites and sites suspected of being contaminated with a view to their hazard potential, determining whether remediation is necessary, remediating identified harmful soil changes and contaminated sites, and carrying out, where necessary, aftercare measures following final inspection of the remedial measure. (orig.)

  4. Complex kidneys for complex patients: the risk associated with transplantation of kidneys with multiple arteries into obese patients. (United States)

    Nath, J; Mastoridis, S; van Dellen, D; Guy, A J; McGrogan, D G; Krishnan, H; Pattenden, C; Inston, N G; Ready, A R


    Conflicting evidence surrounds clinical outcomes in obese individuals after transplantation; nonetheless, many are denied the opportunity to receive a transplant. Allografts with complex vascular anatomy are regularly used in both deceased and living donor settings. We established the risk of transplanting kidneys with multiple renal arteries into obese recipients. A retrospective analysis of data from 1095 patients undergoing renal transplantation between January 2004 and July 2013 at a single centre was conducted. Of these, 24.2% were obese (body mass index >30 kg/m(2)), whereas 25.1% of kidneys transplanted had multiple arteries, thereby making the transplantation of kidneys of complex anatomy into obese recipients a relatively common clinical occurrence. Vessel multiplicity was associated with inferior 1-year graft survival (85.8.% vs 92.1%, P = .004). Obese patients had worse 1-graft survival compared to those of normal BMI (86.8% vs 93.8%, P = .001). The risk of vascular complications and of graft loss within a year after transplantation were greater when grafts with multiple arteries were transplanted into obese recipients as compared to their nonobese counterparts (RR 2.00, CI 95% 1.07-3.65, and RR 1.95, CI 95% 1.02-3.65). Additionally, obese patients faced significantly higher risk of graft loss if receiving a kidney with multiple arteries compared to one of normal anatomy (RR 1.97, 95% CI 1.02-3.72). Thus, obese patients receiving complex anatomy kidneys face poorer outcomes, which should be considered when allocating organs, seeking consent, and arranging for aftercare.

  5. [Suicide prevention activities of psychiatry-related professional societies: the promotion of suicide prevention in psychiatric care]. (United States)

    Otsuka, Kotaro; Kawanishi, Chiaki


    Suicide prevention is promoted nationally in Japan. In the General Principles of Suicide Prevention Policy determined in 2007, the areas in which, psychiatry contributed were shown to be important, for example, psychiatric care, suicide, aftercare program for suicide attempters, mental health promotion, and actual elucidation of the cause of suicide. At a part of these national measures, guidelines on suicide attempters' care are devised by the Japanese Society for Emergency Medicine and the Japanese Association for Emergency Psychiatry, and a training workshop on caring for suicide attempters was held by the Ministry of Health, Labour and Welfare. The Japanese society for Emergency Medicine devised an educational program of care for patients with mental health problems in emergency care in cooperation with the Japanese Association for Emergency Psychiatry and Japanese Society of General Hospital Psychiatry. On the other hand, suicide prevention and staff care at hospitals are important problems, and the Japan Council for Quality Health Care devised a program and conducted a training workshop. Also, the Japanese Association for Suicide Prevention conducted workshops for both the educational program of cognitive-behavioral therapy and facilitator training program for gatekeeper. The Japanese Society of Mood Disorders conducted a training workshop involving clinical high-risk case discussion. Also, the Japanese Society of Psychiatry and Neurology devised clinical guidelines for suicide prevention and distributed them to all society members. In this society, on-site discussion of the guidelines and the holding of workshops are expected in the future. It is hoped that these guidelines will be utilized and training workshops will be held in the future.

  6. Appropriate interventions for the prevention and management of self-harm: a qualitative exploration of service-users' views

    Directory of Open Access Journals (Sweden)

    Platt Stephen


    Full Text Available Abstract Background The engagement of service-users in exploring appropriate interventions for self-harm has been relatively neglected in comparison with clinical studies focusing on the management and prevention of self-harm. The purpose of this study was to investigate perceptions of interventions for self-harm (formal and informal, prevention and treatment among people who have first-hand experience as a result of their own behaviour. Methods Semi-structured interviews were undertaken with 14 patients admitted to hospital following a repeat act of self-harm. Data analysis was undertaken thematically, drawing broadly on some of the principles and techniques of grounded theory Results The patients were a heterogeneous group with respect to their personal characteristics and the nature of their self-harm. Thirteen of the 14 patient accounts could be assigned to one or more of three overlapping experiential themes: the experience of psychiatric illness, the experience of alcohol dependency, and the experience of traumatic life events and chronic life problems. These themes were related to the nature of patients' self-harm and their experiences of, and attitudes towards, interventions for self-harm and their attitudes towards these. There was a clear preference for specialist community-based interventions, which focus on the provision of immediate aftercare and acknowledge that the management of self-harm may not necessarily involve its prevention. The findings generate the preliminary hypothesis that personal circumstances and life history are major influences on the choice of interventions for self-harm. Conclusion This study attests to the importance of recognising differences within the self-harming population, and acknowledging patients' personal circumstances and life history. These may provide clues to the antecedents of their self-harm, and lead to more acceptable and appropriate treatments.

  7. Implementation and scientific evaluation of rehabilitative sports groups for prostate cancer patients: study protocol of the ProRehab Study

    Directory of Open Access Journals (Sweden)

    Zopf Eva M


    Full Text Available Abstract Background Although treatment regimen have improved in the last few years, prostate cancer patients following a radical prostatectomy still experience severe disease- and treatment-related side effects, including urinary incontinence, erectile dysfunction and psychological issues. Despite high incidence rates and the common adverse effects there is a lack of supportive measures for male patients and specific physical exercise recommendations for prostate cancer patients during rehabilitation or in the aftercare are still missing. Methods/Design The ProRehab Project aims to establish rehabilitative sports groups particularly for prostate cancer patients and to evaluate the effects of the offered exercise program. Starting 8–12 weeks after prostatectomy or combination therapy, prostate cancer patients will exercise for 15 months within a patient preference randomized controlled trial. One exercise session will be conducted within a pre-established rehabilitative sports group, while the other will be completed independently. Patients in the control group will not participate in the intervention. The main outcomes of the study include aerobic fitness, quality of life, incontinence and erectile dysfunction. Discussion By combining science, practice, and public relations the first rehabilitative sports groups for prostate cancer patients in Germany have been set up and thus contribute to the care structure for prostate cancer patients. By offering a 15-month physical exercise intervention that is conducted in supervised group sessions, long-term lifestyle changes and therefore improvements in quality of life in prostate cancer patients can be expected. Trial registration German Clinical Trials Register DRKS00004184

  8. An international validation study of two achievement goal measures in a pharmacy education context

    Directory of Open Access Journals (Sweden)

    Alrakaf S


    Full Text Available Saleh Alrakaf,1 Ahmed Abdelmageed,2 Mary Kiersma,2 Sion A Coulman,3 Dai N John,3 June Tordoff,4 Claire Anderson,5 Ayman Noreddin,6 Erica Sainsbury,1 Grenville Rose,7 Lorraine Smith11Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia; 2Faculty of Pharmacy, Manchester University, Fort Wayne, IN, USA; 3School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK; 4School of Pharmacy, University of Otago, Dunedin, NZ; 5School of Pharmacy, University of Nottingham, Nottingham, UK; 6School of Pharmacy, Hampton University, Hampton, VA, USA; 7Aftercare, Sydney, NSW, AustraliaBackground: Achievement goal theory helps us understand what motivates students to participate in educational activities. However, measuring achievement goals in a precise manner is problematic. Elliot and McGregor's Achievement Goal Questionnaire (AGQ and Elliot and Murayama's revised Achievement Goal Questionnaire (AGQ-R are widely used to assess students' achievement goals. Both instruments were developed and validated using undergraduate psychology students in the USA.Methods: In this study, our aims were to first of all, assess the construct validity of both questionnaires using a cohort of Australian pharmacy students and, subsequently, to test the generalizability and replicability of these tools more widely in schools of pharmacy in other English-speaking countries. The AGQ and the AGQ-R were administered during tutorial class time. Confirmatory factor analysis procedures, using AMOS 19 software, were performed to determine model fit.Results: In contrast to the scale developers' findings, confirmatory factor analysis supported a superior model fit for the AGQ compared with the AGQ-R, in all countries under study.Conclusion: Validating measures of achievement goal motivation for use in pharmacy education is necessary and has implications for future research. Based on these results, the AGQ will be used to conduct future cross-sectional and

  9. Suicide attempt in young people: A signal for long-term healthcare and social needs (United States)

    Goldman-Mellor, Sidra J.; Caspi, Avshalom; Harrington, HonaLee; Hogan, Sean; Nada-Raja, Shyamala; Poulton, Richie; Moffitt, Terrie E.


    recession, additional suicide prevention efforts and long-term monitoring and after-care services are needed. PMID:24306041

  10. Patient-reported outcomes as predictors of 10-year survival in women after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Segadal Leidulf


    Full Text Available Abstract Background Patient-reported outcomes are increasingly seen as complementary to biomedical measures. However, their prognostic importance has yet to be established, particularly in female long-term myocardial infarction (MI survivors. We aimed to determine whether 10-year survival in older women after MI relates to patient-reported outcomes, and to compare their survival with that of the general female population. Methods We included all women aged 60-80 years suffering MI during 1992-1997, and treated at one university hospital in Norway. In 1998, 145 (60% of those alive completed a questionnaire package including socio-demographics, the Sense of Coherence Scale (SOC-29, the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF and an item on positive effects of illness. Clinical information was based on self-reports and hospital medical records data. We obtained complete data on vital status. Results The all-cause mortality rate during the 1998-2008 follow-up of all patients was 41%. In adjusted analysis, the conventional predictors s-creatinine (HR 1.26 per 10% increase and left ventricular ejection fraction below 30% (HR 27.38, as well as patient-reported outcomes like living alone (HR 6.24, dissatisfaction with self-rated health (HR 6.26, impaired psychological quality of life (HR 0.60 per 10 points difference, and experience of positive effects of illness (HR 6.30, predicted all-cause death. Major adverse cardiac and cerebral events were also significantly associated with both conventional predictors and patient-reported outcomes. Sense of coherence did not predict adverse events. Finally, 10-year survival was not significantly different from that of the general female population. Conclusion Patient-reported outcomes have long-term prognostic importance, and should be taken into account when planning aftercare of low-risk older female MI patients.

  11. 社交媒体在医患沟通中的应用探讨%A Discussion on the Application of Social Media in Doctor-patient Communication

    Institute of Scientific and Technical Information of China (English)

    侯胜田; 王海星


    The traditional ways of doctor -patient communication , are limited by the communication time and scope , both of them have been unable to meet the patients'communication needs .With the continuous development of network , social media extends the application scope in the field of healthcare .The application of social media in doctor-patient communication has some applicability and feasibility .This paper analyzes the limitations of tradi-tional doctor-patient communication , tries to apply the experience of social media in the field of healthcare , and puts forward some new application strategies:push information initiatively and enhance the doctor -patient interac-tion;carry out pre-hospital and aftercare communication to extend communication scope; collect feedbacks from patients and handle patients'complaints.%传统的医患沟通方式受到了沟通时间短、沟通范围窄的限制,已不能满足患者对于医患沟通的需求。伴随网络技术的发展,社交媒体在医疗服务领域的应用范围扩大,借助社交媒体开展医患沟通具有一定的适用性与可行性。通过分析传统医患沟通方式的局限性,借鉴社交媒体在医疗服务领域的应用经验,提出借助社交媒体主动推送信息、加强医患互动;开展院前、院后沟通,扩展沟通范围;收集患者意见,受理患者投诉的医患沟通策略。

  12. Mobile phone technology: a new paradigm for the prevention, treatment, and research of the non-sheltered "street" homeless? (United States)

    Eyrich-Garg, Karin M


    Individuals experiencing homelessness have disproportionately high rates of health problems. Those who perceive themselves as having greater access to their social support networks have better physical and mental health outcomes as well as lower rates of victimization. Mobile phones offer a connection to others without the physical constraints of landlines and, therefore, may make communication (e.g., access to one's social support networks) more feasible for homeless individuals. This, in turn, could lead toward better health outcomes. This exploratory study examined mobile phone possession and use among a sample of 100 homeless men and women who do not use the shelter system in Philadelphia, PA. Interviews were comprised of the Homeless Supplement to the Diagnostic Interview Schedule, a technology module created for this investigation, and the substance use and psychiatric sections of the Addiction Severity Index. Almost half (44%) of the sample had a mobile phone. In the past 30 days, 100% of those with mobile phones placed or received a call, over half (61%) sent or received a text message, and one fifth (20%) accessed the Internet via their mobile phone. Participants possessed and used mobile phones to increase their sense of safety, responsibility (employment, stable housing, personal business, and sobriety or "clean time"), and social connectedness. Mobile phones could potentially be used by public health/health care providers to disseminate information to the street homeless, to enhance communication between the street homeless and providers, and to increase access for the street homeless to prevention, intervention, and aftercare services. Finally, this technology could also be used by researchers to collect data with this transient population.

  13. A pan-European study of capabilities to manage mass casualties from the release of chemical agents: the MASH project. (United States)

    Baker, David J; Murray, Virginia S G; Carli, Pierre A


    The European Union (EU) Mass Casualties and Health (MASH) project that ran between 2008 and 2010 was designed to study the management of mass casualties from chemical and radiological releases and associated health implications. One area of study for this project concerned arrangements within EU Member States for the management of mass casualties following a chemical release. This was undertaken via a confidential online questionnaire that was sent to selected points of contact throughout the EU. Responses were obtained from 18 states from respondents holding senior positions in chemical planning and incident response. Information gathered shows a lack of uniformity within the EU about the organization of responses to chemical releases and the provision of medical care. This article presents the overall findings of the study demonstrating differences between countries on planning and organization, decontamination, prehospital emergency medical responses, clinical diagnoses, and therapy and aftercare. Although there may be an understandable reluctance from national respondents to share information on security and other grounds, the findings, nevertheless, revealed substantial differences between current planning and operational responses within the EU states for the management of mass chemical casualties. The existing international networks for response to radiation incidents are not yet matched by equivalent networks for chemical responses yet sufficient information was available from the study to identify potential deficiencies, identify common casualty management pathways, and to make recommendations for future operations within the EU. Improvements in awareness and training and the application of modern information and communications will help to remedy this situation. Specialized advanced life support and other medical care for chemical casualties appear lacking in some countries. A program of specialized training and action are required to apply the findings

  14. Thermal waste treatment in China; Die thermische Abfallbehandlung in China

    Energy Technology Data Exchange (ETDEWEB)

    Buekens, Alfons; Yan, Mi; Jiang, Xuguan; Li, Xiaodong; Lu, Shengyong; Chi, Yong; Yan, Jianhua; Cen, Kefa [Zhejiang Univ. (China). Dept. of Energy Engineering; Vehlow, Juergen [Karlsruher Institut fuer Technologie (KIT), Eggenstein-Leopoldshafen (Germany). Inst. fuer Technische Chemie


    Increasing industrialisation and urbanisation as well as fast changing consumption habits in China entail a dramatic increase in waste generation. This development goes along with a severe lack in landfill sites, especially in densely populated areas. In combination with today's growing demand for aftercare free disposal the Chinese government decided to focus on thermal treatment, preferentially with energy recovery, of all types of waste as the only environmentally compatible pre-treatment option prior to final disposal. This principle is followed by the authorities despite entailing costs and recently in few places emerging public concern over this technology. The first incineration plant for municipal solid waste in China using imported technology was commissioned in 1988. Further such plants built during the following years had severe problems with the low calorific value of Chinese waste and failed often to achieve acceptable burnout. This fact and the high costs initiated at the end of the last century the development of a circulating fluidised bed incinerator at the University of Zhejiang which burns residential waste with an addition of 20 % of coal to increase its heating value. This strategy enables a well controlled combustion with burnout as well as emission figures, including those for dioxins, which easily comply with the actual Chinese air emission limits. These are to a great extent comparable with those of the EU Incineration Directive. This technology has successfully entered the market between 2000 and 2010 and will most likely, together with a similar type developed by the Tsinghua University, become the backbone of Chinese waste incineration in future due to its moderate costs and excellent performance. (orig.)

  15. [DGRW-update: neurology--from empirical strategies towards evidence based interventions]. (United States)

    Schupp, W


    Stroke, Multiple Sclerosis (MS), traumatic brain injuries (TBI) and neuropathies are the most important diseases in neurological rehabilitation financed by the German Pension Insurance. The primary goal is vocational (re)integration. Driven by multiple findings of neuroscience research the traditional holistic approach with mainly empirically derived strategies was developed further and improved by new evidence-based interventions. This process had been, and continues to be, necessary to meet the health-economic pressures for ever shorter and more efficient rehab measures. Evidence-based interventions refer to symptom-oriented measures, to team-management concepts, as well as to education and psychosocial interventions. Drug therapy and/or neurophysiological measures can be added to increase neuroregeneration and neuroplasticity. Evidence-based aftercare concepts support sustainability and steadiness of rehab results.Mirror therapy, robot-assisted training, mental training, task-specific training, and above all constraint-induced movement therapy (CIMT) can restore motor arm and hand functions. Treadmill training and robot-assisted training improve stance and gait. Botulinum toxine injections in combination with physical and redressing methods are superior in managing spasticity. Guideline-oriented management of associated pain syndromes (myofascial, neuropathic, complex-regional=dystrophic) improve primary outcome and quality of life. Drug therapy with so-called co-analgetics and physical therapy play an important role in pain management. Swallowing disorders lead to higher mortality and morbidity in the acute phase; stepwise diagnostics (screening, endoscopy, radiology) and specific swallowing therapy can reduce these risks and frequently can restore normal eating und drinking.In our modern industrial societies communicative and cognitive disturbances are more impairing than the above mentioned disorders. Speech and language therapy (SLT) is dominant in

  16. Systemic Case Formulation, Individualized Process Monitoring, and State Dynamics in a Case of Dissociative Identity Disorder (United States)

    Schiepek, Günter K.; Stöger-Schmidinger, Barbara; Aichhorn, Wolfgang; Schöller, Helmut; Aas, Benjamin


    Objective: The aim of this case report is to demonstrate the feasibility of a systemic procedure (synergetic process management) including modeling of the idiographic psychological system and continuous high-frequency monitoring of change dynamics in a case of dissociative identity disorder. The psychotherapy was realized in a day treatment center with a female client diagnosed with borderline personality disorder (BPD) and dissociative identity disorder. Methods: A three hour long co-creative session at the beginning of the treatment period allowed for modeling the systemic network of the client's dynamics of cognitions, emotions, and behavior. The components (variables) of this idiographic system model (ISM) were used to create items for an individualized process questionnaire for the client. The questionnaire was administered daily through an internet-based monitoring tool (Synergetic Navigation System, SNS), to capture the client's individual change process continuously throughout the therapy and after-care period. The resulting time series were reflected by therapist and client in therapeutic feedback sessions. Results: For the client it was important to see how the personality states dominating her daily life were represented by her idiographic system model and how the transitions between each state could be explained and understood by the activating and inhibiting relations between the cognitive-emotional components of that system. Continuous monitoring of her cognitions, emotions, and behavior via SNS allowed for identification of important triggers, dynamic patterns, and psychological mechanisms behind seemingly erratic state fluctuations. These insights enabled a change in management of the dynamics and an intensified trauma-focused therapy. Conclusion: By making use of the systemic case formulation technique and subsequent daily online monitoring, client and therapist continuously refer to detailed visualizations of the mental and behavioral network and

  17. Science Base and Tools for Evaluating Stream Restoration Project Proposals. (United States)

    Cluer, B.; Thorne, C.; Skidmore, P.; Castro, J.; Pess, G.; Beechie, T.; Shea, C.


    and geomorphic contexts; questioning perceived constraints on project design; reducing the use of hard structures and encouraging deformability; promoting designs that address both risk and uncertainty in applying engineering design standards; allowing for future climate and land use changes; and encouraging post-project monitoring, appraisal and project aftercare.

  18. Impact of intermittent aerations on leachate quality and greenhouse gas reduction in the aerobic-anaerobic landfill method. (United States)

    Nag, Mitali; Shimaoka, Takayuki; Komiya, Teppei


    leachate pollutants and the emission of GHGs. Furthermore, the occurrence of simultaneous nitrification-denitrification presents the prospect that intermittent aeration could reduce landfill aftercare and energy costs.

  19. Independent Pre-Transplant Recipient Cancer Risk Factors after Kidney Transplantation and the Utility of G-Chart Analysis for Clinical Process Control.

    Directory of Open Access Journals (Sweden)

    Harald Schrem

    Full Text Available The aim of this study is to identify independent pre-transplant cancer risk factors after kidney transplantation and to assess the utility of G-chart analysis for clinical process control. This may contribute to the improvement of cancer surveillance processes in individual transplant centers.1655 patients after kidney transplantation at our institution with a total of 9,425 person-years of follow-up were compared retrospectively to the general German population using site-specific standardized-incidence-ratios (SIRs of observed malignancies. Risk-adjusted multivariable Cox regression was used to identify independent pre-transplant cancer risk factors. G-chart analysis was applied to determine relevant differences in the frequency of cancer occurrences.Cancer incidence rates were almost three times higher as compared to the matched general population (SIR = 2.75; 95%-CI: 2.33-3.21. Significantly increased SIRs were observed for renal cell carcinoma (SIR = 22.46, post-transplant lymphoproliferative disorder (SIR = 8.36, prostate cancer (SIR = 2.22, bladder cancer (SIR = 3.24, thyroid cancer (SIR = 10.13 and melanoma (SIR = 3.08. Independent pre-transplant risk factors for cancer-free survival were age 62.6 years (p = 0.001, HR: 1.29, polycystic kidney disease other than autosomal dominant polycystic kidney disease (ADPKD (p = 0.001, HR: 0.68, high body mass index in kg/m2 (p<0.001, HR: 1.04, ADPKD (p = 0.008, HR: 1.26 and diabetic nephropathy (p = 0.004, HR = 1.51. G-chart analysis identified relevant changes in the detection rates of cancer during aftercare with no significant relation to identified risk factors for cancer-free survival (p<0.05.Risk-adapted cancer surveillance combined with prospective G-chart analysis likely improves cancer surveillance schemes by adapting processes to identified risk factors and by using G-chart alarm signals to trigger Kaizen events and audits for root-cause analysis of relevant detection rate changes

  20. Correlation between leachate production and construction-operation criteria of MSW landfills; Correlazione tra la produzione di percolato e le caratteristiche costruttive e gestionali di discariche per RSU

    Energy Technology Data Exchange (ETDEWEB)

    Collivignarelli, C.; Bertanza, G.; Cavallari, S. [Brescia Univ., Brescia (Italy). Dipt. di Ingegneria Civile


    This research (which is still going on) is aimed to collect and analyse monitoring of several MSW (Municipal Solid Wastes) landfills, in order to point out possible correlations among design-construction and operation criteria and the characteristics of landfill emissions. This paper deals with three studied landfills, receiving MSW and industrial municipal-like solid wastes. They have been designed, constructed and operated by the same company (in Northern Italy) since 1972. All landfills were realised in degraded areas (quarries), previously used for gravel-sand extraction. Specific construction criteria employed for the different landfills were revised and modified progressively accordingly with current regulation standards and on the basis of previous experience. The analysis of operating data confirm that some factors have influenced leachate production; in particular, among construction criteria: the characteristics of biogas extraction wells (during the opening phase); the type of capping system (during the after-care phase); and, among operation criteria: waste compaction (during the opening phase); the duration of the landfill opening phase (before capping realisation). [Italian] L'obiettivo di questa ricerca (tuttora in corso) e' quello di raccogliere ed analizzare i dati di monitoraggio di alcune discariche per rifiuti solidi urbani, con l'intento di evidenziare eventuali correlazioni fra i criteri costruttivi/gestionali e le caratteristiche delle emissioni. Questo lavoro prende in considerazione 3 discariche in cui sono stati smaltiti rifiuti solidi urbani ed assimilabili. Gli impianti sono stati progettati, costruiti e gestiti, a partire dal 1972, da un'unica azienda che opera nel Nord Italia. Tutte le discariche sono state realizzate in cave dismesse utilizzate per l'estrazione di sabbia e ghiaia. I criteri costruttivi impiegati per le varie discariche sono stati via via modificati in accordo con le specifiche normative e in

  1. Experience in the Treatment of Pernicious Placenta Previa%凶险性前置胎盘的治疗体会

    Institute of Scientific and Technical Information of China (English)



    Objective To explore treatment methods and the clinical effect of the pernicious placenta previa patients, to improve and perfect measures of placenta previa.Methods 10 cases of placenta previa patients were selected from our hospital, the pernicious placenta previa patients were treated from Prepare the preoperative, intraoperative and postoperative care.Results There were 8 cases of patients with placenta implantation in 10 cases of placenta previa patients, 6 cases occurred postoperative bleeding, 2 cases treated with topical hemostatic suture hemostasis, retained the uterus, the other 4 cases were Bleeding shock, treated with performing a hysterectomy and aftercare back to normal.Conclusion The risk of dangerous placenta previa is great, should strength the medical staff awareness, rational preoperative assessment, timely effective hemostasis and postoperative effective nursing may give a timely and effective treatment for patients with pernicious placenta previa.%目的探讨凶险性前置胎盘的治疗方法及临床效果,提高并完善凶险性前置胎盘的应对措施。方法对我院接收的10例凶险性前置胎盘患者进行分析,从术前准备、术中处理和术后护理三方面对凶险性前置胎盘患者进行干预。结果10例凶险性前置胎盘患者中8例伴有胎盘植入,其中6例患者在术后发生大出血,2例通过局部缝扎止血成功止血,保留住子宫,其他4例出现大失血休克,通过子宫切除手术和后期护理恢复正常。结论凶险性前置胎盘危险性极大,要加强医务人员的重视程度,术前的整体合理评估、术中及时有效止血和术后有效护理可以对凶险性前置胎盘患者予以及时、有效救治。

  2. Standard guidelines of care: Lasers for tattoos and pigmented lesions

    Directory of Open Access Journals (Sweden)

    Aurangabadkar Sanjeev


    Full Text Available Introduction: Lasers have revolutionized the treatment of pigmentary disorders and have become the mainstay of therapy for many of them. Machines: Though different laser machines are used, Quality-switched (QS lasers are considered as the gold standard for treatment of pigmented lesions. Proper knowledge of the physics of laser machine, methodology, dosage schedules, etc., is mandatory. Physician Qualification: Laser may be administered by a dermatologist, who has received adequate background training in lasers during postgraduation or later at a center that provides education and training in lasers, or in focused workshops which provide such trainings. He should have adequate knowledge of the machines, parameters, cooling systems, and aftercare. Facility: The procedure may be performed in the physician′s minor procedure room. Indications: Epidermal lesions: Cafι au lait macules (CALM, lentigines, freckles, solar lentigo, nevus spilus, pigmented seborrheic keratosis, dermatosis papulosa nigra (DPN. Dermal lesions: Nevus of Ota, Blue nevus, Hori′s nevus (acquired bilateral nevus of Ota-like macules. Tattoos: Amateur, professional, cosmetic, medicinal, and traumatic. Mixed epidermal and dermal lesions: Postinflammatory hyperpigmentation (PIH, nevus spilus, periorbital and perioral pigmentation, acquired melanocytic nevi (moles, melasma and Becker′s Nevus. Contraindications: Absolute: Active local infection, photo-aggravated skin diseases and medical conditions, tattoo granuloma, allergic reactions to tattoo pigment, unstable vitiligo and psoriasis. Relative: Keloid and keloidal tendencies, patient on isotretinoin, history of herpes simplex, patient who is not co-operative or has unrealistic expectation. Patient selection: Proper patient selection is important. Investigations to identify any underlying cause for pigmentation are important; concurrent topical and systemic drug therapy may be needed. History of scarring, response to previous

  3. Conservative treatment, plate fixation, or prosthesis for proximal humeral fracture. A prospective randomized study

    Directory of Open Access Journals (Sweden)

    Launonen Antti P


    presents a prospective, randomized, national multi-center trial. It gives details of patient flow, randomization, aftercare and also ways of analysis of the material and ways to present and publish the results. Trial registration identifier: NCT01246167

  4. Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices

    Directory of Open Access Journals (Sweden)

    Zimmermann Heinz


    Full Text Available Abstract Background In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influence on patient satisfaction and compliance. Methods This prospective, randomized study, included n = 100 patients who suffered from a lateral ankle ligament injury grade I-II (16, 17. After radiological exclusion of osseous lesions, the patients received early functional treatment and were shown physical therapy exercises to be done at home, without immobilization or the use of stabilizing ortheses. The patients were randomly assigned into two groups of 50 patients each: Group A (ER: Follow-up and final examination in the hospital's emergency unit. Group B (GP: Follow-up by general practitioner, final examination at hospital's emergency unit. The patients were surveyed regarding their satisfaction with the treatment and outcome of the treatment. Results Female and male patients were equally represented in both groups. The age of the patients ranged from 16 – 64 years, with a mean age of 34 years (ER and 35 years (GP. 98% (n = 98 of all patients were satisfied with their treatment, and 93% (n = 93 were satisfied with the outcome. For these parameters no significant difference between the two groups could be noted (p = 0.7406 and 0.7631 respectively. 39% of all patients acquired stabilizing ortheses like ankle braces (Aircast, Malleoloc etc. on their own initiative. There was a not significant tendency for more self-acquired ortheses in the group treated by general practicioners (p = 0,2669. Conclusion Patients who first present at the ER with a lateral

  5. Comparison of FDG-PET/CT and bone scintigraphy for detection of bone metastases in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hahn, Steffen; Heusner, Till; Forsting, Michael; Antoch, Gerald (Dept. of Diagnostic and Interventional Radiology and Neuroradiology, Univ. Hospital Essen, Univ. Duisburg-Essen, Essen (Germany)), email:; Kuemmel, Sherko; Koeninger, Angelika (Dept. of Gynecology and Obstetrics, Univ. Hospital Essen, Univ. Duisburg-Essen, Essen (Germany)); Nagarajah, James; Mueller, Stefan; Boy, Christian; Bockisch, Andreas; Stahl, Alexander (Dept. of Nuclear Medicine, Univ. Hospital Essen, Univ. Duisburg-Essen, Essen (Germany))


    Background Bone scintigraphy is the standard procedure for the detection of bone metastases in breast cancer patients. FDG-PET/CT has been reported to be a sensitive tool for tumor staging in different malignant diseases. However, its accuracy for the detection of bone metastases has not been compared to bone scintigraphy. Purpose To compare whole-body FDG-PET/CT and bone scintigraphy for the detection of bone metastases on a lesion basis in breast cancer patients. Material and Methods Twenty-nine consecutive women (mean age 58 years, range 35-78 years) with histologically proven breast cancer were assessed with bone scintigraphy and whole-body FDG-PET/CT. Twenty-one patients (72%) were suffering from primary breast cancer and eight patients (28%) were in aftercare with a history of advanced breast cancer. Both imaging procedures were assessed for bone metastases by a radiologist and a nuclear medicine physician. Concordant readings between bone scintigraphy and FDG-PET/CT were taken as true. Discordant readings were verified with additional MRI imaging in all patients and follow-up studies in most patients. Results A total of 132 lesions were detected on bone scintigraphy, FDG-PET/CT or both. According to the reference standard, 70/132 lesions (53%) were bone metastases, 59/132 lesions (45%) were benign, and three lesions (2%) remained unclear. The sensitivity of bone scintigraphy was 76% (53/70) compared to 96% (67/70) for FDG-PET/CT. The specificity of bone scintigraphy and FDG-PET/CT was 95% (56/59) and 92% (54/59), respectively. According to the reference standard bone metastases were present in eight out of the 29 patients (28%), whereas 20 patients (69%) were free of bone metastases. One (3%) patient had inconclusive readings on both modalities as well as on MRI and follow-up studies. Bone scintigraphy and FDG-PET/CT correctly identified seven out of eight patients with bone metastases and 20 out of 20 patients free of metastases. Conclusion On a lesion

  6. Recovery post treatment: plans, barriers and motivators

    Directory of Open Access Journals (Sweden)

    Duffy Paul


    Full Text Available Abstract Background The increasing focus on achieving a sustained recovery from substance use brings with it a need to better understand the factors (recovery capital that contribute to recovery following treatment. This work examined the factors those in recovery perceive to be barriers to (lack of capital or facilitators of (presence of capital sustained recovery post treatment. Methods A purposive sample of 45 participants was recruited from 11 drug treatment services in northern England. Semi-structured qualitative interviews lasting between 30 and 90 minutes were conducted one to three months after participants completed treatment. Interviews examined key themes identified through previous literature but focused on allowing participants to explore their unique recovery journey. Interviews were transcribed and analysed thematically using a combination of deductive and inductive approaches. Results Participants generally reported high levels of confidence in maintaining their recovery with most planning to remain abstinent. There were indications of high levels of recovery capital. Aftercare engagement was high, often through self referral, with non substance use related activity felt to be particularly positive. Supported housing was critical and concerns were raised about the ability to afford to live independently with financial stability and welfare availability a key concern in general. Employment, often in the substance use treatment field, was a desire. However, it was a long term goal, with substantial risks associated with pursuing this too early. Positive social support was almost exclusively from within the recovery community although the re-building of relationships with family (children in particular was a key motivator post treatment. Conclusions Addressing internal factors and underlying issues i.e. ‘human capital’, provided confidence for continued recovery whilst motivators focused on external factors such as family and

  7. Diagnosis of Fetal Anomaly and the Increased Maternal Psychological Toll Associated with Pregnancy Termination. (United States)

    Coleman, Priscilla K


    comfortable and free of pain until death. The approach is realistic without shattering hope that the diagnosis was wrong or that a miracle will take place as there is recognition that hope keeps parents going. There is also recognition that building memories is essential to the grieving process and frequent use of ultrasound is designed to provide visualization experience. Perinatal hospice teams assist in the development of birth plans, address the type and location of the delivery as well as aftercare of the mother and infant.

  8. Role of the treating surgeon in the consent process for elective refractive surgery

    Directory of Open Access Journals (Sweden)

    Schallhorn SC


    Full Text Available Steven C Schallhorn,1–3 Stephen J Hannan,3 David Teenan,3 Julie M Schallhorn1 1Department of Ophthalmology, University of California, San Francisco, San Francisco, 2Roski Eye Institute, University of Southern California, Los Angeles, CA, USA; 3Optical Express, Glasgow, UK Purpose: To compare patient’s perception of consent quality, clinical and quality-of-life outcomes after laser vision correction (LVC and refractive lens exchange (RLE between patients who met their treating surgeon prior to the day of surgery (PDOS or on the day of surgery (DOS. Design: Retrospective, comparative case series. Setting: Optical Express, Glasgow, UK. Methods: Patients treated between October 2015 and June 2016 (3972 LVC and 979 RLE patients who attended 1-day and 1-month postoperative aftercare and answered a questionnaire were included in this study. All patients had a thorough preoperative discussion with an optometrist, watched a video consent, and were provided with written information. Patients then had a verbal discussion with their treating surgeon either PDOS or on the DOS, according to patient preference. Preoperative and 1-month postoperative visual acuity, refraction, preoperative, 1-day and 1-month postoperative questionnaire were compared between DOS and PDOS patients. Multivariate regression model was developed to find factors associated with patient’s perception of consent quality. Results: Preoperatively, 8.0% of LVC and 17.1% of RLE patients elected to meet their surgeon ahead of the surgery day. In the LVC group, 97.5% of DOS and 97.2% of PDOS patients indicated they were properly consented for surgery (P=0.77. In the RLE group, 97.0% of DOS and 97.0% of PDOS patients stated their consent process for surgery was adequate (P=0.98. There was no statistically significant difference between DOS and PDOS patients in most of the postoperative clinical or questionnaire outcomes. Factors predictive of patient’s satisfaction with consent quality

  9. Combining Traditional Chinese and Western Medicine Treatment Pregnancy Play Severe Vomiting Experience%中西医结合治疗妊娠剧吐临床体会

    Institute of Scientific and Technical Information of China (English)



    目的:探讨中西医结合方法治疗妊娠剧吐的临床疗效.方法:选取辽宁中医药大学附属一院2009年6月-2010年4月妊娠剧吐患者30例.采用中西医结合治疗,观察其临床疗效.结果:中西医结合治疗妊娠剧吐患者30例,治愈28例,好转1例,无效1例.结论:西医治疗以控制病情,及时输液以迅速控制代谢紊乱,纠正酸碱平衡;中医从根本上纠正脾胃虚弱,肝胃不和症状,达到标本兼治之目的.同时嘱患者注意治愈后的饮食调养和情绪控制,以防止复发.此法疗效确切,值得临床推广应用.%Objective: To study the method of combining traditional Chinese and western medicine treatment of pregnancy severe vomiting clinical curative effect. Methods: Select 30 cases of pregnancy severe vomiting patients from liaoning university of traditional Chinese medicine attached the first hospital that from June 2009 until 2010 April. By combining traditional Chinese medicine with western medicine treatment,observe its clinical curative effect. Results: Combining traditional Chinese medicine with western medicine treatment of 30 cases of pregnancy sereve vomiting patients, cure 28 cases, improvement in 1,1 case ineffective. Conclusion: Treatment of western to control disease, timely infusion by rapid control metabolic disorder, correcting the balance of acid-base, TCM fundamentally correct the symptoms which spleen and stomach, liver and stomach weak. At the end attaining the specimen purposes.After curing ask patients to pay more attention about diet aftercare and controling emotional, so as to prevent recurrence.This method definite effect, and worth being popularized in clinical application.

  10. [Gerodontology consultation in geriatric facilities: general health status (I)]. (United States)

    Katsoulis, Joannis; Huber, Sandra; Mericske-Stern, Regina


    Dental undertreatment is often seen in the older population. This is particularly true for the elderly living in nursing homes and geriatric hospitals. The progression of chronic diseases results in loss of their independence. They rely on daily support and care due to physical or mental impairment. The visit of a dentist in private praxis becomes difficult or impossible and is a logistic problem. These elderly patients are often not aware of oral and dental problems or these are not addressed. The geriatric hospital Bern, Ziegler, has integrated dental care in the concept of physical rehabilitation of geriatric patients. A total of 139 patients received dental treatment in the years 2005/2006. Their mean age was 83 years, but the segment with > 85 years of age amounted to 46%. The general health examinations reveald multiple and complex disorders. The ASA classification (American Society of Anesthesiologists, Physical Status Classification System) was applied and resulted in 15% = P2 (mild systemic disease, no functional limitation), 47% = P3 (severe systemic disease, definite functional limitations) and 38% = P4 (severe systemic disease, constant threat to life). Eighty-seven of the patients exhibited 3 or more chronic diseases with a prevalence of cardiovascular diseases, musculoskelettal disorders and dementia. Overall the differences between men and women were small, but broncho-pulmonary dieseases were significantly more frequent in women, while men were more often diagnosed with dementia and depression. Verbal communication was limited or not possible with 60% of the patients due to cognitive impairment or aphasia after a stroke. Although the objective treatment need is high, providing dentistry for frail and geriatric patients is characterized by risks due to poor general health conditions, difficulties in communication, limitations in feasibility and lack of adequate aftercare. In order to prevent the problem of undertreatment, elderly independently living

  11. Reasons for recall following conditional discharge: explanations given by male patients suffering from dual diagnosis in a London Forensic Unit. (United States)

    Chiringa, J; Robinson, J E; Clancy, C


    Patients who have been discharged from forensic services often have conditions they have to abide by as part of their discharge, and failure to do so leads to recall. We interviewed six men who had been conditionally discharged from forensic services and then been recalled into hospital to find out what they thought went wrong. The reasons they gave for why things went wrong included feeling that the system was unfair and made them feel like criminals even though they did not feel they had put anyone at risk. Some of them were not fully aware of the conditions they needed to adhere to, and some of them had breached the conditions but did not take responsibility for what had happened. In addition, supervision was felt to be very controlling and disruptive rather than supportive when patients were often lonely, bored and needing support. Most participants reported that they experienced poor standards of aftercare in hostels they were required to reside in. In the future, care of patients after conditional discharge should include better communication between patients and their supervisory team, recognition of the need for more support and improvements in the standards of care in hostels, as well as a collaborative approach to risk assessment that might reduce the frequency of relapse and readmission. This study explores how male patients suffering from dual diagnosis in a forensic unit perceive being recalled and readmitted following conditional discharge and their views about how services might be improved. A qualitative approach was used drawing on grounded theory techniques. Audiotaped semistructured interviews collected data from a purposefully selected sample of six participants who had been recalled and met the inclusion criteria of the study. Data were analysed using the constant comparative method. Most participants perceived the recall system as unfair, inappropriately criminalized their behaviour and was based on an assessment of risk that they did not

  12. Caracterização das internações de dependentes químicos em Unidade de Internação Psiquiátrica do Hospital Geral Characterization of admission of chemical-dependents in a Psychiatric Admission Unit of the General Hospital

    Directory of Open Access Journals (Sweden)

    Fernando Sérgio Pereira de Sousa


    Full Text Available A Unidade de Internação Psiquiátrica do Hospital Geral (UIPHG é uma proposta articulada ao movimento da reforma psiquiátrica. O objetivo deste estudo foi avaliar os determinantes das internações de dependentes químicos na UIPHG Dr. Estevam, em Sobral (CE. Este estudo foi do tipo documental com abordagem quantitativa, envolvendo 203 clientes que foram internados na UIPHG no período de outubro de 2005 a abril de 2006. Os dados foram coletados por meio de um roteiro adaptado a partir do documento usado no momento da internação. Observou-se predomínio de pacientes do sexo masculino (95,1%, com idade entre 30 e 40 anos (62,5% e solteiros (59,1%. Em 76,3% dos casos, o diagnóstico da internação foi síndrome de abstinência do álcool. Após alta hospitalar, 70% desses clientes foram encaminhados ao CAPS-AD. Esses resultados demonstram quão imprescindíveis são os serviços de saúde mental que enfoquem a problemática do alcoolismo.The Psychiatric Admission Unit of the General Hospital (UIPHG is integrated to the psychiatric reform movement. The aim of this study was to evaluate chemical-dependent's admission causes at the UIPHG Dr. Estevam in the city of Sobral, Ceará State. It was a documental study with a quantitative approach involving 203 patients who were admitted at the UIPGH Dr. Estevam from October 2005 to April 2006. Data were collected from a document filled during admission process in the hospital. 95.1% of the sample was represented by men, age range of 30-40 years (62.5% and single (59.1%. The alcohol withdrawal syndrome was the main admission cause (76.3%. After leaving the hospital, 70% of the sample was conducted to aftercare at CAPS-AD. These results provide preliminary evidence for the need of mental health services emphasizing alcohol dependence problem.

  13. Stable isotope signatures for characterising the biological stability of landfilled municipal solid waste

    Energy Technology Data Exchange (ETDEWEB)

    Wimmer, Bernhard, E-mail: [AIT Austrian Institute of Technology GmbH, Health and Environment Department, Environmental Resources and Technologies, Konrad-Lorenz-Strasse 24, 3430 Tulln (Austria); Hrad, Marlies; Huber-Humer, Marion [Institute of Waste Management, Department of Water-Atmosphere-Environment, University of Natural Resources and Life Sciences, Muthgasse 107, 1190 Vienna (Austria); Watzinger, Andrea; Wyhlidal, Stefan; Reichenauer, Thomas G. [AIT Austrian Institute of Technology GmbH, Health and Environment Department, Environmental Resources and Technologies, Konrad-Lorenz-Strasse 24, 3430 Tulln (Austria)


    Highlights: ► The isotopic signature of δ{sup 13}C-DIC of leachates is linked to the reactivity of MSW. ► Isotopic signatures of leachates depend on aerobic/anaerobic conditions in landfills. ► In situ aeration of landfills can be monitored by isotope analysis in leachate. ► The isotopic analysis of leachates can be used for assessing the stability of MSW. ► δ{sup 13}C-DIC of leachates helps to define the duration of landfill aftercare. - Abstract: Stable isotopic signatures of landfill leachates are influenced by processes within municipal solid waste (MSW) landfills mainly depending on the aerobic/anaerobic phase of the landfill. We investigated the isotopic signatures of δ{sup 13}C, δ{sup 2}H and δ{sup 18}O of different leachates from lab-scale experiments, lysimeter experiments and a landfill under in situ aeration. In the laboratory, columns filled with MSW of different age and reactivity were percolated under aerobic and anaerobic conditions. In landfill simulation reactors, waste of a 25 year old landfill was kept under aerobic and anaerobic conditions. The lysimeter facility was filled with mechanically shredded fresh waste. After starting of the methane production the waste in the lysimeter containments was aerated in situ. Leachate and gas composition were monitored continuously. In addition the seepage water of an old landfill was collected and analysed periodically before and during an in situ aeration. We found significant differences in the δ{sup 13}C-value of the dissolved inorganic carbon (δ{sup 13}C-DIC) of the leachate between aerobic and anaerobic waste material. During aerobic degradation, the signature of δ{sup 13}C-DIC was mainly dependent on the isotopic composition of the organic matter in the waste, resulting in a δ{sup 13}C-DIC of −20‰ to −25‰. The production of methane under anaerobic conditions caused an increase in δ{sup 13}C-DIC up to values of +10‰ and higher depending on the actual reactivity of the MSW

  14. An efficency of use phonophoresis with an ointment on the basis of chondroitin sulfate and dimetil sulfoxide at the treatment of patients with arthritis of knee joints

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    Виктор Александрович Вишневский


    sulfate and dimethyl sulfoxide in patients with osteoarthritis allows increase an efficiency of treatment by 20 % in comparison with standard scheme of physiotherapy in the control group.3.      Positive dynamics on the background of treatment was confirmed by the 2 international tests and laboratory examination of the level of oxyproline in daily urine and also by the more fast disappearance or decrease of pain syndrome and by increase of joints function in patients of the main group.4.      The use of phonophoresis with an ointment on the basis of chondroitin sulfates and dimethyl sulfoxide on injured knee joint is prescribed not only for inpatient treatment but also for an outpatient one at aftercare of residual effects especially in persons of an elderly age as a more available method that allows increase the quality of life in patients

  15. Wireless energy transmission through the abdominal wall for operating implanted actuators and recharging implanted energy storages with due consideration to the simultaneous undisturbed transcutaneous transmission of encoded signals for controlling various functions of the implant; Drahtloser Energietransfer durch die Bauchdecke zum Betrieb von implantierten Aktoren und zur Wiederaufladung von implantierten Energiespeichern unter Beruecksichtigung der gleichzeitigen ungestoerten transkutanen Uebertragung von codierten Signalen zur Steuerung verschiedener Funktionen eines Implantats

    Energy Technology Data Exchange (ETDEWEB)

    Peter, S.


    One of the two goals of this study was to provide a power supply for a medical implant for artificial micturition such that the energy storages integrated in the system could be recharged without a need for wires passing through the abdominal wall. This goal was achieved by the development and use of an inductive, transcutaneous energy transfer technique adapted to the requirements of an urological implant. The technique provides the following advantages to patients: complete avoidance of infections that would otherwise be provoked by the presence of a permanent open wound in the abdominal wall allowing wires to pass through. This in turn permits reducing medication and eliminates the costs of constant wound treatment. The system can largely be operated independently of stationary power supply systems, since it can run for several days without the patient requiring a wall outlet close by. This greatly improves patient mobility. The development of a transcutaneous signal transmission technique based on infrared or radiofrequency has been a decisive step towards restoring patients' volitional control of micturition, thus eliminating one of their main concerns, namely the prospect of having to live an externally controlled life dominated by a fixed around-the-clock discharge schedule. The additional facility of being able to query the reservoir's filling level allows patients to check on this at any time, making it much easier for them to plan their visits to the toilet. This was the second goal of the study. The combination of transcutaneous energy and signal transfer has produced, amongst other things, a package solution which will substantially improve the quality of life of patients having undergone total bladder extirpation and will also reduce aftercare costs for payers. [German] Eines der beiden ziele der vorliegenden Arbeit war, das medizinische Implantat des kuenstlichen harnableitenden Systems so mit Energie zu versorgen, dass die im System

  16. Comparison of accommodative lag in pre-adolescent myopes one year after wearing rigid gas permeable contact lenses, orthokeratology lenses or spectacles%青少年近视眼配戴RGPCL、Ortho-K及框架眼镜一年后调节滞后的差异

    Institute of Scientific and Technical Information of China (English)

    黄佳; 瞿小妹; 陈志; 褚仁远


    Objective To discuss the differences in accommodative lag between pre-adolescent myopes who wore rigid gas permeable contact lenses (RGPCL), orthokeratology (Ortho-K) lenses or spectacles for a year. Methods Seventy pre-adolescent myopes aged 9 to 14 years were enrolled in the study. Every subject was measured for refraction with MPMVA, corneal curvature radius and corneal topography. Twenty-five subjects were selected to wear RGPCL, 25 subjects were chosen to wear Ortho-K lenses and the other 20 subjects wore spectacles. According to the above measurements and the compliance of children and their parents. Regular after-care visits were made at 3-month in- tervals. Accommodative response (AR) was measured with an open field infrared autorefractor (WAM- 5500) in accommodative stimulus (AS) level of 2~5 D after one year. Accommodative lag and the AR/ AS slope were calculated by statistical methods. Results Fifty-seven subjects completed the experi- ment. The results demonstrate no significant difference in accommodative lag between RGPCL, Ortho- K lens and spectacle wearers for the 2 D AS level (P>0.05), while for the 3 D, 4 D and 5 D AS levels, there were significant differences in accommodative lag among the three groups (F=4.373, P0.05). Conclusion Compared to spectacles, there is an obvious decrease in accommodative lag in pre-adolescent myopes one year after wearing RGPCL and Ortho-K lenses, which strongly suggests that RGPCL and Ortho-K lenses can control the development of myopia in pre-adoleseents.%目的 探讨青少年近视眼配戴硬性透气性角膜接触镜(rigid gas permeable contact lens,RGPCL)、角膜塑型镜(orthokeratology,Ortho-K,OK镜)及框架眼镜后调节滞后的差异.方法 70名(70眼)9~14岁中低度青少年近视眼患儿,行医学验光、角膜曲率、角膜地形图检查后,根据检查结果、患儿及家长依从性等综合评估,对其中25名患儿选择配戴RGPCL,25名患儿配戴Ortho-K,其余20名患儿配

  17. Regarding the Content and Goals of UIM/EJU. (United States)

    Seitz, K


    profession.Considered retrospectively, contents of recent volumes of UiM/EJU - apart from the large block of obstetrical articles - were dominated by CEUS, elastography, the breast and "small parts".Although CEUS has been established scientifically 1 2 3 4, but not really employed everywhere, additional articles are needed in order to help integrate the use of contrast agents in routine practice apart from examination of the liver 5 6 7 8 9 10. Likewise, we have endeavored to support elastography as a new technical feature of sonography. Examples of this are publications regarding its use in diagnosing diseases of the liver 11 12 13 14 15, breast 16 17 18 19 and the thyroid 20, as well as its use in examining the pancreas 21 and gastrointestinal tract 22.In addition, for the benefit of sonographers, who are used to observing associated fields from the sidelines, we have presented unexpected highlights, such as articles on peripheral nerves 23 24 25.The contents of this year's final edition present the common interdisciplinary perspective of the editorial team. In addition to a CME article on elastography in the diagnosis of breast cancer 26, we would particularly refer you to two prospective articles: on the importance of CEUS in the aftercare of colon cancer 27 and the value of high-frequency examination of the liver surface compared to elastography and laparoscopy when cirrhosis is suspected 28.Further articles on elastography 29 30 31 32 indicate that the possibilities and limitations of this technology have yet to be reached.As editors, we will be satisfied if the publication interests as many readers as possible, be it online or in the print version, and that they are able to read about new as well as established techniques. We are certain that the societies for ultrasound in medicine, UiM/EJU, and "our sonographic community" are excited to learn about scientific advancements, and we are pleased when, thanks to submissions by our active and innovative authors together

  18. EDITORIAL: Deep brain stimulation, deontology and duty: the moral obligation of non-abandonment at the neural interface Deep brain stimulation, deontology and duty: the moral obligation of non-abandonment at the neural interface (United States)

    Fins, Joseph J.; MD; FACP


    fiscal responsibility for any associated costs. It is a breach of professional ethics to do otherwise. Such enduring covenants must be articulated in clinical protocols and be determinative in regulatory decisions by local Institutional Review Boards (IRBs) to reject or approve investigative protocols. The articulation of such `after-care' provisions should also be expected in any new IDE application to the Food and Drug Administration. To sustain clinical progress and investigative momentum, the neuromodulation community must embrace its ethical responsibility for comprehensive and on-going follow-up care. We need to populate a clinical infrastructure that can support patients and research subjects in their communities, especially as their conditions deteriorate and travel becomes more difficult. We need to disseminate our sequestered expertise more widely to primary care specialties. This ethical mandate transcends the clinical assessors, operators, and sponsors of clinical trials. It also applies to engineers who are well-positioned to help lessen the burden for patients and subjects. On the engineering side of this equation, innovation is the key. The development of better batteries with longer shelf lives or power management systems that optimize utilization of available capacitance will be a tremendous boon in streamlining follow-up care. So too will be the development of simplified device control systems to manipulate basic functions that would be operable by generalist physicians. Imagine a universal wand that could deactivate a device, and perform some rudimentary functions, that every Emergency Department could stock. Making such a basic parallel low-tech system universal amongst many device manufacturers would provide additional access to care in the community and a degree of safety in an emergency. Engineers might also work towards the development of mechanisms to give patients and subjects greater control over their devices, which are after all extrinsic