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Sample records for depression case management

  1. Depression is more than just sadness: A case of excessive anger and its management in depression

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    Anamika Sahu

    2014-01-01

    Full Text Available People with depressive illness often have symptoms of overt or suppressed anger. Those with anger traits face exaggerated problem during symptomatic period of depression. Pharmacological management helps in control of depressive and anxiety symptoms, but rarely address anger symptoms. Non-pharmacological management like cognitive-behavioral therapy (CBT is effective in depression as well as in anger management, but is not used frequently in anger associated or exacerbated by depression. We present the case of a 27-year-old male suffering from moderate depressive episode with associated anger outburst. He underwent CBT, which resulted in a significant decrease in anger symptoms as well as in severity of depression.

  2. Depression is More Than Just Sadness: A Case of Excessive Anger and Its Management in Depression.

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    Sahu, Anamika; Gupta, Preeti; Chatterjee, Biswadip

    2014-01-01

    People with depressive illness often have symptoms of overt or suppressed anger. Those with anger traits face exaggerated problem during symptomatic period of depression. Pharmacological management helps in control of depressive and anxiety symptoms, but rarely address anger symptoms. Non-pharmacological management like cognitive-behavioral therapy (CBT) is effective in depression as well as in anger management, but is not used frequently in anger associated or exacerbated by depression. We present the case of a 27-year-old male suffering from moderate depressive episode with associated anger outburst. He underwent CBT, which resulted in a significant decrease in anger symptoms as well as in severity of depression.

  3. Case managers speak out: responding to depression in community long-term care.

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    Munson, Michelle; Proctor, Enola; Morrow-Howell, Nancy; Fedoravicius, Nicole; Ware, Norma

    2007-08-01

    This study sought to understand how case managers in one publicly funded health and social service system, community long-term care, understand and address depression among their clients. Four focus groups with a total of 18 case managers were conducted. Case managers were asked a series of questions about their perspectives on the recognition and treatment of depression, including subthreshold depression, in community long-term care. Case managers perceived addressing depression as complex because of competing demands. Furthermore, case managers perceived conflict between their current role and what it would take to expand their role to include addressing depression. Case managers suggested that in order to successfully improve the detection and treatment of depression in community long-term care, systemic changes, such as increased support and training, may be necessary, along with a shift in the professional role of case managers.

  4. The Effects of Collaborative Care Training on Case Managers' Perceived Depression-Related Services Delivery.

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    Landry, Craig M; Jackson, Aurora P; Tang, Lingqi; Miranda, Jeanne; Chung, Bowen; Jones, Felica; Ong, Michael K; Wells, Kenneth

    2017-02-01

    This study examined the effects of a depression care quality improvement (QI) intervention implemented by using Community Engagement and Planning (CEP), which supports collaboration across health and community-based agencies, or Resources for Services (RS), which provides technical assistance, on training participation and service delivery by primarily unlicensed, racially and ethnically diverse case managers in two low-income communities in Los Angeles. The study was a cluster-randomized trial with program-level assignment to CEP or RS for implementation of a QI initiative for providing training for depression care. Staff with patient contact in 84 health and community-based programs that were eligible for the provider outcomes substudy were invited to participate in training and to complete baseline and one-year follow-up surveys; 117 case managers (N=59, RS; N=58, CEP) from 52 programs completed follow-up. Primary outcomes were time spent providing services in community settings and use of depression case management and problem-solving practices. Secondary outcomes were depression knowledge and attitudes and perceived system barriers. CEP case managers had greater participation in depression training, spent more time providing services in community settings, and used more problem-solving therapeutic approaches compared with RS case managers (pTraining participation, time spent providing services in community settings, and use of problem-solving skills among primarily unlicensed, racially and ethnically diverse case managers were greater in programs that used CEP rather than RS to implement depression care QI, suggesting that CEP offers a model for including case managers in communitywide depression care improvement efforts.

  5. Case management to improve major depression in primary health care : a systematic review

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    Gensichen, J; Beyer, M; Muth, C; Gerlach, FM; Von Korff, M; Ormel, J

    2006-01-01

    Background. Deficits in the care of depression lead to poor medication adherence, which increases the risk of an unfavourable outcome for this care. This review evaluates effects on symptoms and medication adherence of case management in primary health care. Method. A systematic literature search wa

  6. Case report on the management of depression in schizoaffective disorder, bipolar type focusing on lithium levels and measurement-based care.

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    Koola, Maju Mathew; Fawcett, Jan A; Kelly, Deanna L

    2011-12-01

    There is little evidence supporting the management of depression in schizoaffective disorder, bipolar type. Managing bipolar depression can be a daunting task for clinicians. Most bipolar patients spend 80% of their time in the depressive phase of illness. In contrast with full-blown mania, patients and family frequently fail to recognize bipolar depression, which may interfere with early diagnosis and treatment. With only a few medications approved for bipolar depression, treatment becomes very challenging. There is evidence to support that schizoaffective depression has a worse outcome than psychotic depression and nonpsychotic depression. We report a patient with schizoaffective disorder, bipolar type with severe depression who responded to an adequate level of lithium and subsequently, on a combination of lithium and quetiapine. Finally, we emphasize the importance of measurement-based care. To our knowledge, this is the first case report focusing on the management of depression in schizoaffective disorder, bipolar type.

  7. Optimal management of perimenopausal depression

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    Barbara L Parry

    2010-06-01

    Full Text Available Barbara L ParryDepartment of Psychiatry, University of California, San Diego, USAAbstract: Only recently has the perimenopause become recognized as a time when women are at risk for new onset and recurrence of major depression. Untreated depression at this time not only exacerbates the course of a depressive illness, but also puts women at increased risk for sleep disorders, cardiovascular disease, diabetes, and osteoporosis. Although antidepressant medication is the mainstay of treatment, adjunctive therapy, especially with estrogen replacement, may be indicated in refractory cases, and may speed the onset of antidepressant action. Many, but not all, studies, report that progesterone antagonizes the beneficial effects of estrogen. Although some antidepressants improve vasomotor symptoms, in general they are not as effective as estrogen alone for relieving these symptoms. Estrogen alone, however, does not generally result in remission of major depression in most (but not all studies, but may provide benefit to some women with less severe symptoms if administered in therapeutic ranges. The selective serotonin reuptake inhibitors (SSRIs in addition to estrogen are usually more beneficial in improving mood than SSRIs or estrogen treatment alone for major depression, whereas the selective norepinephrine and serotonin reuptake inhibitors do not require the addition of estrogen to exert their antidepressant effects in menopausal depression. In addition to attention to general health, hormonal status, and antidepressant treatment, the optimal management of perimenopausal depression also requires attention to the individual woman’s psychosocial and spiritual well being.Keywords: menopause, depression, management

  8. Effects of a Case Management Program on Self-efficacy, Depression and Anxiety in Pregnant Women with Gestational Diabetes Mellitus

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    Eun Sook Baek

    2013-06-01

    Full Text Available PurposeTo examine the effects of a case management program on self-efficacy, depression and anxiety in pregnant women with gestational diabetes mellitus.MethodsThirty-seven patients who enrolled in a diabetes outpatient clinic were randomly assigned to either an experimental group (n=19 or a control group (n=18. The experimental group received a 2-week intervention composed of a series of one face-to-face interactive interview and five telephone interviews based on the National standards for diabetes self-management education and Bandura's self-efficacy resources of performance accomplishment, vicarious experience, verbal persuasion, and emotional arousal. The effects of the intervention were assessed by completion of a 9-item self-efficacy questionnaire, a 20-item depression questionnaire and a 20-item anxiety questionnaire prior to, and after the intervention. The statistical significances were examined using t-test.ResultsThe change in self-efficacy was significantly greater in the experimental group than in the control group. Depression and anxiety changes in the experimental group were significantly greater compared to those in the control group.ConclusionThe results of study suggest that a case management program improves self-efficacy, and decreases depression and anxiety in pregnant women with gestational diabetes mellitus.

  9. Management of bipolar depression

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    Jae Seung Chang

    2011-01-01

    Full Text Available Patients with bipolar disorder spend more time in a depressed than manic state, even with individualized treatment. To date, bipolar depression is often misdiagnosed and ineffectively managed both for acute episodes and residual symptoms. This review attempts to summarize the current status of available treatment strategies in the treatment of bipolar depression. For acute and prophylactic treatment, a substantial body of evidence supports the antidepressive efficacy of lithium for bipolar disorders and its antisuicidal effects. Among numerous anticonvulsants with mood-stabilizing properties, valproate and lamotrigine could be first-line options for bipolar depression. Due to receptor profile, mood-stabilizing properties of second-generation antipsychotics have been explored, and up to date, quetiapine and olanzapine appear to be a reasonable option for bipolar depression. The usefulness of antidepressants in bipolar depression is still controversial. Current guidelines generally recommend the cautious antidepressant use in combination with mood stabilizers to reduce the risk of mood elevation or cycle acceleration. Results from clinical trials on psychosocial intervention are promising, especially when integrated with pharmacotherapy. Most patients with bipolar depression need individualized and combined treatment, although the published evidence on this type of treatment strategy is limited. Future studies on the utility of currently available agents and modalities including psychosocial intervention are required.

  10. The use of the Zung Self-Rating Depression Scale to assist in the case management of patients living with HIV/AIDS.

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    Lombardi, Deborah; Mizuno, Lori T; Thornberry, Anya

    2010-01-01

    Depression is a common comorbidity in people with HIV/AIDS, frequently impacting disease status by direct effects on immune fuinction and adherence to antiretroviral treatment. For case managers, who are often the main contacts for patients, quick and simple identification of patients at high risk for depression can be both a challenge and a priority. These patients should be screened at the primary point of care and then referred to mental health providers for further evaluation or diagnosis. Here we report the experiences in three diverse case management settings using the Zung Self-Rating Depression Scale for patient self-reporting of depression symptoms. The three clinics--Broward House in Wilton Manors, Florida; BIENESTAR Human Services in Los Angeles, California, and the West Midtown Medical Group in New York City--serve diverse racial and ethnic populations with substantial HIV infection rates in urban and rural communities. Benefits of using this validated tool include increased patient self-awareness and acceptance by mental health providers, thereby facilitating a final diagnosis that leads to improved implementation of treatment for depression. Case management settings provide a unique point of contact to unite clients with mental health care, especially in disease settings where depression or other mental health conditions are prevalent.

  11. Case management for the treatment of patients with major depression in general practices – rationale, design and conduct of a cluster randomized controlled trial – PRoMPT (Primary care Monitoring for depressive Patient's Trial [ISRCTN66386086] – Study protocol

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    Krauth Christian

    2005-10-01

    Full Text Available Abstract Background Depression is a disorder with high prevalence in primary health care and a significant burden of illness. The delivery of health care for depression, as well as other chronic illnesses, has been criticized for several reasons and new strategies to address the needs of these illnesses have been advocated. Case management is a patient-centered approach which has shown efficacy in the treatment of depression in highly organized Health Maintenance Organization (HMO settings and which might also be effective in other, less structured settings. Methods/Design PRoMPT (PRimary care Monitoring for depressive Patients Trial is a cluster randomised controlled trial with General Practice (GP as the unit of randomisation. The aim of the study is to evaluate a GP applied case-management for patients with major depressive disorder. 70 GPs were randomised either to intervention group or to control group with the control group delivering usual care. Each GP will include 10 patients suffering from major depressive disorder according to the DSM-IV criteria. The intervention group will receive treatment based on standardized guidelines and monthly telephone monitoring from a trained practice nurse. The nurse investigates the patient's status concerning the MDD criteria, his adherence to GPs prescriptions, possible side effects of medication, and treatment goal attainment. The control group receives usual care – including recommended guidelines. Main outcome measure is the cumulative score of the section depressive disorders (PHQ-9 from the German version of the Prime MD Patient Health Questionnaire (PHQ-D. Secondary outcome measures are the Beck-Depression-Inventory, self-reported adherence (adapted from Moriskey and the SF-36. In addition, data are collected about patients' satisfaction (EUROPEP-tool, medication, health care utilization, comorbidity, suicide attempts and days out of work. The study comprises three assessment times: baseline

  12. Managing depression in primary care

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    Collins, Kerry A.; Wolfe, Vicky V.; Fisman, Sandra; DePace, JoAnne; Steele, Margaret

    2006-01-01

    OBJECTIVE To investigate family physicians’ practice patterns for managing depression and mental health concerns among adolescent and adult patients. DESIGN Cross-sectional survey. SETTING London, Ont, a mid-sized Canadian city. PARTICIPANTS One hundred sixty-three family physicians identified through the London and District Academy of Medicine. MAIN OUTCOME MEASURES Practice patterns for managing depression, including screening, pharmacotherapy, psychotherapy, shared care, and training needs. RESULTS Response rate was 63%. Family physicians reported spending a substantial portion of their time during patient visits (26% to 50%) addressing mental health issues, with depression being the most common issue (51% to 75% of patients with mental health issues). About 40% of respondents did routine mental health screening, and 60% screened patients with risk factors for depression. Shared care with mental health professionals was common (care was shared for 26% to 50% of patients). Physicians and patients were moderately satisfied with shared care, but were frustrated by long waiting lists and communication barriers. Most physicians provided psychotherapy to patients in the form of general advice. Differences in practice patterns were observed; physicians treated more adults than adolescents with depression, and they reported greater comfort in treating adults. Although 33% of physicians described using cognitive behavioural therapy (CBT), they reported having little training in CBT. Moderate interest was expressed in CBT training, with a preference for a workshop format. CONCLUSION Although 40% of family physicians routinely screen patients for mental health issues, depression is often not detected. Satisfaction with shared care can be increased through better communication with mental health professionals. Physicians’ management of adolescent patients can be improved by further medical training, consultation, and collaboration with mental health professionals

  13. The management of depressive symptoms in patients with COPD: a postal survey of general practitioners.

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    Yohannes, A.M.; Hann, M.; Sibbald, B.S.

    2011-01-01

    AIMS: We examined the management of depression by general practitioners (GPs), through the use of case vignettes, in patients with chronic obstructive pulmonary disease (COPD), severe osteoarthritis and depressive symptoms alone. BACKGROUND: Depression is common in patients with COPD. Untreated

  14. The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomised trial.

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    Morgan, Mark A J; Coates, Michael J; Dunbar, James A; Reddy, Prasuna; Schlicht, Kate; Fuller, Jeff

    2013-01-24

    To determine the effectiveness of collaborative care in reducing depression in primary care patients with diabetes or heart disease using practice nurses as case managers. A two-arm open randomised cluster trial with wait-list control for 6 months. The intervention was followed over 12 months. Eleven Australian general practices, five randomly allocated to the intervention and six to the control. 400 primary care patients (206 intervention, 194 control) with depression and type 2 diabetes, coronary heart disease or both. The practice nurse acted as a case manager identifying depression, reviewing pathology results, lifestyle risk factors and patient goals and priorities. Usual care continued in the controls. A five-point reduction in depression scores for patients with moderate-to-severe depression. Secondary outcome was improvements in physiological measures. Mean depression scores after 6 months of intervention for patients with moderate-to-severe depression decreased by 5.7±1.3 compared with 4.3±1.2 in control, a significant (p=0.012) difference. (The plus-minus is the 95% confidence range.) Intervention practices demonstrated adherence to treatment guidelines and intensification of treatment for depression, where exercise increased by 19%, referrals to exercise programmes by 16%, referrals to mental health workers (MHWs) by 7% and visits to MHWs by 17%. Control-practice exercise did not change, whereas referrals to exercise programmes dropped by 5% and visits to MHWs by 3%. Only referrals to MHW increased by 12%. Intervention improvements were sustained over 12 months, with a significant (p=0.015) decrease in 10-year cardiovascular disease risk from 27.4±3.4% to 24.8±3.8%. A review of patients indicated that the study's safety protocols were followed. TrueBlue participants showed significantly improved depression and treatment intensification, sustained over 12 months of intervention and reduced 10-year cardiovascular disease risk. Collaborative care using

  15. Treatment-resistant depression: managed care considerations.

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    Tierney, John G

    2007-07-01

    Treatment-resistant depression (TRD) presents a unique challenge in managed care, requiring review of both the clinical and economic components of care. To review the TRD disease state as well as data supporting the various therapeutic options available for the treatment of persistent depression in managed care. While there is no consensus on the definition of TRD, persistent disease can generally be defined as depression that fails to respond to adequate treatment. When initial treatment is not effective or tolerable after 6 to 8 weeks of therapy, the American Psychiatric Association (APA) treatment guidelines recommend dose titration, augmentation, or switching. In the case of a therapy switch, the body of evidence suggests that selection of an agent with a different mechanism of action than the initial agent may be the most effective treatment. Furthermore, when patients maintain continuous therapy for the recommended treatment duration, outcomes are improved compared with patients who discontinue therapy early. As a result, the most effective treatment strategies promote improved patient compliance as well as the use of agents associated with a reduced incidence of premature discontinuation and therapy change early in the treatment program. While data supporting these clinically effective components of therapy exist, few data are available demonstrating the most cost-effective therapeutic options for TRD. This analysis suggests that managed care providers could benefit from a model that they can customize to evaluate the overall costeffectiveness of different strategies in the management of depression.

  16. Case management.

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    Rosenstein, A H; Propotnik, T

    1997-03-01

    Providing cost-effective high quality healthcare services ranks as the number one concern for anyone involved with the healthcare delivery system. While quality of care should always be the number one priority, controlling healthcare costs receives most of the attention. With limited healthcare dollars and providers assuming more of the financial risk for services rendered, a whole assortment of cost-containment strategies are being introduced in an effort to maintain some semblance of financial viability. Healthcare providers can approach cost control from two different angles. On the fixed-cost operational overhead side, traditional cost-containment techniques have focused on downsizing, maximizing productivity, staffing redesign, improved purchasing contracts, standardization, inventory control, and other more individualized restructured service models. On the variable-cost clinical side, cost control has been approached by introducing a variety of cost-containment strategies designed to improve efficiency and effectiveness of provider performance. While many of these strategies, previously discussed in the Journal of Healthcare Resource Management have stressed the importance of education, guidelines, pathways, and other clinical "tools for improvement," the success of many of these tools resides in the ability to provide real-time intervention. Real-time intervention rather than the more passive retrospective variance analysis has the greatest potential for producing cost savings by actually making a recommendation that prevents the unwanted event from occurring. In many institutions, the case manager bears the responsibility for monitoring and managing these programs. This article describes various case management models currently used by different institutions.

  17. [Evidence-based management of perinatal depression].

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    Chang, Mei-Yueh; Chen, Chung-Hey

    2008-04-01

    Perinatal depression, which may occur from pregnancy to one year after childbirth, is recognized by the World Health Organization as a significant health issue affecting women. Depression during the perinatal period can have enormous consequences, not only affecting the health of the woman herself but also influencing her interaction with her children and other family members. This article introduces several depression screening tools and evidence-based nonpharmacological managements of perinatal depression. There are some fairly valid and feasible screening methods, among which routinely screening perinatal women with EPDS (Edinburgh Perinatal Depression Scale) or BDI (Beck Depression Inventory) in the primary care setting is practicable. A survey of the limited literature available reveals that interpersonal psychotherapy, cognitive behavior therapy and listening to music provide quantifiable depression amelioration effects for perinatal women. More scientific research moderated by women's life experiences and preferences should be conducted, however, and applied to improve women's health.

  18. Managing workplace depression: an untapped opportunity for occupational health professionals.

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    Putnam, Kelly; McKibbin, Laura

    2004-03-01

    Depression is one of the most prevalent and costly health issues affecting the American work force. Despite well established research demonstrating the association between employee depression and reduced on-the-job productivity, increased absenteeism, and higher health care use, most employers remain largely unresponsive to the need for company based depression initiatives. Organizational and individual barriers can prevent companies from effectively managing employee depression. Organizational barriers include information gaps, lack of data to justify increased investment in employee mental health programs, and employers' ambiguous roles in addressing depression. Individual barriers such as an inability to recognize signs and symptoms; stigma; confidentiality and privacy concerns; and unavailability of easily accessible, quality resources can keep employees who are depressed from seeking treatment. Many occupational health professionals may feel ill prepared or uncomfortable taking the lead in creating more aggressive worksite responses to depression, but they are, perhaps, in the best of all possible positions within an organization to succeed. Occupational health professionals have the credentials, credibility, training, and experience necessary to build a strong case for business leaders for why investing in workplace depression programs is so important. Occupational health professionals are the most qualified to design and deliver destigmatized, customer friendly programs and services for employees to access for help with depression, and to integrate their services with other departments such as benefits, health promotion, EAP, and human resources, to create an effective, organization-wide depression initiative.

  19. Project management case studies

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    Kerzner, Harold R

    2013-01-01

    A new edition of the most popular book of project management case studies, expanded to include more than 100 cases plus a ""super case"" on the Iridium Project Case studies are an important part of project management education and training. This Fourth Edition of Harold Kerzner''s Project Management Case Studies features a number of new cases covering value measurement in project management. Also included is the well-received ""super case,"" which covers all aspects of project management and may be used as a capstone for a course. This new edition:Contains 100-plus case studies drawn from re

  20. Managing depression in older people with visual impairment.

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    Watkinson, Susan

    2011-10-01

    The author describes the management of depression in older people with visual impairment. The concept of depression is defined, and the main classifications are outlined. The signs and symptoms of depression are presented and approaches to treatment are discussed. The role of the nurse in managing depression in older people with sight loss is discussed.

  1. Lycanthropy in depression: two case reports.

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    Rao, K; Gangadhar, B N; Janakiramiah, N

    1999-01-01

    Two cases of lycanthropy presenting as part of a depressive disorder are described. The patients responded favorably to pharmacotherapy. In both cases, a positive history of dog bite influenced the presentation of symptoms. The authors speculate whether the defense of identification with the aggressor was operative.

  2. Disaster Case Management

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    U.S. Department of Health & Human Services — The Disaster Case Management Program (DCM) is a time-limited process that involves a partnership between a case manager and a disaster survivor (also known as a...

  3. Assessing and managing depression in older people.

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    Thomas, Hywel

    Depression is the most common mental health condition in people aged 65 and over. It can have a detrimental effect on quality of life and reduce patients' ability to manage their health. Nurses caring for older people with physical health problems are in an ideal position to identify depression; this article outlines how general receive the appropriate mental health care. nurses can do so and ensure their patientsepression can occur as a result of major life changes. It affects an estimated two million people over the age of 65 in the UK and is the most common mental illness

  4. Evidence-based clinical practice guidelines for managing depression in persons living with HIV.

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    Relf, Michael V; Eisbach, Shelly; Okine, Kayj Nash; Ward, Terry

    2013-01-01

    Depressive symptoms and depression are prevalent among persons living with HIV (PLWH). Depression among PLWH is associated with a lower quality of life, reduced adherence to antiretroviral treatment, poorer self-care, worsened treatment outcomes, greater impairment in social and vocational functioning, and increased social isolation. Assessment of depression in PLWH is critical to facilitate referral and management. Fortunately, two simple screening questions can be used to assess for depression, and evidence supports the effective management of depression for PLWH. First-line treatment regimens for depression include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), or a combination of SSRI and CBT. This paper examines the contemporary evidence related to depression in the context of HIV infection. A case study has been included to illustrate an application of evidence-based treatment interventions recommended for clinical practice.

  5. The management of depressive symptoms in patients with COPD: a postal survey of general practitioners.

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    Yohannes, Abebaw Mengistu; Hann, Mark; Sibbald, Bonnie

    2011-07-01

    We examined the management of depression by general practitioners (GPs), through the use of case vignettes, in patients with chronic obstructive pulmonary disease (COPD), severe osteoarthritis and depressive symptoms alone. Depression is common in patients with COPD. Untreated depression leads to poor compliance with medical treatment and increases health-care utilisation. We surveyed a random sample of GPs (n = 3956) in England using a postal questionnaire. The questionnaire explored how GPs would approach the management of emotional distress in patients with and without a chronic condition and gauged their views of and experiences with depression in patients with COPD. A total of 864 completed responses were received (22%). In the vignettes, a significantly greater percentage of GPs reported that they would explore or offer the diagnosis of depression in a patient with COPD (95.4%) compared with patients with either severe osteoarthritis (88.3%) or depressive symptoms alone (86.3%). In each case, the vast majority of GPs reported that they would explore a diagnosis of depression using a clinical diagnostic tool. The preferred method of treatment, if offered, in all three cases was a combination of anti-depressant drugs and psychological therapy. GPs endorsed the importance of routinely screening for depression in patients who have COPD and acknowledged that depression impairs patient self-management of COPD.In conclusion, GPs in England were able to diagnose depression from the vignettes and plan appropriate treatment strategies in patients with chronic diseases. This should be complemented with thorough physical examination by GPs to rule out other factors such as the impact of physical illness. GPs believe depression interferes with patient self-management of COPD.

  6. Managing Depression during the Menopausal Transition

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    Pearson, Quinn M.

    2010-01-01

    The menopausal transition is associated with both first onset of depression and recurrent depression. Risk factors include vasomotor symptoms, a history of premenstrual dysphoria, postpartum depression, major depression, and sleep disturbances. Hormone replacement therapy, complementary and alternative medicine approaches, and counseling…

  7. Managing Depression during the Menopausal Transition

    Science.gov (United States)

    Pearson, Quinn M.

    2010-01-01

    The menopausal transition is associated with both first onset of depression and recurrent depression. Risk factors include vasomotor symptoms, a history of premenstrual dysphoria, postpartum depression, major depression, and sleep disturbances. Hormone replacement therapy, complementary and alternative medicine approaches, and counseling…

  8. Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care.

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    Coventry, Peter A; Hays, Rebecca; Dickens, Chris; Bundy, Christine; Garrett, Charlotte; Cherrington, Andrea; Chew-Graham, Carolyn

    2011-03-22

    The risk of depression is increased in people with long term conditions (LTCs) and is associated with poorer patient outcomes for both the depressive illness and the LTC, but often remains undetected and poorly managed. The aim of this study was to identify and explore barriers to detecting and managing depression in primary care in people with two exemplar LTCs: diabetes and coronary heart disease (CHD). Qualitative in-depth interviews were conducted with 19 healthcare professionals drawn predominately from primary care, along with 7 service users and 3 carers (n = 29). One focus group was then held with a set of 6 healthcare professionals and a set of 7 service users and 1 carer (n = 14). Interviews and the focus group were digitally recorded, transcribed verbatim, and analysed independently. The two data sets were then inspected for commonalities using a constant comparative method, leading to a final thematic framework used in this paper. Barriers to detecting and managing depression in people with LTCs in primary care exist: i) when practitioners in partnership with patients conceptualise depression as a common and understandable response to the losses associated with LTCs - depression in the presence of LTCs is normalised, militating against its recognition and treatment; ii) where highly performanced managed consultations under the terms of the Quality and Outcomes Framework encourage reductionist approaches to case-finding in people with CHD and diabetes, and iii) where there is uncertainty among practitioners about how to negotiate labels for depression in people with LTCs in ways that might facilitate shared understanding and future management. Depression was often normalised in the presence of LTCs, obviating rather than facilitating further assessment and management. Furthermore, structural constraints imposed by the QOF encouraged reductionist approaches to case-finding for depression in consultations for CHD and diabetes. Future work might focus on

  9. Acceptance of home-based telehealth problem-solving therapy for depressed, low-income homebound older adults: qualitative interviews with the participants and aging-service case managers.

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    Choi, Namkee G; Wilson, Nancy L; Sirrianni, Leslie; Marinucci, Mary Lynn; Hegel, Mark T

    2014-08-01

    To report low-income homebound older adults' experience of telehealth problem-solving therapy (tele-PST) and aging-service case managers' (CMs') experience/perception of client-level personal barriers to accessing psychotherapy in general and PST specifically. The study sample consisted of 42 homebound older adults who participated in the feasibility and efficacy trial of tele-PST and completed 36-week follow-up assessments and 12 CMs of a large home-delivered meals program who referred their clients to the tele-PST trial. In-depth interviews with the older adults and written feedback and focus group discussions with the CMs provided the data. Older adults reported a high rate of approval of PST procedures and acknowledged its positive treatment effect. Tele-PST participants were satisfied with videoconferenced sessions because they were convenient and allowed them to see their therapist. However, CMs reported that only about 10%-20% of potentially eligible older adults gave oral consent for PST. Significant treatment engagement barriers were the older adults' lack of motivation, denial of depression, perceived stigma, and other personal attitudinal factors. The real-world implementation of tele-PST or other psychotherapies needs to include educating and motivating depressed homebound elders to recognize their depression and accept treatment. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Associations of depression and depressive symptoms with preeclampsia: results from a Peruvian case-control study

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    Garcia Pedro

    2007-09-01

    Full Text Available Abstract Background Preeclampsia involves endothelial dysfunction, platelet dysfunction/activation and sympathetic over-activity similar to cardiovascular disorders (CVD. Depression, an independent risk factor for progression of CVD, was found to be associated with an increased risk of preeclampsia among Finnish women. We examined the relation between depression/depressive symptoms and preeclampsia risk among Peruvian women. Methods The study included 339 preeclamptic cases and 337 normotensive controls. Depression and depressive symptoms during pregnancy were assessed using the Patient Health Questionnaire (PHQ-9. Odds ratios (OR and 95% confidence intervals (CI were estimated from logistic regression models. Results The prevalence of moderate depression was 11.5% among cases and 5.3% among controls. The corresponding figures for moderate-severe depression were 3.5% for cases and 2.1% for controls. Compared with non-depressed women, those with moderate depression had a 2.3-fold increased risk of preeclampsia (95% CI: 1.2–4.4, while moderate-severe depression was associated with a 3.2-fold (95% CI: 1.1–9.6 increased risk of preeclampsia. Associations of each of the 9-items of the PHQ-9 depression screening module with preeclampsia risk were also observed. Conclusion Our findings are consistent with the only other published report on this topic. Collectively, available data support recent calls for expanded efforts to study and address depression among pregnant women.

  11. Managing depression through needlecraft creative activities: A qualitative study

    OpenAIRE

    2000-01-01

    This qualitative study explored the personal meanings of needlecrafts and their role in the self-management of depression. Written and spoken narratives from 39 women were studied. Respondents described themselves as experiencing chronic or episodic depression (e.g. associated with stressful work situations, bereavement or caring for an ill relative). Some had received treatment for depression but most had not. When analysing the therapeutic effects of creative activity, most women describ...

  12. Practice nurse involvement in primary care depression management: an observational cost-effectiveness analysis

    Science.gov (United States)

    2014-01-01

    Background Most evidence on the effect of collaborative care for depression is derived in the selective environment of randomised controlled trials. In collaborative care, practice nurses may act as case managers. The Primary Care Services Improvement Project (PCSIP) aimed to assess the cost-effectiveness of alternative models of practice nurse involvement in a real world Australian setting. Previous analyses have demonstrated the value of high level practice nurse involvement in the management of diabetes and obesity. This paper reports on their value in the management of depression. Methods General practices were assigned to a low or high model of care based on observed levels of practice nurse involvement in clinical-based activities for the management of depression (i.e. percentage of depression patients seen, percentage of consultation time spent on clinical-based activities). Linked, routinely collected data was used to determine patient level depression outcomes (proportion of depression-free days) and health service usage costs. Standardised depression assessment tools were not routinely used, therefore a classification framework to determine the patient’s depressive state was developed using proxy measures (e.g. symptoms, medications, referrals, hospitalisations and suicide attempts). Regression analyses of costs and depression outcomes were conducted, using propensity weighting to control for potential confounders. Results Capacity to determine depressive state using the classification framework was dependent upon the level of detail provided in medical records. While antidepressant medication prescriptions were a strong indicator of depressive state, they could not be relied upon as the sole measure. Propensity score weighted analyses of total depression-related costs and depression outcomes, found that the high level model of care cost more (95% CI: -$314.76 to $584) and resulted in 5% less depression-free days (95% CI: -0.15 to 0.05), compared to the

  13. Depression

    Science.gov (United States)

    ... caring for children and aging parents, abuse, and poverty may trigger depression in some people. Medical illness – ... federal government website managed by the Office on Women’s Health in the Office of the Assistant Secretary ...

  14. Managing depression: analytic, antidepressants or both?

    Directory of Open Access Journals (Sweden)

    Lucas Richard

    2003-01-01

    Full Text Available Patients with depression cover the spectrum, in terms of severity of psychopathology, between those receptive to analytic psychotherapy and those that require treatment with medication. In this paper, the author demonstrates how a psychoanalytic framework of understanding has a place in the latter group, and can aid general psychiatrists in relating to their depressed patients. The notion of a pathological ego-destructive superego taking over control in depression is explored, with the need to unseat it and replace it with a more mature superego providing an overall framework of approach to treatment.

  15. Contingency management for cigarette smokers with depressive symptoms.

    Science.gov (United States)

    Secades-Villa, Roberto; Vallejo-Seco, Guillermo; García-Rodríguez, Olaya; López-Núñez, Carla; Weidberg, Sara; González-Roz, Alba

    2015-10-01

    Despite depressive symptoms being very common among smokers from the general population, few studies have examined the effects of depressive symptoms on smoking treatment outcomes, and even less research has been carried out in the context of contingency management (CM). The authors conducted a secondary analysis to assess the interrelation between treatment condition, depressive symptoms and treatment outcomes among treatment-seeking smokers. The sample was made up of 147 treatment-seeking smokers who were randomly allocated 2 treatment conditions: cognitive behavioral treatment (CBT; n = 74), or CBT + CM (n = 73). CBT was applied in 1-hr group-based sessions over 6 weeks. The CM protocol was voucher-based with maximum earnings of €300 (US$339). Depressive symptoms were assessed using the Beck Depression Inventory-II. Smoking abstinence was verified though cotinine and carbon monoxide. Several analyses were conducted to explore the effect of treatment condition and baseline depressive symptoms on treatment outcomes, as well as the effect of treatment condition and smoking status on depressive symptoms. The CBT + CM condition was more effective than CBT, independent of depressive symptoms. The presence of depressive symptoms decreased the number of days of continuous smoking abstinence. Participants with a greater number of days of continuous smoking abstinence had fewer depressive symptoms than those with fewer days of continuous smoking abstinence. Findings suggest that health care providers should consider encouraging their patients with depressive symptoms to seek smoking cessation services that include both smoking cessation protocols and behavioral activation for mood management, thus maximizing both smoking and depressive outcomes.

  16. Sleep disorders and depression: brief review of the literature, case report, and nonpharmacologic interventions for depression

    Directory of Open Access Journals (Sweden)

    Luca A

    2013-08-01

    Full Text Available Antonina Luca,1 Maria Luca,2 Carmela Calandra2 1Department GF Ingrassia, Section of Neuroscience, 2Department of Medical and Surgery Specialties, Psychiatry Unit, University Hospital Policlinico-Vittorio Emanuele, Catania, Sicily, Italy Abstract: Sleep disorders are so frequently associated with depression that, in the absence of sleep complaints, a diagnosis of depression should be made with caution. Insomnia, in particular, may occur in 60%–80% of depressed patients. Depressive symptoms are important risk factors for insomnia, and depression is considered an important comorbid condition in patients with chronic insomnia of any etiology. In addition, some drugs commonly prescribed for the treatment of depression may worsen insomnia and impair full recovery from the illness. The aim of this paper is to review briefly and discuss the following topics: common sleep disturbances during depression (in particular pavor nocturnus, nightmares, hypersomnia, and insomnia; circadian sleep disturbances; and treatment of depression by manipulation of the sleep-wake rhythm (chronotherapy, light therapy, cycles of sleep, and manipulation of the sleep-wake rhythm itself. Finally, we present a case report of a 65-year-old Caucasian woman suffering from insomnia associated with depression who was successfully treated with sleep deprivation. Keywords: sleep disorders, depression, insomnia, sleep-wake rhythm

  17. Eighteen months of depression: examining the chronic care management of depression with particular reference to Pacific people

    Directory of Open Access Journals (Sweden)

    Tutty S

    2014-03-01

    Full Text Available INTRODUCTION: Primary care is responsible for the 17% of the population with mild to moderately severe mental illness. Total Healthcare Otara (THO, with 49% of its patients of Pacific ethnicity, presents an opportunity to study the primary care management of depression, inclusive of Pacific people. While it had been assumed that Pacific people in New Zealand suffer less mental illness, Te Rau Hinengaro: The New Zealand Mental Health Survey showed this is not the case. AIM: The aim of the study was to examine a Chronic Care Management (CCM programme for depression in a predominantly Pacific practice. METHODS: A clinical audit of the CCM depression programme used by THO between 31 March 2009 and 30 September 2010. Participants were patients aged 18-64 years who scored ≥15 on the Patient Health Questionnaire-9 (PHQ-9. Computer templates completed for each consultation, including serial PHQ-9s, were analysed over time and across different ethnic groups. RESULTS: Cook Island Maori patients participated in the CCM depression programme in proportionally greater numbers than their enrolment in THO, while Samoan and Tongan patients participated significantly less. The mean PHQ-9 score fell rapidly over the first few visits and then levelled off, without reaching the normal range. Dropout rate was 60% after the third consultation irrespective of ethnicity or gender. DISCUSSION: There is a need for ethnic-specific research into depression in Pacific ethnic groups. A significant immediate improvement in PHQ-9 on entering the CCM depression programme suggests enrolment is therapeutic. However, further research into the CCM depression programme is needed, particularly the reasons for non-attendance.

  18. Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Panagioti M

    2014-11-01

    COPD. Beyond pulmonary rehabilitation, the evidence about optimal approaches for managing depression and anxiety in COPD remains unclear and largely speculative. Future research to evaluate the effectiveness of novel and integrated care approaches for the management of depression and anxiety in COPD is warranted.Keywords: chronic obstructive pulmonary disease, depression and anxiety, health outcomes, pulmonary rehabilitation, cognitive behavioral therapy, multidisciplinary case management

  19. Process evaluation to explore internal and external validity of the "Act in Case of Depression" care program in nursing homes.

    NARCIS (Netherlands)

    Leontjevas, R.; Gerritsen, D.L.; Koopmans, R.T.C.M.; Smalbrugge, M.; Vernooij-Dassen, M.J.F.J.

    2012-01-01

    BACKGROUND: A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): "Act in case of Depression" (AiD). OBJECTIVE: Before effect analyses, to evaluate AiD proc

  20. Dialogues on depression management: the primary care and specialist perspectives.

    Science.gov (United States)

    Collins, Richard L; Escobar, Javier I

    2006-10-01

    Depression is a major public health problem in the United States and is responsible for an enormous economic burden and loss of productivity and quality of life. In many cases, PCPs are well situated to identify and treat unrecognized depression, but an optimal treatment program often comprises both medical and psychotherapeutic interventions. Many collaborative models that integrate the efforts of PCPs, psychiatrists, behavioral health organizations, and workplace assistance programs are being tested and may prove to be the best direction for improving care for patients with depression. Looking ahead, improvement in treatment of depression will depend on numerous factors, including educating health care practitioners to recognize silent depression, expanding current collaborative models to cover more of the population, involving MCOs and payers in the development of effective treatment systems, and improving workplace-support programs to encourage more patients to seek appropriate care.

  1. Depression Awareness and Self-Management Through the Internet: Protocol for an Internationally Standardized Approach

    Science.gov (United States)

    Koburger, Nicole; Larkin, Celine; Karwig, Gillian; Coffey, Claire; Maxwell, Margaret; Harris, Fiona; Rummel-Kluge, Christine; van Audenhove, Chantal; Sisask, Merike; Alexandrova-Karamanova, Anna; Perez, Victor; Purebl, György; Cebria, Annabel; Palao, Diego; Costa, Susana; Mark, Lauraliisa; Tóth, Mónika Ditta; Gecheva, Marieta; Ibelshäuser, Angela; Gusmão, Ricardo; Hegerl, Ulrich

    2015-01-01

    Background Depression incurs significant morbidity and confers increased risk of suicide. Many individuals experiencing depression remain untreated due to systemic and personal barriers to care. Guided Internet-based psychotherapeutic programs represent a promising means of overcoming such barriers and increasing the capacity for self-management of depression. However, existing programs tend to be available only in English and can be expensive to access. Furthermore, despite evidence of the effectiveness of a number of Internet-based programs, there is limited evidence regarding both the acceptability of such programs and feasibility of their use, for users and health care professionals. Objective This paper will present the protocol for the development, implementation, and evaluation of the iFightDepression tool, an Internet-based self-management tool. This is a cost-free, multilingual, guided, self-management program for mild to moderate depression cases. Methods The Preventing Depression and Improving Awareness through Networking in the European Union consortium undertook a comprehensive systematic review of the available evidence regarding computerized cognitive behavior therapy in addition to a consensus process involving mental health experts and service users to inform the development of the iFightDepression tool. The tool was implemented and evaluated for acceptability and feasibility of its use in a pilot phase in 5 European regions, with recruitment of users occurring through general practitioners and health care professionals who participated in a standardized training program. Results Targeting mild to moderate depression, the iFightDepression tool is based on cognitive behavioral therapy and addresses behavioral activation (monitoring and planning daily activities), cognitive restructuring (identifying and challenging unhelpful thoughts), sleep regulation, mood monitoring, and healthy lifestyle habits. There is also a tailored version of the tool for

  2. Management & Communication: Project Management Case Study

    CERN Document Server

    Nathalie Dumeaux

    2004-01-01

    We are pleased to announce the recent launch of a new workshop on Project Management. This is designed for People with budgetary, scheduling and/or organizational responsibilities in a project or a sub-project. The objectives through a management case study specially suited to CERN are: to become familiar with modern management techniques in use for structuring, planning, scheduling, costing and progress monitoring of a project or a sub-project. to understand in-depth issues associated with Deliverable-oriented Project Management, Earned Value Management, Advanced Project Cost Engineering and Project Risk Management. The full description of this workshop can be found here. The next session will be held on 8 October 2004. If you are interested in this workshop, please contact Nathalie Dumeaux, email or 78144. Programme of Seminars October to December 2004 Situation : 21.09.2004 Séminaires bilingues Dates Jours Places disponibles Project Management Case study 8 October 1 oui Intr...

  3. Treatment of Depression by Acupuncture in 36 Cases

    Institute of Scientific and Technical Information of China (English)

    YE Guo-chuan; XIAO Yuan-chun

    2003-01-01

    Thirty-six cases of depression were mainlytreated by needling Shenmen ( HT 7), Sanyinjiao ( SP 6) and Zusanli (ST 36). In the case of liver-qi atagnation, Taichong ( LR 3) and Hegu ( LI 4) were added; in the case of phlegm-dampness accumulation, Fenglong ( ST 40) and Yinlingquan ( SP 9 ) were added; in the case of deficiency of both heart and spleen, Xinshu (BL 15) and Pishu (BL 20) were added. Fifteen cases were cured, 7 cases markedly improved, 8 cases improved and 6 cases failed.

  4. ESTROGEN IN THE TREATMENT OF DEPRESSION: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Putu Andrika Kusuma

    2014-02-01

    Full Text Available Depression led to the decline quality of life. With more incidence in women due tohormonal cycle caused women more susceptible to depression. Hormone that fluctuatesand holds a key role in brain and nerve cells is estrogen. Estrogen in premenopausalwomen already decreases. Treatment of depression in premenopausal women who gopast the various considerations needs to consider the provision of hormonal therapy. Inthe case of patients treated with psychotherapy and pharmacotherapy in the form of 2 x20 mg Fluoxetine by mouth and hormonal therapy in the form of 1 x 2 mg Estradiol.Feasibility study to evaluate the hormonal therapy contraindications such as breastcancer also needs to be done.

  5. Major depressive disorder induced by prolactinoma--a case report.

    Science.gov (United States)

    Liao, Wei-Ting; Bai, Ya-Mei

    2014-01-01

    Prolactinomas, the most common type of pituitary tumor, can induce hyperprolactinemia and cause some psychiatric symptoms, such as anxiety, depression and even psychotic symptoms. However, in previous case reports, no information about estrogen levels was mentioned. Here, we present a 48-year-old female patient who had a recurrent episode of major depressive disorder (MDD) and amenorrhea. Hyperprolactinemia (167 ng/ml), low estrogen (15.31 pg/ml) and a pituitary prolactinoma were found by MRI. After a dopamine agonist (Dostinex) and aripiprazole were prescribed, the patient's depressed mood remitted and her menstruation normalized. The possible mechanism of MDD induced by prolactinoma is discussed.

  6. [Atypical depression in Japan--39 case series].

    Science.gov (United States)

    Tada, Koji; Yamayoshi, Kayoko; Matsuzaki, Yamato; Kojima, Takuya

    2005-01-01

    In Japan, relatively little attention has been paid to atypical depression, which is defined as the presence of mood reactivity and two of four associated features: hyperphagia, hypersomnia, leaden paralysis, rejection sensitivity. The present study was undertaken to obtain detailed clinical information from patients with a diagnosis of atypical depression. We assessed clinical characteristics of each atypical feature, comorbidity of other psychiatric disorders, presence of a stressful life event, and underlying psychological stress in 39 psychiatric outpatients. We also examined the relationship of interpersonal sensitivity to each atypical feature. Mean age of onset was 22 +/- 6, 74% were female, 20 patients (51%) had comorbid social phobia. Thirty (77%) had hyperphagia and 25 of these were women. Twenty (74%) had hypersomnia. Only seven patients reported daytime sleepiness and others (13) reported difficulty in staying awake due to lack of energy. Nineteen (49%) had leaden paralysis. Thirty-two patients (82%) had rejection sensitivity and this symptom correlated with scores of FNE (fears of negative evaluation), LSAS (Liebowits social anxiety scale) and Brief social phobia scale (BSPA). Seven patients reported disappointment in love as a stressful life event preceding the depressive episode. In patients with comorbid social phobia, loss of confidence due to hypersensitivity to rejection or criticism seemed to be the most important factor as a chronic psychologica stress. Seven patients met criteria for bipolar disorder and five out of seven had comorbid generalized social phobia. The clinical and theoretical implications of these findings were discussed.

  7. Depression Care Management: Can Employers Purchase Improved Outcomes?

    Directory of Open Access Journals (Sweden)

    Kathryn Rost

    2011-01-01

    Full Text Available Fourteen vendors are currently selling depression care management products to US employers after randomized trials demonstrate improved work outcomes. The research team interviewed 10 (71.4% of these vendors to compare their products to four key components of interventions demonstrated to improve work outcomes. Five of 10 depression products incorporate all four key components, three of which are sold by health maintenance organizations (HMOs; however, HMOs did not deliver these components at the recommended intensity and/or duration. Only one product delivered by a disease management company delivered all four components of care at the recommended intensity and duration. This “voltage drop,” which we anticipate will increase with product implementation, suggests that every delivery system should carefully evaluate the design of its depression product before implementation for its capacity to deliver evidence-based care, repeating these evaluations as new evidence emerges.

  8. Depression management - from neurobiology to a shared care approach.

    Science.gov (United States)

    Agius, Mark; Darby, Laura; Furczyk, Karolina; Holland, Janathon; Khosravi-Nik, Mo; Vyas, Vishal; Zhang, Junyi

    2011-09-01

    The management of depression has recently been the focus of several articles, in particular regarding the efficacy of pharmacological and other treatments. In order for these to be effective as possible, correct diagnosis, consideration of the underlying neurobiology and an appropriate provision of healthcare services must be ensured.

  9. Managing depression in older age: psychological interventions.

    Science.gov (United States)

    Cuijpers, Pim; Karyotaki, Eirini; Pot, Anne Margriet; Park, Mijung; Reynolds, Charles F

    2014-10-01

    The number of studies on psychological treatments of depression in older adults has increased considerably in the past years. Therefore, we conducted an updated meta-analysis of these studies. A total of 44 studies comparing psychotherapies to control groups, other therapies or pharmacotherapy could be included. The overall effect size indicating the difference between psychotherapy and control groups was g=0.64 (95% CI: 0.47-0.80), which corresponds with a NNT of 3. These effects were maintained at 6 months or longer post randomization (g=0.27; 95%CI: 0.16-0.37). Specific types of psychotherapies that were found to be effective included cognitive behavior therapy (g=0.45; 95% CI: 0.29-0.60), life review therapy (g=0.59; 95% CI: 0.36-0.82) and problem-solving therapy (g=0.46; 95% CI: 0.18-0.74). Treatment compared to waiting list control groups resulted in larger effect sizes than treatments compared to care-as-usual and other control groups (peffect sizes than high-quality studies (pcognitive behavior therapy and problem-solving therapy may be more effective than non-directive counseling and other psychotherapies may be less effective than other therapies. This should be considered with caution, however, because of the small number of studies. There were not enough studies to examine the long-term effects of psychotherapies and to compare psychotherapy with pharmacotherapy or combined treatments. We conclude that it is safe to assume that psychological therapies in general are effective in late-life depression, and this is especially well-established for cognitive behavior therapy and problem-solving therapy.

  10. A Water Management Model for Toshka Depression

    Directory of Open Access Journals (Sweden)

    K. M. Fassieh

    2014-01-01

    Full Text Available Toshka Depression (TD, located about 250 km south west of the High Aswan Dam (HAD, consists of four deep-cut basins connected by natural sills. It is required to assess the contribution of TD as a spillway, in enhancing the effectiveness of Lake Nasser in flood control and water availability. However, most related previous works are descriptive and use qualitative methods. In order to provide the required assessment quantitatively, we developed a numerical model which computes TD mass balance and interbasin water movements. The model computes the variation of water volume, surface area, and water level in each one of the four basins (subdepressions, thus depicting their filling sequence, for the past 130 years. This TD response to realistic time series of water inflow gains and evaporation losses is analyzed to compute the TD overflow time series. This response helps assess water availability for agricultural use and effectiveness in alleviating flood risks. Furthermore, the developed model compares between three TD configurations to help the decision maker and recommends (i building a dam—height 10 m—at the end of the fourth subdepression near Kharga Oasis and/or (ii incorporating the third subdepression into TD by digging a canal through the hill that blocks it from the first subdepression.

  11. Depressants

    Science.gov (United States)

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Depressants KidsHealth > For Teens > Depressants A A A What's ... How Can Someone Quit? Avoiding Depressants What Are Depressants? Depressants are drugs that calm nerves and relax ...

  12. Mindful mood balance: a case report of Web-based treatment of residual depressive symptoms.

    Science.gov (United States)

    Felder, Jennifer; Dimidjian, Sona; Beck, Arne; Boggs, Jennifer M; Segal, Zindel

    2014-01-01

    Residual depressive symptoms are associated with increased risk for relapse and impaired functioning. Although there is no definitive treatment for residual depressive symptoms, Mindfulness-Based Cognitive Therapy has been shown to be effective, but access is limited. Mindful Mood Balance (MMB), a Web-based adaptation of Mindfulness-Based Cognitive Therapy, was designed to address this care gap. In this case study, we describe a composite case that is representative of the course of intervention with MMB and its implementation in a large integrated delivery system. Specifically, we describe the content of each of eight weekly sessions, and the self-management skills developed by participating in this program. MMB may be a cost-effective and scalable option in primary care for increasing access to treatments for patients with residual depressive symptoms.

  13. 个案管理模式护理对脑卒中后抑郁患者主要照顾者的影响%Effect of case management on primary caregivers for patients with post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    朱敏; 赵巧红; 李秀雄; 吴定芳

    2015-01-01

    目的:探讨个案管理护理对脑卒中后抑郁患者主要照顾者的影响。方法选择2012年6月~2014年10月佛山市第一人民医院特需医疗中心96例脑卒中后抑郁患者的主要照顾者为研究对象,按患者的入院时间顺序将其主要照顾者分为对照组(52名)和实验组(44名)。对照组接受常规护理,实验组实施个案管理护理。两组均接受出院后6个月随访。分别收集入院时、出院时及出院后3、6个月两组主要照顾者的自我效能感(GSES)和生活满意度(LSIA),比较两组护理效果。结果入院时、出院时两组GSES、LSIA比较,差异无统计学意义(P跃0.05)。出院后3、6个月的GSES、LSIA实验组均优于对照组,差异均有统计学意义(P0.05), but 3 month and 6 month after discharge, the comparative results of study group were all superior to the control group with significant difference (P<0.05 or P<0.01). Conclusion Case management can improve self-efficacy and life satisfaction of the primary caretakers of patients with post-stroke depression.

  14. A systematically tested intervention for managing reactive depression.

    Science.gov (United States)

    Smith, Carol E; Leenerts, Mary Hobbs; Gajewski, Byron J

    2003-01-01

    Patients and family caregivers repeatedly experience reactive depression that leads to medication errors, mismanagement of chronic disease, and poor self-care. These problems place them at high-risk for malnutrition, infection, heart diseases, and psychiatric sequelae. A secondary data analysis compared findings across a series of studies to evaluate the acceptability, effectiveness, and cost of a therapeutic writing intervention to reduce reactive depression, a common and frequently recurring adverse symptom. Secondary analysis of data from the series of studies was conducted. Data came from patients requiring lifelong, daily central intravenous catheter infusion of home total parenteral nutrition necessitated by nonmalignant bowel disease and their family caregivers who assist with this complex home care. Variables combined across the studies were pre- and postintervention scores from the Center for Epidemiological Studies-Depression Scale (CES-D), the number of weeks patients wrote in their diaries (adherence), and the written content in the diaries. Content analysis was used to analyze written data. The intervention materials and nurses' time spent were averaged across studies to determine costs. The weighted average baseline CES-D scores across studies for patients (17.94) and caregivers (15.75) showed the presence of depression. After journal writing had been used for an average of 10.4 weeks across studies, the effect sizes of the between (d =.27) and within (d =.65) patient group scores indicated moderate to large improvement in depression. Themes from written diaries showed that missing out on activities, financial worries, strain related to the severe illness, and the complexity of home care were related to depression across the studies. The intervention was acceptable to participants, effective for managing reactive depression, and low in cost. The next steps will address testing for the longitudinal effects of the intervention.

  15. Health policy and case management.

    Science.gov (United States)

    Mark, D D

    2000-01-01

    The purpose of this article is to analyze the performance of and support for case management using a policy framework in order to increase case managers' awareness of policy making and facilitate successful planning for future policy initiatives. Feldstein's (1996) theory of opposing legislative outcomes indicates that legislation can be viewed on a continuum, ranging from legislation that meets the needs of the public to legislation considered to be in the self-interest of the participants and legislators. The current health care system requires that case managers working for publicly funded health care organizations balance the need for stewardship of U.S. tax dollars and the health care needs of consumers. It is apparent from the literature that case managers are successfully achieving this balance. However, certain conditions should exist that allow for case manager decision-making that promotes effective and efficient utilization of health care resources. Case managers must work within the context of the health care policy environment. Realizing that it is more likely that the conflicts between stewardship and the provision of health care services will continue, case managers' knowledge and influence regarding policy making becomes imperative in order to ensure that these conflicting goals do not become mutually exclusive.

  16. Cushing's syndrome masquerading as treatment resistant depression

    OpenAIRE

    Anil Kumar, B. N.; Sandeep Grover

    2016-01-01

    Treatment resistant depression (TRD) is a common clinical occurrence among patients treated for major depressive disorder. A significant proportion of patients remain significantly depressed in spite of aggressive pharmacological and psychotherapeutic approaches. Management of patient with treatment resistant depression requires thorough evaluation for physical causes. We report a case of recurrent depressive disorder, who presented with severe depressive episode without psychotic symptoms, n...

  17. Psychotherapeutic strategies in the management of depressed and suicidal patients.

    Science.gov (United States)

    Kiev, A

    1975-07-01

    This paper examines the Crisis Intervention Therapy developed by Dr. Kiev's Cornell Program, for the management of depressed and suicidal patients. Combining chemotherapy with supportive psychotherapy, he emphasizes the acquisition of Life Strategy Skills, using motivational audiotaped material. The therapeutic rationale is also explored and related to the explosive and unpredictable interpersonal world of suicidal patients and attiudes of patients and significant others toward the sick role.

  18. Relationships between obesity management and depression management in a university-based family medicine center.

    Science.gov (United States)

    Barnes, Emily R; Theeke, Laurie; Minchau, Elizabeth; Mallow, Jennifer; Lucke-Wold, Noelle; Wampler, Jason

    2015-05-01

    The purpose of this study is to describe and examine relationships among sociodemographics, obesity, and depression management in Appalachian adults. This study was conducted in a primary care center and used a cross-sectional, quantitative, nonexperimental descriptive, and predictive design. Data were obtained from a random sample of 240 adult records that were stratified by gender. Analysis included exploration of all variables for descriptive information followed by bivariate analyses to determine significant relationships between variables, and regression analysis using variables with significant relation to obesity and depression management. Obesity was prevalent (48%) though less than 1% had documented diagnosis. Over 98% of the 65 participants diagnosed with depression did not have documentation of use of a depression screening tool. Diagnosis of depression correlated significantly with elevated body mass index (BMI) and diagnosis of obesity. Gender bias was evident with males having more documentation of weight-loss discussions and planning, and women receiving more referrals to behavioral health for counseling. Innovations to enhance the diagnosis of obesity could lead to consistent provider-led management. Implementation studies of valid depression screening tools in the electronic medical record could enhance the identification of depressive symptoms and could promote health equity. ©2014 American Association of Nurse Practitioners.

  19. Nursing Home Staff Characteristics and Knowledge Gain from a Didactic Workshop on Depression and Behavior Management

    Science.gov (United States)

    Meeks, Suzanne; Burton, Elizabeth G.

    2004-01-01

    Depression is a prevalent and serious problem among nursing home residents. Nursing home staff members are gatekeepers for mental health treatment for residents, but may know little about depression and its management. We evaluated a didactic workshop for nursing home staff on depressive symptoms and management. Results for 58 staff participants…

  20. The effect of stress management training on stress and depression in women with depression disorders: Using cognitive-behavioral techniques

    OpenAIRE

    Abbasian, Farahzad; Najimi, Arash; Meftagh, Sayyed Davood; Ghasemi, Gholamreza; Afshar, Hamid

    2014-01-01

    Background: The present study aimed to investigate the effect of stress management training through cognitive-behavioral techniques on stress, social adaptability and depression in women with depression disorders. Materials and Methods: In this study, 40 patients diagnosed with depression who had referred to psychiatry and consultation clinics of Isfahan were randomly selected and assigned to intervention and control groups (20 patients in each group). The intervention group received eight 90...

  1. The Managerial Nature of Case Management.

    Science.gov (United States)

    Wolk, James L.; And Others

    1994-01-01

    Contends that case managers engage in the practice of management. Employs Mintzberg's seminal research on chief executive behavior to argue that case managers' work is similarly characterized by brevity, variety, and fragmentation. Notes that case managers perform the 10 roles developed by Mintzberg. Describes roles and presents case managers'…

  2. Management of bipolar depression with Lamotrigine: an antiepileptic mood stabilizer

    Directory of Open Access Journals (Sweden)

    Kedar S Prabhavalkar

    2015-10-01

    Full Text Available The efficacy of lamotrigine in the treatment of focal epilepsies have already been reported in several case reports and open studies, which is thought to act by inhibiting glutamate release through voltage-sensitive sodium channels blockade and neuronal membrane stabilization. However, recent findings have also illustrated the importance of lamotrigine in alleviating the depressive symptoms of bipolar disorder, without causing mood destabilization or precipitating mania. Currently, no mood stabilizers are available having equal efficacy in the treatment of both mania and depression, two of which forms the extreme sides of the bipolar disorder. Lamotrigine, a well established anticonvulsant has received regulatory approval for the treatment and prevention of bipolar depression in more than 30 countries worldwide. Lamotrigine, acts through several molecular targets and overcomes the major limitation of other conventional antidepressants by stabilizing mood from ‘below baseline’ thereby preventing switches to mania or episode acceleration, thus being effective for bipolar I disorder. Recent studies have also suggested that these observations could also be extended to patients with bipolar II disorder. Thus, lamotrigine may supposedly fulfill the unmet requirement for an effective depression mood stabilizer.

  3. Rapid Management of Trigeminal Neuralgia and Comorbid Major Depressive Disorder With Duloxetine.

    Science.gov (United States)

    Hsu, Chung-Chih; Chang, Chun-Wei; Peng, Chia-Ho; Liang, Chih-Sung

    2014-08-01

    To describe a case of a patient diagnosed with major depressive disorder whose trigeminal neuralgia was unexpectedly but rapidly and efficiently responsive to duloxetine. A 37-year-old woman was diagnosed with trigeminal neuralgia, and the initial treatment with carbamazepine 800 mg/d did not improve her pain. In the following 3 years, she was poorly responsive to the combination therapy with several medications, including carbamazepine, valproate, baclofen, diclofenac, and acetaminophen. The repeated gamma knife radiosurgery still did not relieve her symptoms. She developed clinically significant depressive symptoms, and a diagnosis of major depressive disorder was made. Duloxetine 30 mg/d was initiated for the management of depression, with the dose gradually increased to 60 mg/d. Unexpectedly, at the dose of 60 mg/d, the patient reported remarkable relief in her trigeminal neuralgia within the first week. Her depressed mood gradually improved in the following 3 weeks. At the 4-year follow-up, she was gradually tapered off her medications, and her depression and trigeminal neuralgia were well managed on duloxetine 60 mg/d and carbamazepine 600 mg/d. The mechanisms may be related to duloxetine's ability to modulate norepinephrine and serotonin and antagonize N-methyl-d-aspartate (NMDA) receptors. The ignition hypothesis is a proposed etiology of trigeminal neuralgia, in that any individual hyperexcitable neuron can spread its discharge quickly to activate the entire population of neurons. We suggest that duloxetine exerts desynchronizing effects through its NMDA antagonism, modulating the hyperexcitable state of the trigeminal afferents. Duloxetine may be an adjuvant in treatment-resistant trigeminal neuralgia. © The Author(s) 2014.

  4. What's funny about case management?

    Science.gov (United States)

    Saxton, S E

    1997-01-01

    Humor is an effective tool to prevent and resolve burnout, a common problem associated with the practice of case management. Easily accessed by almost everyone, humor has many physiological and psychological benefits. The conscious use of humor in an organization requires a commitment at all levels in order for the organization to benefit as a whole. Offering formal seminars, using humor in company newsletters, and encouraging cartoon or joke sharing impacts on the physical and mental health of the employees. Techniques for bringing laughter to the workplace are outlined, as well as examples from the practice of case management.

  5. Case management: unraveling the confusion.

    Science.gov (United States)

    Bower, K

    1998-01-01

    I'm going to close with some of my ideas about the characteristics that case managers exhibit. I have a great deal of professional respect for case managers. I think that you are a tenacious lot. One of the major things that case managers do is help create new alternatives to problems. You open doors; no ... you first build the door and then you open it. You're creative, persistent, and resourceful. You are sometimes asked to solve all of an organization's problems. I think that is a tremendous burden, and that you can get confused because of that role conflict and confusion. What model is best for my organization? Within that is my patient population. What is it that they need? What are the current issues that you are seeing? How is my case management role different from other roles? How large a scope of practice can I handle and be reasonably successful with the patients with whom I'm dealing? How many different kinds of approaches and models are needed within my organization? Look toward the future; think about the future in terms of your crystal balls. What trends do you see building in either the demographics or the health and social environments that are going to influence health care in the future? What effect will the aging of our population have on you and your case management practice? What issues are going to be related to those trends? How many more people do we have living in fragmented families? What's going to happens in terms of resources available for patients? How can case management influence those changes? I don't think we're going to see the pace of change in the health care industry slow down. We will continue to have health care organizations address social issues in addition to pathophysiologic ones. No matter what the role and how it evolves, case management will always be at the junction of change in health care. This will be difficult at times to deal with. It will also be a source of satisfaction for those in the role because of the

  6. Postpartum Depression: Screening, Diagnosis, and Management Programs 2000 through 2010

    Directory of Open Access Journals (Sweden)

    Barbara P. Yawn

    2012-01-01

    Full Text Available The value and appropriateness of universal postpartum depression (PPD screening remains controversial in the United States. To date, several PPD screening programs have been introduced and a few have been evaluated. Among those programs that have been evaluated, most report screening rates, diagnosis rates, or treatment initiation rates. Only four studies included patient outcomes such as the level of depressive symptoms at 6 to 12 months postpartum, and only two reported success in improving outcomes. Program characteristics that appear to result in low rates of diagnosis and followup after PPD screening include requirements for a formal psychiatric evaluation, the need to refer women to another site for therapy, and failure to integrate the PPD screening into the care provided at the woman’s or her child’s medical home. The two programs that reported improved outcomes were both self-contained within primary care and included specific followup, management, and therapy procedures. Both resulted in the need for outside referrals in less than 10% of women diagnosed with postpartum depression. Future studies should be based on the successful programs and their identified facilitators while avoiding identified barriers. To affect policies, the future program must report maternal outcomes going beyond the often reported process outcomes of screening, referral, and therapy initiation rates.

  7. Postpartum Depression: Screening, Diagnosis, and Management Programs 2000 through 2010.

    Science.gov (United States)

    Yawn, Barbara P; Olson, Ardis L; Bertram, Susan; Pace, Wilson; Wollan, Peter; Dietrich, Allen J

    2012-01-01

    The value and appropriateness of universal postpartum depression (PPD) screening remains controversial in the United States. To date, several PPD screening programs have been introduced and a few have been evaluated. Among those programs that have been evaluated, most report screening rates, diagnosis rates, or treatment initiation rates. Only four studies included patient outcomes such as the level of depressive symptoms at 6 to 12 months postpartum, and only two reported success in improving outcomes. Program characteristics that appear to result in low rates of diagnosis and followup after PPD screening include requirements for a formal psychiatric evaluation, the need to refer women to another site for therapy, and failure to integrate the PPD screening into the care provided at the woman's or her child's medical home. The two programs that reported improved outcomes were both self-contained within primary care and included specific followup, management, and therapy procedures. Both resulted in the need for outside referrals in less than 10% of women diagnosed with postpartum depression. Future studies should be based on the successful programs and their identified facilitators while avoiding identified barriers. To affect policies, the future program must report maternal outcomes going beyond the often reported process outcomes of screening, referral, and therapy initiation rates.

  8. "I'm running my depression:" Self-management of depression in neoliberal Australia.

    Science.gov (United States)

    Brijnath, Bianca; Antoniades, Josefine

    2016-03-01

    The current study examines how the neoliberal imperative to self-manage has been taken up by patients, focusing specifically on Indian-Australians and Anglo-Australians living with depression in Australia. We use Nikolas Rose's work on governmentality and neoliberalism to theorise our study and begin by explicating the links between self-management, neoliberalism and the Australian mental health system. Using qualitative methods, comprising 58 in-depth interviews, conducted between May 2012 and May 2013, we argue that participants practices of self-management included reduced use of healthcare services, self-medication and self-labour. Such practices occurred over time, informed by unsatisfactory interactions with the health system, participants confidence in their own agency, and capacity to craft therapeutic strategies. We argue that as patients absorbed and enacted neoliberal norms, a disconnect was created between the policy rhetoric of self-management, its operationalisation in the health system and patient understandings and practices of self-management. Such a disconnect, in turn, fosters conditions for risky health practices and poor health outcomes.

  9. Dissecting the determinants of depressive disorders outcome: an in depth analysis of two clinical cases

    Directory of Open Access Journals (Sweden)

    Oasi Osmano

    2007-02-01

    Full Text Available Abstract Clinicians face everyday the complexity of depression. Available pharmacotherapies and psychotherapies improve patients suffering in a large part of subjects, however up to half of patients do not respond to treatment. Clinicians may forecast to a good extent if a given patient will respond or not, based on a number of data and sensations that emerge from face to face assessment. Conversely, clinical predictors of non response emerging from literature are largely unsatisfactory. Here we try to fill this gap, suggesting a comprehensive assessment of patients that may overcome the limitation of standardized assessments and detecting the factors that plausibly contribute to so marked differences in depressive disorders outcome. For this aim we present and discuss two clinical cases. Mr. A was an industrial manager who came to psychiatric evaluation with a severe depressive episode. His employment was demanding and the depressive episode undermined his capacity to manage it. Based on standardized assessment, Mr. A condition appeared severe and potentially dramatic. Mrs. B was a housewife who came to psychiatric evaluation with a moderate depressive episode. Literature predictors would suggest Mrs. B state as associated with a more favourable outcome. However the clinician impression was not converging with the standardized assessment and in fact the outcome will reverse the prediction based on the initial formal standard evaluation. Although the present report is based on two clinical cases and no generalizability is possible, a more detailed analysis of personality, temperament, defense mechanisms, self esteem, intelligence and social adjustment may allow to formalize the clinical impressions used by clinicians for biologic and pharmacologic studies.

  10. Generalist care managers for the treatment of depressed medicaid patients in North Carolina: A pilot study

    Directory of Open Access Journals (Sweden)

    Ellis Alan R

    2007-03-01

    Full Text Available Abstract Background In most states, mental illness costs are an increasing share of Medicaid expenditures. Specialized depression care managers (CM have consistently demonstrated improvements in patient outcomes relative to usual primary care (UC, but are costly and may not be fully utilized in smaller practices. A generalist care manager (GCM could manage multiple chronic conditions and be more accepted and cost-effective than the specialist depression CM. We designed a pilot program to demonstrate the feasibility of training/deploying GCMs into primary care settings. Methods We randomized depressed adult Medicaid patients in 2 primary care practices in Western North Carolina to a GCM intervention or to UC. GCMs, already providing services in diabetes and asthma in both study arms, were further trained to provide depression services including self-management, decision support, use of information systems, and care management. The following data were analyzed: baseline, 3- and 6-month Patient Health Questionnaire (PHQ9 scores; baseline and 6-month Short Form (SF 12 scores; Medicaid claims data; questionnaire on patients' perceptions of treatment; GCM case notes; physician and office staff time study; and physician and office staff focus group discussions. Results Forty-five patients were enrolled, the majority with preexisting depression. Both groups improved; the GCM group did not demonstrate better clinical and functional outcomes than the UC group. Patients in the GCM group were more likely to have prescriptions of correct dosing by chart data. GCMs most often addressed comorbid conditions (36%, then social issues (27% and appointment reminders (14%. GCMs recorded an average of 46 interactions per patient in the GCM arm. Focus group data demonstrated that physicians valued using GCMs. A time study documented that staff required no more time interacting with GCMs, whereas physicians spent an average of 4 minutes more per week. Conclusion GCMs

  11. Depression in systemic sclerosis: Review of the neuro-immunologic link and pharmacological management

    Directory of Open Access Journals (Sweden)

    Aditya Somani

    2016-01-01

    Full Text Available Depression is a common neuropsychiatric condition associated with systemic sclerosis. The association of depression and systemic sclerosis is the result of multiple mechanisms such as autoimmune, significant morbidity due to multi-system involvement, distorted self-image due to disfigurement, chronic disability, and iatrogenic. The prevalence of depression in systemic sclerosis is as high as 65% as found in several clinical studies. Early diagnosis and appropriate intervention of depression in systemic sclerosis through integrated multidisciplinary team approach is more likely to improve the global outcome of illness. Hence, multidisciplinary management approach is highly recommended for the management of depression in systemic sclerosis.

  12. Depression

    Science.gov (United States)

    ... overview URL of this page: //medlineplus.gov/ency/article/003213.htm Depression - overview To use the sharing features on this ... older adults Major depression Persistent depressive disorder Postpartum depression Premenstrual ... Review Date 1/4/2016 Updated by: Timothy Rogge, ...

  13. COMPOSITE CONTENT MANAGEMENT-CASE MANAGEMENT AND ENTERPRISE CONTENT MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Lekha Menon

    2012-01-01

    Full Text Available Interest in Composite Content Applications has been climbing higher over the recent years due to the rising need around enabling business process improvements and addressing challenges around business process agility. Such applications can deliver substantial value by leveraging both content and process services for the better orchestration of people and processes and empower organizations to automate routine tasks and aggregate information from multiple sources in a collaborative work environment that enables rapid decision making. In this whitepaper, we have introduced Case Management and its relationship with ECM, the essential functionalities in a Case Management Product stack and expanded on leading vendors in this space along with the salient features of their case management offerings. Subsequently we have built on a sample case scenario of building a contracts management application using EMC Documentum xCelerated Composition Platform (xCP, the business needs and challenges that a well-designed Contracts Management application can address, a real-life application of xCP platform to build such a solution and the observations on the strengths and limitations of this platform, along with a few workarounds to address the limitations.

  14. Case manager as therapy extender for cognitive behavior therapy of serious mental illness: a case report.

    Science.gov (United States)

    Pinninti, Narsimha R; Schmidt, Lisa T; Snyder, Richard P

    2014-05-01

    Cognitive behavior therapy (CBT) is an evidence-based intervention for individuals with serious mental illness and potentiates standard medication management. Americans receiving publicly funded treatment for serious mental illnesses have limited access to CBT and hence we need to devise innovative ways of providing access to this important intervention. We present a case of a man who had severe disability, was medication resistant, and diagnosed with Obsessive Compulsive Disorder and Major Depressive Disorder. After being home bound for many years he was provided CBT utilizing his existing case manager as a therapy extender. The specific roles of the primary therapist and case manager as well as the improvement in quality of life of the individual are delineated. This case report opens up the possibility of further studying case managers as therapy extenders for treating serious mental illnesses.

  15. Pharmacological and psychotherapeutic interventions for management of poststroke depression

    Science.gov (United States)

    Sun, Xuejun; Deng, Linghui; Qiu, Shi; Tu, Xiang; Wang, Deren; Liu, Ming

    2017-01-01

    Abstract Introduction: Poststroke depression (PSD) constitutes an important complication of stroke, leading to great disability as well as increased mortality. Since which treatment for PSD should be preferred are still matters of controversy, we are aiming to compare and rank these pharmacological and nonpharmacological interventions. Methods and analysis: We will employ a network meta-analysis to incorporate both direct and indirect evidence from relevant trials. We will search PubMed, the Cochrane Library Central Register of Controlled Trials, Embase, and the reference lists of relevant articles for randomized controlled trials (RCT) of different PSD treatment strategies. The characteristics of each RCT will be summarized, including the study characteristics, the participant characteristics, the outcome measurements, and adverse events. The risk of bias will be assessed by means of the Cochrane Collaboration's risk of bias tool. The primary outcome was change in Hamilton Depression Scale (HAMD) score. Secondary outcomes involve patient response rate (defined as at least a 50% score reduction on HAMD), and remission rate (defined as no longer meeting baseline criteria for depression). Moreover, we will assess the acceptability of treatments according to treatment discontinuation. We will perform pairwise meta-analyses by random effects model and network meta-analysis by Bayesian random effects model. Conclusion: Formal ethical approval is not required as primary data will not be collected. Our results will help to reduce the uncertainty about the effectiveness and safety of PSD management, which will encourage further research for other therapeutic options. The review will be disseminated in peer-reviewed publications and conference presentations. PROSPERO registration number: CRD42016049049 PMID:28207523

  16. Depression

    DEFF Research Database (Denmark)

    Kessing, Lars Veddel; Bukh, Jens Otto Drachmann

    2014-01-01

    The prevalence of depression is not clearly established, but estimated to 3-4% in a Danish questionnaire study. Lifetime's prevalences of 12-17% are reported in other community samples. In the current diagnostic system depression is defined categorically and operationally. It has been argued......, that these diagnostic criteria represent an oversimplification, which has blurred the concept of depression. We suggest a greater emphasis on the depressed mood as the core symptom of depression, which may increase the specificity of the diagnosis. Furthermore, basic principles for the treatment of depression...

  17. Depression

    DEFF Research Database (Denmark)

    Kessing, Lars Veddel; Bukh, Jens Drachmann

    2014-01-01

    , that these diagnostic criteria represent an oversimplification, which has blurred the concept of depression. We suggest a greater emphasis on the depressed mood as the core symptom of depression, which may increase the specificity of the diagnosis. Furthermore, basic principles for the treatment of depression......The prevalence of depression is not clearly established, but estimated to 3-4% in a Danish questionnaire study. Lifetime's prevalences of 12-17% are reported in other community samples. In the current diagnostic system depression is defined categorically and operationally. It has been argued...

  18. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis.

    Science.gov (United States)

    Thota, Anilkrishna B; Sipe, Theresa Ann; Byard, Guthrie J; Zometa, Carlos S; Hahn, Robert A; McKnight-Eily, Lela R; Chapman, Daniel P; Abraido-Lanza, Ana F; Pearson, Jane L; Anderson, Clinton W; Gelenberg, Alan J; Hennessy, Kevin D; Duffy, Farifteh F; Vernon-Smiley, Mary E; Nease, Donald E; Williams, Samantha P

    2012-05-01

    To improve the quality of depression management, collaborative care models have been developed from the Chronic Care Model over the past 20 years. Collaborative care is a multicomponent, healthcare system-level intervention that uses case managers to link primary care providers, patients, and mental health specialists. In addition to case management support, primary care providers receive consultation and decision support from mental health specialists (i.e., psychiatrists and psychologists). This collaboration is designed to (1) improve routine screening and diagnosis of depressive disorders; (2) increase provider use of evidence-based protocols for the proactive management of diagnosed depressive disorders; and (3) improve clinical and community support for active client/patient engagement in treatment goal-setting and self-management. A team of subject matter experts in mental health, representing various agencies and institutions, conceptualized and conducted a systematic review and meta-analysis on collaborative care for improving the management of depressive disorders. This team worked under the guidance of the Community Preventive Services Task Force, a nonfederal, independent, volunteer body of public health and prevention experts. Community Guide systematic review methods were used to identify, evaluate, and analyze available evidence. An earlier systematic review with 37 RCTs of collaborative care studies published through 2004 found evidence of effectiveness of these models in improving depression outcomes. An additional 32 studies of collaborative care models conducted between 2004 and 2009 were found for this current review and analyzed. The results from the meta-analyses suggest robust evidence of effectiveness of collaborative care in improving depression symptoms (standardized mean difference [SMD]=0.34); adherence to treatment (OR=2.22); response to treatment (OR=1.78); remission of symptoms (OR=1.74); recovery from symptoms (OR=1.75); quality of

  19. Organic depression and Terson′s syndrome in adult polycystic kidney disease: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Ranganath R Kulkarni

    2014-01-01

    Full Text Available Depressive symptoms are common in neurological diseases, at times posing dilemma in organic or functional origin. Cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes that resemble primary depressions both clinically and therapeutically in about half of the patients following acute stroke. Terson′s syndrome is the direct occurrence of vitreous hemorrhage following subarachnoid/subdural hemorrhage, often overlooked in the acute setting. Autosomal dominant (adult polycystic kidney disease may be associated with berry aneurysms and hypertension, and may lead to intracranial bleeds. We report an unusual case of organic depression and Terson′s syndrome in a 50-year-old female with polycystic kidney disease and hypertension, following anterior communicating artery aneurysmal subarachnoid bleed with bilateral subdural extension. Management included anti-hypertensives, antiepileptics, neodymium: YAG laser photocoagulation, and aneurysmal clipping.

  20. 75 FR 27375 - Postal Rate Case Management

    Science.gov (United States)

    2010-05-14

    ... From the Federal Register Online via the Government Publishing Office POSTAL REGULATORY COMMISSION Postal Rate Case Management AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is seeking comments relevant to management of an anticipated exigent postal rate case. It...

  1. Depressants

    Science.gov (United States)

    ... judgment and mental functioning nausea and vomiting memory loss (depressants can cause users to have no memory of events that happened while they were under the influence) Long-Term Effects When people misuse depressants over a long ...

  2. Making the business case for enhanced depression care: the National Institute of Mental Health-harvard Work Outcomes Research and Cost-effectiveness Study.

    Science.gov (United States)

    Wang, Philip S; Simon, Gregory E; Kessler, Ronald C

    2008-04-01

    Explore the business case for enhanced depression care and establish a return on investment rationale for increased organizational involvement by employer-purchasers. Literature review, focused on the National Institute of Mental Health-sponsored Work Outcomes Research and Cost-effectiveness Study. This randomized controlled trial compared telephone outreach, care management, and optional psychotherapy to usual care among depressed workers in large national corporations. By 12 months, the intervention significantly improved depression outcomes, work retention, and hours worked among the employed. Results of the Work Outcomes Research and Cost-effectiveness Study trial and other studies suggest that enhanced depression care programs represent a human capital investment opportunity for employers.

  3. Theory and practice in the management of depressive disorders.

    Science.gov (United States)

    Linden, M

    1999-06-01

    Scientific, professional, and governmental bodies have in recent years intensified efforts to formulate guidelines for the treatment of depression with the goal that medical practice should comply with these standards and thus improve patient care. 'Evidence-based medicine' demands that medical practice should explicitly refer to the best available scientific knowledge. Empirical data on the epidemiology of care suggest that there are major differences between guidelines and routine practice. Failure to detect mental disorders range from 45 to 90%. Only 1 in 10 of those suffering from depression receive adequate treatment. Treatment is insufficient as prescribed dosages are routinely too low, as up to 50% of treatments are ended prematurely and because patient non-compliance interferes with proper treatment application. Psychological treatment is provided only in 60% of cases in need and is mostly unspecific, i.e. listening or giving advice. Furthermore, there are large regional variations in prescribing patterns which show that treatment is influenced by many non-medical factors. Empirical studies show that giving information to physicians or even measures to improve recognition alone are not sufficient to make changes in treatment behaviour. Only if measures are taken to improve treatment interventions directly then, at least for more severe cases, could better illness outcome be shown. If one wants to understand therapist non-compliance with treatment guidelines then one first has to understand the process of medical decision making. Action theory provides a model which brings together theoretical and experimental knowledge, goal setting, medical and emotional assessment, and operational procedures. On the basis of this theory, future guidelines should specify the setting for which they claim to be valid, they should be empirically tested for their feasibility and effects on patient outcome, and they should give proper attention to non-medical factors which have

  4. Pharmacological Management of Treatment-Resistant Pediatric Depression

    Science.gov (United States)

    Kratochvil, Christopher J.; Wagner, Karen Dineen; Emslie, Graham; March, John

    2005-01-01

    A 13-year-old boy presents with treatment-resistant symptoms of major depression. This is his first episode of depression, initially treated with 200 mg sertraline for 12 weeks with no significant benefit. The severe depression has shown a partial response to weekly cognitive-behavioral therapy (CBT) and fluoxetine, which was titrated up to 60 mg…

  5. Depression

    DEFF Research Database (Denmark)

    Cizza, G; Ravn, Pernille; Chrousos, G P

    2001-01-01

    Existing studies of the relationship between depression and osteoporosis have been heterogeneous in their design and use of diagnostic instruments for depression, which might have contributed to the different results on the comorbidity of these two conditions. Nevertheless, these studies reveal...... a strong association between depression and osteoporosis. Endocrine factors such as depression-induced hypersecretion of corticotropin-releasing hormone and hypercortisolism, hypogonadism, growth hormone deficiency and increased concentration of circulating interleukin 6, might play a crucial role...... in the bone loss observed in subjects suffering from major depression....

  6. Rumination-focused cognitive behaviour therapy for residual depression: a case series.

    Science.gov (United States)

    Watkins, Ed; Scott, Jan; Wingrove, Janet; Rimes, Katharine; Bathurst, Neil; Steiner, Herbert; Kennell-Webb, Sandra; Moulds, Michelle; Malliaris, Yanni

    2007-09-01

    The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression.

  7. Disease management for co-morbid depression and anxiety in diabetes mellitus

    DEFF Research Database (Denmark)

    Stoop, Corinne H; Spek, Viola R M; Pop, Victor J M

    2011-01-01

    BACKGROUND: Depression and anxiety are common co-morbid health problems in patients with type 2 diabetes. Both depression and anxiety are associated with poor glycaemic control and increased risk of poor vascular outcomes and higher mortality rates. Results of previous studies have shown...... that in clinical practice, treatment of depression and anxiety is far from optimal as these symptoms are frequently overlooked and undertreated. METHODS/DESIGN: This randomised controlled trial will examine the effectiveness of a disease management programme treating symptoms of depression and anxiety in primary......). DISCUSSION: The disease management model for co-morbid depression and anxiety in primary care patients with diabetes is expected to result in reduced symptoms of depression and anxiety, improved quality of life, reduced diabetes specific distress and improved glyceamic control, compared to care as usual...

  8. Depression

    DEFF Research Database (Denmark)

    Pouwer, Frans

    2017-01-01

    There is ample evidence that depression is000  a common comorbid health issue in people with type 1 or type 2 diabetes. Reviews have also concluded that depression in diabetes is associated with higher HbA1c levels, less optimal self-care behaviours, lower quality of life, incident vascular...... complications and higher mortality rates. However, longitudinal studies into the course of depression in people with type 1 diabetes remain scarce. In this issue of Diabetologia, Kampling and colleagues (doi: 10.1007/s00125-016-4123-0 ) report the 5 year trajectories of depression in adults with newly diagnosed...... type 1 diabetes (mean age, 28 years). Their baseline results showed that shortly after the diagnosis of type 1 diabetes a major depressive episode was diagnosed in approximately 6% of participants, while 8% suffered from an anxiety disorder. The longitudinal depression data showed that, in a 5 year...

  9. A "Mental-Health-at-the-Workplace" Educational Workshop Reduces Managers' Stigma Toward Depression.

    Science.gov (United States)

    Hamann, Johannes; Mendel, Rosmarie; Reichhart, Tatjana; Rummel-Kluge, Christine; Kissling, Werner

    2016-01-01

    Stigma and discrimination are important factors hindering people with mental health conditions to stay employed or successfully make their careers. We surveyed 580 German managers before and after visiting a "mental-health-at-the-workplace" educational workshop using the Depression Stigma Scale. The workshop significantly reduced stigma toward depression. Managers at baseline already exhibited lower stigma toward depression compared with the general population. In addition, female gender and higher education predicted lower stigma, which is in line with findings from other studies. We conclude that an educational workshop giving practical guidance regarding "mental-health-at-the-workplace" reduces managers' stigma toward depression and improves knowledge regarding depression, its course, and its treatment.

  10. Pain intensity influences the relationship between anger management style and depression.

    Science.gov (United States)

    Estlander, Ann-Mari; Knaster, Peter; Karlsson, Hasse; Kaprio, Jaakko; Kalso, Eija

    2008-11-30

    There is an abundance of studies concerning depression and pain, while the mechanisms and the relationships of anger expression and pain are less well known. The validity of commonly used depression questionnaires as measures of depression in pain patients has been questioned, as they include items which can be related to the pain problem as well as to signs of depression. The aim of this study was to investigate the relationships between pain severity, various signs of depression, and anger management style. Subjects were 100 consecutive patients referred to the Helsinki University Pain Clinic. Demographic data and pain intensity (VAS) were collected by a questionnaire. Two subscales (negative view and physical function) from the Beck Depression Inventory, and the Anger Expression Scales (Anger-in and Anger-out) from the Spielberg State Trait Anger Expression Inventory 2 were used to assess depression and anger expression, respectively. The results showed that pain severity modulates the relationship between anger expression and physical signs of depression. In patients with more severe pain, the relationships between anger management style, specifically, inhibition of anger and depression were strong, while no such relationships were found in the group of patients with less severe pain. No correlations were found between pain intensity and depression as measured by the sum score of the BDI. However, analysing separately the two subscales of the BDI, negative view and physical function, significant positive relationships between pain intensity and both subscales appeared.

  11. Adolescents' and Best Friend's Depressive Symptoms and Conflict Management: Intraindividual and Interpersonal Processes Over Time.

    Science.gov (United States)

    Boersma-van Dam, Elise; Hale, Bill; Koot, Hans; Meeus, Wim; Branje, Susan

    2016-12-12

    This 6-year longitudinal study examined the relation between 3 conflict management styles (i.e., problem solving, conflict engagement, and compliance) and depressive symptoms in adolescent-best friend relationships. Participants were 479 Dutch adolescents and their best friend who reported annually on depressive symptoms and conflict management styles toward each other. Bidirectional effects between conflict management styles and depressive symptoms were studied both within adolescents (intraindividual) and between adolescent best friends (interpersonal). A positive interpersonal effect of depressive symptoms of one dyad member on depressive symptoms of the other member was found. Similarly, higher positive problem solving and conflict engagement of one dyad member predicted respectively higher problem solving and conflict engagement of the other dyad member. Adolescents who reported more depressive symptoms reported more conflict engagement and compliance over time. In addition, for boys, higher levels of depressive symptoms of one dyad member were related to more problem solving by the other member over time. The current study contributed to the literature by showing that depressive symptoms and conflict management are related constructs in adolescents and that both intrapersonal and interpersonal processes contribute to this relation.

  12. Contingency management improves outcomes in cocaine-dependent outpatients with depressive symptoms.

    Science.gov (United States)

    García-Fernández, Gloria; Secades-Villa, Roberto; García-Rodríguez, Olaya; Peña-Suárez, Elsa; Sánchez-Hervás, Emilio

    2013-12-01

    Despite depressive symptoms being very common among patients seeking treatment for cocaine dependence, few studies have examined the effects of depressive symptoms on cocaine outpatient treatment outcomes, and there is even less research in the context of Contingency Management (CM). The purpose of this study was to assess the main and interactive effects of co-occurring depressive symptoms on CM outcomes. Cocaine-dependent individuals (N = 108) were randomized to Community Reinforcement Approach (CRA) or CRA plus CM in two outpatient community clinical settings. Participants were categorized according to depression symptoms, self-reported by means of the BDI at treatment entry. Outcome measures included treatment retention and documented cocaine abstinence over a 6-month treatment period. Depressive symptoms were more commonly found in females and in unemployed participants, and were associated with more drug-related, social, and psychiatric problems at treatment entry. Individuals with baseline depressive symptoms had poorer treatment outcomes than patients without depressive symptoms. The addition of CM to CRA made the program more effective than with CRA alone, regardless of depressive symptoms. CM was associated with better abstinence treatment outcomes, while the interaction between unemployment and depressive symptoms was associated with negative retention treatment outcomes. This study supports the efficacy of CM for cocaine-dependent outpatients with and without depressive symptoms, and highlights its importance for improving treatment for unemployed and depressed cocaine-dependent individuals.

  13. Depression.

    Science.gov (United States)

    Strock, Margaret

    Approximately ten percent of the population suffers from a depressive illness each year. Although the economic cost is high, the cost in human suffering is immeasurable. To help educate the population about this disorder, this paper presents a definition of depression and its common manifestations. The symptoms that people often experience are…

  14. Depression

    DEFF Research Database (Denmark)

    Johansen, Jon O. J.

    2013-01-01

    Nyhederne er fulde af historier om depression. Overskrifter som: ’Danskerne propper sig med lykkepiller’ eller ‘depression er stadigvæk tabu’ går tit igen i dagspressen. Men hvor er nuancerne, og hvorfor gider vi læse de samme historier igen og igen? Måske er det fordi, vores egne forestillinger er...

  15. Avoidable costs of comprehensive case management.

    Science.gov (United States)

    Issel, L M; Anderson, R A

    1999-01-01

    Comprehensive case management has become an industry standard and its pervasiveness raises questions about the ubiquitous need for this service. Analyzed from the perspective of transaction cost analysis and access, we argue that in some cases comprehensive case management is an avoidable cost incurred because of system problems that limit access to otherwise eligible clients. Implications are discussed.

  16. Study on Case Teaching of Financial Management

    Science.gov (United States)

    Che, Zhenghong; Che, Zhengmei

    2011-01-01

    Case teaching is an efficient teaching method of management. It plays an important role to enhance the students' ability to practice the theory. However, case teaching of financial management has not achieved the expected results. The paper aims to study the importance, characteristics and corresponding methods of case teaching method of financial…

  17. An investigation into the effects of cognitive behavioral therapy on patients with chronic depression: a small case series

    Directory of Open Access Journals (Sweden)

    Horn GL

    2012-10-01

    Full Text Available Gemma Louise HornUniversity of Dundee, Scotland, UKBackground: National Institute for Clinical Excellence (NICE guidelines recommend a combination of cognitive behavioral therapy (CBT and antidepressants to treat chronic depression. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP is the only therapy model specifically designed for the treatment of chronic depression.Objectives: To determine the clinical response to the CBASP of patients in a specialist clinical service for affective disorder and to ascertain their views on the value of the CBASP for their condition.Methods: Qualitative data from interviews including a questionnaire and objective data from Becks Depression Inventory II symptom rating scales were used to monitor the progress of a small case series of five patients with chronic, treatment refractory depression as they received the CBASP over a 10-month period.Results: Common themes from patient interviews show very positive engagement and attitudes to the CBASP from the questionnaire. Rating scales from Becks Depression Inventory II pre- and posttreatment showed very little change for three patients with improvements between 2 and 7 points but deterioration in symptoms of 2 points for the fourth patient.Conclusion: The CBASP is a well-liked and positive therapy that helps patients manage their lives and deal with personal relationships, although objective data indicate little change in symptom severity.Keywords: cognitive behavioral therapy, chronic depression, CBASP

  18. Shugan Jieyu Yin for Treatment of Senile Depression--A Clinical Report of 84 Cases

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ TCM holds that depression is, in most cases,resulted from injuries of the seven emotions and/or from stagnation of qi. The principle of treatment should be mainly to relieve the depressed liver and to regulate the flow of qi, supplemented by nourishing the blood and the liver, eliminating heat and irritability, promoting blood circulation by removing blood stasis, tranquilizing the mind, and dredging the collaterals to stop pain. Since 1995, we have treated 84 cases of senile depression with the prescription of Shugan Jieyu Yin (舒肝解郁饮Decoction for Relieving the Depressed Liver), and obtained satisfactory therapeutic results. A report follows.

  19. Organizational factors and depression management in community-based primary care settings

    Directory of Open Access Journals (Sweden)

    Kilbourne Amy M

    2009-12-01

    Full Text Available Abstract Background Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework. Methods We used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT infrastructure, and external incentives and process features (e.g., staff performance, degree of integrated depression care, and IT performance. Results The results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment. Conclusions The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition

  20. Understanding Teenage Depression: A Guide to Diagnosis, Treatment, and Management.

    Science.gov (United States)

    Empfield, Maureen; Bakalar, Nicholas

    The incidence of teenage depression has increased all over the world. In some populations it is has been accompanied by suicide, but suicide remains rare. Clinical depression, which entails many debilitating physical and psychological symptoms, is a serious disease that can do terrible and even permanent damage to a teenager's developmental…

  1. Cognitive evolutionary therapy for depression: a case study

    OpenAIRE

    Giosan, Cezar; Muresan, Vlad; Moldovan, Ramona

    2014-01-01

    Key Clinical Message We present an evolutionary-driven cognitive–behavioral intervention for a moderately depressed patient. Standard cognitive and behavioral therapy techniques focused on the patient's perfectionistic and self-downing beliefs, while novel, evolutionary-informed techniques were used to guide behavioral activation and conceptualize secondary emotional problems related to anger. The treatment reduced depressive symptomatology and increased evolutionary fitness.

  2. Manic depression in literature: the case of Virginia Woolf.

    Science.gov (United States)

    Koutsantoni, Katerina

    2012-06-01

    The steady growth of the discipline of medical humanities has facilitated better understanding of the symptoms and signs of mental health conditions and the feelings of the humans experiencing them. In this project, the arts have been seen as enabling re-engagement of the practitioner with the patient's own perceptions and feelings. With respect to the association between creativity and bipolar disorder in particular, work within medical humanities has meant that mentally ill creative individuals have been subject to scientific scrutiny and investigation, rather than continuing to be viewed as naively romanticised cases of mental illness. This paper is an attempt to supplement traditional literary criticism by examining Virginia Woolf's history of bipolar disorder through a medical humanities lens. I will provide an overview of Woolf's history of manic-depressive episodes, their symptoms and manifestation, look back on her circumstances during their occurrence, and observe the author's losing battle to salvage her identity in the throes of the disease. The aim is to offer further insight into Woolf's psychopathology and to gain some understanding of the causes and progression of the condition that led to her death by suicide.

  3. Depression

    Science.gov (United States)

    ... Different people have different symptoms. Some symptoms of depression include: Persistent sad, anxious, or “empty” mood Feelings of hopelessness or pessimism Feelings of guilt, worthlessness, or helplessness ...

  4. Emotionally intelligent case managers make a difference.

    Science.gov (United States)

    Tahan, H A

    2000-01-01

    Emotional intelligence is a skill necessary for case managers because of the diversity of their work, the multiple stakeholders they have to deal with on daily basis, and the increased potential for conflict. Managers and administrators need to be cognizant of the role emotional intelligence plays in employee performance and the importance of developing training programs to assist case managers in learning to deal with change and conflict. Case managers must assume responsibility for their actions and work to develop and improve their emotional intelligence skills set. Ultimately, patients and work associates will appreciate the case manager's efforts. Finally, case managers will find work an enjoyable experience and look forward to new opportunities the future holds.

  5. The Pharmacological management of Depression – Update 2017

    African Journals Online (AJOL)

    Depressive symptoms must be present for a period of at least two weeks in ... Monoamine-deficiency and depletion of central nervous .... antidepressants or patients with major eating disorders is not .... Additional indication in bulimia nervosa.

  6. Treatment of chronic depression with sulpiride: evidence of efficacy in placebo-controlled single case studies.

    Science.gov (United States)

    Maier, W; Benkert, O

    1994-08-01

    Systematic variation of treatment (alternating active drug and placebo in four treatment periods) in individual patients is proposed to collect preliminary evidence for a therapeutic effect of sulpiride in chronic depression; the ARIMA model is applied to evaluate the intervention effects of the tentatively effective treatment in single subjects. Ten single cases of chronic depression with a diagnosis of major depression or dysthymia were selected and seven of these provided evidence for beneficial effects of sulpiride with regard to treating the symptoms of depression and anxiety. However, the drug effects were intraindividually not always replicable. The results obtained with these single cases positively support the recommendation to perform regular randomized placebo-controlled trials with sulpiride in chronic depression. Simultaneously, these single case investigations reveal a lack of temporal stability of treatment response and inconsistencies of response with regard to different treatment targets in individual patients.

  7. Gender dysphoria with homosexuality and comorbid depressive disorder: complexities in concept and management

    Directory of Open Access Journals (Sweden)

    M. S. Bhatia

    2015-09-01

    Full Text Available Gender identity disorder (GID and homosexuality are complex entities debated over decades, whether should be categorized as a disorder or not. There are a number of problems specifically related to the criteria of the GID diagnosis like differences in the terms trans-sexualism and GID, failure of the proposed criteria in conceptualizing the whole spectrum of gender variance phenomena, the potential risk of physically invasive examinations to rule out intersex conditions and the application of diagnosis even after hormonal and surgical treatment. We hereby report complexities faced in the case of a male to female transsexual with homosexuality and depressive disorder and its management. [Int J Res Med Sci 2015; 3(9.000: 2459-2462

  8. Assessing Outcome in Cognitive Behavior Therapy for Child Depression: An Illustrative Case Series

    Science.gov (United States)

    Eckshtain, Dikla; Gaynor, Scott T.

    2009-01-01

    Recent meta-analytic data suggest a need for ongoing evaluation of treatments for youth depression. The present article calls attention to a number of issues relevant to the empirical evaluation of if and how cognitive behavior therapy for child depression works. A case series of 6 children and a primary caregiver received treatment--individual…

  9. Problem-solving treatment for complicated depression in late life: a case study in primary care.

    Science.gov (United States)

    Haverkamp, Rita; Areán, Patricia; Hegel, Mark T; Unützer, Jürgen

    2004-01-01

    Treatment of depression in primary care. To describe the application of problem-solving treatment for a person with complicated depression. Specific treatment details from audiotaped therapy sessions; published literature. This case demonstrates how an older person benefited from problem-solving treatment.

  10. Assessing Outcome in Cognitive Behavior Therapy for Child Depression: An Illustrative Case Series

    Science.gov (United States)

    Eckshtain, Dikla; Gaynor, Scott T.

    2009-01-01

    Recent meta-analytic data suggest a need for ongoing evaluation of treatments for youth depression. The present article calls attention to a number of issues relevant to the empirical evaluation of if and how cognitive behavior therapy for child depression works. A case series of 6 children and a primary caregiver received treatment--individual…

  11. Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment.

    Science.gov (United States)

    McLean, R C; Morrison, D S; Shearer, R; Boyle, S; Logue, J

    2016-04-01

    The objective of the study is to investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme. The study design is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with 'caseness' scoring ≥11 and severity ≥14. The participants were all patients who began a weight management programme between 1 October 2008 and 30 September 2009 (n = 1838). The setting was the Glasgow and Clyde Weight Management Service (GCWMS), a specialist multidisciplinary service, which aims to achieve a minimum of ≥5 kg weight loss. The results were as follows: patients with HADS score ≥14 were referred to the integrated psychology service for psychological assessment or intervention. Patients with caseness (HADS ≥11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socio-economically deprived and a higher proportion was female. There was a significant positive correlation between HADS anxiety and depression scores and increasing body mass index (r(2)  = 0.094, P anxiety or depression. More patients with HADS score ≥11 achieved ≥5 kg or ≥5% weight loss and by 12 months those with anxiety had a significantly higher mean weight loss (P = 0.032). Participants who scored for severe anxiety (HADS ≥14) achieved similar weight loss to those without, whilst participants who scored for severe depression achieved significantly greater weight loss than non-cases at 3, 6 and 12 months of follow-up (P anxiety or depression and were offered additional psychological input achieved similar or better weight loss outcomes.

  12. The employer's case for health management.

    Science.gov (United States)

    Coulter, Christopher H

    2006-01-01

    Employers' past solutions to rising health benefit costs--adopting managed care strategies, cost shifting to employees and reducing benefits-are no longer effectively controlling costs and are depressing the value of health benefits for employee recruitment and retention. An alternative strategy is to implement health management approaches that improve the health status of employees. These programs reduce medical costs and have a documented positive impact on workers' compensation, disability costs, absenteeism and productivity. Further, this approach is complementary to health care consumerism as a strategy for health improvement and benefit cost reduction and results in improved employee health, outlook and satisfaction.

  13. Case Studies in Middle Management Supervision

    Science.gov (United States)

    White, Lori S.

    2011-01-01

    This chapter presents a series of supervision-related case studies of situations that midlevel managers might face. Individuals enrolled in a midlevel management professional development course recommended the topics selected for this chapter. Drawing upon her experience teaching the course, the author selected four case studies that individuals…

  14. Iowa Case Management for Rural Drug Abuse

    Science.gov (United States)

    Hall, James A.; Vaughan Sarrazin, Mary S.; Huber, Diane L.; Vaughn, Thomas; Block, Robert I.; Reedy, Amanda R.; Jang, MiJin

    2009-01-01

    Objective: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. Method: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual…

  15. TRIPPD: a practice-based network effectiveness study of postpartum depression screening and management.

    Science.gov (United States)

    Yawn, Barbara P; Dietrich, Allen J; Wollan, Peter; Bertram, Susan; Graham, Debbie; Huff, Jessica; Kurland, Margary; Madison, Suzanne; Pace, Wilson D

    2012-01-01

    Postpartum depression is common but inadequately recognized and undertreated. Continuing depressive symptoms are associated with adverse outcomes for the woman, her infant, and family. We wanted to determine the effect of a practice-based training program for screening, diagnosis, and management of depression in postpartum mothers. In this practice-based effectiveness study, 28 practices were randomized to usual care (n = 14) or intervention (n = 14), and 2,343 women were enrolled between 5 and 12 weeks' postpartum. The intervention sites received education and tools for postpartum depression screening, diagnosis, initiation of therapy, and follow-up within their practices. Usual-care practices received a 30-minute presentation about postpartum depression. Screening information for the usual care was obtained from baseline surveys sent directly to the central site but was not available for patient care. Outcomes were based on patient-reported outcomes (level of depressive symptoms) from surveys at 6 and 12 months, plus medical record review (diagnosis and therapy initiation). Among the 2,343 women enrolled, 1,897 (80.1%) provided outcome information, and were included in the analysis. Overall, 654 (34.5% of 1,897) women had elevated screening scores indicative of depression, with comparable rates in the intervention and usual-care groups. Among the 654 women with elevated postpartum depression screening scores, those in the intervention practices were more likely to receive a diagnosis (P = .0006) and therapy for postpartum depression (P = .002). They also had lower depressive symptom levels at 6 (P = .07) and 12 months' (P=.001) postpartum. Primary care-based screening, diagnosis, and management improved mother's depression outcomes at 12 months. This practical approach could be implemented widely with modest resources.

  16. Portfolio Manager Selection – A Case Study

    DEFF Research Database (Denmark)

    Christensen, Michael

    2017-01-01

    Within a delegated portfolio management setting, this paper presents a case study of how the manager selection process can be operationalized in practice. Investors have to pursue a thorough screening of potential portfolio managers in order to discover their quality, and this paper discusses how...

  17. Case management in France: an economic perspective.

    Science.gov (United States)

    Frossard, M

    1996-01-01

    Case management is currently an important issue in France. Because neither service providers nor consumers pay for case management in this country, a cost-benefit analysis is often required by the organizations that do pay. Given the context of French social policy and the current focus on justifying case management through cost-benefit analysis, we have developed a way to evaluate its costs. This article presents the limitations of standard economic choice theory, provides a methodology based on the principles of limited rationality, and gives the results of an evaluation of four case management programs. The article provides a method to measure case management costs and efficiency, as well as the willingness of consumers to pay for services.

  18. Factors Influencing Risk of Premature Mortality in Community Cases of Depression: A Meta-Analytic Review

    Directory of Open Access Journals (Sweden)

    Amanda J. Baxter

    2011-01-01

    Full Text Available Background. Depressive disorders are associated with substantial risk of premature mortality. A number of factors may contribute to reported risk estimates, making it difficult to determine actual risk of excess mortality in community cases of depression. The aim of this study is to conduct a systematic review and meta-analysis of excess mortality in population-based studies of clinically defined depression. Methods. Population-based studies reporting all-cause mortality associated with a clinically defined depressive disorder were included in the systematic review. Estimates of relative risk for excess mortality in population-representative cases of clinical depressive disorders were extracted. A meta-analysis was conducted using Stata to pool estimates of excess mortality and identify sources of heterogeneity within the data. Results. Twenty-one studies reporting risk of excess mortality in clinical depression were identified. A significantly higher risk of mortality was found for major depression (RR 1.92 95% CI 1.65–2.23, but no significant difference was found for dysthymia (RR 1.37 95% CI 0.93–2.00. Relative risk of excess mortality was not significantly different following the adjustment of reported risk estimates. Conclusion. A mortality gradient was identified with increasing severity of clinical depression. Recognition of depressive symptoms in general practice and appropriate referral for evidence-based treatment may help improve outcomes, particularly in patients with comorbid physical disorders.

  19. Agribusiness Cases in Supply Chain Management

    OpenAIRE

    Brown, William J

    2002-01-01

    The paper uses case studies of three different agribusinesses to demonstrate the principles of supply chain management and how it is applied. Primary producers must learn to understand and take advantages of the opportunities available to them in the new systems of supply change management. The agribusiness cases demonstrate a practical application of supply chain management that can affect and be applied to farm businesses throughout the world.

  20. ANXIETY AND DEPRESSION: ADVANCES IN MANAGEMENT OF DISORDER

    Directory of Open Access Journals (Sweden)

    Aakruti Kaikini*, Swati Dhande, Kalpana Patil and Vilasrao Kadam

    2013-02-01

    Full Text Available Anxiety and depression is basically a disorder of the present modern world and its prevalence is seen increasing day by day. According to WHO, anxiety and depression will be the second largest cause of disability worldwide by year 2020. The major problem associated with this disorder is that common masses are unaware about this disorder and hence less than 25% of those affected have access to appropriate treatments. The medications currently used for treatment of this disorder are based on the earlier theories of anxiety and depression. These medications have many side effects as well as are associated with tolerance and dependence on prolonged usage. This article mainly focuses on the new theory involved in neurobiology of this disorder and drugs which can be developed on basis of the same.

  1. The depressive façade in a case of compulsive sex behavior with frottage

    OpenAIRE

    Kalra, Gurvinder

    2013-01-01

    Compulsive sexual behavior consists of sexual obsessions and compulsions that are recurrent, distressing, and interfere with daily functioning. It has been called hypersexual disorder in the upcoming diagnostic and statistical manual 5th edition. Though hypersexuality is commonly seen in mania, it can also be seen in depression and anxiety disorders. This case report describes a case that presented with depression and had underlying compulsive sexual behavior in the form of frottage.

  2. Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk.

    Science.gov (United States)

    Gallo, Joseph J; Hwang, Seungyoung; Joo, Jin Hui; Bogner, Hillary R; Morales, Knashawn H; Bruce, Martha L; Reynolds, Charles F

    2016-04-01

    Two-thirds of older adults have two or more medical conditions that often take precedence over depression in primary care. We evaluated whether evidence-based depression care management would improve the long-term mortality risk among older adults with increasing levels of medical comorbidity. Longitudinal analyses of the practice-randomized Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT). Twenty primary care practices randomized to intervention or usual care. The sample included 1204 older primary care patients completing the Charlson Comorbidity Index (CCI) and other interview questions at baseline. For 2 years, a depression care manager worked with primary care physicians to provide algorithm-based care for depression, offering psychotherapy, increasing the antidepressant dose if indicated, and monitoring symptoms, medication adverse effects, and treatment adherence. Depression status based on clinical interview, CCI to evaluate medical comorbidity, and vital status at 8 years (National Death Index). In the usual care condition, patients with the highest levels of medical comorbidity and depression were at increased risk of mortality over the course of the follow-up compared to depressed patients with minimal medical comorbidity [hazard ratio 3.02 (95% CI, 1.32 to 8.72)]. In contrast, in intervention practices, patients with the highest level of medical comorbidity and depression compared to depressed patients with minimal medical comorbidity were not at significantly increased risk [hazard ratio 1.73 (95% CI, 0.86 to 3.96)]. Nondepressed patients in intervention and usual care practices had similar mortality risk. Depression management mitigated the combined effect of multimorbidity and depression on mortality. Depression management should be integral to optimal patient care, not a secondary focus.

  3. Management of bipolar I depression: clinical utility of lurasidone

    Directory of Open Access Journals (Sweden)

    Findlay LJ

    2015-01-01

    Full Text Available Lillian Jan Findlay,1 Peggy El-Mallakh,1 Rif S El-Mallakh2 1College of Nursing, University of Kentucky, Lexington, KY, USA; 2Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA Abstract: Lurasidone is a benzisothiazol derivative second-generation antipsychotic. It has been approved in the United States and Europe for treatment of acute schizophrenia and bipolar depression. In type I bipolar subjects, treatment with lurasidone monotherapy of adjunctive therapy to lithium or valproic acid with doses of 20 to 120 mg once daily with food, results in statistically and clinically significant reduction of depressive symptoms. Patients experience relatively few side effects, which include somnolence, akathisia, nausea, and other gastrointestinal upset. Dopamine related side effects, such as Parkinsonism and elevated prolactin, are rare and mild. Longer term safety data obtained in 6 months long, open continuation observation periods, suggest that metabolic related elevations in weight, glucose, and lipids are absent or minimal. The mechanism of action of lurasidone is not known, but the data are compatible with antagonism of the serotonin 7 receptor. Lurasidone is a new option for the treatment of bipolar depression with relatively few side effects. Keywords: lurasidone, bipolar disorder, bipolar depression, adjunctive therapy

  4. Interactive Voice Response-An Innovative Approach to Post-Stroke Depression Self-Management Support.

    Science.gov (United States)

    Skolarus, Lesli E; Piette, John D; Pfeiffer, Paul N; Williams, Linda S; Mackey, Jason; Hughes, Rebecca; Morgenstern, Lewis B

    2017-02-01

    Automated interactive voice response (IVR) call systems can provide systematic monitoring and self-management support to depressed patients, but it is unknown if stroke patients are able and willing to engage in IVR interactions. We sought to assess the feasibility and acceptability of IVR as an adjunct to post-stroke depression follow-up care. The CarePartner program is a mobile health program designed to optimize depression self-management, facilitate social support from a caregiver, and strengthen connections between stroke survivors and primary care providers (PCPs). Ischemic stroke patients and an informal caregiver, if available, were recruited during the patient's acute stroke hospitalization or follow-up appointment. The CarePartner program was activated in patients with depressive symptoms during their stroke hospitalization or follow-up. The 3-month intervention consisted of weekly IVR calls monitoring both depressive symptoms and medication adherence along with tailored suggestions for depressive symptom self-management. After each completed IVR call, informal caregivers were automatically updated, and, if needed, the subject's PCP was notified. Of the 56 stroke patients who enrolled, depressive symptoms were identified in 13 (23 %) subjects. Subjects completed 74 % of the weekly IVR assessments. A total of six subjects did not complete the outcome assessment, including two non-study-related deaths. PCPs were notified five times, including two times for suicidal ideation and three times for medication non-adherence. Stroke patients with depressive symptoms were able to engage in an IVR call system. Future studies are needed to explore the efficacy of an IVR approach for post-stroke self-management and monitoring of stroke-related outcomes.

  5. Are chronic low back pain outcomes improved with co-management of concurrent depression?

    OpenAIRE

    Pollard Henry; Middleton Peter

    2005-01-01

    Abstract Objective To discuss the role of depression in chronic lower back pain and comment on appropriate methods of screening and co-management. Data Sources The current scientific literature was investigated using the online web databases CINAHL, Medline/PUBMED, Proquest, Meditext and from manual library searches. Data Extraction Databases were searched from 1980 to the present (2005). Articles were searched with the key words "depression" and "low back pain". Over three hundred articles w...

  6. Depressive symptoms associated with hereditary Alzheimer's disease: a case description.

    Science.gov (United States)

    Contreras, Mónica Yicette Sánchez; Vargas, Paula Alejandra Osorio; Ramos, Lucero Rengifo; Velandia, Rafael Alarcón

    The authors describe a family group studied by the Centro de Biología Molecular y Biotecnología, and the Clínica de la Memoria, las Demencias y el Envejecimiento (Universidad Tecnológica de Pereira, Colombia), and evaluate the association of depressive symptoms with Alzheimer's disease (AD). This family presented a hereditary pattern for AD characterized by an early onset of dementia symptoms, a long preclinical depressive course, and, once the first symptoms of dementia appeared, a rapid progression to severe cognitive function impairment. The authors found a high prevalence of depressive symptoms in this family and propose that the symptoms could be an important risk factor for developing AD in the presence of other risk factors such as the APOE E4 allele.

  7. Mindfulness-based cognitive therapy in patients with late-life depression: A case series

    Directory of Open Access Journals (Sweden)

    Sonal Mathur

    2016-01-01

    Full Text Available Depression is the most common mental illness in the elderly, and cost-effective treatments are required. Therefore, this study is aimed at evaluating the effectiveness of a mindfulness-based cognitive therapy (MBCT on depressive symptoms, mindfulness skills, acceptance, and quality of life across four domains in patients with late-onset depression. A single case design with pre- and post-assessment was adopted. Five patients meeting the specified inclusion and exclusion criteria were recruited for the study and assessed on the behavioral analysis pro forma, geriatric depression scale, Hamilton depression rating scale, Kentucky inventory of mindfulness skills, Acceptance and Action Questionnaire II, The World Health Organization quality of life Assessment Brief version (WHOQO-L-BREF. The therapeutic program consisted of education regarding the nature of depression, training in formal and informal mindfulness meditation, and cognitive restructuring. A total of 8 sessions over 8 weeks were conducted for each patient. The results of this study indicate clinically significant improvement in the severity of depression, mindfulness skills, acceptance, and overall quality of life in all 5 patients. Eight-week MBCT program has led to reduction in depression and increased mindfulness skills, acceptance, and overall quality of life in patients with late-life depression.

  8. Case management for persons who are homeless.

    Science.gov (United States)

    Savarese, M; Weber, C M

    1993-01-01

    Comprehensive, client-centered continuous care with a multidisciplinary team using the case management model has proven to be essential in providing health care services to the homeless. Despite their heterogeneity, homeless persons share the common experiences of being poor, isolated, and in crisis. The process of case management is inherently therapeutic for its recipients and providers. It has the potential to be a source of human support for those who have none. Case management models can be effective systems for providing health care to these persons while addressing their special needs and characteristics.

  9. 42 CFR 440.168 - Primary care case management services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Primary care case management services. 440.168... care case management services. (a) Primary care case management services means case management related... services. (b) Primary care case management services may be offered by the State— (1) As a voluntary option...

  10. Depression.

    Science.gov (United States)

    McCarron, Robert M; Vanderlip, Erik R; Rado, Jeffrey

    2016-10-04

    This issue provides a clinical overview of depression, focusing on screening, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  11. Marketing depression care management to employers: design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Marshall Donna

    2010-03-01

    Full Text Available Abstract Background Randomized trials demonstrate that depression care management can improve clinical and work outcomes sufficiently for selected employers to realize a return on investment. Employers can now purchase depression products that provide depression care management, defined as employee screening, education, monitoring, and clinician feedback for all depressed employees. We developed an intervention to encourage employers to purchase a depression product that offers the type, intensity, and duration of care management shown to improve clinical and work outcomes. Methods In a randomized controlled trial conducted with 360 employers of 30 regional business coalitions, the research team proposes to compare the impact of a value-based marketing intervention to usual-care marketing on employer purchase of depression products. The study will also identify mediators and organizational-level moderators of intervention impact. Employers randomized to the value-based condition receive a presentation encouraging them to purchase depression products scientifically shown to benefit the employee and the employer. Employers randomized to the usual-care condition receive a presentation encouraging them to monitor and improve quality indicators for outpatient depression treatment. Because previous research demonstrates that the usual-care intervention will have little to no impact on employer purchasing, depression product purchasing rates in the usual-care condition capture vendor efforts to market depression products to employers in both conditions while the value-based intervention is being conducted. Employers in both conditions are also provided free technical assistance to undertake the actions each presentation encourages. The research team will use intent-to-treat models of all available data to evaluate intervention impact on the purchase of depression products using a cumulative incidence analysis of 12- and 24-month data. Discussion By

  12. Iowa Case Management for Rural Drug Abuse.

    Science.gov (United States)

    Hall, James A; Sarrazin, Mary S Vaughan; Huber, Diane L; Vaughn, Thomas; Block, Robert I; Reedy, Amanda R; Jang, Mijin

    2009-07-01

    OBJECTIVE: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. METHOD: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual (TAU), or to a fourth condition of TAU only. All were assessed at intake and followed at 3, 6, and 12 months. RESULTS: Clients in all four conditions significantly decreased substance use by 3 months after intake and maintained most gains over time. However, the addition of ICM to TAU did not improve substance use outcomes. CONCLUSION: Overall, the addition of case management did not significantly improve drug treatment as hypothesized by both researchers and clinicians. Some results were mixed, possibly due to the heterogeneous sample, wide range of case management activities, or difficulty retaining participants over time.

  13. Managing severe peripartum hyponatraemia: A case report

    Science.gov (United States)

    Lim, Jerry; Laing, Christopher M; MacCallum, Niall S; Brealey, David A

    2014-01-01

    We present a case of severe peripartum hyponatraemia that occurred following a major obstetric haemorrhage causing both an ischaemic stroke and Sheehan's syndrome and outline the investigations and management strategy required. PMID:27512448

  14. Cross-cultural aspects of depression management in primary care.

    Science.gov (United States)

    Hails, Katherine; Brill, Charlotte D; Chang, Trina; Yeung, Albert; Fava, Maurizio; Trinh, Nhi-Ha

    2012-08-01

    Major depressive disorder (MDD) is a prevalent illness in minority populations. Minority patients with MDD are often unrecognized and untreated. This review examines promising interventions to address MDD in primary care settings, where minority groups are more likely to seek care. Since 2010, eleven interventions have been developed to address patient-specific and provider-specific barriers, many of which are adaptations of the collaborative care model. Other promising interventions include cultural tailoring of the collaborative care model, as well as the addition of telepsychiatry, motivational interviewing, cultural consultation, and innovations in interpreting. Overall, collaborative care was found feasible and improved satisfaction and treatment engagement of depressed minority patients in primary care. It remains inconclusive whether these newer intervention models improve MDD treatment outcomes. Future research will be needed to establish the effectiveness of these intervention models in improving the treatment outcomes of minority populations with MDD.

  15. Development of a user-centered health information service system for depressive symptom management.

    Science.gov (United States)

    Bae, Jeongyee; Wolpin, Seth; Kim, Eunjung; Lee, Sowoo; Yoon, Sookhee; An, Kyungeh

    2009-06-01

    A user-centered, Web-based depressive symptoms management system might be particularly useful in Korea, where those who seek mental health care face stigmatizing and where personal computers and the Internet have reached saturation levels. The purpose of this article is to describe the development process of a Web-based system for depressive symptom management through user-centered design principles. Our design process included four distinct phases: a needs assessment, analysis, design/development/testing, and the application release. The final revised website was released with the URL address, "http://www.baejy.com/smiles/". In the 3 years since the site was made available publicly, it is notable that 161,604 Koreans have accessed this website, either for educational purposes or for managing their depressive symptoms. A Web-based depressive symptom management system with a high degree of usability was developed. This website can be used to assess depressive symptoms and to serve as an intervention strategy to improve mental health.

  16. Guideline concordant detection and management of depression among Alaska Native and American Indian people in primary care

    Directory of Open Access Journals (Sweden)

    Vanessa Y. Hiratsuka

    2015-10-01

    Full Text Available Background: A tribal health organization in Alaska implemented a primary care depression screening, detection and management initiative amongst 55,000 Alaska Native/American Indian people (AN/AIs. Objectives: (a To describe the proportion of AN/AIs screening positive for depression with depression noted or diagnosed and proportion with guideline concordant management and (b to assess whether management varied by patient and provider factors. Research design: Secondary analysis of electronic and paper medical record information of 400 AN/AIs. Measures: Provider variables, patient demographics and patient clinical factors were electronically queried. Manual chart audits assessed depression notation, diagnoses and management within 12 weeks of positive screening. Multilevel ordinal logistic modelling assessed management by patient and provider factors. Results: A depression diagnosis was present in 141 (35% charts and 151 (38% had depressive symptoms noted. Detection was higher among AN/AIs with moderate and severe depression (p<0.001. In total, 258 patients (66% received guideline concordant management, 32 (8% had some management, and 110 (28% received no management. Younger patient age and increased provider tenure increased odds of management. Conclusions: Most AN/AIs screening positive for depression received initial guideline concordant management. Additional outreach to older patients and additional support for providers newer to practices appears warranted.

  17. A Study Of 7 Cases Of Depressed Facial Scars Corrected By Subcision

    Directory of Open Access Journals (Sweden)

    Malakar Subrata

    1997-01-01

    Full Text Available Seven (7 cases of depressed facial scars which included depressed distensile acne scars, depressed bound down scars of acne excluding deep ice pick scars, and scars of varicella constituted the study group. The scars were treated with a new method named subcuticular undermining. A tri-bevelled hypodermic needle was inserted through a puncture in the skin surface and its sharp edges were manouevered under the scar. The depression was lifted by the releasing action of the needle maneuevere and from connective tissue that forms in course of normal wound healing. Approximately 50% to 80% improvement of all the scars were noticed. Patient’s compliance was highly satisfactory. Subcision is an appropriate, option in depressed scars of black skin (Type IV-Type VI where dermabrasion and medium-depth and deep chemical peeling are contraindicated.

  18. Outage management: A case study

    Energy Technology Data Exchange (ETDEWEB)

    Haber, S.B.; Barriere, M.T. (Brookhaven National Lab., Upton, NY (United States)); Roberts, K.H. (California Univ., Berkeley, CA (United States). Walter A. Haas School of Business)

    1992-01-01

    Outage management issues identified from a field study conducted at a two-unit commercial pressurized water reactor (PWR), when one unit was in a refueling outage and the other unit was at full power operation, are the focus of this paper. The study was conduced as part of the US Nuclear Regulatory Commission's (NRC) organizational factors research program, and therefore the issues to be addressed are from an organizational perspective. Topics discussed refer to areas identified by the NRC as critical for safety during shutdown operations, including outage planning and control, personnel stress, and improvements in training and procedures. Specifically, issues in communication, management attention, involvement and oversight, administrative processes, organizational culture, and human resources relevant to each of the areas are highlighted by example from field data collection. Insights regarding future guidance in these areas are presented based upon additional data collection subsequent to the original study.

  19. Outage management: A case study

    Energy Technology Data Exchange (ETDEWEB)

    Haber, S.B.; Barriere, M.T. [Brookhaven National Lab., Upton, NY (United States); Roberts, K.H. [California Univ., Berkeley, CA (United States). Walter A. Haas School of Business

    1992-09-01

    Outage management issues identified from a field study conducted at a two-unit commercial pressurized water reactor (PWR), when one unit was in a refueling outage and the other unit was at full power operation, are the focus of this paper. The study was conduced as part of the US Nuclear Regulatory Commission`s (NRC) organizational factors research program, and therefore the issues to be addressed are from an organizational perspective. Topics discussed refer to areas identified by the NRC as critical for safety during shutdown operations, including outage planning and control, personnel stress, and improvements in training and procedures. Specifically, issues in communication, management attention, involvement and oversight, administrative processes, organizational culture, and human resources relevant to each of the areas are highlighted by example from field data collection. Insights regarding future guidance in these areas are presented based upon additional data collection subsequent to the original study.

  20. Food-based strategies for depression management from Iranian traditional medicine resources.

    Science.gov (United States)

    Tavakkoli-Kakhki, Mandana; Motavasselian, Malihe; Mosaddegh, Mahmoud; Esfahani, Mohammad Mahdi; Kamalinejad, Mohammad; Nematy, Mohsen

    2014-02-01

    Considering the increasing prevalence of depression in contemporary societies, general tendency for safer treatments with fewer side effects has recently been a subject of interest. Food-based strategies, which are one of the outstanding medical solutions in Complementary and Alternative Medicine including Iranian Traditional Medicine have been investigated. In this review study, firstly some important sources of Iranian Traditional Medicine including Kamel al-Sanaat al-Tibbyyah, Al-Qanun fi al-Tibb and Zakhireh Kharazmshahi were reviewed. Next, a literature search was performed on PubMed and Magiran databases with the keywords "depression", "depressive", "mood", "antidepressant", "antidepressive", "nutrition", "nutritional", "diet", "meal", "food", "functional food", "healthy food", "healthy diet", "medicinal food" and scientific and English terms of all singular foodstuff and some combined foodstuff which are introduced in this paper. Food-based strategies for depression management in Iranian Traditional Medicine resources involving both prevention and treatment parts have been classified under three headings singular foodstuffs, combined foodstuffs, and nutrition rules with the separation of prohibition and prescription items. Among the prescribed or the prohibited singular and combined foodstuffs in Iranian Traditional Medicine manuscripts, only the effectiveness of fish, garlic, milk, oregano, mint, and spinach on depression has been examined by modern medicine methods. The presented food-based strategies in this study introduce a precise management for depression benefiting from Iranian Traditional Medicine Resources.

  1. Educating family physicians to recognize and manage depression: where are we now?

    Science.gov (United States)

    Gask, Linda

    2013-08-01

    To consider what the barriers are to effective depression education; to understand what attitudes, knowledge, and skills doctors need to acquire, and finally to examine what we currently know about effective ways of training family physicians (FPs) about depression. A narrative review of the published literature compiled from searching reviews and original articles was conducted using the following key words: education, training, attitudes, depression, and primary care. Further relevant articles were identified from reference lists. The identified barriers are FPs' attitudes and confidence toward recognizing and managing depression, the way in which they conceptualize depression, and the difficulties they face in implementing change in the systems in which they work. We, as educators, can identify what FPs need to know, and this should include novel ways of organizing care. However, of key importance is the need to address how more effective interventions may be provided, recognizing that FPs may be starting from many different points on 3 differing continua of attitude, skills, and knowledge in relation to depression. We have to not only ensure that the content of what we teach is perceived as relevant to primary care but also review exactly how we go about providing it, using methods that will engage and stimulate doctors at differing stages of readiness to acquire new attitudes, skills, and knowledge about depression. However, we still need to find better ways of helping FPs to recognize and acknowledge their educational needs. Further research is also required to thoroughly evaluate these novel approaches to tailoring educational interventions.

  2. Yoga Plus Talk Therapy for Depression: A Case Study of a Six Week Group

    Directory of Open Access Journals (Sweden)

    Kelli Foulkrod

    2017-01-01

    Full Text Available Yoga is increasingly becoming a popular method of addressing mental health symptoms. While there is research to support the use of yoga for depression, there is limited literature examining yoga in combination with talk therapy groups as a treatment for depression. The results of this case study series (n=4 provide support for the clinical efficacy of yoga in combination with talk therapy. Treatment consisted of 6 weeks of group sessions (90-min sessions each week with weekly home practice. Each group consisted of yoga, meditation, breathwork, and emotional processing. Decreases in depressive symptoms and increases in self-compassion were found. The findings of the case study are relevant because growing numbers of clients are presenting with depression and seeking alternative treatments.

  3. Mindfulness-based stress reduction for comorbid anxiety and depression: case report and clinical considerations.

    Science.gov (United States)

    Hazlett-Stevens, Holly

    2012-11-01

    Growing research literature has documented the effectiveness of mindfulness-based interventions for anxiety and depressive disorders. Mindfulness-based stress reduction (MBSR) teaches a series of mindfulness meditation and yoga practices, delivered in a group format during eight weekly sessions plus one full-day session. This case report demonstrates how MBSR was associated with dramatic clinical improvement of an individual with symptoms of panic, generalized anxiety, and depression. Scores on clinical assessment measures suggested clinically severe levels of anxious arousal, generalized anxiety, worry, fear of negative evaluation, and depression at the beginning of the intervention. The scores on all these measures fell well within normal limits 7 weeks later at the end of the intervention, and no remaining symptoms were reported afterward. Increased life satisfaction and quality of life were documented as well. This case illustrates the potential benefit of MBSR as an alternative or adjunctive treatment for comorbid anxiety and depressive disorder symptoms.

  4. Social Architecture: An Emergency Management Case Study

    Directory of Open Access Journals (Sweden)

    Asif Qumer Gill

    2015-03-01

    Full Text Available Emergency management agencies are progressively using social media for the sourcing and distribution of disaster information. Emergency management agencies are often unsure as to how to best identify and assess social media concerns (e.g. information security, trust which must be addressed to develop a social media-enabled disaster information management environment. This paper adopts the Social Architecture Viewpoint Assessment (SAVA framework for identifying and assessing social media concerns from four different viewpoints: IT, Value, Resource and Management. This paper demonstrates the use of the SAVA framework in the context of an in-depth empirical case study of an Australian emergency management agency. The results of this study indicate that the SAVA framework is useful for emergency information management managers in identifying and assessing social media concerns.

  5. A case of depressive personality disorder: aligning theory, practice, and clinical research.

    Science.gov (United States)

    Maddux, Rachel E; Johansson, Håkan

    2014-01-01

    Depressive personality disorder (DPD) is highly studied and common in clinical settings. Nevertheless, it is rife with controversies and often overshadowed by major depression and dysthymia with which it shares many similarities but also is clinically distinct. Possibly as a result, DPD is underdiagnosed and misunderstood in clinical care. Thus the goal of this practice review is to present a case from psychiatric clinical work illustrating how DPD may be commonly overlooked in routine care, and how the conceptualization of this case and its treatment plan changed course once DPD was considered by treating staff, ultimately contributing to the successful outcome of the case. Questions elicited by the case are subsequently discussed in the context of the empirical literature on DPD, allowing for a clearer picture to emerge on DPD and its role in the development, course, and treatment of depression.

  6. Metacognitive therapy in recurrent depression: a case replication series in Denmark.

    Science.gov (United States)

    Callesen, Pia; Jensen, Anne Backhausen; Wells, Adrian

    2014-02-01

    Metacognitive therapy (MCT) for depression is derived from the Wells and Matthews (1994) self-regulatory model, in which a Cognitive-Attentional Syndrome (CAS) is the cause of psychological disorders. MCT for depression focuses on identifying patients' CAS and helps them to stop it. The CAS consists of worry, rumination and dysfunctional coping strategies. The focus in MCT is on removing the CAS by challenging positive and negative metacognitive beliefs and eliminating dysfunctional behaviors. In this case series, MCT was delivered to four depressed Danes and treatment was evaluated in 5-11 sessions of up to one hour each. An A-B design with follow-up at 3 and 6 months was conducted and the primary outcome was Beck's Depression Inventory II (BDI-II). We measured CAS processes with the Major depressive Disorder Scale (MDD-S). The results of the case series showed clinically significant improvements in depressive symptoms, rumination and metacognitive beliefs and the effects were still present at follow-up for all patients. The small number of patients and decreasing baselines observed in some cases limits the conclusions. However, the results suggest that this treatment is feasible and was associated with large improvements in symptoms when delivered away from its point of origin and in a Danish help-seeking sample.

  7. Depression and Anxiety Disorders among Patients with Psoriasis: A Hospital-Based Case-Control Study

    Directory of Open Access Journals (Sweden)

    Masoud Golpour

    2012-01-01

    Full Text Available Background. Psoriasis is a common, genetically determined inflammatory and proliferative disease of the skin. Psychological stress can exacerbate the disease. This study sought to investigate the depression and anxiety disorders among patients with psoriasis and control group. Method. In this hospital-based case-control study, One hundred patients with psoriasis (case referred to the dermatology department and 100 patients with otolaryngology problems and dermatological healthy volunteers (control who referred to the Otolaryngology Department of Bouali Sina Hospital in Sari, Iran, in 2007 were studied. Demographic characteristics were recorded. Beck Depression Inventory and Spielberger State-Trait Anxiety Scale I-II were administered to the patients in both groups. Data were analyzed using SPSS statistical software and descriptive statistical tests. Results. From One-hundred patients in each group, 44 (45% were men. Depression score was 67% and 12% in psoriatic patients and control, respectively. The Beck depression scores of patients with psoriasis were significantly higher than scores of the control group (<0.05. Based on Spielberger State-Trait Anxiety Scale, anxiety was found in 45% of patients in case group and 18% of controls. Conclusion. The results revealed that psoriatic patients reported significantly higher degrees of depression and anxiety than controls. In addition, psoriatic women were more depressed than psoriatic men.

  8. Telephone-Based Depression Care Management for Postpartum Women: A Randomized Controlled Trial.

    Science.gov (United States)

    Wisner, Katherine L; Sit, Dorothy K Y; McShea, Mary; Luther, James F; Eng, Heather F; Dills, John L; Moses-Kolko, Eydie L; Wisniewski, Stephen R

    2017-08-08

    With a period prevalence of 21.9% in the year after birth, depression is a common complication of childbearing. We assessed the impact of telephone-delivered depression care management (DCM) on symptom levels, health service utilization, and functional status 3, 6, and 12 months postpartum. The randomized controlled trial was conducted at the University of Pittsburgh, Pittsburgh, Pennsylvania, from March 2006 through September 2010. Women (N = 628) who screened positive for depression (a score of 10 or greater on the Edinburgh Postnatal Depression Scale) 4 to 6 weeks postpartum were evaluated with the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition With Psychotic Screen and enrolled in a randomized trial of DCM compared to enhanced usual care (EUC). Clinicians conducted telephone contacts to educate, assist with treatment decisions, monitor symptoms, facilitate access to services, and encourage links to community resources. Independent evaluators collected symptom scores, functional status, and health services use at 3, 6, and 12 months postpartum. Primary outcome was reduction of symptoms as measured by the Structured Interview Guide for the Hamilton Depression Rating Scale with Atypical Depression Supplement. Mean depressive symptom and function scores significantly improved (by greater than 50%) in both groups of women but did not differ by DCM versus EUC assignment. Health services use was similar in women randomly assigned to DCM compared to EUC. Women with childhood sexual abuse responded significantly more favorably to DCM on depression and functional measures (all P values < .02). Both DCM and EUC favorably impacted depression symptom levels and function. The subgroup of women with childhood sexual abuse benefited significantly more from DCM compared to the EUC condition. Regular telephone availability of a clinician is a resource that appears to be particularly therapeutic to women with childhood sexual abuse

  9. [A computerised clinical decision-support system for the management of depression in Primary Care].

    Science.gov (United States)

    Aragonès, Enric; Comín, Eva; Cavero, Myriam; Pérez, Víctor; Molina, Cristina; Palao, Diego

    Despite its clinical relevance and its importance as a public health problem, there are major gaps in the management of depression. Evidence-based clinical guidelines are useful to improve processes and clinical outcomes. In order to make their implementation easier these guidelines have been transformed into computerised clinical decision support systems. In this article, a description is presented on the basics and characteristics of a new computerised clinical guideline for the management of major depression, developed in the public health system in Catalonia. This tool helps the clinician to establish reliable and accurate diagnoses of depression, to choose the best treatment a priori according to the disease and the patient characteristics. It also emphasises the importance of systematic monitoring to assess the clinical course, and to adjust therapeutic interventions to the patient's needs at all times. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  10. From persecution to depression: a case of chronic depression--associating the Rorschach, the TAT, and Winnicott.

    Science.gov (United States)

    Husain, Odile

    2015-01-01

    In this article, I discuss a case study of a patient with depression, paranoid ideation, and other psychiatric difficulties who presented in a state of acute crisis. I review the Swiss Lausanne model of Rorschach and Thematic Apperception Test (TAT) interpretation, focusing on a psychoanalytic understanding of special contents and verbalizations. I then present a review of Comprehensive System (Exner, 2003) Structural Summary variables based on a modified Rorschach administration, while qualifying the meanings of these variables in light of the modified procedure. I conclude with a review of Winnicott's (1969) ideas on the paranoid potential, tie it to the main points of the case, and offer a 5-year follow-up of the patient's treatment. The case offers an approach to personality assessment that is informed by an international theory built on psychology and philosophy, and offers support for the use of an alternative theory-based, psychoanalytic method of data analysis.

  11. Formative evaluation of practice changes for managing depression within a Shared Care model in primary care.

    Science.gov (United States)

    Beaulac, Julie; Edwards, Jeanette; Steele, Angus

    2017-01-01

    Aim To investigate the implementation and initial impact of the Physician Integrated Network (PIN) mental health indicators, which are specific to screening and managing follow-up for depression, in three primary care practices with Shared Mental Health Care in Manitoba.

  12. The relationship between older adults' self-management abilities, well-being and depression

    NARCIS (Netherlands)

    J.M. Cramm (Jane); J.M. Hartgerink (Jacqueline); P.L. de Vreede (Paul); T.J.E.M. Bakker (Ton); E.W. Steyerberg (Ewout); J.P. Mackenbach (Johan); A.P. Nieboer (Anna)

    2012-01-01

    textabstractThis study aimed to identify the relationship between self-management abilities, well-being and depression. Our study was conducted among older adults (>65 years of age) who were vulnerable to loss of function after hospital discharge. Three months after hospital admission, 296/456

  13. Mood Management Intervention for College Smokers with Elevated Depressive Symptoms: A Pilot Study

    Science.gov (United States)

    Schleicher, Holly E.; Harris, Kari Jo; Campbell, Duncan G.; Harrar, Solomon W.

    2012-01-01

    Objective: This pilot study examined smoking reduction and cessation among college smokers with elevated depressive symptomatology participating in a group-based behavioral counseling, mood management, and motivational enhancement combined intervention (CBT). Participants and Methods: Fifty-eight smokers (smoked 6 days in the past 30) were…

  14. Perceptions of Body Weight, Weight Management Strategies, and Depressive Symptoms among US College Students

    Science.gov (United States)

    Harring, Holly Anne; Montgomery, Kara; Hardin, James

    2010-01-01

    Objective: To determine if inaccurate body weight perception predicts unhealthy weight management strategies and to determine the extent to which inaccurate body weight perception is associated with depressive symptoms among US college students. Participants: Randomly selected male and female college students in the United States (N = 97,357).…

  15. The relationship between older adults' self-management abilities, well-being and depression

    NARCIS (Netherlands)

    J.M. Cramm (Jane); J.M. Hartgerink (Jacqueline); P.L. de Vreede (Paul); T.J.E.M. Bakker (Ton); E.W. Steyerberg (Ewout); J.P. Mackenbach (Johan); A.P. Nieboer (Anna)

    2012-01-01

    textabstractThis study aimed to identify the relationship between self-management abilities, well-being and depression. Our study was conducted among older adults (>65 years of age) who were vulnerable to loss of function after hospital discharge. Three months after hospital admission, 296/456 patie

  16. Improvement of depression after treatment of dural arteriovenous fistula: a case report and a review.

    Science.gov (United States)

    Nakagawa, Minoru; Sugiu, Kenji; Tokunaga, Koji; Sakamoto, Chihoko; Fujiwara, Kenjiro

    2012-01-01

    Patients with dural arteriovenous fistulas (DAVFs) in the transverse-sigmoid sinus suffer from several symptoms: bruit, headache, visual impairment, and so on. But depression is rare in patients with DAVF. The authors reported a rare case presenting the improvement of depression after the treatment of a dural arteriovenous fistula in the left transverse-sigmoid sinus. A 46-year-old male had suffered from depression and was treated with antidepressants at a local hospital for four years. The patient was temporarily laid off due to his depression. Afterwards, he had Gerstmann's syndrome and came to our hospital. A DAVF in the left transverse-sigmoid sinus was demonstrated on the angiogram. The DAVF was successfully treated with endovascular surgery, coil embolization of the isolated diseased sinus through the mastoid emissary vein which was a draining vein from the fistula. After this treatment, his depression as well as Gerstmann's syndrome was improved and the quantity of the antidepressants decreased. The patient returned to work without any antidepressant two years after the treatment. DAVFs might be one of the causes of depression. It may be necessary to evaluate cerebral vessels in patients suffering from depression by using MRA or 3D-CTA even if there are not any abnormal findings on plain CT scans.

  17. Teaching Cases in Management - Amendopar

    Directory of Open Access Journals (Sweden)

    Renata Cesar Torres

    2011-05-01

    Full Text Available This study is a teaching case that deals with a managerial problem faced by a medium-size Brazilian company. Amendopar was a family business in the peanut products industry that operated in the Brazilian market for 47 years. The Londrina, Paraná unit was operating close to its maximum production capacity, imposing a limit to the company’s growth. Having an already well established position in its state of origin, the owners were considering expanding into other markets. There was also interest on their part because of the tax benefits they would reap by establishing a new production unit in São Paulo State. However, the challenge at this time was to decide whether it was the right time to make this move and how much investment would be required. These decisions would be made at a meeting to be held and for which the Industrial Director was preparing.

  18. Food for thought: understanding the value, variety and usage of management algorithms for major depressive disorder.

    Science.gov (United States)

    Katzman, Martin A; Anand, Leena; Furtado, Melissa; Chokka, Pratap

    2014-12-01

    By 2020, depression is projected to be among the most important contributors to the global burden of disease. A plethora of data confirms that despite the availability of effective therapies, major depressive disorder continues to exact an enormous toll; this, in part, is due to difficulties reaching complete remission, as well as the specific associated costs of both the disorder's morbidity and mortality. The negative effects of depression include those on patients' occupational functioning, including absenteeism, presenteeism, and reduced opportunities for educational and work success. The use of management algorithms has been shown to improve treatment outcomes in major depressive disorder and may be less costly than "usual care" practices. Nevertheless, many patients with depression remain untreated. As well, even those who are treated often continue to experience suboptimal quality of life. As such, the treatment algorithms in this article may improve outcomes for patients suffering with depression. This paper introduces some of the principal reasons underlying these treatment gaps and examines measures or recommendations that might be changed or strengthened in future practice guidelines to bridge them.

  19. Managing resistance in cognitive behavioural therapy: the application of motivational interviewing in mixed anxiety and depression.

    Science.gov (United States)

    Westra, Henny A

    2004-01-01

    While cognitive behavioural therapy is highly effective in the treatment of anxiety and depression, a substantive number of individuals either refuse treatment, fail to respond to treatment or respond only partially. Arguably, ambivalence about change or about engaging in treatment tasks may in part be related to incomplete recovery rates in cognitive behavioural therapy. Motivational interviewing is a client-centred, directive treatment originally developed in the addictions domain whose goal is to enhance motivation for change by understanding and resolving ambivalence. This method has consistently received support for enhancing outcomes in the addictions domain, particularly when used as an adjunct to further treatment. As yet, motivational methods have not been generalized to the treatment of prevalent mental health problems, such as anxiety and depression. The present paper presents the application of a treatment targeting motivation (motivational interviewing adapted for anxiety and depression) to the management of resistance in cognitive behavioural therapy for 3 clients with mixed anxiety and depression. Motivational interviewing is conceived as an adjunct to highly effective traditional cognitive behavioural therapy methods, which is indicated for use with clients resistant to and significantly ambivalent about change-based techniques for managing anxiety or alleviating depression.

  20. SINGLE-CASE INVESTIGATION OF AN EMOTION-FOCUSED THERAPY GROUP FOR ANXIETY AND DEPRESSION

    Directory of Open Access Journals (Sweden)

    Adèle Lafrance Robinson

    2012-11-01

    Full Text Available Emotion-focused therapy (EFT is an evidence-based treatment for depression and trauma and has shown promise for other presentations including anxiety. Minimal research exists investigating the outcomes of emotion-focused therapy in a group setting. The current research presents a mixed-method single-case study of one client’s experiences and outcomes following a nine-week EFT group for depression and anxiety. Weekly measures of session-feelings evaluations were collected. Follow-up measures, including a qualitative interview, were administered one year post-treatment. Pre-, post-, and follow-up measures assessed depression, anxiety, and emotional regulation. Results showed clinically significant improvements in anxiety, depression, and emotional regulation over time. Indirect and direct evidence of client change were detected. Five super-ordinate themes with sub-themes emerged from the qualitative analysis.

  1. Clinical and psychopatological features of organic depressive disorder in the individual abusing alcohol (case report

    Directory of Open Access Journals (Sweden)

    Spirina I.D.

    2015-03-01

    Full Text Available The article describes a clinical case of organic depressive disorder in the personality who sustained a traumatic brain injury and who abused alcohol, with distinguishing number of clinical and psychopathological features. Depressed mood, slowed thinking process, sleep disturbances, low self-esteem, hypochondriacal tendencies allowed to diagnose depressive disorder. Clinical history on sustained brain concussion, as well as inertness of nervous and mental processes revealed in psychodiagnostic study testified to organic genesis of the disease. Alcohol abuse by the person having an adverse organic background contributed to appearance of psychotic symptoms in clinical picture. Hallucinatory and delusional inclusions relatively quickly stopped on a background of antipsychotic treatment; this testified that they are secondary to the affective (depressive symptoms.

  2. BOOK REVIEW: Case Studies in Knowledge Management

    OpenAIRE

    BOYACI, Reviewed By Dr. Adnan

    2005-01-01

    161Case Studies in Knowledge ManagementEdited by Murray JennexHersley: PA: Idea Group, 2005, pp. 372, ISBN 1-59140-352-9Reviewed by Dr. Adnan BOYACIAnadolu UniversityEskişehir-TurkeyKnowledge management (KM) as a structured system and the way to the effectiveness isrelatively new field for the contemporary organizations functioning in different andcompetitive domain of public and private sectors in terms of getting optimal effectivenessunderlined by the concepts such as quality, productivity…...

  3. Magnetic seizure therapy in an adolescent with refractory bipolar depression: a case report

    Directory of Open Access Journals (Sweden)

    Noda Y

    2014-10-01

    Full Text Available Yoshihiro Noda,1,2 Zafiris J Daskalakis,1–3 Jonathan Downar,4 Paul E Croarkin,5 Paul B Fitzgerald,6 Daniel M Blumberger1–3 1Department of Psychiatry, Faculty of Medicine, University of Toronto, 2Temerty Centre for Therapeutic Brain Intervention, 3Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 4MRI-Guided rTMS Clinic, University Health Network, Toronto, ON, Canada; 5Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; 6Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia Abstract: Magnetic seizure therapy (MST has shown efficacy in adult patients with treatment-resistant depression with limited impairment in memory. To date, the use of MST in adolescent depression has not been reported. Here we describe the first successful use of MST in the treatment of an adolescent patient with refractory bipolar depression. This patient received MST in an ongoing open-label study for treatment-resistant major depression. Treatments employed a twin-coil MST apparatus, with the center of each coil placed over the frontal cortex (ie, each coil centered over F3 and F4. MST was applied at 100 Hz and 100% machine output at progressively increasing train durations. Depressive symptoms were assessed using the 24-item Hamilton Depression Rating Scale and cognitive function was assessed with a comprehensive neuropsychological battery. This adolescent patient achieved full remission of clinical symptoms after an acute course of 18 MST treatments and had no apparent cognitive decline, other than some autobiographical memory impairment that may or may not be related to the MST treatment. This case report suggests that MST may be a safe and well tolerated intervention for adolescents with treatment-resistant bipolar depression. Pilot studies to further evaluate the effectiveness and safety of

  4. Huntington's disease: review and anesthetic case management.

    Science.gov (United States)

    Cangemi, C F; Miller, R J

    1998-01-01

    Huntington's disease is a dominantly inherited progressive autosomal disease that affects the basal ganglia. Symptoms appear later in life and manifest as progressive mental deterioration and involuntary choreiform movements. Patients with Huntington's disease develop a progressive but variable dementia. Dysphagia, the most significant related motor symptom, hinders nutrition intake and places the patient at risk for aspiration. The combination of involuntary choreoathetoid movements, depression, and apathy leads to cachexia. Factors of considerable concern to the anesthesiologist who treats patients with Huntington's disease may include how to treat frail elderly people incapable of cooperation, how to treat patients suffering from malnourishment, and how to treat patients with an increased risk for aspiration or exaggerated responses to sodium thiopental and succinylcholine. The successful anesthetic management of a 65-yr-old woman with Huntington's disease who presented for full-mouth extractions is described.

  5. A case-control study assessing depression in patients with periodontitis

    Directory of Open Access Journals (Sweden)

    Shiyamali Sundararajan

    2017-01-01

    Full Text Available Background: Chronic periodontitis is an inflammatory disease of the supporting structures of the tooth. One of the important non-oral risk factors for periodontitis is psychosocial stress and depression. Depression affects oral health by affecting the immune system through its effects on hypothalamic pituitary axis system. Periodontal inflammatory surface area (PISA is a system used to assess inflammatory burden in the periodontal tissue. Aim: The aim of this study is to assess the relationship between PISA and depression. Settings and Design: The design of the study is case-control study. Materials and Methods: The study design is a case-control study with forty patients each in case and control groups. The periodontal inflammatory level was assessed by PISA system and the levels of depression was assessed by using Beck's Depression Inventory (BDI. Statistical Analysis: Student's t-test was used to compare PISA and BDI scores. The BDI score (mean ± standard deviation [SD] for controls was 12.75 ± 6.82 compared to 22.73 ± 4.40 for the cases. The comparison (t = 7.78 was statistically significant at P < 0.0001. The PISA score (mean ± SD for controls was 210.47 ± 76.80 compared to the PISA score of 1069.50 ± 204.21 for cases which was statistically significant (t = 24.90; P < 0.0001. Results: Significantly higher BDI scores were observed in patients with chronic periodontitis than healthy controls. Conclusion: This study clearly reveals a significant association between the severity of depression and inflammatory burden.

  6. Cognitive behavioral approaches to the patients suffering from depression due to maladjustment in the work place: two case reports

    OpenAIRE

    Tomotake, Masahito; Okura, Masao; Okabe, Hiromichi

    1999-01-01

    The authors report two cases of depression in which Beck's cognitive therapy was effective. Case 1was a 32-year-old man who had been troubled with the recurrent depression for about eight years in spite of regular medication. Case 2was a 30-year-old man who had been chronically depressed for one year. Maladjustment in the work place was involved in the development of their depressive symptoms. Through the psycho-therapeutic sessions, they were encouraged to identify their cognitive distortion...

  7. Anesthesic Management for Escobar Syndrome: Case Report

    OpenAIRE

    Ayse Hande Arpaci; Fusun Bozkirli; Onur Konuk

    2011-01-01

    Escobar syndrome is a rare autosomal recessive disorder which is characterized by growth retardation, axillary, antecubital, popliteal digital, and intercrural joint flexion contracture, pterygium in the eyes, cleft palate, decreased lung capacity, genital abnormalities, and spinal deformity. In this case, we presented the anesthesic management of a 2-year-old child undergoing frontal sling operation for ptosis and amblyopia etiology exploration.

  8. Anesthesic management for escobar syndrome: case report.

    Science.gov (United States)

    Arpaci, Ayse Hande; Bozkirli, Fusun; Konuk, Onur

    2011-01-01

    Escobar syndrome is a rare autosomal recessive disorder which is characterized by growth retardation, axillary, antecubital, popliteal digital, and intercrural joint flexion contracture, pterygium in the eyes, cleft palate, decreased lung capacity, genital abnormalities, and spinal deformity. In this case, we presented the anesthesic management of a 2-year-old child undergoing frontal sling operation for ptosis and amblyopia etiology exploration.

  9. Linking case management and community development.

    Science.gov (United States)

    Austin, Carol D; McClelland, Robert W; Gursansky, Di

    2006-01-01

    Case management, in various forms, is now institutionalized as a core part of policy and programs designed to deliver home- and community-based services to older adults. The case management role, in theory, requires attention to both client and system goals, although in practice the system goals that have received most attention have been gatekeeping and resource allocation. While case managers have been admonished to find and develop resources in the community, this has primarily taken the form of including informal services in individual client care plans. What has been missing is focused attention to the potential of the community as a nurturing environment with the capacity to support older adults and their caregivers. Sustainable care for older adults cannot be achieved by formal service and family support alone. This article proposes the creation of linkages between case managers, who build the service arrangements for older people, and community developers, who are responsible for building community capacity and social capital. It is argued that this linkage is essential for establishing the foundations of a caring community with the capacity to support older people.

  10. Selegiline remarkably improved stage 5 treatment-resistant major depressive disorder: a case report

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    Kitaichi Y

    2013-10-01

    Full Text Available Yuji Kitaichi,1 Takeshi Inoue,1 Nobuyuki Mitsui,1 Shin Nakagawa,1 Rie Kameyama,1 Yoshiyuki Hayashishita,1 Tohru Shiga,2 Ichiro Kusumi,1 Tsukasa Koyama1 1Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan; 2Department of Nuclear Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan Abstract: We report a case in which selegiline, an irreversible monoamine oxidase B (MAO-B inhibitor, greatly improved depressive symptoms in an adult with stage 5 treatment-resistant major depressive disorder. Four antidepressants and four augmentation therapies had previously been ineffective or intolerable, and electroconvulsive therapy had only a temporary effect. After 20 weeks of treatment with selegiline (10 mg/day, the patient's score on the 17-item Hamilton Depression Rating Scale (HDRS had decreased from 19 to 4 points. [18F]-Fluorodeoxyglucose positron emission tomography (FDG-PET showed increased glucose metabolism in the bilateral basal ganglia after initiating selegiline treatment; blood dopamine levels were also increased after selegiline treatment. These results raise the possibility that selegiline enhances dopaminergic neural transmission in treatment-resistant depression, thus leading to an improvement in depressive symptoms. Keywords: treatment-resistant depression, FDG-PET, glucose metabolism, basal ganglia

  11. Mental depression as a risk factor for periodontal disease: A case-control study

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    Zareen Fatima

    2016-01-01

    Full Text Available Aim: Periodontal disease is an immune-inflammatory response of tooth supporting structures to microbial dental plaque. It is influenced by various factors such as poor oral hygiene, smoking, systemic diseases, and psychological factors such as stress. This case-control study was performed to consider mental depression as a risk factor for periodontal disease. Materials and Methods: A total of 170 subjects were selected. All the subjects were assessed for the presence of depression by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria and severity of depression was measured by Hamilton depression rating scale. For assessment of periodontal disease, clinical periodontal parameters oral hygiene index, gingival index, probing pocket depth (PPD, and clinical attachment level (CAL were recorded. Results: Univariate logistic regression analysis demonstrated that subjects with depression had significantly higher values of debris index, calculus index, gingival index, PPD, and CAL (P 6 months of illness were higher (P < 0.05. Conclusion: Within the limits of this study, it is concluded that mental depression significantly affects the periodontium. It may be considered as risk factor for periodontal disease.

  12. Act In case of Depression: The evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study Protocol

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    Vernooij-Dassen Myrra JFJ

    2011-05-01

    Full Text Available Abstract Background The aim of this study is evaluating the (cost- effectiveness of a multidisciplinary, evidence based care program to improve the management of depression in nursing home residents of somatic and dementia special care units. The care program is an evidence based standardization of the management of depression, including standardized use of measurement instruments and diagnostical methods, and protocolized psychosocial, psychological and pharmacological treatment. Methods/Design In a 19-month longitudinal controlled study using a stepped wedge design, 14 somatic and 14 dementia special care units will implement the care program. All residents who give informed consent on the participating units will be included. Primary outcomes are the frequency of depression on the units and quality of life of residents on the units. The effect of the care program will be estimated using multilevel regression analysis. Secondary outcomes include accuracy of depression-detection in usual care, prevalence of depression-diagnosis in the intervention group, and response to treatment of depressed residents. An economic evaluation from a health care perspective will also be carried out. Discussion The care program is expected to be effective in reducing the frequency of depression and in increasing the quality of life of residents. The study will further provide insight in the cost-effectiveness of the care program. Trial registration Netherlands Trial Register (NTR: NTR1477

  13. Managing depression in people with multimorbidity: a qualitative evaluation of an integrated collaborative care model.

    Science.gov (United States)

    Knowles, Sarah E; Chew-Graham, Carolyn; Adeyemi, Isabel; Coupe, Nia; Coventry, Peter A

    2015-03-05

    Patients with comorbid depression and physical health problems have poorer outcomes compared with those with single long term conditions (LTCs), or multiple LTCs without depression. Primary care has traditionally struggled to provide integrated care for this group. Collaborative care can reduce depression in people with LTCs but evidence is largely based on trials conducted in the United States that adopted separate treat to target protocols for physical and mental health. Little is known about whether collaborative care that integrates depression care within the management of LTCs is implementable in UK primary care, and acceptable to patients and health care professionals. Nested interview study within the COINCIDE trial of collaborative care for patients with depression and diabetes/CHD (ISRCTN80309252). The study was conducted in primary care practices in North West England. Professionals delivering the interventions (nurses, GPs and psychological well-being practitioners) and patients in the intervention arm were invited to participate in semi-structured qualitative interviews. Based on combined thematic analysis of 59 transcripts, we identified two major themes: 1) Integration: patients and professionals valued collaborative ways of working because it enhanced co-ordination of mental and physical health care and provided a sense that patients' health was being more holistically managed. 2) Division: patients and professionals articulated a preference for therapeutic and spatial separation between mental and physical health. Patients especially valued a separate space outside of their LTC clinic to discuss their emotional health problems. The COINCIDE care model, that sought to integrate depression care within the context of LTC management, achieved service level integration but not therapeutic integration. Patients preferred a protected space to discuss mental health issues, and professionals maintained barriers around physical and mental health expertise

  14. Relationship between depression and apolipoproteins A and B: a case-control study

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    Masoumeh Sadeghi

    2011-01-01

    Full Text Available OBJECTIVE: To investigate the relation between major depressive disorder and metabolic risk factors of coronary heart disease. INTRODUCTION: Little evidence is available indicating a relationship between major depressive disorder and metabolic risk factors of coronary heart disease such as lipoprotein and apolipoprotein. METHODS: This case-control study included 153 patients with major depressive disorder who fulfilled the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV, and 147 healthy individuals. All participants completed a demographic questionnaire and Hamilton rating scale for depression. Anthropometric characteristics were recorded. Blood samples were taken and total cholesterol, high-and low-density lipoproteins and apolipoproteins A and B were measured. To analyze the data, t-test, χ2 test, Pearson correlation test and linear regression were applied. RESULTS: Depression was a negative predictor of apolipoprotein A (β = -0.328, p<0.01 and positive predictor of apolipoprotein B (β = 0.290, p<0.05. Apolipoprotein A was inversely predicted by total cholesterol (β = -0.269, p<0.05 and positively predicted by high-density lipoprotein (β = 0.401, p<0.01. Also, low-density lipoprotein was a predictor of apolipoprotein B (β = 0.340, p<0.01. The severity of depression was correlated with the increment in serum apolipoprotein B levels and the decrement in serum apolipoprotein A level. CONCLUSION: In view of the relationship between apolipoproteins A and B and depression, it would seem that screening of these metabolic risk factors besides psychological interventions is necessary in depressed patients

  15. [A case of major depressive disorder barely distinguishable from narcissistic personality disorder].

    Science.gov (United States)

    Saito, Shinnosuke; Kobayashi, Toshiyuki; Kato, Satoshi

    2013-01-01

    The recent increase in cases of depression with a narcissistic tendency, especially among young individuals, has been pointed out. When the narcissistic tendency is conspicuous, patients may be treated for a personality disorder or pervasive developmental disorder, and not for a mood disorder. A case is described of a man in his late twenties who developed depression due to his failure in research work and job hunting, and, after a time, due to the break off of his engagement with his fiancée, manifested with narcissistic symptoms including an exaggerated opinion of himself, a sense of entitlement, interpersonal exploitation, lack of empathy, strong feelings of envy, and an extrapunitive tendency. He was regarded at the start of treatment as having narcissistic personality disorder. However, persevering treatment, mainly with supportive psychotherapy and pharmacotherapy including antidepressants (high dose of maprotiline combined with low dose of mirtazapine), sodium valprote and aripiprazole, finally improved not only his depressive symptoms, but also the symptoms regarded as a deriving from a personality disorder. He presented fierce anger and aggression regarded as a mixed state, and showed the rapid improvement in his depressive state after hospitalization, which we considered to show potential bipolarity. We diagnosed the patient with narcissistic depression, emphasizing the aspect which suggested a mood disorder, such as the episodic presence of narcissistic symptoms as long as a depressive state resided, his circular, recursive discourse, and his potential bipolarity. To accurately evaluate the aspect of mood disorders which patients appearing to show personality disorders have, it is considered useful to grasp a patient's condition from the viewpoint of a personality structure and viable dynamics. From a therapeutic standpoint, we suggest the importance of simple but persevering psychotherapy and a sufficient quantity of antidepressant medication for

  16. Lumbo-sacral radiculopathy referral decision-making and primary care management. A case report.

    Science.gov (United States)

    Haswell, Kate; Gilmour, John Martin; Moore, Barbara Joyce

    2015-04-01

    Low back pain guideline recommendations can inform a decision in primary care to refer for surgical assessment. The purpose of this report is to present a patient with clinical signs and symptoms of lumbo-sacral radiculopathy who experienced pain of high intensity, severe paresis and depression. The guideline informed decision-making process resulted in a decision not to refer. This case report aims to increase awareness of referral guidelines and to demonstrate radicular pain and weakness, disability and depression outcomes subsequent to primary care management. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Behavioral Activation for Comorbid PTSD and Major Depression: A Case Study

    Science.gov (United States)

    Mulick, Patrick S.; Naugle, Amy E.

    2004-01-01

    The present investigation details the assessment and use of Behavioral Activation (BA) therapy to treat a 37-year-old male police officer/military veteran suffering from posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). This case study is an attempt to expand empirical knowledge regarding BA, comorbid PTSD and MDD, and…

  18. Huntington Disease: A Case Study of Early Onset Presenting as Depression

    Science.gov (United States)

    Duesterhus, Pia; Schimmelmann, Benno Graf; Wittkugel, Oliver; Schulte-Markwort, Michael

    2004-01-01

    Huntington disease is a dominantly inherited, neurodegenerative disease characterized by choreiform movement disturbances and dementia, usually with adult onset. The rare juvenile-onset Huntington disease differs from the adult phenotype. A case presenting twice, at age 10 with all the signs of a major depression and age 14 with mutism and…

  19. The examination of sport managers and coaches’ stress levels and depressed mood at work in Turkey

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    Bilge Donuk

    2013-04-01

    Full Text Available This paper is an investigation of stress levels and depressed mood at work in sport managers and coaches. Three different questionnaires were applied to professional sport managers (n=60 and coaches (n=52 in Turkey to regard to potential sources of stress before, during and after competitions. This sample represented approximately 21% of the total professional football, basketball and volleyball clubs in Turkey. The questionnaires used are “Perceived Stress Questionnaire”, “Anxiety-Stress Questionnaire” and “Depressed Mood at Work Questionnaire”. Our findings indicated that: The aim of first questionnaire was to assess perceived stressful situations and results show that general stress levels of managers and coaches are under the average. When we examine the second questionnaire consisting of health, physical condition, tension caused by stress; it is seen that negative effects of these factors increase. At last; according to the depressed mood at work questionnaire which evaluates the physiological conditions related to stress; it’s found out that both managers and coaches aren’t satisfied with their working atmosphere and managers’ unhappiness levels are higher than coaches are.

  20. Integrating Co-Morbid Depression and Chronic Physical Disease Management: Identifying and Resolving Failures in Self-Regulation

    Science.gov (United States)

    Detweiler-Bedell, Jerusha B.; Friedman, Michael A.; Leventhal, Howard; Miller, Ivan W.; Leventhal, Elaine A.

    2008-01-01

    Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes. PMID:18848740

  1. The effectiveness of stress management training program on depression, anxiety and stress of the nursing students

    Science.gov (United States)

    Yazdani, Mohsen; Rezaei, Sara; Pahlavanzadeh, Saeid

    2010-01-01

    BACKGROUND: Stress has been defined as a barrier to concentration, problem solving, decision making, and other necessary abilities for students’ learning; it also has some symptoms and illnesses in the students such as depression and anxiety. In reviewing stress and its consequences, the methods of coping with stress in the method of response to it would be more important than the nature of stress itself. Therefore, this study aimed to determine the effectiveness of stress management training program on depression, anxiety and stress rate of the nursing students. METHODS: This parallel group randomized quasi-experimental trial, was done on 68 Bs nursing students of Nursing and Midwifery School in Isfahan University of Medical Sciences from 2010 to 2011. The questionnaires of this study consisted of individual characteristics and Depression, Anxiety and Stress Scale (DASS-42). In a random fashion, The intervention group was trained with stress management training program in 8 two hours sessions, twice a week. The questionnaires were completed by both groups before, after and one month after the study. RESULTS: The results of the study indicated that there was no significant difference before the intervention in depression, anxiety and stress mean scores in the two groups. After the intervention, the mean scores of anxiety and stress in the intervention group was 5.09 (4.87) and 8.93 (6.01) and in the control group was 10 (6.45) and 13.17 (7.20), that reduction in depression mean score was significantly greater in the intervention group in the control group (p = 0.040). Furthermore, the mean scores of anxiety and stress showed a significant difference between the two groups (Anxiety p = 0.001; Stress p = 0.011); this reduction also had been remained after a month. CONCLUSIONS: According to the results of the present study, holding stress management training program workshops in different courses of the mental health department can improve mental health of the

  2. Hybrid Risk Management Methodology: A Case Study

    Directory of Open Access Journals (Sweden)

    Jacky Siu-Lun Ting

    2009-10-01

    Full Text Available Risk management is a decision-making process involving considerations of political, social, economic and engineering factors with relevant risk assessments relating to a potential hazard. In the last decade, a number of risk management tools are introduced and employed to manage and minimize the uncertainty and threats realization to the organizations. However, the focus of these methodologies are different; in which companies need to adopt various risk management principles to visualize a full picture of the organizational risk level. Regarding to this, this paper presents a new approach of risk management that integrates Hierarchical Holographic Modeling (HHM, Enterprise Risk Management (ERM and Business Recovery Planning (BCP for identifying and assessing risks as well as managing the consequences of realized residual risks. To illustrate the procedures of the proposed methodology, a logistic company ABC Limited is chosen to serve as a case study Through applying HHM and ERM to investigate and assess the risk, ABC Limited can be better evaluated the potential risks and then took the responsive actions (e.g. BCP to handle the risks and crisis in near future.

  3. Coping Card Usage can Further Reduce Suicide Reattempt in Suicide Attempter Case Management Within 3-Month Intervention.

    Science.gov (United States)

    Wang, Ying-Chuan; Hsieh, Ling-Yu; Wang, Ming-Yu; Chou, Cheng-Hsiang; Huang, Min-Wei; Ko, Huei-Chen

    2016-02-01

    This randomized controlled trial was designed to evaluate the effectiveness of using crisis coping cards (n = 32) in the case management of suicide prevention compared with case management without the use of coping cards (n = 32) over a 3-month intervention period. The generalized estimating equation was used to examine the interaction effect between treatments and time on suicide risk, depression, anxiety, and hopelessness. Results indicated that subsequent suicidal behaviors, severity of suicide risk, depression, anxiety, and hopelessness were reduced more in the coping card intervention group compared to the case management only group. Moreover, for the survival curves of time to suicide reattempt, the coping card group showed a significantly longer time to reattempt than the case management only group at 2-month and 3-month intervention periods.

  4. Surgical management of palatine Torus - case series

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    Thaís Sumie Nozu Imada

    Full Text Available INTRODUCTION: Torus palatinus is a specific name to identify exostoses developed in the hard palate along the median palatine suture. Despite of not being a pathological condition, its presence requires attention and knowledge regarding its management. Surgical removal of exostoses is indicated when the patient frequently traumatizes the area of palatine torus during mastication and speech or when it is necessary for the rehabilitation of the upper arcade with complete dentures. OBJECTIVE: The aim of this article is to present three cases of Torus palatinus and to discuss the management of them. CASE REPORT: In the first case, a 57-year-old Caucasian man sought oral rehabilitation of his edentulous maxilla but presented a hard nodules in the hard palate; in the second case, a 40-year-old Caucasian woman was referred for frequent trauma of palatal mucosa during mastication, aesthetic complaint, and discomfort caused by the trauma of her tongue in this area; and in the third case, a 45-year-old Caucasian woman presented with a lesion on the palate that caused difficulty swallowing. When the Torus palatinus was impairing the basic physiological functions of the patients, all cases were surgically treated, improving the patients' quality of life. FINAL CONSIDERATION: The dentist should be properly prepared to choose the best from among the existing surgical approaches for each individual lesion in order to improve the results and avoid possible complications.

  5. The Impact of Supervision on Internal Medicine Residents' Attitudes and Management of Depression in Primary Care: A Pilot Study

    Science.gov (United States)

    Milone, Jennifer M.; Gottumukkala, Aruna; Ward, Christopher P.; York, Kaki M.

    2013-01-01

    Objective: The authors examined the effect of supervision on internal medicine residents' attitudes toward and management of depression. Method: Internal medicine residents completed a survey during preclinical conferences. The survey included a published, validated questionnaire, the Depression Attitude Questionnaire, and items developed by the…

  6. Chronic disease management: implementation and coordination of healthcare systems for depressed elderly persons.

    Science.gov (United States)

    Severinsson, Elisabeth; Holm, Anne Lise

    2014-12-01

    The aim of this study was to evaluate the implementation of the research-based Chronic Care Model (CCM), discuss methods and summarise research recommendations for improving the care of depressed elderly persons. Interviews were conducted and state-of-the-art reviews employed. Three important areas emerged: (1) barriers to and facilitating factors in the implementation of the CCM; (2) the challenges involved in re-designing the delivery system and interdisciplinary team collaboration; and (3) empirical evidence pertaining to self-management support and how older persons manage to live with depressive ill-health. In conclusion, implementation research requires evidence-based knowledge, staff involvement and familiarity with the context in which development occurs.

  7. Postpartum depression: evidence from two clinical cases / Depressão pós-parto: evidências a partir de dois casos clínicos

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    Giana Bitencourt Frizzo

    2010-01-01

    Full Text Available The present study investigated the conjugality in two families in which the wife had postpartum depression, according to the Beck Depression Inventory and a diagnostic interview. The husbands did not have depression. A case-study design was used in order to analyze how conjugality was being experienced in this context. The interviews were individually conducted with both members of the couple. They were audiotaped and transcribed. The results revealed that the conjugality was being experienced with difficulties in both families, but in a particular way in each case, especially regarding the communication between the couple and the structure of the matrimonial relationship. The results corroborated with the literature, which associates the depression with difficulties in the conjugality, but they indicate that there are different aspects that may be affected in each family.

  8. Influences on Case-Managed Community Aged Care Practice.

    Science.gov (United States)

    You, Emily Chuanmei; Dunt, David; Doyle, Colleen

    2016-10-01

    Case management has been widely implemented in the community aged care setting. In this study, we aimed to explore influences on case-managed community aged care practice from the perspectives of community aged care case managers. We conducted 33 semistructured interviews with 47 participants. We drew these participants from a list of all case managers working in aged care organizations that provided publicly funded case management program(s)/packages in Victoria, Australia. We used a multilevel framework that included such broad categories of factors as structural, organizational, case manager, client, and practice factors to guide the data analysis. Through thematic analysis, we found that policy change, organizational culture and policies, case managers' professional backgrounds, clients with culturally and linguistically diverse backgrounds, and case management models stood out as key influences on case managers' practice. In the future, researchers can use the multilevel framework to undertake implementation research in similar health contexts.

  9. Roles and practices of general practitioners and psychiatrists in management of depression in the community

    Directory of Open Access Journals (Sweden)

    Blin Patrick

    2006-01-01

    Full Text Available Abstract Background Little is known about depressed patients' profiles and how they are managed. The aim of the study is to compare GPs and psychiatrists for 1° sociodemographic and clinical profile of their patients considered as depressed 2° patterns of care provision. Methods The study design is an observational cross-sectional study on a random sample of GPs and psychiatrists working in France. Consecutive inclusion of patients seen in consultation considered as depressed by the physician. GPs enrolled 6,104 and psychiatrists 1,433 patients. Data collected: sociodemographics, psychiatric profile, environmental risk factors of depression and treatment. All clinical data were collected by participating physicians; there was no direct independent clinical assessment of patients to check the diagnosis of depressive disorder. Results Compared to patients identified as depressed by GPs, those identified by psychiatrists were younger, more often urban (10.5% v 5.4% – OR = 2.4, educated (42.4% v 25.4% – OR = 3.9, met DSM-IV criteria for depression (94.6% v 85.6% – OR = 2.9, had been hospitalized for depression (26.1% v 15.6% – OR = 2.0 and were younger at onset of depressive problems (all adjusted p Compared to GPs, psychiatrists more often prescribed tricyclics and very novel antidepressants (7.8% v 2.3% OR = 5.0 and 6.8% v 3.0% OR = 3.8 with longer duration of antidepressant treatment. GPs' patients received more "non-conventional" treatment (8.8% v 2.4% OR = 0.3 and less psychotherapy (72.2% v 89.1% OR = 3.1 (all adjusted p Conclusion Differences between patients mainly concerned educational level and area of residence with few differences regarding clinical profile. Differences between practices of GPs and psychiatrists appear to reflect more the organization of the French care system than the competence of providers.

  10. Depressive disorders co-existing with Addison–Biermer anemia – case report

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    Just MJ

    2015-04-01

    Full Text Available Mark Jean Just,1 Mariusz Kozakiewicz2 1Department of General and Endocronological Surgery, Piekary Medical Centre, Piekary Slaskie, 2Department of Food Chemistry Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland Background: Anemia is a disease that can co-exist with depression, other mental disorders, or somatic diseases. Anemia can imitate symptoms of depression, while depression symptoms can mask concurring symptoms of anemia.Case presentation: I am presenting a case of a 48-year-old woman with Addison–Biermer anemia, with co-existing mood disorders. The clinical analysis of the presented patient’s history indicates diagnostic problems and a need for a detailed analysis of drug-related complications that occurred during previous treatment, eg, in the form of neuroleptic malignant syndrome.Conclusion: The presented case report contains valuable guidelines that can be of assistance in diagnostics and treatment of patients treated for mental disorders, who are also diagnosed with somatic diseases. Keywords: anemia, autoimmune diseases, depression, neuroleptic malignant syndrome

  11. Chinese American Parents’ Acculturation and Enculturation, Bicultural Management Difficulty, Depressive Symptoms, and Parenting

    OpenAIRE

    Kim, Su Yeong; Shen, Yishan; Huang, Xuan; Wang, Yijie; Orozco-Lapray, Diana

    2014-01-01

    This study examined whether Chinese American parents’ acculturation and enculturation were related to parenting practices (punitive parenting, democratic child participation, and inductive reasoning) indirectly through the mediation of parents’ bicultural management difficulty and parental depressed mood. Data came from a two-wave study of Chinese American families in Northern California. Mothers and fathers were assessed when their children were in early adolescence and then again in middle ...

  12. General practitioners' choices and their determinants when starting treatment for major depression: a cross sectional, randomized case-vignette survey.

    Directory of Open Access Journals (Sweden)

    Hélène Dumesnil

    Full Text Available BACKGROUND: In developed countries, primary care physicians manage most patients with depression. Relatively few studies allow a comprehensive assessment of the decisions these doctors make in these cases and the factors associated with these decisions. We studied how general practitioners (GPs manage the acute phase of a new episode of non-comorbid major depression (MD and the factors associated with their decisions. METHODOLOGY/PRINCIPAL FINDINGS: In this cross-sectional telephone survey, professional investigators interviewed an existing panel of randomly selected GPs (1249/1431, response rate: 87.3%. We used case-vignettes about new MD episodes in 8 versions differing by patient gender and socioeconomic status (blue/white collar and disease intensity (mild/severe. GPs were randomized to receive one of these 8 versions. Overall, 82.6% chose pharmacotherapy; among them GPs chose either an antidepressant (79.8% or an anxiolytic/hypnotic alone (18.5%. They rarely recommended referral for psychotherapy alone, regardless of severity, but 38.2% chose it in combination with pharmacotherapy. Antidepressant prescription was associated with severity of depression (OR = 1.74; 95%CI = 1.33-2.27, patient gender (female, OR = 0.75; 95%CI = 0.58-0.98, GP personal characteristics (e.g. history of antidepressant treatment: OR = 2.31; 95%CI = 1.41-3.81 and GP belief that antidepressants are overprescribed in France (OR = 0.63; 95%CI = 0.48-0.82. The combination of antidepressants and psychotherapy was associated with severity of depression (OR = 1.82; 95%CI = 1.31-2.52, patient's white-collar status (OR = 1.58; 95%CI = 1.14-2.18, and GPs' dissatisfaction with cooperation with mental health specialists (OR = 0.63; 95%CI = 0.45-0.89. These choices were not associated with either GPs' professional characteristics or psychiatrist density in the GP's practice areas. CONCLUSIONS/SIGNIFICANCE: GPs' choices for

  13. Psychosocial and organizational work environment of nurse managers and self-reported depressive symptoms: Cross-sectional analysis from a cohort of nurse managers

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    Nathalie Nourry

    2014-04-01

    Full Text Available Objectives: The association between depressive symptoms and psycho‑organisational work environment has been established in the literature. Some studies have evaluated depressive symptoms in healthcare workers, but little research has been carried out among nurse managers. The aim of the study is to evaluate the depressive symptoms prevalence among nurse managers' population and work environment factors. Material and Methods: A descriptive correlational research design was used. Data were collected from 296 nurse managers in five hospitals in the eastern area of France between 2007 and 2008. Health outcomes were evaluated by measuring depressive symptoms (CES-D scale, the exposure data by assessing psycho‑organisational work environment with effort-reward imbalance-model of Siegrist. Multiple logistic regressions were used to describe the strength of the association between depressive symptoms and effort-reward imbalance adjusted for personal and occupational characteristics of the nurse managers. Results: Among the nurse managers, a third had depressive symptoms, and 18% presented an effort-reward imbalance (ratio: ≥ 1. A significant association was found between depressive symptoms and effort-reward imbalance (OR = 10.81, 95% CI: 5.1-23, p < 10-3, and with esteem as a reward (OR = 3.21, 95% CI: 1.6-6.3, p < 10-2. Conclusion: In view of the hierarchical situation of nurse managers and their primary roles in hospitals, it is necessaryto take prevention measures to improve their work environment and health.

  14. Chinese American Parents' Acculturation and Enculturation, Bicultural Management Difficulty, Depressive Symptoms, and Parenting.

    Science.gov (United States)

    Kim, Su Yeong; Shen, Yishan; Huang, Xuan; Wang, Yijie; Orozco-Lapray, Diana

    2014-12-01

    This study examined whether Chinese American parents' acculturation and enculturation were related to parenting practices (punitive parenting, democratic child participation, and inductive reasoning) indirectly through the mediation of parents' bicultural management difficulty and parental depressed mood. Data came from a two-wave study of Chinese American families in Northern California. Mothers and fathers were assessed when their children were in early adolescence and then again in middle adolescence (407 mothers and 381 fathers at Wave 1; 308 mothers and 281 fathers at Wave 2). For both waves, we examined cross-sectional models encompassing both direct and indirect links from parental cultural orientations to parenting practices. We also used individual fixed-effects techniques to account for selection bias in testing model relationships at Wave 2. At Wave 1, via bicultural management difficulty and depressive symptoms, American orientation was related to less punitive parenting and more inductive reasoning for both parents, and Chinese orientation was related to more punitive parenting and less inductive reasoning for fathers. The findings indicate that bicultural management difficulty and parental depressed mood are important mechanisms to be considered when studying the relation between Chinese American parents' acculturation/enculturation and parenting.

  15. The duty to be well-informed: the case of depression.

    Science.gov (United States)

    Blease, Charlotte

    2014-04-01

    It is now an ethical dictum that patients should be informed by physicians about their diagnosis, prognosis and treatment options. In this paper, I ask: 'How informed are the 'informers' in clinical practice?' Physicians have a duty to be 'well-informed': patient well-being depends not just in conveying adequate information to patients, it also depends on physicians keeping up-to-date about: (1) popular misunderstandings of illnesses and treatments; and (2) the importance of patient psychology in affecting prognosis. Taking the case of depression as an entry point, this paper argues that medical researchers and physicians need to pay serious attention to the explanations given to patients regarding their diagnosis. Studies on lay understanding of depression show that there is a common belief that depression is wholly caused by a 'chemical imbalance' (such as 'low serotonin') that can be restored by chemically restorative antidepresssants, a claim that has entered 'folk wisdom'. However, these beliefs oversimplify and misrepresent the current scientific understanding of the causes of depression: first, there is consensus in the scientific community that the causes of depression include social as well as psychological triggers (and not just biochemical ones); second, there is significant dissensus in the scientific community over exactly what lower level, biological or biochemical processes are involved in causing depression; third, there is no established consensus about how antidepressants work at a biochemical level; fourth, there is evidence that patients are negatively affected if they believe their depression is wholly explained by (the vague descriptor) of 'biochemical imbalance'. I argue that the medical community has a duty, to provide patients with adequate information and to be aware of the negative health impact of prevalent oversimplifications-whatever their origins.

  16. Cushing's syndrome masquerading as treatment resistant depression

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    B N Anil Kumar

    2016-01-01

    Full Text Available Treatment resistant depression (TRD is a common clinical occurrence among patients treated for major depressive disorder. A significant proportion of patients remain significantly depressed in spite of aggressive pharmacological and psychotherapeutic approaches. Management of patient with treatment resistant depression requires thorough evaluation for physical causes. We report a case of recurrent depressive disorder, who presented with severe depressive episode without psychotic symptoms, not responding to multiple adequate trials of antidepressants, who on investigation was found to have Cushing's syndrome and responded well to Ketoconazole.

  17. Anesthesic Management for Escobar Syndrome: Case Report

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    Ayse Hande Arpaci

    2011-01-01

    Full Text Available Escobar syndrome is a rare autosomal recessive disorder which is characterized by growth retardation, axillary, antecubital, popliteal digital, and intercrural joint flexion contracture, pterygium in the eyes, cleft palate, decreased lung capacity, genital abnormalities, and spinal deformity. In this case, we presented the anesthesic management of a 2-year-old child undergoing frontal sling operation for ptosis and amblyopia etiology exploration.

  18. World’s largest case management RCT

    OpenAIRE

    2016-01-01

    We have developed and implemented a large scale, centralized case management program to prevent healthcare consumption for frequent visitors to Emergency Departments. In a randomized trial of more than 12 000 patients we demonstrate sustained reductions of up to 20-40% in health care utilization. This session will focus on results and learnings gathered during a 5-year multicenter trial, growing from a small pilot to an international concept.The results have been published in several articles...

  19. Neural Changes following Behavioral Activation for a Depressed Breast Cancer Patient: A Functional MRI Case Study

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    Michael J. Gawrysiak

    2012-01-01

    Full Text Available Functional neuroimaging is an innovative but at this stage underutilized method to assess the efficacy of psychotherapy for depression. Functional magnetic resonance imaging (fMRI was used in this case study to examine changes in brain activity in a depressed breast cancer patient receiving an 8-session Behavioral Activation Treatment for Depression (BATD, based on the work of Hopko and Lejuez (2007. A music listening paradigm was used during fMRI brain scans to assess reward responsiveness at pre- and posttreatment. Following treatment, the patient exhibited attenuated depression and changes in blood oxygenation level dependence (BOLD response in regions of the prefrontal cortex and the subgenual cingulate cortex. These preliminary findings outline a novel means to assess psychotherapy efficacy and suggest that BATD elicits functional brain changes in areas implicated in the pathophysiology of depression. Further research is necessary to explore neurobiological mechanisms of change in BATD, particularly the potential mediating effects of reward responsiveness and associated brain functioning.

  20. Electronic case management with homeless youth.

    Science.gov (United States)

    Bender, Kimberly; Schau, Nicholas; Begun, Stephanie; Haffejee, Badiah; Barman-Adhikari, Anamika; Hathaway, Jessica

    2015-06-01

    Case management, a widely practiced form of service brokerage, is associated with a variety of positive outcomes for homeless youth, but it may be difficult to implement, as youth face logistical barriers to attending in-person meetings. As part of a larger clinical trial, the current study investigates the feasibility of providing electronic case management (ECM) to homeless youth, using cell-phones, texts, email, and Facebook. Youth were given prepaid cell-phones and a case manager who provided four ECM sessions every 2-3 weeks over a 3-month period. Contact logs were used to record how many youth engaged in ECM, how many attempts were necessary to elicit engagement, and youths' preferred technology methods for engaging. Although engagement in the number of ECM sessions varied, the majority of youth (87.5%) engaged in at least one ECM session. Youth (41%) most commonly needed one contact before they engaged in an ECM session, and the majority responded by the third attempt. While youth most commonly answered calls directly, their chosen method of returning calls was texting. The majority of youth (80%) described ECM positively, reporting themes of convenience, connection, and accountability. The use of ECM, particularly of texting, offers promising implications for providing services to homeless youth. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. A Case with Bilateral Periventricular Nodular Heterotopia Diagnosed as Depression

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    Melek Kandemir

    2010-06-01

    Full Text Available Periventricular nodular heterotopia is a form of neuronal migration abnormality. Periventricular nodular heterotopia can easily be recognized by cranial magnetic resonance imaging. The most common clinical appearance is epileptic seizures. In some cases, symptoms are accompanied with psychiatric complaints. In this article, we report a 33-year-old female with complaints of left-sided paresthesia induced by emotional stress. She had been followed at an outpatient psychiatry clinic for about 10 years with the diagnosis of somatization disorder. Her electroencephalography recordings -awake as well as during sleep- were found to be normal. The cranial magnetic resonance imaging showed bilateral periventricular nodular heterotopia. Her seizures were controlled with carbamazepine treatment. Partial epileptic seizures might also be observed, even though the cerebral heterotopic lesions are bilateral. When a history is obtained from a patient with somatoform complaints, it should be kept in mind that these symptoms might be seizures, and the patient should be questioned accordingly.

  2. Homoeopathic treatment in a case of co-morbid atopic dermatitis and depressive disorder

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    Suraia Parveen

    2016-01-01

    Full Text Available Atopic dermatitis (AD is a skin disease characterized by itching, typical morphology, and distribution of rash, chronic relapsing course, and personal or family history of “atopic diathesis.” Stress is an important precipitating factor of AD. Stress has also some causal link with depression. Rationale of this case report is to demonstrate the co-occurrence of AD and depression in a patient, and better improvement of AD occurs when homoeopathic treatment focuses on psychological symptoms. Here, a 38-year-old male presented with a 6-month history of eczematous skin lesions with associated symptoms of depression in the background of chronic ongoing stress. A diagnosis of AD with comorbid depression was made. He initially did not show stable improvement on homoeopathic medicine selected on the basis of totality of symptoms and miasmatic background. On changing the medicine giving more priority to psychological symptoms, he gradually showed stable improvement on both the domain of symptoms and reached remission by 3 months. Remission maintained without any recurrence over the next 3½ years. Hence, the main lesson from this case is the demonstration of importance of mental symptoms over other physical symptoms in homoeopathic treatment.

  3. Excessive weight gain after remission of depression in a schizophrenic patient treated with risperidone: case report

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    Psarros Constantin

    2006-09-01

    Full Text Available Abstract Background The use of atypical antipsychotics in schizophrenic patients has been associated with a risk of weight gain. Similarly, recovery from depression is often followed by improved appetite, greater food intake and potential increase in weight. Case presentation A Caucasian 33-year-old schizophrenic female patient was being treated with 6 mg/day of risperidone and 15 mg/day of clorazepate. She developed depressive symptomatology and 40 mg/day of fluoxetine was gradually added to her treatment regimen for about 9 months. After the remission of depression, and the discontinuation of fluoxetine, she experienced an increase in appetite and subsequently excessive weight gain of 52 kg. Re-administration of fluoxetine did not reverse the situation. The patient developed diabetes mellitus, which was successfully controlled with metformin 1700 mg/day. The addition at first of orlistat 360 mg/day and later of topiramate 200 mg/day has helped her to lose a significant part of the weight gained (30 kg. Conclusion The case suggests a probable association between the remission of depressive symptomatology and weight gain in a schizophrenic patient.

  4. Cost effectiveness of telecare management for pain and depression in patients with cancer: results from a randomized trial.

    Science.gov (United States)

    Choi Yoo, Sung J; Nyman, John A; Cheville, Andrea L; Kroenke, Kurt

    2014-01-01

    Pain and depression are prevalent and treatable symptoms among patients with cancer, yet they are often undetected and undertreated. The Indiana Cancer Pain and Depression (INCPAD) trial demonstrated that telecare management can improve pain and depression outcomes. This article investigates the incremental cost effectiveness of the INCPAD intervention. The INCPAD trial was conducted in 16 community-based urban and rural oncology practices in Indiana. Of the 405 participants, 202 were randomized to the intervention group and 203 to the usual-care group. Intervention costs were determined, and effectiveness outcomes were depression-free days and quality-adjusted life years. The intervention group was associated with a yearly increase of 60.3 depression-free days (S.E. = 15.4; P intervention per patient was US$1189, which included physician, nurse care manager and automated monitoring set-up and maintenance costs. Incremental cost per depression-free day was US$19.72, which yields a range of US$18,018 to US$36,035 per quality-adjusted life year when converted to that metric. When measured directly, the incremental cost per quality-adjusted life year ranged from US$10,826 based on the modified EQ-5D to US$73,286.92 based on the SF-12. Centralized telecare management, coupled with automated symptom monitoring, appears to be a cost effective intervention for managing pain and depression in cancer patients. Published by Elsevier Inc.

  5. Electronic Document Management: A Human Resource Management Case Study

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    Thomas Groenewald

    2004-11-01

    Full Text Available This case study serve as exemplar regarding what can go wrong with the implementation of an electronic document management system. Knowledge agility and knowledge as capital, is outlined against the backdrop of the information society and knowledge economy. The importance of electronic document management and control is sketched thereafter. The literature review is concluded with the impact of human resource management on knowledge agility, which includes references to the learning organisation and complexity theory. The intervention methodology, comprising three phases, follows next. The results of the three phases are presented thereafter. Partial success has been achieved with improving the human efficacy of electronic document management, however the client opted to discontinue the system in use. Opsomming Die gevalle studie dien as voorbeeld van wat kan verkeerd loop met die implementering van ’n elektroniese dokumentbestuur sisteem. Teen die agtergrond van die inligtingsgemeenskap en kennishuishouding word kennissoepelheid en kennis as kapitaal bespreek. Die literatuurstudie word afgesluit met die inpak van menslikehulpbronbestuur op kennissoepelheid, wat ook die verwysings na die leerorganisasie en kompleksietydsteorie insluit. Die metodologie van die intervensie, wat uit drie fases bestaan, volg daarna. Die resultate van die drie fases word vervolgens aangebied. Slegs gedeelte welslae is behaal met die verbetering van die menslike doeltreffendheid ten opsigte van elektroniese dokumentbestuur. Die klient besluit egter om nie voort te gaan om die huidige sisteem te gebruik nie.

  6. Plant-derived natural medicines for the management of depression: an overview of mechanisms of action.

    Science.gov (United States)

    Farahani, Marzieh Sarbandi; Bahramsoltani, Roodabeh; Farzaei, Mohammad Hosein; Abdollahi, Mohammad; Rahimi, Roja

    2015-01-01

    Depression is a serious widespread psychiatric disorder that affects approximately 17% of people all over the world. Exploring the neurological mechanisms of the antidepressant activity of plant-derived agents could have a crucial role in developing natural drugs for the management of depression. The aim of the present study is to review the neurological mechanisms of action of antidepressant plants and their constituents. For this purpose, electronic databases, including PubMed, Science Direct, Scopus, and Cochrane Library, were searched from 1966 to October 2013. The results showed that several molecular mechanisms could be proposed for the antidepressant activity of medicinal plants and their constituents. Hypericum species could normalize brain serotonin level. Liquiritin and isoliquiritin from Glycyrrhiza uralensis rhizome act via the noradrenergic system. Rosmarinus officinalis and curcumin from Curcuma longa interact with D1 and D2 receptors as well as elevate the brain dopamine level. Sida tiagii and Aloysia gratissima involve γ-aminobutyric acid and N-methyl-D-aspartate receptors, respectively. Fuzi polysaccharide-1 from Aconitum carmichaeli could affect brain-derived neurotrophic factor signaling pathways. Psoralidin from Psoralea corylifolia seed modulate the hypothalamic-pituitary-adrenal axis. The total glycosides of Paeonia lactiflora demonstrate an inhibitory effect on both subtypes of monoamine oxidase. 3,6'-Di-o-sinapoyl-sucrose and tenuifoliside A from Polygala tenuifolia exhibit cytoprotective effects on neuronal cells. Further preclinical and clinical trials evaluating their safety, bioefficacy, and bioavailability are suggested to prove the valuable role of natural drugs in the management of depressive disorders.

  7. Act In case of Depression: the evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study Protocol

    NARCIS (Netherlands)

    Gerritsen, D.L.; Smalbrugge, M.; Teerenstra, S.; Leontjevas, R.; Adang, E.M.M.; Vernooij-Dassen, M.J.F.J.; Derksen, E.; Koopmans, R.T.C.M.

    2011-01-01

    BACKGROUND: The aim of this study is evaluating the (cost-) effectiveness of a multidisciplinary, evidence based care program to improve the management of depression in nursing home residents of somatic and dementia special care units. The care program is an evidence based standardization of the man

  8. CNS depression in an infant after the ingestion of tobacco: a case report.

    Science.gov (United States)

    Borys, D J; Setzer, S C; Ling, L J

    1988-02-01

    An 8-month-old female infant was brought in after ingesting cigarette butts. Upon presentation to the ED approximately 2.5 hr post-ingestion, the child was very lethargic and respirations were depressed. She was intubated and a NG tube was placed. Gastric lavage was performed, after which activated charcoal and sorbitol were given. Atropine was administered to treat excessive secretions. The patient became progressively more obtunded throughout the emergency department stay. Upon admission to the PICU she was minimally responsive. The urine tox screen was positive only for nicotine. The patient gradually improved with supportive care and was sent home on the third hospital day. Although the effects of Nicotine are well documented, few cases have been reported of severe toxicity in pediatric patients. We believe this to be the only reported case of severe CNS depression secondary to the ingestion of cigarette butts in a pediatric patient.

  9. A case of corpus callosum agenesis presenting with recurrent brief depression

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    Bhattacharyya Ranjan

    2009-01-01

    Full Text Available Agenesis of corpus callosum can have various neuropsychiatric manifestations. Following case report highlights the case of a young man presenting with features of recurrent brief depressive disorder, each lasting for about 3 to 7 days, for over a year. He had history of occasional headache and episodes of swooning attack in between, usually precipitated by emotional events. His neuroimaging revealed agenesis of corpus callosum. He was experiencing swooning attacks as he became aware that some ′unusual′ findings were present in his reports. Recurrent brief depression can be a manifestation of this congenital anomaly, and conversion disorder can be present as comorbid diagnosis perhaps due to ignorance and fear of this apparently innocuous congenital malformation.

  10. Major depressive disorder with delusion of having AIDS: a case report.

    Science.gov (United States)

    Yang, C H; Lee, Y C

    1997-09-01

    Acquired immune deficiency syndrome (AIDS) has become a topic of increasing public concern. Several conditions have been described in patients who are afraid that they have acquired AIDS, including depression, somatization disorders, hypochondriasis, adjustment disorders and various psychoses. This paper presents a case study of a young man with persistent fear of having AIDS. In spite of negative HIV test results, the patient still insisted that he suffered from AIDS. The psychiatric diagnosis was major depressive disorder with delusion of having AIDS. The patient was treated with fluoxetine 40 mg qd and sulpiride 400 mg qn. After two weeks on medication, his fear of AIDS subsided and he improved remarkably. The most important intervention in patients with delusion of having AIDS is to identify and treat the underlying psychopathology. The following case is representative of our experience.

  11. Depressão pós-parto: evidências a partir de dois casos clínicos Postpartum depression: evidence from two clinical cases

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    Giana Bitencourt Frizzo

    2010-04-01

    Full Text Available O presente estudo examinou a conjugalidade em duas famílias em que a esposa apresentava depressão pós-parto, com base no Inventário Beck de Depressão e em uma entrevista diagnóstica. Os maridos não apresentavam depressão. Foi utilizado delineamento de estudo de casos para investigar como a conjugalidade era vivenciada nesse contexto. As entrevistas foram realizadas individualmente com ambos membros do casal, tendo sido gravadas e posteriormente transcritas. Os resultados revelaram que a conjugalidade estava sendo experienciadas com dificuldades em ambas as famílias, mas de maneira particular em cada caso, especialmente com relação à comunicação entre o casal e conseqüente estrutura da relação conjugal. Os resultados corroboraram a literatura, que associa a depressão com dificuldades na conjugalidade, mas indicam que há diferentes aspectos que podem ser afetados em cada família.The present study investigated the conjugality in two families in which the wife had postpartum depression, according to the Beck Depression Inventory and a diagnostic interview. The husbands did not have depression. A case-study design was used in order to analyze how conjugality was being experienced in this context. The interviews were individually conducted with both members of the couple. They were audiotaped and transcribed. The results revealed that the conjugality was being experienced with difficulties in both families, but in a particular way in each case, especially regarding the communication between the couple and the structure of the matrimonial relationship. The results corroborated with the literature, which associates the depression with difficulties in the conjugality, but they indicate that there are different aspects that may be affected in each family.

  12. Are chronic low back pain outcomes improved with co-management of concurrent depression?

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    Pollard Henry

    2005-06-01

    Full Text Available Abstract Objective To discuss the role of depression in chronic lower back pain and comment on appropriate methods of screening and co-management. Data Sources The current scientific literature was investigated using the online web databases CINAHL, Medline/PUBMED, Proquest, Meditext and from manual library searches. Data Extraction Databases were searched from 1980 to the present (2005. Articles were searched with the key words "depression" and "low back pain". Over three hundred articles were sourced and articles were then selected on their relevance to the chronic spinal pain states that present to manual therapy practitioners. Data synthesis Pain is a subjective awareness of peripheral nociceptive stimulation, projected from the thalamus to the cerebral cortex with each individual's pain experience being mediated by his or her psychological state. Thus a psychological component will often be associated with any painful experience. A number of studies suggest (among other things that the incidence of depression predicts chronicity in lower back pain syndromes but that chronic lower back pain does not have the reciprocal action to predict depression. Conclusion The aetiology of chronic pain is multifactorial. There is sufficient evidence in the literature to demonstrate a requirement to draw treatment options from many sources in order to achieve a favourable pain relief outcome. The treatment should be multimodal, including mental and emotional support, counseling and herbal advice. While a strong correlation between depression and chronic low back pain can be demonstrated, an apparent paucity of literature that specifically addresses the patient response to chiropractic treatment and concurrent psychotherapy identifies the need for prospective studies of this nature to be undertaken. It is likely that multimodal/multidisciplinary treatment approaches should be encouraged to deal with these chronic lower back pain syndromes.

  13. Dose-response effects for depression and Schizophrenia management on hospital utilization in Illinois Medicaid: a multivariate regression analysis.

    Science.gov (United States)

    Berg, Gregory D; Donnelly, Shawn; Warnick, Kathleen; Medina, Wendie; Miller, Mary

    2014-07-03

    The prevalence of schizophrenia and depression in the United States is far higher among Medicaid recipients than in the general population. Individuals suffering from mental illness, including schizophrenia and depression, also have higher rates of emergency department utilization, which is costly and may not generate the positive health outcomes desired. Disease management programs strive to help individuals suffering from chronic illnesses better manage their condition(s) and seek health care in the appropriate settings. The objective of this manuscript is to estimate a dose-response impact on hospital inpatient and emergency room utilizations for any reason by Medicaid recipients with depression or schizophrenia who received disease management contacts. Multivariate regression analysis of panel data taken from administrative claims was conducted to test the hypothesis that increased contacts lower the likelihood of all-cause inpatient admissions and emergency room visits. Subjects included 6,274 members of Illinois' non-institutionalized Medicaid-only aged, blind or disabled population diagnosed with depression or schizophrenia. The statistical measure is the odds ratio. The odds ratio association is between the monthly utilization indicators and the number of contacts (doses) a member had for each particular disease management intervention. Higher numbers of intervention contacts for Medicaid recipients diagnosed with depression or schizophrenia were associated with statistically significant reductions in all-cause inpatient admissions and emergency room utilizations. There is a high correlation between depression and schizophrenia disease management contacts and lowered all-cause hospital inpatient and emergency room utilizations.

  14. The Influence of Health Literacy and Depression on Diabetes Self-Management: A Cross-Sectional Study

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    D. Maneze

    2016-01-01

    Full Text Available Despite an increasing focus on health literacy in the clinical setting and in the literature, there is still ongoing debate about its influence on diabetes self-management. The aim of the study was to examine the relationships of sociodemographic, clinical, and psychological factors on health literacy and diabetes self-management. A cross-sectional survey was undertaken on 224 patients with type 2 diabetes at two diabetes centres in Sydney, Australia. Findings showed that people with low health literacy were more likely to (a have lower educational attainment; (b be migrants; and (c have depressed mood. Unexpectedly, those who met HbA1c threshold of good glucose control were more likely to have low health literacy. Predictors of low diabetes self-management included (a younger age group (AOR: 2.58, 95% CI: 1.24–4.64; (b having postsecondary education (AOR: 2.30, 95% CI: 1.05–5.01; (c low knowledge of diabetes management (AOR: 2.29, 95% CI: 1.25–4.20; and (d having depressed mood (AOR: 2.30, 95% CI: 1.30–4.06. The finding that depressed mood predicted both low health literacy and low diabetes self-management stresses the importance of screening for depression. Increasing people’s understanding of diabetes self-management and supporting those with depression are crucial to enhance participation in diabetes self-management.

  15. The Influence of Health Literacy and Depression on Diabetes Self-Management: A Cross-Sectional Study.

    Science.gov (United States)

    Maneze, D; Everett, B; Astorga, C; Yogendran, D; Salamonson, Y

    2016-01-01

    Despite an increasing focus on health literacy in the clinical setting and in the literature, there is still ongoing debate about its influence on diabetes self-management. The aim of the study was to examine the relationships of sociodemographic, clinical, and psychological factors on health literacy and diabetes self-management. A cross-sectional survey was undertaken on 224 patients with type 2 diabetes at two diabetes centres in Sydney, Australia. Findings showed that people with low health literacy were more likely to (a) have lower educational attainment; (b) be migrants; and (c) have depressed mood. Unexpectedly, those who met HbA1c threshold of good glucose control were more likely to have low health literacy. Predictors of low diabetes self-management included (a) younger age group (AOR: 2.58, 95% CI: 1.24-4.64); (b) having postsecondary education (AOR: 2.30, 95% CI: 1.05-5.01); (c) low knowledge of diabetes management (AOR: 2.29, 95% CI: 1.25-4.20); and (d) having depressed mood (AOR: 2.30, 95% CI: 1.30-4.06). The finding that depressed mood predicted both low health literacy and low diabetes self-management stresses the importance of screening for depression. Increasing people's understanding of diabetes self-management and supporting those with depression are crucial to enhance participation in diabetes self-management.

  16. Case Management in Community Corrections: Current Status and Future Directions

    Science.gov (United States)

    Day, Andrew; Hardcastle, Lesley; Birgden, Astrid

    2012-01-01

    Case management is commonly regarded as the foundation of effective service provision across a wide range of human service settings. This article considers the case management that is offered to clients of community corrections, identifying the distinctive features of case management in this particular setting, and reviewing the empirical evidence…

  17. A CASE STUDY OF OCCUPATIONAL THERAPY APPLICATION IN A PATIENT WITH DEPRESSION AND HYPOACUSIS

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    Manuela Mihaela Ciucurel

    2016-07-01

    Full Text Available We chose to present an exemplifying case-study of occupational therapy (OT application in an adult patient with depression and hypoacusis by using the narrative interview method. We started from the principle that in each OT case-study it is important to identify the patient’s previously life roles held and the activities that were fulfilled within these roles. As methodological tool, we applied the Person-Environment-Occupation Model (PEO in a 48 years old woman, with reactive depression (after her husband’s death and congenital hypoacusis. After identifying the occupational routine and life style of the client, we established as a valid aim of OT intervention the client’s return to an old hobby, the flowers photography, and we described the PEO factors that influence flower shooting performance. From a global perspective, client’s occupational performance was considered as satisfactory. Her abilities and independent functional status allow her to be engaged in different daily occupations that match with her environment. After completing the PEO transaction for flower shooting, we extracted the occupational needs of the client. This client centered case study is an example of good practice, which reveals the possibility of achieving a higher level of occupational performance and to increase self-esteem for individuals with depression.

  18. Assessment of an enhanced program for depression management in primary care: a cluster randomized controlled trial. The INDI project (Interventions for Depression Improvement

    Directory of Open Access Journals (Sweden)

    Hernández Josep M

    2007-09-01

    Full Text Available Abstract Background Most depressed patients are attended at primary care. However, there are significant shortcomings in the diagnosis, management and outcomes of these patients. The aim of this study is to determine whether the implementation of a structured programme for managing depression will provide better health outcomes than usual management. Methods/Design Design: A cluster-randomized controlled trial involving two groups, one of which is the control group consisting of patients who are treated for depression in the usual way and the other is the intervention group consisting of patients on a structured programme for treating depression. Setting: 20 primary care centres in the province of Tarragona (Spain Sample: 400 patients over 18 years of age who have experienced an episode of major depression (DSM-IV and who need to initiate antidepressant treatment Intervention: A multi-component programme with clinical, educational and organisational procedures that includes training for the health care provider and evidence-based clinical guidelines. It also includes primary care nurses working as care-managers who provide educational and emotional support for the patients and who are responsible for active and systematic clinical monitoring. The programme aims to improve the primary care/specialized level interface. Measurements: The patients will be monitored by telephone interviews. The interviewer will not know which group the patient belongs to (blind trial. These interviews will be given at 0, 3, 6 and 12 months. Main variables: Severity of the depressive symptoms, response rate and remission rate. Analysis: Outcomes will be analyzed on an intent-to-treat basis and the unit of analysis will be the individual patient. This analysis will take into account the effect of study design on potential lack of independence between observations within the same cluster. Discussion The effectiveness of caring for depression in primary care can be

  19. A Database of Systems Management Cases

    Science.gov (United States)

    1990-09-01

    flaws in the Argyris analysis. Argyris contended that "the case method produced learner problems of conformity, error camouflage, risk minimization, and...would "buy"/take over management of the existing AIL contract. This would decrease the risk associated with th- contract 44 because of Rockwell’s...Irft o 014a00Mad taon. 121 IS 40 eWUM O6ISHihwev l uite 1204. Arlington. ’IA 22202-4302, and to the Oflce of Managemnet and Suidgert PacerwOrs

  20. Association of depression and stress in acute myocardial infarction: a case-control study

    Directory of Open Access Journals (Sweden)

    Patricia RM Goldfeld

    2015-07-01

    Full Text Available Background. Psychosocial factors have been reported to be independently associated with coronary artery disease (CAD. However the stress variable is still sub detailed and there are few studies that used coronary angiography (CA to assess CAD. Objectives. To compare levels of depression, stress and stressful life events in three groups of individuals: post-MI (Myocardial Infarction patients; patients presenting symptoms and no previous MI who underwent cardiac catheterization and had non-significant obstructive CAD and individuals with no symptoms of cardiac disease or others diseases. Methods. We conducted a case-control study, with two cases groups and one control group. The study included 105 patients with recent Myocardial Infarction (MI group, 101 patients with cardiac symptoms and normal CA (CS group, and 100 patients without symptoms of disease (NS group. Multivariate logistic regression was used to assess stress and vital events with an Odds Ratio of 95% confidence interval (CI, controlling for age, sex, education level, income, social support group, Body Mass Index (BMI, sedentary lifestyle and family history of MI or sudden death. Results. MI patients group showed depression with an OR= 4.47(95% CI, 2:36 to 8:46, p<.001, and stress OR= 5.37(95%CI, 2.94-9.78, p<.001 whereas CS group showed depression: OR= 6.95(95%CI, 3.64-13.28, p<.001 and stress: OR=9.18 (95%CI, 4.73-17.82, p<.001 compared to patients without symptoms. After adjusting the groups for the following risk factors: age, sex, education, income, social support, obesity, sedentary lifestyle, family history of MI or sudden death, the OR showed the following variation: in the MI group, depression OR=2.51 (95%CI, 1:05 to 5:98, p=.038, stress, OR=8.76(95%CI, 3:48 to 22:01, p<.001, while the CS group showed: depression OR=3.25(95%CI, 1.40-7.55,p<01 and stress OR=12.24 (95%, CI, 4.81-31.14, p<.001. The raised effect of variable stress after adjustment was promoted by age, sex and

  1. Cost Effectiveness of Telecare Management for Pain and Depression in Patients with Cancer: Results from a Randomized Trial

    Science.gov (United States)

    Choi Yoo, Sung J.; Nyman, John A.; Cheville, Andrea L.; Kroenke, Kurt

    2014-01-01

    Objective Pain and depression are prevalent and treatable symptoms among patients with cancer yet they are often undetected and undertreated. The Indiana Cancer Pain and Depression (INCPAD) trial demonstrated that telecare management can improve pain and depression outcomes. This article investigates the incremental cost effectiveness of the INCPAD intervention. Methods The INCPAD trial was conducted in 16 community-based urban and rural oncology practices in Indiana. Of the 405 participants, 202 were randomized to the intervention group and 203 to the usual-care group. Intervention costs were determined and effectiveness outcomes were depression-free days and quality adjusted life years. Results The intervention group was associated with a yearly increase of 60.3 depression-free days (SE=15.4; pmanager, and automated monitoring set-up and maintenance costs. Incremental cost per depression-free day was $19.72, which yields a range of $18,018 to $ 36,035 per quality-adjusted life year when converted to that metric. When measured directly, the incremental cost per quality-adjusted life year ranged from $10,826 based on the modified EQ-5D to $73,286.92 based on the SF-12. Conclusion Centralized telecare management, coupled with automated symptom monitoring, appears to be a cost effective intervention for managing pain and depression in cancer patients. PMID:25130518

  2. Toward psychiatry as a 'human' science of mind. The case of depressive disorders in DSM-5.

    Science.gov (United States)

    Castiglioni, Marco; Laudisa, Federico

    2014-01-01

    The aim of this paper is to argue that a strictly reductionist approach to psychiatry represents a theoretical and clinical obstacle to a fruitful synthesis between neurobiological and sociocultural aspects of the sciences of mind. We examine the theoretical and practical motivations underlying this approach, by analyzing the case of depressive disorders, as defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the related removal of the "bereavement exclusion clause." We first explore the claim that DSM is atheoretical, observing that, far from being atheoretical, DSM adopts an implicit, biologically inspired view of the mind; we show that such a view leads to a sort of circularity in the definition of depressive disorders, in which psychopharmacology seems to play a key role. We then turn to further problems deriving from this position, analyzing the issue of placebo effects in the treatment of depressive disorders and the philosophical question of normative preconditions for psychopathological diagnosis. Finally, we address the issue of subjectivity, which, together with the related aspect of the subject's relational context, appears to be crucial to any scientific theorizing about mental disorders, despite DSM's attempt to exclude it. Our defense of a non-reductionist view of mental disorders, however, does not imply that we endorse any sort of metaphysical dualism, or anti-diagnostic or anti-psychiatric positions. On the contrary, we argue that the adoption of a reductionist position actually undermines the theoretical and clinical accuracy in explaining depressive disorders.

  3. Case Management of Dengue: Lessons Learned.

    Science.gov (United States)

    Kalayanarooj, Siripen; Rothman, Alan L; Srikiatkhachorn, Anon

    2017-03-01

    The global burden of dengue and its geographic distribution have increased over the past several decades. The introduction of dengue in new areas has often been accompanied by high case-fatality rates. Drawing on the experience in managing dengue cases at the Queen Sirikit National Institute of Child Health in Bangkok, Thailand, this article provides the authors' perspectives on key clinical lessons to improve dengue-related outcomes. Parallels between this clinical experience and outcomes reported in randomized controlled trials, results of efforts to disseminate practice recommendations, and suggestions for areas for further research are also discussed. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  4. Depression Case Control (DeCC) Study fails to support involvement of the muscarinic acetylcholine receptor M2 (CHRM2) gene in recurrent major depressive disorder.

    Science.gov (United States)

    Cohen-Woods, Sarah; Gaysina, Daria; Craddock, Nick; Farmer, Anne; Gray, Joanna; Gunasinghe, Cerisse; Hoda, Farzana; Jones, Lisa; Knight, Jo; Korszun, Ania; Owen, Michael J; Sterne, Abram; Craig, Ian W; McGuffin, Peter

    2009-04-15

    It has been suggested that alteration in the muscarinic-cholinergic system is involved in modulation of mood. Three studies have reported linkage on chromosome 7 with major depressive disorder (MDD) in or close to a region containing the muscarinic receptor CHRM2 gene. A haplotype of SNPs located in CHRM2 (rs1824024-rs2061174-rs324650) has been significantly associated with MDD in a previous study. We report the first study investigating this gene in a large, adequately powered, clinical depression case-control sample (n = 1420 cases, 1624 controls). Our data fail to support association with the CHRM2 polymorphisms previously implicated in the genetic aetiology of depression. It is possible our failure to replicate may be a consequence of differences in definition of the MDD phenotype and/or ethnic differences.

  5. [Recited depression].

    Science.gov (United States)

    Barucci, M; Cossio, M

    1984-01-01

    Several subjects who tell their depression and play a part of it in front of the doctor without being really depressed are reported. Some of them try to hide the symptoms (irritability or erethism, ceremonials of obsessive neurosis, shunning of phobia) which, in their opinion, might be detrimental to their reputation. Others neglect to describe some of the symptoms of their polymorphous clinical picture only underlining the depressive signs. Some others play a part of depression because they have believed to recognize themselves in persons presented by mass media, because it seems to them a duty to show an adequate depression in case of mournful event, or because they "convert" their problem into a depression. Some others use depression as a blackmail, or to obtain an advantage from doctor's conviction about their illness. The reason for the high frequency of similar cases in the present time are examined: the scientific divulgation and the acceptance of depression by the modern society are among the most important ones. The peculiar semantic vicissitudes of the word depression are also reviewed. A widening of the boundaries of depression has contributed to an increase in the number of the cases. Finally, in addition to patients who are depressed without being aware of it, the authors focus the inverse possibility: patients who believed or try to make their doctor believe (playing the part of depression in front of them) that they are depressed.

  6. Management case study: Tampa Bay, Florida

    Science.gov (United States)

    Morrison, Gerold; Greening, Holly; Yates, Kimberly K.; Wolanski, Eric; McLusky, Donald S.

    2011-01-01

    Tampa Bay, Florida, USA, is a shallow, subtropical estuary that experienced severe cultural eutrophication between the 1940s and 1980s, a period when the human population of its watershed quadrupled. In response, citizen action led to the formation of a public- and private-sector partnership (the Tampa Bay Estuary Program), which adopted a number of management objectives to support the restoration and protection of the bay’s living resources. These included numeric chlorophyll a and water-clarity targets, as well as long-term goals addressing the spatial extent of seagrasses and other selected habitat types, to support estuarine-dependent faunal guilds. Over the past three decades, nitrogen controls involving sources such as wastewater treatment plants, stormwater conveyance systems, fertilizer manufacturing and shipping operations, and power plants have been undertaken to meet these and other management objectives. Cumulatively, these controls have resulted in a 60% reduction in annual total nitrogen (TN) loads relative to earlier worse-case (latter 1970s) conditions. As a result, annual water-clarity and chlorophyll a targets are currently met in most years, and seagrass cover measured in 2008 was the highest recorded since 1950. Factors that have contributed to the observed improvements in Tampa Bay over the past several decades include the following: (1) Development of numeric, science-based water-quality targets to meet a long-term goal of restoring seagrass acreage to 1950s levels. Empirical and mechanistic models found that annual average chlorophyll a concentrations were a primary manageable factor affecting light attenuation. The models also quantified relationships between TN loads, chlorophyll a concentrations, light attenuation, and fluctuations in seagrass cover. The availability of long-term monitoring data, and a systematic process for using the data to evaluate the effectiveness of management actions, has allowed managers to track progress and

  7. Anesthetic management of peripartum cardiomyopathy using "epidural volume extension" technique: A case series

    Directory of Open Access Journals (Sweden)

    Akhilesh Kumar Tiwari

    2012-01-01

    Full Text Available Peripartum cardiomyopathy is a rare cause of dilated cardiomyopathy in parturients, occurring in approximately one in 1000 deliveries, manifesting during the last few months or the first 5 months of the postpartum period. It can result in severe ventricular dysfunction during late puerperium. The major concern while managing these patients is to optimize fluid administration and avoid myocardial depression, while maintaining stable intraoperative hemodynamics. We present a case series of five parturients that were posted for elective cesarean section and managed successfully by the epidural volume extension technique.

  8. Quick management of accidental tritium exposure cases.

    Science.gov (United States)

    Singh, Vishwanath P; Badiger, N M; Managanvi, S S; Bhat, H R

    2012-07-01

    Removal half-life (RHL) of tritium is one of the best means for optimising medical treatment, reduction of committed effective dose (CED) and quick/easy handling of a large group of workers for medical treatment reference. The removal of tritium from the body depends on age, temperature, relative humidity and daily rainfall; so tritium removal rate, its follow-up and proper data analysis and recording are the best techniques for management of accidental acute tritium exposed cases. The decision of referring for medical treatment or medical intervention (MI) would be based on workers' tritium RHL history taken from their bodies at the facilities. The workers with tritium intake up to 1 ALI shall not be considered for medical treatment as it is a derived limit of annual total effective dose. The short-term MI may be considered for tritium intake of 1-10 ALI; however, if the results show intake ≥100 ALI, extended strong medical/therapeutic intervention may be recommended based on the severity of exposure for maximum CED reduction requirements and annual total effective dose limit. The methodology is very useful for pressurized heavy water reactors (PHWRs) which are mainly operated by Canada and India and future fusion reactor technologies. Proper management will optimise the cases for medical treatment and enhance public acceptance of nuclear fission and fusion reactor technologies.

  9. Logistics management skills development: A Zimbabwean case

    Directory of Open Access Journals (Sweden)

    Jacobus N. Cronjé

    2015-02-01

    Full Text Available Background: Since logistics emerged as an applied discipline during the latter part of the 20th century, there has been an increased need for skills development in logistics and supply chain management. However, literature suggests a general shortage of educated and skilled logistics and supply chain managers worldwide.Objectives: The purpose of this article was to benchmark an in-house training programme in logistics management in the beverage industry of Zimbabwe with international best practice.Method: A case study approach was followed focusing on the programme curriculum, content and delivery. The article reports on the nature and effectiveness of the programme. The curriculum was benchmarked with skills requirements identified in literature. Relevance was evaluated based on participant perceptions over a period of 3 years using questionnaires with both closed- and open-ended questions.Results: Findings suggested that the programme offering is in line with international practice whilst it also addresses particular issues in Third World countries. Participants perceived the programme as being practical and valuable for enhancing their job performance and career development.Conclusion: The article provides a framework for evaluating logistics training programmes. Future research could include an evaluation that measures changes in on-the-job behaviour of participants.

  10. Managing co-morbid depression and anxiety in primary care patients with asthma and/or chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Pommer, Antoinette M; Pouwer, Francois; Denollet, Johan

    2012-01-01

    in the Netherlands. Patients with asthma/COPD and co-morbid anxiety/depression will be included in order to test the effectiveness of a disease management approach to treat these co-morbid disorders. Important elements of this approach are: 1) systematic screening to improve detection of anxiety and depression 2......BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma are common chronic diseases that are frequently accompanied by depression and/or anxiety. However, symptoms of depression and anxiety are often not recognized and therefore not treated. Currently, only a few studies have tested new...... clinical approaches that could improve the treatment of co-morbid depression and anxiety in these groups of patients. METHODS/DESIGN: The present randomized controlled study will be conducted within the framework of PoZoB (Praktijk Ondersteuning Zuid-Oost Brabant), a large primary care organization...

  11. Leadership development and succession planning in case management.

    Science.gov (United States)

    Miodonski, Kathleen; Hines, Patricia

    2013-01-01

    The director of case management is one of health care's leadership positions most frequently in demand. The lack of qualified and effective case management leaders will continue to be an issue for organizations for years to come, influenced by increasing pressures on health care reimbursement and the aging case management workforce. Organizations have an opportunity to create a program to develop future case management leaders from their internal talent. The proposed strategies are designed for the acute care hospital but also have applicability in other health care settings where there are case managers and a need for case management leadership. The business community offers leadership research and leadership development models with relevance to case management. Identifying and developing internal talent for leadership roles has been proven to be effective in preparation for advanced responsibilities, has a positive effect on staff morale, and minimizes the impact of vacant leadership positions during recruitment and onboarding activities. Creating a case management leadership development program for an organization can be an alternative to the process of external recruitment for case management department leaders. Such a program can be undertaken even in today's budget conscious environment by accessing existing resources in an organization in a creative and organized manner. The authors outline an approach for case management leaders to accept responsibility for succession planning and for case managers to accept responsibility for promoting their own career development through creation of a leadership development program.

  12. BOOK REVIEW: Case Studies in Knowledge Management

    Directory of Open Access Journals (Sweden)

    Reviewed by Dr. Adnan BOYACI

    2005-10-01

    Full Text Available 161Case Studies in Knowledge ManagementEdited by Murray JennexHersley: PA: Idea Group, 2005, pp. 372, ISBN 1-59140-352-9Reviewed by Dr. Adnan BOYACIAnadolu UniversityEskişehir-TurkeyKnowledge management (KM as a structured system and the way to the effectiveness isrelatively new field for the contemporary organizations functioning in different andcompetitive domain of public and private sectors in terms of getting optimal effectivenessunderlined by the concepts such as quality, productivity…etc. Because of the growingimportance and the popularity of the KM either as a research topic or specialized coursesubject, a crucial need for understanding, conceptualization and implementation of KM asa system has emerged since the mid 1990’s. In this sense, the book contributes criticallyto fill the gap between theory and implementation as a teaching material.This edited book is published by Idea Group Publishing. The book has twenty chaptersdivided into seven sections. In addition to a section of authors’ biography contributing thebook and an index, there is a preface that the basic terms and key concepts underliningthe cases discussed following chapters, which is explained in a schematized way.Besides the editor, total of 47 authors have contributed to the book. These authors arefrom different countries, academic backgrounds, and institutions. Although approximatelyone third of the authors are from USA, the rest of the authors are from Canada, England,Austria, Germany, Australia, New Zealand, Egypt, Bahrain and China. The authorsrepresent a variety of universities, private companies, and military institutions. Most ofthem have strong professional backgrounds, which help them address the issues bothfrom theoretical and practical perspectives. Contributions of authors having differentbackgrounds and institutions enable the book to have very comprehensive spectrum andthis makes the book attractive practically for those working different sectors

  13. Stimulation dependent induction of fear and depression in deep brain stimulation: a case report

    Directory of Open Access Journals (Sweden)

    Sabolek Michael

    2009-09-01

    Full Text Available Abstract Introduction Psychiatric side effects of deep brain stimulation are not uncommon. It is often limited to transient mood alterations. We report for the first time a case of acute stimulation-dependent fear during intraoperative test stimulation. Case presentation During test stimulation for electrode placement to the left subthalamic nucleus, a 58-year-old caucasian man with Parkinson's disease developed a severe reproducible feeling of fear together with elevated heart rate and sweating. Postoperatively, the patient developed a therapy refractory major depression in spite of excellent motor-control. Reprogramming the stimulator using a more rostral contact resulted in an abrupt and complete disappearance of the depressive syndrome. Conclusion Postoperative re-evaluation of the stimulation site of the patient inducing acute fear by analyzing his intraoperative microrecordings and Talairach coordinates revealed stimulation within his right substantia nigra. The contrast analysis of the postoperative stimulation site suggests induction of depression in the patient by stimulation of the caudal part of his subthalamic nucleus. Acute psychiatric side effects of deep brain stimulation are relatively rare but must not be overlooked while concentrating on the improvement of motor deficit.

  14. Coma blisters after poisoning caused by central nervous system depressants: case report including histopathological findings.

    Science.gov (United States)

    Branco, Maira Migliari; Capitani, Eduardo Mello De; Cintra, Maria Letícia; Hyslop, Stephen; Carvalho, Adriana Camargo; Bucaretchi, Fabio

    2012-01-01

    Blister formation and eccrine sweat gland necrosis is a cutaneous manifestation associated with states of impaired consciousness, most frequently reported after overdoses of central nervous system depressants, particularly phenobarbital. The case of a 45-year-old woman who developed "coma blisters" at six distinct anatomic sites after confirmed (laboratory) phenobarbital poisoning, associated with other central nervous system depressants (clonazepam, promethazine, oxcarbazepine and quetiapine), is presented. A biopsy from the left thumb blister taken on day 4 revealed focal necrosis of the epidermis and necrosis of sweat gland epithelial cells; direct immunofluorescence was strongly positive for IgG in superficial blood vessel walls but negative for IgM, IgA, C3 and C1q. The patient was discharged on day 21 with no sequelae.

  15. Depression, anxiety, stress and hyperemesis gravidarum: temporal and case controlled correlates.

    Directory of Open Access Journals (Sweden)

    Peng Chiong Tan

    Full Text Available OBJECTIVE: To evaluate the temporal and case-controlled correlations of anxiety, depression and stress with hyperemesis gravidarum. STUDY DESIGN: We performed a longitudinal cohort study of women with hyperemesis gravidarum using the Depression, Anxiety and Stress Scale (DASS-21 to evaluate psychological distress at hospitalization and in the third trimester of pregnancy (from 28 weeks gestation. Third pregnancy trimester controls were recruited from routine antenatal clinic attendees who were matched to gestational age at the second DASS-21 assessment in the HG cohort. RESULTS: The prevalences of nausea and vomiting, depression, anxiety and stress caseness in newly hospitalised hyperemesis gravidarum women were 100% and 100%, 19%, 69% and 21% which by the third trimester had fallen to 15.7% and 9.9%, 4%, 19% and 3% and in third trimester controls were 15.9% and 14.2%, 14%, 61% and 20% respectively. Within the hyperemesis gravidarum cohort, nausea, vomiting depression, anxiety and stress reduced significantly by an absolute 84.3% (95% CI 76.2%-89.8%, 90.1% (82.8%-94.2%, 14.9% (7.2%-23.0%, 49.6% (38.6%-58.7% and 18.2% (10.4%-26.4% respectively between hospitalization for hyperemesis gravidarum and at the third trimester. In the third trimester, when comparing the hyperemesis gravidarum cohort to controls, the risk of nausea or vomiting was similar but depression, anxiety and stress were significantly lower: adjusted odds ratio AOR 0.10 (95% CI 0.03-0.5, 0.11 (0.05-0.23 and 0.08 (0.02-0.33 respectively. CONCLUSION: Our study revealed a reassuring pattern of a strong rebound from depression, anxiety and stress in women with hyperemesis gravidarum such that by the third pregnancy trimester the level of psychological distress was even lower than in controls. This observation imply that much of the psychological distress in acute hyperemesis gravidarum is self-limiting and probably in the causal pathway of hyperemesis gravidarum. Care in women with

  16. Emergency surgical management of traumatic superior sagittal sinus injury: An unusual case

    Directory of Open Access Journals (Sweden)

    Sudhansu Sekhar Mishra

    2012-01-01

    Full Text Available Head injuries following fall of heavy objects are not very uncommon in developing countries. However, compound depressed skull fracture with superior sagittal sinus (SSS laceration caused by a flying asbestos fragment in a stormy afternoon is an unusual mode of head injury. We report such an unusual case of compound depressed skull fracture by an asbestos fragment injuring the middle third of SSS and its successful surgical management in a 14-year-old child. The role of computed tomography (CT scan of head with 3D reconstruction is highlighted. Early steps taken in this case to check the profuse bleeding, which helped save the life of this boy is interesting to note.

  17. Development of practice principles for the management of ongoing suicidal ideation in young people diagnosed with major depressive disorder

    OpenAIRE

    Rice, Simon M.; Simmons, Magenta B; Alan P. Bailey; Alexandra G Parker; Hetrick, Sarah E; Davey, Christopher G; Mark Phelan; Simon Blaikie; Jane Edwards

    2014-01-01

    Objectives: There is a lack of clear guidance regarding the management of ongoing suicidality in young people experiencing major depressive disorder. This study utilised an expert consensus approach in identifying practice principles to complement relevant clinical guidelines for the treatment of major depressive disorder in young people. The study also sought to outline a broad treatment framework for clinical intervention with young people experiencing ongoing suicidal ideation. Methods: In...

  18. Treating postnatal depressive symptoms in primary care: a randomised controlled trial of GP management, with and without adjunctive counselling

    Directory of Open Access Journals (Sweden)

    Leigh Bronwyn

    2011-05-01

    Full Text Available Abstract Background Postnatal depression (PND is under-diagnosed and most women do not access effective help. We aimed to evaluate comparative management of (PND following screening with the Edinburgh Postnatal Depression Scale, using three best-practice care pathways by comparing management by general practitioners (GPs alone compared to adjunctive counselling, based on cognitive behavioural therapy (CBT, delivered by postnatal nurses or psychologists. Methods This was a parallel, three-group randomised controlled trial conducted in a primary care setting (general practices and maternal & child health centres and a psychology clinic. A total of 3,531 postnatal women were screened for symptoms of depression; 333 scored above cut-off on the screening tool and 169 were referred to the study. Sixty-eight of these women were randomised between the three treatment groups. Results Mean scores on the Beck Depression Inventory (BDI-II at entry were in the moderate-to-severe range. There was significant variation in the post-study frequency of scores exceeding the threshold indicative of mild-to-severe depressive symptoms, such that more women receiving only GP management remained above the cut-off score after treatment (p = .028. However, all three treatment conditions were accompanied by significant reductions in depressive symptoms and mean post-study BDI-II scores were similar between groups. Compliance was high in all three groups. Women rated the treatments as highly effective. Rates of both referral to the study (51%, and subsequent treatment uptake (40% were low. Conclusions Data from this small study suggest that GP management of PND when augmented by a CBT-counselling package may be successful in reducing depressive symptoms in more patients compared to GP management alone. The relatively low rates of referral and treatment uptake, suggest that help-seeking remains an issue for many women with PND, consistent with previous research. Trial

  19. Graves′ orbitopathy: Management of difficult cases

    Directory of Open Access Journals (Sweden)

    Wilmar M Wiersinga

    2012-01-01

    Full Text Available Management of Graves′ ophthalmopathy (GO is based on three pillars: to stop smoking, to restore and maintain euthyroidism, and to treat the eye changes according to severity and activity of GO. Difficulties are frequently encountered in each of these three management issues. The advice to discontinue smoking is straightforward, but just a small minority of smokers is able to quit smoking. Detailed information on how smoking adversely affects the outcome of Graves′ disease may convince patients they have to stop smoking right away. Controversy exists on the most appropriate treatment of Graves′ hyperthyroidism in the presence of GO. 131I therapy is associated with a risk of about 15% for worsening of GO; a preventive course of steroids is indicated in the presence of risk factors (smoking, biochemically severe hyperthyroidism, high level of TSH receptor antibodies, active GO. Alternatives are thyroidectomy or long-term treatment with antithyroid drugs, which apparently are rather neutral with respect to the course of GO. Mild GO is not always perceived as being mild by the patients themselves. Selenium improves mild GO. Moderate-to-severe GO is preferably treated with intravenous methylprednisolone pulses, but serious side effects and relapsing GO do occur. After steroid failure combination therapy with low-dose oral prednisone with either cyclosporine or retrobulbar irradiation can be effective. Dysthyroid optic neuropathy is best treated with IV pulses, followed by orbital decompression if visual functions do not improve. In resistant cases, rituximab might be considered, although failures of this drug are also described.

  20. 75 FR 23582 - Annular Casing Pressure Management for Offshore Wells

    Science.gov (United States)

    2010-05-04

    ... casing pressure. This rule will promote human safety and environmental protection, and require Outer... Minerals Management Service 30 CFR Part 250 RIN 1010-AD47 Annular Casing Pressure Management for Offshore... will establish regulations to address sustained casing pressure in oil and gas wells completed in the...

  1. The Woodworker's Website: A Project Management Case Study

    Science.gov (United States)

    Jance, Marsha

    2014-01-01

    A case study that focuses on building a website for a woodworking business is discussed. Project management and linear programming techniques can be used to determine the time required to complete the website project discussed in the case. This case can be assigned to students in an undergraduate or graduate decision modeling or management science…

  2. A Multiple Case Series Analysis of Six Variants of Attentional Bias Modification for Depression

    Science.gov (United States)

    Putman, Peter; Van der Does, Willem

    2013-01-01

    Background. Attention bias modification (ABM) is a new treatment for affective disorders. A meta-analysis of ABM for anxiety disorders showed that the effect size may be large but the number of studies is low. The working mechanism is still unclear, and little is known about the optimal treatment parameters. ABM for depression is much less studied. A few studies claimed positive effects but the sample sizes are low. Furthermore, the treatment parameters varied widely and differed from the anxiety literature. Aim. To select the most promising version of ABM for depression for further evaluation in clinical trials. Methods. Multiple case series design. We tested six versions of ABM that varied on stimulus duration and training direction. Thirty students with mild to moderate symptoms of depression underwent four sessions of ABM. Change of attentional bias was measured during each session. Generalization of treatment effects and the role of awareness of receiving training were also investigated. Results. None of the investigated versions of ABM had a consistent effect on attentional bias. Changes of attentional bias in individual participants the effects did not generalize to untrained stimuli. Conclusion. It is unlikely that any of these ABM versions will have a specific effect on symptoms in controlled studies. PMID:23738217

  3. 'It was all intertwined': Illness representations and self-management in patients with cancer and anxiety/depression.

    Science.gov (United States)

    Richardson, Emma M; Scott, Jennifer L; Schüz, Natalie; Sanderson, Kristy; Schüz, Benjamin

    2017-09-01

    Cancer and anxiety/depression frequently co-occur, leading to poorer outcomes for these illnesses. However, the majority of existing research investigates how participants view single illnesses alone. This study aimed to explore the content of individuals' multimorbid representations and how these relate to their coping behaviours and self-management strategies for cancer and anxiety/depression. A semi-structured qualitative research design with theoretical thematic analysis. Multimorbid illness representations, coping behaviours, and self-management strategies. In interviews with 21 participants multimorbid representations varied, three participants viewed cancer and anxiety/depression as unrelated, five participants were uncertain about the relationship between cancer and anxiety/depression, and the majority of participants perceived cancer and anxiety/depression as related. This third group of participants often described relationships as causal, with representations having both positive and negative influences on coping behaviours and self-management strategies. Representations were shown to change over the course of the cancer experience, with fear of cancer recurrence and the influence of participants' most challenging illness also discussed. People hold multimorbid illness representations that can influence self-management. An awareness of these representations by researchers, health professionals, and patients is important for the creation of future interventions that aim to improve and maintain patient wellbeing.

  4. A case study of a mother's intertwining experiences with incest and postpartum depression.

    Science.gov (United States)

    Røseth, Idun; Bongaardt, Rob; Binder, Per-Einar

    2011-01-01

    The association between childhood sexual abuse (CSA) and major depression disorder (MDD) gives reason to suspect that many mothers with postpartum depression (PPD) have a history of CSA. However, few studies have investigated how CSA and PPD are related. In this case study we explore how the experience of incest intertwines with the experience of postpartum depression. We focus on participant subject "Nina," who has experienced both. We interviewed her three times and we analysed the interviews with Giorgi's phenomenological descriptive method to arrive at a contextualised meaning structure. Nina's intruding fantasies of men who abuse her children merge with her recollections of her own incest experiences. She may succeed in forcing these fantasies out of her consciousness, but they still alter her perceptions, thoughts, and emotions. She feels overwhelmed and succumbs to sadness, while she also is drawn towards information about CSA, which in turn feeds her fantasies. The psychodynamic concepts of repetition compulsion, transference, and projection may provide some explanation of Nina's actions, thoughts, and emotions through her past experiences. With our phenomenological stance, we aim to acknowledge Nina's descriptions of her everyday life here and now. With reference to Husserl, Heidegger, Merleau-Ponty, and Minkowski, we show that Nina's past is not a dated memory; rather it determines the structure of her consciousness that constitutes her past as her true present and future. Incest dominates Nina's world, and her possibilities for action are restricted by this perceived world. Any suspension of action implies anguish, and she resolves this by incest-structured action that in turn feeds and colours her expectations. Thus anxiety and depression are intertwined in the structure of this experience.

  5. A case study of a mother's intertwining experiences with incest and postpartum depression

    Directory of Open Access Journals (Sweden)

    Idun Røseth

    2011-07-01

    Full Text Available The association between childhood sexual abuse (CSA and major depression disorder (MDD gives reason to suspect that many mothers with postpartum depression (PPD have a history of CSA. However, few studies have investigated how CSA and PPD are related. In this case study we explore how the experience of incest intertwines with the experience of postpartum depression. We focus on participant subject “Nina,” who has experienced both. We interviewed her three times and we analysed the interviews with Giorgi's phenomenological descriptive method to arrive at a contextualised meaning structure. Nina's intruding fantasies of men who abuse her children merge with her recollections of her own incest experiences. She may succeed in forcing these fantasies out of her consciousness, but they still alter her perceptions, thoughts, and emotions. She feels overwhelmed and succumbs to sadness, while she also is drawn towards information about CSA, which in turn feeds her fantasies. The psychodynamic concepts of repetition compulsion, transference, and projection may provide some explanation of Nina's actions, thoughts, and emotions through her past experiences. With our phenomenological stance, we aim to acknowledge Nina's descriptions of her everyday life here and now. With reference to Husserl, Heidegger, Merleau-Ponty, and Minkowski, we show that Nina's past is not a dated memory; rather it determines the structure of her consciousness that constitutes her past as her true present and future. Incest dominates Nina's world, and her possibilities for action are restricted by this perceived world. Any suspension of action implies anguish, and she resolves this by incest-structured action that in turn feeds and colours her expectations. Thus anxiety and depression are intertwined in the structure of this experience.

  6. Management of Bilateral Femoral Fractures in Pregnancy: A Case ...

    African Journals Online (AJOL)

    Management of Bilateral Femoral Fractures in Pregnancy: A Case Report. ... There was no history of loss of consciousness, abdominal pains or vaginal bleeding. ... and manage the pregnancy to the point where the baby is safe for delivery.

  7. Examining End-of-Life Case Management: Systematic Review

    Directory of Open Access Journals (Sweden)

    Roger E. Thomas

    2014-01-01

    Full Text Available Case management was initiated in the 1970s to reduce care discontinuity. A literature review focused on end-of-life (EOL case management identified 17 research articles, with content analysis revealing two themes: (a seeking to determine or establish the value of EOL case management and (b identifying ways to improve EOL case management. The evidence, although limited, suggests that EOL case management is helpful to dying individuals and their families. Research is needed to more clearly illustrate its usefulness or outcomes and the extent of need for it and actual availability. Among other benefits, EOL case management may help reduce hospital utilization, a major concern with the high cost of hospital-based care and the increased desire for home-based EOL care.

  8. [Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive Disorder: Part II: General Aspects of Treatment, Management of the Acute Phase, Continuation and Maintenance of Patients with a Depression Diagnosis].

    Science.gov (United States)

    Peñaranda, Adriana Patricia Bohórquez; Valencia, Jenny García; Guarín, Maritza Rodríguez; Borrero, Álvaro Enrique Arenas; Díaz, Sergio Mario Castro; de la Hoz Bradford, Ana María; Riveros, Patricia Maldonado; Jaramillo, Luis Eduardo; Brito, Enrique; Acosta, Carlos Alberto Palacio; Pedraza, Ricardo Sánchez; González-Pacheco, Juan; Gómez-Restrepo, Carlos

    2012-12-01

    This article presents recommendations based on evidence gathered to answer a series of clinical questions concerning the depressive episode and the recurrent depressive disorder, with emphasis on general treatment aspects, treatment in the acute phase and management of the continuation/maintenance, all intended to grant health care parameters based on the best and more updated available evidence for achieving minimum quality standards with adult patients thus diagnosed. A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from NICE90 and CANMAT guides were adopted and updated so as to answer the questions posed while de novo questions were developed. Recommendations 5-22 corresponding to management of depression are presented. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  9. Huntington's disease: review and anesthetic case management.

    OpenAIRE

    Cangemi, C. F.; Miller, R. J.

    1998-01-01

    Huntington's disease is a dominantly inherited progressive autosomal disease that affects the basal ganglia. Symptoms appear later in life and manifest as progressive mental deterioration and involuntary choreiform movements. Patients with Huntington's disease develop a progressive but variable dementia. Dysphagia, the most significant related motor symptom, hinders nutrition intake and places the patient at risk for aspiration. The combination of involuntary choreoathetoid movements, depress...

  10. Case management for the baby boom generation: a strengths perspective.

    Science.gov (United States)

    Tice, C; Perkins, K

    1998-01-01

    To understand the challenges and opportunities for case management as the turn of the century approaches, we must consider the 76 million individuals born between 1946 and 1964, commonly referred to as the baby boom generation. This article examines the baby boom generation in the context of planning effective case management services. The generation's strengths are highlighted to suggest how case management systems can meet the anticipated service needs of baby boomers as they age.

  11. Improving treatment of depression in primary health care: a case study of obstacles to perform a clinical trial designed to implement practice guidelines.

    Science.gov (United States)

    Richter-Sundberg, Linda; Nyström, Monica Elisabeth; Krakau, Ingvar; Sandahl, Christer

    2015-04-01

    The aim of this study is to investigate factors contributing to the failure of a randomized clinical trial designed to implement and test clinical practice guidelines for the treatment of depression in primary health care (PHC). Although the occurrence of depression is increasing globally, many patients with depression do not receive optimal treatment. Clinical practice guidelines for the treatment of depression, which aim to establish evidence-based clinical practice in health care, are often underused and in need of operationalization in and adaptation to clinical praxis. This study explores a failed clinical trial designed to implement and test treatment of depression in PHC in Sweden. Qualitative case study methodology was used. Semi-structured interviews were conducted with eight participants from the clinical trial researcher group and 11 health care professionals at five PHC units. Additionally, archival data (ie, documents, email correspondence, reports on the clinical trial) from the years 2007-2010 were analysed. The study identified barriers to the implementation of the clinical trial in the project characteristics, the medical professionals, the patients, and the social network, as well as in the organizational, economic and political context. The project increased staff workload and created tension as the PHC culture and the research activities clashed (eg, because of the systematic use of questionnaires and changes in scheduling and planning of patient visits). Furthermore, there was a perception that the PHC units' management did not sufficiently support the project and that the project lacked basic incentives for reaching a sustainable resolution. Despite efforts by the project managers to enhance and support implementation of the innovation, they were unable to overcome these barriers. The study illustrates the complexity and barriers of performing clinical trials in the PHC.

  12. Knowledge Management Analysis: A Case Study

    Science.gov (United States)

    Mecha, Ezi I.; Desai, Mayur S.; Richards, Thomas C.

    2009-01-01

    It is imperative for businesses to manage knowledge and stay competitive in the marketplace. Knowledge management is critical and is a key to prevent organizations from duplicating their efforts with a subsequent improvement in their efficiency. This study focuses on overview of knowledge management, analyzes the current knowledge management in…

  13. Knowledge Management Analysis: A Case Study

    Science.gov (United States)

    Mecha, Ezi I.; Desai, Mayur S.; Richards, Thomas C.

    2009-01-01

    It is imperative for businesses to manage knowledge and stay competitive in the marketplace. Knowledge management is critical and is a key to prevent organizations from duplicating their efforts with a subsequent improvement in their efficiency. This study focuses on overview of knowledge management, analyzes the current knowledge management in…

  14. Tratamento homeopático da depressão: relato de série de casos Homeopathic treatment of depression: series of case report

    Directory of Open Access Journals (Sweden)

    Ubiratan Cardinalli Adler

    2008-01-01

    Full Text Available CONTEXTO: Não há estudos metodologicamente adequados sobre a eficácia da homeopatia na depressão. Relatos de casos clínicos são os primeiros degraus da evidência clínica, a caminho de estudos controlados. OBJETIOS: Relatar resultados preliminares do tratamento homeopático de pacientes com depressão no SUS de Jundiaí. MÉTODOS: Revisão dos prontuários dos casos novos, atendidos entre março e dezembro de 2006. O diagnóstico foi confirmado por entrevista estruturada. Os pacientes receberam homeopatia individualizada e a evolução foi avaliada pela escala de Montgomery & Åsberg (MADRS. RESULTADOS: Foram tratados 15 casos e observou-se resposta terapêutica (redução maior que 50% dos escores de depressão em 14 pacientes (93%, após uma média de sete semanas de tratamento; um paciente apresentou piora clínica e foi encaminhado ao tratamento convencional. O escore média (± dp na Escala de Avaliação de Depressão de Montgomery-Åsberg diminuiu de 24,9 (± 5,8 a 9,7 (± 8,2, p BACKGROUND: Evidence for the efficacy of homeopathy for depression is limited due to lack of clinical trials of high quality. Case reports are the first steps of clinical evidence, towards controlled trials. OBJECTIVES: To report preliminary results of homeopathic treatment of depression in Jundiai's public health system, Sao Paulo. METHODS: Review of the medical records of new patients, treated between March and December 2006. Their diagnosis was confirmed by a semi-structured interview. Patients received individualized homeopathy and their response was measured by the Montgomery & Åsberg depression scale (MADRS. RESULTS: Fifteen patients were treated and response (more than 50% decrease of MADRS scores was observed in 14 patients (93%, after an average of seven weeks of treatment; one patient had clinical worsening and was refered to conventional antidepressant therapy. The MADRS mean scores (± dp decreased from 24.9 (± 5.8 to 9.7 (± 8.2, p < .0001

  15. Perinatal Depression Algorithm: A Home Visitor Step-by-Step Guide for Advanced Management of Perinatal Depressive Symptoms

    Science.gov (United States)

    Laszewski, Audrey; Wichman, Christina L.; Doering, Jennifer J.; Maletta, Kristyn; Hammel, Jennifer

    2016-01-01

    Early childhood professionals do many things to support young families. This is true now more than ever, as researchers continue to discover the long-term benefits of early, healthy, nurturing relationships. This article provides an overview of the development of an advanced practice perinatal depression algorithm created as a step-by-step guide…

  16. Intensive case management for severe mental illness

    Science.gov (United States)

    Dieterich, Marina; Irving, Claire B; Park, Bert; Marshall, Max

    2014-01-01

    Background Intensive Case Management (ICM) is a community based package of care, aiming to provide long term care for severely mentally ill people who do not require immediate admission. ICM evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (less than 20) and high intensity input. Objectives To assess the effects of Intensive Case Management (caseload 20) and with standard community care in people with severe mental illness. To evaluate whether the effect of ICM on hospitalisation depends on its fidelity to the ACT model and on the setting. Search methods For the current update of this review we searched the Cochrane Schizophrenia Group Trials Register (February 2009), which is compiled by systematic searches of major databases, hand searches and conference proceedings. Selection criteria All relevant randomised clinical trials focusing on people with severe mental illness, aged 18 to 65 years and treated in the community-care setting, where Intensive Case Management, non-Intensive Case Management or standard care were compared. Outcomes such as service use, adverse effects, global state, social functioning, mental state, behaviour, quality of life, satisfaction and costs were sought. Data collection and analysis We extracted data independently. For binary outcomes we calculated relative risk (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data we estimated mean difference (MD) between groups and its 95% confidence interval (CI). We employed a random-effects model for analyses. We performed a random-effects meta-regression analysis to examine the association of the intervention’s fidelity to the ACT model and the rate of hospital use in the setting where the trial was conducted with the treatment effect. Main results We included 38 trials (7328 participants) in this review. The trials provided data for two

  17. Management of recalcitrant Trichomonas vaginalis in pregnancy: a case report.

    Science.gov (United States)

    Tayal, Sarup

    2016-02-01

    A case report of a pregnant woman with recalcitrant Trichomonas vaginalis is described. This case was managed with suppressive treatment with metronidazole during pregnancy and cleared with paromomycin vaginal treatment after delivery.

  18. Cognitive-Behavioral Therapy for Depression in an Older Gay Man: A Clinical Case Study

    Science.gov (United States)

    Satterfield, Jason M.; Crabb, Rebecca

    2010-01-01

    Although strong evidence supports cognitive-behavioral therapy for late-life depression and depression in racial and ethnic minorities, there are no empirical studies on the treatment of depression in older sexual minorities. Three distinct literatures were tapped to create a depression treatment protocol for an older gay male. Interventions were…

  19. Cognitive-Behavioral Therapy for Depression in an Older Gay Man: A Clinical Case Study

    Science.gov (United States)

    Satterfield, Jason M.; Crabb, Rebecca

    2010-01-01

    Although strong evidence supports cognitive-behavioral therapy for late-life depression and depression in racial and ethnic minorities, there are no empirical studies on the treatment of depression in older sexual minorities. Three distinct literatures were tapped to create a depression treatment protocol for an older gay male. Interventions were…

  20. Pharmacological approaches to manage persistent symptoms of major depressive disorder: rationale and therapeutic strategies.

    Science.gov (United States)

    Epstein, Irvin; Szpindel, Isaac; Katzman, Martin A

    2014-12-01

    Major depressive disorder (MDD) is a highly prevalent chronic psychiatric illness associated with significant morbidity, mortality, loss of productivity, and diminished quality of life. Typically, only a minority of patients responds to treatment and meet criteria for remission as residual symptoms may persist, the result of an inadequate course of treatment and/or the presence of persistent side effects. The foremost goal of treatment should be to restore patients to full functioning and eliminate or relieve all MDD symptoms, while being virtually free of troublesome side effects. The current available pharmacological options to manage persistent depressive symptoms include augmentation or adjunctive combination strategies, both of which target selected psychobiological systems and specific mood and somatic symptoms experienced by the patient. As well, non-pharmacological interventions including psychotherapies may be used in either first-line or adjunctive approaches. However, the evidence to date with respect to available adjunct therapies is limited by few studies and those published have utilized only a small number of subjects and lack enough data to allow for a consensus of expert opinion. This underlines the need for further longer term, large population-based studies and those that include comorbid populations, all of which are seen in real world community psychiatry.

  1. A case study evaluating the use of clozapine in depression with psychotic features

    Directory of Open Access Journals (Sweden)

    Vieweg Ray

    2006-11-01

    Full Text Available Abstract The purpose of this case study was to use an evidence based medicine approach to work through an unusual way of treating a common problem. We looked at an example of an in-patient with severe refractory psychotic depression who had been resistant to treatment with a combination of antidepressant, antipsychotics, mood stabiliser, and concomitant ECT therapy. We then undertook a literature search for the use of clozapine in a patient with severe refractory depression. Although the resulting evidence was low level and thin, we felt on balance that a trial of clozapine was justified. We used a BPRS inventory to monitor her mood prior to commencing clozapine. Her mood and functional abilities were monitored as her clozapine was titrated upwards. Our patient showed a significant improvement in mood and functional abilities and a reduction in her BPRS score during this period. Her symptoms improved to the point where she was successfully discharged home on a combination of clozapine and an antidepressant. The improvement was sustained for a further two years. We thought this was an important case to highlight the limited evidence in using this successful form of treatment for a common clinical problem and that further research in this area was needed.

  2. Adding metoclopramide to paroxetine induced extrapyramidal symptoms and hyperprolactinemia in a depressed woman: a case report

    Directory of Open Access Journals (Sweden)

    Igata R

    2016-09-01

    Full Text Available Ryohei Igata, Hikaru Hori, Kiyokazu Atake, Asuka Katsuki, Jun Nakamura Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan Abstract: A 54-year-old Japanese woman was diagnosed with major depressive disorder and prescribed paroxetine 20 mg/day. In around May 2013, the patient experienced gastric discomfort, so metoclopramide was prescribed. Beginning on June 4, 2013, the patient was given metoclopramide, 10 mg intravenously, twice per week. On the seventh day after beginning metoclopramide, facial hot flushes, increased sweating, muscle rigidity, and galactorrhea were noted. Extrapyramidal symptoms (EPS rapidly subsided in response to an intramuscular injection of biperiden. Blood biochemical tests revealed an elevated serum prolactin level of 44 ng/mL. After stopping metoclopramide, EPS disappeared. Serum prolactin level decreased to 15 ng/mL after 4 weeks. In our case, although no adverse reactions had previously occurred following the administration of metoclopramide, the patient developed EPS and hyperprolactinemia following the administration of this antiemetic in combination with paroxetine. Paroxetine and metoclopramide are mainly metabolized by CYP2D6, and they are inhibitors for CYP2D6. We report a case with EPS and hyperprolactinemia whose plasma paroxetine and metoclopramide level rapidly increased after the addition of metoclopramide. Our experience warrants the issuing of a precaution that adverse reactions may arise following the coadministration of metoclopramide and paroxetine even at their respective standard dose levels. Keywords: metoclopramide, paroxetine, extrapyramidal symptoms, SSRI, hyperprolactinemia, depression

  3. Comprehensive nursing case management. An advanced practice model.

    Science.gov (United States)

    Taylor, P

    1999-01-01

    Under managed care and capitated reimbursement systems, case management is a core strategy for providing high-quality, cost-effective care by decreasing fragmentation, enhancing quality, ensuring efficient use of resources, and containing costs. Although case management is used in various areas of the healthcare arena, it suffers from a lack of consensus regarding its definition, essential components, and appropriate application. The purpose of this paper is to examine the components and limitations of existing case management models, outline the competencies of an effective case manager, and present a model of advanced practice nursing case management that focuses on a continuum of care that integrates medical and psychosocial resources to promote optimal clinical fiscal outcomes and enables patients to work as partners with the healthcare team in facilitating and maintaining their physical and emotional well-being.

  4. The Sustainable Tourism Management of Cultural Heritage: the Case of the Rosas Mine in Sardinia

    Directory of Open Access Journals (Sweden)

    Rita Cannas

    2016-12-01

    Full Text Available The paper focuses on the management of an ex mine complex listed as a UNESCO geopark, located in Sardinia (Italy, in which cultural and hospitality services are provided for visitors. First, it aims to explore a local community’s attempt to re-appropriate its former mining territory and seek a tailor-made sustainable development approach to manage its cultural and industrial heritage. Then, it analyses the organisational framework and sustainable management model of the Rosas mine village aimed at generating value both for local people and tourists, within a broader conceptual framework in which the tangible and intangible resources that comprise a milieu are crucial for implementing sustainable tourism development policies. The study was carried out using a qualitative approach, and methods adopted included case-study research and interviews with stakeholders. The main result reveals the performance of a challenging business model, based on a novel approach to the management of public-private heritage in a depressed area, inspired by the sustainable reinvention of its local heritage. The purpose of the study was to investigate a case of sustainable management heritage that might be applied in similar contexts. It may hopefully be the basis for future investigation as a case in itself, and for comparative research particularly in sustainable business models for heritage management.

  5. Anxiety and depression in patients with endometriosis: impact and management challenges

    Directory of Open Access Journals (Sweden)

    Laganà AS

    2017-05-01

    Full Text Available Antonio Simone Laganà,1 Valentina Lucia La Rosa,2 Agnese Maria Chiara Rapisarda,3 Gaetano Valenti,3 Fabrizio Sapia,3 Benito Chiofalo,1 Diego Rossetti,4 Helena Ban Frangež,5 Eda Vrtačnik Bokal,5 Salvatore Giovanni Vitale1 1Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G Barresi”, University of Messina, Messina, 2Unit of Psychodiagnostics and Clinical Psychology, 3Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, 4Department of Maternal and Child Health, Gavardo Hospital, Brescia, Italy; 5Department of Reproduction, University Medical Center Ljubljana, Ljubljana, Slovenia Abstract: Endometriosis is one of the most common gynecological diseases and affects ~10% of women in reproductive age. The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain (CPP, dysmenorrhea, dyspareunia and infertility. Symptoms of endometriosis often affect psychological and social functioning of patients. For this reason, endometriosis is considered as a disabling condition that may significantly compromise social relationships, sexuality and mental health. Considering this point, the aim of this narrative review is to elucidate the impact of anxiety and depression in the management of women with endometriosis. Psychological factors have an important role in determining the severity of symptoms, and women who suffer from endometriosis report high levels of anxiety, depression and other psychiatric disorders. In addition, endometriosis is one of the most important causes of CPP; women with endometriosis suffer from a wide range of pelvic pain such as dysmenorrhea, dyspareunia, nonmenstrual (chronic pelvic pain, pain at ovulation, dyschezia and dysuria. Several studies have underlined the influence of CPP on quality of life and psychological well-being of women with endometriosis. Data suggest that the experience of pelvic pain is an

  6. Intensive case management for severe mental illness.

    Science.gov (United States)

    Dieterich, Marina; Irving, Claire B; Bergman, Hanna; Khokhar, Mariam A; Park, Bert; Marshall, Max

    2017-01-06

    Intensive Case Management (ICM) is a community-based package of care aiming to provide long-term care for severely mentally ill people who do not require immediate admission. Intensive Case Management evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (fewer than 20) and high-intensity input. To assess the effects of ICM as a means of caring for severely mentally ill people in the community in comparison with non-ICM (caseload greater than 20) and with standard community care. We did not distinguish between models of ICM. In addition, to assess whether the effect of ICM on hospitalisation (mean number of days per month in hospital) is influenced by the intervention's fidelity to the ACT model and by the rate of hospital use in the setting where the trial was conducted (baseline level of hospital use). We searched the Cochrane Schizophrenia Group's Trials Register (last update search 10 April 2015). All relevant randomised clinical trials focusing on people with severe mental illness, aged 18 to 65 years and treated in the community care setting, where ICM is compared to non-ICM or standard care. At least two review authors independently selected trials, assessed quality, and extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses.We performed a random-effects meta-regression analysis to examine the association of the intervention's fidelity to the ACT model and the rate of hospital use in the setting where the trial was conducted with the treatment effect. We assessed overall quality for clinically important outcomes using the GRADE approach and investigated possible risk of bias within included trials. The 2016 update included two more

  7. PCA-induced respiratory depression simulating stroke following endoluminal repair of abdominal aortic aneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Ahmad Javed

    2007-07-01

    Full Text Available Abstract Aim To report a case of severe respiratory depression with PCA fentanyl use simulating stroke in a patient who underwent routine elective endoluminal graft repair for abdominal aortic aneurysm (AAA Case presentation A 78-year-old obese lady underwent routine endoluminal graft repair for AAA that was progressively increasing in size. Following an uneventful operation postoperative analgesia was managed with a patient-controlled analgesia (PCA device with fentanyl. On the morning following operation the patient was found to be unusually drowsy and unresponsive to stimuli. Her GCS level was 11 with plantars upgoing bilaterally. A provisional diagnosis of stroke was made. Urgent transfer to a high-dependency unit (HDU was arranged and she was given ventilatory support with a BiPap device. CT was performed and found to be normal. Arterial blood gas (ABG analysis showed respiratory acidosis with PaCO2 81 mmHg, PaO2 140 mmHg, pH 7.17 and base excess -2 mmol/l. A total dose of 600 mcg of fentanyl was self-administered in the 16 hours following emergence from general anaesthesia. Naloxone was given with good effect. There was an increase in the creatinine level from 90 μmol/L preoperatively to 167 μmol/L on the first postoperative day. The patient remained on BiPap for two days that resulted in marked improvement in gas exchange. Recovery was complete.

  8. Renal provider perceptions and practice patterns regarding the management of pain, sexual dysfunction, and depression in hemodialysis patients.

    Science.gov (United States)

    Green, Jamie A; Mor, Maria K; Shields, Anne Marie; Sevik, Mary Ann; Palevsky, Paul M; Fine, Michael J; Arnold, Robert M; Weisbord, Steven D

    2012-02-01

    Although pain, sexual dysfunction, and depression are common in patients receiving chronic hemodialysis, these symptoms frequently remain untreated. We sought to characterize renal provider perceptions and practice patterns regarding the treatment of these symptoms. We surveyed renal providers whose patients were participating in a clinical trial of symptom management at nine hemodialysis units in southwestern Pennsylvania. We used Spearman's correlation to assess the association of provider characteristics with the reported frequency of providing treatment. Overall, 27 of 35 (77%) providers completed the survey. While 21 (78%) believed symptom management to be "very" important and 23 (85%) reported spending a "moderate" to "a lot" of time managing symptoms, <50% reported treating pain and <20% reported treating sexual dysfunction or depression "most" or "all" of the time. Most providers believed it was nonrenal providers' responsibility to treat these symptoms. A greater reported comfort level managing symptoms was associated with a higher reported frequency of treating pain (r=0.6; p<0.01), sexual dysfunction (r=0.67; p<0.01), and depression (r=0.43; p<0.03). Providers who believed it was nonrenal providers' responsibility to treat these symptoms reported treating pain (r=-0.62; p<0.01) and depression (r=-0.48; p=0.02) less frequently. Despite reporting considerable importance and substantial time managing symptoms in general, renal providers commonly describe not treating pain, sexual dysfunction, and depression in hemodialysis patients. Given renal providers' beliefs that nonrenal clinicians are primarily responsible for treating these symptoms, multidisciplinary approaches to symptom management in these patients are needed.

  9. Facilities Management and Value Adding - The LEGO case

    DEFF Research Database (Denmark)

    Jensen, Per Anker; Katchamart, Akarapong

    on the management model for FM included in the European FM standards, recent theories on added value of FM and real estate and the related concept of Value Management from building projects. The paper outlines a preliminary theoretical based management concept, which is investigated, tested and discussed based...... on a case study of LEGO. Results: The study shows that the management model for FM creates a relevant starting point but also that stakeholder and relationship management is an essential aspect of Value Adding Management. The case study confirms the relevance of the basic concept and provides an important...... example of how Value Adding Management can be implemented and added value measured. Practical Implications: The concept of Value Adding Management is expected to increase the awareness of the impacts and strategic importance of FM for organisations and can be a practical tool for facilities managers...

  10. Effectiveness of cognitive behavioral stress management on depression and anxiety symptoms of patients with epilepsy and migraine

    Directory of Open Access Journals (Sweden)

    Mohammad Dehghanifiroozabadi

    2015-01-01

    Conclusion: According to the results of this study, cognitive behavioral stress management was effective on the depression and anxiety of epileptic and migraine patients, and chronic disease has no effect on this effectiveness. This method can be used in combination with drug therapy.

  11. 42 CFR 441.18 - Case management services.

    Science.gov (United States)

    2010-10-01

    ... case management providers; or (iii) The methodology under which case management providers will be paid..., including for foster care programs, services such as, but not limited to, the following: (1) Research... placements. (3) Recruiting or interviewing potential foster care parents. (4) Serving legal papers. (5)...

  12. Case Management Promotion of Social Media for the Elderly Who Live Alone.

    Science.gov (United States)

    Hashi, Ilham

    2016-01-01

    Professional case managers advocate patient access to necessary and appropriate services, while educating the patient and family and/or caregiver about resource availability within practice settings. The purpose of this article is to explain the role case managers can have to promote the use of social media by the elderly, as a means to decrease their loneliness and isolation. The promotion of the use of social media will take place in the community setting, involving willing and competent elderly patients who live alone. It is framed as one strategy to help combat loneliness. The primary target audiences for this initiative are case managers who work in the community, as they are the ones who have contact with this population. However, hospital case managers could also benefit, as they need to be aware of ways to help discharged elderly patients feel more connected to their community; the use of social media is one way to achieve this outcome. The elderly population experience changes brought on by their longer life. One of those changes or undesirable effects is an increase in social isolation and experiencing loneliness. There are many factors that contribute to loneliness and social isolation in the elderly such as a change in financial situations, death, divorce, or migration. Utilizing the capabilities of the internet, coupled with the use of social media (e.g., Facebook), can facilitate opening up a virtual world where the elderly can communicate with family and friends, make new friends, or occupy their time with the many interactive games that are available online. Case managers should increase their awareness to identify patients who are socially isolated; the outcome is to decrease the risk of developing a major depressive disorder. Community case managers might at times be the only professional health care givers who are visiting patients in their home; therefore, they should also be aware of the signs and symptoms of depression so they can encourage

  13. Validity of the diagnosis of a single depressive episode in a case register

    Directory of Open Access Journals (Sweden)

    Gether Ulrik

    2009-02-01

    Full Text Available Abstract Objective To validate the ICD-10 diagnosis of a single depressive episode as used in daily clinical psychiatric practice and as recorded in the Danish Psychiatric Central Research Register. Methods Patients discharged with a diagnosis of a single depressive episode were consecutively sampled from the register and diagnosed according to an interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN. Results A total of 75.4% of 399 patients with a register diagnosis of a single depressive episode also got this diagnosis according to the SCAN interview (82.8% for severe type of a single depression, 76.0% for moderate type of a single depression and 65.2% for mild type of a single depression. Conclusion The ICD-10 diagnosis of a single depressive episode can be used in daily clinical practice with sufficient precision. The validity of the diagnosis is highest for severe and moderate type of depression and decreases for mild depression.

  14. Using teaching case studies for management research

    OpenAIRE

    Ambrosini, Veronique; Bowman, Cliff; Collier, Nardine

    2010-01-01

    Teaching case studies are widely deployed in business schools. They are contextually rich in detail, and students learn by applying and adapting theoretical concepts to specific business situations described in the case. This article proposes a new way to use teaching case studies, as research materials for academics. The article addresses three questions: (1) Can teaching cases be used as an alternative to field research? (2) When can teaching case studies be used as second...

  15. Detection, Management Approach of Depression and Antidepressant Utilization in Adult Patients: Results of a Cross-Sectional Survey.

    Science.gov (United States)

    Newale, Sanket; Bachani, Deepak S

    2016-10-01

    The study was conducted to understand the demographics, prevalence of co-morbid conditions and treatment modalities of depression. A cross-sectional, nationwide observational study was conducted to understand the management pattern of depression in India. Depression was majorly diagnosed with DSM-IV TR criteria. The data of 2276 Indian patients across 18 states were collected through 135 mental health professionals. The study population was predominantly from urban (81.2%) area. The prevalence of uneducated and employed patients in the study was 7.2% and 54.6% respectively. The main co-morbidities observed were diabetes, hypertension, anxiety and insomnia. Overall, escitalopram monotherapy was used in 67.2% patients. Escitalopram was found to be the preferred antidepressant in patients with co-morbid conditions including hypertension and diabetes. Counseling was the most common non-pharmacological therapy practiced. This large cross sectional study in real life settings demonstrates high prevalence of depression among employed and educated adult Indian patients. Hypertension and diabetes are the two most common co-morbidites in patients with depression. Escitalopram is commonly used and preferred antidepressant in all studied age groups and even in co-morbid depression.

  16. Case management for persons with substance use disorders

    DEFF Research Database (Denmark)

    Hesse, Morten; Vanderplasschen, Wouter; Rapp, Richard

    2007-01-01

    Background Patients with alcohol and other drug use disorders (AOD) frequently have multiple social, physical, and mental health treatment needs, yet have difficulty accessing community services, including drug abuse treatment.  One strategy for linking patients with AOD with relevant services...... is case management, where a single case manager is responsible for linking patients with multiple relevant services. Objectives To conduct a systematic review  of all RCTs on the use of case management for helping drug abusers in or out of treatment. Outcome criteria included successful linkage with other......). Reference searching; personal communication; conference abstracts; book chapters on case management. Selection criteria Randomized controlled studies that compared a specific model of case management with either treatment as usual or another treatment model, included only patients with at least one alcohol...

  17. Supportive monitoring and disease management through the internet: an internet-delivered intervention strategy for recurrent depression.

    Science.gov (United States)

    Kordy, Hans; Backenstrass, Matthias; Hüsing, Johannes; Wolf, Markus; Aulich, Kai; Bürgy, Martin; Puschner, Bernd; Rummel-Kluge, Christine; Vedder, Helmut

    2013-11-01

    Major depression is a highly prevalent, disabling disorder associated with loss of quality of life and large economic burden for the society. Depressive disorders often follow a chronic or recurrent course. The risk of relapses increases with each additional episode. The internet-deliverable intervention strategy SUMMIT (SUpportive Monitoring and Disease Management over the InTernet) for patients with recurrent depression has been developed with the main objectives to prolong symptom-free phases and to shorten symptom-loaden phases. This paper describes the study design of a six-sites, three-arm, randomized clinical trial intended to evaluate the efficacy of this novel strategy compared to treatment as usual (TAU). Two hundred thirty six patients who had been treated for their (at least) third depressive episode in one of the six participating psychiatric centers were randomized into one of three groups: 1) TAU plus a twelve-month SUMMIT program participation with personal support or 2) TAU plus a twelve-month SUMMIT program participation without personal support, or 3) TAU alone. Primary outcome of this study is defined as the number of "well weeks" over 24months after index treatment assessed by blind evaluators based on the Longitudinal Interval Follow-Up Evaluation. If efficacious, the low monetary and nonmonetary expenditures of this automated, yet individualized intervention may open new avenues for providing an acceptable, convenient, and affordable long-term disease management strategy to people with a chronic mental condition such as recurrent depression. © 2013.

  18. Influence of adjuvant detached mindfulness and stress management training compared to pharmacologic treatment in primiparae with postpartum depression.

    Science.gov (United States)

    Ahmadpanah, Mohammad; Nazaribadie, Marzieh; Aghaei, Elham; Ghaleiha, Ali; Bakhtiari, Azade; Haghighi, Mohammad; Bahmani, Dena Sadeghi; Akhondi, Amineh; Bajoghli, Hafez; Jahangard, Leila; Holsboer-Trachsler, Edith; Brand, Serge

    2017-07-18

    Ten to 15% of mothers experience postpartum depression (PPD). If untreated, PPD may negatively affect mothers' and infants' mental health in the long term. Accordingly, effective treatments are required. In the present study, we investigated the effect of detached mindfulness (DM) and stress management training (SMT) as adjuvants, compared to pharmacologic treatment only, on symptoms of depression in women with PPD. Forty-five primiparae (mean age: M = 24.5 years) with diagnosed PPD and treated with an SSRI (citalopram; CIT) took part in the study. At baseline, they completed questionnaires covering socio-demographic data and symptoms of depression. Experts rated also symptoms of depression. Next, participants were randomly assigned to one of the following study conditions: adjuvant detached mindfulness (CIT+DM); adjuvant stress management training (CIT+SMT); control condition (CIT). Self- and experts' ratings were completed at the end of the study 8 weeks later, and again at 8 weeks follow-up. Symptoms of depression decreased significantly over time, but more so in the CIT+DM and CIT+SMT group, compared to the control condition. The pattern of results remained stable at follow-up. In primiparae with PPD and treated with a standard SSRI, adjuvant psychotherapeutic interventions led to significant and longer-lasting improvements.

  19. Improving the Management of Late-Life Depression in Primary Care: Barriers and Facilitators

    Directory of Open Access Journals (Sweden)

    Tamara Sussman

    2011-01-01

    Full Text Available The objectives of this study were to elicit Canadian health professionals' views on the barriers to identifying and treating late-life depression in primary care settings and on the solutions felt to be most important and feasible to implement. A consensus development process was used to generate, rank, and discuss solutions. Twenty-three health professionals participated in the consensus process. Results were analysed using quantitative and qualitative methods. Participants generated 12 solutions. One solution, developing mechanisms to increase family physicians' awareness of resources, was highly ranked for importance and feasibility by most participants. Another solution, providing family physicians with direct mental health support, was highly ranked as important but not as feasible by most participants. Deliberations emphasized the importance of case specific, as needed support based on the principles of shared care. The results suggest that practitioners highly value collaborative care but question the feasibility of implementing these principles in current Canadian primary care contexts.

  20. Musical hallucinations - a challenge for psychiatric therapeutical management. Case report.

    Science.gov (United States)

    Focseneanu, B E; Marian, G

    2015-01-01

    Background. Musical hallucinations occur in individuals with and without mental illness, and many patients tend to have intact reality testing. Although literature on musical hallucinations is limited, they have been associated with hearing abnormalities, adverse effects of pharmacological agents, female gender, advances in age and psychiatric illness. Aim. To present the psychiatric management of a case of an old female patient, who suddenly developed verbal and musical hallucinations with a pervasive impact on her daily activities. Method. Female, 71 years old, developed verbal and musical hallucinations 6 months before that have intensified later. She was known with bilateral hypoacusia starting with the age of 45, and magnetic resonance imaging performed 1 year before proved multiple lacunar infarcts. Because of the persistence, most of the time of these auditory hallucinations, the patient experienced pervasive difficulties with her major areas of activities. She was referred to a psychiatric department for evaluation and treatment. Results. The psychiatric consult revealed neither a depressive relapse, nor a mild cognitive impairment, and obsessive-compulsive disorder was suspected with intrusive obsessions. Patient received, as antiobsessional augmentation escitalopram 10mg/ day, an atypical antipsychotic, risperidone, which at 3 mg/ day induced extrapyramidal symptoms and cognitive impairment. Therefore, the dose of risperidone was reduced, extrapyramidal symptoms disappeared, and 300mg/ day of acidum valproicum was initiated. Discussion. Our patient presented with diminished sensory input to the auditory cortex, and it was hard to make a differential diagnosis between an organic and a mental etiology. Conclusion. The integration of musical hallucinations into a psychiatric disorder may be a difficult task, and, their treatment represents a challenge.

  1. Matrix analysis and risk management to avert depression and suicide among workers

    Directory of Open Access Journals (Sweden)

    Takeuchi Takeaki

    2010-11-01

    Full Text Available Abstract Suicide is among the most tragic outcomes of all mental disorders, and the prevalence of suicide has risen dramatically during the last decade, particularly among workers. This paper reviews and proposes strategies to avert suicide and depression with regard to the mind body medicine equation hypothesis, metrics analysis of mental health problems from a public health and clinical medicine view. In occupational fields, the mind body medicine hypothesis has to deal with working environment, working condition, and workers' health. These three factors chosen in this paper were based on the concept of risk control, called San-kanri, which has traditionally been used in Japanese companies, and the causation concepts of host, agent, and environment. Working environment and working condition were given special focus with regard to tackling suicide problems. Matrix analysis was conducted by dividing the problem of working conditions into nine cells: three prevention levels (primary, secondary, and tertiary were proposed for each of the three factors of the mind body medicine hypothesis (working environment, working condition, and workers' health. After using these main strategies (mind body medicine analysis and matrix analysis to tackle suicide problems, the paper talks about the versatility of case-method teaching, "Hiyari-Hat activity," routine inspections by professionals, risk assessment analysis, and mandatory health check-up focusing on sleep and depression. In the risk assessment analysis, an exact assessment model was suggested using a formula based on multiplication of the following three factors: (1 severity, (2 frequency, and (3 possibility. Mental health problems, including suicide, are rather tricky to deal with because they involve evaluation of individual cases. The mind body medicine hypothesis and matrix analysis would be appropriate tactics for suicide prevention because they would help the evaluation of this issue as a

  2. Depressive symptoms, self-esteem, HIV symptom management self-efficacy and self-compassion in people living with HIV.

    Science.gov (United States)

    Eller, L S; Rivero-Mendez, M; Voss, J; Chen, W-T; Chaiphibalsarisdi, P; Iipinge, S; Johnson, M O; Portillo, C J; Corless, I B; Sullivan, K; Tyer-Viola, L; Kemppainen, J; Rose, C Dawson; Sefcik, E; Nokes, K; Phillips, J C; Kirksey, K; Nicholas, P K; Wantland, D; Holzemer, W L; Webel, A R; Brion, J M

    2014-01-01

    The aims of this study were to examine differences in self-schemas between persons living with HIV/AIDS with and without depressive symptoms, and the degree to which these self-schemas predict depressive symptoms in this population. Self-schemas are beliefs about oneself and include self-esteem, HIV symptom management self-efficacy, and self-compassion. Beck's cognitive theory of depression guided the analysis of data from a sample of 1766 PLHIV from the USA and Puerto Rico. Sixty-five percent of the sample reported depressive symptoms. These symptoms were significantly (p ≤ 0.05), negatively correlated with age (r = -0.154), education (r = -0.106), work status (r = -0.132), income adequacy (r = -0.204, self-esteem (r = -0.617), HIV symptom self-efficacy (r = - 0.408), and self-kindness (r = - 0.284); they were significantly, positively correlated with gender (female/transgender) (r = 0.061), white or Hispanic race/ethnicity (r = 0.047) and self-judgment (r = 0.600). Fifty-one percent of the variance (F = 177.530 (df = 1524); p self-esteem, HIV symptom self-efficacy, and self-judgment. The strongest predictor of depressive symptoms was self-judgment. Results lend support to Beck's theory that those with negative self-schemas are more vulnerable to depression and suggest that clinicians should evaluate PLHIV for negative self-schemas. Tailored interventions for the treatment of depressive symptoms in PLHIV should be tested and future studies should evaluate whether alterations in negative self-schemas are the mechanism of action of these interventions and establish causality in the treatment of depressive symptoms in PLHIV.

  3. The influence of posttraumatic stress disorder, depression, and sensory processing patterns on occupational engagement: a case study.

    Science.gov (United States)

    Champagne, Tina

    2011-01-01

    The purpose of this article is to provide a brief overview of how Posttraumatic Stress Disorder (PTSD), Depression, and Sensory Processing patterns influence occupational engagement, including work performance. Interventions and outcomes of the Sensory Modulation Program and approaches from Cognitive Behavior Therapy (CBT) are reviewed through single case exploration with a 42 year-old woman in outpatient services. The marked increase in occupational engagement and improved work performance in this single case review demonstrates the need for more research on the use of the Sensory Modulation Program and approaches from CBT with populations with PTSD, Depression, and Sensory Processing disorder.

  4. What is Case Management? A Scoping and Mapping Review

    Directory of Open Access Journals (Sweden)

    Sue Lukersmith

    2016-10-01

    Full Text Available The description of case management in research and clinical practice is highly variable which impedes quality analysis, policy and planning. Case management makes a unique contribution towards the integration of health care, social services and other sector services and supports for people with complex health conditions. There are multiple components and variations of case management depending on the context and client population. This paper aims to scope and map case management in the literature to identify how case management is described in the literature for key complex health conditions (e.g., brain injury, diabetes, mental health, spinal cord injury. Following literature searches in multiple databases, grey literature and exclusion by health condition, community-based and adequate description, there were 661 potential papers for data extraction. Data from 79 papers (1988–2013 were analysed to the point of saturation (no new information and mapped to the model, components and activities. The results included 22 definitions, five models, with 69 activities or tasks of case managers mapped to 17 key components (interventions. The results confirm the significant terminological variance in case management which produces role confusion, ambiguity and hinders comparability across different health conditions and contexts. There is an urgent need for an internationally agreed taxonomy for the coordination, navigation and management of care.

  5. Value adding management: A concept and a case

    DEFF Research Database (Denmark)

    2012-01-01

    Purpose: To develop a management concept that can assist facilities managers in implementing value adding strategies and practices. The FM Value Map has been developed to analyse and demonstrate the different ways FM can add value. However, there is a need to develop management tools that can...... be used more directly and proactively by facilities managers to implement adding value strategies and practices. Methodology: The development of the concept of Value Adding Management is based on the management model for FM included in the European FM standards, recent theories on added value of FM...... and real estate and the related concept of Value Management from building projects. The chapter outlines a preliminary theoretical based management concept, which is investigated, tested and discussed based on a case study of LEGO. Findings: The case study provides a clear example of a company that actual...

  6. Sintomas obsessivo-compulsivos na depressão pós-parto: relatos de casos Obsessive-compulsive symptoms in postpartum depression: case reports

    Directory of Open Access Journals (Sweden)

    Carla Fonseca Zambaldi

    2008-08-01

    Full Text Available A depressão pós-parto é o transtorno afetivo mais prevalente no puerpério. O seu quadro clínico apresenta algumas peculiaridades sintomatológicas, podendo uma delas ser a presença mais freqüente de obsessões e compulsões. Relatamos seis casos identificados pela análise de prontuários de puérperas atendidas no Programa de Saúde Mental da Mulher do Hospital das Clínicas da Universidade Federal de Pernambuco. Todas elas tinham diagnóstico de depressão através do Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I e apresentavam concomitantemente sintomas obsessivo-compulsivos. Nos relatos, abordamos o período de aparecimento desses sintomas nas mulheres deprimidas, assim como o seu conteúdo, duração e resposta ao tratamento. Em duas mulheres, os sintomas obsessivo-compulsivos precederam os depressivos, e em outras duas, deu-se o inverso. Houve exacerbação de obsessões e compulsões preexistentes em duas puérperas. O conteúdo mais freqüente foi de pensamentos agressivos contra o bebê. Os sintomas tenderam a diminuir juntamente com a melhora da depressão.Postpartum depression is the most common affective disorder in the puerperium. There are some particular symptoms in its clinical presentation, and one might be the higher frequency of obsessions and compulsions. We report six cases identified from the analysis of medical charts of puerperal women receiving care at the Women's Mental Health Program, Hospital das Clínicas, Universidade Federal de Pernambuco, Brazil. All the women were diagnosed with postpartum depression using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I and had associated obsessive-compulsive symptoms. We report time of onset, topics, course and treatment response of these symptoms. Obsessive-compulsive symptoms preceded depressive symptoms in two women, and were succeeded in two other women. There was exacerbation of preexisting obsessions and compulsions in two

  7. Interdependency Management in Universities: A Case Study

    Science.gov (United States)

    Braun, Dietmar; Benninghoff, Martin; Ramuz, Raphaël; Gorga, Adriana

    2015-01-01

    There remains uncertainty in scientific discussions regarding the governance of universities in new public management regimes in terms of who actually "rules" in the university. Apparently, a strengthened management leadership is confronted with continuing elements of academic self-regulation and professional autonomy in knowledge…

  8. [Depression and stress management in medical students. A comparative study between freshman and advanced medical students].

    Science.gov (United States)

    Jurkat, H B; Richter, L; Cramer, M; Vetter, A; Bedau, S; Leweke, F; Milch, W

    2011-05-01

    International studies have indicated a high prevalence of depression and a lack of coping with stress in medical students. Freshman and advanced medical students were investigated using a specific questionnaire and the Beck Depression Inventory (BDI) with a response rate of 100%. Of the subjects studied 81.1% did not have any depression, 13.1% slight and 5.8% clinically relevant symptoms of depression. The severity of symptoms was highly associated with subjective appraisal of stressors. Coping skills of first year students significantly influenced the depression symptoms calling for preventative measures even in freshman medical students.

  9. [Latent tetany masked by syndroms of bronchial asthma and depressive syndrome. Case report].

    Science.gov (United States)

    Wajda, Beata; Drozdowska, Adrianna; Kuziemski, Krzysztof; Górska, Lucyna; Lewandowska, Katarzyna; Jassem, Ewa

    2006-01-01

    Tetany, which occurs in young women, poses common diagnostic problem. Two types of tetany are distinguished: one which is characterized by hypocalcemia and which rarely occurs (in person after strumectomy in the course of post-operational hypoparathyroidism) and latent one, which occurs more often. In the literature there is a lack of precise data concerned witch most probably results from its underestimation. Clinical symptoms which appear in latent tetany (normocalcemic) are related to the intracellular magnesium deficiency and increased respiratory drive. A noncharacteristic clinical picture and the lack of a pathognomonic symptom, cause that despite of the fearly common occurrence, the latent tetany is rarely recognized. In this paper the case of a 53 year old women has been described. The women had the symptoms of gastroesophageal reflux of asthma and depressive syndrome, witch masked the symptoms of the latent tetany.

  10. Alagille Syndrome: A Case Report Highlighting Dysmorphic Facies, Chronic Illness, and Depression

    Science.gov (United States)

    Winthrop, Zachary A.; Salman, Rabia; Majeed, Salman

    2016-01-01

    Alagille syndrome is a rare multisystem disorder affecting the liver, heart, vertebrae, eyes, and face. Alagille syndrome shares multiple phenotypic variants of other congenital or chronic childhood illnesses such as DiGeorge syndrome, Down syndrome, spina bifida, type 1 diabetes mellitus, and cystic fibrosis. All of these chronic illnesses have well-established links to psychiatric conditions. There are few community resources for Alagille patients, as it is an extremely rare condition. Despite the overlap with other chronic childhood illnesses, the psychiatric manifestations of Alagille syndrome have not been previously discussed in literature. The current study is a case report of a twelve-year-old female hospitalized in our pediatric psychiatric hospital for suicidal ideation with intent and plan. The patient had major depressive disorder, anxiety, other specified feeding and eating disorder, and attention-deficit/hyperactive disorder. PMID:28018696

  11. Alagille Syndrome: A Case Report Highlighting Dysmorphic Facies, Chronic Illness, and Depression

    Directory of Open Access Journals (Sweden)

    James J. Bresnahan

    2016-01-01

    Full Text Available Alagille syndrome is a rare multisystem disorder affecting the liver, heart, vertebrae, eyes, and face. Alagille syndrome shares multiple phenotypic variants of other congenital or chronic childhood illnesses such as DiGeorge syndrome, Down syndrome, spina bifida, type 1 diabetes mellitus, and cystic fibrosis. All of these chronic illnesses have well-established links to psychiatric conditions. There are few community resources for Alagille patients, as it is an extremely rare condition. Despite the overlap with other chronic childhood illnesses, the psychiatric manifestations of Alagille syndrome have not been previously discussed in literature. The current study is a case report of a twelve-year-old female hospitalized in our pediatric psychiatric hospital for suicidal ideation with intent and plan. The patient had major depressive disorder, anxiety, other specified feeding and eating disorder, and attention-deficit/hyperactive disorder.

  12. Case management for the self-insured hospital.

    Science.gov (United States)

    Dzyacky, S C

    1997-01-01

    It is rare for employers who self insure to have on-site case management. Generally, self-insured employers rely on the third-party-plan administrators to control health care costs, provide enrollees with health care benefit management services, and maintain customer satisfaction. In this article, the author discusses the internal workings of an employee case management program implemented in a self-insured hospital in Northwest Indiana. Information is presented on the goals and role of the case manager, scope of practice, barriers to the program, and resources involved to deliver health care services to its enrollees. Also presented is pertinent information to track and trend data for administrative reports. In addition, customer satisfaction and the value of an on-site case manager for self-insured organizations will be addressed. The results demonstrate a reduction in the volume of inpatient admissions, length of stay, and, therefore, an improved use of the health plan.

  13. A Case-Based System for Construction Project Risk Management

    Institute of Scientific and Technical Information of China (English)

    YANG Lan-rong; ZHANG Jin-long

    2002-01-01

    This paper presents a Case-Based system for assisting construction project managers in identifying risk factors and the corresponding construction project risk. The construction project risk identification model captures the case, acquired from previous completed construction projects and experience. A prototype is developed based on the proposed Case-Based system to determine risk factors along with their risk effects.

  14. Study of 50 cases of modern management of ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Rajita S. Jani

    2014-04-01

    Results: Lower abdominal pain was most common presenting symptom of ectopic pregnancy in 96% cases. The classical triad of symptoms (amenorrhea, abdominal pain and vaginal bleeding was present in only 28% cases. PID contributed 24% cases and previous abortion contributed 28% cases indicating these two as the common risk factors. Ampulla was the commonest site for ectopic pregnancy, in 52% cases. Salpingostomy performed mainly at this site. In 6% cases ectopic pregnancy in infundibulum were treated with fimbrial expression and fimbriectomy. 22% patients were managed medically (methotraxte. These were the cases having unruptured ectopic pregnancy and ectopic mass <4 cm. Laparoscopy was done in 34% cases, in 2 cases it was converted to laparotomy. While open laparotomy was done in 40% cases. Conclusions: Ectopic pregnancy is a treatable problem. Ultrasonography plays central role in the diagnosis and management. Mode of therapy is determined by a combination of clinical symptoms, sonography findings and serum b-HCG values. Surgical management is still a cornerstone of management of ectopic pregnancy. But now scope of medical and laparoscopic management is also there. In recent years laparotomy has been replaced by laparoscopic surgery which is more conservative, minimally invasive and less time consuming which leads to quick recovery. [Int J Reprod Contracept Obstet Gynecol 2014; 3(2.000: 374-379

  15. Hypomanic shift observed during rTMS treatment of patients with unipolar depressive disorder: four case reports

    Science.gov (United States)

    2013-01-01

    Objective Repetitive transcranial magnetic stimulation (rTMS) can enhance the excitement of the brain through adjusting the biological activities of the cerebral cortex and has wide biological effects, making it one basic mechanism of therapy for depression. In the treatment of unipolar depressive disorder, almost in every treatment method, hypomanic and manic shifts can be observed. There is still a lack of data regarding manic and hypomanic symptoms triggered by rTMS applications. Method We describe four cases with unipolar depression in which high-frequency rTMS over the left dorsolateral prefrontal cortex applied as an add-on antidepressive strategy may have induced a hypomanic episode. Results In these cases, 25 Hz rTMS combined with antidepressants may have contributed to the occurrence of hypomanic symptoms. Conclusion Using an intensive methodology of rTMS may induce hypomanic or manic symptoms. PMID:23618105

  16. Anxiety and depression levels in prepubertal obese children: a case-control study

    Directory of Open Access Journals (Sweden)

    Esposito M

    2014-10-01

    depressive symptoms, the Children Depression Inventory (CDI and the Italian Self-Administered Psychiatric Scales for Children and Adolescents (SAFA were administered. The control group consisted of 273 healthy children (129 males and 144 females (mean age 9.1±1.8 years, enrolled in schools within the Campania region of Italy. Results: No significant differences between the two study groups were found for age (8.9±1.23 years in the obese sample and 9.1±1.8 years in the control group (P=0.228 or sex (ratio male/female: 69/79 in the obese group versus 129/144 in the control group (P=0.983. Obviously, significant difference was found for the BMI z-score (2.46±0.31 in the obese group vs 0.73±0.51 in the control group (P<0.001. The obese subjects showed significant higher level of depressive symptoms (CDI total score (16.82±7.73 vs 8.2±2.9 (P<0.001 and anxiety (SAFA – Anxiety [SAFA-A] scale score (58.71±11.84 vs 27.75±11.5 (P<0.001 compared with the control group. Moreover, the Pearson’s correlation analysis showed a significantly positive relationship between the BMI z-score and both the CDI (r=0.677; P<0.001 and SAFA-A scores (r=0.591; P<0.001. Conclusion: Our findings highlighted the importance of assessing the presence of internalizing problems, such as anxiety and depression, in the common management of childhood obesity. Keywords: childhood obesity, internalizing problems, SAFA, CDI

  17. Improving depression care: barriers, solutions, and research needs.

    Science.gov (United States)

    Von Korff, M; Katon, W; Unützer, J; Wells, K; Wagner, E H

    2001-06-01

    Potential solutions for barriers to improved organization of care of depressive illness were identified. These included (1) aligning efforts to improve depression care with broader strategies for improving care of other chronic conditions; (2) increasing the availability of depression case management services in primary care; (3) developing registries and reminder systems to ensure active follow-up of depressed patients; (4) achieving agreement on how depression outcomes should be measured to provide outcomes-based performance standards; (5) providing greater support from mental health specialists for management of depressed patients by primary care providers; (6) campaigns to reduce the stigma associated with treatment of depressive illness; (7) increased dissemination of interventions that activate and empower patients managing a depressive illness; (8) redefining the lack of time of primary care providers for high-quality depression care as issues in organization of care and provider training; and (9) development of incentives (organizational or financial) for high-quality depression care. Research needs were identified according to what has been learned to date. Identified research needs included: studies of approaches to organization of case management, research in new populations (e.g., new diagnostic groups, rural populations, the disadvantaged, the elderly, and those with chronic medical illnesses), research on stepped care and relapse prevention strategies, evaluation of the societal benefits of improved depression care, and multisite trials and meta-analytic approaches that can provide adequate statistical power to assess societal benefits of improved care.

  18. The Case for Software Health Management

    Data.gov (United States)

    National Aeronautics and Space Administration — Software Health Management (SWHM) is a new field that is concerned with the development of tools and technologies to enable automated detection, diagnosis,...

  19. Potential link between caffeine consumption and pediatric depression: A case-control study

    Directory of Open Access Journals (Sweden)

    Farias Lucilene G

    2011-08-01

    Full Text Available Abstract Background Early-onset depressive disorders can have severe consequences both from developmental and functional aspects. The etiology of depressive disorders is complex and multi-factorial, with an intricate interaction among environmental factors and genetic predisposition. While data from studies on adults suggest that caffeine is fairly safe, effects of caffeine in children, who are in period of rapid brain development, are currently unknown. Furthermore, systematic research addressing the relationship between depressive symptoms in children and caffeine consumption is lacking. The present study examined the effects of caffeine consumption on depressed mood in children with depression and non-depressed participants. Methods Children and adolescents (n = 51 already enrolled in an ongoing longitudinal study, aged 9-12 years, were assessed for depressive symptoms with the Children Depressive Inventory (CDI. Psychopathological symptoms were assessed with the Child Behavioral Checklist (CBCL and eating habits were assessed with the Nutrition-Behavior Inventory (NBI 1. The children were compared to control children without psychopathology attending public schools in a Southern Brazilian city. Results Participants with CDI scores ≥ 15 (mean = 19; S.D. = 4 also had high NBI scores (mean = 52; S.D. = 19, p Conclusions These findings indicate that depressed children consume more caffeinated drinks than non-depressed children. Nonetheless while a strong association between depressive symptoms and caffeine consumption among children was found, further research should investigate whether or not this association is due to a cause and effect relationship.

  20. A Paradigm for Single-Case Research: The Time Series Study of a Long-Term Psychotherapy for Depression.

    Science.gov (United States)

    Jones, Enrico E.; And Others

    1993-01-01

    Study articulates model for single-case research in psychotherapy. Saw patient with major depressive disorder for 2.5 years of psychotherapy. Videotaped sessions and obtained assessments of change at regular intervals. Used time-series analysis to model fluctuations in therapy process. Bidirectional analysis of causal effects showed that influence…

  1. Rheumatoid Arthritis - Neuropsychology, Depression and Anxiety. A case - control study -120 Portuguese Female subjects.

    Directory of Open Access Journals (Sweden)

    Luis Maia

    2012-07-01

    Full Text Available Objectives: Impact of Rheumatoid Arthritis in cognitive functions has not been well acknowledged in Portugal. With this original article we intended to elucidate this problem in this specific country. Methods: We measured the results of 60 Rheumatoid Arthritis female patients (study group, comparing every patient in a case control paired plan (years in school and age, with control subjects (n = 60, in a total of 120 subjects. All participants were evaluated with Paced Auditory Selective Attention Test, Word List Generation Test, Luria Nebraska Neuropsychological Battery, a Portuguese depressive screening test (IACLIDE, STAI (anxiety trace and trait test and the Mini Mental state examination.Results: The outcomes demonstrate, for the first conclusive time in Portuguese patients, the occurrence of main deficits in terms of cognitive functioning (measured by a variety ofneuropsychological tests, and depressive and anxietysymptomatology. Conclusion: This article asset the need to pay attention in psychoeducational, psychotherapeutic and cognitive stimulation, and reinforcement of neuropsychological intervention in these types of patients.Objectivos: O impacto da artrite reumatóide nas funçõescognitivas não tem sido bem reconhecido em Portugal. Com este artigo original pretendemos elucidar este problema neste país específico.Métodos: Avaliámos os resultados de 60 pacientes femininos com artrite reumatóide (grupo de estudo, comparando cada paciente num estudo de caso-controle, emparelhando ossujeitos com Artrite Reumatóide (60 sujeitos com 60 pacientes Artrite Reumatóide, nas variáveis anos de escolaridade eidade (a variável género era uma constante = feminino.Todos os participantes foram avaliados com o Teste de Atenção Auditiva Selectiva (PASAT, teste de geração de lista de palavras, Bateria Neuropsicológica de Luria Nebraska, um teste português de despistagem de sintomatologia depressiva (IACLIDE, um teste de rastreamento de tra

  2. Unexplained Painful Physical Symptoms in Patients with Major Depressive Disorder: Prevalence, Pathophysiology and Management.

    Science.gov (United States)

    Jaracz, Jan; Gattner, Karolina; Jaracz, Krystyna; Górna, Krystyna

    2016-04-01

    Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines

  3. INFORMATION MODEL OF MAJOR DEPRESSION TREATMENT COST - RELEVANCE OF QUALITY MANAGEMENT OF HEALTH SYSTEM

    Directory of Open Access Journals (Sweden)

    Danijela Tadić

    2010-09-01

    Full Text Available This paper develops multirelational data base for major depression costs. It lists how data are collected and stored into the fact base and dimension base. Uncertain data is described linguistically and modelled by fuzzy sets. Linguistic expressions are stored in dimension base. Models of major depression treatment costs are developed for each patient and all population. On the basis of this model and multirelational data base MD-OLAP a model for major depression treatment costs is developed.

  4. Treatment resistant adolescent depression with upper airway resistance syndrome treated with rapid palatal expansion: a case report

    Directory of Open Access Journals (Sweden)

    Miller Paul

    2012-12-01

    Full Text Available Abstract Introduction To the best of our knowledge, this is the first report of a case of treatment-resistant depression in which the patient was evaluated for sleep disordered breathing as the cause and in which rapid palatal expansion to permanently treat the sleep disordered breathing produced a prolonged symptom-free period off medication. Case presentation An 18-year-old Caucasian man presented to our sleep disorders center with chronic severe depression that was no longer responsive to medication but that had recently responded to electroconvulsive therapy. Ancillary, persistent symptoms included mild insomnia, moderate to severe fatigue, mild sleepiness and severe anxiety treated with medication. Our patient had no history of snoring or witnessed apnea, but polysomnography was consistent with upper airway resistance syndrome. Although our patient did not have an orthodontic indication for rapid palatal expansion, rapid palatal expansion was performed as a treatment of his upper airway resistance syndrome. Following rapid palatal expansion, our patient experienced a marked improvement of his sleep quality, anxiety, fatigue and sleepiness. His improvement has been maintained off all psychotropic medication and his depression has remained in remission for approximately two years following his electroconvulsive therapy. Conclusions This case report introduces the possibility that unrecognized sleep disordered breathing may play a role in adolescent treatment-resistant depression. The symptoms of upper airway resistance syndrome are non-specific enough that every adolescent with depression, even those responding to medication, may have underlying sleep disordered breathing. In such patients, rapid palatal expansion, by widening the upper airway and improving airflow during sleep, may produce a prolonged improvement of symptoms and a tapering of medication. Psychiatrists treating adolescents may benefit from having another treatment option for

  5. Healthcare waste generation and its management system: the case ...

    African Journals Online (AJOL)

    Healthcare waste generation and its management system: the case of health ... in the course of activities, the generation of hazardous and non hazardous waste is a ... Segregation of wastes and pre treatment of infectious wastes were not ...

  6. Conservative management of a cervical ligamentum flavum hematoma: Case report

    Directory of Open Access Journals (Sweden)

    Hanna Algattas

    2016-01-01

    Conclusion: Spontaneous epidural hematoma arising from ligamentum flavum is a rare cause of spinal cord compression. Previous reports have described success with surgical decompression. However, initial observation and conservative management may be successful as illustrated in this case.

  7. Role of Academic Managers in Workload and Performance Management of Academic Staff: A Case Study

    Science.gov (United States)

    Graham, Andrew T.

    2016-01-01

    This small-scale case study focused on academic managers to explore the ways in which they control the workload of academic staff and the extent to which they use the workload model in performance management of academic staff. The links that exist between the workload and performance management were explored to confirm or refute the conceptual…

  8. The impact of parent behavior-management training on child depressive symptoms.

    Science.gov (United States)

    Webster-Stratton, Carolyn; Herman, Keith C

    2008-10-01

    The present study tested the impact of a parent behavior-management intervention on child depressive and internalizing symptoms. One hundred eighty-one children were randomly assigned to receive a videotape modeling parenting intervention, the Incredible Years, or to a wait-list control group. Children who received the intervention were more likely to have lower mother-rated mood and internalizing symptoms at post-treatment, compared with children in a wait-list control group. The effect sizes observed in the present intervention fell in the small-to-medium range for the sample as a whole, and some evidence supported the authors' hypothesis that effects would be strongest for children with baseline internalizing symptoms in the clinical range. Subsequent analyses also revealed that perceived changes in parenting effectiveness mediated the effect of treatment on children's post-treatment internalizing symptoms. The finding was consistent with study hypotheses and social learning explanations of child internalizing symptoms that guided selection of putative mechanisms. Implications for counseling psychologists and for designing interventions and prevention strategies for children with internalizing symptoms are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  9. Sir Robert Boyle and his unique case report on depressed cranial fracture.

    Science.gov (United States)

    Rengachary, Setti S; Ashan, Sidra

    2007-09-01

    Sir Robert Boyle is one of the foremost English scientists in history. He received his inspiration from the scientific approaches initiated by Galileo and his disciple, Torricelli. Through rigorous experimentation, Boyle established the fundamental gas laws as we know them today. Although not a physician himself, he contributed enormously to the practice of medical sciences. His voluminous observations and writings represent a landmark in the history of human thought. This article summarizes the scientific contributions of Robert Boyle, with particular emphasis on his contributions to medicine. Boyle wrote a unique case report describing in detail a patient with depressed cranial fracture who underwent successful surgery. Although on only a single case report, it provides us with a unique and rare opportunity to look at the practice of neurosurgery in the mid-17th century. Also presented in this article is Boyle's accurate description of a horse with holoprosencephaly, which was perhaps the first in history. The oft-quoted axiom in clinical medicine "First, do no harm (primum non nocere)" attributed to Sydenham, may be partially credited to Robert Boyle as well.

  10. Adding metoclopramide to paroxetine induced extrapyramidal symptoms and hyperprolactinemia in a depressed woman: a case report

    Science.gov (United States)

    Igata, Ryohei; Hori, Hikaru; Atake, Kiyokazu; Katsuki, Asuka; Nakamura, Jun

    2016-01-01

    A 54-year-old Japanese woman was diagnosed with major depressive disorder and prescribed paroxetine 20 mg/day. In around May 2013, the patient experienced gastric discomfort, so metoclopramide was prescribed. Beginning on June 4, 2013, the patient was given metoclopramide, 10 mg intravenously, twice per week. On the seventh day after beginning metoclopramide, facial hot flushes, increased sweating, muscle rigidity, and galactorrhea were noted. Extrapyramidal symptoms (EPS) rapidly subsided in response to an intramuscular injection of biperiden. Blood biochemical tests revealed an elevated serum prolactin level of 44 ng/mL. After stopping metoclopramide, EPS disappeared. Serum prolactin level decreased to 15 ng/mL after 4 weeks. In our case, although no adverse reactions had previously occurred following the administration of metoclopramide, the patient developed EPS and hyperprolactinemia following the administration of this antiemetic in combination with paroxetine. Paroxetine and metoclopramide are mainly metabolized by CYP2D6, and they are inhibitors for CYP2D6. We report a case with EPS and hyperprolactinemia whose plasma paroxetine and metoclopramide level rapidly increased after the addition of metoclopramide. Our experience warrants the issuing of a precaution that adverse reactions may arise following the coadministration of metoclopramide and paroxetine even at their respective standard dose levels. PMID:27621638

  11. Clinical Study on Electro-acupuncture Treatment for 30 Cases of Mental Depression

    Institute of Scientific and Technical Information of China (English)

    韩毳; 李晓泓; 罗和春; 赵学英; 李学武

    2004-01-01

    To observe the clinical therapeutic effects of electro-acupuncture therapy for mental depression, 30 cases were treated by electro-acupuncture on Baihui (GV20), Yintang (EX-HN3) and the differential points.Maprotiline was used in the control group of 31 cases. After the treatment, the scores in HAMD for both groups were found to be obviously decreased as compared with those before the treatment (P<0.01),without significant between-group differences (P>0.05). The total effective rate in the treatment group was 96.7%, and that of the control group was 90.3%, showing no significant between-group differences (P>0.05). After the treatment, the two groups all showed obvious decrease in the TCM symptomatic integrals (P<0.01), with significant between-group differences (P<0.05), the integral of the treatment group showing obvious superiority to that of the control group. And the decrease of the Asberg scores testing the side effect of antidepressants of the treatment group was obviously superior to that of the control group. After the treatment, the cortisol (CORT) content and the endothelin-1 (ET-1) content of the two groups were all obviously decreased (P<0.01), and basically turned to normal, without significant between-group differences (P>0.05). Conclusion: Electro-acupuncture therapy can produce the same clinical therapeutic effect as that produced by the tetracyclic drug maprotiline, giving less side effect and better symptomatic improvement.

  12. Case III: Managing Conflict--The Case of the Faculty Stuck in the Middle.

    Science.gov (United States)

    Trombly, Robert M.; Comer, Robert W.; Villamil, Juanita E.

    2002-01-01

    Explores techniques of conflict management as well as the positive and negative factors that may exert progressive or detrimental influences. Presents a case scenario, drawn from a faculty development workshop, involving a dental school faculty member, and highlights central issues of the case and relevant management concepts. (EV)

  13. Proceedings of the CASE Management Workshop

    Science.gov (United States)

    1992-09-01

    workshop, and to reviewers of this paper, in particular, Sandy Brenner , Bill Curtis, Richard Martin, Joe Morin, Jock Rader, Dave Kitson, Anita ...Hart, Grace Downey, Wendy Gissendanner, Helen Joyce, Wendy Rossi, Tracy Lewis, Attilio Marini, Frank Authenreith, Jeff Herman, Ed Morris, Sandy Brenner ...CASE Tools/Environments OO-ALC/TISAC Bldg. 100 Hill AFB, UT 84056 (801)777-8045 FAX: (801) 777-8069 Sandy Brenner Secretary III, Case & SAE

  14. Body movements and their role in music therapy in the treatment of depression and an eating disorder : a case study

    OpenAIRE

    Karvonen, Riikka

    2015-01-01

    Music and dance play an important role in every culture and society. In some parts of the world, the word for music and dance is the same. Due to this, one good treatment and psychological support can be music and dance. The purpose of this master’s thesis was to investigate how body movements and their role in music therapy in the treatment of depression and an eating disorder can offer one insights, and improve depression and quality of life. This case study was conducted within a cl...

  15. Congenital eversion of upper eyelids: Case report and management

    Directory of Open Access Journals (Sweden)

    Maheshwari Rajat

    2006-01-01

    Full Text Available Congenital eversion of the upper eyelids is a rare condition, the exact cause of which remains unknown. It is more frequently associated with Down′s syndrome and black babies. If diagnosed early and treated properly, the condition can be managed without surgery. We report a case of congenital bilateral severe upper eyelid eversion in a normal infant, born by vaginal delivery. The case was conservatively managed by lubricants, antibiotics and eyelid patching.

  16. Dynamic Condition Response Graphs for Trustworthy Adaptive Case Management

    DEFF Research Database (Denmark)

    Mukkamala, Raghava Rao; Hildebrandt, Thomas; Slaats, Tijs

    2013-01-01

    By trustworthy adaptive case management we mean that it should be possible to adapt processes and goals at runtime while guaranteeing that no deadlocks and livelocks are introduced. We propose to support this by applying a formal declarative process model, DCR Graphs, and exemplify its operational...... specified either as linear time logic (LTL) or DCR Graphs, extend the language with time and data and offer extended support for cross-organizational case management systems....

  17. Management of dental implant fractures. A case history.

    Science.gov (United States)

    Al Quran, Firas A M; Rashan, Bashar A; Al-Dwairi, Ziad N

    2009-01-01

    The widespread use of endosseous osseointegrated implants to replace missing natural teeth increases the chances of implant complications and failures, despite the high initial success rate reported in the literature. Implant fracture is one possible complication that results in ultimate failure of the dental implant. Such a complication poses a management crisis even for the most experienced clinician. This article reports on a case of implant fracture, its possible causes, and how the case was managed.

  18. ANAESTHESIA MANAGEMENT OF CSF RHINORRHEA REPAIR : A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Kirti Arvind

    2015-09-01

    Full Text Available Anaesthesiologist plays a major role in Cerebrospinal Fluid (CSF rhinorrhea repair surgery as the prognosis of which is dependent on provision of clear bloodless surgical field and surgeons satisfaction. Anaesthesiologist also plays vital role in the management of CSF Lumbar drain. This case highlights the importance of hypotensive anaesthesia during endoscopic repair of a case of spontaneous CSF Rhinorrhea with successful perioperative management of Lumbar drainage of CSF

  19. Building Perinatal Case Manager Capacity Using Quality Improvement

    OpenAIRE

    Fitzgerald, Elaine

    2015-01-01

    Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote a...

  20. Organizational diversity and disability management: Dutch cases

    NARCIS (Netherlands)

    Kopnina, H.; Haafkens, J.

    2009-01-01

    Recent EU initiatives promote employability of the growing number of the chronically ill and disabled employees. While HRM professionals and managers could play a significant role in the prevention of job-related problems and in promotion of early job-continuation, the chronically ill remain largely

  1. Organizational diversity and disability management: Dutch cases

    NARCIS (Netherlands)

    Kopnina, H.; Haafkens, J.

    2009-01-01

    Recent EU initiatives promote employability of the growing number of the chronically ill and disabled employees. While HRM professionals and managers could play a significant role in the prevention of job-related problems and in promotion of early job-continuation, the chronically ill remain largely

  2. Time management for case managers--so much work, so little time.

    Science.gov (United States)

    Cesta, Toni

    2014-08-01

    The world of a case manager is a busy one, and you may not have all the resources you need each and every day. If you can maintain a routine it will make the workload more manageable for you and will allow room for those surprises that invariably happen. Whether you are a new or a seasoned case manager, organizing your workload can always help smooth out the rough edges in anyone's hectic day!

  3. Effectiveness of a mood management component as an adjunct to a telephone counselling smoking cessation intervention for smokers with a past major depression: a pragmatic randomized controlled trial

    NARCIS (Netherlands)

    R.M. van der Meer; M.C. Willemsen; F. Smit; P. Cuijpers; G.M. Schippers

    2010-01-01

    Aims To assess whether the addition of a mood management component to telephone counselling produces higher abstinence rates in smokers with past major depression and helps to prevent recurrence of depressive symptoms. Design Pragmatic randomized controlled trial with two conditions, with follow-up

  4. Effectiveness of a mood management component as an adjunct to a telephone counselling smoking cessation intervention for smokers with a past major depression: A pragmatic randomized controlled trial

    NARCIS (Netherlands)

    Meer, van der R.; Willemsen, M.C.; Smit, H.F.E.; Cuijpers, P.; Schippers, G.M.

    2010-01-01

    Aims To assess whether the addition of a mood management component to telephone counselling produces higher abstinence rates in smokers with past major depression and helps to prevent recurrence of depressive symptoms. Design Pragmatic randomized controlled trial with two conditions, with follow-up

  5. Conservative management of vesicouterine fistula. A report of 2 cases.

    Science.gov (United States)

    Ravi, Bala; Schiavello, Henry; Abayev, David; Kazimir, Michal

    2003-12-01

    Vesicouterine fistulas usually require laparotomy for repair. A vesicouterine fistula occurring after cesarean section was successfully managed hormonally. In another case it developed in association with an intrauterine device and was repaired translaparoscopically. Laparotomy may be avoidable in the management of a vesicouterine fistula.

  6. Data management for genomic mapping applications: A case study

    Energy Technology Data Exchange (ETDEWEB)

    Markowitz, V.M.; Lewis, S.; McCarthy, J.; Olken, F.; Zorn, M.

    1992-05-01

    In this paper we describe a new approach to the construction of data management systems for genomic mapping applications in molecular biology, genetics, and plant breeding. We discuss the architecture of such systems and propose an incremental approach to the development of such systems. We illustrate the proposed approach and architecture with a case study of a prototype data management system for genomic maps.

  7. The management of traumatic ankylosis during orthodontics: a case report.

    LENUS (Irish Health Repository)

    McNamara, T G

    2000-01-01

    Dental ankylosis may be a significant complication in orthodontic clinical practice. This case report describes the management of a malocclusion, complicated by an ankylosed maxillary central incisor, which arose during orthodontic treatment, following an acute traumatic injury. The use of the ankylosed incisor in successfully managing the significant Class II division 1 malocclusion is described.

  8. The management of premolar supernumeraries in three orthodontic cases.

    LENUS (Irish Health Repository)

    McNamara, C M

    1997-01-01

    This paper reviews the incidence, etiology and location of supernumerary teeth with emphasis on premolar supernumeraries and examines the management of supernumerary premolars of three patients undergoing orthodontics. These cases demonstrate that the management of premolars is assessed individually and treatments based on potential complications, which may occur during the orthodontic and surgical management of the dentition. Progress and posttreatment radiographs are recommended for the assessment of late forming supernumerary teeth.

  9. Project management: a case study in construction industry

    OpenAIRE

    Kömürcü, Ahmet Murat

    1996-01-01

    Ankara : The Faculty of Management and the Graduate School of Business Administration of Bilkent University, 1996. Thesis (Master's) -- Bilkent University, 1996. Includes bibliographical references leaves 55-56 One of the application areas that project management can effectively be applied is the construction industry. In this thesis, a case study is carried out in order to point out the importance and essentiality of project management, especially project scheduling and control. For...

  10. Potential link between caffeine consumption and pediatric depression: A case-control study.

    Science.gov (United States)

    Benko, Cássia R; Farias, Antonio C; Farias, Lucilene G; Pereira, Erico F; Louzada, Fernando M; Cordeiro, Mara L

    2011-08-25

    Early-onset depressive disorders can have severe consequences both from developmental and functional aspects. The etiology of depressive disorders is complex and multi-factorial, with an intricate interaction among environmental factors and genetic predisposition. While data from studies on adults suggest that caffeine is fairly safe, effects of caffeine in children, who are in period of rapid brain development, are currently unknown. Furthermore, systematic research addressing the relationship between depressive symptoms in children and caffeine consumption is lacking.The present study examined the effects of caffeine consumption on depressed mood in children with depression and non-depressed participants. Children and adolescents (n = 51) already enrolled in an ongoing longitudinal study, aged 9-12 years, were assessed for depressive symptoms with the Children Depressive Inventory (CDI). Psychopathological symptoms were assessed with the Child Behavioral Checklist (CBCL) and eating habits were assessed with the Nutrition-Behavior Inventory (NBI) 1. The children were compared to control children without psychopathology attending public schools in a Southern Brazilian city. Participants with CDI scores ≥ 15 (mean = 19; S.D. = 4) also had high NBI scores (mean = 52; S.D. = 19, p consumption of sweets and caffeine individually, showed that caffeine, but not sweets, was associated with depressive symptoms. These findings indicate that depressed children consume more caffeinated drinks than non-depressed children. Nonetheless while a strong association between depressive symptoms and caffeine consumption among children was found, further research should investigate whether or not this association is due to a cause and effect relationship.

  11. How family physicians address diagnosis and management of depression in palliative care patients.

    NARCIS (Netherlands)

    Warmenhoven, F.C.; Rijswijk, H.C.A.M. van; Hoogstraten, E. van; Spaendonck, K.P.M. van; Lucassen, P.L.B.J.; Prins, J.B.; Vissers, K.; Weel, C. van

    2012-01-01

    PURPOSE Depression is highly prevalent in palliative care patients. In clinical practice, there is concern about both insufficient and excessive diagnosis and treatment of depression. In the Netherlands, family physicians have a central role in delivering palliative care. We explored variation in fa

  12. ACUTE MANAGEMENT CONCEPTS OF THE ACROMIOCLAVICULAR JOINT: A CASE REPORT

    Science.gov (United States)

    2012-01-01

    Acromioclavicular injuries are quite common and approaches to early management of those that are described as a Type III are controversial. The Rockwood Type III classification implies complete disruption of the acromioclavicular and coracoclavicular ligaments, resulting in inferior positioning of the scapula and, thus, the glenohumeral complex while the clavicle appears more superiorly prominent. Clinical management can include surgical or conservative techniques. This case report outlines the decision making process related to this type of injury, as applied in the diagnosis and management of 61 year‐old recreational athlete. Level of Evidence 5 (Single Case report) PMID:23091789

  13. Identifying and managing preparatory grief and depression at the end of life.

    Science.gov (United States)

    Periyakoil, Vyjeyanthi S; Hallenbeck, James

    2002-03-01

    Grief and depression present similarly in patients who are dying. Conventional symptoms (e.g., frequent crying, weight loss, thoughts of death) used to assess for depression in these patients may be imprecise because these symptoms are also present in preparatory grief and as a part of the normal dying process. Preparatory grief is experienced by virtually all patients who are dying and can be facilitated with psychosocial support and counseling. Ongoing pharmacotherapy is generally not beneficial and may even be harmful to patients who are grieving. Evidence of disturbed self-esteem, hopelessness, an active desire to die and ruminative thoughts about death and suicide are indicative of depression in patients who are dying. Physicians should have a low threshold for treating depression in patients nearing the end of life because depression is associated with tremendous suffering and poor quality of life.

  14. The power of belief and expectancy in understanding and management of depression.

    Science.gov (United States)

    Alladin, Assen

    2013-01-01

    This article examines how beliefs can influence the definition, classification, understanding, and treatment of depression. It is organized in five parts: The first part critically reviews the definition of depression; the second part explores the medicalization of depression; the third part examines the role of the pharmaceutical industry in the promotion and marketing of antidepressant medications; the fourth part surveys the psychological therapies for depression and examines the role of expectancy in outcome; and the last part looks at the mechanisms involved in the placebo effect. A list of evidence-based strategies, including hypnosis, are discussed in the context of cognitive hypnotherapy for depression to illustrate how expectancy effect can be maximized in psychotherapy.

  15. 面部皮肤病致郁验案%Proved Cases of Depression Caused by Skin Diseases of Face

    Institute of Scientific and Technical Information of China (English)

    周探; 周宝宽

    2012-01-01

    Objective: To summarize ZHOU Bao-kuan's clinical experience on depression caused by skin diseases of face. Methods : Discuss principles, methods, formulae and medicinals of hypomnesia based on medical records. Results: Those cases showed good effect that depression caused by acne was treated by modified Shugan Huatan decoction, depression caused by chloasma was treated by modified Shugan Jianpi Yangxin decoction, depression caused by rosacea was treated by modified Kaiyu Huatan Sanjie decoction. Conclusions : Common treatment of skin disease of face and depression shows advantage of treatment of traditional Chinese medicine.%目的:总结周宝宽主任医师治疗面部皮肤病及郁证经验.方法:以医案形式,融理、法、方、药为一体阐述.结果:采用自拟疏肝化痰汤治疗痤疮致郁案、疏肝健脾养心汤治疗黄褐斑致郁案、开郁化痰散结汤治疗酒渣鼻致郁案,疗效满意.结论:面部皮肤病与郁证同治,彰显中医药优势.

  16. [Should assistance to suicide be allowed in a case of chronic persistent depression in a nursing home patient].

    Science.gov (United States)

    Wettstein, A

    2010-05-12

    A 75 years old widower suffered since 26 years of many episodes of recurrent depressions. A compensated diabetes and a chronic, slowly progressive sensory-motor Neuropathy are relevant somatic comorbidities. Because of anxiety attacks complicating his progressively severe depression he could not be cared adequately in the old people home he lived in and was hospitalised. The anxiety responded well to Benzodiazepines, but the severe depression persisted despite a pharmacotherapy with Lithium, Mianserin and Citalopran. He was therefore transferred into a nursing home. There he demanded - supported by his son - an assisted suicide. 2 psychiatrists judged his wish to die as independent to his actual depression, a geronto-psychiatrist judged his suicidal ideas as a typical symptom of depression. Therefore the demanded assisted suicide was not allowed in the nursing home according to communal legal rules not allowing assisted suicide of persons with psychiatric illness in communal institutions. A hospitalisation against his own and his son's will was however not done and the assisted suicide was executed in privacy. This in Switzerland is legal even in cases of severe chronic psychiatric illness without a terminal disease.

  17. [Pancreas divisum: endoscopic management. Case report].

    Science.gov (United States)

    Martínez, Henry; Espinoza, Miguel; Huaman, César; Monge, Eduardo; Salazar, Sonia; Tapia, Abel

    2002-01-01

    This is a case report of a 19 year-old woman, with an acute recurrent pancreatitis diagnose, and pancreas divisum as anatomic alteration. An extensive evaluation including specialized labs, ERCP was done. The diagnosis is suspected during ERCP and confirmed by minor papilla injection. Treatment is directed towards relieving outflow obstruction at the level of the minor papilla, with successful results.

  18. Rationale and methods of the iFightDepression study: A double-blind, randomized controlled trial evaluating the efficacy of an internet-based self-management tool for moderate to mild depression.

    Science.gov (United States)

    Justicia, Azucena; Elices, Matilde; Cebria, Ana Isabel; Palao, Diego J; Gorosabel, Jesús; Puigdemont, Dolors; de Diego-Adeliño, Javier; Gabilondo, Andrea; Iruin, Alvaro; Hegerl, Ulrich; Pérez, Víctor

    2017-04-19

    During the last decade online interventions have emerged as a promising approach for patients with mild/moderate depressive symptoms, reaching at large populations and representing cost-effective alternatives. The main objective of this double-blind, randomized controlled trial is to examine the efficacy of an internet-based self-management tool (iFightDepression) for mild to moderate depression as an add-on to treatment as usual (TAU) versus internet-based psychoeducation plus TAU. A total of 310 participants with major depression disorder (MDD) will be recruited at four different mental-health facilities in Spain. Participants will be randomly allocated to one of two study arms: iFightDepression (iFD) tool + TAU vs. internet-based psychoeducation + TAU. Both interventions last for 8 weeks and there is a 12 weeks follow up. The primary outcome measure is changes in depressive symptoms assessed with the Hamilton Depression Rating Scale. Additionally, pre-post interventions assessments will include socio-demographic data, a brief medical and clinical history and self-reported measures of depressive symptoms, quality of life, functional impairments and satisfaction with the iFD tool. iFightDepression is an easy-prescribed tool that could increase the efficacy of conventional treatment and potentially reach untreated patients, shortening waiting lists to receive psychological treatment. Confirming the efficacy of the iFD internet-based self-management tool as an add-on treatment for individuals with mild to moderate depression will be clinically-relevant. Registration number NCT02312583 . Clinicaltrials.gov . December 4, 2014.

  19. Anti-inflammatory effects of antidepressant and atypical antipsychotic medication for the treatment of major depression and comorbid arthritis: a case report

    Directory of Open Access Journals (Sweden)

    Eyre Harris

    2010-01-01

    Full Text Available Abstract Introduction This case report describes the effects of psychotropic treatment, quetiapine in particular, on systemic inflammation, pain, general functioning and major depression in the treatment of a woman with arthritis. Case presentation A 49-year-old Caucasian Australian woman with arthritis, pain and depression was treated with a course of escitalopram, mirtazapine and quetiapine. Pain levels, general functioning and degree of depressive symptoms were evaluated with a visual analogue scale. Systemic inflammation had been assessed by C-reactive protein serum levels since 2003. C-reactive protein levels, physical pain, symptoms of arthritis and depression decreased significantly during the past 12 months of treatment with quetiapine, while treatment with selective serotonin reuptake inhibitors and mirtazapine remained the same. Conclusions We suggest that the treatment particularly with quetiapine may have anti-inflammatory effects in arthritis and comorbid major depression, which eventually led to a remission of pain and depression and to normal general function.

  20. Management of dentinogenesis imperfecta: a review of two case reports.

    Science.gov (United States)

    Rafeek, Reisha N; Paryag, Amit; Al-Bayaty, Haytham

    2013-01-01

    Dentinogenesis imperfecta (DI) is an inherited disorder that affects dentin and often manifests as tooth discoloration; in addition, the dentition is also extremely susceptible to wear. Treatment of DI focuses primarily on protecting affected dentin, reducing sensitivity, and improving esthetics. Routine restorative materials, such as amalgams and composites, may be used. In more severe cases, the treatment of choice is full coverage crowns, while bonding of veneers may be used to improve the esthetics of the anterior teeth. This study presents two cases of Type II DI in the same family and the management of each case. Restorative management included amalgams, composite veneers, crowns, bridges, and overdentures.

  1. Management case study: Tampa Bay, Florida

    Science.gov (United States)

    Morrison, G.; Greening, H.S.; Yates, K.K.

    2012-01-01

    Tampa Bay, Florida,USA, is a shallow,subtropical estuary that experienced severe cultural eutrophication between the 1940s and 1980s, a period when the human population of its watershed quadrupled. In response, citizen action led to the formation of a public- and private-sector partnership (the Tampa Bay Estuary Program), which adopted a number of management objectives to support the restoration and protection of the bay’s living resources. These included numeric chlorophyll a and water-clarity targets, as well as long-term goals addressing the spatial extent of sea grasses and other selected habitat types, to support estuarine-dependent faunal guilds.

  2. The management of stress urinary incontinence: A case report

    Directory of Open Access Journals (Sweden)

    Preshani Reddy

    2015-04-01

    Full Text Available Introduction: Conservative management is the first option for patients with stress urinary incontinence (SUI. However, successful management of women diagnosed with SUI is dependent on a proper assessment and a tailored treatment plan. This case report aims to show the effectiveness of physiotherapy management in a 42-year-old patient diagnosed with SUI.Patient presentation: The patient’s main complaints were involuntary loss of urine on coughing, sneezing and lifting of heavy objects, which started following the birth of her third child.Management and outcome: The patient was taught the ‘Knack’ manoeuvre and provided with a tailored pelvic floor exercise programme. Improvement was noted at the third visit and the patient no longer had involuntary episodes.Conclusion: This case report shows the successful outcome of conservative management in a patient with stress urinary incontinence.

  3. Group Training of Stress Management vs. Group Cognitive-Behavioral Therapy in Reducing Depression, Anxiety and Perceived Stress Among HIV-Positive Men

    OpenAIRE

    Hemmati Sabet, Akbar; Khalatbari, Javad; Abbas Ghorbani, Maryam; Haghighi, Mohammad; Ahmadpanah, Mohammad

    2013-01-01

    Objective: To compare the effectiveness of group training of stress management with cognitive-behavioral therapy (CBT) in reducing depression, anxiety and stress perceived among HIV-positive men. Methods:Inthis semi-experimental study, three groups of HIV-positive men (CBT group, stress management group, and control group) including 15 patients in each group were compared regarding depression, anxiety, and stress using pre-test and post-test tools. Results: Both interventions (CBT and stress ...

  4. Vendor managed forecasting: A case study of small enterprise

    Directory of Open Access Journals (Sweden)

    Atul B. Borade

    2009-07-01

    Full Text Available Enterprises use supply chain management practices for improving business or supply chain performance. It is observed that supply chain technologies like VMI are now becoming an integral part of enterprise’s strategy. Even small and medium enterprises can adopt this practice and improve the performance of supply chain. This paper discusses vendor managed forecasting with the help of case study. It shows how a small enterprise improves supply chain performance by using demand related information obtained from retailer. The results obtained in the study shows that vendor managed forecasting in supply chain reduces the demand variation and improves inventory management significantly.

  5. Case-based Influence in Conflict Management

    Science.gov (United States)

    2014-10-31

    published in a book of essays on cyber analogies that he commissioned (Axelrod, 2014). The third phase of the project developed a mathematical ...phase analyzed how historical analogies are used to make sense of novel events, comparing historical analogies invoked in three events in newspapers...from five countries. Case-based reasoning was found to be very common, with almost one historical analogy per article (963/1061). The second phase

  6. Teaching Cases in Management - Cordilheira de Santana

    Directory of Open Access Journals (Sweden)

    Astor Eugênio Hexsel

    2011-01-01

    Full Text Available The Cordilheira de Santana case, from now on referred to simply as Cordilheira, was conducted and reported with the main purpose of contributing to the understanding of the process of strategy formulation in the winery sector. It presents the case of a recently created small firm aiming to compete in the market by offering high quality based on reduced premium line products, with prices established in accordance. Even so, it has not achieved the expected results. The wine industry with its basis in the wineries of the extreme south of Brazil, which is the most productive sector in the whole country, is also discussed. The case study began in 2008, when Rosana, owner and director of the company, travelled from São Paulo to Porto Alegre and highly concerned that the expected results had not been achieved. Data included as a technical note on the wine industry provides information on the industry as a whole, enabling students to reconsider the firm´s positioning in the market. The teaching note that follows provides the professor with information that will allow him to explore several perspectives that will have to be faced by Rosana further. She may choose to strengthen the present strategy or to take it in a new direction.

  7. Schema therapy for patients with chronic depression: a single case series study

    NARCIS (Netherlands)

    I.A. Malogiannis; A. Arntz; A. Spyropoulou; E. Tsartsara; A. Aggeli; S. Karveli; M. Vlavianou; A. Pehlivanidis; G.N. Papadimitriou; I. Zervas

    2014-01-01

    Background and objectives: This study tested the effectiveness of schema therapy (ST) for patients with chronic depression. Methods: Twelve patients with a diagnosis of chronic depression participated. The treatment protocol consisted of 60 sessions, with the first 55 sessions offered weekly and the

  8. Interpersonal Theory and Music Techniques: A Case Study for a Family With a Depressed Adolescent

    Science.gov (United States)

    Hendricks, C. Bret; Bradley, Loretta J.

    2005-01-01

    Interpersonal psychotherapy (IPT-A) is a brief, time-limited therapy developed for use with adolescents diagnosed with major depression. IPT-A has been shown to be effective with adolescents in family counseling milieus. Music therapy techniques also have been successfully used to treat adolescent depression. This article provides mental health…

  9. Not Myself and the Connected Self: Cases of Youth Depression and Recovery in Malaysia

    Science.gov (United States)

    Kok, Jin Kuan; Lai, Wai Yoong

    2017-01-01

    This study aims to explore the subjective experience of depressed young people in Malaysia. Twelve participants aged 20-24, who were diagnosed as suffering from depression but who had recovered, were interviewed. An adapted grounded theory approach guided our data collection and data analysis process. Two themes emerged which revealed the…

  10. Researcher Allegiance and Meta-analysis: The Case of Cognitive Therapy for Depression.

    Science.gov (United States)

    Gaffan, E. A.; And Others

    1995-01-01

    Reexamines the studies of K. S. Dobson regarding metaanalysis of cognitive-behavioral therapy for depression using the Beck Depression Inventory as an outcome measure. Confirms Dobson's conclusions but shows that about half the difference between CT and other treatments was predictable from researcher allegiance. Comparable analysis of a later set…

  11. Not Myself and the Connected Self: Cases of Youth Depression and Recovery in Malaysia

    Science.gov (United States)

    Kok, Jin Kuan; Lai, Wai Yoong

    2017-01-01

    This study aims to explore the subjective experience of depressed young people in Malaysia. Twelve participants aged 20-24, who were diagnosed as suffering from depression but who had recovered, were interviewed. An adapted grounded theory approach guided our data collection and data analysis process. Two themes emerged which revealed the…

  12. Case Study: Longitudinal Treatment of Adolescents with Depression and Inflammatory Bowel Disease

    Science.gov (United States)

    Szigethy, Eva; Carpenter, Johanna; Baum, Emily; Kenney, Elyse; Baptista-Neto, Lourival; Beardslee, William R.; DeMaso, David Ray

    2006-01-01

    Objective: To assess longitudinal maintenance of improvements in depression, anxiety, global functioning, and physical health perception in 11 adolescents at 6 and 12 months following completion of manual-based cognitive-behavioral therapy. Method: Standardized instruments assessed follow-up changes in depression, anxiety, physical health, and…

  13. Case Study: Longitudinal Treatment of Adolescents with Depression and Inflammatory Bowel Disease

    Science.gov (United States)

    Szigethy, Eva; Carpenter, Johanna; Baum, Emily; Kenney, Elyse; Baptista-Neto, Lourival; Beardslee, William R.; DeMaso, David Ray

    2006-01-01

    Objective: To assess longitudinal maintenance of improvements in depression, anxiety, global functioning, and physical health perception in 11 adolescents at 6 and 12 months following completion of manual-based cognitive-behavioral therapy. Method: Standardized instruments assessed follow-up changes in depression, anxiety, physical health, and…

  14. Clinical Observation on Acupuncture Treatment of Depressive Neurosis in 30 Cases

    Institute of Scientific and Technical Information of China (English)

    Zhao Jiahui; Sang Peng

    2006-01-01

    @@ Depressive neurosis refers to a psychonosema disease,characterized by emotional depression with anxiety and dyssomnia. Usually antidepressants are used for this disease. However, they are slow in giving effects with more side-effects. The authors of this essay have adopted acupuncture for the treatment, and obtained good therapeutic results as reported in the following.

  15. Pregnancy and delivery while receiving vagus nerve stimulation for the treatment of major depression: a case report

    Directory of Open Access Journals (Sweden)

    Stegman Diane

    2005-09-01

    Full Text Available Abstract Background Depression during pregnancy can have significant health consequences for the mother and her infant. Antidepressant medications, which pass through the placenta, may increase the risk of low birth weight and preterm delivery. The use of selective serotonin reuptake inhibitors (SSRIs during pregnancy may induce serotonergic symptoms in the infant after delivery. Antidepressant medications in breast milk may also be passed to an infant. Vagus nerve stimulation (VNS therapy is an effective non-pharmacologic treatment for treatment-resistant depression (TRD, but little information exists regarding the use of VNS therapy during pregnancy. Case presentation The patient began receiving VNS therapy for TRD in March 1999. The therapy was effective, producing substantial reductions in depressive symptoms and improvement of function. In 2002, the patient reported that she was pregnant. She continued receiving VNS therapy throughout her pregnancy, labor, and delivery, which enabled the sustained remission of her depression. The pregnancy was uneventful; a healthy daughter was delivered at full term. Conclusion In this case, VNS therapy provided effective treatment for TRD during pregnancy and delivery. VNS was safe for the patient and her child.

  16. How Adolescent Girls Understand and Manage Depression Within Their Peer Group: A Grounded Theory Investigation.

    Science.gov (United States)

    Pinto-Foltz, Melissa D; Hines-Martin, Vicki; Logsdon, M Cynthia

    2010-03-01

    Depression is prevalent among adolescent girls, but few receive mental health treatment. Adolescent girls often forgo needed mental health treatment because they fear responses of peers about depression. Understanding the processes of how adolescent girls respond to peers with depression is an important first step to improve access to mental health treatment. This qualitative study describes the knowledge, perceptions, and behaviors of adolescent girls about depression and mental health treatment within their peer group. The investigators conducted two focus groups, with adolescent girls (n=21), in a public high school in the southern U.S. Grounded theory methods were utilized to identify a beginning substantive theory about perceptions and behaviors of adolescent girls related to depression in their peers. Participants cognitively processed mental health concepts similarly to adults. However, their affective responses to peers with mental illness fluctuated between adult and child perspectives. Participants expressed concerns about individuals with depression that have previously been identified in adults, but expressed unique perspectives that reflect their transitional stage of development. Findings provide new information about how adolescent girls respond to peers with depression, define areas for further investigation, provide directions for constructing developmentally appropriate mental health educational interventions for adolescent girls, and elucidate the need to provide guidance to women with whom adolescent girls have sustained contact.

  17. Evaluating Depression Care Management in a Community Setting: Main Outcomes for a Medicaid HMO Population with Multiple Medical and Psychiatric Comorbidities

    Directory of Open Access Journals (Sweden)

    Jeanette A. Waxmonsky

    2012-01-01

    Full Text Available The authors describe the implementation of a depression care management (DCM program at Colorado Access, a public sector health plan, and describe the program’s clinical and system outcomes for members with chronic medical conditions. High medical risk, high cost Medicaid health plan members were identified and systematically screened for depression. A total of 370 members enrolled in the DCM program. Longitudinal analyses revealed significantly reduced depression severity scores at 3, 6, and 12 months after intervention as compared to baseline depression scores. At 12 months, 56% of enrollees in the DCM program had either a 50% reduction in PHQ-9 scores or a PHQ-9 score < 10. Longitudinal economic analyses comparing 12 months before and after intervention revealed a significant but modest increase in ER visits, outpatient office visits, and overall medical and pharmacy costs when adjusted for months enrolled in DCM. Limitations and recommendations for the integrated depression care management are discussed.

  18. Impact of Prenatal Cognitive-Behavioral Stress Management Intervention on Maternal Anxiety and Depression and Newborns’ Apgar Scores

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    Mahsa Karamoozian

    2015-06-01

    Full Text Available Background: Motherhood is a transformative and pleasing experience in a woman’s life. However, given the physical and psychological changes, it can induce a degree of stress and anxiety in mothers. The aim of the present study was to evaluate the effects of cognitive-behavioral stress management (CBSM on maternal anxiety and depression during pregnancy and newborns’ Apgar scores. Methods: This semi-experimental study was performed by applying a pretest-posttest control-group design. Overall, 30 primiparous mothers were selected among women referring to health clinics of Kerman, Iran, using convenience sampling. Subjects were randomly allocated to experimental and control groups. Data were collected, using Pregnancy-Related Anxiety Questionnaire and Edinburgh Postnatal Depression Questionnaire. After completing the pretest, the experimental group was subjected to 12 sessions of CBSM training; posttest data were collected after the intervention. Multivariate analysis of covariance was performed, using SPSS version 16. P-value < 0.05 was considered statistically significant. Results: The obtained results revealed a significant decrement in the average posttest scores of anxiety and depression in the experimental group, compared to pretest scores and the control group. Moreover, differences in 1- and 5-minute Apgar scores between the two groups were statistically significant. These findings indicated the effectiveness of CBSM during pregnancy in reducing maternal anxiety and depression. Conclusion: Pregnant women can benefit from psychological interventions such as CBSM in medical and health care centers.

  19. Teaching Cases in Management - O Chocolate Importado

    Directory of Open Access Journals (Sweden)

    Dusan Schreiber

    2009-10-01

    Full Text Available International trade plays a special role in all countries due the influence exerted in the economic and social field. At the same time, subjects such as planning and implementing the operation of export and import becomes very important, with particular relevance among entrepreneurs and academics. When it comes to this issue, the aim of this teaching case is to provide discussions about the subjects of entrepreneurship, business planning and the learning of strategists. It describes the experience of company SK, started in July of 1997, which began its businesses through exporting and importing leather and its artifacts. Later, the enterprise redirected its focus and began importing chocolates for the Brazilian market. The entrepreneur found, during the process of the business construction, a series of challenges that obliged him to make decisions and make choices. Having an amount of capital and willingness to undertake, he had to decide which path to follow and how to decide. Were there right and wrong choices? How would he plan and operationalize a start-up business? How would he evaluate opportunities and estimate the risk of an enterprise? These are some of many questions that the reader will be challenged to answer after analyzing this case.

  20. The assemblage of compliance in psychiatric case management.

    Science.gov (United States)

    Brodwin, Paul

    2010-08-01

    In the post-asylum era, case managers perform much of the face-to-face work of pharmaceutical compliance for people with severe and persistent mental illness. Their work demands careful orchestration of the assemblage of compliance, including the actual medications, the ideology of biopsychiatry, the division of professional labor, and certain mundane tools. Ethnographic vignettes from an Assertive Community Treatment (ACT) team show how case managers use this assemblage in their everyday routines, but also how it undercuts key elements of the original ACT mission. Reflecting its roots in the deinstitutionalization movement, the ACT model gives case managers limitless responsibilities for clients' lives, but then narrowly defines their role as the prosthetic extension of psychiatric authority. To produce compliance, case managers depend on the medication cassette, analyzed here as a human/non-human hybrid woven into their ordinary work. The medication cassette has pre-scripted uses that enlist clinicians in biopsychiatric thinking and also silently impose compliant behavior on clients. The elements in the assemblage of compliance depend on each other, but they do not form a seamless whole, as evidenced by the dilemmas and micropolitics of the clinical front-line. Theoretical notions of assemblages and technologies of compliance, drawn from science and technology studies, illuminate a core conundrum of practice in psychiatric case management.

  1. Interactive televideo and the Internet in rural case management.

    Science.gov (United States)

    Redford, L J; Parkins, L G

    1997-01-01

    The purpose of this article is to stir the imagination and incite the creative energies of case managers in finding ways to capitalize on communication and information technologies to improve access to care as well as the quality of care in rural communities. Today, the general dearth of services and logistics of providing services in rural areas challenges even the most seasoned case managers. Given the current economic and political climate, it is unlikely that these challenges will lessen, particularly if we continue to pursue our more traditional approaches to case management and service delivery. Telecommunications technologies are opening exciting opportunities for changing this trajectory and expanding the role and reach of case managers, while improving access to many services. This article highlights the new and the potential applications of interactive televideo in health and human services, as well as the vast opportunities offered by the Internet. There are, however, also pitfalls we must overcome to realize the full potential of these technologies. Case managers, in their roles as advocates, coordinators, and facilitators, are ideally positioned to be on the cutting edge of these technological applications and play a catalytic role in moving rural communities into the "information age."

  2. Moclobemide as add-on therapy to agomelatine in a patient with treatment-resistant major depressive disorder: a psychopharmacological case.

    Science.gov (United States)

    Stuhec, Matej; Oravecz, Robert

    2016-04-01

    Treatment-resistant depression is a major depressive disorder that does not respond to adequate treatment of at least two antidepressants and is one of the major clinical challenges for clinicians and clinical pharmacists. One treatment option is to switch the patient to a different medication. Another option is to add a medication to the patient's current pharmacotherapy. This article presents an improvement of symptoms induced by a combination of moclobemide (MOC) and agomelatine (AG) treatment in a 48-year-old Caucasian woman with treatment-resistant major depressive disorder (MDD). The patient had been treated with numerous antidepressants in the last 2 years that had not been effective or had caused serious adverse effects. When MOC 300 mg daily was added to AG 25 mg daily, the patient recovered progressively without any adverse effects. Her functional status also appeared stable. No other drugs known to interact with AG were administered. The MOC dose was subsequently increased to 600 mg daily and was taken with AG 25 mg daily and zolpidem 5 mg daily. The positive effects of AG or MOC on MDD have been widely reported, but there have not been reports of a combined treatment with MOG and AG improving symptoms of treatment-resistant MDD. The exact mechanism of this effect on the central nervous system is unknown. The additive activity could have been caused by a broader spectrum activity of AG and MOC. In this report, we identified a case with positive evidence of this antidepressant combination relieving the symptoms of treatment-resistant MDD, which is otherwise difficult to manage. This case report may serve to help clinicians and clinical pharmacists as a new treatment option for treatment-resistant MDD, although further research is needed to confirm this practice.

  3. Comparison of treatment selections by Japanese and US psychiatrists for major depressive disorder: A case vignette study.

    Science.gov (United States)

    Nakagawa, Atsuo; Williams, Aya; Sado, Mitsuhiro; Oguchi, Yoshiyo; Mischoulon, David; Smith, Felicia; Mimura, Masaru; Sato, Yuji

    2015-09-01

    A review of the published work on treatments for major depressive disorder suggests that there is an alarming gap between guideline recommendations and actual clinical practices worldwide. The purpose of this study was to compare early-career psychiatrists' selections of treatment for mild to moderate major depression in Japan and the USA. The authors surveyed 120 early-career psychiatrists from two residency programs in Japan and the USA using web-based questionnaires. In response to two case vignettes of mild to moderate major depression, the subjects selected treatment modalities and first- and second-line pharmacotherapy. Eighty-one psychiatrists (68%) returned surveys, of whom 42 (52%) were Japanese and 39 (48%) American. Fewer Japanese subjects selected psychotherapy than Americans. The Japanese psychiatrists favored benzodiazepine monotherapy for the treatment of mild depression, whereas the American psychiatrists favored antidepressant monotherapy. For the initial treatment of moderate depression, approximately half of the Japanese selected antidepressant monotherapy, and a quarter selected benzodiazepine monotherapy, whereas the Americans unanimously selected selective serotonin reuptake inhibitors monotherapy. As a second-line strategy, the Japanese were more likely to augment medication and less likely to increase dosage for moderate depression than their American counterparts. Differences were found between the treatment selections of early-career psychiatrists in Japan and the USA, despite comparable guidelines and postgraduate training. The results suggest that the gap between guidelines and practice may also be shaped by physician workload, attitudes toward side-effects, and the sociocultural contexts in which clinical decisions are made. © 2015 The Authors. Psychiatry and Clinical Neurosciences © 2015 Japanese Society of Psychiatry and Neurology.

  4. Activity/rest rhythm of depressed adolescents undergoing therapy: case studies

    Directory of Open Access Journals (Sweden)

    Maria Eugênia Mesquita

    Full Text Available Abstract Introduction: Disorders of circadian rhythms have been reported in studies of both depressed children and of depressed adolescents. The aim of this study was to evaluate whether there is a relationship between the 24-hour spectral power (24h SP of the activity/rest rhythm and the clinical course of depression in adolescents. Methods: Six 14 to 17-year-old adolescents were recruited for the study. They were all suffering from major depressive disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV criteria, as identified by the Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version (K-SADS-PL. Depressive symptoms were assessed using the Children's Depression Rating Scale - Revised (CDRS-R and clinical evaluations. Locomotor activity was monitored over a period of 13 consecutive weeks. Activity was measured for 10-minute periods using wrist-worn activity monitors. All patients were prescribed sertraline from after the first week up until the end of the study. Results: We found a relationship between high CDRS values and low 24-hour spectral power. Conclusions: The 24h SP of the activity/rest rhythm correlated significantly (negatively with the clinical ratings of depression.

  5. The "wins" of change: evaluating the impact of predicted changes on case management practice.

    Science.gov (United States)

    Stanton, Marietta P; Barnett Lammon, Carol Ann

    2008-01-01

    A variety of strategies were employed to identify current and future trends that would impact the practice of case management. Historical review, consultation with case management experts, literature review, and environmental scanning by practicing case managers were strategies employed to determine the impact of current and future trends on case management. The trends identified in this article have implications for case managers in a variety of settings. Case managers participating in the environmental scanning process to evaluate the impact of the identified trends on their organization included representation from acute care, home care, behavioral health, workers' compensation, and private insurance settings. The top 7 trends identified by experts in the field of case management included pay for performance, recovery audit contractors, Medicare demonstration projects, transitions of care, informatics in healthcare and case management, metrics for case management, and the impact of an aging population in case management. Practicing case managers were asked to react to these trends in terms of likelihood of occurrence in their organization and impact of these trends on their case management practice. Case management will ultimately have a higher degree of accountability for its practice if metrics to evaluate and reimbursement for case management become a reality. A multitude of performance measures exist that will be monitored and be tied to reimbursement. To ensure that agencies are accomplishing these performance measures, case management will potentially have a growing importance. Case managers perceive that these trends have a predominantly positive impact on case management.

  6. Hospital overcrowding: an opportunity for case managers.

    Science.gov (United States)

    Simmons, Florence M

    2005-01-01

    Hospital overcrowding is primarily a shortage of inpatient beds, not a lack of emergency department capacity, as initially assumed. According to Asplin et al., many factors contribute to overcrowding, including inadequate or inflexible nurse-to-patient staffing ratios, isolation precautions, or delays in cleaning rooms after patient discharge; an overreliance on intensive care or telemetry beds; inefficient diagnostic and ancillary services on inpatient units; and delays in discharging hospitalized patients to postacute-care facilities. Hospital overcrowding presents a challenge for hospital employees and clients, often leading to frustration and dissatisfaction. Overcrowding also has a direct effect on patient care, including compromised patient safety, increased costs, increased length of stay, and increased mortality and morbidity rates. The emergency department is changed from a temporary holding area to an extended patient care unit, decreasing its ability to handle new admissions and to manage a mass casualty. Beds in the critical care units become filled with inappropriate patients if floor beds are not available, making placement of seriously ill patients difficult. Trauma patients may have to be diverted to other hospitals to receive the appropriate level of care. Patients who require specialty services may have to wait for extended periods to obtain a bed in a referral center.

  7. Depression and a sense of coherence in case of people with anxiety disorders

    Directory of Open Access Journals (Sweden)

    Krystyna Kurowska

    2013-03-01

    Full Text Available Introduction: Anxiety and depressive disorders belong to the most prevalent mental diseases. Concomitance of anx‑ iety and depression is very strongly correlated with increased sense of guilt, low self-esteem and hopelessness, which significantly contributes to worse social functioning. The sense of coherence (SOC is a factor which influences the ability to cope with stress and is inseparably related with health. A high level of SOC makes people more self-confi‑ dent and gives them strength to fight with the disease. Aim: Defining the correlation between the level of the sense of coherence and the level of depression in people treated for anxiety disorders, as a determinant having an influence on maintaining the optimal health. Material and methods: The research was carried out among 96 patients treated in the Anxiety and Affective Disorders Ward in Bydgoszcz. The sense of coherence was assessed using Antonovsky’s Orientation to Life Questionnaire (SOC-29 and the level of depression was assessed using the Beck Depression Inventory. Results: People suffering from anxiety disorders have a low level of the sense of coherence and a high level of depression. A strong negative correlation was found between the level of the sense of coherence and the level of depression: with a lower level of the sense of coherence the level of depression grows and vice versa. Conclusions: The obtained results may significantly affect the level of understanding and accepting the people with anxiety disor‑ ders. Determining the level of the sense of coherence and the level of depression may have a significant impact on therapy and may be used as a determinant in prediction and planning of the care for the patient.

  8. Depression and creativity - the case of the German poet, scientist and statesman J. W. v. Goethe.

    Science.gov (United States)

    Holm-Hadulla, Rainer M; Roussel, Martin; Hofmann, Frank-Hagen

    2010-12-01

    Goethe was one of the most creative poets, scientists and statesmen ever existing. Since the age of fourteen, he suffered from severe mood swings. His descriptions of feelings, emotions, and mental states related to temperamental and poetic melancholy, depressive episodes, dysthymic phases, and creativity are unique in respect to their phenomenological precision and richness. Furthermore, his (self-) therapeutic strategies and his self transformation in literature remain interesting until today for psychopathology, psychotherapy and creativity research. Goethe's self-assessments in his works and letters as well as the description of him by others are analysed by phenomenological and hermeneutic methods from the perspective of current psychiatric classification and psychotherapeutic knowledge. From a modern scientific perspective Goethe's mood swings are not to be regarded as expressions of a "poet's melancholy" in fashion at his time but as symptoms of depressive episodes. Several distinctive depressive episodes can be diagnosed which were characterized by long lasting depressive mood, lack of drive, interests and self-esteem combined with social retreat and physical illness. Moreover, Goethe described a mood disorder which fits into the modern concept of "driven dysthymia" or Bipolar II disorder. Goethe's depressive moods were associated with eminent poetic creativity whereas in times of scientific and political productivity Goethe seemed to be protected against depressive episodes. Phenomenological and hermeneutic analysis cannot offer causal explanations but only reasons for understanding and communicative action. In Goethe's life poetic incubation, illumination and elaboration seemed to be associated with psychic labilisation and dysthymia, sometimes with depressive episodes in a clinical sense. Thus, creative work was on the one hand triggered by depressive and dysthymic moods and served on the other hand to cope with depressive moods as well as with suicidal

  9. Management of intracranial pathology during pregnancy: Case example and review of management strategies

    Directory of Open Access Journals (Sweden)

    Vijay M Ravindra

    2015-01-01

    Conclusions:Pregnancy presents a challenge for any patient requiring neurosurgical intervention. We present an interesting case example with a rare central nervous system neoplasm and discuss the management of intracranial pathology in pregnant patients.

  10. Community matrons and case managers: who are they?

    Science.gov (United States)

    Lillyman, Sue; Saxon, Ann; Treml, Helen

    2009-02-01

    In 2005 John Reid, the then Secretary of Health, announced the need for 3?000 community matrons to be appointed to coordinate the care of the growing numbers of people living with long term conditions. Although by the date agreed there were only 1?348 in post, according to Snow (2007), some PCTs have decided not to recruit further community matrons. Following the first evaluations of the role there also appears to be some confusion as to the title used by professionals who case manage this client group. The title of community matron has been used interchangeably with case manager, and therefore requires some clarification. This paper attempts to review the role of community matron and case manager, identify the professionals who take up these posts, and the professional qualifications and preparation required for the roles.

  11. Essential case management services for young children in foster care.

    Science.gov (United States)

    Zlotnick, C; Kronstadt, D; Klee, L

    1999-10-01

    A growing number of children in the United States are being placed into foster care. Past studies indicate that effective case manager interventions have helped foster families with a variety of different problems. This study enrolled a randomly selected sample of 130 children under age four who had been newly placed into foster care. The purpose of this study was to identify the services needed by foster care families and determine which services require the most case manager effort. Consistent with other research, many foster care children in this study exhibited developmental, medical and psychosocial concerns. Nevertheless, we found that it was services aimed at the foster care parents, rather than the foster care children, that required the most labor-intensive case management services.

  12. Social Customer Relationship Management: A Case Study

    Directory of Open Access Journals (Sweden)

    Paliouras Konstantinos

    2017-06-01

    Full Text Available Social Customer Relationships Management (CRM is a current business trend providing new channels of two-way communication with customers through social media sites, such as Facebook, Twitter etc. Social CRM enables companies to interact in an easy and contemporary way directly with customers as well as to track customer interactions and their social influence. In this paper we examine the importance of CRM, e-CRM and Social CRM for businesses. We provide perspectives on objectives and types of CRM, the working cycle of CRM, the stages of a CRM Strategy and technology tools that are used in CRM. Social CRM is in particularly analyzed, since this new trend requires active engagement by customers and other stakeholders. The engagement process is essential to successful Social CRM and to successful social business practices. Finally, we describe experiences from three family businesses that introduced Social CRM as a result of a project carried out as an assignment in the ‘Social Media Networking’ module of the MSc course in ‘Web Intelligence’ at the Department of Informatics of Alexander Technological Educational Institute of Thessaloniki. The assignment of the groups was to create a Social CRM Strategy in collaboration with a company. This study is a follow-up of the outcome of the projects carried out in the autumn semester 2014 and 2015. The results show that all three companies consider that Social CRM is an excellent tool for obtaining real time valuable data about customers and a cheap way to reach them.

  13. THE IMPACT OF MINING ACTIVITIES ON THE WEST OF PETROŞANI DEPRESSION AND IDENTIFICATION OF AFFECTED GEOMORPHOLOGICAL RESOURCES. CASE STUDY: ANINOASA-VULCAN-LUPENI SECTOR

    Directory of Open Access Journals (Sweden)

    N. NIMARĂ

    2015-10-01

    Full Text Available The Impact of Mining Activities on the West of Petroşani Depression and Identification of Affected Geomorphological Resources. Case Study: Aninoasa- Vulcan-Lupeni Sector. The west region of Petroşani Depression, like the whole depression, suffered some changes in the geomorphologic environment as a result of coal mining activities. Following displacement processes of mass materials and relocation of it, changes in shape are brought to the original territory that contrast with the natural landscape. The human impact on the West of Petroşani Depression and hence to the analyzed sector is especially highlighted as it materializes into waste dumps and coal pits.

  14. Management's role in customer satisfaction. Case company X

    OpenAIRE

    Parviainen, Nelli

    2016-01-01

    The purpose of this study was to identify the aspects affecting customer satisfaction and to find out how the management can improve customer service. The purpose was to give guidelines to the case company of how to improve customer service and thus gain competitive advantage over competitors. The data to this study was gathered from various online sources and literature. The core theories and concepts were CRM, creating customer satisfaction, managing employees and complaint handling pro...

  15. Combining Collaborative Networks and Knowledge Management: The SENAI Case

    OpenAIRE

    Vallejos, Rolando,; Oliveira Gomes, Jefferson,; Lima, Celson; Nesello, Priscila

    2014-01-01

    Part 19: Knowledge Management in Networks; International audience; This work describes a practical case combining collaborative networks and knowledge management, at SENAI environment. SENAI was founded in 1942 to support the Brazilian industry through professional and technological education, and services. In 2011 SENAI started implementing a national program targeting the industrial competitiveness all over the country. Such an ambitious program relies upon several key elements and this wor...

  16. Nonsurgical management of two unusual cases of dens in dente

    Directory of Open Access Journals (Sweden)

    Gupta R

    2005-01-01

    Full Text Available The management of two unusual cases of dens invaginatus in a maxillary and a mandibular lateral incisor with a periradicular lesion are reported. The patient presented with pain and localized swelling. Despite the complex anatomy and diagnosis of dens invaginatus, nonsurgical root canal treatment was performed successfully. Furthermore essential clinical considerations and treatment options are suggested. Early diagnosis and management are important to avoid complications.

  17. Process management in healthcare.Sant Camil Hospital case study

    OpenAIRE

    Sánchez Ruiz, Lidia; Blanco Rojo, Beatriz; Simón, Rosa María

    2013-01-01

    Nowadays due to the crisis, some government measures are aimed at reducing healthcare spending, affecting in some level or another the quality offered. Process management is said to be a useful tool for reducing healthcare costs by improving management without any additional economic investment. That is doing more with the same resources and without reducing the quality offered. In this study an empirical case of a Catalan hospital is presented. Overall, the usefulness of process managemen...

  18. MANAGEMENT OF LARGE AMELOBLASTOMA: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Rudagi B M

    2010-03-01

    Full Text Available Ameloblastoma, first recognized by Cusack in 1827, is a neoplasm of odontogenic epithelium, especially of enamel organ-type tissue that has not undergone differentiation to the point of hard tissue formation. It accounts for about 1% of all oral tumors and about 9-11% of odontogenic tumors. Ameloblastoma in the mandible can progress to a great size and cause facial asymmetry, displacement of teeth, malocclusion, and pathologic fractures. A case of large ameloblastoma of mandible in a 39 year old male patient is being reported. Patient had large swelling on left lower side of the jaw since 2 years. Swelling was approximately 15 X 10cm in size. Intraorally the swelling involved buccal and lingual cortical plates and was obliterating the vestibular space. Patient did not seek medical attention because swelling was painless. The patient was investigated and treated with surgical excision and was providedwith prosthesis to correct the post operative sequale. The patient showed uneventful recovery with no recurrence after a follow up of one year.

  19. Hepatic hydatid cyst, laparoscopic management. Case report

    Directory of Open Access Journals (Sweden)

    Robert William Campos-Guzmán

    2015-12-01

    Full Text Available We report a case of male patient of 32 years old; with a history of thoracic surgery for hydatid cyst at 9 years of age; admission was at the general surgery Service of the Hospital II Lima Norte Callao Luis Negreiros Vega, with a history of illness of 1 year, referring abdominal pain oppressive predominance of the upper abdomen, especially on right upper quadrant. Refers concomitantly history of previous surgery in thoracic region and positive epidemiological history. After clinical evaluation by the staff of surgery, outpatient clinic and the observation and reporting of CT in which well-defined lesions in segment IV and V multicystic appearance and lesser sac showing peripheral enhancement it is observed after administration contrast; associated with positive Western Blot, surgical treatment is decided. Laparoscopic Surgery was performed consisting of cyst aspiration drainage and washing the interior with hipersodio (20% ClNa and placement of laminar drain was done. Presented a postoperative biliary fistula that was resolved in five weeks, beginning of oral tolerance on the first postoperative day and liver function controls within normal ranges discharge was performed four days after surgery.

  20. Diagnosing postpartum depression in a mother of developmentally delayed infant: a case report

    Directory of Open Access Journals (Sweden)

    Genco Usta

    2015-12-01

    Full Text Available Postpartum depression is the most common clinical entity of childbirth. Although there are conflicting results about the influence of postpartum depression on the children, the consequences of the illness might extend to preschool age or further. Because physicians encounter mothers at the same time with the babies in the examination room, it might be of particular importance to have the knowledge of symptoms of maternal depression and pay attention to the mental and physical well-being of both the mother and the baby. In this article we would like to present an 18 month old child who presented with psychomotor retardation with a mother diagnosed as postpartum depression. [Int J Reprod Contracept Obstet Gynecol 2015; 4(6.000: 2056-2058

  1. Milnacipran in panic disorder with agoraphobia and major depressive disorder: a case report.

    Science.gov (United States)

    Chen, Mu-Hong; Liou, Ying-Jay

    2011-01-01

    A 51-year-old woman had panic disorder with agoraphobia and major depressive disorder sequentially. The aforementioned symptoms subsided significantly after treatment with milnacipran, 125 mg, administered daily for 2 months. However, panic attacks with agoraphobia were noted frequently when she tapered down milnacipran to 50 mg daily. She consequently experienced depression that gradually increased in degree, with poor energy, poor sleep, thoughts of helplessness, and ideas of death. After administration of a daily dose of 125 mg of milnacipran for 1 month, her panic attacks with agoraphobia and depressed mood were again alleviated. The present report shows significant effects of milnacipran on the comorbidity of panic disorder with agoraphobia and major depressive disorder.

  2. Introducing a nursing guideline on depression in dementia: A multiple case study on influencing factors

    NARCIS (Netherlands)

    Jessika Ouwerkerk; Anneke Francke; prof Berno van Meijel; Miel Ribbe; Josien Bensing; Renate Verkaik

    2011-01-01

    Successfully introducing care innovations depends on the type of care setting, the intervention and specific circumstances. In this study the factors influencing the introduction of an evidence based nursing guideline on depression in psychogeriatric nursing home residents were studied.

  3. Introducing a nursing guideline on depression in dementia: A multiple case study on influencing factors

    NARCIS (Netherlands)

    Verkaik, Renate; Francke, Anneke; Meijel, Berno van; Ouwerkerk, Jessika; Ribbe, Miel; Bensing, Josien

    2011-01-01

    Successfully introducing care innovations depends on the type of care setting, the intervention and specific circumstances. In this study the factors influencing the introduction of an evidence based nursing guideline on depression in psychogeriatric nursing home residents were studied.

  4. [Case management. The nursing business of care or cost].

    Science.gov (United States)

    Sandhu, B K; Duquette, A; Kérouac, S; Rouillier, L

    1992-01-01

    Less money spent on health services, cost-effectiveness, better productivity and more efficiency are some of the driving forces of contemporary "neo-liberalism" and political trends. How can nursing services and the profession's human values adapt in this difficult context? The authors describe the newest modality of patient care delivery system: nursing case management. They examine the factors and assumptions that led up to its development and point out the validity of asking some serious questions before embarking on the euphoria of case management.

  5. Managing radical innovation: The case of the Home Communication Concept

    DEFF Research Database (Denmark)

    Madsen, Arne Stjernholm; Ulhøi, John Parm

    2002-01-01

    This case addresses the Home Communication Concept (HCC) and represents the response of a major ICT manufacturer to the reshaping of the telecom market, paved by Internet technology. The project is described from its start in summer 1997 to the end of 2001. This is a unique case study in more than...... of management during disruptive technological development, but also illustrates the internal problem of allowing a creative BDD to become "sectarian," i.e. blindly believing in itself and suspicious of the rest of the world. Using the framework presented in this paper, several fundamental concerns regarding...... existing research are identified and discussed. In closing, implications for research and management are addressed....

  6. Care for the case manager: balancing your wheel of life.

    Science.gov (United States)

    Crowell, D M

    1998-01-01

    The case manager's role in our complex health care system is demanding and draining without some self-reflective attention. The Wheel of Life is a key tool for individuals to assess how well they are leading a fully balanced life. The eight aspects of a balanced life--values, self-care, work, relationships, leisure, relaxation, exercise, and centering--are explained and discussed. A self-reflective activity is presented that encourages readers to assess their current life balance. This focused clarification of personal and professional life will facilitate a more fully balanced life with rewards for case managers as individuals, and for their family, clients, and the health care organization.

  7. Lifestyle medicine for depression.

    Science.gov (United States)

    Sarris, Jerome; O'Neil, Adrienne; Coulson, Carolyn E; Schweitzer, Isaac; Berk, Michael

    2014-04-10

    The prevalence of depression appears to have increased over the past three decades. While this may be an artefact of diagnostic practices, it is likely that there are factors about modernity that are contributing to this rise. There is now compelling evidence that a range of lifestyle factors are involved in the pathogenesis of depression. Many of these factors can potentially be modified, yet they receive little consideration in the contemporary treatment of depression, where medication and psychological intervention remain the first line treatments. "Lifestyle Medicine" provides a nexus between public health promotion and clinical treatments, involving the application of environmental, behavioural, and psychological principles to enhance physical and mental wellbeing. This may also provide opportunities for general health promotion and potential prevention of depression. In this paper we provide a narrative discussion of the major components of Lifestyle Medicine, consisting of the evidence-based adoption of physical activity or exercise, dietary modification, adequate relaxation/sleep and social interaction, use of mindfulness-based meditation techniques, and the reduction of recreational substances such as nicotine, drugs, and alcohol. We also discuss other potential lifestyle factors that have a more nascent evidence base, such as environmental issues (e.g. urbanisation, and exposure to air, water, noise, and chemical pollution), and the increasing human interface with technology. Clinical considerations are also outlined. While data supports that some of these individual elements are modifiers of overall mental health, and in many cases depression, rigorous research needs to address the long-term application of Lifestyle Medicine for depression prevention and management. Critically, studies exploring lifestyle modification involving multiple lifestyle elements are needed. While the judicious use of medication and psychological techniques are still advocated

  8. Magazine Publishing Innovation: Two Case Studies on Managing Creativity

    Directory of Open Access Journals (Sweden)

    Simon Das

    2016-06-01

    Full Text Available This paper aims to highlight a link between publishing business innovation and how editors manage creativity in the digital era. Examining the changing industrial and historical business context for the U.K. magazine publishing industry, two case studies are analyzed as representatives of different ends of the publishing company spectrum (one a newly launched magazine published by a major, the other an independent ‘magazine’ website start-up. Qualitative data analysis on publishing innovation and managing creativity is presented as a springboard for further research on magazine media management.

  9. Risk Management from Corporate and FM Perspectives: Two case studies

    DEFF Research Database (Denmark)

    2012-01-01

    Purpose: To investigate how Risk Management (RM) is perceived and practiced in Facilities Management (FM) and corporate management and to evaluate the potential benefits of an increased application. Theory: RM is a generic management discipline, but apparently it has not achieved the attention...... it deserves in FM. Application of RM in FM could help to increase the strategic importance and awareness of FM among corporate managers. Approach: A preliminary study with expert interviews was initially conducted followed by a main study with an interview survey in two Danish case companies - a real estate...... company and a consulting engineering company. Findings: The research showed that RM was applied in both companies to a higher degree than initially expected, but often using other terminology. The real estate company had a much stronger focus on RM in relation to the technical aspects of real estate...

  10. Congenital depressed skull fracture in the absence of trauma: case report and literature review

    Directory of Open Access Journals (Sweden)

    Tovar-Spinoza ZS

    2012-02-01

    Full Text Available Zulma S Tovar-Spinoza, Peter D KimDepartment of Neurosurgery, SUNY Upstate Medical University, Syracuse NYAbstract: There are limited reports of neonatal depressed skull fractures in the absence of any known trauma or obvious risk factors. Here we describe a male neonate with a significant frontal nontraumatic depressed fracture, his course of treatment, and a literature review. A male neonate was attended for a significant congenital depressed skull fracture in the left frontal bone. He was born full term after an uncomplicated delivery to a multiparous mother who was a human immunodeficiency syndrome (HIV-positive immigrant from sub-Saharan Africa. The pregnancy was otherwise uncomplicated. There was no history of trauma to the mother during the pregnancy or delivery. Ultrasonography had been unremarkable. No other abnormalities were noted. The patient was brought to the operating room at the age of 13 days for elevation of his fracture due to its nonreducible nature. A small linear incision was made just posterior to the coronal suture. The dura mater was stripped and a combination of Penfield and periostial elevators was used to elevate the depressed fracture. Nontraumatic depressed skull fractures are uncommon in neonates. The cause of this entity has not been identified, and many theories about its origin have been proposed. Treatment can be either surgical or conservative.Keywords: neonatal, congenital, depressed fracture, spontaneous, nontraumatic

  11. Assessing infant suck dysfunction: case management.

    Science.gov (United States)

    Marmet, C; Shell, E; Aldana, S

    2000-11-01

    Based on this more thorough assessment, the lactation consultant may be able to identify all of the factors contributing to this complex case. In some situations, her skilled interventions will suffice once the underlying problem is addressed. Occasionally, she will identify a factor that falls outside of her area of expertise; when this happens, she must make the appropriate referrals. For example, a referral to a physician for a frenotomy or suspected neurological or other medical problem is appropriate. It is clear that because Baby E's problems were not resolved after 6 weeks of concerned effort, something was missed. It would certainly be appropriate for the lactation consultant to refer the dyad to another lactation consultant who has more expertise in handling clinically challenging breastfeeding problems. If possible, the referring lactation consultant should accompany the dyad so that she can improve her clinical skills. Assuming Baby E does not have underlying medical problems, the most likely causes of Baby E's difficulties are anatomical variation and/or sucking dysfunction. Because the baby is so fussy, it also would be wise to consider the possibility of allergies or food tolerance. Our first rule is " Feed the baby." The second rule is " Correct or work on correcting the problem or problems." Our goal is to achieve exclusive breastfeeding or as close an approximation as possible. We almost never give up on this goal, but we do educate the mother and work professionally with her choices. Until the baby is breastfeeding well, the lactation consultant will probably need to instruct the mother to continue using a pump ( preferably a hospital-grade, electric, bilateral pump). The mother should use the pump physiologically, pumping as many times a day as the baby would breastfeed. As soon as the situation improves, the mother should be instructed to wean gradually from the pump and any other breastfeeding equipment she is using. The goal should always be

  12. Student Affairs Case Management: Merging Social Work Theory with Student Affairs Practice

    Science.gov (United States)

    Adams, Sharrika D.; Hazelwood, Sherry; Hayden, Bruce

    2014-01-01

    Case management is a functional area in higher education and student affairs that emerged after the mass shootings at Virginia Tech in 2007. Although new to higher education, case management emerged from established social work practice. This article compares social work theory and case management standards with a new case management model for…

  13. [Rare side effects in management of hyperthyroidism. Case report].

    Science.gov (United States)

    Sohár, Gábor; Kovács, Mónika; Györkös, Andrea; Gasztonyi, Beáta

    2016-05-29

    The authors present the case history of a patient suffering from hyperthyroidism. The diagnostic procedures revealed the presence of propylthiouracyl induced vasculitis with renal involvement, that recovered completely after the withdrawal of propylthiouracyl and corticosteroid treatment. Thereafter, the patient was treated with thiamasol, that caused agranulocytosis with fever. After transient litium carbonate therapy a succesful thyreoidectomy was performed. Cumulative serious side effects of antithyroid drugs are rare. This case highlights some of the challenges and complications encountered in the management of hyperthyroidism.

  14. Epidermolysis bullosa: dental and anesthetic management of two cases.

    Science.gov (United States)

    Wright, J T

    1984-02-01

    Epidermolysis bullosa (EB) is a group of rare genetic disorders which are of dental interest because of their specific oral manifestations and management difficulties. Two cases of recessive EB which may be classified clinically as the atrophicans-gravis Herlitz type are described. Dental therapy consisted of extractions and stainless steel crown restorations, with inhalation general anesthesia. The need for and advantages of early preventive and restorative dental care are illustrated by the cases presented.

  15. Depression with psychotic features in a child with SLE: successful therapy with psychotropic medications--case report.

    Science.gov (United States)

    Milovancevic, Milica Pejovic; Miletic, Vladimir; Deusic, Smiljka Popovic; Gajic, Saveta Draganic; Tosevski, Dusica Lecic

    2013-04-01

    Systemic lupus erythematosus (SLE) is a multisystemic, autoimmune disease of unknown etiology, which affects multiple organ systems, including the central nervous system (CNS). Neuropsychiatric manifestations are seen in 13-75% of all SLE patients, with equal frequency in children and adults. Despite a high prevalence of psychiatric manifestations, there is no consensus on the proper treatment of such cases. We report here a case of an 11-year-old girl diagnosed with a severe depressive episode with psychotic features, treated successfully with risperidone and sertraline as an adjunct to immunosuppressive therapy.

  16. Depression (Major Depressive Disorder)

    Science.gov (United States)

    ... generally miserable or unhappy without really knowing why. Depression symptoms in children and teens Common signs and ... in normal activities, and avoidance of social interaction. Depression symptoms in older adults Depression is not a ...

  17. Responding to the Increased Needs of College Students: A Case Study of Case Management

    Science.gov (United States)

    Shelesky, Kristin; Weatherford, Ryan D.; Silbert, Janelle

    2016-01-01

    The psychological needs of college students lead to overwhelming demand on college counseling centers' resources. In this article, we review models of case management in Higher Education including the administrative, behavioral intervention, and counseling center models. We also present a case study of the 3-year development of a counseling center…

  18. Case I: Managing People--The Case of the Frustrated Faculty Member.

    Science.gov (United States)

    Glickman, Gerald N.; Comer, Robert W.; Filler, Steven J.; Fine, James Burke

    2002-01-01

    Presents an overview of some critical theories in human relations management. Offers a hypothetical case, drawn from a faculty development workshop, involving a dental school faculty member and her dean, for discussion and application of principles. Finally, presents the central issues of the case along with a review of relevant management…

  19. Case I: Managing People--The Case of the Frustrated Faculty Member.

    Science.gov (United States)

    Glickman, Gerald N.; Comer, Robert W.; Filler, Steven J.; Fine, James Burke

    2002-01-01

    Presents an overview of some critical theories in human relations management. Offers a hypothetical case, drawn from a faculty development workshop, involving a dental school faculty member and her dean, for discussion and application of principles. Finally, presents the central issues of the case along with a review of relevant management…

  20. Transcranial direct current stimulation for the treatment of post-stroke depression in aphasic patients: a case series.

    Science.gov (United States)

    Valiengo, Leandro; Casati, Roberta; Bolognini, Nadia; Lotufo, Paulo A; Benseñor, Isabela M; Goulart, Alessandra C; Brunoni, André R

    2016-01-01

    Aphasia is a common consequence of stroke; it is estimated that about two-thirds of aphasic patients will develop depression in the first year after the stroke. Treatment of post-stroke depression (PSD) is challenging due to the adverse effects of pharmacotherapy and difficulties in evaluating clinical outcomes, including aphasia. Transcranial direct current stimulation (tDCS) is a novel treatment that may improve clinical outcomes in the traditionally pharmacotherapy-refractory PSD. Our aim was to evaluate the safety and efficacy of tDCS for patients with PSD and with aphasia. The Stroke Aphasic Depression Questionnaire (SADQ) and the Aphasic Depression Rating Scale (ADRS) were used to evaluate the severity of PSD. The diagnoses of PSD and aphasia were confirmed by a psychiatrist and a speech-language pathologist, respectively. In this open case series, patients (n = 4) received 10 sessions (once a day) of bilateral tDCS to the dorsolateral prefrontal cortex (DLPFC) and two additional sessions after two and four weeks, for a total of 12 sessions. All patients exhibited improvement in depression after tDCS, as indicated by a decrease in SADQ (47.5%) and in ADRS (65.7%). This improvement was maintained four weeks after the treatment. In this preliminary, open-label study conducted in four PSD patients with aphasia, bilateral tDCS over the DLPFC was shown to induce a substantial mood improvement; tDCS was safe and well tolerated by every patient. Stroke patients with aphasia can be safely treated for PSD with tDCS. Sham-controlled studies are necessary to evaluate this technique further.

  1. Case III: Managing conflict--the case of the faculty stuck in the middle.

    Science.gov (United States)

    Trombly, Robert M; Comer, Robert W; Villamil, Juanita E

    2002-04-01

    The need for administrative faculty members to have superior leadership and management skills to handle their increasingly complex responsibilities is well established. As a part of the 2000-01 ADEA Leadership Institute curriculum, fellows were responsible for developing situational case studies for a faculty development workshop to develop participants' leadership and management skills. The case presented here involved managing conflicts in the dental academic setting. The foundation of conflict management centers on communication techniques including transparent communication, open discussion, open confrontation, and active listening. Management options such as avoidance, accommodation, competition, negotiation, and collaboration are potential strategies for the faculty leader. This case study involves a fictitious public dental school, New Horizons University, which has embarked on solutions to address limited resources, but unwittingly has created conflicts between individuals and groups of faculty members. The case discussion analyzes the cause of conflicts, presents the positive and negative potential of the conflicts, reviews techniques of conflict management, and discusses specific management concepts regarding resource allocation and equity theory.

  2. Implementation of Risk Management in Malaysian Construction Industry: Case Studies

    Directory of Open Access Journals (Sweden)

    Hamzah Abdul-Rahman

    2015-01-01

    Full Text Available Construction industries are exposed to wide array of risks, such as financial, design, and contractual ones, which might have a direct impact on their performance toward achieving the desired objectives. Risk Management is a proactive decision-making process used to minimize and manage the risks in the most efficient and appropriate manner. However, most construction firms in Malaysia do not apply formal risk management in their projects. Thus, this study aims to identify the actual process of risk management that is being applied in the construction projects and to determine the effects of risk management implementation on the performance of the construction projects in terms of time and cost. The data were obtained from four case studies in Kuala Lumpur, Malaysia, through semistructured interviews. It was found that the implementation of risk management process in Malaysian construction industry is still at a low level, mainly due to the fact that most of the construction employees involved in risk management are not fully aware of the available risk management techniques that can be applied in construction projects.

  3. The Scanfin Merger: Managing Organisational Change (Case C)

    DEFF Research Database (Denmark)

    Smith, Pernille; Carugati, Andrea; Giangreco, Antonio

    the integration process of the merger. The main issue is how a middle manager constitutes an obstacle to this organisational change by re-inforcing the 'old' ways of working in his group. To solve this case satisfactorily students should be able to see the organisation from several different layers (employee...

  4. Multidisciplinary conservative management in classical Volkmann's contracture: A case report

    NARCIS (Netherlands)

    Reinders, M.F.; Geertzen, J.H.B.; Eisma, W.H.

    1996-01-01

    This clinical note describes the case of a nine-year-old girl with classical Volkmann's contracture of the left forearm. The report demonstrates the results and follow-up of conservative orthotic management used as a mode of treatment by a multidisciplinary team. When using an orthosis it is

  5. Magic from Social Networks that Talk to Management: Four Cases

    Science.gov (United States)

    Sugarman, Barry

    2010-01-01

    Purpose: The purpose of this paper is to understand how social networks can help to produce the "magic" of extraordinary results for organizations. Design/methodology/approach: In this exploratory study four cases (from published reports) are compared in order to illustrate different management approaches to utilizing the power of networks.…

  6. Establishing Classroom Management for Cooperative Learning: Three Cases

    Science.gov (United States)

    Emmer, Edmund T.; Gerwels, Mary Claire

    2005-01-01

    The purpose of this study was to identify how effective teachers manage productive groups in elementary grade classrooms. Multiple instrumental case study methods were used to document the managerial actions of selected teachers who made extensive use of cooperative learning (CL) activities. Four teachers in three elementary grade classrooms (two…

  7. School Asthma Screening and Case Management: Attendance and Learning Outcomes

    Science.gov (United States)

    Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.

    2013-01-01

    Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…

  8. Managing Educational Change: A Case of Two Leadership Approaches

    Science.gov (United States)

    Chow, Alice

    2013-01-01

    This article reports a case study that investigated the ways in which heads of subject departments managed the development and application of new assessment strategies in one secondary school in Hong Kong. The data of the study were gathered through participant observation and interviews with 12 teachers who participated in an assessment for…

  9. Case management: key to access, quality, and financial success.

    Science.gov (United States)

    Smith, Alison P

    2003-01-01

    Several strategic, organizational, and operational variables drive successful case management programs. Organizational goals and accountability for support by administrative and medical staff leaders set the stage for a comprehensive program. The integration of utilization review, discharge planning, and other functions into the role of the case manager improves productivity and continuity. Choosing a model for assigning patients, a variable unique to the institution, should be carefully considered. Regardless of the power of strategic goals or the creative selection of a model, daily practices that promote daily review and communication will reveal all of the opportunities for improved performance. Complications are avoided one patient at a time and patients deserve vigilance. Length of stay is shortened 1 day at a time and we can no longer afford to miss these opportunities. In the period of high census, an unnecessary day for one patient at the end of his/her stay may mean another patient being diverted to another hospital away from his/her physician and past medical records. Creating constructive physician partnerships and cooperative relationships with postacute care providers can bring a case management program to higher level of performance. While many organizations have employees called "case managers," fewer have a comprehensive approach that has the potential to drive so many important indicators of performance.

  10. Sigmoid volvulus: A pediatric case report and review of management

    Directory of Open Access Journals (Sweden)

    Lena M. O'Keefe

    2016-04-01

    Full Text Available Volvulus in the pediatric population commonly occurs in the small bowel associated with malrotation or internal hernia whereas sigmoid volvulus (SV is extremely rare. Herein we report a case of SV, review the literature and provide a suggested algorithm for diagnosis and management.

  11. Dynamic Condition Response Graphs for Trustworthy Adaptive Case Management

    DEFF Research Database (Denmark)

    Mukkamala, Raghava Rao; Hildebrandt, Thomas; Slaats, Tijs

    2013-01-01

    By trustworthy adaptive case management we mean that it should be possible to adapt processes and goals at runtime while guaranteeing that no deadlocks and livelocks are introduced. We propose to support this by applying a formal declarative process model, DCR Graphs, and exemplify its operational...

  12. Management Science in Higher Education Institutions: Case Studies from Greece

    Science.gov (United States)

    Saiti, Anna

    2010-01-01

    Regardless of the source of funding, university quality is based on knowledge, teaching, and research, and hence cannot be run like private enterprises as they are expert organisations that provide solely a public service. The purpose of this paper is to investigate, through the analysis of case studies, whether or not management theory,…

  13. School Asthma Screening and Case Management: Attendance and Learning Outcomes

    Science.gov (United States)

    Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.

    2013-01-01

    Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…

  14. Case study: Industrial Portfolio Management for New Products

    DEFF Research Database (Denmark)

    Larsson, Flemming

    This report describes the content of a case-study, which was carried out in a Scandinavian company. The purpose of the study is to identify and indicate the current company approach to portfolio management (tools, methods, and processes) for new products combined with suggestions for improvement...

  15. The evolution of Banner health's case management program.

    Science.gov (United States)

    Stutz, Linda

    2013-01-01

    The evolution of case management programs continues as health care systems adapt to the requirements and provisions under the Patient Protection and Affordable Care Act. One such provision establishes a new category of health care provider-the accountable care organization. These organizations provide a form of coordinated health care delivery. The successful integration of an accountable care organization, along with a better coordinated, higher quality case management care model, will provide better access to health care, improved care transitions and safety for the patients, and lower costs to the health system. Acute-care hospitals; ambulatory care centers; and primary care physician practices. A successful implementation of this type of case management model requires systematic changes to technological and organizational structures. The stewards of the case management model must be proactive in garnering and maintaining executive and financial support. y designing an electronic documentation system with one work flow and a standard set of data definitions, health systems will be able to provide standardization and reduce variations of care. This type of standardization creates a central database for easy reporting and decision making.• Achieved successes, associated with improved clinical outcomes, can translate into considerable reductions in the controllable expenses for a health system.

  16. Chiropractic management of chronic idiopathic meralgia paresthetica: a case study.

    Science.gov (United States)

    Houle, Sébastien

    2012-03-01

    This report describes the case of a patient with chronic idiopathic meralgia paresthetica associated with bilateral sacroiliac joint dysfunction who was managed with chiropractic care. A 35-year-old white woman presented to a private chiropractic clinic with a complaint of numbness in the right anterolateral thigh region. Neurological assessment revealed a diminution of sensibility and discrimination on the right lateral femoral cutaneous nerve territory. Pain was rated as 8.5 on a numeric pain scale of 0 to 10. Musculoskeletal examination of the pelvic region disclosed bilateral sacroiliac joint dysfunction. Chiropractic management included pelvic mobilizations, myofascial therapy, transverse friction massage, and stretching exercises. After 3 visits (2 weeks later), result of neurological evaluation was normal, with no residual numbness over the lateral thigh. In the present case, chiropractic management with standard and applied kinesiology techniques resulted in recovery of meralgia paresthetica symptoms for this patient.

  17. Management of idiopathic pulmonary fibrosis: selected case reports

    Directory of Open Access Journals (Sweden)

    Michael Kreuter

    2014-06-01

    Full Text Available In 2011, revised international guidelines were issued jointly by the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society and the Latin American Thoracic Association, which provide a valuable framework for the diagnosis and management of idiopathic pulmonary fibrosis (IPF. However, due to the complexity of IPF, these guidelines may not comprehensively account for the management of individual IPF patients in clinical practice. We describe three patient cases that were presented and discussed during the 2013 AIR: Advancing IPF Research meeting in Nice, France. These cases highlight the heterogeneity in the presentation, history and clinical course of IPF, together with expert insights regarding the diagnosis and management of IPF in the real-life setting.

  18. A multifaceted education intervention for improving family physicians' case management.

    Science.gov (United States)

    Reyes-Morales, Hortensia; Flores-Hernández, Sergio; Tomé-Sandoval, Patricia; Pérez-Cuevas, Ricardo

    2009-04-01

    The Mexican Institute of Social Security (IMSS) is the largest public health care system in Mexico. IMSS family physicians' management of clinical problems is frequently not consistent with published evidence. This study aimed to evaluate the effects of a multifaceted educational intervention to improve management of acute respiratory infections (ARI) by IMSS family physicians. A non-randomized pre-post intervention with comparison group design was conducted in eight IMSS family medicine clinics in which 106 family physicians practiced. An evidence-based clinical guideline for ARI management was developed, and clinical tutors were trained. The three-stage intervention comprised interactive workshops, individual tutorials, and round-table peer-review sessions. The main outcome was appropriate ARI case management. The intervention effect was calculated by using the differences-in-differences model, adjusting for cluster of physicians. In the intervention group, the difference in mean proportion of improvement compared with baseline evaluation was 22.6% (95% confidence interval [CI]=10.3 to 34.9) for appropriate prescription of antibiotics, 29.8% (95% CI=17.2 to 42.4) for indication of worsening signs, and 19.6% (95% CI=11.2 to 28.0) for overall appropriate case management. The comparison group showed no significant changes. The educational intervention improved ARI management. Further studies are needed to analyze organizational implications, cost, sustainability, and effects on health outcomes.

  19. Body dysmorphic disorder and depression: phenomenological and psychotherapeutic aspects: a report of five cases.

    Science.gov (United States)

    Schmoll, Dirk

    2011-01-01

    Body dysmorphic disorder (BDD) is a hard-to-treat disorder that often coincides with depression and suicidal tendency. We investigate the correlations between depression and BDD in an idiographic study of 5 patients receiving treatment in the psychiatric ward of a general hospital in 2008. Among these patients we found common triggering factors - mainly separation - that were associated with humiliation, childhood stresses, worries in regard to attractiveness and masculinity, and personality structures showing dependent-avoidant, self-insecure and sensitive traits, as described by Kretschmer. It transpired that their BDD had developed out of a self-aggravating cycle of shame, controlling actions, alienation and self-disempowerment. After a certain period their self-disempowerment then gradually transforms into a depressive cycle of despair, increased withdrawal, inward-directed anger and self-depreciation. These correlations indicate that the depressive symptomatology among these patients can be better classified as adjustment disorder in regard to their BDD than as independent major depression. Finally, we present dance/movement therapy as a promising additional psychotherapeutic approach that can complement the recognized therapy forms (serotonin re-uptake inhibitors and cognitive behavioral therapy).

  20. The influence of depression on personality traits in patients with fibromyalgia: a case-control study.

    Science.gov (United States)

    Santos, Daniela M; Lage, Laís V; Jabur, Eleonora K; Kaziyama, Helena H S; Iosifescu, Dan V; De Lucia, Mara Cristina S; Fráguas, Renério

    2017-01-01

    We developed this study to investigate the association of fibromyalgia with personality traits, controlling for depression and other potential confounders. We assessed personality traits using the Cloninger's Temperament and Character Inventory (TCI) in 78 female patients with fibromyalgia and in a control group of 78 subjects without fibromyalgia. The Mini-International Neuropsychiatric Interview was used to assess depression and anxiety diagnoses. To investigate the association between fibromyalgia and the Cloninger's Temperament and Character Inventory we performed unadjusted and adjusted analyses of covariance, using the TCI score as dependent variable and adjusting the model for depression, anxiety and for clinical and socio-demographic variables. We used a backward selection method to choose the final model. In the unadjusted analysis, fibromyalgia was associated with all personality traits, except persistency. After adjusting for depression and anxiety, patients with fibromyalgia presented decreased novelty seeking compared to controls; the differences in other personality traits were no longer significant. Novelty seeking was also correlated with the length of history of fibromyalgia and pain intensity. Decreased novelty seeking may be a personality trait associated with fibromyalgia. Depression and anxiety should be considered potential confounders in the evaluation of personality traits in this population.

  1. Improvement of Depression after Treatment of Dural Arteriovenous Fistula: A Case Report and a Review

    Directory of Open Access Journals (Sweden)

    Minoru Nakagawa

    2012-01-01

    the treatment of a dural arteriovenous fistula in the left transverse-sigmoid sinus. A 46-year-old male had suffered from depression and was treated with antidepressants at a local hospital for four years. The patient was temporarily laid off due to his depression. Afterwards, he had Gerstmann's syndrome and came to our hospital. A DAVF in the left transverse-sigmoid sinus was demonstrated on the angiogram. The DAVF was successfully treated with endovascular surgery, coil embolization of the isolated diseased sinus through the mastoid emissary vein which was a draining vein from the fistula. After this treatment, his depression as well as Gerstmann's syndrome was improved and the quantity of the antidepressants decreased. The patient returned to work without any antidepressant two years after the treatment. DAVFs might be one of the causes of depression. It may be necessary to evaluate cerebral vessels in patients suffering from depression by using MRA or 3D-CTA even if there are not any abnormal findings on plain CT scans.

  2. A case study in treating chronic comorbid obsessive-compulsive disorder and depression with behavioral activation and pharmacotherapy.

    Science.gov (United States)

    Arco, Lucius

    2015-06-01

    Obsessive-compulsive disorder (OCD) is difficult to treat, and more so when comorbid with major depressive disorder (MDD). The aim of the present case study was to examine effects of behavioral activation (BA) and pharmacotherapy with an adult with chronic comorbid OCD and MDD. BA aimed at increasing approach behaviors in life activities and decreasing avoidant and inactive behaviors. After 21 months of treatment at a community mental health clinic, OCD and MDD symptoms, including compulsive checking behaviors, were no longer at clinical levels. Symptom alleviation and psychological health improved in line with increases in activities of living such as self-care, domestic, social, and studying, and decreases in medications from a regimen of mood stabilizers and anxiolytics to a sole antidepressant. The participant was satisfied with treatment procedures and outcome. The results add to growing evidence of effective BA treatments for comorbid disorders that include depression.

  3. Using a Data Mining Approach to Discover Behavior Correlates of Chronic Disease: A Case Study of Depression

    Science.gov (United States)

    YOON, Sunmoo; TAHA, Basirah; BAKKEN, Suzanne

    2015-01-01

    The purposes of this methodological paper are: 1) to describe data mining methods for building a classification model for a chronic disease using a U.S. behavior risk factor data set, and 2) to illustrate application of the methods using a case study of depressive disorder. Methods described include: 1) six steps of data mining to build a disease model using classification techniques, 2) an innovative approach to analyzing high-dimensionality data, and 3) a visualization strategy to communicate with clinicians who are unfamiliar with advanced statistics. Our application of data mining strategies identified childhood experience living with mentally ill and sexual abuse, and limited usual activity as the strongest correlates of depression among hundreds variables. The methods that we applied may be useful to others wishing to build a classification model from complex, large volume datasets for other health conditions. PMID:24943527

  4. Intranasal delivery of paroxetine nanoemulsion via the olfactory region for the management of depression: formulation, behavioural and biochemical estimation

    Science.gov (United States)

    Pandey, Yogendra Raj; Kumar, Shobhit; Gupta, Bijay Kumar; Ali, Javed; Baboota, Sanjula

    2016-01-01

    Paroxetine is a selective serotonin reuptake inhibitor (SSRI) and is used for the treatment of depression and anxiety problems, but suffers from the drawback of poor oral bioavailability (less than 50%) due to its extensive first pass metabolism. The objective of the present study was to develop a paroxetine loaded nanoemulsion (o/w type) for direct nose-to-brain delivery. Nanoemulsions were prepared by the spontaneous emulsification technique using Capmul MCM, Solutol HS 15 and propylene glycol as oil phase, surfactant and co-surfactant, respectively, for delivery of drug directly to the brain through the nasal route for better management of depression. Formulations were studied for droplet size, polydispersity index (PDI), percentage transmittance, refractive index, viscosity, zeta potential, surface morphology and in vitro permeation study. TEM images of optimized formulation showed spherical droplets with a mean diameter of 58.47 ± 3.02 nm, PDI of 0.339 ± 0.007 and zeta potential values of -33 mV. The formulation showed good results for transmittance (100.60 ± 0.577%), refractive index (1.412 ± 0.003) and viscosity (40.85 ± 6.40 cP). Permeation studies revealed a 2.57-fold enhancement in permeation as compared to the paroxetine suspension. Behavioural studies such as the forced swimming test and locomotor activity test were done on Wistar rats to study the antidepressant effect of the optimized formulation. Treatment of depressed rats with paroxetine nanoemulsion (administered intranasally) significantly improved the behavioural activities in comparison to paroxetine suspension (orally administered). Biochemical estimation results revealed that the prepared nanoemulsion was effective in enhancing the depressed levels of glutathione and decreasing the elevated levels of TBARS.

  5. Surviving shot through the heart: Management in two cases.

    Science.gov (United States)

    Siddiqui, Fraz Anwar; Kabeer, Jamal; Shahabuddin, Syed

    2015-01-01

    Penetrating cardiac injuries after gunshot are usually fatal and are very challenging to manage for surgeons even in fully- equipped centres. Such injuries can cause ventricular septal defect (VSD) or cardiac tamponade depending upon the distance, direction and velocity of the bullet. Stable patients can be subjected to investigations like computed tomography (CT) to avoid unnecessary intervention, but unstable patients should be rushed to the operating room. We discuss management in two cases of traversing bullet injury to the heart. In the first case, traumatic VSD was significant, requiring closure on cardiopulmonary bypass (CPB) along with repair of right and left ventricular injury. In the second case, only the repair of right and left ventricles was performed without CPB. They both had traversing bullet injury through the heart.

  6. Case Studies in Project, Program, and Organizational Project Management

    CERN Document Server

    Milosevic, Dragan Z; Srivannaboon, Sabin

    2011-01-01

    The ever expanding market need for information on how to apply project management principles and the PMBOK contents to day-to-day business situations has been met by our case studies book by Harold Kerzner.  That book was a spin-off from and ancillary to his best selling text but has gained a life of its own beyond adopters of that textbook.  All indications are that the market is hungry for more cases while our own need to expand the content we control, both in-print and online woudl benefit from such an expansion of project management "case content". 

  7. Prevalence, impact, and management of depression and anxiety in patients with Parkinson’s disease

    Directory of Open Access Journals (Sweden)

    Renfroe JB

    2016-04-01

    Full Text Available Jenna B Renfroe,1 Travis H Turner,2,3 Vanessa K Hinson1,4 1Department of Neurology, Medical University of South Carolina, Charleston, SC, USA; 2Mental Health Service, Ralph H. Johnson VA Medical Centre, Charleston, SC, USA; 3Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; 4Neurology Service, Ralph H. Johnson VA Medical Centre, Charleston, SC, USA Abstract: Individuals with Parkinson’s disease (PD exhibit higher rates of depression and anxiety than the general and other medically disabled populations. Evidence suggests that mood and anxiety symptoms are related to disease pathology. Rates of depression and anxiety in PD vary depending on how these symptoms are measured, but they are estimated to occur in up to 40% of patients. These conditions have adverse effects on patient and caregivers’ quality of life, level of disability, and mortality, with several studies suggesting greater contribution than motor symptom severity. Pharmacological and psychotherapeutic interventions, particularly in combination, have demonstrated efficacy in treating depression and anxiety in PD. However, additional randomized controlled trials are needed to better delineate when and how to best treat these disabling symptoms. Keywords: Parkinson’s disease, depression, anxiety, prevalence, treatment

  8. [An autopsy case of head injury with a manic-depressive states (author's transl)].

    Science.gov (United States)

    Deshimaru, M; Miyakawa, T; Suzuki, T

    1977-07-01

    M. M. a man aged 49. He suffered from a head injury at the aged of 41. At that time he lost consciousness for a few minutes and he was diagnosed as a consquassatio cerebri. The sequelaes of his head injury were a change of character and a disturbance of autonomic nerve function. The changes of character were decreased of activity, lie-down for all day, decrease of speech and depressive mode, and occasionally he was ill-humored, restless and irritative. Periodically he became euphoris, talkative and childisch. He had a disturbance of autonomic nerve function which became worse in parallel to the depressive states. We speculated that character changes, such as manic-depressive states and disturbances of autonomic nerve function were due to the bruising of the bilateral orbital surfaces of frontal lobes.

  9. The relation between anger management style and organ system-related somatic symptoms in patients with depressive disorders and somatoform disorders.

    Science.gov (United States)

    Koh, Kyung Bong; Park, Joong Kyu

    2008-02-29

    The objective of this study was to examine the relation between anger management style and organ system- related somatic symptoms in depressive disorder and somatoform disorder patients. The subjects included 73 patients with depressive disorders and 47 with somatoform disorders. Anger management styles were assessed by the Anger Expression Scale, while the severity of organ system-related somatic symptoms was evaluated using the Somatic Stress Response Scale (SSRS). The severity of depression and hostility was assessed by the Symptom Checklist-90-Revised (SCL-90-R) depression and hostility subscales. The results of multiple regression analyses showed that, in depressive disorder patients, the level of anger expression was significantly associated with the severity of somatic symptoms related to neuromuscular, cardiorespiratory and gastrointestinal systems. However, in these patients, the level of anger suppression was not significantly associated with the severity of somatic symptoms related to any specific organ systems. In patients with somatoform disorders, there was no significant association between the level of anger suppression or anger expression and the severity of the somatic symptoms related to any specific organ systems. These results suggest that, in depressive disorder patients, anger expression is likely to be predominantly involved in the neuromuscular, cardiorespiratory and gastrointestinal organ systems. However, in each of depressive disorder and somatoform disorder patients, anger suppression is not likely to be associated with any specific organ systems.

  10. APPLIED KNOWLEDGE MANAGEMENT IN SMALL DESIGN FIRMS: CASE STUDY

    Directory of Open Access Journals (Sweden)

    Christian Donin

    2016-09-01

    Full Text Available Knowledge is the new strategic imperative of organizations. The ability to manage knowledge is a crucial part of any organizations operational processes. The creation and diffusion of knowledge have become ever more important factors in competitiveness. This paper investigates the Knowledge Management and flow information and in small design firms. It is divided into three main parts. The first part of this paper describes the importance of Knowledge Management for organizations are described together with responsibilities needed to ensure successful Knowledge Management implementations and the Spiral of Organizational Knowledge Creation conception. The second part approaches literature available about process and organizational structure and information flow related to Brazilian design firms. Finally, this paper presents a case study of small design office of Civil Engineering identifying organizational process, verifying the types of communication practices and identifying the types of dynamic process of The Spiral of Organizational Knowledge Creation, KM strategy and dynamic through Knowledge Transfer.

  11. Cognition and HPA axis reactivity in mildly to moderately depressed outpatients. A case-control study

    DEFF Research Database (Denmark)

    Krogh, Jesper; Videbech, Poul; Renvillard, Signe Groth

    2012-01-01

    Background: Patients with depression display neurobiological changes of the hypothalamic-pituitary axis as well as cognitive disturbances. Aims: To assess any association between hypothalamus-pituitary-adrenal (HPA) axis reactivity and memory-related cognitive functions. Methods: Depressed......, a positive association between post-DST cortisol and Rey's Complex figure test (1.3; 95% CI 0.3-3.6; P =¿0.02) was found. We found no significant associations between other memory functions and cortisol measures. Conclusions: Contrary to our hypothesis, we found a positive association between cortisol levels...

  12. Course of symptom change during anxiety treatment: Reductions in anxiety and depression in patients completing the Coordinated Anxiety Learning and Management program.

    Science.gov (United States)

    Bomyea, Jessica; Lang, Ariel; Craske, Michelle G; Chavira, Denise A; Sherbourne, Cathy D; Rose, Raphael D; Golinelli, Daniela; Campbell-Sills, Laura; Welch, Stacy S; Sullivan, Greer; Bystritsky, Alexander; Roy-Byrne, Peter; Stein, Murray B

    2015-09-30

    When treating anxious patients with co-occurring depression, research demonstrates that both types of symptoms independently improve. The current analyses examined how reductions in anxiety and depression may be interrelated both during treatment, as well as over time following treatment. Participants were 503 individuals with one or more DSM-IV anxiety disorders who completed a collaborative care anxiety management program. Anxiety and depression were assessed at each treatment session (i.e., session by session data) and also at 6, 12, and 18-month post-baseline assessments (i.e., long-term outcomes data). Mediation analyses examined changes in symptoms in session by session data and long-term outcomes data. Anxiety and depression changed reciprocally in session by session data; change in anxiety mediated change in depression to a greater extent than vice versa. In the long-term outcomes data, change in anxiety mediated change in depression. However, the reverse mediation model of the long-term outcomes period revealed that accounting for changes in depression altered the effect of time on anxiety. Thus, temporal change during active treatment may share similarities with those related to maintaining gains after treatment, although differences arose in the reverse mediation models. Limitations of the methodology and implications of anxiety treatment for depression outcomes are discussed.

  13. Case management directors: how to manage in a transition-focused world: part 2.

    Science.gov (United States)

    Bankston White, Cheri; Birmingham, Jackie

    2015-01-01

    Case management directors are in a dynamic position to affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role.This is Part 2 of a two-part article written for case management directors, particularly new ones.Part 1 covered the first 4 of 7 tracks: (1) Staffing and Human Resources, (2) Compliance and Accreditation, (3) Discharge Planning and (4) Utilization Review and Revenue Cycle. Part 2 addresses (5) Internal Departmental Relationships (Organizational), (6) External Relationships (Community Agency), and (7) Quality and Program Outcomes.This article attempts to answer the following questions: : The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems and have frontline case managers (CMs) reporting to them. Part 1 found that case management directors would benefit from further research and documentation of "best practices" related to their role, particularly in the areas of leadership and management. The same conclusion applies to Part 2, which addresses the director's responsibilities outside her immediate department. Leadership and management skills apply as well to building strong, productive relationships across a broad spectrum of external organizations that include payer, provider, and regulatory agencies. At the same time, they must also develop the skills to positively influence the revenue cycle and financial health of both the organization for which they work and those to whom they transition patients. A director of case management with responsibility for transitions of care has more power and influence over patient safety than is commonly known. Few of the

  14. Case management directors: how to manage in a transition-focused world: part 1.

    Science.gov (United States)

    Bankston-White, Cheri; Birmingham, Jackie

    2015-01-01

    Case management directors are in a dynamic position to affect the transition of care for patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role. The purpose of this two-part article is to provide case management directors, particularly new ones, with a framework for understanding and fulfilling their role.We have divided the guide into seven tracks of responsibility. Part 1 discusses the first four tracks: (1) staffing and human resources, (2) compliance and accreditation, (3) discharge planning, and (4) utilization review and revenue cycle. Part 2 addresses (5) internal departmental relationships (organizational), (6) external relationships (Community agency), and (7) quality and program outcomes. The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems, and have frontline case managers reporting to them. Case management directors would benefit from further research and documentation of "best practices" related to their role, particularly in the areas of leadership and management. New directors would benefit from mentoring and networking with one another. As new regulations and models of care bring increased emphasis and focus to transitions of care, the role of the case management director continues to evolve, growing in importance and complexity. The growing financial impact of readmissions also brings added scrutiny and increased pressure to get the transitions of care right the first time.To operate most effectively, case management directors must understand the full range of their responsibilities and impact. They must find opportunities for themselves and their departments to learn and stay

  15. Energy management study: A proposed case of government building

    Energy Technology Data Exchange (ETDEWEB)

    Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd [School of Technology Management and Logistics, Universiti Utara Malaysia, 06010 Sintok, Kedah (Malaysia); Baharum, Mohd Faizal [School of Building, Housing and Planning, Universiti Sains Malaysia, 11800 Penang (Malaysia)

    2015-05-15

    Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building.

  16. Energy management study: A proposed case of government building

    Science.gov (United States)

    Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Baharum, Mohd Faizal

    2015-05-01

    Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building.

  17. Development of practice principles for the management of ongoing suicidal ideation in young people diagnosed with major depressive disorder

    Directory of Open Access Journals (Sweden)

    Simon M Rice

    2014-11-01

    Full Text Available Objectives: There is a lack of clear guidance regarding the management of ongoing suicidality in young people experiencing major depressive disorder. This study utilised an expert consensus approach in identifying practice principles to complement relevant clinical guidelines for the treatment of major depressive disorder in young people. The study also sought to outline a broad treatment framework for clinical intervention with young people experiencing ongoing suicidal ideation. Methods: In-depth focus groups were undertaken with a specialist multidisciplinary clinical team (the Youth Mood Clinic at Orygen Youth Health Clinical Program, Melbourne working with young people aged 15–25 years experiencing ongoing suicidal ideation. Each focus group was audio recorded and transcribed verbatim using orthographic conventions. Principles of grounded theory and thematic analysis were used to analyse and code the resultant data. Results: The identified codes were subsequently synthesised into eight practice principles reflecting engagement and consistency of care, ongoing risk assessment and documentation, individualised crisis planning, engaging systems of support, engendering hopefulness, development of adaptive coping, management of acute risk, and consultation and supervision. Conclusions: The identified practice principles provide a broad management framework, and may assist to improve treatment consistency and clinical management of young people experiencing ongoing suicidal ideation. The practice principles may be of use to health professionals working within a team-based setting involved in the provision of care, even if peripherally, to young people with ongoing suicidal ideation. Findings address the lack of treatment consistency and shared terminology and may provide containment and guidance to multidisciplinary clinicians working with this at-risk group.

  18. The Impact of Comprehensive Case Management on HIV Client Outcomes.

    Directory of Open Access Journals (Sweden)

    Mark Brennan-Ing

    Full Text Available In 1990, New York State instituted Comprehensive Medicaid Case Management, also known as Target Case Management (TCM, for people dealing with multiple comorbid conditions, including HIV. The goal of TCM is to assist clients in navigating the health care system to increase care engagement and treatment adherence for individuals with complex needs. HIV-positive individuals engaged in care are more likely to be virally suppressed, improving clinical outcomes and decreasing chances of HIV transmission. The purpose of this study was to understand the impact of TCM management on outcomes for people with HIV. Data were obtained from Amida Care, which operates not-for-profit managed care Medicaid and Medicare Special Needs Plans (SNPs for HIV clients. Changes in clinical, cost, as well as medical and pharmacy utilization data among TCM clients were examined between January 2011 through September 2012 from the start of case management enrollment through the end of the study period (i.e., up to 6 months after disenrollment. Additionally, CD4 counts were compared between Amida Care TCM clients and non-TCM clients. Notable findings include increased CD4 counts for TCM clients over the one-year study period, achieving parity with non-TCM clients (i.e., Mean CD4 count > 500. When looking exclusively at TCM clients, there were increases in medication costs over time, which were concomitant with increased care engagement. Current findings demonstrate that TCM is able to achieve its goals of improving care engagement and treatment adherence. Subsequent policy changes resulting from the Affordable Care Act and the New York State Medicaid Redesign have made the Health Home the administrator of TCM services. Government entities charged with securing and managing TCM and care coordination for people with HIV should provide thoughtful and reasonable guidance and oversight in order to maintain optimal clinical outcomes for TCM clients and reduce the transmission of

  19. Quality of life, depression, anxiety and loneliness in patients with bullous pemphigoid. A case control study*

    Science.gov (United States)

    Kouris, Anargyros; Platsidaki, Eftychia; Christodoulou, Christos; Armyra, Kalliopi; Korkoliakou, Panagiota; Stefanaki, Christina; Tsatovidou, Revekka; Rigopoulos, Dimitrios; Kontochristopoulos, George

    2016-01-01

    Background Bullous pemphigoid (BP) is a chronic, autoimmune blistering skin disease that affects patients' daily life and psychosocial well-being. Objective The aim of the study was to evaluate the quality of life, anxiety, depression and loneliness in BP patients. Methods Fifty-seven BP patients and fifty-seven healthy controls were recruited for the study. The quality of life of each patient was assessed using the Dermatology Life Quality Index (DLQI) scale. Moreover, they were evaluated for anxiety and depression according to the Hospital Anxiety Depression Scale (HADS-scale), while loneliness was measured through the Loneliness Scale-Version 3 (UCLA) scale. Results The mean DLQI score was 9.45±3.34. Statistically significant differences on the HADS total scale and in HADS-depression subscale (p=0.015 and p=0.002, respectively) were documented. No statistically significant difference was found between the two groups on the HADS-anxiety subscale. Furthermore, significantly higher scores were recorded on the UCLA Scale compared with healthy volunteers (p=0.003). Conclusion BP had a significant impact on quality of life and the psychological status of patients, probably due to the appearance of unattractive lesions on the skin, functional problems and disease chronicity. PMID:27828632

  20. ANAESTHETIC MANAGEMENT OF PERIPARTUM CARDIOMYOPATHY: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Prabhu

    2016-02-01

    Full Text Available Anaesthetic management for caesarean section of a patient with peripartum cardiomyopathy (PPCM can be challenging. These patients require analgesia/anaesthesia for normal delivery or caesarean section. In this case report we describe the anaesthetic management of a 20-year-old patient at 37 weeks of gestation, with peripartum cardiomyopathy, heart failure and pulmonary oedema. She was scheduled for emergency caesarean section because of a threat to mother’s life and fetal distress. GA was induced with Etomidate and fentanyl safely. No adverse outcome on mother or new born was observed.

  1. Management challenges in a case of gender identity disorder

    Directory of Open Access Journals (Sweden)

    Anubhav Rathi

    2014-01-01

    Full Text Available Gender identity disorder (GID is a complex disorder and can be defined as a group of disorders whose common feature is a strong and persistent preference for living as a person of the other sex. It is associated with significant impairment in social, occupational, interpersonal, and other areas of functioning. We describe the case of an adolescent, biologically male who was brought to our outpatient department primarily with symptoms of adjustment disorder with GID and the management provided. The role of a psychiatrist in the management, ethical and legal issues involved is also discussed.

  2. Case reports and clinical guidelines for managing radix entomolaris

    Science.gov (United States)

    Thomas, Bejoy J.; Nishad, A.; Paulaian, Benin; Sam, Jonathan Emil

    2016-01-01

    Knowledge about the external and internal anatomy of the tooth is essential for successful dental practice. Anomalies in the tooth are often encountered which poses difficulties in dental treatments. As like any other tooth, mandibular first molars are also prone for anatomic malformations. One such anatomic variation is the presence of extra root distolingually. This distolingual root is called radix entomolaris (RE). The presence of an additional root can lead to difficulties during endodontic therapy. This article is a report of two cases describing the management of the first mandibular molars with an RE and clinical guidelines for its management. PMID:27829770

  3. Transdiagnostic Treatment of Co-occurrence of Anxiety and Depressive Disorders based on Repetitive Negative Thinking: A Case Series

    Directory of Open Access Journals (Sweden)

    Mehdi Akbari

    2015-11-01

    Full Text Available  Objective: The transdiagnostic cognitive behavioral treatments for treating the coexistence of anxiety and mood disorders received useful empirical supports in the recent years. However, these treatments still have moderate efficacy. Following the improvements and developments in transdiagnostic protocols and considering the importance of repetitive negative thinking as a core transdiagnostic factor in emotional disorders, this study examined a new form of transdiagnostic treatment based on Repetitive Negative Thinking (TTRNT of co-occurrence of anxiety and depressive disorders.  Methods:Treatment efficacy was assessed using single case series with multiple baselines. Three patients meeting the criteria for co-occurrence of anxiety and depressive disorders were selected using the Anxiety Disorders Interview Schedule for DSM-IV. The patients were treated individually for 12 weekly sessions. Participants completed the standardized outcome measures during the baseline, treatment and one-month follow-up. Results:At post-treatment, all participants showed significant clinical changes on a range of standardized outcome measures, and these gains were largely maintained through the one-month follow-up both in the principle and co-principal diagnosis. Conclusions:Although the results of this preliminary investigation indicated that TTRNT could be a time effective and efficient treatment for individuals with co-occurrence of anxiety and depressive disorders, further controlled clinical trials are necessary to examine this new treatment approach.

  4. Anxiety and depression in rheumatologic diseases: the relevance of diagnosis and management.

    Science.gov (United States)

    Torta, R; Pennazio, F; Ieraci, V

    2014-06-06

    The high prevalence of emotional disorders (anxiety, chronic stress, mood depression) in patients with pain during rheumatologic diseases (particularly fibromyalgia) is closely related to the common pathogenic mechanisms concerning emotions and pain. Therefore a prompt identification of any psychic component of pain, also by means of specific tools, is a must, because it can require an adjustment of the therapeutic approach by combining both an analgesic treatment and antidepressants and/or psychotherapeutic strategies.

  5. Anxiety and depression in rheumatologic diseases: the relevance of diagnosis and management

    Directory of Open Access Journals (Sweden)

    R. Torta

    2014-06-01

    Full Text Available The high prevalence of emotional disorders (anxiety, chronic stress, mood depression in patients with pain during rheumatologic diseases (particularly fibromyalgia is closely related to the common pathogenic mechanisms concerning emotions and pain. Therefore a prompt identification of any psychic component of pain, also by means of specific tools, is a must, because it can require an adjustment of the therapeutic approach by combining both an analgesic treatment and antidepressants and/or psychotherapeutic strategies.

  6. Prevalence, impact, and management of depression and anxiety in patients with HIV: a review

    OpenAIRE

    Chaudhury, Suprakash; Bakhla,Ajay; Saini, Rajiv

    2016-01-01

    Suprakash Chaudhury,1 Ajay Kumar Bakhla,2 Rajiv Saini,3 1Department of Psychiatry, Pravara Institute of Medical Sciences (Deemed University), Loni, Maharashtra, 2Department of Psychiatry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, 3Department of Psychiatry, Armed Forces Medical College (AFMC), Pune, Maharashtra, India Abstract: The prevalence of depression and anxiety in people living with HIV/AIDS (PLWHA) ranges from 7.2% to 71.9% and 4.5% to 82.3%, respectively. This wide v...

  7. The noradrenergic paradox: implications in the management of depression and anxiety.

    Science.gov (United States)

    Montoya, Alonso; Bruins, Robert; Katzman, Martin A; Blier, Pierre

    2016-01-01

    Both major depressive disorder and the anxiety disorders are major causes of disability and markedly contribute to a significant global burden of the disease worldwide. In part because of the significant socioeconomic burden associated with these disorders, theories have been developed to specifically build clinical treatment approaches. One such theory, the monoaminergic hypothesis, has led to the development of several generations of selective and nonselective inhibitors of transporters of serotonin and norepinephrine, with the goal of augmenting monoaminergic transmission. These efforts have led to considerable success in the development of antidepressant therapeutics. However, there is a strong correlation between enhanced noradrenergic activity and fear and anxiety. Consequently, some physicians have expressed concerns that the same enhanced noradrenergic activity that alleviates depression could also promote anxiety. The fact that the serotonergic and noradrenergic reuptake inhibitors are successfully used in the treatment of anxiety and panic disorders seems paradoxical. This review was undertaken to determine if any clinical evidence exists to show that serotonergic and noradrenergic reuptake inhibitors can cause anxiety. The PubMed, EMBASE, and Cochrane Library databases were searched, and the results limited to randomized, double-blind, placebo-controlled studies performed in nongeriatric adults and with clear outcome measures were reported. Based on these criteria, a total of 52 studies were examined. Patients in these studies suffered from depression or anxiety disorders (generalized and social anxiety disorders, panic disorder, and posttraumatic stress disorder). The large majority of these studies employed venlafaxine or duloxetine, and the remainder used tri-cyclic antidepressants, atomoxetine, or reboxetine. All the studies reported clinically significant alleviation of depressive and/or anxious symptoms by these therapeutics. In none of these

  8. Flood risk management: cases studies in French Mediterranean area

    Directory of Open Access Journals (Sweden)

    Defossez Stéphanie

    2016-01-01

    Full Text Available In France, for a long time, flood risk management has only oriented to controlling flood hazard with structural measures such as dikes. But since 1990’s many events have proved they have not totally efficient measures. So, institutions decided it’s necessary to manage flood risk with others ways like prevention. Risk management is so organize about holistic policies with different stakeholders and societies exposed at risk. Our study have the aim to demonstrate through several examples how flood risk is manage in French Mediterranean area. Post event feedback permit us to evaluate damage and crisis management. This method is use for show if this strategies is efficient or not. This study demonstrate how is risk management in France. Regulations are they efficient, so have they an influence about the reduction of deaths and damages? Individual measures are they more important than collective action? Finally, what policies and strategies are used and effective? The main results about cases studies show that natural event has most important that publics policies and it determines preventive policies.

  9. Embedding care management in the medical home: a case study.

    Science.gov (United States)

    Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D

    2014-04-01

    Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.

  10. Stock management and vendor managed inventory: a case study in a supermarket network

    Directory of Open Access Journals (Sweden)

    Letícia de Cassia Teixeira Vilhena

    2015-04-01

    Full Text Available Among logistics activities, inventory management stands out for cost increasing, demand fluctuations and for ensuring reasonable operational resources use. Therefore, a tool that enables more efficient inventory management Vendor Managed Inventory - VMI. It enables inventory monitoring by the supplier, being his responsibility immediately resupply when safety stock is reached. In face of such importance, this study aims to analyze VMI adoption in a food retailer inventory. So, a qualitative approach was used, presenting a case study, with semi-structured interviews with a script of questions. Thus, through this research we could identify advantages such as stock and delivery cost reduction.

  11. Dapoxetine: An Innovative Approach in the Therapeutic Management In Animal Model of Depression

    Directory of Open Access Journals (Sweden)

    Hira Rafi

    2016-01-01

    Full Text Available Stress is a complicated condition that effects on person’s mental and physical health, and it is the precursor of other psychological disorders mainly depression. Serotonin (5-Hydroxytryptamine; 5-HT is well known to have hypofunction in unpredictable chronic mild stress whereas, unpredictable chronic mild stress (UCMS has produced the most steady and continuous results of anhedonia and learned helplessness particularly in rats. The stress-induced depressive like behavior can be reversed by many antidepressants such as SSRIs. Selective serotonin [5-hydroxytryptamine (5-HT] reuptake inhibitors (SSRIs is mostly prescribed antidepressant that can deplete neurochemical and behavioral deficits. The present study was designed to investigate whether repeated administration of dapoxetine at dose (1.0 mg/kg could reverse the behavioral deficits induced by UCMS in rat model of depression. UCMS induced behavioral deficits. Locomotor  activity in familiar environment (home cage, novel (open field environment and anxiolytic behavior in light/dark activity box were greater in unstressed group than stressed group. The inhibition of serotonin reuptake at pre-synaptic receptors by repeated dapoxetine administration is mainly the mechanism involved and discussed. This particular study may assist in novel approach for understanding the interaction between stress and behavioral functions and extending the therapeutic use of dapoxetine.

  12. Toward psychiatry as a ‘human’ science of mind. The Case of Depressive Disorders in DSM-5

    Directory of Open Access Journals (Sweden)

    Marco eCastiglioni

    2015-01-01

    Full Text Available The aim of this paper is to argue that a strictly reductionist approach to psychiatry represents a theoretical and clinical obstacle to a fruitful synthesis between neurobiological and sociocultural aspects of the sciences of mind. We examine the theoretical and practical motivations underlying this approach, by analyzing the case of depressive disorders, as defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM, and the related removal of the bereavement exclusion clause. We first explore the claim that DSM is atheoretical, observing that, far from being atheoretical, DSM adopts an implicit, biologically-inspired view of the mind; we show that such a view leads to a sort of circularity in the definition of depressive disorders, in which psychopharmacology seems to play a key role. We then turn to further problems deriving from this a position, analyzing the issue of placebo effects in the treatment of depressive disorders and the philosophical question of normative preconditions for psychopathological diagnosis. Finally, we address the issue of subjectivity, which, together with the related aspect of the subject’s relational context, appears to be crucial to any scientific theorizing about mental disorders, despite DSM’s attempt to exclude it. Our defence of a non-reductionist view of mental disorders, however, does not imply that we endorse any sort of metaphysical dualism, or anti-diagnostic or anti-psychiatric positions. On the contrary, we argue that adoption of a reductionist position actually undermines theoretical and clinical accuracy in explaining depressive disorders.

  13. Comparison of symptom management strategies for pain, erectile dysfunction, and depression in patients receiving chronic hemodialysis: a cluster randomized effectiveness trial.

    Science.gov (United States)

    Weisbord, Steven D; Mor, Maria K; Green, Jamie A; Sevick, Mary Ann; Shields, Anne Marie; Zhao, Xinhua; Rollman, Bruce L; Palevsky, Paul M; Arnold, Robert M; Fine, Michael J

    2013-01-01

    Pain, erectile dysfunction (ED), and depression are common yet frequently untreated in chronic hemodialysis patients. This study compared two management strategies for these symptoms in this patient population. Pain, ED, and depression were assessed monthly during an observation usual care phase. Patients were then randomized to 12-month participation in either a feedback arm in which these symptoms were assessed monthly, renal providers were informed of patients' symptoms, and treatment was left treatment at their discretion; or a nurse management arm in which symptoms were assessed monthly and trained nurses were used to evaluate patients and generate and facilitate the implementation of treatment recommendations. Of 288 patients enrolled into observation between January 1, 2009 and March 30, 2010, 220 (76%) were randomized. Compared with the feedback approach, the results (shown as Δ symptom score [95% confidence interval]) indicated that nurse management was not associated with improved pain (0.49 [-0.56, 1.54]), ED (0.20 [-0.55, 0.95]), or depression (0.32 [-0.94, 1.58]). Relative to their symptoms during observation, feedback patients experienced small, statistically significant improvements in pain (-0.98 [-1.67, -0.28]), ED (-0.98 [-1.54, -0.41]), and depression (-1.36 [-2.19, -0.54]), whereas nurse management patients experienced small, statistically significant improvements in ED (-0.78 [-1.41, -0.15]) and depression (-1.04 [-2.04, -0.04]). Compared with informing renal providers of their patients' pain, ED, and depression and leaving management at their discretion, a nurse-implemented management strategy does not improve these symptoms. Both approaches modestly reduced symptoms relative to usual care.

  14. The Science Manager's Guide to Case Studies

    Energy Technology Data Exchange (ETDEWEB)

    Branch, Kristi M.; Peffers, Melissa S.; Ruegg, Rosalie T.; Vallario, Robert W.

    2001-09-24

    This guide takes the science manager through the steps of planning, implementing, validating, communicating, and using case studies. It outlines the major methods of analysis, describing their relative merits and applicability while providing relevant examples and sources of additional information. Well-designed case studies can provide a combination of rich qualitative and quantitative information, offering valuable insights into the nature, outputs, and longer-term impacts of the research. An objective, systematic, and credible approach to the evaluation of U.S. Department of Energy Office of Science programs adds value to the research process and is the subject of this guide.

  15. Management of the difficult airway in children. A case report

    Directory of Open Access Journals (Sweden)

    Magaly Álvarez Bárzaga

    2011-03-01

    Full Text Available The anesthesiologist plays a unique role in the health care of all patients who will undergo a surgical procedure. In this sense, he is a key factor in the appropriate and timely management of the airway. There are special situations that condition a difficult airway and can have a profound impact on anesthetic morbidity and mortality. These risks increases in the case of children, that is why the case of a pediatric patient with a difficult airway caused by limitation of mouth opening, scheduled for elective surgery in order to treat this condition in the Pediatric University Hospital ¨Paquito González Cueto " in Cienfuegos, is presented.

  16. Innovation in Services and Stakeholder Interactions: Cases from Facilities Management

    DEFF Research Database (Denmark)

    Nardelli, Giulia

    services are a set of support services. They are meant to ensure that the employees of an organisation can carry out the tasks and activities related to the core business, without having to worry about, for example, the management of the workplace, catering and cleaning, security and safety. Facilities...... research approach (inductive, abductive and deductive), which includes a literature review and four empirical papers. The empirical work for this dissertation includes an explorative study, three mini case studies and an in-depth longitudinal case study. The collected data range from interviews to archive...

  17. Hospital‑based case management for migrant patients

    DEFF Research Database (Denmark)

    Ølholm, Anne Mette; Christensen, Janne B; Kamionka, Stine Lundstrøm

    2016-01-01

    to patients with a refugee or immigrant background. Provision of specialized services for migrant patients, including case management with multidisciplinary physical, cognitive and social interventions, has been suggested as a way to tackle inequalities in response to a growing recognition of the complexity...... of both their health needs and the skills needed to meet these. However, categorical care is generally considered to be stigmatizing and to decrease care quality. The evidence base for both arguments is unclear. The aim of this review was therefore to investigate the effectiveness of specialized hospital...... - b ased case management for ethnic minority patients. Methods: This review used a health technology assessment model, including a systematic search of literature in the PubMed, Embase, the Cochrane Library, Sociological Abstracts, the Cumulative Index to Nursing and Allied Health Literature databases...

  18. [Importance of compliance in nutritional management. Case report].

    Science.gov (United States)

    Mikulka, Ilona

    2016-04-10

    Disease-related malnutrition is usually caused by the joint action of the underlying disease itself and dietary deficiency. The consequences of malnutrition, if left untreated, are serious, causing a marked decline in physical and psychological health and function, and an increased rate of complications and decreased effectiveness of the medical treatments. In case a functional gastrointestinal tract is present, the recommended form of nutritional management is the use of oral nutritional supplements. However, just like to any other therapy, compliance to oral nutritional supplements is highly influenced by the consistency, taste, smell, volume consumed, and side effects. The aim of the present case report is to illustrate that nutritional management is a successful and effective treatment option of disease-related malnutrition when the selection of the oral nutritional supplement takes into consideration patient's preferences as well.

  19. Mental health case management in Canada: job description analyses.

    Science.gov (United States)

    Forchuk, Cheryl; Ouwerkerk, Alice; Yamashita, Mineko; Martin, Mary-Lou

    2002-01-01

    The purpose of this study was to examine case managers' (CM) job position descriptions through content analysis. There were 29 case manager job position descriptions examined. The job descriptions could be grouped into four categories: (1) what the individuals should bring to the position, (2) what they did as CM, (3) to whom they were accountable, and (4) what was valued. Themes included focus on client as individual, focus on the external/system, or outer-directed work, and the articulation point between the individual and broader system. The CM works directly and indirectly in the system and community through education, organizing, planning, and networking, as well as through provision of direct care to the individual client. The expectations of the positions are extensive.

  20. Application of integrative information system improves the quality and effectiveness of cancer case management.

    Science.gov (United States)

    Lee, Pei-Yi; Chang, Tsue-Rung

    2015-01-01

    Cancer case management provides consecutive care during the entire process through diagnosis to treatment and follow-up. We established an integrative information system with integration of the health information system. This integrative information system shortened the time spent on case screening, follow-up data management, and monthly data summarization of case managers. It also promoted the case follow-up rate. This integrative information system may improve the quality and effectiveness for cancer case management, one important part of cancer nursing.

  1. Clinical Management of Two Root Resorption Cases in Endodontic Practice

    Directory of Open Access Journals (Sweden)

    Jozef Mincik

    2016-01-01

    Full Text Available Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment.

  2. Meta-analysis of screening and case finding tools for depression in cancer: Evidence based recommendations for clinical practice on behalf of the Depression in Cancer Care consensus group

    DEFF Research Database (Denmark)

    Mitchell, A. J.; Meader, N.; Davies, E.

    2012-01-01

    Background: To examine the validity of screening and case-finding tools used in the identification of depression as defined by an ICD10/DSM-IV criterion standard. Methods: We identified 63 studies involving 19 tools (in 33 publications) designed to help clinicians identify depression in cancer...... as cases. The main cautions are the reliance on DSM-IV definitions of major depression, the large number of small studies and the paucity of data for many tools in specific settings. Conclusions: Although no single tool could be offered unqualified support, several tools are likely to improve upon...... unassisted clinical recognition. In clinical practice, all tools should form part of an integrated approach involving further follow-up, clinical assessment and evidence based therapy. (C) 2012 Elsevier B.V. All rights reserved....

  3. Doctors as managers: moving towards general management? The case of unitary management reform in Norwegian hospitals.

    Science.gov (United States)

    Mo, Tone Opdahl

    2008-01-01

    The paper seeks to explore whether the development in department management in Norwegian hospitals after the unitary management reform in 2001 constitutes a development in the direction of general management. Interviews were conducted with ten managers from different levels in a large Norwegian university hospital in 2001-2002, as a unitary management model was implemented. There is an emerging change of practice among the physician managers according to this study. The manager function is more explicit and takes a more general responsibility for the department and the professions. However, the managerial function is substantiated by conditions related to the professional field of knowledge, which gives legitimacy within a medical logic. Contact with the clinic is stressed as important, but it is possible to adjust both amount and content of a clinical engagement to the demands of the new manager position. This has both a symbolic and a practical significance, as it involves both legitimacy and identity issues. The paper shows that the institutionalised medical understanding of management has a bearing on managerial reforms. Managerial changes need to relate to this if they are to have consequences for the managerial roles and structures on department level in hospitals. The paper suggests that the future development of this role will depend on the way the collectivist and individualist aspects of responsibility are handled, as well as on the further development of managerial knowledge of physicians.

  4. Friedreich's ataxia cardiomyopathy: case based discussion and management issues.

    LENUS (Irish Health Repository)

    Hanley, A

    2010-04-01

    Cardiac involvement is common in Friedreich\\'s Ataxia and is a common cause of premature death. Evidence regarding treatment of congestive heart failure in patients with Friedreich\\'s Ataxia is lacking. The case of a 31-year-old male with advanced Friedreich\\'s Ataxia who presented with an acute diarrhoeal illness and features of acute heart failure is discussed. We then review the reported cardiac manifestations of Friedreich\\'s Ataxia and discuss management options.

  5. Towards Trustworthy Adaptive Case Management with Dynamic Condition Response Graphs

    DEFF Research Database (Denmark)

    Mukkamala, Raghava Rao; Hildebrandt, Thomas; Slaats, Tijs

    2013-01-01

    We describe how the declarative Dynamic Condition Response (DCR) Graphs process model can be used for trustworthy adaptive case management by leveraging the flexible execution, dynamic composition and adaptation supported by DCR Graphs. The dynamically composed and adapted graphs are verified...... for deadlock freedom and liveness in the SPIN model checker by utilizing a mapping from DCR Graphs to PROMELA code. We exemplify the approach by a small workflow extracted from a field study at a danish hospital....

  6. ENDODONTIC MANAGEMENT OF FUSED MAXILLARY LATERAL INCISOR: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Wavdhane

    2014-11-01

    Full Text Available Fusion is a rare occurrence and its definitive diagnosis is of prime importance for successful root canal treatment. This case report discusses the endodontic and esthetic management of fused maxillary right lateral incisor. Root canal treatment was performed on the fused tooth. Nickel Chromium with ceramic crown was fabricated in the shape of lateral incisor. The patient remained asymptomatic and there was a reduction in the size of periapical radiolucency after six months.

  7. Strategic Communication in Chaos Management and a Case Study

    OpenAIRE

    Latif, Hasan; ELMAS, Tuğçe

    2017-01-01

    Abstract. Effective communication may be sufficient under normal conditions, but in chaos conditions strategic communication is required. There has been cases of unsuccessful management during times of sudden huge problems due to the use of wrong communication behaviors. This work presents together an example and the requisites of a successful a strategic communicator in chaotic conditions. The study begins with examples of mismanagement behaviors in strategic communication. It establishes a ...

  8. A report of two cases of ascariasis pancreatitis managed conservatively

    Directory of Open Access Journals (Sweden)

    Laleng M Darlong

    2011-01-01

    Full Text Available Ascaris lumbricoides is a common intestinal parasite in tropical and temperate regions. Although usually asymptomatic, infection can lead to biliary or intestinal obstruction and very rarely obstruction of the main pancreatic duct due to its smaller lumen. We report two cases of ascariasis in the main pancreatic duct, which is not a common site, presenting as acute pancreatitis and recovering uneventfully with conservative management.

  9. Successful Management of a Recurrent Supralevator Abscess: A Case Report

    Directory of Open Access Journals (Sweden)

    S. Sanyal

    2012-01-01

    Full Text Available Anorectal abscesses are commonly encountered in clinical surgical practice. These abscesses require surgical management. Supralevator abscesses are thought to originate either from an ischiorectal or intersphincteric abscess extension or from an intraperitoneal source. These abscesses are quite uncommon and present a difficult surgical problem. We present a case here of a 42-year-old female with a recurrent supralevator abscess requiring multiple surgical procedures for adequate drainage and care of her abscess.

  10. Anesthetic management in a case of antiphospholipid antibody syndrome.

    Science.gov (United States)

    Mikkiliineni, Venkata Rama Rao; Panidapu, Nagarjuna; Parasa, Mrunalini; Shaik, Mastan Saheb

    2015-01-01

    Antiphospholipid antibody (APLA) syndrome is one of the most common thrombocytophilias but, unfortunately, goes unrecognized most often. It is an auto-immune disorder in which thrombotic events and a recurrent fetal loss occur in the presence of antibodies to phospholipids. It is the most common acquired hyper-coagulable state. There is a limited literature on peroperative management of patients with this syndrome. We report a case of APLA syndrome in a parturient due to its rarity and complexity.

  11. A Case for Customizable Resource Management in Networks,

    Science.gov (United States)

    2007-11-02

    00C Ca~aegie ej=)n ’C= 4P -jý A Case for Customizable Resource Management in Networks Peter Steenkiste Allan Fisher Hui Zhang October 21, 1998 CMU-CS-98...167 School of Computer Science Carnegie Mellon University Pittsburgh, PA 15213 Abstract We envision the deployment of an electronic services market ...that will deliver a wide range of electronic ser- vices over networks. This market will allow applications to combine resources at endpoints with

  12. Integration of QR codes into an anesthesia information management system for resident case log management.

    Science.gov (United States)

    Avidan, Alexander; Weissman, Charles; Levin, Phillip D

    2015-04-01

    Quick response (QR) codes containing anesthesia syllabus data were introduced into an anesthesia information management system. The code was generated automatically at the conclusion of each case and available for resident case logging using a smartphone or tablet. The goal of this study was to evaluate the use and usability/user-friendliness of such system. Resident case logging practices were assessed prior to introducing the QR codes. QR code use and satisfactions amongst residents was reassessed at three and six months. Before QR code introduction only 12/23 (52.2%) residents maintained a case log. Most of the remaining residents (9/23, 39.1%) expected to receive a case list from the anesthesia information management system database at the end of their residency. At three months and six months 17/26 (65.4%) and 15/25 (60.0%) residents, respectively, were using the QR codes. Satisfaction was rated as very good or good. QR codes for residents' case logging with smartphones or tablets were successfully introduced in an anesthesia information management system and used by most residents. QR codes can be successfully implemented into medical practice to support data transfer. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Managing knowledge: a technology transfer case study in IEN

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Ana Gabriella Amorim Abreu [Instituto de Engenharia Nuclear (IEN), Rio de Janeiro, RJ (Brazil). Servico de Transferencia de Tecnologia], e-mail: agaap@ien.gov.br

    2009-07-01

    Knowledge management is paramount nowadays. In order to enable the members of an organization to deal with their current situations effectively it is mandatory to know and enhance its intellectual capital. Managing the organization knowledge is important to the extent that it allows and reinforce its mission (what we are trying to accomplish?), and performance (how do we deliver the results?). As a result of a knowledge management effort, the organization can create value for itself and for society as a whole. In this paper, we argue that a technology developed at a research institute and transferred to an industry is knowledge to be managed in order to create value, both for the society and for the Institute. In order to manage such knowledge, it is proposed an approach to enhance the value creation potential of a technology transfer. This paper propose an investigation to expand the understanding on how a public research institute and a private firm could introduce their value creation wishes into a technology transfer agreement in a way to reflect and provide the realization of those wishes. It is proposed that, from the identification of the organizations expectations it is possible to infer which agreement attributes will contribute to that value creation and to establish satisfactory agreement configurations. These configurations have the potential to generate those consequences, given that, through the transfer, each organization seeks to increase potential benefits and to reduce potential sacrifices. Supported by exchange flow and value creation models, by the knowledge management and the means-end theory, an approach to increase the value creation potential of a technology transfer is proposed. Evidences from a case study sustain the proposed approach. The case study unity is the Instituto de Engenharia Nuclear, a public research institute. (author)

  14. Improving reimbursement with nursing case manager status assignment.

    Science.gov (United States)

    Bledsoe, Marlyn K; Marshall, Michele L

    2013-01-01

    Historically, physicians completed status assignment during the admission process. Incorrect status assignment of patients can result in reimbursement problems and denial of payment by Medicare, Medicaid, and private insurance companies. The purpose of this study was to evaluate the impact of case manager's role with status assignment during the admission process by looking at the denial of payment for services rendered. Denial rates were evaluated for two 15-month time periods: preintervention group (status assignment completed by physicians) and intervention group (status assignment recommended by case managers with physician signature). Denial data for all diagnosis-related groups possessing a more than 2% denial rate related to status assignment were further examined to identify the rationale for denial of payment. FINDINGS/OUTCOMES: The greatest denial rates for payment occurred during the Preintervention Period, when physicians assigned status for patients independently. There was a significant reduction in denial of payment for most diagnosis-related groups during the Intervention time period when case managers were recommending status assignment. Evaluation of denial data provides an opportunity to target creative performance improvement solutions to reduce denial of payment related to incorrect status assignment.

  15. Ketamine, Transcranial Magnetic Stimulation, and Depression Specific Yoga and Mindfulness Based Cognitive Therapy in Management of Treatment Resistant Depression: Review and Some Data on Efficacy

    Directory of Open Access Journals (Sweden)

    Basant Pradhan

    2015-01-01

    Full Text Available Depression affects about 121 million people worldwide and prevalence of major depressive disorder (MDD in US adults is 6.4%. Treatment resistant depression (TRD accounts for approximately 12–20% of all depression patients and costs $29–$48 billion annually. Ketamine and repetitive transcranial magnetic stimulation (rTMS have useful roles in TRD, but their utility in long term is unknown. As per the latest literature, the interventions using Yoga and meditation including the mindfulness based cognitive therapy (MBCT have been useful in treatment of depression and relapse prevention. We present a review of rTMS, ketamine, and MBCT and also report efficacy of a depression specific, innovative, and translational model of Yoga and mindfulness based cognitive therapy (DepS Y-MBCT, developed by the first author. DepS Y-MBCT as an adjunctive treatment successfully ameliorated TRD symptoms in 27/32 patients in an open label pilot trial in TRD patients. Considering the limitations of existing treatment options, including those of ketamine and rTMS when used as the sole modality of treatment, we suggest a “tiered approach for TRD” by combining ketamine and rTMS (alone or along with antidepressants for rapid remission of acute depression symptoms and to use DepS Y-MBCT for maintaining remission and preventing relapse.

  16. Primary care physicians' perspective on the management of anxiety and depressive disorders: a cross-sectional survey in Emilia Romagna Region.

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    Casini, Federica; Sighinolfi, Cecilia; Tedesco, Paola; Bandieri, Pier Venanzio; Bologna, Maria; Colombini, Niccolò; Curcetti, Clara; Magnani, Michele; Morini, Mara; Serio, Alberto; Tarricone, Ilaria; Berardi, Domenico; Menchetti, Marco

    2013-06-07

    Evidences from literature suggest that Primary Care Physicians' (PCPs) knowledge and attitude about psychological and pharmacological treatments of anxiety and depressive disorders could influence their clinical practice. The aim of the study is double: 1) to assess PCPs' opinions about antidepressants (ADs) and psychotherapy for the management of anxiety and depressive disorders; 2) to evaluate the influence of PCPs' gender, age, duration of clinical practice, and office location on their opinions and attitudes. This cross-sectional multicentre survey involved 816 PCPs working in four Local Health Units of the Emilia Romagna Region. Participating PCPs were asked to complete a questionnaire during educational meetings between October 2006 and December 2008. The response rate was 65.1%. Eighty-five percent of PCPs agreed on the effectiveness of ADs for depressive disorder whereas lower agreement emerged for anxiety disorder and on psychotherapy for both anxiety and depression. Forty percent of PCPs reported to feel "very/extremely confident" in recognizing depression and 20.0% felt equally confident in treating it with pharmacotherapy. Considering anxiety disorder, these proportions increased. Female PCPs and those located in the rural/mountain areas reported to adopt more psycho-educational support compared to male and suburban colleagues. Our results suggest that an effort should be made to better disseminate recent evidences about the management of anxiety and depressive disorders in Primary Care. In particular, the importance of psychological interventions and the role of drugs for anxiety disorder should be addressed.

  17. Angina self-management plan and quality of life, anxiety and depression in post coronary angioplasty patients.

    Science.gov (United States)

    Moattari, Marzieh; Adib, Fakhteh; Kojuri, Javad; Tabatabaee, Seyed Hamid Reza

    2014-11-01

    Coronary artery diseases are the most frequent cause of mortality in industrialized countries as well as Iran. Coronary artery disease affects patient's quality of life (QoL) and produces some degrees of anxiety and depression. Although self-management programs have shown significant impact on chronic diseases, there is limited evidence in Iran regarding the effectiveness of these interventions, particularly in patients with coronary artery disease. This study aimed to evaluate the effects of angina plan on QoL, anxiety, and depression in post coronary angioplasty patients referred to selected hospitals in Shiraz. This parallel randomized, controlled trial was conducted in selected hospitals in Shiraz, Iran. We enrolled 80 post coronary angioplasty eligible patients in the study. After acquisition of the informed consent, eligible patients were randomly divided into two groups: control and experimental. Pretest data were obtained by using a demographic data form and two valid and reliable questionnaires for QoL, anxiety, and depression. Blood pressure, weight, and height (to calculate body mass index) were measured too. Patient's history of smoking, diabetes, hypercholesterolemia, hypertension, and coronary vascular involvement (with grade and severity) were obtained from their medical records. A 12-week angina plan intervention consisted of a 30 to 40 minutes of counseling interview and telephone follow up at the end of 1, 4, 8, and 12 weeks were performed for experimental group. Post-test data were obtained three months after the pretest using the same questionnaires as pretest. QoL data were analyzed by analysis of co-variance (ANCOVA). The results (before and after intervention) regarding anxiety and depression were analyzed by independent t-tests or their equivalent nonparametric Mann-Whitney test using SPSS v. 11.5. There was no statistically significant difference in demographic variables between two groups. Baseline mean scores for QoL, anxiety, and

  18. Continuation treatment of major depressive disorder: is there a case for duloxetine?

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    Trevor R Norman

    2010-02-01

    Full Text Available Trevor R Norman, James S OlverDepartment of Psychiatry, University of Melbourne, Austin Hospital, Heidelberg, Victoria, AustraliaAbstract: Duloxetine is a serotonin–noradrenaline reuptake inhibitor with established efficacy for the short-term treatment of major depressive disorder. Efficacy in continuation treatment (greater than six months of continuous treatment has been established from both open and placebocontrolled relapse prevention and comparative studies. Seven published studies were available for review and showed that in both younger and older populations (aged more than 65 years the acute efficacy of duloxetine was maintained for up to one year. Response to treatment was based on accepted criteria for remission of depression and in continuation studies remission rates were greater than 70%. Comparative studies showed that duloxetine was superior to placebo and comparable to paroxetine and escitalopram in relapse prevention. Importantly a study of duloxetine in patients prone to relapse of major depressive disorder showed that the medication was more effective than placebo in this difficult to treat population. Side effects of duloxetine during continuation treatment were predictable on the basis of the known pharmacology of the drug. In particular there were no significant life-threatening events which emerged with continued use of the medication. On the other hand vigilance is required since the data base on which to judge very rare events is limited by the relatively low exposure to the drug. Duloxetine has established both efficacy and safety for continuation treatment but its place as a first-line treatment of relapse prevention requires further experience. In particular further comparative studies against established agents would be useful in deciding the place of duloxetine in therapy.Keywords: major depression, duloxetine, continuation treatment, placebo studies, relapse prevention, clinical trials

  19. Depression, anxiety, and heart rate variability: A case-control study in Taiwan

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    Li-Fen Chen

    2014-01-01

    Full Text Available Objective: Decreased heart rate variability (HRV has been reported in persons with major depressive disorder (MDD, but the results obtained are inconsistent. Little is known about the impact of comorbid anxiety disorders on HRV in MDD patients. Both issues necessitate further investigation. Materials and Methods: Forty-nine unmedicated, physically healthy, MDD patients without comorbidity, 21 MDD patients with comorbid generalized anxiety disorder (GAD, 24 MDD patients with comorbid panic disorder (PD, and 81 matched controls were recruited. The Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale are employed to assess the severity of depression and anxiety, respectively. The cardiac autonomic function was evaluated by measuring the HRV parameters. The frequency-domain indices of HRV were obtained. Results: MDD patients without comorbidity had lower high-frequency (HF-HRV (which reflected vagal control of HRV than controls. Any comorbid anxiety disorder (GAD or PD was associated with significantly faster heart rates, relative to the controls, and caused greater reductions in HF-HRV among MDD patients. MDD participants with comorbid GAD displayed the greatest reductions in HF-HRV, relative to controls. Correlation analyses revealed that the severity of both depression and anxiety were significantly associated with the mean R wave to R wave (R-R intervals, variance, low-frequency (LF-HRV, and HF-HRV. Conclusion: The present results show decreased HRV in MDD patients, suggesting that reduction in HRV is a psychophysiological marker of MDD. MDD patients with comorbid GAD had the greatest reductions in HRV. Further investigation of the links between MDD and comorbid GAD, HRV, and cardiovascular disease is warranted.

  20. A multicenter randomized controlled trial for bright light therapy in adults with intellectual disabilities and depression: Study protocol and obstacle management.

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    Hamers, Pauline C M; Evenhuis, Heleen M; Hermans, Heidi

    2017-01-01

    Due to the limited cognitive and communicative abilities of adults with intellectual disabilities (ID), current treatment options for depression are often limited to lifestyle changes and pharmacological treatment. Bright light therapy (BLT) is an effective intervention for both seasonal and non-seasonal depression in the general population. BLT is an inexpensive, easy to carry out intervention with minimal side effects. However, knowledge on its anti-depressant effect in adults with ID is lacking. Obstacles in realizing a controlled intervention study in this particular study population may have contributed to this lack. To study the effect of BLT on depression in this population, it is necessary to successfully execute a multicenter randomized controlled trial (RCT). Therefore, the study protocol and the management of anticipated obstacles regarding this trial are presented.

  1. Depression - resources

    Science.gov (United States)

    Resources - depression ... Depression is a medical condition. If you think you may be depressed, see a health care provider. ... following organizations are good sources of information on depression : American Psychological Association -- www.apa.org/topics/depress/ ...

  2. The noradrenergic paradox: implications in the management of depression and anxiety

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    Montoya A

    2016-03-01

    Full Text Available Alonso Montoya,1 Robert Bruins,1 Martin A Katzman,2 Pierre Blier3 1Eli Lilly Canada Inc, 2START Clinic for the Mood and Anxiety Disorders, Toronto, 3Mood Disorders Research Unit, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada Abstract: Both major depressive disorder and the anxiety disorders are major causes of ­disability and markedly contribute to a significant global burden of the disease worldwide. In part because of the significant socioeconomic burden associated with these disorders, theories have been developed to specifically build clinical treatment approaches. One such theory, the monoaminergic hypothesis, has led to the development of several generations of selective and nonselective inhibitors of transporters of serotonin and norepinephrine, with the goal of augmenting monoaminergic transmission. These efforts have led to considerable success in the development of antidepressant therapeutics. However, there is a strong correlation between enhanced noradrenergic activity and fear and anxiety. Consequently, some physicians have expressed concerns that the same enhanced noradrenergic activity that alleviates depression could also promote anxiety. The fact that the serotonergic and noradrenergic reuptake inhibitors are successfully used in the treatment of anxiety and panic disorders seems paradoxical. This review was undertaken to determine if any clinical evidence exists to show that serotonergic and noradrenergic reuptake inhibitors can cause anxiety. The PubMed, EMBASE, and Cochrane Library databases were searched, and the results limited to randomized, double-blind, placebo-controlled studies performed in nongeriatric adults and with clear outcome measures were reported. Based on these criteria, a total of 52 studies were examined. Patients in these studies suffered from depression or anxiety disorders (generalized and social anxiety disorders, panic disorder, and posttraumatic stress disorder. The

  3. The Brain-Resuscitation Acupuncture Method for Treatment of Post Wind-Stroke Mental Depression- A Report of 45 Cases

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    In order to observe the therapeutic effects of the brain-resuscitation acupuncture method for post wind-stroke mental depression, 90 such cases were randomly divided into two groups, each consisting of 45 cases. For the treatment group, the brain-resuscitation acupuncture method was adopted, with Neiguan (PC 6), Renzhong (GV 26), Sanyinjiao (SP 6), Baihui (GV 20), and Shenmen (HT 7) selected as the main points. For the control group, oral medication of Fluoxetine was prescribed. Therapeutic effects and changes in the HAMD integrals of the two groups were observed. The total effective rate in the treatment group was 77.7%, and that in the control group was 75.1%, showing no significant difference between the two groups (P>0.05). The average effect starting time of the treatment group was 11.58±4.89 days, while that of the control group was 15.96±6.50 days, showing a significant difference between the two groups (P<0.05). It can be concluded that for the post wind-stroke mental depression, the brain-resuscitation acupuncturemethod may show a good and quicker therapeutic effect with no side effects as compared with pharmacotherapy.

  4. Duloxetine and care management treatment of older adults with comorbid major depressive disorder and chronic low back pain: results of an open-label pilot study

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    Karp, Jordan F.; Weiner, Debra K.; Dew, Mary A.; Begley, Amy; Miller, Mark D.; Reynolds, Charles F.

    2010-01-01

    Objective: In older adults, major depressive disorder (MDD) and chronic low back pain (CLBP) are common and mutually exacerbating. We predicted that duloxetine pharmacotherapy and Depression and Pain Care Management (DPCM) would result in (1) significant improvement in MDD and CLBP and (2) significant improvements in health-related quality of life, anxiety, disability, self-efficacy, and sleep quality. Design and Intervention: Twelve week open-label study using duloxetine up to 120 mg/day + DPCM. Setting: Outpatient late-life depression research clinic. Patients: Thirty community-dwelling adults >60 years old. Outcome Measures: Montgomery Asberg Depression Rating Scale (MADRS) and McGill Pain Questionnaire-Short Form (MPQ-SF). Results: 46.7% (n = 14) of the sample had a depression remission. All subjects who met criteria for the depression remission also had a pain response. 93.3% (n = 28) had a significant pain response. Of the subjects who met criteria for a low back pain response, 50% (n = 14) also met criteria for the depression remission. The mean time to depression remission was 7.6 (SE = 0.6) weeks. The mean time to pain response was 2.8 (SE = 0.5) weeks. There were significant improvements in mental health-related quality of life, anxiety, sleep quality, somatic complaints, and both self-efficacy for pain management and for coping with symptoms. Physical health-related quality of life, back pain-related disability, and self-efficacy for physical functioning did not improve. Conclusions: Serotonin and norepinephrine reuptake inhibitors like duloxetine delivered with DPCM may be a good choice to treat these linked conditions in older adults. Treatments that target low self-efficacy for physical function and improving disability may further increase response rates. PMID:19750557

  5. A case of error disclosure: a communication privacy management analysis

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    Sandra Petronio

    2013-12-01

    Full Text Available To better understand the process of disclosing medical errors to patients, this research offers a case analysis using Petronios’s theoretical frame of Communication Privacy Management (CPM. Given the resistance clinicians often feel about error disclosure, insights into the way choices are made by the clinicians in telling patients about the mistake has the potential to address reasons for resistance. Applying the evidenced-based CPM theory, developed over the last 35 years and dedicated to studying disclosure phenomenon, to disclosing medical mistakes potentially has the ability to reshape thinking about the error disclosure process. Using a composite case representing a surgical mistake, analysis based on CPM theory is offered to gain insights into conversational routines and disclosure management choices of revealing a medical error. The results of this analysis show that an underlying assumption of health information ownership by the patient and family can be at odds with the way the clinician tends to control disclosure about the error. In addition, the case analysis illustrates that there are embedded patterns of disclosure that emerge out of conversations the clinician has with the patient and the patient’s family members. These patterns unfold privacy management decisions on the part of the clinician that impact how the patient is told about the error and the way that patients interpret the meaning of the disclosure. These findings suggest the need for a better understanding of how patients manage their private health information in relationship to their expectations for the way they see the clinician caring for or controlling their health information about errors.

  6. Toxoplasma gondii Infection and Mixed Anxiety and Depressive Disorder: A Case-Control Seroprevalence Study in Durango, Mexico

    Science.gov (United States)

    Alvarado-Esquivel, Cosme; Sanchez-Anguiano, Luis Francisco; Hernandez-Tinoco, Jesus; Berumen-Segovia, Luis Omar; Torres-Prieto, Yazmin Elizabeth; Estrada-Martinez, Sergio; Perez-Alamos, Alma Rosa; Ortiz-Jurado, Maria Nalleli; Molotla-de-Leon, Gabriel; Beristain Garcia, Isabel; Rabago-Sanchez, Elizabeth; Liesenfeld, Oliver

    2016-01-01

    Background The parasite Toxoplasma gondii (T. gondii) may invade the brain and might induce behavioral changes. We sought to determine the association of T. gondii infection and mixed anxiety and depressive disorder. Methods Through an age- and gender-matched case-control seroprevalence study, we examined 65 patients suffering from mixed anxiety and depressive disorder (WHO ICD-10 code: F41.2) attending in a public hospital of mental health and 260 control subjects without this disorder from the general population. Sera of participants were analyzed for anti-Toxoplasma IgG and IgM antibodies using enzyme-linked immunoassays. Results Fifteen (23.1%) of the 65 patients and 18 (6.9%) of the 260 controls had anti-T. gondii IgG antibodies (odds ratio (OR): 4.03; 95% confidence interval (CI): 1.90 - 8.53; P 150 IU/mL) anti-T. gondii IgG levels was similar in cases and controls (OR: 0.25; 95% CI: 0.05 - 1.06; P = 0.05). Seroprevalence was similar in male cases and controls (P = 1.0); however, seroprevalence was significantly higher in female cases than in female controls (OR: 7.08; 95% CI: 2.83 - 17.67; P < 0.00001). Patients aged 31 - 50 years old had a significantly higher seroprevalence of T. gondii infection than controls of the same age group (OR: 21.04; 95% CI: 5.22 - 84.80; P < 0.00001). Anti-T. gondii IgM antibodies were found in four (26.7%) of the 15 anti-T. gondii IgG seropositive cases and in 10 (55.6%) of the 18 anti-T. gondii IgG seropositive controls (P = 0.15). Conclusions Results support for the first time an association between seropositivity to T. gondii and mixed anxiety and depressive disorder. Further research to confirm this association and to determine the seroepidemiology of T. gondii infection in patients with this disorder is needed. PMID:27298660

  7. Depression in Parkinson's disease: study of 60 cases Depressão na doença de Parkinson: estudo de 60 casos

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    Roberto César Pereira do Prado

    2005-09-01

    Full Text Available Depression is very frequent in Parkinson’s disease (PD and largely unrecognized by neurologists, emphasizing the need of an approach to psychiatric symptoms by non psychiatrists in order to ensure an early diagnosis of depression in PD; clinical characteristics and the prevalence rate of depression in PD were evaluated and the relationship of depression in PD with other variables were determined. Sixty PD subjects, who fulfilled the clinical criteria for primary PD, 56,6% males, age range from 44 to 85 years old, in different stages of the disease were investigated. All subjects were submitted to the UPDRS-III, V and VI, Clinical Interview Schedule and the Hamilton depression scale. A significant correlation was found between depression and UPDRS-III, V and VI, anxiety and irritability. The frequency of depression in PD in this study was nearly 40% possessing specific features. Structured interviews and evaluation scales are essential for an accurate diagnosis and proper treatment of depression in PD.A depressão é manifestação freqüente na evolução da doença de Parkinson (DP, gerando a necessidade de nova abordagem neuropsiquiátrica por parte dos médicos não psiquiatras, visando o reconhecimento precoce do quadro depressivo na DP. Foram estudadas as características clínicas e freqüência da depressão na DP e correlacionadas com outras variáveis. Sessenta pacientes que preenchiam os critérios clínicos atuais para DP, sendo 56,6% do sexo masculino (44 a 85 anos, em diferentes estágios clínicos da doença, foram submetidos ás escalas de avaliação para DP (UPDRS-III, V e VI, para transtornos neuropsiquiátricos - Entrevista Clínica Estruturada e Escala de Hamilton. Houve associação estatisticamente significante entre depressão e UPDRS-III, V e VI, ansiedade e irritabilidade. A freqüência de depressão, situou-se em torno de 40% apresentando características próprias. Entrevistas estruturadas e escalas de avaliação s

  8. Randomised controlled trial of tailored interventions to improve the management of anxiety and depressive disorders in primary care

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    Terluin Berend

    2011-07-01

    Full Text Available Abstract Background Anxiety and depressive disorders are highly prevalent disorders and are mostly treated in primary care. The management of these disorders by general practitioners is not always consistent with prevailing guidelines because of a variety of factors. Designing implementation strategies tailored to prospectively identified barriers could lead to more guideline-recommended care. Although tailoring of implementation strategies is promoted in practice, little is known about the effect on improving the quality of care for the early recognition, diagnosis, and stepped care treatment allocation in patients with anxiety or depressive disorders in general practice. This study examines whether the tailored strategy supplemented with training and feedback is more effective than providing training and feedback alone. Methods In this cluster randomised controlled trial, a total of 22 general practices will be assigned to one of two conditions: (1 training, feedback, and tailored interventions and (2 training and feedback. The primary outcome measure is the proportion of patients who have been recognised to have anxiety and/or depressive disorder. The secondary outcome measures in patients are severity of anxiety and depressive symptoms, level of functioning, expectation towards and experience with care, quality of life, and economic costs. Measures are taken after the start of the intervention at baseline and at three- and six-month follow-ups. Secondary outcome measures in general practitioners are adherence to guideline-recommended care in care that has been delivered, the proportion of antidepressant prescriptions, and number of referrals to specialised mental healthcare facilities. Data will be gathered from the electronic medical patient records from the patients included in the study. In a process evaluation, the identification of barriers to change and the relations between prospectively identified barriers and improvement

  9. Teaching Cases in Management - Sabor de Casa Restaurant

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    Nilda Maria de Clodoaldo Pinto Guerra Leone

    2009-01-01

    Full Text Available Small family businesses present a series of peculiarities and challenges, especially when it comes to the management of human resources. This case describes the true situation of an enterprise, Restaurante Sabor de Casa, and portrays the relationship between the founder and successor and its consequences on the practice and policy of human resources. The story is told from the point of view of the successor, who thinks about the situation of the company and his deep involvement in the dynamic and complex stage of working with his mother, the founder of the company, whose performance is that of an entrepreneur, albeit a traditional one. It shows his reflections on the directions the company has taken, the opinions of employees, based on research conducted in 2006 by university students and their questions about the way the contributions of the employees are managed, mainly by recognizing their importance for both the present and the future of the company. This case deals with the complexity of the management of human resources in a family organizational environment.

  10. Empowerment and change management in Aboriginal organisations: a case study.

    Science.gov (United States)

    McEwan, Alexandra B; Tsey, Komla; McCalman, Janya; Travers, Helen J

    2010-08-01

    The social organisation of work, management styles and social relationships in the workplace all matter for health. It is now well recognised that people who have control over their work have better health and that stress in the workplace increases the level of disease. In the context of organisational change, the potential benefits of empowerment strategies are two-fold: a positive impact on the organisation's effectiveness and enhancements in staff health, wellbeing and sense of control. This case study describes the University of Queensland Empowerment Research Program's experience working with the Apunipima Cape York Health Council in a change management process. Participatory action research and empowerment strategies were utilised to facilitate shifts in work culture and group cohesion towards achieving Apunipima's vision of being an effective lead agency for Indigenous health reform in Cape York. As part of the project, staff morale and confidence were monitored using a pictorial tool, Change Curve, which outlined the phases of organisational change. The project findings indicated that organisational change did not follow a clear linear trajectory. In some ways the dynamics mapped over a period of 18 months mirror the type of struggles individuals commonly encounter as a part of personal growth and development. In this case, one of the factors which influenced the program's success was the willingness of executive employees to actively support and participate in the change management process.

  11. Sonolência excessiva diurna e depressão: causas, implicações clínicas e manejo terapêutico Excessive daytime sleepiness and depression: causes, clinical implications, and therapeutic management

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    Sarah Laxhmi Chellappa

    2009-01-01

    Full Text Available A sonolência excessiva diurna (SED é frequentemente associada à depressão, e as possíveis relações entre as duas afecções são numerosas. A SED pode ocorrer devido a insônia ou hiperssonia. A sintomatologia da depressão inclui, notadamente, a insônia e a consequente SED, que podem ser, em alguns casos, sintomas residuais após a resposta ao tratamento antidepressivo. Paralelamente, a insônia e a sonolência diurna podem, inclusive, ser efeitos colaterais de curta ou longa duração do manejo terapêutico antidepressivo. Independente de a SED ser um sintoma de um quadro depressivo atual, sintoma residual de depressão prévia ou efeito colateral de medicação antidepressiva, faz-se necessária uma adequada avaliação clínica da SED na depressão. A fim de discorrer sobre as atuais evidências das investigações da SED na depressão, foi feito um levantamento da literatura médica nos bancos de dados ISI, MEDLINE e SciELO, compreendendo-se o período de 1990 a 2007. Apesar de os mecanismos responsáveis pela relação entre a sonolência diurna e a depressão serem complexos e entrelaçados, a avaliação compreensiva desse transtorno do sono desempenha um papel fundamental na predição de respostas ao manejo terapêutico, recaídas e modelos etiológicos da depressão.Excessive daytime sleepiness (EDS is often related to depression, and there are several possible relationships between them. EDS can usually occur due to either insomnia or hypersomnia. The symptomatology of depression prominently includes insomnia and the resultant EDS, which may, in such cases, be residual symptoms as a response to antidepressant treatment. Furthermore, insomnia and daytime sleepiness may be short- or long-term side effects of antidepressant treatment as well. The clinical assessment of depression should adequately address whether EDS is a symptom of current depression, a prior depression residual symptom, or a side effect of antidepressant

  12. The Effectiveness of Self Management Program on Pain, Fatigue, Depression, Anxiety, and Stress in Sickle Cell Patients: A Quasi-Experimental Study

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    Ahmadi

    2015-10-01

    Full Text Available Background Patients with sickle cell disease, who must manage serious and unpredictable complications related to their disease, particularly chronic pain, suffer from numerous psychosocial problems such as depression, anxiety, stress, and disruption of interpersonal relationships; these problems often lead to fatigue and poor quality of life. Objectives This study aimed to determine the effectiveness of self-management programs targeting pain, fatigue, depression, anxiety, and stress in sickle cell patients. Patients and Methods This was a quasi-experimental study; participants were 53 patients with sickle cell disease who were referred to the Thalassemia Clinic of Ahvaz Shafa Hospital. Participants were recruited by census in 2013. Participants received a self-management program that was implemented in five sessions over 12 weeks. Levels of fatigue, depression, anxiety, and stress were assessed before and 24 weeks after the intervention; pain was assessed during the intervention and at a 24 week post-intervention follow-up using the fatigue severity scale (FSS, DASS21, and a pain record. Descriptive statistics, Fisher’s exact test, Chi-square, independent t-tests, paired t-tests, repeated measures tests and correlations were used to analyze the data. Results Scores for fatigue, anxiety, depression, and stress after the intervention were significantly decreased compared to before the intervention (P < 0.001. Repeated measures testing showed that mean scores for frequency and duration of pain decreased significantly during the 12 weeks of intervention, as well as during the 24 weeks of follow-up (P < 0.001. Conclusions The results suggest the effectiveness of self-management programs on the reduction of pain, fatigue, anxiety, depression, and stress in sickle cell patients. Therefore, self-management programs are advisable in order to empower patients and assist their management of health-related problems.

  13. Major depressive disorder in an adolescent with Turner syndrome: a case report.

    Science.gov (United States)

    Mao, Shujiong; Sun, Liying; Li, Rong; Zhao, Zhengyan; Yang, Rongwang

    2016-01-01

    Turner syndrome (TS) is a chromosomal abnormality, of which the presence and impact of coexisting psychiatric morbidity has received little attention. The present report describes an adolescent with mosaic karyotype TS who had major depressive disorder with the predisposing cause of psychosocial burden, and relieved with the treatment of sertraline and complete remission with combined use of estradiol valerate. The report suggests us to pay more attention on the mood disorders in children with TS, especially in adolescents. For treatment aspect, medications for improving the puberty development and short stature should be added to in addition to antidepressants if they had mood disorders.

  14. Knowledge management in local government: The case of Stellenbosch Municipality

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    Shamin Gaffoor

    2010-08-01

    Full Text Available Knowledge management (KM was a well-founded management approach that held significant benefits for public sector organisations. KM as a management philosophy had an impact on various components of an organisation and it could therefore significantly advance organisational efficiency. The successful implementation of KM initiatives had to be ensured because, different organisational processes and departments had to collaborate and functional silos had to be eliminated. KM required long-term commitment and dedication from all organisational members. Furthermore, there were certain knowledge management enablers in an organisation that needed to be developed and that were necessary for the achievement of organisational effectiveness. These enablers were the organisational culture, human resources, information technology, organisational structure and, the organisation’s strategy and leadership. This article assessed each of these enablers and how they impacted on an organisation’s KM efforts. Stellenbosch Municipality was used as a case in point. The article further examined how local governments were able to effectively implement KM practices as strategic tools used to achieve service delivery and operational goals. The article concluded with a number of recommended strategies, (1 to develop the KM enablers that were present in organisations and (2 to aid the implementation of successful organisational KM initiatives.

  15. [Lean logistics management in healthcare: a case study].

    Science.gov (United States)

    Aguilar-Escobar, V G; Garrido-Vega, P

    2013-01-01

    To study the applicability of the principles of Lean Production to manage the supply chain of a hospital. In particular, to determine which Lean practices and principles are applicable, the benefits obtained and the main barriers for its implementation. Managing the hospital supply chain is an important issue, both for its effect on the quality of care and its impact on costs. This study is based on a case study. 2005-10. Hospital Virgen Macarena in Seville. Process of implementing a comprehensive logistics management plan based on Lean principles and technological investments. The implementation of the comprehensive plan has reduced inventory, decreased lead times and improved service quality. Also, there have been other important improvements: enhanced employee satisfaction and increased staff productivity, both dedicated to health and the logistics. The experience analysed has shown the applicability and appropriateness of Lean principles and some of its techniques in managing the logistics of hospitals. It also identifies some of the main difficulties that may arise. Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.

  16. A structural multidisciplinary approach to depression management in nursing-home residents: a multicentre, stepped-wedge cluster-randomised trial

    NARCIS (Netherlands)

    Leontjevas, R.; Gerritsen, D.L.; Smalbrugge, M.; Teerenstra, S.; Vernooij-Dassen, M.J.F.J.; Koopmans, R.T.C.M.

    2013-01-01

    BACKGROUND: Depression in nursing-home residents is often under-recognised. We aimed to establish the effectiveness of a structural approach to its management. METHODS: Between May 15, 2009, and April 30, 2011, we undertook a multicentre, stepped-wedge cluster-randomised trial in four provinces of t

  17. Palliative care case management in primary care settings: A nationwide survey

    NARCIS (Netherlands)

    Plas, A.G. van der; Deliens, L.; Watering, M. van de; Jansen, W.J.; Vissers, K.C.P.; Onwuteaka-Philipsen, B.D.

    2013-01-01

    BACKGROUND: In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the

  18. Case Managers' Attitudes toward the Use of Homework for People Diagnosed with a Severe Psychiatric Disability

    Science.gov (United States)

    Kelly, Peter J.; Deane, Frank P.; Kazantzis, Nikolaos; Crowe, Trevor P.

    2007-01-01

    The study examined mental health case managers' attitudes toward the use of homework and explored the relationship between clinician attitudes and systematic homework administration practices. A survey examining attitudes toward the use of homework was completed by 122 Australian mental health case managers. Case managers who held more positive…

  19. On Therapeutic Principles for Five Depressions in NeiJing by Effective Cases%《内经》五郁治则临证验案举隅

    Institute of Scientific and Technical Information of China (English)

    王小军

    2014-01-01

    Clinical application of therapeutic principles for five depressions in HuangDi NeiJing were dis-cussed from five effective cases:depressed wood treated by outthrust, fire depression by effusion, depressed earth by despoliation, depressed metal by discharge and depressed water by regulation, the key of its clinical application was pattern determination and the causes seek, correct syndrome differentiation, varying according to the person and the syndrome, consequently, therapeutic principles for five depressions could be used widely and applied to other dis-eases of internal medicine.%从木郁达之、火郁发之、土郁夺之、金郁泄之以及水郁折之5个验案探讨《黄帝内经》中五郁治则在临床运用的关键在于审证求因,辨证正确,因人因证而异,其五郁治则方可灵活变通、广泛应用于内科杂病的治疗。

  20. Managing open access with EPrints software: a case study

    Directory of Open Access Journals (Sweden)

    Valerie McCutcheon

    2016-03-01

    Full Text Available Recent additional open access (OA requirements for publications by authors at UK higher education institutions require amendments to support mechanisms. These additional requirements arose primarily from the Research Councils UK Open Access Policy,1 applicable from April 2013, and the new OA policy for Research Excellence Framework2 eligibility published in March 2014 and applicable from April 2016.  Further provision also had to be made for compliance with the UK Charities Open Access Fund, the European Union, other funder policies, and internal reporting requirements.  In response, the University of Glasgow has enhanced its OA processes and systems. This case study charts our journey towards managing OA via our EPrints repository. The aim was to consolidate and manage OA information in one central place to increase efficiency of recording, tracking and reporting. We are delighted that considerable time savings and reduction in errors have been achieved by dispensing with spreadsheets to record decisions about OA.