Preferences for Aftercare Among Persons Seeking Short-Term Opioid Detoxification.

Science.gov (United States)

Stein, Michael D; Anderson, Bradley J; Bailey, Genie L

2015-12-01

Without aftercare treatment, the period following discharge from short-term inpatient detoxification for opioid dependence presents a high risk of relapse. Yet the role of patient preference in treatment selection is rarely discussed in the substance-abuse literature. We surveyed 485 persons initiating inpatient opioid detoxification who were predominantly male (71.3%) and had detoxed in the past (73.2%). When asked to choose the one treatment that would work best for them after discharge, 43% of participants selected medication-assisted treatment (MAT), 29% preferred residential, 12% selected drug-free counseling, 12% NA/AA meetings only, and 4% preferred no additional treatment. Residential treatment preference was significantly associated with homelessness, having been in a detox program within the past year, and having pending legal problems, indicating that there is a distinct profile of detox patients who prefer residential treatment despite its limited availability. Detox program staff should work with patients to understand reasons for treatment preferences to optimize aftercare services. Copyright © 2015 Elsevier Inc. All rights reserved.

A 15-Year Comparative Prospective Study of Surgical and Prosthetic Care and Aftercare of Overdenture Treatment in the Atrophied Mandible : Augmentation Versus Nonaugmentation

NARCIS (Netherlands)

Visser, Anita; Stellingsma, Cornelis; Raghoebar, Gerry M.; Meijer, Henny J. A.; Vissink, Arjan

2016-01-01

BackgroundDifferent treatment strategies for the atrophied mandible are described in literature. The need for long term care and aftercare for these strategies is sparsely described, however. PurposeTo prospectively assess the need for prosthetic and surgical care and aftercare of two implant

Improved methodology to assess modification and completion of landfill gas management in the aftercare period

International Nuclear Information System (INIS)

Morris, Jeremy W.F.; Crest, Marion; Barlaz, Morton A.; Spokas, Kurt A.; Åkerman, Anna; Yuan, Lei

2012-01-01

Highlights: ► Performance-based evaluation of landfill gas control system. ► Analytical framework to evaluate transition from active to passive gas control. ► Focus on cover oxidation as an alternative means of passive gas control. ► Integrates research on long-term landfill behavior with practical guidance. - Abstract: Municipal solid waste landfills represent the dominant option for waste disposal in many parts of the world. While some countries have greatly reduced their reliance on landfills, there remain thousands of landfills that require aftercare. The development of cost-effective strategies for landfill aftercare is in society’s interest to protect human health and the environment and to prevent the emergence of landfills with exhausted aftercare funding. The Evaluation of Post-Closure Care (EPCC) methodology is a performance-based approach in which landfill performance is assessed in four modules including leachate, gas, groundwater, and final cover. In the methodology, the objective is to evaluate landfill performance to determine when aftercare monitoring and maintenance can be reduced or possibly eliminated. This study presents an improved gas module for the methodology. While the original version of the module focused narrowly on regulatory requirements for control of methane migration, the improved gas module also considers best available control technology for landfill gas in terms of greenhouse gas emissions, air quality, and emissions of odoriferous compounds. The improved module emphasizes the reduction or elimination of fugitive methane by considering the methane oxidation capacity of the cover system. The module also allows for the installation of biologically active covers or other features designed to enhance methane oxidation. A methane emissions model, CALMIM, was used to assist with an assessment of the methane oxidation capacity of landfill covers.

Improved methodology to assess modification and completion of landfill gas management in the aftercare period

Energy Technology Data Exchange (ETDEWEB)

Morris, Jeremy W.F., E-mail: jmorris@geosyntec.com [Geosyntec Consultants, 10220 Old Columbia Road, Suite A, Columbia, MD 21046 (United States); Crest, Marion, E-mail: marion.crest@suez-env.com [Suez Environnement, 38 rue du President Wilson, 78230 Le Pecq (France); Barlaz, Morton A., E-mail: barlaz@ncsu.edu [Department of Civil, Construction, and Environmental Engineering, Campus Box 7908, North Carolina State University, Raleigh, NC 27695-7908 (United States); Spokas, Kurt A., E-mail: kurt.spokas@ars.usda.gov [United States Department of Agriculture - Agricultural Research Service, 1991 Upper Buford Circle, 439 Borlaug Hall, St. Paul, MN 55108 (United States); Akerman, Anna, E-mail: anna.akerman@sita.fr [SITA France, Tour CB 21, 16 Place de l' Iris, 92040 Paris La Defense Cedex (France); Yuan, Lei, E-mail: lyuan@geosyntec.com [Geosyntec Consultants, 10220 Old Columbia Road, Suite A, Columbia, MD 21046 (United States)

2012-12-15

Highlights: Black-Right-Pointing-Pointer Performance-based evaluation of landfill gas control system. Black-Right-Pointing-Pointer Analytical framework to evaluate transition from active to passive gas control. Black-Right-Pointing-Pointer Focus on cover oxidation as an alternative means of passive gas control. Black-Right-Pointing-Pointer Integrates research on long-term landfill behavior with practical guidance. - Abstract: Municipal solid waste landfills represent the dominant option for waste disposal in many parts of the world. While some countries have greatly reduced their reliance on landfills, there remain thousands of landfills that require aftercare. The development of cost-effective strategies for landfill aftercare is in society's interest to protect human health and the environment and to prevent the emergence of landfills with exhausted aftercare funding. The Evaluation of Post-Closure Care (EPCC) methodology is a performance-based approach in which landfill performance is assessed in four modules including leachate, gas, groundwater, and final cover. In the methodology, the objective is to evaluate landfill performance to determine when aftercare monitoring and maintenance can be reduced or possibly eliminated. This study presents an improved gas module for the methodology. While the original version of the module focused narrowly on regulatory requirements for control of methane migration, the improved gas module also considers best available control technology for landfill gas in terms of greenhouse gas emissions, air quality, and emissions of odoriferous compounds. The improved module emphasizes the reduction or elimination of fugitive methane by considering the methane oxidation capacity of the cover system. The module also allows for the installation of biologically active covers or other features designed to enhance methane oxidation. A methane emissions model, CALMIM, was used to assist with an assessment of the methane oxidation

Report on Third International Intensive Aftercare Conference in Norrköping, Sweden

DEFF Research Database (Denmark)

Jones, Christina; Bäckman, Carl; Egerod, Ingrid

2015-01-01

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...

Examining the Effects of Intensive Supervision and Aftercare Programs for At-Risk Youth: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Bouchard, Jessica; Wong, Jennifer S

2018-05-01

Community correctional sentences are administered to more juvenile offenders in North America than any other judicial sentence. Particularly prominent in juvenile corrections is intensive supervision probation and aftercare/reentry, yet the effects of these supervision-oriented interventions on recidivism are mixed. The purpose of this meta-analysis is to determine the effects of intensive supervision probation and aftercare/reentry on juvenile recidivism. An extensive search of the literature and application of strict inclusion criteria resulted in the selection of 27 studies that contributed 55 individual effect sizes. Studies were pooled based on intervention type (intensive supervision probation or aftercare/reentry) and outcome measure (alleged or convicted offenses). The pooled analyses yielded contradictory results with respect to outcome measure; in both cases, supervision had a beneficial effect on alleged offenses and negatively affected convicted offenses. These patterns across intervention type and outcome measure, as well as recommendations for future research, are discussed.

The feasibility and efficacy of a multidisciplinary intervention with aftercare meetings for fibromyalgia

NARCIS (Netherlands)

Kroese, Mariëlle; Schulpen, Guy; Bessems, Monique; Nijhuis, Frans; Severens, Johan; Landewé, Robert

2009-01-01

The objective of this study is to examine the feasibility and long-term results of a 12-week multidisciplinary part-time daycare intervention with five aftercare meetings in fibromyalgia (FM) patients. One hundred and five patients diagnosed with FM started with a multidisciplinary intervention and

[Aftercare for durability and profitability of single-unit and multi-unit fixed dental prostheses

NARCIS (Netherlands)

Baat, C. de; Loveren, C. van; Maarel-Wierink, C.D. van der; Witter, D.J.; Creugers, N.H.J.

2013-01-01

An important aim ofa treatment with single-unit and multi-unit fixed dental prostheses is a durable and profitable treatment outcome. That requires aftercare, too. First, the frequency of routine oral examinations should be assessed, using an individual risk profile. The objectives of the routine

The view of severely burned patients and healthcare professionals on the blind spots in the aftercare process: a qualitative study.

Science.gov (United States)

Christiaens, Wendy; Van de Walle, Elke; Devresse, Sophie; Van Halewyck, Dries; Benahmed, Nadia; Paulus, Dominique; Van den Heede, Koen

2015-08-01

In most Western countries burn centres have been developed to provide acute and critical care for patients with severe burn injuries. Nowadays, those patients have a realistic chance of survival. However severe burn injuries do have a devastating effect on all aspects of a person's life. Therefore a well-organized and specialized aftercare system is needed to enable burn patients to live with a major bodily change. The aim of this study is to identify the problems and unmet care needs of patients with severe burn injuries throughout the aftercare process, both from patient and health care professional perspectives in Belgium. By means of face-to-face interviews (n = 40) with individual patients, responsible physicians and patient organizations, current experiences with the aftercare process were explored. Additionally, allied healthcare professionals (n = 17) were interviewed in focus groups. Belgian burn patients indicate they would benefit from a more integrated aftercare process. Quality of care is often not structurally embedded, but depends on the good intentions of local health professionals. Most burn centres do not have a written discharge protocol including an individual patient-centred care plan, accessible to all caregivers involved. Patients reported discontinuity of care: nurses working at general wards or rehabilitation units are not specifically trained for burn injuries, which sometimes leads to mistakes or contradictory information transmission. Also professionals providing home care are often not trained for the care of burn injuries. Some have to be instructed by the patient, others go to the burn centre to learn the right skills. Finally, patients themselves underestimate the chronic character of burn injuries, especially at the beginning of the care process. The variability in aftercare processes and structures, as well as the failure to implement locally developed best-practices on a wider scale emphasize the need for a comprehensive network

Perceived wellbeing of patients one year post stroke in general practice - recommendations for quality aftercare

NARCIS (Netherlands)

de Weerd, Leonie; Rutgers, Wijnand A. F.; Groenier, Klaas H.; van der Meer, Klaas

2011-01-01

Background: Annually, 41,000 people in the Netherlands have strokes. This has multiple physical and psychosocial consequences. Most patients return home after discharge from hospital. Quality aftercare by general practitioners is important to support patients at home. The purpose of this study is to

[Effectiveness of aftercare treatment after release from prison: A first evaluation of the forensic therapeutic outpatient clinic for serious violent and sexual offenders in Berlin].

Science.gov (United States)

Sauter, J; Voss, T; Dahle, K-P

2015-05-01

The Forensic Therapeutic Outpatient Clinic (FTA) in Berlin targets the professional aftercare treatment of classified high-risk violent and sexual offenders released from prison or forensic psychiatric hospitals. A comparison sample (n = 32) matched to the patients of the FTA (complete survey n = 32) according to similar criminal histories and diagnoses (ICD-10) was collected from offenders released from prison and forensic psychiatry at a time before the FTA was established. The focus of the study was on recidivism measured by complaints received by police departments during the follow-up period. Sexual recidivism occurred significantly later in the case of released offenders with aftercare treatment compared to those without. Moreover, for the duration of aftercare treatment the general risk of recidivism was approximately 85 % lower; however, after termination of treatment the recidivism rates of both samples converged to almost the same level. Individually adapted measures should be maintained after finishing aftercare treatment; however, because prisoners released from prison are frequently less prepared than patients from forensic psychiatric hospitals, the therapeutic work often reaches its limits in these cases. Therefore, social work should be taken into account right from the start.

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

2016-01-01

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...... psychological treatment whenever and wherever the patient finds it convenient....

[Modern information and communication technology in medical rehabilitation. Enhanced sustainability through Internet-delivered aftercare].

Science.gov (United States)

Kordy, H; Theis, F; Wolf, M

2011-04-01

Internet and mobile phones open new avenues for the optimization of health services in medical rehabilitation. Various models of Internet-delivered aftercare after psychosomatic inpatient treatment have shown promising results. The focus of this report is on the experience in translating one of the promising models, the Internet-Bridge ("Internet-Brücke"), to every day health care. Effectiveness was estimated through comparison of 254 patients who were treated in a hospital specialized in psychosomatic medicine and who participated in the Internet-Bridge as well as in the 1-year follow-up in the frame of standard quality assurance between 2003-2010 with 364 patients of the same hospital who also participated in the 1-year follow-up, but did not utilize the aftercare. Sustainable, reliable, and clinically significant improvements were more frequent in participants of the Internet-Bridge, especially with regard to psychological well-being, social problems, and psychosocial competence-at small additional costs. Results are understood as encouragement to start translation to routine care accompanied by research.

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

Science.gov (United States)

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

2015-10-01

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.

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

Science.gov (United States)

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

2014-01-01

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. PMID:24595815

The Design of an Effective Family Reintegration and Aftercare Program for Youth Successfully Leaving Residential Care.

Science.gov (United States)

Roley, Jeffrey H.

The lack of support services following the release of adolescent youths from a residential treatment center back to their families is examined in this practicum. Consequently, the development of a family reintegration program for the treatment center is focused on the concept that effective aftercare begins at intake. Understandably, families…

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

2014-01-01

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...... service use in the TA programme group is in line with day treatment programme research for patients with affective disorders.......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...

Pilot implementation and user preferences of a Bariatric After-care application.

Science.gov (United States)

Zhang, Melvyn W B; Ho, Roger C M; Hawa, Raed; Sockalingam, Sanjeev

2015-01-01

The respective rates of obesity in Canada and the United states are estimated to be 24.1% and 34.1%. Due to the increased incidence of obesity, Bariatric surgery has been recognized as one of the treatment options. Patients who have undergone Bariatric surgery tend to need chronic long-term follow-up with a multi-disciplinary team. In the past decade, there has been massive advancement and development in Internet, Web-based and Smartphone technologies. However, there seemed to be a pacuity of applications in this area that enables post-bariatric patients to self-manage their own condition. In addition, past research have highlighted the limited evidence based with regards to currently available bariatric applications, mainly due to the lack of medical professionals involvement. Our current research objective is to illustrate the development of a Bariatric After-care smartphone application and to highlight user preferences with regards to the features integrated within the application. The Bariatric Aftercare application was developed between the months of March 2014 to April 2014. Making use of low-cost online web-based application developmental technologies, the authors embarked on the development of the web-based application. Patients who attended their routine follow-up appointments are given the links to the web-based application. They were also recruited to participate in an online user evaluation survey to identify their preferences with regards to the features integrated. Since the inception of the web-based application to date, there has been a cumulative total of 385 unique assess to the online web-based application. There is a slight change in the confidence levels of the participants with regards to using the application to help them self-manage their own condition. The majority of the users have indicated that they preferred the information pertaining to what happens during each consult with members of the multidisciplinary team and also greatly valued

A novel tool for continuous fracture aftercare - Clinical feasibility and first results of a new telemetric gait analysis insole.

Science.gov (United States)

Braun, Benedikt J; Bushuven, Eva; Hell, Rebecca; Veith, Nils T; Buschbaum, Jan; Holstein, Joerg H; Pohlemann, Tim

2016-02-01

Weight bearing after lower extremity fractures still remains a highly controversial issue. Even in ankle fractures, the most common lower extremity injury no standard aftercare protocol has been established. Average non weight bearing times range from 0 to 7 weeks, with standardised, radiological healing controls at fixed time intervals. Recent literature calls for patient-adapted aftercare protocols based on individual fracture and load scenarios. We show the clinical feasibility and first results of a new, insole embedded gait analysis tool for continuous monitoring of gait, load and activity. Ten patients were monitored with a new, independent gait analysis insole for up to 3 months postoperatively. Strict 20 kg partial weight bearing was ordered for 6 weeks. Overall activity, load spectrum, ground reaction forces, clinical scoring and general health data were recorded and correlated. Statistical analysis with power analysis, t-test and Spearman correlation was performed. Only one patient completely adhered to the set weight bearing limit. Average time in minutes over the limit was 374 min. Based on the parameters load, activity, gait time over 20 kg weight bearing and maximum ground reaction force high and low performers were defined after 3 weeks. Significant difference in time to painless full weight bearing between high and low performers was shown. Correlation analysis revealed a significant correlation between weight bearing and clinical scoring as well as pain (American Orthopaedic Foot and Ankle Society (AOFAS) Score rs=0.74; Olerud-Molander Score rs=0.93; VAS pain rs=-0.95). Early, continuous gait analysis is able to define aftercare performers with significant differences in time to full painless weight bearing where clinical or radiographic controls could not. Patient compliance to standardised weight bearing limits and protocols is low. Highly individual rehabilitation patterns were seen in all patients. Aftercare protocols should be adjusted to real

49 CFR 40.303 - What happens if the SAP believes the employee needs additional treatment, aftercare, or support...

Science.gov (United States)

2010-10-01

... recommended services. You may also make use of SAP and employee assistance program (EAP) services in assisting... 49 Transportation 1 2010-10-01 2010-10-01 false What happens if the SAP believes the employee needs additional treatment, aftercare, or support group services even after the employee returns to...

[Intensified rehabilitation aftercare (IRENA): utilization alongside work and changes in work-related parameters].

Science.gov (United States)

Lamprecht, J; Behrens, J; Mau, W; Schubert, M

2011-06-01

An aftercare programme following medical rehabilitation may be beneficial in order to reinforce and stabilize the positive effects of rehabilitation and to encourage individual health-related modifications of behaviour and lifestyle. Medical rehabilitation and the aftercare programme of the German Pension Insurance Fund primarily are intended to sustain earning capacity. As part of an evaluation of the Intensified Rehabilitation Aftercare Programme (IRENA) established by the German Pension Insurance Fund, work-related aspects in orthopaedic patients were analyzed based on various data sources. Firstly, the significance of institutional and individual conditions for utilization of IRENA alongside work was of interest. Secondly, the IRENA participants' judgements of the changes of work-related parameters due to the programme were examined, differentiating specifically by extent of earning capacity impairments as well as by particular work problems. The data set used for the analysis is composed of person-related routine data of the German Pension Insurance Fund relative to IRENA records of the year 2007 (n=30 663), interview data from orthopaedic rehabilitation centres providing IRENA (n=225), and questionnaires of IRENA participants (n=750) that were either collected during a broad evaluation of the IRENA programme or provided by the German Pension Insurance Fund. The results show that the compatibility of IRENA and work is facilitated by the institutional conditions. However, differences between inpatient and outpatient settings have to be recognized. The possibilities to participate in IRENA throughout the day frequently are more diverse in an outpatient setting. In contrast to inpatient centres, outpatient rehabilitation centres see clearly better chances for patients to return to work and to participate in IRENA alongside. With respect to the work-related parameters (work ability, periods of sick leave), clear improvements were reported by participants from

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

Web-Based Aftercare for Women With Bulimia Nervosa Following Inpatient Treatment: Randomized Controlled Efficacy Trial.

Science.gov (United States)

Jacobi, Corinna; Beintner, Ina; Fittig, Eike; Trockel, Mickey; Braks, Karsten; Schade-Brittinger, Carmen; Dempfle, Astrid

2017-09-22

Relapse rates in bulimia nervosa (BN) are high even after successful treatment, but patients often hesitate to take up further treatment. An easily accessible program might help maintain treatment gains. Encouraged by the effects of Web-based eating disorder prevention programs, we developed a manualized, Web-based aftercare program (IN@) for women with BN following inpatient treatment. The objective of this study was to determine the efficacy of the web-based guided, 9-month, cognitive-behavioral aftercare program IN@ for women with BN following inpatient treatment. We conducted a randomized controlled efficacy trial in 253 women with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) BN and compared the results of IN@ with treatment as usual (TAU). Assessments were carried out at hospital admission (T0), hospital discharge/baseline (T1), postintervention (T2; 9 months after baseline), 9-month follow-up (T3; 18 months after baseline). The primary outcome, abstinence from binge eating and compensatory behaviors during the 2 months preceding T2, was analyzed by intention to treat, using logistic regression analyses. Frequencies of binge eating and vomiting episodes, and episodes of all compensatory behaviors were analyzed using mixed effects models. At T2, data from 167 women were available. There were no significant differences in abstinence rates between the TAU group (n=24, 18.9%) and the IN@ group (n=27, 21.4%; odds ratio, OR=1.29; P=.44). The frequency of vomiting episodes in the IN@ group was significantly (46%) lower than in the TAU group (P=.003). Moderator analyses revealed that both at T2 and T3, women of the intervention group who still reported binge eating and compensatory behaviors after inpatient treatment benefited from IN@, whereas women who were already abstinent after the inpatient treatment did not (P=.004; P=.002). Additional treatment utilization was high in both groups between baseline and follow-up. Overall, data

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

2004-01-01

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

The characteristics, management, and aftercare of patients with suicide attempts who attended the emergency department of a general hospital in northern Taiwan

Directory of Open Access Journals (Sweden)

Chen-Ju Lin

2014-06-01

Conclusion: Individuals who harmed themselves had a high rate of psychiatric morbidity and interpersonal problems. However, their adherence to psychiatric outpatient aftercare was low. Improved identification of the needs of patients with suicidal tendencies who did not attend outpatient services will have implications for future services provided to this patient population, and will better enable medical personnel to most effectively assist in suicide attempt interventions.

Like a hotel, but boring: users' experience with short-time community-based residential aftercare.

Science.gov (United States)

Roos, Eirik; Bjerkeset, Ottar; Svavarsdóttir, Margrét Hrönn; Steinsbekk, Aslak

2017-12-16

The discharge process from hospital to home for patients with severe mental illness (SMI) is often complex, and most are in need of tailored and coordinated community services at home. One solution is to discharge patients to inpatient short-stay community residential aftercare (CRA). The aim of this study was to explore how patients with SMI experience a stay in CRA established in a City in Central Norway. A descriptive qualitative study with individual interviews and a group interview with 13 persons. The CRA aims to improve the discharge process from hospital to independent supported living by facilitating the establishment of health and social services and preparing the patients. The philosophy is to help patients use community resources by e.g. not offering any organized in-house activities. The main question in the interviews was "How have you experienced the stay at the CRA?" The interviews were analyzed with a thematic approach using systematic text condensation. The participants experienced the stay at the CRA "Like a hotel" but also boring, due to the lack of organized in-house activities. The patients generally said they were not informed about the philosophy of the CRA before the stay. The participants had to come up with activities outside the CRA and said they got active help from the staff to do so; some experienced this as positive, whereas others wanted more organized in-house activities like they were used to from mental health hospital stays. Participants described the staff in the CRA to be helpful and forthcoming, but they did not notice the staff being active in organizing the aftercare. The stay at the CRA was experienced as different from other services, with more freedom and focus on self-care, and lack of in-house activities. This led to increased self-activity among the patients, but some wanted more in-house activities. To prepare the patients better for the stay at the CRA, more information about the philosophy is needed in the pre

More than re-establishing the partner relationship: Intimate aftercare for Somali parents in diaspora.

Science.gov (United States)

Binder, Pauline; Johnsdotter, Sara; Essén, Birgitta

2013-08-01

to explore the sexual relationship and couples' perceptions about intimate partner support following childbirth. a hermeneutic design using a naturalistic inquiry framework as a qualitative proxy for medical anthropology. Data were collected using a fictional and culturally-specific narrative during focus group discussions (FGDs) in early 2011. Analysis was conducted by 'functional narrative analysis' and interpreted for conceptual constructions. Recruitment was by snowball and purposive sampling. a diasporic context among participants living in six urban centres across Sweden. successful recruitment included 16 Somali-Swedish fathers and 27 mothers. Three FDGs were conducted with fathers (3-7 participants) and seven with mothers (3-6 participants). within day 40 post partum, parents learn to rely on each other in the absence of traditional support networks. After the first 40 days, the re-introduction of sexual intimacy is likely to occur. Of the fathers experiencing postpartum sexual aversion, these seemed to experience 'existential angst' resulting from a combination of profound remorse over having put the partner into what they perceived as a life-threatening situation during childbirth and their perceived moral and ethical obligations to provide support in this setting. Mothers in general did not directly discuss their own sexuality. Women could imagine men's sexual aversion after witnessing childbirth. However, they seemed unaware of men's potential for angst. Mothers are situated between the loss of traditional postpartum support networks, comprised of close female kin, and their own newly-defined responsibilities in the host setting. Fathers embrace their new role. Both partners articulated the mother's new role as enhancing autonomy and independence in the host setting. However, women held mixed attitudes about fathers replacing traditional kin support. to date, late postpartum aftercare for immigrant African parents is anecdotally linked to evidence

[Aftercare for durability and profitability of single-unit and multi-unit fixed dental prostheses].

Science.gov (United States)

de Baat, C; van Loveren, C; van der Maarel-Wierink, C D; Witter, D J; Creugers, N H J

2013-01-01

An important aim ofa treatment with single-unit and multi-unit fixed dental prostheses is a durable and profitable treatment outcome. That requires aftercare, too. First, the frequency of routine oral examinations should be assessed, using an individual risk profile. The objectives of the routine oral examinations are the prevention and, when necessary, the treatment of pathological conditions and complications. With regard to prevention, attention should be paid to information and instruction, oral biofilm and calculus, non-functional activities, hard tooth tissues, periodontal and peri-implant tissues, and saliva. Subsequently, it can be determined whether the intended durability and profitability have been achieved or can still be achieved, whether or not through indicated adjustments. Special attention should be paid to endodontically treated teeth. Restorative, repair or replacement treatments may be indicated in case ofcomplications, such as loose single- or multi-unitfixed dental prosthesis, fracture of a fixed dental prosthesis unit, lost tooth pulp vitality, tooth root fracture, and implant or implant abutment problems.

Consultation with the filipino boarding home: an after-care facility in Hawaii.

Science.gov (United States)

Yutiao, M; Kinzie, J D

1975-01-01

This report describes a unique Hawaiian after-care facility the Filipino operated boarding home, and the approaches useful in consultation with the operators. The majority of the boarding homes for psychiatric patients are operated by recent Filipino immigrants. This fact is explained by their current social position and also by cultural values--such as aiding others and an extended family system--which are present in the Philippines. In consultation with seventeen such boarding home operators, cultural beliefs and values played a great part in their approach to patients. These approaches created special problems and assets in their management of patients from other ethnic groups such as Japanese, Caucasian and Hawaiian. A problem-oriented approach to consultation proved useful initially and set the stage for other forms of intervention. This included allowing the operator to ventilate her feelings about the patient; bridging the communication gap between operators and patients; dissipating the operators' stereotypic perception of patients; and educating the operators about mental illness. Our impressions and indirect evidence indicated that Filipino boarding home operators perform a useful service and, with consultation sensitive to their values, can become even more effective.

Implications of human trafficking in Asia: a scoping review of aftercare initiatives centered on economic development.

Science.gov (United States)

Camp, Meghan A; Barner, John R; Okech, David

2018-01-01

The trafficking of persons is one of the most egregious violations of human rights in modern society. Given the disproportionate effects across demographic categories of age and gender, as well as concentrated impacts within the developing world, there is a strong need for research and literature on program effectiveness and appropriate aftercare efforts for those persons whose lives and livelihoods have been impacted by trafficking. The purpose of this article is to provide a scoping review of what is known about effectively helping survivors of human trafficking experiencing lack of economic opportunity and the implications for practice and future research regarding the absence of literature. From over 14,000 initial search results, this article focuses on those initiatives (N = 16) that support economic development of the individual or family after being trafficked. Implications arising from the review for trafficking policy, areas for further research, and implications for practitioners are highlighted and discussed.

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

Science.gov (United States)

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

2017-02-01

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 < 0.001). This did not occur in the control wards. The qualitative data (n = 20 interviews) showed improvements in participants' experiences of discharge planning. MAP increased inpatient input into discharge planning and was valued by participants. The effect on subsequent health service use needs evaluation. © 2016 Australian College of Mental Health Nurses Inc.

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

2010-03-15

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.

Can we omit scintiscanning of the skeleton in follow-up aftercare of carcinoma of the breast?

International Nuclear Information System (INIS)

Schuenemann, H.

1989-01-01

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.) [de

Psychosocial support for trauma-affected students after school shootings in Finland.

Science.gov (United States)

Turunen, Tuija; Punamäki, Raija-Leena

2014-01-01

In Finland, as many as 20 people have lost their lives in two school shootings within one year. This article describes trauma-theoretical rationale, planning, and implementation of acute and long-term psychosocial aftercare that was organized in Kauhajoki where one of the school shootings happened. The aftercare was embedded in the school community's everyday life to enhance easy access. The aftercare proceeded in 6 phases, involving the immediate support phase at the first 24 hr, the acute phase for the first 2 weeks, followed by a 5-month period of empowerment, normalization, and creating "a safe place." The habituation phase coincided with the completion of the renovation of the damaged school building and students returning to the scene. The first anniversary was marked by shared rituals and remembrance, and the follow-up phase lasted until the end of the aftercare in 2 years. The aftercare contained, for example, psychoeducation, screening, and services at community, group, and individual levels.

Effectiveness of telephone-based aftercare case management for adult patients with unipolar depression compared to usual care: A randomized controlled trial.

Directory of Open Access Journals (Sweden)

Laura Kivelitz

Full Text Available Patients with depression often have limited access to outpatient psychotherapy following inpatient treatment. The objective of the study was to evaluate the long-term effectiveness of a telephone-based aftercare case management (ACM intervention for patients with depression.We performed a prospective randomized controlled trial in four psychotherapeutic inpatient care units with N = 199 patients with major depression or dysthymia (F32.x, F33.x, F34.1, according to the ICD-10. The ACM consisted of six phone contacts at two-week intervals performed by trained and certified psychotherapists. The control group received usual care (UC. The primary outcome was depressive symptom severity (BDI-II at 9-month follow-up, and secondary outcomes were health-related quality of life (SF-8, EQ-5D, self-efficacy (SWE, and the proportion of patients initiating outpatient psychotherapy. Mixed model analyses were conducted to compare improvements between treatment groups.Regarding the primary outcome of symptom severity, the groups did not significantly differ after 3 months (p = .132; ES = -0.23 or at the 9-month follow-up (p = .284; ES = -0.20. No significant differences in health-related quality of life or self-efficacy were found between groups. Patients receiving ACM were more likely to be in outpatient psychotherapy after 3 months (OR: 3.00[1.12-8.07]; p = .029 and 9 months (OR: 4.78 [1.55-14.74]; p = .006 than those receiving UC.Although telephone-based ACM did not significantly improve symptom severity, it seems to be a valuable approach for overcoming treatment barriers to the clinical pathways of patients with depression regarding their access to outpatient psychotherapy.

Health care in patients 1 year post-stroke in general practice : research on the utilisation of the Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident

NARCIS (Netherlands)

de Weerd, L.; Rutgers, A.W.F.; Groenier, K.H.; van der Meer, K.

2012-01-01

This study evaluates the kind of aftercare that ischaemic stroke patients receive and the extent that aftercare fulfils the criteria of the 'Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident'. Fifty-seven patients were interviewed 1 year post-stroke about secondary

Follow-up after intensive care treatment

DEFF Research Database (Denmark)

Kjer, C K W; Estrup, S; Poulsen, L M

2017-01-01

common early ICU-aftercare items were as follows: respiratory care (82%), tracheostomy care (59%) and nutritional care (59%). For late ICU-aftercare, the most common eligibility criterion was LOS (41%). Guidelines (71%), but not checklist at patient contact (35%), were more common. Most frequent late ICU...

Theoretical analysis of municipal solid waste treatment by leachate recirculation under anaerobic and aerobic conditions

NARCIS (Netherlands)

van Turnhout, A.G.; Brandstätter, Christian; Kleerebezem, R.; Fellner, Johann; Heimovaara, T.J.

2018-01-01

Long-term emissions of Municipal Solid Waste (MSW) landfills are a burden for future generations because of the required long-term aftercare. To shorten aftercare, treatment methods have to be developed that reduce long-term emissions. A treatment method that reduces emissions at a lysimeter

Episiotomy - aftercare

Science.gov (United States)

... its own during a vaginal birth. Rarely, this tear will also involve the muscle around the anus or the rectum. (The last two problems are not discussed here.) Both episiotomies and perineal lacerations require stitches to repair and ensure the best ...

Evaluation of the Effectiveness of a Multimodal Complementary Medicine Program for Improving the Quality of Life of Cancer Patients during Adjuvant Radiotherapy and/or Chemotherapy or Outpatient Aftercare.

Science.gov (United States)

Domnick, Martin; Domnick, Manju; Wiebelitz, Karl-Rüdiger; Beer, André-Michael

2017-01-01

Evidence for complementary therapies as important strategies to relieve cancer treatment-associated symptoms is increasing. Mostly, these complementary therapies start at the end of adjuvant treatments, resulting in a long delay until the well-being of patients is addressed. Further, long distances between the rehabilitation center and the patients' residence hinder patients' compliance. The multimodal outpatient LOTUS Care Cure Project (LCCP) was tested in a randomized controlled trial including patients of various cancer entities and stages while on adjuvant chemotherapy and/or radiotherapy or outpatient aftercare. The intervention group received the LCCP additionally to the conventional treatment (LCCP group, n = 50). The control group (CG) was split into 2 groups, with (CG1, n = 33) and without (CG2, n = 17) weekly talks. The primary endpoint was quality of life (QoL) after 3 months. In the LCCP group, QoL significantly improved after 3 months compared to CG2 (p = 0.022) but not compared to CG1. Other parameters showing a significant improvement were cognitive (p < 0.05, vs. CG1 and CG2) and social function (p < 0.05, vs. CG2). This pilot study describes a multimodal outpatient complementary therapy program conducted in parallel with conventional therapies and its potential to significantly improve QoL and reduce treatment-associated side effects. To substantiate these data, multicenter trials are needed. © 2017 S. Karger AG, Basel.

Barriers to the collaborative care of patients with orofacial injury.

Science.gov (United States)

Wong, Eunice C; Marshall, Grant N

2010-05-01

Collaborative care interventions show significant promise in facilitating integrative care, which addresses the physical and mental health needs of patients with orofacial trauma. Ensuring the successful implementation of collaborative care interventions depends on having an adequate understanding of the potential barriers to the provision and receipt of mental health services within specific clinical settings. This article reviews recent findings on the patients' and providers' perceptions of barriers to psychosocial aftercare services in oral and maxillofacial trauma care settings. These findings indicate that although patients and providers recognize the need for psychosocial aftercare, they report substantial barriers to these services. Structural barriers, such as not knowing where to obtain services and financial cost, are the major obstacles among patients. Among providers, structural barriers also serve as significant impediments to the provision of psychosocial services. Some of the most common structural barriers reported by providers include a shortage of financial resources, trained clinical staff, and space. Although collaborative care interventions may be well suited to capitalize on patients' and providers' interests in psychosocial aftercare programs, further research is needed to determine the viability of this promising aftercare model within oral and maxillofacial trauma care settings.

Hamstring strain - aftercare

Science.gov (United States)

Pulled hamstring muscle; Sprain - hamstring ... There are 3 levels of hamstring strains: Grade 1 -- mild muscle strain or pull Grade 2 -- partial muscle tear Grade 3 -- complete muscle tear Recovery time depends ...

Tailbone trauma - aftercare

Science.gov (United States)

... at the lower tip of the spine. At home, be sure to follow your doctor's instructions on how to ... rare cases is there a fracture or broken bone. Tailbone injuries are often caused by backward ...

Hand fracture - aftercare

Science.gov (United States)

... an orthopedic surgeon if: Your metacarpal bones are broken and shifted out of place Your fingers do not line up correctly Your fracture nearly went through the skin Your fracture went through the skin Your pain is severe or becoming worse Self-care at Home You may have pain and swelling for 1 ...

Postherpetic neuralgia - aftercare

Science.gov (United States)

... your everyday activities and make it hard to work. Affect how involved you are with friends and family. Cause feelings of frustration, resentment, and stress. These feelings may make your pain worse.

Meniscus tears -- aftercare

Science.gov (United States)

... Quickly stop moving and change direction while running, landing from a jump, or turning Kneel down Squat ... Health and Human Services National Institutes of Health Page last updated: 30 April 2018

Foot sprain - aftercare

Science.gov (United States)

... stay in place. Some of these sports include football, snowboarding, and dance. There are three levels of ... Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, ...

Bacterial vaginosis - aftercare

Science.gov (United States)

Bacterial vaginosis (BV) is a type of vaginal infection. The vagina normally contains both healthy bacteria and unhealthy bacteria. BV occurs when more unhealthy bacteria grow than healthy bacteria. No one knows ...

Implant-retained overdentures for young children with severe oligodontia: a series of four cases.

Science.gov (United States)

Filius, Marieke A P; Vissink, Arjan; Raghoebar, Gerry M; Visser, Anita

2014-09-01

The treatment need is high in children with severe oligodontia and anodontia, because they often have functional and esthetic problems owing to missing teeth. Because the intraforaminal region barely grows after eruption of the permanent mandibular incisors, dental implant treatment should be considered a treatment option for these children. The purpose of our study was to assess the treatment outcomes regarding satisfaction and the care and aftercare of implant-retained mandibular overdentures in a series of 4 young children without erupted mandibular teeth from either severe oligodontia (n = 3) or anodontia (n = 1). Four children without erupted mandibular teeth, aged 6 to 13 years, were provided with an implant-retained overdenture on 2 implants. The surgical and prosthetic care and aftercare were scored by the clinicians. Also, the patients and their parents were queried about how satisfied they were with the overdenture. The median follow-up of the patients was 5.2 years (range 3.2 to 8.4). No implants were lost, no cases of peri-implantitis occurred, and the need for treatment and aftercare was low. Patient and parent satisfaction with this treatment was high. A 2-implant, retained overdenture in children with no erupted mandibular teeth is a safe treatment modality when appropriate treatment and aftercare can be provided. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Metatarsal stress fractures - aftercare

Science.gov (United States)

... Metatarsal stress fracture. In: Safran MR, Zachazewski J, Stone DA, eds. Instructions for Sports Medicine Patients . 2nd ed. Elsevier Saunders; 2012:648-652. Smith MS. Metatarsal fractures. In: Eiff PM, Hatch R, eds. Fracture Management for Primary Care . 3rd ed. ...

Hip flexor strain -- aftercare

Science.gov (United States)

... flexors. Runners, people who do martial arts, and football, soccer, and hockey players are more likely to ... herein should not be used during any medical emergency or for the diagnosis or treatment of any ...

Sinusitis in adults - aftercare

Science.gov (United States)

... any unused antibiotic pills you may have at home. Watch for common side effects of antibiotics, including: Skin rashes Diarrhea For women, yeast infection of the vagina (vaginitis) Stay Healthy to Avoid Sinus Infections Reduce stress and ...

Achilles tendon rupture - aftercare

Science.gov (United States)

... to go from walking to running, or to running uphill Tripped and fell, or had another accident Played a sport like tennis or basketball, with a lot of stopping and sharp turns Most injuries can be diagnosed during a physical exam. You ...

Irritable bowel syndrome - aftercare

Science.gov (United States)

... because of your pain Changes or problems at work or at home A busy schedule Spending too much time alone Having other medical problems A first step toward reducing your stress is to figure out what makes you feel ...

Metatarsal fracture (acute) - aftercare

Science.gov (United States)

... of your 5th metatarsal bone closest to the ankle is called a Jones fracture. This area of the bone has low blood ... Swelling, pain, numbness, or tingling in your leg, ankle, or foot that becomes worse Your leg or foot turns purple Fever

75 FR 67017 - Presidential Determination with Respect to Foreign Governments' Efforts Regarding Trafficking in...

Science.gov (United States)

2010-11-01

..., poverty reduction, livelihoods, family planning, and macroeconomic growth including anti- corruption, and..., identification, rescue/removal, aftercare (shelter, counseling) training, and reintegration; or (c) expand...

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.)

1989-08-01

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.).

Forebyggelse og efterbehandling af suicidal adfaerd--en litteraturoversigt

DEFF Research Database (Denmark)

Stenager, E N

1991-01-01

In this review of the literature on studies concerning the prevention of suicide and the effect of after-care of patients who have attempted to take their lives it is concluded that no treatment which works has yet been discovered. Of five clinically controlled studies only one suggested...... that it affected the repetition frequency of attempts at suicide. When other effects were assessed there was an improvement in the patients' social functions and a reduction in their abuse of alcohol. The studies have shown that not only psychiatrists but also other physicians and categories of personnel can...... undertake attendance on, and after-care of patients who have attempted suicide provided that they receive the necessary training and supervision....

3 CFR - Presidential Determination With Respect to Foreign Governments' Efforts Regarding Trafficking in...

Science.gov (United States)

2010-01-01

..., poverty reduction, livelihoods, or family planning, or which would have a significant adverse effect on..., aftercare (shelter, counseling), training, and reintegration; or (c) expand prevention efforts through...

Material flow-based economic assessment of landfill mining processes.

Science.gov (United States)

Kieckhäfer, Karsten; Breitenstein, Anna; Spengler, Thomas S

2017-02-01

This paper provides an economic assessment of alternative processes for landfill mining compared to landfill aftercare with the goal of assisting landfill operators with the decision to choose between the two alternatives. A material flow-based assessment approach is developed and applied to a landfill in Germany. In addition to landfill aftercare, six alternative landfill mining processes are considered. These range from simple approaches where most of the material is incinerated or landfilled again to sophisticated technology combinations that allow for recovering highly differentiated products such as metals, plastics, glass, recycling sand, and gravel. For the alternatives, the net present value of all relevant cash flows associated with plant installation and operation, supply, recycling, and disposal of material flows, recovery of land and landfill airspace, as well as landfill closure and aftercare is computed with an extensive sensitivity analyses. The economic performance of landfill mining processes is found to be significantly influenced by the prices of thermal treatment (waste incineration as well as refuse-derived fuels incineration plant) and recovered land or airspace. The results indicate that the simple process alternatives have the highest economic potential, which contradicts the aim of recovering most of the resources. Copyright © 2016 Elsevier Ltd. All rights reserved.

Collateral ligament (CL) injury -- aftercare

Science.gov (United States)

... twisting injury. Skiers and people who play basketball, football, or soccer are more likely to have this ... herein should not be used during any medical emergency or for the diagnosis or treatment of any ...

Pelvic inflammatory disease (PID) - aftercare

Science.gov (United States)

... But they also kill other types of helpful bacteria in your body. This can cause diarrhea or vaginal yeast infections in women. Probiotics are small organisms found in yogurt and some supplements. Probiotics are thought to help ...

Ready for eHealth? Health Professionals' Acceptance and Adoption of eHealth Interventions in Inpatient Routine Care.

Science.gov (United States)

Hennemann, Severin; Beutel, Manfred E; Zwerenz, Rüdiger

2017-03-01

eHealth interventions can be effective in treating health problems. However, adoption in inpatient routine care seems limited. The present study therefore aimed to investigate barriers and facilitators to acceptance of eHealth interventions and of online aftercare in particular in health professionals of inpatient treatment. A total of 152 out of 287 health professionals of various professional groups in four inpatient rehabilitation facilities filled out a self-administered web-based questionnaire (response rate: 53%); 128 individuals were eligible for further data analysis. Acceptance and possible predictors were investigated with a complex research model based on the Unified Theory of Acceptance and Use of Technology. Acceptance of eHealth interventions was rather low (M = 2.47, SD = 0.98); however, acceptance of online aftercare was moderate (M = 3.08, SD = 0.96, t(127) = 8.22, p eHealth literacy was elevated. Social influence, performance expectancy, and treatment-related internet and mobile use significantly predicted overall acceptance. No differences were found between professional and age groups. Although acceptance of eHealth interventions was limited in health professionals of inpatient treatment, moderate acceptance of online aftercare for work-related stress implies a basis for future implementation. Tailored eHealth education addressing misconceptions about inferiority and incongruity with conventional treatment considering the systemic aspect of acceptance formation are needed.

Follow-up services for stroke survivors after hospital discharge--a randomized control study

DEFF Research Database (Denmark)

Andersen, Hanne Elkjaer; Eriksen, Karen; Brown, Anne

2002-01-01

OBJECTIVE: To evaluate whether follow-up services for stroke survivors could improve functional outcome and reduce readmission rate. In this paper results of functional outcome are reported. DESIGN: Randomized controlled trial allocating patients to one of three different types of aftercare: (1......) follow-up home visits by a physician, (2) physiotherapist instruction in the patient's home, or (3) standard aftercare. SUBJECTS: Stroke patients with persisting impairment and disability who, after completing inpatient rehabilitation, were discharged to their homes. OUTCOME MEASURES: Six months after...... discharge, functional outcome was assessed with Functional Quality of Movement, Barthel Index, Frenchay Activity Index and Index of Extended Activites of Daily Living. RESULTS: One-hundred and fifty-five stroke patients were included in the study. Fifty-four received follow-up home visits by a physician, 53...

A simple risk scoring system for prediction of relapse after inpatient alcohol treatment.

Science.gov (United States)

Pedersen, Mads Uffe; Hesse, Morten

2009-01-01

Predicting relapse after alcoholism treatment can be useful in targeting patients for aftercare services. However, a valid and practical instrument for predicting relapse risk does not exist. Based on a prospective study of alcoholism treatment, we developed the Risk of Alcoholic Relapse Scale (RARS) using items taken from the Addiction Severity Index and some basic demographic information. The RARS was cross-validated using two non-overlapping samples, and tested for its ability to predict relapse across different models of treatment. The RARS predicted relapse to drinking within 6 months after alcoholism treatment in both the original and the validation sample, and in a second validation sample it predicted admission to new treatment 3 years after treatment. The RARS can identify patients at high risk of relapse who need extra aftercare and support after treatment.

Continuity of care of outpatients with schizophrenia in Pretoria

Directory of Open Access Journals (Sweden)

A M E Kotze

2010-10-01

Full Text Available Objective. To study the needs of outpatients suffering from schizophrenia and their primary caregivers. Methods. A qualitative descriptive design was selected to study the needs of a non-probability purposive sample of 50 outpatients with schizophrenia and their primary caregivers. Data were collected on their compliance-related needs as well as psychosocial and aftercare treatment needs. Results. Compliance needs: Eighty-three per cent of the participants supported their medication treatment and aftercare, but needed more information on the illness than they had received or had managed to gather. Psychosocial needs: Participants had difficulty in accepting the illness and in understanding its consequences for their everyday functioning. Ninety-seven per cent of patients were aware that their illness had affected the health of their primary caregiver. The majority of participants had lost friendships since the diagnosis of schizophrenia. Eighty-eight of the primary caregivers supported the patient financially, despite the fact that many were over 60 years of age. Aftercare treatment needs: A strong need was expressed for services such as day-care centres, workshops, and psycho-educational and social work services. Conclusions. As South African health policy is moving towardsde-institutionalisation and treating mental health as part of primary care, support must be improved for sufferers of schizophrenia and their primary caregivers. Many people are prepared to face up to the challenge of caring for a mentally ill family member, yet are faced with significant needs that should be addressed.

Can readmission after stroke be prevented? Results of a randomized clinical study: a postdischarge follow-up service for stroke survivors

DEFF Research Database (Denmark)

Andersen, H E; Schultz-Larsen, K; Kreiner, S

2000-01-01

the completion of inpatient rehabilitation, were discharged to their homes. The patients were randomized to 1 of 2 follow-up interventions provided in addition to standard care or to standard aftercare. Fifty-four received follow-up home visits by a physician (INT1-HVP), 53 were provided instructions......BACKGROUND AND PURPOSE: About 50% of stroke survivors are discharged to their homes with lasting disability. Knowledge, however, of the importance of follow-up services that targets these patients is sparse. The purpose of the present study was to evaluate 2 models of follow-up intervention after...... by a physiotherapist in their home (INT2-PI), and 48 received standard aftercare only (controls). Baseline characteristics for the 3 groups were comparable. Six months after discharge, data were obtained on readmission and institutionalization. RESULTS: The readmission rates within 6 months after discharge were...

Anterior cruciate ligament (ACL) injury -- aftercare

Science.gov (United States)

... Quickly stop moving and change direction while running, landing from a jump, or turning Skiers and people ... Health and Human Services National Institutes of Health Page last updated: 30 April 2018

Urinary tract infection in girls - aftercare

Science.gov (United States)

... improve within 1 to 2 days in most girls. The advice below may not be as accurate for girls with more complex problems. ... The following steps can help prevent UTIs in girls: Avoid giving your child bubble baths. Have your ...

Posterior cruciate ligament (PCL) injury -- aftercare

Science.gov (United States)

... blood vessels. Skiers and people who play basketball, football, or soccer are more likely to have this ... herein should not be used during any medical emergency or for the diagnosis or treatment of any ...

28 CFR 91.2 - Definitions.

Science.gov (United States)

2010-07-01

... reduction management, post-release assistance and an assessment of recidivism rates. (g) Correctional..., and substance abuse counseling or treatment; and (4) Post-incarceration aftercare services for participants that are coordinated with the program carried out during the period of imprisonment. (i) Truth in...

Challenges in demonstrating the effectiveness of multidisciplinary treatment on quality of life, participation and health care utilisation in patients with fibromyalgia: a randomised controlled trial

NARCIS (Netherlands)

van Eijk-Hustings, Yvonne; Kroese, Mariëlle; Tan, Frans; Boonen, Annelies; Bessems-Beks, Monique; Landewé, Robert

2013-01-01

This study aimed to examine the effectiveness of a multidisciplinary intervention with aftercare (MD) compared to aerobic exercise (AE) and usual care (UC) in recently diagnosed patients with fibromyalgia (FM). In a Zelen-like design, eligible patients from the outpatient rheumatology clinics of

Surgical treatment of a comminuted articular fracture of the accessory carpal bone in a thoroughbred horse

International Nuclear Information System (INIS)

Munroe, G.A.; Cauvin, E.

1997-01-01

The clinical, radiographic and ultrasonographic findings in a case ofa comminuted articular fracture of the accessory carpal bone of a thoroughbred chaser are described, and its surgical treatment and aftercare are detailed. The horse made an uneventful recovery and successfully returned to racing

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

Directory of Open Access Journals (Sweden)

Meraner Verena

2012-02-01

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.

Permissive weight bearing in trauma patients with fracture of the lower extremities: prospective multicenter comparative cohort study.

Science.gov (United States)

Kalmet, Pishtiwan H S; Meys, Guido; V Horn, Yvette Y; Evers, Silvia M A A; Seelen, Henk A M; Hustinx, Paul; Janzing, Heinrich; Vd Veen, Alexander; Jaspars, Coen; Sintenie, Jan Bernard; Blokhuis, Taco J; Poeze, Martijn; Brink, Peter R G

2018-02-02

The standard aftercare treatment in surgically treated trauma patients with fractures around or in a joint, known as (peri)- or intra-articular fractures of the lower extremities, is either non-weight bearing or partial weight bearing. We have developed an early permissive weight bearing post-surgery rehabilitation protocol in surgically treated patients with fractures of the lower extremities. In this proposal we want to compare our early permissive weight bearing protocol to the existing current non-weight bearing guidelines in a prospective comparative cohort study. The study is a prospective multicenter comparative cohort study in which two rehabilitation aftercare treatments will be contrasted, i.e. permissive weight bearing and non-weight bearing according to the AO-guideline. The study population consists of patients with a surgically treated fracture of the pelvis/acetabulum or a surgically treated (peri)- or intra-articular fracture of the lower extremities. The inclusion period is 12 months. The duration of follow up is 6 months, with measurements taken at baseline, 2,6,12 and 26 weeks post-surgery. ADL with Lower Extremity Functional Scale. Outcome variables for compliance, as measured with an insole pressure measurement system, encompass peak load and step duration. This study will investigate the (cost-) effectiveness of a permissive weight bearing aftercare protocol. The results will provide evidence whether a permissive weight bearing protocol is more effective than the current non-weight bearing protocol. The study is registered in the Dutch Trial Register ( NTR6077 ). Date of registration: 01-09-2016.

Particuliere reclassering en overheid in Nederland sinds 1823

NARCIS (Netherlands)

Heinrich, Jean-Paul

1995-01-01

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

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

2014-01-01

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....

Quantification of long term emission potential from landfills

NARCIS (Netherlands)

Heimovaara, T.J.

2011-01-01

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

75 FR 35460 - Funding Opportunity; Basic Center Program

Science.gov (United States)

2010-06-22

... appropriate shelter; individual, family, and group counseling, as appropriate; and aftercare. I. Funding... shelter (up to 21 days) for RHY. To deliver individual, family and group counseling services to youth that... shelter and support services that assist youth in crisis (food, clothing, counseling and referrals for...

Measuring Effects of a Skills Training Intervention for Drug Abusers.

Science.gov (United States)

Hawkins, J. David; And Others

1986-01-01

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…

Water balance modeling for estimation of residence time of water in a full-scale landfill using a data-assimilation approach

NARCIS (Netherlands)

Heimovaara, T.J.; Bun, A.; Van Turnhout, A.G.

2015-01-01

In order to develop novel approaches for reducing the after-care of Municipal Solid Waste (MSW) sanitary landfills methods are required with which we can quantify the emission potential present in waste bodies. Currently full-scale experiments are being prepared at three Dutch landfills based on

Restorative Justice: Principles, Practices, and Application

Science.gov (United States)

O'Brien, Sandra Pavelka

2007-01-01

A modern-day movement is transforming the way that communities and justice systems think about and respond to crime and wrongful occurrences. This response implements a holistic continuum of services, providing for prevention, intervention, diversion, commitment, probation, reentry, and aftercare. This approach--known as restorative justice--seeks…

A seismic processing approach dedicated to quantitative characterization of landfill heterogeneities

NARCIS (Netherlands)

Konstantaki, L.A.; Ghose, R.; Draganov, D.S.; Diaferia, G.; Heimovaara, T.J.

2014-01-01

The ability to image and quantify the heterogeneity in municipal landfills is crucial for improving the landfill treatment methods, for predicting the behaviour of processes that take place inside the landfills and hence, for estimating the after-care period. Our aim is to image the flow paths

Promising Practices in Drug Treatment: Findings from Southeast Asia

Science.gov (United States)

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

2005-01-01

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…

Continuity of care.indd

African Journals Online (AJOL)

from psycho-educational groups conducted by the researchers over time. They consisted of a checklist of topics addressing the categories of treatment compliance needs, as well as psychosocial and aftercare treatment needs. Each category consisted of nine questions.6 To increase the trustworthiness of observations and.

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...

Imaging scatterers in landfills using seismic interferometry

NARCIS (Netherlands)

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

2013-01-01

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

The Development of a Collegiate Recovery Program: Applying Social Cognitive Theory within a Social Ecological Framework

Science.gov (United States)

Beeson, Eric T.; Whitney, Jennifer M.; Peterson, Holly M.

2017-01-01

Background: Collegiate recovery programs (CRPs) are emerging as a strategy to provide after-care support to students in recovery from substance use disorders (SUDs) at institutions of higher education. CRPs are an innovative strategy for Health Educators to support the personal, academic, and professional goals of students in recovery. Purpose:…

Sustainable restitution/recultivation

African Journals Online (AJOL)

RECHERCHE02

factors. Between 1960 and 2002, the area of natural forests of Rwanda underwent a ... forests (ROR, 2010). Nowadays, forest restoration is being addressed at the national and ... of survival of newly planted trees such as tree planting method, tree planting season, types and quality of seedlings used while planting, aftercare ...

Spirituality as a Component in a Treatment Program for Sexually Addicted Roman Catholic Clergy.

Science.gov (United States)

Hudson, Patricia E.

1997-01-01

A treatment program that integrates spirituality and therapy for sex abusers who are Roman Catholic priests or brothers is described. Selections from an interview with the program director cover definitions, philosophy, women as therapists, daily activity, candidates, and the spiritual dimension. Measures of success and after-care are discussed.…

Strategies for Incorporating Women-Specific Sexuality Education into Addiction Treatment Models

Science.gov (United States)

James, Raven

2007-01-01

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…

Supportive Housing in Foster Care: The Views of Young People

Science.gov (United States)

Sinkkonen, Hanna-Maija; Kyttälä, Minna

2015-01-01

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…

Lapse and relapse following inpatient treatment of opiate dependence.

LENUS (Irish Health Repository)

Smyth, B P

2010-06-01

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.

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

Directory of Open Access Journals (Sweden)

Ondřej Krupčík

2014-12-01

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

A temporal profile of pro-abstinence-oriented constructs from the modified theory of planed behavior in a Slovenian clinical sample of treated alcoholics – an 18-year follow-up

Directory of Open Access Journals (Sweden)

Radovanović Mirjana

2018-01-01

Full Text Available Using the modified Theory of Planned Behaviour (mTPB, different indicators of therapeutic success were studied to understand pro-abstinence behavioural orientation during an 18-year after-care period following a 3-month intensive alcoholism treatment. The indicators were: perceived needs satisfaction (NS, normative differential (ND, perceived alcohol utility (UT, beliefs about treatment programme benefits (BE and behavioural intentions (BI.

[Aftercare of newborn infants in a patient hotel].

Science.gov (United States)

Lindgren, C

2000-05-10

Postnatal care of the healthy term newborn and the mother has, in modern times, taken place in the hospital setting. As a result of tightened hospital budgets as well as maternal preferences the duration of hospital stay has successively been shortened. Most women in Scandinavia today leave the hospital within four days after delivery. Postnatal care in a hotel like setting has emerged as an alternative to the well-baby nursery unless medical conditions makes this option inappropriate. To evaluate the safety of postnatal care a study was undertaken to investigate whether correct criteria were being used for referral of the newborn to the hotel. We also wanted to document the duration of stay, unexpected medical complications, and weight development of the infants. Data from 865 infants were used for analysis. Ten (1.1%) newborns had to be readmitted to the hospital due to medical complications. 488 (56%) of the mothers went home within 96 hours, and only 23 (2.6%) stayed more than 120 hours. The weight of the infants reached a nadir on the fourth day post partum (-5.2% of birth weight). The patient hotel is a medically safe alternative to the traditional well-baby nursery, provided that appropriate criteria for referral are used.

Aftercare Guidelines for Drug and Alcohol Program Advisors

Science.gov (United States)

1991-10-21

Relationships Relaxing Resentment Respect Responsibility Rigidity Risks Secrets Self-acceptance Self-esteem Serenity Shame Sharing Silence Slips Slippery ...Bit You (1967) 22041 A Time For Decision (1968) 22138 The Summer We Moved To Elm Street (1972) 22144 The Secret Love of Sandra Blain (1971) 22154

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

Science.gov (United States)

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

2008-06-18

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.

[Treatment of traumatic lesions of the bursa olecrani and chronic bursitis olecrani].

Science.gov (United States)

Saul, D; Dresing, K

2017-06-01

Complete olecranon bursectomy with debridement, protection of veins and nerves. Risk-adapted antibiotic therapy and early functional aftercare. Acute, traumatic laceration of the bursa olecrani, chronic therapy-resistant bursitis olecrani. For traumatic bursa injuries: general contraindications for anesthesia and surgery; chronic bursitis: initially not closable skin defect (plastic surgery required), hemodynamically instable patient (e.g. systemic inflammatory response syndrome [SIRS] or sepsis), pre-existing skin infection. Local anesthesia beyond the lesion, careful debridement, identification and removal of the entire bursa, excision of contaminated skin, lavage, drain insertion (Redon, Easy-flow, Penrose). Wound closure, elastic bandage, and splint. Elastic bandage for 2 days, followed by drain removal. Wound assessment, early functional aftercare without splint, antibiotic therapy in septic bursitis for 2 weeks, PRICE scheme. Removal of stitches after 10-12 days. Over 5 years, 138 cases of traumatic bursa lesion or chronic bursitis olecrani were treated in our clinic, 82 patients underwent surgery. Ten patients were treated with vacuum-assisted closure therapy and consecutive wound healing; fistulae occurred in two patients and in another two dehiscence developed. All of the defects could be closed without flaps.

Význam fyzioterapie na gerontopsychiatrii

OpenAIRE

Kozlová, Eliška

2010-01-01

The subject of this work is application of physiotherapy at gerothopsychiatric patients, the image of care of geronthopsychiatric patient on inpatient department and at after-care facilities (facilities, that are providing respite care and day care). In form of casuistry it is describing process and results of individual physiotherapy of polymorbidic patient with organic anxious disorder and schizoaffective disorder of depressive type, of which during exacerbation of chronic obstructive pulmo...

Double-contrast imaging of the pharynx in case of dysphagia as the leading symptom

International Nuclear Information System (INIS)

Feyerabend, T.; Schmitt, R.; Richter, E.; Bohndorf, W.

1989-01-01

The article explains the value of double-contrast pharyngography in the gradual programme of diagnostic means for clarifying the symptom of dysphagia. The method is simple and quick and well suited as a first screening method before more complicated methods are used. It allows reliable assessment of postoperative or postradiogenic morphology in case of malignant oro- or hypopharynx tumors and thus also is suitable for tumor aftercare programmes. (orig./GDG) [de

Double-contrast imaging of the pharynx in case of dysphagia as the leading symptom. Methodology and diagnostic value

Energy Technology Data Exchange (ETDEWEB)

Feyerabend, T; Schmitt, R; Richter, E; Bohndorf, W

1989-01-01

The article explains the value of double-contrast pharyngography in the gradual programme of diagnostic means for clarifying the symptom of dysphagia. The method is simple and quick and well suited as a first screening method before more complicated methods are used. It allows reliable assessment of postoperative or postradiogenic morphology in case of malignant oro- or hypopharynx tumors and thus also is suitable for tumor aftercare programmes. (orig./GDG).

The role of the EAP in the identification and treatment of substance abuse.

Science.gov (United States)

Kramer, R M

1998-12-01

Employee Assistance Programs (EAPs) are cost-effective strategies for employers to contain the substantial direct and indirect costs of substance abuse in the workplace. EAPs offer prevention, early detection, assessment of referral, and after-care programs to help stem the enormous costs of substance abuse in the workplace. Most effective employer substance abuse programs integrate drug-testing and EAP services to ensure a well coordinated, cost-effective program.

Supplying emergency contraception to adolescents: the nurse's role.

Science.gov (United States)

Hopkins, Craig

2014-12-02

This article explores issues surrounding the supply of emergency contraception to adolescents to reduce the risk of unintended pregnancy. It explains the female reproductive cycle, and describes the types of emergency contraception that may be supplied following unprotected sexual intercourse or contraception failure. The aftercare that should be offered to adolescents following the supply of emergency contraception is discussed, alongside issues surrounding the safeguarding of children and vulnerable adults.

Ošetřovatelská péče u klientů s inkontinencí moči dlouhodobě upoutaných na lůžku.

OpenAIRE

KUBÍKOVÁ, Nikola

2014-01-01

Bachelor thesis titled ,,Nursing care for long-term bedridden patients with urinary incontinence" deals with the nursing care of clients with urinary incontinence has long restrained on a bed on the aftercare department. Urinary incontinence is a condition of involuntary leakage of urine, which is a major health and social problem (Kalvach and team, 2004). According to the International Continence Society (ICS) urinary incontinence is classified into extraurethal and urethral. Extraurethal in...

Improving Parolees' Participation in Drug Treatment and Other Services through Strengths Case Management

OpenAIRE

Prendergast, Michael; Cartier, Jerome J.

2008-01-01

In an effort to increase participation in community aftercare treatment for substance-abusing parolees, an intervention based on a transitional case management (TCM) model that focuses mainly on offenders' strengths has been developed and is under testing. This model consists of completion, by the inmate, of a self-assessment of strengths that informs the development of the continuing care plan, a case conference call shortly before release, and strengths case management for three months post...

Natural attenuation of biogas in landfill covers

International Nuclear Information System (INIS)

Cossu, R.; Privato, A.; Raga, R.

2005-01-01

In the risk evaluation of uncontrolled biogas emissions from landfills, the process of natural attenuation in landfill covers assumes a very important role. The capacity of biogas oxidation in the cover soils seems to be the most important control to mitigate the biogas emission during the aftercare period when the biogas collection system might fail. In the present paper laboratory experiences on lab columns to study the biogas oxidation are discussed [it

The Effect of Postpurchase Communication on Customer Satisfaction

OpenAIRE

Ward, Robert; Turley, Darach

1996-01-01

To most practitioners, effective marketing has invariably meant "looking after the customer". However, attention is being increasingly directed at the preposition in this expression. " Looking after the customer " is more than ever a matter of "looking to the customer afterwards". Customer aftercare can take many forms, from courtesy phone calls to special client get-togethers. It seems reasonable to suppose that each form may have a characteristic impact on customer satisfaction. This articl...

Understanding the acceptability of e-mental health - attitudes and expectations towards computerised self-help treatments for mental health problems

OpenAIRE

Musiat, Peter; Goldstone, Philip; Tarrier, Nicholas

2014-01-01

Background E-mental health and m-mental health include the use of technology in the prevention, treatment and aftercare of mental health problems. With the economical pressure on mental health services increasing, e-mental health and m-mental health could bridge treatment gaps, reduce waiting times for patients and deliver interventions at lower costs. However, despite the existence of numerous effective interventions, the transition of computerised interventions into care is slow. The aim of...

Tri-Service Disability Evaluation Systems Database Analysis and Research. Annual Report 2011

Science.gov (United States)

2011-12-28

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... cellulitis and abscess 135 3.0 722: Intervertebral disc disorders 17 2.6 996: Complications peculiar to certain specified procedures 134 3.0 738

Vliv časné nutriční podpory a rehabilitace během akutního onemocnění na následnou soběstačnost a tělesnou kondici u geriatrických pacientů - prospektivní dlouhodobá studie

OpenAIRE

Dědková, Zuzana

2018-01-01

- Effect of clinical nutrition and physiotherapy in acutely ill geriatric patients on self-sufficiency and physical condition - prospective longitudinal study Background & aims: Acute internal disease of the elderly often leads to loss of muscle mass and self-sufficiency. Reversal of muscle tissue, especially in geriatric patients, is very difficult and thus can an acute illness leads to necessity a second person helping a form of subsequent social care at home or in institutions aftercare. T...

Aftercare to chemically addicted adolescents: An exploration of their ...

African Journals Online (AJOL)

2013-04-29

Apr 29, 2013 ... The negative effects of harmful chemical substances, as well as their addictive nature, leads to various ... the community and includes the focus on networking with ...... and juvenile delinquency (Bezuidenhout 2008:133–135).

First 2 Years of Experience of "Residential Care" at "Sakalawara Rehabilitation Services," National Institute of Mental Health and Neurosciences, Bengaluru, India.

Science.gov (United States)

Manjunatha, Narayana; Agarwal, Preeti Pansari; Shashidhara, Harihara N; Palakode, Mohan; Raj, E Aravind; Mary Kapanee, Aruna Rose; Nattala, Prashanthi; Kumar, C Naveen; Sudhir, Paulomi; Thirthalli, Jagadisha; Bharath, Srikala; Sekar, Kasi; Varghese, Mathew

2017-01-01

There is an unmet need for continuity-of-care is well known for those with severe mental disorders (SMDs) after acute care at hospitals in India. The "Sakalawara Rehabilitation Services (SRS)" functioned from March 2014 at "Sakalawara Community Mental Health Centre" (SCMHC) of "National Institute of Mental Health and Neurosciences," Bengaluru, India in the concepts of residential care (half-way-home) with the aim to develop a replicable model. To review the inpatient records after the initial 2 years of experience in residential care at SCMHC. Retrospective file review of inpatients at SCMHC from March 2014 to March 2016 in a semi-structured proforma designed for the study. Ethical committee of NIMHANS Bengaluru has approved the study. The total number of inpatients during this period was 85. It was found that Schizophrenia spectrum disorders were the most common diagnosis among these patients. The activity of daily living and psycho-education were the most common individual interventions. The majority of families underwent structured family psycho-educational interventions. This review also demonstrated the feasibility of tele-aftercare in continuity of care after discharge of patients. SRS kind of residential set-up is feasible and demonstrated effectiveness in maintaining continuity of care of SMDs. There is a need for better structured and customized interventions. There is further a scope for tele (video) aftercare for those with SMDs.

Nurse as a support of long - term hospitalized senior

OpenAIRE

TUŠLOVÁ, Michaela

2017-01-01

This thesis "Nurse as a support of long-term hospitalized senior" is divided into a theoretical and an empirical part. It deals with the issue of long-term hospitalization of seniors at the aftercare department, especially with the nurses' support to seniors and their interrelationships. Three main goals were appointed. It was examined how the seniors perceive nurses who takes care of them. Then in which areas nurses are supportive and which techniques they try to use to be a support for seni...

Simultaneous Bilateral Cochlear Implantation for a 6-Month Child with a History of Meningitis

Directory of Open Access Journals (Sweden)

Kh. M. Diab

2015-01-01

Full Text Available The article presents the first case of simultaneous bilateral cochlear implantation for a 6-month child with IV degree sensorineural hearing loss after meningocephalitis in Russia. Despite partial ossification of the cochlear basal turns, the early timing of implantation allowed to fully implant active electrodes to both ears. The simultaneous bilateral cochlear implantation in young children, who had meningitis, is a minimally invasive and highly efficient procedure with good long-term results of oral-aural after-care.

[Transfer managment of postoperative acute pain therapy to outpatient aftercare].

Science.gov (United States)

Tank, C; Lefering, R; Althaus, A; Simanski, C; Neugebauer, E

2014-10-01

The significance of postoperative pain management for patients in the hospital is well known and has been a focus of research for several years. The ambulatory care after hospital discharge, however, is not well investigated. A prospective observational study was therefore conducted to study the transfer management from in-hospital patients to ambulatory care. A patient questionnaire was developed and patients were asked to fill it out at different time points after the operation: during the time in the hospital, then at 2 weeks and 6 months after hospital discharge. In addition, the responsible family doctor was approached and interviewed. The main focus of the questionnaire was the measurement of post-surgical pain (numeric rating scale NRS), patient satisfaction (Cologne patient questionnaire), and quality of life (SF 12). Of a total of 128 patients 72.9% described moderate to severe pain after the orthopaedic operations in the hospital. 90.8% of the patients had pain directly after discharge from the hospital; in 67.4% of the cases pain was ≥3 and in 23.4% of the cases pain was ≥6. Six months after discharge pain was significant in 29.4% of the patients, 60.8% of the patients were satisfied with the transfer to the home setting. 16% were not satisfied at all and 23.2% were neutral. Important factors for dissatisfaction with the transfer management were, according to stepwise logistic regeression analysis, sex (female patients), young age, a poor bodily constitution at the hospital and thereafter, and the pain management in the hospital and after discharge. The study shows the significance of the acute pain therapy not only during the hospital stay but also after discharge. There are very few data on pain therapy after discharge from the hospital. Based on the significance of the chronification of acute pain it is of the utmost importance to close this gap. © Georg Thieme Verlag KG Stuttgart · New York.

Juvenile reentry and aftercare interventions: is mentoring a promising direction?

Science.gov (United States)

Abrams, Laura S; Mizel, Matthew L; Nguyen, Viet; Shlonsky, Aron

2014-01-01

This study uses systematic review methods to investigate the use of mentoring programs to assist young people in successfully transitioning back into their communities following a juvenile correctional placement. Few studies were found that used comparison or control groups and measured recidivism outcomes. The results of the studies were mixed, with one study finding no differences between groups, and the other two studies finding some recidivism reductions among youth who received the intervention. However, the absence of detailed information on the interventions, weak research designs, and the diversity of the mentoring programs contributed to an overall dearth of knowledge about the effectiveness of these interventions in reducing recidivism.

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

2010-12-01

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

From Passive Victims to Partners in Their Own Reintegration: Civil society’s role in empowering returned Thai fishermen

Directory of Open Access Journals (Sweden)

David Rousseau

2018-04-01

Full Text Available Despite the significant international attention to human trafficking in the fishing industry in Southeast Asia, victims continue to experience poor outcomes after their return to Thailand. The Labour Rights Promotion Network (LPN has assisted many returned fishermen in the difficult journey that begins after their rescue and repatriation. In this paper, we argue that the poor outcomes are the product of systemic failures in the aftercare processes, which are not sufficiently victim-centred and discourage trafficked fishermen’s participation in prosecutions. This is the case in the criminal justice system, where flaws in victim identification and evidence collection can undermine trafficked persons’ rights and make it extremely difficult for them to obtain compensation—a significant factor in their recovery and reintegration. This same cycle of disenfranchisement is pervasive in reintegration services at large in Thailand, many of which are overly paternalistic and neglect survivors’ individual needs and interests. Civil society organisations can remediate these problems by supporting the government in its efforts to strengthen prosecutions and make the criminal justice system more victim-friendly. More broadly, civil society can contribute to a victim-centred approach that places aftercare in a larger perspective—one that extends beyond the purview of the criminal justice system. This paper will examine two emerging models in post-trafficking service provision: Unconditional Cash Transfers (UCTs and volunteer social networks, which recognise victim empowerment not just as a means towards better law enforcement, but as an end in itself.

[Psychosocial support after school shootings--what was learned from the Kauhajoki case].

Science.gov (United States)

Kähärä, Kirsti; Ala-aho, Sirkka; Hakala, Asta-Leena; Toivonen, Tarja; Turunen, Tuija

2010-01-01

On September 29, 2008 in Kauhajoki, a student killed ten persons and committed suicide. Many people in the region were subjected to an extensive sensation of threat and experienced mental effects of the tragedy. Aftercare of the tragedy has been coordinated by the Kauhajoki project. The project has aimed at ensuring that persons and communities traumatized by the event in their life and functioning will receive the required psychosocial support and appropriate treatment. The goal is to restore the mental balance and to maintain the ability to work and function.

Pilot investigations of surface parts of three closed landfills and factors affecting them.

Science.gov (United States)

Saarela, Jouko

2003-05-01

Aftercare of closed sanitary landfills in a major environmental problem. Rehabilitation of the landfill with vegetation and reducing leachate production are two issues that must be dealt. For this reason, Finnish Environment Institute has conducted several projects on closed landfills. This research aims at determining the physical and chemical properties of the soils at three closed landfills in Helsinki, Finland. Research was conducted to understand the impact by studying the following properties: Chemical, nutrient metal, gamma and radon analysis of surface soils of three closed landfills in Helsinki area.

A Systematic Review of Unmet Information and Psychosocial Support Needs of Adults Diagnosed with Thyroid Cancer.

Science.gov (United States)

Hyun, Yong Gyu; Alhashemi, Ahmad; Fazelzad, Rouhi; Goldberg, Alyse S; Goldstein, David P; Sawka, Anna M

2016-09-01

Patient education and psychosocial support to patients are important elements of comprehensive cancer care, but the needs of thyroid cancer survivors are not well understood. The published English-language quantitative literature on (i) unmet medical information and (ii) psychosocial support needs of thyroid cancer survivors was systematically reviewed. A librarian information specialist searched seven electronic databases and a hand search was conducted. Two reviewers independently screened citations from the electronic search and reviewed relevant full-text papers. There was consensus between reviewers on the included papers, and duplicate independent abstraction was performed. The results were summarized descriptively. A total of 1984 unique electronic citations were screened, and 51 full-text studies were reviewed (three from the hand search). Seven cross-sectional, single-arm, survey studies were included, containing data from 6215 thyroid cancer survivor respondents. The respective study sizes ranged from 57 to 2398 subjects. All of the studies had some methodological limitations. Unmet information needs were variable relating to the disease, diagnostic tests, treatments, and co-ordination of medical care. There were relatively high unmet information needs related to aftercare (especially long-term effects of the disease or its treatment and its management) and psychosocial concerns (including practical and financial matters). Psychosocial support needs were incompletely met. Patient information on complementary and alternative medicine was very limited. In conclusion, thyroid cancer survivors perceive many unmet information needs, and these needs extend to aftercare. Psychosocial information and supportive care needs may be insufficiently met in this population. More work is needed to improve knowledge translation and psychosocial support for thyroid cancer survivors.

Social networks and their influence on drinking behaviors: differences related to cognitive impairment in clients receiving alcoholism treatment.

Science.gov (United States)

Buckman, Jennifer F; Bates, Marsha E; Cisler, Ron A

2007-09-01

Mechanisms of behavioral change that support positive addiction treatment outcomes in individuals with co-occurring alcohol-use disorders and cognitive impairment remain largely unknown. This article combines person- and variable-centered approaches to examine the interrelated influence of cognitive impairment and social support on stability of and changes in drinking behaviors of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) outpatients and aftercare clients (N = 1,726) during the first year after their entry into treatment. Latent class analysis identified homogeneous groups of clients based on the nature and extent of social support for abstinence or drinking at treatment entry. Cognitive impairment and drinking outcomes were compared across latent classes, and the interaction between impairment and social support on drinking outcomes was examined using mixture probit regression. Three independent social support classes (frequent positive, limited positive, and negative) were identified. In the outpatient sample, the frequent positive support class had greater cognitive impairment at treatment entry versus other classes, and extent of impairment significantly predicted improved drinking outcomes in this class. In the aftercare sample, the frequent positive and negative support classes had heightened impairment, yet cognitive impairment significantly predicted relatively poorer drinking outcomes in the negative support class only. Cognitive impairment may increase the influence of the social network on the drinking outcomes of persons receiving treatment for alcohol-use disorders, but more research is needed to understand client characteristics that determine whether this influence is more likely to be manifest as increased salience of helping agents or of hindering agents in the social network.

Efficacy of Mobile Health Care Application and Wearable Device in Improvement of Physical Performance in Colorectal Cancer Patients Undergoing Chemotherapy.

Science.gov (United States)

Cheong, In Yae; An, So Yeon; Cha, Won Chul; Rha, Mi Yong; Kim, Seung Tae; Chang, Dong Kyung; Hwang, Ji Hye

2018-06-01

The use of a mobile health care application, the delivery of health care or health care-related services through the use of portable devices, to manage functional loss, treatment-related toxicities, and impaired quality of life in cancer patients during chemotherapy through supervised self-management has been increasing. The aim of the present study was to evaluate the efficacy and feasibility of comprehensive mobile health care using a tailored rehabilitation program for colorectal cancer patients undergoing active chemotherapy. A total of 102 colorectal cancer patients undergoing chemotherapy underwent 12 weeks of smartphone aftercare through provision of a mobile application and wearable device that included a rehabilitation exercise program and information on their disease and treatment. The grip strength test, 30-second chair stand test, 2-minute walk test, amount of physical activity (International Physical Activity Questionnaire short-form), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30), and nutritional status (Patient-generated Subjective Global Assessment) were assessed and measured at baseline, at mid-intervention (6 weeks), and at completion of the intervention (12 weeks). The rehabilitation exercise intensity was adjusted by the test results at every assessment and through real-time communication between the patients and clinicians. Of the 102 patients, 75 completed all 12 weeks of the smartphone aftercare rehabilitation program. The lower extremity strength (P mobile health care application was effective in improving patients' physical capacity and treatment-related symptoms even during active chemotherapy. Copyright © 2018 Elsevier Inc. All rights reserved.

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

DEFF Research Database (Denmark)

Nilsson, Karen; Berner, Susanne; Hertz, Iben

2013-01-01

-up dialoguepieces in the puzzle of recovery. World Crit Care Nursing 2011; 8(2):75. [(journal article - abstract) ISSN: 1748–6254]. 3. 4th EfCCNa & FSAIO Congress Copenhagen 2011 http://www.efccna.org/index.php?option=com_content&view=article&id=88&Itemid=96. 4. Storli SL, Lind R. The meaning of follow...

Clonidine hydrochloride detoxification from methadone treatment--the value of naltrexone aftercare.

Science.gov (United States)

Rawson, R A; Washton, A M; Resnick, R B; Tennant, F S

1984-01-01

Treatment outcomes were compared for 2 groups of subjects detoxified from methadone using clonidine. One group of 12 subjects was encouraged to continue in treatment with naltrexone, while the other 12 subjects did not have naltrexone treatment available. Results suggested that those subjects who had naltrexone available were more successful at completing the 10 day detoxification treatment and that the relapse rate at 30 days post-treatment was significantly reduced by naltrexone treatment.

[Routine oral examinations and specific after-care for removable partial dentures].

Science.gov (United States)

de Baat, C; Witter, D J; Keltjens, H M A M; Creugers, N H J

2011-01-01

Following treatment with a removable partial denture, routine oral examinations are required to stabilize the existing condition in a sustainable way and to make possible the timely treatment of anomalies which have appeared. In cases of problems assessed during a routine oral examination in relation to the removable partial dentures, maintenance, restorative and prosthetic treatment may be indicated. Maintenance treatments are indicated for small and easily retrievable alterations. In removable partial denture treatment, adequate space between prepared tooth and denture is essential. Possible prosthetic treatments of a removable partial denture are relining, rebasing, improving or renewing the maxillomandibular relation, repairment, and extension.

[Routine oral examinations and specific after-care for removable partial dentures

NARCIS (Netherlands)

Baat, C. de; Witter, D.J.; Keltjens, H.M.A.M.; Creugers, N.H.J.

2011-01-01

Following treatment with a removable partial denture, routine oral examinations are required to stabilize the existing condition in a sustainable way and to make possible the timely treatment of anomalies which have appeared. In cases of problems assessed during a routine oral examination in

Malignant thyroid tumours

International Nuclear Information System (INIS)

Boerner, W.; Reiners, C.

1987-01-01

The subjects dealt with at the symposium cover all topical aspects of pathology, epidemiology, diagnosis, therapy, and aftercare of the malignant thyroid tumours. A survey of the histological classification of the thyroid tumours and a review of the latest findings concerning the radiocarcinogenesis are followed by a detailed discussion of the most significant tumours. There are also papers dealing with controversial aspects of the histological classification, the value of diagnostic methods, radicality of the therapy, or after care. For five conference papers, separate records are available in the database. (orig./ECB) With 59 figs.; 57 tabs [de

Improving quality of care among patients hospitalised with schizophrenia

DEFF Research Database (Denmark)

Jørgensen, Mette; Mainz, Jan; Svendsen, Marie Louise

2015-01-01

BACKGROUND: The effectiveness of systematic quality improvement initiatives in psychiatric care remains unclear. AIMS: To examine whether quality of care has changed following implementation of a systematic monitoring programme of hospital performance measures. METHOD: In a nationwide population.......27-1.62), psychoeducation (RR: 1.33, 95% CI: 1.19-1.48), psychiatric aftercare (RR: 1.06, 95% CI: 1.01-1.11) and suicide risk assessment (RR: 1.31, 95% CI: 1.21-1.42). CONCLUSIONS: Quality of care improved from 2004 to 2011 among patients hospitalised with schizophrenia in Denmark. DECLARATION OF INTEREST: None. COPYRIGHT...

Expanding harm reduction services through a wound and abscess clinic.

Science.gov (United States)

Grau, Lauretta E; Arevalo, Silvia; Catchpool, Christopher; Heimer, Robert

2002-12-01

A wound and abscess clinic, held concurrently with a syringe exchange, provided economical treatment and aftercare for injection-associated soft tissue infections. During 20 two-hour clinic sessions, 173 treatment episodes were logged, and the visit cost was estimated at $5 per patient. Increased patient-clinician interactions provided opportunities beyond those afforded by the syringe exchange for patients to obtain resources and referrals to services such as HIV counseling and testing, medical care, and drug treatment. Distribution of cards advertising the clinic was substantially less effective than word of mouth in increasing community awareness of the clinic.

Medical aspects of the nuclear accident in the Chernobylsk-4 reactor

International Nuclear Information System (INIS)

Arndt, D.; Schmidt, W.

1989-01-01

The Kiev conference on the Chernobylsk reactor accident was concerned with the following items: (1) Medical consequences and organization of medical assistance as well as aftercare of radiation-exposed persons. (2) Analysis of the postirradiation situation and judgement of the consequences of the accident as to the USSR population. (3) Peculiarities of external and internal radiation exposure of the population in the area controlled. (4) Organization and efficiency of the epidemiological register of the USSR. (5) Organization and judgement of educational work and public relations concerning the sanitary conditions in populations exposed to an increased contamination

Challenges in demonstrating the effectiveness of multidisciplinary treatment on quality of life, participation and health care utilisation in patients with fibromyalgia: a randomised controlled trial.

Science.gov (United States)

van Eijk-Hustings, Yvonne; Kroese, Mariëlle; Tan, Frans; Boonen, Annelies; Bessems-Beks, Monique; Landewé, Robert

2013-02-01

This study aimed to examine the effectiveness of a multidisciplinary intervention with aftercare (MD) compared to aerobic exercise (AE) and usual care (UC) in recently diagnosed patients with fibromyalgia (FM). In a Zelen-like design, eligible patients from the outpatient rheumatology clinics of three medical centres in the South of the Netherlands were consecutively recruited and pre-randomised to MD (n = 108), AE (n = 47) or UC (n = 48). MD consisted of a 12-week course of sociotherapy, physiotherapy, psychotherapy and creative arts therapy (three half days per week), followed by five aftercare meetings in 9 months. AE was given twice a week in a 12-week course. UC varied but incorporated at least education and lifestyle advice. Primary outcomes were health-related quality of life (HR-Qol), participation and health care utilisation. Secondary outcome was the Fibromyalgia Impact Questionnaire (FIQ). Total follow-up duration of the study was 21-24 months. As willingness to participate in AE was limited, this group has been analysed but interpretation of the data is considered arguable. Within the MD group, a statistically significantly improved HR-Qol and a statistically significant reduction in number of hours sick leave, number of contacts with general practitioners and number of contacts with medical specialists was found. Moreover, statistically significant improvements were found on the FIQ, which increased after the intervention. However, no statistically significant between-group differences were found at the endpoint of the study. MD seemed to yield positive effects, but firm conclusions with regard to effectiveness cannot be formulated due to small between-group differences and limitations of the study.

Cosmetic tourism: public opinion and analysis of information and content available on the Internet.

Science.gov (United States)

Nassab, Reza; Hamnett, Nathan; Nelson, Kate; Kaur, Simranjit; Greensill, Beverley; Dhital, Sanjiv; Juma, Ali

2010-01-01

The medical tourism market is a rapidly growing sector fueled by increasing health care costs, longer domestic waiting times, economic recession, and cheaper air travel. The authors investigate public opinion on undergoing cosmetic surgery abroad and then explore the information patients are likely to encounter on the Internet when searching for such services. A poll of 197 members of the general public was conducted in the United Kingdom. An Internet search including the terms plastic surgery abroad was conducted, and the first 100 relevant sites were reviewed. Of the 197 respondents, 47% had considered having some form of cosmetic surgery. Most (97%) would consider going abroad for their procedure. The Internet was a source of information for 70%. The review of the first 100 sites under "plastic surgery abroad" revealed that most centers were located in Eastern Europe (26%), South America (14%), and the Far East (11%). Exploring the information provided on the Web sites, we found 37% contained no information regarding procedures. Only 10% of sites contained any information about potential complications. Even less frequently mentioned (4%) were details of aftercare or follow-up procedures. The authors found that the overwhelming majority of respondents considering plastic surgery would also consider seeking cosmetic surgical treatment abroad. The Internet sites that appear most prominently in an online search contained a distinct lack of information for potential patients, particularly with regard to complications and aftercare. There is, therefore, a need for improved public awareness and education about the considerations inherent in medical tourism. The introduction of more stringent regulations for international centers providing such services should also be considered to help safeguard patients.

Evaluation of a four- versus six-week length of stay in the Navy's alcohol treatment program.

Science.gov (United States)

Trent, L K

1998-05-01

Attempts to balance escalating health care costs with resource downsizing have prompted alcohol treatment directors in the U.S. Navy to consider reducing the standard length of stay in treatment. The objectives of this study were to (1) determine whether a 4-week inpatient treatment program is as effective as a 6-week program, and (2) explore the potential for matching patients to a 4- or 6-week program according to the severity of their condition at intake. A total of 2,823 active-duty alcohol-dependent inpatients (2,685 men, 138 women) at 12 Navy treatment facilities participated in the evaluation. All facilities conducted a 6-week program until data had been collected for 1,380 participants; they then switched to a 4-week program (n = 1,443). Background information and clinical profile were obtained when patients entered treatment; 1-year outcome data (e.g., alcohol use, behavior problems, job performance, quality of life) were obtained from participants, work supervisors and aftercare advisors. Hierarchical multiple regression analyses were used to assess the effect of length of stay on outcome and to examine patient-program interactions. The single best predictor of success at 1 year was months of aftercare attendance. Program membership failed to explain any of the observed differences in the criterion measures, once the effects of other predictors had been taken into account. Severity of condition and patient-program interactions were likewise nonsignificant. It was concluded that a reduction in length of stay from 6 weeks to 4 weeks in the Navy's inpatient alcohol treatment program would not have an adverse effect on outcome.

Comparison of patient-reported need of psycho-oncologic support and the doctor's perspective: how do they relate to disease severity in melanoma patients?

Science.gov (United States)

Nolte, Sandra; van der Mei, Sicco H; Strehl-Schwarz, Kerstin; Köster, Johanna; Bender, Armin; Rose, Matthias; Kruse, Johannes; Peters, Eva M J

2016-11-01

Psycho-neuro-immune research suggests an association between cancer outcomes and psychosocial distress. Objective criteria to determine patients' levels of distress are important to establish potential links to disease outcomes. We compared three patient-reported with one doctor-reported measures of psycho-oncologic distress frequently used in routine cancer care and investigated associations with standard disease severity parameters in melanoma patients. We enrolled n = 361 patients, successively seen at two outpatient university clinics in Germany. In the naturalistic study, n = 222 patients had been diagnosed 180 days and were in after-care (Group II). Across groups, only moderate associations were seen between patient- reported and doctor-reported measures. Regarding clinical variables, disease severity and perceived need of psycho-oncologic support reported by patients or doctors showed hardly any association. After subgroup stratification, in patients of Group II, patient-reported and doctor-reported instruments showed some small associations with disease parameters commonly linked to more rapid cancer progression in patients who are in cancer after-care. Overall, the few and low associations suggest that need of psycho-oncologic support and clinical variables were largely independent of each other and doctors' perception may not reflect the patient's view. Therefore, the assessment of the patient perspective is indispensable to ensure that melanoma patients receive appropriate support, as such need cannot be derived from other disease parameters or proxy report. More research is needed applying psychometrically robust instruments that are ideally combined with sensitive biomarkers to disentangle psycho-neuro-immune implications in melanoma patients. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis.

Science.gov (United States)

Kelly, John F; Hoeppner, Bettina; Stout, Robert L; Pagano, Maria

2012-02-01

Evidence indicates that Alcoholics Anonymous (AA) participation reduces relapse risk but less is known about the mechanisms through which AA confers this benefit. Initial studies indicate self-efficacy, negative affect, adaptive social networks and spiritual practices are mediators of this effect, but because these have been tested in isolation, their relative importance remains elusive. This study tested multiple mediators simultaneously to help determine the most influential pathways. Prospective, statistically controlled, naturalistic investigation examined the extent to which these previously identified mechanisms mediated AA attendance effects on alcohol outcomes controlling for baseline outcome values, mediators, treatment, and other confounders. Nine clinical sites within the United States. Adults (n = 1726) suffering from alcohol use disorder (AUD) initially enrolled in a randomized study with two arms: aftercare (n = 774); and out-patient (n = 952) comparing three out-patient treatments (Project MATCH). AA attendance during treatment; mediators at 9 months; and outcomes [percentage of days abstinent (PDA) and drinks per drinking day (DDD)] at 15 months. Among out-patients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self-efficacy. Among more impaired aftercare patients, in addition to mediation through adaptive network changes and increases in social self-efficacy, AA lead to better outcomes through increasing spirituality/religiosity and by reducing negative affect. The degree to which mediators explained the relationship between AA and outcomes ranged from 43% to 67%. While Alcoholics Anonymous facilitates recovery by mobilizing several processes simultaneously, it is changes in social factors which appear to be of primary importance. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Age-related differences in self-harm presentations and subsequent management of adolescents and young adults at the emergency department.

Science.gov (United States)

Diggins, Emma; Kelley, Rachael; Cottrell, David; House, Allan; Owens, David

2017-01-15

Characteristics of self-harm differ across ages, but there is little work identifying age-related differences in younger people. Young people entering adolescence face emotionally and developmentally different challenges to those entering adulthood. This study investigates how Emergency Department (ED) presentations and management of self-harm differ through adolescence and early adulthood. 3782 consecutive self-harm episodes involving 2559 people aged 12-25 years were identified from an existing database of Leeds ED attendances from 2004 to 2007. Odds ratios for each of four age bands were compared to the remaining young people. The female to male ratio was 6.3:1 at 12-14 years old, decreasing with successive age groups to 1.2:1 at 22-25 years old. Self-poisoning was commoner in those under 18 years old. 18-25 year olds were more likely to self-poison with prescribed medications, mixed overdoses, alcohol or recreational drugs. 18-25 year olds more often required medical treatment for the effects of the self-harm. 12-14 year olds were more often seen urgently by ED medical staff and offered high intensity mental health aftercare. Repetition of self-harm was commonest in 12-14 year olds, although multiple repetition of self-harm was commonest in 22-25 year olds. Data were not collected on whether the aftercare offered was received. The study sample included hospital attenders only. The large excess of females over males in young people's self-harm is only true at the younger age range. Older adolescents present with more severe acts of self-harm, yet receive the lowest intensity of assessment and after care. Copyright © 2016 Elsevier B.V. All rights reserved.

Landfill reduction experience in The Netherlands.

Science.gov (United States)

Scharff, Heijo

2014-11-01

Modern waste legislation aims at resource efficiency and landfill reduction. This paper analyses more than 20 years of landfill reduction in the Netherlands. The combination of landfill regulations, landfill tax and landfill bans resulted in the desired landfill reduction, but also had negative effects. A fierce competition developed over the remaining waste to be landfilled. In 2013 the Dutch landfill industry generated €40 million of annual revenue, had €58 million annual costs and therefore incurred an annual loss of €18 million. It is not an attractive option to prematurely end business. There is a risk that Dutch landfill operators will not be able to fulfil the financial obligations for closure and aftercare. Contrary to the polluter pays principle the burden may end up with society. EU regulations prohibiting export of waste for disposal are in place. Strong differentials in landfill tax rate between nations have nevertheless resulted in transboundary shipment of waste and in non-compliance with the self-sufficiency and proximity principles. During the transformation from a disposal society to a recycling society, it is important to carefully plan required capacity and to guide the reorganisation of the landfill sector. At some point, it is no longer profitable to provide landfill services. It may be necessary for public organisations or the state to take responsibility for the continued operation of a 'safety net' in waste management. Regulations have created a financial incentive to pass on the burden of monitoring and controlling the impact of waste to future generations. To prevent this, it is necessary to revise regulations on aftercare and create incentives to actively stabilise landfills. Copyright © 2014 Elsevier Ltd. All rights reserved.

Guide book mammary glands ultrasonography. A textbook according to the DEGUM and KBV guidelines. 3. upd. ed.

International Nuclear Information System (INIS)

Madjar, Helmut

2012-01-01

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.

Toshiba's advanced technologies contributing to heavy-ion radiotherapy for cancer treatment

International Nuclear Information System (INIS)

Iikura, Takahiko

2013-01-01

Toshiba has been focusing effects on cancer treatment in the healthcare field, which is likely to continue to expand in the future. Our objective is to offer healthcare processes from early detection by means of regular cancer examinations, through to precise diagnosis, treatment ensuring the quality of life (QOL) appropriate to individual patients, and aftercare. In particular, we are promoting the development of heavy-ion radiotherapy systems incorporating our range of technologies for particle accelerators, irradiation devices, superconducting magnets, and information processing and networks. By offering heathcare processes with advanced heavy-ion radiotherapy systems as a core, our approach is expected to contribute to high-quality cancer treatment. (author)

Issues in the assessment of personality disorder and substance abuse using the Millon Clinical Multiaxial Inventory (MCMI-II).

Science.gov (United States)

Flynn, P M; McCann, J T; Fairbank, J A

1995-05-01

Substance abuse treatment clients often present other severe mental health problems that affect treatment outcomes. Hence, screening and assessment for psychological distress and personality disorder are an important part of effective treatment, discharge, and aftercare planning. The Millon Clinical Multiaxial Inventory-II (MCMI-II) frequently is used for this purpose. In this paper, several issues of concern to MCMI-II users are addressed. These include the extent to which MCMI-II scales correspond to DSM-III-R disorders; overdiagnosis of disorders using the MCMI-II; accuracy of MCMI-II diagnostic cut-off scores; and the clinical utility of MCMI-II diagnostic algorithms. Approaches to addressing these issues are offered.

Restoration of the water balance in the lignite mining areas of central Germany and Lusatia; Sanierung des Wasserhaushalts in den Braunkohlenbergbaugebieten Mitteldeutschlands und der Lausitz

Energy Technology Data Exchange (ETDEWEB)

Benthaus, Friedrich-Carl [Lausitzer und Mitteldeutsche Bergbau-Verwaltungsgesellschaft mbH (LMBV), Senftenberg (Germany). Ingenieurbereich Sanierung, Strategie und Entwicklung; Scholz, Eckhard [Lausitzer und Mitteldeutsche Bergbau-Verwaltungsgesellschaft mbH (LMBV), Senftenberg (Germany). Ingenieurbereich Sanierung; Uhlig, Christiane [Lausitzer und Mitteldeutsche Bergbau-Verwaltungsgesellschaft mbH (LMBV), Senftenberg (Germany). Ingenieurbereich Sanierung, Geotechnik Mitteldeutschland; Heine, Rudi [Lausitzer und Mitteldeutsche Bergbau-Verwaltungsgesellschaft mbH (LMBV), Senftenberg (Germany). Ingenieurbereich Sanierung, Planung Wasserbau Lausitz; Totsche, Oliver [Lausitzer und Mitteldeutsche Bergbau-Verwaltungsgesellschaft mbH (LMBV), Senftenberg (Germany). Ingenieurbereich Sanierung, Geotechnik Lausitz

2010-10-15

The lignite mining industry in central Germany and Lusatia has interfered with the water balance in the regions by long-standing lowering of the ground water and changing of the surface waters. The restoration is aimed at re-establishment of a largely self-regulating water balance by flooding and aftercare. The planning of the linkage of the 220 lakes in the aftermath of the mining industry to the public waterway network should be based on the conditions prevailing after abandonment of the mining industry. Innovative geochemical and biological processes are being further developed to improve the water quality, which is characterised by oxidation of the iron sulphides. (orig.)

Clinical management of borderline tumours of the ovary - experience from the "Berlin online tumour conference for gynaecological malignancies".

Science.gov (United States)

Sehouli, Jalid; Oskay-Oezcelik, Guelten; Pietzner, Klaus; Chen, Frank; Coumbos, Alexandra; Darb-Esfahani, Silvia; Schuback, Beatrix; Heinrich, Georg; Kronenberger, Christel; Lorsbach, Michael; Lichtenegger, Werner; Chekerov, Radoslav

2010-05-01

Borderline ovarian tumour (BOT) represents a rare and special tumour entity. Despite a generally favourable prognosis for patients with BOT, the presence of invasive peritoneal implants decreases the survival rate to 30-50%. In contrast to ovarian cancer, only few data exist concerning the current clinical management of patients with BOT. For this reason, the present analyses were performed for patients with BOT who were admitted into our online tumor conference for patients with gynaecological malignancies. Based on the results discussed in this article, the current aspects and problems regarding the diagnostic, surgical and conservative treatment and aftercare management of patients with BOT are considered.

Nuclear medicine

International Nuclear Information System (INIS)

Reichelt, H.G.

1980-01-01

Nuclear medicine as a complex diagnostical method is used mainly to detect functional organic disorders, to locate disorders and for radioimmunologic assays (RIA) in vitro. In surgery, its indication range comprises the thyroid (in vivo and in vitro), liver and bile ducts, skeletal and joint diseases, disorders of the cerebro-spinal liquor system and the urologic disorders. In the early detection of tumors, the search for metastases and tumor after-care, scintiscanning and the tumor marcher method (CEA) can be of great practical advantage, but the value of myocardial sciritiscanning in cardiac respectively coronary disorders is restricted. The paper is also concerned with the radiation doses in nuclear medicine. (orig.) [de

[An art education programme for groups in the psycho-oncological after-care].

Science.gov (United States)

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

2011-03-01

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. © Georg Thieme Verlag KG Stuttgart · New York.

Recommendations, Experiences and Conclusions From Realized Aftercare Public Policies in Czech Republic

OpenAIRE

Jan Stejskal; Tana Karlikova

2006-01-01

Czech Republic has become one of leading destinations for production foreign investments in Europe in last ten years. This success has been influenced by several factors including history, geography, policy development, economic and social progress transformation and also from Czech Republic’s entrance into NATO and the European Union. We must also take into account traditions, labour skills, price and labour productivity. The central and regional government initiatives (from municipalities...

The untapped potential of smartphone sensors for stroke rehabilitation and after-care.

Science.gov (United States)

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

2016-01-01

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.

A Randomized Study of Incentivizing HIV Testing for Parolees in Community Aftercare.

Science.gov (United States)

Saxena, Preeta; Hall, Elizabeth A; Prendergast, Michael

2016-04-01

HIV risk-behaviors are high in criminal justice populations and more efforts are necessary to address them among criminal justice-involved substance abusers. This study examines the role of incentives in promoting HIV testing among parolees. Participants were randomly assigned to either an incentive (n = 104) or education group (control; n = 98), where the incentive group received a voucher for testing for HIV. Bivariate comparisons showed that a larger proportion of those in the incentive group received HIV testing (59% versus 47%), but this was not statistically significant (p = .09). However, in a multivariate logistic regression model controlling for covariates likely to influence HIV-testing behavior, those in the incentive group had increased odds of HIV testing in comparison to those in the education group (OR = 1.99, p testing and other healthy behaviors in criminal justice populations.

Predictors of Vitamin Adherence After Bariatric Surgery.

Science.gov (United States)

Sunil, Supreet; Santiago, Vincent A; Gougeon, Lorraine; Warwick, Katie; Okrainec, Allan; Hawa, Raed; Sockalingam, Sanjeev

2017-02-01

Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients. A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis. Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001). Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.

Weight-bearing recommendations after operative fracture treatment-fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole.

Science.gov (United States)

Braun, Benedikt J; Veith, Nils T; Rollmann, Mika; Orth, Marcel; Fritz, Tobias; Herath, Steven C; Holstein, Jörg H; Pohlemann, Tim

2017-08-01

Rehabilitation after lower-extremity fractures is based on the physicians' recommendation for non-, partial-, or full weight-bearing. Clinical studies rely on this assumption, but continuous compliance or objective loading rates are unknown. The purpose of this study was to determine the compliance to weight-bearing recommendations by introducing a novel, pedobarography system continuously registering postoperative ground forces into ankle, tibial shaft and proximal femur fracture aftercare and test its feasibility for this purpose. In this prospective, observational study, a continuously measuring pedobarography insole was placed in the patients shoe during the immediate post-operative aftercare after ankle, tibial shaft and intertrochanteric femur fractures. Weight-bearing was ordered as per the institutional standard and controlled by physical therapy. The insole was retrieved after a maximum of six weeks (28 days [range 5-42 days]). Non-compliance was defined as a failure to maintain, or reach the ordered weight-bearing within 30%. Overall 30 patients were included in the study. Fourteen (47%) of the patients were compliant to the weight-bearing recommendations. Within two weeks after surgery patients deviated from the recommendation by over 50%. Sex, age and weight did not influence the performance (p > 0.05). Ankle fracture patients (partial weight-bearing) showed a significantly increased deviation from the recommendation (p = 0.01). Our study results show that, despite physical therapy training, weight-bearing compliance to recommended limits was low. Adherence to the partial weight-bearing task was further decreased over time. Uncontrolled weight-bearing recommendations should thus be viewed with caution and carefully considered as fiction. The presented insole is feasible to determine weight bearing continuously, could immediately help define real-time patient behaviour and establish realistic, individual weight-bearing recommendations.

Holistic assessment of a landfill mining pilot project in Austria: Methodology and application.

Science.gov (United States)

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

2016-07-01

Basic technical and economic examinations of Austrian mass waste landfills, concerning the recovery of secondary raw materials, have been carried out by the 'LAMIS - Landfill Mining Austria' pilot project for the first time in Austria. A main focus of the research - the subject of this article - was the first devotion of a pilot landfill to an integrated ecological and economic assessment so that its feasibility could be verified before a landfill mining project commenced. A Styrian mass waste landfill had been chosen for this purpose that had been put into operation in 1979 and received mechanically-biologically pre-treated municipal waste till 2012. The whole assessment procedure was divided into preliminary and main assessment phases to evaluate the general suitability of a landfill mining project with little financial and human resource expense. A portfolio chart, based on a questionnaire, was created for the preliminary assessment that, as a result, has provided a recommendation for subsequent investigation - the main assessment phase. In this case, specific economic criteria were assessed by net present value calculation, while ecological or socio-economic criteria were rated by utility analysis, transferring the result into a utility-net present value chart. In the case of the examined pilot landfill, assessing the landfill mining project produced a higher utility but a lower net present value than a landfill leaving-in for aftercare. Since no clearly preferable scenario could be identified this way, a cost-revenue analysis was carried out in addition that determined a dimensionless ratio: the 'utility - net present value quotient' of both scenarios. Comparing this quotient showed unmistakably that in the overall assessment, 'leaving the landfill in aftercare' was preferable to a 'landfill mining project' in that specific case. © The Author(s) 2016.

Evaluation of a transdiagnostic psychodynamic online intervention to support return to work: A randomized controlled trial.

Directory of Open Access Journals (Sweden)

Rüdiger Zwerenz

Full Text Available Given their flexibility, online interventions may be useful as an outpatient treatment option to support vocational reintegration after inpatient rehabilitation. To that purpose we devised a transdiagnostic psychodynamic online intervention to facilitate return to work, focusing on interpersonal conflicts at the workplace often responsible for work-related stress.In a randomized controlled trial, we included employed patients from cardiologic, psychosomatic and orthopedic rehabilitation with work-related stress or need for support at intake to inpatient rehabilitation after they had given written consent to take part in the study. Following discharge, maladaptive interpersonal interactions at the workplace were identified via weekly blogs and processed by written therapeutic comments over 12 weeks in the intervention group (IG. The control group (CG received an augmented treatment as usual condition. The main outcome, subjective prognosis of gainful employment (SPE, and secondary outcomes (psychological complaints were assessed by means of online questionnaires before, at the end of aftercare (3 months and at follow-up (12 months. We used ITT analyses controlling for baseline scores and medical group.N = 319 patients were enrolled into IG and N = 345 into CG. 77% of the IG logged in to the webpage (CG 74% and 65% of the IG wrote blogs. Compared to the CG, the IG reported a significantly more positive SPE at follow-up. Measures of depression, anxiety and psychosocial stressors decreased from baseline to follow-up, whereas the corresponding scores increased in the CG. Correspondingly, somatization and psychological quality of life improved in the IG.Psychodynamic online aftercare was effective to enhance subjective prognosis of future employment and improved psychological complaints across a variety of chronic physical and psychological conditions, albeit with small effect sizes.

Long-term effectiveness and moderators of a web-based tailored intervention for cancer survivors on social and emotional functioning, depression, and fatigue: randomized controlled trial.

Science.gov (United States)

Willems, Roy A; Mesters, Ilse; Lechner, Lilian; Kanera, Iris M; Bolman, Catherine A W

2017-12-01

The web-based computer-tailored Kanker Nazorg Wijzer (Cancer Aftercare Guide) supports cancer survivors with psychosocial issues during cancer recovery. The current study investigates whether the 6-month effects in increasing emotional and social functioning and reducing depression and fatigue hold at 12 months from baseline. Moreover, it explores whether patient characteristics moderate the 6- and 12-month intervention effectiveness. Cancer survivors from 21 Dutch hospitals (November 2013-June 2014) were randomized to an intervention (n = 231) or a wait-list control group (n = 231). Intervention effects on emotional and social functioning (EORTC QLQ-C30), depression (HADS), and fatigue (CIS) were evaluated through multilevel linear regression analyses. At 12 months from baseline, the intervention group no longer differed from the control group in emotional and social functioning, depression, and fatigue. Moderator analyses indicated that, at 6 months, the intervention was effective in improving social functioning for men (d = 0.34), reducing fatigue for participants ≤56 years (d = 0.44), and reducing depression for participants who received chemotherapy (d = 0.36). At 12 months, participants with a medium educational level reported higher social functioning (d = 0.19), while participants with a low educational level reported lower social functioning (d = 0.22) than participants with a similar educational level in the control group. The intervention gave cancer patients a head start to psychological recovery after the end of cancer treatment. The control group caught up in the long run. The Cancer Aftercare Guide expedited recovery after cancer treatment. Being a low intensity, easy accessible, and relatively low cost intervention, it could serve as a relevant step in recovery and stepped care.

Compliance and hygiene behaviour among soft contact lens wearers in the Maldives.

Science.gov (United States)

Gyawali, Rajendra; Nestha Mohamed, Fathimath; Bist, Jeewanand; Kandel, Himal; Marasini, Sanjay; Khadka, Jyoti

2014-01-01

Significant levels of non-compliance and poor hygiene among contact lens wearers have been reported previously from different parts of the world. This survey aimed at identifying the scope of hygiene and non-compliant behaviour of soft contact lens wearers in the Maldives. Established soft lens wearers attending two eye clinics in Male' city, were interviewed in office or via telephone. A set of interviewer-administered questions was used to access the subjective response on compliance and hygiene behaviour (hand and lens case hygiene, water exposure, adherence to lens replacement schedule, dozing and overnight wear, awareness of aftercare visits and reuse of disinfecting solution). Participants were also asked to rate themselves as a contact lens user based on their perceived compliance and hygiene practices. Out of 107 participants, 79 (74.8 per cent) were interviewed in the office and the rest via telephone. The majority of lens wearers were female, office workers and students, with a mean age of 20.64 ± 4.4 years. Mean duration of lens wear was 28.04 ± 8.36 months. Most of them were using spherical lenses (86.9 per cent) on a daily wear basis (96.3 per cent). Major reported forms of non-compliance were poor hand hygiene (60.7 per cent), lack of aftercare awareness (39.3 per cent), water exposure (35.5 per cent) and over-use of lenses (24.3 per cent). While females were more likely to overuse their lenses than males (p hygienic behaviour. A significant number of Maldivian contact lens wearers exhibited poor levels of hygiene and compliance with contact lenses and lens care systems. An effective educational reinforcement strategy needs to be developed to modify lens wearers' non-compliance. © 2013 The Authors. Clinical and Experimental Optometry © 2013 Optometrists Association Australia.

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).

Science.gov (United States)

Petrakis, Melissa; Joubert, Lynette

2013-01-01

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.

Diagnosing early onset dementia and then what? A frustrating system of aftercare resources

Directory of Open Access Journals (Sweden)

Chemali Z

2012-01-01

Full Text Available Z Chemali1–3, S Schamber2, EC Tarbi2, D Acar1,2, M Avila-Urizar21Harvard Medical School, 2Departments of Neurology and Psychiatry, Division of Cognitive and Behavioral Neurology, Brigham and Women’s Hospital, 3Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA, USAAbstract: Recent studies indicate that the prevalence of early onset dementia (EOD is more common than it was once presumed. As such, and considering the substantial challenges EOD presents to the patient, caregivers, and health care providers, this study sought to investigate the mechanism of care delivered to these patients. A medical record chart review was conducted for 85 patients attending a memory disorder unit who initially presented to rule out EOD as a working diagnosis. The results suggest that while the majority of these patients received an extensive work-up and were heavily medicated, they remained at home, where they lacked adequate age-related services and could not be placed, despite the crippling caregiver burden. This manuscript is a platform to discuss our current system limitations in the care of these patients with an eye on new opportunities for this challenging group.Keywords: early onset dementia, social work, services, caregiving

Application of RI power sources to cardiac pacemakers and aftercare in its implantation

International Nuclear Information System (INIS)

Hori, Motokazu

1974-01-01

RI power sources have long life when they are implanted into human bodies together with cardiac pacemakers, as compared with e.g. mercury batteries. Therefore, the frequency of their replacement can be by far less. However, there are the problems of radiation protection, high cost, availability, etc. The following matters are described: The cardiac pacemaker and its power supply, implantation into human body, problems with patients and conventional power sources; the current state of RI power sources for cardiac pacemakers, including plutonium-238 RTG and 147 Pm and 3 H batteries; and problems with the RI power sources. (Mori, K.)

Logistic considerations for a successful institutional approach to the endovascular repair of ruptured abdominal aortic aneurysms.

Science.gov (United States)

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

2010-01-01

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.

Manual for the energy consultant: Sector profiles: Part 3: Non Food and other services; Handboek voor de energieconsulent: Brancheprofielen: Deel 3: Non Food en overige dienstverlening

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-06-01

At the Information Center for the Built Environment of the Netherlands Agency for Energy and Environment (NOVEM) in Apeldoorn, Netherlands, manuals are available in the following categories: (1) Basic Information (f.e. indicators, climate data, calculation factors and examples); (2) Information on Energy Management (`seven-steps plan`, tasks for the energy consultant and the client, aftercare); (3) Information of the Target Groups (overall characteristics, energy conservation options, methods and approaches); and (4) sector profiles. The aim of this manual is to support the energy consultant in developing an energy strategy for the non-food and service sector. Special attention is paid to the home furnishing sector, the textile retail trade, service stations, repair services, beauty parlors, do-it-yourself stores, and dry-cleaners

Chemical dependency and adolescent self-esteem.

Science.gov (United States)

Wasson, D; Anderson, M A

1995-08-01

The purpose of this descriptive study is to determine whether self-esteem differs between chemically dependent adolescents and adolescents from the general high school population. The Self-Esteem Inventory (Coopersmith, 1987) was completed by 119 adolescents (31 inpatient, 31 aftercare, and 57 general high school students) aged 13 to 18. Findings suggest that inpatient, chemically dependent adolescents have lower self-esteem than the other two groups. For the chemically dependent adolescent, nursing case management with communication among and between health care providers, school professionals, and family may facilitate successful, long-term recovery. For adolescents at risk for development of chemical dependence, nursing health promotion behaviors, such as early assessment and implementation of self-esteem-building activities, may assist in prevention of chemical dependency.

Radon therapy in the Soviet Union

International Nuclear Information System (INIS)

Sansoni, B.; Andrejew, S.V.

1991-08-01

In the Soviet Union approximately one million courses of radon treatment each lasting three weeks are prescribed every year. The curative application of radon used for cardiovascular diseases, including aftercare in cases of cardiac infarction, disorders of the locomotor system and joints and muscles, the male and female sexual system, diseases of the nervous system, endocrinology and metabolic diseases. Contraindication practice is similar to that in Central Europe. Radon is given to skin stimulation by wet and above all dry baths. The radiation exposure of patients from these three-week radon treatments is relatively low. The radon effect is interpreted as 'radiation flash' stimulating the nervous system. The skin plays a particular role in this process, acting as the stimulus acceptor. (orig./MG) [de

Characterization of methane oxidation in a simulated landfill cover system by comparing molecular and stable isotope mass balances.

Science.gov (United States)

Schulte, Marcel; Jochmann, Maik A; Gehrke, Tobias; Thom, Andrea; Ricken, Tim; Denecke, Martin; Schmidt, Torsten C

2017-11-01

Biological methane oxidation may be regarded as a method of aftercare treatment for landfills to reduce climate relevant methane emissions. It is of social and economic interest to estimate the behavior of bacterial methane oxidation in aged landfill covers due to an adequate long-term treatment of the gas emissions. Different approaches assessing methane oxidation in laboratory column studies have been investigated by other authors recently. However, this work represents the first study in which three independent approaches, ((i) mass balance, (ii) stable isotope analysis, and (iii) stoichiometric balance of product (CO 2 ) and reactant (CH 4 ) by CO 2 /CH 4 -ratio) have been compared for the estimation of the biodegradation by a robust statistical validation on a rectangular, wide soil column. Additionally, an evaluation by thermal imaging as a potential technique for the localization of the active zone of bacterial methane oxidation has been addressed in connection with stable isotope analysis and CO 2 /CH 4 -ratios. Although landfills can be considered as open systems the results for stable isotope analysis based on a closed system correlated better with the mass balance than calculations based on an open system. CO 2 /CH 4 -ratios were also in good agreement with mass balance. In general, highest values for biodegradation were determined from mass balance, followed by CO 2 /CH 4 -ratio, and stable isotope analysis. The investigated topsoil proved to be very suitable as a potential cover layer by removing up to 99% of methane for CH 4 loads of 35-65gm -2 d -1 that are typical in the aftercare phase of landfills. Finally, data from stable isotope analysis and the CO 2 /CH 4 -ratios were used to trace microbial activity within the reactor system. It was shown that methane consumption and temperature increase, as a cause of high microbial activity, correlated very well. Copyright © 2017 Elsevier Ltd. All rights reserved.

Medical rehabilitation of leprosy patients discharged home in abia and ebonyi States of Nigeria.

Science.gov (United States)

Enwereji, Ezinne Ezinna; Ahuizi, Eke Reginald; Iheanocho, Okereke Chukwunenye; Enwereji, Kelechi Okechukwu

2011-11-01

To examine the extent to which medical coverage is available to discharged leprosy patients in communities. Evidence has shown that after care services, follow-up visits and national disease prevention programs are important components of medical rehabilitation to leprosy patients discharged home after treatment. Denying them accessibility to these services could expose them to multiple disabilities as well as several disease conditions including HIV/AIDS. These adverse health conditions could be averted if health workers extend healthcare services to discharged leprosy patients. This study was conducted to examine the extent to which discharged leprosy patients have access to healthcare services in the communities. All 33 leprosy patients who were fully treated with multi-drug therapy (MDT) and discharged home in the two leprosy settlements in Abia and Ebonyi States of Nigeria were included in this study. The list of discharged leprosy patients studied and their addresses were provided by the leprosy settlements where they were treated. Also, snowball-sampling method was used to identify some of the leprosy patients whose addresses were difficult to locate in the communities. Instruments for data collection were questionnaire, interview guide and checklist. These were administered because respondents were essentially those with no formal education. Analysis of data was done quantitatively and qualitatively. Findings showed that 20 (60.6%) of discharged patients did not receive health programs like HIV/AIDS prevention or family planning. Also, follow-up visits and after-care services were poor. About 14 (42.4%) of the patients live in dirty and overcrowded houses. On the whole, discharged patients were poorly medically rehabilitated (mean score: 4.7±1.1 out of total score of 7). Denying discharged leprosy patients opportunity of accessing health care services could increase prevalence of infectious diseases including HIV/AIDS among them. There is need to extend

Development of clinical process measures for pediatric burn care: Understanding variation in practice patterns.

Science.gov (United States)

Kazis, Lewis E; Sheridan, Robert L; Shapiro, Gabriel D; Lee, Austin F; Liang, Matthew H; Ryan, Colleen M; Schneider, Jeffrey C; Lydon, Martha; Soley-Bori, Marina; Sonis, Lily A; Dore, Emily C; Palmieri, Tina; Herndon, David; Meyer, Walter; Warner, Petra; Kagan, Richard; Stoddard, Frederick J; Murphy, Michael; Tompkins, Ronald G

2018-04-01

There has been little systematic examination of variation in pediatric burn care clinical practices and its effect on outcomes. As a first step, current clinical care processes need to be operationally defined. The highly specialized burn care units of the Shriners Hospitals for Children system present an opportunity to describe the processes of care. The aim of this study was to develop a set of process-based measures for pediatric burn care and examine adherence to them by providers in a cohort of pediatric burn patients. We conducted a systematic literature review to compile a set of process-based indicators. These measures were refined by an expert panel of burn care providers, yielding 36 process-based indicators in four clinical areas: initial evaluation and resuscitation, acute excisional surgery and critical care, psychosocial and pain control, and reconstruction and aftercare. We assessed variability in adherence to the indicators in a cohort of 1,076 children with burns at four regional pediatric burn programs in the Shriners Hospital system. The percentages of the cohort at each of the four sites were as follows: Boston, 20.8%; Cincinnati, 21.1%; Galveston, 36.0%; and Sacramento, 22.1%. The cohort included children who received care between 2006 and 2010. Adherence to the process indicators varied both across sites and by clinical area. Adherence was lowest for the clinical areas of acute excisional surgery and critical care, with a range of 35% to 48% across sites, followed by initial evaluation and resuscitation (range, 34%-60%). In contrast, the clinical areas of psychosocial and pain control and reconstruction and aftercare had relatively high adherence across sites, with ranges of 62% to 93% and 71% to 87%, respectively. Of the 36 process indicators, 89% differed significantly in adherence between clinical sites (p measures represents an important step in the assessment of clinical practice in pediatric burn care. Substantial variation was observed

Alterations of the ECG after frationated radiotherapy of the mediastine

International Nuclear Information System (INIS)

Alheit, C.; Alheit, H.D.; Herrmann, T.

1986-01-01

In 72 patients with irradiation of the mediastine the ECGs were examined before, immediately after, and 3-6 months after termination of radiotherapy. In comparison with starting findings 41.7% ECG alterations were found at the end of irradiation and 40.1% in control examinations. Mainly it was the question of alterations in ST-lines, in type of position, in P-waves, and an increase of the heart rate. However, in result of uni- and multivariant variance analyses it could be shown, that extracardiac factors and general reactions of the irradiated organism resulted in ECG alterations too. Considering the correlation of ECG alterations to the heart dose however, a direct influence of the capillary system of the heart has also to be discussed and an adequate after-care of patients with irradiation of the mediastine must be recommended. (author)

An outcome study of an inpatient treatment program for pathological gamblers.

Science.gov (United States)

Russo, A M; Taber, J I; McCormick, R A; Ramirez, L F

1984-08-01

In 1972 the Brecksville Unit of the Cleveland Veterans Administration Medical Center began the first inpatient treatment program for pathological gambling in the United States. The 30-day, highly structured gambling treatment program aims for abstinence from gambling, reduction of the urge to gamble, and restoration of a maximum level of social functioning. The authors report the results of a preliminary outcome study of 60 former patients who completed a survey form rating various aspects of their lives one year postdischarge. Fifty-five percent of the respondents reported complete abstinence from gambling since discharge. Chi-square analyses demonstrated significant relationships between abstinence from gambling and improved interpersonal relationships, better financial status, decreased depression, and participation in professional aftercare and Gamblers Anonymous. The authors believe that their initial results support the contention that pathological gambling is a treatable disorder.

Diagnosis of local tumor recidivations after continence excision of rectal carcinoma by means of CAT scanning

Energy Technology Data Exchange (ETDEWEB)

Castrup, W.; Schlueter, B.; Wedell, J.; Banzhaf, G.

1984-05-01

On a patient collective of 19 with recurrent rectal carcinomas following previous resection and one patient with tumor recidivation after local excision of a villiferous adenoma, the demonstration of the different intra and extraluminal tumor infiltration paths by means of CAT scanning is investigated. After thorough cleaning of the intestine and additional application of a contrast enema using a watery contrast medium it is even possible to demonstrate tumor stenoses or a circumscribed thickening of the intestinal wall. With the majority of patients the tumor extends mainly outside the region of the anastomosis in the perirectal area. Early diagnosis of such perirectal infiltration therefore is decisive for the further treatment. As the possibilities of X-ray investigations of the colon and endoscopy for judging the extraluminal growth are limited, CAT scanning is an essential method in tumor aftercare.

Playing the game of IQ testing in England and Denmark in the 1950s and 1960s - A Socio-Material perspective

DEFF Research Database (Denmark)

Ydesen, Christian; Ørskov, Frederik Forrai

2018-01-01

The promotion of performance measurement and international large-scale assessments (ILSAs) is often explained in terms of the rise and expansion of the neoliberal thought collective; in other words, testing constitutes a core component of neoliberal education reform. A less well-known feature...... of the neoliberal regime is its numerous precursors and antecedents - including its testing, numbers, and metrics components - in the 19th and 20th centuries. This article provides a study of such historical precursors in the treatment of children seen as "mentally defective" in two emerging welfare states, namely...... Denmark in the interwar period and England in the immediate post war era. Based on the records of the municipal Educational Psychology Office in Copenhagen and the Birmingham Special Schools After-Care Subcommittee respectively, we argue that IQ testing and other metrics were integral to efforts...

The Danish Depression Database

DEFF Research Database (Denmark)

Videbech, Poul Bror Hemming; Deleuran, Anette

2016-01-01

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...

[Subjective Level of Information and Information Needs of Patients with an Approved Rehabilitation Application and Patients at the End of Rehabilitation Results of a Written Survey].

Science.gov (United States)

Walther, Anna Lena; Schreiber, Dora; Falk, Johannes; Deck, Ruth

2017-08-01

Aim The aim of the study was to identify the subjective level of information and information needs of patients with an approved rehabilitation application and patients at the end of rehabilitation with regard to preferred subjects and kind of information transfer. Method Written survey with N=283 patients with approved rehabilitation application and N=388 patients at the end of rehabilitation. Results Both groups reported high information needs particularly regarding treatments during rehabilitation, rehabilitation aftercare and rehabilitation aims. A conversation with their physician, a brochure and a website are the preferred information pathways. Conclusion Taking into account the topics for which both groups require information and the preference regarding the kind of information transfer can make a valuable contribution for the development of needs-oriented information material. © Georg Thieme Verlag KG Stuttgart · New York.

Stability of Comorbid Psychiatric Diagnosis among Youths in Treatment and Aftercare for Alcohol Use Disorders

Science.gov (United States)

Hawke, Josephine M.; Kaminer, Yifrah; Burke, Rebecca; Burleson, Joseph A.

2008-01-01

Objectives: To examine the stability of comorbid psychiatric diagnoses among a sample of 50 adolescents in cognitive-behaviorally-based treatment for alcohol and other substance use disorders (AOSUD). Methods: A standardized psychiatric interview was administered at baseline and 12 month later to obtain current comorbid psychiatric disorders. Chi…

Landfill reduction experience in The Netherlands

International Nuclear Information System (INIS)

Scharff, Heijo

2014-01-01

Highlights: • ‘Zero waste’ initiatives never consider risks, side effects or experience of achieved low levels of landfill. • This paper provides insight into what works and what not. • Where strong gradients in regulations and tax occur between countries, waste will find its way to landfills across borders. • Strong landfill reduction can create a fierce competition over the remaining waste to be landfilled resulting in losses. • At some point a public organisation should take responsibility for the operation of a ‘safety net’ in waste management. - Abstract: Modern waste legislation aims at resource efficiency and landfill reduction. This paper analyses more than 20 years of landfill reduction in the Netherlands. The combination of landfill regulations, landfill tax and landfill bans resulted in the desired landfill reduction, but also had negative effects. A fierce competition developed over the remaining waste to be landfilled. In 2013 the Dutch landfill industry generated €40 million of annual revenue, had €58 million annual costs and therefore incurred an annual loss of €18 million. It is not an attractive option to prematurely end business. There is a risk that Dutch landfill operators will not be able to fulfil the financial obligations for closure and aftercare. Contrary to the polluter pays principle the burden may end up with society. EU regulations prohibiting export of waste for disposal are in place. Strong differentials in landfill tax rate between nations have nevertheless resulted in transboundary shipment of waste and in non-compliance with the self-sufficiency and proximity principles. During the transformation from a disposal society to a recycling society, it is important to carefully plan required capacity and to guide the reorganisation of the landfill sector. At some point, it is no longer profitable to provide landfill services. It may be necessary for public organisations or the state to take responsibility for the

Results of a pilot randomised controlled trial to measure the clinical and cost effectiveness of peer support in increasing hope and quality of life in mental health patients discharged from hospital in the UK.

Science.gov (United States)

Simpson, Alan; Flood, Chris; Rowe, Julie; Quigley, Jody; Henry, Susan; Hall, Cerdic; Evans, Richard; Sherman, Paul; Bowers, Len

2014-02-05

Mental health patients can feel anxious about losing the support of staff and patients when discharged from hospital and often discontinue treatment, experience relapse and readmission to hospital, and sometimes attempt suicide. The benefits of peer support in mental health services have been identified in a number of studies with some suggesting clinical and economic gains in patients being discharged. This pilot randomised controlled trial with economic evaluation aimed to explore whether peer support in addition to usual aftercare for patients during the transition from hospital to home would increase hope, reduce loneliness, improve quality of life and show cost effectiveness compared with patients receiving usual aftercare only, with follow-up at one and three-months post-discharge. A total of 46 service users were recruited to the study; 23 receiving peer support and 23 in the care-as-usual arm. While this pilot trial found no statistically significant benefits for peer support on the primary or secondary outcome measures, there is an indication that hope may be further increased in those in receipt of peer support. The total cost per case for the peer support arm of the study was £2154 compared to £1922 for the control arm. The mean difference between costs was minimal and not statistically significant. However, further analyses demonstrated that peer support has a reasonably high probability of being more cost effective for a modest positive change in the measure of hopelessness. Challenges faced in recruitment and follow-up are explored alongside limitations in the delivery of peer support. The findings suggest there is merit in conducting further research on peer support in the transition from hospital to home consideration should be applied to the nature of the patient population to whom support is offered; the length and frequency of support provided; and the contact between peer supporters and mental health staff. There is no conclusive evidence to

Landfill reduction experience in The Netherlands

Energy Technology Data Exchange (ETDEWEB)

Scharff, Heijo, E-mail: h.scharff@afvalzorg.nl

2014-11-15

Highlights: • ‘Zero waste’ initiatives never consider risks, side effects or experience of achieved low levels of landfill. • This paper provides insight into what works and what not. • Where strong gradients in regulations and tax occur between countries, waste will find its way to landfills across borders. • Strong landfill reduction can create a fierce competition over the remaining waste to be landfilled resulting in losses. • At some point a public organisation should take responsibility for the operation of a ‘safety net’ in waste management. - Abstract: Modern waste legislation aims at resource efficiency and landfill reduction. This paper analyses more than 20 years of landfill reduction in the Netherlands. The combination of landfill regulations, landfill tax and landfill bans resulted in the desired landfill reduction, but also had negative effects. A fierce competition developed over the remaining waste to be landfilled. In 2013 the Dutch landfill industry generated €40 million of annual revenue, had €58 million annual costs and therefore incurred an annual loss of €18 million. It is not an attractive option to prematurely end business. There is a risk that Dutch landfill operators will not be able to fulfil the financial obligations for closure and aftercare. Contrary to the polluter pays principle the burden may end up with society. EU regulations prohibiting export of waste for disposal are in place. Strong differentials in landfill tax rate between nations have nevertheless resulted in transboundary shipment of waste and in non-compliance with the self-sufficiency and proximity principles. During the transformation from a disposal society to a recycling society, it is important to carefully plan required capacity and to guide the reorganisation of the landfill sector. At some point, it is no longer profitable to provide landfill services. It may be necessary for public organisations or the state to take responsibility for the

Relapse prevention in anorexia nervosa: Experiences of patients and parents.

Science.gov (United States)

Berends, Tamara; van de Lagemaat, Marleen; van Meijel, Berno; Coenen, Jasmijn; Hoek, Hans W; van Elburg, Annemarie A

2018-03-24

One of the main aims of treatment after successful recovery from anorexia nervosa (AN) is to prevent a relapse. The Guideline Relapse Prevention (GRP) Anorexia Nervosa offers a structured approach to relapse prevention. This study explores how patients and their parents experience working with the guideline. It also describes the factors that support or hinder successful application of the guideline. A descriptive qualitative research design was chosen involving in-depth interviews with seventeen patients with anorexia nervosa and six sets of parents. Patients and family members were generally satisfied with the support provided by the GRP. It contributed significantly to a better understanding of the personal process of relapse. Patients and families valued being able to keep in touch with their professional during the aftercare programme. The GRP supports the patient's use of self-management strategies for relapse prevention. © 2018 Australian College of Mental Health Nurses Inc.

The results using scintiscanning in the diagnosis of osseous metastases of mammary carcinomas

International Nuclear Information System (INIS)

Werlich, T.

1983-01-01

From 1013 female patients with mammary carcinomas, who had in the framework of aftercare untergone a skeletal scintiscanning with 99mTc-MDP, 336 showed activity accumulations which were from a benign disease and 91 showed bone metastases. The scintigraphic examination method of metabolic processes in bones, in this case metastasis at a very early diagnostic point of time, is considered to a great extent as sensitive and superior to other techniques. For this reason it is used as a basic examination in the diagnosis of osseous metastases, whereas X-ray images of the skeleton and tomography are used specifically to clarify scintigraphic activity accumulations. The very early diagnosis of bone metastases improves the chances of a systemic chemotherapy. Schemata for the use of various diagnostic methods are discussed with consideration of radiation load, time required, cost/benefit analysis, and of the psychological ability of the patients under stress. (TRV) [de

Radiation protection medical care of radiation workers

International Nuclear Information System (INIS)

Walt, H.

1988-01-01

Radiation protection medical care for radiation workers is part of the extensive programme protecting people against dangers emanating from the peaceful application of ionizing radiation. Thus it is a special field of occupational health care and emergency medicine in case of radiation accidents. It has proved helpful in preventing radiation damage as well as in early detection, treatment, after-care, and expert assessment. The medical checks include pre-employment and follow-up examinations, continued long-range medical care as well as specific monitoring of individuals and defined groups of workers. Three levels of action are involved: works medical officers specialized in radiation protection, the Institute of Medicine at the National Board for Atomic Safety and Radiation Protection, and a network of clinical departments specialized in handling cases of acute radiation damage. An account is given of categories, types, and methods of examinations for radiation workers and operators. (author)

Five years' experience of the modified Meek technique in the management of extensive burns.

Science.gov (United States)

Hsieh, Chun-Sheng; Schuong, Jen-Yu; Huang, W S; Huang, Ted T

2008-05-01

The Meek technique of skin expansion is useful for covering a large open wound with a small piece of skin graft, but requires a carefully followed protocol. Over the past 5 years, a skin graft expansion technique following the Meek principle was used to treat 37 individuals who had sustained third degree burns involving more than 40% of the body surface. A scheme was devised whereby the body was divided into six areas, in order to clarify the optimal order of wound debridements and skin grafting procedures as well as the regimen of aftercare. The mean body surface involvement was 72.9% and the mean area of third degree burns was 41%. The average number of operations required was 1.84. There were four deaths among in this group of patients. The Meek technique of skin expansion and the suggested protocol are together efficient and effective in covering an open wound, particularly where there is a paucity of skin graft donor sites.

Natural attenuation of biogas in landfill covers; Attenuazione naturale del flusso di biogas nella copertura superficiale delle discariche

Energy Technology Data Exchange (ETDEWEB)

Cossu, R.; Privato, A.; Raga, R. [Padova Univ., Padova (Italy). IMAGE, Dipartimento di Idraulica, Marittima, Ambiente e Geotecnica; Zane, M. [SPINOFF S.R.L., Padova (Italy)

2005-08-01

In the risk evaluation of uncontrolled biogas emissions from landfills, the process of natural attenuation in landfill covers assumes a very important role. The capacity of biogas oxidation in the cover soils seems to be the most important control to mitigate the biogas emission during the aftercare period when the biogas collection system might fail. In the present paper laboratory experiences on lab columns to study the biogas oxidation are discussed. [Italian] Nella valutazione del pericolo di emissioni incontrollate di biogas da una discarica, il processo dell'attenuazione naturale della copertura superficiale assume un ruolo molto importante. La capacita' di ossidazione del biogas nel terreno di copertura sembra rappresentare il controllo piu' importante nella mitigazione di fughe incontrollate di biogas, soprattutto nel lungo periodo quando la captazione del biogas perde efficienza. Nel presente lavoro si riportano alcune esperienze di laboratorio per valutare l'ossidazione di metano in diverse tipologie di copertura.

Quality assurance when surface welding nickel-based alloys; Qualitaetssicherung bei der Auftragsschweissung von Nickelbasislackierungen

Energy Technology Data Exchange (ETDEWEB)

Metschke, J. [Muellkraftwerk Schwandorf Betriebsgesellschaft mbH (Germany)

2003-07-01

The cladding of evaporator heat exchanger surfaces in refuse incineration boilers with alloy 625 can effectively protect against the corrosive wear of the basic tube if the described rules concerning the pre-treatment, processing, quality control and after-care are observed. This statement is supported by the positive experience with this alloy at the Schwandorf refuse-fired power plant over a period of eight years now. Since the maximum service temperature is limited to 420 C, alloy 625 is only suitable for protecting superheater pipes subject to certain conditions. Long-term experience with alternative nickel-based alloys (alloy 622, alloy 686 and others) are not yet available. (orig.) [German] Die Schweissplattierung von Verdampferwaermetauscherflaechen in Muellverbrennungskesseln mit Alloy 625 kann einen wirksamen Schutz gegen den korrosiven Verschleiss des Grundrohres darstellen, wenn die vorstehenden Regeln ueber Vorbehandlung, Verarbeitung, Qualitaetskontrolle und laufende Nachsorgearbeiten beachtet werden. Diese Aussage wird durch die positiven Erfahrungen mit dieser Legierung im Muellkraftwerk Schwandorf ueber einen Zeitraum von nunmehr acht Jahren gestuetzt. (orig.)

Delayed somatic effects following extended radiotherapy. Studies of 135 patients with Hodgkin's disease in long-term remission (Freiburg collective, treatment years 1948 to 1974). Untersuchungen ueber somatische Spaetschaeden nach ausgedehnter Strahlentherapie

Energy Technology Data Exchange (ETDEWEB)

Slanina, J

1977-01-01

A group of 135 patients who suffered from Hodgkin's disease with long-term remission following radiotherapy was investigated. By restricting the investigations to the patient group with long-term remission and correlative examinations, it was tried to differentiate between exclusive or principal delayed radiation effects and delayed effects due to other factors. The study reports about the most significant results obtained in the fields of catamnesis, laboratory diagnostics, hematology, pulmology, cardiology, thyroid function tests, neurology, andrology and dermatology. Due to the numerous detectable delayed effects the group of patients with long-term remission receives a special status. Although those effects are in no proportion to the deletary risks of an untreated Hodgkin's disease and though they are consequently tolerable in the present state of the therapeutic development, they must initiate the completion of the therapeutic concept including performance of radiotherapy and aftercare, because only then the risk for the patient provoked by these effects, which ranges beyond the malignity of this disease can be reduced or prevented.

Delayed somatic effects following extended radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Slanina, J

1977-10-27

A group of 135 patients was investigated, who suffered from Hodgkin's disease with long-term remission following radiotherapy. By restricting the investigations to the patient group with long-term remission and correlative examinations, differentiation was made between exclusive or principal delayed radiation effects and delayed effects due to other factors. The study reports the most significant results obtained in the fields of catamnesis, laboratory diagnostics, hematology, pulmology, cardiology, thyroid function tests, neurology, andrology and dermatology. Due to the numerous detectable delayed effects the group of patients with long-term remission receives a special status. Although those effects are in no proportion to the deletary risks of an untreated Hodgkin's disease and though they are consequently tolerable in the present state of the therapeutic development, they must initiate the completion of the therapeutic concept including performance of radiotherapy and aftercare, because only then the risk for the patient provoked by these effects, which ranges beyond the malignity of this disease can be reduced or prevented.

Women's experiences of coping with pregnancy termination for fetal abnormality.

Science.gov (United States)

Lafarge, Caroline; Mitchell, Kathryn; Fox, Pauline

2013-07-01

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.

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.

2001-07-01

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.)

[DGRW-update: neurology--from empirical strategies towards evidence based interventions].

Science.gov (United States)

Schupp, W

2011-12-01

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

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

2009-01-01

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...

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

2008-01-01

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...

The Hermann Holthusen Institute for Radiotherapy - a clinic for the diagnosis, treatment and aftercare of malignant tumors

International Nuclear Information System (INIS)

Heilmann, H.P.

1983-01-01

The well-known Radiotherapy Department of the Hermann Holthusen Institute in the St. Georg Hospital of the city of Hamburg moved into a new building and has got a variety of new equipment. It thus keeps abreast with the latest developments and is able to cope with enhanced needs. The organizational structure and the tasks of this modern centre for radiotherapy and oncology are explained. (orig.) [de

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

2009-01-01

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...... feasibility because of high acceptability and adherence, and has an acceptable effectiveness in the follow up period of 1 year. We have therefore initiated a similar study using a randomization design in order to study efficacy....

Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness.

Science.gov (United States)

Buckley, Peter F

2006-01-01

The co-occurrence of a severe mental illness and a substance use or abuse disorder is common in the United States as well as internationally and could be considered as more the expectation than the exception when assessing patients with serious mental illness. Substance use disorders can occur at any phase of the mental illness, perhaps even inducing psychosis. Causes of this comorbidity may include self-medication, genetic vulnerability, environment or lifestyle, underlying shared origins, and/or a common neural substrate. The consequences of dual diagnosis include poor medication compliance, physical comorbidities and poor health, poor self-care, increased suicide risk or aggression, increased sexual behavior, and possible incarceration. All of these factors contribute to a greater health burden, which reduces the health care system's capacity to adequately treat patients. Therefore, screening, assessment, and integrated treatment plans for dual diagnosis that can address both the addiction disorder and the mental illness are recommended in order to provide accurate treatment, after-care, and other health care to accommodate patients' social and vocational needs.

The Papanicolaou test for cervical cancer detection. A triumph and a tragedy.

Science.gov (United States)

Koss, L G

1989-02-03

The complex detection system leading to the discovery and treatment of precancerous lesions and early cancer of the uterine cervix is described in detail and discussed. By far the most difficult and underestimated component of this system is the screening and interpretation of cervical (Papanicolaou) smears. Cytologic case finding may fail because of inadequate samples, insufficient time devoted to screening, or human fatigue. Other weak points of the system, such as an inadequate clinical component, inadequate patient compliance, poor reproducibility of diagnoses, and ineffective aftercare, are also described. For example, obtaining a second smear to confirm or refute a diagnosis of cellular atypia is often a misleading practice. Although this cancer detection system has been shown to be effective in reducing the rate of morbidity and mortality from invasive cervical cancer in appropriately screened populations, there is no evidence that the Papanicolaou test has succeeded anywhere in complete eradication of this theoretically preventable disease. It is important to inform the public about the potential failures of the system and the reasons for them.

Skin Care in the Tattoo Parlor: A Survey of Tattoo Artists in New York City.

Science.gov (United States)

Rosenbaum, Brooke E; Milam, Emily C; Seo, Lauren; Leger, Marie C

2016-01-01

To understand the role that tattooists play in providing skin care advice, we conducted an online, survey-based study of 90 licensed tattooists in New York City. The survey asked tattooists about their exposure to adverse tattoo events, advising on tattoo removal/correction, behaviors regarding preexisting skin conditions and aftercare, confidence in addressing client questions about adverse events and preexisting conditions, and prior training about skin conditions related to tattoos. Most tattooists (92.8%) reported being asked by clients to evaluate adverse tattoo reactions, 85% were asked about tattoo removal, and 90% were asked about the safety of getting a tattoo with a preexisting skin condition. About half (56.1%) had received training about skin conditions related to tattoos. Tattooists with prior training reported higher rates of optimal skin care behaviors and higher confidence with tattoo-related skin conditions; 91.4% reported interest in skin care education. Tattooists play a major role in the skin health of their clients. Providing education for tattooists may improve skin care in populations less likely to see a dermatologist. © 2016 S. Karger AG, Basel.

First Dutch national guidelines--pharmacological care for detained opioid addicts.

Science.gov (United States)

Arends, M T; De Haan, H A; Van 't Hoff, G I C M

2009-01-01

Heterogenic care of addicted detainees in the various prisons in The Netherlands triggered the National Agency of Correctional Institutions of the Ministry of Justice, to order the Dutch Institute for Health Care Improvement (CBO) to formulate the first national guideline titled 'Pharmacological care for detained addicts'. This article presents the content of this guideline, which mainly focuses on opioid-dependent addicts. In The Netherlands, approximately 50% of the detainees are problematic substance abusers, while again half of this group suffers from psychiatric co-morbidity. In addition, somatic co-morbidity, especially infectious diseases, is also common. Due to the moderate outcome seen with voluntary drug counselling regimes in prison, there is a policy shift to extent utilization of legally enforced approaches. Continuity of care is of great importance. In case of opioid addicts this, in general, means continuation of methadone maintenance treatment. Aftercare immediately after detention and optimalization of medical information transfer is crucial. This guideline aims to realize optimal and uniform management of addiction disorders in the Dutch prison system.

The uncertain role of life cycle costing in the renewable energy debate

International Nuclear Information System (INIS)

Finch, E.F.

1994-01-01

The significance of 'aftercare' has struck a chord with many stake holders in the building process. None more so than clients who are mindful of inheriting a building that will incur costs long after hand-over. Energy saving has served the interest of the client as well as the global concerns of society at large. Cost savings provide a strong incentive and may not conflict with environmental objectives. Other energy conscious measures may not result in direct savings for the client. To foster these solutions, two strategic approaches apply; either make greater demands on the benevolence and responsibility of clients; or adopt an adversarial approach of legislative control over the design of facilities. The former is clearly a more desirable approach. However, the client still needs a framework for making realistic environmental decisions within the context of other competing business constraints. This paper describes how life cycle costing can be changed to meet just such a need. In this way, clients will be able to make more informed decisions concerning environmental impacts. (author)

Developing mindfulness in children through participation in music activities

Directory of Open Access Journals (Sweden)

Christina Auerbach

2018-04-01

Full Text Available The vast majority of young South African children grow up in socially- and economicallychallenging settings. These impeding conditions hamper their intellectual growth and affect their physical, mental, emotional and spiritual well-being. Increasingly, mindfulness is being recognised as a means to enhance holistic well-being of children. Likewise, music is widely acknowledged for its potential contribution to the holistic development of children. In this article, we reflect on a non-formal music programme, implemented on a weekly basis over a period of 10 months, at an aftercare facility in an impoverished township area in South Africa. Our aim was to develop, through the children’s active participation in music activities, some aspects of mindfulness. Data were generated through personal observations, field notes and semi-structured interviews. Two salient themes emerged, namely, enhanced awareness of self and others, and improved listening and attention skills. These are key aspects of mindfulness. We subsequently argue that aspects of mindfulness in young children can be developed through focused activities centred on music and sound.

Stent-assisted recanalization of atherosclerotic intracranial stenosis

International Nuclear Information System (INIS)

Soo Mee Lim; Dae Chul Suh

2006-01-01

Intracranial atherosclerosis is a major cause of ischemic stroke, and depending on the studied population, it accounts for 8%-15% of all strokes that are due to cerebral atherosclerosis. The prognosis of patients with symptomatic intracranial stenoses seems to depend on the location and extent of intracranial atherosclerosis. Currently, the primary treatment in intracranial atherosclerosis is the control of vascular risk factors such as hypertension, diabetes, hypercholesterolemia, and smoking. Secondary prevention with antiplatelet therapy has been shown to reduce the risk of subsequent vascular events in patients who have suffered a recent ischemic stroke or transient ischemic attack (TIA). Unfortunately, a significant number of patients with intracranial atherosclerosis continue to suffer from repeated strokes or TIA despite maximal medical treatment. Although endovascular revascularization for symptomatic intracranial stenoses remains at the investigational stage and much of the pertinent information is anecdotal, intracranial angioplasty and stenting are being increasingly performed to treat stenotic lesions. This article reviews basic principles involved in the patient selection, premedication, angio-interventional procedures, angiographic and clinical results, periprocedural complication, patients aftercare. (authors)

Aspects of internal fixation of fractures in porotic bone. Principles, technologies and procedures using locked plate screws.

Science.gov (United States)

Perren, S M; Linke, B; Schwieger, K; Wahl, D; Schneider, E

2005-01-01

Fractures of the bones of elderly people occur more often and have a more important effect because of a generally diminished ability to coordinate stance and walking. These fractures occur at a lower level of load because of lack of strength of the porotic bone. Prompt recovery of skeletal support function is essential to avoid respiratory and circulatory complications in the elderly. To prevent elderly people from the risks of being bedridden, demanding internal fixation of fractures is required. The weak porotic bone and the high level of uncontrolled loading after internal fixation pose complex problems. A combination of several technical elements of design, application and aftercare in internal fixation are proposed. Internal fixators with locked screws improve the biology and the mechanics of internal fixation. When such fixators are used as elevated splints they may stimulate early callus formation because of their flexibility, the limit of flexibility being set by the demands of resistance and function of the limb. Our own studies of triangulation of locked screws have demonstrated their beneficial effects and unexpected limitations.

Parenting training for women in residential substance abuse treatment. Results of a demonstration project.

Science.gov (United States)

Camp, J M; Finkelstein, N

1997-01-01

This paper presents findings on the impact of implementing a parenting component in two urban residential treatment programs in Massachusetts for pregnant and parenting chemically-dependent women. The parenting component consisted of multiple services for both women and their infants while they were in residential treatment as well as aftercare services after discharge from treatment. Findings presented focus on: (a) the characteristics of the 170 pregnant and parenting women who participated in the parenting component during its 48 months of implementation; (b) changes in the parenting skills and self-esteem of women who completed parenting training; (c) the quality of mother-child interaction; and (d) the participants' perceptions about the impact of the parenting training. Women in both programs made dramatic improvements in self-esteem and experienced significant gains in parenting knowledge and attitudes. The participants were also overwhelmingly positive about the impact of the parenting training on their lives. Study findings underline the importance of parenting services for pregnant and parenting women in residential substance abuse treatment.

Nourishing the Spirit: Exploratory Research on Ayahuasca Experiences along the Continuum of Recovery from Eating Disorders.

Science.gov (United States)

Lafrance, Adele; Loizaga-Velder, Anja; Fletcher, Jenna; Renelli, Marika; Files, Natasha; Tupper, Kenneth W

2017-01-01

Eating disorders (EDs) are serious health conditions that are among the most difficult to treat. Innovative treatments are needed and modalities from across cultures must be considered. Ayahuasca is a psychoactive plant-based tea originally used by Amazonian indigenous groups. A growing body of research points to its promise in the healing of various mental health issues. This study explored the potential therapeutic value of ayahuasca in the context of EDs, including the perceived impact of the preparatory diet and the ayahuasca purge. Sixteen individuals previously diagnosed with an ED participated in a semi-structured interview relating to their experiences with ceremonial ayahuasca drinking. Interviews were analyzed using thematic analysis. Themes presented relate to the reduction or cessation of ED and mental health symptoms, shifts in body perception, and the importance of a ceremonial setting and after-care. For some, the preparatory diet resulted in familiar patterns of concern; however, none felt triggered by the purge in ayahuasca. Ceremonial ayahuasca drinking shows promise in the healing of EDs and warrants further research.

Repetition of Attempted Suicide Among Immigrants in Europe

Science.gov (United States)

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

2014-01-01

Objectives To compare frequencies of suicide attempt repetition in immigrants and local European populations, and the timing of repetition in these groups. Method: Data from 7 European countries, comprising 10 574 local and 3032 immigrant subjects, were taken from the World Health Organization European Multicentre Study on Suicidal Behaviour and the ensuing Monitoring Suicidal Behaviour in Europe (commonly referred to as MONSUE) project. The relation between immigrant status and repetition of suicide attempt within 12-months following first registered attempt was analyzed with binary logistic regression, controlling for sex, age, and method of attempt. Timing of repetition was controlled for sex, age, and the recommended type of aftercare. Results: Lower odds of repeating a suicide attempt were found in Eastern European (OR 0.50; 95% CI 0.41 to 0.61, P Europe stands in contrast to their markedly higher tendency to attempt suicide in general, possibly pointing to situational stress factors related to their suicidal crisis that are less persistent over time. Our findings also raise the possibility that suicide attempters and repeaters constitute only partially overlapping populations. PMID:25565687

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

Directory of Open Access Journals (Sweden)

Philipp Zimmer

2016-01-01

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.

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

Directory of Open Access Journals (Sweden)

Abdul Aziz Ab. Latif

2012-01-01

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

Specifics of geriatric patients in oncology

International Nuclear Information System (INIS)

Jonas, P.; Krizanova, M.

2012-01-01

Prolonging human life by the growing number of seniors in the population is accompanied by an increased incidence of cancer in this population. The incidence of cancer in the elderly accounts for 50% of all cancers and is a steeper increase in the male population than female. In Slovakia, the incidence and spread of cancer identical to that in most EU countries. Early cancer detection rate among the elderly is limited poly morbidity and reluctance of patients to undergo preventative as well as diagnostic action. Early diagnosis of cancer allows selection of the appropriate treatment modality that takes into account performance status and co morbidities. Some of these patients require intensive training and so on and aftercare in the treatment of cancer. Failure when treatment when sick or getting into health care already at an advanced stage of the disease is suitable for palliative care. Palliative care is a complex of measures to improve the quality of life of patients and their families in the face of life-threatening disease so that timely identify and promptly diagnose and treat pain and other physical, psychosocial and spiritual problems, reducing suffering. (author)

A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note.

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

2009-05-01

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.

What is the Best Strategy to Minimize After-Care Costs for Total Joint Arthroplasty in a Bundled Payment Environment?

Science.gov (United States)

Slover, James D; Mullaly, Kathleen A; Payne, Ashley; Iorio, Richard; Bosco, Joseph

2016-12-01

The post-acute care strategies after lower extremity total joint arthroplasty including the use of post-acute rehabilitation centers and home therapy services are associated with different costs. Providers in bundled payment programs are incentivized to use the most cost-effective strategies. We used decision analysis to examine the impact of extending the inpatient hospital stay to avoid discharge of patients to a post-acute rehabilitation facility. The results of this decision analysis show that extended acute hospital care for up to 5.2 extra days to allow for home discharge, rather than discharge to a post-acute inpatient facility can be financially preferable, provided quality is not negatively impacted. The data demonstrate that because the cost of additional acute care hospital days is relatively small and because the cost of an extended post-acute inpatient rehabilitation facility is high, keeping patients in the acute facility for a few extra days and then discharging them directly to home may result in an overall lower cost than discharge after a shorter hospital stay to an expensive post-acute facility. However, this approach will have challenges, and future studies are needed to evaluate this change in strategy. Copyright © 2016 Elsevier Inc. All rights reserved.

[Intramedullary nailing of the tibia with the expert tibia nail].

Science.gov (United States)

Hansen, Matthias; El Attal, René; Blum, Jochen; Blauth, Michael; Rommens, Pol Maria

2009-12-01

Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare. Early functional aftercare to maintain joint mobility. Good bony healing in closed and open fractures. All closed and open fractures of the tibia and complete lower leg fractures (AO 42). Certain extraarticular fractures of the proximal and distal tibia (AO 41 A2/A3; AO 43 A1/A2/A3). Segmental fractures of the tibia. Certain intraarticular fractures of the tibia with use of additional implants (AO 41 C1/C2; AO 43 C1/C2). Stabilization during and after segmental bone transport or callus distraction of the tibia. Patients in poor general condition (e.g., bedridden). Flexion of the knee of less than 90 degrees . Infection in the nail's insertion area. Infection of the tibial cavity. Complex articular fractures of the proximal or distal tibia with joint depression. Closed reduction of the fracture. If necessary, use of reduction clamps through additional stab incisions or open surgical procedures. In some cases, additional osteosynthesis procedures are necessary (e.g., screws). Positioning of the patient may be performed on a radiolucent table or a traction table. Opening of the proximal tibia in line with the medullary canal. Cannulated or noncannulated insertion of the Expert Tibia Nail((R)) with or without reaming of the medullary canal depending on the fracture type and soft-tissue condition. Control of axis, length, and rotation. Distal interlocking with the radiolucent drill and proximal interlocking with the targeting device. Immediate mobilization of ankle joint and knee joint. Depending on the type of fracture, mobilization with 20 kg partial weight bearing or pain-dependent full weight bearing with crutches. X-ray control 6 weeks postoperatively and increased weight bearing depending on the fracture status. In a prospective, international multicentric study, 181 patients with 186 fractures were included between July 2004 and

Inmate Prerelease Assessment (IPASS) Aftercare Placement Recommendation as a Predictor of Rural Inmate's 12-Step Attendance and Treatment Entry Postrelease

Science.gov (United States)

Oser, Carrie B.; Biebel, Elizabeth P.; Havens, Jennifer R.; Staton-Tindall, Michele; Knudsen, Hannah K.; Mooney, Jenny L.; Leukefeld, Carl G.

2009-01-01

The purpose of this study is to use the Criminal Justice Drug Abuse Treatment Studies' (CJ-DATS) Inmate Prerelease Assessment (IPASS), which recommends either intensive or nonintensive treatment after release, to predict rural offenders' 12-step attendance and treatment entry within six months of release from prison. IPASS scores indicated that…

Perceptions of hyperbaric oxygen therapy among podiatrists practicing in high-risk foot clinics.

Science.gov (United States)

Henshaw, Frances R; Brennan, Lauren; MacMillan, Freya

2018-01-03

Foot ulceration is a devastating and costly consequence of diabetes. Hyperbaric oxygen therapy is recognised as an adjunctive therapy to treat diabetes-related foot ulceration, yet uptake is low. Semi-structured interviews were conducted with 16 podiatrists who manage patients with foot ulcers related to diabetes to explore their perceptions of, and the barriers/facilitators to, referral for hyperbaric oxygen. Podiatrists cited logistical issues such as location of facilities as well as poor communication pathways, lack of delegation and lack of follow up when patients presented for hyperbaric treatment. In general, podiatrists had an understanding of the premise of hyperbaric oxygen therapy and evidence to support its use but could only provide very limited citations of key papers and guidelines to support their position. Podiatrists stated that they felt a patient was lost from their care when referred for hyperbaric oxygen and that aftercare might not be adequate. Improved referral and delegation pathways for patients presenting for hyperbaric oxygen, as well as the provision of easily accessible evidence to support this therapy, could help to increase podiatrists' confidence in deciding whether or not to recommend their patients for hyperbaric oxygen therapy. © 2018 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Utilisation of biological and secondary raw materials VI. Recycling - conversion to energy; Bio- und Sekundaerrohstoffverwertung VI. Stofflich - energetisch

Energy Technology Data Exchange (ETDEWEB)

Wiemer, Klaus; Kern, Michael

2011-07-01

In a lot of contributions the Kasseler waste and bio-energy forum reports on a sustainable management of wastes. The organizers hope that this results in a lively dialogue on sustainable activities in waste management corresponding to the responsibility towards future generations. Within the 23rd Kasseler waste and bio-energy forum at 12th to 14th April, 2010 in Kassel (Federal Republic of Germany) lectures were held to the following themes: (1) Perspectives of the waste management; (2) Ressource conservation and securing of raw material; (3) Common capture of packages and high-grade materials; (4) Bin for reusable materials - system trusteeship, material flows, qualities, financing, practical examples; (5) Industrial waste flows, EBS quality assurance and increase of efficiency; (6) New technological developments in the area of fermentation of biological wastes; (7) Perspectives of material and energetical utilization of biological wastes; (8) Renewable Energy Law and direct marketing of 'green' electricity; (9) Technology and experiences with biogas processing; (10) Fermentation of biogenic residues and catering waste; (11) Increase of efficiency of mechanical-biological treatment plants; (12) Mechanical-biological treatment technology in an international environment; (13) Concepts of energetic utilization for landfill sites; (14) Landfill law and landfill after-care; (15) Renaturation of landfills.

The impact of a single surgical intervention for patients with a cleft lip living in rural Ethiopia.

Science.gov (United States)

Fell, Matthew J; Hoyle, Tom; Abebe, Mekonen E; Kebede, Yegeremu; Medhin, Yohannes D; Hiwot, Fikre A; Cifeta, Taye H; Ali, Ibrahim M; McGurk, Mark

2014-09-01

Humanitarian organisations commonly provide reconstructive treatment for patients with cleft lip within developing countries, but follow-up is often non-existent, particularly for those living in rural areas. This study aimed to assess whether a single surgical intervention was sufficient to produce an observable change to the life of a patient with cleft lip living in rural Hararghe in eastern Ethiopia. 356 patients with isolated cleft lips, who received a single surgical treatment at least 6 months previously, were evaluated in 21 rural health centres. Patients and their families expressed unhappiness before treatment, mainly because the society reacted negatively towards the deformities, isolating the patients from community activities. Postoperatively, the percentage of school-aged children participating in education increased from 46% to 79%, some older patients were able to marry, but employment was unaffected. The prevalence of wound dehiscence in the lip repair was 3% and occurred more frequently in patients with a bilateral cleft lip compared to a unilateral cleft lip (p charitable organisations treating rural patients and that the majority of patients report a positive impact following surgical intervention. We recommend that bilateral cleft lips have a more intense rural aftercare. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Flexible intramedullary nailing for unicameral cysts in children's long bones : Level of evidence: lV, case series.

Science.gov (United States)

Glanzmann, Michael C; Campos, Lautaro

2007-07-01

The purpose of this study was to evaluate the outcome of flexible intramedullary nailing for unicameral bone cysts in terms of function and osseous consolidation. Twenty-two unicameral bone cysts in children's long bones were treated by flexible intramedullary nailing. In 13 cases the bone cyst was diagnosed in a traumatic event leading to a pathologic fracture. Fifteen patients were referred to our clinic after failed conservative treatment. In 16 patients the cyst was located in the humerus, and in 6 patients in the femur. Mean duration of follow-up after surgery was 24 months. According to Capanna's criteria healing was obtained in 20 cases with a mean time of 16 months. Sixteen cysts healed completely. Four lesions were classified as grade 2, meaning that residual radiolucencies were radiographically visible at the latest follow-up. Two recurrences of humeral cysts were seen at 16 and 18 months postoperatively. The complication rate was minimal. Due to the immediate stabilization of the lesion aftercare becomes facile. This method allows prompt mobilization and early weight bearing without the necessity of a plaster cast. Further it prevents effectively the most common complication, a re-fracture or a pathologic fracture. Therefore we propose this surgical procedure as the treatment of choice for unicameral bone cysts in children's long bones.

[Development and Evaluation of herzwegweiser.de - An Informational Website designed for Post-Rehabilitation Support of Cardiac Patients and their Healthcare Professionals in Berlin-Brandenburg].

Science.gov (United States)

Stamm-Balderjahn, Sabine; Bartel, Susanne; Wilke, Kristin; Spyra, Karla

2018-02-01

The internet portal 'herzwegweiser.de' was developed to assist individuals with cardiovascular diseases in the phase III rehabilitation in the region of Berlin-Brandenburg. It provides information on this specific disease as well as on aftercare services, e. g. regional cardiac groups. For the medical and therapeutic colleagues specific information such as treatment guidelines and a cardiac group placement service for trainers and medical doctors were set up. The study was based on a mixed-methods design. Initially, structured interviews were conducted to identify the expectations and needs of the internet portal. After implementation of the portal, a partially standardized written survey was used to evaluate its acceptance and usability. 105 former rehab patients and 42 medical colleagues participated. The evaluation of the questionnaires was carried out with frequency distributions, mean comparisons and Chi-square tests. The site was rated with an overall high approval rating. Over 90% of the former rehab patients rated content, structure, design, and the search function of the portal positive as did more than 85% of the medical colleagues. 97% of the former rehab patients and 95% professionals would recommend 'herzwegweiser.de'. This internet portal can serve as a model for other regions and possibly other diseases. © Georg Thieme Verlag KG Stuttgart · New York.

Child and Adolescent Inpatient Unit in General Hospital “Tzaneio”

Directory of Open Access Journals (Sweden)

E. Tseva

2017-01-01

Full Text Available The Child and Adolescent Psychiatry Inpatient Service offers comprehensive diagnostic evaluation and treatment of children and adolescents (typical age ranges from 3-16 years old with a variety of emotional and behavioral problems including mood disorders, anxiety disorders, psychotic disorders, severe disruptive behavior, and suicide attempts. Treatment Team. The inpatient treatment team includes psychiatrists, psychologists, registered nurses, special education teacher, social worker, speech and occupational therapists. In addition, pediatricians from a full range of medical subspecialties are available for consultations. The multi-disciplinary staff emphasizes a family-oriented approach and parents and care-givers are encouraged to be active participants in the treatment team throughout a child’s stay. Treatment Program. The program offers developmentally appropriate therapeutic activities in a closely supervised environment. Extensive opportunities for observation, assessment, and intervention are possible in this intensive setting. Specialized assessments including neuropsychological testing, speech and language testing, and occupational therapy assessments are all available. Treatment plans typically include a combination of individual psychotherapy, behavior management, family counseling and medications. Staff members develop an individualized treatment plan emphasizing safety for each patient during the hospital stay. The plan is closely coordinated with families, outpatient providers, and resource programs to coordinate aftercare plans and facilitate a smooth transition to home.

Radiology and the Internet: A systematic review of patient information resources

Energy Technology Data Exchange (ETDEWEB)

Smart, James M; Burling, David

2001-11-01

AIM: To determine whether the internet is a useful resource for patients seeking information on radiological procedures. MATERIALS AND METHODS: A systematic search of the world wide web was performed by means of four general search engines (AltaVista, Yahoo{exclamation_point}, Infoseek and Excite). Twenty-eight suitable patient-directed websites on arteriography were identified for analysis. The value of this material was measured by establishing inclusion or exclusion of a number of factors relating to the procedure. Readability of the materials was evaluated using the Flesch reading ease score. RESULTS: Advice on preparation was included in 21 (75%) sites. Contraindications were found in 16 (57%) sites, risks in 6 (21%) and aftercare in 25 (89%). Result availability was discussed in 15 (54%) sites, with links to other radiology sites in 13 (46%). Visual aids were used in 6 (21%) sites and a contact address found in 27 (96%). Mean Flesch reading ease score was 57, with 46% of sites below the preferred minimum of 60. CONCLUSIONS: Few sites provide the range of information a patient needs before arriving for a procedure. In addition, the readability of the material on these sites is frequently set at a level incomprehensible to patients with lower levels of literacy. Smart, J.M. and Burling, D. (2001)

Radiology and the Internet: A systematic review of patient information resources

International Nuclear Information System (INIS)

Smart, James M.; Burling, David

2001-01-01

AIM: To determine whether the internet is a useful resource for patients seeking information on radiological procedures. MATERIALS AND METHODS: A systematic search of the world wide web was performed by means of four general search engines (AltaVista, Yahoo!, Infoseek and Excite). Twenty-eight suitable patient-directed websites on arteriography were identified for analysis. The value of this material was measured by establishing inclusion or exclusion of a number of factors relating to the procedure. Readability of the materials was evaluated using the Flesch reading ease score. RESULTS: Advice on preparation was included in 21 (75%) sites. Contraindications were found in 16 (57%) sites, risks in 6 (21%) and aftercare in 25 (89%). Result availability was discussed in 15 (54%) sites, with links to other radiology sites in 13 (46%). Visual aids were used in 6 (21%) sites and a contact address found in 27 (96%). Mean Flesch reading ease score was 57, with 46% of sites below the preferred minimum of 60. CONCLUSIONS: Few sites provide the range of information a patient needs before arriving for a procedure. In addition, the readability of the material on these sites is frequently set at a level incomprehensible to patients with lower levels of literacy. Smart, J.M. and Burling, D. (2001)

Femoral shaft fractures in children, treaties with elastic nails of titanium - TENs

International Nuclear Information System (INIS)

Solano Urrutia, Antonio Luis; Gallon, Luis Alfonso; Echandia, Carlos

2003-01-01

Femoral shaft fractures are a common and temporarily disabling injury in children. Recent advances in orthopedic traumatology have led us at the Hospital Universitario del Valle, in Cali, Colombia, to perform a case series observational study with the use of a more aggressive approach with the new endomedullar titanium nails (TENs) in children suffering femur shaft fractures, in a closed procedure performed under image intensification. The main purpose of this study was to evaluate the outcome of 30 children treated with these nails. Pediatric femoral shaft fractures are more common in males with approximately a 2.75:1 male to female ratio. The age distribution is bimodal, with peaks in the younger than 5 years and mid-teenage groups (10-14 years) because of the increased incidence of high-energy trauma in teenage children (mean age: 9 years). Overall, TENs allowed rapid mobilization with few complications. The results were excellent or satisfactory in our cases. No child lost rotational alignment in the postoperative period. Irritation of the soft tissue near the knee by the nail tip occurred in one patient. As indications, implantation technique, and aftercare are refined, TENs may prove to be the ideal implant to stabilize most pediatric femur shaft fractures, avoiding the prolonged immobilization and complications of traction and spica cast

Persistent psychotic symptoms after long-term heavy use of mephedrone: A two-case series.

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

2016-06-15

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.

Does mental health service integration affect compulsory admissions?

Directory of Open Access Journals (Sweden)

André I. Wierdsma

2009-09-01

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.

Trauma history is associated with prior suicide attempt history in hospitalized patients with major depressive disorder.

Science.gov (United States)

Brown, Lily A; Armey, Michael A; Sejourne, Corinne; Miller, Ivan W; Weinstock, Lauren M

2016-09-30

Although the relationships between PTSD, abuse history, and suicidal behaviors are well-established in military and outpatient samples, little data is available on this relationship in inpatient samples. This study examines the relationships between these variables and related demographic and clinical correlates in a sample of psychiatric inpatients with a diagnosis of major depressive disorder using electronic medical record (EMR) data. Controlling for relevant demographic and clinical variables, PTSD diagnosis and history of abuse were both significantly associated with history of suicide attempt, but in a combined model, only history of abuse remained as a significant predictor. Whereas history of abuse was associated with a history multiple suicide attempts, PTSD diagnosis was not. Both insurance status and gender acted as significant moderators of the relationship between history of abuse and history of suicide attempt, with males and those with public/no insurance having greater associations with history of suicide attempts when an abuse history was present. These data indicate the importance of documentation of PTSD, abuse history, and history of suicide attempts. The results also suggest that in the presence of an abuse history or PTSD diagnosis, additional time spent on safety and aftercare planning following hospital discharge may be indicated. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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.

Science.gov (United States)

Ono, Yutaka; Awata, Shuichi; Iida, Hideharu; Ishida, Yasushi; Ishizuka, Naoki; Iwasa, Hiroto; Kamei, Yuichi; Motohashi, Yutaka; Nakagawa, Atsuo; Nakamura, Jun; Nishi, Nobuyuki; Otsuka, Kotaro; Oyama, Hirofumi; Sakai, Akio; Sakai, Hironori; Suzuki, Yuriko; Tajima, Miyuki; Tanaka, Eriko; Uda, Hidenori; Yonemoto, Naohiro; Yotsumoto, Toshihiko; Watanabe, Naoki

2008-09-15

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. This 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). The present study is designed to evaluate the effectiveness of the community-based suicide prevention program in the seven participating areas. UMIN Clinical Trials Registry (UMIN-CTR) UMIN000000460.

Development and Evaluation of an Educational E-Tool to Help Patients With Non-Hodgkin's Lymphoma Manage Their Personal Care Pathway.

Science.gov (United States)

Stienen, Jozette Jc; Ottevanger, Petronella B; Wennekes, Lianne; Dekker, Helena M; van der Maazen, Richard Wm; Mandigers, Caroline Mpw; van Krieken, Johan Hjm; Blijlevens, Nicole Ma; Hermens, Rosella Pmg

2015-01-09

An overload of health-related information is available for patients on numerous websites, guidelines, and information leaflets. However, the increasing need for personalized health-related information is currently unmet. This study evaluates an educational e-tool for patients with non-Hodgkin's lymphoma (NHL) designed to meet patient needs with respect to personalized and complete health-related information provision. The e-tool aims to help NHL patients manage and understand their personal care pathway, by providing them with insight into their own care pathway, the possibility to keep a diary, and structured health-related information. Together with a multidisciplinary NHL expert panel, we developed an e-tool consisting of two sections: (1) a personal section for patients' own care pathway and their experiences, and (2) an informative section including information on NHL. We developed an ideal NHL care pathway based on the available (inter)national guidelines. The ideal care pathway, including date of first consultation, diagnosis, and therapy start, was used to set up the personal care pathway. The informative section was developed in collaboration with the patient association, Hematon. Regarding participants, 14 patients and 6 laymen were asked to evaluate the e-tool. The 24-item questionnaire used discussed issues concerning layout (6 questions), user convenience (3 questions), menu clarity (3 questions), information clarity (5 questions), and general impression (7 questions). In addition, the panel members were asked to give their feedback by email. A comprehensive overview of diagnostics, treatments, and aftercare can be established by patients completing the questions from the personal section. The informative section consisted of NHL information regarding NHL in general, diagnostics, therapy, aftercare, and waiting times. Regarding participants, 6 patients and 6 laymen completed the questionnaire. Overall, the feedback was positive, with at least 75

Predictors of health-related quality of life in children with chronic heart disease.

Science.gov (United States)

Niemitz, Mandy; Gunst, Diana C M; Hövels-Gürich, Hedwig H; Hofbeck, Michael; Kaulitz, Renate; Galm, Christoph; Berger, Felix; Nagdyman, Nicole; Stiller, Brigitte; Borth-Bruhns, Thomas; Konzag, Ines; Balmer, Christian; Goldbeck, Lutz

2017-10-01

Chronic paediatric heart disease is often associated with residual symptoms, persisting functional restrictions, and late sequelae for psychosocial development. It is, therefore, increasingly important to evaluate the health-related quality of life of children and adolescents with chronic heart disease. The aim of this study was to determine medical and socio-demographic variables affecting health-related quality of life in school-aged children and adolescents with chronic heart disease. Patients and methods The Pediatric Cardiac Quality of Life Inventory was administered to 375 children and adolescents and 386 parental caregivers. Medical information was obtained from the charts. The socio-demographic information was provided by the patients and caregivers. Greater disease severity, low school attendance, current cardiac medication, current parental employment, uncertain or limited prognosis, history of connection to a heart-lung machine, number of nights spent in a hospital, and need for treatment in a paediatric aftercare clinic independently contributed to lower health-related quality of life (self-report: R2=0.41; proxy-report: R2=0.46). High correlations between self-reports and parent-proxy reports indicated concordance regarding the evaluation of a child's health-related quality of life. Beyond medical treatment, integration into school is important to increase health-related quality of life in children and adolescents surviving with chronic heart disease. Regular screening of health-related quality of life is recommended to identify patients with special needs.

Stabilization of organic matter and nitrogen immobilization during mechanical-biological treatment and landfilling of residual municipal solid waste

International Nuclear Information System (INIS)

Heiss-Ziegler, C.

2000-04-01

Synthesis of humic substances and nitrogen immobilization during mechanical-biological treatment of waste and the behavior of biologically stabilized waste under anaerobic landfill conditions were investigated. Samples were taken from a large-scale treatment plant. Anaerobic conditions were simulated in lab scale test cells. Humic substances were analyzed photometrically and gravimetrically. The nitrogen immobilization was investigated by sequential leaching tests and by analyzing the non acid hydrolyzable nitrogen. Humic acids were mainly synthesized during the beginning of the intensive rotting phase. Later on in the process no significant changes occurred. The humic acid content rose up to 6,8 % DS org. It correlated well with the stability parameters respiration activity and accumulated gas production. In the coarse of the treatment the nitrogen load emitted during the consecutive leaching tests dropped from 50 % down to less than 20 % total nitrogen. The non acid hydrolyzable nitrogen rose from 17 up to 42 % Kjeldahl nitrogen content. Nevertheless the mechanical-biological treatment is not significantly shortening the aftercare period of a landfill concerning liquid nitrogen emissions. The reduced nitrogen emission potential is released more slowly. When reactive waste material was exposed to anaerobic conditions, humic and fulvic acids were synthesized up to the point when intensive gas production started and then were remineralized. Stabilized waste materials after treatment of various intensity behaved differently under anaerobic conditions. Steady and decreasing humic acid contents were observed. (author)

Individual Risk and Prevention of Complications: Doctors' Advice to Persons Wishing a New Tattoo.

Science.gov (United States)

Serup, Jørgen

2017-01-01

Doctors who are consulted about health and tattoo risks have an important role in the prevention of an individual's tattoo complications. Tattooing is a tremendous exposure of the human body to needle operation, particles, and chemicals. The risk is related to a person's health condition, level of insight, decision-making, and to the operation of tattooing, tattoo inks and utensils, tattoo parlour, and the aftercare. Tattooing is painful minor surgery performed without anesthesia. It can be associated with syncope. It is major needle trauma with histamine release and wheal and flare in the operation field. The skin barrier is broken. Bacterial infections come early. Chronically intermittent and mild complaints affect 4/10 of all the tattooed, and 2/10 have sensitivity to sun. Chronic complications with allergy in red tattoos and nodules due to pigment agglomeration and foreign body formation in black tattoos are less common but certainly at the level of cumbersome skin disease. Reactions to black tattoos are strongly associated with sarcoidosis. There are many other distinct entities of tattoo complications. A campaign called 'Tattoo - know your risk' is presented with detailed fact sheets about tattoos, tattoo problems, how to reduce risk, and a checklist for the tattoo customer before decision-making. The sheets with keynote information are useful aids for doctors giving advice to persons curious about acquiring a tattoo. © 2017 S. Karger AG, Basel.

Occupational disease caused by ionizing radiation

International Nuclear Information System (INIS)

Kluepfel, H.U.

1983-01-01

The study investigates the course of the disease of persons whose occupational exposure to radiation had resulted in impairment of their professional ability and entitled them to damages under the current regulations. 35 receivers of damages were found who by answering the question form and partly giving permission to study their file at the insurance institution under the conditions of data protection made is possible to carry through this investigation. 14 receivers of damages were occupied in the technical industry, 21 in the sector of medicine. The radiation disease acknowledged as professional concerned in 30 cases the skin, in two cases the lungs and in one case each the haematopoietic system, the eyes and the pelvic organs. In 8 indemnified, acute radiation exposure had caused the disease, in 25 the time of exposure had ranged from one year to several decades. The investigation describes when and under what professional circumstances the radiation exposure took place, the course of the disease, what kind of diagnostic and therapeutical measures were carried through and what personal and professional consequences the indemnified sustained. It gives suggestions to set up a future, more effective documentation system on the basis of the experience gathered on the occasion of this investigation with the currently valid registration system, which is unsuitable for further scientific studies, and with the currently practised methods of after-care. (orig./HP) [de

Improving Parolees' Participation in Drug Treatment and Other Services through Strengths Case Management.

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Prendergast, Michael; Cartier, Jerome J

2008-01-01

In an effort to increase participation in community aftercare treatment for substance-abusing parolees, an intervention based on a transitional case management (TCM) model that focuses mainly on offenders' strengths has been developed and is under testing. This model consists of completion, by the inmate, of a self-assessment of strengths that informs the development of the continuing care plan, a case conference call shortly before release, and strengths case management for three months post-release to promote retention in substance abuse treatment and support the participant's access to designated services in the community. The post-release component consists of a minimum of one weekly client/case manager meeting (in person or by telephone) for 12 weeks. The intervention is intended to improve the transition process from prison to community at both the individual and systems level. Specifically, the intervention is designed to improve outcomes in parolee admission to, and retention in, community-based substance-abuse treatment, parolee access to other needed services, and recidivism rates during the first year of parole. On the systems level, the intervention is intended to improve the communication and collaboration between criminal justice agencies, community-based treatment organizations, and other social and governmental service providers. The TCM model is being tested in a multisite study through the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative funded by the National Institute of Drug Abuse.

Pathways to psychiatric care in European prison systems.

Science.gov (United States)

Dressing, Harald; Salize, Hans-Joachim

2009-01-01

The aims of this study were to describe and analyse the concepts of provision of mental health services for prison inmates in 24 countries in the European Union and the EFTA. Data were gathered by means of a structured questionnaire that was completed by national experts in the participating countries. This article stresses the different organizational models of mental health care for inmates, different legal standards for screening their mental health status and different pathways to psychiatric care and aftercare. The study revealed serious shortcomings. Even the most rudimentary health reporting standards for mental health care in prison are lacking almost everywhere in Europe. Psychiatric screening and assessment procedures at prison entry and during imprisonment differ substantially and do not fulfil recognized quality standards. In many countries, the appointment of inadequately trained staff to perform such screenings increases considerably the risk that mental disorders or psychiatric needs of the inmates will remain undetected. Furthermore, the pathways to care in the case of an acute psychotic episode differ significantly, since referral to prison hospitals, medical prison wards, forensic hospitals, or general psychiatric hospital are used in various combinations depending on different national legal regulations and on the availability of services or other regional circumstances. Therefore, the collaborating experts place the quality of European prison mental health care into serious question. (c) 2009 John Wiley & Sons, Ltd.

Mindfulness practice moderates the relationship between craving and substance use in a clinical sample.

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Enkema, Matthew C; Bowen, Sarah

2017-10-01

Relapse following treatment for substance use disorders is highly prevalent, and craving has been shown to be a primary predictor of relapse. Mindfulness-Based Relapse Prevention (MBRP) is a psychosocial aftercare program integrating mindfulness and cognitive-behavioral approaches, aimed at reducing the risk and severity of relapse. Results from a recent randomized clinical trial demonstrate enhanced remission resilience for MBRP participants versus both cognitive-behavioral and treatment-as-usual controls. The current study investigated between-session formal and informal mindfulness practice, a hypothesized primary mechanism of action in this treatment, as an attenuating factor in the relationship between craving and substance use. Participants in this secondary analysis were 57 eligible adults who completed either inpatient treatment or intensive outpatient treatment for substance use disorders, were randomized in the parent study to receive MBRP, and completed relevant follow-up assessments. For formal mindfulness practice at post-intervention, both number of days per week and number of minutes per day significantly moderated the relationship between craving at post-intervention and number of substance use days at 6-month follow up. Informal practice did not significantly influence the craving-use relationship in this analysis. These results indicate that increasing formal mindfulness practice may reduce the link between craving and substance use for MBRP participants and enhance remission resiliency. Copyright © 2017. Published by Elsevier B.V.

A crisis worker's observations on the psychosocial support for victims and families following child sexual abuse; a case study.

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Gibney, Daniel R; Jones, Alyson

2014-10-01

The Lancashire Sexual Assault Forensic Examination (SAFE) centre in Preston saw 204 children aged 16 and under for examination following allegation of sexual assault in 2013. The psychological impact on the child is well known but not always addressed correctly or appropriately; the impact and resulting difficulties faced by the parent/carer of the child can also easily go un-noticed. Mrs A attended the centre with her 2 year old daughter in 2013, where I was the crisis worker in the case. She was contacted five months later and the support they received after attending the centre discussed. Her experiences, along with my own anecdotal experiences are discussed. Independent Sexual Assault Advisors (ISVAs) offer support following attendance at the centre, and various charitable organisations offer counselling, emotional and practical support. Health visitors, paediatricians, school nurses and social workers also play a role in looking after children and families following allegations of assault. However, the organisations and agencies involved in psychological aftercare for victims and parents are hindered by strict referral criteria and lack of funding or appropriate specialist expertise. The psychological, educational and behavioural support for parents and children, and specifically pre-trial counselling for children need significant improvement if we are to offer the best support for victims. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Therapeutic Communities for Addictions: A Review of Their Effectiveness from a Recovery-Oriented Perspective

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Vanderplasschen, Wouter; Colpaert, Kathy; Autrique, Mieke; Rapp, Richard Charles; Pearce, Steve; Broekaert, Eric; Vandevelde, Stijn

2013-01-01

Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators. PMID:23401669

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

Directory of Open Access Journals (Sweden)

Suzuki Yuriko

2008-09-01

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.

Coping mediates the effects of cognitive-behavioral therapy for alcohol use disorder among out-patient clients in Project MATCH when dependence severity is high.

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Roos, Corey R; Maisto, Stephen A; Witkiewitz, Katie

2017-09-01

There is inconsistent evidence that alcohol-specific coping is a mechanism of change in cognitive-behavioral therapy (CBT) for alcohol use disorder (AUD). Our primary aim was to test whether baseline dependence severity moderates the mediational effect of CBT on drinking outcomes via coping. Secondary data analysis of Project MATCH , a multi-site alcohol treatment trial in which participants, recruited in out-patient and aftercare arms, were randomized to three treatments: CBT, motivational enhancement therapy (MET) and Twelve-Step facilitation (TSF). Nine research sites in the United States. A total of 1063 adults with AUD. The primary outcomes were percentage days abstinent and percentage heavy drinking days at the 1-year follow-up. Coping was assessed with the Processes of Change Questionnaire . Dependence severity was measured with the Alcohol Dependence Scale . Among the full available sample (across treatment arms), there were no significant moderated mediation effects. Double moderated mediation analyses indicated that several moderated mediation effects were moderated by treatment arm (all P cognitive-behavioral therapy for alcohol use disorder was conditional on dependence severity. End-of-treatment coping mediated the positive treatment effects of cognitive-behavioral therapy on 1-year drinking outcomes among out-patient clients when dependence severity was high, but not when dependence severity was low or moderate. © 2017 Society for the Study of Addiction.

Therapeutic effect of 60Co teletherapy and radium treatment to various malignant neoplasm

International Nuclear Information System (INIS)

Kim, Jin Yong; Park, Sang Sook; Chung, Jin Woo

1970-01-01

In radiation therapy, a complete study of patients on the indication of radiotherapy, delicate consideration during the radiotherapy, adequate after-care, the follow-up study and reconsideration are necessary. The radiotherapy patients are quite different in treatment and care. It takes, time to evaluate. Sometimes the misjudgement of patients last several years. However, the great endurance and efforts are vital necessity for the radiotherapy evaluation and improvement of radiotherapy techniques. At the Radiological Research Institute, all the radiotherapy patients from November 23, 1963 to December 31, 1968 were observed, and among them, those who survived three years after radiotherapy were analyzed in order to report the difficulty in follow-up study and to help formulate a better method of radiotherapy. All the follow-up study was done by questionnaire form. We have sent 8,470 letters, and received 2,084 Positive answers (24.6%) and the returned and no-reply were 6,386 (75.4%). As a sample case, 121 patients, who reside in Chongro-ku Seoul, were selected for home-visiting by our staffs. 67 patients (48.6%) could be located easily where as 71 patients (51.4%) could not be located. The results of follow-up correspondences were analyzed and categorized by the international classification of disease. Three-years survivors and the surviving rate are listed

[Psychosocial care following the firework disaster in Enschede; the lessons from the Bijlmer airline disaster].

Science.gov (United States)

Gersons, B P R; Huijsman-Rubingh, R R R; Olff, M

2004-07-17

When the psychosocial-care scheme for victims of the firework explosion in Enschede, the Netherlands (2000) was set up, lessons learned from the Bijlmer airline disaster (Amsterdam 1992) were put into practice. The aftermath of this incident showed that psychological and physical health problems can still occur many years later. The main failure of the aftercare of the Bijlmer disaster lay in the coordination of aid and the monitoring of health problems. In Enschede steps were taken to redress these problems. An information and advice centre (IAC) was set up to monitor the well-being of the victims, and to provide them with information and, where necessary, assistance. It is responsible for limiting the effects of the disaster. A total of 13,000 people have consulted the IAC. A residents' association was formed. This gave the victims a common voice during the process of attempting to restore normality in their lives. A specialized mental health-care unit was founded to treat disaster-related disorders using evidence-based treatments. So far approximately 1,300 people have consulted this body. A longitudinal study has been set up to map the consequences of the disaster and to advise aid organizations. This will also give information on the extent to which these methods have been able to limit the long-term consequences.

Supportive text messages for patients with alcohol use disorder and a comorbid depression: a protocol for a single-blind randomised controlled aftercare trial.

Science.gov (United States)

Hartnett, Dan; Murphy, Edel; Kehoe, Elizabeth; Agyapong, Vincent; McLoughlin, Declan M; Farren, Conor

2017-05-29

Alcohol use disorders (AUDs) and mood disorders commonly co-occur, and are associated with a range of negative outcomes for patients. Mobile phone technology has the potential to provide personalised support for such patients and potentially improve outcomes in this difficult-to-treat cohort. The aim of this study is to examine whether receiving supporting SMS text messages, following discharge from an inpatient dual diagnosis treatment programme, has a positive impact on mood and alcohol abstinence in patients with an AUD and a comorbid mood disorder. The present study is a single-blind randomised controlled trial. Patients aged 18-70 years who meet the criteria for both alcohol dependency syndrome/alcohol abuse and either major depressive disorder or bipolar disorder according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV Axis I will be randomised to receive twice-daily supportive SMS text messages for 6 months plus treatment as usual, or treatment as usual alone, and will be followed-up at 3, 6, 9 and 12 months postdischarge. Primary outcome measures will include changes from baseline in cumulative abstinence duration, which will be expressed as the proportion of days abstinent from alcohol in the preceding 90 days, and changes from baseline in Beck Depression Inventory scores. The trial has received full ethical approval from the St. Patrick's Hospital Research Ethics Committee (protocol 13/14). Results of the trial will be disseminated through peer-reviewed journal articles and at academic conferences. NCT02404662; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Safety and efficacy of 2,790-nm laser resurfacing for chest photoaging.

Science.gov (United States)

Grunebaum, Lisa D; Murdock, Jennifer; Cofnas, Paul; Kaufman, Joely

2015-01-01

Chest photodamage is a common cosmetic complaint. Laser treatment of the chest may be higher risk than other areas. The objective of this study was to assess the safety and efficacy of 2,790-nm chest resurfacing for photodamage. Twelve patients with Fitzpatrick skin types I-III were enrolled in this university IRB-approved study. Photo documentation was obtained at baseline and each visit. A test spot with the 2,790-nm resurfacing laser was performed on the chest. Patients who did not have adverse effects from the test spot went on to have a full chest resurfacing procedure. Patients were instructed on standardized aftercare, including sunscreen. A 5-point healing and photodamage improvement scale was used to rate improvement by both investigators and the patients and was obtained at 2 weeks, 1 month, 2 months, and 3 months. One pass chest treatment with the 2,790-nm resurfacing laser at fluences greater than or equal to 3.0 mJ with 10% overlap leads to unacceptable rates of hyperpigmentation. Double pass chest treatment at fluences less than or equal to 2.5 mJ with 10% overlap leads to mild improvement in chest photodamage parameters without significant or persistent adverse effects. Laser treatment of aging/photodamaged chest skin remains a challenge due to the delicacy of chest skin. Mild improvement may be obtained with double pass resurfacing with the 2,790-nm wavelength.

Environmental systems in Amcoal

International Nuclear Information System (INIS)

Zyl, H.C. van

1997-01-01

The impact of Amcoal collieries on the environment is assessed and recorded in great detail in the Environmental Management Programme Reports. Before mining authorization is granted by the Department of Mineral and Energy Affairs, each mine is required by the Minerals Act of 1991 to develop an EMPR in consultation with the departments of Mineral and Energy Affairs, Water Affairs, Environment Affairs, Agriculture, and Nature Conservation, as well, as parties that are or may be affected by the mining operations. The effects mining has or will have on the topography, geology, soils, vegetation, animal life, surface and ground water, cultural resources, and the socio-economy are assessed for each mine. Detailed plans concerning how these impacts will be prevented, minimized or ameliorated are recorded in the EMPRs. Commitments made and recorded in an EMPR are legally binding. They include details of financial mechanisms required to guarantee final rehabilitation, closure and after-care of mine sites. Through experience and involvement in a broad spectrum of environmental management issues, Amcoal has nurtured environmental awareness among its staff and a commitment to excellence in environmental management. It has developed the capability and capacity to respond to current and future environmental challenges. Progress has been made in addressing environmental issues at the mines in a systematic and comprehensive manner. As well as improving the situation at mine level, these efforts will also contribute to maintaining regional land use capabilities and river quality

Risk factors of suicide mortality among multiple attempters: A national registry study in Taiwan.

Science.gov (United States)

Chen, I-Ming; Liao, Shih-Cheng; Lee, Ming-Been; Wu, Chia-Yi; Lin, Po-Hsien; Chen, Wei J

2016-05-01

Little is known about the risk factors of suicide mortality among multiple attempters. This study aims to investigate the predictors of suicidal mortality in a prospective cohort of attempters in Taiwan, focusing on the time interval and suicide method change between the last two nonfatal attempts. The representative data retrieved from the National Suicide Surveillance System (NSSS) was linked with National Mortality Database to identify the causes of death in multiple attempters during 2006-2008. Cox-proportional hazard models were applied to calculate the hazard ratios for the predictors of suicide. Among the 55,560 attempters, 6485 (11.7%) had survived attempts ranging from one to 11 times; 861 (1.5%) eventually died by suicide. Multiple attempters were characterized by female (OR = 1.56, p suicidal death were identified as male, older age (≥ 45 years), shorter interval and not maintaining methods of low lethality in the last two nonfatal attempts. Receipt of nationwide aftercare was associated with lower risk of suicide but the effect was insignificant. The time interval of the last two nonfatal attempts and alteration in the lethality of suicide method were significant factors for completed suicide. Risk assessment involving these two factors may be necessary for multiple attempters in different clinical settings. Effective strategies for suicide prevention emphasizing this high risk population should be developed in the future. Copyright © 2015. Published by Elsevier B.V.

Diagnosis by computer-aided tomography in patients with carcinomas in the rectum-sigma area

International Nuclear Information System (INIS)

Gnann, H.; Huebener, K.H.; Ahlemann, L.M.; Harms, S.

1984-01-01

In a retrospective study on the patients at Tuebingen between 1977 and 1980, the diagnostic value of computer-aided tomography was investigated in 232 cases of carcinomas in the rectum-sigma area. 192 examinations were post-operative. Whether computer-aided tomography will catch on as a staging measure in the pre-operative phase must for now remain unanswered until prospective studies on a large number of patients have been carried through. However, it is useful as a decision-taking aid as regards the choice of the operation method and to clarify whether the carcinoma is operable. Far more important in view of the known high rate of recurvency and metastatic spread seems to be the role of computer-aided tomography in the aftercare especially of those patients who had their rectum removed: the diagnosis of the recidivation permits direct therapeutic action (a second operation, radiation therapy) at an early date. The search for clinically not previously known recidivations revealed that computer-aided tomography had in 124 patients with operated rectal carcinoma a high sensitivity of 98 per cent, a specificity of 87 per cent and an accuracy of 91.9 percent. How long after the operation CAT checks should be carried through is quite as uncertain at present as the role of CAT in the staging of those tumors. The authors recommend intervals of 2-3 months within the first two post-operative years. (orig.) [de

Evaluation and selection of decision-making methods to assess landfill mining projects.

Science.gov (United States)

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

2015-09-01

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. © The Author(s) 2015.

Social inclusion and relationship satisfaction of patients with a severe mental illness.

Science.gov (United States)

Koenders, Jitske F; de Mooij, Liselotte D; Dekker, Jack M; Kikkert, Martijn

2017-12-01

Research suggests that patients with a severe mental illness (SMI) are among the most social excluded in society. However, comparisons of social network composition and relationship satisfaction between SMI patients and a control group are rare. Our aim was to compare differences in size, satisfaction and composition of the social network between patients with SMI and a control group. Potential sociodemographic and clinical risk factors in relation to social network size in SMI patients were explored. The sample consisted of a control group ( N = 949) and SMI patients ( N = 211) who were under treatment in Dutch mental health care institutions. In these groups, network size, relationship satisfaction, sociodemographic and clinical (patients only) characteristics were assessed. Social network size was 2.5 times lower in SMI patients, which was also reflected in a lower relationship satisfaction. The composition of the social network of SMI patients differs from that of controls: patients' network seems to consist of a smaller part of friends. Different risk factors were associated with the impoverishment of the social network of family, friends and acquaintances of patients with SMI. SMI patients have very small networks compared to controls. This may be a problem, given the ongoing emphasis on outpatient treatment of SMI patients and self-dependence. This outcome advocates for more attention to social isolation of SMI patients and involvement of family in the treatment and aftercare of SMI patients.

[Analysis of a Family-centred Care Programme with Follow-up Home-visits in Neonatology - In Times of the Directive from G-BA].

Science.gov (United States)

Hüning, B M; Reimann, M; Sahlmen, S; Leibold, S; Nabring, J C; Felderhoff-Müser, U

2016-07-01

Marked progress in neonatology changed care of very preterm infants (VLBW) over the last decades - but also the attitude towards family-centred care (FCC). With the directive of the German Federal Joined Committee (G-BA), politicians recognize the necessity of neonatal FCC. To evaluate time and personnel costs necessary at a centre of established FCC. Elternberatung "Frühstart" is a FCC programme for VLBW and seriously ill neonates from preganancy at risk to follow-up home-visits delivered by one interdisciplinary team. Analysis (2011-2014): 1.) Number of cases /participation in programme, 2.) resources of time, 3) and personnel, 4.) funding, 5) economic impact. 1.1.2011-31.12.2014: 441 cases (total cases: 2 212) participated in the programme. Participation of VLBW: mean 92% (86.4-97,2%). Costs of time are highest in neonates with congenital malformations: median 13.8 h, VLBW: median 11,2 h. Transition to home is most time intensive: median 7,3 (0-42.5) h. In average of 3.1 full-time nurses (part-time workers) are able to counsel 48 families/quarter. In severe cases funding is partly provided by health care insurances for social medical aftercare: positive applications: mean 92.7% (79.6-97.7%). Participation in the FCC programme in neonatology is high and costs of time are manageable. © Georg Thieme Verlag KG Stuttgart · New York.

Prediction of Long-Term Outcomes in Young Adults with a History of Adolescent Alcohol-Related Hospitalization.

Science.gov (United States)

Groß, Cornelius; Kraus, Ludwig; Piontek, Daniela; Reis, Olaf; Zimmermann, Ulrich S

2016-01-01

Empirical data concerning the long-term psychosocial development of adolescents admitted to inpatient treatment with alcohol intoxication (AIA) are lacking. The aim of this study was to identify the factors that, at the time of admission, predict future substance use, alcohol use disorders (AUD), mental health treatment, delinquency and life satisfaction. We identified 1603 cases of AIA treated between 2000 and 2007 in one of five pediatric departments in Germany. These former patients were invited to participate in a telephone interview. Medical records were retrospectively analyzed extracting potential variables predicting long-term outcomes. Interviews were conducted with 277 individuals, 5-13 [mean 8.3 (SD 2.3)] years after treatment, with a response rate of 22.7%; of these, 44.8% were female. Mean age at the interview was 24.4 (SD 2.2) years. Logistic and linear regression models revealed that being male, using illicit substances and truancy or runaway behavior in adolescence predicted binge drinking, alcohol dependence, use of illicit substances and poor general life satisfaction in young adulthood, explaining between 13 and 24% of the variance for the different outcome variables. This naturalistic study confirms that known risk factors for the development of AUD also apply to AIA. This finding facilitates targeted prevention efforts for those cases of AIA who need more than the standard brief intervention for aftercare. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Landfill mining: Development of a cost simulation model.

Science.gov (United States)

Wolfsberger, Tanja; Pinkel, Michael; Polansek, Stephanie; Sarc, Renato; Hermann, Robert; Pomberger, Roland

2016-04-01

Landfill mining permits recovering secondary raw materials from landfills. Whether this purpose is economically feasible, however, is a matter of various aspects. One is the amount of recoverable secondary raw material (like metals) that can be exploited with a profit. Other influences are the costs for excavation, for processing the waste at the landfill site and for paying charges on the secondary disposal of waste. Depending on the objectives of a landfill mining project (like the recovery of a ferrous and/or a calorific fraction) these expenses and revenues are difficult to assess in advance. This situation complicates any previous assessment of the economic feasibility and is the reason why many landfills that might be suitable for landfill mining are continuingly operated as active landfills, generating aftercare costs and leaving potential hazards to later generations. This article presents a newly developed simulation model for landfill mining projects. It permits identifying the quantities and qualities of output flows that can be recovered by mining and by mobile on-site processing of the waste based on treatment equipment selected by the landfill operator. Thus, charges for disposal and expected revenues from secondary raw materials can be assessed. Furthermore, investment, personnel, operation, servicing and insurance costs are assessed and displayed, based on the selected mobile processing procedure and its throughput, among other things. For clarity, the simulation model is described in this article using the example of a real Austrian sanitary landfill. © The Author(s) 2016.

Atheists, agnostics and Alcoholics Anonymous.

Science.gov (United States)

Tonigan, J Scott; Miller, W R; Schermer, Carol

2002-09-01

In spite of the strong emphasis in AA on spiritual beliefs and practices, findings are mixed about the importance of such beliefs in predicting AA affiliation. This study of the Project MATCH outpatient (N = 952) and aftercare (N = 774) samples tested three hypotheses about the role of client God belief and subsequent AA attendance and benefit, taking into account that some individuals may, in fact, deny the existence of a God. Longitudinal analyses were conducted (N = 1,526) investigating client God beliefs, AA attendance, patterns of AA attendance and alcohol use. Assessments were conducted at intake and in 3-month intervals using the Form 90, Religious Behaviors and Background, and the Alcoholics Anonymous Inventory. 12-Step treatment was significantly more likely to promote pre-post shifts in client God beliefs, and atheist and agnostic clients attended AA significantly less often throughout follow-up relative to clients self-labeled as spiritual and religious. AA attendance, however, was significantly associated with increased abstinence and reductions in drinking intensity regardless of God belief. Finally, no differences in percent days abstinence and drinking intensity were found between atheist and agnostic versus spiritual and religious clients, but clients unsure about their God belief reported significantly higher drinking frequency relative to the other groups. God belief appears to be relatively unimportant in deriving AA-related benefit, but atheist and agnostic clients are less likely to initiate and sustain AA attendance relative to spiritual and religious clients. This apparent reticence to affiliate with AA ought to be clinically recognized when encouraging AA participation.

Perspectives of decision-making in requests for euthanasia: a qualitative research among patients, relatives and treating physicians in the Netherlands.

Science.gov (United States)

Dees, Marianne K; Vernooij-Dassen, Myrra J; Dekkers, Wim J; Elwyn, Glyn; Vissers, Kris C; van Weel, Chris

2013-01-01

Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient's autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in the Netherlands, there is little known about how decision-making occurs and no guidance to support this difficult aspect of clinical practice. To explore the decision-making process in cases where patients request euthanasia and understand the different themes relevant to optimise this decision-making process. A qualitative thematic analysis of interviews with patients making explicit requests for euthanasia, most-involved relative(s) and treating physician. Thirty-two cases, 31 relatives and 28 treating physicians. Settings were patients' and relatives' homes and physicians' offices. Five main themes emerged: (1) initiation of sharing views and values about euthanasia, (2) building relationships as part of the negotiation, (3) fulfilling legal requirements, (4) detailed work of preparing and performing euthanasia and (5) aftercare and closing. A patient's request for euthanasia entails a complex process that demands emotional work by all participants. It is characterised by an intensive period of sharing information, relationship building and negotiation in order to reach agreement. We hypothesise that making decisions about euthanasia demands a proactive approach towards participants' preferences and values regarding end of life, towards the needs of relatives, towards the burden placed on physicians and a careful attention to shared decision-making. Future research should address the communicational skills professionals require for such complex decision-making.

Multiple-tracer tests for contaminant transport process identification in saturated municipal solid waste

International Nuclear Information System (INIS)

Woodman, N.D.; Rees-White, T.C.; Stringfellow, A.M.; Beaven, R.P.; Hudson, A.P.

2015-01-01

Highlights: • Multiple tracers were applied to saturated MSW to test dual-porosity properties. • Lithium demonstrated to be non-conservative as a tracer. • 260 mm diameter column too small to test transport properties of MSW. • The classical advection-dispersion mode was rejected due to high dispersivity. • Characteristic diffusion times did not vary with the tracer. - Abstract: Two column tests were performed in conditions emulating vertical flow beneath the leachate table in a biologically active landfill to determine dominant transport mechanisms occurring in landfills. An improved understanding of contaminant transport process in wastes is required for developing better predictions about potential length of the long term aftercare of landfills, currently measured in timescales of centuries. Three tracers (lithium, bromide and deuterium) were used. Lithium did not behave conservatively. Given that lithium has been used extensively for tracing in landfill wastes, the tracer itself and the findings of previous tests which assume that it has behaved conservatively may need revisiting. The smaller column test could not be fitted with continuum models, probably because the volume of waste was below a representative elemental volume. Modelling compared advection-dispersion (AD), dual porosity (DP) and hybrid AD–DP models. Of these models, the DP model was found to be the most suitable. Although there is good evidence to suggest that diffusion is an important transport mechanism, the breakthrough curves of the different tracers did not differ from each other as would be predicted based on the free-water diffusion coefficients. This suggested that solute diffusion in wastes requires further study

Avoiding unfavorable results in postburn contracture hand

Science.gov (United States)

Bhattacharya, Sameek

2013-01-01

Deformities of the hands are a fairly common sequel of burn especially in the developing world. This is because of high incidence of burns, limited access to standard treatment and rehabilitation. The best outcome of a burnt hand is when deformities are prevented from developing. A good functional result is possible when due consideration is paid to hands during resuscitation, excisional surgery, reconstructive surgery and physiotherapy. The post-burns deformities of hand develop due direct thermal damage or secondary to intrinsic minus position due to oedema or vascular insufficiency. During the acute phase the concerns are, maintenance circulation minimize oedema prevent unphysiological positioning and wound closure with autogenous tissue as soon as possible. The rehabilitation program during the acute phase starts from day one and goes on till the hand has healed and has regained full range of motion. Full blown hand contractures are challenging to correct and become more difficult as time passes. Long-standing cases often land up with attenuation of extensor apparatus leading to swan neck and boutonniere deformity, muscle shortening and bony ankylosis. The major and most common pitfall after contracture release is relapse. The treatment protocol of contracture is solely directed towards countering this tendency. This article aims to guide a surgeon in obtaining optimal hand function and avoid pit falls at different stages of management of hand burns. The reasons of an unfavourable outcome of a burnt hand are possible lack of optimal care in the acute phase, while planning and performing reconstructive procedure and during aftercare and rehabilitation. PMID:24501479

The prevalence of oral and peri-oral piercings in young adults: a systematic review.

Science.gov (United States)

Hennequin-Hoenderdos, N L; Slot, D E; Van der Weijden, G A

2012-08-01

To determine the prevalence of oral and/or peri-oral piercings in young adults based on a systematic review of the available literature. The MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE databases were comprehensively searched through April 2012 to identify appropriate studies. The prevalence of oral and/or peri-oral piercings was evaluated in the general population, as well as by gender and by anatomical site. An independent screening of 1711 unique titles and abstracts resulted in 13 publications that met the eligibility criteria. In total, 11 249 participants (mean age, 20.6 years) were questioned and/or examined for oral and/or peri-oral piercings. In the studies that provided information concerning the presence of oral and/or peri-oral piercings, the prevalence varied from 0.8% to 12%, resulting in a mean prevalence of 5.2%. When examined based on anatomical site, the most common sites were the tongue (a prevalence of 5.6%), followed by the lip (1.5%). Oral piercings were more prevalent in women (5.6%) than men (1.6%). Among the populations that were studied, oral and/or peri-oral piercings were observed in a relatively small percentage (5.2%) of young adults. The prevalence was approximately four times higher among females when compared with males. On the basis of the literature, the tongue was the most common oral site for a piercing. Dental care professionals are in an ideal position to offer information regarding safe piercings and to provide advice regarding oral hygiene, aftercare and possible complications. © 2012 John Wiley & Sons A/S.

Gender differences in first onset Schizophrenia spectrum psychoses.

Science.gov (United States)

Talonen, Sanni; Väänänen, Juha; Kaltiala-Heino, Riittakerttu

2017-02-01

Mental health profiles differ between boys and girls from puberty onwards. It is not known whether differences also extend to symptom presentation in schizophrenia spectrum disorders. It may be that girls and boys are not treated entirely equally by the professionals. To study gender differences in symptom profiles, family adversities, pathway to care, and characteristics of inpatient treatment at the first episode of diagnosed schizophrenia spectrum disorder (F20-29) among adolescents aged 13-17. A retrospective chart review of all (n = 106) consecutive adolescents diagnosed for the first time with schizophrenia spectrum disorder (F20-29) in a specified catchment area. Girls and boys were compared with regard to sociodemographics, pathways to care, living arrangements, symptom profiles, and treatment received. During the study period more adolescent girls (n = 70, 66%) than boys (n = 36, 34%) were diagnosed with schizophrenia spectrum (F20-29) psychoses, most commonly F29. Girls were moreover younger (mean age = 15.46) than boys (mean age = 16.62) at admission. Girls more often displayed mood symptoms and boys aggressive behaviours, alcohol abuse problems, and isolation. Family adversities recorded as current stressors were more numerous among girls. Girls were more likely to be referred to specialized after-care than boys. The gender differences observed in symptoms presentation are reminiscent of differences encountered in the general adolescent population. Prior to transition to psychosis, girls and boys are equally in contact with psychiatric services due to other (possibly prodromal) symptoms/disorders. Family adversities may be more stressful for girls vulnerable to psychosis than to boys.

Size acceptance and intuitive eating improve health for obese, female chronic dieters.

Science.gov (United States)

Bacon, Linda; Stern, Judith S; Van Loan, Marta D; Keim, Nancy L

2005-06-01

Examine a model that encourages health at every size as opposed to weight loss. The health at every size concept supports homeostatic regulation and eating intuitively (ie, in response to internal cues of hunger, satiety, and appetite). Six-month, randomized clinical trial; 2-year follow-up. White, obese, female chronic dieters, aged 30 to 45 years (N=78). Free-living, general community. Six months of weekly group intervention (health at every size program or diet program), followed by 6 months of monthly aftercare group support. Anthropometry (weight, body mass index), metabolic fitness (blood pressure, blood lipids), energy expenditure, eating behavior (restraint, eating disorder pathology), and psychology (self-esteem, depression, body image). Attrition, attendance, and participant evaluations of treatment helpfulness were also monitored. Analysis of variance. Cognitive restraint decreased in the health at every size group and increased in the diet group, indicating that both groups implemented their programs. Attrition (6 months) was high in the diet group (41%), compared with 8% in the health at every size group. Fifty percent of both groups returned for 2-year evaluation. Health at every size group members maintained weight, improved in all outcome variables, and sustained improvements. Diet group participants lost weight and showed initial improvement in many variables at 1 year; weight was regained and little improvement was sustained. The health at every size approach enabled participants to maintain long-term behavior change; the diet approach did not. Encouraging size acceptance, reduction in dieting behavior, and heightened awareness and response to body signals resulted in improved health risk indicators for obese women.

An integrated programme after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: effect on emotional and functional dimensions of quality of life.

Science.gov (United States)

Moullec, G; Ninot, G

2010-02-01

To assess whether a maintenance integrated health care programme is effective in improving functional and emotional dimensions of quality of life in patients with chronic obstructive pulmonary disease (COPD) after a first pulmonary rehabilitation. Prospective controlled trial. Three rehabilitation centres and three patient self-help associations within a health care network in France. Forty patients with moderate to severe COPD. After a first four-week inpatient pulmonary rehabilitation programme, patients took part in a maintenance integrated health care programme or usual care for 12 months. The primary outcomes were the change in functional and emotional dimensions of quality of life measured by the St George's Respiratory Questionnaire (SGRQ), the brief World Health Organization Quality of Life questionnaire (Brief-WHOQOL) and six specific questions using a 10-cm visual analogue scale. Secondary outcomes were change in exercise tolerance measured by six-minute walking test and cycle exercise. At one year, the maintenance intervention (n = 11) produced improvements in functional and emotional dimensions scores of quality of life and exercise tolerance. Patients in the usual aftercare group (n = 16) exhibited maintenance of functional dimension scores of quality of life, but a clinically relevant decline in emotional scores of quality of life and in six-minute walking distance one year after the pulmonary rehabilitation. Patient self-help association seems to be an innovative and efficient organizational structure to support patients with COPD after pulmonary rehabilitation in real-life settings. A distinction between emotional and functional dimensions of quality of life may improve the design and evaluation of integrated health care programmes in patients with COPD.

Enhancing inpatient psychotherapeutic treatment with online self-help: study protocol for a randomized controlled trial.

Science.gov (United States)

Zwerenz, Rüdiger; Becker, Jan; Knickenberg, Rudolf J; Hagen, Karin; Dreier, Michael; Wölfling, Klaus; Beutel, Manfred E

2015-03-17

Depression is one of the most debilitating and costly mental disorders. There is increasing evidence for the efficacy of online self-help in alleviating depression. Knowledge regarding the options of combining online self-help with inpatient psychotherapy is still limited. Therefore, we plan to evaluate an evidence-based self-help program (deprexis®; Gaia AG, Hamburg, Germany) to improve the efficacy of inpatient psychotherapy and to maintain treatment effects in the aftercare period. Depressed patients (n = 240) with private internet access aged between 18 and 65 are recruited during psychosomatic inpatient treatment. Participants are randomized to an intervention or control group at the beginning of inpatient treatment. The intervention group (n = 120) is offered an online self-help program with 12 weekly tasks, beginning during the inpatient treatment. The control group (n = 120) obtains access to an online platform with weekly updated information on depression for the same duration. Assessments are conducted at the beginning (T0) and the end of inpatient treatment (T1), at the end of intervention (T2) and 6 months after randomization (T3). The primary outcome is the depression score measured by the Beck Depression Inventory-II at T2. Secondary outcome measures include anxiety, self-esteem, quality of life, dysfunctional cognitions and work ability. We expect the intervention group to benefit from additional online self-help during inpatient psychotherapy and to maintain the benefits during follow-up. This could be an important approach to develop future concepts of inpatient psychotherapy. ClinicalTrials.gov Identifier: NCT02196896 (registered on 16 July 2014).

Changes in siblings after the death of a child from cancer.

Science.gov (United States)

Foster, Terrah L; Gilmer, Mary Jo; Vannatta, Kathryn; Barrera, Maru; Davies, Betty; Dietrich, Mary S; Fairclough, Diane L; Gerhardt, Cynthia A

2012-01-01

Few studies have examined changes in siblings after the death of a brother or sister, particularly from mother, father, and sibling perspectives within the first year after death. This descriptive study identified and assessed the frequency of changes in siblings after a child's death from cancer. Participants were recruited from cancer registries at 3 hospitals in the United States and Canada 3 to 12 months after the child's death. Thirty-six mothers, 24 fathers, and 39 siblings from 40 families were included. Semistructured interviews using open-ended questions were conducted with each parent and sibling separately in the home. Content analysis identified emerging themes, and the McNemar tests compared frequencies between each paired set of reports (sibling vs mother, sibling vs father, mother vs father). Sixty-nine percent of participants reported personal changes in siblings (eg, changes in personality, school work, goals/life perspective, activities/interests). Forty-seven percent noted changes in siblings' relationships with family members and peers. Only 21% of participants reported no changes attributed to the death. Comparisons of frequencies across informants were not significant. Most siblings experienced changes in multiple areas of their lives after the death of a brother or sister to cancer. Some changes reflected siblings that were positively adapting to the death, whereas other changes reflected difficulties. Our findings offer guidance to improve aftercare for bereaved siblings and their families. Additional research is needed to further delineate the needs of bereaved siblings and to develop strategies to promote adaptation to loss.

Contact lens wear and dry eyes: challenges and solutions

Directory of Open Access Journals (Sweden)

Markoulli M

2017-02-01

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

Multiple-tracer tests for contaminant transport process identification in saturated municipal solid waste

Energy Technology Data Exchange (ETDEWEB)

Woodman, N.D., E-mail: n.d.woodman@soton.ac.uk; Rees-White, T.C.; Stringfellow, A.M.; Beaven, R.P.; Hudson, A.P.

2015-04-15

Highlights: • Multiple tracers were applied to saturated MSW to test dual-porosity properties. • Lithium demonstrated to be non-conservative as a tracer. • 260 mm diameter column too small to test transport properties of MSW. • The classical advection-dispersion mode was rejected due to high dispersivity. • Characteristic diffusion times did not vary with the tracer. - Abstract: Two column tests were performed in conditions emulating vertical flow beneath the leachate table in a biologically active landfill to determine dominant transport mechanisms occurring in landfills. An improved understanding of contaminant transport process in wastes is required for developing better predictions about potential length of the long term aftercare of landfills, currently measured in timescales of centuries. Three tracers (lithium, bromide and deuterium) were used. Lithium did not behave conservatively. Given that lithium has been used extensively for tracing in landfill wastes, the tracer itself and the findings of previous tests which assume that it has behaved conservatively may need revisiting. The smaller column test could not be fitted with continuum models, probably because the volume of waste was below a representative elemental volume. Modelling compared advection-dispersion (AD), dual porosity (DP) and hybrid AD–DP models. Of these models, the DP model was found to be the most suitable. Although there is good evidence to suggest that diffusion is an important transport mechanism, the breakthrough curves of the different tracers did not differ from each other as would be predicted based on the free-water diffusion coefficients. This suggested that solute diffusion in wastes requires further study.

Titanium elastic nailing in pediatric femoral diaphyseal fractures

Directory of Open Access Journals (Sweden)

Singh Roop

2006-01-01

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.

Codeine misuse and dependence in South Africa: Perspectives of addiction treatment providers

Directory of Open Access Journals (Sweden)

Charles D H Parry

2017-05-01

Full Text Available Background. General practitioners are referring patients with codeine-related problems to specialist treatment facilities, but little is known about the addiction treatment providers, the kinds of treatment they provide, and whether training or other interventions are needed to strengthen this sector. Objectives. To investigate the perspectives of addiction treatment providers regarding treatment for codeine misuse or dependence. Method. Twenty addiction treatment providers linked to the South African Community Epidemiology Network on Drug Use and the South African Addiction Medicine Society were contacted telephonically and asked 20 questions. Results. While many participants had received training in pharmacological management of individuals with opioid dependence, only two had received specific training on codeine management. Between half and two-thirds of the treatment settings they worked in provided detoxification, pharmacotherapy, psychosocial treatment and aftercare. Very few treatment settings offered long-term treatment for codeine misuse and dependence. Participants indicated that over half of their codeine patients entered treatment for intentional misuse for intoxication, and dependence resulting from excessive or long-term use. The main barriers to patients entering treatment were seen as denial of having a problem, not being ready for change, mental health problems, stigma, and affordability of treatment. Participants identified a need for further training in how to manage withdrawal and detoxification, treatment modalities including motivational interviewing, and relapse prevention. Conclusions. Gaps in training among treatment providers need to centre on how to manage withdrawal from codeine use and detoxification, motivational interviewing and relapse prevention. Interventions are needed to address barriers to entering treatment, including user denial.

Who cares for involuntary clients?

Science.gov (United States)

Soliman, Soheil; Pollack, Harold A; Alexander, Jeffrey A

2009-01-01

The objectives of this study were to compare characteristics of outpatient substance abuse treatment (OSAT) units that serve high proportions of involuntary clients (ICs) with those that serve a low percentage of such clients. The authors analyze unit-level 1995-2005 data from the National Drug Abuse Treatment System Survey (NDATSS). Approximately 1/6 of OSAT units draw the dominant majority of their clients from involuntary referrals. OSAT units that treat a high proportion of ICs are less likely to be accredited by professional organizations, have fewer treatment staff with advanced degrees, and have shorter average treatment duration than do OSAT units that serve few ICs. OSAT units that serve ICs are more likely to offer legal and domestic violence services but are less likely to offer mental health services or aftercare. OSAT units that serve ICs are less likely to be hospital-affiliated than are other units. Clients at such facilities are more likely to be convicted of driving while intoxicated (DWI), are younger, are less likely to have received prior treatment, are more likely to remain abstinent after treatment, but are more likely to be remanded back to courts. The authors conclude that ICs are an important market niche in OSAT care. DWI is by far the most common offense reported in units that specialize in ICs. Aside from legal and domestic violence services, units with a high proportion of ICs appear to offer somewhat less intensive and professionalized services than do other facilities; however, clients at these units are more likely to be abstinent at the end of treatment and but more likely to be remanded back to the courts.

Overdose prevention training with naloxone distribution in a prison in Oslo, Norway: a preliminary study.

Science.gov (United States)

Petterson, Aase Grønlien; Madah-Amiri, Desiree

2017-11-21

Prison inmates face a ten times increased risk of experiencing a fatal drug overdose during their first 2 weeks upon release than their non-incarcerated counterparts. Naloxone, the antidote to an opioid overdose, has been shown to be feasible and effective when administered by bystanders. Given the particular risk that newly released inmates face, it is vital to assess their knowledge about opioid overdoses, as well as the impact of brief overdose prevention training conducted inside prisons. Prison inmates nearing release (within 6 months) in Oslo, Norway, voluntarily underwent a brief naloxone training. Using a questionnaire, inmates were assessed immediately prior to and following a naloxone training. Descriptive statistics were performed for main outcome variables, and the Wilcoxon signed-rank test was used to compare the participants' two questionnaire scores from pre-and post-training. Participating inmates (n = 31) were found to have a high baseline knowledge of risk factors, symptoms, and care regarding opioid overdoses. Nonetheless, a brief naloxone training session prior to release significantly improved knowledge scores in all areas assessed (p < 0.001). The training appears to be most beneficial in improving knowledge regarding the naloxone, including its use, effect, administration, and aftercare procedures. Given the high risk of overdosing that prison inmates face upon release, the need for prevention programs is critical. Naloxone training in the prison setting may be an effective means of improving opioid overdose response knowledge for this particularly vulnerable group. Naloxone training provided in the prison setting may improve the ability of inmates to recognize and manage opioid overdoses after their release; however, further studies on a larger scale are needed.

Active LifestyLe Rehabilitation interventions in aging spinal cord injury (ALLRISC): a multicentre research program.

Science.gov (United States)

van der Woude, L H V; de Groot, S; Postema, K; Bussmann, J B J; Janssen, T W J; Post, M W M

2013-06-01

With today's specialized medical care, life expectancy of persons with a spinal cord injury (SCI) has considerably improved. With increasing age and time since injury, many individuals with SCI, however, show a serious inactive lifestyle, associated with deconditioning and secondary health conditions (SHCs) (e.g. pressure sores, urinary and respiratory tract infections, osteoporosis, upper-extremity pain, obesity, diabetes, cardiovascular disease) and resulting in reduced participation and quality of life (QoL). Avoiding this downward spiral, is crucial. To understand possible deconditioning and SHCs in persons aging with a SCI in the context of active lifestyle, fitness, participation and QoL and to examine interventions that enhance active lifestyle, fitness, participation and QoL and help prevent some of the SHCs. A multicentre multidisciplinary research program (Active LifestyLe Rehabilitation Interventions in aging Spinal Cord injury, ALLRISC) in the setting of the long-standing Dutch SCI-rehabilitation clinical research network. ALLRISC is a four-study research program addressing inactive lifestyle, deconditioning, and SHCs and their associations in people aging with SCI. The program consists of a cross-sectional study (n = 300) and three randomized clinical trials. All studies share a focus on fitness, active lifestyle, SHCs and deconditioning and outcome measures on these and other (participation, QoL) domains. It is hypothesized that a self-management program, low-intensity wheelchair exercise and hybrid functional electrical stimulation-supported leg and handcycling are effective interventions to enhance active life style and fitness, help to prevent some of the important SHCs in chronic SCI and improve participation and QoL. ALLRISC aims to provide evidence-based preventive components of a rehabilitation aftercare system that preserves functioning in aging persons with SCI.

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

2011-08-15

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.)

Mobile phone technology: a new paradigm for the prevention, treatment, and research of the non-sheltered "street" homeless?

Science.gov (United States)

Eyrich-Garg, Karin M

2010-05-01

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.

Could we use parent report as a valid proxy of child report on anxiety, depression, and distress? A systematic investigation of father-mother-child triads in children successfully treated for leukemia.

Science.gov (United States)

Abate, Cybelle; Lippé, Sarah; Bertout, Laurence; Drouin, Simon; Krajinovic, Maja; Rondeau, Émélie; Sinnett, Daniel; Laverdière, Caroline; Sultan, Serge

2018-02-01

Systematic assessment of emotional distress is recommended in after care. Yet, it is unclear if parent report may be used as a proxy of child report. The aim of this study was to assess agreements and differences and explore possible moderators of disagreement between child and parent ratings. Sixty-two young survivors treated for acute lymphoblastic leukemia (9-18 years) and both parents responded to the Beck Youth Inventory (anxiety and depression) and the distress rating scale on the child's status. Parents completed the Brief Symptom Inventory-18 on their own psychological status. Systematic analyses of agreement and differences were performed. Mother-child and father-child agreements were fair on anxiety, depression, and distress (median intraclass correlation coefficient = 0.37). Differences between parents and children were medium sized (median d = 0.55) with parents giving higher scores than their children on anxiety, depression, and distress. Mothers reported distress more frequently than fathers (39 vs. 17%) when children reported none. The child being female and lower parental income were associated with lower agreement in fathers when rating child distress. Higher levels of parental psychological symptoms were consistently associated with lower agreement. Parent-child differences when rating adolescent survivors' difficulties may be more important than previously thought. Parent report probably cannot be considered as a valid proxy of older child report on such internalized domains as anxiety, depression, or distress in the after-care clinic. Parents' report is also likely to be influenced by their own mood, a factor that should be corrected for when using their report. © 2017 Wiley Periodicals, Inc.

Novel insights into the polycythemia-paraganglioma-somatostatinoma syndrome.

Science.gov (United States)

Därr, Roland; Nambuba, Joan; Del Rivero, Jaydira; Janssen, Ingo; Merino, Maria; Todorovic, Milena; Balint, Bela; Jochmanova, Ivana; Prchal, Josef T; Lechan, Ronald M; Tischler, Arthur S; Popovic, Vera; Miljic, Dragana; Adams, Karen T; Prall, F Ryan; Ling, Alexander; Golomb, Meredith R; Ferguson, Michael; Nilubol, Naris; Chen, Clara C; Chew, Emily; Taïeb, David; Stratakis, Constantine A; Fojo, Tito; Yang, Chunzhang; Kebebew, Electron; Zhuang, Zhengping; Pacak, Karel

2016-12-01

Worldwide, the syndromes of paraganglioma (PGL), somatostatinoma (SOM) and early childhood polycythemia are described in only a few patients with somatic mutations in the hypoxia-inducible factor 2 alpha (HIF2A). This study provides detailed information about the clinical aspects and course of 7 patients with this syndrome and brings into perspective these experiences with the pertinent literature. Six females and one male presented at a median age of 28 years (range 11-46). Two were found to have HIF2A somatic mosaicism. No relatives were affected. All patients were diagnosed with polycythemia before age 8 and before PGL/SOM developed. PGLs were found at a median age of 17 years (range 8-38) and SOMs at 29 years (range 22-38). PGLs were multiple, recurrent and metastatic in 100, 100 and 29% of all cases, and SOMs in 40, 40 and 60%, respectively. All PGLs were primarily norepinephrine-producing. All patients had abnormal ophthalmologic findings and those with SOMs had gallbladder disease. Computed tomography (CT) and magnetic resonance imaging revealed cystic lesions at multiple sites and hemangiomas in 4 patients (57%), previously thought to be pathognomonic for von Hippel-Lindau disease. The most accurate radiopharmaceutical to detect PGL appeared to be [ 18 F]-fluorodihydroxyphenylalanine ([ 18 F]-FDOPA). Therefore, [ 18 F]-FDOPA PET/CT, not [ 68 Ga]-(DOTA)-[Tyr3]-octreotate ([ 68 Ga]-DOTATATE) PET/CT is recommended for tumor localization and aftercare in this syndrome. The long-term prognosis of the syndrome is unknown. However, to date no deaths occurred after 6 years follow-up. Physicians should be aware of this unique syndrome and its diagnostic and therapeutic challenges. © 2016 Society for Endocrinology.

Chemical sterilisation of animals: A review of the use of zinc- and CaCl2 based solutions in male and female animals and factors likely to improve responses to treatment.

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Cavalieri, John

2017-06-01

Chemical sterilisation can be used as an alternative to surgical castration in some circumstances. This review focuses on responses to treatment with zinc- or CaCl 2 -based chemosterilants, factors that have affected treatments and their potential use to sterilise female cattle. Successful treatment with a low incidence of adverse side effects in male animals has occurred with the use of zinc gluconate (ZG), neutralised in arginine and a 20% solution of CaCl 2 in ethanol. Injection technique plays an important role in success. Less satisfactory results appear to occur following use in animals with relatively larger testes. In animals with relatively small testes adjustment of the dose according to testicular size appears to optimise results. The techniques appear to be most suited to population control strategies in companion animals where low cost treatment of animals in environments where surgical facilities and specialised aftercare are lacking. The need for careful administration and likely slower speed of administration compared to surgical castration are likely to hamper application within the cattle industries. Recently transvaginal, intraovarian administration of CaCl 2 in ethanol has been shown to cause complete ovarian atrophy without apparent pain in some heifers, although variable responses were found. Chemical sterilisation can play a role in the sterilisation of animals but careful attention to dose, volume, chemical composition, administration technique are needed to avoid adverse side effects and variability in responses associated with some treatments. Application in female animals requires further study but CaCl 2 in ethanol can potentially cause complete ovarian atrophy when administered to heifers. Copyright © 2017 Elsevier B.V. All rights reserved.

Pathways to change: Use trajectories following trauma-informed treatment of women with co-occurring post-traumatic stress disorder and substance use disorders.

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López-Castro, Teresa; Hu, Mei-Chen; Papini, Santiago; Ruglass, Lesia M; Hien, Denise A

2015-05-01

Despite advances towards integration of care for women with co-occurring substance use disorder (SUD) and post-traumatic stress disorder (PTSD), low abstinence rates following SUD/PTSD treatment remain the norm. The utility of investigating distinct substance use trajectories is a critical innovation in the detection and refining of effective interventions for this clinical population. The present study reanalysed data from the largest randomised clinical trial to date for co-occurring SUD and PTSD in women (National Drug Abuse Treatment Clinical Trials Network; Women and Trauma Study). Randomised participants (n = 353) received one of two interventions in addition to treatment as usual for SUD: (i) trauma-informed integrative treatment for PTSD/SUD; or (ii) an active control psychoeducation course on women's health. The present study utilised latent growth mixture models (LGMM) with multiple groups to estimate women's substance use patterns during the 12-month follow-up period. Findings provided support for three different trajectories of substance use in the post-treatment year: (i) consistently low likelihood and use frequency; (ii) consistently high likelihood and use frequency; and (iii) high likelihood and moderate use frequency. Covariate analyses revealed improvement in PTSD severity was associated with membership in a specific substance use trajectory, although receiving trauma-informed treatment was not. Additionally, SUD severity, age and after-care efforts were shown to be related to trajectory membership. Findings highlight the necessity of accounting for heterogeneity in post-treatment substance use, relevance of trauma-informed care in SUD recovery and benefits of incorporating methodologies like LGMM when evaluating SUD treatment outcomes. © 2015 Australasian Professional Society on Alcohol and other Drugs.

[Return to Work from Vocational RetrainingA Long-Term Analysis of Individual Trajectories: Biografical and Structural Conditions of Success and Failure].

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Meschnig, Alexander; von Kardorff, Ernst; Klaus, Sebastian

2018-03-28

The study aimed at the reconstruction of the trajectories of participants of a two-year vocational-retraining into new workplaces thereby identifying favourable and risky conditions of the return-to-work process. From a practical point of view the study identified special needs and necessities for after-care facilities. A Mixed-Method-Design was used. Quantitatively the follow-up-study included 214 persons who participated for three times on filling out a questionnaire over a period of eighteen months after the end of the vocational retraining. In the qualitative part of the study thirty persons consented to participate in a narrative-episodic interview on their vocational biography, their illness experiences at work and their way back into work. The study focused on the experiences of the participants from within, on their decision-making, coping, and rearrangement processes as well as on the experienced support from family members and rehabilitation professionals. About 75% of the participants of the vocational retraining succeeded in getting a job within the range of 18 months after finishing the retraining. Indicators for successful Return to Work are a high identification with the new vocation, effective coping with the remaining health problems, and an accepted arrangement with the disabilities in the work place and in everyday-life, a positive anticipation of the health condition in the future, and last but not least a satisfying social inclusion. As specific risk constellations for Return to Work emerged a lack of partnership, unfinished mental coping with the illness, negative subjective health prognosis, and a more passive attitude to life. © Georg Thieme Verlag KG Stuttgart · New York.

Interventions developed with the Intervention Mapping protocol in the field of cancer: A systematic review.

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Lamort-Bouché, Marion; Sarnin, Philippe; Kok, Gerjo; Rouat, Sabrina; Péron, Julien; Letrilliart, Laurent; Fassier, Jean-Baptiste

2018-04-01

The Intervention Mapping (IM) protocol provides a structured framework to develop, implement, and evaluate complex interventions. The main objective of this review was to identify and describe the content of the interventions developed in the field of cancer with the IM protocol. Secondary objectives were to assess their fidelity to the IM protocol and to review their theoretical frameworks. Medline, Web of Science, PsycINFO, PASCAL, FRANCIS, and BDSP databases were searched. All titles and abstracts were reviewed. A standardized extraction form was developed. All included studies were reviewed by 2 reviewers blinded to each other. Sixteen studies were identified, and these reported 15 interventions. The objectives were to increase cancer screening participation (n = 7), early consultation (n = 1), and aftercare/quality of life among cancer survivors (n = 7). Six reported a complete participatory planning group, and 7 described a complete logic model of the problem. Ten studies described a complete logic model of change. The main theoretical frameworks used were the theory of planned behaviour (n = 8), the transtheoretical model (n = 6), the health belief model (n = 6), and the social cognitive theory (n = 6). The environment was rarely integrated in the interventions (n = 4). Five interventions were reported as effective. Culturally relevant interventions were developed with the IM protocol that were effective to increase cancer screening and reduce social disparities, particularly when they were developed through a participative approach and integrated the environment. Stakeholders' involvement and the role of the environment were heterogeneously integrated in the interventions. Copyright © 2017 John Wiley & Sons, Ltd.

Quantification of methane and nitrous oxide emissions from various waste treatment facilities by tracer dilution method

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Mønster, Jacob; Rella, Chris; Jacobson, Gloria; Kjeldsen, Peter; Scheutz, Charlotte

2013-04-01

Urban activities generate solid and liquid waste, and the handling and aftercare of the waste results in the emission of various compounds into the surrounding environment. Some of these compounds are emitted as gasses into the atmosphere, including methane and nitrous oxide. Methane and nitrous oxide are strong greenhouse gases and are considered to have 25 and 298 times the greenhouse gas potential of carbon dioxide on a hundred years term (Solomon et al. 2007). Global observations of both gasses have shown increasing concentrations that significantly contribute to the greenhouse gas effect. Methane and nitrous oxide are emitted from both natural and anthropogenic sources and inventories of source specific fugitive emissions from the anthropogenic sources of methane and nitrous oxide of are often estimated on the basis of modeling and mass balance. Though these methods are well-developed, actual measurements for quantification of the emissions is a very useful tool for verifying the modeling and mass balance as well as for validation initiatives done for lowering the emissions of methane and nitrous oxide. One approach to performing such measurements is the tracer dilution method (Galle et al. 2001, Scheutz et al. 2011), where the exact location of the source is located and a tracer gas is released at this source location at a known flow. The ratio of downwind concentrations of the tracer gas and the methane and nitrous oxide gives the emissions rates of the greenhouse gases. This tracer dilution method can be performed using both stationary and mobile measurements and in both cases, real-time measurements of both tracer and quantified gas are required, placing high demands on the analytical detection method. To perform the methane and nitrous oxide measurements, two robust instruments capable of real-time measurements were used, based on cavity ring-down spectroscopy and operating in the near-infrared spectral region. One instrument measured the methane and

Survived so what? Identifying priorities for research with children and families post-paediatric intensive care unit.

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Manning, Joseph C; Hemingway, Pippa; Redsell, Sarah A

2018-03-01

The involvement of patients and the public in the development, implementation and evaluation of health care services and research is recognized to have tangible benefits in relation to effectiveness and credibility. However, despite >96% of children and young people surviving critical illness or injury, there is a paucity of published reports demonstrating their contribution to informing the priorities for aftercare services and outcomes research. We aimed to identify the service and research priorities for Paediatric Intensive Care Unit survivors with children and young people, their families and other stakeholders. We conducted a face-to-face, multiple-stakeholder consultation event, held in the Midlands (UK), to provide opportunities for experiences, views and priorities to be elicited. Data were gathered using write/draw and tell and focus group approaches. An inductive content analytical approach was used to categorize and conceptualize feedback. A total of 26 individuals attended the consultation exercise, including children and young people who were critical care survivors; their siblings; parents and carers; health professionals; academics; commissioners; and service managers. Consultation findings indicated that future services, interventions and research must be holistic and family-centred. Children and young people advisors reported priorities that focused on longer-term outcomes, whereas adult advisors identified priorities that mapped against the pathways of care. Specific priorities included developing and testing interventions that address unmet communication and information needs. Furthermore, initiatives to optimize the lives and longer-term functional and psycho-social outcomes of Paediatric Intensive Care Unit survivors were identified. This consultation exercise provides further evidence of the value of meaningful patient and public involvement in identifying the priorities for research and services for Paediatric Intensive Care Unit survivors

Methane oxidation and attenuation of sulphur compounds in landfill top cover systems: Lab-scale tests.

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Raga, Roberto; Pivato, Alberto; Lavagnolo, Maria Cristina; Megido, Laura; Cossu, Raffaello

2018-03-01

In this study, a top cover system is investigated as a control for emissions during the aftercare of new landfills and for old landfills where biogas energy production might not be profitable. Different materials were studied as landfill cover system in lab-scale columns: mechanical-biological pretreated municipal solid waste (MBP); mechanical-biological pretreated biowaste (PB); fine (PBS f ) and coarse (PBS c ) mechanical-biological pretreated mixtures of biowaste and sewage sludge, and natural soil (NS). The effectiveness of these materials in removing methane and sulphur compounds from a gas stream was tested, even coupled with activated carbon membranes. Concentrations of CO 2 , CH 4 , O 2 , N 2 , H 2 S and mercaptans were analysed at different depths along the columns. Methane degradation was assessed using mass balance and the results were expressed in terms of methane oxidation rate (MOR). The highest maximum and mean MOR were observed for MBP (17.2gCH 4 /m 2 /hr and 10.3gCH 4 /m 2 /hr, respectively). Similar values were obtained with PB and PBS c . The lowest values of MOR were obtained for NS (6.7gCH 4 /m 2 /hr) and PBS f (3.6gCH 4 /m 2 /hr), which may be due to their low organic content and void index, respectively. Activated membranes with high load capacity did not seem to have an influence on the methane oxidation process: MBP coupled with 220g/m 2 and 360g/m 2 membranes gave maximum MOR of 16.5gCH 4 /m 2 /hr and 17.4gCH 4 /m 2 /hr, respectively. Activated carbon membranes proved to be very effective on H 2 S adsorption. Furthermore, carbonyl sulphide, ethyl mercaptan and isopropyl mercaptan seemed to be easily absorbed by the filling materials. Copyright © 2017. Published by Elsevier B.V.

Performance of zirconia ceramic cantilever fixed dental prostheses: 3-year results from a prospective, randomized, controlled pilot study.

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Zenthöfer, Andreas; Ohlmann, Brigitte; Rammelsberg, Peter; Bömicke, Wolfgang

2015-07-01

Little is known about the clinical performance of ceramic cantilever fixed dental prostheses on natural teeth. The purpose of this randomized controlled pilot study was to evaluate the clinical performance of ceramic and metal ceramic cantilever fixed dental prostheses (CFDPs) after 3 years of service. Twenty-one participants were randomly allocated to 2 treatment groups. Participants in the ceramic (ZC) group (n=11) each received 1 CFDP made of yttria-stabilized, tetragonal zirconia polycrystal; the others (n=10) were fitted with a metal ceramic (MC) CFDP. All CFDPs were retained by 2 complete crown abutments and replaced 1 tooth. The clinical target variables were survival, incidence of complications, probing pocket depth (PPD), probing attachment level (PAL), plaque index (PI), gingival index (GI), and esthetic performance as rated by the participants. The United States Public Health Service (USPHS) criteria were used to evaluate chipping, retention, color, marginal integrity, and secondary caries. Descriptive statistics and nonparametric analyses were applied to the target variables in the 2 groups. The esthetic performance of the CFDPs was also visualized by using a pyramid comparison. The overall survival of the CFDPs was 100% in both groups. During the 3-year study, 6 clinically relevant complications requiring aftercare were observed among 5 participants (4 in the ZC group and 2 in the MC group). Changes in the PI, GI, PPD, and PAL of the abutment teeth were similar for both groups (P>.05). The participants regarded the esthetic performance of ZC-CFDPs and MC-CFDPs as satisfactory. Within the 3-year observation period, the clinical performance of MC-FDPs and ZC-FDPs was acceptable. More extensive research with larger sample sizes is encouraged, however, to confirm the evaluation of the survival of Y-TZP hand-veneered cantilever FPDs. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair.

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Heidekrueger, Paul I; Thu, Myat; Mühlbauer, Wolfgang; Holm-Mühlbauer, Charlotte; Schucht, Philippe; Anderl, Hans; Schoeneich, Heinrich; Aung, Kyawzwa; Mg Ag, Mg; Thu Soe Myint, Ag; Juran, Sabrina; Aung, Thiha; Ehrl, Denis; Ninkovic, Milomir; Broer, P Niclas

2017-10-01

OBJECTIVE Although rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to neurosurgeons and plastic reconstructive surgeons. Especially when faced with limited infrastructure and resources, establishing reliable and safe surgical techniques is of paramount importance. The authors present a case series in order to evaluate a previously proposed concise approach for meningoencephalocele repair, with a focus on sustainability of internationally driven surgical efforts. METHODS Between 2001 and 2016, a total of 246 patients with frontoethmoidal meningoencephaloceles were treated using a 1-stage extracranial approach by a single surgeon in the Department of Neurosurgery of the Yangon General Hospital in Yangon, Myanmar, initially assisted by European surgeons. Outcomes and complications were evaluated. RESULTS A total of 246 patients (138 male and 108 female) were treated. Their ages ranged from 75 days to 32 years (median 8 years). The duration of follow-up ranged between 4 weeks and 16 years (median 4 months). Eighteen patients (7.3%) showed signs of increased intracranial pressure postoperatively, and early CSF rhinorrhea was observed in 27 patients (11%), with 5 (2%) of them requiring operative dural repair. In 8 patients, a decompressive lumbar puncture was performed. There were 8 postoperative deaths (3.3%) due to meningitis. In 15 patients (6.1%), recurrent herniation of brain tissue was observed; this herniation led to blindness in 1 case. The remaining patients all showed good to very good aesthetic and functional results. CONCLUSIONS A minimally invasive, purely extracranial approach to frontoethmoidal meningoencephalocele repair may serve well, especially in middle- and low-income countries. This case series points out how the frequently critiqued lack of sustainability in the field of humanitarian surgical missions, as well as the often-cited missing aftercare and dependence on foreign supporters, can be circumvented by meticulous

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

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Seyed Ahmad Rasoulinejad

2014-09-01

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.

Etiology of Readmissions Following Orthopaedic Procedures and Medical Admissions. A Comparative Analysis.

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Maslow, Jed; Hutzler, Lorraine; Slover, James; Bosco, Joseph

2015-12-01

The Federal Government, the largest payer of health care, considers readmission within 30 days of discharge an indicator of quality of care. Many studies have focused on causes for and strategies to reduce readmissions following medical admissions. However, few studies have focused on the differences between them. We believe that the causes for readmission following orthopaedic surgery are markedly different than those following medical admissions, and therefore, the strategies developed to reduce medical readmissions will not be as effective in reducing readmissions after elective orthopaedic surgery. All unplanned 30-day readmissions following an index hospitalization for an elective orthopaedic procedure (primary and revision total joint arthroplasty and spine procedure) or for one of the three publicly reported medical conditions (AMI, HF, and pneumonia, which accounted for 11% of readmissions) were identified at our institution from 2010 through 2012. A total of 268 patients and 390 medical patients were identified as having an unplanned 30-day readmission. We reviewed a prospectively collected data base to determine the reason for readmission in each encounter. A total of 233 (86.9%) orthopaedic patients were readmitted for surgical complications, most commonly for a wound infection (56.0%) or wound complication (11.6%). Following an index admission of HF or AMI, the primary reason for readmission was a disease of the circulatory system (55.9% and 57.4%, respectively). Following an index admission for pneumonia, the primary reason for readmission was a disease of the respiratory system (34.5%). The causes of readmissions following orthopaedic surgery and medical admissions are different. Patients undergoing orthopaedic procedures are readmitted for surgical complications, frequently unrelated to aftercare, and medicine patients are readmitted for reasons related to the index diagnosis. Interventions designed to reduce orthopaedic readmissions must focus on

Current state and future prospects of remedial soil protection. Background

Energy Technology Data Exchange (ETDEWEB)

Frauenstein, Joerg

2009-08-15

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.)

[Integrated intensive treatment of tinnitus: decrease of the tinnitus-related distress during a one-year follow-up study].

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Mazurek, B; Seydel, C; Haupt, H; Szczepek, A; Klapp, B F; Schrom, T

2009-01-01

The therapy of the chronic tinnitus is aimed at improving the way patients cope with their tinnitus and at reducing the tinnitus-related distress. The present study investigated the changes of psychometric parameters that occurred in patients with chronic tinnitus after 7-days outpatient multidisciplinary therapy. The changes were monitored for up to 1 year in order to evaluate the long-term efficiency. Main emphasis of the intensive tinnitus therapy applied was placed on tinnitus habituation and on teaching the patients how to apply coping strategies. The main elements of the multimodal concept included progressive muscle relaxation according to Jacobson, physiotherapy, educative seminars, training of selective attention and, lastly, the change of judgment, attitude and behaviour towards tinnitus. Psychometric parameters and tinnitus-related distress were assessed prior to and after the therapy (at 3, 6 and 12 months) using the tinnitus questionnaire (TQ) according to Goebel and Hiller. Furthermore, subjects waiting for therapy (waiting list) were recruited to the control group and compared with the therapy group which had received therapy 3 months earlier. The therapy group showed a significant reduction of the TQ total score after 3 months as compared to the control group. Moreover, we observed a long-term, progressive positive outcome during the one-year follow-up. The TQ total score was reduced by 10.9 points. There was an obvious decrease of the emotional and cognitive distress as well as of the intrusiveness of tinnitus, as per evaluation of TQ subscales. The outpatient intensive multidisciplinary tinnitus therapy with long-term aftercare has proved to be an effective method in the treatment of patients with chronic tinnitus. The outpatient setting enables the instant implementation of strategies learned during therapy in the patients' everyday life.

A Qualitative Study of Service Provision for Alcohol Related Health Issues in Mid to Later Life.

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Catherine Haighton

Full Text Available Epidemiological surveys over the last 20 years show a steady increase in the amount of alcohol consumed by older age groups. Physiological changes and an increased likelihood of health problems and medication use make older people more likely than younger age groups to suffer negative consequences of alcohol consumption, often at lower levels. However, health services targeting excessive drinking tend to be aimed at younger age groups. The aim of this study was to gain an in-depth understanding of experiences of, and attitudes towards, support for alcohol related health issues in people aged 50 and over.Qualitative interviews (n = 24, 12 male/12 female, ages 51-90 years and focus groups (n = 27, 6 male/21 female, ages 50-95 years were carried out with a purposive sample of participants who consumed alcohol or had been dependent.Participants' alcohol misuse was often covert, isolated and carefully regulated. Participants tended to look first to their General Practitioner for help with alcohol. Detoxification courses had been found effective for dependent participants but only in the short term; rehabilitation facilities were appreciated but seen as difficult to access. Activities, informal groups and drop-in centres were endorsed. It was seen as difficult to secure treatment for alcohol and mental health problems together. Barriers to seeking help included functioning at a high level, concern about losing positive aspects of drinking, perceived stigma, service orientation to younger people, and fatalistic attitudes to help-seeking. Facilitators included concern about risk of fatal illness or pressure from significant people.Primary care professionals need training on improving the detection and treatment of alcohol problems among older people. There is also a compelling need to ensure that aftercare is in place to prevent relapse. Strong preferences were expressed for support to be provided by those who had experienced alcohol problems themselves.

Guidelines for psychosocial interventions in addictive disorders in India: An introduction and overview.

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Murthy, Pratima

2018-02-01

dichotomies neither exist in the affected individual's mind, nor should be present in the treating clinician. A comprehensive understanding of addiction requires an understanding of the person in his/her environment and needs a personalised holistic approach that addresses the diverse physical/mental health, occupational, legal, social and aftercare needs.

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

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Platt Stephen

2007-01-01

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.

How to stay in touch with adolescents and young adults after a suicide attempt? Implementation of a 4-phones-calls procedure over 1 year after discharge from hospital, in a Parisian suburb.

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Normand, D; Colin, S; Gaboulaud, V; Baubet, T; Taieb, O

2018-01-26

Post-discharge treatment is a major part of youth suicide prevention. However, many adolescents and young adults suicidal patients released from emergency department (ED) fail to follow through with subsequent outpatient psychiatric appointments. The aims were to (1) implement a one-year follow-up phone-call program for adolescent and young adults suicide attempters admitted at the ED (2) assess its feasibility (3) describe outcomes measures (repeated suicide attempt and observance of outpatient care) and (4) access risk factors to be out of sight at one year follow up and (5) elicit subjective feedback after one year, using narrative data. A cohort of adolescents and young adults aged 15-21 years admitted to Avicenne University Hospital ED for suicide attempt (SA) was created and re-contacted using phone calls at one week, one month, six months and twelve months after discharge. Sociodemographic information was collected at baseline. At one year, qualitative data was collected from patients or their parents. One hundred and seventy-three adolescents and young adults were included. At 1 year, 93 young patients had been successfully contacted, among whom 23 had reattempted suicide, at least once. Adolescents and young adults that were unreachable at one year showed a higher rate of school dropout and had more migration history at baseline. Feedback showed that the intervention was experienced as supportive. Phone-calls after discharge from hospital might help enhance compliance to aftercare treatment, and were well-accepted by both adolescents and parents. Nevertheless, half of our sample was lost of sight at one year. Further studies are needed to find the most effective prevention strategy with young suicide attempters, especially for migrants and school droppers. Copyright © 2017 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Bioresorbable pins and interference screws for fixation of hamstring tendon grafts in anterior cruciate ligament reconstruction surgery: a randomized controlled trial.

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Stengel, Dirk; Casper, Dirk; Bauwens, Kai; Ekkernkamp, Axel; Wich, Michael

2009-09-01

Biodegradable cross-pins have been shown to provide higher failure loads than do screws for fixation of hamstring tendons under laboratory conditions. To compare the clinical results of biodegradable pins (RigidFix) and interference screws (BioCryl) for fixation of hamstring grafts in arthroscopically assisted anterior cruciate ligament reconstruction. Study Design Randomized controlled trial; Level of evidence, 1. To test the hypothesis of a difference of 1.0 +/- 1.2 mm in anterior knee laxity between the two fixation options, 54 patients were randomly assigned to groups via a block randomization scheme and sealed envelopes. All patients underwent standardized hamstring graft reconstruction and had similar postoperative aftercare by an accelerated rehabilitation protocol. Measures assessed at baseline and after 1 and 2 years of follow-up included (1) the side-to-side difference in anterior laxity (KT-1000 arthrometer), (2) Short Form 36 physical and mental component scores, and (3) the International Knee Documentation Committee form scores. After 1 and 2 years, 26 and 21 patients in the BioCryl group and 28 and 24 patients in the RigidFix group were available for follow-up examination. No significant difference was noted in instrumented anterior translation between BioCryl and RigidFix fixation: 1 year, 0.11 (95% CI, -0.60 to 0.82; P = .7537); 2 years, 0.33 (95% CI, -0.43 to 1.08 mm; P = .3849). Also, there were no significant differences in the mean physical and mental component scores and International Knee Documentation Committee form scores and in overall complication and surgical revision rates. A pin dislocation was classified as the sole procedure-specific serious adverse event. Bioresorbable pins do not provide better clinical results than do resorbable interference screws for hamstring graft fixation in anterior cruciate ligament reconstruction surgery.

Understanding the acceptability of e-mental health--attitudes and expectations towards computerised self-help treatments for mental health problems.

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Musiat, Peter; Goldstone, Philip; Tarrier, Nicholas

2014-04-11

E-mental health and m-mental health include the use of technology in the prevention, treatment and aftercare of mental health problems. With the economical pressure on mental health services increasing, e-mental health and m-mental health could bridge treatment gaps, reduce waiting times for patients and deliver interventions at lower costs. However, despite the existence of numerous effective interventions, the transition of computerised interventions into care is slow. The aim of the present study was to investigate the acceptability of e-mental health and m-mental health in the general population. An advisory group of service users identified dimensions that potentially influence an individual's decision to engage with a particular treatment for mental health problems. A large sample (N = 490) recruited through email, flyers and social media was asked to rate the acceptability of different treatment options for mental health problems on these domains. Results were analysed using repeated measures MANOVA. Participants rated the perceived helpfulness of an intervention, the ability to motivate users, intervention credibility, and immediate access without waiting time as most important dimensions with regard to engaging with a treatment for mental health problems. Participants expected face-to-face therapy to meet their needs on most of these dimensions. Computerised treatments and smartphone applications for mental health were reported to not meet participants' expectations on most domains. However, these interventions scored higher than face-to-face treatments on domains associated with the convenience of access. Overall, participants reported a very low likelihood of using computerised treatments for mental health in the future. Individuals in this study expressed negative views about computerised self-help intervention and low likelihood of use in the future. To improve the implementation and uptake, policy makers need to improve the public perception of such

Patient preference and satisfaction with implant-supported mandibular overdentures retained with ball or locator attachments: a crossover clinical trial.

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Krennmair, Gerald; Seemann, Rudolf; Fazekas, Andres; Ewers, Rolf; Piehslinger, Eva

2012-01-01

modalities, the Locator attachment required more postinsertion aftercare (activation of retention) than the ball anchors.

Colorectal cancer patient's self-efficacy for managing illness-related problems in the first 2 years after diagnosis, results from the ColoREctal Well-being (CREW) study.

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Grimmett, Chloe; Haviland, Joanne; Winter, Jane; Calman, Lynn; Din, Amy; Richardson, Alison; Smith, Peter W F; Foster, Claire

2017-10-01

There is a growing emphasis on self-management of cancer aftercare. Little is known about patient's self-efficacy (confidence) to manage illness-related problems and how this changes over time. This paper describes the patterns of self-efficacy for managing illness-related problems amongst colorectal cancer patients in the 2 years following diagnosis. In this prospective cohort study, questionnaires were administered at baseline (pre-surgery), 3, 9, 15 and 24 months to 872 colorectal cancer patients. Self-efficacy (confidence to manage illness-related problems), anxiety, social support, affect, socio-demographics, physical symptoms and clinical and treatment characteristics were assessed. Group-based trajectory analysis identified trajectories of self-efficacy up to 24 months and predictors. Four trajectories of self-efficacy were identified: group 1 (very confident) 16.0% (95% confidence interval (CI) 10.7-21.3%), group 2 (confident) 45.6% (95% CI 40.3-51.0%), group 3 (moderately confident) 29.5% (95% CI 25.1-33.8%) and group 4 (low confidence) 8.9% (95% CI 6.4-11.4%). Greater deprivation, domestic status, more co-morbidities, worse fatigue and pain, lower positivity and greater negativity were significantly associated with lower self-efficacy. There was an increase in mean scores for self-efficacy over time for the whole sample, but this did not reach the cut-off for minimally important differences. At 2 years, the lowest level of confidence to manage was for symptoms or health problems. Around 40% of patients had suboptimal levels of confidence to manage illness-related problems with little change from the time of diagnosis across the four groups. Screening for self-efficacy at diagnosis would enable targeted, early intervention which could in turn enhance health-related quality of life.

Filmless versus film-based systems in radiographic examination costs: an activity-based costing method

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Sase Yuji

2011-09-01

Full Text Available Abstract Background Since the shift from a radiographic film-based system to that of a filmless system, the change in radiographic examination costs and costs structure have been undetermined. The activity-based costing (ABC method measures the cost and performance of activities, resources, and cost objects. The purpose of this study is to identify the cost structure of a radiographic examination comparing a filmless system to that of a film-based system using the ABC method. Methods We calculated the costs of radiographic examinations for both a filmless and a film-based system, and assessed the costs or cost components by simulating radiographic examinations in a health clinic. The cost objects of the radiographic examinations included lumbar (six views, knee (three views, wrist (two views, and other. Indirect costs were allocated to cost objects using the ABC method. Results The costs of a radiographic examination using a filmless system are as follows: lumbar 2,085 yen; knee 1,599 yen; wrist 1,165 yen; and other 1,641 yen. The costs for a film-based system are: lumbar 3,407 yen; knee 2,257 yen; wrist 1,602 yen; and other 2,521 yen. The primary activities were "calling patient," "explanation of scan," "take photographs," and "aftercare" for both filmless and film-based systems. The cost of these activities cost represented 36.0% of the total cost for a filmless system and 23.6% of a film-based system. Conclusions The costs of radiographic examinations using a filmless system and a film-based system were calculated using the ABC method. Our results provide clear evidence that the filmless system is more effective than the film-based system in providing greater value services directly to patients.

Filmless versus film-based systems in radiographic examination costs: an activity-based costing method.

Science.gov (United States)

Muto, Hiroshi; Tani, Yuji; Suzuki, Shigemasa; Yokooka, Yuki; Abe, Tamotsu; Sase, Yuji; Terashita, Takayoshi; Ogasawara, Katsuhiko

2011-09-30

Since the shift from a radiographic film-based system to that of a filmless system, the change in radiographic examination costs and costs structure have been undetermined. The activity-based costing (ABC) method measures the cost and performance of activities, resources, and cost objects. The purpose of this study is to identify the cost structure of a radiographic examination comparing a filmless system to that of a film-based system using the ABC method. We calculated the costs of radiographic examinations for both a filmless and a film-based system, and assessed the costs or cost components by simulating radiographic examinations in a health clinic. The cost objects of the radiographic examinations included lumbar (six views), knee (three views), wrist (two views), and other. Indirect costs were allocated to cost objects using the ABC method. The costs of a radiographic examination using a filmless system are as follows: lumbar 2,085 yen; knee 1,599 yen; wrist 1,165 yen; and other 1,641 yen. The costs for a film-based system are: lumbar 3,407 yen; knee 2,257 yen; wrist 1,602 yen; and other 2,521 yen. The primary activities were "calling patient," "explanation of scan," "take photographs," and "aftercare" for both filmless and film-based systems. The cost of these activities cost represented 36.0% of the total cost for a filmless system and 23.6% of a film-based system. The costs of radiographic examinations using a filmless system and a film-based system were calculated using the ABC method. Our results provide clear evidence that the filmless system is more effective than the film-based system in providing greater value services directly to patients.

Suicide attempt in young people: a signal for long-term health care and social needs.

Science.gov (United States)

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

2014-02-01

-term monitoring and after-care services are needed.

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

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Zimmermann Heinz

2008-12-01

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

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

Science.gov (United States)

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

2008-12-23

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. 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. 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). Patients who first present at the ER with a lateral ankle ligament injury grade I-II can be referred to a

Meniscectomy: indications, procedure, outcomes, and rehabilitation

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Anetzberger H

2013-12-01

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

Patterns and determinants of acute psychiatric readmissions

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Graham Michael Behr

2002-12-01

Full Text Available Objectives . Deinstitutionalisation and shortage of psychiatric beds worldwide has led to extensive research into the risk fac- tors and interventions associated with rapid and recurrent admission to hospital. Little research of this nature has taken place in South Africa, particularly with regard to acute hospital admissions. This study attempted primarily to assess the effect of length of stay and administration of depot antipsychotics in hospital on time to readmission. Design. A retrospective cohort of 180 admissions was fol- lowed up for 12 months, after an index discharge, by means of multiple hospital and community-based record reviews. Each readmission was analysed as an event using a survival analysis model. Setting. Chris Hani Baragwanath Hospital, Gauteng. Subjects. A random sample of patients admitted during a 6-month period in 1996. Outcome measures. Time to readmission. Results. Two hundred and eighty-four admissions were analysed. The only factor that provided a significant protective effect was being married or cohabiting ( P = 0.015. Clinic attendance showed a slight protective effect early on but con- ferred a significantly higher risk of readmission on those who had been out of hospital for a long period ( P = 0.001. Only 21% of discharged patients ever attended a clinic. The overall risk of readmission was significantly higher in the first 90 days post discharge. Conclusions. The lack of impact of length of hospital stay and use of depot neuroleptics on time to readmission may indicate that patients are being kept for appropriate duration and that the most ill patients are receiving depot medication. Several sampling and statistical artefacts may explain some of our findings. These results confirm the worldwide difficulty in finding consistent and accurate predictors of readmission. Low rates of successful referral to community aftercare need to be addressed before their effectiveness can be reasonably assessed. The inherent

Systemic Case Formulation, Individualized Process Monitoring, and State Dynamics in a Case of Dissociative Identity Disorder.

Science.gov (United States)

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

2016-01-01

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

Hybrid 3D visualization of the chest and virtual endoscopy of the tracheobronchial system: possibilities and limitations of clinical application.

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Seemann, M D; Claussen, C D

2001-06-01

guiding bronchoscopic biopsy, surgical intervention and palliative therapy and is likely to be increasingly accepted as a screening method for people with suspected endobronchial malignancy and as control examination in the aftercare of patients with malignant diseases.

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

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Alrakaf S

2014-09-01

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

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

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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

Body piercing: complications and prevention of health risks.

Science.gov (United States)

Holbrook, Jaimee; Minocha, Julia; Laumann, Anne

2012-02-01

Body and earlobe piercing are common practices in the USA today. Minor complications including infection and bleeding occur frequently and, although rare, major complications have been reported. Healthcare professionals should be cognizant of the medical consequences of body piercing. Complications vary depending on the body-piercing site, materials used, experience of the practitioner, hygiene regimens, and aftercare by the recipient. Localized infections are common. Systemic infections such as viral hepatitis and toxic shock syndrome and distant infections such as endocarditis and brain abscesses have been reported. Other general complications include allergic contact dermatitis (e.g. from nickel or latex), bleeding, scarring and keloid formation, nerve damage, and interference with medical procedures such as intubation and blood/organ donation. Site-specific complications have been reported. Oral piercings may lead to difficulty speaking and eating, excessive salivation, and dental problems. Oral and nasal piercings may be aspirated or become embedded, requiring surgical removal. Piercing tracts in the ear, nipple, and navel are prone to tearing. Galactorrhea may be caused by stimulation from a nipple piercing. Genital piercings may lead to infertility secondary to infection, and obstruction of the urethra secondary to scar formation. In men, priapism and fistula formation may occur. Women who are pregnant or breastfeeding and have a piercing or are considering obtaining one need to be aware of the rare complications that may affect them or their child. Though not a 'complication' per se, many studies have reported body piercing as a marker for high-risk behavior, psychopathologic symptoms, and anti-social personality traits. When it comes to piercing complications, prevention is the key. Body piercers should take a complete medical and social history to identify conditions that may predispose an individual to complications, and candidates should choose a

Innovative dual-step management of semi-aerobic landfill in a tropical climate.

Science.gov (United States)

Lavagnolo, Maria Cristina; Grossule, Valentina; Raga, Roberto

2018-04-01

Despite concerted efforts to innovate the solid waste management (SWM) system, land disposal continues to represent the most widely used technology in the treatment of urban solid waste worldwide. On the other hand, landfilling is an unavoidable step in closing the material cycle, since final residues, although minimized, need to be safely disposed of and confined. In recent years, the implementation of more sustainable landfilling aims to achieve the Final Storage Quality conditions as fast as possible. In particular, semi-aerobic landfill appears to represent an effective solution for use in the poorest economies due to lower management costs and shorter aftercare resulting from aerobic stabilisation of the waste. Nevertheless, the implementation of a semi-aerobic landfill in a tropical climate may affect the correct functioning of the plant: a lack of moisture during the dry season and heavy rainfalls during the wet season could negatively affect performance of both the degradation process, and of leachate and biogas management. This paper illustrates the results obtained through the experimentation of a potential dual-step management of semi-aerobic landfilling in a tropical climate in which composting process was reproduced during the dry season and subsequently flushing (high rainfall rate) during the wet period. Eight bioreactors specifically designed: four operated under anaerobic conditions and four under semi-aerobic conditions; half of the reactors were filled with high organic content waste, half with residual waste obtained following enhanced source segregation. The synergic effect of the subsequent phases (composting and flushing) in the semi-aerobic landfill was evaluated on the basis of both types of waste. Biogas production, leachate composition and waste stabilization were analysed during the trial and at the end of each step, and compared in view of the performance of anaerobic reactors. The results obtained underlined the effectiveness of the

Monitoring carcinogenesis in a case of oral squamous cell carcinoma using a panel of new metabolic blood biomarkers as liquid biopsies.

Science.gov (United States)

Grimm, Martin; Hoefert, Sebastian; Krimmel, Michael; Biegner, Thorsten; Feyen, Oliver; Teriete, Peter; Reinert, Siegmar

2016-09-01

diagnostic tool for the addition to the OSCC staging system and as a routine procedure in the aftercare.

Protocol of a cluster randomised stepped-wedge trial of behavioural interventions targeting amphetamine-type stimulant use and sexual risk among female entertainment and sex workers in Cambodia.

Science.gov (United States)

Page, Kimberly; Stein, Ellen S; Carrico, Adam W; Evans, Jennifer L; Sokunny, Muth; Nil, Ean; Ngak, Song; Sophal, Chhit; McCulloch, Charles; Maher, Lisa

2016-05-09

HIV risk among female entertainment and sex workers (FESW) remains high and use of amphetamine-type stimulants (ATS) significantly increases this risk. We designed a cluster randomised stepped wedge trial (The Cambodia Integrated HIV and Drug Prevention Implementation (CIPI) study) to test sequentially delivered behavioural interventions targeting ATS use. The trial combines a 12-week Conditional Cash Transfer (CCT) intervention with 4 weeks of cognitive-behavioural group aftercare (AC) among FESW who use ATS. The primary goal is to reduce ATS use and unprotected sex among FESW. The CCT+AC intervention is being implemented in 10 provinces where order of delivery was randomised. Outcome assessments (OEs) including biomarkers and self-reported measures of recent sexual and drug use behaviours are conducted prior to implementation, and at three 6-month intervals after completion. Consultation with multiple groups and stakeholders on implementation factors facilitated acceptance and operationalisation of the trial. Statistical power and sample size calculations were based on expected changes in ATS use and unprotected sex at the population level as well as within subjects. Ethical approvals were granted by the Cambodia National Ethics Committee; University of New Mexico; University of California, San Francisco; and FHI360. The trial is registered with ClinicalTrials.gov. Dissemination of process indicators during the multiyear trial is carried out through annual in-country Stakeholder Meetings. Provincial 'Close-Out' forums are held at the conclusion of data collection in each province. When analysis is completed, dissemination meetings will be held in Cambodia with stakeholders, including community-based discussion sessions, policy briefs and results published and presented in the HIV prevention scientific journals and conferences. CIPI is the first trial of an intervention to reduce ATS use and HIV risk among FESW in Cambodia. Will inform both CCT+AC implementation

Systemic Case Formulation, Individualized Process Monitoring, and State Dynamics in a Case of Dissociative Identity Disorder.

Directory of Open Access Journals (Sweden)

Guenter Karl Schiepek

2016-10-01

Full Text Available 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

Multimodal document management in radiotherapy

International Nuclear Information System (INIS)

Fahrner, H.; Kirrmann, S.; Roehner, F.; Schmucker, M.; Hall, M.; Heinemann, F.

2013-01-01

workflow via continuous processes. Since the completion of the concepts and the implementation in our test environment 15,000 documents were introduced into the departmental workflow following routine approval. Furthermore approximately 5000 appointment letters for patient aftercare per year were automatically generated by the BAS. In addition patient record extracts in the form of PDF files for the medical services of the healthcare insurer can be generated. (orig.)

Do Programs for Runaway and Homeless Youth Work? A Qualitative Exploration From the Perspectives of Youth Clients in Diverse Settings

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Marya Gwadz

2018-04-01

Full Text Available Runaway and homeless youth (RHY comprise a large population of young people who reside outside the control and protection of parents and guardians and who experience numerous traumas and risk factors, but few buffering resources. Specialized settings have developed to serve RHY, but little is known about their effects. The present cross-sectional qualitative descriptive study, grounded in the positive youth development approach and the Youth Program Quality Assessment model, addressed this gap in the literature. From a larger sample of 29 RHY-specific settings across New York State, RHY ages 16–21 from 11 settings were purposively sampled for semi-structured in-depth interviews on their transitions into homelessness, experiences with settings, and unmet needs (N = 37 RHY. Data were analyzed with a theory-driven and inductive systematic content analysis approach. Half of participants (54% were female; almost half (49% identified as non-heterosexual; and 42% were African American/Black, 31% were Latino/Hispanic, and 28% were White/other. Results indicated that because RHY are a uniquely challenged population, distrustful of service settings and professional adults and skilled at surviving independently, the population-tailored approaches found in RHY-specific settings are vital to settings’ abilities to effectively engage and serve RHY. We found the following four major themes regarding the positive effects of settings: (1 engaging with an RHY setting was emotionally challenging and frightening, and thus the experiences of safety and services tailored to RHY needs were critical; (2 instrumental support from staff was vital and most effective when received in a context of emotional support; (3 RHY were skilled at survival on the streets, but benefited from socialization into more traditional systems to foster future independent living; and (4 follow-through and aftercare were needed as RHY transitioned out of services. With respect to gaps

Recovery post treatment: plans, barriers and motivators.

Science.gov (United States)

Duffy, Paul; Baldwin, Helen

2013-01-30

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. 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. 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. 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 maintaining aspects of a 'normal' life i.e. 'social and physical

Recovery post treatment: plans, barriers and motivators

Directory of Open Access Journals (Sweden)

Duffy Paul

2013-01-01

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

Positron emission tomography of malignant tumours at head and neck. Evaluation of the diagnostic value of positron emission tomography by comparison with computed tomography; Positronenemissionstomographie bei malignen Tumoren im Kopf- und Halsbereich. Beurteilung der diagnostischen Wertigkeit der Positronenemissionstomographie im Vergleich zur Computertomographie

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Kettler, Nele

2011-12-02

Imaging methods for early, accurate diagnosis and aftercare of malignant growths is currently one of the most important research topics. The objective of this thesis is to evaluate the diagnostic value of FDG-positron emission tomography by comparison with computed tomography for patients with squamous cell carcinoma, malignant melanoma or sarcoma at head and neck. Measurement criteria are sensitivity and specificity. A retrospective evaluation of 100 examinations on 85 patients of University clinic Aachen was performed. The examination reports were supported by reports from histology, positron emission tomography and computed tomography. In each case, the histological results were assumed to provide a reliable benchmark. Sensitivity and specificity for the primary tumour site, metastatic lymphatic nodes and defined anatomic structures were compared across all patients. Comparisons were also performed on sub groups separated by gender, cancer type and the time and frequency at which tumours arose. The statistic analysis was done with MedCalc. Results: The results for sensitivity and specificity of the primary tumour site were 86.42% and 42.86%, and 64.71% and 66.07%, for positron emission tomography and computed tomography respectively. The results for the lymphatic nodes were 51.52% and 92.86% and 64.71% and 66.07%. When the constituent anatomic structures were evaluated separately, the specificity was significantly higher. The separation by gender showed no difference. Because the classification by tumor type resulted in samples that were of varying size, a comparison was difficult. For the diagnosis of primary tumours, the examination with positron emission tomography was superior, whereas computed tomography proved more effective for the diagnosis of recurrent tumours. For the diagnosis of the main tumour site, both methods were shown to be equally suitable. For the assessment of lymphatic nodes, positron emission tomography was superior to computed tomography

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

Directory of Open Access Journals (Sweden)

Gilburt Helen

2012-02-01

engagement including completion of assessment, detoxification and aftercare. Discussion Results of this trial will help clarify the potential beneficial effects of ACT for people with alcohol dependence and provide information to design a definitive trial. Trial registration number ISRCTN: ISRCTN22775534

Positron emission tomography of malignant tumours at head and neck. Evaluation of the diagnostic value of positron emission tomography by comparison with computed tomography

International Nuclear Information System (INIS)

Kettler, Nele

2011-01-01

Imaging methods for early, accurate diagnosis and aftercare of malignant growths is currently one of the most important research topics. The objective of this thesis is to evaluate the diagnostic value of FDG-positron emission tomography by comparison with computed tomography for patients with squamous cell carcinoma, malignant melanoma or sarcoma at head and neck. Measurement criteria are sensitivity and specificity. A retrospective evaluation of 100 examinations on 85 patients of University clinic Aachen was performed. The examination reports were supported by reports from histology, positron emission tomography and computed tomography. In each case, the histological results were assumed to provide a reliable benchmark. Sensitivity and specificity for the primary tumour site, metastatic lymphatic nodes and defined anatomic structures were compared across all patients. Comparisons were also performed on sub groups separated by gender, cancer type and the time and frequency at which tumours arose. The statistic analysis was done with MedCalc. Results: The results for sensitivity and specificity of the primary tumour site were 86.42% and 42.86%, and 64.71% and 66.07%, for positron emission tomography and computed tomography respectively. The results for the lymphatic nodes were 51.52% and 92.86% and 64.71% and 66.07%. When the constituent anatomic structures were evaluated separately, the specificity was significantly higher. The separation by gender showed no difference. Because the classification by tumor type resulted in samples that were of varying size, a comparison was difficult. For the diagnosis of primary tumours, the examination with positron emission tomography was superior, whereas computed tomography proved more effective for the diagnosis of recurrent tumours. For the diagnosis of the main tumour site, both methods were shown to be equally suitable. For the assessment of lymphatic nodes, positron emission tomography was superior to computed tomography

Development and pilot testing of an informed consent video for patients with limb trauma prior to debridement surgery using a modified Delphi technique.

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Lin, Yen-Ko; Chen, Chao-Wen; Lee, Wei-Che; Lin, Tsung-Ying; Kuo, Liang-Chi; Lin, Chia-Ju; Shi, Leiyu; Tien, Yin-Chun; Cheng, Yuan-Chia

2017-11-29

Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients' knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items to forecast outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department (ED) were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and

Do Programs for Runaway and Homeless Youth Work? A Qualitative Exploration From the Perspectives of Youth Clients in Diverse Settings.

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Gwadz, Marya; Freeman, Robert M; Kutnick, Alexandra H; Silverman, Elizabeth; Ritchie, Amanda S; Cleland, Charles M; Leonard, Noelle R; Srinagesh, Aradhana; Powlovich, Jamie; Bolas, James

2018-01-01

Runaway and homeless youth (RHY) comprise a large population of young people who reside outside the control and protection of parents and guardians and who experience numerous traumas and risk factors, but few buffering resources. Specialized settings have developed to serve RHY, but little is known about their effects. The present cross-sectional qualitative descriptive study, grounded in the positive youth development approach and the Youth Program Quality Assessment model, addressed this gap in the literature. From a larger sample of 29 RHY-specific settings across New York State, RHY ages 16-21 from 11 settings were purposively sampled for semi-structured in-depth interviews on their transitions into homelessness, experiences with settings, and unmet needs ( N  = 37 RHY). Data were analyzed with a theory-driven and inductive systematic content analysis approach. Half of participants (54%) were female; almost half (49%) identified as non-heterosexual; and 42% were African American/Black, 31% were Latino/Hispanic, and 28% were White/other. Results indicated that because RHY are a uniquely challenged population, distrustful of service settings and professional adults and skilled at surviving independently, the population-tailored approaches found in RHY-specific settings are vital to settings' abilities to effectively engage and serve RHY. We found the following four major themes regarding the positive effects of settings: (1) engaging with an RHY setting was emotionally challenging and frightening, and thus the experiences of safety and services tailored to RHY needs were critical; (2) instrumental support from staff was vital and most effective when received in a context of emotional support; (3) RHY were skilled at survival on the streets, but benefited from socialization into more traditional systems to foster future independent living; and (4) follow-through and aftercare were needed as RHY transitioned out of services. With respect to gaps in settings

"I just feel comfortable out here, there's something about the place": staff and client perceptions of a remote Australian Aboriginal drug and alcohol rehabilitation service.

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Munro, Alice; Allan, Julaine; Shakeshaft, Anthony; Breen, Courtney

2017-12-06

rehabilitation service, with the country or location being fundamental to the daily practice of, and access to, culture. Developing reliable and valid assessments of the program components of culture and treatment alliance would be valuable, given this study has reinforced their perceived importance in achieving positive treatment outcomes. Further, strengthening the aftercare program, as part of an integrated model of care, would likely provide greater support to clients after discharge.

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

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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: steffen.hahn@uk-essen.de; 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))

2011-11-15

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

Effectiveness of rehabilitation after a total hip arthroplasty: a protocol for an observational study for the comparison of usual care in the Netherlands versus Germany.

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Seeber, Gesine H; Wijnen, Annet; Lazovic, Djordje; Bulstra, Sjoerd K; Dietz, Günter; van Lingen, Christiaan P; Stevens, Martin

2017-08-11

Osteoarthritis is the most common joint disorder worldwide. Total hip arthroplasty (THA) is considered one of the most effective treatments for end-stage hip osteoarthritis. The number of THAs is expected to increase dramatically in the coming decades. Usual postoperative rehabilitation after primary THA differs between the German and the Dutch system. In the Netherlands, patients undergo fast-track surgery and are discharged into their home environment within a few days without receiving any aftercare. In Germany, patients stay in the hospital for about 12 days before being transferred to a rehabilitation centre for a period of 3 weeks. The superficially more cost-effective Dutch system of usual care after THA is judged critically in both countries due to suboptimal rehabilitation outcomes. The aim of this study is therefore to compare the Dutch with the German usual care rehabilitation after primary THA. It is hypothesised that the German procedure is more effective in terms of functional outcomes and patient satisfaction than the Dutch procedure and that in the long run the German approach is more cost-effective than the Dutch system. Medical effectiveness will be assessed at four different time points by means of patient self-reported questionnaires and functional tests. Assessments include the Hip disability and Osteoarthritis Outcome Score, Patient Acceptable Symptom State, Short Form 36, EuroQol 5 Dimensions 3 Level Questionnaire, Timed Up & Go Test and Five Times Sit-to-Stand Test. Additionally, long-term economic aspects in both countries will be assessed from a societal perspective, to get a first impression on whether cutting costs for rehabilitation, as practised in the Netherlands, really disburdens the healthcare system efficiently. The study is approved by the Institutional Review Boards of both University Medical Center Groningen (METc2015/483) and Hannover Medical School (no 2874-2015) and will be conducted according to the principles of the

[General conditions concerning the implementation of an outpatient education programme--characteristics and distinctions from an inpatient training programme].

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Brandes, I; Wunderlich, B; Niehues, C

2011-04-01

The aim of the EVA study was to develop an outpatient education programme for women with endometriosis with a view to permanent transfer into routine care. Implementation of the programme generated several problems and obstacles that are not, or not to this extent, present in the inpatient setting of a rehabilitation clinic. The patient education programme was developed in line with an existing inpatient programme, taking into account the criteria for evaluating such training programmes. Several adjustments to process, structure and content level had to be made to achieve the conditions of the outpatient setting. Since May 2008, 17 training courses took place in various outpatient and acute inpatient settings, and a total of 156 women with diagnosed endometriosis participated. The problems and obstacles that emerged affected similarly the process, structure and content of the training programme. On the structural level, especially problems with availability of rooms, technical equipment and trainers occurred, leading to significant time pressures. The main problem on the procedural level was the recruitment of participants, since--in contrast to the inpatient setting and to disease management programmes--no assignment by physicians or insurers takes place. Furthermore, gainful activity of the participants and the resulting shift of the training beyond the usual working and opening hours are important barriers for implementation. The unavailability of trainers in these settings requires creative solutions. Regarding the contents of the training it has to be taken into consideration that--unlike the inpatient setting--no aftercare intervention and no individual psychological consultation are possible. The training programme has to be designed in such a way that all problems that have occurred could be dealt with appropriately. In summary, the permanent implementation of an outpatient training programme is possible but is more time-consuming than inpatient trainings

Suivi après le traitement du cancer du sein

Science.gov (United States)

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

2016-01-01

Résumé Objectif Offrir aux médecins de famille un résumé des recommandations fondées sur les données probantes pour guider les soins aux survivantes traitées pour le cancer du sein. Qualité des données Une recherche documentaire a été effectuée dans MEDLINE entre 2000 et 2016 à l’aide des mots-clés anglais suivants : breast cancer, survivorship, follow-up care, aftercare, guidelines et survivorship care plans, en se concentrant sur la revue des lignes directrices publiées récemment par les organismes nationaux de cancérologie. Les données étaient de niveaux I à III. Message principal Les soins aux survivantes comportent 4 facettes : surveillance et dépistage, prise en charge des effets à long terme, promotion de la santé et coordination des soins. La surveillance des récidives ne se traduit que par une mammographie annuelle, et le dépistage d’autres cancers doit suivre les lignes directrices basées sur la population. La prise en charge des effets à long terme du cancer et de son traitement aborde des problèmes courants tels la douleur, la fatigue, le lymphœdème, la détresse et les effets indésirables des médicaments, de même que les préoccupations à long terme comme la santé du cœur et des os. La promotion de la santé met en relief les bienfaits de l’activité chez les survivantes du cancer, avec l’accent mis sur l’activité physique. Les soins aux survivantes sont de meilleure qualité lorsque divers services et professionnels de la santé participent aux soins, et le médecin de famille joue un rôle important dans la coordination des soins. Conclusion Les médecins de famille sont de plus en plus souvent les principaux fournisseurs de soins de suivi après le traitement du cancer du sein. Le cancer du sein doit être considéré comme une affection médicale chronique, même chez les femmes en rémission, et les patientes profitent de la même approche que celle utilisée pour les autres affections chroniques en

[Evaluation of a simple screening tool for ambulant fall prevention].

Science.gov (United States)

Knobe, M; Rasche, P; Rentemeister, L; Bliemel, C; Bücking, B; Bollheimer, L C; Pape, H-C

2018-02-02

An individual's risk of falling is generally difficult to detect and it is likely to be underestimated. Thus, preventive measures are challenging and they demand sufficient integration and implementation into aftercare and outpatient management. The Aachen Falls Prevention Scale (AFPS) is a quick and easy tool for patient-driven fall risk assessment. Older adults' risk of falling is identified in a suitable manner and they then have the opportunity to independently assess and monitor their risk of falling. The aim of the current study was to evaluate the AFPS as a simple screening tool in geriatric trauma patients via the identification of influencing factors, e.g. objective or subjective fall risk, fear of falling (FOF) and demographic data. In this context, we investigated older adults' willingness to take part in special activities concerning fall prevention. Retrospectively, all patients over 70 years of age who received in-hospital fracture treatment between July 2014 and April 2016 were analyzed at a level I trauma center. After identification of 884 patients, participants completed a short questionnaire (47 questions, yes/no, Likert scale) comprising the AFPS. A history of falls in the past year was considered an indicator of a balance disorder. In addition, ambulant patients were invited to participate between July and August 2016. In total, 201 patients (mean 80.4 years, range 63-97 years) performed a self-assessment based on the AFPS. After steps 1 and 2 of the AFPS had been completed, 95 (47%) participants rated their subjective risk of falling as high (more than 5 points). Of the participants 84 (42%) were objectively classified as "fallers" with significant effects on their AFPS evaluation and rating of their subjective risk of falling. Furthermore, 67% of the participants identified a general practitioner as their main contact person, and 43% of the respondents viewed the AFPS as a beneficial screening tool in fall risk evaluation (8

A study protocol of a three-group randomized feasibility trial of an online yoga intervention for mothers after stillbirth (The Mindful Health Study).

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Huberty, Jennifer; Matthews, Jeni; Leiferman, Jenn; Cacciatore, Joanne; Gold, Katherine J

2018-01-01

among mothers after a stillbirth. If feasible, the findings from this study will inform a full-scale trial to determine the effectiveness of home-based online-streamed yoga to improve PTSD. Long-term, health care providers could use online yoga as a non-pharmaceutical, inexpensive resource for stillbirth aftercare. NCT02925481.

[Crisis unit at the general hospital: Determinants of further hospitalization].

Science.gov (United States)

Norotte, C; Omnès, C; Crozier, C; Verlyck, C; Romanos, M

2017-10-01

The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored. The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room. All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge. Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of

Diagnosis of Fetal Anomaly and the Increased Maternal Psychological Toll Associated with Pregnancy Termination.

Science.gov (United States)

Coleman, Priscilla K

2015-01-01

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.

Individual quality of life in patients undergoing radiotherapy. A longitudinal survey

International Nuclear Information System (INIS)

Wenskus, Julia Katharina

2015-01-01

The way that Quality of Life (QoL) is perceived has crucially changed over the last few decades. As a consequence of demographic change and ongoing technical progress, QoL gained in importance and became established as a major outcome parameter in clinical trials. Scientists in the field of QoL differentiate between three categories: health-related, global and individual QoL. For the assessment of individual QoL, Becker et al. (2014) and Merk (2011) developed and validated an easily applicable and economical questionnaire; the SEIQoL-Q. The purpose of our study was to modify the SEIQoL-Q based on Merk's approach (2011) and apply the revised version in a longitudinal survey of different patient populations in the Clinic for Radiotherapy of the University Hospital of Freiburg. Apart from that, other crucial factors, which might affect the evaluation of one's QoL, were gathered by use of a newly established questionnaire. 132 patients undergoing radiotherapy and having been diagnosed with breast cancer (BC), prostate cancer (PC), bone metastasis (BM) or a benign disease (B) were included in our study. The participants were interviewed at four definitive times in their treatment (1. before the radiotherapy had started, 2. after 50 % of the total radiation dose had been given, 3. at the end of the therapy, 4. during the aftercare). A total of 419 interviews were carried out. While the highest possible score was 100, the average individual QoL was 60.48 (BC: 56.55; PC: 64.13; BM: 59.27; B: 58.85). Significant differences of the individual QoL were revealed between the diagnosis groups (BC vs. PC, PC vs. B, PC vs. BM), the age (< 66 years: 55.39; = 66 years: 62.27) and the gender (women: 57.11; men: 62.88). Additionally, the expectations and the mood influenced the assessment of the individual QoL. Furthermore, it could be shown that there were correlations between the individual QoL and personality, depressive tendencies, ego strength, optimism, self-concept, faith and

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

Directory of Open Access Journals (Sweden)

Schallhorn SC

2016-11-01

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

Individual quality of life in patients undergoing radiotherapy. A longitudinal survey; Individuelle Lebensqualitaet von Strahlentherapie-Patienten. Eine Laengsschnittuntersuchung

Energy Technology Data Exchange (ETDEWEB)

Wenskus, Julia Katharina

2015-07-01

The way that Quality of Life (QoL) is perceived has crucially changed over the last few decades. As a consequence of demographic change and ongoing technical progress, QoL gained in importance and became established as a major outcome parameter in clinical trials. Scientists in the field of QoL differentiate between three categories: health-related, global and individual QoL. For the assessment of individual QoL, Becker et al. (2014) and Merk (2011) developed and validated an easily applicable and economical questionnaire; the SEIQoL-Q. The purpose of our study was to modify the SEIQoL-Q based on Merk's approach (2011) and apply the revised version in a longitudinal survey of different patient populations in the Clinic for Radiotherapy of the University Hospital of Freiburg. Apart from that, other crucial factors, which might affect the evaluation of one's QoL, were gathered by use of a newly established questionnaire. 132 patients undergoing radiotherapy and having been diagnosed with breast cancer (BC), prostate cancer (PC), bone metastasis (BM) or a benign disease (B) were included in our study. The participants were interviewed at four definitive times in their treatment (1. before the radiotherapy had started, 2. after 50 % of the total radiation dose had been given, 3. at the end of the therapy, 4. during the aftercare). A total of 419 interviews were carried out. While the highest possible score was 100, the average individual QoL was 60.48 (BC: 56.55; PC: 64.13; BM: 59.27; B: 58.85). Significant differences of the individual QoL were revealed between the diagnosis groups (BC vs. PC, PC vs. B, PC vs. BM), the age (< 66 years: 55.39; = 66 years: 62.27) and the gender (women: 57.11; men: 62.88). Additionally, the expectations and the mood influenced the assessment of the individual QoL. Furthermore, it could be shown that there were correlations between the individual QoL and personality, depressive tendencies, ego strength, optimism, self

Effectiveness and cost-effectiveness of a guided Internet- and mobile-based intervention for the indicated prevention of major depression in patients with chronic back pain-study protocol of the PROD-BP multicenter pragmatic RCT.

Science.gov (United States)

Sander, L; Paganini, S; Lin, J; Schlicker, S; Ebert, D D; Buntrock, C; Baumeister, H

2017-01-21

from a societal and public health perspective. This is the first study examining an IMI for depression prevention in a sample of chronic pain patients. If this implementation of a depression prevention IMI into orthopedic aftercare proves effective, the intervention could be integrated into routine care with minimal costs and extended for use with other chronic diseases. Results will have implications for researchers, health care providers and public health policy makers. The trial is registered at the WHO International Clinical Trials Registry Platform via the German Clinical Studies Trial Register (DRKS): DRKS00007960 . Registered 12 August 2015.

Assessment of the methane oxidation capacity of compacted soils intended for use as landfill cover materials

International Nuclear Information System (INIS)

Rachor, Ingke; Gebert, Julia; Groengroeft, Alexander; Pfeiffer, Eva-Maria

2011-01-01

The microbial oxidation of methane in engineered cover soils is considered a potent option for the mitigation of emissions from old landfills or sites containing wastes of low methane generation rates. A laboratory column study was conducted in order to derive design criteria that enable construction of an effective methane oxidising cover from the range of soils that are available to the landfill operator. Therefore, the methane oxidation capacity of different soils was assessed under simulated landfill conditions. Five sandy potential landfill top cover materials with varying contents of silt and clay were investigated with respect to methane oxidation and corresponding soil gas composition over a period of four months. The soils were compacted to 95% of their specific proctor density, resulting in bulk densities of 1.4-1.7 g cm -3 , reflecting considerably unfavourable conditions for methane oxidation due to reduced air-filled porosity. The soil water content was adjusted to field capacity, resulting in water contents ranging from 16.2 to 48.5 vol.%. The investigated inlet fluxes ranged from 25 to about 100 g CH 4 m -2 d -1 , covering the methane load proposed to allow for complete oxidation in landfill covers under Western European climate conditions and hence being suggested as a criterion for release from aftercare. The vertical distribution of gas concentrations, methane flux balances as well as stable carbon isotope studies allowed for clear process identifications. Higher inlet fluxes led to a reduction of the aerated zone, an increase in the absolute methane oxidation rate and a decline of the relative proportion of oxidized methane. For each material, a specific maximum oxidation rate was determined, which varied between 20 and 95 g CH 4 m -2 d -1 and which was positively correlated to the air-filled porosity of the soil. Methane oxidation efficiencies and gas profile data imply a strong link between oxidation capacity and diffusive ingress of

[Characteristics in treatment of the hip in patients with Down syndrome].

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Peterlein, C-D; Schiel, M; Timmesfeld, N; Schofer, M D; Eberhardt, O; Wirth, T; Fernandez, F F

2013-12-01

The treatment of hip instability in patients with Down syndrome is challenging. We have performed different pelvic osteotomies and corrections at the proximal femur for this indication. This retrospective study was conducted to evaluate the clinical and radiological outcome of each intervention. All in all, 166 patients with Down syndrome were treated at our orthopaedic department in the observation period. Problems related to the hip joint were diagnosed in 63 of those patients. Only patients who underwent surgery were included in this study. The charts and X-rays of these 31 patients were evaluated with respect to the following parameters: incidence of the hip problem, concomitant diseases, temporal progress, kind of operation method and date, duration of stay in the hospital, after-care, follow-on surgery related to complications, AC angle, CE angle, ACM angle, CCD angle, index of migration according to Reimers, classification of Bauer and Kerschbauer and general morphology of the femoral head. The group was compared with an age-matched group of 21 patients with hip dysplasia. Those patients underwent the same sort of operation in the same year. In the Morbus Down group, we performed surgery for preservation of the hip in 49 cases. This included 13 osteotomies according to Chiari, 11 triple osteotomies according to Tönnis, 10 corrections by femoral varus derotation osteotomy, 8 pelvic osteotomies according to Pemberton, 5 pelvic osteotomies according to Salter and 2 open reductions of the hip. With respect to the moment of surgery, we detected three peaks of age. There was no difference in course of disease and quantity of complications between the groups. Satisfactory results concerning clinical and radiological outcome were achieved predominantly by complete redirectional acetabular osteotomies. Half of the patients who were solely treated by femoral varus derotation osteotomy needed follow-on surgery in the form of pelvic osteotomy. Comparison of

Standard guidelines of care: Lasers for tattoos and pigmented lesions

Directory of Open Access Journals (Sweden)

Aurangabadkar Sanjeev

2009-08-01

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

Self-reported competence in long term care provision for adult cancer survivors: A cross sectional survey of nursing and allied health care professionals.

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Faithfull, S; Samuel, Carol; Lemanska, Agnieszka; Warnock, Clare; Greenfield, Diana

2016-01-01

complex symptom management, for those providing dimensions of care coordination and proactive care. Differences in confidence were seen between practitioner groups. Community nurses felt less skilled in managing adult cancer patients long-term. Nurses and allied health professionals self-reported confidence, in managing all areas of care for adult cancer survivors, is variable with deficits in important areas of practice. Despite this being a small proportion of practitioners who are working in cancer care, those responding had perceived gaps in knowledge and educational needs. In providing cancer aftercare there is a requisite shift to proactive care, supported self-management and collaborative management if patient's long-term consequences of cancer and its treatment are to be addressed. If health care providers are to transform cancer survivor services then investment is required in education and capability planning across nurses, allied health professionals in both the hospital and the community setting. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Neuro-chemical activation of brain reward meso-limbic circuitry is associated with relapse prevention and drug hunger: a hypothesis.

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Blum, Kenneth; Gold, Mark S

2011-04-01

drug use in adolescents. Exploration of various treatment approaches for the most part reveal poor outcomes in terms of relapse prevention and continued drug hunger. The authors are proposing a new paradigm shift in residential, non-residential and aftercare involving the incorporation of genetic testing to identify risk alleles coupled with D2 receptor stimulation using neuroadatogen amino acid precursor enkephlinase--catecholamine-methyltransferase (COMT) inhibition therapy. A natural but therapeutic nutraceutical formulation potentially induces DA release could cause the induction of D2-directed mRNA and proliferation of D2 receptors in the human. We further hypothesize that this proliferation of D2 receptors in turn will induce the attenuation of drug-like craving behavior. Finally, pharmacological therapies have had limited success because these powerful agents have focused on maintenance or interference with drug euphoria rather than correcting or compensating for pre-morbid dopamine system deficits These concepts await further confirmation via required neuro-imaging studies. Copyright © 2011. Published by Elsevier Ltd.

A clinical example of extreme dose exposure for an implanted cardioverter-defibrillator. Beyond the DEGRO guidelines

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Hristova, Yoana; Koehn, Janett; Preuss, Stefanie [Johann Wolfgang Goethe University Frankfurt, Department of Radiation Oncology, University Hospital, Frankfurt (Germany); Roedel, Claus; Balermpas, Panagiotis [Johann Wolfgang Goethe University Frankfurt, Department of Radiation Oncology, University Hospital, Frankfurt (Germany); German Cancer Research Center (DKFZ), Heidelberg (Germany); German Cancer Consortium (DKTK), Frankfurt am Main (Germany)

2017-09-15

Considering that the number of malignant diseases in patients over 65 years of age is increasing, it often occurs that patients who carry a cardiac implanted electronic device must undergo radiotherapy. Ionizing radiation can disturb the function of the implantable cardioverter-defibrillator (ICD). As a result of this, an update of the DEGRO/DKG guidelines for radiotherapy of this patient group has been published. We report the case of a patient with an ICD and T-lymphoblastic lymphoma with cardiac involvement, who received i.a. a total body irradiation with 8 Gy followed by a consolidating radiotherapy of the pericardium with 14 Gy as well as additional radiotherapy courses after consecutive recurrences. For the purposes of the treatment, the antitachyarrhythmia (ATA) therapy was deactivated and temporarily replaced through a life vest. According to the current DEGRO guidelines for irradiation of patients with cardiac implanted electronic devices, a categorization of the patient in the ''high-risk'' group was made. Furthermore, regular telemetric checks of the ICD device were performed before and after treatment. Despite unavailable declaration of the manufacturer regarding the cumulative tolerable dose and DEGRO recommendation for a cumulative dose <2 Gy, the aftercare was unproblematic and normal values were assessed for all relevant ICD parameters, despite a cumulative dose >10 Gy in the device. This case shows that if the cardiac implanted electronic devices are not directly irradiated und the energy used is reduced to 6 MV, irradiation-induced damage is less likely and can possibly be prevented. (orig.) [German] Vor dem Hintergrund der steigenden Zahl von Krebserkrankungen bei Patienten ueber 65 Jahren kommt es haeufig vor, dass sich Patienten mit einem kardialen implantierten elektronischen Geraet einer Strahlentherapie unterziehen muessen. Ionisierende Strahlung kann die Funktion des implantierbaren Kardioverter-Defibrillators (ICD

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

Directory of Open Access Journals (Sweden)

Виктор Александрович Вишневский

2015-06-01

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

[Intramedullary nailing of the distal tibia illustrated with the Expert(TM) tibia nail].

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El Attal, R; Hansen, M; Rosenberger, R; Smekal, V; Rommens, P M; Blauth, M

2011-12-01

Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare and to maintain joint mobility. Good bony healing in closed and open fractures. Closed and open fractures of the tibia and complete lower leg fractures distal to the isthmus (AO 42), extraarticular fractures of the distal tibia (AO 43 A1/A2/A3), segmental fractures of the tibia with a fracture in the distal tibia, and certain intraarticular fractures of the distal tibia without impression of the joint line with the use of additional implants (AO 43 C1) Patient in reduced general condition (e.g., bed ridden), flexion of the knee of less than 90°, patients with knee arthroplasty of the affected leg, infection in the area of the nail's insertion, infection of the tibial cavity, complex articular fractures of the proximal or distal tibia with joint depression. Closed reduction of the fracture preferably on a fracture table or using a distractor or an external fixation frame. If necessary, use pointed reduction clamps or sterile drapery. In some cases, additional implants like percutaneous small fragment screws, poller screws or k-wires are helpful. Open reduction is rarely necessary and must be avoided. Opening of the proximal tibia in line with the medullary canal. Canulated insertion of the Expert(TM) tibia nail (ETN; Synthes GmbH, Oberdorf, Switzerland) with reaming of the medullary canal. Control of axis, length, and rotation. Distal interlocking with the radiolucent drill and proximal interlocking with the targeting device. Immediate mobilization of ankle and knee joint. Mobilization with 20 kg weight-bearing with crutches. X-ray control 6 weeks postoperatively and increased weight-bearing depending on the fracture status. In cases with simple fractures, good bony contact, or transverse fracture pattern, full weight-bearing at the end of week 6 is targeted. Between July 2004 and May 2005, 180 patients were included in a

Mobile Health in Oncology: A Patient Survey About App-Assisted Cancer Care.

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Kessel, Kerstin Anne; Vogel, Marco Me; Kessel, Carmen; Bier, Henning; Biedermann, Tilo; Friess, Helmut; Herschbach, Peter; von Eisenhart-Rothe, Rüdiger; Meyer, Bernhard; Kiechle, Marion; Keller, Ulrich; Peschel, Christian; Schmid, Roland M; Combs, Stephanie E

2017-06-14

In the last decade, the health care sector has been enriched by numerous innovations such as apps and connected devices that assist users in weight reduction and diabetes management. However, only a few native apps in the oncological context exist, which support patients during treatment and aftercare. The objective of this study was to analyze patients' acceptance regarding app use and to investigate the functions of an oncological app that are most required, and the primary reasons for patients to refuse app-assisted cancer care. We designed and conducted a survey with 23 questions, inquiring patients about their technical knowledge and equipment, as well as the possible advantages and disadvantages, data transfer, and general functionality of an app. A total of 375 patients participated; the participation rate was 60.7% (375/618). Gender distribution was about 3:4 (female:male) with a median age of 59 years (range 18-92 years). Whereas 69.6% (261/375) of patients used mobile devices, 16.3% (61/375) did not own one, and 9.1% (34/375) only used a personal computer (PC). About half of the patients rated their usability skills as very good and good (18.9% 71/375; 35.2% 132/375), 23.5% (88/375) described their skills as intermediate, and 14.4% (54/375) as bad. Of all patients, 182 (48.5%, 182/375) were willing to send data to their treating clinic via an app, that is, to a server (61.0% 111/182) or as email (33.5%, 61/182). About two-thirds (68.7%, 125/182) believed that additional and regularly sent data would be an ideal complement to the standard follow-up procedure. Additionally, 86.8% (158/182) wished to be contacted by a physician when entered data showed irregularities. Because of lack of skills (34.4%, 56/163), concerns about the use of data (35.0%, 57/163), lack of capable devices (25.8%, 42/163), and the wish for personal contact with the treating physician (47.2%, 77/163), a total of 163 (43.5%, 163/375) patients refused to use an app. Pearson correlation

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

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Fins, Joseph J.; MD; FACP

2009-10-01

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